The potential therapeutic uses of 3,4-methylenedioxymethamphetamine (MDMA) as an adjunct in psychotherapy have been a focus of discussion since the beginning of the expansion of this substance. During the hearings that took place in the United States, previous to the prohibition of this substance, a lot of psychiatrists and psychotherapists supported the idea that MDMA should be placed in a schedule that allowed investigation in this way (1). MDMA has been given to human beings since 1986 in order to study pharmacological, psychological, cardiovascular and neuroendocrine effects, but as this drug is classified in the restrictive Schedule I, it has been very difficult to evaluate therapeutic properties in controlled clinical trials.
In relation with therapeutic clinical trials and MDMA, the International Narcotics Control Board expresses concern in their last report because of “the possible misuse of research activities for propagation of the non-medical use of drugs”(2) and calls the attention of the governments “to the need to view any medical benefits of a substance in Schedule I of the 1971 Convention in conjunction with the widespread abuse of the substance”(2).
Intravenous heroin use or the growing popularity of synthetic drugs as gamma- hydroxybutyrate (GHB) or ketamine are phenomena with important social and health consequences. Nevertheless, therapeutic potential of these substances must be considered independently to this fact: morphine and derivatives have been used as analgesics for centuries, GHB is authorized by the Food and Drug Administration to treat narcolepsy- cataplexy and ketamine is an anaesthetic widely used in developing countries, health emergencies and war because of its effectiveness and security. Regarding to ketamine, there are clinical trials that show benefit as an adjunct in psychotherapy in alcoholic and heroin addict patients(3,4).
Taking into account this difference, it would only seem reasonable not to authorize or interrupt a therapeutic clinical MDMA trial because of strictly scientific reasons. Data published about the interruption of the spanish clinical trial, available after my article was published, do not suggest this idea (5). It is not the justification of recreational use of MDMA that is at stake, but a hope to relieve pain in people in which other therapeutic options have been unsuccessful.
(1) Documents from the DEA Scheduling Hearing of MDMA, 1984-1988. The Multidisciplinary Association for Psychedelic Studies (consulted 07/06/03). URL available in: http://www.maps.org/dea-mdma
(2) International Narcotics Control Board. 2002 Report. Vienna: UN,2002; p. 26 (consulted 08/06/03). URL available in: http://www.incb.org/e/ar/2002/incb_report_2002_2.pdf
(3) Krupitsky EM, Grinenko AY. Ketamine psychedelic therapy (KPT): a review of the results of ten years of research. J Psychoactive Drugs. 1997;29:165-83.
(4) Krupitsky E, Burakov A, Romanova T, Dunaevsky I, Strassman R, Grinenko A. Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up. J Subst Abuse Treat. 2002; 23:273-83.
(5) Bouso, JC. MDMA/PTSD research in Spain: An Update.MAPS Bulletin 2003;13:7-8. (consulted 08/06/03) URL available in: http://www.maps.org/news-letters/v13n1/13107bou.pdf