It’s best known as the key active ingredient that contributes the feeling of euphoria and elation to the effect of the party drug Ecstasy, but clinical researchers are now seriously looking into the potential medical properties of MDMA.

More associated with energetic, joyful, trippy nights on the dance floor than as a valuable pharmaceutical tool in psychotherapy, MDMA is categorised as a Class A drug. But in its pure, unadulterated, pharmaceutical grade, MDMA is also showing evidence of being able to help treat drugs resistant mental illnesses. And investment capital is pouring in to fund research and a number of early stage clinical trials of MDMA as a therapy are now underway.

MDMA is one of a raft of psychedelics that also include LSD (better known as Acid) psilocybin (the active compound that puts the ‘magic’ into magic mushrooms, the evergreen rainforest shrub iboga and ayahuasca, a psychoactive drink made from chagruy leaves, showing promise as treatments for addiction to substances from alcohol to cocaine and heroine. As well as PTSE, depression and anxiety.

LSD was promoted by the Harvard professor Timothy Leary as a potentially valuable tool in psychiatry as far back as the 1960s. Professor Leary’s stance on the drug saw him labelled “the most dangerous man in America”, by no less than President Nixon.

But attitudes towards psychedelics have since softened. And in recent years serious clinical research of their potential for controlled use as part of a programme of psychiatric treatment has been renewed.

One of MDMA’s new champions is the respected psychotherapist James Hawkins. He first became intrigued by the potential of psychedelics while studying philosophy at Cambridge in the late 1960s. After experimenting with LSD as a student led him on a 12-hour “inner voyage” Hawkins decided to bin his philosophy studies and retrained first as a physician and to then study psychotherapy.

Several decades later, Hawkins, who helped found the Psychedelic Health Professionals Network, is convinced psychedelics should be part of the psychotherapy toolbelt. He recently told The Times newspaper:

“They can absolutely make a difference, especially for people who have treatment-resistant mental health problems. It’s a very exciting time.”

Depression is a deep societal problem but can psychedelics really help?

A recent estimate put the financial cost of depression to the UK economy at about £10 billon a year. As many as 2.7 million Brits suffering from mental illness fail to respond to the two most common courses of treatment. However, trials of psychedelics on these patient run by experts including Dr Robin Carhart-Harris, founder of the Glasgow-based Scottish Psychedelic Society and head of psychedelic research at Imperial College London, have shown promise. He has said that after three weeks of psilocybin treatment, half of the patients involved in one trial were “depression free”. The same patients had previously suffered acutely and “had tried pretty much everything”.

MDMA as psychiatric medicine

Hawkins, however, is focused on the potential medical properties of MDMA. He is especially encouraged by a recent clinical research project of the US Multidisciplinary Association for Psychedelic Studies (MAPS). Recent phase 3 trials showed 67% of a group of PTSD sufferers given MDMA for two months no longer suffered from the condition. That was double the success rate seen in the placebo group, 32% of which were no longer given a PTSD diagnosis at the end of the trial.

One participant in the trial, Nick Matchorn, is an Australian police officer who has suffered from flashbacks since 1996, where he was a witness of Tasmania’s Port Arthur massacre that saw a gunman kill 35 people and injure another 23. Neither talking therapies nor prescribed antidepressants had helped him. But MDMA did.

He told journalists:

“I was able to go and revisit things that were so painful and see them in a different way.”

Hawkins comments of the phase 3 trial results:

“The results are really encouraging. This is pretty unprecedented in the field of psychiatry. It’s so promising. I don’t think psychedelics are for everybody. But if you look at other medication or psychotherapy there is very little evidence that they are producing better outcomes than 30 years ago.”

“It is extremely likely MDMA will be licensed for therapy in three years. There will be a big need for this in Scotland.”

The practical challenges of introducing prescription MDMA in psychotherapy

A lack of familiarity with the potential medical qualities of psychedelics categorised as Class A drugs, as well as a healthy dose of stigma, is likely to be the greatest barrier for MDMA and other drugs to overcome. However, the journal Frontiers in Psychiatry recently published a report that showed a significant minority of NHS psychiatrists are confident discussing psychedelics-based therapies with patients. However, they felt unprepared to personally actively participate in such treatments.

Hawkins raises a pertinent question when he asks “Who the heck will be administering it?”

Aren’t drugs like Ecstasy dangerous?

Throughout the years there have been numerous high profile cases of promising young lives tragically lost as a result of consuming Ecstasy. If the drug is dangerous, potentially fatal, who in their right might would prescribe it as medicine?

Another doctor, Jake Hawthorn, a psychiatrist in southeast Scotland, is also an advocate of introducing psychedelics and MDMA as treatments for depression and other mental illnesses who has working alongside Hawkins to raise awareness of the experimental approach. He points out that the vast majority, if not all, deaths attributed to Ecstasy have been the result of impurities in uncontrolled drugs sold illegally on the black market.

What he and Hawkins are advocating is the use of pharmaceutical grade substances administered under supervision and in controlled quantities. Both doctors believe psychedelics should also be use in moderation. For example, an eight-week therapy course might only involve two sessions involving the ingestion of psychedelics, several weeks apart.

When might MDMA be legalised as a psychiatric medicine?

As mentioned, Hawkins believes MDMA could be approved as a treatment of PTSD, depression and addictions within a few short years. Regulators in both the USA and Europe have already eased up on restrictions around the compound being used to treat PTSD and are taking a similar approach for using psilocybin to treat depression.

MAPS’s phase 3 clinical trials of MDMA are nearing the point they could pass the strict requirements that could lead to approval by the U.S. Food and Drugs Administration.

As well as showing hugely promising signs of being an effective psychiatric treatment, MDMA has the additional advantage of being extremely cost effective. One of the reasons why it is so popular as a party drug is Ecstasy’s relative inexpensiveness. That’s partly influenced by the impurities standardly mixed into black market drugs to increase profits for suppliers and dealers. But even pharmaceutical grade equivalents are not expensive to produce.

One major indication psychedelics are close to a mainstream medical breakthrough is that Big Pharma is already extremely interested. Johnson & Johnson recently patented esketamine, a filtered ketamine. Putting their name and clinical research to esketamine, and its patent protection, allows the pharmaceuticals giant to sell it at around $850 a dose. Hawthorn says this compares to just $2 for generic ketamine. The implication is the practical difference between the two probably isn’t much. And certainly not $848.

Neither Hawkins and Hawthorn see MDMA or psychedelics as a silver bullet for the psychiatry profession and admit that the “trips” they invoke may not be a positive for everyone. Hawkins sums his position up as encouraging “a thoughtful weighing of pros and cons”.

But he’s clearly personally a fan, saying that when a psychedelics journey does offer sufferers of mental illnesses healing “it is sublime”. Of his own experience, he says taking psilocybin lead to his “heart opened like a flower” and that it was “huge. Extraordinary. Unforgettable. Like floating out in the depths of space”.

It certainly sounds more enjoyable than most courses of medical treatment!