tag:theconversation.com,2011:/us/topics/molly-24670/articlesMolly – The Conversation2021-05-05T12:10:32Ztag:theconversation.com,2011:article/1603342021-05-05T12:10:32Z2021-05-05T12:10:32ZMDMA may help treat PTSD – but beware of claims that Ecstasy is a magic bullet<figure><img src="https://images.theconversation.com/files/398754/original/file-20210504-18-qqqs9u.jpg?ixlib=rb-1.1.0&rect=30%2C0%2C6669%2C4476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">PTSD is typically treated with therapy and sometimes medications, under the care of a psychiatrist. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/depressed-veteran-meets-with-psychologist-royalty-free-image/639017362?adppopup=true">SDI Productions/Getty Images</a></span></figcaption></figure><p>Recent clinical trials, <a href="https://www.nytimes.com/2021/05/03/health/mdma-approval.html">including one soon to be published in Nature Medicine</a>, have suggested that <a href="https://www.drugabuse.gov/drug-topics/mdma-ecstasymolly">MDMA</a> combined with psychotherapy may help treat post-traumatic stress disorder, or PTSD. The news generated considerable optimism and excitement <a href="https://www.nytimes.com/2021/05/03/health/mdma-approval.html">in the media</a>, and some in the scientific community. </p>
<p>As a <a href="https://www.starclab.org/members/arash-javanbakht">psychiatrist and an expert in neurobiology and treatment of PTSD</a>, I think these developments may be important – but not the major breakthrough that some people are suggesting. This approach is not a new magic bullet.</p>
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<figcaption><span class="caption">A combat veteran discusses his experience with PTSD.</span></figcaption>
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<h2>PTSD, a disorder of emotional memories</h2>
<p>Post-traumatic stress disorder is a result of <a href="https://theconversation.com/veterans-refugees-and-victims-of-war-crimes-are-all-vulnerable-to-ptsd-130144">exposure to extreme traumatic experiences,</a> such as natural disasters, motor vehicle accidents, assault, robbery, rape, combat and torture. Based on the type and severity of the trauma, people may develop PTSD, a condition of heightened anxiety that includes flashbacks, nightmares and avoidance of any reminder of trauma.</p>
<p>In the neuroscience world, we see <a href="https://www.ptsd.va.gov">PTSD</a> as a disorder of emotional memories, where recall of a traumatic memory can trigger high anxiety as if the event is happening in the here and now. People with PTSD often develop fear responses to anything remotely reminding them of the trauma.
We also see PTSD as a disorder of context processing: A person has the <a href="https://doi.org/10.1016/j.neuron.2016.09.039">same emotional response</a> to a loud noise in the safe civilian environment as in the battlefield. </p>
<h2>Current treatments for PTSD are effective</h2>
<p>Treatments for PTSD mostly include <a href="https://www.ptsd.va.gov/understand_tx/meds_for_ptsd.asp">antidepressant medications,</a> and <a href="https://www.ptsd.va.gov/understand_tx/talk_therapy.asp">psychotherapy</a>.</p>
<p>Psychotherapy is among the most effective treatments for PTSD, as it addresses traumatic memories and related emotional and cognitive reactions. That is, a person with PTSD may conflate the experience of trauma with being a bad person. Psychotherapies address these thought processes, or cognitions, caused by trauma.</p>
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<img alt="A double exposure of a woman with her hands in front of her mouth." src="https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398757/original/file-20210504-21-1ub10ky.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">PTSD is often treated by directly addressing the trauma that underlies triggers.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/conceptual-image-royalty-free-image/1271702591?adppopup=true">MICROGEN IMAGES/SCIENCE PHOTO LIBRARY/Getty Images</a></span>
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<p>Trauma therapists also use <a href="https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy">exposure therapy</a> to gradually help people expose themselves to situations they avoid or the memories that terrify them until they learn that these situations are safe. The goal is to also help the brain of the person with PTSD disassociate the traumatic memories from the negative emotions that they trigger. This process is called <a href="https://doi.org/10.1523/JNEUROSCI.4268-10.2010">extinction of fear memories</a>. And it is here where researchers and others hope that MDMA and other drugs will help, by enhancing the extinction of these fear memories.</p>
<h2>MDMA: It won’t work by itself to treat PTSD</h2>
<p>Exposure therapy to traumatic memories is a difficult and exhausting process for some patients. Researchers are working to identify drugs that can enhance the effects of psychotherapy and make extinction of traumatic memories happen faster, or more effectively.</p>
<p>MDMA, or <a href="https://pubchem.ncbi.nlm.nih.gov/compound/3_4-Methylenedioxymethamphetamine">3,4-methylenedioxymethamphetamine</a>, is an agent that affects a wide range of neurotransmitters, or brain chemicals facilitating signaling between neurons including <a href="https://doi.org/10.1523/JNEUROSCI.1659-20.2020">serotonin, dopamine and norepinephrine</a>. No one knows for certain just how MDMA affects the learning brain in therapy, but there are some theories. MDMA may enhance psychotherapy by <a href="https://doi.org/10.1007/s00213-020-05548-2">reducing anxiety during recall</a> of trauma memories, helping the patient feel better about himself and others, increasing bonding with the therapist and enhancing extinction learning. </p>
<p>Recent clinical trials suggest that use of MDMA paired with carefully delivered psychotherapy <a href="https://doi.org/10.1080/20008198.2020.1840123">might improve patient outcomes</a>. Furthermore, these effects seem to persist months after the treatment. Given these positive results, the studies entered a multisite phase 3 clinical trial of 90 patients with severe PTSD with 67% experiencing significantly diminished symptoms.</p>
<p>It is very important to note that MDMA is not suggested as a standalone treatment for any condition, and only “MDMA-assisted” psychotherapy is researched in these studies. </p>
<h2>Breakthroughs sometimes break hearts</h2>
<p>Although these reports sound promising, I am skeptical of breakthrough medical pronouncements. Throughout the history of psychiatry, people have become too excited about promising cures like psychoanalysis, <a href="https://www.medicalnewstoday.com/articles/302663">ketamine</a>, <a href="https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know">cannabinoids</a>, virtual reality, <a href="https://www.healthline.com/health/propranolol-oral-tablet">propranolol</a>, opioids and memory-enhancing agents for treatment of PTSD and other psychiatric disorders. </p>
<p>Although each of these treatments helped some patients, none was a magic bullet. Many, including opioids, <a href="https://www.healthline.com/health/propranolol-oral-tablet">propranolol</a> and memory-enhancing agents, did not find their way out of the research laboratories into the real clinical world. </p>
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<a href="https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Rainbow pill capsule on blue background." src="https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=763&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=763&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=763&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=959&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=959&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398758/original/file-20210504-20-1s5ls71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=959&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">MDMA, though a promising candidate in PTSD treatment, is not a panacea.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/tie-dye-capsule-royalty-free-image/145958929?adppopup=true">James Worrell/Getty Images</a></span>
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<p>For MDMA, we still do not have a <a href="https://doi.org/10.1080/02791072.2014.873690">solid mechanistic explanation</a> for how this drug might have rapid effects in enhancing long-lasting effects of therapy. </p>
<p>There is a large difference between a highly controlled research study with a limited number of participants and the complexities of real clinical work. For instance, a lot of psychiatric or medical conditions that many patients have are excluded from the clinical trials. Also, psychotherapies are delivered in their ideal form. In the cases of drugs such as ketamine and MDMA, it is almost impossible to blind these studies – meaning, to keep both patient and doctor in the dark about who received the trial drug or a placebo. Most patients, and consequently probably therapists, will know whether the patient received the psychoactive agent or the placebo.</p>
<p>Consequences of trauma cover a spectrum of symptoms, from zero to extremely high level. For having consistent language in research, we draw an imaginary line on this spectrum – say, 70% – and designate whoever is above the line as having PTSD. That does not mean that someone at a 65% or 60% does not have symptoms or distress. None of the studied approaches thus far totally eradicated symptoms. They just showed a larger decrease in symptoms compared with a placebo.</p>
<h2>Potential risks and dangers of MDMA</h2>
<p>While drugs called <a href="https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825">selective serotonin uptake inhibitors</a>, or SSRIs, and psychotherapy are relatively safe, agents like cannabis, ketamine and MDMA have many risks. The first is addiction. Although patients in the clinical trials are given only a limited number of doses, it is likely that someone experiencing a great feeling of relief from a drug given in the clinic will seek it on the street. </p>
<p>We are still dealing with the terrible opioid and <a href="https://theconversation.com/where-is-my-xanax-rx-why-your-doctor-may-be-concerned-about-prescribing-benzodiazepines-125346">benzodiazepine</a> pandemic, the medications about which people were so excited a few decades ago. Longitudinal studies of risks of future substance use with MDMA are currently lacking. This can be further complicated among those with a history of problems with prescription or illegal drug abuse, or those with personality disorders.</p>
<p>While the hype often suggests the drug itself is the cure, it is important to remember that what worked in these studies involved drugs and psychotherapy together.</p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>Also, it is vital to remind people not to expect a cure from street drugs. At best, the effects will be as good as the therapy provided. So an unskilled person providing therapy, consultation or even friendship using such agents might create much more harm than help. Negative memories could arise that the unskilled person does not have the expertise to deal with. It is also important to know drugs obtained on the street might be very different from what is used in research. Impurities can cause a lot of harm. </p>
<p>We in the psychiatric treatment world have been here before many times. And, in some cases, we are still paying dearly for the initial excitement.</p><img src="https://counter.theconversation.com/content/160334/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s buzz about MDMA – yes, the same ingredient in the street drug known as Ecstasy – being a game changer in the treatment of PTSD. A psychiatrist who treats PTSD says, “Not so fast.”Arash Javanbakht, Associate Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1276092019-12-19T21:26:27Z2019-12-19T21:26:27ZMDMA-assisted couples therapy: How a psychedelic is enhancing intimacy and healing PTSD<figure><img src="https://images.theconversation.com/files/306751/original/file-20191213-85417-l5ggy.jpg?ixlib=rb-1.1.0&rect=188%2C98%2C5144%2C3342&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research over the last decade has shown MDMA-assisted psychotherapy to be effective in treating PTSD from military combat, sexual assault and childhood abuse. Now researchers are trialing MDMA with couples and finding promising results. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Post-traumatic stress disorder (PTSD) is a mental health condition, triggered by experiencing or witnessing a terrifying or threatening event. Symptoms can include re-experiencing the trauma, avoidance, nightmares and severe anxiety. Living with PTSD can feel devastating, permanent and life-defining. </p>
<p>The path to relieving suffering can also feel overwhelming — diving into past pain, memories and experience to understand and move through them can be horrifying, especially when your system is screaming for you to avoid them. People’s defence systems can be so strong, their narratives about the world so stuck, that the best treatments we have available do not work for everyone. </p>
<p>That’s where the synthetic psychoactive drug MDMA (3,4 methylenedioxymethamphetamine) comes in — as a supportive catalyst to a therapeutic process.</p>
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Read more:
<a href="https://theconversation.com/the-real-promise-of-lsd-mdma-and-mushrooms-for-medical-science-100579">The real promise of LSD, MDMA and mushrooms for medical science</a>
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<p>MDMA has been showing excellent effect for the treatment of PTSD from many different causes — including <a href="https://doi.org/10.1016/S2215-0366(18)30135-4">military combat</a>, <a href="https://doi.org/10.1177/0269881110378371">sexual assault and childhood abuse</a> — over the <a href="https://doi.org/10.1007/s00213-019-05249-5">past decade</a>, coupled with an inner-directed, supportive model of psychotherapy. </p>
<p>This therapy combination has received “<a href="https://doi.org/10.3389/fpsyt.2019.00650">breakthrough therapy designation</a>” from the Food and Drug Administration (FDA) in the United States. It is currently being tested in a large, multi-site randomized controlled trial, sponsored by the <a href="https://mdmaptsd.org/">Multidisciplinary Association for Psychedelic Studies (MAPS)</a>. </p>
<h2>How MDMA works in the brain</h2>
<p>MDMA is a drug that alters mood and perception. In non-clinical settings, it is a common recreational drug — known as Ecstasy (E) or Molly. </p>
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<img alt="" src="https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306713/original/file-20191212-85412-1xf1hsg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">MDMA can produce blissful experiences, but also can be used to revisit traumatic memories.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>MDMA works on numerous <a href="https://doi.org/10.1016/j.biopsych.2013.12.015">neural structures</a> (especially the amygdala and pre-frontal cortex) and <a href="https://journals.lww.com/drug-monitoring/Abstract/2004/04000/Human_Pharmacology_of_MDMA__Pharmacokinetics,.9.aspx">enhances the secretion of hormones and neurotransmitters</a> — namely <a href="https://www.the-scientist.com/news-opinion/serotonin-and-dopamine-responsible-for-the-pros-and-cons-of-mdma--66837">serotonin, dopamine</a>, norepinephrine and oxytocin, among others. </p>
<p>The drug can produce joyful, blissful experiences and, in the context of PTSD treatment, can <a href="https://doi.org/10.1016/j.pnpbp.2018.03.003">allow for a revisiting of traumatic memories</a>, emotions and context with greater ease and less avoidance than would be possible without the drug. </p>
<p>MDMA-facilitated psychotherapy embeds the use of MDMA within a psychotherapy treatment for PTSD, therefore providing a deeply evocative template to be able to work from — to move the seemingly immovable presence of the trauma. </p>
<h2>Revisiting traumatic memories</h2>
<p>As a clinical psychologist and researcher, I’ve focused my work on trauma and relationships for the past decade. As the <a href="http://www.remedycentre.ca/">founder of Remedy</a>, a mental health innovation community, and an adjunct professor in psychology at Ryerson University, my goal has been to illuminate treatments for trauma that can have deep, profound and lasting effects. This is what inspired me to work with MDMA.</p>
<p>Our <a href="https://doi.org/10.1080/02791072.2019.1589028">team recently conducted a pilot trial</a> of cognitive behavioural conjoint therapy (CBCT) for PTSD in combination with MDMA, with six couples in Charleston, S.C. The therapy was successful in reducing PTSD symptoms in the majority of couples and improved their relationship satisfaction.</p>
<p>We are now preparing to run a pilot trial of cognitive processing therapy (CPT) with MDMA and a larger randomized controlled trial of CBCT with MDMA that will take place in Toronto, pending government and regulatory approvals. </p>
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<img alt="" src="https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306723/original/file-20191212-85422-nfvein.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">MDMA-assisted psychotherapy could offer hope to those in the military who serve in conflict zones, and veterans who struggle with PTSD.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<h2>Preparation and integration</h2>
<p>Cognitive behavioural conjoint therapy, <a href="https://jamanetwork.com/journals/jama/fullarticle/1346190">a treatment for couples</a>, has demonstrated excellent effect in reducing symptoms for people with PTSD, and also for their intimate relationships and their loved ones.</p>
<p>Cognitive processing therapy, a treatment that focuses on meaning-making about a trauma in order to unravel thoughts and feelings that are stuck, is one of the approaches that has received the strongest recommendation in <a href="https://istss.org/clinical-resources/treating-trauma/new-istss-prevention-and-treatment-guidelines">international treatment guidelines</a>. It was also recently featured on <a href="https://www.thisamericanlife.org/682/ten-sessions">NPR’s <em>This American Life</em></a>. </p>
<p>We test these highly effective trauma-focused treatments alongside the catalyst of MDMA, to see if it offers an additive or potentiating effect. </p>
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Read more:
<a href="https://theconversation.com/ketamine-the-illicit-party-psychedelic-that-promises-to-heal-depression-115697">Ketamine: The illicit party psychedelic that promises to heal depression</a>
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<p>Sessions with MDMA are daylong, occurring two or three times over the course of several weeks or months, depending on the study. Research participants are accompanied by two therapists. </p>
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<img alt="" src="https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306714/original/file-20191212-85417-2h4yin.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">If MDMA-assisted psychotherapy becomes legal, it may be life-saving for people living with PTSD.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>The therapeutic work done before the MDMA sessions prepares clients for the experience. The work afterwards integrates the experience, using the template of the MDMA session to scaffold new learnings and new ways of potentially understanding their traumatic experiences.</p>
<h2>A life-saving legal medicine?</h2>
<p>The large randomized controlled trial sponsored by MAPS is designed to collect enough evidence on the safety and efficacy of MDMA in treatment to make it a legal medicine.</p>
<p>As evidence accumulates for MDMA’s effectiveness, there is the possibility that MDMA will become legal — a medicine to be used in psychotherapy and prescribed for PTSD. </p>
<p>The ability to use it in practice will be potentially life-altering and life-saving for people living with PTSD.</p>
<p>[ <em><a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/127609/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Wagner received funding from the Multidisciplinary Association for Psychedelic Studies. </span></em></p>MDMA is better known as the party psychedelic Ecstasy or Molly. Used clinically, together with psychotherapy, it reduces symptoms of post-traumatic stress disorder, and shows promise with couples.Anne Wagner, Adjunct Professor, Psychology, Faculty of Arts, Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1114092019-02-11T13:53:02Z2019-02-11T13:53:02ZEcstasy users are more empathetic than those who take other drugs – even when not on it<figure><img src="https://images.theconversation.com/files/257810/original/file-20190207-174880-6kybyw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1023027616?src=XeApyOQcuCaRC9AgmWvz3g-1-0&size=medium_jpg">Couperfield/Shutterstock</a></span></figcaption></figure><p>If you’ve ever seen someone in a club on MDMA, it may not surprise you to hear it’s linked to a heightened ability to share other people’s feelings and emotions. Yet in our new study, we found that even when the effects have faded, mild MDMA users showed greater empathy than people who use other common recreational drugs, such as cannabis, cocaine and ketamine.</p>
<p>MDMA (also known as “ecstasy” or “molly”) is used in rave culture because it increases energy and makes people feel euphoric and sociable. Recently, though, researchers have been looking at how the pure form of MDMA can be used in therapy to treat mental health problems such as post-traumatic <a href="https://www.ncbi.nlm.nih.gov/pubmed/29728331">stress </a><a href="https://www.ncbi.nlm.nih.gov/pubmed/30371148">disorder</a>, alcohol <a href="https://www.ncbi.nlm.nih.gov/pubmed/29126911">addiction</a> and more. </p>
<p>Recent trials have shown that when used alongside psychotherapy, MDMA can treat post-traumatic <a href="https://www.ncbi.nlm.nih.gov/pubmed/30371148">stress</a> in people who have not responded to any other treatments, and these improvements can still be seen many months after treatment. It is thought that the effect of MDMA enables patients to think about very difficult memories that are often too painful to address, helping them to recover. </p>
<p>Other researchers have been looking at how MDMA can be used to help <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208958/">autistic people</a> by reducing social anxiety and increasing social adaptability. MDMA-assisted psychotherapy also has been suggested to help with addictions, such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/29126911">alcoholism</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257933/original/file-20190208-174883-1l7cffz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257933/original/file-20190208-174883-1l7cffz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257933/original/file-20190208-174883-1l7cffz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257933/original/file-20190208-174883-1l7cffz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257933/original/file-20190208-174883-1l7cffz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257933/original/file-20190208-174883-1l7cffz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257933/original/file-20190208-174883-1l7cffz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ecstasy is known for its use in rave culture.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1009040557?src=0X5GaAaTYasAhfjlsKI7mQ-1-1&size=medium_jpg">glazok90/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Longer-term effects</h2>
<p>But little research has investigated the longer-term impact of using MDMA on how we get on with other people. It’s important to understand this if we’re looking to use the drug in a therapeutic setting, as most psychological disorders involve difficulty in interacting with others. We also found in our study that mild MDMA users were no more distressed than alcohol users after being socially excluded, contrary to previous concerns that MDMA use would heighten social distress and anxiety in the long term.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/30717615">Our study</a> involved 67 young people, 25 of whom used MDMA, 19 who used other drugs and 23 who only used alcohol. We assessed empathy by using a questionnaire and a computer task. In the questionnaire, the MDMA users rated higher in empathy and sympathy for others (known as “emotional empathy”) than the other drug users, who mainly used cannabis, cocaine and ketamine. During the computer task, the MDMA users were also better at correctly identifying the emotions of others (known as “cognitive empathy”). </p>
<p>The MDMA users in our study used MDMA about once a month. This level of use is about the same as what could be used for therapy, so looking at this group is more informative than looking at heavy users to figure out the longer-term effects of MDMA as a treatment. But the people in this group were recreational users, meaning they bought MDMA off the street. Street MDMA is often contaminated with other substances, so it can vary in purity. In a therapeutic setting, MDMA would be used in its pure form. Alongside psychotherapy, patients would be given a standard dose in a controlled setting and would be closely monitored and guided by a therapist. </p>
<p>The findings from our study do not mean that using MDMA makes people more empathetic as it is highly possible that more empathetic people who use drugs are drawn to MDMA due to its sociable effects (meaning that there could be preexisting differences in empathy). To truly see whether MDMA can increase empathy in the long term, a study would need to assess people before using drugs and would need to look at changes in empathy over time.</p>
<p>Nevertheless, this study is important because understanding the longer-term effects of using MDMA is pivotal in determining whether it can be used as a viable treatment for mental health disorders.</p><img src="https://counter.theconversation.com/content/111409/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Molly Carlyle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study suggests that MDMA could be a useful therapeutic tool.Molly Carlyle, PhD Candidate, Addiction and Psychopharmacology, University of ExeterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/980712018-06-12T16:31:12Z2018-06-12T16:31:12ZMind molding psychedelic drugs could treat depression, and other mental illnesses<figure><img src="https://images.theconversation.com/files/222661/original/file-20180611-191959-1xq0kl3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/cpu-mind-series-design-made-human-704693527">By agsandrew/shutterstock.com</a></span></figcaption></figure><p>It seems that psychedelics do more than simply alter perception. According to <a href="https://www.cell.com/cell-reports/fulltext/S2211-1247(18)30755-1">the latest research</a> from my colleagues and me, they change the structures of neurons themselves.</p>
<p>My <a href="https://www.olsonlab.org/">research group</a> has been studying the effects of psychedelics on neuronal structure and function, and we found that these compounds cause neurons to grow. A lot. Many of these compounds are well-known and include lysergic acid diethylamide (LSD), psilocin (from magic mushrooms), <em>N,N</em>-dimethyltryptamine (DMT, from ayahuasca) and 3,4-methylenedioxymethamphetamine (MDMA, aka ecstasy).</p>
<p>These are among the most powerful drugs known to affect brain function, and <a href="http://dx.doi.org/10.1016/j.celrep.2018.05.022">our research</a> shows that they can alter the structure of the brain as well. Changes in neuronal structure are important because they can impact how the brain is wired, and consequently, how we feel, think and behave.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/v0g9jf6GqEE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Prior to our study, there were relatively few compounds known to have such drastic and rapid effects on neuronal structure. One of those compounds was ketamine – a dissociative anesthetic and <a href="http://doi.org/10.1126/science.1190287">quite possibly the best fast-acting antidepressant</a> that we have available to us at the moment.</p>
<p>If you think of a neuron like a tree, then its dendrites would be the large branches, and its dendritic spines – which receive signals from other neurons – would be the small branches. Some of these small branches might have leaves, or synapses in the case of a neuron. In fact, neuroscientists often use terms like “arbor” and “pruning” much like a horticulturist would. When we grew neurons in a dish – which is not unlike growing a plant in a pot – and fed them psychedelic compounds, the neurons sprouted more dendritic branches, grew more dendritic spines, and formed more connections with neighboring neurons.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/222616/original/file-20180611-191971-1jg989x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222616/original/file-20180611-191971-1jg989x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222616/original/file-20180611-191971-1jg989x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222616/original/file-20180611-191971-1jg989x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222616/original/file-20180611-191971-1jg989x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222616/original/file-20180611-191971-1jg989x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222616/original/file-20180611-191971-1jg989x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The rainbow-colored neuron was treated with LSD, while the purple neuron was the control. LSD altered the structure of the neuron, allowing it to grow more branches and develop a more complex structure.</span>
<span class="attribution"><span class="source">Calvin Ly and Joanne Ly</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Rethinking depression</h2>
<p>Thanks to <a href="http://doi.org/10.1038/nm.4050">studies on ketamine, slow-acting antidepressants and chronic stress models of depression</a>, scientists now know that depression is not simply the result of a “chemical imbalance,” as pharmaceutical companies like to suggest. It is far more complicated and <a href="http://doi.org/10.1038/nm.4050">involves structural changes in key neural circuits that regulate emotion, anxiety, memory and reward</a>.</p>
<p>One of the hallmarks of depression is the <a href="http://doi.org/10.1016/j.ceb.2011.09.002">atrophy of neurons in the prefrontal cortex</a> – a region of the brain that controls anxiety and regulates mood among other things. Basically, these branches and spines shrivel up, disconnecting from other neurons in the brain. One hypothesis for why ketamine is so effective is because it can rapidly regrow the arbors and spines of these critical neurons.</p>
<p>Like ketamine, psychedelics have shown promise in the clinic for treating neuropsychiatric diseases. The DMT-containing herbal tea known as ayahuasca produces <a href="http://dx.doi.org/10.1590/1516-4446-2014-1496">fast-acting antidepressant effects within a day</a>, <a href="http://doi.org/10.1001/archgenpsychiatry.2010.116">psilocybin eases the anxiety of terminally ill cancer patients</a> and <a href="http://doi.org/10.1177/0269881112456611">MDMA can reduce fear in those suffering from post-traumatic stress disorder</a> (PTSD). Our <a href="https://www.cell.com/cell-reports/fulltext/S2211-1247(18)30755-1">recent</a> <a href="http://doi.org/10.1021/acschemneuro.8b00134">papers</a> suggest the intriguing possibility that psychedelic compounds and ketamine might share a common therapeutic mechanism.</p>
<h2>Psychedelics vs. psychoplastogens</h2>
<p>Strictly speaking, a psychedelic is a “mind-manifesting” drug – a definition that’s open to interpretation. They tend to produce perceptual distortions or hallucinations by activating 5-HT2A receptors. Our research group has found that compounds typically regarded as psychedelics, like LSD and DMT, as well as those that are sometimes called psychedelics, like MDMA, and those that are not usually called psychedelics, like ketamine, are all capable of profoundly impacting neuronal structure. </p>
<p>Our group has coined the term “psychoplastogen” to refer to such compounds, and we believe that these molecules may hold the key to treating a wide variety of brain diseases.</p>
<p>Our studies on neurons grown in dishes, as well as experiments performed using fruit flies and rodents, have demonstrated that several psychoplastogens, including psychedelics and ketamine, encourage neurons to grow more branches and spines. It seems that all of these compounds work by activating mTOR – a key protein involved in cell growth.</p>
<p>The biochemical machinery that regulates mTOR activity is intricate. As we tease apart how psychedelics and other psychoplastogens turn on mTOR signaling, we might be able to engineer compounds that only produce the therapeutic effects on neuronal growth while bypassing pathways that lead to undesired hallucinations.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/222637/original/file-20180611-191962-b7cju8.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222637/original/file-20180611-191962-b7cju8.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=253&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222637/original/file-20180611-191962-b7cju8.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=253&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222637/original/file-20180611-191962-b7cju8.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=253&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222637/original/file-20180611-191962-b7cju8.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=318&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222637/original/file-20180611-191962-b7cju8.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=318&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222637/original/file-20180611-191962-b7cju8.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=318&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This figure shows the effects of three psychedelics and one control (VEH) on cortical neurons. These neurons were treated for 24 hours before being visualized using super-resolution microscopy. The colors represent proteins found in specific locations of the neuron. Orange protrusions from the purple dendrite indicate dendritic spines.</span>
<span class="attribution"><span class="source">Ly et al.</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>The field has known for some time now that <a href="https://doi.org/10.3109/00952990.2016.1170135">psychedelics can produce lasting positive effects on brain function</a>, and it’s possible that these long-lasting changes result from the psychoplastogenic effects of these drugs. If true, this would suggest that psychoplastogens might be used to repair circuits that are damaged in mood and anxiety disorders.</p>
<h2>Panacea or poison?</h2>
<p>Many diseases, such as depression and anxiety disorders, are characterized by atrophy of dendritic branches and spines. Therefore, compounds capable of rapidly promoting dendritic growth, like psychedelics, have broad therapeutic potential. The number of papers demonstrating that psychedelics can produce therapeutic effects continues to grow every year.</p>
<p>However, we should temper our enthusiasm because we do not yet know all of the risks associated with using these drugs. For example, it’s possible that promoting neuronal growth during development could have negative consequences by interfering with the normal processes by which neural circuits are refined. We just don’t know, yet.</p>
<p>Similarly, it is unclear what effects psychoplastogens will have on the aging brain. It’s important to keep in mind that excessive mTOR activation is also associated with a number of diseases <a href="https://doi.org/10.1016/j.neuron.2014.07.040">including autism spectrum disorder</a> (ASD) and <a href="https://doi.org/10.2147/NDT.S75717">Alzheimer’s disease</a>.</p>
<p>To me, it’s obvious that we need to understand how these powerful compounds affect the brain, in both positive and negative ways, if we hope to fully comprehend the fundamental laws governing how the nervous system works and how to fix it when it doesn’t.</p><img src="https://counter.theconversation.com/content/98071/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David E. Olson receives funding from the NIH. </span></em></p>Psychedelic drugs have inspired great songs and works of art. But they may also have potential for treating disease like depression and PTSD by helping to regrow damaged regions of the brain.David E. Olson, Assistant Professor, Department of Chemistry; Department of Biochemistry & Molecular Medicine; Center for Neuroscience, University of California, DavisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/695332016-11-29T02:25:50Z2016-11-29T02:25:50ZFlakka is a dangerous drug, but it doesn’t turn you into a zombie<figure><img src="https://images.theconversation.com/files/147974/original/image-20161129-17065-1anzxsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">"Bath salts," or synthetic street drugs with amphetamines. Via DEA.</span> <span class="attribution"><span class="source">DEA</span></span></figcaption></figure><p>Stories of horrific crimes resulting from drug use have been propagated by the media for <a href="https://www.washingtonpost.com/news/the-watch/wp/2014/06/19/drug-war-coverage-is-still-filtered-through-race/?utm_term=.5e81f0acdee3">over a century</a>. Such stories began with <a href="http://www.cnn.com/2011/HEALTH/07/22/social.history.cocaine/">cocaine in 1914</a> and were followed by <a href="http://www.theatlantic.com/magazine/archive/1994/08/reefer-madness/303476/">“reefer madness” </a> stories in the 1930s and reports of <a href="http://www.rawstory.com/2016/02/meet-the-psychiatrists-who-are-bringing-lsd-back-to-the-medical-mainstream/">“LSD murders”</a> in the 1960s. Our latest drug said to be associated with murderous stories is a “bath salt” called Flakka, which some media have even called a “<a href="http://www.rollingstone.com/culture/news/florida-zombie-drug-flakka-everything-you-need-to-know-w435074">zombie drug</a>.” </p>
<p>It’s gained this moniker by being associated with bizarre and violent behavior of some drug users. </p>
<p>In August, 19-year-old Austin Harrouff attacked and killed a couple in their Florida home, and he was found <a href="http://www.palmbeachpost.com/news/crime--law/update-sheriff-office-austin-harrouff-remains-critical-condition/uDeXCSRXxXnP4RVR51ErIN/">biting</a> the face and abdomen of one of his victims. The attacker’s parents reported he had displayed strange behavior for months prior to the incident and that he possibly suffered from undiagnosed schizophrenia. <a href="http://www.rollingstone.com/culture/news/florida-zombie-drug-flakka-everything-you-need-to-know-w435074">Authorities</a>, however, believed Harouff was likely high on the new street drug called Flakka, as use had previously been <a href="http://www.nbcnews.com/news/us-news/devils-drug-flakka-driving-florida-insane-n471531">attributed</a> to widespread incidents of <a href="http://www.abc2news.com/news/health/mens-health/flakka-synthetic-drug-behind-increasingly-bizarre-crimes">strange</a> and sometimes violent behavior.</p>
<p>On Nov. 23, however, <a href="http://www.cbsnews.com/news/florida-face-biting-attack-austin-harrouff-drug-test-results/">media coverage</a> of Harouff’s toxicology tests revealed that Flakka was not detected in Harrouff’s system. Thus, this “cannibal” incident did not involve the drug, as was widely believed.</p>
<p>Regardless, Flakka is a new and potentially dangerous synthetic drug. Flakka is a street name for alpha-PVP – a very potent synthetic cathinone drug. Synthetic cathinones are a new variety of amphetamine-like street drugs, which are commonly referred to as “bath salts.”</p>
<p>Flakka is a very potent and inexpensive stimulant. In fact, it appears to be more potent than methamphetamine, and it is believed to have higher <a href="http://www.newsweek.com/flakka-more-addictive-meth-study-suggests-330746">addictive</a> potential. Flakka use has been <a href="https://www.ncbi.nlm.nih.gov/pubmed/27185821">found</a> to be associated with paranoia, delusions and hallucinations (which may be somewhat dependent on frequent and/or extensive use). Within 16 months (2014-2015) in <a href="http://www.cbsnews.com/news/after-ravaging-florida-street-drug-flakka-disappears/">Fort Lauderdale</a> and its suburbs alone, 63 supposed Flakka users died from acute intoxication, accidents, suicides and homicides. </p>
<p>Flakka is particularly infamous for being tied to rashes of bizarre behavior in <a href="http://www.abc2news.com/news/health/mens-health/flakka-synthetic-drug-behind-increasingly-bizarre-crimes">Florida</a> and recently in <a href="http://www.news.com.au/lifestyle/health/health-problems/hallucinations-seizures-aggression-flakka-hits-the-gold-coast/news-story/c38e2ee8d7efb3c6ba975b34c72f80eb">Australia</a>.</p>
<p>“Bath salts” such as Flakka quickly became extremely stigmatized drugs in response to media coverage of users supposedly turning into zombies or cannibals. As someone who studies drug use epidemiology, I think it is very important to separate truth from myth when it comes to drugs.</p>
<h2>Cannibals and zombies high on ‘bath salts’?</h2>
<p>The zombie/cannibal label phenomenon began in Miami on May 26, 2012 when Rudy Eugene – naked and thought to be high on “bath salts” – <a href="http://www.dailymail.co.uk/news/article-2152519/Rudy-Eugene-Last-words-Miami-cannibal-girlfriend-attack-Ronald-Poppo.html">chewed the face and eyeball off of a homeless man</a>. The attacker was killed by police, and the homeless man was left disfigured and blind. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Doctors for a man whose face and eyeball were eaten by Rudy Eugene.</span>
<span class="attribution"><span class="source">Alan Diaz/AP</span></span>
</figcaption>
</figure>
<p>However, <a href="http://www.cbsnews.com/news/rudy-eugenes-toxicology-report-experts-speculate-on-what-caused-face-chewing-attack/">toxicology</a> tests later confirmed that “bath salts” were not present in the attacker’s system.</p>
<p>Still, the zombie/cannibal pop culture phenomenon had begun and would continue.</p>
<p>Prevalence of self-reported “bath salt” use among high school seniors remained relatively stable at about <a href="http://www.newsweek.com/one-percent-teens-use-bath-salts-survey-says-354485">1 percent</a> over the last few years; however, between 2012 and 2016, perceived <a href="http://www.monitoringthefuture.org/pubs/monographs/mtf-vol1_2015.pdf">harmfulness</a> of trying “bath salts” nearly doubled – from 33 percent to 58 percent. This is likely a result of the zombie/cannibal label, as perception of harm often leads to less use.</p>
<p>The belief that Flakka or other “bath salt” use can turn you into a zombie or cannibal appears to have been a somewhat effective deterrent against use. However, what a lot of young people don’t know is that they have been using Flakka or other “bath salts,” or both, without knowing it, as these drugs are common adulterants, in “Molly” – the newest street name for ecstasy/MDMA.</p>
<p>Last year I collected hair samples from dozens of nightclub and dance festival attendees in New York City to be tested for <a href="https://theconversation.com/legal-highs-a-look-at-the-growing-use-of-synthetic-drugs-38404">new psychoactive substances</a>. Many attendees <a href="http://www.businessinsider.com/mdma-ecstasy-contaminated-with-bath-salts-2016-2">joked</a> that they would never use “bath salts” as “they are not zombies or cannibals.” </p>
<p>But what my colleagues and I actually <a href="http://www.drugandalcoholdependence.com/article/S0376-8716(16)00057-0/abstract">found</a> was that among self-reported ecstasy users who denied “bath salt” use (after being provided a list of dozens of compounds in this class), four out of 10 actually tested positive for one of more of these compounds.</p>
<p>So a lot of drug users are actually using Flakka and/or other “bath salts” unknowingly or unintentionally, thinking it’s Molly. (And no, these people didn’t turn into cannibals or zombies.)</p>
<h2>Let’s try to get the facts straight</h2>
<p>While information based on falsehoods can help deter people from (intentionally) using potentially dangerous drugs such as Flakka, legitimate and truthful information is needed not only to deter use, but also to prevent those who reject abstinence from experiencing harm.</p>
<p>Sometimes scary information works to deter drug use. But “scary” should be based on truthful information about potentially harmful drugs. If we continue to exaggerate adverse effects, then this can work against our prevention efforts in two ways. </p>
<p>First, potential users – especially experienced drug users – may disregard our warnings. Second, exaggerating dangerous effects usually leads to increased stigma toward those who use or happen to be dependent on the drug. This usually leads only to further ostracization and a lower likelihood of seeking treatment.</p>
<p>Drug-induced cannibalism now appears to be a hot media topic. This is understandable as much of the public is now obsessed with zombie TV shows. But we need to ensure that we remain cautious about news we hear, and responsible for news we share.</p><img src="https://counter.theconversation.com/content/69533/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Palamar receives funding from the National Institute on Drug Abuse. </span></em></p>Flakka was believed to be behind two cannibalistic attacks in Florida that left one man blind and a married couple dead. It wasn’t so. Here’s why we need facts, not myths, about dangerous drugs.Joseph Palamar, Associate Professor of Population Health, New York UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/544712016-02-10T19:09:33Z2016-02-10T19:09:33ZMolly is lacking as a TV show but millions, including me, are hooked<figure><img src="https://images.theconversation.com/files/110895/original/image-20160210-3260-low725.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'It's peculiar the way in which viewers of my vintage judged the first part of Seven's miniseries on its authenticity.'</span> <span class="attribution"><span class="source">Image courtesy of Channel 7.</span></span></figcaption></figure><p>One of the more pointed – almost poignant – bits of the 1986 Richard Lowenstein film <a href="http://www.imdb.com/title/tt0092904/">Dogs in Space</a> is the Sunday night when the whole household comes together in mutual fascination over the Australian music TV show Countdown. No matter they’re all countercultural, mainstream-scorning punks: they need their Sunday night fix, connecting them to the wider pop world. </p>
<p>While <a href="http://www.imdb.com/title/tt0250846/">Countdown</a> (1974–1987) was clearly (even at the time) a group effort, Molly Meldrum was its heart. Meldrum was connected to many scenes and networks but far, far more important than that was the passion he displayed, often for what was clearly old tat that no-one should have made, let alone have had to sit through. </p>
<p>Now we’re halfway through Channel 7’s miniseries <a href="https://au.tv.yahoo.com/plus7/molly/">Molly</a>, starring Samuel Johnson as Meldrum, and a couple of million of us are hooked. Any of us with any experience of television knows that the producers don’t have to try as hard with the second half of the enterprise, but they still want us to stay to the end if only so advertisers can shift (for instance) more tickets to golden oldies rock concerts. </p>
<p>I suppose that, as I’m 50, Molly is absolutely my demographic: I was nine when Countdown began and 23 when it ended, and I was a devotee for most of that time (whatever you’d call a devotee who was often disgusted, horrified, contemptuous of what was presented – but who, like so many others, always watched). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/110899/original/image-20160210-3271-1gql8bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/110899/original/image-20160210-3271-1gql8bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/110899/original/image-20160210-3271-1gql8bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110899/original/image-20160210-3271-1gql8bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110899/original/image-20160210-3271-1gql8bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110899/original/image-20160210-3271-1gql8bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110899/original/image-20160210-3271-1gql8bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110899/original/image-20160210-3271-1gql8bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Australian Foreign Minister Julie Bishop and Molly Meldrum at the Grand Final breakfast in 2015.</span>
<span class="attribution"><span class="source">AAP Image/Tracey Nearmy</span></span>
</figcaption>
</figure>
<p>Meldrum’s autobiography, <a href="https://www.goodreads.com/book/show/23462986-the-never-um-ever-ending-story">The Never, Um, Ever Ending Story</a> (2014) – a compilation of numerous false starts over time, with different ghostwriters – was as elusive as it was revealing. Word has it that Molly was reluctant to write a memoir, but surely his <a href="http://www.news.com.au/entertainment/celebrity-life/my-life-has-changed-forever-molly-meldrum-after-serious-fall/story-e6frfmqi-1226330883413">near-death experience</a> in 2011 – and the outpouring of grief it inspired among many, as close to reading your own obituaries as most of us could hope for – inspired its completion. </p>
<p>The notorious fall from the ladder is the hook on which the Molly mini-series hangs. Molly is based largely on scenes from the book, with a handy get-out-of-jail card in the framing device of its being the slightly psychedelic memories of a 68-year-old man with brain trauma. </p>
<p>Like his long-time friend <a href="https://theconversation.com/gudinski-by-stuart-coupe-is-a-fast-and-wild-tale-of-australias-music-industry-43838">Michael Gudinski</a>, Meldrum is obsessive about his privacy – ridiculously, particularly since both men enjoy the spotlight and are clearly celebrities on the basis of nothing but their association with the talented. </p>
<p>Even given that, I felt the presentation of Meldrum’s unease at being in front of the cameras on Countdown, as though this was a major leap for a journalist, was a deception taken too far: Meldrum had been a television personality for close to a decade by the time the show went to air in 1974. </p>
<p>But the rather peculiar idea of him remembering writing the song The Real Thing (1969) as a child in 1950s Quambatook (he didn’t write it, <a href="https://en.wikipedia.org/wiki/The_Real_Thing_(Russell_Morris_song)">Johnny Young</a> did) was an inspired moment, suggesting perhaps a thwarted talent – or that his drive was, in part, connected to his lack of performing ability. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/wBVJFGxyxgE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The Real Thing – Russell Morris.</span></figcaption>
</figure>
<p>What is peculiar, perhaps – and is this a particularly Australian thing? – is the way in which viewers of my vintage and older judged the first part of Seven’s miniseries on its authenticity, that is, against that which they already (thought they) knew. </p>
<p>This was particularly so, for me at least, in relation to the recreations of certain Countdown moments, as well as the general ambience of the mid-1970s. Why do we need to have our lives (in this case, our lives as passive viewers of the life/ work of a popular media figure) relayed back to us? </p>
<p>Social media <a href="https://twitter.com/search?q=%23molly&src=typd">comments</a> on Molly since the show aired have included a wide range of positive, negative and incredulous responses from people who were “there” as consumers or even music industry insiders in the 1970s, interspersed with plenty of praise for Samuel Johnson’s rendering of Meldrum. </p>
<p>All these (and others – there is, of course, a strong voice antipathetic to Meldrum altogether) demonstrate is that Meldrum is a multifaceted character with different meanings for many. His inarticulate and distracted ramblings allow us that kind of imprinting. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/110901/original/image-20160210-3265-1v8ouzj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/110901/original/image-20160210-3265-1v8ouzj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/110901/original/image-20160210-3265-1v8ouzj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=903&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110901/original/image-20160210-3265-1v8ouzj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=903&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110901/original/image-20160210-3265-1v8ouzj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=903&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110901/original/image-20160210-3265-1v8ouzj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1135&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110901/original/image-20160210-3265-1v8ouzj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1135&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110901/original/image-20160210-3265-1v8ouzj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1135&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Michael Gudinski and Molly Meldrum with the cast of the Countdown Spectacular at the Rod Laver Arena in Melbourne, in 2006.</span>
<span class="attribution"><span class="source">AAP Image/Martin Philbey</span></span>
</figcaption>
</figure>
<p>It is extraordinary that, even in the era of the always-more-meta, so many of us still expect our television (or any) drama to be “believable”. </p>
<p>(It is also preposterous that, with no irony at all, so many fiftysomethings will express the serious opinion that the music of their youth was better than today’s, as if the concept of “music” was more important than the concept of “youth” in this regard – but let it pass). </p>
<p>Of course one can pick holes in Molly, not least because of the way in which it reframes the 1970s through a lens of what we in 2016 want to believe hip people were interested in back then (I’m thinking particularly of the pitch for Countdown as a show featuring live bands; you have to spend two minutes on YouTube to realise this is a misnomer but more importantly, was it even a concern of Countdown’s producers? I think not). </p>
<p>Of course, I’ll be watching Molly this coming Sunday, if for no other reason than to see the ABC “suit” Wade get his comeuppance (or something; I always thought this particular cipher was two minutes away from donning a kaftan and offering Molly a kiss). </p>
<p>Yes, Molly lacks a lot as a show, and yes, it is entertainment first and historically accurate second – but even the very best history is often “entertainment first”. </p>
<p><br>
<em>Episode two of Molly airs on Seven on Sunday at 8.30pm.</em></p><img src="https://counter.theconversation.com/content/54471/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Nichols does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘I suppose that, as I’m 50, Molly is absolutely my demographic: I was nine when Countdown began and 23 when it ended, and I was a devotee for most of that time – a devotee who was often disgusted …’David Nichols, Lecturer - Urban Planning, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.