Can MDMA Play a Role in the Treatment of Substance Abuse?

Psychedelic compounds show promise as treatments for substance abuse disorders. MDMA, which shares features with psychedelics and has reduced PTSD symptoms in assisted psychotherapy, may also help. Early reports indicate some people reduced or stopped substance use after receiving MDMA, especially therapeutically. MDMA releases monoamines, activates 5-HT2A receptors indirectly, and increases prosocial feelings via oxytocin. Heavy lifetime ecstasy use is linked to fewer serotonin transporters and impaired verbal memory. Animal and human studies show moderate abuse liability, but in two recent clinical studies, participants who received MDMA-assisted psychotherapy did not seek ecstasy and tested negative on random drug tests during follow-up. MDMA might directly treat addiction-related neuropharmacological abnormalities or indirectly aid therapy and comorbid conditions.

Study at a glance

Abstract

A wider array of treatments are needed for people with substance abuse disorders. Some psychedelic compounds have been assessed as potential substance abuse treatments with promising results. MDMA may also help treat substance abuse based on shared features with psychedelic compounds and recent reports indicating that MDMAassisted psychotherapy can reduce symptoms of PTSD. Narrative reports and data from early investigations found that some people reduced or eliminated their substance use after receiving MDMA, especially in a therapeutic setting. MDMA is a potent monoamine releaser with sympathomimetic effects that may indirectly activate 5-HT2A receptors. It increases interpersonal closeness and prosocial feelings, potentially through oxytocin release. Findings suggest that ecstasy, material represented as containing MDMA, is associated with deleterious long-term effects after heavy lifetime use, including fewer serotonin transporter sites and impaired verbal memory. Animal and human studies demonstrate moderate abuse liability for MDMA, and this effect may be of most concern to those treating substance abuse disorders. However, subjects who received MDMA-assisted psychotherapy in two recent clinical studies were not motivated to seek out ecstasy, and tested negative in random drug tests during follow-up in one study. MDMA could either directly treat neuropharmacological abnormalities associated with addiction, or it could indirectly assist with the therapeutic process or reduce symptoms of comorbid psychiatric conditions, providing a greater opportunity to address problematic substance use. Studies directly testing MDMA-assisted psychotherapy in people with active substance abuse disorder may be warranted.