December 11, 2006

 

Dr. Maartje M. de Win,

 

I'm Rick Doblin, Ph.D., President of the Multidisciplinary Association for Psychedelic Studies (MAPS, www.maps.org). As you may know, MAPS is sponsoring research in the US, Switzerland and Israel exploring the risks and benefits of the psychotherapeutic use of MDMA in subjects with treatment-resistant posttraumatic stress disorder (PTSD). In addition, a MAPS-initiated study testing MDMA in advanced-stage cancer patients with anxiety is about to start at Harvard Medical School.

 

I have just read the text associated with your presentation at the Monday, Nov. 27, 2006 RSNA conference about your research in Ecstasy users. I'm writing you now to inquire about a statement in the Clinical Relevance/Application section of your RSNA presentation, in which you wrote,  "Low doses ecstasy have effects on the brain. Therefore, recreational use and prescription of ecstasy as adjuvant in psychotherapy should be discouraged."

 

I wonder why you felt it necessary to urge that the psychotherapeutic use of MDMA should be discouraged?  I thought it was standard practice in medicine to weigh costs against benefits and then make decisions about the relative risk/benefit ratio for both research and prescription use. You are making your statement on the basis of claims about risk only, and furthermore on claims about risk that are contradicted by the findings of many other studies, including a recent study which you co-authored.

 

For example, in Liesbeth Reneman's recently published study, "Memory function and serotonin transporter promoter gene polymorphism in ecstasy (MDMA)  users",  Journal of Psychopharmacology 20(3) (2006) 389–399, you were a co-author. The abstract states,   "While the use of MDMA in quantities that may be considered ÔmoderateÕ is not associated with impaired memory functioning, heavy use of MDMA use may lead to long lasting memory impairments." In addition, there are quite a few other studies from research teams around the world that have failed to find impaired cognitive functioning in people who used "moderate" or fewer doses of MDMA.

 

The therapeutic model for the use of MDMA does not call for daily dosing for months or for years but for the use of MDMA a few times over a period of several months, a use pattern that would not even be called moderate but, more accurately, low.

 

In our US MDMA/PTSD study, in which 14 out of 20 subjects have already completed the study, we have found increases in cognitive performance after two or three MDMA sessions, not decreases. It is widely accepted that depression, anxiety and other psychiatric disorders can have a negative impact on neurocognitive performance and that the successful resolution of these psychiatric disorders can lead to increases in neurocognitive performance.   We feel that this is what is taking place in our study. Most importantly, we feel that decisions about the therapeutic use of MDMA should be based primarily on data gathered from clinical research using pure MDMA in well-controlled settings rather than on studies in Ecstasy users exposed to often impure drugs in settings that can include vigorous dancing in environments with hot ambient temperatures in people who may or may not be adequately hydrated.

 

Since the Drug War has resulted in such enormous political pressure to restrict, obstruct and prevent clinical research into the potential therapeutic uses of MDMA, your statement urging that the therapeutic use of MDMA be discouraged could have particularly pernicious effects.  I hope you will reconsider whether the evidence from your study, and from the entire body of MDMA research, actually supports such a drastic recommendation.

 

Due to the widespread presentation of the results of your latest published research in media articles around the world, many of which seem to exaggerate your actual findings in multiple ways, I've asked Ilsa Jerome, Ph.D. of MAPS to write a commentary on your study for posting on the MAPS website. She'll be sending you a draft later today with a few questions. We'd welcome any comments or additional background information that you are willing to send. We'd like to discuss your research, and the implications of your research, in as accurate a manner as we can.

 

 

 

Sincerely,

 

Rick Doblin, Ph.D.

MAPS President