MAPS' effort to sponsor research in Israel into the use
of MDMA-assisted psychotherapy in subjects with war and
terrorism-related posttraumatic stress disorder (PTSD)
began in 1998, when I first met with Israeli psychiatrist Dr.
Moshe Kotler. At that time, MDMA/PTSD research had
not yet begun in the United States (that would take six
more years) nor had the MAPS-sponsored MDMA/PTSD
dose-response study in Spain been approved (that would
take about two more years). Three MAPS-sponsored scientific
conferences in Israel later (September 1999,
MAPS Bulletin online archives Volume 9, Number 3; November
2002, archives Volume 13, Number 1; and March 2005, see
page 4), and after FDA had approved two MAPS-sponsored
MDMA-assisted psychotherapy studies (Dr. Mithoefer's
MDMA/PTSD study, approved in February 2004, and
Dr. Halpern's MDMA/cancer anxiety study, approved in
December 2004), the Israeli research team felt that the
time had arrived to submit the protocol for review.
On May 3, 2005, MAPS donated $5,000 to the Medical
Research Fund at Beer Yaakov Mental Health Center,
to cover costs and professional time associated with the
review of the protocol by the local and national ethics
committees. An additional $5,000 will
be donated after the protocol has
been approved by both the ethics
committees, to cover costs associated
with the review of the protocol by the Ministry of Health. Once
the study becomes fully approved,
we have budgeted $75,000, from
funds we still need to raise.
On June 6, 2005, the ethics
committee at Beer Yaakov Mental
Health Center, where the study
will take place, approved the protocol. They subsequently passed the
protocol on to the national ethics
committee for its review. We expect
to hear from them around the
end of the summer. If approved, the protocol will then be
submitted to the Ministry of Health. We're hoping we will
have all the approvals required to begin the study before
the end of this year.
The Israeli protocol differs from Dr. Mithoefer's US
MDMA/PTSD study in several respects. This study focuses
specifically on people who have developed PTSD as a result
of war or terrorism, while Dr. Mothoefer's study includes
victims of rape and sexual assault as well. Instead of an
inactive placebo, we're proposing the use of low-dose
MDMA as an active placebo that should be more effective
at creating uncertainty as to which dose was received.
We're also proposing that subjects receive a supplemental
dose of half the initial dose, to be administered about
2 1/2 hours after the initial dose. This will extend the
period of the peak therapeutic effects into a plateau lasting
for several more hours, enabling the subjects and therapists
to do additional emotional work. We're going to keep the
model of a male/female co-therapist team and use the same
primary outcome measure, the Clinician Administered
PTSD Scale (CAPS).
MAPS' long-term goals are to obtain permission from
the FDA as well as the European Medicines Agency for the
use of MDMA-assisted psychotherapy by prescription, in
specially-licensed clinics by specially trained and licensed
therapists. Our strategy to achieve this goal is to conduct
pilot studies and one of the two required large-scale Phase
III studies in the US, while also
having pilot studies and the other
of the two required large-scale
Phase III studies conducted in
Europe. We hope to develop studies
in Israel, Spain, Switzerland and
elsewhere, perhaps even Palestine.
Around 300 subjects would be
enrolled in the US studies and a
similar number in those around
the world.
Though it may seem surprising, much credit for the progress
that we have made so far in the
review process is due to the Israeli
Anti-Drug Authority. We arranged
a meeting at their office the day
before our scientific conference to discuss in detail the purpose
of the initial pilot study and our longer-term plans. In
particular, the chief scientist of the Authority, Dr. Rachel
Bar-Hamburger, attended the conference and spoke to the
media expressing support for the study. See page 11 for
some of her comments.
We look forward to continuing to work closely with all
the Israeli regulators to shepherd this study through the
approval process. We're eager to reach the point where we
are able to actually gather data about whether MDMA-
assisted psychotherapy can indeed play a role in reducing
the terrible amount of trauma suffered by many people in
Israel and Palestine.
Rick Doblin, Ph.D.
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