The Drive with Peter Attia — Rick Doblin

On: The creation, scheduling, toxicity, therapeutic use, and changing public opinion of what is possibly the single most important synthetic molecule ever created by our species

Episode: 65

Date: August 2019

Key Subjects:

  • Founder and executive director of MAPS
  • The history of MDMA.
    • Invented in 1912 (by Merck), but not further developed or used.
    • Rediscovered in the 1970s in underground therapy circles.
    • Leaked into recreational scenes in 1980s as “ecstacy”.
    • Criminalization starts in mid-1980s (labeled a Schedule 1 drug).
  • Differences between MDMA and other psychedelics.
    • More empathy (emphatogen).
    • More alertness (no dissociation, no hallucination).
    • More control of experience (no ego dissolution, etc.)
  • Neuroscience:
    • MDMA releases oxytocin, which causes neurogenesis in prosocial parts of the brain.
    • [From Wikipedia:
      • MDMA acts primarily by increasing the activity of neurotransmitters (serotonin, dopamine, and noradrenaline).
      • Induces rapid and powerful release of serotonin and dopamine.
      • Long-term effects on human brain structure and function have not been fully determined.
      • MDMA in moderate use may be neurotoxic.]
    • Potential risks:
      • Hyperthermia (overheating); hyponatremia (low sodium); integration of emerging emotional trauma.
      • Discredits evidence of: neurotoxicity, memory loss, depression, Parkinson’s, etc.
      • Maybe avoid if you have: heart issues (MDMA increases blood pressure); certain psychiatric conditions (schizophrenia, bipolar); epilepsy.
    • Doblin’s efforts to promote MDMA therapy provides a potential playbook for other drugs (psilocybin, LSD, etc.):
      • Decriminalize and remove it from Schedule 1.
      • Demonstrate no neurotoxicity (Phase 1: completed).
      • Find population / condition to target: PTSD (Phase 2: completed).
      • Show safety / efficacy (Phase 3: ongoing).
      • Therapy (MDMA + treatment) could be approved by end of 2021.
      • Expanded access for compassionate use before that.
    • Personal history discussion covers many topics also discussed in “How to Change Your Mind“:
      • History of LSD, counter-culture, etc.
    • Backlash against psychedelics:
      • Not because of psychedelics gone “wrong”.
        • Mainstream recreational use, bad science, etc.
      • But because of psychedelics gone “right”:
        • Changes in how people view and interact with “authority”.
    • 7/10

Worth Listening

A helpful introduction to MDMA and its therapeutic potential. The conversation highlights Doblin’s personal transformation as a person and his long, difficult and uneven fight with authorities to make MDMA’s potential therapeutic benefits available to an especially deserving population (those suffering from PTSD).

What is less clear from this discussion is how MDMA actually works, which is surprising, given the usually technical nature of this podcast. Perhaps because of that, doubts linger about MDMA’s potential risks, which multiple studies and researchers continue to be concerned about. See for example Sam Harris’ podcast with Roland Griffiths where questions about neurotoxicity are explored in more detail (I think), Here, most of the risks are dismissed seemingly based on one piece of discredited research .

Perhaps the focus here is more on therapeutic use, where dosage and frequency are less likely to pose risks, as opposed to recreational (ab)use, where the potential for risk may be more ambiguous. A point that gets easily lost and worth emphasizing more clearly especially when you label MDMA the most important molecule ever created.

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