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MDMA-Assisted Psychotherapy May Help Patients With Severe PTSD, Study Finds

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Military combat veterans and other patients with treatment-resistant post-traumatic stress disorder (PTSD) may find symptom relief through psychotherapy that involves the use of MDMA, a new scientific review finds.

“MDMA-assisted psychotherapy demonstrated a high rate of clinical response, remission, with a large effect size at reducing the symptoms of PTSD,” the paper states. “Available evidence indicates that MDMA was well-tolerated, with few serious adverse events reported across studies.”

In other words, the authors write, this type of therapy “appears to be a potentially safe, effective, and durable treatment for individuals with chronic, treatment-refractory PTSD.”

Current options for dealing with severe chronic PTSD are limited. A growing body of research, however, suggests that MDMA (which is restricted as an illegal Schedule I substance) has therapeutic potential when used in a medical setting. To assess where that evidence currently stands, researchers in Canada conducted a systematic review of randomized controlled trials involving the administration of this psychoactive substance.

Their findings were published last week in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry.

The study’s authors reviewed research published up to December 2018. They focused on trials that involved participants who’d been diagnosed with PTSD or appeared to have chronic PTSD based on how long their reported symptoms lasted, and involved the use of MDMA (familiarly known as “ecstasy” and formally called 3,4-methylenedioxymethamphetamine) with the intention of reducing symptoms associated with the mental disorder.

Ultimately, the authors narrowed their analysis to five studies with a total of 106 participants. That research was conducted in primarily outpatient settings and spanned from 2004 to 2017. The majority of participants were female (69 percent). All five studies offered MDMA-assisted psychotherapy to participants in an experimental group, and the dosage of the substance ranged from 50 mg to 125 mg.

Here are the review’s overall findings:

  • A majority of patients responded to MDMA-assisted psychotherapy. Seventy-two percent of those who received MDMA treatment saw a clinical response, compared to 19 percent in the control group.
  • The number and severity of PTSD symptoms among patients improved significantly after MDMA-assisted psychotherapy: “The overall standardized mean difference for the change in PTSD symptom scores pre-versus-post intervention was 1.30, indicating a large effect size,” the review’s authors wrote.
  • During follow-up, researchers found the effects had persisted: According to the paper, “as little as 2 or 3 sessions of MDMA-assisted psychotherapy were found to last several months after the completion of the intervention.”
  • How well MDMA works, and at what dosage, is still unclear: One trial included in the review did not find “statistically significant reductions” when researchers rated patients objectively, though subjective PTSD ratings had improved. In another clinical trial, patients who consumed 75 mg and 125 mg of MDMA had “significantly greater decreases in PTSD symptom severity” than those who consumed 30 mg.
  • As for safety concerns, four out of five studies reported no adverse effects.

“Collectively,” the authors wrote, “these results support MDMA-assisted psychotherapy’s short- and long-term effectiveness for the treatment of PTSD.”

Researchers think that MDMA’s effectiveness for people dealing with PTSD may have something to do with its ability to reduce some of the negative effects of recalling a traumatic event, such as anxiety, fear and feeling overwhelmed. The psychedelic substance also appears to enhance mood, empathy and pro-sociability, making it easier for patients to talk with a trained professional about their experiences.

“Facilitating the fear-extinction process is widely cited as one of MDMA’s potential therapeutic mechanisms,” they wrote. “Under careful medical supervision and with specialized psychotherapy, a few sessions that include MDMA pre-treatment appear to facilitate the recall of traumatic memories without the user feeling overwhelmed by the negative affect that usually accompanies such memories.”

More clinical trials involving the use of MDMA during therapy are currently underway. Importantly, however, key federal agencies recently indicated they have no plans to reclassify any psychedelics currently listed as Schedule I—including MDMA.

Federal Health Agencies Acknowledge Therapeutic Potential Of Psychedelics

Photo courtesy of Pretty Drugthings/Unsplash.

Marijuana Moment is made possible with support from readers. If you rely on our cannabis advocacy journalism to stay informed, please consider a monthly Patreon pledge.

Kimberly Lawson is a former altweekly newspaper editor turned freelance writer based in Georgia. Her writing has been featured in the New York Times, O magazine, Broadly, Rewire.News, The Week and more.

Science & Health

Hemp-Derived CBD Helps Chronic Pain Patients Reduce Opioid Use, Study Finds

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Chronic pain patients consuming hemp-derived cannabidiol, or CBD, on a daily basis for eight weeks reported a decrease in the opioid medications they needed, a new study reports.

“This is a prospective, single-arm cohort study for the potential role of cannabinoids as an alternative for opioids,” the paper states. “The results indicate that using the CBD-rich extract enabled our patients to reduce or eliminate opioids with significant improvement in their quality of life indices.”

The study, published this month in Postgraduate Medicine, sheds new light on the potential benefits of CBD extracted from hemp, a crop that became federally legal under the 2018 Farm Bill, although the Food and Drug Administration has yet to issue finalized guidelines that would allow CBD to be sold in dietary supplements and food products.

Researchers recruited 131 patients who obtain their care from the same pain clinic; 97 completed the eight-week follow-up period. All had been diagnosed with chronic pain and were taking opioid medications for relief.

For the study, participants were given a 60-count bottle of hemp-derived, CBD-rich soft gels. Each gel, according to the study, contained 15.7 mg CBD, 0.5 mg THC, 0.3 mg cannabidivarin, 0.9 mg cannabidiolic acid, 0.8 mg cannabichrome, and less than 1 percent of a botanical terpene blend. Nearly all (91) took two gel caps a day, totaling 30 mg of CBD; three participants opted not to use the hemp extract at all.

“CBD could significantly reduce opioid use and improve chronic pain and sleep quality among patients who are currently using opioids for pain management.”

Researchers asked participants to complete a series of questionnaires to access various factors at the onset of the study, at the four-week mark and at the eight-week point. Among them: their pain intensity level, how much their pain disrupted their lives, the quality of their sleep and how willing they were to cut back on opioids.

Of the total 94 participants who took CBD regularly, 50 reported they were able to reduce opioid medications at week 8. The authors also note: “Additional reductions in polypharmacy on the medication receipt were noted; six participants reported reducing or eliminating their anxiety medications, and four participants reported reducing or eliminating their sleep medication.”

Overall, 89 participants reported their quality of life had improved over the study period. Two measures changed significantly: patients’ self-rating of sleep quality and pain intensity and interference.

At baseline, the study’s authors calculated respondents’ scores regarding sleep quality to an average of 12.09—the higher the score, the poorer the quality of sleep. At the four-week and eight-week check-in points, the score decreased to 10.7 and 10.3, respectively. Similarly, another scale the authors used to measure pain and how it interferes with the enjoyment of life found the mean score value change from 6.5 at baseline to 5.9 at week 4 and 5.7 at week 8.

“The results of this study suggest that using CBD-rich hemp extract oil may help reduce opioid use and improve quality of life, specifically in regards to pain and sleep, among chronic pain patients,” the study concludes. “This is consistent with emerging literature on the topic, which has concluded that CBD is an effective analgesic, and one that helps reduce barriers to opioid reduction, such as physiological withdrawal symptoms.”

In an interview with Appalachian News Express, the study’s lead author Alex Capano said that outside of survey studies, her research is “the largest study on the use of CBD to reduce the use of opioids in the treatment of chronic pain.”

“It’s also the first study on CBD and opioid reduction to identify key data points, such as hemp extract doses, delivery method, and specific cannabinoid content,” she continued. “Most participants used a relatively low dose of 30mg of CBD per day, whereas other studies on CBD have tested very large doses, 10x or 20x that amount. Lower doses of CBD mean reduced risk of side effects and improved outcomes.”

Americans Are Googling CBD More Than Acupuncture, Meditation And Exercise, Study Finds

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Science & Health

Problematic Marijuana Use Is Declining Among People Who Consume Every Day, Study Finds

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Contrary to the expectations of public health experts, the rate of frequent marijuana consumers who are diagnosed with cannabis use disorder (CUD) is not increasing, a new study reports. In fact, it’s actually decreasing, and that may be due to the growing number of states that have legalized access to marijuana.

According to the paper, “CUD prevalence decreased significantly across all ages reporting daily/almost daily cannabis use between 2002-2016. Cannabis dependence prevalence decreased for adolescents and young adults and was stable only among adults ages 26+ reporting daily/almost daily cannabis use.”

Recent studies have had mixed results on the prevalence of CUD—a diagnosis that includes either misuse and/or dependence—in the last two decades. Because people who consume marijuana every day or almost every day are the most at risk for problematic use, researchers at Columbia University’s Mailman School of Public Health set out to get a better understanding of this group’s general health.

Their findings were published last month in the journal Drug and Alcohol Dependence.

The study’s authors used data from the National Surveys on Drug Use and Health for the years 2002-2016. The final sample, totaling 22,651 people, included participants who were 12 and older and reported using marijuana at least 300 days in the past year.

To measure problematic marijuana use, the authors used criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for cannabis dependence and cannabis abuse, such as:

  • Spent a great deal of time over a period of a month obtaining, using, or getting over the effects of marijuana
  • Unable to keep set limits
  • Unable to cut down cannabis use
  • Recurrent use resulting in failure to fulfill major role obligations
  • Continued use despite persistent or recurrent social or interpersonal problems

Other factors considered in the research asked whether participants had a perceived need for mental health treatment, whether a doctor had indicated they had other health issues and whether or not they’d driven under the influence of illegal drugs with and without alcohol.

Over the study period, the authors found that the prevalence of CUD decreased among their sample in all age groups: For adolescents ages 12 to 17, the rate fell by 26.8 percent; for 18- to 25-year-olds, by 29.7 percent; and for adults 26 and older, by 37.5 percent.

“Among those with past-year daily/almost daily cannabis use, there were reductions in the prevalence of DSM-IV cannabis abuse across all age groups, with reductions observed for all individual abuse items in adolescents and young adults,” the study states. “There were also reductions in the prevalence of DSM-IV cannabis dependence among adolescents and young adults, but not in adults ages 26+. Reductions in most DSM-IV dependence items were observed in young adults while reductions in only a few dependence items were found for adolescents and older adults.”

Researchers offer several possible explanations for the declining rates, many of which point to the influence of legalization. “First, the new national cannabis policy environment, with 33 states legalizing medical use and 10 states allowing recreational use of cannabis may have played a role in reducing stigma and perceptions of risk associated with cannabis use,” Silvia Martins, one of the study’s authors, said in a statement. “Secondly, increasing legalization may also be associated with changes in social attitudes resulting in fewer conflicts with relatives and friends around cannabis use.”

As a result, according to the paper, “[t]his could explain reductions in the abuse item ‘Continued use despite persistent or recurrent social or interpersonal problems,’ which reflects difficulties in interactions with others due to cannabis use.”

It’s also possible that “a sector of the population that is healthier overall” is starting to use marijuana more because of legal access, which “may have diluted the prevalence of cannabis abuse/dependence over time.” They may use “less potent” cannabis or in lower daily amounts, researchers note. Additionally, more people may feel less afraid to admit on a federal survey that they use marijuana frequently.

Ultimately, Martins said, the study’s results “contradict the predominating hypothesis that the prevalence of DSM-IV CUD would be stable, or increase, among those using with this regularity.”

Here’s What Researchers Know So Far About How Marijuana Legalization Affects Public Health

Photo courtesy of Sharon McCutcheon on Unsplash 

Marijuana Moment is made possible with support from readers. If you rely on our cannabis advocacy journalism to stay informed, please consider a monthly Patreon pledge.
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Marijuana Use Tied To Lower Rates Of Depression And Suicidal Ideation Among PTSD Patients

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People suffering from post-traumatic stress disorder (PTSD) who consume marijuana experience significantly fewer depressive episodes and lower rates of suicidal ideation compared to non-users, according to a new study.

The research, published in the Journal of Psychopharmacology on Tuesday, analyzed nationally representative health data from Statistics Canada’s 2012 Community Health Survey and found that people with PTSD who have not reported past-year marijuana use are much more likely to have suicidal thoughts and go through depressive phases.

“This study provides preliminary epidemiological evidence that cannabis use may contribute to reducing the association between post-traumatic stress disorder and severe depressive and suicidal states.”

Among the more than 24,000 people who were eligible for the study, with was conducted by researchers at the the British Columbia Centre on Substance Use and University of British Columbia, 420 were clinically diagnosed with PTSD. Of those, 106 individuals with PTSD (28.2 percent) said they used cannabis in the past year. That’s markedly higher than the average of those who don’t have PTSD (11.2 percent).

“We know that with limited treatment options for PTSD, many patients have taken to medicating with cannabis to alleviate their symptoms,” Stephanie Lake, lead author of the study, said in a press release. “However, this is the first time that results from a nationally representative survey have shown the potential benefits of treating the disorder with cannabis.”

Those suffering from PTSD who didn’t report past-year cannabis use were about seven times as likely to have experienced a recent major depressive episode, the study found. They were also 4.3 times as likely to have contemplated suicide.

“Among cannabis-using respondents, PTSD was not associated with a recent depressive episode or suicide ideation.”

While the study only looked at Canadian respondents, the findings are relevant to U.S. patients as well, as members of the military stateside also experience higher rates of PTSD compared to the general population.

A former secretary of the U.S. Department of Veterans Affairs (VA), David Shulkin, has said recently that he’s in favor of having the department conduct clinical research into the therapeutic benefits of marijuana for veterans with PTSD, stating that the suicide rate among the population demonstrates that ignoring the treatment option comes at the “peril” of service members.

While VA declined to support research initiatives into cannabis for medical conditions that commonly afflict veterans under his leadership, Shulkin said this week that the department “should be involved and should be open to research for anything that will help veterans improve their lives, including medical cannabis.”

“We’re only just beginning to understand what the therapeutic potential of cannabis may be for a variety of health conditions,” M-J Milloy, senior author of the new study, said. “These findings are promising, and merit further study in order to fully understand the benefits of cannabis for people living with PTSD.”

Former VA Secretary Again Calls For Marijuana Research That His Department Resisted

Photo by davide ragusa on Unsplash.

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