How and when could psychedelic therapy go mainstream?

Psychedelic therapy has been in the news recently due to new results from experiments done with fMRI scans of patients on a dose of LSD (see video), to the results of new high-profile MDMA studies being revealed. Many scientists and researchers see a real chance for MDMA to be made a prescription medication. To be clear, the scientific work is being done mostly with an eye toward prescription of MDMA, not decriminalization or legalization. 

So when and how might this happen? Well no one can answer the when (or even if) at this point, but should any of the psychedelic drugs become legal for doctors in the therapy, some interesting plans are already in place for how the clinics would look and operate, and how they would keep their medical drugs off the streets. 

Lets look a little into the questions surrounding the very uncertain future of MDMA therapy:

 

Will medical legalization of MDMA happen in the foreseeable future?

There is a lot we don't know about the medical uses of psychedelics. Because of their legal status, the types of tests used to vet medications for the FDA simply haven't been conducted on most psychedelics. A lot has to be done to move from where the research is now to where it needs to be to have a hope of getting the FDA and DEA to allow medical use. Currently, MDMA is at the phase of research known as Phase II human trials, meaning a drug has passed animal and human tests for safety, and can now be tested on small groups for effects and side effects. Phase III trials, the largest studies needed before the FDA can rule on a new drug, look for statistical data on the effects discovered in Phase II by testing larger numbers of a wider variety of people. This will take years, but likely not decades. The stated goal of MAPS is to have prescription status for MDMA by 2021, which is possible given the rate of completion of Phase II trials. 

 

If MDMA is ever legalized, what sort of training and treatment ideas will work on a large scale?

There's a long road ahead before medical use of psychedelics will be possible. Using MDMA for PTSD has been one of the most studied and tested areas in psychedelic psychotherapy, and once that small wedge is in the door, the hope is that use will expand to other studied conditions like end-of-life anxiety, anxiety disorders, addiction, or recovery from other traumas. This therapy would not involve take-home prescriptions picked up from a pharmacy, but rather consumed on-site under the guidance of therapists in approved clinics.

While clinics like these seem a world away at this moment, many of the hurdles that have kept psychedelics out of scientific and public awareness for the last 45 years are slowly starting to give way. The reason this is such a huge roadblock on the road to medicalization is that Schedule I drugs, unlike those on any other Schedule, are only allowed to be possessed and given out by the DEA or organizations it approves. This creates a bottleneck with tax-payer funded government bodies in the unsavory role of both fighting drugs and dealing them to scientists and researchers. 

 

How will these drugs be kept off the street once legal?

When talking about making a powerful drug more accessible for medical use, the first question asked is often about how to make sure these drugs don’t get into the hands of unauthorized users or drug dealers. With the model of psychedelic therapy currently being pushed by MAPS, this problem is addressed from the outset. These drugs would only be available from a qualified therapist, in single doses, and only to be consumed on-site at their office or clinic. There are no plastic bottles with 30 or 60 pills in them that are taken home, tempting patients to be abusers or dealers. Also, only 2-4 doses are included in the entire regimen of therapy over a total of 8-12 weeks. This means only small amounts of the drug will need to be produced, stocked, and transported, reducing the potential profits from stealing or skimming from shipments. Overall, the therapeutic model for MDMA as it is evolving will have tighter controls over the drug itself, and less production of the drug in general, than almost any other abuse-prone prescription drugs now available.