In the early 1980s, however, MDMA escaped from the clinic to the dance floor, where it became known as Ecstasy. In 1985, the Drug Enforcement Administration criminalized MDMA as a Schedule I substance, defined as having “no currently accepted medical use and a high potential for abuse.”
Some mental health professionals continued to administer MDMA-assisted therapy underground, but most stopped. The numbers of scientists who pursued studies with MDMA also dwindled. But a few individuals continued to push strongly on behalf of MDMA research, including Dr. Doblin, who founded his association in 1986 to focus on developing MDMA and other psychedelics into medications approved by the F.D.A. It took nearly two decades to overcome alarmist claims about Ecstasy’s dangers, including that it ate holes in users’ brains, to finally gain approval to begin studies. Research in animals and humans confirms that MDMA produces no neurotoxic effects at the doses administered in clinical trials.
Ecstasy or Molly, on the other hand, can be adulterated with other potentially dangerous substances, and users may take far higher doses than are safe. In 2011, MDMA accounted for 1.8 percent of all U.S. drug-related emergency department visits, according to a database maintained until that year by the Substance Abuse and Mental Health Services Administration. In Europe, MDMA was responsible for 8 percent of drug-related emergency visits to 16 major hospitals in 10 countries from 2013 to 2014.
Scientists still do not fully understand the source of MDMA’s therapeutic effects. The substance binds to proteins that regulate serotonin, a neurotransmitter that can, among other things, lift mood. Antidepressant medications like Prozac bind to these same proteins and block their reabsorption of serotonin, but MDMA takes this process further, causing the proteins to pump serotonin into synapses, strengthening their chemical signal.
MDMA also elevates levels of oxytocin, dopamine and other chemical messengers, producing feelings of empathy, trust and compassion.
But its primary therapeutic effect may come from its seeming ability to reopen what neuroscientists refer to as a “critical period,” the window during childhood when the brain has the superior ability to make new memories and store them. Evidence from a mouse study published in Nature in 2019 indicates that MDMA may return the adult brain to this earlier state of malleability.
An estimated 7 percent of the U.S. population will experience PTSD at some point in their life, and as many as 13 percent of combat veterans have the condition. In 2018, the U.S. Department of Veterans Affairs spent $17 billion on disability payments for over one million veterans with PTSD.