POD 108: Rachel Nuwer on the history of MDMA
Added 2024-07-26 23:22:01 +0000 UTCIn this episode I talk with journalist Rachel Nuwer about her recent book about the history of MDMA "I Feel Love" and her thoughts on the FDA's advisory committee's recent vot against MDMA assisted therapy for treatment of PTSD.
I Feel Love: MDMA and the Quest for Connection in a Fractured World
Critical analyses of Psymposia and the FDA advisory committee's decision:
The Unbelievable Claims of Psymposia about MAPS and MDMA-Assisted Therapy by Geoff Bathje
Highlighting Bias and Misinformation from Psymposia and its Supporters by Ames Tallisker
Perspective: FDA Advisory Committee vote on MDMA-AT by Liana Gillooly
FDA advisors voted against MDMA therapy – researchers are still fighting for it by Rachel Nuwer
It’s not the psychedelic renaissance. It’s the psychedelic adolescence by Andrew Penn
A Bitter Pill to Swallow by Daniel Pinchbeck
When it’s edgy to be critical of medicalized psychedelics by @mycopreneur
Brian Pace embarrassing himself the following year at Wonderland
The FDA hearing in its entirety:
June 4, 2024 Meeting of the Psychopharmacologic Drugs Advisory Committee (PDAC)
Nese Devenot making dishonest and defamatory remarks about Veronika Gold
The real-world impact of these lies being woven uncritically into mainstream reporting:
The biggest unknown in psychedelic therapy is not the psychedelics by Sigal Samuel
It's important to note that the session being described in this report was not sponsored by MAPS, didn't even involve MDMA, and is not reflective of the MAPS protocol (i.e., the criticism "someone under the influence of MDMA might not remember a safe word, especially if they’re in the midst of a panic attack" is reasonable per se, but "safe words" were not part of the MAPS protocol).
Comments
Yes...a lot of people consume both of them together. I wouldn't recommend mixing the two for harm reduction purposes, but in the US at least where I have lived, I've seen them both mixed a lot. Although there are some who avoid the mix, there are lots who will consume MDMA and mix it with alcohol.
Creepy Crawley
2024-12-31 23:02:39 +0000 UTCSeems obiously more sinister than that as they are recklessly slandering people's reputation and consistently lying.
Creepy Crawley
2024-12-31 22:59:39 +0000 UTCDo you do "Quantitative + report (GC/MS or HPLC/MS):120€"? I already do reagent testing which feels relatively sufficient, all things considered, but this is just so expensive if you are experimenting with a variety of substances. I wish I had access to some at home testing apparatus that was better than just reagent testing.
Ericaceous
2024-11-03 19:07:16 +0000 UTCInternational energy control!
Rachel Nuwer
2024-11-02 20:34:03 +0000 UTCRachel mentions testing her MDMA for % purity. How can one get this level of testing done? Is there a specific resource where I can learn more advanced 'testing' methods, such as using melting point apparatus?
Ericaceous
2024-10-28 03:59:08 +0000 UTCYou mention the use of methamphetamine as part of psychotherapy in the past; where can I read more about this? I am generally interested in the history of drug-assisted psychotherapy and how we have come to a place where psychology and psychiatry are so separate.
Ericaceous
2024-10-28 03:58:04 +0000 UTCI’m pretty sure it’s a copypasta — I was scrolling through Reddit a few days ago and found nearly the exact same comment in a different subreddit, but instead of Hamilton being the subject, it was somebody like, I dunno, Keanu Reeves.
Rory Dillon
2024-10-11 16:35:53 +0000 UTCI don't imagine it necessarily is. From the armchair, I imagine that most public figures' private lives--in which they spend most of their time--aren't dissimilar to the average person's, relative to their respective social contexts. By contrast, relative to my daily life, it seems exceptionally strange to live on an oil rig or to work as a district attorney. There's no doubt that some public figures maintain their public image in their private lives, but I'd be surprised if the majority of them didn't tune out when they're off-air, settling into behavior patterns that aren't too dissimilar from the average person's. It's not easy to evaluate regularity independently of your own perspective, of course. I'm constantly struck by the strangeness of everybody else's lives, whereas mine is entirely normal.
Ephedra
2024-09-23 20:41:40 +0000 UTCCan we just talk to Grignard and get him to react already?
Pvt. Idaho
2024-09-08 17:59:46 +0000 UTCplz send HgCl2
Brendan Moore
2024-09-08 17:15:52 +0000 UTCThis is how people *choose* to talk about these things... Your words toward journalism and us consumers of information may be your wisest of all... I can feel your confusion, disillusion, frustration and disdain --your authenticity-- from across the country.
Pvt. Idaho
2024-08-30 03:40:18 +0000 UTCMisrepresentation is still bad faith and bad faith is the social denaturant at play here.
Pvt. Idaho
2024-08-30 03:18:15 +0000 UTCI guard my remaining NaBH4 jealously
Pvt. Idaho
2024-08-30 03:14:46 +0000 UTCThis isn't how we were/are trained to do MDMA-assisted therapy though. There is a lot of nuance and clinical discretion that is relied upon in these types of sessions, and I would hope most therapists would agree that abreactions should be avoided in therapy as those do not actually help clients process through trauma to reconsolidate and integrate their memories. Absolutely therapists should be held to a high standard in such therapies because of the risk of vulnerability and suggestibility, but a lot of claims against the therapists during the MAPS trials have been exaggerated (obviously this doesn't apply to the therapists who sexually abused their client, that was horrific). If anything, I hope this discussion just further illustrates the importance of informed consent and preparation sessions.
Marley Cote
2024-08-24 19:17:17 +0000 UTCHamilton, I think if you read the longer version of Nese's criticism of Veronika Gold on the Chemical Poetics Substack her critique makes more sense (https://chemicalpoetics.substack.com/p/maps-is-an-mdma-therapy-cult). Her larger point is aimed at problems with the sort of therapy MAPS supports which asserts that painful experiences during psychedelic therapy are always good and that therapists should use touch to help patients push through them. Sometimes painful situations in psychedelic therapy are just painful - they are not healing and can lead to iatrogenic harms, especially if the therapist administering the therapy is trained to assume that patient distress is somehow healing and firm boundaries aren't established. While in that particular case, the client was helped by this approach, I can personally attest to the fact that abreactive experiences can cause lasting harm if a therapist tries to elicit them and then push the client through them too aggressively even outside the context of psychedelic therapy. A few of the trial participants also expressed their mental health declined after abreactions they experienced during MDMA therapy in their comments on the FDA advisory Panel. People with PTSD really need access to MDMA, but without critically evaluating the therapy used to treat them, we may end up doing more harm then good. Maybe the MAPS approach is the right way, but I think the concerns Nese and others raised indicate we should scrutinize it more closely.
Jacob
2024-08-22 23:01:45 +0000 UTCits cultural, not at all the case in europe and especially aus/nz
Eban (Sully)
2024-08-20 11:56:58 +0000 UTCThis is a terrific discussion! Thank you Hamilton for continuing to bring these topics to light, and articulating their importance eloquently. Your capacity to interview effectively never ceases to amaze me! Keep up your amazing work. 🙏❤️
Jim See
2024-08-07 17:03:51 +0000 UTCThank you both, Hamilton and Rachel! Wonderful discussion.
Leigh Bergin
2024-08-07 13:46:03 +0000 UTCReally happy to see the motif of the coelacanth coming up again
Kd
2024-08-06 15:00:25 +0000 UTCFrom what I can tell, Psymposia is trying to do two things: Raise awareness for abuse in psychedelic therapy, and stop medicalization of psychedelics. Stopping abuse is mission critical, but instead of offering constructive solutions, they are using these SA stories to bolster their anti-capitalism agenda.
Mason Earle
2024-08-02 14:58:57 +0000 UTCThank you for the information :)
Crypto Tonight
2024-08-01 18:06:31 +0000 UTCLove you Mike <3
gossamer
2024-08-01 00:58:40 +0000 UTCThanks Hamilton
Xanadu
2024-07-31 22:40:56 +0000 UTCBeing a public figure must be exceptionally strange
Samantha Firoze Sethna
2024-07-31 19:35:23 +0000 UTCAre you in school for chemistry or have a degree?
M
2024-07-30 23:11:28 +0000 UTCI'm sure people suffering will pay whatever they can, that doesn't make it right to charge them that much. I bet your point, but hopefully these folks can get the treatment that helps without going into debt
Cheminterested
2024-07-30 01:53:39 +0000 UTCBut also, to add to your point, I think anyone suffering from severe lifetime PTSD actually WOULD pay 25k to reduce its impact on their life, if they could.
Josh Galloway
2024-07-30 01:22:21 +0000 UTCMDMA is a serious alcohol industry competitor. Anyone that takes MDMA will not consume alcohol (at least most sane people), I have personally seen how nightclub alcohol consumption dumps when the crowd is mostly on MDMA (water bottles). There is a very strong financial incentive for the alcohol industry lobby against MDMA legal progress.
Alejandro C.
2024-07-30 00:14:45 +0000 UTCThanks for the response Hamilton. Good episode, and you made some good points. I appreciate how informed you are and how well you are able to explain your thoughts on the issues.
B-Boy Bungus
2024-07-30 00:08:38 +0000 UTC@ Mia regarding the two variable study there are ethical concerns related to giving MDMA to patients with PTSD and not providing therapy for the sake of creating a clinical control. Mike has talked about this in the past. Millions of people have used MDMA outside of a formal clinical context, I'm sure some of those people have achieved therapeutic effects that rival or even surpass what was observed in the MAPS research, but it's clear that the therapy alone improves PTSD scores and to a greater extent when done in conjunction with MDMA, for that reason I think MAPS made the right decision not to test MDMA on patients who were left alone in a room or as a form of unassisted outpatient therapy.
Hamilton Morris
2024-07-29 19:30:54 +0000 UTCThanks for sharing these Michael. Are there ethical concerns for it within a therapeutic container? I just am trying to solution for them having a 2 variable study with one control.
mia
2024-07-29 18:22:59 +0000 UTCThanks for the response. I liken these nerves to having a female president. Theoretically am I 100% on board? Yes. Is it time? Way past it. Do I think it's unfair to have a standard of perfection for one party and not others? Of course. But, there's so much pressure for success you want it to be as close to perfect as possible. It's driven by the fear that you give people one reason to make generalizations about how this was a wrong decision and should never be attempted again. Straight scared 🫣
mia
2024-07-29 18:21:01 +0000 UTCGreat episode, I think it would be very interesting if you two would collaborate on a project in the future!
Erik
2024-07-29 18:10:42 +0000 UTCThank you. I will check out the PDF
Cheminterested
2024-07-29 03:52:42 +0000 UTC@ B-Boy, that's a good and balanced article, but Kudler isn't mentioning any specific issues other than saying that he wants to see larger studies that aren't connected to the psychedelic community. I'd like to see that as well. Some of that information would come in the form of post marketing surveillance if the FDA approves the treatment, otherwise we will have to wait until actual Big Pharma steps into the game.
Hamilton Morris
2024-07-29 03:48:17 +0000 UTCThese people really make me sick man. They just think they morally superior. They really think they are on some sort of crusade against big pharma. Is the commercialization of psychedelics driven by profit? Probably to some degree, but that doesn't negate all the benefit that people will get from it being more widely available in a safer and legal setting. I just saw someone in their Twitter feed claiming that this won't help veterans because they will have to pay 25k for their treatment. Even if that is what it ends up costing, clearly the vets themselves wouldn't paying that. The VA would cover most of if not all of that cost, and we the tax payers would actually end up paying it. Which I'm fine with.
Cheminterested
2024-07-29 03:30:07 +0000 UTC1. Yes, it was small. Obviously the relative resource-intensity of the intervention (42 hours of therapy over 12 weeks from two therapists) and the fact that it was being developed by a non-profit made it harder to fund a massive trial. For comparison Pfizer's phase III trial of Zoloft for PTSD had 395 participants relative to 104 participants for MDMA's phase III trial. 2. This is discussed in the interview, low dose MDMA was tested as an active placebo and found to be anxiogenic. 3. There are two participants who are vocally opposed to the MAPS/Lykos intervention, their experiences are important to discuss and learn from, but it's safe to say they represent a small minority. If a therapist truly said worsening symptoms is evidence of spiritual awakening that's obviously bad. The Jules Evans PR campaign article you linked seems like another example of the "every accusation is a confession" phenomenon discussed in the interview, Evans allegedly receives support from the Sarlo family, though I haven't seen direct evidence. On the other hand I have seen no evidence of MAPS/Lykos conspiring with Musk, Crenshaw, Heroic Hearts, etc. I spoke with Heroic Hearts and they told me that support from Crenshaw and Musk was organic, not some kind of paid PR campaign, which seems like the simplest explanation to me.
Hamilton Morris
2024-07-29 03:29:15 +0000 UTCI noticed it immediately but haven't seen any public discussion about it. I do know that MAPS subsequently conducted a comprehensive review of Veronika Gold's recorded sessions and found no evidence of abuse. I have linked a PDF of the book that Nese uses as a source for her claim. If you look up the passage Nese quotes from you will see there is nothing about pinning a patient down, that it is not MDMA psychotherapy, and that its not a MAPS clinical trial. This is absolutely the way Nese wanted it to be interpreted and no effort has been made to correct that false interpretation reported in the Vox article linked in the description.
Hamilton Morris
2024-07-29 03:16:43 +0000 UTChttps://www.amazon.com/Heavens-Tale-Scientist-remarkable-inspiring/dp/1532896913
Hamilton Morris
2024-07-29 03:11:47 +0000 UTCPsymposia just really sucks! Seriously. They think they are fighting "big pharma" and capitalism but in reality they are just making it more difficult for people who need these medications to get them in a safe and legal way.
Cheminterested
2024-07-29 00:39:05 +0000 UTCHamilton has the information about Nese lying to the advisory board been sent to the FDA or made public? If so, where can I find that? Has anyone posted this to X or other media sources to push back against Psymposia?
Cheminterested
2024-07-29 00:36:51 +0000 UTCHamilton, I’d love to talk to you. My whole life has been affected by drugs in both the worst ways imaginable as well as also being responsible for me digging myself out of it all. Then I started doing chem and realised it’s SUCH a harder drug than any ‘drug’ iv actually used! No idea if you check these…probably not…um I’m not Jesus ha that’s it I guess
rabidreject
2024-07-28 17:47:39 +0000 UTCGreat interview, bought the book!
Aidan
2024-07-28 04:48:00 +0000 UTCFWIW, when I had stumbled across that absolutely insane comment on reddit about you blowing smoke in a cashier’s face, I had immediately interpreted it as someone trying to troll as opposed to something potentially believable. Just wanted to reassure you that anyone who actually knows anything about you would find that comment absurd as well 💚
Nathan Stichter
2024-07-27 23:49:07 +0000 UTCAs a suffer of CPTSD I stumbled on MDMA 10 yrs ago and did it recreationally not knowing how beneficial it would be for my mental health. I’m not into dance music or into the scene but after about 4 uses spread out over 3 months my mental health improved significantly. I didn’t attribute it to the mdma. Looking back it makes so much sense. I stopped using it when I felt better because I had no use for it. Hamilton you are a true gem. I love how objective you are about this. I really dislike the stigma drug use has. No one scrutinizes ozempic like this and it has been made available to millions.
Monica Mendez
2024-07-27 22:45:54 +0000 UTCWho cares bro. Hamiltons doing 100x more than you or most other people for the community than you'll ever do in your life.
M
2024-07-27 21:40:40 +0000 UTCCounting the releases Hamilton doesn't release with an apology for delays on one hand
Landon Byrd
2024-07-27 19:54:14 +0000 UTCN-hydroxy-MDA book reference?
Andy Braham
2024-07-27 18:42:39 +0000 UTCI will reupload louder today.
Hamilton Morris
2024-07-27 18:27:41 +0000 UTCThanks for this 👍
Anthony
2024-07-27 17:56:23 +0000 UTCFrom yesterday (7/26/24): (https://abcnews.go.com/US/wireStory/veterans-lobbied-psychedelic-therapy-save-mdma-drug-application-112301076): "Dr. Harold Kudler of Duke University met with veterans and MAPS leaders while serving as the VA’s top consultant on mental health services. He believes FDA's experts are justifiably skeptical of the science behind the drug, which he says has been drowned out by messaging from MAPS and its leader, Rick Doblin, who began pursuing MDMA's approval in the mid-1980s. “Rick is the most persuasive advocate within the scientific community that I’ve ever seen. You want to believe him because he's offering you something you sorely need — an effective treatment for PTSD,” Kudler said. “But I think the FDA committee caught a glimpse of how much of this is Rick’s zeal and how much is real.” [...] Dr. John Krystal, a Yale University psychiatry professor, said Lykos' setback "will hopefully ensure that future studies are conducted in ways that give reviewers greater confidence about the effectiveness and the safety of these drugs.”
B-Boy Bungus
2024-07-27 16:13:34 +0000 UTCMy paleo company excavates fossil coelacanth a few times each year, I could definitely save one for you 🤙
Tom Suazo
2024-07-27 15:41:17 +0000 UTCWell said Mia.
B-Boy Bungus
2024-07-27 14:34:11 +0000 UTCI've noticed this before on this podcast - the audio quality is good, but sometimes the overall volume is low, and it was especially low in this ep.
Zach
2024-07-27 13:19:17 +0000 UTCWas wondering the same thing, this is informative, thx
Zach
2024-07-27 13:17:46 +0000 UTCPlacebo is massive issue in analgesia, and where the effect was discovered in modern science. With this longer history comes a greater ability to control for placebo in pain trials vs MDMA/psychedelic clinical development. But there are noteworthy exceptions- ATAI recently failed to separate placebo from oxycodone (the positive control) in a trial of deuterated mitragynine. https://www.nasdaq.com/articles/atai:-additional-research-needed-to-further-characterize-therapeutic-potential-of-kur-101
Michael Cunningham
2024-07-27 12:59:22 +0000 UTCGiving a potentially anxiogenic stimulant as an active placebo to PTSD patients (without a therapeutic container), while a reasonable option scientifically, may not be an appropriate option due to ethical concerns. Prior phase 1 studies conducted by various groups have explored blinding MDMA with comparators of amphetamine (Bedi et al., 2010, 2014; Bershad et al., 2016; Cami et al., 2000; Kirkpatrick et al., 2014a; Mas et al., 1999; Tancer and Johanson, 2003) or methylphenidate (Dolder et al., 2018; Kuypers and Ramaekers, 2007; Ramaekers et al., 2006). Previous phase 2 clinical trials used inactive placebo (Mithoefer et al., 2011) and a low dose MDMA as comparator (25 mg or 30 mg) (Mithoefer et al., 2018; Oehen et al., 2013).
Michael Cunningham
2024-07-27 12:49:29 +0000 UTCPrior phase 1 studies conducted by various groups have explored blinding MDMA with comparators of amphetamine (Bedi et al., 2010, 2014; Bershad et al., 2016; Cami et al., 2000; Kirkpatrick et al., 2014a; Mas et al., 1999; Tancer and Johanson, 2003) or methylphenidate (Dolder et al., 2018; Kuypers and Ramaekers, 2007; Ramaekers et al., 2006). Previous phase 2 clinical trials used inactive placebo (Mithoefer et al., 2011) and a low dose MDMA as comparator (25 mg or 30 mg) (Mithoefer et al., 2018; Oehen et al., 2013).
Michael Cunningham
2024-07-27 12:43:44 +0000 UTCThe most likely pharmacological placebo reference would be amphetamine.
M
2024-07-27 12:20:34 +0000 UTCi just cant understand why they wouldn't have an active placebo to reference. either DXM or R-Ket would be good enough and fairly easy to try
Anthony
2024-07-27 11:22:18 +0000 UTCI've thought that of every single episode. Could for sure use some compression and raising of overall volume. Also the lack of an outro makes me always think my app has crashed rather than the episode being over. Some have been ridiculously abrupt.
Crypto Tonight
2024-07-27 07:29:15 +0000 UTCWhy isnt placebo control such a big issue for other mind altering drugs? I've never heard this being an issue when pain medications are trialed.
Crypto Tonight
2024-07-27 07:26:25 +0000 UTCYes, I notice that too. I had to turn up my volume in my car super high but I’m not gonna complain because the content is amazing! Thank you Hamilton for describing the hearing. That’s the type of topic that comes up in conversations with people involved in the “psychedelic space” who oppose mdma and maps. Your description of it gives us an educated perspective on the topic. I listen to your podcast to have less idk moments in conversations. Thanks
Anthony Roman
2024-07-27 06:33:31 +0000 UTCcan’t wait to listen to
Conor Watters
2024-07-27 06:09:56 +0000 UTCAhhhh so excited to hear this!!!
Siwanand Das
2024-07-27 05:06:24 +0000 UTCThis was an amazing ep! Really enjoyable listen
gossamer
2024-07-27 04:57:42 +0000 UTCFinally, in the intro, Hamilton mentions people being hesitant to criticize Psymposia, but I am more concerned at how hard it is to criticize MAPS as they are a “god-like” figure in the community and I wonder if that is how things were escalated. I certainly respect the decades of work done by MAPS, but I do wonder if these inconveniently timed criticisms could have been avoided if there was more of a culture of democratic checks and balances. MAPS has been called out on things before, made promises, and never followed through (specifically, their independent ethics review board). Maybe the extremeness of the criticisms comes from multiple years of not being heard and feeling like this is their last chance? And I do want to iterate, that I don't think the solutions to these concerns should be keeping a substance illegal. I am pro-regulatory practices for substances and professions and holding therapists / practitioners accountable would surely be easier in an above-ground practice.
mia
2024-07-27 03:28:54 +0000 UTCThe concerns I have against MAPS: 1. The efficacy results are great, but the sample size is very small (and for a Phase 3 clinical trial). It doesn’t seem large enough to be considered representative. 2. Functional unblinding is acceptable, but why can’t there be an active placebo as a third group to better control for expectations effects? 3. I guess this is outside the FDA concern, but I’m most passionate about the therapy being a “black box”. I haven’t seen the results of the adherence raters published and it’s not mentioned in the studies. Without this, it’s hard not to be swayed by reports of negative experiences like the assault, obviously, but also the statement a therapist encouraged the patient to view “worsening symptoms as evidence of healing and ‘spiritual awakening’” (which is in my opinion, is a whole other issue in the psychedelic space that relies on outdated psychology ideologies that can be harmful). With the lack of transparency and participant testimonies (specifically referencing this one from the NPR article: https://www.regulations.gov/comment/FDA-2024-N-1938-0038), I do not think the data presented is complete. At worst, it seems cherry-picked, and at best, the measurements were insufficient to capture the actual experiences of the participants. Without a comprehensive collection of this data, then the voices raising criticisms can’t be countered. I also want to share this article about the PR campaign(s) initiated after the advisory board as I found it interesting. https://www.ecstaticintegration.org/p/lykos-rallies-the-troops
mia
2024-07-27 03:19:24 +0000 UTCOr use an external audio device to externally increase audio
M
2024-07-27 02:59:45 +0000 UTCSounds fine imo. Wear headphones if necessary
M
2024-07-27 02:59:29 +0000 UTCHer book at times was fascinating and other times I had to skip because it got a bit boring. I did enjoy her writing about mdma in the 80’a not so much about hearing about middle aged people taking mdma to work out their marriages
Ari Givony
2024-07-27 02:44:19 +0000 UTCCool!
M
2024-07-27 02:23:06 +0000 UTCGreat episode. Anyone else think the volume could be increased on these? I find these difficult to hear if one is anywhere but in a relatively silent environment and I don't have this issue with most other podcasts.
Materialmind
2024-07-27 01:29:13 +0000 UTCI'm not used to getting this notification at a time other than midnight on a Sunday. You're not playing into my insomnia this time! Can't wait to listen to it.
Brian
2024-07-27 00:38:44 +0000 UTCGreat Episode!
IsoTope
2024-07-27 00:19:31 +0000 UTCohhh yeeeeah that notification just gave me a nice dose of dopamine
Matt4dma78dhf
2024-07-26 23:43:38 +0000 UTCOh this is gonna be a banger
Ryan Campbell
2024-07-26 23:24:36 +0000 UTC
