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Subjective Reports of the Effects of MDMA in a Clinical Setting

Authors:
  • Heffter Research Institute

Abstract

This article is a summary report of data gathered from the first 29 people administered MDMA in a clinical setting. Because the primary purpose of the project was to assist the subjects in achieving their particular and varied goals for having the sessions, the data available for analysis is limited. Only phenomenological descriptions were obtained of the therapists' observations and of the subjects' experiences before, during and after the sessions. Psychological evaluations by independent observers with testing before and after sessions, placebo control group data with double-blind assessment, and laboratory examinations of organ and metabolic functions were not conducted. Providing the reports of these 29 subjects' experiences will hopefully encourage further research into the beneficial effects of MDMA. Presenting evidence establishing the limits of its usefulness should discourage any movement to promote it as a social or psychological panacea.
Subjective Reports
of the Effects of MDMA
in
a Clinical Setting
GEORGE GREER, M.D.* & REQUA TOLBERT, R.N., M.S.N.*
The psychological effects of MDMA were first re-
ported in 1978 by Shulgin and Nichols. Because it had
originally been patented in Germany in 1914 and was no
longer patentable. no pharmaceutical manufacturer could
be found who was interested in sponsoring an Investiga-
tional New Drug application with the Food and Drug
Administration or in supporting research (Shulgin 1980).
In 1980. it was learned that. in California at least, drugs
that were not yet available commercially could be used
within a physician's practice if they were manufactured by
the physician or by a pharmacist (Younger 1978). The
state medical board recommended that there be peer re-
view. informed consent and supporting scientific litera-
ture when conducting experimental work (California
Board of Medical Quality Assurance 1980). This article is
a summary report of data gathered from the first 29 people
administered MDMA in a clinical setting.
Because the primary purpose of the project was to
assist the subjects in achieving their particular and varied
goals for having the sessions. the data available for analy-
sis is limited. Only phenomenological descriptions were
obtained of the therapists' observations and of the sub-
jects' experiences before. during and after the sessions.
Psychological evaluations by independent observers with
testing before and after sessions. placebo control group
data with double-blind assessment. and laboratory exami-
nations of organ and metabolic functions were not con-
ducted.
METHOD
The MDMA used in this study was synthesized in the
':'3 Azul Drive. Santa Fe. New Mexico X7505.
Journal of Psvchoactive Drugs
laboratory of Alexander Shulgin, Ph.D., who had col-
laborated in writing the only published papers on its
synthesis (Braun. Shulgin
&
Braun 1980). Dr. Shulgin
was present during the entire procedure for consultation
and assistance. Identity was verified primarily by infrared
spectrophotometry.
The sessions were conducted in San Francisco and in
Santa Fe, New Mexico, from 1980 to 1983. All subjects
were referred by psychotherapists or friends specifically
for the purpose of having an MDMA session, and none
were referred from the author's (Greer) private psychiat-
ric practice. A questionnaire designed for screening and
preparing the subjects for MDMA sessions was filled out,
and lengthy informed consent information was explained
both verbally and in writing. (Information regarding "In-
formed Consent for MDMA Session" is available from
the authors.) Parenthetically. five subjects (well-known
by the authors) filled out the questionnaire retrospectively
at the time of follow-up.
In this preparatory process. the possible side effects
that could occur (resulting primarily from MDMA 's sym-
pathomimetic effects) were described in detail. Subjects
were also told that they should not take MDMA unless
they were certain that they were willing to deal with any
disturbing experience they might have, including (but not
limited to) previous psychological difficulties.
The following medical conditions were criteria for
exclusion from the study: hypertension, heart disease,
hyperthyroidism, diabetes mellitus, hypoglycemia, sei-
zure disorder. glaucoma, diminished liver function and
actual or possible pregnancy. Subjects with a history of a
socially or vocationally disabling psychological condi-
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GREER
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tion. other than that caused by alcohol or other drug
intoxication. were also excluded. Subject No. 19 was an
exception because the disability was not known until after
the session.
The following agreements were made before the
session to ensure an atmosphere of security during the
session: (I) Everyone agreed to remain on the premises
until it was mutually agreed that the session was over and
that it was safe to leave: (2) The subjects agreed to refrain
from any destructive activity to self, others or property:
(3) All agreed that there would be no sexual activity
between the therapists and the subjects; and (4) The sub-
jects agreed to follow any instructions given by a therapist
when explicitly stated as part of the structure of the ses-
sion.
Most of the sessions were held in the subjects'
homes. A six-hour fast was instituted to ensure rapid
absorption of the MDMA and to prevent nausea. Before
the dose was administered there was time to reestablish
contact with the therapists and answer questions. An oral
dose of 75-150 mg of MDMA was then given. (Subject
No.7 received higher doses, which are discussed below.)
Lower doses were used in interpersonal sessions and
higher doses were given to heavier people. During indi-
vidual sessions, the subject listened to instrumental
music-with or without headphones and/or eyeshades-
to facilitate an internal experience. During interpersonal
sessions, music was usually played in the background.
The therapists were attentive and available to respond to
requests or needs, to receive and record communications,
and to interact with subjects as was deemed appropriate.
When subjects noticed that the effect of MDMA was
beginning to subside-usually before two hours-they
were offered a second dose of 50 mg or, rarely, 75 mg.
The purpose of the second dose was to prolong the session
and to provide a more gradual return to their usual state of
consciousness. Some subjects were offered propranolol
(20-40 mg, every three and a half to four hours) or a single
five milligram dose of diazepam to reduce unwanted
sympathomimetic side effects. Others received /-
tryptophan (500 mg) to reduce discomforts occurring late
in the session.
When the sessions were over, the subjects' ability to
drive was assessed before they were allowed to drive a
car. The usual duration of sessions was five to eight hours.
depending on the dosage and setting. Follow-up was
conducted both verbally (soon after the session) and much
later by written questionnaire.
RESULTS
The data gathered from the questionnaires are pre-
sented here in narrative form. (These data are available
Journal of Psychoactive Drugs
SUBJECTIVE REPORTS
from the authors in tabular form.) The findings are pre-
sented in the categories of the questions asked. Much
information was gathered on the presession question-
naires. but most was for screening purposes or for com-
parison with the follow-up questionnaires. The only items
from that questionnaire mentioned here are preexisting
physical or psychological problems and the subjects' pur-
poses for having the session.
Fourteen (14)of the 29 subjects reported psychologi-
cal problems. none of which was of a severe nature. Six
individuals reported a dissatisfaction with themselves,
such as fear of rejection, perfectionism or lack of self-
confidence. Mild depression was reported by four sub-
jects. anxiety by two. hate or sadness at being alone by
two, normal existential despair or angst by two and diffi-
culty making major life choices by one. (Subjects with
diagnosable psychiatric disorders are discussed below.)
Additionally. two subjects had significant health prob-
lems: subject No.4 had essential hypertension that was
well controlled with medication. and subject No.7 had
chronic macula edema in one eye with an ocular implant.
Follow-up questionnaires were completed by 28 of
the 29 subjects from two months to two years after the last
session, and most were around nine months. The other
subject (No. 22) responded with a letter over two years
later instead of filling out the questionnaire.
Benefits During Sessions
Every subject experienced some benefit from
MDMA during his/her session. Twenty-seven (27) sub-
jects felt closer and more intimate with anyone present.
(The other two had solo sessions.) A1l21 subjects who had
sessions in couples or groups experienced more closeness
and/or enhanced communication, and two found it easier
to receive compliments and criticism.
All 29 subjects reported positive changes in their
attitudes or feelings. Sixteen (16) felt warmer, fresher,
more alive, euphoric or loving feelings. Ten (10) subjects
mentioned greater self-confidence or self-acceptance, and
10felt that their defenses were lowered. Two of these and
five others reported undergoing a therapeutic emotional
process. Five subjects said they had a transcendent experi-
ence. Five noticed having fewer negative thoughts or
feelings. Three felt more self-aware or self-grounded, and
two reported feeling blessed or at peace.
Twenty-two (22) subjects reported some cognitive
benefit: an expanded mental perspective, insight into per-
sonal patterns or problems, improved self-examination or
"intrapsychic communication" skills, or "issue resolu-
tion." Five subjects used a low dose (50 mg) to facilitate
their creative writing abilities-four in a group session
and one alone. All found it quite useful. Five subjects
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reported clear cognition or enhanced presence of mind.
One subject reported an enhanced sense of touch.
Another subject felt pleasantly warm, which was unusual
for her.
Undesirable Effects
All subjects reported some undesirable experience
during or after their sessions. The longest that any of these
symptoms persisted was one week, except in two sub-
jects. Subject No. 14 experienced a week of increased
appetite and a 15 pound weight gain over a few weeks. He
enjoyed eating more for a few months and then lost 10
pounds. No other subjects reported increased appetite.
Subject No. 19 had difficulty coping with work, friends
and relatives a few weeks later. He then had anxiety
attacks that caused him to miss seven days of work. Work
had been a major life stress both before and after the
session. and had led to similar episodes of disabling
anxiety in the past. He was "not receptive to the sensa-
tion" of MDMA and
"stressled]
that the session itself
was not the anxiety-inducing catalyst. Rather, I think it
served to open up some tightly controlled emotions that
spilled out in a frightening way." He entered long-term,
semiweekly psychotherapy for the first time. A year later
he said. "It probably was a good thing. It speeded up
processes that needed to happen."
Every subject reported some undesirable physical
symptom and one subject (No.7) had many more physical
symptoms than any other. She was by far the oldest (74
years). though in good general physical health, except for
her macula edema. In two separate sessions. she took a
much higher single dose (200 mg) and total dose (350 mg)
than any other subject because she had not responded to
lower doses. The side effects she reported during sessions
were nausea, a small amount of vomiting, jaw tension.
ataxia. urinary urgency, blurred vision, sweating. brief
short-term memory loss, and brief distortion in depth
perception with a brief hallucination. During the evening
after the sessions. she-experienced loss of appetite, a little
vomiting, less taste for alcohol. a strong body odor.
blurred vision, urinary urgency. a mild hearing impair-
ment, difficulty opening her jaws wide, insomnia and the
biting of her cheek during sleep. Her jaw-opening diffi-
culty continued for several days, along with two days of
fatigue and hoarseness. one day of feeling uncertain on
her feet and a brief visual illusion the second night, which
lasted only until she turned on the light. She also reported
a pleasant two-day relief from her usual sensitivity to light
in the eye with chronic macula edema.
Twenty-two (22) subjects reported jaw tension or
shaking. or teeth clenching during the session. Two of
these and one other also reported it for the day after.
Journal of Psychoactive Drugs
SUBJECTIVE REPORTS
Diazepam (5 mg) clearly relieved this effect in two sub-
jects, and propranolol (40 mg) also relieved it in two. One
subject (No. 12) who had taken propranolol at the start of
his session reported more jaw tension than he had had in
an earlier, identical-dose session without it. He wondered
if it was due to his purposefully more cognitive orientation
during the second session. None of the other eight subjects
who used propranolol during their sessions complained of
jaw or other muscle tension after taking it.
Twenty-three (23) subjects reported fatigue lasting a
few hours to a few days after the session; for 16 this lasted
two days or less. Four of the 23 felt sleepy or tired during
the session. though one had also taken diazepam (5 mg) to
prevent the jaw clenching she had experienced with
MDMA in the past. One other subject felt tired late in the
session.
Eleven (I I) subjects reported some insomnia the
night after the session, though three subjects reported
sleeping better. Eight subjects experienced muscle aches
or tightness; six during the sessions and four afterward for
a day or less. Six of the eight also had jaw tension.
All but one of the subjects lost their appetites during
sessions-though none found it unpleasant-and all had
fasted overnight or for a few hours before. Seven subjects
felt nauseated during sessions, most for about five to 30
minutes. Two reported stomach upset for the next one or
two days and one subject (No. 17) lost her appetite for
three days and was mildly constipated for a few days.
During the session she related her nausea to thoughts and
feelings about her parents when they were in German
concentration camps. After an unsuccessful attempt to
vomit, the nausea and negative feelings stopped. Two
subjects felt mildly nauseated during the evening after the
session and one other subject was constipated for a day.
Three subjects reported difficulty walking during the
session. Two reported feeling cold during sessions. Many
others mentioned coldness early in the sessions-though
not as a problem-and it usually lasted for less than 30
minutes. Two other subjects mentioned sweating during
sessions. but it too was a common occurrence that was
only mentioned in passing.
The following undesirable physical symptoms were
each reported by only one subject: jittery vision early in
the session; lip swelling. shakiness. and numb hands and
face. all during sessions; headache late in the session;
fainting the evening of the session (subject No. 16. who
thought it was psychosomatic because she had been think-
ing about her difficult relationship with her boyfriend
when it occurred): anorgasmia the day after: and de-
creased sexual desire for one to two days.
Pulse and blood pressure were measured in two sub-
jects. Subject No. 10 had a baseline pulse of60 and blood
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pressure of90/50. During the session, the maximum pulse
recorded was 112, and the maximum blood pressure was
128170. Subject No. II had a baseline pulse of 64 and
blood pressure of 110178. His pulse reached 100, and his
blood pressure went up to 154/88. Readings were taken 35
minutes after ingestion. when the subjects reported the
first sensations of MDMA. and after one hour and 20
minutes, when side effects were felt most intensely.
Sixteen ( 16) subjects reported undesirable emotional
symptoms. Five reported anxiety or nervousness during
the session, including subject No. 19. Two subjects expe-
rienced mild depression the day after. One subject re-
ported mental fatigue and one reported mild emotional
inflation, both for a day. One subject reported feeling
lonely or sad for brief periods during his session. One
other felt one to three minutes of fear and paranoia early in
his session. and then a flattened affect later in the evening.
One subject (No. 18) described waves of physical and
emotional "crud" during his session and over the next
few days. He believed it had built up over the previous few
days and felt he was "letting go" of it during the session.
One subject reported feeling simply more emotional after
her session. and subject No. 17 felt more emotionally
vulnerable and off center for three to four days. including
a few hours of nonspecific anger two days after her ses-
sion.
Four subjects described undesirable cognitive symp-
toms. One had a "racing mind" and one reported confu-
sion. both during the evening of their sessions. Subject
No.6 said it was hard to work the next day because there
was "too much going on" inside her mind, and she felt
confused about her relationship with her boyfriend for two
days. One subject reported five to seven days of "negative
self-talk. "
Realization of the Session's Purpose
All but one subject had some purpose or goal, other
than curiosity, for having a session and most had multiple
reasons. Sixteen (16) of these felt that their purpose was
completely realized. four reported significant progress
made toward all their goals, and seven felt that some goals
were realized while others were not. One reported that his
curiosity was satisfied, but that no new learning about
himself occurred.
Nine subjects implied they wanted more cognitive
understanding of themselves and expressed it in several
ways: self-analysis; rational self-examination; learning
about themselves: understanding losses, fears or attitudes;
gaining insight into life patterns; objectivity with insights
into feelings and behavior; and clarifying thinking. Three
of these subjects felt that this goal was fully achieved, one
said progress was made. one was less than satisfied with
Journal of Psychoactive Drugs
SUBJECTIVE REPORTS
the results, and four reported no results at all in this area.
Of the eight subjects who wanted a peak experience
of a visionary or mystical nature-or a sense of whole-
ness, connectedness or enlightenment-six felt that they
realized such a goal and two felt that they did not. Two of
the six and three others desired personal or spiritual
growth or self-exploration, and all five felt that this pur-
pose was fully realized.
Six subjects wanted enhanced communication with
someone (often their spouse) taking MDMA with them.
Five felt that this occurred and one was less than satisfied.
One of the five also desired to have more open com-
munication with people after the session and reported
possible progress. Three other subjects desired closeness
with their mates during the session, and all said that they
achieved it.
As mentioned previously, five subjects had low-dose
(50 mg) sessions specifically for the purpose of facilitat-
ing their creative writing. All reported being satisfied with
the results.
Four subjects mentioned fun or enjoyment as a goal.
One of these and two others wanted increased awareness.
All six said that these goals were attained.
Three subjects wanted to change their personality or
behavior patterns in some lasting way. Two reported
progress and one was less satisfied than he wanted or
expected to be. One of the two, and two others, wanted to
work or move through emotional blocks. All three said
they made significant progress. One subject sought to
resolve inner conflicts regarding her husband, from whom
she was separated, and she also made progress.
Two subjects wanted to experience a different state
of consciousness, and two others desired more awareness
of their feelings. All four felt they realized these goals.
One subject desired psychotherapy for sadness at being
alone, and one other wanted to lessen his fear of rejection
during a session with friends. Both reported fully reaching
these goals.
Changes in Psychiatric Disorders
All nine subjects with Diagnostic and Statistical
Manual of Mental Disorders (DSM-/I1) (American Psy-
chiatric Association 1980) diagnoses reported significant
relief from their problems. Two subjects reported full and
lasting remissions: subject No. 17 with a dysthymic dis-
order (follow-up after nine months) and subject No. 23
with a postabortion simple phobia of sexuality and possi-
ble pregnancy. All three subjects with atypical or mixed
personality disorders (Nos. 5, 9 and 13) and the four other
subjects with depressive disorders (adjustment disorders
with depressed mood in Nos. 6 and 22, dysthymic dis-
order in No. 17, and atypical depression in No. 16)
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reported improvement.
,\
Mood Changes
Eighteen (18) subjects described positive changes in
their mood or emotional state, lasting from several hours
to several weeks, and averaging about one week. Fourteen
(14) reported having more good feelings. Five of these
specifically mentioned euphoria or improved mood and
four mentioned an increase in energy. Eleven (I I) re-
ported feeling more relaxed, calm, detached, serene and!
or less anxious or agitated. Two reported increased alert-
ness for at least a few weeks (one had just begun a leave of
absence from work) and two others felt more amorous or
sexual after their sessions. In addition, one subject felt
more physical relaxation after his session.
Attitudinal Changes
Twenty-three (23) subjects reported posrtrve
changes in attitude that lasted from a week to a follow-up
time of two years. Again, the average duration was rough-
ly a week. Eleven (II) of these specifically mentioned
increased self-esteem. Ten (10) subjects said they felt
more acceptance of negative experiences or more patient
in some way, four of these in relation to achieving their
life goals. Four subjects reported simply feeling more
positive. Three mentioned feeling less guilty, three re-
ported having a more spiritual orientation in their lives and
two felt more powerful. One subject each reported an
increase in the following characteristics: self-awareness;
hopefulness; satisfaction; lucky to have her position in life
with her husband and friends: and flexibility to openness
to change. self-discipline and commitment. Another sub-
ject described a clear and brisk feeling with a sense that
there is more love in the world. One felt less self-
defeating. one felt less self-conscious and inhibited, and
one felt less needy.
Some attitude changes were primarily interpersonal
in nature and wi
/I
be described below. Negative changes
reported by seven subjects were previously discussed. but
four of these also had some of the positive changes men-
tioned above.
Five subjects reported changes in their attitudes
toward death since their sessions. Two now see death as a
change and not an end. two others feel less fear of their
own or their parents' deaths. and one subject found that he
thought more about death. though his feelings about it
were no different.
Belief Changes
Sixteen (16) subjects reported belief changes that
persisted after the sessions. but rarely did two report the
same specific change. All changes resulted in more posi-
Journal of Psychoactive Drugs
SUBJECTIVE REPORTS
tive beliefs about themselves, individually or in relation to
others or the world in general. Six subjects reported
greater self-acceptance. self-confidence. independence,
self-control. or appreciation of being alive. Four express-
ed more interest or ability in pursuing spiritual growth and
three others reported a sense of unity with people, with the
world or with "being." Four perceived an increased
willingness to love. a greater appreciation of others or a
greater capacity for interpersonal warmth. Four learned
new ways to deal with psychological problems, two said
their beliefs in their limited possibilities were diminished
and one reported that his beliefs about himself and the
universe were strengthened and deepened.
Relationship Changes
Only two subjects reported negative changes in their
interpersonal relationships after sessions. One subject
(No. 22) felt more guilt around men for "a while." She
thought it resulted from an insight gained during the
session concerning the childhood death of her brother.
She also proceeded with a divorce, having separated from
her husband before the session. The other subject (No. 19)
has been mentioned above.
Every subject except No. 25 reported positive
changes in their relationships after sessions, and he said,
"It is possible that I have become more capable of ex-
pressing myself without having as much hesitation about
how people will respond to my openness." The closeness
and enhanced communication present during sessions
continued for a few days to two years (at follow-up) for
three of the five couples. In the two couples who had prior
difficulties. they resolved significant conflicts after the
session. Three subjects whose spouses were present, but
not using MDMA. also reported more closeness and/or
improved communication with them-two briefly. but
the other still at follow-up after 10 and a half months. In
addition to the three couples, 14 subjects reported the
same changes with people other than their mates. In six of
these. the changes were still present at follow-up between
four and 24 months later. and in three others changes
lasted from one to several weeks.
Ten ( 10) subjects reported that soon after their ses-
sions they resolved conflicts with others. and for five of
these people the conflicts concerned partners who did not
have a session with them. Two of the latter (one being
married) and two others (whose partners were also not
present for the session) reported the continued decline and
eventual termination of primary romantic relationships
that were already failing before the sessions. On the other
hand. two subjects who both had solo sessions subse-
quently got married (though not to each other).
An increase in the interpersonal expression of feel-
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ings after sessions was reported by seven subjects. An
increase in acceptance and/or tolerance of others after-
ward was reported by six subjects. Three said that they
now avoid superficial social interactions, two specifically
mentioning cocktail parties. Three subjects reported
seeing others as more autonomous and less in terms of
their own needs and/or projections. Two said they found it
easier to ask for help or make demands. One couple
reported enhanced sexual enjoyment afterward-partly
due to delayed orgasm-and one couple gained more
awareness of their prior sexual problems.
Subject No. 17reported feeling closer to her mother,
seeking out people like herself more often (while avoiding
egotistical people), and being able to state her beliefs
more easily to others. All other relationship changes were
reported by one subject each and included the following:
feeling more compassionate; having greater freedom to
have friends and a willingness to risk more with them;
actually making more close friends; feeling more forgive-
ness toward others (along with receiving feedback from
friends about "positive changes in the heart"); feeling
comfort and rightness with wife; having a more confident
and comfortable attitude toward wife without fear (with
more confident and direct social behavior); experiencing
an increased awareness of wife and others, with more
empathy; having greater interest in others; recognizing
how he distances others while wanting to be close; and
understanding better the relationships with friends who
shared the session.
Occupation Changes
Sixteen (16) subjects reported positive changes in
their work since their sessions. Six felt better on the job in
some way: less driven, compulsive, tense, stressed, tem-
peramental or burned out; more patient and tolerant; or
reported having more fun working or having more energy
to do their work. Four had improved work relationships
with more patience and tolerance, connectedness, accep-
tance or just getting along better with others. Most sub-
jects did not say how long these changes lasted, but some
indicated a range of one to 10 days.
Three subjects reported an increase in income since
their sessions. One had changed jobs, one had graduated
from school and begun her professional career and one
had switched from the technical side of his work to the
management side, where he enjoys spending more time
with people. One subject (No. 19) reported increased job
satisfaction, while another reported a decrease, but neith-
er attributed the change to their sessions. One subject said
he had become more active since his sessions and one
subject said he had become more active in his independent
professional work.
Journal of Psychoactive Drugs
SUBJECTIVE REPORTS
Two subjects reported negative changes. Subject
No.6 found it harder to work the day after a session and
subject NO.7 found it harder to deal with demands and
was less interested in work, but did not say for how long.
Activity Changes
Six subjects reported changes in their involvement
with activities other than work. Two subjects joined
groups for spiritual growth. One noticed an improvement
in his creative writing abilities during the months after his
session, when he took a leave of absence from work to
complete a book of poetry. One subject was able to
resume golf (his lifetime sport) after years of back pain,
which had required multiple surgeries, ceased. Subject
No. 19 took up woodworking for the first time, and one
subject said he enjoyed his hobbies more. One reported a
decrease in political activity, but did not attribute it to the
session.
Spiritual and Physical Practice Changes
Fourteen (14) subjects reported positive changes in
their regular practices for improving their spiritual or
physical well-being. Six subjects began some sort of
meditation or spiritual practice after their sessions. Twoof
these described MDMA-like states occurring during
meditation, and one other subject said her meditation had
improved. One subject. who continued a previous prac-
tice. felt that meditation was more important and medi-
tated more often with clearer goals in mind. One subject
reported looking at Buddhism (which he practiced) more
analytically than emotionally or spiritually, but placed no
value judgment on the change.
Three subjects had started new exercise programs by
the time of follow-up. while one had stopped a previous
routine. Two others increased prior exercise routines,
though one said that it was due more to advancing age than
to his session. One subject became more interested in
health foods and improved his diet.
Substance Use Changes
Fourteen (14) of the 28 subjects who answered
follow-up questionnaires reported a decrease in the use of
mind- or mood-altering substances, and three reported
increases. Six reported a decrease in alcohol intake: two
continued to drink less at follow-up, with one reporting a
marked decrease in his inclination to do so; two stopped
drinking completely; and one of the remaining two said
the decrease lasted two to four weeks. One subject re-
ported an increase in consumption from three to five beers
a week. One other subject did not feel like drinking
alcohol, coffee or tea (as was her custom) after her ses-
sions, but did not mention changes in long-term use.
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.\
Six subjects decreased their marijuana intake: one
for only two to four weeks, but the rest continued to use
less at follow-up, four to 18 months later. One stopped
entirely and another reported a decrease in his desire for
marijuana. One of the six said marijuana enhanced the
sensations she remembered from MDMA sessions, even
though her actual use decreased significantly. One subject
had increased his marijuana use by follow-up time at nine
months.
Five subjects reported a decreased caffeine intake. In
four the change lasted, with one stopping entirely. In the
one remaining subject, the decrease lasted several days.
One subject who drank six to eight cups of coffee a day
also stopped completely, but he does not relate it to his
MDMA sessions. One noncoffee drinker now drinks it
two to three times a week, and another increased his use,
but not soon after his session.
. Two subjects continue to smoke less tobacco. One
other reported a greater urge to smoke after sessions.
One subject had continued to refrain from cocaine
use for the four and a half months between his session and
follow-up. Another reported a decreased desire for
cocaine, without mentioning a change in use. These were
the only two frequent users of cocaine in this study.
One subject reported less LSD use, one said he
desired all psychedelics less, while one said he desired
them more. One subject had a much more introspective
psychedelic experience, and one had a more enhanced
experience than usual, after MDMA sessions. One sub-
ject said she would be interested only in MDMA to alter
her state of mind in the future because she "learned from
it. "
Changes in Life Goals
Fifteen (15) subjects changed some of their life goals
after sessions, all implying that they were positive. Five
said they felt more commitment to the same goals or felt
that their goals were closer or that they felt more intense or
"emergent." Four others reported a change toward seek-
ing more self-awareness, personal growth and/or well-
being. Another four had given up pursuing goals that were
not being achieved or were trying less hard to reach their
goals. Two subjects' goals had shifted away from con-
cerns with money and financial security. Individuals re-
ported the following varied changes: a shift from avoiding
the negative to seeking the positive in life; greater desire to
communicate and bond with husband; having a new goal
of understanding relationships; becoming more active in
work, and a greater interest in intellectual activities.
Changes in Experiences Being Sought Out
Nine subjects reported desirable changes in the kinds
journal of Psychoactive Drugs
SUBJECTIVE REPORTS
of experiences they seek out in life. Four sought more
trust, honesty. openness, closeness, or direct communica-
tion in their relationships-in addition to actual changes
in their relationships described above. One subject now
wants to be with more spiritually oriented people, and
another seeks to offer more loving service to people.
Two subjects sought both to experience more love
and open-heartedness as well as more freedom to be
creative and/or artistic. Another two reported now having
a more spiritual orientation in their lives, while two others
found themselves more amorous or sexual after their
sessions. Subject No. 19sought intensive psychotherapy.
Changes in Experiences Being Avoided
Nine subjects described positive changes in the kinds
of experiences they avoided in life. Three now avoid
superficial socializing (two mentioning cocktail parties),
while another avoids egotistical people, and one now
avoids habitually taking care of others in her rela-
tionships.
Two subjects now avoid "sloth" or boring things.
One reports accepting negative experiences more (less
avoidance of them), and another (No. 19) chose to face
problems rather than avoid them. The latter is also avoid-
ing all psychoactive drugs. One subject is trying to avoid
"negative karma" for herself and others.
Changes in Attitudes Preventing Self-actualization
Thirteen (13) subjects reported changes in this area,
all for the better. Seven reported gaining lasting insight
into psychological problems during their sessions. Three
said they experience less guilt, such as that over enjoying
small pleasures. Two reported a decrease in limiting be-
liefs about their possibilities. One of these individuals also
now feels less self-defeating and recognizes how he dis-
tances others while he wants to be close. One subject feels
less defensive and compulsive, one sees that she can
change her defenses and one feels less impatient and
rebellious. One reported feeling less strongly that emo-
tions should not be expressed, one feels less self-
conscious and inhibited and one feels less bound by anxi-
ety. Subject No. 17 said she "literally got rid of a lot of
negative material I had carried around with me forever,"
and now takes more risks in life. Nine months after her
session, she said, "L'rn continually getting better, bright-
er, happier, clearer and more grounded." One subject
reported dissolving' 'useless structures within the mind,"
and one said that her sessions accelerated her
psychotherapy.
DISCUSSION
MDMA was apparently physically safe for all 29
325
Vol. 18(4) Oct-Dee, 1986
GREER
&
TOLBERT
subjects in this study. No side effects were serious and
only one subject had a side effect last more than a week.
Vital signs recorded in two subjects revealed some in-
crease in blood pressure and heart rate. These increases
would be safe in a healthy person, but not in anyone with
vascular disease. Other contraindications are standard for
any sympathomimetic drug.
Only one subject (No. 19) experienced postsession
psychological difficulties that were disabling or of more
than a few days duration. He had been briefly disabled by
the same symptoms of anxiety a few years earlier. During
the session, he became afraid that he would become
overwhelmed by unwanted emotions. He worked at pre-
venting this from happening and became intermittently
anxious in the process. He felt that other events in his life
were the causes of his postsession anxiety. A year later he
even
felt that his session was probably beneficial. Subject
No.
17
also had a past history of disabling anxiety attacks,
but she had already received a long course of psychother-
apy for them. In any case, there is an indication that
MDMA may predispose people to a recurrence of previ-
ous psychological disabilities.
In future studies, informing subjects in detail of
possible risks in taking MDMA and emphasizing them
should be mandatory and will appropriately discourage
some prospective subjects. Exclusion of those with a prior
psychological disability-or an inability or unwillingness
to
have
any disturbing experience that might occur during
or after the session-should result in a safe population for
clinical trials. It is also recommended that people who
want MDMA to cure their problems should be excluded,
whereas people who want to use it to learn about them-
selves should make good candidates.
In regard to the efficacy of MDMA for treating
psychiatric disorders. all nine subjects with
DSM-Il/
di-
agnoses reported significant benefit. with two reporting
lasting remission. A trend also exists toward relieving low
self-esteem and increasing self-acceptance and self-
confidence. One subject (No. 21) reported relief of back
pain from which he had suffered for a few years. It is most
likely that the psychosomatic component in this disorder
was
relieved.
as opposed to any anatomic abnormality.
MDMA might be useful in other medical conditions in-
volving a psychological factor, though there is no support-
ing evidence from this study.
In general. it is reasonable to conclude that the single
best use of MDMA is to facilitate more direct communica-
tion between people involved in a significant emotional
relationship. Not only is communication enhanced during
the session, but afterward as well. Once a therapeutically
motivated person has experienced the lack of true risk
involved in direct and open communication, it can be
Journal of Psychoactive Drugs
SUBJECTIVE REPORTS
practiced without the assistance of MDMA. This ability
can not only help resolve existing conflicts, but it can also
prevent future ones from occurring due to unexpressed
fears or misunderstandings. Regardless of the mecha-
nism, most subjects expressed a greater sense of ease in
relating to their partners. friends and co-workers for days
to months after their sessions.
MDMA's use as an adjunct to insight-oriented
psychotherapy was specifically recommended by six sub-
jects. Many felt that MDMA enhanced self-understanding
and was useful in their personal and spiritual growth.
A value in treating at least mild alcohol and other
drug abuse is indicated by the decreased use (reported by
14
subjects) of substances that have psychological depen-
dence potential. Some subjects mentioned that these sub-
stances seemed less appealing after experiencing
MDMA. The ability not only to feel free of conflict-
which can be provided by many drugs of abuse-but also
to learn how to prevent conflicts in everyday life seems
unique to MDMA as a therapeutic adjunct.
In addition, MDMA's diminished pleasurable
effects and markedly increased side effects when taken in
either large doses or with greater frequency distinguish it
from most drugs of abuse. Subjects Nos.
3
and
II
took
four 50 mg supplemental doses after their initial dose.
They found the fourth dose to cause only more agitation
and confusion without any pleasant effects at all. Some
subjects reported using MDMA on their own, but only
subject No. 22 used it twice in the same week. The second
experience was therapeutically useful, but left her de-
pressed and exhausted for about two days. Therefore,
both the positive experience of MDMA and the impracti-
cality of using it frequently can motivate people to find
other ways to achieve a desirable state of mind in everyday
life. Sixteen
(16)
subjects began or increased their medita-
tion practices or exercise programs, which supports this
conclusion.
Providing the reports of these 29 subjects' experi-
ences will hopefully encourage further research into the
beneficial effects of MDMA. Presenting evidence estab-
lishing the limits of its usefulness should discourage any
movement to promote it as a social or psychological
panacea.
ACKNOWLEDGMENTS
The authors wish to thank Jack Downing, M.D.,
Stanislav Grof, M.D., Robert Hausner, M.D., Rodney
Houghton, M.D., Will Macl-lendrie, M.D., Ralph Metz-
ner, Ph.D. and John Perry. M.D. for serving as the peer
review committee for this project; Alexander Shulgin,
Ph.D. and Ann Shulgin for their support and instruction;
326 Vol. 18(4) Oct-Dec. 1986
GREER
&
TOLBERT
and Mary Greer and Ron Romanik, M.D. for editorial
assistance.
SUBJECTIVE REPORTS
REFERENCES
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Shulgin. A.T.
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&
Willette. R.E. (Eds.). The
Phurmacologv of Hallucinogens, New York: Pergamon.
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&
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Yol. 18(4) Oct-Dee, 1986
... MDMA is a psychoactive compound structurally similar to both amphetamine and mescaline that does not exist naturally and is created by laboratory synthesis [99]. It is considered an entactogen, a class of compounds that promote acceptance and compassion, modulate emotional responses, and augment interpersonal relationships and closeness [100,101]. MDMA has been illegal in the United States since 1985, when the DEA placed an emergency ban on the compound [102]. ...
... Research had suggested that MDMA could allow a patient to engage openly in discussion about relationships and internal struggles, seemingly incapacitating prior defenses, prompting mental health practitioners to incorporate it into their practice [102]. Despite preliminary evidence of therapeutic potential, MDMA research was suppressed after being rescheduled by the DEA in 1986 given concerns about its increasing recreational use [100,102,105]. It has remained a schedule I substance ever since. ...
... The potential for MDMA in the treatment of negative symptoms in schizophrenia primarily revolves around its potential for targeting social function and reward processing. As described above, there is an abundance of evidence that MDMA increases sociality and can augment personal relationships and closeness [100,102,104,105,154]. MDMA has the potential to at the very least elicit an episode of closeness with a practitioner, thereby facilitating a strengthening of therapeutic alliance that may lead to improved care and outcomes [155]. ...
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... 3,4-Methylenedioxymethamphetamine (MDMA) is not classified as a prototypical psychedelic; it is better described as an entactogen or empathogen, and was used in psychotherapy in the 1970s to enhance couples counselling and address trauma. The first clinical study reporting on the therapeutic effects of MDMA was published by Greer and Tolbert (1986). It has the unique properties of creating empathy with the clinical staff, allowing the client to re-experience the traumatic event within the window of tolerance, and overcome survivor's guilt. ...
... However, if a patient encounters emotional or somatic blocks that stymie this process, the therapist can provide more active guidance to help them work through past events and arrive at a new emotional resolution. Therapists help explore and validate new perspectives about other life experiences and authentically join participants in embracing joyful moments [26]. ...
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The Food and Drug Administration (FDA) granted breakthrough therapy status to 3,4-methyl enedioxy methamphetamine-assisted therapy (MDMA-AT) in 2017 due to preliminary evidence supporting its efficacy and safety in treating post-traumatic stress disorder (PTSD). A series of six phase-II clinical trials studying MDMA-AT for treatment-resistant PTSD found that 54% of MDMA-AT full-dose participants no longer met the diagnosis of PTSD after two MDMA sessions, compared to 23% in the control group. In the first phase-III clinical trial, 67% no longer met the criteria for PTSD after three sessions. The effects are durable, with 67% no longer diagnosable after one year and 74% at nearly four years. The MDMA-AT is being fast-tracked for potential FDA approval by 2023. In 2021, Hawaii's Senate Bill 738 unsuccessfully proposed that psilocybin be removed from the Schedule I controlled substances list due to its clinical efficacy for major depressive disorder. Methyl enedioxy methamphetamine is also a Schedule I controlled substance and has proven to be a treatment option that could potentially benefit the people of Hawaii.
... Although MDMA-assisted Therapy has been studied for the treatment of psychiatric disorders such as post-traumatic stress disorder, anxiety and depression, its use for SUD remains poorly explored -we only found one prospective pilot study and one study with the objective of evaluating the psychological improvement of participants after a MDMA-assisted session ( Table 2 ). This study describes the subjective reports of individuals with different psychological problems after having a MDMA session (with an optional second dose) and shows that besides having favorable effects on participants' attitudes and feelings, MDMA decreased substance use, including alcohol, cannabis and tobacco [208] . Sessa [209] hypothesized that MDMA can present therapeutic potential in AUD considering the trauma-related comorbidities that often follow this disorder and MDMA's empathogen features. ...
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Substance use disorder (SUD) is a global public health concern that affects millions of people worldwide. Considering current research, addiction has been noted as the last stage of a chronic disease that may impair brain reward circuit responses and affects personal and social life. Treatments for SUD face challenges including availability and limited pharmacological response, often resulting in low retention of patients. A growing number of studies from the 'psychedelic renaissance' have highlighted the therapeutic potential of psychedelics for several psychiatric disorders, including SUD. In this non-systematic review we discuss past and current clinical and observational studies with classic (LSD, DMT, psilocybin and mescaline) and non-classic (ibogaine, ketamine, MDMA, salvinorin A and THC) psychedelics for the treatment of SUD published until December 2021. Although results are still inconclusive for LSD, DMT, mescaline, MDMA and Salvinorin A, in general, the literature presents moderate evidence on the controlled use of psilocybin and ketamine for Alcohol Use Disorder, ketamine for management of opiate and alcohol withdrawal, and THC preparations for reducing withdrawal symptoms in Cannabis and possibly in Opioid Use Disorder. Importantly, studies suggest that psychedelics should be more effective when employed as an adjunct therapy. Extensive research is warranted to further elucidate the role of psychedelics in the treatment of SUD.
... Their focus was not on a specific clinical condition; rather, they worked with the "worried well," noting improved communication patterns amongst couples following the sessions. This work led to one of the earliest papers describing the therapeutic potential of MDMA (Greer and Tolbert, 1986). Along with Leo Zeff, Ralph Metzner, Stan and Christina Groff, and many others, Greer and Tolbert helped lay the foundation for the MDMA-assisted psychotherapy model that now is being pursued in ongoing clinical trials. ...
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... There is ongoing research on the therapeutic potential of incorporating ±3,4-methylenedioxymethamphetamine (MDMA) into therapy for PTSD due to its unique pharmacodynamic profile. MDMA is a psychoactive compound that reduces fear and anxiety and increases feelings of trust, affiliation, relatedness, and prosociality in humans (Bershad et al., 2016;Gabay et al., 2019;Greer and Tolbert, 1986;Sumnall, Cole and Jerome, 2006). ...
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... They have been developed by clinical research groups within academic, corporate, and non-profit entities to support their trials of various psychedelic medicines in the treatment of a range of indications. The specific approaches of these models have drawn influence from the work of early PAP pioneers inside and outside of formal research contexts (Eisner, 1967;Grof, 1980;Greer and Tolbert, 1986;Stolaroff, 2004), indigenous approaches to the use of psychedelic substances for healing (Fotiou, 2020), and elements of non-psychedelic therapeutic approaches (Walsh and Thiessen, 2018;Horton et al., 2021). Although these models share some similarities (e.g., attention to set and setting, a structure consisting of preparation, medicine, and integration sessions), they vary greatly in how much non-drug therapy time they offer; the extent to which they incorporate extrinsic, non-psychedelic psychotherapeutic knowledge and best practices; and whether they view the support they provide as therapy per se or a distinct form of non-psychotherapeutic support. ...
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The known central nervous system activity of 3,4-methylenedioxyphenylisopropylamine and its N-methyl homolog prompted the synthesis of a series of analogs with substituents on the nitrogen atom. Most of these analogs (R = alkyl, alkenyl, hydroxy, alkoxy, and alkoxyalkyl) were prepared by the reductive alkylation of 3,4-methylenedioxyphenylacetone with the appropriate amine and sodium cyanoborohydride. Hindered isomers were synthesized indirectly. Measurements of their pharmacological activity in several animal assays and in human subjects indicated that the central activity decreased with the increasing bulk of the N-substituent.
Article
The known central nervous system activity of 3,4-methylenedioxyphenylisopropylamine and its N-methyl homolog prompted the synthesis of a series of analogs with substituents on the nitrogen atom. Most of these analogs (R = alkyl, alkenyl, hydroxy, alkoxy, and alkoxyalkyl) were prepared by the reductive alkylation of 3,4-methylenedioxyphenylacetone with the appropriate amine and sodium cyanoborohydride. Hindered isomers were synthesized indirectly. Measurements of their pharmacological activity in several animal assays and in human subjects indicated that the central activity decreased with the increasing bulk of the N-substituent.
Personal communication Characterization of three new psychotomimetics The Phurmacologv of Hallucinogens
  • A T Shulgin
  • A T Shulgin
  • D E Nichols
Shulgin, A.T. 1980. Personal communication. Shulgin. A.T. & Nichols. D.E. 1978. Characterization of three new psychotomimetics. In: Stillman. R.C. & Willette. R.E. (Eds.). The Phurmacologv of Hallucinogens, New York: Pergamon. Younger. E.J. 1978. Opinion of Evelle J. Younger. Attorney General. State of California. on questions from the State Board of Pharmacy, May 2. (Reference Nos. CY 76/212 & CY 77/236).
Opinion of Evelle J. Younger. Attorney General. State of California. on questions from the State Board of Pharmacy
  • E J Younger
Younger. E.J. 1978. Opinion of Evelle J. Younger. Attorney General. State of California. on questions from the State Board of Pharmacy, May 2. (Reference Nos. CY 76/212 & CY 77/236).
Taskforce on Nomenclature and Statistics Diagnostic and Statistical Manual of Mental Disorders 105M-III)
  • American Psychiatric Association
American Psychiatric Association. Taskforce on Nomenclature and Statistics. 1980. Diagnostic and Statistical Manual of Mental Disorders 105M-III). 3rd ed. Washington. D.C.: American Psychiatric Association.