In the next year or two, MDMA will become the first psychedelic drug to be approved as a psychiatric medication by the FDA in the United States. This has been made possible by the perseverance of Rick Doblin and his long-time organisation, MAPS, which has spent years and hundreds of millions of dollars on scientific studies to prove that this molecule, known on the street as “ecstasy“, is effective in the treatment of post-traumatic stress disorder, among other promising applications.
Twenty-five years ago, in the late 1990s, a pioneering study carried out in Spain reached (or, rather, may have reached, as we will see below) similar conclusions: MDMA or ecstasy was highly promising in the treatment of post-traumatic stress disorder. Unfortunately, an unfortunate combination of misinformation, journalistic sensationalism and political bungling aborted the study and prevented a Spanish team – backed and funded by MAPS – from taking the lead, several decades ahead, in what has now become known as the “psychedelic renaissance”.
The story of the ill-fated study on MDMA for post-traumatic stress is told in detail by its promoter, researcher José Carlos Bouso, the most renowned Spanish scientist in the scientific study of psychedelics, in an interview with psychologist Iker Puente published in the book ‘Psychedelic psychotherapy and research. Past, present and future’. The study, carried out at the Hospital Dr. Rodriguez Lafora (former Hospital Psiquiátrico, in Madrid), took two years to design (between 1996 and 1998), through “almost daily emails with Rick Doblin”. As complicated or more complicated than the design itself was obtaining the administrative permissions to carry out a clinical study with MDMA, “which is a real bureaucratic madness starting from nothing”, in Bouso’s words.
Post-traumatic stress in abused women
The Spanish study focused on post-traumatic stress disorder (PTSD) in sexually abused women. The choice of this pathology had to do with MAPS’ interest in using MDMA for PTSD victims among former combatants in the US Army, an unfortunately large population in that bellicose country. In Spain, however, the only war veterans were survivors of the Civil War, so Bouso’s team chose to target women victims of sexual abuse. He was possibly playing with fire,” recalls José Carlos Bouso in conversation with Iker Puente, “by bringing together two taboos: the subject of ecstasy and the subject of sexual abuse.
Indeed, they were sitting on a political bomb that was about to explode. Today, in 2022, newspapers and scientific journals are full of positive references to the therapeutic possibilities of MDMA, LSD, psilocybin or ketamine. However, in the 1990s, the only mentions of these drugs had to do with drug trafficking, the ‘ruta del bakalao’, overdoses and problems associated with the prohibitionist discourse. Indeed, “1996 was the year in which most MDMA was consumed in Spain in history, and the late nineties were the years when ecstasy received the most media attention (…). We are talking about a very delicate context for someone with political responsibility to sign a study with MDMA”.
But that someone was the director of the Agencia Española del Medicamento, dependent on the Ministry of Health, who, after a meeting in August 1999 with the main researcher of the study, Bouso himself and the psychiatrist Pedro Sopelana. At that meeting, the researchers managed to dispel the politician’s doubts about MDMA: “We had to explain to her that [MDMA] is a coadjuvant to psychotherapy and not a drug that acts symptomatically… and it seems that we convinced her”. It was also decisively influenced by the people the Agency’s director consulted, as far as I know at least two pharmacologists of recognised prestige who spoke well of the study because they knew about it, having been direct advisors and very much involved in it.
The media bombshell
The study was designed for 29 people, but only managed to treat six. The study had to be abruptly interrupted in 2002 after the publication of two news items in the media, the first in ‘Interviú’ (which had hardly any repercussions, as it was summer) and the second on the front page of ‘El País‘, which caused a political earthquake that ended with the cancellation of the study. Curiously, the approach of the news item signed by Rafael Méndez is not sensationalist, but the title (“Sanidad autoriza un estudio con ‘éxtasis’ para terapia de violadas”) and, above all, the tempo: the publication was ahead of the conclusion of the study and, therefore, compromised it.
“The news in El País was reason enough to set off a chain reaction of panic. The studio began to be moved in a political key from that moment on, and was finally closed. Within 24 hours we had a health inspection from the Community of Madrid (…) The next day the hospital manager called me, who was a politician, who had been called “from above”, we met and he told me very clearly: “The study may be very interesting and all that you want, I’m not going into that, but you will understand that between you and me, I’m going to stay”. And the studio closed and that’s where the story ended. All very Spanish, with that power that the authorities have to break the law with impunity,” Bouso concludes.
And so ended what could have been a pioneering study in the treatment of post-traumatic stress disorder with MDMA and, who knows, could have placed Spain at the forefront of psychedelic research. Unfortunately, this was not the case and the research fled from the capital of the kingdom to other more open and friendly territories, specifically to Catalonia, a community that today leads, along with Switzerland, California and some other countries, the world in psychedelic research.
As a coda to this article, I ask its protagonist, José Carlos Bouso, directly about the possibility that, in a parallel universe, that pioneering study was happily concluded, and, eventually, Spain would be leading the famous ‘psychedelic renaissance’ today. This is Bouso’s emailed reply to me:
“If this study had ended, a second study had already been designed, with a larger sample of 48 patients in which the most effective dose of the previous study would be used. I have no doubt that if we had been allowed to do it in 10 years (i.e. 10 years ago) we would have authorised, at least in the EU, the medical use of MDMA, and at a ridiculous cost compared to the cost of clinical trials in the United States. We would now be at a different level of analysis, testing other indications and, of course, having helped many, many people and having introduced MDMA into the treatments of professional colleagues using different therapeutic techniques. MDMA does not cure, it cures the whole therapeutic process of which MDMA is a tool, a very powerful tool, but a tool nonetheless.
You can read the pharmacological and methodological details about this research in Iker Puente’s book of interviews, ‘Psychedelic psychotherapy and research. Past, present and future’.
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