Unnecessary drug-related deaths

Amanda Feilding, The Independent

As we enter the festive season, it is inevitable that many people will be taking recreational drugs, including MDMA, at parties and at home. In the UK, over 100,000 young people have taken MDMA, or ecstasy as it is often called, in the last month, and over 300,000 in the last year. Sadly, it is possible that there will be some casualties and even fatalities.

I believe that current government policy towards MDMA contributes to this problem. The law is endangering more citizens than it is protecting — in particular, the young.

MDMA is a popular psychoactive substance. Its effects include increased energy, euphoria and enhanced sociability. To date, it has been largely mistreated and misunderstood. MDMA is rather unique among the other recreational substances in that it has relatively low abuse potential, with 96.5 per cent of users indulging in MDMA less than once a month.

I have been fighting for evidence-based drug policy reform for over two decades now. Throughout this time there has been an urgent need for comprehensive, unbiased information that deals with exactly how we can introduce new thinking around regulation. Many on the frontlines of the war on drugs now agree that zero tolerance policies cause more harm than good.

In fact, clinical research carried out over the past decade demonstrates the strong therapeutic benefits of MDMA-assisted therapy for the treatment of post-traumatic stress disorder (PTSD), and more recently alcoholism and autism research has shown positive outcomes. However, despite the potential medical benefits, current prohibition-based policies are driving forward the illegal trade in MDMA. We are heading into far riskier territory than ever before.

In order to develop a scientific evidence base, a recent report by the Beckley Foundation titled “Roadmaps to Regulation: MDMA”, published earlier this month, reveals that many of the harms associated with MDMA use arise, specifically, from its unregulated status as an illegal drug.

None of the adverse effects associated with MDMA, such as hyperthermia, hyponatraemia, serotonin syndrome, and isolated physiological disorders, have occurred in a clinical setting. This implies that risks could be prevented with comprehensive harm reduction advice and better regulation.

Under the current policy, people can only purchase MDMA from an illegal market which is not subject to any production standards. This exposes people to the risk of taking substances of far greater strength and purity than the body can handle. Illegality also leads to a higher potential for contamination, with dangerous substances finding their way into the manufacturing process. Many of those who do suffer an MDMA-related emergency are also less likely to seek medical help for fear of being prosecuted.

In short, zero tolerance drug policies are leading to record levels of deaths. To be more precise, in 2018 there were 92 unnecessary deaths across England and Wales — nearly two people per week and almost double the number of deaths recorded the year before.

A legally regulated market would go a long way towards mitigating the risks associated with MDMA use. While many still consider this view controversial, it is one that is gaining support — from parents of those whose lives have been lost or ruined by harms related to the prohibition of MDMA; academics and scientists undertaking groundbreaking research into the therapeutic potential of MDMA; and former police members now fighting for reform.

The reason for this is simple — regulation disrupts the illegal market and leads to improved controls overall. Whereas, as it stands, there is no way of controlling the quality or the use of the prohibited substance, which hands the power and the profits to the criminal market.

MDMA remains classified as a schedule 1 substance — which designates substances with no medical use and a high potential for abuse — while more dangerous and highly addictive drugs such as heroin and cocaine remain schedule 2. As the recent report has found, we must reschedule MDMA to schedule 2. This will help to reduce the political, bureaucratic, and financial barriers blocking MDMA research so that we can better understand the risks and potential benefits of this popular substance.

We must also decriminalise the possession of MDMA, and all drugs for that matter, to end the devastating social and economic effects that these policies exert and instead treat drug abuse as a health issue. Simultaneously, improve safety by encouraging harm reduction interventions such as on-site drug safety testing. Finally, we would seek to establish a strictly regulated legal market for MDMA products with age-restrictions, point-of-sale-education, and appropriate licensing for those for whom it would be safe to use. This would significantly reduce the number of MDMA-related deaths in the UK, while generating tax revenue such as those from alcohol and tobacco sales.

In 2012, the Beckley/Imperial Research Programme carried out a detailed neuroimaging study on MDMA to explain why it is so valuable for psychotherapy. We found that pleasant memories were experienced as more vivid, emotionally intense and positive with MDMA, while traumatic memories were less negative and therefore more useful in therapy.  Then, in 2015, a Beckley-sponsored study at UCL demonstrated that MDMA reduces self-criticism and improves self-compassion. We also observed increases in feelings of openness and decreased neuroticism, prolonging the benefits of MDMA-assisted psychotherapy.

Combined, these attributes indicate that MDMA may be a powerful tool to facilitate the recall of traumatic memories in such a way that it can be useful for healing the mind.MDMA-assisted psychotherapy for PTSD has been given breakthrough status by the US Food and Drug Administration and has now reached the final phase of clinical testing before it can be approved as a licensed medicine.