B.C. health workers train to provide MDMA-assisted psychotherapy

For six days, 20 medical professionals packed into a rented event space in Vancouver’s Mount Pleasant neighbourhood to learn about the potential health benefits of MDMA, a recreational drug also known as ecstasy or molly.

CBC News attended parts of these training sessions earlier this month, which included discussing what an MDMA experience feels like, case studies on how patients have fared during and after therapy, and how to treat patients from a diversity and inclusion lens.

The sessions were a first of their kind for B.C.-based non-profit organization TheraPsil, which up until now has advocated for the therapeutic use of the psychedelic compound psilocybin, better known as magic mushrooms.

As more promising research emerges about MDMA, there’s been more interest in how health-care practitioners can be equipped to treat their patients using the drug, TheraPsil says, with hundreds more medical professionals on its training waitlist.

But mental health and drug experts still caution there are many unknowns about MDMA.

Dr. Laura McLean, a physician specializing in treating sleep disorders in Maple Bay on Vancouver Island, says she decided to do the MDMA training because she often recognizes signs of trauma in her patients that prevent them from getting better.

“People blame themselves when they can’t get better and unfortunately other people blame them when they can’t get better as well,” McLean told CBC News, tearing up slightly.

 “Everybody’s doing the best they can with what they got and we need to see people and hear what they’re telling us.”

Physicians, nurse practitioners, clinical counsellors and psychiatrists from B.C. and other parts of Canada attended the sessions that were largely developed by Ingrid Pacey, a retired psychiatrist who worked with trauma survivors for more than 40 years in Vancouver.

She says MDMA-assisted therapy sessions are a very involved process for both health-care practitioners and patients.

“The relationship is so important. People regress, people go back to being young, to times of trauma. And it’s important to have somebody right there to comfort them, hold their hand, and really support them in whatever’s going on,” Pacey said.

One of her patients was a 58-year-old man, who was physically abused by his mother and abandoned by his father. During the MDMA therapy sessions, Pacey said, the man was able to go back to his childhood and see how he blamed himself for the abuse.

“The MDMA had lowered his fear response sufficiently that he could now remember and process what had happened,” Pacey said. “He feels more alive and is managing his life better.”

How MDMA sessions work

A typical MDMA session lasts four to six hours, Pacey said.

Patients are given a 125-milligram dose of MDMA and usually start by laying down on a bed.

They wear eye shades, listen to music, and are accompanied by therapists to provide them with talk therapy throughout the experience.

“It gives people the possibility to face really difficult things in their lives … and they can move forward,” Pacey said.

Since regulatory changes came into effect in 2022, licensed physicians and other health-care practitioners have been able to request access to MDMA through Health Canada’s Special Access Program.

The agency says 41 requests for MDMA have been authorized — a number TheraPsil expects will jump as more medical professionals are trained to provide psychedelic therapy.

There is a growing body of research about the health benefits of MDMA, particularly in treating PTSD.

In 2023, Phase 3 clinical trials led by Multidisciplinary Association for Psychedelic Studies (MAPS) in the U.S. showed about 71 per cent of participants who took MDMA no longer qualified for a diagnosis of PTSD after receiving three dosing sessions, along with therapy.

The U.S. Food and Drug Administration is currently reviewing MAPS’s application to approve MDMA to treat PTSD and could make a decision later this year.

Mark Haden, adjunct professor at the University of British Columbia school of population and public health, says Canada needs to be prepared to train more health-care professionals in MDMA therapy in case it’s approved in the U.S. — and Canada follows suit.

Health Canada watching U.S. review

“It’s really important that they do it within the context of skilled therapeutic practice,” said Haden, who is also the founder and former executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS) Canada, and who lists himself as an advisor to a psychedelics company.

“MDMA-assisted therapy is completely different from regular therapy and we need as many therapists trained as possible so when the door opens we can provide this service widely.”

Health Canada is monitoring the FDA’s review of MDMA “with interest,” the department told CBC in a statement, adding it has not yet received an application for market authorization of MDMA.

Dr. Ishrat Husain, head of the clinical trials unit at the Centre for Addiction and Mental Health in Toronto, says the clinical trials are encouraging. 

“The rates of improvement were substantially larger than with what we have traditionally at our disposal and that includes antidepressant medicines and usual talk therapies.”

What’s unknown

But Husain is also cautious of the results.

“Oftentimes people with other psychiatric illnesses or addictions or substance use disorders were not included in these studies. Those that were actively suicidal were not included in these studies. So we don’t know if MDMA therapy is necessarily going to help all patients with post traumatic stress disorder,” he said.

As MDMA becomes more mainstream, Husain wants to see a standardized approach to training therapists who are working with vulnerable people.

There have been complaints of abuse during a clinical trial in B.C, which have led to lawsuits and a psychiatrist resigning her licence.

“We want to make sure that we have some oversight into the standards that therapists are adhering to and the training requirements that they meet. At this point, there is no governing body to oversee psychedelic therapies, including MDMA therapy,” he said.

McLean says she recognizes that MDMA-assisted therapy is not for everyone but believes it can change some people’s lives.

“These people could go from just surviving to actually thriving in life,” she said.