While New Zealand refuses to consider decriminalisation of medicinal cannabis derivatives, Canada shows the way once again. In Vancouver two therapists will be permitted to give ecstasy to patients in a scientific trial. The project will try to find new ways to help people with post-traumatic stress disorder.
Psychologist Andrew Feldmar and psychiatrist Ingrid Pacey and Boston’s Multidisciplinary Association for Psychedelic Studies (MAPS) will recruit 12 people to participate in the trial, which might include Canadian soldiers and police officers. Like Insite, Vancouver’s supervised-injection site, the trial is exempt from Canada’s narcotics laws, and only awaits an import permit for the Swiss-manufactured drug.
This experiment is one of a series of international clinical trials that use drugs such as LSD, MDMA or ecstasy, and psylocibin in the context of therapeutic treatment. MAPS was founded in 1986 and is a non-profit focused on lobbying to have psychedelic drugs and marijuana used for medicinal purposes.
“There is a new interest,” said Mr. Feldmar, who worked at Vancouver’s Hollywood Hospital in the 1960s when it used LSD as a treatment for alcoholism. “These substances are extremely effective. It was just when they were used irresponsibly that it created a senseless panic.”
MDMA was synthesized by Merck in 1912. It was rediscovered in the 1960s and considered an aid to psychotherapy before it became popular at dance clubs,
Mr. Feldmar said MDMA helps people with post-traumatic stress disorder by dismantling barriers that block their recovery. They can experience a sense of being in the present, feeling connected to their therapist, and emotional reconnection.
MAPS executive director Rick Doblin said one U.S. trial in Charleston South Carolina was highly effective although its results haven’t been published in a peer-reviwed science journal yet. Israel and Switzerland ran a similar project along the same lines, although another study in Spain had to be cancelled after it ran into opposition there. In the Journal of Psychopharmacology, these two trials were described as displaying initial promise in trauma treatment. Pal-Orjan Johansen and Teri Krebs (Norwegian University of Science and Technology) examined the three effects MDMA has on brain chemistry:
It boosts levels of oxytocin, which creates feelings of connectedness and warmth that people on ecstacy experience. It balances two regions of the brain, which enables therapeutic users to control emotional responses better. It elevates levels of cortisol and norepinephrine, neurohormones that control emotional learning.
MAPS designed the Vancouver study. It also steered it through the regulatory process, and will now raise the $C200,000 needed to run the project. Eight of the 12 patients will get full-strength doses of ecstacy three times during their treatment, while the remainder will receive a neutral placebo.
“We want to see if we can replicate the U.S. results in a similar cultural context. Also, it’s important to start research in Canada, because you have a tradition of being pioneering in psychedelic research.”
The Vancouver duo have sent out messages to other Vancouver therapists to recruit patients for their clinical trial, which could include Afghan war veterans, police, firefighters, violent crime victims, or immigrants who have been tortured in their societies of origin.
Unfortunately, the news isn’t so good for a clinical heroin trial in the same country. Quebec’s provincial government was forced to cut $600,000 in funding from a study that would give maintenance heroin to IV drug users. This setback jeopardizes a programme of controversial treatment that would have been a global first.
Doctors involved are baffled by the decision, which occurred at the same that research from a different project was published. This study stated that said giving heroin to people with IV drug use problems was far more effective than administration of methadone. The Quebecois government said the decision has nothing to do with the study’s merits and pleads budgetary constraints.
The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) would have compared medically prescribed heroin against hydromorphone, a licensed narcotic and whether users will accept the drug in pill form rather than through intravenous injection. Given the financial constraints that now face its Quebec arm, the study may not go forward, said Martin Schechter, director of the school of population and public health at the University of British Columbia. Vancouver will take on the entirety of the trial’s cost, resulting in increased duration and cost of the proposed study, or the trials could be cancelled.
Suzanne Brissette, head of addiction medicine services at Montreal’s Saint Luc hospital, said the cuts are ridiculous:
“For the people for whom it’s the only option, it’s telling them, ‘Sorry, we’re going to leave you where you are,’ which is for me unacceptable and unethical. … Scientifically it makes no more sense: The results were published in an excellent journal and they’re solid.”
SALOME was originally intended to act as a sequel study to the North American Opiate Medication Initiative (NAOMI). In that project, prescribed maintenance heroin and methadone were supplied to patient control groups at clinics in Vancouver and Montreal. NAOMI results were published in the New England Journal of Medicine during late August. They show patients treated with the active ingredient in heroin are almost two-thirds more likely to remain in addiction treatment and forty per cent less likely to take street drugs. It also deters them from commiting crimes to support their habit compared to those given methadone.
Quebec’s Health and Social Services Ministry said the funds were withdrawn as a cost-cutting measure a couple of weeks ago. According to Health and Social Services Minister Lise Thériault, money would be better spent funding treatment for a wider range of people:
“For now, we would rather invest the $600,000 that was supposed to go to phase two into different types of projects that could reach a greater number of people that have different types of addictions.”
The SALOME study could have given health-care providers an additional tool in the fight against unsafe drug use.Dr. Brissette said she’s awaiting a letter from the ministry confirming the funding cut, which she will appeal.
“If you had a new treatment for a disease for a group of people who fail all the treatments … and the government would say ‘No,’ how as physicians can we let this pass?”
One awaits the outcomes of the above with considerable interest, given that they have profound implications for the future of our own Misuse of Drugs Act. I’m beginning to wonder if these options for remedial treatment don’t neccessitate a complete overhaul.
Frances Bula: “Landmark Study lets people find relief with Ecstacy” Globe and Mail: 02.09.09: http://www.theglobeandmail.com/…/landmark…study-lets…find-relief-with-ecstasy/article1271380/
Anna Mehler Paperny: “Quebec’s landmark heroin study in jeopardy” Globe and Mail: 25.08.09: http://www.theglobeandmail.com/…/quebecs-landmark-heroin-study-in-jeopardy/article1263224/
September 3, 2009