US could soon approve MDMA therapy
nature.com
nature.com
I have a bsc. in psychology, so partially already there to become a licensed clinical psychologist.
It'd be one hell of a career switch though. I guess, so was yours :)
Edit: I just read your blog post about it. Damn! This is illuminating. It'll definitely help me in my journey. Thanks!
Also, definitely envious that you got to work with Bret Victor. A few years ago, I really wanted to but given I'm from the EU and he didn't seem to be looking, I never messaged him. I think I should have.
@haswell I read your comment. I'm happy to know that as well :)
Best of luck on your journey.
You probably already know but Oregon started licensing recently for psilocybin therapy.
https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Pages/Psilo...
I’m currently seriously considering a similar career change, as daunting as it seems at first glance.
It’s pretty interesting to find comment threads like this in this particular moment of my life.
I think there’s something about being an empathic person in an environment that values systems thinking. As I’ve cultivated that mindset and skillset, it has become more and more obvious that the world needs systems thinkers outside of tech. As a person who benefited greatly from a therapist who helped me apply this kind of thinking to my own life, I’ve learned just how impactful that can be.
I don’t know exactly what the next thing looks like yet, but it’s fascinating and informative to see others who have made or are considering the same career change. Thanks for sharing this.
You took the words right out of my mouth. That's exactly how I am feeling these days.
I had a similar experience to the first half of your story. Was so unfulfilled in tech that I ended up quitting and took time off not working, trying lots of different things, getting very frustrated and depressed along the way.
I did try LSD (ok, a lot of LSD) and instead of it helping me process/sort through/integrate some of my troubles it added new ones and created recurring intrusive thoughts. Overall, bad experience & wish I didn't do that.
After ~2y outside of full time employment (i did some contract work eventually), I found myself more depressed than when I left. I had tried a lot of things (hobbies for joy, tech in non-FTE ways, entrepreneurship, travel, classes, intimate relationships..) but found no grander meaning or goals at the end of it, just some isolated interesting experiences (some were peak positive, others a pit). So back to tech. I don't love it, but having an external demand of me was sufficient to lift me out of the pit of despair i was in.
The risks are absolutely real and should not be taken lightly, but there’s a huge difference between going on a personal journey of experimentation without the tools to navigate that journey, and going through a careful screening process with counseling during and after each trip.
Michael Pollan’s work (book and documentary) explores this somewhat. I don’t think most people would describe the experience as ambiguous. That is not to say that the experience can be sufficiently described with language.
Hilarious revelation to have from a trip. I never put it like that in my mind, but I feel kind of similar.
My take is.. people want an external locus of control and/or instructions on how to live so bad that in the modern bent towards Atheism/Agnosticism, they transfer that responsibility elsewhere (star signs, tarot cards, psychedelics, their political party, some 'expert'..)
The research will eventually catch up, and within a decade or two tripping in a doctor's office will be much more responsible and fruitful. Doctors can already provide a lot of pharmacological advantages: they have access to consistent, predictable, controlled dosages, and access to prescription antipsychotics to end a trip if it is not going well, which is obviously a much better situation than eating a few mushrooms with an unknown amount of psilocybin then hanging on and hoping for the best.
Edit: Also, as another commenter noted, because very few places allow you to get psychedelics legally, dosage and purity is always questionable; naturally you're going to have a bad time with something that is cut with really nasty drugs if you aren't aware of it and prepared for it, but this is pretty true of most things in life, even those not related to drugs.
Search engines, well, Google at least, are pretty complicit in this too, as it seems that sites discouraging drug use are brought to the top when searching for relatively reasonable things like "safe dosage $drug" or "$drug interaction with $other_drug". Even between different countries, the same search query on google will give quite different results.
I don't think among the people I've talked to that enjoy psychedelics have ever introduced a newbie to any drug without a safety warning and a fair amount of preparation, and in Amsterdam where mushrooms are legal, the shops are quite careful to ensure they are giving you the rundown on what to prepare for, dosages, finding a comfortable and reliable setting, safety, etc.
> but the "how" is largely ambiguous.
Honest question, have you taken any drugs that weren't prescription or alcohol/caffeine/nicotine? Because it's very easy to pinpoint how drugs (especially psychedelics) are life changing, at least for me.
Ecstasy - For a few brief hours, I not only felt good, but thought good thoughts about myself. It was a complete reset after many years of extremely low and dark times in my life, and after that I had a baseline of "hey, I actually _can_ feel good and think good things about myself; I am capable of it." And it was basically all I needed, a single time to break me out of years of depression
Psychedelics - It is an immense spark of creativity and just fascinating to see what your mind can invent and how everything has additional "perspectives", like the color of music, visualizing a world or scene in your imagination that you probably never thought of before, and the good sensations you have amplified by 1000x. Your mind makes connections and associations which sure, with time you could maybe reach sober, but it happens rapidly, effortlessly, and repeatedly on psychedelics, and the experience stays with you. If you've never had a moment of clarity, be it academic, problem solving, etc, then I'm not sure that psychedelics are the biggest concern for you :). These experiences _can_ happen sober, but at least for me, only with guided meditation over many sessions could I reach such an experience.
I'm not sure it's possible to be more specific than this with simple descriptive words, and I think the art and other drug-inspired pieces more than speak for themselves as to how it can be life changing.
Last time I was in Amsterdam was quite a few years ago but... magic mushrooms were illegal. Instead they sell psilocybin truffles so roughly the same thing. When I've bought them, from a few different popular shops, no words of caution or safety were exchanged.
people do. But just maybe 'negative' doesn't mean catastrophically bad, and just maybe bad experiences are in the minority hence the flood of positives. What your post comes across as, to me anyway, is that you want drugs to be a bad thing.
> but the "how" is largely ambiguous
Does it matter? Or are people just not allowed to have a positive thing happen from psychedelics?
You seem to be bringing a mindset to this discussion without apparently considering maybe drugs aren't always that bad. And you may be right, and you may be wrong, but you do seem determined to look on the darker side of things.
I am curious how you could interpret that.
that
> It's a sobering and necessary counterpoint...
and that.
One thing that people didn't want to talk about with the cannabis legalization boom was how common paranoid schizophrenia is. My step-father has marijuana-induced paranoid schizophrenia, I have a few other friends also diagnosed with the same thing. For all the good that it has done for x demographics, it has damaged y demographics irreparably. A future of powerful and debilitating prescription drugs to treat their schizophrenia is what they have to look forward to now, they are objectively worse off for it and classified as legally disabled.
Nobody is hiding negative experiences. Again, you come across as wanting more badness than perhaps there actually is.
<A paragraph about personal knowledge of drug damage >
Yes, we know about this kind of thing . I personally know of alcohol deaths, permanent damage from amphetamines, addiction to cannabis, and second-hand reports of mental illness from cannabis abuse (note: abuse not use), anecdotal but reliable reports about mental damage from LSD. These conversations are happening.
You seem only receptive to the negative side of things.
Psychedelics seem to somehow have simply amazing PR: plentiful testimonies of their life-changing abilities, encouraging us to try them, but very little acknowledgement of their dark side. The subculture is very quick to brush away anything that goes against the narrative of the "mind-opening wonder drugs that big pharma doesn't want you to know about."
My experiences with psilocybin over a few months started with awe and wonder and spiritual awakening (or what seemed to be at the time), and ended with horrifying lasting harm. Insomnia, constant vivid nightmares, sleep paralysis, intrusive thoughts, anxiety, tics, and all kinds of weirdness at the periphery of conscious experience that I can't really explain.
It feels like I flashed my brain's firmware with no way to undo it. I took all the precautions I thought I was supposed to. I wish someone had warned me.
Anyone who has been in the hallucinogens scene long enough knows someone who either did too much over the years and is a basket case or just had one really bad trip and never recovered or were the same after.
It's certainly not as dangerous as other drugs, but I'm fairly tired of people acting like it is inert or can only produce positive experiences.
I cannot imagine doing this substance without someone else there. There were multiple times I simply needed a hand to hold as I was… descending, and my second trip was a “bad” one. The therapist was absolutely critical for helping me frame what happened in a positive light.
Oh here we go again."
No sense of irony?
I could see it being either, because "the dose makes the poison", but some people are almost certainly biologically more sensitive to some compounds.
Oh here we go again. Give me three comments below (in direct links) that "brush away" the obvious risks. I think you just made stuff up. Of course there are risks.
Maybe the reason a whole lot of people are not complaining about bad experiences is that they are maybe, maybe, not as common as you want them to be.
If you want rational drug discussion then you should probably start with yourself – not everyone suffers from significant harm in drug use.
> I wish someone had warned me.
A little bit of reading around would have shown you there are risks. Either you didn't do your due diligence or you ignored them.
Edit: start here https://www.google.com/search?q=psilocybin+risks
He claims things get brushed away by a certain subculture but can't or won't give examples.
He provides his bad experience but seems to believe that must overshadow any good experiences of others' like mine. It doesn't because my experience with drugs has been generally positive and MDMA actually turned my life around. Without it my life would not be worth living now (and I assure you it's not much fun even now) after a childhood you could not imagine.
He laments that nobody told him the risks but clearly didn't make sufficient effort to determine them. Two words and one click on the web and he would have found plenty.
Respond to what I said, not what you want me to have said.
(edit: cleanup & clarify)
I suggest this to people even when they feel they are out of a pit primarily because being out of the pit is the perfect time to get help, as they don't have the usual struggles that makes reaching out feel impossible.
It's fantastic you have really great empathetic friends to help you out, sometimes you really do just need someone to listen to you.
With all this experience, I still don't know how I would filter a list of therapists except maybe remove ones that seem married to a particular method/style. Like a real relationship (that you don't pay for), it takes time to get to know eachother. And at anywhere from $100-400 (nyc.. sigh) per session, it's not free to keep trying (ignoring the emotional costs..).
And my experiences have taught me that like any regular person, therapists can be deeply wounded individuals or struggling with their own demons. Maybe they've conquered them, maybe they're hiding behind a facade of being able to 'help' others. It's messy. I think there's something weird/wrong about our current zeitgeist putting therapists on a pedestal or that everyone should go to one. They aren't doctors, and you aren't necessarily sick.
IMHO things like CBT and ACT can be self-studied successfully from books. Writing can achieve much of the effect of talking therapy - both expressing difficult thoughts and obtaining objectivity. Maybe not for everyone but I think nerdy autodidacts can cover a huge amount of ground without paying a professional. Such individuals might also be in need of supportive human contact though!
Based on my experiences I think MDMA likely has much more therapeutic value. To me regular psychedelics merely give the illusion of profoundness rather than actual profoundness, though I’ve heard they are the best treatment for cluster headaches and I’m not against people with treatment resistant depression giving it a shot
I'm not sure how many of my thoughts are not intrusive!
There are definitely risks, but also ways to minimize the chance of negative effects and to constructively handle them afterwards.
All too many people go in strong psychedelic sessions with little preparation, in very poor settings, without experienced people they respect and trust around, and often even without knowing the substance or the dose of what they're taking.
If there are negative effects during the trip they don't know how to handle them, and many are lost as to what to do afterwards, and don't take advantage of support offered by trained psychedelic therapists or even ordinary psychologists.
It's a formula for increasing the odds of trauma and subsequent PTSD.
If anyone is considering taking psychedelics, please, please educate yourself thoroughly on them and how to use them constructively, test them, and know with certainty the dose you are taking, and take them only with experienced people you like and trust.
James Fadiman's Psychedelics Explorers Guide*[1] is a great resource for this.
[1] - https://www.amazon.com/Psychedelic-Explorers-Guide-Therapeut...
This is inaccurate. We can reduce the risk but not make it ‘minimal’. Also, we can’t always provide ways to constructively handle negative effects.
https://en.wikipedia.org/wiki/PiHKAL https://en.wikipedia.org/wiki/TiHKAL
It's a fascinating read about the chemist Alexander Shulgin
And as the other commenter mentioned, there was an abundance of love in that relationship too. That much is evident.
Getting triggered, I use to take hours or days to recover. Now, it can be minutes to hours.
I'm not kidding. My life is immeasurably improved. Cannot recommend the Stellate Institute in Annapolis, MD enough.
For PTSD, please, if you can, seek out ultrasound guided SGB.
these platitudes are deceiving
sure, some people will get an advantage from these treatments
never the less, this is no revolution. in US during the early 80s we had MDMA being made in huge quantities and being consumed in clubs, in addition to therapists using it in guided sessions.
for 40 years since, the likes of rick doblin and his associates have been trying to push for this treatment. the reason the government is now seriously considering this is because of the needs of combat veterans. it works for PTSD where nothing else in the pharmacopeia does. there are very strong psychedelics like 5-meo-dmt and ibogaine and to some degree ayahuasca and mushrooms that work perhaps even better. that's basically it for treating serious mental problems in post-combat vets. for many people in those extreme mental health crisis situations, they are coming to private clinics outside of the USA to receive these treatments, the government needs to fix this situation because it's ridiculous.
despite all this, the use case for MDMA and other psychedelics in the general population is less well understood. certainly, we should explore it, and perhaps it will help to improve our relationships with these drugs in general to have a positive, healthy way to use them that steers them us the right direction. at least, a framework that we can reference.
i just don't know that all of this is going to be "an era" or a revolution or whatever people have in their minds. mental health in this country is at al all time low as far as i can tell. if we can even make a dent, that's great. if we start to improve some previously unfixable situations for people, great. we'll need our best abilities to get through what's coming next.
as an aside, rick doblin took almost 40 years to do what peter thiel's company did in 4.
https://www.bendbulletin.com/localstate/oregons-first-licens...
While I am not as much of a fan of MDMA I could see a similar situation where, if done responsibly, it could yield wonderful results. Best of luck to all the researchers out there trying to make this possible. RIP Sasha and Ann.
The "gifting" scheme of DC seems sketchy AF to me: an awkward and awful compromise to sidestep useful regulation that would create more safety, reliability, and transparency.
Am I wrong?
MDMA can reset your dopamine baseline much lower. That is, after you come down, you may feel depressed, and it may be hard to climb out of that depression for a while.
Use caution please.
> MDMA-exposed primates showed reduced numbers of serotonergic neurons 7 years later, indicating that some of MDMA’s effect on the brain can be long lasting.
> Low serotonin is associated with poor memory and depressed mood, thus these findings are consistent with studies in humans that have shown that some people who use MDMA regularly experience confusion, depression, anxiety, paranoia, and impairment of memory and attention processes. In addition, studies have found that the extent of MDMA use in humans correlates with a decrease in serotonin metabolites and other markers of serotonin function and the degree of memory impairment.
Great resource with lots of citations: https://nida.nih.gov/publications/research-reports/mdma-ecst...
One example is that PTSD also causes "confusion, depression, anxiety, paranoia, and impairment of memory and attention processes." And it's likely that some people with PTSD are self-medicating with MDMA.
The longer-term effects of MDMA are actually fairly well-established, in part because the mechanism of action is known and the relevant effects can be directly measured. It's not just a matter of symptomatic evaluation.
Fwiw, MDMA affects 3 neurotransmitters: serotonin, dopamine, and norepinephrine.
Having a low dopamine baseline can also be really bad tho! Hard to get motivated...
And while caution is definitely needed, the research is mind-blowing. Veterans who have seen and done horrible things find relief in MDMA therapy (in a proper clinic) when nothing else has worked. Powerful stuff, not just a party drug.
Drug companies said that about ketamine, and then they realised they couldn't make much money from ketamine infusions, so they tweaked ketamine to get eskatamine and turned it into a nasal spray. That's patentable and it gives them more money.
The results are pretty poor though.
SSRIs had mind-blowing research, but that was based on very carefully selected test subjects. As soon as it got rolled out to the general population the efficacy drops pretty alarmingly. Some people don't get much benefit from them (SSRIs are a useful, life-saving medication. I am not saying these meds are useless for everyone). See also SNRIs, exercise, etc etc.
Everything in medicine has a risk factor that must be weighed against the benefits.
The process for drug approval is extremely rigorous for a reason, and does have some downsides as a result. Let's not negate that work please by ignoring all of the hard work that's already been done to show exceptionally safe viability within the context it's being used in.
As noted above/below in different comments, the dose/dosing period/etc always makes a difference in whether a drug is harmful or helpful. In this case, the benefits strongly outweigh the downsides within this particular narrow kind of usecase, and of course hopefully we'll be able to get an even better handle on that in a broader set of examples in the ongoing Phase IV studies.
Plus, it's not like MDMA is some new chemical or anything like that. It's pretty darn well characterized under a variety of treatment/usage conditions at this point.
The problem is these drugs aren't being presented as dangerous pharmaceuticals that still have worthwhile cost-benefit ratios for certain serious conditions. Instead the "drugs are good" crowd actually argues, laughably, that they're completely safe, and safer than alcohol (I don't drink, btw), despite extremely good observational data suggesting moderate drinking doesn't increase all-cause mortality, while no similar data at present exists for these drugs.
Here's an example of something they never discuss: https://slatestarcodex.com/2018/06/06/hppd-and-the-specter-o...
The "microdosing" fad is one of the best examples of how uninformed people are about the dangers of psychedelics, thanks to the propaganda. If I polled 100 of these microdosers at random and asked them about 5HT2B, do you honestly think more than half would know what I was talking about, and what my concerns are? Yeah, some are highly informed and know what risks they're taking, but they're the exception.
Some drugs have a narrow dosing window. Some have a wider dosing window. Some have serious dangers associated with them. This is a core part of psychopharmacology, as you likely well know.
Strawmanning and extremifying arguments can perpetuate an echo chamber but not much else. Most people I talk to who support psychedelics seem to have a very reasonable and mature approach to the topic. Some people of course will have extreme views on either side but that is bound to happen.
Also, safer than alcohol is a... horrendously poor comparison to use. Alcohol actually is quite a dangerous drug, and MDMA I'd put up there but one step below if misused. I'm not sure where you anchored alcohol's safety here, it's very much implicated in a number of very bad things healthwise, not to mention addiction. The withdrawal syndrome alone is fatal in the wrong circumstances, something even drugs like heroin can't claim.
Once again on the microdosing side, I'm not sure what "propaganda" you're referring to. There are plenty of peer-reviewed studies on the topic. MDMA of course is not microdosed, though LSD and psilocybin still could be candidates on the table for that.
However, as far as I understand from the literature, the concerns you presented strongly are still based on theoretical evidence. It's not guaranteed, and as in all things, it for now is in the realm of "we don't know". Caution is good.
All in all, every drug class has problems and potential issues. We find those out with time and studies. Using caution as we figure that out is good. Strongly bashing things or putting down entire cultures of people with opinions that they generally don't hold is less so.
I can't speak to much more than that, and these are just my own personal opinions after all. Extremely selective-to-5ht2a ligands will likely be something that gains momentum over the coming decades unfortunately, but thankfully at least so far with the history of use that we see, so far there's not necessarily a clear smoking "negative gun" as far as I personally see. But tools are tools, and different tools have different risks, and I personally believe/feel that we should treat them as such.
We happened to take MDMA for the first time(at home) and we talked about the TV situation. We figured out a way to have both of them in the living room and make it look good.
We were so impressed that we ended up designing our backyard landscaping after that.
That's not to say that medications can't be useful in tackling the root cause, they can be, but not uncommonly, the negative side effects outweigh the benefits of taking them versus just resolving the problems in your life. CBT (Cognitive Behavioural Therapy) can be very effective for a lot of problems.
But the problem I am having in mind is not war-related PTSR. I don't imagine how to heal from problem when you are a massacre survivor. Especially if you were mobilized against your will.
What kind of pain may block even talking about it? I have built an idea while reading those PTSR-witnessers that mobilization for males is an analog of rape for females and the pain is not from killing and seeing kills but from being enslaved. I have a lot of friends who use to kill Russians in Russo-Ukrainian war, or use to be a medic, and everybody is totally happy to discuss at least some analytical problems (equipment, strategy, caveats, how to avoid being killed in combat, etc). I am just trying not to be jerk and listen more than talk to them and those people even do not claim they heavily suffer from anything like PTSR.
What kind of questions were asked to patients and participants of what military group were the patients? If my theory is wrong, then the questions is always about killing and seeing massacre. I really want to know criterions of being chosen to mdma-assisted therapy instead of other antidepressant.
in the context of MDMA assisted psychotherapy, people objectively use it to discuss painful topics and memories to deal with root causes
I'm not sure how to answer some of the psychology specific details, and so apologize, but given that MDMA does indeed seem to be one of those drugs that helps people deal with the root causes of their issues, I'm sure the info is out there for someone determined to learn it
I wish you luck with your business idea
I think that the appropriate substance depends on the nature of the problem. If the nature of the problem is a lack of empathy and interpersonal connection, I think MDMA could be a good fit. It can provide biological and experiential practice in dropping the barriers people put up between themselves and others.
Mushrooms, LSD, and hallucinogen seem better suited for addressing motivation and control issues as well as cognitive dissonance within an individual.
MDMA is used as therapeutic grease. People with PTSD frequently can’t talk about or otherwise process what happened to them without reliving the event(s) and re-traumatizing them. MDMA tamps down the fear response and makes them more open to communication. It frequently makes people want to connect to someone else which also helps with therapy. MDMA isn’t what relives the PTSD, it is the therapy.
If I recall the MAPS study, patients were given 2-3 doses of MDMA over 8 months of therapy.
If you anesthetize me, I will protest less when you do something that would otherwise cause me pain, but you haven't taken away my ability to feel pain in the long-term.
If you get me high, I'll be less anxious in the short-term, but the root cause of my anxiety hasn't been solved.
Tools are tools. My inability to ram a nail into a wall with my thumb isn't being "masked" by my use of a hammer, and while I might get better at it with practice and better thumb technique that wouldn't be a more valid solution.
No, it's a tool. Nobody is saying you should take casual MDMA to discuss every day solutions. But it does highlight the power of allowing people to express things that they might otherwise have difficulty expressing.
And maybe you learn something about your partner in the process.
This is why it's a powerful therapeutic tool. People with PTSD can talk through their most troubled experiences and lift that weight from their shoulders. Something they may be incapable of doing in a sober context.
In that sense, it's not just "anesthetizing" as you so lovingly put it, there is therapeutic value beyond a a momentary high.
Obviously, self medicating to perpetuate avoidant or maladaptive behavior is generally considered drug abuse and never recommended.
She eventually was accepted into a limited program in Victoria, BC for ketamine treatments. 3 large doses rendering intense trips that lasted the course of hours in a clinic under the supervision of doctors and therapists. After the first session she was fundamentally changed. After the third she looked back wondering how she ever could have felt so low.
It’s not a silver bullet, she required some therapeutic work afterward and may do another session in the future. But it still stands that the person she is today (travelling, seeing friends, seeing family, etc) is radically different and restored compared to just a few years ago. She full heartedly credits those sessions, but also doesn’t feel a strong need to return-just to get on with life while she’s still in possession of her functioning body.
I’ve come to think it’s very important that we re-integrate these plants/practices/visions/what have you into society and we stand to benefit from a deeper level down than just salving creature comforts. Some people never forgot that matter and I’m sure are relieved to see some more “rational” people like myself coming around!
Honestly though, I'm not convinced about it in a clinical setting, unless there's a particularly severe issue that needs addressing.
I reckon most people are best off just buying some, getting together with a couple of very good mates on a nice day, rolling out into the country with some very good speakers, and just working it all out by yourselves. Sure-fire cure for what ails ya.
On a sensible note: don't drink alcohol with it, titrate your dose up to ~150mg, if possible get it from a Tor-enabled marketplace so you can be relatively confident in quality.
I don't think it's a terrible start, but yes, of course, YMMV and one should never go doing such things without a bit of reading about.
Mainly I fear people will read this and mistake it for a defense of MDMA as a drug for going out with your mates. I think this can be helpful for some and very helpful for others but not as helpful as a clinical setting. Where a clinical setting is a therapists office and not a cold clinic room.
I do think people would do just as well or better with a couple good mates, a nice set and setting like you described, and some intentionality (vaguely even) about why they are going on the trip. The problem is many don’t have a couple good mates, or don’t know how to talk things through with themselves or otherwise, and would benefit from guidance. Better if people go into it with an agenda like a therapist would have.
Edit: The reason this bothers me is because I’ve tried to think through what gave the few old hippies I’ve met burnout. And maybe they were just high but I fear it was psychedelics too often and for people on message boards to assume MDMA discussions are the same as psychedelic discussions when the dosing patterns I’ve heard discussed are very different.
This is I’m content with these synthetic drugs remaining prescription only. Having a system about it supports cultural expectations. The MAPS guys are really doing it right. The only problem is our system that doesn’t get approval for drugs out of patent. e.g. ketamine/s-ketamine
Naturally, not applicable in all cases, but I guess my point is you can get a lot of benefit in that context.
I suspect the clinically depressed/ptsd impacted folks don't have "a couple good mates" who are appropriate trip sitters.
1) Human recall is imperfect. The act of remembering an event actively modifies the memory for future recall, which can be tinted by other thoughts and experiences someone is having while doing the recollection.
2) It's rather difficult to feel strong negative emotion while on MDMA. While under the effects, the baseline is somewhere between "happy" and "downright euphoric".
Combine those two ideas, and you have a pretty compelling groundwork for how MDMA would help those with traumatic memories, particularly PTSD. Dose them with feel-good drugs, have them recall and talk through their traumatic memories without the usual, extreme negative emotional response, and the new memories are less associated with extreme negative emotion. Rinse, repeat, until someone can remember a traumatic experience without setting off an extreme stress response.
I am floored by this assertion, as it's completely contrary to my experience. My reaction to MDMA was a nightmare of disorientation, fear, and anxiety. I don't remember the dosage, but the setting was my own home, among friends and acquaintances at my own birthday party.
I don't know if my strongly negative memories of this event constitute "trauma," but they are certainly neither warm nor fuzzy.
Actual, pure MDMA can only ever make you feel good.
This is patently incorrect.
My experience is that MDMA makes one feel emotions much more intensely, with a bias towards positive emotions.
I've personally felt a number of negative emotions on MDMA as well, primarily loneliness when I've taken it alone, or ended up alone after taking it. This makes sense because it makes one strongly desire physical intimacy and physical touch of various kinds (hugs, shoulder rubs, compliments, deep expressions of love, etc)
Even the negative emotions I've experienced on it have however generally occurred at the same time of very positive physical sensations, and a strong sense of connection with myself.
FWIW, I haven't hade the same effect from other psychedelics.
Therapeutic doses aren’t designed to be fun, they are there to stop you from being afraid and willing to talk to someone. In addition, the subjects are only occasionally using MDMA in context of extended therapy. It’s not like they give you molly and see how you feel afterwards. MDMA is a tool for making therapy better or even possible for people with entrenched issues that couldn’t be solved with conventional treatments.
Tucker Max wrote at length about mdma therapy. [1]
Vice News had a piece on mdma therapy and ptsd. [2]
By the time I took Ketamine in a clinical setting (legalized in California), I was spending 80% of my time fighting negative narratives inside my head. "I want to die" (not really, but my engineering brain had decided this was eventually a solution to every problem... Louis CK has a bit that is basically identical to the way my brain was thinking)... "this person hates me so I should hate them"... "all I ever do is fail". I only had 20% of my brain left for interacting with others. I was not a nice person to be around for any period of time. I would be withdrawn a lot because I was in my head.
My therapist asked me once "what would it feel like to wake up and not immediately feel defeated?" and I legitimately had no idea.
After a series of ketamine treatments the narratives calmed down immensely. 80%->10% to some periods in a day of 0%.
I truly despise the actual act of taking ketamine. If you're doing lozenges it tastes like shit, I always felt very nauseous after the trip. I found the trips weird and not therapeutic. Like weird patterns, sometimes seeing things gloopy, sometimes odd experiences that sound fun but just felt strange and disconcerting like flying through hyperspace with Gandalf. But the long-term results have been life-changing.
I would recommend ketamine to anyone who has gone for 2+ years or 2+ psychiatrists and haven't seen the results they had hoped for.
This occurred prior to the official training that's occurring now but after the decriminalization of drugs in Oregon. The guide was not a licensed clinician, but she had guided 100s of clients.
My mother-in-law found it incredibly helpful in processing traumas from childhood and in getting "unstuck" in thinking patterns. She described the experience as a seismic shift.
She had been in therapy for her entire life. I suspect that her prior therapy had laid the groundwork for understanding the thinking patterns that weren't serving her.
My wife and I have noticed a subtle personality change. She seems happier and more open to new ideas. This personality change seems to have faded slightly with time. These are of course just our observations, which could be completely off.
Psilocybin mushrooms grow everywhere here in the Pacific Northwest-- I see them all of the time in mulch around our city. I've had many friends take them recreationally, and none of these friends have had such an impactful experience. All of this is anecdotal of course, but it leads me to believe that working with a therapist might be essential for efficacy of the therapy.
I'm a neuroscience researcher, and I'm hopeful that these treatments will be helpful for many people. It is tragic that there haven't been more clinical trials. I'm hesitant to try them myself until there's more data. If I was suffering from intractable depression or anxiety, I'd feel differently.
With MDMA I certainly had lovely time talking with friends but again without a therapeutic goal it was just a good time.
I've come to the reality that the future is using science instead of Physicians and buying medicine from other countries who don't have cartels in control of the medical industry.
On a political note it is perverse how alcohol which often renders people violent and risk taking is celebrated, whilst a substance that causes one to dance, hug and spends hours discussing and friendly debating Marxist political theory is distained.
I think the real issue [EDIT with trying to restrict alcohol] is that alcohol is so easy to produce. I've got some "tea wine" brewing ATM that consists of tea, sugar, and bread yeast. You could literally make hard apple cider with just pressed apple juice in a jar with a lid loose enough to let the CO2 escape; the apples will have wild yeast on them already. No idea how to make MDMA, but I presume it's nowhere near that easy.
Personally I wouldn't risk the DEA either; but a lot of people would -- particularly if it seemed like "everyone else" was doing it too.
Right, and harming all sorts of people in the process:
https://astralcodexten.substack.com/p/the-government-is-maki...
Seriously, why does anyone seriously think "this needs fixing"?
> "And it’s unclear whether approving MDMA on the basis of MAPS’s data would ease the way for other companies hoping to study and develop the drug, or whether anyone would even want to. MDMA has been around since 1912 and cannot be patented, creating little financial incentive."
Not only that, but if people can improve their condition with three treatments to the point that they no longer need their daily dose of anti-depressant or ADHD medication (or alcohol / opiates / etc. for the self-medicating cohort) then overall drug consumption will drop steeply. This is probably good for social progress but poor for profit margins and ROI in the drug sector.
The pharmaceutical industry makes a lot more money by selling maintenance programs in than it does by selling cures. For example:
> "“Is curing patients a sustainable business model?” Goldman Sachs analysts ask?"
https://arstechnica.com/tech-policy/2018/04/curing-disease-n...
How would MDMA (or any drug) alter this? Stimulants used to treat ADHD typically work by either getting you to produce more of those neurotransmitters or getting them to stick around for longer by inhibiting reuptake. I'm not sure of any drug or treatment that could permanently change these things in the brain.
Therapy isn't very effective because you can't focus on the techniques when you need them.
ADHD is at its core an executive function disorder, and even the symptoms of anxiety caused by ADHD are rooted in difficulties in executive function, which is unrelated to anxiety with other etiologies (such as anxiety disorders, depression, or PTSD).
It's implausible that MDMA would be useful for this purpose, because there's no theory that would connect MDMA to improved executive function after the acute effects have worn off.
> Knowing what the lack of anxiety feels like could be very powerful paired with therapy to train a body to return to lower anxiety levels.
You have a misunderstanding of how ADHD works. "Knowing what lack of anxiety feels like" won't fix the executive function disorder that prevents an individual from translating that knowledge into action.
And to answer the "but you can't patent an old molecule", in fact, yes you can. Adderall is plain old amphetamine, but with a specific ratio of the D and L type, so it could be patented. The pharmaceutical industry is adept at making small tweaks to existing drugs, a supposed improvement according to their own studies, but most importantly, a way to get a patent.
> Not only that, but if people can improve their condition with three treatments to the point that they no longer need their daily dose of anti-depressant or ADHD medication (or alcohol / opiates / etc. for the self-medicating cohort) then overall drug consumption will drop steeply.
The key thing here is the claim being made that three doses of MDMA will eliminate the need to take an existing ADHD medication. How would that work? It wouldn't. It's not possible.
Your end point - that MDMA is not a substitute for ADHD medication - is correct, but the reasoning you're providing is faulty.
Even assuming you were taking a pure and unadulterated substance - which I'm willing to bet you weren't[0] - this personal anecdote doesn't really refute the original point. Set, setting, and dosing make a huge difference. MDMA is much closer to methamphetamine - both biochemically and in its effect - than most people realize. And methamphetamine is itself a prescribed ADHD medication, fairly similar in effect (when dosed appropriately) to Dexedrine, which itself largely interchangeable with the medication everyone knows and associates with ADHD: Adderall.
MDMA can actually be taken to improve focus, in the right dose and setting. However, the reason that it shouldn't be used for this purpose is because MDMA is more selective for serotonin than most other amphetamines, and serotonin depletion and downregulation means that it can't be used this way regularly (ie, on the order of weeks-to-months to restore baseline levels).
[0] Virtually all MDMA outside of clinical settings is contaminated to some degree, usually with another amphetamine.
You can’t just look at the structures or names and assume that fully explains the effects. Yes, it’s an amphetamine. Imagine there was some form of alcohol that both got you drunk but also gave you a strong cannabis high - if you went a bar serving that you’d notice entirely different behavior compared to regular alcohol. That’s like MDMA compared to a regular amphetamine - not in that it’s like cannabis but it stacks a completely different and overpowering effect on top of the base it gets from being a phenethylamine.
Yes, regular MDMA usage is harmful to the brain much more than other amphetamines, that’s just another reason it would not be a suitable replacement.
This is a very common misconception. Just because MDMA is sold in powder form does not make it less likely to be adulterated, and color is a misleading (and easily manipulated) heuristic.
You can test for the presence of hypothesized adulterants, though most people unfortunately don't, and tests will fail to detect heterogeneous adulterants or adulterants in small quantities. Furthermore, reagants test for the presence of specific hypothesized adulterants; they cannot test for the absence.
The only way to be 100% sure is to use a mass spectrometer, and very few people will have access to use a mass spectrometer for testing street drugs outside of law enforcement (who emphatically cannot be trusted for these purposes[0]). That leaves clinicians, researchers, and a small number of groups who perform drug testing services for recreational users. From those, we have a pretty good sense that unadulterated MDMA is quite rare[1], which means that comparing subjective experiences of recreational (street) drug use to subjective experiences of pharmaceutical drug use is methodologically fraught.
> You can’t just look at the structures or names and assume that fully explains the effects.
I did not say that it fully explains the effects. However, it does provide some information. And in this particular case, the differences are dramatically overstated, due to the massive difference in set, setting, dosage, and chemical composition (possible adulterants).
My point is that you can't compare your subjective experience of these two drugs to draw the conclusion you're drawing, because there are many different confounding variables that would each explain the difference in effect you're describing, let alone in combination.
Again, I do agree that MDMA should not be used as a treatment for ADHD. I'm just pointing out the problem in drawing this conclusion based on subjective personal (and presumably recreational) experiences with the drug.
[0] Law enforcement routinely lies about and misrepresents facts around drugs, for various purposes. It's most commonly seen with regards to fentanyl, but by and large you can't trust LEO claims about tests performed on any drugs seized without independent means of corroboration.
[1] That doesn't mean that the adulterated versions are necessarily harmful, but it does provide an additional wrinkle when using it to draw inferences about hypothetical clinical use (which would not have any adulterants).
If you modified that superlative to read "Most people who have taken MDMA would not consider it suitable for ADHD", then yes, I would agree with that statement.
I just don't find it a particularly profound or useful one, because most people have a particularly bad understanding of how recreational experiences translate to therapeutic ones.
(Most recreational methamphetamine or cocaine users would find it hard to imagine therapeutic uses for either drug, for example, even though both are well-established.)
The article gives away the game here:
>> But Doblin still envisions treatment centres sprouting up around the world — he predicts that more than 6,000 will emerge in the United States alone — where people with PTSD and other psychiatric illnesses can safely and legally use MDMA and other psychedelics under the guidance of therapists. Beyond this, he hopes ultimately for full legalization that would allow anyone to take the drugs however they wish. “MAPS has been the beacon to kind of take on this work,” says neuroscientist Amy Kruse, who is chief investment officer at venture capital firm Satori Neuro and is based in Annapolis, Maryland. “There are many people that can benefit from this treatment, and I think it shows a pathway for the potential rescheduling of other molecules.”
They are breathless in anticipation of a billion dollar industry. They even include this link:
https://www.bloomberg.com/press-releases/2022-07-18/psychede...
It was in the linked article:
https://www.nature.com/articles/s41591-021-01336-3
It's always good to go to the sources when looking at these potentially overhyped news articles. I would love this to be the answer to depression, but I'm somewhat skeptical. I'm also cognizant of the power of the placebo effect (and related psychological factors) in changing the brain, having fully recovered from ME/CFS and severe depression/anxiety myself.
It's possible that was ketamine therapy but I thought it was mdma.
Very highly doubtful. MDMA is an amphetamine, and use of amphetamines for pain management is pretty rare. And even among amphetamines, MDMA is pretty undesireable for that purpose, due to its rapid development of tolerance compared to other amphetamines and risks of lasting negative side effects with repeated use in short durations - which rules out nearly all use cases for physical pain management.
> It's possible that was ketamine therapy
Ketamine is used to treat both acute and chronic pain, so this is much more plausible.
And sometimes I feel like I just need a "click" in my mind to change perspective. I know what my problem is, when I'm looking at myself as an observer, but it is just so hard to get out of it.
I have been making steady progress by reading up and working on my self "naturally", but it sure would help if something external could make things easier. Unfortunately I don't know if these drug therapies will ever come to India.
Just throwing medication at a problem and calling it a day will never be useful, but seeing a lot of people find success with a mix of medications (amphetamines, ketamine, mushrooms, etc.) with therapy has been kind of eye opening.
A lot of this stems from blanket stigmatization of some drugs versus others.
Fixing society is a much larger (and ultimately fluid, unsolvable) problem so I feel like whatever people can do to find contentment should be on the table.
But why is it unsolvable? As the parent comment noted, these issues aren't as prevalent in other cultures. So why here? Why is these so much pain that needs to be medicated?
I'm not anti-meds. I think the re-introduction of MDMA and other formerly alternative meds is a good thing as they are more effective. And there will always going to be some people who need such assistance. However, we can still ask why? Why are so many suffering so much that they need meds?
Because as we solve societal problems new ones will arise. There's no utopian ideal.
> As the parent comment noted, these issue dont
They don't what?
Why can't we be content but not "complicit" and still address issues? I'd argue having a growing population with mental health issues is less prepared to functionally address larger problems.
This feels like it's piggy backing off of a caricature of a zoned out druggie who doesn't care what's happening around them.
Never said it was impossible to improve. I said it was impossible to "fix" society.
Your absolute take on this is a deflection to avoid any change
I have never said we shouldn't improve things. That's very much a strawman.
I've seen an increase in the pursuite of hedonism over the past decade, and what it would take to steer society away from hedonism would be some huge event like 9/11 or ww3 to get people's eyes off the inordinate consumerism and chasing money. Or maybe just fix the economy, but the oligarchs would rather hoard money than ensure a healthy society.
They said it without citing a source. There is evidence that there is higher treatment seeking for PTSD in high-income countries, including the US, but that doesn't mean it's exclusive to the US or that it isn't prevalent in lower-income countries with less access to mental healthcare.
They aren't "less prevalent". They're underdiagnosed and untreated.
Remember anti-vaxxers that yell about how vaccines caused autism? Except that western medicine started to correctly diagnose a lot of neurodivergent conditions better, that's why we realised that a lot of kids that can't stay still have a form of ADHD.
I'm guessing it has a bit to do with pharmaceutical advertising targeted directly at consumers too.
I was surprised at how many HN users happily talk about which SSRIs they are on.
I'm glad you brought that up. I always found it amusing that the best medicine for depression is to go out, meet people, engage with the world around you, but depression keeps you from doing that. American culture is very individualistic and there's very little pushing communities together, which would seem to exacerbate depression once it takes its hold..
This is not about "correcting" imbalances in the brain or brushing issues under the rug, it's about dealing with them directly.
The other great thing about psychedelics is that they're typically only used temporarily as opposed to many other kinds of prescription antidepressants, which often need to be taken for extended periods or for life. The pharma industry has tended to favor solutions that incentivize the latter and I think we desperately need alternatives that don't require long-term intervention.
Totally sympathize with that viewpoint, but I'm not sure if this commenter knows that MDMA will not be a prescription medication — no one is prescribed or goes home with MDMA. The treatment in the trials is only 3 medication-assisted therapy sessions with normal preparation and integration therapy sessions before and after. After those 3 MDMA sessions, the patient doesn't take MDMA again.
It's been clear since the beginning that it's psychedelic-assisted therapy — not just psychedelics — that makes the treatment effective.
People already buy it illegally. I don't see how this will meaningfully change the supply or demand.
You should read up on harm reduction.
MDMA very realistically shouldn’t be lumped in with cocaine, heroin, etc. Hell, opiates as a whole! Just based on the effect profile and typical usage patterns, I baselessly posit that one is more likely to be a daily marijuana user than a daily MDMA user, even taking into account the number of people that use each drug in the first place.
Nobody is holding you up with a knife or gun, or stealing the coins out of your car, to get their next fix of MDMA.
Nobody is acting aggressively on the street or in a nightclub because they’ve had MDMA, or not gotten enough of it.
MDMA is certainly not without its risks / dangers. Someone can easily irresponsibly take too much and end up in hospital or dead. Someone can easily take the right amount of the right stuff and end up in hospital or dead just because they had an adverse reaction. You could ruin your relationships, throw your brain off-balance such that you never really enjoy anything again. There’s the whole ‘gateway drug’ argument. Blah blah blah.
Let’s really stop and think very carefully about whether these risks (which unlike say…meth, heroin, etc, have an absolutely negligible societal impact per capita compared to alcohol, tobacco, etc) should even show up on the radar when weighed up against the increasingly proven positive effects of MDMA-assisted psychotherapy.
Thank you for pointing this out. This is the key point that so many people miss by skimming the headlines.
These medication-assisted therapy trials are about the therapy first and foremost. Some of the trials have several dozen therapy sessions in their protocols and only a single or couple medication-assisted sessions.
People taking these drugs on their own at home are not doing anything resembling the therapy discussed in these trials. There are numerous stories of people taking psychedelics ad-hoc and ending up with worsened anxiety, derealization, persistent fears, delusional thoughts, and so on. The common wisdom in psychedelic circles was that set and setting is everything - Taking psychedelics while in a state of depression, anxiety, PTSD, or other conditions outside of the setting of closely monitored professional therapy is potentially quite negative.
The article gives away perhaps the big underlying motivation to get these to market: its a potential billion dollar industry.
And that is fine. It's a good motivator to provide a great product.
I will never see anyone here complaining about the video game industry... The whole video games industry is pretty much a drug for a lot of mental issues. In fact all of the recreational activities have similar mental condition boosting effects.
It's just your social acceptance of a certain substance is deemed "acceptable"(alcohol), while others are deemed "bad"(THC).
I suspect war and bad family environment are a massive source of trauma of US persons; the path to mitigating the former at least facially is a bit more obvious.
I live in a country where it's very hard to get weapons legally, yet almost every drug bust in the news also contains a significant amount of confiscated firearms.
It would also certainly cut down on the numbers of toddlers shooting their siblings.
If not, then banning guns would be, in software terms, a premature optimization.
If we can reduce the level of trauma and fear in society, we can reduce associated behaviors.
How many lives are saved and traumas avoided through people's ability to defend themselves with guns? If that number is higher than the number of toddler accidents, gun ban would effectively cause an increase in PTSD and deaths.
P.S.: just to clarify, by "significant" I mean significant in a statistical sense of not being insignificant (very close to zero, noise-level), not "majority".
> How many lives are saved and traumas avoided through people's ability to defend themselves with guns
Self defence with guns sounds pretty traumatising for all involved to be fair.
Still, we're stepping deep into the speculation area here, so I won't stand behind this argument very strongly.
Realistically, your argument isn't to lessen trauma, but to simply normalize it. Which is exactly what American culture already does.
No, actually, my argument is that killing or injuring a person in self-defense is less traumatic than being helpless while getting assaulted.
Besides, trauma is relative - "normalizing" trauma is another way of saying "being desensitised" - which is exactly the process therapy itself employs to help people relieve the effects of it.
A person unknown to me was holding a submachine gun, and I could literally feel the muscles tensing in my stomach, where the gun was pointed at, anticipating the pain of a bullet. It was one of the most uncomfortable and frightening things I've felt in my life, so much that I still remember the dream quite vividly.
I assume being held at gunpoint in real life would be even more frightening.
Most people gleefully chant "The war on drugs has failed"...yet, "The war on guns" will somehow succeed?
And... really, any other evidence. It is illegal for you to build and detonate a bomb in the city. Not shockingly, we have few incidents of this happening. Far fewer than random gun violence in places you are allowed to carry guns.
Heck, just set realistic goals here. We make it illegal to drive without a seatbelt, and have largely succeeded in getting folks to wear a belt while in a car. Something far far easier to just not do than the active "seek out an illegal gun" idea that you posit would continue to be a thing.
We control fireworks more readily than we do guns. Again, no surprise that we have far fewer counts of incidents with fireworks. And again, also no surprise it isn't zero.
It is illegal to kill someone, even without a gun, under most circumstances. Perhaps we should make it double-illegal?
> Far fewer than random gun violence in places you are allowed to carry guns
This is false. Most gun violence does not occur from legal gun owners, or in places allowing concealed or overt carry.
No, most gun violence occurs with illegal guns by people committing crimes.
There is no realistic way for you or anyone to take away all of the illegal guns in America. Therefore, any proposed gun ban solely impacts legal gun owners - which statistically are not the problem. It sure sounds good though...
And how is it false that we have more random gun violence than bombing? I can list, this week, more than 1 place where a legal gun owner killed someone. It is famously in the news right now. When is the last time we had a random bomb in a city here?
I haven't even proposed taking away all guns. Nobody gives a shit about most hunting weapons. Nor do they care about any properly held weapons with responsible care and protections.
And here's the issue then. What anti-gun advocates argue are weapons not good for hunting is misguided. Additionally, it doesn't matter if a gun was designed to hunt or not - the gun is an inanimate object.
People like to discuss banning AR-15's all day, failing to realize just how many similar-but-not-AR-15's model rifles exist out there, most of which fire the same cartridge too. No, but that one particular model is the problem because it says "AR-15" on the side (most don't even say that btw).
California already tried this and failed. California banned certain model rifles by name. Famously it banned "Colt AR-15" rifles... well guess what, people just bought S&W AR-15's instead. Ban the word "AR-15" and people will just buy "AR-16"s, or "NOT-15"s, or whatever. It's an impossible thing to ban.
It apparently doesn't matter than handguns kill the most people... those scary black AR-15's we see on movies are clearly the problem. After all, the bullet explodes and ruins the meat!
The anti-gun debate is not grounded in facts or reality - which is why anti-gun proponents make no headway (thankfully).
> And how is it false that we have more random gun violence than bombing?
People rarely seek to indiscriminately kill or maim large numbers of people - which is what a bomb does. Your mass shootings are super rare events.
Not long ago, bombs were going off with a near cadence all across the US, mostly from political extremists. Why did the bombing stop? Was it because we made bombs illegal? Of course not, blowing people and buildings up was already illegal.
You should research Weather Underground[1]...
So, I reiterate. Nobody gives a shit about those. They are instead trotted out as a straw man to silence regulation of weapons.
I'm a little confused by your angle at this point, honest. Gun regulation should go after high capacity items and hand guns. After that, reckless regard to care and storage of munitions. Could probably move to control of the ammunition, as I can think of frightening few reasons for folks to have hollow point or incendiary rounds? Unsure that would make any real impact. Controlling handguns, though, is clearly something that should be done. It sounds like you agree there? Why sideline it with talking about how people are talking about AR-15s inaccurately? You literally brought that into this conversation.
If you want to know why bombing has gotten less, btw. It almost certainly went with more regulation of the ingredients that go into bombs. If you buy a lot of the ingredients that go into TNT, expect you will be rightfully checked up on.
And you'd be wrong with this assertion again, because the definition of "high powered" and "high capacity" are vastly different for your anti-gun advocates versus reality.
A .223 Remington cartridge is not "high powered". A 20 round magazine was what the gun was designed for, making that the standard capacity magazine, not 10 rounds like some advocate for.
A .50 BMG could be considered "high powered" - and it's banned in California. However, in California you can purchase .416 Barret, which is even more effective at range than .50 BMG - and it's perfectly legal. Make sense out of that one...
> frightening few reasons for folks to have hollow point or incendiary rounds
This is a statement made out of ignorance. It's all about the energy transferred into the target. A HP bullet is designed to transfer as much energy into the target as possible to prevent over-penetration (where you shoot someone through a wall accidentally, for instance) and can be considered a safety-feature for defense. You really do not want a reality where people are forced to use FMJ for self defense...
> If you buy a lot of the ingredients that go into TNT, expect you will be rightfully checked up on.
Look up how to make Anfo. It's not difficult, and the components are not regulated. The use, however, is regulated, ie. it's illegal to make a bomb and blow people up.
> Back when I did bird hunt, the entire community would jump on any fool that fired more than the allowed shells in a gun in rapid fire
Sport hunting is akin to golf. There are rules for etiquette and "fairness" reasons, even if that seems silly to an outsider. Additionally, at an established gun range, few allow rapid fire unless you are a member. This is for safety reasons, nothing else. Joe walking in off the street with zero firearms training should not be mag-dumping for obvious reasons.
> Nobody is hunting with handguns
There's an entire community of folks who do just that.
We cannot have productive conversations about gun control until anti-gun advocates educate themselves and refrain from abusing and redefining established words.
The statement on hollow and incendiary isn't ignorance, it is somewhat flat disbelief that it is typically successful at the things you put forth. I'm well aware of the reasons to try and use them. That said, I'm also well aware that that is never what is accomplished with them. Though, again, I had a question mark on that sentence as I really don't care too much about those. They are, for all practical purposes a side show.
And I want you to reread the "that is for safety reasons, nothing else." What the flying fuck do you think we are talking about? Gun safety regulation. Fucking period.
Your comments about HP bullets, and particularly incendiary munitions (lol) are absurd and uninformed. But it doesn't matter, you will not educate yourself on the topic no matter how wrong you may be, and therefore we cannot have a productive conversation regarding gun control.
The "I fired a gun once, and now I'm an expert" crowd is exhausting. You've spent hundreds of words here, in public, clearly demonstrating your staggeringly poor command of this topic.
And gun control advocates always ask, why has no progress been made? Because the conversation is not being held from a rational position.
And I have the exact opposite point of view with regard to HP rounds. If we're talking handguns, we're talking self defense, and in self defense situations, the only rounds you want are hollow point. Because they're designed to flatten out on impact, they go through a lot fewer walls, ceilings, and home invaders, making the shooter far less likely to accidentally over-penetrate into their family or neighbors. Using full metal jacket for home defense is putting everybody else at excessive risk.
Incendiary rounds are for fun, and little else. They look scary, but they don't really have any real effect.
This kind of illustrates one of the big issues with firearms discourse in the US: people who like having guns tend to know a lot about them, and take for granted that people have that same knowledge, neglecting the fact that there's a whole other group of people who know next to nothing about them. Then the people who know next to nothing about firearms propose gun legislation which is just baffling to anyone who knows anything about guns, like banning specific models of firearm, or certain ergonomic features, or banning silencers/suppressors (this isn't Goldeneye, they just make it less hearing damagingly loud to shoot).
Guns are largely fun for most that have them. Little else. Such that I don't think that changes things.
I should note that I've probably owned more guns than makes sense. Had friends with desert eagles. There is basically no reason for any high school age kid to have access to the kind of crap I had access to. It isn't so much ignorance as flat disregard for the bullshit reasons so many pro gun folks put forth. Including here. Your "need this for self defense" is a large part of the reason folks "need them for self defense." It is circular at best, and you can only make it work by poisoning the conversation with pulling in hunting.
What's the plan for taking away all the illegal guns? What's the plan to protect citizens that are now disarmed?
Why don't we just focus on taking away all the illegal guns? Oh, right... we have been... for 89 years - yet there's more illegal guns on the streets today than in 1934. What a shock...
Kind of like how there's more drugs readily available to average citizens than before the "war on drugs" started. It's literally an impossible task... have you seen the homemade guns in countries with outright bans? Or worse, illegally imported automatic firearms. Regular Joe - no gun. Criminal Joe, full auto!
People like to point at Prohibition as evidence an outright ban of Drugs can never work. Yet, it's different with guns somehow?
You're looking at an infected wound and deciding the appropriate treatment is duct tape.
Why duct tape? Because you haven't bothered to even learn rudimentary medical knowledge but are a self-proclaimed expert. Duct tape holds things together, so why not? Banning guns means no gun violence, right? Why don't we just make it illegal to hurt or kill people? It's already illegal? Ok, make it double-illegal, that'll show them!
I have put forth regulating all guns. But, it doesn't take an active imagination to see that regulation is not a total banning/taking away. We still have cats, after all.
Edit: leaving cats, for obvious reasons. I meant cars.
So all those 18 and 19 year old “children” gang bangers are included in the statistic.
You say that drugs busts etc. outside the US will often have guns involved. Yes, criminals can still find ways to get them but ordinary people won't be bothered with this.
The Netherlands for example has Europe's biggest port in Rotterdam and sees an incredible amount of drug-related smuggling. It has 3.9 guns per 100,000 people (107th in the world) while the US has 88.8 (1st in the world).
The rate of murder is 73 times more than the Netherlands.
Sources here: https://www.nationmaster.com/country-info/compare/Netherland...
Look at the murder rate: https://www.nationmaster.com/country-info/stats/Crime/Violen...
See how high the US then see how far you have to scroll down before you start seeing European countries appearing there.
Sources for more control leading to reduced homicides and guns on crime scenes:
1. https://www.hsph.harvard.edu/hicrc/firearms-research/guns-an...
No the absolute number is 73x, the rate is like 8x.
Since you've cherry picked a European state, I will now cherry pick the state New Hampshire.
Murder rate New Hampshire: 0.9 / 100k [0] Murder rate Netherlands: ~0.6 / 100k [1]
Also bear in mind the expected murder chance of the average person from the Netherlands dropped into the US is not expected to be anything like the US average murder rate. The US is not nearly as demographically homogenous as the Netherlands and someone with Dutch heritage experiences much closer to Dutch murder rates in the US.
[0] https://247wallst.com/state/how-the-murder-rate-in-new-hamps...
[1] https://data.worldbank.org/indicator/VC.IHR.PSRC.P5?location...
I cherry picked the Netherlands because of the large amount of drug trade there. Every other country in Europe compared favorably to the United States.
From what I can see there is a similar level of diversity in the Netherlands and the US. In both countries around 30% of people are born abroad. In the US around 72% are white and in the NL around 76% are ethnically Dutch. In Rotterdam in particular around half of the population was born to Non-Dutch parents.
1. https://www.indexmundi.com/united_states/demographics_profil...
2. https://www.indexmundi.com/netherlands/demographics_profile....
Even being gun regulation advocate, I cannot accept the premise that banning guns will do much to reduce murder rates.
Vermont has allowed people to carry a concealed weapons without a license - literally buy a handgun, stick it in your pants - and has had a consistently lower murder rate than Washington DC which banned handguns until recently.
https://www.publichealth.columbia.edu/news/state-gun-laws-ma...
My high-school friend was killed on holiday shortly after takeoff when a Buk 9M38 surface-to-air missile shot the plane down, killing 196 Dutch civilians.
A famous crime reporter got shot in the street for covering a story about a high ranking drug lord.
A news outlet got shot with a bazooka.
So lets do some statistics:
How many American civilians in the past 10 years have been killed with a surface-to-air-missle, adjusted for population? Zero. 196 for The Netherlands.
How many crime reporters got killed in that period? Five for the US, two for The Netherlands.
How many news outlets got shot with a bazooka? I can't find any, but please correct me. One in The Netherlands.
The thing with statistics is. You can make up anything you want to frame a certain view.
Want to say as an aside from the discussion that I'm sorry to hear about your friend and I hope that you got all the support you deserved during that time and since.
The typical American argument is that the US is exceptional and that the views of “these damn foreigners” don’t matter.
I on the other hand seldom hear Americans actively argue that US gun policy is looked upon favourably by the worldwide community. This is exactly what you’re doing by implying that a non-US resident speaking against US gun policy holds a certain political persuasion which means that they should be dismissed. The more likely reality: they have a very typical perspective that transcends the US.
Imagine if we got week-long, wall-to-wall coverage of nearly every stabbing that took place in the EU... Americans would start to believe you Europeans really need to get that knife situation under control.
The reality is, by the numbers, legal gun owners are rarely involved in illegal violence while using their firearms... and there isn't a darn thing anyone can do to remove guns from illegal gun owners.
Therefore, the issue, as perceived by a foreigner, is usually reduced to irrelevant talking points. It's just unproductive.
Why have the gun laws not changed significantly in the past few decades? Because most Americans do not agree with the sensationalized views pushed by the click/eyeball driven media. It's that simple. So then, as a foreigner, you should consider why that may be... perhaps there is another viewpoint after all?
A lot of Americans unironically do believe that.
Obviously this view of the US is deeply misguided - but this is the problem our sensational media creates. It makes rare events seems commonplace and irrationally freaks people out.
So, I do understand why we turn to medication.
Yes, taking guns away would reduce shootings, but so would helping people who are so fearful they feel the need to shoot someone who isn’t threatening them.
In US mental conditions are undertreated, while outside of US they are underdiagnosed and self medicated. I'm from Lithuania, one of the "leaders" in suicide... which are easily preventable by normalizing mental healthcare.
The stigmatization of mental conditions in Europe is sky high, to the point that it's barely possible to be seen as sane if you're just seeing a therapist. However, comments like your, are widespread amongst many in Europe and farther stigmatize accessible mental healthcare.
A lot of cases prescription medication is what people need to live with their mental issues, and should not be seen as "obsession". It's no more an obsession, than chemotherapy is an obsession to a person with cacner.
I think this is just not true. I've never seen so many people talk openly about seeing a therapist as in the last few years. I'm almost surprised by how mainstream it has become.
You can have someone with cancer openly talk about it, but any psychological issue is treated like it's your own personal fault.
There are huge differences in this giant country, and foreigners too easily think it's just Manhattan and LA, from watching TV.
But I would say the ~50 countries of Europe is an order of magnitude more diverse than the 50 US states.
Some Americans throw around "in Europe they do X" statements, which usually just mean they observed that in the 1-3 cities they visited.
2. Similarly, unbroken families aren't profitable, but split up ones are: divorce proceedings, 2x apartments/houses/taxes, higher dependency on the state for assistance, no family to help through issues which may beget drugs (see #1).
A politician that bans or regulates sugar is not going to be popular. People want their sweets, or at least the option to have sweets. So what is the medical system to do if it can’t modify the food environment? It generates drugs that treat the diseases caused by the food environment. Similar with mental health.
There are society-wide environmental factors likely contributing to huge rates of depression and anxiety, but how is any one person or organization supposed to change that? So what does the medical system do? It generates drugs to treat the mental health conditions caused by environmental factors.
It’s a bad equilibrium but it’s hard to see a path out. Otherwise if you decide drugs are bad you have still have the environmental causes there and a bunch of untreated diabetes and suicidal people.
The list of countries with high antidepressant consumption is topped by Iceland, Australia, Portugal, UK, Canada and Sweden. All countries with a high quality of life, good safety nets, universal healthcare. Australia, Sweden and Iceland are exemplary progressive countries that are in the top 10 of the Human Development Index.
The funny thing is that the reason Americans know the names of their medications is almost the exact same reason people seem to think the USA are always some sort of outlier; they hear about it more in the media! Branding for drugs is much more emphasized in the US.
While at the same time despite being a controlled substance because they're supposedly so addictive people with ADHD forget to take adderall and with normal use you don't take it every day.
We got this this shit so unbelievably backwards because we haven't shook the puritanical bullshit of "oh no someone might experience euphoria if they go out of their way to abuse it." Like bro, people with real medical issues shouldn't suffer because of this crap. If everyone who is buying cocaine from their dealer switched to medically supervised stimulants we would be unquestionably better off.
This is incorrect: Normal use of stimulant medication is to take it regularly every day.
We also have evidence from studies showing that the brain adapts to consistent dosing in order to counter some of the damaging oxidative effects of amphetamine. Inconsistent dosing could undermine this adaptation and does not mirror the dosing protocol used in studies to determine long term safety. Sporadic dosing is also known to cause sensitization effects in studies, which can sensitize people to the negative side effects of a drug or exaggerate cravings.
Some people do take medication holidays as recommended by doctors, but even those should be done on a pre-determined schedule.
People get themselves into trouble when they start treating Adderall like an ad-hoc drug that they can take more or less of depending on how they feel that day or how much work they need to get done. This not only leaves the brain in a constant and unpredictable state of flux, it creates an association between “I need to do work” and “I need more Adderall”. Patients who go down this path often end up escalating doses, playing games with saving up pills to take more, or trying to talk their prescribers into extra dosages beyond what they need. It ultimately ends with higher tolerance and reduce effectiveness.
> If you don't refill your Rx of antidepressants your doctor will be notified and reach out to you because stopping has such pronounced effects.
This also isn’t true. There are many medications with withdrawal symptoms far worse than antidepressants. Some drugs can be potentially fatal if discontinued abruptly. Pharmacies don’t generally hunt down doctors when a patient doesn’t get a refill.
Antidepressant withdrawal (without taper) can be difficult for some, but so can withdrawing from Adderall. There are entire subreddits acting as support groups for people tapering down Adderall and trying to get back to feeling normal after taking Adderall for years.
Stimulants are definitely habit-forming and have a high abuse potential. Let’s not downplay it.
Yeah, that doesn't really track with the fact that non-extended release lasts about 6 hours and extended release lasts about 8. Every single doctor I have ever been to has told me to take it as needed and try to not take it if possible so I don't form a habit and build a tolerance. Doing this I've managed to stay on the same exact dose for years. I would be willing to chalk it up to doctor doing it wrong but I see people whose job is specifically to oversee ADHD patients' medication and they say the same thing.
It's technically possible to be under it's effects for your entire waking hours and overlap to smooth the comedown in the middle but it's never prescribed this way so you'll always be in a state of flux.
> and does not mirror the dosing protocol used in studies to determine long term safety [...] it creates an association between “I need to do work” and “I need more Adderall”
Both of these are absolutely true which is why the studies are silly since nobody takes stimulants this way. And I absolutely have that association but it leads me to take less not more. If I want to spend the day hyperfixating on a new video game I can and just skip it. I can wait until understimulation and executive dysfunction actually impacts me.
I know it's not what you mean but I still think "this medication is incredibly habit forming so make sure to take it habitually" is really funny.
> Pharmacies don’t generally hunt down doctors when a patient doesn’t get a refill.
It was my insurance company actually. They called my doctor to see if I was supposed to still be taking it, told him to reach out, and then called me and sent a whole informational pamphlet about why it's important to take it regularly.
But I also personally think that adderall has less side effects and better/smoother withdrawals. SSRIs and other antidepressants usually have a heavier impact on the brain too.
Now I don't doubt that Adderall is probably over prescribed, but I think that it is better to look at entire families of drugs to compensate for differences between markets.
[0]: https://www.health.harvard.edu/medications/do-not-get-sold-o...
There hasnt been advertising for them for a long tkmr.
The reason for the US being close to them could be the high prescription culture and the social aggression inherent in everyday US life, masked behind curteous words, customer-oriented interaction and polished looks.
Seasonal Affective Disorder also occurs in the United States. Much of the US population lives in areas with significantly shorter days in the winter.
And Seattle is sort of cherry-picked -- it's one of the northern-most cities in the continental US, representing 1.2% of the US population (including the full metro area). LA sees 9.75 hours of daylight on the solstice. Honolulu sees 10.75 hours.
The US population-weighted centroid is approximately Missouri[1], which sees 9.5 hours of daylight on the solstice -- more than 50% more than Stockholm.
[1]: https://oceanservice.noaa.gov/news/mar22/center-population.h...
Sunshine is what helps alleviate seasonal affective disorder.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258674/ [2] https://blogs.worldbank.org/endpovertyinsouthasia/stressed-a...
(Funny though that you actually say that everyday life is masked behind courteous words in the US, which is one of the those widespread stereotypes about... Scandinavia and nordic countries in general.)
What was that about Swedes not even sharing meals with visitors, and eating in front of them while the visitor sits at the dinner table looking at them eat? Or Denmark kicking out all of their syrian refugees after they have lived there for years, kids included, to send them back to a warzone? See that explains the antidepressant intake!
Except they are but they are just ignored because of lack of knowledge and money. Many countries don't even recognize ADHD so the kid never goes to college and doesn't reach their full potential.
Yes but don't confuse short term use of medication to help with therapy with long-term to help sell pills.
The first can be beneficial, the latter is very profitable. And because of the profit motive, millions of poor people with serious conditions go untreated.
What is really bad is the complete absence of any public debate about prevention. Individuals are completely blamed for mental health issues and society gets a pass.
> and are constantly challenged about their self-identification.
Huh? What are you talking about??
And, sure, argue that ADHD’s mere categorisation as a ‘bad thing’ is a reflection of society’s expectations of a person. But…so what? I’d love a socialist utopia. This is a big part of the reason I’d never ever move to the US in the first place. But I damn well still take my Vyvanse and don’t look down on anyone else that does so because we are all still cogs, even me as a fairly privileged tech worker.
Stroking your chin and saying “yeah, but we live in a society!” belongs right at the top of the metaphorical food pyramid. If you do it any more than rarely, you’re going to quite rightfully come across as a privileged dick.
This is notwithstanding the wider point that this whole thing is about using MDMA as a short-term therapy aid.
Humans are innately horrible.
Freedom also means freedom to be horrible.
Unfortunately.
You're even more pessimistic than me ;-). I think that most humans are good or at least neutral, but the horrible ones are a lot more visible. And a lot of what we call horrible is just rhetoric -- when the shit hits the fan, people pull together, even when they're ideologically opposed. At least in my experience. There are outliers, of course.
mountain remains mountain regardless
'actually drugs are good now. Just give us your credit card and insurance info and step right this way'. Fuck off. Do drugs in the woods and sort your shit out like we've been doing for thousands of years. Get out of here nerd.
But I've also met a few folks that have been deeply traumatized by bad trips - one particularly painful example is someone who saw a friend he loved fall to her death whilst tripping on shrooms.
Responsible tripping is important. There's a reason trip-sitters, good setting, etc are generally recommended.
and the last bit 'get out of here nerd' was really uncalled for. You make yourself look... ungentlemanly at best. I'd go as far as saying you just made yourself seem like an absolute twat, but I'm sure you're a kind person deep down and maybe you're just upset by 'the man' co-opting your edgy lifestyle choices like a hipster upset by his/her favorite band becoming popular and this is how you express that :3
If this helps people heal their trauma and have nicer lives, I think we should support, not everyone can be cool kids with easy access to drugs like us ;)
I like mushrooms. I enjoy them recreationally a few times a year. I think there are benefits to be derived from their use. I think I've derived some of those benefits. But I also think, sometimes, it's just fucking fun to be high at a concert, and I don't think there's anything wrong with doing that in a responsible and safe manner.
I want to see us move in a less prohibition direction, and I think that legalizing psychedelics for therapy could be a boon for many people. But I would also like to live in a world where I can be trusted to consume an occasional dose of a non-addictive, naturally occurring substance without the whole thing being medicalized, regulated, and only allowed to happen with the guidance of a psychiatrist.
I sort of like the approach Ann Arbor took, where they're not illegal for personal possession and cultivation, but also not legal for sale. Seems like a decent balance for personal responsibility to me.
I truly understand the fear and caution around these substances. They require serious forethought and care to be used safely. But at the end of the day, I know I'm more than capable of that forethought and care and resent being told that I'm not allowed to grow a mushroom because psychedelics are scary.
Citations sorely needed. The only paper I’ve seen make neurotoxicity claims was retracted long ago[1].