I don't think it's going to replace ADHD medication whatsoever. How would that even work?
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.)
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.