The Multidisciplinary Association for Psychedelic Studies (MAPS) hosted the first-ever MDMA Therapy Training for Communities of Color between August 10-17 in Louisville, Kentucky. It was designed for mental health professionals who work primarily with people of color and in marginalized communities.
MDMA is a psychedelic, and the active ingredient in the recreational drugs known as “molly” or “ecstasy.” It has also shown excellent therapeutic value for conditions such as alcohol use disorder and post-traumatic stress disorder, and MAPS is currently conducting FDA Phase III clinical trials of MDMA-assisted psychotherapy for PTSD.
The eight-day event consisted of an opening workshop followed by a six-day MDMA therapist training.
“It’s as if it opens a magic portal in their minds.”
“We’re changing the landscape of who is able and available to offer this treatment,” Dr. Monnica T. Williams, a clinical psychologist, told Filter. She led the training along with Marcela Ot’alora, a counselor. “Up until this point it’s been almost exclusively white people researching MDMA, so there’s been very few who have taken this treatment to communities of color. We hope that increasing the diversity of the therapists will increase the diversity of those receiving the therapy.”
Attendees came from all over the country and included both licensed therapists and people finishing their education. MAPS provided financial assistance for some, and the event was funded in part by the Open Society Foundations and other foundations and private donors.
“It can take clients years to have the kind of transformation they can have in two or three sessions of MDMA psychotherapy,” said Dr. NiCole T. Buchanan, an associate professor at Michigan State University, who completed the training. “It’s as if it opens a magic portal in their minds. It allows them to process and put away the trauma as something they don’t need to be constantly worried about.”
Training participants relax by the river. Photo courtesy of Ismail Ali.
The Barriers to Accessing MDMA Therapy
Therapists seeking to provide MDMA therapy in a research setting have to complete a five-part program, including online courses, an apprenticeship and supervised work. The training provided by MAPS did not involve working directly with patients, but satisfied the training retreat element of the required program.
“Dr. Williams estimated that overall treatment costs ranged from $12,000-20,000.”
Besides the under-representation of people of color among providers and patients, there are also financial barriers to patients accessing legal MDMA therapy. The protocol requires two licensed therapists, about 20 psychotherapy sessions and possible overnight hospital stays; Dr. Williams estimated in 2018 that overall treatment costs ranged from $12,000-20,000.
One remedy MAPS has proposed is to allow one of the therapist team members to be a non-licensed student completing their education. “The FDA isn’t happy about that idea, and they want both therapists to be licensed,” Williams said. “But that would make the costs prohibitive to all but the wealthiest patients, which is not our goal.”
Currently, qualified therapists would need to work at a MAPS research site to provide this treatment. But they may soon be able to offer it independently, via the FDA’s Expanded Access program. This program allows healthcare providers to offer a medication not yet approved for market but recognized as beneficial by the FDA.
“We’re still waiting on the FDA to approve MDMA through Expanded Access,” said Williams, who is trying to pursue this route at her practice in Connecticut. “No one has been able to move forward with that, though we’re all ready to go. It seems they want to start with a small number of clinics and patients at first to ensure safety.”
A growing chorus has highlighted the severe under-representation of people of color in MDMA research—and psychedelic research overall. Williams was the principal investigator on the first and only MDMA clinical study focused on people of color and other minority populations. Her study at the University of Connecticut (UConn) ran throughout 2018. It was discontinued before reaching the randomized, placebo-controlled stage due to conflicts between the research team and university.
The Consequences of Exclusion
Dr. Williams’ work has emphasized the unique challenges of involving people of color in psychedelic therapy. This includes combatting racial stigmas of the War on Drugs, a white male-centric approach to the treatment, and systemic barriers to healthcare access in minority communities.
“We have enough anecdotal evidence to know this treatment will be equally effective for people of color,” said Dr. Buchanan. “But the fact that so little research has centered on these populations is unacceptable. And the basic study protocol itself has not been adjusted much to be culturally sensitive or responsive.”
Buchanan explained how researchers like Williams modified different aspects of the therapy—including language in the informed consent documents, the physical layout of the patient room and even music played during therapy—in an effort to make it more welcoming for people from diverse backgrounds.
Filter has reported previously on the disappointing demographics of ongoing MDMA research. Only two principle investigators across 14 MDMA study sites worldwide in 2017 were women of color. Among study participants, white and Asian people were over-represented relative to the general population, while Black and Latinox people were under-represented.
Williams has shown that these trends exist right across psychedelic research. In a 2018 24-year literature review of psychedelic research, she and her co-authors showed that participants in psychedelic studies were overwhelmingly white (82.3 percent).
And without understanding the specific concerns and needs of people of color, psychedelic research findings will be skewed. “The conceptualization of psychopathologies rarely include important cultural considerations such as the importance of including race-based trauma when recruiting participants of color for MDMA-assisted psychotherapy for PTSD,” the authors wrote.
Diversity Essential as a Movement Gains Steam
The recent MDMA training comes at a unique time for the psychedelic movement. By MAPS’ own estimates, MDMA will be a federally-approved medical treatment by the end of 2021. The FDA has already approved psychedelic-derived medications such as Epidiolex (from cannabis, which is sometimes considered a psychedelic) and Spravato (from ketamine). It is therefore a critical moment for psychedelic practitioners and activists to remove financial, social or cultural barriers to these treatments.
“We have to go above and beyond if we want to create environments where people of color will come forward for research trials.”
“What we’ve been doing is talking to people in our communities and through forums to educate and dispel some of their concerns,” Dr. Buchanan said. “We do this work now so by the time this is an open-label treatment, our communities have already been saturated with information about the safety and impact of these medications. And we want them to be familiar that there are people who look like them who will be guiding this work for them, whom they already have a level of trust with.”
MAPS executive director and founder Rick Doblin with two of the training participants. Photo courtesy of Dr. Monica Williams.
With political progress on psychedelic research only inching forward, psychedelic activists must not wait for the government to ensure people of color and low-income people have access to these treatments, but instead take the initiative.
“There is a long legacy of people of color being used as guinea pigs and being mistreated in medical research,” Buchanan said. “We have to go above and beyond if we want to create environments where people of color will come forward for research trials. Especially when we’re talking about a drug that’s so highly stigmatized in these communities.”
The top photo shows participants at MAPS’ MDMA therapy training, courtesy of Dr. NiCole Buchanan.