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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Monday 3rd October 2011

I’ve written before Thursday 21st July about the difficulties many people experience in getting adequate pain medication as a result of the prohibition on substances derived from Papaver somniferum, opium poppy, such as morphine, heroin and codeine.

Now comes news of a different way in which the prohibition of certain substances can limit the advance of medical science. This time the substance is not plant derived but, I think, the issues raised are important enough to include here.

3,4-methylenedioxymethamphetamine (MDMA) is the active ingredient that should be found in ecstasy tablets. I say ‘should be’ because manufacturers of these tablets, being outside the law, have no controls on them as to what ingredients they use. The most extreme example of this lack of manufacturing control came early last year when police in Hampshire had to release two men who had been found with over 1,000 ‘tabs of E’ on their way to a town centre after tests found no MDMA to be present in the pills.

MDMA in its pure state has, however, attracted some attention from mainstream medicine. In the USA, Dr Michael Mithoefer, a psychiatrist who practices in Charleston, South Carolina, conducted a small trial using MDMA for patients suffering post-traumatic stress disorder (PTSD). In July 2010, the Journal of Psychopharmacology reported the results of this very small trial. Only 20 subjects took part with 12 receiving MDMA and 8 receiving placebo. The trial involved the subjects having sessions with a psychiatrist after taking MDMA.

All the subjects had been suffering PTSD for long periods and previous treatments had not helped. The trial seemed to show that people become more trusting under the influence of MDMA and, in that state, are better able to share their trauma with their therapist and, thus, achieve a substantial benefit. Even with such a small trial, the difference in outcome between subjects receiving MDMA and those on placebo was found to be statistically significant.

In the development of healthcare, the stage after a small trial of this sort is to conduct further studies yourself, which Dr. Mithoefer intends to do by focussing on military veterans, and to have somebody else undertake a trial, hopefully with more subjects, to see if the results can be replicated. But that is where the legal status of MDMA becomes a problem.

Professor David Nutt, who established the Independent Scientific Committee on Drugs (ISCD) after he was forced out of the Advisory Committee on the Misuse of Drugs (ACMD), is working with Taunton-based psychiatrist Dr Ben Sessa to present an application for permission to use MDMA in a trial. Where the proposed trial differs from the American work is that it is intended to use brain-imaging to see what activity the MDMA is producing and how this differs from the placebo.

You would think that getting permission for such a trial would be just a formality requiring the applicant to demonstrate how the MDMA would be obtained, how the amount produced would be monitored and how its use would be restricted to trial subjects. But Professor Nutt, who has a great deal of experience of dealing with the politics of controlled substances fears that sections of the media would present their usual distorted reports to create a public outcry against any medical use of MDMA even in a carefully controlled trial.

I think Nutt may well be right. The continued prohibition of substances under the Misuse of Drugs Act relies on the public perception remaining as drugs = bad. Even the use of opiate medications for legitimate medical purposes has to preserve this perception. Doctors would never talk about using heroin for pain relief. It is always known as diamorphine.

Any indication that MDMA might have benefits if properly used would risk damaging public confidence in the prohibition argument and that might be enough to prevent any trials of its therapeutic possibilities. And that could mean more innocent people continuing to suffer from PTSD.

Perhaps, Nutt and Sessa should follow Dr. Mithoefer’s lead and use only ex-servicemen in their trial. It would be harder for the likes of the Daily Mail to object if the trial was aimed at helping ‘our brave heroes’.