Dr. Julie Holland on MDMA-Assisted Psychotherapy

When a therapist wants to stretch the session out a bit, there's the option of a booster, usually half of the 125 milligram dose, which keeps the plateau going. Going past one booster isn't something most people advise. Push the experience much further than that and the reports tend to turn unpleasant, with more dysphoria creeping in.

Erik asked Dr. Holland where she sees MDMA heading, and whether it might eventually land in the pharmacy as a prescription drug. Her answer started with the paperwork. The real bottleneck, she said, is that MDMA currently sits in Schedule I alongside heroin, LSD and cannabis. She called the way the United States classifies drugs scientifically off base. Alcohol and cigarettes would both tick the boxes for Schedule I, yet neither is scheduled at all. Meanwhile medicinal plants and a compound with genuine therapeutic promise like MDMA get parked in Schedule I, when Schedule II or III would be a better fit.

That classification matters for practical reasons. Research on a Schedule I substance is painfully difficult to carry out, and prescribing it or running any kind of outpatient MDMA-assisted therapy is simply off the table while it stays there. So the scheduling has to move before anything else can follow.

Even then, she was clear about what this would not look like. Nobody is going to pick up a bottle at the drugstore and dose themselves at home the way they might with Prozac or Zoloft. The whole point is to fold MDMA into psychotherapy, with clinicians who know how to do the therapy and who understand the altered state the drug produces. Whether that happens in a dedicated clinic, some outpatient arrangement, or another format entirely is still an open question. What she felt confident saying is that it will have to be closely regulated. First principle: do no harm, with patient safety at the top of the list. Right behind that comes efficacy. You want the treatment to be both safe and actually effective.

Erik wanted to know what kind of outcomes people are seeing, and whether the shifts in their trauma tend to stick. Dr. Holland pointed to the numbers. Roughly 80 percent of patients who complete the Mithoefer protocol see their PTSD symptoms drop so sharply that they no longer meet the diagnostic criteria. Put another way, if those same people tried to enroll in the study after finishing it, they wouldn't be accepted, because the severe symptoms that would have qualified them are gone.