AMA on Wed 6/10/20: Drug Science (leading independent scientific body on drugs) Clinical Lead

We are excited to announce that Dr. Chloe Sakal, the Clinical Lead for Project Twenty21 of Drug Science, will be joining us for an AMA on Wed Jun 10 from 12-1pm PT.

Drug Science is the leading independent scientific body on drugs in the UK. They work to provide clear, evidence-based information without political or commercial interference. Project Twenty21 is committed to scientific excellence and the development of independent scientific evidence. Founded in 2010 by Professor David Nutt following his removal from his post as Chair of the Advisory Council on the Misuse of Drugs, Drug Science is the only completely independent, science-led drugs charity, uniquely bringing together leading drugs experts from a wide range of specialisms to carry out groundbreaking research into drug harms and effects.

Dr. Chloe Sakal, Clinical Lead


Having gained a BSc in neuroscience, Dr Chloe Sakal went on to study medicine and qualify as a psychiatrist, working in a variety of community and inpatient settings with particular attention to substance misuse. She has a keen interest in the psychopharmacology and the potential for the therapeutic use of psychedelic drugs in treating a wide range of psychiatric disorders. She is a study doctor for the UKs first MDMA-assisted psychotherapy trial looking at the safety and tolerability of its use in the treatment of alcoholism. Alongside this, she also campaigns for and provides progressive harm reduction strategies for recreational drug use, including work within drug testing services in Bristol and at festivals.

Dr. Sakal also hosts a youtube channel called Psychiachix.

Topics Dr. Sakal can speak to:

  1. Medical cannabis
  2. Study of MDMA and psilocybin in clinical trials and psychedelic medicine more broadly
  3. Drug policy
  4. Drug harm reduction practices

Format: please post your questions before and during the event and Dr. Sakal will answer on the forum!

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what do you think the U.S. and UK can learn from each other when it comes to drug policy, research, etc. for psychedelic medicine?

thank you for being here!

Thank you for doing this
I see you are studying MDMA-assisted psychotherapy for the treatment of alcoholism. MAPS is obviously studying it for PTSD but also has a few other indications it has expressed interest in.
How do you (and others in the industry) choose indications for each of these psychedelic compounds? Intuitively it makes sense each of them could help with a variety of indications, e.g. if it helps with alcoholism I imagine it could also be useful for quitting tobacco or opioid use disorder. How do you choose the most promising one to go after, and what factors do you and others weigh in choosing the indication?

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Hello!

I recently suffered from a comedown caused by half a pill of untested street ecstasy (first time trying the drug). I understand that this is not the same as proved real MDMA in a clinical setting. In retrospect, I personally believe that my symptoms were significantly worsened and prolonged by illness anxiety disorder (no official diagnosis) surrounding the thought of having caused myself some permanent brain damage. I have since recently recovered from these mental health problems (which lasted for about a month).

As someone who has obsessively read countless MDMA studies, I have noticed that there are very few studies out there that have looked at long term outcomes of MDMA use (and many studies seem to suffer from alarmist interpretation of results, small sample sizes, mismatched control groups, unexplored possible causal factors and other flaws).

Are you planning on following up on the participants after something like 6 - 12 months for example? I think this is somewhat important, both from the perspective of treatment effectiveness and evaluating potential long term negative consequences. Will you test the cognition of participants? Will there be brain imaging?

Thank you for this AMA, and good luck with the study! MDMA in a clinical setting does seem very promising. Because of personal history I am now scared of MDMA, but for the same reason interested in the research. I’m still personally interested in trying a low dose of psilocybin mushrooms some day.

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I am interested in MDMA and psychedelic assisted therapy treatment. Do you have any referrals for where to find therapists doing this work?

What questions should I be asking the therapist or clinical trial team before engaging in this type of therapy with them?

Also, I know that MDMA depletes a person’s serotonin. Given this, how do you treat depression with MDMA in a clinical setting? Do you wait a certain amount of time between MDMA treatment sessions so the serotonin builds back up? Do you give antidepressants? Is there extra talk therapy support right after an MDMA session to mitigate depression that can follow the MDMA come down?

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What do harm reduction strategies look like at festivals? so curious about what that involves

Thanks so much for doing this! I have a few questions.

  • My partner and I have had huge breakthroughs using MDMA to treat our intimacy struggles. We write intentions before our sessions, talk openly without defensiveness while under the influence of the MDMA, and integrate afterwards with each other and journal as well to help integrate. Of course we test the MDMA and have based our dosages off of MAPS protocols. Are there any studies on using MDMA for couple’s therapy? Could studies happen in the near future or is that super far out considering couples therapy isn’t as “acute” (that may be the wrong word) as PTSD, depression, etc.?

  • Does MAPS and Drug Science conduct MDMA sessions with patients with such little time between sessions because they assume patients are never going to take MDMA again after they are treated?

  • Is their actual scientific evidence that taking MDMA recreationally too often (not waiting 2-3 months between each dose) is harmful for the brain or leads to “losing the magic?” Or is it all anecdotal evidence at this point?

Could you please give an unbiased overview of the studies around addiction and physical dependence for psychedelics and related compounds (cannabis, MDMA, psilocybin, ketamine, LSD, etc.)? Is there good data on these, and how do they compare to the addictive nature of something like alcohol?

Thank you!

Similar to some questions that @pornsandwich69 and @cyberpunkvalues and @jwrld asked above, could you please go over what scientists and doctors know about long-term use of other substances? Specifically around cognition, memory, etc.
Others asked about MDMA above, but also cannabis, psilocybin, other psychedelics
thanks :slight_smile:

How do you see the opioid epidemic in the US affecting the psychedelics movement?

Also just curious, have there been issues with opioids in other countries as well, or is it a big problem mainly in the US (perhaps given our medical system overrelying on reactive, pharmacologic-focused treatments)

Also, how does the cannabis movement in the US over the past few years affected the psychedelics movement? What similarities and differences do you expect here

Thank you!

what can we in the psychedelic medicine movement learn from the medical cannabis movement?

Excited to be here! I’ve answered some questions over video and will answer the remaining via written response. Thank you for having me!

Also, I host a youtube channel called Psychiachix if you want to check it out :slight_smile:

Hi!

Psychedelic-assisted therapy is currently illegal in most countries, unless it is within the framework of a clinical study. The Maps website is a great resource listing clinical studies currently recruiting participants: https://maps.org/participate/participate-in-research

There are a few exceptions to this in countries where ‘psychedelic wellness retreats’ are indeed legal (but are not classed as a medical treatment), e.g. Synthesis retreat in Amsterdam (https://www.synthesisretreat.com/).

Both will have a pre-assessment process and specific eligibility criteria to ensure this is a suitable and safe option for you as an individual. It is important you feel safe and are able to trust the clinical/therapy team - any reputable provider should be happy and willing to answer ANY questions you have, about the process from start to finish, including follow-up/aftercare.

Clinical studies will indeed provide psychological support after the drug-assisted sessions (this may be missing if you were to access this treatment underground). Initial data suggests clinical MDMA does NOT result in a drop in mood (perhaps conflicting with anecdotal reports of street ecstasy use); the serotonin depletion theory is also somewhat contentious. There is a four week gap between drug-assisted sessions, with psychological support before, after, and in the interim. Traditional anti-depressants are stopped prior to commencing drug-assisted therapy as they can interact with MDMA, often attenuating the effects of MDMA, and running the risk of ‘serotonin syndrome’ if used in combination.

Thanks for the question and all the best!

Hi!

I’m not currently aware of any studies looking at MDMA-assisted therapy for couples, however it was certainly used for this purpose prior to illegalisation. It’s hard to predict how future licensing will look from country to country, but I can certainly see a place for this.

As far as I’m aware, there is little evidence that MDMA use leads to dependence or compulsive use (unlike substances such as opiates or benzodiazepines), so considerations regarding ongoing harmful usage aren’t as pressing.

There’s evidence in animal studies that MDMA can be neurotoxic (e.g. harmful to the brain), although the dosage in such studies far exceeds that in human studies when correcting for weight, so should not be generalised to humans. The full data set of this particular MDMA study is yet to be analyzed and published, although I’m not aware that there was evidence of tolerance (e.g. reduced effects at the second MDMA-assisted therapy session).

Thanks for the question and all the best!

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