MDMA Report Preface by Professor David Nutt

I am delighted to be asked to provide a preface to this important policy document
as MDMA has been concern of mine since the early 1990s when I was first asked
to help advise the UK government on how to mitigate its harms. At the time I
had recently returned from the USA and still cherished the belief that UK drugs
policy was more evidence-based than that in the USA. Initially the discussions
about MDMA were sensible, with our policy recommendations of education,
and chill out rooms plus free water in clubs being instigated – and effective.

However a few years later when I accepted to take on the chair of the
scientific committee of the ACMD I found that things had deteriorated. When
I tried to instigate a sensible discussion about whether the harms of MDMA
really warranted Class A, Schedule 1, status I was confronted with statements
such as “I would never support a downgrade of MDMA classification” “it would
give the wrong message”. Still I persevered and instigated a new structured harms
assessment process that clearly showed MDMA was more like amfetamine
sulphate [Class B] than crack cocaine [Class A] in terms of harms. But the
Home Office were resistant and refused to allow the ACMD to do a formal
review of MDMA.

Eventually a few years years later, after being admonished by the
parliamentary Science and Technology committee, the Home Office allowed
us to review MDMA, though at the hearing the Drug Minister made it very
clear that they would not downgrade MDMA whatever findings our review
came up with.

To help make politicians and the public make sense of this impasse I wrote
a thought piece – that was to become my most cited paper with over 7000
downloads. The paper was entitled Equasy – a harmful addiction with implications
for the current debate on drug harms. In it I compared the harms of ecstasy
[MDMA] with those of another addiction I called equasy [equine addiction
syndrome]. The latter idea had come to me as a result of seeing a patient who had
suffered significant brain damage from falling from a horse and was developed
when speaking about comparative harms of different activities at a Beckley
Foundation event at the House of Lord’s the year before. As most of you will
know I concluded that MDMA was less harmful than horse riding especially
when the latter involves jumping and eventing.

I hoped that this comparative analysis would help politicians become more
reasonable about MDMA but the opposite happened. The Home Secretary
at the time was Jacqui Smith who reacted very aggressively, calling me up and
shouting down the phone that I had exceeded my position as ACMD Chair
by comparing a legal activity with an illegal one. I tried to explain that we had
to have some harmful activities with which to compare the harms of drugs
in order to decide if a drug was harmful enough to be banned; but she just
couldn’t [or wouldn’t] get it. She showed the same level of intransigence when
the ACMD report came out recommending downgrading MDMA to Class
B and this suggestion was summarily dismissed. So MDMA stayed as a Class
A drug, and the effective ban on research that its Scheduling in the 1980s had
resulted in, persisted.

But there is now light at the end of the tunnel. Research on the brain
mechanisms of MDMA conducted by our group funded by Channel 4 opened
up people’s eyes to the science of MDMA and the pioneering work by MAPS
demonstrating its utility in treatment-resistant PTSD has helped to change
public attitudes. Also the hostile pseudo-scientific claims that MDMA use
damaged the brain have been overturned by more recent better controlled
scientific analyses. Now I give a lecture on MDMA with the title “A decade of
MDMA – from brain damage to brain healing” which emphasises the complete
volte face that has occurred as a result of many research teams around the world.
In this report you will discover the most recent one by Ben Sessa and others
in our Unit showing how two MDMA treatments given as part of an alcohol
treatment programme can help people with PTSD overcome their alcohol
dependence. I believe that this is just the start of a major breakthrough in the
use of MDMA therapy that will occur if it gets re-scheduled as per this report.
Thanks must go to the Beckley Foundation for leading this vital campaign.

Prof David Nutt DM FRCP FRCPsych FMedSci DLaws
Former of the Advisory Council of Misuse of Drugs
Edmond J. Safra Prof of Neuropsychopharmacology
Imperial College London
November 2019