MDMA is not a viable option for people with autism

Toxicity and regrowth of serotonergic neurons after a single dose of MDMA in monkeys
Toxicity and regrowth of serotonergic neurons after a single dose of MDMA in monkeys

The autism community is constantly bombarded with potential treatments, cures, and other claims for products that have no scientific evidence. Even worse, some of these products are known to be harmful and there have been reports of deaths after such treatments, like chelation. Unfortunately, another one of these non-evidence-based, potentially-harmful compounds, has made its way into the mainstream media, potentially confusing families and individuals with autism about the promise or potential of such treatments.

In March, investigators at the Los Angeles Biomedical Research Institute in California published the rationale and methodology for a new study investigating the effectiveness of MDMA or 3,4-methylenedioxymethamphetamine for the treatment of social anxiety in adults with autism.1 This drug has shown some promise for the treatment of post-traumatic-stress disorder. This recent publication, which presented no data, went mostly unnoticed or ignored in the scientific community until the mainstream media picked up on the idea and it has since ended up in the newsfeed. MDMA is the main ingredient in the drug commonly known as Ecstacy or Molly, which was added to the DEA Controlled Schedule list in 1985. The authors claim it is safer because in the pure form because it does not include any additives or fillers that may be included in the street form of the drug. However, this theory has a problem.

One important point that the authors of this publication completely failed to mention is the potent neurotoxicity of MDMA.  This scientific fact is in stark contrast to the image the authors portray of it being a benign substance which opens the mind and promotes closeness. It is a form of amphetamine which has been proven to cause long lasting loss of neurons for serotonin in the cortex of animals exposed to MDMA2. As these animals age, some of the neurons start to grow back, but with shorter or absent dendritic spines3.   In humans, MDMA exposure produces a similar pattern of neurotoxicity and leads to cognitive problems, sleep issues, and psychiatric issues.4-6   MDMA also induces an increase in body temperature, and has shown to be toxic on cardiac and liver tissues.7,8 According to scientific evidence a less-pure form of Ecstacy may actually be safer than the pure unaltered compound. Therefore, the claim that the version given in this study is ‘safer’ is misleading.

There is no known safe dose in humans. In fact, in non-human primates, one dose was sufficient to produce long lasting deficits in serotonergic functioning.9 Serotonin is associated with mood, emotion, and cognitive ability, so it is not really a surprise that MDMA use causes deficits in these areas of behavior. Evidence using post-mortem brain tissue shows that people with autism have neurons that are already disorganized, misplaced, and irregularly shaped10.  Therefore, giving this compound to individuals with ASD may be especially dangerous.

For those who were intrigued by this news story, concentrate on safe, non-toxic, evidence-based interventions. While the study received IRB approval, this is a dangerous compound that should be avoided. To see a comprehensive list of evidence and non-evidence based treatments, please go to our website. The autism community deserves better than to have money wasted on a study using a drug that is known to be toxic and in some cases, lethal.

  1. Danforth AL, Struble CM, Yazar-Klosinski B, Grob CS. MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults. Progress in neuro-psychopharmacology & biological psychiatry. Mar 25 2015.
  2. Sarkar S, Schmued L. Neurotoxicity of ecstasy (MDMA): an overview. Current pharmaceutical biotechnology. Aug 2010;11(5):460-469.
  3. Williams MT, Skelton MR, Longacre ID, et al. Neuronal reorganization in adult rats neonatally exposed to (+/-)-3,4-methylenedioxymethamphetamine. Toxicology reports. 2014;1:699-706.
  4. Parrott AC. Human psychobiology of MDMA or ‘Ecstasy’: an overview of 25 years of empirical research. Human psychopharmacology. Jul 2013;28(4):289-307.
  5. Benningfield MM, Cowan RL. Brain serotonin function in MDMA (ecstasy) users: evidence for persisting neurotoxicity. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. Jan 2013;38(1):253-255.
  6. Gerra G, Zaimovic A, Ferri M, et al. Long-lasting effects of (+/-)3,4-methylenedioxymethamphetamine (ecstasy) on serotonin system function in humans. Biological psychiatry. Jan 15 2000;47(2):127-136.
  7. Turillazzi E, Riezzo I, Neri M, Bello S, Fineschi V. MDMA toxicity and pathological consequences: a review about experimental data and autopsy findings. Current pharmaceutical biotechnology. Aug 2010;11(5):500-509.
  8. Baumann MH, Rothman RB. Neural and cardiac toxicities associated with 3,4-methylenedioxymethamphetamine (MDMA). International review of neurobiology. 2009;88:257-296.
  9. Mueller M, Yuan J, McCann UD, Hatzidimitriou G, Ricaurte GA. Single oral doses of (+/-) 3,4-methylenedioxymethamphetamine (‘Ecstasy’) produce lasting serotonergic deficits in non-human primates: relationship to plasma drug and metabolite concentrations. The international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum. May 2013;16(4):791-801.
  10. Hutsler JJ, Zhang H. Increased dendritic spine densities on cortical projection neurons in autism spectrum disorders. Brain research. Jan 14 2010;1309:83-94.

20 Replies to “MDMA is not a viable option for people with autism”

  1. Very disappointed. The literature is full of these scare stories, which fail to translate into any actual behavioural differences in the users.
    The rest of the world is actually happy about this news.
    Perhaps the patent has expired?

  2. what IQ do you guys have?. long-term ABUSE of MDMA may cause damage…

    They want to treat people with AUTISM with MDMA only in a few sessions. there will be no damage caused. you think MDMA causes damage? what do the SSRI’s do?… if anything , a lot worse.

  3. Empathogens and psychedelics both have very interesting characteristics for treating people with Autism. While it is not the most interesting empathogen available (Methylone is far more promising as a pure empathogen) nor the most interesting psychedelic (LSD is far more promising as a pure psychedelic), what’s interesting about MDMA is that it’s an intermediate between both categories and thus contains characteristics of both.

  4. Actually there is scientific data backing mdma use to treat the social anxieties that come with autism. This ‘blog’ should get its facts straight.

  5. 1. Animals in studies were exposed to unsafe doses of MDMA. No human in any trial would take dosages of such intensity and such frequency.
    2. Toxicity has been studied in humans in non-laboratory conditions. MDMA trials with humans for autism, PTSD, etc. are conducted by professionals who provide adequate care and medication after therapy, which counteract any toxic effects MDMA might have.

    The autism community deserved better than to have research hampered by fear-mongering.

    1. It’s been a while since I visited this thread. I really appreciate the level of rational discussion and specific data here. Thank you.

  6. Have you seen the ongoing FDA approved studies for using MDMA to assist in treating PTSD? The first phase of the study showed that the drug was safe for humans, at least in the amounts used in the study. Of course it can be lethal, any substance can if you can take enough. But it can also be very effective and safe, which the Phase 1 and Phase 2 studies have shown.

    I haven’t been able to find the full text of the Sarkar study, and I’m very curious just how much MDMA those monkeys were given.

    So, again, too much of anything can be toxic. The question is how to use it well. Using MDMA in a controlled setting, following appropriate precautions, can mitigate whatever risks are there. Check out this Reddit discussion for a more nuanced discussion: https://www.reddit.com/r/Drugs/comments/12v5f8/research_suggests_no_neurotoxicity_in_mdma/

    To the author: please consider researching the studies that show how safe and effective this substance can be before dismissing it as outright unsafe. I don’t know about its potential to treat autism (hopefully future studies will show how it can be safely and effectively), but if it really IS a viable treatment, you are doing your readers a disservice by condemning it based on a few selected studies.

    1. Thanks. I had a chance to read the Reddit thread. It talked about unproven and untested ways to protect against the toxic effects. The literature around the neurotoxicity is not a selected few, they are review articles from hundreds of peer review articles that show MDMA and methamphetamine are toxic to brain cells in humans and in animals. This is not what the autism community should be betting on.

      1. Don’t throw the baby out with the bathwater.

        You call it “potent neurotoxicity”. What do you mean by potent? And what does “long lasting loss of neurons” mean? How long? Let’s talk about what we mean by toxicity. I just scanned the 2013 Mueller study that your referenced (9). I couldn’t pick out what they meant by “significant 5-HT neurochemical deficits”. I get that there was a “hit” to 5-HT a week after administration, but I can’t tell *how* significant that hit is. Are we talking acute depression, or a slightly lowered mood? And the effect was measured a week out. What would happen if they measured it two months out or a year out? The fact is (the studies back this up) that MDMA therapy is helping people. They feel better. So whatever “hit” they experience seems to be worth it.

        I don’t know if mdma works for treating autism, or if there is a neurological basis for your defensiveness around using MDMA-assisted therapies for that population, but to outright dismiss it seems like robbing an entire population of something potentially beneficial.

        I’m glad that this discussion is taking place. To assume that one can ingest MDMA freely without any sort of “hit” is potentially dangerous. To assume that one can use MDMA many times over the long term without *truly* long-lasting effects is very dangerous. However, to assume that a course of treatment (in the studies, 1-3 doses, iirc) is not beneficial is, again, robbing people of something that can make a profound positive difference in their lives. That “hit” may be worth it. They should be made aware of the potential “hit” as a matter of disclosure, as well as the potential benefits.

        I think it is important to get these treatments in the context of a supervised medical environment (generally, though I wouldn’t tell someone what to do with their body), where dose can be controlled, and the psychological “stuff” that gets worked can be addressed carefully and resolved. That is exactly what we see happening in the MAPS studies.

        There are lots of things in this world that are toxic to our bodies and brains that some freely choose to ingest (alcohol, pharmaceuticals). It’s a matter of risk/reward – and many people can navigate their relationship with those substances and live happier lives because of them. I’m not saying there aren’t dangers to be aware of, but *sometimes* an experience of something is worth the cost, especially when we are talking about something as life-threatening as MDMA.

        Whether it would be worth it for someone with autism, I don’t know. I’ve heard people benefit from it – that they get to overcome some of the more detrimental aspects of autism, without losing the gifts of it. I’m hoping that the studies will reveal more.

        Thank you for the airtime.

      2. Please do not equate ‘results of a study’ with ‘data relevant to the real world,’ they are not always the same thing and in highly politicized spaces, they frequently are not.

        I haven’t read all of the studies on the subject, but I have read over a dozen of them testing MDMA’s neurotoxicity on mice, rats, and primates, and in *all* of them the dosages given were so absurdly high it’s a wonder the animals actually survived.

        E.g., the typical MDMA dose considered neurotoxic is 20mg/kg, and study animals are given at least that much. For a typical 160-pund male, that would translate to me taking 1400mg of MDMA… roughly 12x the normal ‘party’ dose of 120mg.

        Anyone who takes 12 doses of MDMA should very well expect to suffer brain damage, assuming they live to tell the tale. In many experiments, animals are given 2-5x that dose, sometimes multiple times at 3-4 hour intervals.

        Put bluntly, these studies do not produce data that connects in any way to real-world situations.

        Your concerns are understandable, potent psychoactive drugs are not to be taken lightly. Perhaps the reasoned approach here is to actually allow rational, real-world human studies to run their course, let them be peer-reviewed, and assess the outcomes dispassionately, including not just raw biological measurements but real-world outcomes and impact on quality of life.

        However understandable, it seems unwise and short-sighted to allow fear and emotions to shut down promising pathways before they’ve even had a chance to see the light of day.

  7. The neurotoxicity of MDMA is hotly contested, I wouldn’t say there is sufficient evidence to yet confirm one way or the other, and certainly not enough evidence to be “potent”. Moreover, when you look at the neurotoxicity of methamphetamine (which is well evidenced, and notably more dangerous than anything MDMA comes close to), a Schedule 2 substance still used in medicine (you can also look into the use of amphetamines for attention disorders), the relevance of the neurotoxicity seems a bit discounted. Granted, neurotoxicity is an important factor, but if the potential benefits far outweigh the potential harms (which the evidence seems to suggest in the case of MDMA), then the cause for concern is not as great as has been presented here.

    Furthermore, doses given to monkeys in test settings make for poor demonstrators as: The monkeys cannot provide qualitative evidence, the doses given often far exceed recreational (and particularly medical) doses, and are (not always, but frequently) administered multiple times over short timespans, something vastly different from the nature of common MDMA psychotherapy. With claims such as “In fact, in non-human primates, one dose was sufficient to produce long lasting deficits in serotonergic functioning”, we also need specific evidence, or how are we to know that the dose given wasn’t, say, in excess of 10x the recommended recreational dose?

    Furthermore, several studies of lifetime users of MDMA demonstrated that only few suffered any actual, notable (more than minute) cognitive deficit. Sure, frequent use of MDMA results in notable negative cognitive deficit, but this is drug use on a level totally different to therapy. The majority of current research suggests MDMA is incredibly physiologicall safe (moreso than many currently legalised drugs), and is altogether well and truly promising enough to warrant further interest, and certainly to not be discounted so quickly as is here.

  8. > review articles from hundreds of peer review articles that show MDMA and methamphetamine are toxic to brain cells in humans and in animals.

    Hundreds of peer review articles showing the effects of extremely high doses of MDMA or repeated exposure of high doses over time.

    Actual human studies have found little to no behavioural long-term effects for reasonable exposure levels in humans. So while it’s true that serotonergic effects exist, this does NOT necessarily translate into any kind of observable or negative effects in humans.

    You might as well write off chemotherapy as a cancer treatment, because in vitro it clearly kills off both healthy and cancerous cells, so “obviously” it can’t serve as a viable treatment of any kind.

  9. It really upsets me how you use that image.

    Click to access 1999_hatzidimitriou_neuroscience_1_text.pdf

    This is the study it’s from.

    Their treatment procedure was:
    “Racemic MDMA hydrochloride, dissolved in a sterile
    0.9% sodium chloride solution, was injected subcutaneously at a dose of
    5 mg/kg twice daily (9 A.M. and 5 P.M.) for 4 consecutive days”

    A “single dose” of MDMA for a recreational human user is 100mg.
    The average human weight is 62kg.
    This works out to 1.6mg/kg MDMA for a standard dose.

    So what they gave to monkeys was like a human taking 3 pills, twice a day, for 4 straight days (i.e. 24 doses).

  10. This article is morally twisted. There’s no proof of longterm negative effects of recreational doses at all. But hey, if you want to keep believing that, imagine what the superstressed and anxietyoverloaded brain would look like then after a couple of years, or why not a lifetime? And all other medicines given like SSRI and Atarax? You think those are better? They don’t give anything but temporary relief at best. MDMA can let people actually LEARN and LOVE. I work with traumatized autistic individuals and look forward to this treatment!!! ❤

    1. Please refer to the references in the blog for specific scientific studies showing the neurotoxic effects of MDMA

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