WEBVTT 00:00:11.200 --> 00:00:16.724 (applause) 00:00:16.804 --> 00:00:22.070 3,4-Methylenedioxymethamphetamine: MDMA. 00:00:22.070 --> 00:00:27.489 Now you're probably heard of this compound in the context of the recreational drug Ecstasy. 00:00:27.489 --> 00:00:31.768 But today I want to talk about MDMA not as a recreational drug, 00:00:31.768 --> 00:00:35.629 but as a potential new treatment in medicine. 00:00:35.629 --> 00:00:39.870 And then very important treatment for psychiatry because MDMA could offer us 00:00:39.870 --> 00:00:44.609 in psychiatry for the first time the opportunity to tackle trauma. 00:00:45.079 --> 00:00:50.069 And psychological trauma particularly that caused by child abuse and maltreatment 00:00:50.069 --> 00:00:57.139 is at the heart of all or most psychiatric disorders due to anxiety and addictions. 00:00:57.759 --> 00:01:02.000 Psychiatry is in need of this innovative approach, 00:01:02.000 --> 00:01:04.731 because current treatments are failing patients. 00:01:05.911 --> 00:01:09.860 Hi, my name's Ben Sessa. I'm a child and adolescent psychiatrist. 00:01:09.860 --> 00:01:12.349 Now that means I trained as a medical doctor, 00:01:12.349 --> 00:01:14.440 then specialized in mental health 00:01:14.440 --> 00:01:17.400 and then specialized in child and adolescent mental health. 00:01:17.400 --> 00:01:20.220 But for the last five years I've been working with adults with 00:01:20.220 --> 00:01:24.480 mental health disorders and addictions due to misuse of drugs. 00:01:24.480 --> 00:01:27.509 And that developmental pathway of my own, 00:01:27.509 --> 00:01:30.299 from working with child abuse into adults 00:01:30.299 --> 00:01:34.069 with mental disorders and addictions has brought me to the door of MDMA. 00:01:34.829 --> 00:01:37.299 And I'm gonna propose today that MDMA could be 00:01:37.299 --> 00:01:41.699 important for the future of psychiatry as the discovery of antibiotics was 00:01:41.699 --> 00:01:44.499 for general medicine a hundred years ago. 00:01:44.999 --> 00:01:51.090 So when we think about child abuse we think about physical abuse, mental abuse, 00:01:51.090 --> 00:01:54.430 emotional abuse, sexual abuse and neglect. 00:01:55.370 --> 00:01:58.180 And we think about noxious environments. 00:01:58.180 --> 00:02:00.280 About parents with mental disorder. 00:02:00.280 --> 00:02:02.450 We think about parents who are addicted to drugs. 00:02:02.450 --> 00:02:06.709 And social issues like poverty and poor housing, poor education. 00:02:07.389 --> 00:02:10.257 Now I'm going to illustrate my talk today with a patient 00:02:10.257 --> 00:02:12.330 and I'm going to call her Claire. 00:02:12.330 --> 00:02:16.020 Now Claire was no single particular patient of mine. 00:02:16.060 --> 00:02:18.640 Rather she's an amalgamation of many different people 00:02:18.640 --> 00:02:22.070 I've met in the last 18 years working as a medical doctor. 00:02:23.350 --> 00:02:25.060 She's certainly not the worst. 00:02:25.820 --> 00:02:29.170 Now what was Claire's environment like when she was growing up? 00:02:29.170 --> 00:02:31.380 Well, her mother was depressed. 00:02:31.380 --> 00:02:34.890 Now unfortunately the family doctor didn't have time to accurately 00:02:34.890 --> 00:02:37.670 diagnose and treat depression, rather, 00:02:37.670 --> 00:02:40.620 Claire's mother was put onto one antidepressant after another, 00:02:40.620 --> 00:02:42.690 never really got therapy. 00:02:42.690 --> 00:02:44.960 Claire's mother also had a lot of aches and pains 00:02:44.960 --> 00:02:48.110 typical what we call psychosomatic symptoms in depression, 00:02:48.110 --> 00:02:52.850 and as a result the family doctor put her on to opiate based painkillers 00:02:52.850 --> 00:02:55.610 which she promptly became addicted to. 00:02:55.950 --> 00:02:59.100 Now Claire's father, now he was alcoholic and he was often 00:02:59.100 --> 00:03:01.110 not around in and out of prison. 00:03:01.110 --> 00:03:03.160 Which is just as well because when he was there 00:03:03.160 --> 00:03:06.390 he was physically abusive to Claire and her mother. 00:03:06.390 --> 00:03:08.130 Okay so what does this kind 00:03:08.130 --> 00:03:10.940 of chaotic, frightening environment do 00:03:10.940 --> 00:03:13.720 to the developing child brain? 00:03:13.720 --> 00:03:16.710 I'm going to give you a brief neurophysiology lesson if I may. 00:03:16.710 --> 00:03:19.650 There's a part of the brain called the amygdala. 00:03:19.650 --> 00:03:23.030 Now the amygdala is a very ancient part of the mammalian brain 00:03:23.030 --> 00:03:26.580 and many other animals other than humans have an amygdala. 00:03:26.580 --> 00:03:29.509 The amygdala lights up when stimulated by 00:03:29.509 --> 00:03:32.600 fear in the environment, by a frightening stimulus. 00:03:32.600 --> 00:03:36.849 It lights up and it says: fight-or-flight, get out! 00:03:36.849 --> 00:03:40.170 Now there's another part of the brain much more sophisticated part, 00:03:40.170 --> 00:03:44.510 called the prefrontal cortex and it's right here at the front above the eyes. 00:03:44.510 --> 00:03:47.360 Now the prefrontal cortex only humans have. 00:03:47.360 --> 00:03:52.500 And it's in the prefrontal cortex where we use logic and reasoning to 00:03:52.500 --> 00:03:55.130 rationalize the situation and we can use 00:03:55.130 --> 00:03:57.780 our prefrontal cortex to overcome that 00:03:57.780 --> 00:04:00.670 instinctive fear response from the amygdala. 00:04:00.670 --> 00:04:02.750 Now when Claire was growing up 00:04:02.750 --> 00:04:04.710 she never knew from one moment to the next 00:04:04.710 --> 00:04:07.520 whether the adult coming into the room's going to give her a kiss 00:04:07.520 --> 00:04:09.770 or a cuddle or do a jigsaw with her, 00:04:09.770 --> 00:04:11.960 or were they going to punch her or kick her 00:04:11.960 --> 00:04:14.329 or burn her with their cigarette. 00:04:14.329 --> 00:04:16.709 Or were they going to rape her. 00:04:16.709 --> 00:04:20.409 Because throughout her childhood Claire was also subjected to sexual abuse. 00:04:21.630 --> 00:04:25.800 Now, there's a group of disorders called the anxiety disorders, 00:04:26.000 --> 00:04:31.839 and one of the most important is what we call post-traumatic stress disorder or PTSD. 00:04:31.839 --> 00:04:34.841 Now PTSD, some of the core features: 00:04:34.841 --> 00:04:38.610 very low mood, anxiety, high levels of anxiety, 00:04:38.610 --> 00:04:40.829 what we call hyper vigilance: 00:04:40.829 --> 00:04:43.249 this edginess, this jumpiness. 00:04:43.249 --> 00:04:46.860 Exactly how Claire felt throughout her childhood and adolescence. 00:04:46.860 --> 00:04:49.650 Never knowing whether the next assailant or assault 00:04:49.650 --> 00:04:51.849 was around the corner. 00:04:51.849 --> 00:04:56.460 Another core feature of PTSD, what we call re-experiencing phenomena. 00:04:56.460 --> 00:05:01.520 Flashbacks, when the patient has sudden remembrances of painful traumatic memories. 00:05:01.520 --> 00:05:02.940 They can just pop into the head 00:05:02.940 --> 00:05:07.320 at any time, triggered by some cue in the environment. 00:05:07.320 --> 00:05:10.770 And when they have those experiences, those daytime flashbacks, 00:05:10.770 --> 00:05:15.050 they relive the trauma in all the sensory modalities and this results in 00:05:15.050 --> 00:05:19.220 them freezing or dissociating to try and block out the pain. 00:05:19.850 --> 00:05:23.410 Claire experienced all of this as she was growing up. 00:05:24.450 --> 00:05:29.450 High levels of self-harm and suicide are associated with PTSD. 00:05:29.450 --> 00:05:32.070 Claire would cut her thighs and her breasts. 00:05:32.670 --> 00:05:37.269 Pretty common form of cutting in children who've been sexually abused. 00:05:37.269 --> 00:05:40.010 She was being sexually abused by her mother's clients, 00:05:40.010 --> 00:05:43.599 because her mother had moved on from the addiction to painkillers and 00:05:43.599 --> 00:05:46.890 was using street heroin when Claire was a teenager. 00:05:46.890 --> 00:05:51.310 Because of the way the war on drugs has set up that reduces access to treatment 00:05:51.310 --> 00:05:54.789 for people with opiate dependence, she had to pay for her 00:05:54.789 --> 00:05:58.939 heroin using sex work and the clients would sexually abuse Claire. 00:06:00.319 --> 00:06:05.169 It's very hard to treat PTSD and it has a high treatment resistance, 00:06:05.169 --> 00:06:09.380 50% of people do not respond to the traditional treatments. 00:06:09.920 --> 00:06:11.320 How do we treat it? 00:06:11.320 --> 00:06:14.979 We can treat it with medications. We can treat it with psychotherapies. 00:06:14.979 --> 00:06:18.900 And the medications we use: there's a broad range of drugs. 00:06:18.900 --> 00:06:24.520 No single drug, and this is very important, no single drug cures PTSD. 00:06:24.520 --> 00:06:27.210 Rather we treat the disorder symptomatically: 00:06:27.220 --> 00:06:30.250 If the patient's depressed give them an antidepressant. 00:06:30.250 --> 00:06:33.800 If their mood fluctuates give them a mood stabilizer. 00:06:33.800 --> 00:06:36.670 If they can't sleep give them a hypnotic. 00:06:36.670 --> 00:06:40.800 And if that edginess and that fear spills over into paranoia and psychosis, 00:06:40.800 --> 00:06:43.880 give the patient an anti-psychotic drug. 00:06:43.880 --> 00:06:48.240 And they have to take these drugs day in day out for weeks, months, decades. 00:06:48.240 --> 00:06:53.710 They have to keep taking them because the drugs we use to treat trauma when it's 00:06:53.710 --> 00:06:59.320 due to this level of severity do not attack the root cause of trauma. 00:06:59.320 --> 00:07:01.570 They paper over the cracks. 00:07:01.570 --> 00:07:07.700 A good analogy would be taking aspirin or ibuprofen when you have a fever. 00:07:07.700 --> 00:07:13.100 A fever is caused by an infection, by a microorganism. 00:07:13.100 --> 00:07:17.680 Sure, you can take paracetamol or ibuprofen and this will lower the temperature 00:07:17.680 --> 00:07:22.190 and make you feel a bit better but it doesn't attack the root cause. 00:07:22.190 --> 00:07:26.560 And that's what we do when we give these patients these daily SSRI drugs. 00:07:26.560 --> 00:07:27.860 We paper over the cracks. 00:07:27.860 --> 00:07:32.090 We maintain the symptoms at a manageable level. 00:07:32.090 --> 00:07:35.640 We also use psychotherapies to treat PTSD, and there's 00:07:35.640 --> 00:07:41.790 again a broad range of these: DBT, CBT, EMDR, trauma focused psychotherapy, 00:07:41.790 --> 00:07:45.010 CAT, APT... Now all of them have a pretty 00:07:45.010 --> 00:07:48.810 similar approach which actually is an old wives tales which is: 00:07:48.810 --> 00:07:51.210 a problem shared is a problem halved. 00:07:51.210 --> 00:07:56.320 "Let's talk about your trauma. Claire tell me about your rape." 00:07:56.320 --> 00:08:03.850 Now that's fine for 50% of patients but for a significant half they just cannot do that. 00:08:03.850 --> 00:08:07.440 As soon as Claire is asked to talk about her rape she freezes, 00:08:07.440 --> 00:08:10.360 she flees, she drops out of treatment. 00:08:10.360 --> 00:08:14.320 By the time she was 15 Claire had been removed from the family home and she was 00:08:14.320 --> 00:08:18.320 brought up in a succession of foster placements and children's houses and 00:08:18.450 --> 00:08:21.559 hostels where the abuse continued. 00:08:22.159 --> 00:08:25.339 She was self-harm cutting and she started drinking and 00:08:25.339 --> 00:08:29.260 by the time she was 18, she was using heroin as well. 00:08:29.260 --> 00:08:34.010 Sometimes working in psychiatry can feel pretty desperate, can feel pretty hopeless. 00:08:34.410 --> 00:08:39.160 Sometimes it feels as if psychiatry is a palliative care profession. 00:08:39.160 --> 00:08:42.109 And this is the truth because the treatments we use do not get to the 00:08:42.109 --> 00:08:44.559 root cause of the problem, the trauma. 00:08:44.559 --> 00:08:46.740 They paper over the cracks. 00:08:46.740 --> 00:08:50.090 And I think the pharma industry know this and they queue up and they 00:08:50.090 --> 00:08:53.510 provide us with product after product to give to our patients that doesn't quite 00:08:53.510 --> 00:08:58.380 cure them but it gets them slightly better to function. 00:08:58.380 --> 00:09:00.370 And they have to keep taking them. 00:09:00.370 --> 00:09:04.800 I'd say that we're in psychiatry today where we were in general medicine 100 years ago. 00:09:04.800 --> 00:09:06.540 100 years ago in general medicine, 00:09:06.540 --> 00:09:10.160 humanity was losing the battle to the infectious diseases. 00:09:10.160 --> 00:09:12.800 Oh we were very good at classifying and diagnosing them. 00:09:12.800 --> 00:09:14.770 We knew who got smallpox. 00:09:14.770 --> 00:09:17.320 We knew people died of post-operative surgery. 00:09:17.320 --> 00:09:20.640 We knew there were microorganisms but we didn't have a treatment. 00:09:20.640 --> 00:09:25.850 And then at the beginning of the 20th century we discovered the antibiotics. 00:09:25.850 --> 00:09:29.810 Not symptomatic treatment but treatment that goes to the core of the cause 00:09:29.810 --> 00:09:33.660 and we started getting on top of infectious disease. 00:09:33.760 --> 00:09:37.090 Psychiatry today is in a similar place. 00:09:37.090 --> 00:09:39.550 We're very good at classifying and diagnosing. 00:09:39.550 --> 00:09:41.670 Our epidemiology is superb. 00:09:41.670 --> 00:09:44.000 We write these thick diagnostic manuals. 00:09:44.000 --> 00:09:45.529 We know who gets depression. 00:09:45.529 --> 00:09:47.070 We know who gets anxiety. 00:09:47.070 --> 00:09:53.700 We even know the cause: trauma, child abuse, maltreatment, poor social conditions. 00:09:53.700 --> 00:09:56.150 But our treatments are lousy. 00:09:57.810 --> 00:10:00.820 And I'm quite shocked the way the empathy 00:10:00.820 --> 00:10:05.030 switch and our understanding of these patients seems to be switched off. 00:10:05.550 --> 00:10:09.520 We have lots of gushing sentimentality for the little five and six year old who's 00:10:09.520 --> 00:10:14.710 being abused and we throw money at our television sets on these campaigns to 00:10:14.710 --> 00:10:17.930 improve the lives of these poor little innocent victims. 00:10:17.930 --> 00:10:21.000 Let me tell you what happens to that little five or six year old, 00:10:21.000 --> 00:10:23.180 when they're 11 or 12. 00:10:23.180 --> 00:10:26.830 On goes the hood, start smoking weed. 00:10:26.830 --> 00:10:29.240 By the time they're 16 they're buying and selling amphetamine 00:10:29.240 --> 00:10:31.490 and by the time they're Claire's age in their mid-20s, 00:10:31.490 --> 00:10:33.670 they're addicted to heroin and alcohol. 00:10:33.670 --> 00:10:36.580 And suddenly we have lost our empathy. 00:10:36.580 --> 00:10:39.450 These people are public enemy number one. 00:10:39.450 --> 00:10:45.160 "It's your fault Claire. You brought this upon yourself. It's your lifestyle choice." 00:10:45.160 --> 00:10:50.400 And I'm quite shocked and having worked in pediatrics and seen the developmental 00:10:50.400 --> 00:10:55.300 trajectory that is so inevitable from early trauma into adolescent and then 00:10:55.300 --> 00:10:59.799 adult mental health and addictions, we have to hold on to that sense of compassion 00:10:59.799 --> 00:11:04.470 and evidence-based understanding about the developmental trajectory there. 00:11:05.720 --> 00:11:08.720 So it does sound desperate, but all is not lost. 00:11:09.740 --> 00:11:14.220 MDMA. MDMA has some fascinating qualities. 00:11:14.220 --> 00:11:19.410 I would suggest that if you were to invent a hypothetical drug to treat trauma, 00:11:19.410 --> 00:11:21.940 it would be MDMA. 00:11:21.940 --> 00:11:25.610 The way it works in terms of its receptors and its subjective psychological effects 00:11:25.610 --> 00:11:27.550 ticks all the right boxes. 00:11:27.550 --> 00:11:31.420 At one level of receptors it causes a increased positive mood. 00:11:31.420 --> 00:11:34.200 Lowering of depression, lowering of anxiety. 00:11:34.200 --> 00:11:37.160 At another group of receptors it speeds the patient up, 00:11:37.160 --> 00:11:41.570 mild stimulation which motivates them to engage in therapy. 00:11:41.570 --> 00:11:45.140 At another level it relaxes the patient paradoxically 00:11:45.140 --> 00:11:50.120 at the same time as the stimulation and this puts the patient into the optimal arousal 00:11:50.120 --> 00:11:53.330 zone where they can engage in psychotherapy. 00:11:53.330 --> 00:11:58.610 But perhaps the most important thing about MDMA and the most important clinical tool 00:11:58.610 --> 00:12:06.020 is its ability to provide a sense of empathy and understanding and emotional security. 00:12:06.960 --> 00:12:12.230 It can hold the patient in a place where they can think about and access their trauma 00:12:12.230 --> 00:12:15.310 like they've never been able to do before. 00:12:15.710 --> 00:12:17.690 One of the ways in which MDMA works is 00:12:17.690 --> 00:12:21.650 it increases the release of a hormone called oxytocin. 00:12:21.650 --> 00:12:25.600 Oxytocin is released from the brains of breastfeeding mothers. 00:12:25.600 --> 00:12:28.760 It's a hormone that engenders a sense of attachment and bonding. 00:12:28.760 --> 00:12:32.710 And that's what's happening in the patient who takes MDMA. 00:12:32.710 --> 00:12:36.450 And also it acts directly on the amygdala to reduce 00:12:36.450 --> 00:12:41.280 that fear response whilst at the same time boosting the prefrontal response, 00:12:41.280 --> 00:12:44.240 allowing the patient to see things in a new light. 00:12:44.240 --> 00:12:46.130 A positive light. 00:12:46.130 --> 00:12:48.320 So let's go back to Claire. 00:12:48.320 --> 00:12:50.340 She's 40 now. 00:12:50.340 --> 00:12:52.950 She's been in and out of psychiatric hospitals, 00:12:52.950 --> 00:12:55.210 having tried to take her own life and the inception. 00:12:55.210 --> 00:12:58.780 She's been on all the antipsychotic and antidepressant mood stabiliser drugs. 00:12:58.780 --> 00:13:01.560 She's tried all the psychotherapies but she cannot engage 00:13:01.560 --> 00:13:05.890 because she will not talk about her feelings. 00:13:05.890 --> 00:13:11.160 So she comes into a course of MDMA-assisted psychotherapy. 00:13:11.860 --> 00:13:13.379 What does it look like? 00:13:13.379 --> 00:13:17.809 It's weekly sessions, maybe eight, ten, twelve weeks long. 00:13:17.809 --> 00:13:20.599 There're two therapists, male-female pair. 00:13:20.599 --> 00:13:25.359 You do not take MDMA everyday, you do not take it every week. 00:13:25.359 --> 00:13:29.259 Over that course of 12 sessions you'll take the MDMA three times and the 00:13:29.259 --> 00:13:34.390 other sessions you talk about the material that's released on the MDMA session. 00:13:35.010 --> 00:13:39.909 So what does Claire actually feel when she takes this MDMA? 00:13:39.909 --> 00:13:46.289 What she feels is a sense of warmth and understanding and a sense of containment 00:13:46.289 --> 00:13:51.099 within that relationship she's having with the therapist. 00:13:51.099 --> 00:13:55.550 MDMA is like a lifejacket like a bulletproof vest 00:13:55.550 --> 00:13:58.870 to wear to go into battle with your trauma. 00:13:58.870 --> 00:14:01.169 This is not ecstasy! 00:14:01.169 --> 00:14:06.310 She's not enjoying some raver's euphoric ecstasy delight. 00:14:06.310 --> 00:14:10.790 This is still trauma focused psychotherapy and it's still hard and distressing for her, 00:14:10.790 --> 00:14:14.929 but she can just about do it with MDMA on board. 00:14:14.929 --> 00:14:19.909 So when the therapist says: "Claire, tell me about your rape". 00:14:19.909 --> 00:14:22.320 In the past just the word rape and she'd be out the door, 00:14:22.320 --> 00:14:25.889 but on MDMA she says: "yeah, I can talk about that! 00:14:25.889 --> 00:14:31.899 I can see him now coming into the room. I can smell the whiskey on his breath and 00:14:31.899 --> 00:14:35.829 I can feel the stubble on his face as he's raping me". 00:14:35.829 --> 00:14:40.280 And she talks about it and she explores it and she reflects upon it 00:14:40.280 --> 00:14:42.989 and she can begin the process of healing. 00:14:42.989 --> 00:14:45.639 And from here she can start her journey. 00:14:45.639 --> 00:14:48.889 She can attack the root cause of her problems. 00:14:48.889 --> 00:14:52.729 Not just maintain the symptoms at a level. 00:14:54.989 --> 00:14:56.829 So, does it work? 00:14:56.829 --> 00:14:59.439 Well, we've known about MDMA for very long time 00:14:59.439 --> 00:15:04.530 and indeed we've used MDMA in underground therapy for 30 or 40 years. 00:15:04.530 --> 00:15:07.409 And there are thousands of positive anecdotal cases. 00:15:07.409 --> 00:15:12.729 I get five emails a week from all over the world: "Dr. Sessa, I've had PTSD for years. 00:15:12.729 --> 00:15:17.389 I've tried everything and now I tried MDMA and I'm starting to make a breakthrough!" 00:15:17.469 --> 00:15:21.269 Now, anecdotal reports like that are interesting but they're not science so 00:15:21.269 --> 00:15:23.150 we've done the science. 00:15:23.150 --> 00:15:26.119 And some important studies in recent years. 00:15:26.119 --> 00:15:32.609 Big study in the States showed that a single course of MDMA therapy, 16-week course, 00:15:32.609 --> 00:15:36.459 patient takes MDMA three times tested against a placebo. 00:15:36.459 --> 00:15:44.129 At the end of that course 85% of the people no longer met the diagnostic criteria for PTSD. 00:15:44.129 --> 00:15:48.820 Not just a relief of symptoms, they didn't have PTSD! 00:15:48.820 --> 00:15:54.010 Now that cohort were then followed up three years later, the same no PTSD. 00:15:54.010 --> 00:15:57.949 Many of those people had come of their daily medications. 00:15:57.949 --> 00:16:03.190 They were cured! We don't use the "cure" word in psychiatry. 00:16:03.190 --> 00:16:08.350 We've become learned helplessness position of--This is the truth! 00:16:08.350 --> 00:16:11.999 If you're diagnosed with a severe mental disorder like anxiety or depression 00:16:11.999 --> 00:16:16.580 in your 20s, and the developmental route of that disorder is severe child abuse, 00:16:16.580 --> 00:16:19.429 there's a pretty good chance chance-- and I'm sorry to say this-- 00:16:19.429 --> 00:16:21.769 there's a pretty good chance you will still be going to 00:16:21.769 --> 00:16:24.589 psychiatric clinics in your 60s and 70s. 00:16:24.589 --> 00:16:30.749 Now that is not good enough and we're in this position because we're not tackling trauma. 00:16:31.749 --> 00:16:35.130 So, it works but is it safe? 00:16:35.130 --> 00:16:39.599 When we talk about safety of clinical MDMA, what we must not do is 00:16:39.599 --> 00:16:43.659 look at the risks of recreational ecstasy. 00:16:44.179 --> 00:16:47.000 I don't even know what ecstasy is anymore! 00:16:47.000 --> 00:16:49.370 Ecstasy is over here, what is ecstasy? 00:16:49.370 --> 00:16:53.050 Some dodgy pill bought in some dodgy club of some dodgy geezer, 00:16:53.050 --> 00:16:59.929 that may or may not contain MDMA plus or minus whatever far more toxic substance. 00:17:01.240 --> 00:17:05.969 When you hear about the very high-profile deaths of people who take ecstasy, 00:17:05.969 --> 00:17:10.018 it invariably is not MDMA. 00:17:10.018 --> 00:17:13.420 So, let's not look at ecstasy as a measure of MDMA. 00:17:13.420 --> 00:17:15.600 Let's look at clinical MDMA. 00:17:15.600 --> 00:17:21.229 When you use clinical MDMA, you take it under medical supervision. It is pure. 00:17:21.229 --> 00:17:25.720 The MDMA that I'm using in my studies is 99.98% pure! 00:17:27.280 --> 00:17:31.029 Very expensive! (laughter) 00:17:31.029 --> 00:17:34.930 We do it under medical supervision with a doctor and a nurse and a psychologist. 00:17:34.930 --> 00:17:40.180 And under those conditions the risks are reduced to a absolute minimum. 00:17:40.180 --> 00:17:42.850 Indeed, after 40 years of MDMA research, 00:17:42.850 --> 00:17:47.610 there has not been a single serious adverse drug reaction, not one! 00:17:47.610 --> 00:17:51.090 And certainly no deaths. 00:17:51.090 --> 00:17:53.580 So, we need to do this research and 00:17:53.580 --> 00:17:59.580 we need to do this research in an evidence-based, compassionate way. 00:17:59.580 --> 00:18:02.070 Looking at the data. 00:18:02.070 --> 00:18:05.039 We need to ignore the socio-political agenda that says any drug 00:18:05.039 --> 00:18:11.110 that's being used recreationally must also be very bad and dangerous. 00:18:11.110 --> 00:18:14.270 That sort of attitude hampers research. 00:18:15.490 --> 00:18:18.340 And we need scientists to drive this. 00:18:18.900 --> 00:18:20.860 It works, it's safe. 00:18:20.860 --> 00:18:24.640 And it offers patients like Claire for the first time in their life an opportunity 00:18:24.640 --> 00:18:30.220 to break through from that trauma and not become a lifelong chronic PTSD sufferer. 00:18:30.220 --> 00:18:32.790 So, where were we going with MDMA research? 00:18:32.790 --> 00:18:35.630 Well, we've had some studies, we've got more coming here. 00:18:35.630 --> 00:18:39.509 I'm doing a study in Cardiff with neuroimaging in which we're going to give patients 00:18:39.509 --> 00:18:43.980 with PTSD, MDMA and placebo and we're going to look at that relationship 00:18:43.980 --> 00:18:47.420 between the amygdala and the prefrontal cortex. 00:18:47.420 --> 00:18:53.739 We're doing a study here in Bristol giving MDMA to patients with alcohol use disorder 00:18:53.739 --> 00:18:58.040 because underlying the root of this addiction is trauma. 00:18:58.040 --> 00:18:59.950 This is an exciting time. 00:18:59.950 --> 00:19:01.849 Now people say: "This is controversial!" 00:19:01.849 --> 00:19:04.320 And indeed, I was introduced as a controversial speaker. 00:19:04.320 --> 00:19:07.530 I'm not controversial, I'm a very boring conservative doctor. 00:19:07.530 --> 00:19:10.040 I like data. 00:19:10.040 --> 00:19:13.620 I like evidence-based data that helps my patients. 00:19:13.620 --> 00:19:15.669 I'll tell you what's controversial! 00:19:15.669 --> 00:19:20.580 What's controversial is that more people have died returning from Afghanistan and Iraq 00:19:20.580 --> 00:19:24.190 because they've committed suicide because of their untreated PTSD 00:19:24.190 --> 00:19:26.980 then ever died in the conflict out there. 00:19:26.980 --> 00:19:30.590 That is controversial and that is unethical! 00:19:32.370 --> 00:19:35.330 So, this is an important time for science. 00:19:35.330 --> 00:19:40.140 MDMA could be the antibiotic that psychiatry has been waiting for. 00:19:40.140 --> 00:19:43.619 We owe that population of patients who are being failed, 00:19:43.630 --> 00:19:46.040 we owe them this research! 00:19:46.040 --> 00:19:47.748 We owe this Claire! 00:19:47.748 --> 00:19:55.328 Thank you. (applause)