0:00:11.200,0:00:16.804 (applause) 0:00:16.804,0:00:22.070 3,4-Methylenedioxymethamphetamine: MDMA. 0:00:22.070,0:00:27.489 Now you're probably heard of this compound[br]in the context of the recreational drug Ecstasy. 0:00:27.489,0:00:31.768 But today I want to talk about MDMA not [br]as a recreational drug, 0:00:31.768,0:00:35.629 but as a potential new treatment in medicine. 0:00:35.629,0:00:39.750 And then very important treatment [br]for psychiatry because MDMA could offer us 0:00:39.750,0:00:44.609 in psychiatry for the first time the[br]opportunity to tackle trauma. 0:00:45.079,0:00:49.289 And psychological trauma particularly that[br]caused by child abuse and maltreatment 0:00:49.289,0:00:57.139 is at the heart of all or most psychiatric[br]disorders due to anxiety and addictions. 0:00:57.759,0:01:02.069 Psychiatry is in need of this [br]innovative approach, 0:01:00.900,0:01:04.731 because current treatments [br]are failing patients. 0:01:06.051,0:01:09.860 Hi, my name's Ben Sessa. I'm a child and[br]adolescent psychiatrist. 0:01:09.860,0:01:12.349 Now that means I trained as a medical doctor, 0:01:12.349,0:01:14.440 then specialized in mental health 0:01:14.440,0:01:17.400 and then specialized in child [br]and adolescent mental health. 0:01:17.400,0:01:20.220 But for the last five years I've [br]been working with adults with 0:01:20.220,0:01:24.480 mental health disorders and addictions[br]due to misuse of drugs. 0:01:24.480,0:01:27.509 And that developmental pathway [br]of my own, 0:01:27.509,0:01:30.299 from working with child abuse into adults 0:01:30.299,0:01:34.069 with mental disorders and addictions has[br]brought me to the door of MDMA. 0:01:34.829,0:01:37.299 And I'm gonna propose today [br]that MDMA could be 0:01:37.299,0:01:41.699 important for the future of psychiatry[br]as the discovery of antibiotics was 0:01:41.699,0:01:44.499 for general medicine a hundred years ago. 0:01:44.999,0:01:51.090 So when we think about child abuse we think[br]about physical abuse, mental abuse, 0:01:51.090,0:01:54.430 emotional abuse, sexual abuse and neglect. 0:01:55.370,0:01:58.180 And we think about noxious environments. 0:01:58.180,0:02:00.220 We think about parents with mental disorder. [br] 0:02:00.220,0:02:02.450 We think about parents[br]who are addicted to drugs. 0:02:00.221,0:02:06.709 And social issues like poverty and[br]poor housing, poor education. 0:02:07.389,0:02:10.257 Now I'm going to illustrate my talk[br]today with a patient 0:02:10.257,0:02:12.330 and I'm going to call her Claire. 0:02:12.330,0:02:16.020 Now Claire was no single particular[br]patient of mine. 0:02:16.060,0:02:18.640 Rather she's an amalgamation[br]of many different people 0:02:18.640,0:02:22.070 I've met in the last 18 years working[br]as a medical doctor. 0:02:23.350,0:02:25.060 She's certainly not the worst. 0:02:25.820,0:02:29.170 Now what was Claire's environment like [br]when she was growing up? 0:02:29.170,0:02:31.380 Well, her mother was depressed. 0:02:31.380,0:02:34.890 Now unfortunately the family[br]doctor didn't have time to accurately 0:02:34.890,0:02:37.670 diagnose and treat depression, rather, 0:02:37.670,0:02:40.620 Claire's mother was put onto one[br]antidepressant after another, 0:02:40.620,0:02:42.690 never really got therapy. 0:02:42.690,0:02:45.140 Claire's mother also had a lot of aches and pains 0:02:45.140,0:02:48.110 typical what we call [br]psychosomatic symptoms in depression, 0:02:48.110,0:02:52.850 and as a result the family doctor [br]put her on to opiate based painkillers 0:02:52.850,0:02:55.610 which she promptly became addicted to. 0:02:55.950,0:02:59.100 Now Claire's father, now he was alcoholic and he was often 0:02:59.100,0:03:01.110 not around in and out of prison. 0:03:01.110,0:03:03.160 Which is just as well because when he was[br]there 0:03:03.160,0:03:06.390 he was physically abusive to Claire[br]and her mother. 0:03:06.390,0:03:08.130 Okay so what does this kind 0:03:08.130,0:03:10.940 of chaotic, frightening environment do 0:03:10.940,0:03:13.720 to the developing child brain? 0:03:13.720,0:03:16.710 I'm going to give you a brief[br]neurophysiology lesson if I may. 0:03:16.710,0:03:19.650 There's a part of the brain called the amygdala. 0:03:19.650,0:03:23.030 Now the amygdala is a very[br]ancient part of the mammalian brain 0:03:23.030,0:03:26.580 and many other animals other than humans[br]have an amygdala. 0:03:26.580,0:03:29.509 The amygdala lights up when stimulated by 0:03:29.509,0:03:32.600 fear in the environment,[br]by a frightening stimulus. 0:03:32.600,0:03:36.849 It lights up and it says:[br]fight-or-flight, get out! 0:03:36.849,0:03:40.170 Now there's another part of the brain[br]much more sophisticated part, 0:03:40.170,0:03:44.110 called the prefrontal cortex and it's[br]right here at the front above the eyes. 0:03:44.110,0:03:47.360 Now the prefrontal cortex only humans have. 0:03:47.360,0:03:52.500 And it's in the prefrontal cortex[br]where we use logic and reasoning to 0:03:52.500,0:03:55.130 rationalize the situation and we can use 0:03:55.130,0:03:57.780 our prefrontal cortex to overcome that 0:03:57.780,0:04:00.670 instinctive fear response from the amygdala. 0:04:00.670,0:04:02.750 Now when Claire was growing up 0:04:02.750,0:04:04.710 she never knew from one moment to the next 0:04:04.710,0:04:07.520 whether the adult coming into the room,[br]were they going to give her a kiss 0:04:07.520,0:04:09.770 or a cuddle or do a jigsaw with her, 0:04:09.770,0:04:11.960 or were they going to punch her or kick her 0:04:11.960,0:04:14.329 or burn her with their cigarette. 0:04:14.329,0:04:16.709 Or were they going to rape her. 0:04:16.709,0:04:20.409 Because throughout her childhood[br]Claire was also subjected to sexual abuse. 0:04:21.630,0:04:25.800 Now, there's a group of disorders[br]called the anxiety disorders, 0:04:25.800,0:04:27.160 and one of the most important 0:04:27.160,0:04:31.839 is what we call[br]post-traumatic stress disorder or PTSD. 0:04:31.839,0:04:34.841 Now PTSD, some of the core features: 0:04:34.841,0:04:38.610 very low mood, anxiety,[br]high levels of anxiety, 0:04:38.610,0:04:40.829 what we call hyper vigilance: 0:04:40.829,0:04:43.249 this edginess, this jumpiness. 0:04:43.249,0:04:46.860 Exactly how Claire felt [br]throughout her childhood and adolescence. 0:04:46.860,0:04:49.650 Never knowing whether[br]the next assailant or assault 0:04:49.650,0:04:51.849 was around the corner. 0:04:51.849,0:04:56.460 Another core feature of PTSD,[br]what we call re-experiencing phenomena. 0:04:56.460,0:05:01.520 Flashbacks, when the patient has sudden[br]remembrances of painful traumatic memories. 0:05:01.520,0:05:02.940 They can just pop into the head 0:05:02.940,0:05:07.320 at any time, triggered by[br]some cue in the environment. 0:05:07.320,0:05:10.770 And when they have those experiences,[br]those daytime flashbacks, 0:05:10.770,0:05:15.050 they relive the trauma in all the[br]sensory modalities and this results in 0:05:15.050,0:05:19.220 them freezing or dissociating[br]to try and block out the pain. 0:05:19.850,0:05:23.410 Claire experienced all of this[br]as she was growing up. 0:05:24.450,0:05:29.450 High levels of self-harm and suicide[br]are associated with PTSD. 0:05:29.450,0:05:32.070 Claire would cut her thighs and her breasts. 0:05:32.670,0:05:37.269 Pretty common form of cutting in[br]children who've been sexually abused. 0:05:37.269,0:05:40.010 She was being sexually abused[br]by her mother's clients, 0:05:40.010,0:05:43.599 because her mother had moved on[br]from the addiction to painkillers and 0:05:43.599,0:05:46.890 was using street heroin[br]when Claire was a teenager. 0:05:46.890,0:05:51.310 Because of the way the war on drugs has[br]set up that reduces access to treatment 0:05:51.310,0:05:54.789 for people with opiate dependence,[br]she had to pay for her 0:05:54.789,0:05:58.939 heroin using sex work and the clients[br]would sexually abuse Claire. 0:06:00.319,0:06:05.169 It's very hard to treat PTSD and it has a high treatment resistance, 0:06:05.169,0:06:09.380 50% of people do not respond to the traditional treatments. 0:06:09.920,0:06:11.320 How do we treat it? 0:06:11.320,0:06:14.979 We can treat it with medications. We can treat it with psychotherapies. 0:06:14.979,0:06:18.900 And the medications we use:[br]there's a broad range of drugs. 0:06:18.900,0:06:24.520 No single drug, and this is very important,[br]no single drug cures PTSD. 0:06:24.520,0:06:27.210 Rather we treat the disorder symptomatically: 0:06:27.220,0:06:30.250 If the patient's depressed[br]give them an antidepressant. 0:06:30.250,0:06:33.800 If their mood fluctuates give them a mood stabilizer. 0:06:33.800,0:06:36.670 If they can't sleep give them a hypnotic. 0:06:36.670,0:06:40.800 And if that edginess and that fear [br]spills over into paranoia and psychosis, 0:06:40.800,0:06:43.880 give the patient an anti-psychotic drug. 0:06:43.880,0:06:48.240 And they have to take these drugs[br]day in day out for weeks, months, decades. 0:06:48.240,0:06:53.710 They have to keep taking them because[br]the drugs we use to treat trauma when it's 0:06:53.710,0:06:59.320 due to this level of severity do not attack the root cause of trauma. 0:06:59.320,0:07:01.570 They paper over the cracks. 0:07:01.570,0:07:07.700 A good analogy would be taking aspirin[br]or ibuprofen when you have a fever. 0:07:07.700,0:07:13.100 A fever is caused by an infection, by a microorganism. 0:07:13.100,0:07:17.680 Sure, you can take paracetamol or ibuprofen[br]and this will lower the temperature 0:07:17.680,0:07:22.190 and make you feel a bit better but it doesn't attack the root cause. 0:07:22.190,0:07:26.560 And that's what we do when we give these patients these daily SSRI drugs. 0:07:26.560,0:07:27.860 We paper over the cracks. 0:07:27.860,0:07:32.090 We maintain the symptoms at a manageable level. 0:07:32.090,0:07:35.640 We also use psychotherapies to treat PTSD, and there's 0:07:35.640,0:07:41.790 again a broad range of these: DBT, CBT,[br]EMDR, trauma focused psychotherapy, 0:07:41.790,0:07:45.010 CAT, APT... Now all of them have a pretty 0:07:45.010,0:07:48.810 similar approach which actually is an old wives tales which is: 0:07:48.810,0:07:51.210 a problem shared is a problem halved. 0:07:51.210,0:07:56.320 "Let's talk about your trauma.[br]Claire tell me about your rape." 0:07:56.320,0:08:03.850 Now that's fine for 50% of patients but for[br]a significant half they just cannot do that. 0:08:03.850,0:08:07.440 As soon as Claire is asked to talk about her rape she freezes, 0:08:07.440,0:08:10.360 she flees, she drops out of treatment. 0:08:10.360,0:08:14.320 By the time she was 15 Claire had been[br]removed from the family home and she was 0:08:14.320,0:08:18.320 brought up in a succession of foster[br]placements and children's houses and 0:08:18.450,0:08:21.559 hostels where the abuse continued. 0:08:22.159,0:08:25.339 She was self-harm cutting and[br]she started drinking and 0:08:25.339,0:08:29.260 by the time she was 18,[br]she was using heroin as well. 0:08:29.260,0:08:34.010 Sometimes working in psychiatry can feel[br]pretty desperate, can feel pretty hopeless. 0:08:34.410,0:08:39.160 Sometimes it feels as if psychiatry[br]is a palliative care profession. 0:08:39.160,0:08:42.109 And this is the truth because[br]the treatments we use do not get to the 0:08:42.109,0:08:44.559 root cause of the problem, the trauma. 0:08:44.559,0:08:46.740 They paper over the cracks. 0:08:46.740,0:08:50.090 And I think the pharma industry know this[br]and they queue up and they 0:08:50.090,0:08:53.510 provide us with product after product to[br]give to our patients that doesn't quite 0:08:53.510,0:08:58.380 cure them but it gets them slightly better to function. 0:08:58.380,0:09:00.370 And they have to keep taking them. 0:09:00.370,0:09:04.800 I would say that we're in psychiatry today where[br]we were in general medicine 100 years ago. 0:09:04.800,0:09:06.540 100 years ago in general medicine, 0:09:06.540,0:09:10.160 humanity was losing the battle to the infectious diseases. 0:09:10.160,0:09:12.760 Oh we were very good at classifying and diagnosing them. 0:09:12.800,0:09:14.770 We knew who got smallpox. 0:09:14.770,0:09:17.320 We knew people died of post-operative surgery. 0:09:17.320,0:09:20.640 We knew there were microorganisms [br]but we didn't have a treatment. 0:09:20.640,0:09:25.850 And then at the beginning of the 20th century we discovered the antibiotics. 0:09:25.850,0:09:29.810 Not symptomatic treatment but treatment[br]that goes to the core of the cause 0:09:29.810,0:09:33.660 and we started getting on top [br]of infectious disease. 0:09:33.760,0:09:37.090 Psychiatry today is in a similar place. 0:09:37.090,0:09:39.550 We're very good at classifying and diagnosing. 0:09:39.550,0:09:41.670 Our epidemiology is superb. 0:09:41.670,0:09:44.000 We write these thick diagnostic manuals. 0:09:44.000,0:09:45.529 We know who gets depression. 0:09:45.529,0:09:47.070 We know who gets anxiety. 0:09:47.070,0:09:53.700 We even know the cause: trauma, child abuse,[br]maltreatment, poor social conditions. 0:09:53.700,0:09:56.150 But our treatments are lousy. 0:09:57.810,0:10:00.820 And I'm quite shocked the way the empathy 0:10:00.820,0:10:05.030 switch and our understanding of these[br]patients seems to be switched off. 0:10:05.550,0:10:09.520 We have lots of gushing sentimentality for[br]the little five and six year old who's 0:10:09.520,0:10:14.710 being abused and we throw money at our[br]television sets on these campaigns to 0:10:14.710,0:10:17.930 improve the lives of these[br]poor little innocent victims. 0:10:17.930,0:10:20.500 Well, let me tell you what happens to that little five or six year old, 0:10:20.500,0:10:23.180 when they're 11 or 12. 0:10:23.180,0:10:26.830 On goes the hood, start smoking weed. 0:10:26.830,0:10:29.360 By the time they're 16 they're buying and selling amphetamine 0:10:29.360,0:10:31.490 and by the time they're Claire's age in their mid-20s, 0:10:31.490,0:10:33.670 they're addicted to heroin and alcohol. 0:10:33.670,0:10:36.580 And suddenly we have lost our empathy. 0:10:36.580,0:10:39.450 These people are public enemy number one. 0:10:39.450,0:10:45.160 "It's your fault Claire. You brought this[br]upon yourself. It's your lifestyle choice." 0:10:45.160,0:10:50.400 And I'm quite shocked and having worked in[br]pediatrics and seen the developmental 0:10:50.400,0:10:55.300 trajectory that is so inevitable from[br]early trauma into adolescent and then 0:10:55.300,0:10:59.079 adult mental health and addictions, we have[br]to hold on to that sense of compassion 0:10:59.079,0:11:04.470 and evidence-based understanding[br]about the developmental trajectory there. 0:11:05.720,0:11:08.720 So it does sound desperate,[br]but all is not lost. 0:11:09.740,0:11:14.220 MDMA. MDMA has some fascinating qualities. 0:11:14.220,0:11:19.410 I would suggest that if you were to invent[br]a hypothetical drug to treat trauma, 0:11:19.410,0:11:21.940 it would be MDMA. 0:11:21.940,0:11:25.610 The way it works in terms of its receptors[br]and its subjective psychological effects 0:11:25.610,0:11:27.550 ticks all the right boxes. 0:11:27.550,0:11:31.420 At one level of receptors it causes[br]a increased positive mood. 0:11:31.420,0:11:34.200 Lowering of depression, lowering of anxiety. 0:11:34.200,0:11:37.160 At another group of receptors it speeds[br]the patient up, 0:11:37.160,0:11:41.570 mild stimulation which motivates them[br]to engage in therapy. 0:11:41.570,0:11:45.140 At another level it relaxes[br]the patient paradoxically 0:11:45.140,0:11:50.120 at the same time as the stimulation and this[br]puts the patient into the optimal arousal 0:11:50.120,0:11:53.330 zone where they can engage in psychotherapy. 0:11:53.330,0:11:58.610 But perhaps the most important thing about[br]MDMA and the most important clinical tool 0:11:58.610,0:12:06.020 is its ability to provide a sense of empathy[br]and understanding and emotional security. 0:12:06.960,0:12:12.230 It can hold the patient in a place where[br]they can think about and access their trauma 0:12:12.230,0:12:15.310 like they've never been able to do before. 0:12:15.710,0:12:17.690 One of the ways in which MDMA works is 0:12:17.690,0:12:21.650 it increases the release of a[br]hormone called oxytocin. 0:12:21.650,0:12:25.600 Oxytocin is released from the brains of[br]breastfeeding mothers. 0:12:25.600,0:12:28.760 It's a hormone that engenders a sense of[br]attachment and bonding. 0:12:28.760,0:12:32.710 And that's what's happening in the[br]patient who takes MDMA. 0:12:32.710,0:12:36.450 And also it acts directly on[br]the amygdala to reduce 0:12:36.450,0:12:41.280 that fear response whilst at the same[br]time boosting the prefrontal response, 0:12:41.280,0:12:44.240 allowing the patient to see things in a new light. 0:12:44.240,0:12:46.130 A positive light. 0:12:46.130,0:12:48.320 So let's go back to Claire. 0:12:48.320,0:12:50.340 She's 40 now. 0:12:50.340,0:12:52.190 She's been in and out of psychiatric hospitals, 0:12:52.190,0:12:54.390 having tried to take her own life and the inception. 0:12:54.390,0:12:57.780 She's been on all the antipsychotic and antidepressant mood stabiliser drugs. 0:12:57.780,0:13:01.560 She's tried all the psychotherapies but she cannot engage 0:13:01.560,0:13:08.750 because she will not talk about her feelings. 0:13:04.290,0:13:11.160 So she comes into a course of[br]MDMA-assisted psychotherapy. 0:13:11.160,0:13:16.389 What does it look like? 0:13:13.779,0:13:18.699 It's weekly sessions, maybe eight, ten,[br]twelve weeks long. 0:13:16.389,0:13:22.569 There are two therapists, male-female pair. 0:13:18.699,0:13:24.759 You do not take MDMA everyday,[br]you do not take it every week. 0:13:24.759,0:13:29.259 Over that course of 12 sessions you'll[br]take the MDMA three times and the 0:13:29.259,0:13:33.730 other sessions you talk about the material[br]that's released on the MDMA session. 0:13:33.730,0:13:40.839 So what does Claire actually feel[br]when she takes this MDMA? 0:13:37.089,0:13:43.029 What she feels is a sense of warmth and[br]understanding and a sense of containment 0:13:45.839,0:13:52.269 within that relationship she's having with the therapist. 0:13:48.519,0:13:54.550 MDMA is like it's like a lifejacket like a bulletproof vest 0:13:54.550,0:14:01.829 to wear to go into battle with your trauma. 0:13:57.730,0:14:05.470 This is not ecstasy! 0:14:01.829,0:14:07.389 She's not enjoying some raver's euphoric ecstasy delight. 0:14:05.470,0:14:09.790 This is still trauma focused psychotherapy[br]and it is still hard and distressing for her, 0:14:09.790,0:14:15.339 but she can just about do it with MDMA on board. 0:14:11.949,0:14:18.009 So when the therapist says:[br]"Claire, tell me about your rape". 0:14:18.009,0:14:22.629 In the past just the word rape and she'd be out the door, 0:14:20.920,0:14:25.689 but on MDMA she says:[br]"yeah, I can talk about that! 0:14:25.689,0:14:31.990 I can see him now coming into the room.[br]I can smell the whiskey on his breath and 0:14:28.899,0:14:34.329 I can feel the stubble on his face[br]as he's raping me". 0:14:34.329,0:14:39.040 And she talks about it and she explores it[br]and she reflects upon it 0:14:39.040,0:14:44.559 and she can begin the process of healing. 0:14:42.069,0:14:47.649 And from here she can start her 0:14:44.559,0:14:50.709 journey. She can attack the root cause of 0:14:47.649,0:14:56.769 her problems. Not just maintain the 0:14:50.709,0:14:58.959 symptoms at a level. So, does it work? Well 0:14:56.769,0:15:00.970 we've known about MDMA for very long 0:14:58.959,0:15:03.910 time and indeed we've used MDMA in 0:15:00.970,0:15:06.189 underground therapy for 30 or 40 years. 0:15:03.910,0:15:09.309 And there are thousands of positive 0:15:06.189,0:15:11.679 anecdotal cases. I get five emails a week 0:15:09.309,0:15:13.509 from all over the world: "Dr. Sessa, I've 0:15:11.679,0:15:16.209 had PTSD for years. I've tried everything 0:15:13.509,0:15:16.929 and now I tried MDMA and I'm starting to 0:15:16.209,0:15:19.689 make a breakthrough!" 0:15:16.929,0:15:21.850 Now, anecdotal reports like that are 0:15:19.689,0:15:23.230 interesting but they're not science so 0:15:21.850,0:15:26.439 we've done the science. And some 0:15:23.230,0:15:27.310 important studies in recent years. 0:15:26.439,0:15:29.949 Big study in the States 0:15:27.310,0:15:33.100 showed that a single course of MDMA 0:15:29.949,0:15:35.439 therapy, 16-week course, patient takes 0:15:33.100,0:15:39.129 MDMA three times tested against a 0:15:35.439,0:15:41.949 placebo. At the end of that course 85% of 0:15:39.129,0:15:45.129 the people no longer met the diagnostic 0:15:41.949,0:15:47.980 criteria for PTSD. Not just a relief of 0:15:45.129,0:15:50.410 symptoms, they didn't have PTSD! 0:15:47.980,0:15:54.339 Now that cohort were then followed up 0:15:50.410,0:15:56.709 three years later, the same no PTSD. Many 0:15:50.438,0:15:56.709 of those people had come off their daily 0:15:56.709,0:16:03.790 medications. They were cured! We don't use 0:16:00.610,0:16:07.930 the word "cure" in psychiatry. We've become 0:16:03.790,0:16:09.579 learned helplessness position of-- This is 0:16:07.930,0:16:11.559 the truth! If you're diagnosed with a 0:16:09.579,0:16:13.300 severe mental disorder like anxiety or 0:16:11.559,0:16:15.220 depression in your 20s and the 0:16:13.300,0:16:17.740 developmental route of that disorder is 0:16:15.220,0:16:19.569 severe child abuse, there's a pretty good 0:16:17.740,0:16:21.639 chance, and I'm sorry to say this, there's 0:16:19.569,0:16:23.589 a pretty good chance you will still be 0:16:21.639,0:16:26.589 going to psychiatric clinics in your 60s 0:16:23.589,0:16:28.809 and 70s. Now that is not good enough and 0:16:26.589,0:16:33.370 we're in this position because we're not 0:16:28.809,0:16:36.819 tackling trauma. So, it works but is it 0:16:33.370,0:16:39.610 safe? Well, when we talk about safety of 0:16:36.819,0:16:42.639 clinical MDMA, what we must not do is 0:16:39.610,0:16:45.790 look at the risks of recreational 0:16:42.639,0:16:46.720 ecstasy. I don't even know what ecstasy 0:16:45.790,0:16:48.790 is anymore! 0:16:46.720,0:16:51.550 Ecstasy is over here, what is ecstasy? 0:16:48.790,0:16:54.100 Some dodgy pill bought in some dodgy 0:16:51.550,0:16:56.889 club of some dodgy geezer, that may or 0:16:54.100,0:17:00.480 may not contain MDMA plus or minus 0:16:56.889,0:17:03.040 whatever far more toxic substance. And 0:17:00.480,0:17:05.109 indeed when you hear about the very 0:17:03.040,0:17:10.359 high-profile deaths of people who take 0:17:05.108,0:17:12.219 ecstasy, it invariably is not MDMA. So, 0:17:10.358,0:17:15.219 let's not look at ecstasy as a measure 0:17:12.220,0:17:18.398 of MDMA. Let's look at clinical MDMA. Now, 0:17:15.220,0:17:20.709 when you use clinical MDMA, you take 0:17:18.397,0:17:23.279 it under medical supervision. It is pure. 0:17:20.709,0:17:30.289 The MDMA that I'm using in my studies is 0:17:23.280,0:17:32.850 99.98% pure! Very expensive! [br](laughter) 0:17:30.289,0:17:34.470 We do it under medical supervision with 0:17:32.850,0:17:37.950 a doctor and a nurse and a psychologist. 0:17:34.470,0:17:40.740 And under those conditions the risks are 0:17:37.950,0:17:42.990 reduced to a absolute minimum. Indeed 0:17:40.740,0:17:45.690 after 40 years of MDMA research, there 0:17:42.990,0:17:48.630 has not been a single serious adverse 0:17:45.690,0:17:53.580 drug reaction, not one! And certainly no 0:17:48.630,0:17:55.500 deaths. So, we need to do this research 0:17:53.580,0:17:59.880 and we need to do this research in an 0:17:55.500,0:18:02.970 evidence-based, compassionate way. Looking 0:17:59.880,0:18:05.159 at the data. We need to ignore the 0:18:02.970,0:18:06.630 socio-political agenda that says any 0:18:05.159,0:18:11.610 drug that's being used recreationally 0:18:06.630,0:18:15.780 must also be very bad and dangerous. That 0:18:11.610,0:18:19.320 sort of attitude hampers research. And we 0:18:15.780,0:18:21.720 need scientists to drive this. It works, 0:18:19.320,0:18:23.760 it's safe. And it offers patients like 0:18:21.720,0:18:25.590 Claire for the first time in their life 0:18:23.760,0:18:27.840 an opportunity to break through from 0:18:25.590,0:18:31.110 that trauma and not become a lifelong 0:18:27.840,0:18:33.179 chronic PTSD sufferer. So where were we 0:18:31.110,0:18:35.190 going with MDMA research? Well, we've had 0:18:33.179,0:18:37.049 some studies, we've got more coming here. 0:18:35.190,0:18:38.669 I'm doing a study in Cardiff with 0:18:37.049,0:18:41.940 neuroimaging in which we're going to 0:18:38.669,0:18:43.320 give patients with PTSD MDMA and placebo 0:18:41.940,0:18:44.700 and we're going to look at 0:18:43.320,0:18:47.730 that relationship between the 0:18:44.700,0:18:49.159 amygdala and the prefrontal cortex. We're 0:18:47.730,0:18:51.419 also doing a study here in Bristol 0:18:49.159,0:18:54.840 giving patients with alcohol use 0:18:51.419,0:18:58.230 disorder MDMA, because underlying the 0:18:54.840,0:19:00.809 root of this addiction is trauma. So this 0:18:58.230,0:19:02.460 is an exciting time. Now people say: "This 0:19:00.809,0:19:04.320 is controversial!" And indeed, I was 0:19:02.460,0:19:06.270 introduced as a controversial speaker. 0:19:04.320,0:19:08.880 I'm not controversial, I'm a very boring 0:19:06.270,0:19:11.880 conservative doctor. I like data. 0:19:08.880,0:19:14.429 I like evidence-based data that helps my 0:19:11.880,0:19:16.860 patients. I'll tell you what's 0:19:14.429,0:19:19.110 controversial! What's controversial is 0:19:16.860,0:19:21.179 that more people have died returning 0:19:19.110,0:19:22.590 from Afghanistan and Iraq because 0:19:21.179,0:19:25.500 they've committed suicide because of 0:19:22.590,0:19:27.510 their untreated PTSD then ever died in 0:19:25.500,0:19:32.760 the conflict out there. That is 0:19:27.510,0:19:35.150 controversial and that is unethical! So 0:19:32.760,0:19:38.340 this is a important time for science. 0:19:35.150,0:19:40.620 MDMA could be the antibiotic that 0:19:38.340,0:19:42.419 psychiatry has been waiting for. We owe 0:19:40.620,0:19:43.630 that population of patients who are 0:19:42.419,0:19:46.690 being failed, 0:19:43.630,0:19:50.220 we owe them this research! We owe this 0:19:50.220,0:19:53.750 Claire! Thank you.[br](applause)