The psychiatrist who can now prescribe MDMA

Dr Gary Wynn is one of two psychiatrists who have just been approved to administer and prescribe MDMA in New Zealand, to treat post-traumatic stress disorder (PTSD).In legal terms, MDMA is a Class B high risk drug. It is also known as ecstasy, E, or molly, and is a stimulant and hallucinogen.It is the first time MDMA assisted treatment has been allowed in Aotearoa.Dr Wynn talked with Saturday Morning about the research his team will be doing, who could be treated, and what their sessions might look like.In the 1970s, MDMA's first use was as a medicine known as 'empathy', used by therapists," Wynn says."It creates an openness, a connection. An empathy-enhancing compound that sort of reduces the fear centres in the brain, and puts people in this really open space to do some deep work, particularly around traumas that they've experienced in their life."In the early 1980s MDMA became better known as a party drug, and by the mid-1980s it was made illegal in the United States - which soon became the norm around the world. "And we spent 40-ish years with it being illegal, until Australia in 2023."Australia's medicines regulator granted permission in 2023 for psychedelics to be used in therapy nationally there, including psilocybin for depression, and MDMA for PTSD.What could MDMA do clinically?MDMA's potential "is pretty amazing," Wynn says.He has done training in Canada and Australia on providing MDMA treatment, and will be working with Dr Tom Paterson for the New Zealand trials."It's one of those drugs that when it works it feels almost magical, people get better sometimes so quickly and so intensely that you're like 'wow', it's almost unbelievable given the typical history of psychiatric treatments where medications take months to work, therapies sometimes years to work."In one study, about 80 percent of people were significantly better from treatment from three rounds of MDMA treatment, and at least 50 percent had full remission of their PTSD. And I don't know anything else that even comes close to those numbers in terms of treatment efficacy for PTSD."Who could receive the treatments?"There's a lot of reasons people can be severely traumatised," Wynn says."Military and veteran PTSD had got a lot of attention - I think deservedly so - but the truth of the matter is people get traumatised and severely traumatised from a whole host of reasons." Among them, sexual assault, prolonged childhood abuse and domestic violence, he says.The test patients will be people who have PTSD, and who have not had success with an earlier treatment, such as SSRIs (selective serotonin reuptake inhibitor medicines) or talk therapy."Typically we're looking at more severe cases upfront."That's the other really unique thing about MDMA, most treatments for PTSD as you get more severe the treatments work less and less, so they work the best in sort of mild to moderate PTSD. And then gosh, really severe PTSD, nothing seems to work."But so far, MDMA trials seem to show pretty even benefit across the different severities of PTSD, he says.What will the work involve?MDMA affects a number of neurotransmitters in the brain, including serotonin, dopamine, norepinephrine and oxytocin - a brain chemical involved with feelings of connection. It also quietens down the fearful side of the brain, Wynn says."So it's not just the connection, it's the connection and then this quieting down of the fearful parts of the brain. I think those two things work in tandem to put someone into this really open state where they can look at their traumas in a less overwhelmed way."The protocol the team will use is a "fairly intense and fairly long protocol", he says. It is modelled off the earlier US FDA approved MAPS (Multidisciplinary Association for Psychedelic Studies) clinical trial protocol.First, prospective patients are screened with a full psychiatric examination and health screening. Then there will be rounds of treatment, which each consist of three stages - a preparation phase, a medicine session and an integration session."There's two therapists for all of this time - so the two therapists and the individual will get to know each other. You do need a lot of trust and understanding, a lot of rapport, a lot of understanding of what the shape of all their traumatic experiences are, understanding about their social supports."You need to understand the person pretty well, so that can take a lot of hours to get to that point."They will then run a full day medicine session, during which the MDMA dose will be given, after "careful preparation to get them into a calm state"."We administer the drug, it takes maybe half an hour to work, at which point they go into this altered state. Some people get pretty significantly into an altered state, some people have a sort of milder experience."Then during that time we do the therapeutic work looking at the traumas, processing things, somewhat allowing them to go where their mind wants to take them. There's a classic comment in psychedelics talking about the inner healing intelligence - that some of the job is getting out of the way and letting the mind do the work of healing itself."It's a long day with a lot of emotions, he says: "pretty intense"."Then after that completes, we'll do three or four more sessions with the two therapists and the individual where you're trying to integrate what happened, you're trying to make sense of it, you're trying to take these learnings from that day-long experience and action them into the real world."With three rounds typical for each of the preparation phase, medicine session and integration sessions for each patient: "All told, there's about 50-ish hours of therapist time, and there's two therapists the entire time."Wynn says people using MDMA recreationally are not guaranteed of the purity of what they're taking, whereas the MDMA used in this approved trial will be pharmaceutical grade and pure.MDMA is also known as ecstasy, E or molly.Supplied/ NZ Drug FoundationThe Drug Foundation has warned that drugs illegally sold as MDMA in New Zealand can sometimes have other things mixed into them, or even be another substance altogether - in particular synthetic cathinones (often called bath salts): And that "these drugs can have more unpleasant and unpredictable effects than MDMA".Wynn says he hopes their team will have their first patient receiving the treatment within the next two to three months."It's been a really exiting time, it's been quite a bit of work with Medsafe and getting all the processes right, but we're just exited it's finally come to fruition."