The future of MDMA research: 5 Questions for Australian psychologist Gill Bedi

Bedi discusses her MDMA research, and changing trends in the field over the last two decades as well as the psychedelics scene in Australia.

Gill Bedi came of age in Australia as part of the “ecstasy generation” of the 1990s when the drug was big in rave scenes. When she entered college, she planned to study the sociology of ecstasy users, but grew enamored with psychology instead. Bedi has been studying MDMA since 2001, first as a clinical psychology PhD student at Monash University, then as a postdoctoral fellow at the University of Chicago and a faculty member at Columbia University’s medical center in New York.

Now an associate professor at the University of Melbourne and a senior research fellow at the youth mental health organization Orygen, she studies substance use and misuse, particularly in young people, and works with patients as a clinical psychologist. The Microdose spoke with her about her MDMA research, and changing trends in the field over the last two decades as well as the psychedelics scene in Australia.

Over the 20 or so years you’ve been studying psychedelics, how has the field changed and how has that informed your research questions?

There’s been a real swing of the pendulum in terms of the research around MDMA. Having been in the field for such a long time, I've seen it go from something that was considered to be terrible, that was going to cause all these problems — it was considered to be a very, very big public health threat. Seeing the pendulum swing entirely the other direction is very interesting.

There’s been bias in both directions. Back in the day, Oprah was saying MDMA causes holes in the brain. There were brain imaging studies that found decreased function in, say, hippocampal regions, and the interpretation was that it was because the hippocampus was not working properly, due to the damage to the serotonergic system. Another study found increased functioning in hippocampal regions and people interpreted that activity as compensatory; they thought toxicity had damaged normal hippocampal functioning. Essentially, that was just people reading the results based on what they believe. And most of the studies coming out on naturalistic MDMA use showed negative effects.

Now, studies almost always show positive outcomes associated with naturalistic MDMA use. I can't really put that down to anything except bias — not necessarily on the behalf of the individual researchers, but just more broadly about the sort of societal discourse about this particular substance. I've seen very clearly how broader societal trends can influence the way something is presented in the scientific field, and that has affected my approach to research. I've always tried to be in the skeptical middle ground — to ask, “Is this really the case?”

You study substance use and substance use disorder, especially in young people. What does psychedelic use look like at the moment, and what constitutes substance use disorder?

As for the latter, it’s when people start having difficulties related to a substance. It's dependent on their insight into their own difficulties, as well as their life demands. If they don’t have a lot of life demands, then the drugs aren’t going to affect them as much, because their life is not making demands of them.

For cannabis, for instance, there's really clear evidence that there's a whole bunch of people who just don't have any problems with it at all, as well as a bunch of people who really do. We got a really nice data set that shows there are different levels of cannabis use disorder in people who all use cannabis quite a lot. The majority of people who use cannabis daily or near daily and don't have cannabis use disorder — but then there are people who use daily or near daily that do have cannabis use disorder. They're showing up saying, “I can't stop using it, I can't control the use, it's causing a whole bunch of problems for me. I'm having fights with my family members about it.”

With stereotypically addictive substances such as methamphetamine, alcohol, or opioids, you are more likely to see a pattern of binge and recovery, as well as withdrawal effects and physiological dependence. That's quite different from what we see with psychedelics. For instance, there’s some older data showing that about 10% of regular ecstasy users meet the criteria for substance use disorder, people who show that binge and recovery pattern of use. But even then, it was quite unusual to see case reports of people using it daily.

We just don't really see the same patterns of dependent use. In terms of working with young people, the use of these drugs takes place in the context of a broader pattern of opportunistic poly drug use — and early onset use of any drug is a bad sign. That's a marker for a whole bunch of risks, like negative mental health outcomes. It’s a bit chicken-or-the-egg, though: someone who's taking LSD at the age of 12 has likely not had a typical background, and may have a lot of big issues to confront.

Do we have any good data on how common it is for young people to have a negative reaction after trying these drugs at a young age?

That's a great question, and I actually don't know of any good data on this. In general, from what I know, it's quite low; we're not talking about huge numbers of young people using psychedelics, and for the most part, negative reactions are typically not catastrophic. Some can very occasionally develop psychotic disorders after use of hallucinogens, but nowhere near as commonly as we see that from something like methamphetamine. Again, it is the question of what the causal relationship here is; it's a fine line between not demonizing the substance, but also speaking to people about their real life experiences with them. The reality is that young people often will use drugs, have a bit of fun, and get on with their lives. If we present these drugs as the worst thing ever, with an abstinence-based D.A.R.E-like approach, then they just stop listening to what we say because it's not accurate.

Last year, Australia’s Therapeutic Goods Administration began allowing psychiatrists to prescribe psilocybin for depression and MDMA for PTSD. Has that had any affect on the Australian psychedelics research scene?

The whole thing was very unexpected, and no one was ready for it. As a result there’s been a pretty long lead time before anyone started receiving the drugs. As I understand it, only around nine prescribers countrywide have been authorized, and it wasn't until earlier this year that we started to see the reports of the first people being dosed. It's been very slow, and I've been on the record saying that I felt like it was too early, because we just didn’t have the infrastructure. And one really frustrating thing about the way that this has been implemented is that the TGA did not mandate a common registry of outcome measures. If they had done that, we researchers would have at least had some outcome data to know how things were going.

The other thing that's a bit frustrating about the process is that it doesn't make it any easier for us researchers from a regulatory perspective, because the TGA’s ruling was a bifurcated scheduling. Here in Australia, MDMA and psilocybin are Schedule 9 drugs, or prohibited substances, and now MDMA is Schedule 8, or a controlled drug, only if it’s used for PTSD treatment with an authorized prescriber. For every other indication, including in clinical trials, it's still Schedule 9, so we are still dealing with enormous regulatory burden in trying to get studies up.

Here in the U.S., the future of MDMA is uncertain after the Food and Drug Administration did not approve it for use in treating PTSD. What do you think the future of MDMA looks like in Australia?

I know that the FDA had concerns about Lykos’s studies including people with a history of MDMA use. That’s an interesting question here, because in Australia, we have really high rates of ecstasy use; in the 18 to 25 age group, it’s around 20%. So in our research, we made the call that it is not feasible to rule out people who have used the drug, although we would have liked to.

There were also concerns about the therapy used in those trials. One new study we’re working on that we’re really excited about is a new study examining therapeutic approach in MDMA-assisted therapy. I had difficulty with the therapeutic approach being used in Lykos’s MDMA studies; it’s an internally focused approach, which is coming from the underground, essentially, which tells people to access their “inner healer” and let the medicine do the work. Many of those practices are a massive departure from what we would say in normal therapy, yet it’s been accepted uncritically as the way that it has to be done. We’re learned a lot in the last 50 years, and there’s no reason we should take something that was essentially developed 70 years ago and put it into practice now.

Maybe I’ll eat my words at some point, but we're actually developing a different approach where we apply a more structured, evidence-based approach that also takes into account the fact that you can’t just do cognitive behavioral therapy for the eight hours of a trip. It’s a model that takes into account a gentler and more invitational way of delivering structured therapy that does take from that sort of more reflective and patient-focused approach. This will be a study with people who have social anxiety; they’d have an opportunity to take a different approach to their own thoughts and beliefs about who they are, why they are that way, what they’re capable of, and the thoughts that are driving fear.

This interview has been edited and condensed for clarity and length.