Phase II Dose-response Pilot Study of 3,4-methylenedioxymethamphetamine (MDMA)-Assisted Psychotherapy in Subjects With Anxiety Associated With Advanced-stage Cancer.
People who learn they have cancer can feel frightened, upset and depressed, and a diagnosis
of advanced stage cancer can generate intense anxiety. People with advanced stage cancer may
be anxious about their deteriorating health and the nearness of death, disruption in their
close relationships caused by current or future changes in health, and grief for the life
planned and expected prior to learning they had advanced stage cancer. There are treatments
for reducing intense anxiety, such as Valium and related drugs, but these drugs have
unwanted side effects that may be especially distressing for people already taking
medication for pain control and seeking to remain clear-headed.
3,4-methylenedioxymethamphetamine (MDMA) is a drug that can produce effects uniquely suited
to reducing anxiety for people with anxiety arising from a cancer diagnosis. MDMA has been
hypothesized to belong to a class of drugs, called entactogens, that produce feelings of
closeness to others, empathy, wellbeing, and insightfulness. Currently, MDMA is scheduled
(illegal) and cannot be used outside of research studies like this one. However, prior to
its being made illegal, some psychotherapists treated people with cancer or other terminal
illnesses with MDMA-assisted psychotherapy, and they reported a reduction in anxiety and
improved quality of life.
This study will examine the effects of MDMA-assisted psychotherapy in 12 people aged 18 or
older who have received a diagnosis of advanced stage cancer (usually meaning inoperable and
with metastases) who have anxiety as a result of this diagnosis that is either not helped by
conventional anti-anxiety medication (such as Xanax or Valium), or who do not wish to take
these medications because of their side effects. In Stage 1, all study subjects will receive
an initial dose of MDMA followed by a second (supplemental) dose approximately two and a
half hours later if the initial dose does not produce any problems. Eight of twelve study
subjects will get 83.3 mg MDMA followed by 47.1 mg the first time, and 125 mg followed by
67.5 mg the second time. Four of twelve study subjects will receive 25 mg followed by 12.5
mg MDMA. Whether a person receives low doses or full doses of MDMA will be decided at
random, as if by coin toss, and none of the researchers will know which dose of MDMA a
person will get in Stage 1. The four subjects who received the lower doses of MDMA in Stage
1 may continue to participate into Stage 2 in which they repeat the study except that they
will receive open-label 83.3 mg MDMA followed by 47.1 mg the first time, and 125 mg followed
by 67.5 mg the second time. The eight participants in Stage 1 who had MDMA-assisted
psychotherapy sessions at these higher dose strengths will not continue into Stage 2. The
Stage 2 study extension will provide potential additional data on the MDMA doses being
evaluated without having to recruit additional subjects.
For Stage 1, the study will last 14 weeks (about three and a half months). All study
participants will have six (6) hour-long psychotherapy sessions and two (2) MDMA-assisted
psychotherapy sessions lasting six to eight hours and requiring an overnight stay at the
treatment facilities. The ordinary and MDMA-assisted sessions will be conducted by the same
therapists. For the four subjects continuing into Stage 2, the study will last an
additional 10 weeks (about two and a half months) with additional six (6) hour-long
psychotherapy sessions and two (2) MDMA-assisted psychotherapy sessions lasting six to eight
hours and requiring an overnight stay at the treatment facilities.
People enrolled in the study can continue taking anti-anxiety medications, but cannot take
any other psychiatric medications for the entire course of the study. They can take their
usual pain control medications, but if they take more pain control medications than usual on
the day of the MDMA-assisted session, they may have to delay or reschedule the session.
People enrolled in this study will complete questionnaires about their anxiety and quality
of life, and they will keep a daily diary where they write down how much anxiety and pain
control medication they are using, and a daily record of the amount of pain they experience.
Anxiety and quality of life will be measured at the start of the study, before each sessions
of MDMA-assisted therapy, one week after receiving MDMA-assisted therapy and once at the end
of the study, 84 days after a person started the study (approximately two months after the
second MDMA-assisted psychotherapy session; for Stages 1 and 2). All study subjects will
also receive a second medical examination 36 days after the study has begun (and again 36
days after starting Stage 2). The medical examination will be performed at the Lahey Clinic
Medical Center's Medical Oncology department or at McLean Hospital.
Study participants will not be paid for taking part in the study. We will pay for all tests
and measures used to determine study eligibility. Transportation, if needed, will also be
paid for by the study. MDMA-assisted sessions require overnight stay at McLean Hospital: we
will provide overnight accommodations and all meals and snacks for the subject and a
significant support person of the subject's choosing on those days.
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Factorial Assignment, Masking: Double Blind (Subject, Caregiver, Investigator), Primary Purpose: Treatment
Anxiety - Spielberger State-Trait Anxiety Inventory (STAI)
Obtained over the 3 months of active participation
John H Halpern, MD
United States: Food and Drug Administration
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