A reflection on paradigmatic tensions within the FDA advisory committee for MDMA-assisted therapy.

The FDA's rejection of MDMA-assisted therapy highlights a fundamental clash between two paradigms in psychopharmacology. The dominant paradigm treats drugs as having purely biological effects, with context treated as noise to be controlled. An emerging paradigm sees therapeutic effects as interactive with context. Psychedelics challenge the dominant model because researchers insist they are drugs combined with psychotherapy. The FDA's critique of the studies partly concerns experiential and psychotherapeutic elements, which the FDA claims not to regulate, creating paradoxes that suggest a need for regulatory and research shifts to integrate a new paradigm where drugs and psychotherapy interact.

Study at a glance

Abstract

The recent rejection of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy by the U.S. Food and Drug Administration (FDA) is a dramatic moment in the re-emergence of psychedelic research. In this perspective, I argue that it represents a case study for paradigmatic tensions within psychopharmacology. The regulatory system is still influenced by a paradigm that sees the therapeutic effects of drugs as primarily biological, and context is noise to control for. An emergent paradigm considers the therapeutic effects of drugs as interactive with context. Psychedelics are the anomaly that questions the dominant paradigm, mainly due to the determination of psychedelic researchers that the medicines are drugs with psychotherapy. While some of the critique offered by the FDA towards MAPS/Lykos's studies is crucial, much of it is related to the experiential and psychotherapeutic elements - which the FDA claims not to regulate. This leads to some paradoxes within the regulatory procedure, which hint at a need for a shift in how psychedelic-assisted therapy is regulated and researched. Both regulators and researchers will need to find ways to accommodate each other in service of a successful integration of a new paradigm in which drugs and psychotherapy interact.