MAPS Brings MDMA-Assisted Therapy to the War in Ukraine
The full-scale Russian invasion of Ukraine, which began over three years ago, has kept the nation in the international spotlight. Now, it is the seventh site for the Multidisciplinary Association of Psychedelic Studies’ (MAPS) International Therapist Education (ITE) Program.
Launched in 2023, the program has educated over 300 practitioners from more than 30 countries, expanding training for psychedelic-assisted therapy (PAT) in areas “of greatest need around the globe.” Participants spend several days learning the fundamentals of MAPS’ therapy protocol, developed for MDMA-assisted therapy.
Bringing psychedelic-assisted therapy to people in conflict zones has long been a goal of MAPS founder Rick Doblin. In April, Doblin, along with Marcela Ot’alora G. MA, LPC, and Bruce Poulter RN, MPH, traveled to Ukraine to train 55 therapists in the therapy model MAPS developed. Ukrainian teaching staff who had previously completed the ITE training assisted.
Over six days, a group of trainees – mostly military and clinical psychologists and psychotherapists – convened in the country, where MDMA is not only illegal, but also unavailable for scientific research (a restriction inherited from the Soviet era). Oleh Orlov, chairman and CEO of Ukrainian Psychedelic Research Association (UPRA) and co-founder of Heal Ukraine Trauma, explains that “there was no PAT research in the Soviet era in Ukraine. There was also no counterculture. But there was the war on drugs.”
After the revolution in 2014, people could finally talk publicly about drugs without fear of Russian persecution, and a campaign to legalize medical cannabis began. Supporters included the former Ukrainian Minister of Health.
Orlov and his colleagues organized the country’s first PAT conference, but it was canceled due to COVID-19. Despite the cancellation, interest grew, and the original planning committee swelled to over 500 members.
At that time, Orlov first connected with Rick Doblin, MAPS founder and president, who suggested that Ukrainian therapists join the 2020 virtual MDMA-assisted therapy training cohort, which was also canceled. The seeds were planted “before the war started, when no one could find Ukraine on a map,” said Orlov.
For Doblin and Orlov, the urgency has heightened. “This is more important now than ever before as America is wavering in support for freedom all over the world and domestically,” said Doblin. “For me, it’s a chance to show how we respond to the world. Ukrainians are fighting for freedom, and the more we can help, the better.”
The Need For PAT Increases
“After the full-scale invasion of Russia started in 2022, the need for PAT moved to another level,” Orlov said. “It became easier to talk to Ukrainian authorities [and] the worldwide community became very active in helping Ukraine in all spheres.” Over 2023-24, the first Ukrainian PAT conference and key meetings at Parliament and the Ministry of Health took place. A meeting in Warsaw, Poland, organized by the Psychedelic Access and Research European Alliance (PAREA), International Renaissance Foundation (IRF), and Open Society Foundations (OSF), focused on PAT advocacy and plans and featured international experts, including Doblin.
In the United States, the current administration’s stance on Ukraine has shifted. Psychedelic-assisted therapy has notably had advocates willing to reach across the political aisle despite the FDA’s decision last year not to approve MDMA-assisted therapy for PTSD. Going to Ukraine is part of MAPS’ larger strategy “to win bipartisan support for MDMA-assisted therapy,” said Doblin. “MAPS is working to go where the suffering is.”
The most recent training was the second to include Ukrainians. The first, held in Sarajevo in 2023, hosted 15 Ukrainians. Of those, seven specialists were part of the assistant team for this year’s training.
Participants were selected by the groups Ukrainian Psychedelic Research Association and Heal Ukraine Trauma in collaboration with potential research sites. Interest exceeded available spots. The organizing team sent the call for applications to a database of 2,500 doctors. Two hundred applicants were then rated based on criteria including education, job title, knowledge of English, and experience.
The highest-rated applicants took part in the training. “We prioritized registered psychiatrists with 10+ years of experience, a doctoral degree, and experience in treating PTSD in veterans. They all understand that we need new treatment methods to overcome the impact of war,” Orlov said.
The training team used the MAPS therapy model, scrutinized during the FDA Advisory Committee hearing in 2024, with no major changes. Participants received a Ukrainian translation of the treatment manual.
Approaches To The Therapy
For Doblin, offering MDMA with therapy, regardless of the protocol, is essential. He cites studies funded by MAPS combining MDMA with different therapeutic modalities, noting that MDMA is the tool, but that “research clearly demonstrates it is the therapeutic alliance between patients and therapists that is important, more so than the school of therapy.”
Offering the MAPS protocol is a critical way MAPS continues to advocate for that therapeutic alliance, but Doblin emphasizes it is one of many options for therapy. The FDA does not regulate the practice of medicine once a drug is approved, meaning it can then be prescribed off-label and without regulation of the prescribing practice.
For Doblin, that’s a critical mistake. “The field is going in the wrong direction” by offering these drugs without therapy, he said. “MDMA is a tool that can be used in many different therapeutic contexts. We want therapists to customize their approach.”
OSF provided MAPS funding to run the training, which was provided at no cost to participants. Lykos Therapeutics, the public benefit corporation founded by MAPS to develop MDMA, is fully separate from MAPS’s humanitarian projects. The Ukrainian government gave its full support, with some officials and politicians attending part of the program, said Doblin.
If lawmakers allow it, future trainings could include the opportunity to volunteer to receive MDMA as part of the protocol. As with the clinical trials, all sessions would be supervised, videotaped, and given adherence ratings. Once participants have finished the training, “they are free to do as they want to scale to meet the need,” Doblin said.
The Future of PAT in Ukraine and Beyond
Orlov and his team are in the process of consultations with the Ukrainian government and health authorities. On the table are discussions of a Ukrainian bylaw regulating how to do research with scheduled substances – there is no such law currently in existence. Also being considered is rescheduling of MDMA, psilocybin, psilocin, LSD, DMT, 5-MeO-DMT, and ibogaine to Schedule 2, allowing research and medical use. Ukraine is also not part of the European Union and can act independently of both the European Medicines Agency and the FDA.
The prevalent stance in Ukraine is still that MDMA is a dangerous drug, said Orlov. “Most people treat MDMA as an illegal, dangerous recreational drug, ecstasy. They don’t differentiate between MDMA and heroin.” Others “know of international research and see it as a source of hope.”
The stakes are high, and the payoff could be great, he added. “We at UPRA see PAT as a powerful transformative tool. If done properly, it can help the human species evolve. It can help the Ukrainian nation survive.”
Doblin and MAPS have already expanded training to additional sites such as Somaliland, Rwanda, and Beirut, which he visited in May, and they plan to roll out initiatives in other countries, including Lebanon and Dubai. Many of the areas identified as in need are also very conservative in their drug policies and cultures, or have different understandings of mental illness than those prevalent in Western medical models.
In some areas, a combination of these and other challenges has led to innovative approaches. Rwanda, for example, does not have many therapists and psychiatrists, so the team is working with local healers and nurses, and is developing protocols for group and family therapy. Somaliland has different ways of conceptualizing mental health and lacks DSM-recognized terminology.
“People there tend to somaticize mental health issues and express things differently,” Doblin said. “We’ll be studying ‘mood disorders’ of a wide range, rather than PTSD specifically, to capture whatever they say in the problem. It’s exciting to figure out how to make this fit within different cultural contexts.”
One other cultural challenge trainers and therapists face is the acceptance that mental health issues are dictated by fate. “People have to struggle against those defenses and have the will to get better,” Doblin said.
MAPS has partnered with institutions in Israel, which have a sophisticated medical infrastructure and where research can be conducted freely. Doblin is also prepared to go to the West Bank, where he says a hospital is willing to work with MAPS if the organization can raise funds. “That area is a hot zone,” he said.“One of the main principles of MAPS is healing for all. Both victims and perpetrators need healing. It’s also sometimes harder for perpetrators to forgive themselves than for victims to make peace with what has happened to them. I think it’s my obligation to try to reduce trauma in Arab countries.”
As he travels to take the protocol to new people, Doblin says he wants to keep the therapy front and center. “We have a much broader mission than just medicalizing MDMA through the FDA,” he said. “We have a global mission. And while a lot of psychedelic pharmaceutical companies are trying to ditch therapy, I think that’s a fundamental mistake. It’s not just the drug. Really, it’s the drug plus therapy. That’s what we are trying to emphasize around the world. It’s not about what’s easiest through the FDA. It’s about what’s best for patients.”
Net-Zero Trauma
Doblin’s goal remains achieving “net-zero trauma by 2070,” a plan that has garnered criticism, some of it harsh, from detractors. Offering these therapies to soldiers, he notes, is a critical part of this. “When soldiers are activated by their trauma, they are likely to be more mistake-prone and easily triggered,” he said. “This idea that this is making wars easier to fight is not the case. We are opening the door to people talking more about the trauma of war and giving them tools to cope with it. Russia’s invasion of Ukraine makes it clear that we need a military because of totalitarian states. Helping people process trauma is hopefully a way to produce less trauma.”
Scheduled for the upcoming Psychedelic Science conference, held on June 16-20 in Denver, the discussion “The Potential for Psychedelic- Assisted Therapy in Conflict-Afflicted Populations: Ukraine and the Balkans,” will explore the training and next steps in Ukraine. The panel features Zina Besirevic (Healing Balkans Org), Oksana Gryshchenko (Heal Ukraine Trauma), Tadeusz Hawrot (PAREA), Galyana Pidpruzhnykova (an independent consultant), and Elise Wilson (Heal Ukraine Trauma) and will take place Friday, June 20 at 10:30 AM MT. Session recordings will be available after the conference.
Correction: This article has been updated to show that no therapists received MDMA as part of this training, but it was a discussion of a hypothetical future if lawmakers allow it.