MDMA-assisted therapy for PTSD and substance use disorders: A scoping review of feasibility and future directions

Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) frequently co-occur (PTSD-SUD). This co-occurrence is associated with reduced treatment efficacy compared to PTSD-only, underscoring the necessity for optimized or additional treatment options. MDMA-Assisted Therapy (MDMA-AT) has been investigated for PTSD, but patients with co-occurring SUD are frequently excluded. This scoping review (i) summarizes evidence on MDMA-AT’s efficacy and safety for PTSD, SUD and PTSD-SUD and (ii) integrates these findings to evaluate its feasibility for PTSD-SUD whilst providing future research directions. A systematic literature search through PubMed/MEDLINE, Web of Science, and PsycINFO. Seven reviews suggest MDMA-AT is efficacious and safe for PTSD and two studies provide preliminary safety evidence for SUD and PTSD-SUD. MDMA-AT demonstrates potential as a feasible treatment for PTSD-SUD, yet conclusive evidence regarding its efficacy and safety for this population is lacking. Future studies should primarily explore MDMA-AT’s safety for PTSD-SUD across diverse SUD types and severities, thereby establishing a clearer empirical foundation for its feasibility. • This review explores MDMA-assisted therapy in PTSD and substance use co-occurrence • MDMA-assisted therapy is efficacious and safe for treating PTSD • MDMA-assisted therapy shows potential feasibility for the co-occurring population • Findings may inform future research on MDMA-assisted therapy for dual diagnosis