Newsweek (International Edition)
May 9, 2005
A Psychedelic Cure
Some doctors want to see if ecstasy, a dangerous illicit drug, can help cancer patients and trauma victims.
By Eve Conant
[MAPS comments in brackets] Imagine a gorgeous suite: sky-lights flood the room with sunlight, the strains of violins play softly from a CD player. A terminally ill cancer patient lies on a soft bed, surrounded by the best equipment the Harvard medical world has to offer. But a deep anxiety is keeping her from dealing with end-of-life issues, from saying goodbye to family or perhaps asking for forgiveness. Then she is given a powerful drug that allows her to peacefully confront her deepest fearswithout sedation. The drug is called MDMA. But if you’re a teenager or an FBI agent, you might know it by its other name: ecstasy.
Two decades after what’s officially methylenedioxymethamphetamine became an illegal drug, it is seeing a quiet and cautious renaissance in mental-health circles. Despite some deaths usually linked to dehydration or lethal combinations with other drugs, researchers nonetheless believe ecstasy could act as a tool to unlock anxiety by targeting areas of the brain that don’t usually respond to antidepressants. In December, the U.S. Food and Drug Administration, with little fanfare, approved a Harvard proposal to test MDMA in 12 patients diagnosed with moderate or greater anxiety in the advanced stages of terminal cancer. And in South Carolina, the first FDA-approved MDMA trials on humans with post-traumatic stress disorder (PTSD) are reaching their first-year mark, and recently expanded to include vets from Iraq and Afghanistan. Similar tests are being discussed in Switzerland, and two in Spain and Israel are pending approval. “People who were young in the ‘ 60s and more comfortable with psychedelics are now in positions of authority,” says Rick Doblin, an expert on MDMA who is bankrolling both U.S. studies through his nonprofit Multidisciplinary Association for Psychedelic Studies. “Times have changed.”
The drug is better known by its street names – ecstasy (or X), Adam, the hug drug or disco biscuit – which conjure images of teens and twentysomethings dancing wildly at all-night raves, sometimes half naked in whipped cream or soap foam. The side effects are addiction, depression and paranoia weeks after ingestion, and occasionally seizures, heart attacks and death. Russian, Israeli and Southeast Asian gangs have controlled most ecstasy trafficking, but America and Europe are top markets.
[Persisting paranoia or psychosis does not commonly occur after ecstasy use, and the factors involved may be complex, with family or personal history of psychosis reported in nearly half of the case reports collected up through 2001. While some people do report feeling sad, moody or depressed a few days after MDMA or ecstasy, clinical depression lasting more than a few days is is also rare, and the relationship between ecstasy use and self-reported psychological problems is also complex. For more details, read the comprehensive MDMA literature review and updates.]
MDMA is pleasurable because of what it does to two parts of the brain: it gives free rein to the nucleus accumbens, a region involved with feeling good, and it suppresses the amygdala, which plays a role in anxiety. MDMA also triggers the release of dopaminethe brain’s feel-good hormonewhich partially explains the acute flush of happiness one gets after ingesting it. Unlike antidepressants, the effect is immediate. And MDMA also quells the anxiety of PTSD victims, who live in a constant state of alertness. “Traditional antidepressants won’t tackle that battle zone in the mind,” says Bruce Cohen, chief psychiatrist and president of the Harvard-affiliated McLean Hospital.
Researchers at Tel Aviv University in Israel are hoping to test the drug soon for soldiers suffering from PTSD. Spanish psychiatrists want to revive a trial of MDMA for rape victims that was canceled in 2002 by Spanish authorities following negative press coverage. They’re proposing expanding the study to include male and female PTSD sufferers. Europeans have done many more safety studies on MDMA than their U.S. counterparts, but in large part have fallen behind on studying therapeutic uses of the drug, says Doblin.
[The press coverage was very positive, which outraged the Madrid Anti-Drug Authority which intimidated the hospital to shut down the study. This study is a story of political suppression of research, not of negative press coverage. The Ministry of Health never withdrew approval, the IRB for all the public hospitals in the Madrid area withdrew permission. Now we will be working with a private hospital with its own IRB, and with the Ministry of Health.]
Trials in Boston with terminally ill cancer patients will test MDMA’s efficacy for easing anxiety about treatment without sedation. Each patient will get six sessions over two months, followed by an overnight at the hospital and extensive therapy with a psychiatrist. Everyone is cautious. The PTSD study in South Carolina, for example, includes a $1 million insurance policy and $40,000 for an emergency-room doctor and nurse during each session. “We’ve learned not to overlook the risks,” says Doblin.
[Each patient gets 2 separate day-long MDMA sessions, each followed by overnight stay, with six additional non-drug sessions before and after the MDMA sessions]
Drug-enforcement authorities are against the studies. David Murray, a policy analyst with the White House, says trials send the wrong signal: “Kids will say, ‘Hey, it’s a medicine. They give it out at Harvard’.” Even supporters of the trials, like oncologist Todd Shuster, who will help select patients for the Harvard trials, were skeptical at first. “I thought of MDMA as the rave drug. But the more I read, the more I realized this was a scientific question worth asking.” All eyes are watching to see if he’s right.
Learn more about MAPS-supported MDMA research.
The International edition of Newsweek published “A Psychedelic Cure”, a piece similar to the a piece published last week in the domestic edition, but with greater discussion of proposed studies of MDMA-assisted psychotherapy in Spain and Israel.