Summary: Al Jazeera America’s America Tonight reports on the success of MAPS-sponsored clinical research into MDMA-assisted psychotherapy to treat posttraumatic stress disorder (PTSD), featuring interviews with study participant Tony Macie and Principal Investigator Michael Mithoefer, M.D. “What it did was allow me to address things without judgment. I was able to think about the war. I was able to think about when I got back,” explains Macie. “It gave me a lot of closure. And it also gave me a lot of power to live my life and put me back in control.”
Originally appearing here.
Army Sgt. Tony Macie remembers vividly the day he knew he was at war. He was a forward observer in Iraq, on patrol outside of Baghdad, at the height of the surge in 2006. At the time, he was only 19.
“We were doing a dismounted patrol, and two guys in front of me stepped on an IED,” he said, referring to an improvised explosive device. “It was surreal seeing someone blown up, and also being just two people away from it … [The experience] kind of jolted me into this war. This is real. It’s not training anymore.”
Macie served in the Army for 15 months before a back injury not related to combat forced him to leave the Army. He returned to his childhood home in a small town outside of Brattleboro, Vermont, but couldn’t shake what he had seen. He replayed the war over and over in his mind, willing himself back in time to change the past.
“I would think about, ‘If I had been there in this situation, I could have prevented it,’ or ‘If I could have gotten retaliation after, that would have made me feel better,’” he said.
Like tens of thousands of veterans from the wars in Afghanistan and Iraq, Macie was eventually diagnosed with PTSD. But he says the care he received at the VA – anti-anxiety and anti-depressants combined with therapy, and painkillers for his back – only made him numb. He eventually became addicted to Oxycodone.
“You’re not dead, you’re not alive,” he said. “You’re just in this in-between state.”
It was desperation, curiosity, and faint hope that drove Macie to contact the researchers running a clinical trial for a surprising alternative treatment for PTSD: using psychotherapy in conjunction with MDMA, the key ingredient in the illegal drug ecstasy.
“I was skeptical,” Macie said. “But I was going down a very bad road and didn’t feel like I had anything to lose at that point.”
Macie had stumbled onto the culmination of over two decades of work by a dedicated group of psychotherapists who believe that MDMA-assisted psychotherapy for PTSD should be legal. The study that Macie enrolled in was the second phase of clinical trials that have treated one hundred people. The results have been remarkable: 83 percent of the subjects no longer meet the criteria for PTSD after being given MDMA and psychotherapy.
“As far as the percentage of people that have these really robust responses, I’ve never seen anything like it,” said Dr. Michael Mithoefer, the study’s principal investigator. “It’s the most promising drug I’ve come across as a psychiatrist.”
He says MDMA works by weakening the grip of traumatic memories.
“People that are traumatized and then develop PTSD are trapped in a way where the past is always present,” Mithoefer said. “The MDMA reduces their fear of these memories. Suddenly, they can revisit the trauma without being overwhelmed but still with a clear memory.”
He says ecstasy is a misleading nickname for MDMA.
“They don’t get blissed out and everything’s fine. It’s still processing trauma in therapy. It’s painful,” he said. “MDMA makes it easier.”
From doom to hope
Mithoefer was by Macie’s side when he took his first dose of MDMA. He was given an eye mask and headphones to listen to music. He lay down and waited for the drug to take affect.
“It was just like a paradigm shift. The medication kicked in and I went from feeling anxious to for the first time post-deployment feeling nothing, just complete relaxation,” Macie said. “I felt like I had an ache in my chest and it was just released. It was a wave of not pleasure – but relief – that I could let this memory go.”
He added: “I still remembered it, but was just moving on from it.”
Macie says a single session of MDMA-assisted psychotherapy accomplished what four years of conventional therapy and medications at the VA could not.
“What it did was allow me to address things without judgment. I was able to think about the war. I was able to think about when I got back,” he said. “It gave me a lot of closure. And it also gave me a lot of power to live my life and put me back in control.”
After the trial, Macie immediately stopped taking Oxycodone and eventually weaned off all other medication. The change in his behavior was so startling that his family was initially wary.
“My loved ones were skeptical on how long this was to last for,” Macie said. “They didn’t want to hurt again, themselves.”
But the results have lasted. It’s been four years since the trial and Macie remains off of all medication.
‘Not a care in the world’
Macie’s treatment would not have been possible without the efforts of the Multidisciplinary Association for Psychedelic Studies (MAPS). Leading the charge is Rick Doblin, the group’s executive director, who became familiar with MDMA in the early 1980s when it was being used to enhance therapy sessions throughout the United States. But as MDMA spread beyond the psychotherapy community and people started using it as a party drug, Doblin saw the writing on the wall.
“The recreational use was going to doom the medical use. It was clear that was going to happen,” he said. “So I started a non profit, MAPS, to organize the underground psychotherapy community to defend MDMA once the DEA cracked down.”
In 1985, the DEA classified MDMA as a Schedule 1 drug, the same category as heroin and LSD: defined as having a high potential for abuse with no known medical benefit.
Over the next two decades, MDMA became another target of the “war on drugs,” blamed for Parkinson’s disease, permanent depression and even draining spinal fluid. Experts appeared on Oprah and MTV, showing brain scans they said proved MDMA created holes in the brains of users. One study in the highly respectable journal Science even charged that a single use could permanently damage the dopamine system. It was retracted after the lead scientist was found to have injected his test monkeys not with recreational doses of MDMA, but with fatal concentrations of methamphetamine.
Through it all, Doblin kept the faith.
“It just didn’t make sense to me: the beauty of the MDMA experience combined with the propaganda about how terrible it was,” Doblin said.
For Doblin, the way forward would prove difficult, but not impossible. It would just require “a long bureaucratic process you have to go through to get permission to do that,” he says.
In the 1990s, Doblin says new leadership at the FDA was symp
athetic to his arguments that carefully controlled doses of MDMA could significantly enhance traditional psychotherapy. Years of meetings followed, and in 2000, the agency allowed MAPS to move ahead with the first clinical trial of MDMA-assisted psychotherapy in Spain. With Mithoefer’s PTSD early trials showing such strong results, Doblin is hopeful the FDA will allow MAPS to forge ahead with Phase III trials. That will entail treating 250 patients at eight to 10 locations around the U.S.
If all goes well, he predicts that MDMA will become a prescription medication in 2021.
The fight ahead
Macie says six more years is too long for the veterans currently suffering through what he experienced, especially, he says, when an average of 22 veterans are committing suicide every day. Macie is pushing for the VA to actively support further research into MDMA.
“I’m not saying prescribe this to everyone who has PTSD,” he said. “I’m saying for people who are at the point where they are chronic resistant, I believe that it will have very good results. And it’s been proven to be safe.”
Macie has set up meetings with members of Congress and met with staffers from the Veterans Affairs Committee. “Unfortunately, the majority of them were dismissive because of the word ‘ecstasy’ and just the negative connotation with it,” Macie said.
Staff at the Veterans Affairs Committee promised him they’d look into the issue, but a year and a half later, they have yet to reach out to Macie. But he says he won’t stop trying.
“I feel a little guilty,” he told America Tonight. “I got this treatment. It worked really good, and I know there’s other people who could benefit from it.”
All Macie wants is other veterans to be able to experience the peace he now feels: “My mind just finally shut off and realized I was home.”