Can Ecstasy Help Dying Cancer Patients?
Masthead Date May 23, 2005
A new study takes a serious look at MDMA (Ecstasy)
Ecstasy has gained infamy on the streets as a club drug that entices young men and women who seek feelings of well-being, sexual stimulation, or other types of drug-induced highs. But researchers at a Harvard-affiliated medical center are wondering if the pure substance, +/-3,4-methylenedioxymethamphetamine (MDMA), which is what is supposed to be in the illegal Ecstasy pills sold on the street, might have a legitimate place in helping patients with terminal cancer rein in uncontrollable anxiety and achieve a better quality of life as they approach death.
A new way to face the issues?
The objective of their study is not to develop a standard daily or take-home medication, says John H. Halpern, MD, associate director of substance abuse research at Harvards McLean Hospital in Belmont, Mass. Instead, the study, which is sponsored by the Multidisciplinary Association for Psychedelic Studies, is designed to determine if hospital-based MDMA therapy, in combination with psychotherapy, can help patients better unmask and cope with the issues they face as death draws near.
Approximately half of the people who are dying of cancer are given prescriptions for antidepressants and/or benzodiazepines. But benzodiazepines cause oversedation, unsteady gait, and memory problems. Dying patients must choose between taking these medications and feeling less anxious, or not taking the medications and remaining alert, but experiencing more anxiety and panic attacks.
The study will include 12 medical-oncology patients from the Lahey Clinic Medical Center in Burlington, Mass., who have advanced-stage cancer, with a projected 12 months to live. Halpern will conduct the research with cotherapist Umadevi Naidoo, MD. Nurses are not involved in the study at this time, but some of the clinical staff nurses and faculty at McLean Hospital have been discussing collaboration. If the therapy proves viable, it will be important to expand the data and include other disciplines in the research.
The benefits of this therapy would have greater application for nurses who tend to dying patients on a daily basis than for the physicians who prescribe the therapy, Halpern says.
Appropriate patients for study
To be accepted into this study, patients must have clinical levels of anxiety that are a direct result of their terminal diagnoses. Patients who have a primary anxiety disorder that predates the cancer will not be accepted into the study. Patients enrolled in the study will have either failed to respond to standard anxiety treatments, such as benzodiazepines or antidepressants, or have chosen not to use these treatments because of a perceived social stigma related to psychotropic medications.
The study of MDMA is controversial, but Halpern is accustomed to debate. As a Harvard researcher, his full-time job is to study hallucinogens. I became curious about the potential powers of MDMA because of case and anecdotal reports that suggested people who used the drug felt they benefited from it in various ways, he says.
The MDMA that will be administered to patients is a Schedule I compound, which is legal only for research purposes. A synthetic psychoactive drug, it is chemically similar to the stimulant, methamphetamine, and the hallucinogen, mescaline.
The compound 3,4-methylenedioxymethamphetamine contains only that substance. Says Halpern, Often, what is sold on the street does not contain any Ecstasy at all or is contaminated. In fact, many drugs of abuse including methamphetamine, cocaine, tincture of opium, and others remain on the U.S. Pharmacopeia because they have accepted medical value, Halpern adds.
The researchers will administer the drug only twice during the study, carefully monitoring patients throughout their drug-induced experiences.
Halpern is not studying the acute effects of MDMA on these patients; rather he is studying if the drug can help patients open up during traditional psychotherapy. We want to learn if people can resolve some of the issues they were too fearful to look at, Halpern says. Through the use of daily diaries, the study will track the medications patients use every day and their increasing or decreasing needs for pain or anxiety medication.
Halpern and Naidoo will conduct six, one-hour psychotherapy sessions and two, six- to eight-hour MDMA sessions. Four of the 12 subjects will receive a low dose of MDMA for two treatment sessions. Eight subjects will receive full doses in a range of strengths. Halpern expects the study will take at least a year to complete.
Lisette Hilton is a frequent contributor to Nursing Spectrum.
Online Publication Nursing Spectrum puts forth an article discussing the Harvard study of MDMA psychotherapy for treatment of anxiety associated with terminal cancer. Author Lisette Hilton quotes Dr. John Halpern that “the benefits of this therapy would have greater application for nurses who tend to dying patients on a daily basis than for the physicians who prescribe the therapy.”