MDMA And The Cure for PTSD

Originally appearing here. Seven years ago, John was in crisis, cut off from the rest of humanity and disconnected from the people he loved. He was suffering extreme anxiety in social situations and having trouble sleeping, and even when he did sleep he was waking suddenly with night terrors. He was 23, fresh out of a five-year stint in the U.S. military, including six months fighting in Iraq, and could see no help in sight. “When I got out there was no transition therapy or anything. This was 2004, and I wasn’t offered any kind of psychological help on the way out, nor was I advised on what I should do,” he says. Although he was never officially diagnosed, John, who didn’t want his real named used for legal reasons, thinks he was likely experiencing post-traumatic stress disorder (PTSD), a severe anxiety disorder caused by psychological trauma that, according to one estimate, affects nearly one in five U.S. soldiers returning from service in Iraq and Afghanistan. Relief finally came, but not by any officially prescribed means. Although John was undergoing psychotherapy at the time, the most effective treatment he came across was self-administered: the illicit use of MDMA. “I had a large sense of guilt that I carried, and I think MDMA, when I did it, was most effective at relieving me of any feelings of guilt or anxiety over what I had done over there, and where I fit in life now that I was back,” he says. “And those feelings have lasted a long time.” Seven years later, John is a professional living in the Bay Area. He maintains deep and meaningful friendships and no longer feels alienated from the rest of society. But the drug he credits with ending his suffering remains highly illegal. War at Home Two weeks ago, health officials in neighboring Santa Clara County fed the ever-burning drug war a new campaign, this time against MDMA and “ecstasy,” the version of MDMA sold on the black market. Officials warned of a statewide increase in MDMA use and cited a 2010 survey that found one in four Santa Clara County high school students have tried the drug. The campaign released a new documentary, Ecstasy: Lives Out of Balance, now on the public school circuit. There are good reasons to be wary of MDMA. It’s been known to cause rare fatalities due to insufficient water consumption and cardiac arrhythmia caused by sudden overheating, most commonly in rave scenarios where people are dancing for long periods of time. The real danger, though, lies with the other drugs that lace the street product ecstasy, according to Jim Sibley, supervising deputy of the narcotics unit at the district attorney’s office in Santa Clara. MDMA, colloquially referred to as Molly, often comes in through black-market shipments of pills or capsules containing powder, Sibley says, which can lead to the drugs being cut with methamphetamine, ketamine, benzylpiperazine (BZP) or dextromethorphan (DXM)—the latter which, when mixed with MDMA, considerably increases the possibility for dangerous dehydration. “The frightening thing, when you look at it, is that so few of them actually contain [MDMA],” Sibley says. Of the tablets seized by law enforcement, Sibley estimates that as few as one in four may actually contain MDMA. “Unless you test it in a lab, you really don’t know what you’re getting when you buy it on the black market,” says writer David Jay Brown, who warns that the much-publicized dangers of black market ecstasy mask MDMA’s potential for therapeutic benefit. “MDMA is a relatively safe drug, without a lot of risks, that really should be legal for recreational use—and most certainly it should be available for medical use, which, right now, it’s not,” says Brown. Medicalize It Brown is talking about a very specific medical use. The Santa Cruz–based Multidisciplinary Association of Psychedelic Studies, or MAPS, for which Brown is guest editor, is currently the only organization in the world funding clinical trials of MDMA-assisted psychotherapy, and the results have been promising. A recent case study, which was carried out in South Carolina with the approval of the Food and Drug Administration, shows that a high percentage of women sexually assaulted and abused can overcome post-traumatic stress disorder with the help of MDMA-enhanced therapy. “We found that 83 percent of participants in that study no longer qualified for a diagnosis of PTSD,” says Brad Burge, a communications director at MAPS. “And those benefits we saw were confirmed with long-term follow-up.” The study was conducted by Dr. Michael Mithoefer and his wife Ann Mithoefer, B.S.N. MAPS is trailblazing its way through a second study—this time with a focus on 24 war veterans with PTSD—and is a quarter of the way through the process. According to Burge, the PTSD cases in this current study encompass combat trauma as well as trauma from sexual assault in the military—and the latter appears to be on the rise. Since 2006, the rate of violent sexual crime in the military has increased by 64 percent, according to a report that Defense Secretary Leon Panetta presented to the Pentagon earlier this month. Quelling Fear MAPS’ study entails three double-blind MDMA-assisted therapy sessions a month apart. Each session lasts between eight and 10 hours, and the patient is accompanied by a male and female psychiatrist for the entirety of the session. Afterward, the patient stays the night in the clinic and is monitored with regular therapy sessions between the MDMA or placebo-assisted sessions. “Some of the time they spend focused inward, listening to music with headphones and eye shades on, and some of the time they spend talking to us. But it’s a very non-directive form of therapy. During that time they may process the trauma, but we don’t try to direct them too much,” says Michael Mithoefer. Anecdotal reports of the drug’s effects include feelings of love, empathy, self-confidence, an upwelling of unexpected emotions, feelings of euphoria, heightened sensuality, mild hallucinations and decreased fear. But it’s not all pleasure and bliss for the PTSD patients. “In the right setting, people who have had traumatic experiences—or anybody—can have difficult things come up,” says Mithoefer, who adds that several of his patients have remarked they don’t even know why it’s called “ecstasy.” “Although sometimes they have some very affirming experiences and sometimes even joyful experiences, a lot of the time it was bringing up and processing very traumatic experiences, and it was not easy,” says Mithoefer. MDMA has been able to effectively bridge the two obstacles Mithoefer notes in psychotherapeutic treatment of PTSD: an overwhelming emotion that inhibits the patient from revisiting the traumas, and on the other hand an emotional disconnect from the traumas they are able to talk about with ease. “So we kind of think of it that it gives people an optimal zone of arousal. It connects people to emotions, but they’re not overwhelmed by them,” he says. One sex abuse survivor in Mithoefer’s study described it this way: “After you’ve ridden a few of those waves of fear then it gets easier and easier to trust the next one.” As with many psychedelics, scientists understand what MDMA does, but they can’t explain why or how it works. Scientists know that MDMA settles down the amygdala, which is the fear center of the brain, but the feelings of inner peace, spiritual depths and life-changing effects commonly associated with the drug remain mysterious. One veteran who participated in a study described it this way: “I have a sense of much greater connection with a wise inner voice, inner knowing. It used to h
appen occasionally over the years, but now since the MDMA sessions it’s very common,” the veteran said. “Some think it’s my inner wisdom. I think it’s God.” Looking Ahead If several more of these small-scale studies can reproduce positive results, then MAPS scientists will be able to apply for permission to move on to multi-center trials with 200–300 subjects. “We’ll need two of those in order to apply for MDMA to become a prescription medicine. My guess is that it will take around 10 years, but it’s hard to predict,” says Mithoefer. Proponents guess the medicalization of MDMA will cost around $10 million, but MAPS scientists are optimistic that it will be achieved. As it happens, the scientific community is abuzz right now with news of studies underway to see whether ketamine, one of the substances often cut with MDMA in street ecstasy, is useful in treating major depression. “A lot of resistance to our work—and there’s less and less of it—comes just as a result of some of the sort of general fear and suspicion that people have surrounding these substances, and a lot of that fear comes from anti-drug education campaigns,” says Burge. MDMA remains in its Schedule 1 classification alongside substances like heroin, pot and LSD—all drugs the federal Drug Enforcement Agency deems to have no accepted medicinal uses. But a tipping point seems closer now than it did in 1985, when the drug was criminalized. Meanwhile, says Brown, those who experiment with illegal substances are serving as a vanguard of sorts for science. “I think that the brave individuals who have courageously experimented with these novel psychedelic drugs should be considered heroic explorers, like Sir Francis Drake or Ferdinand Magellan,” he says, “charging the unknown topography of these new states of consciousness and helping us to establish a symbiotic relationship with the rest of the biosphere.” And, he adds, as a society we have a moral obligation to care for our veterans. “Keeping MDMA from our military, and allowing them to suffer, is one of the meanest and most misguided things our government is doing,” he says. The front page article in the Santa Cruz Weekly tells the whole story: A traumatized veteran speaks out about how MDMA helped him, the black market widens the gulf between “Ecstasy” and pure MDMA, and MAPS finds real therapeutic benefit in MDMA-assisted psychotherapy for PTSD.