Treating PTSD With MDMA

Originally appearing here (publication layout) and here (print layout). Multidisciplinary Association for Psychedelic Studies (MAPS) celebrates 25 years funding research into MDMA-assisted therapy for post-traumatic stress disorder (PTSD) As thousands of military service members come home from Iraq and Afghanistan, many veterans need immediate mental health care, especially to deal with post-traumatic stress disorder (PTSD). Meanwhile, Santa Cruz, California based Multidisciplinary Association for Psychedelic Studies (MAPS) is funding research that calls for using MDMA-assisted therapy to treat veterans who have chronic, treatment-resistant PTSD. MAPS was founded by Oak Park, Illinois native Rick Doblin, and this year the organization celebrates 25 years of funding education and research on the use of psychedelic drugs for treatment. Doblin, who earned a doctorate in public policy from the Kennedy School of Government at Harvard University in 2001, created MAPS in 1986 with the idea of making MDMA an FDA-approved prescribed medication. Doblin became aware of and tried MDMA in 1982 while at home with his girlfriend. According to Doblin, the experience “felt real, genuine and authentic,” and has stayed with him to this day. The idea behind MDMA-assisted therapy is that dosages of pure MDMA-MAPS uses full dosages of 125 mg-can lead to new insights for patients when therapists monitor them closely in a controlled setting. Proponents also say that MDMA-assisted therapy helps patients warm up to the therapist more quickly, which can be especially helpful if a patient is suicidal and time is not a luxury. MDMA may begin working in as little as 45 minutes, whereas most prescription antidepressants may take a couple of weeks to start working. According to Paul Sullivan of Veterans for Common Sense, a veterans’ advocacy group, of the 2.3 million U.S. service members who have deployed to the Iraq and Afghanistan wars, 1.3 million are now veterans eligible for five years of free (Veterans Administration) medical care. Since 2004, VA hospitals and clinics have treated 654,000 new patients, or slightly more than half of the eligible veterans. Of these new patients, 332,000 are diagnosed by the VA with at least one mental health condition. Among those, 192,000, or nearly 30 percent, of all the veterans seen and treated by VA doctors are diagnosed with PTSD. These stats are based on reports prepared by the Department of Veterans Affairs obtained exclusively by Veterans for Common Sense under the Freedom of Information Act. “This represents a true, enormous and escalating epidemic of PTSD among our returning veterans,” Sullivan said. MDMA is Ecstasy in its purest form, while the illegal Ecstasy form on the street sometimes includes traces of crystal meth, PCP and other dangerous components-and sometimes little or no MDMA. MDMA use became criminalized in 1985, when it was added to the goverment’s list of Schedule One drugs-the Drug Enforcement Administration’s category for drugs with a high risk for abuse. MDMA also gets a bad reputation for its use in the dance-club music scene, where its been responsible for several deaths, usually due to the user not drinking enough water or drinking too much water too fast for the body to process. In MAPS’s initial U.S. MDMA/PTSD study, subjects had suffered from PTSD for an average of 19 years, and more than 80 percent of the subjects were cured of chronic, treatment-resistant PTSD after getting MDMA-assisted therapy. MAPS researchers Michael Mithoefer and his wife Ann are expected to publish follow-up results of a pilot study later this year, with the outcome that 17 of 20 participants no longer met the criteria for PTSD after they completed two or three MDM Aassisted therapy sessions led by the couple. The follow-up results come after the Mithoefers, Doblin, Mark Wagner and Lisa Jerome published their results of MAPS’s research study in 2010 in the Journal of Psychopharmacology. According to Doblin, the phase two results are probably about six months away from being published; however, destigby Matizing MDMA will be a long journey. “To move MDMA out of Schedule One is going to take at least 10 years of doing all of the necessary clinical research,” Doblin says. “MDMA, I think, will continue to be used at bars, clubs and raves and there will continue to be tragedies from people that for one reason or another don’t cool down or don’t drink enough water,” he says. “So I think the stigmatization is there because that’s what our society promotes as far as drug prohibition. “What we’re hoping for is that people will shift toward more of a public health approach than criminal justice approach or [move toward more of] a drug policy to reduce the harm of [using] drugs, and that I think will help the de-stigmatization.” Some critics of MDMA-assisted therapy contend that the best way to treat PTSD is to follow Edna Foa’s prolonged exposure therapy. Foa is known as the expert on how to treat PTSD, and her method calls for recording PTSD patients talking about their trauma in 8 to 15 weekly appointments, and then listening to the recordings. Dr. Rodney Benson, Ph.D., of the Depression and Anxiety Specialty Clinic of Chicago says he prefers to treat PTSD with therapy. “I wouldn’t characterize my position of treating combat-exposed veterans with MDMA-assisted therapy as a bad idea,” he says. “I consider myself a scientist, so my position would best be stated as, ‘let’s see the evidence.’ I am not aware of scientific evidence to support the addition of MDMA to treatment of PTSD. If it exists, I want to learn. My hesitation to endorse MDMA-assisted therapy is that I have not read any empirical articles that have supported its use. I am guessing those studies are underway.” What does Doblin say to critics who strictly recommend therapy? “The more therapy that’s available, the better,” Doblin says. “But we work with people in our studies who have failed under other psychotherapies and other medications, so prolonged exposure is not for everybody.” Prolonged exposure triggers revisiting the trauma, he says, adding, “MDMA helps to reduce that” fear of revisiting the trauma. Doblin also says he’s all for having the maximum number of treatments available for people, and notes that there are elements of prolonged exposure therapy in what MAPS therapists and researchers do during MDMA-assisted therapy to help people go over the incident that caused the trauma. According to Benson, “Good treatments for PTSD do exist. Prolonged exposure is still considered the gold standard. However, we as a treatment community are aware that we have so much work to do. I want us to keep getting better.” Currently, MAPS is helping to fund and coordinate studies of MDMA-assisted therapy to treat PTSD among veterans, not only in the States, but also in other countries. MAPS is writing about the results of a Swiss study of MDMA-assisted therapy, which, according to Doblin has results that are about half as good as the U.S. study. “We’re still trying to get approval in Canada, Australia and Jordan, and the Israel study is approved and we’re working on that to get it started,” he says. As for phase three in MAP’S U.S. MDMA/PTSD study, Doblin says MAPS will likely end up doing a larger study with about 600 people at 15 to 20 sites. Asked what he would like for MAPS to accomplish in the next 25 years, Doblin says that he would like to build a network of psychedelic therapy clinics and to get psychedelics and marijuana placed as prescription medicine on the market. “That would be phenomenal,” he says. Mindful Metropolis reports on the current state of research for using MDMA-assisted psychotherapy with United States combat veterans who suffer from Posttraumatic stress disorder (PTSD). At least 30% of veterans seen by Veterans Administration doctors suffer from PTSD. In
the MAPS study of MDMA-assisted psychotherapy for PTSD, the participants had dealt with the condition for 19 years on average, and more than 80% of participants were cured of chronic, treatment-resistant PTSD after their MDMA-assisted therapy sessions. Michael and Annie Mithoefer of MAPS are expected to publish follow-up results of their study by the end of the year, with the phase two results to follow about six months after.