By Scott Thill
An experimental study that treats PTSD veterans with the drug MDMA could make life after war a lot more livable.
"We need to be positioning ourselves now to provide the assistance that our veterans need," said House Committee on Veterans' Affairs chairman Bob Filner (D-CA) during a hearing, called "Stopping Suicides: Examining the Mental Health Challenges Facing the Department of Veterans Affairs," held in December 2007. "Not only for those brave men and women who are returning home from Iraq and Afghanistan, but also for our veterans from previous conflicts. We cannot afford to put this issue off."
Filner's choice of words is instructive, as are his sentiments: With upwards of 25 million veterans in the United States, not counting those overseas in the morally murky theater of Iraq and Afghanistan who may return home sometime after the 2008 presidential election, that's a lot of assistance and funding needed to head off what he called a "rate of veteran suicide [that] has reached epidemic proportions," to the point that it has doubled the suicide rate of civilians. Safeguards already put into place have failed, for a variety of reasons, and given the severity of the mental and physical problems carried by returning soldiers, some daring out-of-the-box thinking is not only desperately needed, but required.
Enter the Multidisciplinary Association for Psychedelic Studies (MAPS), and its currently funded trials using 3,4-methylenedioxy-N-methamphetamine -- otherwise known as MDMA, or ecstasy -- to treat post-traumatic stress disorder (PTSD). Although the U.S. Army had carried out lethal dose studies of MDMA back in the 1950s, work which was not classified until the close of the 1960s, it was only centered on animals and was mixed in with a variety of other compounds. At the closure of that research, MDMA languished in clinical obscurity until its rise as a club drug in the '80s and '90s brought it the kind of attention that dooms better drugs to Schedule I classifications -- that is, illegality -- and lesser drugs to approval by the Food and Drug Administration (FDA). But MAPS founder and president Rick Doblin became aware of MDMA in 1982, and since then has been convinced of its therapeutic uses. Accordingly, his organization has coordinated and/or funded recent studies into MDMA treatment of PTSD and has its eyes set on a higher goal.
"We're looking to make MDMA into a prescription medication in the United States, United Kingdom and elsewhere," he explained by phone.
So far, MAPS has gone a long way to helping legitimize MDMA treatment for PTSD, as well as anxiety in cancer patients and more. The organization is supporting and funding Dr. Michael Mithoefer's double-blind sessions and protocol on MDMA/PTSD, initially approved by the FDA in 2001 and due to conclude this June, as well as co-sponsoring a pilot MDMA/PTSD study with the Swiss Medical Association for Psycholytic Therapy and coordinating research at Harvard Medical School's McLean Hospital into MDMA's ability to aid the suffering of terminal cancer patients.
In short, MAPS is putting its money where your mouth is, in hopes of saving your brain and heart. And their help can't come fast enough, given hundreds of thousands of troops have already returned home from Iraq and Afghanistan to face everything from a possible economic recession to homelessness, homicide and suicide, with hundreds of thousands on the way behind them. According to some estimates, America can expect a minimum of 300,000 cases of PTSD, at a cost of over $600 billion, rivaling the cost of the wars themselves. And that's just the military wing of PTSD's vast network, which leans all too heavily on those who have suffered horrific experiences such as rape, violence, abuse and more. Post-traumatic stress disorder is a deadly assassin when it comes to the humanity's overall mental health, and its costs are extensive and lasting. This is why some physicians and professionals are keeping an eye on MDMA treatment, which so far has proven to be almost uniformly successful in helping patients work through their crippling traumas with the help of ecstasy's cathartic yet calming influence.
"I've seen each and every one of these patients, and, just as a clinical psychologist, it is impressive to see the degree of treatment response these folks have had," explained testing expert Mark Wagner, a clinical psychologist at the Medical University of South Carolina, to the Washington Post after serving as an independent evaluator of Mithoefer's work. "I didn't see a single individual who thought: 'Oh, yeah, this is great fun. I'm going to try to go out and use this for recreational use.' All of them took this very seriously and therapeutically."
Indeed, out of all of the MDMA research underway, it seems to be Mithoefer's work, conducted in a warmly lit cottage in South Carolina with his wife and registered nurse Annie, that seems best positioned to aid MDMA's American crossover from a Schedule I danger to a FDA-approved wonder drug. But that's just the beginning of a long, bureaucratically tangled road to redemption. "Michael's study is the furthest along," added Doblin, "and after June, we'll do the data analysis and submit our findings to the FDA. After that, we will work with the FDA to come up with ideas about phase three studies, and that's when we have to spend the millions of dollars and treat hundreds of patients."
Mithoefer's current study, in phase two and working with barely over 20 patients, is crucial, according to Doblin, "to prove safety and efficacy." Safety and efficacy are the prime obstacles standing in MAPS and MDMA's way, especially since the drug was given the Schedule I assignation in 1985, shortly after it was nicknamed "ecstasy" in 1984. Since then, studies have come and gone in hopes of proving its lethality, but, as with its cousin-in-controversy cannabis, nothing conclusive came of it. Doblin, Mithoefer and other interested physicians and figures from around the world have stepped forward to subject it to rigorous testing, and have found little to complain about. In fact, they've found quite a bit to celebrate, which has not sat well with the shrinking contingency of drug warriors intent on keeping MDMA from people who may need it.
"I find it important to discriminate between medical research and drug policy," asserted Pal-Orjan Johansen, a Ph.D. candidate at the Norwegian University of Science and Technology's department of psychology who has worked with Michael and Annie Mithoefer on MDMA treatment and research, via email. "One area cannot be used to promote the other, and vice versa. It is inconsistent with traditional medical ethics or outright unethical to block treatment development and research based on drug policy."
It may be unethical, but it certainly isn't inconsistent, at least within the last century, which found several drugs with specific medicinal properties, including MDMA and cannabis, nevertheless criminalized by governments across the world. And while it is true that some have loosened their hypocritical restrictions on such substances, many still harbor puritanical paranoias about them. In America, it has been far easier to obtain prescriptions for medicine that can kill you outright, such as oxycontin or vioxx, than for drugs that can chill you out. And that's before one even engages more dangerous legal substances, such as nicotine or alcohol, which have wrecked lives and ruined bank accounts. One could argue, with some success, that it would be inconsistent with traditional medical ethics to legalize such substances, even though their positives seem to far outweigh their negatives.
But, of course, this argument, stretching back for decades if not centuries, is not about ethics or health, but about money. Just ask Doblin, who's happy that Mithoefer's work has passed phase two with flying colors but nervous about the coming challenges of a much more expansive, and expensive, phase three.
"Where do we get five million dollars?" he answered with a question, when asked what will be phase three's biggest obstacle. When asked if a new administration, one less in love with the idea of wars on abstracts, would come to the rescue, Doblin was equally sanguine. "The change in administration won't make a difference. We're doing this now with the Bush administration. The level we're working at now is made up of mostly scientists interested in science over politics. From our perspective, the FDA is a delight to work with, because they focus on that science. It's not until it comes to policy that the political influences come in. But we're many, many years away from that."
For now, Doblin and his cadre of outside-the-box doctors are focusing on the data, which is growing by the day, and pointing to a possible light at the end of PTSD's long, dark tunnel. And that means navigating the labyrinth of not just the FDA, but also the medical establishment's program of rigorous testing and analysis.
"We are preparing a protocol to submit to the FDA in February to train therapists for phase three studies," he explained. "We're going to ask permission to administer MDMA to therapist trainees, so they know what the drug is about, and so they can practice with one another. We're transcribing audio and video of all the sessions, and developing a treatment manual. We're initiating contact with another group interested in MDMA for cognitive behavioral therapy."
So, what if it works? What if MDMA treatment of PTSD comes to pass, and everyone from rape and abuse victims to returning soldiers demand the catharsis that comes from ecstasy to help them normalize their turbulent lives? The scenario scares some politicians and physicians alike, but their fears of rampant XTC ravers gumming up the public works may, in the end, prove unfounded.
"It's not going to be a normal prescription drug like the antidepressants," promised Doblin. "It's only going to be administered under therapist supervision. There would be a chain or network of clinics where use would be limited to special training. Patients would be requited to spend the night in the facility. It's not like cannabis. Our approach is catharsis, enhancing the psychotherapeutic interchange. We want patients to integrate their trauma into their normal lives."