5 Realities Of Using Ecstasy To Treat Veterans With PTSD
Even if you regularly use mind-altering substances, you probably still have that annoying friend or roommate who's a little too into it. We're talking about the guys who insist their weed is preventing cancer or who insist they've had spiritual, life-altering experiences on ecstasy ("Molly," or whatever name MDMA goes by these days). It's like it's not enough for recreational drugs to help them have fun at parties or tolerate Thanksgiving with the family -- they have to insist that the shit they're buying off street corners is some kind of miracle cure.
Well, it turns out that Camp: Drugs Can Be Good For You has more members than your roommate and that guy who sold you pills at Bonnaroo. While researching his new book, Cracked editor Robert Evans sat down with a scientist currently testing MDMA on people suffering from severe post-traumatic stress disorder -- Dr. Michael Mithoefer -- as well as two of his patients, Tony Macie and Nicholas Blackston. Much to our surprise, he found ...
Yes, Dropping Ecstasy Can Help Cure PTSD
Somewhere on America's East Coast, a young man takes MDMA in what looks like a divorced stockbroker's studio apartment while an older married couple watches.
The flowers should be a bottle of bourbon, but close.
Contrary to that deeply misleading opening sentence, nothing the least bit kinky or illegal is going on here. The couple is Dr. Michael Mithoefer and his wife, Ann Mithoefer, a psychiatric nurse. The young man is a veteran of one of America's most recent wars, seeking treatment for his PTSD. Over the last decade-and-change, Michael and Ann have treated dozens of men and women this way -- combat vets, firefighters, survivors of sexual assault. One of their patients, Nicholas, told us how his therapy went:
"So, once a week you go in, no drug, and talk with them. Getting to know each other, what to go through ... and at the end of the month, you have an all-day session. You're given a drug in the morning. They give you a half-dose midway through; it keeps you going all day. And then you stay the night."
Which, frankly, sounds a little quiet for a full day of rave drugs.
The Mithoefers are there in their capacity as psychotherapists. Nicholas describes their role as creating a "comfortable space" to act as a "vessel of healing." He says, "It's just talking for hours. ... There are times when I'd get my mind in knots and they'd say, 'Hey remember to use your breath,' or, 'Trust the medicine,' or, 'Do you think this would be a good time to lay down and go within?'" At no point did either of the Mithoefers wave a glow stick in Nicholas' face or try to sell him hits off a nitrous balloon for $5.
Instead they help find the nitrous balloon within.
So, how in the world is this supposed to help? "I would have these deep visions," says Nicholas. "I've always been very imaginative, but the drug just made things real. ... I was reliving my experiences. I was there. ... I'd sit up and talk through them, and as I'm talking [the therapists] were there to listen and talk through things." He adds, "Within four hours you're getting like four years of therapy."
Or, as Dr. Michael Mithoefer says, "I think ... it tends to make people much more aware and able and willing to express what their deeper unconscious processes are." OK, that's nice, but dropping club drugs all day while some guy stares at you can't be better than, well, however we normally treat PTSD. Right?
A Lot Of PTSD Patients Are Given Painkillers ... And Quickly Become Addicted
Both of our patient sources for this article are combat veterans. The guy we quoted above, Nicholas, is a Marine who served in Iraq. One day he was manning the machine gun on an armored vehicle when his squad went in to raid a house. "As the machine-gunner, it was my responsibility to kill anyone before they could kill us." While his team was kicking in doors and raiding buildings, Nicholas and his driver waited outside to cover them.
"I was telling a joke [to the driver]. I told him he was so fat -- he wasn't, but when you have all your gear on ... you're so fat you can't reach the steering wheel. And I said, 'That's why we're always running over IEDs [improvised explosive devices]. You're so fat you can't turn around and see rockets.' We were all laughing about that when we got hit by a rocket."
Dark, tragic irony really has an impeccable sense of timing.
Nicholas' driver died. Nicholas survived. He went home to settle into a life of getting out of speeding tickets thanks to his Purple Heart license plate, but he quickly found his plans disrupted by PTSD:
"I'd had an incident right when I got back. I was out with my fiancee; we went to the beach off the base. ... The artillery range is there by the beach. And on the way back I was driving, and just the concussion from them firing the artillery. Every time it would happen it'd force my mind back to the moment I got blown up in Iraq. Every time I felt that concussion, I was there. I fell apart. I was punching the steering wheel. My mom didn't know what to do; my wife didn't know what to do."
We're beginning to get the impression that nobody really is ready for it.
The other patient, Tony, was Army infantry. At age 19, he watched two people explode in front of him when they stepped on an IED. Neither Nicholas nor Tony received much in the way of helpful PTSD treatment from the Veteran's Administration ... but Tony did get something else: a crippling painkiller addiction.
Yeah, it turns out we're actually not all that great at treating PTSD. In 2007, a panel of scientists convened by the federal government reported that there was no evidence that the majority of PTSD treatments used by the VA worked at all. Things don't seem to have gotten much better in the last almost-decade: A 2014 survey of 3,100 veterans with PTSD showed only 16 percent "saw their medical treatment as being clearly beneficial to their health."
Which seems a bit light for a treatment plan that resulted in 50,000 cases of opioid addiction just last year.
Meanwhile, as of 2014, the VA was treating 650,000 U.S. veterans with painkillers (averaging one opiate prescription per patient) -- many of whom have PTSD. What seems to happen is veterans come in complaining of both physical pain and PTSD, and the VA finds that prescribing some sweet, sweet opiates dulls the pain of both. Tony had that experience with the VA. "They got me the same kind of drugs to make me numb again," he says. "I was on the medication for like six months, and I was fed up with it. In my mind I felt like, to get a cure for what I needed ... had to be at a soul level."
This is becoming a major problem for combat vets, who have both a perpetual excuse for free hydrocodone and something worth self-medicating over. When Tony first reached out to the Mithoefers, he says, things were getting bad. "I was doing over 210 mg of Oxycontin a day. ... They were for pain, and a 'shut the fuck up' from the VA." There had been hints here and there since the early 1970s that MDMA could help, but ...
The War On Drugs Held Back Research For Years
Just a few miles away from Nicholas and Tony, also in South Carolina, Dr. Michael Mithoefer and Ann Mithoefer had been studying if MDMA could assist in therapy (for those wondering: Yes, both had used MDMA back when it was legal). It wasn't easy, though -- you try proving the medicinal value of a drug the government has already banned to keep out of the hands of ravers. You might be saying, "But it's to help combat veterans and other heroes get over trauma! That should be a blank check, shouldn't it?" Are you kidding? This is a country in which we will pull you out of your car and probe your anus to make sure you're not hiding a joint in there.
So getting around the legal barriers required a years-long slog through layer after layer of government bullshit. First, there's getting clearance from the FDA ("The whole application was over 500 pages."). Then, they would have to talk a university or lab into hosting the research (the university where Mithoefer worked refused, fearing controversy). And then, finally, they would have to present a proposal to the Drug Enforcement Administration.
Which seems like rolling the dice with your safety after that anal-probe business a paragraph back.
After months of work, they were able to secure approval from the FDA and find an Institutional Review Board (an ethics committee required for all human research) willing to approve the study's protocol, at which point it proceeded to the DEA ... only to have the IRB abruptly pull out, setting the whole fucking thing back years. "At first they didn't give a reason. As it turned out, it was because of an article by George Ricaurte."
The article he's talking about is one major contributor to the "MDMA EATS HOLES IN YER BRAIN" myth you might have seen spread around Facebook by your concerned in-laws. It was retracted a year after publication for being only slightly more scientific than Reefer Madness. The brain damage caused to the monkeys in the study was done by an overdose of methamphetamine the monkeys were accidentally given instead. (Lesson: Always keep your illegal drugs in separate, clearly marked containers.) But even with the retraction, the damage had been done.
Though a mix-up is kind of understandable from people busy trying to wrangle a bunch of crank-addled monkeys.
"The delay was about 2.5 years. ... There were constant delays with that, the reason of which was not clear. [The DEA] seemed to have concerns, and there were a couple of delays because they 'lost' the application and that kind of thing through bureaucratic problems, concern about getting an 'outside panel' to review it to see if they thought it was a good idea. ... There was no sense of hostility, but there was a sense of inertia and, perhaps, maybe hoping we would go away."
But Dr. Mithoefer didn't go away. Eventually they got their approval and started rounding up PTSD-sufferers to dose with ecstasy. That's when they found ...
Vets With PTSD Are Desperate To Find Something That Works
The Mithoefers' first pilot study on MDMA started in 2003 and was published in 2011. It showed incredible results: Eighty-three percent of the active treatment group showed "very significant" improvement in their symptoms, compared with the 25 percent who got only the verbal therapy and a placebo.
In the first study, subjects had been recruited, with some difficulty, via print and internet ads. Most of them suffered PTSD from experiences as crime victims; many of them were survivors of sexual assault. The second study started trawling for patients in 2010, almost a decade into the War on Terror. Let's just say that the Mithoefers had much, much less trouble finding applicants:
"We've had over 600 individuals [mostly veterans] call us from around the country without having to advertise. We did a little bit in the very beginning but we were flooded with so many requests or calls. It was very sad in one way, because we could only take a few of them."
Six hundred may seem like a lot of applicants, but it's just a drop in the bucket of the number of suffering Americans.
Nicholas and Tony are two of those volunteers. When Tony emailed them, he was addicted to pain pills and in a very bad place. "I was like, oh fuck. ... I wrote them a long email like, this is my story. They called me the next day. We did an interview. And legitimately I was the perfect fit for them. If they hadn't accepted me into it I would be dead right now. I would've overdosed."
Nicholas had started his experiments with psychedelics on his own, via psilocybin mushrooms. He learned about the Mithoefers' study via a Sanjay Gupta article and began obsessively emailing them. "When I looked them up, they were beginning to conduct research right in Charleston. They weren't accepting anyone at this time, but I was just calling, calling, leaving messages. ... [In the] beginning of 2011, I was able to start up."
Apparently, getting approved for critical medical treatment and winning a radio call-in contest are remarkably similar processes.
The 24 participants of the Mithoefers' second MDMA study attended drug-free pre-sessions, followed by two doses of MDMA over an eight-hour session. After two sessions like that, the participants had months of weekly follow-up sessions.
Well, that was the plan, anyway; Tony dropped out after his first session with MDMA. He'd experienced enough relief that he felt ready to go back out into the world and explore. He was in Cambodia when we spoke with him. "It was so profound to me. I looked at the doctor -- I was paranoid as fuck [at the time] ... big into MKUltra and all this bullshit. And I was like, 'What did you give me?' He was like, 'How do you feel? How's your anxiety?'"
When Tony answered, "Zero," the doctor replied that he needed it on a scale from one to five. To which Tony replied, "No, it's a zero."
"Here, gimme that clipboard and I'll even draw a happy face in the zero."
If you've ever been around someone high on ecstasy, you know what he's talking about. Everything is warm sunshine; everyone is your best friend. Combine that feeling with a competent therapist, and you get a lowering of the defense mechanisms that keep PTSD sufferers (and, hell, most other people) from getting effective therapy. For Nicholas -- who attended the full gamut of sessions -- it just felt like a surge of trust. "[The therapists] kinda felt like ... parents, grandparents. ... You're so unbelievably comfortable with them, and you just want to talk about things. With PTSD ... you feel like you can't relate to anybody. Once you just let it all out ... there's a lot of therapy in that."
And, suddenly, he was finally able to put Iraq behind him. "I came back home, and I was able to finally feel myself here. And be here now. I was finally released from the desert."
Ecstasy May Be Coming To A Doctor Near You (Eventually)
Two examples isn't going to be enough to convince the world to just give in to those decadent ravers with their pills and glow sticks. Neither will two dozen. But all of the data seem to be lining up. "These are anecdotal comments," says Mithoefer, "but they're backed up by independent scientists who test the symptoms before and after treatment. So we've got the numbers to back up those statements."
Dr. Mithoefer's Phase 2 study (with Tony and Nicholas) hasn't been published yet, but at this point it seems like it's been a huge success. And the early stages of MDMA/PTSD research have been so promising that studies are now being conducted concurrently in Israel, Canada, and Colorado. Another study just concluded in Switzerland.
"I expected it was likely to be helpful to a significant number of people. But the fact that we showed such a significant effect in these studies ... exceeded our expectations." Still, it's not a miracle cure -- it's a tool that appears to help some people when combined with a competent therapist. "It's not a magic bullet. ... We had three people say, 'I don't know why they call this ecstasy.' MDMA didn't make it a cakewalk. It was still painful therapy."
Just because the street version of your medicine has cartoons on it doesn't mean it's a fun trip.
All right, so how long until you can stroll into your doctor and get prescribed some Molly to help with your combat flashbacks? Well, once the results of the Phase 2 studies are published, Dr. Mithoefer (as well as other researchers working with MAPS, the sponsors of the first studies) will have to conduct either one or two Phase 3 studies involving more human subjects before MDMA can gain FDA approval. If MDMA therapy becomes officially legal, here's how Dr. Mithoefer expects it to look:
"I think it's likely it'll happen eventually. There is that 'if,' but if we do, this would be approved not for a take-home medicine but to be used in specialized clinics. Kind of like for methadone clinics. I know there was a time when any physician could organize a methadone clinic, get the training and license, and give methadone in that setting. In a way it's analogous to that."
Obviously we're not here to shill for Big Molly, but it is hard not to get swept up in our sources' enthusiasm. Keep in mind, about 5 million adults suffer from PTSD in the USA alone; about 8 percent of you will deal with it at some point in your lives. A reliable treatment method with no significant side effects would be huge. Combine those numbers with how Nicholas describes the effects, and it's hard not to hope this all works out:
"MDMA turned on this light inside of my head. [PTSD] is like trying to clean your room with the light off, getting frustrated whenever you bump your head. Plus, in the shadows things can look like demons, even if they're a coat rack. But with the light turned on, you can see things as they are."
If you'd like to support more research into the therapeutic usage of psychedelics, please donate to MAPS.
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