When Tony Macie returned from Iraq in 2007, he knew deep down something was wrong. The former Army sergeant, who served 15 months in Baghdad as a scout, struggled to readjust to civilian life.
“In Iraq I had to be hypervigilant, five steps ahead. Back home, I was still in the mindset for combat and my brain wouldn’t shut off,” he said. “I wasn’t sleeping, looking at everyone as the enemy.”
Macie went back to college, but his nervous system was stuck on high alert. He was irritable, moody and sometimes paranoid, reliving memories of buddies dying in combat. He drank heavily. He swallowed five or six pills at a time–oxycontin, Xanax prescribed by military doctors, and painkillers for his back injury. He stopped showing up for class.
He was formally diagnosed with post-traumatic stress disorder, or PTSD, but it would take him years to admit it. “At that point I was taking so many different drugs, I was zombied out. Looking back, I was actively seeking help,” he said.
Macie is far from the exception when it comes to combat-related PTSD. Since October 2001, approximately 1.8 million U.S. troops have been deployed to Afghanistan and Iraq, of which 20 percent are estimated to be suffering from PTSD. As PTSD is notoriously difficult to assess, diagnose and treat, the numbers could be much higher. A 2009 National Center for PTSD report states 41 percent of troops have chronic symptoms.
Macie tried therapy, but nothing worked. Then he discovered a clinical trial lead by Michael Mithoefer, using MDMA-assisted psychotherapy to treat chronic PTSD. MDMA is the active ingredient in Ecstasy, the popular dance drug. But due to controversial publicity over the decades, its credibility as a therapeutic tool has largely been ignored.
Macie joined the trial, and after only one session, stopped taking his meds. “It was a paradigm shift. I want all vets to have the same tool at their disposal.”
Macie isn’t alone. An increasing number of researchers, scientists and therapists who recognize MDMA’s beneficial use are pushing to medicalize it, seeing it as a viable option for those suffering from PTSD. Yet the military is slow to catch on due to MDMA’s decades-old stigma as an illicit substance. (The only place MDMA is mentioned on the US Department of Veterans Affair’s website is under substance abuse for veterans with HIV.) Macie, among others, is pressing for the military to overcome its institutional fear of MDMA and opt for a drug policy that helps heal its veterans.
While MDMA is widely associated with the global electronic dance subculture that swept the ’80s and ’90s, and the image of blissed-out ravers waving glow sticks, the drug has a longer history. Before MDMA was classified as a Schedule I controlled substance in 1985, it gained traction in therapy circles for what psychiatrists and psychotherapists saw as its most salient effect–not euphoria, but empathy.
“MDMA induces powerful empathetic states and in a therapeutic context, this is a strong, positive predictor of a therapeutic outcome,” said Charles Grob, director of the Division of Child and Adolescent Psychiatry at Harbor-UCLA Medical Center. Grob, a longtime researcher of hallucinogenic drugs, received the first FDA approval to conduct MDMA research in 1992.
Grob’s research was sponsored by Santa Cruz, Calif.-based Multidisciplinary Association of Psychedelic Studies, the world’s only organization funding clinical trials of MDMA-assisted psychotherapy. MAPS is undertaking an ambitious eight-year, $18.5 million plan to make MDMA into an FDA-approved prescription medicine by 2021.
“What MDMA seems to do is decrease fear and defensiveness, which helps sufferers connect with their feelings without being overwhelmed,” said Michael Mithoefer, a psychiatrist practicing in Charleston who specializes in PTSD. MAPS also funded Mithoefer’s trial.
Mithoefer explains how MDMA works: the drug acts by quieting the amygdala, considered the brain’s fear center, while serotonin and dopamine (neurochemicals associated with pleasure) surge in the frontal cortex, promoting feelings of openness and therefore, safety.
One of the primary reasons traditional therapy doesn’t always work treating PTSD, Mithoefer said, is that patients are either overwhelmed by anxiety or emotionally numbed out, making it difficult to confront their pain. The irony is vets often feel too stigmatized or frightened to seek help, yet once they do, frustration and resistance sets in.
“Soldiers are quite vulnerable. What they have witnessed or done is overwhelming and when overseas, they’re not in a safe place to examine those feelings,” said Grob.
MDMA does two things. One, as an empathogen, it engenders trust between patient and therapist, lowering emotional barriers and kickstarting the therapeutic process. Two, MDMA, according to Grob, “has the uncanny facility to allow people to put their feelings into words.” Repressed feelings can lead to serious psychological damage. But expressed feelings can help shift perspective and heal.
This was what Macie experienced.
“MDMA grounded me. I was able to feel sadness and loss without blocking them out. It made me realize I had real issues to deal with, that I was stuck in a cycle that would only get worse. It brought back trust in me, which I had forgotten along the way.”
Rick Doblin, MAPS executive director, said, “MDMA is uniquely capable of opening people up, reducing fear and dealing with suppressed emotions; it stimulates oxytocin, which enhances nurturing, bonding love, forgiveness and acceptance. These are core aspects of being human.”
While the effects of MDMA can include feelings of love, empathy and euphoria, within a therapeutic setting it’s not all bliss.
“Euphoria? I wouldn’t use that word,” said Macie of MDMA. “To me that means being irrational. I was the clearest I ever felt in my life, able to process whatever came up. I learned that though some memories are awful, you can always learn from them. I now feel like I’m constantly evolving.”
Perhaps it’s MDMA’s ability to dig deep but gently into the psyche, flooding the brain with compassion, that makes it so highly effective. In MDMA-assisted psychotherapy, MDMA is only administered a few times. In Mithoefer’s 2010 study, a pilot phase II clinical trial with 20 patients with chronic PTSD, 80% of participants no longer qualified for PTSD, though many had suffered an average of 19 years.
“From a clinical standpoint, this is a very appealing model,” said Mithoefer, who explains that because no drug is without toxicity, taking a substance a limited number of times, rather than on a daily basis for years, as with antidepressants, decreases that concern. “We think it’s very safe to use in this way. MDMA seems to act as catalyst that gets at the root of the problem. Once you get to the root, you don’t need the drug anymore.”
The Military’s Approach
In sharp contrast, the military is heavily reliant on prescription drugs to treat PTSD. According to the Department of Veterans Affairs, 89% of suffering veterans are treated with antidepressants like sertraline (Zoloft) or paroxetine (Paxil), the only two FDA-approved SSRI (selective serotonin reuptake inhibitor) medications for PTSD.
But being FDA-approved still leaves a lot to be desired. Take the case of the antipsychotic Seroquel, manufactured by the biopharmaceutical company AstraZeneca, which sold $340 million worth of prescriptions to the Armed Forces by pushing it as a sleep aid. AstraZeneca was sued for promoting the drug’s unapproved use (among others, to children and the elderly,) and had to cough up an estimated $1.9 billion to defend and settle personal injury cases and government investigations–peanuts considering that number represents less than five months of Seroquel sales.