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Clinician's Digest - Page 2

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Ecstasy in the Consulting Room

At a time when public attitudes toward the medical use of marijuana are rapidly changing, it’s probably not surprising that the therapeutic use of MDMA—better known by its street name, ecstasy—is receiving renewed attention. But rather than recalling Harvard psychologists Timothy Leary and Richard Alpert’s Psilocybin Project in the 1960s, today’s investigators are undertaking government-sanctioned research using the traditional methods of systematic observation and careful measurement. Leading the way is the Multidisciplinary Association for Psychedelic Studies (MAPS), an independent nonprofit that’s raised millions of dollars to fund research on the use of MDMA to treat war veterans and other trauma survivors.

In 2008, after years of waiting on approval from the Food and Drug Administration (FDA) and the Drug Enforcement Administration, psychiatrist Michael Mithoefer and his wife Annie, a nurse, completed their first randomly controlled pilot study, funded by MAPS, on the therapeutic efficacy of MDMA. Published in the Journal of Psychopharmacology, the research reported that MDMA-enhanced psychotherapy sessions with trauma victims resulted in a significant reduction in post-traumatic stress disorder (PTSD) symptoms for more than 80 percent of the participants, compared with only 25 percent in a placebo group. A 2012 follow-up study, published in the same journal, indicated that these positive results held up over an average of three and a half years without any reports of negative effects from taking the drug. The success of this pilot study led the Mithoefers’ team to begin a second study, still underway, involving police officers, firefighters, and veterans from Iraq and Afghanistan. All participants had PTSD and combat or sexual trauma, and all had engaged in psychotherapy or pharmacotherapy treatment that had proven unsuccessful. Former students of Stanislav Grof, a psychiatrist known for his studies on LSD and the psyche, the Mithoefers view MDMA as a catalyst to a more spiritual type of healing. “I saw the benefit of giving people a chance to have this deeper kind of experience in therapy, and that it helped a lot of people with PTSD before it became illegal,” explains Michael Mithoefer.

In the Mithoefer study, participants attended several talk therapy sessions to prepare for the drug-assisted experience. The subsequent three to five MDMA sessions were each eight hours long and held a month apart, with talk therapy sessions sprinkled in between to help participants integrate the experiences. After taking the drug, participants were encouraged to lie down and spend roughly half the time listening to music, wearing eyeshades, and focusing inward. For the rest of each MDMA session, the Mithoefers guided them through revisiting traumatic events.

According to Mithoefer, therapy with a mind-altering substance like ecstasy hits the fast-forward button on the therapeutic alliance, with patients feeling safe enough to reveal the most difficult of secrets or traumatic experiences. He describes MDMA as a mechanism for helping them pull back from the immediacy of their current symptoms, allowing them to hover over the landscape of their lives to gain a more therapeutic perspective. As he puts it, the impact of MDMA is that “it enables people to be neither overaroused nor underaroused, so they can revisit events with emotional connection but with enough equanimity to not be flooded by the emotions.”

Nevertheless, many barriers still exist to MDMA’s wider acceptance in the field of trauma research because of prevailing health concerns and the stigma of psychedelic drug use. “We have to be really careful about what we’re saying when we decide that someone is treatment resistant and therefore has to receive a novel form of treatment,” explains Francine Shapiro, the originator and developer of eye movement desensitization and reprocessing. “For instance, did they really have all the validated forms of therapy, or only one? And we need to be rigorous in evaluation. The Mithoefer study had only 19 people. By the follow-up, even though there were reductions in the PTSD symptoms, half of them were in active psychotherapy, and 12 were taking psychiatric medicines. How are we saying that this is a ‘cure’ if they’re still taking medications or getting psychotherapy?”

Mithoefer, aware of the skepticism about his research, admits, “Attitudes are changing, but the Department of Defense and the Veteran’s Administration are still very cautious about wanting to get involved.” However, research teams in Israel, Canada, and Colorado have been trained by the Mithoefers to repeat the protocol and have been granted approval to test the drug-assisted therapy as part of the MAPS $18.5 million plan to earn FDA approval of MDMA as a prescription medicine by 2021. The organization also funds clinical trials to develop the psychedelics psilocybin and LSD as prescription medications to treat anxiety in cancer patients.

Looking forward, Mithoefer envisions the use of psychedelics with more than just treatment-resistant cases of PTSD, and he’d like to use neuroimaging to explore the neuromechanisms that account for the effects, but he’s convinced that MDMA seems to activate a kind of “inner healing intelligence that takes the treatment where it needs to go.” He believes MDMA is especially useful for helping those unresponsive to other treatments to visualize and move in the direction of healing.

“People have revealing imagery of what the healing process looks like,” he says. “One traumatized woman described herself as feeling lost in the underbrush. ‘I didn’t know where I needed to go,’ she admitted. After some MDMA sessions, she said, ‘Now I have a map.’”

—Kathleen Smith

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