Twenty-two veterans commit suicide every day.  Since the global war on terror started in October 2001, the world has been constantly reminded of the cost of war.  Millions of Americans have put boots on the ground in Iraq, Afghanistan, and other high risk areas of the world; some have not returned home, others have returned home with debilitating physical injuries, and many more have returned with mental wounds.  These mental scars are lifelong and extremely prevalent among military personnel, first responders, and victims of traumatic events.  This mental illness, diagnosed as Post Traumatic Stress Disorder (PTSD) often causes victims to feel as if they cannot go on.  There is currently no cure for PTSD, but a new controversial treatment has been cleared for trials by the U.S. F.D.A..  The treatment is therapy assisted by the illegal drug party drug MDMA.

Post Traumatic Stress Disorder is a mental illness “that develops in some people who have experienced a shocking, scary, or dangerous event.” (NIH).  The disorder can affect nearly every aspect of life, and can make those suffering from it feel like they never left the traumatic situation that haunts them.  After three tours in Iraq and Afghanistan, C.J. Hardin felt the full effects of PTSD.  “Divorced, alcoholic and at times suicidal, he had tried almost all the accepted treatments for post-traumatic stress disorder: psychotherapy, group therapy and nearly a dozen different medications.” (Phillips).  But in 2013, he was able to participate in an experimental PTSD treatment that would ultimately save his life.  He was administered the illegal drug MDMA, or ecstasy as its known on the streets, and it turned his life around.  

MDMA (3, 4-methylenedioxymethamphetamine), better known as Ecstasy was first synthesized in 1912; it is a psychoactive drug used primarily as a recreational drug in the nightclub and concert scenes.  It is classified as a schedule 1 drug in the United States, meaning it currently has no designated medical uses, and is illegal to possess in most cases.  Trials spearheaded by the Multidisciplinary Association for Psychedelic Studies (MAPS) aim to change this designation.  MDMA produces a feeling of immense euphoria, and “has shown promise in the treatment of post-traumatic stress disorder (PTSD) as an adjunct to post-trauma psychological therapy.” (Sessa).  The feelings of euphoria “increases sense of readiness and improves recall of state-dependent memories of stressful events.” (Sessa).

The key to effectively treating a patient’s PTSD symptoms is getting the patient to open up to a therapist or medical professional, but the fragile mental state that PTSD causes patients to not be receptive to typical psychotherapy.  With no pharmaceutical cure, PTSD presents unique obstacles for medical professionals.  MDMA allows patients to more easily find comfort while talking through the traumatic events they have experienced. “About 11-20 out of every 100 Veterans (or between 11-20%) who served in OIF or OEF have PTSD in a given year.” (ptsd.va.gov).  PTSD is reaching epidemic stages, and if no effective cure is found then veteran suicide rates will continue be high.  Despite MDMA being a Schedule 1 drug, it has been shown to be effective in curbing the effects of PTSD, and that alone should break the stigma that psychedelics are not a viable treatment.

MDMA has very few adverse effects, especially when used in moderation.  Of course, there are serious adverse health effects identified of MDMA use.  “A series of studies using sophisticated brain imaging techniques to assess different aspects of the human brain have found persisting abnormalities in brain morphology in ex-users of ecstasy, even with moderate use” (Gowing, 3).    Since being first synthesized in 1912, six fatalities have been attributed to the drug.  These six fatalities pale in comparison to seven thousand-four hundred-and three veteran suicides in the U.S. in 2016 alone.  Eighteen percent of all U.S. adult deaths from suicide were identified as veterans of U.S. military service.  Current widely accepted PTSD treatments do very little in reducing this number, but MDMA assisted psychotherapy has the potential to greatly reduce veteran suicide rates.  

The Multidisciplinary Association for Psychedelic Studies has shown promising results in the treatment of PTSD with MDMA as of late and the Food and Drug Administration (F.D.A.) has taken note.  In November of 2016, after limited trials conducted by MAPS, the F.D.A. gave permission for “large-scale, Phase 3 clinical trials of the drug — a final step before the possible approval of Ecstasy as a prescription drug.” (Phillips).  If successful the trials could change the notion that illegal street drugs are not an option in treating medical disorders.  Medical professionals have voiced their optimism in the experimental treatments, but they that nothing is certain in the future of the treatment.  “‘I’m cautious but hopeful,’ said Dr. Charles R. Marmar, the head of psychiatry at New York University’s Langone School of Medicine, a leading PTSD researcher who was not involved in the study. “If they can keep getting good results, it will be of great use. PTSD can be very hard to treat. Our best therapies right now don’t help 30 to 40 percent of people. So we need more options.” (Phillips).

PTSD is not only common in military veterans returning from war, but also first responders, nurses, doctors, rape victims, and those that have witnessed traumatic events such as the 9/11 attacks.  The nature of the job of first responders and medical professionals causes them to see the worst in humanity, and it often haunts them for years.  I have seen firsthand the effect of PTSD as my father was a captain in the Baltimore County Fire Department.  He retired in 2014, but will never be able to let go of some of horrific sights he has seen.  If we do not focus on treating those who have sacrificed their mental health to protect those who cannot protect themselves, then we have failed them.  Experimental treatments for PTSD, such as those that focus on MDMA assisted psychotherapy have the possibility to greatly improve the quality of life for millions, and these solutions should be approached as quickly as possible if researchers want to save lives.

Advocates for MDMA assisted psychotherapy have hurdles to get over; most of these hurdles are attributed to MDMA and other psychoactive drugs being classified as Schedule 1 drugs in the United States.  “The widespread perception that because a substance is classified as Schedule I, it must pose a significant danger to humans still exists among law-makers and the general public — and possibly also among neuroscientists. However, this perception is generally incorrect. Importantly, the current regulations are based on this misperception and make research — both basic and clinical — hugely difficult.” (Nutt).  Not only do researchers have problems getting trials green lighted when it comes to conducting their trials with psychoactive drugs, but they often have problems acquiring the drugs necessary to conduct the trials.  “For example, it took a research group in Canada sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS) more than 4 years to obtain approvals to import MDMA from Switzerland for a trial of its therapeutic use in post-traumatic stress disorder (PTSD) in Canada, even after Health Canada (the department of the Canadian government that is responsible for national public health) and a Canadian Institutional Review Board had approved the protocol design (Canadian MDMA/PTSD Study MP-4)." (Nutt).  This beureaucratic nightmare is not only a danger to pioneering research in the field of neuroscience research, but also is a danger to the lives of those who could have been positively effected by the treatment.

MDMA assisted psychotherapy has shown promising results in decreasing the severity of symptoms felt by those suffering from PTSD.  “After three doses of MDMA administered under a psychiatrist’s guidance, the patients reported a 56 percent decrease of severity of symptoms on average, one study found. By the end of the study, two-thirds no longer met the criteria for having PTSD. Follow-up examinations found that improvements lasted more than a year after therapy.” (Phillips).  Further research, now green lighted by the FDA could save thousands of lives every year if approached correctly.  Researchers are well aware of the negative connotations that come with MDMA, but adjustments to treatment have been made to appeal better to federal bureaucrats.  “Under the researchers’ proposal for approval, the drug would be used a limited number of times in the presence of trained psychotherapists as part of a broader course of therapy.”. (Phillips).

Even strict guidelines focusing on the administration of MDMA cannot fully decrease the worry that approval of the drug for medical use will increase the amount of illegal use of the drug.  The positive outcomes of the trials send a message that the drug is a solution to all mental problems, but that notions is far from the truth.  While investigating the long term effects of MDMA on the human body and psyche researchers found “Longer-term effects reported by users include insomnia, depression, headaches and muscle stiffness” (Gowing, 2).  These long term negative effects could exacerbate the effects of PTSD if MDMA is administered incorrectly or abused by patients.  Despite the negative effects that the drug can have, the positives seem to far outweigh the negatives.  “Although the substance started its life in clinical medicine and there is now a renewed research effort and growing body of evidence about its relative efficacy and safety in clinical applications, there remain immense challenges for those wishing to further research the potential positive benefits of MDMA in psychiatry” (Sessa).

However, if any drug were to be particularly cut out for PTSD treatment, it would be MDMA.  The drug is “relatively short-acting”, “non-toxic at the level and pattern of dosage required for a course of therapy”, “paradoxically reduce[s] anxiety”, “stimulate[s] new and innovative ways of thinking”, and “reduce[s] feeling of depression that accompany PTSD” (Sessa, 1).  Current widely accepted drugs used for the treatment of PTSD (Zoloft, prazosin, Paxil, sertraline) cannot boast these qualities, and can sometimes do more harm then good to those taking them.  Not to mention that these drugs have been widely used since the onset of the global war on terror that started in 2001, yet veteran suicide rates remain higher than suicide rates for the average U.S. citizen.  It is no wonder that the pharmaceutical industry is split between wanting to market MDMA, and wanting to push against it.

The effectiveness of MDMA as a treatment for PTSD and depression related diseases is because it “produces an acute, rapid enhancement in the release of both serotonin (5-HT) and dopamine from nerve endings in the brain” as well as “increased locomotor activity and the serotonin behavioral syndrome” (Green).  Serotonin is widely believed to be a major contributor to feelings of happiness.  MDMA increases production of serotonin, often pushing its users into a state of ecstasy.  This state of ecstasy allows for therapists to break down the traumatic thoughts that those suffering with PTSD have walled off.  PTSD treatment is most successful when patients are able to talk through the traumatic event they experienced, instead of holding in the event.  One must be able to absolve themselves of a sense of responsibility for the traumatic event occurring for PTSD treatment to be effective, and MDMA allows for patients to more easily get to this crucial point.

Opponents of the use of MDMA to treat PTSD and other mental illnesses would argue, that like marijuana which is relatively safe, MDMA has the potential to be a gateway drug for the millions of users that could possibly employ the treatment.  Often, MDMA users, especially those that are young tend to be polydrug users, meaning they often use other drugs such as LSD, cocaine, and marijuana.  With the current opioid epidemic wreaking havoc on the United States legislators, and opponents of MDMA treatments will most likely claim that MDMA will increase opioid substance abuse.  However, MDMA treatments will be precise and extremely well regulated.  For each PTSD treatment there is only three separate sessions where MDMA is administered, and patients will be observed the entire time of the administration.  The drug would not be commercially available via doctors’ notes, but instead only delivered to approved therapists, and only administered by approved medical professionals.  Every precaution is being taken to avoid causing a new drug problem in the United States as a result of the revolutionary MDMA treatment.

The most convincing arguments for the treatment of PTSD with MDMA come from the patients themselves.  All survivors of horrific traumatic events that have left them clawing at every medical treatment possible without any real progress in overcoming their mental illness. That is until they were approved as patients in a trial for MDMA assisted psychotherapy.  MDMA saved the life of one childhood sexual abuse survivor named Alice.  “There were many triggers: physical contact, being alone, showering, seeing someone who resembled a family member, loud sounds, even a red baseball cap – the kind her father wore. He and his friends also sexually abused her on numerous occasions. The disorder imprisoned Alice; she couldn’t answer the phone or go to the shops on her own. ‘I would get triggered by something and I’d shake or shiver,’ she says” (Solon).  Alice had tried every PTSD treatment available, but was not getting anywhere; she felt suicidal at times.  Like many survivors of traumatic events she felt as if she could not go on.  Then she enrolled in an MDMA assisted psychotherapy trial.  “During the session, her psychiatrist guided the conversation according to goals she had set with Alice beforehand. ‘I had the first few minutes of peace I’ve had in years,’ Alice says, though the sessions weren’t all plain sailing. “Some parts were wonderful and others were kind of hellacious. I was super-sad and couldn’t stop crying. It was not just an automatic love drug. But I was always able to come back to feeling good.’” (Solon).  Alice’s CAPS score, a score given to test the prevalence of PTSD went from severe to zero.  MDMA assisted psychotherapy had absolved her of her PTSD.

MDMA has the possibility to be the wonder drug of PTSD treatment, and many bureaucrats do not know how to react.  For years, the United States of America has been cracking down on the illegal drug, but now it is shown that there is a possibility for medical use of the drug, and that scares people.  Schedule 1 drugs, other than cannabis, are often not looked at in a positive light, but the use of MDMA as a treatment for PTSD could change the American public’s view of illegal drugs.  The topic in and of itself is controversial, and that is why it is so important that we delve deeper into MDMA assisted psychotherapy.  It is not only an important topic for those who suffer from and treat PTSD, but also to the American public as a whole.
