As thousands of service members come home from Iraq and Afghanistan, many veterans need immediate mental health care, especially to deal with post-traumatic stress disorder (PTSD). Meanwhile, Santa Cruz, California-based MAPS (Multidisciplinary Association for Psychedelic Studies) is funding research that calls for using MDMA-assisted therapy to treat veterans who have chronic, treatment-resistant PTSD.

The idea behind MDMA-assisted therapy is that dosages of pure MDMA—MAPS uses full dosages of 125 mg—can lead to new insights for patients when therapists monitor them closely in a controlled setting. Also, proponents say that MDMA-assisted therapy helps patients to warm up to the therapist more quickly, and that can be especially helpful if a patient is suicidal, when time is not a luxury. MDMA may begin working in 45 minutes or longer, whereas most prescription antidepressants may take a couple of weeks to start working.

Of the 2.3 million U.S. service members who have deployed to the Iraq and Afghanistan wars, 1.3 million are now veterans eligible for five years of free Veterans Administration medical care. Since 2004, VA hospitals and clinics have treated 654,000 new, first-time patients, or slightly more than half of the eligible veterans. And of the new patients, 332,000 are diagnosed by VA with at least one mental health condition, and among those, 192,000 are diagnosed by VA with PTSD, or nearly 30 percent of all the veterans seen and treated by VA doctors.

Those statistics are according to Paul Sullivan of Veterans for Common Sense, a veterans’ advocacy group. The stats are based on reports prepared by the Department of Veterans Affairs obtained exclusively by Veterans for Common Sense under the Freedom of Information Act.
“This represents a true, enormous, and escalating epidemic of PTSD among our returning veterans,” Sullivan said.

MAPS was founded by Oak Park native Rick Doblin, who lives in the Boston area, and this year the organization celebrates 25 years of funding education and research about psychedelics. Doblin, who earned a doctorate in public policy from the Kennedy School of Government from Harvard University in 2001, created MAPS in 1986 with the idea of making MDMA an FDA-approved prescribed medication.

Doblin became aware of and tried MDMA in 1982. At the time, he was in his then-home in Sarasota, Florida, with his girlfriend. He remembers that he felt “so much love” and that the experience “felt real, genuine and authentic” and “It has stayed with me to this day.”

MDMA is Ecstasy in its purest form, while the illegal “Ecstasy” form on the street sometimes includes traces of crystal meth, PCP and other dangerous components—and sometimes little or no MDMA. MDMA also gets a bad reputation because it became criminalized in 1985; that’s when it became a Schedule I drug, the Drug Enforcement Administration’s category for drugs with a big risk for abuse.

MDMA also sometimes gets a bad rep because many people in the dance music scene take it to help them stay awake and dance the night away, and sometimes they get their bodies overheated and don’t drink enough water or drink too much water too fast for the body to process, sometimes leading to death.

In MAPS’s initial U.S. MDMA/PTSD study, subjects had suffered from PTSD for an average of 19 years, and more than 80 percent of the subjects were cured of chronic, treatment-resistant PTSD after getting MDMA-assisted therapy.

MAPS researchers Michael Mithoefer and his wife Ann later this year are expected to publish follow-up results of a pilot study that they did, with the outcome being that 17 of 20 participants no longer met the criteria for PTSD after they completed two or three MDMA-assisted therapy sessions led by him and his wife.

The follow-up results come after the Mithoefers, Doblin, Mark Wagner and Lisa Jerome wrote and published their results of MAPS’s research/study in 2010 in the Journal of Psychopharmacology. The Phase Two results are probably about six months away from being published, Doblin said. “It’s coming along well,” he said of the paper.

However, de-stigmatizing MDMA will be a long journey, Doblin said.

“To move MDMA out of Schedule One is going to take at least 10 years of doing all of the necessary clinical research,” Doblin said.

“MDMA, I think, will continue to be used at bars, clubs and raves and there will continue to be tragedies from people that for one reason or another don’t cool down or don’t drink enough water,” he said, “so I think the stigmatization is there because that’s what our society promotes as far as drug prohibition.

“What we’re hoping for is that people will shift toward more of a public health approach than criminal justice approach or [move toward more of] a drug policy to reduce the harm of [using] drugs, and that I think will help the de-stigmatization.”

Some critics of MDMA-assisted therapy contend that the best way to treat PTSD is to follow Edna Foa’s prolonged exposure therapy. Foa is known as the expert on how to treat PTSD, and her method calls for PTSD patients to talk about their trauma in eight to 15 weekly appointments and listening to recordings of appointments.

Dr. Rodney Benson, Ph.D., of the Depression & Anxiety Specialty Clinic of Chicago, said he prefers to treat PTSD with therapy. He said, “I wouldn't characterize my position of treating combat-exposed veterans with MDMA-assisted therapy as a bad idea. I consider myself a scientist, so my position would best be stated as, ‘let's see the evidence.’ I am not aware of scientific evidence to support the addition of MDMA to treatment of PTSD. If it exists, I want to learn.  My hesitation to endorse MDMA-assisted therapy is that I have not read any empirical articles that have supported its use. I am guessing those studies are underway.”

What does Doblin say to critics who recommend strictly therapy?

“The more therapy that’s available, the better,” Doblin said, “but we work with people in our studies who have failed under other psychotherapies and other medications, so prolonged exposure is not for everybody.” Prolonged exposure triggers revisiting the trauma, he said, adding, “MDMA helps to reduce that” fear of revisiting the trauma.

Also, Doblin said he is all for having the maximum number of treatments available for people, and he said that there are elements of prolonged exposure therapy in what MAPS therapists/researchers do during MDMA-assisted therapy “by helping people go over the incident that caused the trauma.”

Benson said, “Good treatments for PTSD do exist. Prolonged exposure is still considered the gold standard. However, we, as a treatment community, are aware that we have so much work to do. I want us to keep getting better.”

Currently, MAPS is helping to fund and coordinate studies of MDMA-assisted therapy to treat PTSD among veterans in not only the States but also in other countries. MAPS is writing about the results of a Swiss study of MDMA-assisted therapy, which Doblin said has results that are “about half as good as the U.S. study.” He said, “We’re still trying to get approval in Canada, Australia and Jordan, and the Israel study is approved and we’re working on that to get it started.”

As for Phase Three in MAPS’s U.S. MDMA/PTSD study, Doblin said that in that phase, MAPS likely would end up doing a larger study with about 600 people in 15 to 20 sites.

Asked what he would like for MAPS to accomplish in the next 25 years, Doblin said that he would like to build a network of psychedelic therapy clinics and to get psychedelics and marijuana placed as prescription medicine on the market. “That would be phenomenal,” he said.