International drug trials are investigating whether MDMA can be a useful psychiatric tool in treating post-traumatic stress disorder
During the Six Day War, a 24-year-old communications officer named Josef was stationed on the front line in the Golan Heights when one morning, a bullet tore between the eyes of his commanding officer. He was a bright and pleasant fellow whom Josef had grown fond of—they had slept beside each other, talked about their families, and worked closely together in the army. Josef was rattled by his death, as he was by the rest of the carnage he witnessed that day, when more than a dozen other young men were killed.
After the war, Josef went back to the kibbutz where he lived with his wife and two children and tried acting like everything was normal, except it wasn’t. He became prone to explosions of anger. His marriage fell apart. He felt distrustful of everyone. He remarried and divorced again, and then again. He started abusing drugs. Nothing could shake the memory of what he had experienced that morning in the war and his crippling shame over having survived. “I got hurt mentally in ’67,” he told me. “I see all kinds of pictures from the event itself. I can smell it.”In the mid-1990s, he began having nightmares.
“Every night the same,” he said. “It’s a dream of a trap I can’t get out of. It’s called different names, but it’s the same place. You see and feel it, heavier and heavier. You can’t stop it.”
Josef went to see a therapist but scoffed at her recommendation that he take medication; a previous trial with psychiatric drugs had backfired and triggered his violent temper. Nor did he want to become dependent on sleeping pills. He sought help at Beer Yaakov Mental Health Center, half an hour southeast of Tel Aviv, and found out about a clinical trial taking place there to test the effects of MDMA—the drug commonly known as Ecstasy—on post-traumatic stress disorder. He felt he had nothing to lose.
As a patient in the trial, Josef participated in a series of psychotherapy sessions, followed by two days of taking a dose of MDMA with a pair of therapists sitting quietly nearby and monitoring his vital signs. From the outside, it didn’t seem like much. Internally, however, what happened to him was unspeakably complex and cathartic. “I didn’t become what I’m not, but I had a big release,” he said. “I released my guilt: ‘Why him and not me? How come I’m alive at all?’ Whatever happened, happened, and I can’t do anything about it. On the basic level, I got rid of these heavy feelings that I was carrying.”
Josef is 70 now and lives in a village in the Galilee overlooking the sea. He speaks about his MDMA experience with a tinge of amusement, aware of how incongruous it must seem that an aging former soldier with 10 grandchildren took a drug best known for fueling all-night dance parties and youthful bacchanalia. For him, of course, it was something entirely different. “It was a kind of salvation,” he said. “Those two pills really did it.”
Researchers in Israel believe that Josef’s experience can be replicated, and that MDMA could become a significant tool in helping those with chronic, intractable PTSD. An official clinical trial that began at Beer Yaakov in February is on track to test the drug’s effects on 10 patients within the next two years, one of a number of related studies happening around the world. If the results are positive, MDMA may become known as something far more profound than the impetus for a gazillion teenagers to don neon, wave glow sticks, and grind their teeth all night to ear-splitting bass lines. It could become a vital element of psychiatric care.
If MDMA surmounts its illicit reputation and becomes a prescription medicine—a goal that researchers have been working toward for more than a decade—one might say that it all started with Rick Doblin’s bar mitzvah.
Doblin, 59, is the founder of the Multidisciplinary Association for Psychedelic Studies orMAPS, a nonprofit organization that has driven the effort to cultivate a legal, therapeutic context for the use of MDMA and other psychedelic drugs for over 20 years. Doblin grew up in a Conservative Jewish family in suburban Chicago in the 1960s, the kind of heady, engaged household where remembrance of the Holocaust and devotion to Israel got equal billing with complex conversations about the Vietnam War. He was a spiritual seeker from a young age: His personal path was in many ways kick-started by the deflation he felt at his own bar mitzvah.
“My bar mitzvah was pivotal for me because nothing happened,” he said. “I was really expecting a spiritual experience, and it was a big shocker for me that my bar mitzvah didn’t transform me into a man. I was 17 when I first took LSD, and I had a somewhat difficult time, but I felt like I was engaging a kind of psychic energy that I had anticipated from my bar mitzvah, that deeper spiritual experience that older rituals don’t offer most people anymore.”
As a student at the New College of Florida, Doblin studied the era of psychedelic research that flourished mid-century and decided that he wanted to become a psychedelic therapist, an unlikely goal since almost all such work had ended with the criminalization of psychedelic drugs amid their explosion in the ’60s counterculture. Still, Doblin harbored his dream and became particularly interested in the therapeutic reputation of a substance called MDMA.
Synthesized by German chemists in the early 20th century, MDMA was a compound that didn’t have much of a life until the 1970s, when an underground community of therapists discovered its unique ability to reduce anxiety and facilitate openness, and they started exploring its benefits in treatment. By the 1980s, however, it had seeped from therapeutic torecreational settings, where it was renowned for melting inhibitions, pumping out feelings of empathy, and enhancing the sound of dance music. In 1985, it was outlawed.
Yet interest in MDMA’s therapeutic potential never really went away, and for Doblin it became deeply personal. In 1986, his grandmother, Leona Perlman, was suffering from unipolar depression, and he suggested to his family that he facilitate a session of MDMA-assisted therapy with her. His parents balked because of the drug’s illegality, so Doblin took it himself and sat with her one afternoon at her house on Chicago’s west side. (“I figured I would try for a contact high,” he said.) As his grandmother declared that she wanted to die, Doblin gently invited anything deeper she wanted to process.
She admitted that there was one thing she’d never found closure around: In 1923, her Orthodox father—Doblin’s great-grandfather—had fulfilled a lifelong dream by moving their family from Chicago to Israel, and there she started a romance with a young Jewish man who served in the Palestinian police force. For reasons that were unclear—perhaps because the young man was irreligious or lower class—her parents disapproved of the relationship and sent her alone back to Chicago, where she eventually married the man who would become Doblin’s grandfather. Yet she never forgot about that youthful romance, and she showed Doblin an illuminated copy of the Song of Songs, a shriveled rose, and a note the young man had given her for her wedding.
Doblin attributed her revelation of this buried family secret to his own demeanor under the influence of MDMA and the space it afforded his grandmother to open up, and it triggered a mission within him. “I came out of being under the influence of MDMA feeling like we had to get politics out of the way so we can do the science and see what it can actually be helpful for,” he said. “We’ll never know if MDMA could have helped my grandmother, but I think it could have.”
That year, Doblin founded MAPS with the intent of reintroducing MDMA as a prescription drug in the United States and, ultimately, around the world. The Santa Cruz-based organization has since flourished as a nonprofit broadly devoted to drug policy reform, public education, and research on the medical benefits of a wide range of psychedelics as well as marijuana. Yet even as the organization’s profile has expanded, it has maintained Doblin’s original goal of establishing legal MDMA-assisted psychotherapy as part of its focus.
Because of hurdles to psychedelic research in the United States, Doblin developed an international strategy to try and get MDMA research approved elsewhere. In Israel, he saw not just a place where he had deep personal ties and feelings of kinship, but a country that had already produced some of the world’s top PTSD researchers, that had a culture of independent-mindedness, and that frankly harbored a lot of trauma.
“All that meant that we had a really good chance of doing research in Israel that would potentially contribute to the entire field,” Doblin said.
Teen Use of Ecstasy
The 26th annual Monitoring the Future study found that use of MDMA (ecstasy) has increased in all age groups. This is the second consecutive year there has been an increase among 10th and 12th graders; and the first increase among 8th graders.
Problems with the use of Ecstasy
Many problems Ecstasy users encounter are similar to those found with the use of amphetamines and cocaine. Psychological difficulties can include confusion, depression, sleep problems, severe anxiety, and paranoia. Physical problems can include muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating. Use of the drug has also been associated with increases in heart rate and blood pressure, which are special risks for people with circulatory or heart disease. Recent research also links MDMA (Ecstasy) use to long-term damage to those parts of the brain critical to thought, memory, and pleasure.
The Spread of Ecstasy Abuse
Ecstasy is now being used in urban, suburban, and rural areas throughout the country and continues to be used in its traditional settings of al-night dance parties, called “raves”, and night clubs; use also is common now on college campuses and at small group gatherings.
Ecstasy is used by all ages but still mainly by teenagers and young adults; use has increased sharply in population in the recent years as shown in the 26th annual Monitoring the Future study.
Like Methamphetamine, “Ecstasy” May Cause Long-Term Brain Damage
Heavy users of ecstasy, a synthetic drug that is structurally similar to methamphetamine and the hallucinogen mescaline, may be risking brain damage that remains long after the high has worn off, according to NIDA-supported research. In a series of studies conducted with rats and nonhuman primates, Dr. George Ricaurte and his colleagues at Johns Hopkins Medical Institutions first determined that a single dose of MDMA (3,4-methylenedioxymethamphetamine), only slightly higher than the size of doses taken by humans, significantly damaged brain cells called neurons that produce serotonin. Serotonin is a major neurotransmitter, or chemical messenger, in the brain that is thought to influence mood, appetite, sleep, and other important functions. Then Dr. Ricaurte reported that 12 to 18 months after the brains of squirrel monkeys had been damaged by MDMA, serotonin-producing nerve fibers had regrown abnormally in some brain regions and failed to regrow at all in others. Unlike methamphetamine, which damages brain neurons that produce both serotonin and another important chemical messenger called dopamine, “MDMA selectively damages serotonin neurons in virtually all species examined to date,” Dr. Ricaurte says.
Dr. Ricaurte’s studies have found that MDMA damages serotonin-producing neurons in the brains of nonhuman primates. The illustration on the left shows a normal neuron. The shaded area in the middle illustration shows the axon terminals of the neuron that are damaged by MDMA. The illustration on the right shows how, 12 to 18 months after being damaged by MDMA, serotonin-producing nerve fibers have regrown excessively in some areas and not at all in others.
“With MDMA, the doses that people take very closely approach the doses known to produce neurotoxic effects in animals,” Dr. Ricaurte says.
“At this point, the major question is whether the neuronal changes we see in animals from methamphetamine and MDMA exposure occur in human beings who use these drugs,” he says.
To help answer that question, he is conducting separate clinical studies using brain imaging techniques to evaluate the possibility of long-term brain damage in humans who have previously used either methamphetamine or MDMA. These studies also are assessing the potential functional consequences of such neuronal damage on aspects of mood, movement, memory, impulse control, aggression, and sleep cycles.
Determining the functional consequences of MDMA exposure may be more complex than previously thought, Dr. Ricaurte says. The long-term study with squirrel monkeys indicated that in some brain areas, such as those containing structures involved in memory and learning, damaged neurons failed to recover. However, in other brain areas, specifically those involved in regulating such functions as sleep and appetite, damaged neurons regrew nerve fiber excessively, resulting in an overabundance of serotonin being released. “This means that when we evaluate humans previously exposed to high doses of MDMA, we should be looking for loss of serotonin function in some brain regions, but perhaps normal or increased serotonin function in other regions,” Dr. Ricaurte says.
Determining the possible damaging effects of ecstasy has become more important in recent years because the pattern of MDMA use has changed, points out Dr. Ricaurte. Although ecstasy has been available as a street drug since the 1980s, its use escalated in the 1990s among college students and young adults, particularly those who participate in all-night dance parties called “raves.” In 1995, 2.3 percent of college students said they had used ecstasy at some time during the year, more than quadruple the 0.5 percent of students who reported using the drug in 1994, according to NIDA’s latest Monitoring the Future study. The percentage of young adults, ages 19 to 28, who used ecstasy in the past year also jumped significantly to 1.6 percent in 1995 from 0.7 percent in 1994, according to the survey.
Computer Game Simulates Drug Dealing
Dope Wars, a new game available for download from the Internet, enables users to buy and sell drugs in virtual reality. Dope Wars is the sixth-most popular download game on the Download.com web site.
In the game, players start with $2,000 in cash and $5,500 in debt. Players have 31 trips into neighborhoods to make as much money as they can selling marijuana, ecstasy, cocaine or any other drug. During the selling process, players come upon police officers and other obstacles.
Several politicians, including Kansas Sen. Sam Brownback, condemned the game at a December hearing on violence in the media.