It is hardly surprising that Tony Macie has an over-developed sense of awareness. As a US Army private he served for 15 months in Baghdad, calling in artillery and air support in his role as a member of a reconnaissance unit. Deadly roadside bombs and insurgent attacks were everyday occurrences in the city divided by sectarian violence. Being hyper-vigilant can help keep a soldier alive in a warzone, but when Macie returned home in 2007, he couldn’t switch off. “My brain was working on overdrive all the time,” he says. “I couldn’t relax, couldn’t unwind.”
He was diagnosed with Post-Traumatic Stress Disorder (PTSD), but found the standard treatments – mainly psychotherapy and anti-depressants – were of little help. While searching for an effective alternative, Macie came across the website of Multidisciplinary Association for Psychedelic Studies (MAPS). This not-for-profit group was sponsoring research into the use of MDMA, better known by its street name ecstasy, as a treatment for PTSD. He enrolled in a study that is currently looking at whether combined use of the drug and psychotherapy could provide relief for those with the debilitating anxiety disorder.
MDMA was originally developed by scientists at the German chemical and pharmaceutical company Merck a century ago, while they were investigating ways to stop abnormal bleeding. In the 1970s, a number of psychiatrists used the chemical to enhance communication with patients. The practice ended when MDMA became better known as a party drug, leading to it being outlawed in the US in 1985.
Evidence for its therapeutic efficacy was largely anecdotal. However, a small clinical trial published in 2010 suggested the drug can increase response to psychotherapy among people with PTSD. Now Rick Doblin, the founder and executive director of MAPS, hopes further studies, such as the one Macie is taking part in, will eventually lead to MDMA being approved by the US Food and Drug Administration as a new effective treatment option for PTSD. “Everywhere we go, what we’re told is ‘this is really important’, but the people we’ve spoken with were not high enough in the hierarchy to comfortably say yes,” says Doblin. He does, however, believe he is making headway. He recently had a meeting in the Pentagon to discuss his research (although he declined to identify the office on the record).
MAPS also funded the clinical trial published three years ago, which was led by Michael Mithoefer, a psychiatrist based in South Carolina. It involved 20 PTSD patients, the majority of whom had the disorder after being sexually assaulted, or being sexually or physically abused as children. Participants were given either MDMA or an inactive placebo during psychotherapy sessions, and were later assessed for symptoms of PTSD. Ten of the 12 (83%) given MDMA responded positively, compared to just two of the eight (25%) who took placebos.
Mithoefer’s interest in MDMA dates back to a career shift in 1991, when he moved from emergency medicine to psychiatry. “I was interested in experiential therapy, helping people shift their consciousness in some way,” he says. He became interested in MDMA's possible use in psychotherapy from anecdotal evidence reported prior to the drug's US ban. "There were published reports, but no controlled research," he says. PTSD was beginning to rise in the public consciousness in light of the wars in Iraq and Afghanistan. "I thought it behoved us to take a careful look at whether these anecdotal reports of MDMA could be born out with rigorous controlled trials."
Mithoefer is also running the trial that Macie is participating in. A group of 24 veterans and firefighters will take part in three sessions during which they will be given MDMA before undergoing psychotherapy. The hypothesis is that participants will feel less fear and be better able to talk about the traumatic experiences that caused their PTSD while under the influence of the drug.