One problem with the previous study was the use of inactive placebos. Those in the control group would have known that they were not receiving the active drug and this knowledge could have influenced their mental state. To get around this Mithoefer is giving those in the current study low, medium, or high doses. As participants will not know which does they have been given, he says this should effectively create double-blind conditions that would give the study greater validity. Results will be measured using a questionnaire-based PTSD diagnostic tool. The study is due to be completed next year.
Treatment options for PTSD are by and large ineffective, and so MDMA is not the only “non-traditional” treatment under investigation. At the Army’s Fort Bliss Restoration and Resilience Center in Texas, patients receive therapies ranging from acupuncture to Reiki, a Japanese spiritual treatment. In California, researchers at the Pentagon-funded Institute for Creative Technologies have studied the use of virtual reality as part of “exposure therapy” for veterans with PTSD.
These days, researchers have no problems finding subjects for such work. It is estimated that the US military is diagnosing between 14,000 and 15,000 new cases of PTSD every year among deployed service members. “We have 400 veterans on a waiting list who have called us, and that’s without doing recruiting,” says Mithoefer.
Doblin thinks that getting MDMA through the FDA’s regulatory hurdles will only take eight to 10 years and $15 to $20 million – relatively speedy and cheap compared to what is normally required to license a new drug. “The FDA knows more about MDMA right now than any drug that they’ve ever approved in their entire history,” he says, pointing to a wealth of literature generated, ironically, by MDMA’s illegal status.
But whether the new research will convince critics, particularly those influenced by MDMA's reputation as a party drug, is more doubtful. Part of the problem is overcoming the stigma of hallucinogens, and some of the biased research that has been done in the past. Jonathan Moreno, a bioethicist and professor at the University of Pennsylvania, points to the studies conducted by Timothy Leary of Harvard in the 1960s. In a prison study, Leary claimed that hallucinogens combined with psychotherapy could reduce re-offending among prisoners, but those conclusions were later shown to be erroneous. Doblin published a follow-up study, highlighting problems with Leary's means of tracking re-offending in the long-term.
“It’s striking that even in the 60s and 70s people lined up on different sides on hallucinogens,” says Moreno. The lines are drawn pretty dark on various positions.”
It’s not just the recreational use and abuse of MDMA that raises concerns. There is what Doblin calls the “disastrous legacy of mind control experiments” at the Pentagon. During the Cold War, both the Army and the CIA experimented with using hallucinogens as a weapon. Particularly notorious was MK Ultra, a CIA project which experimented with the use of psychedelics for mind control, sometimes with unwitting subjects.
“That is in people’s minds,” says Doblin, adding that it has been sufficiently far in the past that it is not their dominant concern.” Doblin does say he was approached by a former member of the military who asked about the possibility of using MDMA, which fosters feeling of trust, as a tool for interrogating terrorists. “That was a scary thing,” says Doblin, who also expressed doubt such use would be effective.
The bigger barrier, Doblin says, is the fear of MDMA's recreational associations, and that it could be misused. Several researchers at the US Department of Veterans Affairs (VA) turned down requests to be interviewed about Mithoefer's MDMA study. "VA does not use ecstasy as a treatment for PTSD," said a spokesman in a statement. "Nor has it conducted, nor is currently conducting, any studies into whether it could be used in such a capacity." Ecstasy "is an illegal drug and VA would not involve veterans in the use of such substances."
For Macie, however, much of the debate is academic. He has taken part in one session of combined MDMA and psychotherapy as part of Mithoefer's study and already believes the approach has helped him. He does not see the drug as a magic bullet and recognises such treatment is likely to still require a great deal of effort on his part. “I don’t want you to think that doing it puts you in happy mode forever,” he says. “It’s hard work.”