By Alfa · Oct 5, 2004 ·
  1. Alfa

    It may be illegal but the popular "club drug" MDMA is coming back to its
    psychotherapeutic roots.

    Sitting on a couch is Melissa, a woman in her mid-20s who has just taken
    125 mg of methyllenedioxymethamphetamine (MDMA), or ecstasy, in a glass of
    juice. Sitting in a rocking chair to the left of Melissa is licensed
    psychotherapist Dr. Jane, who will work intensely with her patient over the
    next few hours, as Melissa's brain bathes in the surplus neurochemicals
    brought on by the MDMA.

    Melissa and her therapist aren't part of any currently approved research.
    They consider themselves to be conscientious, law-abiding citizens, but
    have decided to augment traditional psychotherapy with what the U.S. Drug
    Enforcement Agency currently classifies as a Schedule I substance---an
    illegal drug.

    But, illegal or not, Dr. Jane (not her real name) has a rationale for using
    this drug with her patient: MDMA eases anxiety surrounding traumatic
    events, allowing them to be recalled with extensive clarity, then amplified
    by a desire to discuss them, perhaps for the first time in the patient's life.

    Dr. Jane is one of an informal network of a half dozen or so
    psychologists--licensed social workers and psychiatrists practicing from
    Logan to Provo--with the experience and willingness to work with patients
    who choose to use MDMA in conjunction with other drug-free therapy sessions.

    She and her underground clinical colleagues aren't doing anything new. Long
    before its popularity blossomed under the moniker of "ecstasy" in dance
    clubs and warehouses across Europe and North America, and long after its
    first patent by German pharmaceutical company Merck in 1914, MDMA was used
    by scores of psychotherapists during the 1970s and halfway through the
    1980s. With its relatively minimal side effects, therapists classified the
    drug as an "empathogen" for its ability to open the heart, increase
    awareness and foster sensations of self-love and acceptance. In addition,
    the drug has the added benefit of keeping the patient firmly grounded and
    in control, rather than orbiting Pluto as occurs with stronger drugs. From
    the perspective of the analyst's chair, these are all very desirable traits.

    From its ingestion, MDMA takes about 45 minutes to take effect. During
    this time, Melissa nods her head in affirmation, as Dr. Jane reads aloud
    the goals for this session and the safety contract, both of which have been
    developed and agreed upon during six earlier preparation sessions.

    It is now 60 minutes past the point when Melissa unwrapped a small triangle
    of tinfoil, emptied the white, powdered contents into a glass of juice and
    drank it down in one long gulp. Her earlier, tense posture has given way to
    a more relaxed position on the doctor's leather couch. The pillow she had
    been clutching nervously in her lap is now resting under her right leg, and
    her head rests gently on the back of the sofa. Melissa is both alert, and
    noticeably relaxed, as she talks openly about abuse that occurred early in
    her childhood. Dr. Jane listens intently, only occasionally asking
    questions that probe lightly into progressively deeper layers of her memories.

    Now two hours into her session, tears fall from Melissa's face and into a
    white Kleenex she holds in her hand as she recounts one particularly strong
    memory. Using a succession of questions, Dr. Jane assists Melissa in
    understanding how her earlier trauma caused her to project certain beliefs
    into her present relationships--beliefs that are creating some problems.

    Towards the end of her session Melissa says: "Reliving this incident helped
    me free up my emotions in a number of ways. =85 I know that I have a lot
    more to do, but I know now that I molded my views about the world--that I
    now know are not true--because that one incident caused me to distrust my

    Melissa, who works as a computer programmer, seems visibly relieved, and
    hopeful. Weeks after the sessions, she sent a promised e-mail describing
    the sum of her three MDMA-assisted therapy sessions: "I was able to dump my
    file =85 the medicine cleared my channels =85 insights and memories poured
    through me =85 fragments and pieces of the puzzle all came together. I had
    a cloud of trauma that had seemed in front of me =85 that for almost my
    whole life had been distorting my beliefs about myself =85 it seems behind
    me now, and I've gotten a new sense of who I am."

    Don't rush out to your local psychotherapist for sessions on the couch with
    this "love drug" just yet, though.

    First of all, these renegade therapists will allow only certain patients to
    use the drug, and only after a careful screening and analysis process of
    several therapy sessions in advance of taking the drug. The drug's
    therapeutic effects have been found especially beneficial to those
    suffering from post-traumatic stress disorder (PTSD).

    Second, don't go thinking that your time on the couch will amount to some
    sort of drug-crazed party of one. Most patients take MDMA during therapy
    twice at least, maybe three times at most. Perhaps most discouraging of all
    is the fact that you will have to score the drug yourself. Patients who
    desire this type of therapy assume all the responsibility in obtaining,
    possessing and ingesting the drug. Finding authentic MDMA, free of
    adulterants and of known strength, takes some work, but is not difficult.
    Dr. Jane cautions any prospective MDMA patient against running down to the
    local warehouse or club to buy a hit from a raver sporting an X on his
    shirt. You're more likely to end up with a fake drug or sometimes-harmful
    counterfeit. Some have had luck procuring legitimate samples from
    undergraduate chemistry students who've figured out that MDMA is not all
    that difficult to synthesize.

    Once the patient procures the drug, Dr. Jane provides guidance on
    determining potency of the MDMA, and assists with dosing. Preparation
    sessions are crucial. Not only are patients given information on the risks
    and benefits of therapy using the drug, they also establish goals for the
    session, discuss expectations, and how information yielded during the MDMA
    session will be integrated in the patient's life. Dr. Jane follows a safety
    protocol that involves having a trusted friend or relative assume charge
    for the patient after the session, among other things.

    In short, MDMA-assisted psychotherapy is serious business, not a dance
    party for which it's commonly used. Those who take the drug recreationally
    to enhance the repetitive beat of dance music and feel closer to other
    people at a party will gain a few pleasant hours with little or no insight
    into themselves. An MDMA session in the confines of an office and under the
    guidance of an experienced professional is something else entirely.

    Before the drug was criminalized in 1985, Rick Doblin, an expert on the
    therapeutic and medical uses of marijuana and psychedelics who earned his
    doctorate from Harvard University's Kennedy School of Government, was
    witness to MDMA's effects on patients during psychotherapy. "I saw first
    hand just how helpful it was for certain patients," he said during a
    telephone interview from his Boston home.

    But as the drug gained more and more publicity for its pleasurable
    qualities at dance and club parties, as opposed to its less sensational
    benefits during psychotherapy, the DEA moved to ban the drug under Schedule
    I classification. Therapists protested, suing the government in court. An
    administrative law judge agreed that the drug shouldn't be classified as
    such but could only make a recommendation to the DEA. The agency said, in
    effect, "Thanks, but no thanks." As if to buttress the DEA's position, the
    scientific community released study after study questioning the drug's
    safety and long-term effects. The most damning studies by Johns Hopkins
    University researcher Dr. George A. Ricaurte concluded that MDMA use lead
    to permanent brain damage in primates and damaged the brain's dopamine
    neurons. Upping the fear factor, the doctor also concluded that use of the
    drug could lead to Parkinson's disease in humans. But in a stunning
    reversal, Ricaurte himself put those findings to rest September 2003 when
    he admitted in Science magazine that his researchers had not given primates
    used in his studies MDMA, but another drug entirely. However, even some of
    Ricaurte's detractors say his earlier studies demonstrating the drug's
    neurotoxic qualities may have merit. Debate about the drug's long-term
    effects continues, but many hope that with Ricaurte's primate study now
    invalidated, a new era of study surrounding the drug's benefits will soon
    dawn. About time, too, they say.

    Doblin founded the Multi-Disciplinary Association for Psychedelic Studies
    (MAPS) in 1986 with just that goal in mind. Based in Sarasota, Fla., his
    organization works to advance the study of MDMA's therapeutic value through
    legitimate scientific studies. The United States isn't the only nation with
    resistance to studying the drug's therapeutic uses. Spain hosted the first
    scientific study of MDMA in the world, testing its therapeutic value on
    women survivors of sexual assault. The study seemed to be advancing quite
    well according to media reports. Then the International Narcotic Control
    Board shut it down.

    Although there is considerable anecdotal evidence about the benefits of
    MDMA-assisted therapy, scientific confirmation of its effectiveness is
    admittedly minimal. The most notable of the few studies originate from a
    group of Swiss psychiatrists who used MDMA in conjunction with
    psychotherapy from 1988 to 1993. During this six-year period, 121 patients
    underwent a total of 818 sessions. More than 90 percent of the patients
    described themselves as "significantly improved." During the course of the
    study, there were no adverse incidents, no suicides, no psychiatric
    hospitalizations and no negative reactions.

    Doblin's MAPS is working hard to change the drug's research landscape. It
    launched a "$5 million, five-year Clinical Plan" to one day see MDMA made
    into a prescription drug for the treatment of post-traumatic stress
    disorder. The organization is also trying to secure funding for research at
    Harvard University, where the drug might be tested on advanced cancer
    patients to help mitigate their fear of death and other anxieties, Doblin
    said. But the truly big news among MDMA's proponents was the FDA's November
    2001 green light for a study of the drug's effects on people with PTSD.
    Early this year, in February, the proposed study also earned necessary
    regulatory approval from the DEA. Together, both approvals mark the first
    time since the drug was criminalized that it will officially be studied for
    therapeutic value.

    For Doblin, this kind of approval for scientific study of MDMA makes the
    perfect bookmark to 1963, when Timothy Leary got the boot from Harvard
    University for his studies regarding LSD.

    "The Israelites, so to speak, have been wandering in the desert for 40
    years. Researchers have been locked out of the lab, wandering the
    wilderness for that long. It's really the first time in decades that we've
    had any research on these substances at all," he said. "The quest for
    verification and scientific research is totally appropriate. What's
    fundamentally problematic is that it's taken us so long to even get to that
    point. It's especially difficult to gain traditional funding sources for
    this kind of research, too. The drug is just too controversial for them to
    even touch it."

    All this is extremely important news for therapists like Dr. Jane, too. A
    practicing psychotherapist in Salt Lake City for years, one of the degrees
    on her wall boasts the blue and white accents of a relatively conservative
    Utah school. Displayed on the wall just below that degree is a license
    issued by the Utah Department of Occupational Licensing to practice as a
    clinical psychologist. She's gravely aware that her license and livelihood
    could be in jeopardy each time a patient of hers takes MDMA under her
    supervision. One patient with one bad reaction is about all that separates
    her from a bee's nest of legal problems, investigators, and a trip (no pun
    intended) in front of the licensing board.

    Nevertheless, she is resolute. "I would rather tender my license and make
    widgets than turn a blind, fearful eye away from an avenue of treatment
    that may help someone," she said. "MDMA has a fantastic ability to scan
    through the unconscious, lock onto areas of emotional tension, and then
    allow the patient to talk about themselves in spite of any defensive walls
    they've created."

    Like her patient Melissa, the Utah doctor has her own description of
    MDMA-assisted therapy: "Feelings of self-love and self-acceptance suffuse
    the session and, frequently, they can endure long after the drug has left
    the body," she said.

    And any good psychotherapist knows that any long-lasting behavioral change
    has its roots in feelings of genuine self-love.

    People ask me all the time if I can refer them to therapists [using MDMA],
    and I cannot. I know it's going on, but I don't know exactly who's doing
    it. I know they're out there."

    Those are the words of Julie Holland, M.D. A New York University psychiatry
    professor and psychiatrist in practice at Greenwich Village, she's widely
    considered the most celebrated authority regarding MDMA's therapeutic
    value. And with Ricaurte's studies discredited, her comments are no longer
    seen as those of the naive proponent. Just ask Newsweek, and other
    publications in which her words have gotten a forum. Taking a break from
    vacation in Massachusetts to speak by phone, her voice is measured and
    assured, even if occasionally surprised.

    "You found some underground therapists? That's great, and it's not easy to
    do," she said.

    Anyone who's ever heard of Prozac or lithium knows that the marriage of
    drugs and therapy is nothing new. That's one of the reasons Holland has no
    qualms about entertaining the use of MDMA with patients on the couch. She
    seems shocked that anyone would consider its use such a radical departure.
    In addition to authoring an exhaustive research paper on the drug, she
    edited articles by 21 of the world's most noted MDMA experts, compiled in
    2001 under the title Ecstasy: The Complete Guide.

    One of Holland's favorite quotes from an article included in her book comes
    from George Greer, a therapist who prescribed the drug for patients while
    it was legal, only to find himself forced to stop using it. "I felt like an
    artist who'd just discovered oil paints, but had to put them away and start
    using charcoal again because people were sniffing the oil paint," Greer wrote.

    Holland sympathizes with any physician forced to put effective medicine
    aside. And she believes MDMA can be especially beneficial, not just for
    people with PTSD, but also with adults who were physically or sexually
    abused as children. "Psychiatry doesn't really have many good tools in its
    armament when you get right down to it. This is a really good tool," she
    said. "And it's very possible that if the government said this was a good
    drug for therapy, fewer people would be enticed by its illegal status."

    The irony of recent FDA and DEA decisions to approve preliminary studies of
    the drug, however, is that now government seems to have taken the lead
    where universities and private companies haven't taken the trouble.
    Universities, of course, are cautious to do anything that smacks of
    illegality. But the reason why corporations never took MDMA's case before
    the FDA or DEA is clear, Holland believes.

    "No pharmaceutical company has gotten behind this because [MDMA's] patent
    is expired, and it's a drug that the average patient will take once or
    twice during therapy, and that's it. There's no profit margin in it," she said.

    But that doesn't mean there's no connection between current favorites such
    as Prozac and MDMA. Both drugs work to release serotonin, which brings on a
    general sense of openness, energy and well being. But where Prozac merely
    stops the recycling of serotonin, so that it backs up in the brain to make
    more available for the synapses, MDMA, on the other hand, floods the brain
    with serotonin. In addition, like Prozac, it also stops the recycling, or
    uptake, of serotonin as well.

    Once again, this isn't the party drug you may have heard of. You're
    certainly not dancing to loud music in psychotherapy. No, you're talking
    about potentially painful events in your life.

    "It's a very subtle experience. For most people it's about as subtle as
    having one or two glasses of wine," Holland said. "It's not as big of a
    break from normal consciousness as people might think it is. But give it a
    name like Ecstasy and people have a lot of assumptions about it.

    "It's similar to anesthesia during surgery. It's not that you're pain-free,
    but you are very much more relaxed. You have to really peel through layers
    of defenses to get to core therapy. People are pretty much laid out, and
    you're much more likely to get to the malignant core of what's going on. It
    allows you to more readily examine it, and potentially excise it or remove
    it. It makes therapy much more efficient and effective. You don't have to
    spend three years building an alliance with your therapist. It really
    strengthens that alliance, which is really important for future sessions."

    And unlike alcohol or other sedatives that would result in blurry
    disinhibition, MDMA has the added benefit of letting a patient recall the
    experience of what was discussed. That's due to the drug's amphetamine
    base, which gives patients greater ability to remember what's happened. And
    when an issue is recalled and remembered, there's no need to talk about it
    over and over. Taken once or twice during therapy, Holland said, MDMA can
    reap multiple benefits in future sessions.

    Doblin concurs. "In a way, MDMA is the anti-drug, because Prozac and Zoloft
    are drugs people have to take every day, and when people stop taking them
    their problems come back," he points out. "MDMA in therapy is taken only a
    few times. In the PTSD study, people take it only twice. It was never
    intended to be a regular daily drug in a therapeutic setting, and was never
    intended to be a take-home drug."

    Concern over the drug's current status as an illegal substance is that it
    may sit forever in the recreational realm, where it's most often used
    incorrectly. Used in the context of a dance party, users frequently
    experience dehydration, overheating or elevated blood pressure. Used in
    psychotherapy and under professional supervision, those conditions are much
    less likely to occur.

    "Millions of people around the world are using it recreationally; it gets
    more popular every year," Holland said. "But people who could really
    benefit from it, can't. It's a real tragedy and a real shame."

    Even though "Mike" (not his real name) has been apprised in advance of
    steps that will be taken to protect his anonymity, he's understandably
    guarded in talking about MDMA and his psychotherapy practice. A clinical
    social worker practicing in the Cache County area, he brings hand to chin
    when asked about his initial reasons for using MDMA with select patients.

    "There was no big `eureka' moment or anything," he said. "To me, the
    decision to add it to my psychotherapy practice was just common sense =85
    consider a therapist with a strong Jungian orientation. Well, using Jungian
    therapeutic techniques doesn't work with every client and so, unless you're
    neurotically rigid, you use some cognitive behavioral therapy or some other
    modality that is going to make a difference. It was kind of like that. I
    never struggled with it as an ethical question. The greater moral wrong
    seemed to be in denying relief to a human being seeking it."

    He estimates that in the years he's maintained a practice in Utah, he has
    treated about 30 people using different psychedelics. He prefers MDMA for
    much the same reasons as other therapists do, but has used psilocybin,
    ayahuasca, and the research chemicals 2ct2 and 2ct7--all with good results.

    Mike believes that MDMA's area of greatest promise is in couples or marital
    counseling. "MDMA, with or without couples-counseling, has salvaged a
    handful of marital relationships I had considered doomed," he said.

    As evidence, he furnished a written account by one of his MDMA patients,
    who initially presented relationship problems: "During my session I could
    see clearly for the first time in my life =85 many of the patterns or
    cycles of conflict I had been having with [my wife] I realized were
    responsible for our separation, and that my continued happiness in my
    relationship with her depended on me stopping those behaviors completely. I
    saw that she was a caring and loving person, and let old anger and grudges
    fall away. I made a commitment to myself to give up those behavioral
    patterns =85 I would never again focus on our differences or pretend to
    ignore them. I learned that they are necessary, and that I would celebrate
    them =85 at that moment, and now, even five months later I found it was no
    longer necessary for her to change in order for me to be happy in the

    Mike, for one, is hopeful that the attitudes of the authorities will change
    regarding his type of work as a psychotherapist. He's well aware of MAPS'
    work in this regard.

    Concern by Mike and Dr. Jane for their anonymity is not difficult to
    understand. Being present, much less having a participatory role in the use
    of MDMA, clearly violates a handful of laws and licensing rules. The Utah
    State Department of Occupational and Professional Licensing (DOPL) has not
    been ambiguous about therapists practicing in this manner. Providing
    MDMA-assisted psychotherapy is one of only a handful of major infractions
    that would result in the revocation of a license, as opposed to other
    lesser sanctions.

    However, it's fair to say that MDMA, like every other medication, is not
    completely safe, as well as not completely understood in its mechanism of
    action. Chalk that up, again, to its status as an illegal, Schedule I drug.
    As a result, there is not an abundance of research directed at answering
    questions about the drug's mechanism of action and, unfortunately, most of
    the few studies completed to date have focused only on its tendency to
    release the brain chemical serotonin. It's hoped that MDMA's unhindered
    study will be a significant turning point in assembling a comprehensive
    picture of its very unique pharmacological functions. Experts know that
    questions about MDMA having a neurotoxic effect, or a depleting effect on
    the brain's supply of serotonin, need further study.

    But in consideration of the universal side effects described by the
    millions of people who've used the drug, MDMA's major risks to any
    individual appear to be the very real possibility of being arrested and jailed.

    Still, even proponents such as Doblin know the importance of research,
    whether that be to prove the drug's effectiveness, or demonstrate its
    risks. "That's one of the lessons we learned from the '60s," Doblin said.
    "You can't downplay the risks or emphasize the benefits."

    Mike and Dr. Jane in no way perceive themselves as divergent warriors on
    the frontlines in the effort to legitimize MDMA. However, as the resurgence
    of therapeutic research on MDMA begins, it's therapists such as they who
    may one day be in a position to teach other mental health professionals the
    techniques of harnessing the potential of this new but, really, somewhat
    old, treatment tool. If, and when, MAPS provides the FDA with sufficient
    evidence of MDMA's usefulness and it's approved as a prescription
    medication, adults suffering from emotional problems will have the option
    to walk into a local clinic and receive the drug in a setting conducive to

    For his part, Doblin roots for any Wasatch Front psychotherapist brave
    enough to blaze such a trail while the drug remains illegal. "I feel a lot
    of sympathy and pride that there are two people in Utah who care enough
    about their patients that they're willing to risk their freedom and
    licenses," he said. "That creates a lot of inspiration and responsibility

    in me to work even harder to see this through."

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