This is Your Therapy on Ecstasy
How therapists use MDMA to treat patients with chronic PTSD
You might have seen the large corrugated cardboard yurt across the dusty haze of the playa at Burning Man. Inside you would have discovered Burners in various altered states attended to by a cadre of sober volunteers soothing, hydrating, and working with with the ‘trips’ of their respective charges.
The ‘Zendo,’ as it’s called, is a harm-reduction project offered by the Multidisciplinary Association for Psychedelic Studies (M.A.P.S.) at festivals across the country that provides care, education, and integration techniques for revellers experiencing challenging psychedelic experiences. It’s also one arm of the organisation’s larger, and more controversial, mission to research and utilize the therapeutic, spiritual, and creative potentials of psychedelic drugs.
Founded by Rick Doblin in 1986, M.A.P.S. brings scientific and scholarly protocols compliant with mainstream medicine to what are often considered ‘alternative’ or traditional medicinal therapies: think Ayahuasca for drug addiction, or Psilocybin for OCD.
In 2014 M.A.P.S. celebrated a watershed victory, winning the first ever government-funded grant for the study of whole-plant botanical cannabis for the treatment of PTSD in U.S. veterans.
They now find themselves in bureaucratic limbo waiting for the actual marijuana that, according to federal law, must be grown by the National Institute for Drug Abuse (NIDA), and cannot be sourced from local expert growers.
Shannon Clare-Petitt is a marriage and family therapist who serves as co-therapist for a M.A.P.S. clinical study on the use of MDMA for end of life anxiety. Here Clare-Petitt lets us in on how MDMA assisted psychotherapy works, and why NIDA won’t give up the bud.
How do you choose participants for MDMA assisted therapy?
The participants undergo many physical and psychological tests before they are able to take part, and there are exclusion factors such as hypertension or borderline personality. It’s a long screening process with extensive questionnaires and measurements. In the case of the MDMA-assisted therapy for trauma, we only choose people with chronic, treatment-resistant PTSD. We are usually working with veterans, firefighters, and police officers. They’ve already tried the prescribed drugs, Zoloft and Paxil, and have had years of traditional talk therapy and cognitive behavioral therapy, but are still struggling.
Walk me through the process.
For our clinical studies there is always a co-therapist team, a male and female, present for each session and we begin with three 90-minute non-drug sessions with the co-therapist team.The first MDMA session goes from 10 am to 6 pm, and is conducted in a very comfortable space with the patient lying down on a couch. Sometimes the therapists will play soothing music and have the patient wear an eye mask — which is meant to orient the process towards being internal and reflective.
In many ways it looks like a typical talk therapy session, but 8 hours long. Some therapists will incorporate other approaches, like holotropic breathwork, Hakomi, EMDR therapy, Internal Family Systems therapy, there’s often massage during and after the session.
Why do you have a male and female therapist team?
When you’re working with survivors of sexual abuse, it can be useful for the patient to identify one therapist as a perpetrator (usually male) and one as the ally (usually female). They don’t literally see the male therapist as the perpetrator, but that projection helps people work on trauma with the gender they might identify as threatening. Also, therapy is often addressing issues around relationships with parents, and for most people this tends to look like a mother and a father — male and female.
I tend to frame this in more spiritual or energetic terms: A therapeutic team brings a balance of energy, the yin and yang; one might tend to focus on actions, the future, the relationship with parents, etc. and the other might think more about spiritual aspects, the body, the past.
What happens after a session with MDMA?
The participant stays in the same therapy room. There’s a bed, and a night attendant comes in to prepare food and be a resource.
The next morning the therapists return for a 2-hour follow-up. The therapists check in with the subject daily through a phone call or Skype for a week following the session.
Then three to five weeks from the date of the first MDMA assisted session, the entire process is repeated, and we go through the cycle a total of three times.
How do you evaluate the efficacy of the treatment?
We started this in 2010, so we’re in a position now where we can conduct long-term follow up studies at the 18 month and 2 year mark. Our main method of evaluation is the C.A.P.S. score, the Clinician Administered PTSD Scale. We interview the participant at baseline before the sessions and then at some point following. After 2 years we found that the C.A.P.S. score for 80% of participants was so low that they no longer qualified for PTSD studies.
What makes MDMA helpful in the therapeutic process?
There’s a whole neurobiological part of it that has to do with a part of the brain called the amygdala. With severe cases of PTSD the amygdala is so overworked that in initial MRIs before the therapy, we can see that other parts of the brain have begun to atrophy. The amygdala is essentially taking over. The MDMA helps to take the amygdala ‘offline,’ it relaxes the fear and survival response and you’re able to access other parts of the brain.
People with PTSD when triggered often re-experience the original trauma, but they’re not able to move through it because the amygdala will stop the action. It’s trying to protect you, like, “if you go back there you could die.”
And it’s not just about the original event; There is a tremendous amount of fear that has built up, layers and layers over years and even decades, that has developed on top of it. MDMA helps get to the root. That combined with the sense of connection and trust with the therapist — it’s amazing to see what happens in the sessions — the release and the unblocking of the fear. People begin to forgive themselves and other people.
How do the therapists in the program insure the integrity of the actual MDMA? Who provides it?
MDMA was first created and synthesized by Merck in 1912. They had a patent, but it expired and MDMA essentially became public domain. Because there’s no patent a lot of big pharmaceutical companies aren’t interested in MDMA because there’s no money to be made. Also, the therapy is finite: three sessions and you’re done.
Therapists began using MDMA in the ‘70’s and ‘80’s and found it especially effective for couples therapy. But the rave scene also got a hold of it and the DEA cracked down. They thought it was just a drug popular amongst kids dancing with glow sticks. They didn’t look at its therapeutic benefits, labeled it a ‘drug of abuse,’ and made it illegal.
So the MDMA we use is from a 500 gallon drum made in the 80’s by Sasha Shulgin when it was still legal. It was made pure in a lab.
Let’s talk cannabis. You just received a $2 million grant to study marijuana as a treatment for veterans with PTSD.
Up until December [of 2014] we were completely privately funded by individual donors and family foundations, etc. This grant from the Colorado Department of Public Health and Environment (CDPHE) is the first government grant to study whole-plant smoked marijuana. We’ve been trying to do it for ten years, and there have been so may hold-ups: finding an IRB review board, securing a place willing to host the study, and now having NIDA give us the marijuana.
The Doctor who was put in charge of the study, Sue Sisley, was actually fired last summer from the University of Arizona. We hired her as our Principal Investigator for the study a year a half ago. As we gained momentum, Sue was starting to speak and let people know about it in her area. There was suddenly lots of publicity around cannabis and the U of A, and she was terminated. The University even asked us if we could get another Principal.
But the good thing was that many other universities came out of the woodwork and said, “We believe in science.” So now we have three locations for the study — one at UC Denver, one at Johns Hopkins, and Sue is finding one in Phoenix.
So why do you not have access to marijuana — especially in Colorado?
This is a government grant, so that means the only place we can get the marijuana is from NIDA. And NIDA has stalled a lot. When we were approved they said, “We’ll start growing it now. It will be ready in 10 months.” Which is now, basically.
For the purposes of the study we requested one high THC variety and one high CBD variety — and they didn’t get us the percentages we need. We’re also anticipating that it will take a lot money to have them roll it into cigarettes!
The marijuana has to come from NIDA because that’s how the federal government controls marijuana. We’ve been doing a lot of activism with legislators to end the NIDA monopoly, because this makes it nearly impossible to do the research on cannabis.
In fact Rick Doblin was hoping that NIDA wouldn’t get it together — because that would open things up to other growers to supply for federal research. We even considered requesting marijuana from other legal countries like Canada or Israel.
There are so many expert growers who could be legal federal providers. But NIDA doesn’t want anyone to be legally able to grow. So we’re still waiting.
