MDMA Therapy for PTSD Could Be Legal by 2023. A DIY Culture is Already Thriving.

Miles has taken MDMA three times in his life. The first time was in 2000, recreationally. The second time was two months ago, non-recreationally. The third time was within the past fortnight, when he sat down on his couch at home – quiet, relaxed, prepared – and ingested the stimulant. A short while later, he ingested a second dose. And then, for the three hours that ensued, he turned his mind’s eye in on itself: plumbing the depths of his psyche for hidden memories and long-buried traumas.

It was, he says, the “first real MDMA experience [I had] that qualifies as therapeutic.”

Speaking to VICE World News over email, Miles – who requested anonymity for fear of repercussions in his private life – broadly describes himself as violent, dangerous, unpredictable, angry, and “incredibly lonely most of all.” His primary life goal is to not go to prison, his second is to not die, and his third is to not become homeless. 

Miles says he was sexually and emotionally abused by both his parents from childhood until his teenage years. He was addicted to drugs between the ages of 14 and 18, then again between the ages of 30 and 35. He says he was abducted and raped by a friend when he was in his early 30s and has spent the majority of the last few years being suicidal and homicidal. At one point, he put a gun to his head and pulled the trigger, “but the gun malfunctioned.” He estimates that he’s tried to kill himself on more than 100 different occasions – most of them “disguised as drinking and drugging extremes.”

Miles, now 51 and living in the U.S. state of Indiana, suffers from complex post-traumatic stress disorder (CPTSD). “Without psychedelics,” he says, “I’d be dead.”

“No pharmaceutical or therapeutic approach compares. I know quite a bit about living in the kind of pain where just existing causes more pain, and this is changing all that. Fuck, now I’m crying. It would be impossible to overstate the positive power of what’s going on here.”

Experts emphasise that self-medicating with street-grade ecstasy is not recommended. The reasons for this are manifold, but can broadly be boiled down to a lack of understanding and oversight around what it is you’re taking, how much, and when you might be approaching a dangerous – even fatal – dose. In the wrong setting, things can quickly get out of hand. 

The therapeutic benefits of so-called “recreational drugs” in the right setting however, are, by now, well-documented. 

Over the past decade, researchers have been exploring the potential clinical uses of substances like psilocybin, LSD and ketamine to treat conditions like addiction, depression and anxiety. Many of these studies have yielded compelling results – but perhaps none more so than the ongoing body of research into the efficacy of MDMA as a treatment for chronic, treatment-resistant PTSD.

The first pilot study into the matter in 2011 found that 10 out of 12 participants who ingested MDMA (83 percent) no longer met the criteria for PTSD following the treatment protocol. Six subsequent Phase 2 trials, conducted between 2014 and 2017, indicated that “MDMA-assisted psychotherapy was efficacious and well tolerated in a large sample of adults with PTSD.”  In August 2017, the United States Food and Drug Administration (FDA) officially designated the drug a “breakthrough therapy” for the treatment of PTSD. And earlier this month, the results of the first Phase 3 trial on psychedelic-assisted therapy were made public.

Those results, published in Nature Medicine, showed that more than two thirds of participants who ingested MDMA during talk therapy sessions no longer qualified for a diagnosis of PTSD two months down the track. For comparison, less than a third of participants who ingested an inactive MDMA placebo achieved similar results. The MDMA also significantly mitigated depressive symptoms in participants who suffered from more “intractable” forms of the condition, such as childhood trauma and dissociative subtype PTSD, which are often considered treatment resistant.

“Millions of people suffer from PTSD, stress, anxiety, and depression and we are in desperate need of better therapeutics,” Jennifer M. Mitchell, the lead author on the study, told VICE World News over email. 

She added, “The hope is that these data could potentially lead to the legalization of a psychedelic medicine for the treatment of PTSD, and that this could pave the way for research on the efficacy of other psychedelic compounds for any number of indications.”

It bears repeating that MDMA alone has not been scientifically proven to be an effective treatment for any condition, psychiatric or otherwise. As Professor Mitchell is quick to point out, it is MDMA-assisted therapy – the chemical effects of the drug in combination with professional guidance – that has shown promise against conditions like PTSD: by allowing an individual to unlock their own vault and engage with their repressed traumas in a controlled, clinical setting.

“Data suggest that MDMA acts to reopen a critical period, and that this may enable new learning about past traumas and therefore can provide one with the opportunity to process and release them,” Professor Mitchell explains. She is speaking as an empirical observer, offering the preclinical analysis of what it is that’s going on here. But her explanation also echoes first-hand accounts from people who have themselves taken MDMA for therapeutic purposes. 

Alex, 23, is a survivor of childhood sexual abuse who suffered CPTSD since at least the age of 5. Speaking to VICE World News via private message, they explain that they spent several years trying and failing to open up in the context of traditional therapy, and were desperate to try any alternative method that might help alleviate the symptoms of their disorder. It was their therapist, they say, who suggested ecstasy. 

“I took powdered MDMA in her office,” says Alex, who also requested anonymity for reasons of privacy. “And what happened was that all of my defence mechanisms – deflecting, shutting down if feelings came up, disassociating – all of that went away about an hour after ingesting it.”

As Alex came up on the drug, settling into the high, their therapist asked if there was a part of them that wanted to speak. Without warning, Alex felt their 14-year-old self emerge.

“All of the feelings from that time came up: very heavy feelings of being scared, alone, traumatized,” they recall. “I started rocking myself back and forth and shaking my head in disbelief.”

Their therapist asked if there was another part that wanted to come out, and 17-year-old Alex, they say, emerged. Then, in turn, their 5-year-old self. To their own incredulity, Alex started clapping their hands “like a toddler.” They say their therapist noted that this part of their psyche clearly wanted to express itself.

“I remember at 5 I was hugging random relatives and climbing into their laps to get some affection, due to my parents not giving me validation and affection,” Alex explains. “My dad was also violent – spanked me, screamed at me and told me to shut up – [so] I was already traumatized at age 5.” 

While processing this in their therapist’s office, still rolling on a higher-than-recreational dose of MDMA, Alex says they felt “horrible.” It was a feeling that stayed with them for a full week afterwards. But the outcome, they say, was “amazing”: they felt connected to themself for the first time in years, as though they had finally regained an elusive sense of peace.

“If I had to describe what the experience is like,” they say, “it would be this: you endure trauma, your brain and body stores it away from your consciousness, and you feel depressed on a daily basis and don't know why. Then, when you go to MDMA therapy, your defence mechanisms go away and your brain takes memories and feelings from a stored box in your brain and lets it wash over you. You process it, relive it and feel it. You might self soothe, you might cry, you might talk about what happened. And then when you're done processing it, your brain lets go of that memory and the feelings associated with it.” 

Afterwards, Alex says, “You feel so much better, because the trauma isn't weighing you down anymore… It was like I went 10 steps forward with MDMA therapy compared to traditional talk therapy.”

A second Phase 3 trial into the efficacy of MDMA-assisted therapy is currently underway, and if it proves successful then the Food and Drug Administration (FDA) could approve the substance for therapeutic use by 2023. That might seem expeditious. But for many patients who have spent decades languishing under the weight of debilitating conditions like PTSD, it’s long overdue. For some, in fact, it hasn’t come soon enough. 

Last year, the 2020 Global Drug Survey revealed that a growing number of people are using psychedelics – a term that, as MAPS founder Rick Doblin notes, can be used broadly to encapsulate MDMA – to self-treat mental health. Of the 110,000 worldwide respondents, 6,500 (just under six percent) reported using recreational drugs as a do-it-yourself treatment for psychiatric illnesses and emotional distress. These included cases of people who took the substances alone – like Miles – as well as those who took them under the supervision of someone else in an unregulated setting – like Dany, another survivor of childhood sexual abuse and a sufferer of CPTSD.

“My life is completely different post MDMA therapy,” Dany – who also requested anonymity for legal reasons – tells VICE World News via private message. “It’s the best thing I ever did for myself… call it serendipity or fate, but I found this just when I needed it the most. Most people, due to the legality issues, do not have access to this therapy. But I was lucky to find a legitimate guide.”

By “legitimate,” Dany means “an underground guide experienced in psychedelic therapy”: one of the growing number of healers, shamans and trip sitters who have started offering their services in lieu of more conventional, and legal, alternatives. This too is a growing trend. The Global Drug Survey found that while people engaging in psychedelic-assisted therapy most commonly did so under the supervision of friends and partners, the practice also took place in such unregulated settings as psychedelic retreats and so-called “traditional healing groups.”

This, says Professor Mitchell, is cause for concern.

“If the therapy is attempted without the assistance of well-trained practitioners, I’d be concerned that there would be negative side-effects that could derail both the individual participant’s progress and that of the field at large,” she said. “My concerns are that one: it can be hard to vet a practitioner who provides therapy in an underground setting; and two: many practitioners, healers, guides, shamans, etc. have recently been springing from the woodwork, and not all are reputable.”

“This provides us with some insight into what might happen if MDMA is not legalized soon,” she added.

Researchers from the Global Drug Survey made similar observations, noting that “positive outcomes and healing can only occur with the holistic preparation and integration of psychedelic experiences in a supportive environment with access to additional resources if needed.”

“The longer the delay in rolling out these treatments through clinical services,” they noted, “the greater the risk that vulnerable people will be tempted to access these drugs in situations that carry potential greater risk of harm.”

For some people though, that is the lesser of two evils. Miles for one describes his PTSD as an “extreme case” that makes it impossible for him to undergo MDMA-assisted therapy in typical clinical conditions: with eye shades on and earphones in, lying on a couch with a stranger in the room (if he hasn’t known someone for at least a decade, he says, then they are still not qualified to be with him when he’s vulnerable).

Instead, he’s solicited the help of a close friend – “another horrific incest and abuse survivor” – to supervise his next MDMA journey. This person will act as the “listener” while Miles unpacks his memories and verbalises his feelings. In the not uncommon event that he becomes agitated, she will also be there to calm him down.

It’s an informal and unscientific approach, but for Miles it’s the only option. Which also means, treacherously, that he is forced to continue putting himself in dangerous, potentially life-threatening situations in order to treat his crippling mental health disorder – wagering his life just to survive it.

“I absolutely worry about my health and safety,” he says. “But I’m dying, in that if I don’t get relief from my trauma I will kill myself. I have to have MDMA to live, and it needs to be now. If I wait until 2023 for this to become available to me in a regulated and licensed clinical setting, I’ll be dead. I can’t wait that long.”

Because of his extreme circumstances, Miles will keep taking illegally-bought MDMA at home, pseudo-therapeutically, until such time as he is allowed to do so in the presence of a licensed professional, in a context that’s comfortable for him. It prompts the question: what if Phase 3 fails? What if the mission of researchers like Professor Mitchell and organisations like MAPS falls short, tripping at the final hurdle, and MDMA doesn’t end up being legalised for therapeutic use?

“If it’s not legalized, then I don’t know,” he says. “I am definitely not stopping, as it’s keeping me alive.”

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