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Embracing Ecstasy

On a chilly spring morning in 2017, Boris Heifets took the podium to talk about MDMA in an Oakland, California, hotel ballroom packed with scientists, therapists, patients, and activists. If he noticed the occasional whiffs of incense and patchouli oil coming from the halls of the Psychedelic Science meeting, he didn’t let on. After all, anyone studying the therapeutic benefits of the drug that sparked an underground dance revolution 30 years ago knows that ravers, Burners, and old hippies flock to this meeting. It’s the world’s largest gathering on psychoactive substances.Ecstasy enthusiasts and university professors alike heard several research teams report that MDMA helped patients recover from post-traumatic stress disorder (PTSD) and other disabling psychiatric conditions after conventional treatments had failed. Meeting rooms buzzed with excited chatter about the prospect of MDMA getting approved as a prescription therapy for PTSD. That could come as early as 2021 if it proves safe and effective in large clinical studies that are just getting underway. For many advocates of this work, regulatory approval can’t arrive too soon.But Heifets, a Stanford neuroanesthesiologist, had come to lay out an even grander role for the drug federal officials banned in 1985 in a futile effort to quash the burgeoning rave scene. Psychiatric treatments lag decades behind the rest of medicine, even though serious mental disorders carry just as much risk of disability and death as cardiovascular disease, Heifets explained. Psychiatrists desperately need more targeted therapies to give their patients the same kind of rapid, enduring relief that stents and bypass surgery provide for heart patients. He thought they’d benefit from thinking like surgeons. “I don’t want to suggest that we can cure psychiatric disease in 30 minutes in the operating room,” Heifets said. But we can harness powerful drugs like MDMA that act like a surgeon’s knife to alter consciousness and exorcise psychological demons. MDMA’s therapeutic power may come from strengthening the bond between therapist and patientFor many at the meeting and in the reemerging field of what some call psychedelic medicine, there’s no reason to look further than MDMA. A few hours after Heifets spoke, two therapists who used MDMA in sessions with 28 PTSD patients in Colorado reported that 19 participants no longer met the criteria for their diagnoses a year after treatment. MDMA helps melt the walls people hide behind to protect themselves, said Marcela Ot’alora, the principal investigator of the study. That allows patients to explore the coping strategies that have failed them for so long. Other teams reported encouraging results from small studies using MDMA to alleviate severe anxiety in adults with autism and in people confronting life-threatening illnesses. MDMA’s therapeutic power may come from strengthening the bond between therapist and patient by enhancing feelings of trust, emotional openness, and empathy, Heifets told the audience, pointing to the commentary he and his mentor, Robert Malenka, published in the journal Cell . To his surprise, a few therapists approached him after the talk to say they quote the paper to tell their patients that the world needs more empathy.There’s no question that MDMA is showing therapeutic promise and could potentially help a range of socially debilitating disorders, Heifets allows. But MDMA, an amphetamine derivative, can raise heart rate and blood pressure, which can prove dangerous for people with cardiac and vascular problems. Though ecstasy is almost never pure MDMA, recreational use can cause panic attacks. In rare cases, it can trigger psychosis in susceptible individuals, which is an unnerving experience ravers have shared on Reddit. Such risks, combined with its bad rap as a party drug, may limit its ability to help patients, Heifets cautions. He’s convinced that MDMA has an even greater potential to revolutionize psychiatric care by giving scientists clues about how to develop next-generation drugs. Ideally, those drugs would be more clearly targeted and have fewer risks than MDMA. Potentially, they could even treat more disorders.What they’re saying doesn’t matter, but the deep emotional connection they’re experiencing doesIf psychiatrists are ever going to catch up with the rest of medicine, they need a better understanding of how the brain works so they can guide it back to health when it breaks down. MDMA is the only psychoactive drug that enhances positive social interactions and empathy. Heifets believes this offers researchers a unique opportunity to probe the brain.The same properties that make ecstasy-fueled ravers hug between dance grooves also make the drug uniquely suited to help scientists figure out how the brain supports social behaviors. Because its powerful effects don’t last long, researchers can model those behaviors in animals and link them to cellular networks in the brain. Go to a rave, and you’ll find people glassy-eyed, staring inches from each other’s faces in rapt conversation, Heifets says. What they’re saying doesn’t matter. The deep emotional connection they’re experiencing, however, does. “That’s what we’re after. How can we bottle that?”If scientists can capture that magic, he believes, they can sidestep the inherent difficulties of working with a demonized substance steeped in the trappings of a subculture that still inhabits the fringes of society. After the Colorado investigators described how they used MDMA in therapy, a woman in the audience complimented them on the power of their aura, which she said was violet blue and “pretty incredible.” After a brief pause, Ot’alora smiled and thanked the woman, who said she works in the Akashic Records, described by adherents as a sort of cosmic transcript of everything that has ever happened in the history of the world.Talk of auras and Akashic Records comes with the territory at a meeting with “psychedelic” in the name, and most researchers take it in stride. They’re waiting to see if mainstream medicine will embrace MDMA, assuming the promising results from early PTSD studies hold up under the scrutiny of the larger clinical trials. But Heifets doesn’t want to take any chances that shifting political winds will once again shut down work with the still-popular club drug — along with any hope of ushering in a new era of psychiatry.Heifets works in Malenka’s lab in one of the nation’s largest regenerative medicine facilities. The center was built a decade ago to foster groundbreaking therapies for some of medicine’s most intractable diseases. A massive Chihuly chandelier hangs just inside the center’s front entrance where the sculptor’s trademark glass tendrils evoke the networks of neurons that hold the secrets to health and disease. It’s just a short walk from the lab to the hospital where Heifets spends one day a week tending to brain surgery patients.Heifets didn’t set out to study a controlled substance. “My mom told me I should never study psychedelics,” he says with an impish grin. “It’s a good way to kill a promising career.”Still, MDMA piqued his interest even as an undergrad. So when he wandered into Malenka’s lab one day and heard him speaking with a colleague about a controlled substance application to do research with MDMA, he went “full in.”Heifets was just seven years old in the summer of 1984 when the Drug Enforcement Administration proposed new rules to ban MDMA under Schedule I of the Controlled Substances Act, citing “illicit trafficking,” high abuse potential and “no legitimate medical use.” By then, ecstasy had become so popular, Heifets says, that you could buy it with a credit card over the counter at clubs in Texas. The allure of MDMA’s feel-good effects has captured the imagination of adventurers ever since a trailblazing cadre of psychotherapists started using it in the late 1970s. MDMA was discovered in 1912 by German chemists looking for drugs to stop bleeding. It was rediscovered in 1976 by chemist Alexander Shulgin. The legendary psychedelic chemist famously cataloged the effects of nearly 200 psychedelic compounds he’d made in his home lab. He reported feeling “pure euphoria” on MDMA, which he called his “low-calorie Martini” with the “special magic,” and shared the compound with psychotherapists he thought might find it of use.“It makes you love everybody. Now, who doesn’t want to take ecstasy?”Those therapists had seen more than a thousand MDMA-assisted breakthroughs with patients, with no major side effects, by the time the government moved to criminalize the drug. Many of them petitioned federal officials to keep it available for their patients. Philip Wolfson, a San Francisco-area psychiatrist who’d used MDMA in hundreds of therapy sessions, testified that the drug had helped patients in severe emotional distress with a poor prognosis. “I am extremely concerned that this promising new psychotherapeutic agent will be lost to the medical profession,” he said.The government’s campaign to ban a drug with potential medical benefits caught the attention of the era’s king of daytime talk TV, Phil Donahue. In 1985, he devoted an entire show to MDMA. “It makes you love everybody,” Donahue said. “Now, who doesn’t want to take ecstasy?” Several people on the show explained how MDMA had helped them come to terms with life-threatening illnesses and heal fractured family relationships in therapy. Chicago addiction expert Charles Schuster, however, said he had “great concern” about MDMA because he and his colleagues had found that MDA, a chemical cousin, produced long-term brain damage in rats. “If MDA does this,” Schuster warned, “then I have reason to suspect that MDMA may as well.”That was all DEA deputy assistant administrator Gene Haislip, who also condemned MDMA on Donahue’s show, needed to hear. A month after appearing on Donahue , Haislip announced an emergency ban on MDMA. The DEA’s ban effectively shut down research on MDMA’s medical benefits, but it did nothing to stop the explosion of underground ecstasy-fueled parties where DJs prided themselves on spinning the most eclectic electronica. Filmmakers mined raves’ trance-inducing beats and light shows as the backdrop for thrillers, crime capers, documentaries, and love stories. Irvine Welsh of Trainspotting fame explored his fascination with “rolling” on ecstasy in a collection of “chemical romance” stories, one of which was eventually adapted for the big screen.Meanwhile, Schuster was tapped to head the National Institute of Drug Abuse (NIDA), which showered scientists investigating MDMA’s toxicity with millions of federal dollars. It didn’t take long for the NIDA’s investment to pay off. In 2002, researchers led by George Ricaurte — a co-author on Schuster’s MDA study — reported in the prestigious journal Science that recreational doses of ecstasy could cause permanent brain damage in monkeys and possibly lead to Parkinson’s disease. Psychiatrists familiar with the drug questioned the plausibility of the $1.3 million study, which was funded partly by grants on methamphetamine toxicity. Politicians, meanwhile, cited the research to push the Illicit Drug Anti-Proliferation Act — originally introduced in 2002 by Sen. Joe Biden (D-DE) as the Reducing Americans’ Vulnerability to Ecstasy (RAVE) Act — to imprison and fine club owners and promoters for allowing MDMA on their property.Five months after Congress passed its anti-rave legislation, Ricaurte reported that he’d mistakenly given his animals meth, not MDMA, and retracted the paper. The fiasco, described as an “almost laughable laboratory blunder,” got its own chapter in the book When Science Goes Wrong: Twelve Tales from the Dark Side of Discovery. But the damage had been done. Federal officials continued to bankroll their preoccupation with proving that MDMA causes brain damage while ignoring known risks along with its healing potential. It took researchers almost 20 years after the ban to get federal permission to test MDMA as an experimental therapy. But federal agencies don’t fund clinical studies on the drug, forcing researchers to rely on nonprofit sources such as the Multidisciplinary Association for Psychedelic Studies (MAPS). MAPS director Rick Doblin, who founded the organization in 1986, has been instrumental both in getting the Food and Drug Administration’s permission to test MDMA in people and in shepherding it through the drug approval process. Although MDMA could gain FDA approval for PTSD within two years, Doblin is working to make it available as soon as August under the agency’s expanded access program. The program gives patients with severe or life-threatening illnesses access to experimental drugs when no other suitable options exist. They’ll have to pay for the drug themselves and recognize that there could be risks since the drug hasn’t been approved yet, Doblin explains.MDMA could get the green light from the FDA as a prescription drug for PTSD within two yearsTo qualify for the trial, patients will need to have PTSD and tried multiple therapies that didn’t work. MAPS is training therapists to work with MDMA, and it’s setting up expanded access sites around the country, Doblin says.While Doblin’s trying to make up for time lost to restrictive drug laws, Heifets worries about moving too fast. “MDMA might work for a lot of people, but there’s going to be a large subset for whom it may create problems,” he says. The clinical trials exclude people with conditions that MDMA might exacerbate, and they give the drug under closely supervised conditions. Using pure MDMA in this way has revealed minimal risks. That’s not what concerns Heifets. Rather, he’s concerned about what might happen if MDMA is given in unrestricted, unsupervised settings. Say therapists use the drug without following the carefully crafted MAPS protocol. Who will help people manage the tidal wave of emotions that come up without feeling overwhelmed? Plus, some psychiatric drugs don’t mix with MDMA, so patients will have to be weaned off their meds, Heifets says. “Who’s watching that process? We’re in new territory here.”Ideally, everyone who provides MDMA-assisted therapy will have received MAPS training. But expanding use from a few hundred to the millions of people with PTSD raises the potential for a susceptible person to have a bad reaction that triggers another government backlash, Heifets says. “How are we going to avoid that outcome this time?”That’s why he wants to focus on nailing down the brain networks associated with MDMA’s heightened feelings of emotional closeness and empathy. Learning how MDMA works could point to other treatments, maybe ones with fewer risks.Heifets knew he wanted to study the brain from an early age. But at medical school, he grew increasingly frustrated with his profession’s failure to help people. During a rotation at the Bronx Psychiatric Center, where most patients had failed to respond to every treatment offered, it hit him just how little doctors knew about the roots of psychological distress. “I was so dissatisfied with our ability to do anything,” he says.A stint in the operating room gave him hope that he could find a way to help people. Psychiatrists are stuck with “wimpy,” often ineffective drugs that take weeks or m ...Read more

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