Unexplainable - Ecstasy therapy

Episode Date: August 7, 2024

The FDA is about to announce whether it’s going to approve MDMA as a treatment for PTSD. Our friends at Today, Explained explore what this kind of therapy looks like, and why it’s so controversial. For show transcripts, go to vox.com/unxtranscripts For more, go to vox.com/unexplainable And please email us! [e-mail] We read every email. Support Unexplainable by becoming a Vox Member today: vox.com/members Learn more about your ad choices. Visit podcastchoices.com/adchoices

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The FDA is about to announce whether they're going to approve MDMA as a medical treatment. You might be more familiar with MDMA as Ecstasy or Molly. It's usually used as a party drug, but it's also shown some promising results when it comes to treating PTSD. Our friends at Today Explained are working on a three-part series all about this, called ecstasy therapy. So I wanted to sit down with reporter Halima Shah to talk about it. Hello, Halima. Hello, Noam.

Can you introduce yourself for the unexplainable audience? Yes, I am Halima Shah. I'm a senior producer, reporter on Today Explained, where you and I actually work together for a little while. It's been a while. It's been like almost four years. It has. Welcome to our side of the equation over here. Yeah, it's exciting to be here. Yeah, so what got you interested in ecstasy therapy in the first place?

Well, I wanted to know how a drug basically undergoes a 180-degree change, where it's something that's maligned, as something that will make holes in your brain, to something that in 2024, in 2024, is viewed as healing and therapeutic. And so I wanted to understand how such a brand transformation happens for a drug. And the answer really lies in the advocacy of what I would say are a group of true believers, as well as the text. testimonies of some people who really did find relief by trying MDMA in a therapeutic setting. And this has gotten to the point where the FDA is actually interested in this. So what exactly is going on there? So the FDA is scheduled to announce whether or not it'll approve an application for using MDMA in conjunction with psychotherapy to treat PTSD. Now, there was at the beginning of the year, a lot of excitement because a lot of people who were watching this thought that this was

almost a sure shot. But since then, we've seen a growing chorus of voices raising red flags about potential bias in the data, bias in the trials, and even cases of trial misconduct. But if the FDA does approve this, then it would make MDMA one of the first psychedelics to actually make it into mainstream medicine. So we're going to share episode two of your series this week. It gets into the science behind this kind of therapy. It gets into what it actually feels like to participate in studies like this. But since we're coming into the middle of the series here,

what do you think our listeners need to know before we start? Well, I think listeners should know that this idea that MDMA can be useful in psychotherapy, especially for people who are struggling with PTSD, is actually a very old idea. It was something that the people who pioneered this drug in the 70s and 80s in Northern California really saw as the drug's most promising use, or one of its most promising uses. And now we're living in a moment where PTSD hasn't seen any novel therapies in a long time. And there's growing frustration among veterans and other people who suffer from PTSD that,

The treatments that are out there right now just aren't working for everyone. And so that sort of lays the groundwork for MDMA to be considered as something therapeutic and promising. Okay, here's today explained and host Sean Ramos for him. Okay, Halima, let's get to it. You spoke to some veterans who want the government to legalize MDMA assisted therapy. I did. And one of those veterans is Jonathan Lubecki. He's a retired Army sergeant who was deployed to.

to Iraq in 2005. There's a lot of people that were on my base that never stepped foot outside the base. That have severe PTSD simply because of all the raining bombs. Hmm. And Jonathan notices his mental health deteriorating while he's still deployed. There's a thing called Patriot Clinic where you could go talk to anybody at any time. What they told me is actually true for a lot of people. Like, you're in a combat zone.

You're going to freak out a little bit. And they're like, when you get home, things should get better. But when he gets home in 2006, things don't get better. And a heads up to our listeners. We're going to discuss suicide in this episode. My wife of eight years was gone, moved in with someone else. My dog was gone. My house was empty.

I took a taxi back to my house. And within two months of getting back, actually, in the early hours of Christmas, 2006, after going to a church, after going to Womack Army Medical Center, was the first time I tried to take my life. Oh, no. Yeah, so Jonathan said that was the first of five suicide attempts. There was so much day-to-day agony of just living with PTSD. It's very bizarre when your brain betrays you.

There were certain things that would be very triggering for me, whether I wanted them to be or not. One of them was if I saw people dressed in traditional Muslim garb in the United States, especially if they had a backpack. Because people dressed like that in Iraq were a threat. I cognitively knew, like, this is a perfectly fine person. This is wrong. But it didn't mean it didn't trigger me.

He even said, like, fireworks would send him into a closet with body armor and his service dog. crowds were off limits. It was even hard for him to be at family events. Hmm. What does he do other than, you know, taking shelter in a closet? Yeah, he tried a lot of things through the VA. He tries cognitive behavioral therapy. He tries exposure therapy. He gets the maximum dosage of Zoloft, which is a first-line SSRI for this. And for some people, this treatment regimen really helps. For Jonathan, it helps. It helps. some, but not enough. I don't fault the VA.

I mean, I've had some bad doctors at the VA, but I've had some fantastic ones. The problem is, VA doctors can only do what they're allowed. Jonathan said he was the type of patient his doctors feared getting a call about. They were not sure if he'd make it.

And he tells me that one day when he was hospitalized after his fifth suicide attempt, an intern slides him a piece of paper and tells him to put it in his pocket. And so I walked out and I opened it and I said Google MDMA PTSD. So I did. It was 2014. Millennials were taking Molly at music festivals, but the psychedelic Renaissance was not what it is today. Jonathan learns about a clinical trial for MDMA-assisted

therapy for PTSD. This trial is organized by a group called the Multidisciplinary Association for Psychedelic Studies. MAPS was founded in the 19th. by a guy named Rick Doblin, and he has a very utopian way of speaking about psychedelics. This is from his TED Talk. Psychedelics gave me this feeling of our shared humanity, of our unity with all life. And I felt that these experiences had the potential to help be an antidote to tribalism, to fundamentalism, to genocide, and environmental destruction. Dobblin is a political scientist by training, and his political strategy to make psychedelics like MDMA acceptable is to prove to the FDA that it's medicinal and a specific population needs it. To bring psychedelics back from the underground, it was necessary to, first off, have a patient population that general public is sympathetic with and for which big pharma's drugs are not really working for every.

His team said he was not available for an interview. But on Marianne Williamson's podcast, he told her why veterans are the target population, even though there are other groups who face PTSD, like women. Women who have been sexually abused or raped or domestic violence, and they're sympathetic as well, not quite as much as you could say the veterans. But that's how I chose MDMA for PTSD. So Jonathan enrols in a clinical trial and becomes part of a co-openinger. cohort of veterans who received this novel PTSD therapy amid really alarming rates of veteran suicide.

And at a time when Doblin and MAPs are trying to make their case to the FDA. Okay, so what is this clinical trial experience like? It starts with screenings and an intake process with trial therapists. There's always a male and a female one, which is an old protocol that was put in place. actually after a psychiatrist was sued for sexual assault in an MDMA session back in the 80s. So there's always two trial therapists today. And Jonathan reported to his first session at the trial site with them. It was a tiny house on Scott Street in Mount Pleasant, South Carolina, that was converted over into an office space.

Maps has a certain way of doing psychedelic-assisted therapy trials. You do one session with the pill, and then you do three sessions. sessions called integration where you unpack that experience with your therapists. And then again, one session with the pill, then three sessions of integration. And a third time, one session with the pill, three sessions of integration. So at his first session with the pill, Jonathan gets his vitals checked, and he's hooked up to a bunch of monitors. And that's because MDMA does come with some risk. It can cause rapid heart rate, blood pressure increases, teeth grinding, chills, sweating, things like that. And once all of those monitors are set up, the pills come out.

I was so hoping this would be like the Matrix, blue pill, red pill. I got to pick one. But no, it's a little green pill. It takes like 40 minutes to kick it. I'm just in there with my eyes closed, and I start seeing like wavy graph paper. And I'm like, well, I guess this is kicking in now. And then there's a bit of, what this is awesome. I totally get where people do this now.

Ah. I have described it as doing therapy while being humble. hugged by everyone who loves you in a bathtub full of puppies, like, in your face. And throughout the experience, Jonathan says he feels this sense of safety with his therapist that he has not felt before. Being in the military, you don't go talk to the shrink. You don't trust the shrink. So I had tons of trust issues with mental health professionals.

That didn't exist. Scientists think that feeling of safety comes from decreased activity in the amygdala. the part of the brain that controls the fight or flight response. And what Jonathan describes the rest of the experience as is getting to work, processing the trauma, things that made it hard to move through day-to-day life. And after this one-time trial, Jonathan told me he has never again attempted suicide. He still goes to therapy and life still tests him. But he tells me he feels so healthy he's gone back to a war zone. That's part of a blown-up Russian tank from the front lines.

That's an artillery shell fired by the Russians. And this is a piece of an asset. So what he's showing me are things that he got on the front lines of Ukraine. After he completes the trial, he begins volunteering in Ukraine in a combat zone to basically show that his mental health is not fragile, that he's not afraid of relapsing. And so I decided to go down to the front lines and get shot at just to prove it. That's bananas.

But how do we know if it was the MDMA or all the therapy he had once the MDMA like opened him up to, you know, sharing all of his ish with these doctors? So according to MAP's literature, you do need both. And one without the other is not enough. In a later stage study after the one Jonathan was in, there was a placebo group and they didn't show the same results. which brings me to the other veteran I talked to. My full name is Ari Polavi. And people call me Ari. Ari was a Marine Corps pilot.

And one night, towards the end of his deployment, he was trying to land a plane during the Battle of Mosul while avoiding rocket fire. And then literally weeks later, he finds himself at home in a completely different world. So I came home that February 2017. I came home to a newborn son. He was four months old,

so I was flying all those missions with my wife at home, and then all of a sudden, I'm coming home from this, and I'm injected into a four-month-old son that I didn't know how to be a dad. So Ari is focused on bonding with his son, his new role as a parent.

You've seen the movie The Hang. Hangover? You haven't. Okay. Well, Zach Galfanakus, he wears a baby and a baby carrier. Okay. And I watched that movie a number of years prior. So when I thought about being a dad, that was like my, I can't wait to carry my kid in one of those baby carriers. I thought they were funny looking. I thought they were cool. I got all my life lessons from the Hangover Trilogy. Well, one day, Ari is, you know, channeling his inner is Zach Galaficus. And he's on a walk with the baby in the carrier. And he starts experiencing

this incredible discomfort in his chest. Oh, no. It felt like fire ants kind of biting at my chest. It was really, really uncomfortable. He finds out he has nerve damage. But his wife is also

noticing something else. She describes some of the moments of like, you know, sitting and playing with my son and not having any emotion on my face whatsoever, not laughing at the funny moments. Ari starts to do research on PTSD

and pretty much self-diagnosis himself. And like Jonathan, he first seeks out VA help. It doesn't work for him. And then he tries talk therapy on his own. He tries yoga, another experimental therapy that uses a magnetic field to stimulate brain function. That doesn't work for him either. It's 2020 and MAPS is doing late-stage clinical trials.

Ari gets in. And he reports to the basics to the baby. of an apartment in Brookline, Massachusetts. It's a similar deal to what Jonathan had. A cozy space, a pair of therapists, and a pill. We were talking. Some of the emotions started coming out. I started crying, and I started having this kind of out-of-body experience,

feeling sensations and becoming aware of sensations that I arguably had never felt before. Didn't Jonathan describe this experience as like puppies and rainbows or something? Like, what is going on with Ari? Yeah, he's having an incredibly different experience. And people do cry and get emotional and have cathartic experiences on MDMA. But the reason Ari is experiencing what he is is because he's not getting MDMA. Oh. He's getting placebo.

Okay. But the placebo effect doesn't last. At the second session, there was nothing. Like, there was no crying. There was no out-of-body experience. There was nothing. And he's just like, something is off. So I actually kind of accused them.

I said, hey, I got the medicine at the first session. And you guys messed something up. I didn't get it at the second session. He knows that he's not getting the MDMA. I mean, he's just, like, kind of sitting there. And that's a very big deal. Because about 75% of placebo participants in that study were able to correctly guess what they got. And that's an issue because when a participant knows whether or not they got the drug,

you can't be sure if it was their expectations or the pill that kind of dictated the experience. What did it mean for Ari, though? I mean, he had this emotional experience. Even on the placebo, does that mean that this treatment helped or this lack of a treatment, this experiment? You know, even though he doesn't get the actual MDMA as part of the study, he gets a lot of time with two therapists who he really respects. And that, combined with some other changes in his life, bring him some relief. It also motivates him to figure out some way to try psychedelics for himself.

So he goes on a really intense retreat in Mexico where he experiments with some other drugs. And then when he comes home, he also gets another chance to participate on the MDMA side of the MAPS trial. I went through psychedelic-assisted therapy. And while the psychedelic itself is a hot topic, my opinion is that it's the full process, the therapist, the preparation, the integration, and what you do afterwards that has the power to heal. So Ari comes out of this experience of believer, just like the other veteran we heard from Jonathan Lubecki. But for Jonathan, MDMA-assisted therapy sets him on a completely different journey. If you Google the word veterans and psychedelics, like his name will inevitably come up. He sort of becomes MDMA's Republican whisperer.

Oh. Because Republicans aren't going to buy it from the hippies. Who are Republicans going to buy it from? They're going to buy it from a veteran. Oh, buy it like by the testimony, not like by the truck. No, no. I'm really glad we cleared that up. Today explained.

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With its 626 horsepower twin turbo V8 engine, the Defender Octa is taking on the Dakar rally. The ultimate off-road challenge. Learn more at landrover.com. Perkinson, Mila Perkinson, Perkinson, Marley Perkinson, Repet, yeah, got a repriset, Chase a chick, never chasing. Today, explain is back with Halema Shah. Halima, when we left off, Jonathan, the veteran, is like in the middle of advocating for MDMA as a treatment for PTSD.

How is that going for Jonathan? That sounds like a tough path. It is, but, I mean, he's really made a career out of, of doing this. He's very dedicated to this because he even moved to Washington, D.C. so that he can do this work. I actually met him at his apartment in what's kind of known as the Republican corner of D.C. You know what we're talking about. So I can, you know, end of a rough day, come up here, relax and smoke a cigarette. Until they built that building, you could see the Pentagon, Crystal City, which is where all like the, the,

defense contractors are, and the Capitol, so you could actually see the entire military industrial complex from the roof. Dreamy of you. I mean, he says his work now is really about changing hearts and minds, he tells me. And his goal is really to cleanse psychedelics of their old reputation and association with hippies. And frankly, that's part of the problem and why we don't have access. The government is reactionary. they reacted because of the actions of the counterculture.

And to be blunt, like when you drop acid and say, let's go blow up some ROTC buildings after this orgy, the government's going to do something about it. Did that happen? Did anyone ever blow up a building after an orgy? Like, I just have no way of fact-checking that. Yeah. But the point he's trying to make is that MDMA is in that lineage

of countercultural psychedelics like LLGEL. LSD, which boomed and busted with the hippie counterculture. And he thinks that if that association sticks, it'll never become an FDA-approved medical intervention. Health insurance will never cover it. Medicaid will never cover it. Medicare will never cover it. The VA will never cover it. Jonathan wants increased access to MDMA, but he's not down with the policies we saw in the past decade that increased access to marijuana.

ICD criminalization is horrible. Why is that? Because I know that's MAP's position. I know. And that's a lot of people's position in this community. That does put you at odds with a lot of MDMA advocates. Yeah, because this was never about medicine. Decrim, by its very nature, has nothing to do with medical or mental health or any of that.

Decriminalization is a criminal justice reform movement. And personally, I can get someone out of jail tomorrow. I can't bring someone back to life after they kill them. themselves. So when we're talking about psychedelics, we are talking about a group of compounds that are associated with the anti-war movement, very critical of the military industrial complex. And now it's come back into its second life. And the main defense for it is veterans need it. Which is interesting because when you actually work in this community, the anti-military is very prevalent throughout the whole community. I'll be honest, I didn't understand. I didn't

understand what microaggressions and tokenism was until I was a veteran working in this counterculture. Same way. The snide comments being told, just say what we want, things like this. I don't care about the parties. I don't care about festivals. I don't care about burning men. I care about saving people's lives.

Hmm. Is he talking about this group we've been talking about, Maps, the multidisciplinary association for a site? psychedelic studies? Are those the people he thinks what? They like don't actually care about how he feels or what he thinks? So Jonathan did not say MAPS specifically as trying to Trojan horse psychedelics to approval. But it has been criticized by some veterans for kind of using veteran testimonies to sort of push forward this broader agenda of drug legalization of recreational psychedelic use. And from my research, I can tell you this, none of which is a secret. MAPS is rooted in counterculture. It's been a fixture of burning man for years. Doblin speaks proudly of opposing the Vietnam War, his mission for mass mental health and spiritualized humanity. And for a lot of people, there's nothing wrong with that goal. I mean, drug decriminalization is a racial and criminal justice imperative for many. Indigenous groups have used psychedelics for, ritual and ceremonial purposes for centuries. But Jonathan says those things are not his goals.

There are objectives that are sort of wading in the wings, hoping to ride the coattails of a PTSD intervention that's very reliant on the testimonies of veterans. So is this working? I mean, has Jonathan accomplished what he set out to do here? Has he helped sort of push this movement forward? Well, if you look at attitudes, towards psychedelics, it does seem like they are increasingly positive.

More than half of Americans who have mental illness say they want more access to them. And psychiatrists increasingly favor legalizing these drugs for medical use, which suggests that the medicinal narrative has support among patients and clinicians. Okay, so there's public support for psychedelics as medicine, as treatment. There are PTSD patients who need it, want it. who will travel to Mexico for alternatives, and there are some very convincing veterans, like the one we heard from, making the case to Congress.

Aside from the hippies and, like, the new-agey vibes, is there a lot standing in the way of MDMA-assisted therapy? At the beginning of 2024, if you asked me that question, I would say no, but I am not so sure anymore. Because last June, there was an FDA independent advisory panel that met and recommended that the agency does not let this treatment go public. There were lots of different reasons that came up, and it ranged from the double-blinding problem we talked about,

to cardiovascular risks, to therapist misconduct, and allegations that there's actually bias in the data of these studies. And the FDA doesn't have to listen to its advisory committee, but it usually does. And on top of that, there are a handful of, of trial participants who say that they came out of the trial worse than when they started. I think that there are really, really big problems with the way these trials are conducted, and so I asked the FDA to conduct an investigation.

Okay, back to Unexplanable here. So, Halima, that was episode two of ecstasy therapy. Episode three is coming out on the Today Explain Feed this week. What can listeners expect from that episode? Listeners can expect to hear an account that you don't really hear very often in the coverage of psychedelic-assisted therapy, particularly MDMA-assisted therapy, which is an account of somebody feeling like they were worse off after going through this trial. And so the episode really explores the perils of this therapy. And some of the cases from participants who say that their negative experience is not really reflected in the data. Halima Shaw is a senior reporter-producer for Today Explained.

Her reporting for this series was supported by a grant from the Ferris-U-C. Berkeley Psychedelic Journalism Fellowship. This episode was edited by Lissa Soap and Matthew Collette, fact-checked by Laura Bullard, mixed by Rob Byers and Andrea Kristen's daughter, and hosted by Sean Ramosferam. If you want to hear the whole three-part ecstasy therapy series, go check that out in the Today Explained feed. The third and final episode is out this week. And as always, Unexplainable is part of the show.

the Vox Media Podcast Network, and we'll be back next week.