Pubdate: Mon, 27 Dec 2004
Source: Washington Post (DC)
Copyright: 2004 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: Rick Weiss, Washington Post
Bookmark: http://www.mapinc.org/mdma.htm (Ecstasy)

'Ecstasy' Use Studied to Ease Fear in Terminally Ill

For some, the diagnosis comes out of the blue. For others, it arrives
after a long battle. Either way, the news that death is just a few
months away poses a daunting challenge for both doctor and patient.

Drugs can ease pain and reduce anxiety, but what about the more
profound issues that come with impending death? The wish to resolve
lingering conflicts with family members. The longing to know, before
it's too late, what it means to love, or what it meant to live. There
is no medicine to address such dis-ease.

Or is there?

This month, in a little-noted administrative decision, the Food and
Drug Administration gave the green light to a Harvard proposal to test
the benefits of the illegal street drug known as "ecstasy" in patients
diagnosed with severe anxiety related to advanced cancer.

The drug, also known as 3,4-methylenedioxymethamphetamine, or MDMA,
has been referred to by psychiatrists as an "empathogen," a drug
especially good at putting people in touch with their emotions. Some
believe it could help patients come to terms with the biggest
emotional challenge of all: the end of life.

The FDA's approval puts the study on track to become the first test of
a psychedelic substance since 1963 at Harvard, where drug guru Timothy
Leary lost his teaching privileges after using students in experiments
with LSD and other hallucinogens.

It also marks a milestone for a small but increasingly effective
movement favoring a more open-minded attitude toward the therapeutic
potential of psychedelic drugs, virtually all of which have been
criminalized and disparaged for decades as medically useless.

Already, MDMA is being tested for its ability to reduce symptoms of
post-traumatic stress disorder. And two U.S. studies are looking at
the usefulness of psilocybin -- the active ingredient in "magic
mushrooms" -- in terminally ill cancer patients and in people with
obsessive-compulsive disorder.

In the coming year, advocates also hope to submit to the FDA an
application to test psilocybin and LSD as treatments for a
debilitating syndrome known as cluster headaches.

That would be a fitting birthday present for Albert Hofmann, the
chemist who discovered both compounds while working for the Swiss drug
company Sandoz and who turns 99 in January, said Rick Doblin,
president of the Multidisciplinary Association for Psychedelic
Studies. The Sarasota-based nonprofit has organized and funded much of
the new research.

Hofmann, who has expressed support for clinical studies such as the
one being planned at Harvard, has referred to LSD as his "problem
child" -- a reference to his belief that despite its widespread abuse,
the mind-altering drug has the potential to help some people.

Although they vary in their chemical structures and specific effects,
many psychedelic drugs work on the parts of the brain that regulate
serotonin -- the same brain chemical that is the target of many
FDA-approved antidepressants. That does not indicate that the drugs
are necessarily safe; indeed, they all carry some medical and
psychiatric risk.

Yet even scientists who have been vocal about those risks have
expressed at least guarded support for the idea that, in the company
of a therapist and with proper medical monitoring, moderate doses
might benefit some people. "When taken under adverse circumstances by
ill-prepared individuals, there are substantial psychological risks,"
said Charles Grob, a psychiatrist at Harbor-UCLA Medical Center in Los
Angeles. "But when taken in the context of carefully structured and
approved research protocols and facilitated by individuals with
expertise, adverse effects can be contained to a minimum."

Grob is leading an FDA-approved study in which terminally ill cancer
patients are being given psilocybin to see whether it can help them
sort through emotional and spiritual issues. He said the patients take
a "modest" dose of synthetic psilocybin, equivalent to two or three
illicit mushrooms. They spend the next six hours or so in a
comfortable setting with a psychiatrist -- talking, thinking and
sometimes listening to music with headphones.

"So far they have had very impressive results in terms of amelioration
of anxiety, improvement of mood, improved rapport with close family
and friends and, interestingly, significant and lasting reductions in
pain," Grob said of the first few patients to enroll. "These are
extraordinary compounds that seem to have an uncanny ability to
reliably induce spiritual or religious experiences when taken in the
right conditions."

Promising results have also been reported at the University of Arizona
from a 10-person study of psilocybin for obsessive-compulsive
disorder, which locks people into repetitive thoughts and actions. And
Charleston, S.C., psychiatrist Michael Mithoefer has seen no
complications in any of the five patients who have enrolled in his
20-person study of MDMA for victims of violence struggling with
post-traumatic stress disorder.

With the FDA's Dec. 17 approval of the Harvard MDMA protocol -- and
permission in hand from ethics review boards at Harvard and the nearby
Lahey Clinic, where patients will be recruited -- the only remaining
hurdle is getting a special license from the Drug Enforcement
Administration. A dozen subjects with less than 12 months to live will
get either low or moderate doses of MDMA during two sessions a few
weeks apart, along with counseling and a variety of psychological
tests before and after treatment.

The approach has its doubters.

"Even in antiquity, some groups thought it was especially important to
take whatever their local psychedelic was -- including alcohol -- when
confronting mortality, whether it's to see into the hereafter, improve
spiritual growth or just numb yourself to the reality," said Joanne
Lynn, president of the Washington-based Americans for Better Care of
the Dying and director of RAND Health, a science and policy research
center. But drugs can be disorienting, she said.

"It's sometimes poetic, sometimes majestic, but often mundane work to
wrap up one's life," Lynn said. "I think it's unlikely there's a pill
that will make that go away."

John Halpern, associate director of substance abuse research in the
biological psychiatry lab at Harvard's McLean Hospital, who will lead
the MDMA study there, agreed that it is not for everyone. But creating
a sense of connection with something greater than oneself "may be
helpful" for many facing death, he said.

Halpern emphasized the differences between his study and the
freewheeling experiments conducted by Leary in the 1960s.

"This is not about hippy dippy Halpern trying to turn on the world.
I'm not looking at this as a magic bullet," he said. "But for a lot of
people, the anxiety about death is so tremendous that there is no way
to get their arms around the problems that were ongoing in their
family. This could be a substantial contribution to the range of
palliative care strategies we're trying to develop for people facing
their death."

Laura Huxley, widow of the author and metaphysical pioneer Aldous
Huxley, said her husband asked for -- and she provided -- a dose of
LSD as he lay dying in 1963. "He wanted to be aware," the 93-year-old
supporter of the new research said last week. "It's a very important
moment."

Leary took a wide array of psychedelics in the weeks leading up to his
death from cancer in 1996. Some suspect the drugs clouded rather than
sharpened his perceptions, but he died with a positive attitude.

"It's kind of interesting really," he said of dying, talking to a
friend in his final days. "You should try it sometime."
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MAP posted-by: Derek