Pubdate: Mon, 20 Jul 2015
Source: Maclean's Magazine (Canada)
Copyright: 2015 Maclean Hunter Publishing Ltd.
Contact:  http://www.macleans.ca/
Details: http://www.mapinc.org/media/253
Author: Zoe Cormier

COULD ECSTASY BE A POTENTIAL TREATMENT FOR PTSD?

The first clinical trial in Canada is under way to test whether the
party drug could be part of a treatment for those with PTSD

For the first time in four decades, an illegal psychedelic drug is
being clinically tested in Canada. A team of psychiatrists and
psychologists in Vancouver are giving 3,4-methylenedioxy-methamphetamine
(MDMA)-better known as the party drug ecstasy-to 12 people suffering
from chronic post-traumatic stress disorder (PTSD). The drug will be
administered in therapeutic sessions to help them deal with memories
they have found difficult or impossible to confront, as part of a
group of clinical trials, including in the U.S. and Israel.

The aim is to see if the club drug will help people with debilitating
symptoms-including re-experiencing trauma through flashbacks or
nightmares, as well as sky-high stress levels-who have not responded
to conventional remedies. More typical treatments for PTSD include
daily medications, cognitive behavioural therapy, traditional
"talking" treatments and exposure therapies. Despite the range of
options, at least a quarter of people coping with PTSD do not respond
to any of them.

MDMA has already been studied for treatment-resistant PTSD in
Switzerland, Israel and the U.S., and, although the studies are very
small, the preliminary results sometimes seem too good to be true. A
2011 paper-the first randomized, controlled study-reported that 83 per
cent of patients given MDMA-assisted psychotherapy experienced a
significant reduction in their symptoms, compared to just 25 per cent
given standard psychotherapy. It's crucial that the MDMA dosing occurs
in conjunction with focused psychotherapy. The current trials consist
of a number of sober sessions to establish a trusting relationship
with the therapist, followed by three therapy sessions when the
patient is also given a set dose of MDMA.

It took six years and $200,000 to get approval from Health Canada,
which even required building a bomb-proof room with multiple locks,
motion sensors and a locked cabinet bolted to the floor to store a
tablespoon of medical-grade MDMA. "Yes, it's been difficult-but, at
the end of the day, they said yes, and I do want to applaud them for
saying yes," says Mark Haden, adjunct professor at the University of
British Columbia's school of population and public health, and
chairman of the Canadian branch of the Multidisciplinary Association
for Psychedelic Studies (MAPS), which is running the study. Haden has
devoted much of his recent professional life to advocating for
research into the benefits of illegal drugs, such as cannabis for pain
and psilocybin (magic mushrooms) for end-of-life anxiety in terminally
ill patients. Now the study will help to determine if MDMA could be a
treatment for trauma.

The widespread public perception is that MDMA is dangerous and can
cause brain damage, or worse. That weekend party warriors have
collapsed on the dance floor after popping ecstasy is without
question. However, it's not clear that MDMA is always to blame. A
spate of deaths in recent years in Britain were initially attributed
to MDMA, but were later found to be due to another drug, PMA, a
cheaper synthetic amphetamine known as "Dr. Death" that had been
passed off by dealers as the real thing. "PMA is five to 10 times more
dangerous than MDMA," says Dr. David Nutt, a psychiatrist and
neuropharmacologist at Imperial College in London.

But one crucial question remains unanswered: What is the effect of
quality-controlled MDMA on the body?

Nutt inflamed British media in 2009 when he publicly stated that
taking MDMA is less dangerous than horse riding-showing statistically
how the sport is far more likely to cause injury than taking MDMA-and
the furor led to his dismissal as the chair of the government's
Advisory Council on the Misuse of Drugs. Six years later, he says
evidence continues to demonstrate that the risks of MDMA have been
greatly exaggerated-and the benefits under-reported. "I'm not
interested in helping people get high; my goal is to get MDMA approved
as a treatment for PTSD in the U.K., because there is nothing that
works the way this drug can. And it certainly isn't as dangerous as
legal drugs, such as alcohol and tobacco."

Mark Haden is not unfamiliar with the dangers of drugs: He has worked
for three decades as a drug counsellor with addicts in Vancouver. Nor
is he unfamiliar with the hazards of MDMA: His brother died in 2008
while cooking a batch of the drug for sale on the black market.

Haden first became interested in the potential for illegal
narcotics-and psychedelics, in particular-as possible treatments six
years ago when a patient of his, addicted to heroin for a decade, felt
transformed by an experience in Mexico with the hallucinogenic
substance called ibogaine, which helped him kick heroin. Haden had
never seen such a speedy recovery from addiction.

When Haden found it difficult to have a conversation with professional
colleagues about the potential benefits of illegal or banned drugs to
help addicts, he left his job as a counsellor to work as head of MAPS
Canada. "Frankly, I'd like to apologize for the past lies of drugs
educators-including myself," says Haden. "We exaggerated the harms of
drugs, we never discussed the potential benefits, and we failed to
deal with the dominant model for dealing with addiction, which is
prohibition, which just doesn't work," he adds.

Furthermore, given the enormous overlap between PTSD and addiction-how
many people become addicted to drugs in response to trauma in their
lives and how few treatments are available for both
afflictions-MDMA (long medically championed by MAPS in the U.S.,
which instigated the Vancouver study before Haden's involvement) was
an obvious drug to investigate.

PTSD (once largely associated with war veterans) is a complex
manifestation of trauma stored in the body. Victims of war, rape,
childhood sexual abuse and other devastating experiences can find
themselves continuing to shake, sweat and crumble with anxiety and
flashbacks, decades after the initial trauma. Perhaps more than any
other condition, PTSD demonstrates the intimate relationship between
mind and body: Psychological scars can have physical
repercussions.

Virgil Huston is an American vet who served in Iraq in 2004 and 2005,
and was a contractor in Afghanistan in 2011. During his time overseas,
Huston saw people killed, flew in planes that were shot at, and his
Iraqi base was attacked daily. Back in the U.S., he suffered from
depression, nightmares and haunting visions. "I tried every single
antidepressant there is; none of them worked," he says. "They just
numbed me, and they were so much more addictive than I ever imagined.
The withdrawal was horrible. And I wasn't even given simple talking
therapy. Psychiatry in America has become nothing but about altering
chemical balances in the brain with daily medications."

Although using a drug that is, in many respects, far more potent than
any he had been prescribed (including Klonopin and Wellbutrin) to
alter chemical balances in the brain might seem like the last thing he
would want, Huston signed up for an MDMA PTSD trial after seeing
discussions on Facebook. "I was stunned that MAPS was operating in
Charleston, S.C. I thought it would be in California or Colorado-not
here, where even marijuana will never be legal," he laughs.

"I was definitely high, but totally in control-which is a good thing,"
he says now, adding that he went through more therapy sessions without
MDMA than with it. "This isn't just about the drug; it's about the
psychological process, and building trust with a wonderful therapist,"
he says. "I still think about the wars, but they don't keep me awake
at night all the time-which is, frankly, incredible."

Haden thinks the key to MDMA's potential to heal traumatic stress may
lie in its molecular makeup. "It is a marriage between methamphetamine
and mescaline," he explains. "The stimulant gives people confidence,
and the psychedelic allows people to reflect on themselves and their
experiences in a different way. The combination helps them confront
painful memories."

Haden, Nutt and other proponents of MDMA-assisted therapy know they
face an uphill battle in convincing colleagues of the efficacy of the
drug. Most therapists and doctors who work with patients suffering
from PTSD will have reservations about MDMA until large trials are
successfully concluded.

Psychiatrist David Wright of the Homewood Health Centre in Guelph,
Ont.-one of the few facilities providing live-in care for PTSD
patients in Canada-is cautious to endorse the use of any inebriant. As
of now, Homewood does not approve of marijuana-even for those with a
licence. "A third of the patients here are trying to recover from
addiction; it's not fair to expose them to their triggers," he says.
"But if this is truly capable of enhancing people's capacity to learn,
then I would approve of it. I will be driven by the science."

What Wright finds far more useful than talk of silver-bullet
cures-which have been trotted out before, from propranolol to
lobotomy-is routine, security, and focused psychotherapy. "People who
come here usually just need to be stabilized, more than anything else.
It's not useful to think about cures only in terms of how few sessions
are needed," says Wright.

He does agree with some of what MDMA's proponents suggest, however.
"Basic antidepressants just don't have a robust response," he says.
And he agrees that the biggest hurdle is "building trust."

Which is why Norwegian psychologist Pal-Orjan Johansen thinks MDMA
could be so effective. In a 2009 scientific article, he argued that
MDMA might work through several mechanisms-mainly by increasing levels
of oxytocin, colloquially known as the "cuddle chemical" also released
during breastfeeding. This would have the net effect of preventing the
amygdala (thought of as the brain's emotional processing centre, key
for regulating fear) from overpowering the prefrontal cortex
(considered the centre of higher thought). He thinks the overall
effect is a fostering of the capacity for trust, while at the same
time quelling hyperactive fear.

Johansen has experienced the effects of MDMA. A decade ago, he was so
persuaded by what he read about MDMA therapy that he decided to treat
his own depression and excessive drinking following the sudden deaths
of his brother and several relatives. MDMA-assisted psychotherapeutic
trials were not available where he lived, he says, so Johansen
acquired the drug himself and asked a close friend trained in
psychology to help him. "MDMA made it easier for me to be open, and
talk about difficult and shameful experiences in my life," he says.

"The reason pharmaceutical companies are not interested in exploring
the benefits of these drugs has more to do with money-because the
patents have expired-than anything else," Johansen adds. Which is one
reason he and his wife and academic partner, Teri Krebs, founded
EmmaSofia, which aims to produce affordable, medical-grade MDMA and
other psychedelics. Having partnered with a Norwegian pharmaceutical
firm, they hope to "democratize" legitimate access to these drugs.
Their unorthodox approach has garnered attention and criticism.

One big hurdle researchers face when it comes to MDMA research is
cost: A gram of medical-grade MDMA can cost thousands of dollars.
Haden says MAPS Canada is spending $170 per gram, which is the
equivalent of $75 for an average dose. (Three doses are given during
the trial.) MAPS is working through traditional regulatory channels
and, if the trials prove the drug effective, it hopes to get MDMA
approved as a treatment for PTSD by the U.S. Food and Drug
Administration and by Health Canada by 2021.

For now, Homewood's Wright says although PTSD can be difficult to
treat, recovery with existing methods is possible: He has seen
countless people recover with compassionate, focused psychotherapy-so
much so, that the terminology used to describe his patients has
shifted from "PTSD victims" to "PTSD survivors."

"It's not all negative; sometimes people can respond to trauma by
deciding to then change the world for the better," Wright says. "PTSD
shows how the body can be fragile-but also how can it can recover."
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MAP posted-by: Matt