After MDMA was placed on Schedule I in 1985, illicit use of Ecstasy skyrocketed and the drug's reputation grew ever more demonic. On a 2000 MTV special, nuclear radiologist Dominick Conca, MD, presented a cautionary brain scan showing what looked like actual holes in the gray matter of a heavy Ecstasy user, Lynn Smith; the following year, Smith and her scan appeared on an episode of The Oprah Winfrey Show. But although the high-contrast image seemed to be proof positive of MDMA's powers to turn young minds into Swiss cheese, it in fact merely depicted variations in cerebral blood flow.
Even peer-reviewed scientific journals were vulnerable to Ecstasy panic. In 2002 Science published a sensational paper by Johns Hopkins neurologist George Ricaurte claiming that injecting recreational doses of MDMA into monkeys and baboons causes dopamine toxicity—that it poisons and destroys the neurons that synthesize dopamine, which can result in early-onset Parkinson's. Two of the animals in the study died instantly. A year later, the paper was retracted in its entirety when researchers discovered that vials of MDMA had been accidentally switched out for methamphetamine. (An editorial in Nature called the mix-up "one of the more bizarre episodes in the history of drug research.")
Urban legends notwithstanding, MDMA undoubtedly has its risks. In addition to increasing heart rate and blood pressure, the drug causes the heart to pump less efficiently (increasing its demand for oxygen), which puts stress on the cardiac wall. MDMA can also clash with other medications (including the antidepressants known as MAO inhibitors) to cause "serotonin syndrome": The brain literally overdoses on its own reserves of serotonin, resulting in sweating, tremors, and hallucinations. In severe cases, the syndrome leads to hyperthermia (a dangerous increase in body temperature), which can cause seizures, renal failure, even coma and death. But serotonin syndrome is a risk with many medications that we think of as safe, such as the antidepressants known as SSRIs.
Some scientists speculate that MDMA could be just a rough draft of an effective PTSD drug. "Therapeutic MDMA didn't come about through rational drug design—it fell into their laps," says William Fantegrossi, PhD, assistant professor in the department of pharmacology and toxicology at the University of Arkansas for Medical Sciences. Fantegrossi wonders if, through trial and error in the laboratory, a research chemist could uncouple the signature flourishes of the MDMA "high"—the mental euphoria, the sensory rapture—from its healing powers, crafting a prescription drug with far less potential for abuse. "If we could take MDMA as a starting molecule and tweak it to get rid of the intoxicating effects, the accelerated heart rate, the hyperthermia—who would have a problem with that?"
But even if MDMA could be given a low-intensity makeover, many psychologists would point out that people with PTSD already have an extremely effective option for healing trauma—one that's clinically safe, drug-free, widely available, and perfectly legal: prolonged exposure (PE) therapy. In PE, patients rake over the details of their trauma in eight to 15 weekly sessions; between appointments, homework assignments include listening to recordings of sessions and visiting triggering environments (a walk down the street where you were mugged, perhaps). A completed course of PE therapy is reported to work in up to 95 percent of cases—a stunning success rate. But the number of dropouts hovers around 20 percent, and no one knows how many potential patients count themselves out of the difficult, rigorous protocol before giving it a chance.
The pioneer of PE therapy is Edna Foa, PhD, professor of clinical psychology at the University of Pennsylvania and director of its renowned Center for the Treatment and Study of Anxiety. Foa says she was intrigued when Michael Mithoefer first described his MDMA study to her. Then she watched a video of a session. "I didn't know what was going on there. I was alarmed," she says. "Two therapists, a husband and wife, in very close physical proximity for hours to a patient who looks very drugged. The patient just talks about whatever he or she wants to talk about, and gets a lot of support. The therapy doesn't make sense to me.
"It's not that I'm so conservative," Foa continues. "But I am conservative with regard to the well-being of my patients. With MDMA, you're submitting your patient to a drug that you agree you have to be very careful about, and from what I can tell, you don't get better results than you would otherwise. I would like to see a much larger, much more well-controlled study that can be replicated with a high probability of success before I get everybody excited about it."
Psychotherapist Elna Yadin, PhD, also of the Center for the Treatment and Study of Anxiety at Penn, shares her colleague's reservations. Recovering from PTSD "requires a lot of hard work, but when you make that investment to break this disorder, you feel so good about yourself," Yadin says. "Research shows that, in psychological treatment, if you get healthy from a medication you've taken"—instead of a drug-free treatment such as PE—"it's not as satisfying.
"I joke with my patients: 'My magic wand is on back order from the magic-wand company, and it might never show up,'" Yadin says. "People are impressionable, and you have to be careful about what you give them. They want hope. They want magic. There is no magic."