A Really Good Day(51)

Word has spread amidst the network of soldiers returned from war about the efficacy of MDMA therapy. Of the more than one thousand veterans who have reached out to Mithoefer for help, his pilot study was permitted to enroll only twenty. The poignancy and tragedy of these figures cannot be overstated. The need is overwhelming, and people are desperate for help. Veterans have a suicide rate 50 percent higher than that of the general population. Rates for female vets are even worse. There is reason to believe that MDMA-assisted psychotherapy could save thousands of lives.

MAPS, which funds the Mithoefers’ work, is also funding research investigating the use of MDMA to treat social anxiety in people with autism. For years, many people with autism have been using illegally obtained MDMA for this purpose, without the benefit of guidance from therapists, and have reported improvements in their social anxiety, perception, and ability to communicate. The MAPS-funded study—currently in progress at the Los Angeles Biomedical Research Institute, a joint enterprise of UCLA and Stanford University—is comparing the results of MDMA-assisted psychotherapy sessions on twelve adults with autism, none of whom have ever taken the drug before, with an inactive-placebo control group of similar subjects. The researchers have begun to see effects resembling those reported by autistic people who had used MDMA out of the research context.

Annie and Michael Mithoefer recently received formal FDA approval for MDMA conjoint therapy with couples in which one member has PTSD. Their interest in couples therapy stems from their personal use of MDMA in a therapeutic context before the drug was placed on Schedule I. They found it so useful to enhancing communication and resolving conflicts in their marriage that Mithoefer told me he believes criminalization is a real loss for the practice of couples therapy. Having a partner respond with the kind of honest, loving empathy MDMA facilitates is profoundly restorative to a marriage.

I asked Mithoefer whether he imagined that his new study, if successful, might lead beyond the confines of PTSD treatment to the treatment of the mundane communication difficulties of typical couples such as my husband and me. To my surprise and delight, he was confident that one day we might be able to undergo legally prescribed MDMA-assisted couples counseling. He said that his hope is that, by 2021, MDMA will be removed from Schedule I, and that prescriptions will be allowed. He anticipates that the FDA might confine use to licensed clinical settings, in a manner similar to methadone treatment, but he pointed out that even if the FDA approves MDMA only for use for PTSD, off-label use is likely to be allowed.*6

Why, though? I asked. Won’t the FDA and DEA seek to limit a drug like MDMA as much as possible?

There, he told me, is where Big Pharma might prove useful. It is in the pharmaceutical industry’s financial interest to encourage widespread use of products, and so it has lobbied aggressively to prevent any limitations on off-label use for any drug. Mithoefer imagines that Big Pharma won’t even allow this narrow wedge in the door—the thinking being, if the FDA limits off-label use of MDMA, it will set a precedent for other drugs to be so limited. Others in the field, however, are less optimistic. They point out that the FDA occasionally does approve drugs with off-label limitations. They believe that MDMA, even if approved, is likely to be so limited.

But if Mithoefer is right, my husband and I need only wait five years to perform our marriage-recharging ritual legally!

Still, I don’t want to wait. I know from experience that taking MDMA would allow us to continue and accelerate the process of recovering and reconnecting that began after our last argument and has continued in therapy. However, it has been a long time since I’ve been able to obtain MDMA. My friend network has dried up, and by all accounts, what’s available on the black market now is so badly compromised and toxic that even if I were willing to buy drugs from a dealer, I’d be afraid to take them. Even more important: one of the things I tell my children, perhaps the critical part of my harm-reduction message, is that drug interactions can be dangerous. Don’t mix drugs, I insist. Don’t mix alcohol and marijuana, don’t mix antidepressants and mushrooms. Definitely don’t mix LSD with MDMA. Even if the LSD is just microdoses. Even if you really miss MDMA. I feel like I am my own parent and my own child; I am straining our relationship, but still I must insist.

I’ve been honest with my children about MDMA. I’ve told them it’s been helpful to their father and me, that it’s a very special drug, though their peers use it foolishly. I’ve warned my children that the vast majority of what is called MDMA or Molly on the market is either methamphetamine or something more toxic. If they do MDMA, they must test it first. If they cannot establish through testing that a drug is pure, they must not risk taking it.

I’ve also counseled my children about the dangers MDMA poses to body temperature regulation and water toxicity, and explained that this is why they must not use the drug at a rave or a party, but only in a small group in a cool room. Or, better yet, one to one, with someone they love. And then I’ve gone beyond harm reduction to life enhancement, and explained to my children that MDMA is one of those rare experiences that are at their very best the first time you do them. About what else in life can we say that? Not sex, that’s for sure! I believe that with whom you do MDMA for the first time might even be more important than with whom you have sex for the first time. Ideally, you’d have sex for the first time with someone you love, after serious contemplation and discussion, but, whatever happens, chances are it’s not going to be great. And even if by some miracle it’s wonderful, even if you happen to be one of the infinitesimal number of women who orgasm in their first sexual encounter, sex only gets better the more practice you have. The opposite is true about MDMA. The first time you use MDMA is the most profound, and tolerance inevitably develops.