'Real people are paying the price'
Additional studies using MDMA against PTSD either have been completed, are planned or are under way in Colorado, Canada, Spain, Switzerland, Israel, Australia and Great Britain. Meanwhile, Mithoefer is conducting a study treating military veterans and firefighters; so far 11 people have enrolled and more than 280 have called to see if they might take part.
While the military and Department of Veterans Affairs have expanded services in recent years, they struggle to keep pace with the inflow of new patients. The number of active-duty military personnel seeking treatment for PTSD rose from 10,408 in 2002 to 281,468 last year, according to Cynthia Smith, a Department of Defense spokeswoman.
One reason MDMA seems tempting is the sense that existing treatments are not enough. "It's not like we don't have effective treatments for PTSD," said Dr. Boadie Dunlop, director of the Mood and Anxiety Disorders Program at Emory University. "But there are many people for whom these therapies don't work."
Retired Brig. Gen. Loree Sutton, who headed the DOD's Centers of Excellence for Psychological Health and Traumatic Brain Injury from 2007 to 2010, said she left the Army in part because she felt existing treatments often do more harm than good.
"We invested in conventional approaches towards research, but I also knew we had to go beyond that," said Sutton. "Real people are paying the price for our failure to harness knowledge."
The National Center for PTSD, a branch of the VA, says approved treatments include a type of antidepressant known as SSRIs (selective serotonin reuptake inhibitors), along with EMDR, CBT and PE, developed by Foa. In some studies, more than three-quarters of those who complete PE therapy are "cured." But success can be hard to evaluate, in part because treatment is too emotionally painful for many patients to complete.
The DOD and VA also support a variety of research, much of it to try to fine-tune existing approaches. For example, Foa is leading a study offering more sessions in a shorter amount of time -- twice weekly -- to soldiers at Fort Hood, Texas. About 360 people are expected to enroll.
Neither the VA nor the military is part of clinical MDMA research, but Sutton said that before leaving the Army, she did call Rick Doblin to encourage his work. Doblin is the founder of MAPS, the Multidisciplinary Association for Psychedelic Studies, which wants to turn mind-altering drugs like Ecstasy into prescription medicine.
"With MDMA -- Ecstasy -- if rigorously designed studies show there's a benefit, better than existing therapies, then we should use it," Sutton said.
Doblin said he's working with the Defense Department to develop a protocol involving active-duty troops, and said he would gladly give up his status as the prime backer of MDMA research: "If there are other people who have a better idea, or want to try it with cognitive behavioral therapy, or whatever -- if there are other people trying to fund MDMA research, we think that would be great." With a laugh, he added, "We could even provide them with free MDMA. We have a lot more than we need."
Hope no longer has flashbacks or night terrors, and she no longer jumps when the phone rings. After finishing with Mithoefer, she decided to abandon her quiet life on Maui and moved to Los Angeles.
In 2008 she felt strong enough to have a second child. "That's another part of the gift of MDMA," she said recently. "Before those sessions, I just couldn't get it together, to expand my family the way I wanted to."
Crowds no longer faze her. In fact, she spent two months this fall as a full-time climate-change protester, doing street theater in a polar bear hat in front of hostile crowds at presidential debates and similar events.
"It gets pretty intense," she said. "It's something I couldn't have done, before the treatment."
Grateful as she is for Mithoefer's study, she feels as strongly as ever about avoiding recreational drug use. "I have a very, very serious respect for that medicine. You really don't want anybody to do this without professional supervision. It could open portals, in a way that could really damage you."
Chatting in his office, where books about shamanism sit side by side with standard psychology texts, Mithoefer remained cautious.
"I think at this point, what we know is that MDMA can be administered safely to people with PTSD, to the right people in the right setting with the right screening. It shows very encouraging signs of being effective, you know, but the numbers are too small to say we can definitively prove that."