Blue Dreams

by Lauren Slater

  Banned

  Psychedelics have been imbibed for centuries by people seeking spiritual enlightenment, but thanks in part to Timothy Leary, who welded them to the 1960s counterculture—when drugs like psilocybin and LSD were taken by the palmful—they were fast made illegal and relegated to the fringe, associated in most people’s minds with tie-dye and Deadheads, Jerry Garcia strumming stoned on a stage. At MAPS, the Multidisciplinary Association for Psychedelic Studies, Rick Doblin, in addition to reexamining past experiments with psilocybin, is trying hard to change these associations. Unaffiliated with a university, MAPS is a nonprofit organization that develops and funds clinical trials to investigate a range of psychedelics in treating physical and psychological conditions that have proven resistant to more traditional pharmacological approaches. According to Doblin, “Leary didn’t do psychedelics any favor when he made them agents of rebellion. There was a sort of arrogance to his stance. He was telling people to sever themselves from society, to go form communes, to go back to the land. It was a rejection of the dominant culture in the extreme.”

  If Doblin is correct and Leary’s goal was to cut psychedelics off from the dominant culture, he was supremely successful. According to the National Household Survey on Drug Abuse (NHSDA), by 1972, despite the exhortation to “tune in and turn on,” only 5 percent of Americans, most of them under the age of eighteen, had used psychedelics. Nor did use of hallucinogens become part of the mainstream, with still only 14 percent of the population reporting lifetime usage a quarter century later, in the mid-1990s. Most of us know people who smoke pot, but how many of us are friends with people who regularly imbibe psychedelics? “There’s been this sense,” Doblin says, “that these drugs are dirty, dangerous, and that those who use them are somehow irreparably irresponsible, perpetually spaced out, and not the kind we’d like to keep company with.”

  MDMA as Medicine

  While the dominant culture may continue to conflate Leary and LSD, or Deadheads and psychedelics, and cast a less than favorable light on this admittedly mysterious class of drugs, the medical community is undergoing its own revolution. Fifty-odd years after Leary, researchers around the world are newly and seriously interested in investigating psychedelics for their potential capacity to ease everything from death-related anxiety to cluster headaches, and to aid in the treatment of addiction, posttraumatic stress disorder (PTSD), and autism.

  Charles Grob, in addition to conducting his end-of-life psilocybin study at the Harbor-UCLA Medical Center, has worked with transpersonal psychotherapist Alicia Danforth to publish a phase-one study in which adults with dual diagnoses of autism and social anxiety are given MDMA to see if the drug might help them more effectively relate to others. Danforth and Grob have reason to believe that MDMA could be crucial in breaking down the barriers autistic people face, especially their extreme difficulty in connecting to the “neurotypical” world. There are ample accounts from those with autism who have taken MDMA independently, without medical guidance, stating that the drug makes it possible for them to function—not only while they’re on the drug, but for weeks and sometimes months afterward. In Danforth’s own study of how autistic adults experience the subjective effects of MDMA, she found that 91 percent of respondents reported an increase in feelings of connectedness on MDMA, while 86 percent of them said that communication became easier.

  Though this study is a profound breakthrough in the treatment of autism, the use of psychedelics for this purpose isn’t an entirely new idea. In fact, as Grob and Danforth found in their research, throughout the 1960s more than a hundred minors with autism or the now obsolete diagnosis of “juvenile schizophrenia” participated in trials in which they ingested psychedelics, and in at least six of these studies LSD was administered to children as young as five. Lest our only reaction be shock, however, it’s worth noting that while the autistic children were under the influence of these drugs, researchers observed that they displayed an increase in vocabulary and emotional responsiveness to others, mood enhancement, more eye-to-eye contact, and a decrease in compulsive behaviors. LSD was also given to mute catatonic schizophrenics, who finally spoke, a result that spurred still more studies on treating noncommunicative autistic people with psychedelics. But as we saw with psilocybin, despite the promise of psychedelics in the treatment of autism and catatonic states, Nixon’s Controlled Substances Act of 1970 decisively discouraged all investigations with psychedelic compounds.

  John Halpern, formerly of McLean Hospital, is, like Danforth, investigating MDMA’s effects on high-functioning autistic patients who want help connecting to the neurotypical world. Halpern has surveyed autistic adults who self-medicate with MDMA. “We don’t want to put the cart before the horse,” he said on the day I spoke to him. “We need good medical research that validates what we’re seeing, which is that MDMA is a game changer.” Halpern went on to describe how one of the autistic people he’d been observing had insisted that on MDMA he could appreciate and respect other people’s feelings and that once the MDMA wore off he was still able to remember the behaviors he’d learned while under its influence. Halpern paused, touched a smooth stone on his desk, a flat rock the color of caramel with visible white veins branching through its body, of the sort that I might see on the shelves of my own rock-collecting doctor. His hope, he said, was that they would get the necessary funding to conduct high-quality medical research that would confirm what has already been suggested anecdotally. “Some psychedelics, and MDMA in particular,” he said, “are powerful empathogens that could be made into medicines to treat a whole range of conditions, from distinct diseases to shadow syndromes, like extreme shyness.”

  An empathogen is the name given to a psychoactive drug, like MDMA, that brings about emotional communion or openness—in other words, empathy. Halpern pointed out the range of human problems that, in one way or another, involve connection and its impairment. “Delic,” he said, typing the suffix into his computer and staring at the screen, “means ‘to make aware, to reveal.’ That’s what these drugs do. They reveal people to each other; they increase one’s awareness of the signals others are sending. And because they’re prosocial, they give people who are stymied by, say, shyness a chance to interact with others.” Halpern, like Ann Shulgin before him, has evidence from those who use psychedelics like MDMA illegitimately that these empathogens have therapeutic potential not only for the treatment of social phobias and autism but also for couples counseling.

  For Trauma

  Psilocybin and its close cousin LSD also have empathogenic properties, but of all the empathogenic psychedelics, MDMA may be the most potent. Along with psilocybin, it is experiencing a second life. No longer the “hug drug” of the 1980s and ’90s clubbing culture, it appears now in pristine clinical settings, one of which is run by Michael Mithoefer, a psychiatrist in private practice in Charleston, South Carolina. Mithoefer completed an FDA- and DEA-approved trial of MDMA for the treatment of severe PTSD, with stunning results. In 2011, with the support of MAPS, he and his team created a double-blind design in which twelve severely traumatized patients were given MDMA and psychotherapy, and eight patients were given an active placebo and psychotherapy. The researchers used the Clinician Administered PTSD Scale (CAPS) as a means of measuring symptom reduction after intervention. In the placebo group, only two out of the eight subjects had a significantly lowered CAPS score post-intervention, whereas in the MDMA group, ten out of the twelve subjects had significantly lowered CAPS scores and were able to maintain those scores at a two-month follow-up. Furthermore, in the MDMA group, ten of the twelve patients were so improved that they no longer met the DSM criteria for PTSD. The second phase of the study allowed seven subjects who had previously taken the placebo (six of whom had failed to respond to the placebo and one of whom had relapsed after the placebo) to now try MDMA. They found a clinical response rate of 100 percent, and the three people who had previously said they weren’t able to perform their jobs on account of their PTSD were now
able to work once again.

  The drug appears to act by allowing traumatized victims to recall their terror in an utterly peaceful frame of mind, thereby forging new neuronal associations in the brain. According to Halpern, “It is because empathogens give people the ego strength to tolerate frightening images or thoughts that they are so useful for people who have had traumatic experiences.” Under the influence of MDMA, victims of violent crime and veterans of war have both the mental stamina and the serenity to talk about what happened without fear. The drug creates a state in which the subject is calm and feels deep trust in his or her therapist, which allows for a more profound processing of the trauma. On MDMA patients are able, perhaps for the first time, to explore their trauma, rendering it with words rather than reacting with mute terror. Part of how PTSD afflicts those who suffer from it is by increasing blood flow to the amygdala, the part of the brain responsible for feelings of fear, and decreasing blood flow to the cortex, where reasoning takes place and narrative is built, thereby making it much harder for people to reframe and revise painful life events. The thinking is that MDMA may reverse this phenomenon, allowing trauma victims, who sometimes blame themselves, to feel instead a deep sense of compassion, not only for others but also for themselves.

  The Love Hormone

  Kelly Shuge turned out to be one of the people MDMA could help. Her experience paints a remarkable picture of how certain psychedelics can improve and intensify relationships. Prior to the MDMA, Kelly and Thomas were polarized, their different coping skills fracturing their marriage and keeping them apart emotionally and physically. Kelly agreed to try MDMA—six guided therapeutic counseling sessions—with the hope that she would learn to deal with the anxiety her cancer was causing her in a way that was less noxious to Thomas. That’s not what happened, though. The drug helped her, but in a different way than she’d imagined it would. Under the influence of MDMA, Kelly had “a powerfully empathic experience of what it was going to be like for her husband to lose her,” her therapist explained to me. “That empathic experience was so strong that it just cut through the bickering and the strain. Kelly was able to see the suffering in her husband’s heart and to communicate that understanding to him, and it just drastically improved the time they had to spend together.” Four months after her MDMA sessions, Kelly died in her husband’s arms.

  One theory about how MDMA achieves its special pair-bonding effect has to do with the rising levels of oxytocin it promotes. In a 2004 study in the Netherlands, researchers measured the concentration of oxytocin in fifteen MDMA users’ blood, operating from the hypothesis that as “prosocial” feelings increased, so too would levels of oxytocin, known informally as “the hormone of love,” so named because of its capacity to forge human bonding. That the researchers guessed correctly is no surprise given that ample studies of animals had already shown that, under the influence of MDMA, the brain is “just flooded” with oxytocin, according to Doblin. Oxytocin, an extremely powerful hormone that has the capacity to alter human and animal behavior, has been researched extensively in prairie voles, an animal known for its monogamous sexual habits. The prairie vole is one of the few mammals on this planet to stick with a partner for life. If you inject a female vole with an oxytocin antagonist, however, she will show a complete receptivity to a new mate. Cease the oxytocin antagonist and the rodents immediately return to their first-picked partner and happily resume their loyal lives.

  Like prairie voles, humans also manufacture oxytocin, and have the capacity to do so in large amounts. Without oxytocin we would likely have trouble loving our offspring, especially right after birth, when they’ve ripped us up and lie there screaming, looking less like a human than some sort of surrealist depiction of an alien life form. Yet love these little creatures we usually do, often immediately, and probably because the oxytocin that causes the spasms of labor to begin with also sticks around after the birth and is triggered once again in huge amounts by breast-feeding, not to mention in lesser but still significant amounts whenever we touch or are touched. Without oxytocin, chances are good we’d be reduced to robots.

  Raves

  Oxytocin is a chemical you can easily procure. In fact it is sold in mail-order catalogues as an aphrodisiac. MDMA, at the present time, is harder to get hold of. If we were living in the late 1970s or early ’80s, however, we would be able to obtain it without a lot of trouble, but there’d be no guarantee that what we were buying was pure. Back then, before the DEA got wind of this empathogen, you could find it in a nightclub and even charge it on your credit card. The tablets sometimes came in a brown bottle labeled “Sassyfras.” (MDMA is in part derived from the sassafras plant.) Before the drug achieved widespread recreational use, batches were cooked up primarily by a group of therapeutically minded chemists around Boston called the “Boston Group.” But as the drug became more profitable, large labs dedicated to making and distributing empathogens sprang up all across the country. Like any good thing, MDMA, or “Adam” (a reference to the Edenic state it induced), became a topic of gossip. It entered the mainstream enough to be written about everywhere from Newsweek to the Doonesbury cartoon strip. People began to abuse it, taking dose after dose during all-night raves—MDMA dance parties, Dionysian in the extreme.

  For the chemical chefs behind MDMA, business was good, even great, to the extent that their main concern was what to call the stuff, how to find a name that best reflected its amazing properties. The name is not the sole reason Ecstasy finally caught the attention of police officers, legislators, and distressed doctors who were seeing people post-rave, dehydrated and depressed from dancing and drugging all night, but it has something to do with it. “Ecstasy,” so christened in 1981 by an early distributor who thought it would sell better—“‘Empathy’ might be more appropriate,” he said, “but how many people know what it means?”—has a sort of sliding sound, and because we’re Americans who supersize everything from our cars to our candy, some of us slid down the slide of Ecstasy, using it to excess and causing a ruckus as we went along. When the biggest distributor for the Boston Group in the Southwest opened his own laboratory, in Texas, production went into overdrive, and by 1985, at the height, almost a quarter-million doses a month were being produced by the new “Texas Group” alone. According to Jerome Beck, of the Institute of Scientific Analysis in Berkeley, and Marsha Rosenbaum, the director of the Center for Drug Studies, “The quiet use of Adam in limited therapeutic circles had been transformed into a phenomenon. Ecstasy was now the ‘drug of choice’ among Texas yuppies.”

  Senator Lloyd Bentsen of Texas, soon to be the Democratic nominee for vice president, grew concerned about the proliferation of the drug and the accompanying raves, especially in the Austin and Dallas–Fort Worth areas—his whole huge state, it must have seemed, had gone bananas—and he sought to put a stop to it. In 1985 he brought Ecstasy to the attention of the DEA, with a request for a temporary emergency ban, at the same time that neurology researcher George Ricaurte, at Johns Hopkins, published a study which showed that MDMA caused neurotoxicity in rats. The tactic proved to be successful, and on May 31 of that year, the DEA did indeed issue a one-year ban. “We saw it coming,” Doblin says. “We saw that this incredibly valuable substance was going to be criminalized, and so we organized, and did whatever we could to stop it.”

  After the DEA criminalized the drug, Doblin sued, a move that forced the issue into court, where an administrative law judge looked closely at the evidence for and against MDMA. Doblin and his group argued that Ricaurte had given his rodents doses so huge they would burn through even a bionic brain, while simultaneously pointing out the fact that there were to date no deaths associated with MDMA and no evidence that it caused any kind of brain damage whatsoever in human users. Doblin’s goal, and the goal of MAPS, was not to keep MDMA on the street, where it could continue to be used in excess, but instead to have it formally and legally scheduled in such a way that researchers and physicians would still have access to it for clinical
purposes. Despite the fact that Doblin won his lawsuit and the judge recommended to the DEA that it put MDMA on Schedule 3, along with other highly controlled but clinically useful drugs, the DEA overrode the judge’s recommendation and put MDMA permanently on Schedule 1, which includes dangerous drugs such as heroin and quaaludes—in other words, drugs the DEA has deemed to have no clinical or research relevance.

  The Spurious Study

  “If I thought about goals,” Doblin told me, “I’d get depressed. For me the work has to be not about what we’ve achieved but about the meaning in the struggle.” And struggle he has. Doblin has fought the DEA every step of the way, almost his entire professional life, about getting MDMA and its allied empathogens made available for limited legal use as prescription pills.

  Those of Ricaurte’s persuasion do not make Doblin’s life any easier. In 2002, almost two decades after his study on the putative neurotoxicity of MDMA when given to rats, Ricaurte published a still more alarming paper claiming he’d fed MDMA to primates and that a few had died as a result, and there was evidence of neurotoxicity in all. This study threw a serious curveball into the MDMA debate. Doblin, along with Mithoefer, was on the cusp of getting institutional review board approval for his study using MDMA to treat severe PTSD, but as soon as Ricaurte released his new MDMA results, Doblin said, “they shut us right down.” Of course, who could argue with that? If our closest genetic cousins are dropping dead from the love drug, well then, you’d better stop loving the drug. Along with his published paper, Ricaurte released images of primate brains post–MDMA exposure. The images are ghostly, haunting black-and-white brains with huge ragged holes ripped in them, the damage so severe and worrisome that Oprah Winfrey did a segment on MDMA and the supposedly severe side effects it caused, along with the obvious message to just please, now, once and for all and forever, say no to drugs.