--:-- Sean Rameswaram: Welcome to Today Explained. I'm Sean Rameswaram.
--:-- Halima Shah: Hi, I'm Halima Shah, and I'm reporting and producing this episode.
--:-- Sean Rameswaram: Today, we're going to talk about MDMA-assisted therapy for PTSD. The FDA is considering making it a medical treatment, and it's an idea that's been around for decades.
--:-- Halima Shah: That's right. Reporter Halima Shah wanted to talk about ecstasy on yesterday's show, Today Explained. She spoke to veterans who want the government to legalize MDMA-assisted therapy.
--:-- Sean Rameswaram: [pause] Let's get to it. Halima, you spoke to some veterans who want the government to legalize MDMA-assisted therapy. Who did you talk to?
--:-- Halima Shah: I talked to Jonathan Lubecki, a retired Army sergeant who was deployed to Iraq in 2005. He's a veteran who says that MDMA-assisted therapy helped him heal from PTSD.
--:-- Sean Rameswaram: [pause] Okay, Halima, let's get to it. You spoke to some veterans who want the government to legalize MDMA-assisted therapy. I did. And one of those veterans is Jonathan Lubecki. He's a retired Army sergeant who was deployed to Iraq in 2005.
--:-- Halima Shah: There's a lot of people that were on my base that never stepped foot outside the base, that have severe PTSD simply because of all the raining bombs. And Jonathan notices his mental health deteriorating while he's still deployed.
--:-- Sean Rameswaram: [pause] What happened when he got home?
--:-- Halima Shah: When he gets home in 2006, things don't get better. My wife of eight years was gone, moved in with someone else. My dog was gone. My house was empty. I took a taxi back to my house. And within two months of getting back, actually, in the early hours of Christmas 2006, after going to a church, after going to Womack Army Medical Center, was the first time I tried to take my life.
--:-- Sean Rameswaram: [pause] Oh no. Yeah, so Jonathan said that was the first of five suicide attempts.
--:-- Halima Shah: There was so much day-to-day agony of just living with PTSD. It's very bizarre when your brain betrays you. There were certain things that would be very triggering for me, whether I wanted them to be or not.
--:-- Sean Rameswaram: [pause] What does he do other than, you know, taking shelter in a closet?
--:-- Halima Shah: He tried a lot of things through the VA. He tries cognitive behavioral therapy. He tries exposure therapy. He gets the maximum dosage of Zoloft, which is a first-line SSRI for this. And for some people, this treatment regimen really helps. For Jonathan, it helped some, but not enough.
--:-- Sean Rameswaram: [pause] So what happens next?
--:-- Halima Shah: He learns about a clinical trial for MDMA-assisted therapy for PTSD. This trial is organized by a group called the Multidisciplinary Association for Psychedelic Studies. MAPS was founded in the 1980s by a guy named Rick Doblin, and he has a very utopian way of speaking about psychedelics.
--:-- Sean Rameswaram: [pause] Okay, so what is this clinical trial experience like?
--:-- Halima Shah: It starts with screenings and an intake process with trial therapists. There's always a male and a female one, which is an old protocol that was put in place actually after a psychiatrist was sued for sexual assault in an MDMA session back in the 80s.
--:-- Sean Rameswaram: [pause] Okay, so what happens during the trial?
--:-- Halima Shah: You do one session with the pill, and then you do three sessions called integration where you unpack that experience with your therapists. And then again, one session with the pill, then three sessions of integration, and a third time, one session with the pill, three sessions of integration.
--:-- Sean Rameswaram: [pause] Okay, so what does Jonathan experience during the trial?
--:-- Halima Shah: At his first session with the pill, Jonathan gets his vitals checked and he's hooked up to a bunch of monitors. And that's because MDMA does come with some risk. It can cause rapid heart rate, blood pressure increases, teeth grinding, chills, sweating, things like that.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Once all of those monitors are set up, the pills come out. I was so hoping this would be like the Matrix, blue pill, red pill. I got to pick one. But no, it's a little green pill. Takes like 40 minutes to kick in.
--:-- Sean Rameswaram: [pause] Okay, so what does Jonathan experience during the trial?
--:-- Halima Shah: I'm just sitting there with my eyes closed and I start seeing like wavy graph paper. And I'm like, well, I guess this is kicking in now. And then there's a bit of, what, this is awesome. I totally get why people do this now.
--:-- Sean Rameswaram: [pause] Okay, so what does Jonathan say about his experience?
--:-- Halima Shah: He says it's like doing therapy while being hugged by everyone who loves you in a bathtub full of puppies licking your face.
--:-- Sean Rameswaram: [pause] Okay, so what happens after the trial?
--:-- Halima Shah: After this one-time trial, Jonathan told me he has never again attempted suicide. He still goes to therapy and life still tests him, but he tells me he feels so healthy, he's gone back to a war zone.
--:-- Sean Rameswaram: [pause] Okay, so what's the next part of the story?
--:-- Halima Shah: I also talked to another veteran, Ari Pahlavi, a Marine Corps pilot. He's a veteran who also received MDMA-assisted therapy through the MAPS trial.
--:-- Sean Rameswaram: [pause] Okay, so what's Ari's story?
--:-- Halima Shah: Ari was a Marine Corps pilot. And one night, towards the end of his deployment, he was trying to land a plane during the Battle of Mosul while avoiding rocket fire.
--:-- Sean Rameswaram: [pause] Okay, so what happens after he gets home?
--:-- Halima Shah: He comes home to a newborn son. He's four months old. So I was flying all those missions with my wife at home. And then all of sudden I'm coming home from this and I'm injected into a four-month-old son that I didn't know how to be a dad.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Ari starts to do research on PTSD and pretty much self-diagnoses himself. And like Jonathan, he first seeks out VA help. It doesn't work for him. And then he tries talk therapy on his own. He tries yoga, another experimental therapy that uses a magnetic field to stimulate brain function. That doesn't work for him either.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: It's 2020, and MAPS is doing late-stage clinical trials. Ari gets in. And he reports to the basement of an apartment in Brookline, Massachusetts. It's a similar deal to what Jonathan had. A cozy space, a pair of therapists, and a pill.
--:-- Sean Rameswaram: [pause] Okay, so what happens during the trial?
--:-- Halima Shah: We were talking. Some of the emotions started coming out. I started crying, and I started having this kind of out-of-body experience. Feeling sensations and becoming aware of sensations that I arguably had never felt before.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: But the reason Ari is experiencing what he is is because he's not getting MDMA. He's getting placebo.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: At the second session, there was nothing. Like, there was no crying, there was no out-of-body experience, there was nothing.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And he just like something is off. So I actually kind of accused him I said hey I got the medicine at the first session and you guys messed something up I didn't get it at the second session.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: He knows that he's not getting the MDMA. I mean, he's just like kind of sitting there.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And that's a very big deal because about 75% of placebo participants in that study were able to correctly guess what they got.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And that's an issue because when a participant knows whether or not they got the drug, you can't be sure if it was their expectations or the pill that kind of dictated the experience.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: What did it mean for Ari, though? I mean, he had this emotional experience even on the placebo. Does that mean that this treatment helped or this lack of a treatment, this experiment?
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: You know, even though he doesn't get the actual MDMA as part of the study, he gets a lot of time with two therapists who he really respects. And that, combined with some other changes in his life, bring him some relief.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: It also motivates him to figure out some way to try psychedelics for himself. So he goes on a really intense retreat in Mexico where he experiments with some other drugs.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And then when he comes home, he also gets another chance to participate on the MDMA side of the MAPS trial.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: I went through psychedelic-assisted therapy. And while the psychedelic itself is a hot topic, my opinion is that it's the full process, the therapist, the preparation, the integration, and what you do afterwards that has the power to heal.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: So Ari comes out of this experience a believer, just like the other veteran we heard from, Jonathan Lubecky.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: But for Jonathan, MDMA-assisted therapy sets him on a completely different journey. If you Google the word veterans and psychedelics, like his name will inevitably come up.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: He sort of becomes MDMA's Republican whisperer.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Oh, because Republicans aren't going to buy it from the hippies. Who are Republicans going to buy it from? They're going to buy it from a veteran.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: He's very dedicated to this because he even moved to Washington, D.C. so that he can do this work.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: I actually met him at his apartment in what's kind of known as the Republican corner of D.C.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: You know what we're talking about. So I can, you know, end of a rough day, come up here, relax, and smoke a cigarette.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Until they built that building, you could see the Pentagon, Crystal City, which is where all, like, the defense contractors are, and the Capitol.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: So you could actually see the entire military industrial complex from the roof. Dreamy view.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: He says his work now is really about changing hearts and minds, he tells me.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And his goal is really to like cleanse psychedelics of their old reputation and association with hippies.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And frankly, that's part of the problem and why we don't have access.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: The government is reactionary. They reacted because of the actions of the counterculture.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And to be blunt, like when you drop acid and say, let's go blow up some ROTC buildings after this orgy, the government's going to do something about it.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Did that happen? Did anyone ever blow up a building after an orgy?
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: I just have no way of fact-checking that.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: But the point he's trying to make is that MDMA is in that lineage of countercultural psychedelics like LSD, which boomed and busted with the hippie counterculture.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And he thinks that if that association sticks, it'll never become an FDA-approved medical intervention.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Health insurance will never cover it. Medicaid will never cover it. Medicare will never cover it. The VA will never cover it.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Jonathan wants increased access to MDMA but he's not down with the policies we saw in the past decade that increased access to marijuana.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: I see decriminalization as horrible.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Why is that? Because I know that MAP position I know.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And that's a lot of people's position in this community.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Well, yeah, because this was never about medicine. Decrim, by its very nature, has nothing to do with medical or mental health or any of that.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Decriminalization is a criminal justice reform movement.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And personally, I can get someone out of jail tomorrow. I can't bring someone back to life after they kill themselves.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: So when we're talking about psychedelics, we are talking about a group of compounds that are associated with the anti-war movement, very critical of the military industrial complex.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And now it's come back into its second life.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And the main defense for it is veterans need it.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Which is interesting because when you actually work in this community, the anti-military is very prevalent throughout the whole community.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: I'll be honest, I didn't understand what microaggressions and tokenism was until I was a veteran working in this counterculture.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: The snide comments, being told just say what we want, things like this.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: I don't care about the parties. I don't care about festivals. I don't care about Burning Man. I care about saving people's lives.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Hmm. Is he talking about this group we've been talking about, MAPS, the Multidisciplinary Association for Psychedelic Studies?
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Are those the people he thinks, what, that, like, don't actually care about how he feels or what he thinks?
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: So Jonathan did not say MAPS specifically is trying to Trojan horse psychedelics to approval, but it has been criticized by some veterans for kind of using veteran testimonies to sort of push forward this broader agenda of drug legalization, of recreational psychedelic use.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And from my research, I can tell you this, none of which is a secret. MAPS is rooted in counterculture. It's been a fixture of Burning Man for years.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Doblin speaks proudly of opposing the Vietnam War, his mission for mass mental health and spiritualized humanity.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And for a lot of people, there's nothing wrong with that goal. I mean, drug decriminalization is a racial and criminal justice imperative for many.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Indigenous groups have used psychedelics for ritual and ceremonial purposes for centuries.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: But Jonathan says those things are not his goals. They're objectives that are sort of waiting in the wings, hoping to ride the coattails of a PTSD intervention that's very reliant on the testimonies of veterans.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: So is this working? I mean, has Jonathan accomplished what he set out to do here? Has he helped sort of push this movement forward?
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Well, if you look at attitudes towards psychedelics, it does seem like they are increasingly positive.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: More than half of Americans who have mental illness say they want more access to them.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And psychiatrists increasingly favor legalizing these drugs for medical use, which suggests that the medicinal narrative has support among patients and clinicians.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Okay, so there's public support for psychedelics as medicine, as treatment.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: There are PTSD patients who need it, want it, who will travel to Mexico for alternatives.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And there are some very convincing veterans, like the one we heard from, making the case to Congress.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Aside from the hippies and, like, the new-agey vibes, is there a lot standing in the way of MDMA-assisted therapy?
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: At the beginning of 2024, if you asked me that question, I would say no, but I am not so sure anymore.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Because last June, there was an FDA independent advisory panel that met and recommended that the agency does not let this treatment go public.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: There were lots of different reasons that came up, and it ranged from the double-blinding problem we talked about to cardiovascular risks to therapist misconduct and allegations that there's actually bias in the data of these studies.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And the FDA doesn't have to listen to its advisory committee, but it usually does.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And on top of that, there are a handful of trial participants who say that they came out of the trial worse than when they started.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: I think that there are really, really big problems with the way these trials are conducted.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: And so I asked the FDA to conduct an investigation.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Uh-oh. And we'll hear from one of those participants next week.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Wow, next week? I guess this is like TV now.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Halima Shah, she reports and produces at Today Explained. She was edited by Lissa Soep and Matthew Collette, fact-checked by Laura Bullard and mixed by Andrea Christensdottir and Rob Byers.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Halima's reporting here is brought to you with support from the Ferris UC Berkeley Psychedelic Journalism Fellowship.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: I'm Sean Rameswaram. The rest of us are Abishai Birthday, Hadi Mawagdi, Amanda Llewellyn, Miles Bryan, Victoria Chamberlain, Peter Balanon-Rosen, Denise Guerra, Patrick Boyd, Amna Al-Sadi, Miranda Kennedy, and Noel King.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: We use music by Breakmaster Cylinder.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Today Explained is distributed on the radio by WNYC.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: The show is a part of Vox.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: You can support our journalism by joining our membership program today.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: You can go to vox.com slash members to sign up.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Thank you if you do. Thanks if you don't, too.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Come on. Thank you for listening.
--:-- Sean Rameswaram: [pause] Okay, so what happens next?
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--:-- Sean Rameswaram: [pause] Okay, so what happens next?
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--:-- Sean Rameswaram: [pause] Okay, so what happens next?
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--:-- Sean Rameswaram: [pause] Okay, so what happens next?
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--:-- Sean Rameswaram: [pause] Okay, so what happens next?
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--:-- Sean Rameswaram: [pause] Okay, so what happens next?
--:-- Halima Shah: Mercury, banking that does more.
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--:-- Sean Rameswaram: [pause] Okay, so what happens next?
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--:-- Sean Rameswaram: [pause] Okay, so what happens next?
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--:-- Sean Rameswaram: [pause] Okay, so what happens next?
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