About three years after his discharge from the US Marine Corps, Nicholas Blackston is in an unfamiliar office, starting to feel the effects of an unfamiliar drug: as he watches, an old-fashioned banker’s lamp in the office suddenly bursts into kaleidoscope fractals. While the MDMA Blackston’s been dosed with is usually more associated with raves, glow sticks, and rap lyrics, the chemical also has a second life as a medication used to heal psychological wounds.
In some ways, Blackston is an ideal patient for MDMA — and one of a growing number of people with PTSD who are turning to the compound, as The Verge has previously reported. He wasn’t responding to the drugs that are typically prescribed for PTSD, and he has an open mind when it comes to alternative treatments. Blackston is part of a study that’s revived interest in the original use of MDMA: therapy.
Blackston joined the Marine Corps when he graduated from high school in 2004 — as the war in Iraq was steadily intensifying. On December 20th, 2006, during his second deployment, Blackston was in the passenger seat of a Humvee in Ramadi, acting as the machine gunner. The Humvee was struck by a rocket-propelled grenade fired by an insurgent. New armor was installed on the driver’s side of the truck, but the RPG caused a piece of metal to shoot underneath the driver’s window and through the driver’s lap. The shrapnel pierced ammo cans at Blackston’s feet and caused an explosion. "I took shrapnel to my butt, legs, and left testicle," says Blackston. "My driver was killed."
Blackston remembers he had been laughing at some joke when everything became a "black void." The world around him seemed to be moving in slow motion; he felt no fear at the time. "I was really outside of myself," he says. The fear would come later.
About six months after leaving Iraq — but while still in the military — Blackston discovered he didn’t feel like himself. He went to a military clinic in Camp Lejeune, North Carolina, where a computerized test flagged him for post traumatic stress disorder (PTSD). Blackston received the same treatment the majority of veterans with PTSD receive. The military doctors put him on Seroquel, an antipsychotic, and Zoloft, an antidepressant. The talk therapy he received was minimal; he says he had to wait six weeks between hour-long therapy sessions. "There was just so much time in between that the therapy sessions were pointless, and the medication just makes you feel like a zombie," he says.
He finished his four years with the Marines in 2008; back home, he began studying at Trident Technical Community College in South Carolina. But the drugs made it harder to focus on his schoolwork — so he stopped taking them. He tried using marijuana and psychedelic mushrooms instead, which he describes as Band-Aids on his wounds. He had experienced suicidal thoughts. And that was when Blackston came across a study designed to treat PTSD with MDMA. "I was at the end of my rope. I was ready to try anything," he says.
Before becoming a participant in the study, which was conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS), applicants have to do psychological tests to confirm they have PTSD and show that they’ve been taking prescription drugs that haven’t worked. Everything checked out for Blackston.
Patients like him have three 90-minute meetings with Dr. Michael Mithoefer and his wife Annie to get them oriented, Mithoefer tells The Verge. After that, they begin the MDMA-assisted psychotherapy sessions. The patients come into the office in the morning and take their pill. The therapists stay with the patients for eight hours, during which the session focuses on discussing the experiences that caused patients’ PTSD. Each MDMA-assisted session is one month apart; the therapists and patient discuss symptoms and general mental health regularly in between sessions over the phone or in person.
In the study, participants receive either low-, medium-, or full-dose MDMA — 30mg, 75mg, or 125mg, respectively. Patients who were in groups with lower doses have the option to receive three full doses one month after their second session; Mithoefer says everyone gets three full-dose sessions. Two months after the final session, an independent psychologist measures where the patient is on the Clinician-Administered PTSD Scale (CAPS). The test is conducted again a year later.
It’s not clear how MDMA may help patients recover from PTSD. Imaging studies of PTSD have shown increased activity in the amygdala, the fear center of the brain, and decreased activity in the prefrontal cortex and in the hippocampus. Essentially, three parts of the brain are operating irregularly, which prevents people with PTSD from processing everyday experiences normally. However, once people take MDMA, there’s increased activity in the prefrontal cortex, and decreased activity in the amygdala — it basically evens out the scale so proper therapy can be done, Mithoefer says.
PTSD patients are often "too aroused or mostly numb" during therapy without MDMA; the drug helps therapy happen for them "meaningfully, without being overwhelmed by the fear," Mithoefer says.
Whatever the explanation, the results in small trials look promising. A previous study found 10 of 12 patients no longer registered PTSD on their CAPS scores after receiving MDMA-assisted psychotherapy. Mithoefer says his group hasn’t fully analyzed the results for the study Blackston participated in. He says the outcomes look similar to the first study so far; analysis will be released in May.
As for Blackston, he says MDMA and therapy cured him. He did three 75mg sessions and three full dose sessions, finishing in 2012 — and no longer registers on the PTSD scale. He views the trial positively. "I had a profound moment, I guess it felt like a bird’s-eye view of how everything went down [in Iraq] and why it happened," he says. "I was a machine gunner. I was supposed to take anyone out before they take us out, and getting hit was my responsibility, and my driver dying weighed a lot on me. I had that guilt for the longest time," he says. In therapy, he had a moment where he finally saw the big picture. "I saw my whole past completely differently," he says. "It no longer became something that was haunting me."
Blackston says he still has normal anxieties, but he turns to making art to stay relaxed. "I was so young to have life and death in my hands," he says. When he was still suffering from PTSD, he says he feared his own right hand, because that was his shooting hand. Now, he says he uses it to paint.