Take MDMA for the Pain

[originally published in September 2020 for Shoeleather Magazine]

MDMA has proven itself to be an effective treatment for those struggling with post-traumatic stress disorder, but it won’t become widely available unless it overcomes the stigma surrounding it, both nationally and within the veteran community.

In the 1998 film Fear and Loathing in Las Vegas, a journalist and an attorney, played by Johnny Depp and Benicio Del Toro, embark on a drug-fueled road trip across the country. They’ve tucked cocaine, ecstasy, mescaline, and every other imaginable illicit drug into a leather suitcase shoved in the back of their red 1970 Chevy convertible. Draped in Hawaiin shirts and with heads full of acid, the two men skid up to a Vegas hotel and stumble through its doors. Depp’s character pours sweat, waiting anxiously in line to check in. He turns his gaze to the left of the receptionist, only to see the floral pattern of the hotel carpet start creeping up the wall. He practices his lines in his head – name, rank, press affiliation – and tells himself to “ignore this powerful drug.” He approaches the desk and spits out a word salad; the receptionist turns into a lizard and lunges for his head.

Depp’s performance is but one iteration of the fictive depiction of the psychedelic experience: manic and paranoid users, trapped in their own heads, seeing things that aren’t there. Yet this narrative diverges starkly from the earliest history of the drugs in the 1930s, when scientists developed psychedelics to heal, not as a source of reckless entertainment. Even the tamer drug use imagery of the 1970s—long-haired hippies running barefoot through fields or blissed out in the back of a van—takes more away from the history than it adds.

Neither version, however, captures the potential for relief psychedelics can provide for the one million veterans and others who suffer from post-traumatic stress disorder and are desperate to find peace. For the past five years, they’re looking to the outlawed substances to survive the wars they continue to battle with themselves.

In 2017, the FDA designated MDMA, or 3,4-methylenedioxymethamphetamine, commonly but not correctly known as Ecstasy or Molly, as a drug for the treatment of PTSD, available only in approved clinical trials. One of the 11 US centers for exploring this breakthrough therapy is, unsurprisingly, Boulder, Colorado. My family moved to Boulder when I was eight years old. The city, population just under 100,000, mostly white, liberal, upper-middle-class people, likes to think of itself as a town. Celebrated as the happiest, healthiest, and second most educated city in the country, it is home to the largest Whole Foods in Colorado. Teslas have replaced Subarus as the vehicle of choice for the many former hippies who have made the city their home. And downtown on Fourteenth Street, inside a converted 1950s roller rink-turned-office complex, one of the world’s 16 clinical trials testing MDMA-assisted psychotherapy is in its third phase. The leading MDMA research organization, Multidisciplinary Association for Psychedelic Studies, known as MAPS, has been running clinical trials in my hometown since 2012.

In January, the city is dry, the air cold and stagnant. None of this can be attributed to the landscape, as the abundance of pines keep the hills largely the same deep shade of green year-round. But it is easy to feel that life is at a standstill. Bikes hang forgotten in the garage, heavy boots bury the running shoes on the closet floor. A stream of skiers load their gear into their cars and drive well out of sight to one of the neighboring mountains. The sun stops by for a moment early on, just long enough to be counted as one of Colorado’s 300 days of sunshine.

On one of these desolate winter mornings, I met Dr. Marcela Ot’alora, the principal researcher at Boulder’s MDMA trial site at The Rink.

The exterior of the complex still holds its original shape, with six tall archways turned out to face the parking lot. In the summers, farmers pull up across the street, setting up booths and tents down the block to sell fresh produce and homemade crafts. I walked through the main doors and took a second to reorient myself. I found the sign pointing towards suite 150 and counted my way to the end of a tight hallway. Behind a door just like all the other doors—laminate wood with no sign and blinds to cover the glass pane cut into its middle—the large bright room of the clinic opens up. Its walls are mostly white and lightly adorned with a few muted posters of plants and mountains. No swirling waves or electric rainbows. Three smaller rooms cut the space into an overgrown E, with Dr. Ot’alora’s office at the top.

I took a seat on the couch that looked the least like something out of Freud’s notebook. Dr. Ot’alora sat opposite in a linen-covered armchair, propping her feet up on a small stool. When I asked how her morning had been so far she smiled softly.

“It’s been good. I had my coffee, just gave somebody MDMA,” she said with a laugh.

It was just after 9 am. Mindful of the importance of time in trauma treatment, I noted the hour on my phone.

In The Body Keeps the Score, Dr. Bessel Van Der Kolk, a pioneer in trauma research, explains how trauma distorts time, how it “makes you feel as if you are stuck forever in a helpless state of horror. The overwhelming experience is split off and fragmented,” he reports, “so that the emotions, sounds, images, thoughts, and physical sensations related to the trauma take on a life of their own.”

Past, present, and future all meld together in a terrifying blur every time the patients see, smell, or hear something tied to the tortuous event or events in their lives.

In a clinical setting, time becomes regimented. Under the influence of MDMA, it becomes an ally. Dr. Ot’alora laid out the typical routine:

8:45 am, arrive at the clinic.

9:00 am, Take the medicine. 150mg of 99.9% pure MDMA.

The hours that follow leave more room for variation. A different playlist sets the patient’s mental tempo for the beginning, middle, and end of each session: some of the music works to soothe, some to energize. Reactions change from patient to patient. Where one might cry, another screams. Yet another might make no sound at all.

“The therapist’s job is to step into their world,” Dr. Ot’alora said. “We’re there to hold that container, that safe place, be able to offer a hand when it’s needed, be able to help them move through things when they’re stuck.”

All eight clinicians at the site, including Dr. Ot’alora, work in pairs, encouraging participants to talk, but only if they want to. Over and over again, the clinicians whisper the phrase, “Go inside with that.” They meet requests for headphones and eye masks on demand.

10:30 am, clinicians administer a supplemental dose, this time only 75mg, and check vitals.

For the patient, the experience of the drug moves in waves throughout the session, ranging from intense swells to calm ripples, until the effects completely subside. One clinician explained that patients spend about half the time with their eyes closed, which creates the space for them to feel a sense of healing themselves from the inside out.

5:00 pm, an approved support person takes the patient home. The routine repeats over twelve weeks, with three single-dose drug sessions spaced at least three weeks apart.

Since the Phase 3 trials started in 2016, Dr. Ot’alora and her team have achieved significant results. In the past six months alone, 78 percent of the clinic’s trial participants no longer qualify for a PTSD diagnosis.

Ironically, it is the proximity of Boulder’s ideological opposite, Colorado Springs, 97 miles due south, that has made the advances at the MDMA site possible. And though the drive takes only two hours, it’s hard to believe there’s no visa required for crossing city limits.

As soon as the city’s welcome sign comes into view, the atmosphere takes a sharp right. Green-and-white highway signs signal the four entrances ahead to the Air Force Academy. They line I-25 for the first five miles after the city limits Colorado Springs. In Boulder, marijuana dispensaries sponsor the roads more often than not; in Colorado Springs, veteran support groups have named the bridges and tunnels after fallen soldiers. Plastered onto the backs of Ford trucks in all colors are bumper stickers of Purple Hearts, not pale ales like in Boulder. In Colorado Springs, the military spirit that Boulder has protested, rejected, and even tried to degrade is alive and well.

Of the 650,000 residents of Colorado Springs, 120,000 are either active service members or veterans. That’s more people than Boulder’s total population and a fourth of all the veterans in the state. Colorado Springs is home to four military bases, including the US Air Force Academy, which occupies 18,500 acres along the edge of the foothills. High demand from military and defense contractors drives the city’s economy. Since 2018, the Springs has had a larger population of soldiers on active duty than ever before, a number that previously had not been surpassed since Vietnam. And while outsiders may find this commanding military presence insular and threatening, it is the exact environment that veterans count on to welcome them home.

The voice on my navigation system overtook my pre-selected soundtrack and alerted me that I had arrived. Turning off the highway, I felt my hands tense around the steering wheel. New York, where I’ve lived for the past four years, had accustomed me to feeling like I don’t belong, but never Colorado. At the end of a long parking lot, through a maze of monolithic office buildings distinguishable only by white signs posted at the edge of each row, I found my destination, a large navy-and-gold crest under the words “Regis University.” I parked my car, took a deep breath, and entered.

Waiting on the other side of the large glass-paned doors was Dr. Josh Kreimeyer, Ph.D., LPC, LMFT. He served for six years as a Russian linguist for the US Army. He was stationed in Kosovo in 1998 and was one of the first US soldiers to enter Iraq in 2003. Since leaving the army in 2004, he has become one of the leading counselors looking at the impact of trauma on military populations. And now he was sitting across from me, smoothing down the collar of his maroon Polo shirt.

Trauma, Dr. Kriemeyer explained, cannot be faced alone, not even when the impulse of sufferers is to hide in the corner of their minds and let the world pass by. Trauma, he said, refuses to be ignored, it will find its way into everything one does and every word one says, demanding to be felt. But trauma also lies, desperately and completely, and makes sufferers think that nobody could ever understand what they’re going through.

“When I have something traumatic that happened, I avoid dealing with it because I feel embarrassed, ashamed, guilty,” Dr. Kreimeyer said, his kind eyes contorting slightly under thick spectacles, giving the appearance that tears had started to form. “The avoidance of that is what can cause the problems. I’m not getting it out there.”

For soldiers, part of this avoidance also comes from a desire to hold on to life in the military.

“You come back and people will say, I really missed that, I felt more comfortable there than I do here, because even with the chaos of war, you knew your role,” Dr. Kreimeyer said. “You knew what to expect, life or death, black or white, and you come back, and then they worry because it’s like, I can’t even handle going to Walmart.”

In 2018, the Veterans Administration paid billions of dollars in disability benefits to its million PTSD veteran sufferers. PTSD is the third most compensated veteran disability, behind tinnitus—a constant ringing in the ear—and hearing loss. But PTSD does not look the same for everyone. Think of the fight, flight, or freeze responses that one might find in a survival movie: someone breaks into a main character’s house and the protagonists either punch the intruder in the face, sprint through the back door, or stop dead in their tracks. On the screen, the response is a result of the character’s choice and bravery, but in real life, the difference is biological. While some people may respond to a traumatic episode by sobbing uncontrollably or angrily lashing out at someone in their path, others shut down completely.

A total shutdown means an inability to be fully present with what one is thinking or feeling. That was the explanation of Courtney Hutchison, a PhD student at Rutgers in Social Work.“When that happens, you’re there, but you’re not really there,” she said, letting out a sigh. “When this happens during a therapy session, it can make it very difficult to do the work.” Hutchison specializes in trauma research and is part of the Berkeley Center for Psychedelic Research.

This process of zoning out, known as dissociation, is a defense mechanism that restricts the ability of patients to access their memories and emotions. It makes it more difficult for them to think clearly. And for many, the desire to get better is not enough to allow them to overcome this block. It is not a passing mood or a conscious choice. It’s chemical. Studies show that the dissociating brain blanks out when reminded of past trauma, with nearly every area of the brain displaying decreased activity.

On the other end of the spectrum are PTSD victims who experience vivid flashbacks. Dr. Kreimeyer explained that in these instances, the entire brain lights up, especially the limbic system, which deals with emotions and memory. Victims do not just remember the trauma, they experience it all over again. Their bodies tense up, their hands start to shake, and their heart rates increase. Fear takes over. “They’re so worked up that the things we say to people, they don’t hear it,” he said. “They can’t even sit still because they’re so in their limbic system.”

For both reactions, engaging with traditional forms of therapy can be incredibly difficult, especially when the healthcare system is working against you. All too often, the first response to behavioral health challenges is medication.

For the many patients suffering from PTSD, Paxil and Zoloft are the only medications currently approved for treatment. But John Krystal, who directs the Clinical Neuroscience Division of the VA National Center for PTSD, told the Washington Post that neither has proved effective for combat veterans. “If you’re a combat veteran with multiple tours of duty,” he was quoted as saying, “the chance of a good response to these drugs is 1 in 3, maybe lower.”

When the Department of Defense and the VA do recommend psychotherapy, they stick to the three main evidence-based methods. The first two, Prolonged Exposure Therapy (PET) and Cognitive Processing Therapy (CPT), involve the patients in retelling their stories in a variety of ways, such as writing, drawing, or recording themselves, and playing back the tape. The hope is, through extensive exposure, patients eventually will become desensitized and will no longer react to their traumas.

The third and most effective method is Eye Movement Desensitization and Reprocessing, more commonly known as EMDR, a practice rooted in the idea that our brains and bodies have an innate tendency to mend themselves. Dr. Kreimeyer explained how it works: “If I get a cut, it heals,” he said. “The brain is really no different except that we have free will and rational thought, so we can keep ourselves captive from natural healing processes in the brain because of how we think.”

Tapping into this predisposition involves therapists moving their fingers back and forth across their patients’ field of vision while they focus on the traumatic events that have affected them. The point of focus can be a color or a sound, a feeling in their chest or throat, or anything that somehow provides a connection to the trauma. It does not have to be known to anyone other than the patient. “With EMDR you don’t even have to say the words,” Dr. Kreimeyer said. “You’re exposing them to the trauma, but it’s using the body’s own natural propensity towards healing.”

The healing comes from the eyes moving from left to right, across the brain’s hemisphere, similar to the way they behave during REM sleep. The exact science behind the process isn’t fully understood, even by the experts.

At their best, these techniques take between 10 and 15 weeks to produce significant results, and success is largely contingent on the ability of patients to remember their story without getting triggered. “It’s all about getting them into that material,” Dr. Kreimeyer said, “the thing they fear, sharing, processing, working through, making it safe for them to do that.”

Sometimes, however, victims of PTSD are unable to reach that safe place naturally. That’s where MDMA comes in.

MAPS organizes and pays for the majority of MDMA research, which advertises itself as a non-profit pharmaceutical company, focused on making MDMA widely available for the benefit of the public rather than the company. Private donations cover the entire $500 million price tag attached to the firm’s research. And as psychedelics have grown more popular, MAPS has piqued the interest of larger pharmaceutical companies, even receiving offers of financial involvement. Dr. Rick Doblin, who founded MAPS, told attendees of Psych Congress 2019 that MAPS had uniformly rejected these proposals, just after identifying the MAPS research teams as “refugees from Big Pharma.”

MDMA itself is relatively risk-free when taken in controlled doses. Contrary to popular belief, it won’t melt the brain or cause Parkinson’s. In fact, studies show a connection between lifetime use of psychedelics and a lower rate of mental health problems. Dr. Ot’alora has experienced the benefits of MDMA personally, using it as far back as the 1980s, when it was first developed, to help treat her own non-combat related PTSD, which stemmed from a violent sexual assault. “I had really tried lots of different things, and I was really, really struggling,” she said, brushing a grey curl back behind her ear. “It really pointed me in the right direction.”

In addition to releasing large amounts of dopamine and serotonin, which help promote a sense of well-being and bonding, taking MDMA boosts the activity levels in the prefrontal cortex, which is essentially the brain’s main control center. Picture a little person sitting right behind your eyes and calling out orders to the rest of the brain.

Dr. Ot’alora said MDMA allows users to give themselves a sense of feeling that connection “without it being dangerous. You can trust yourself.” With additional energy, the brain is able to think critically about complex subjects and better make decisions. On the other hand, activity is decreased in the hippocampus and the amygdala, where memory and emotions are stored. “It’s still active enough that you can feel fear and that you can feel your emotions,” she said, “but it’s manageable, so it doesn’t send you over the top.”

This means that not only are traumatic memories held at bay, but also the fears that so often weave themselves oppressively through every thought and feeling. “You’re able to really make connections and have your feelings,” she said, “but understand those connections and have insight to recall parts of the trauma that maybe you couldn’t do before because it was too scary and your body had protected you from it.”

It is important to take a moment to resolve the many conflicting names given to this drug. MDMA itself is a chemical compound, created in a lab, and distributed for scientific research with 99.9% purity. It comes in the form of a red capsule, hardly discernible from over-the-counter ibuprofen. The high lasts two to three hours. The comedown is gentle and rolling. When taken clinically, it has no long-lasting effects on cognitive function and there is no evidence that it causes neurotoxicity.

The stuff found on the street is a different story. Molly and Ecstasy, the drugs most often associated with young adults at dance raves, come as pressed tablets, typically with a design like a smiley face or star printed on the front. The pills are made up of a variety of substances, but since they’re pressed into one uniform shape, it is hard to know exactly how much of anything each pill contains. Since 1999, Dance Safe, an organization that tests drugs nationwide, has been analyzing tablets produced by the Ecstasy market. They found that while most of the supply contains high amounts of adulterants that mimic the sensation of being high, hardly any had a concentration of MDMA higher than 10%. Most Molly and Ecstasy on the street market is close to 40% caffeine.

“We’re very clear to say ecstasy is not MDMA,” Dr. Ot’alora said, her gentle tone growing firm. “It can have MDMA, you hope it has MDMA, but what we use is pure.”

The misunderstanding that MDMA is analogous to Ecstasy is harmful not only for the overall image of the drug but also the perception that the participants bring with them into the study.

“We’ve had people that have had Ecstasy before who come into the study and at the beginning, they think the effects are mild,” she said. “But then they realize it just doesn’t have that adulterant.”

The struggle between clinic and street represents the ongoing battle in the world of psychedelics, one that it is fighting only with itself. One side wants to be recognized as a medical tool and the other is just looking for a good time. Both are hoping for legalization.

This internal tug-of-war started in the 1960s when substances like LSD, DMT, and psilocybin mushrooms started to leak out into the mainstream. Up until that point, psychedelics had overwhelmingly been used for medical purposes, starting with the first investigations into mescaline in the 1880s. Each of these drugs, which we now associate with teenage rebellion has therapeutic origins—MDMA started as an appetite suppressant, psilocybin as a treatment for severe depression, and ketamine as a powerful anesthetic. In 1938, when Albert Hoffman first developed LSD, he intended it to be no more than a vasoconstrictor, working to increase circulation in the way that Advil or Tylenol do today. The psychoactive effects weren’t discovered until five years later when Hoffman accidentally ingested a small amount of the drug and started to perceive “an uninterrupted stream of fantastic pictures, extraordinary shapes with intense, kaleidoscopic play of colors.” Despite the vivid hallucinations, further research showed that LSD had hardly any effect on the human body. Blood pressure would rise and pupils would dilate, but in the end, it was deemed safe for human consumption.

Even the US government started to take an interest. In the 1950s and 60s, federal agencies spent millions on research into the possible use of psychedelics as a tool for warfare.

But as word got out, the drugs were close behind. No one person, place, or thing can be blamed for this release—lots of small drops happened across the country. Allen Ginsburg was a participant in one of Stanford’s clinical trials for LSD in 1959. Ken Kesey joined the CIA’s MKUltra program to try and make some extra money the same year. Timothy Leary left Harvard in 1963, taking his work on psychedelics with him to start the League for Spiritual Development. And all the while, stirring in the background, a generation of young adults was growing eager for an opportunity to tune in and drop out.

By 1965, more than two million Americans had taken LSD, and none of them was getting it from a physician. Just as quickly as the drugs spread, the narrative started to change.

And then came Nixon.

I’m not sure if my skepticism around American drug policy is because I grew up in the town that legalized weed before the rest of Colorado, or because I’ve spent the better part of my life watching the people closest to me struggle with addictions to legal drugs like alcohol. Maybe it was the conversation I had with my dad when I was 10 about how cigarettes were only legal because tobacco companies could afford such good lawyers. And then I found Dan Baum, the journalist behind Smoke and Mirrors: The War on Drugs and The Politics of Failure.

Dan originally agreed to meet me at a cafe downtown, but a storm has started to come in from the south and Boulder was bearing the brunt.

“I am being strongly advised not to ride my bike to the cafe,” he informed me apologetically via email. We rescheduled, with a plan to meet at his house in case the weather decided to act up again. The following week I arrived in a neighborhood adjacent to one I used to explore in high school. My friends’ boyfriend has lived a couple of streets over and she used to brag about how his block had the best Christmas lights in town. I passed them on my way to Baum’s, but in late January only a few were still on display.

I knocked on his door and was greeted by tired eyes and a kind smile. He wore a handknit beanie that had slightly outstretched his head, its edges now resting on the tips of his ears. I caught him in the middle of some writing he was doing for his memoir, Baum explained as he quickly shuffled the papers on his desk into neat piles. It would be his fifth book. Smoke and Mirrors was his first.

He started reporting on drug policy almost by accident. Baum and his wife were living in Missoula, Montana, when the DEA raided the town, arresting half of the citizens on drug charges. But the real turning point was an interview Baum had with John Ehrlichman, one of Nixon’s top aides during his presidency, with a special focus on domestic affairs.

“The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people,” Ehlichman told Baum in 1994. “You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

With the medicinal origins of psychedelics long forgotten, Nixon designated LSD, psilocybin, and marijuana as Schedule I narcotics. This meant that not only were they now considered as dangerous as heroin, but were also categorized as having no medical benefit and a high risk for abuse. Psychedelic research ground to a halt.

“What governments do, is they identify things they want to do, they identify the solution first, and then they manufacture the problem to justify the solution,” Baum said, leaning forward in his chair. “This thing has always been about wanting to do certain things and using drugs as the justification.”

When MDMA came onto the scene in the early 80s, Ronald Reagan took the same approach. In the two months it took for MDMA to reach the public, most often in its adulterated form of Ecstasy, publications went from praising its safety and labeling it “not a party drug” to criticizing its dangerous potential for abuse. It was classified as a Schedule I drug in 1985.

“Political tools that work are tough to pry out of the cold dead hands of cynics and those who would use fear and cultural warfare to get what they want,” Baum said, scratching his unshaven face.

There is a concept known as pharmacological determinism which essentially boils down to the belief that drugs do what we are told they do. “Bad” drugs are menacing and dangerous, melting your brain and triggering the unprecedented urge to run through the streets. High long-term risk, high short-term reward. “Good” drugs are safe and restorative. The assumed risk is similar to that of a gentle hug and a bowl of chicken noodle soup. The reward is banal. But when the federal government spends over $1.7 billion annually to enforce the biased boundaries of these two rigid categories, there is little incentive for the citizenry to take a closer look.

Even if people did, it would be hard for them to get much of a view. I took a social neuroscience class my junior year. I walked in on the first day and convinced myself that I wasn’t as nervous as my shaking leg and sweaty palms were trying to tell me. I figured I’d learned enough during my previous years in the psychology department, seen enough charts, heard the terms thrown around enough, that the transition into a more complex view of the brain would be relatively smooth. I was wrong. The brain is a winding mess of grey mush that even the foremost experts in neuroscience don’t fully understand. Every part has its name, but without knowledge of Latin, the name won’t help much in describing its function. Throw drugs into the mix and the roles become even more complicated.

It’s not enough to say that certain drugs make people happy and others change their worldview. Ambiguity leads to misinterpretation and misunderstanding, which in turn leaves people vulnerable to external propaganda. This was the case in the early 2000s, when a wave of disinformation swept across the nation and prompted a mass Ecstasy scare, complete with a PBS documentary and an Oprah segment. Science, the peer-reviewed magazine, published the study that started the panic, leading the pack of Ecstasy horror stories with gorey scans of hole-ridden brains, but later retracted it when its researchers disclosed that they had been testing Meth, not Molly.

Despite their government labels, the “good” drugs are still not risk-free. But even now, in the midst of the worst drug epidemic the US has ever seen, this messaging has proven difficult to overcome.

At the center of it all are the 68,000 veterans who find themselves disproportionately vulnerable to opioid addiction and overdose.

The origins of the epidemic can be traced to the 1990s, when a new narrative around pain management emerged in medicine. Doctors learned that not only had they been undertreating pain, but they had failed to identify pain other than in its most extreme forms. The approach overlooked chronic and acute pain almost entirely. With this came the introduction of what the American Pain Society deemed the “fifth vital sign.” Pain was finally given the attention it demanded, even gaining its own picture-based measurement scale where smiley faces become progressively more contorted and distraught. Pharmaceutical companies lied to the VA, as they did to other healthcare providers, about both the effectiveness of medications they were selling and how addictive they could become. Doctors, afraid to fall back into the habit of undertreatment, quickly became vulnerable to pharmaceutical propaganda.

In the military community, what followed was nearly a decade of reckless overprescription. The “endure and overcome” mentality around treating pain carried over from the days of basic training, pushing soldiers in the direction of seemingly easy solutions that would allow them to get back into the world as quickly as possible.

“The way pain was addressed is that you suck it up, Buttercup,” said Tony Drees, an Army vet. “You have to be superhuman just to exist, just to hold on.”

I met Drees on his way back from a day of skiing. It was late in the afternoon and most of the coffee shops in Boulder had closed so we decided to conduct the interview in the parking lot of a Thai restaurant near the turn-off for the highway. He pulled his car up next to mine and lifted himself into my passenger seat, adjusted his weight, and checked his reflection to ensure his Purple Heart baseball cap didn’t shift in the process. His service dog Diva, a salt-and-pepper Italian mastiff, hung her head out the back window to keep watch.

Drees enlisted in the Army in 1986, right out of high school. “The military was amazing to me,” he said. “I felt like I belonged there.”

After serving four years in Germany, Drees moved back to his home state of North Dakota where he hoped to take advantage of the G.I. Bill and study aeronautical engineering at a local university. Less than a year in, however, his plans changed. He got called back to serve, this time in Iraq. Shortly after arriving, the tank Tony was driving exploded, spraying his leg with shrapnel. “I got hit with the deadliest missile of the Iraqi war,” Drees said. “And that changed everything.”

Drees had never been a pill guy. He did a bit of drinking and smoking when he was younger, but his pill use never went further than tossing back a couple of Advil with some water.

“After I got injured, I stayed awake the whole time,” Drees said. “It wasn’t until after they got me in the hands of a nurse that I said, ‘Can I pass out now?’ And then, when I woke up, I went four days without any pain medicine.”

When Drees expressed his concerns about using painkillers, recalling the fraught experiences of Vietnam-era soldiers with morphine, he was met with well-spun fiction. The doctor told him, “first of all, we don’t really use morphine-like that anymore, we use some other stuff that’s less addictive, it’s more synthetic,” Drees said. “And second of all, with your personality style, you’re not the type to get addicted. And both of those were bullshit.”

His poison was Versed, a prescription anesthetic in the benzodiazepine family that Drees obtained at $1,000 a gram. The dependency that started that day in 1992 followed him off and on through 74 surgeries, marriage and the birth of his four children. It reached its peak when, in 2017, Drees was told that the shrapnel in his leg had caused cancer to develop, and it was starting to spread.

“It was gonna kill me or I had to get my leg cut off, and I wasn’t ready yet,” Drees said. “I was on all of them again. When it was time to clean up my space and get ready to throw all these pills away I had 17 bottles. And then they sent me a letter that said ‘We suspect you might be at high risk for opioid addiction.’”

Benzodiazepines, which include the anti-anxiety medications Xanax and Ambien along with Versed, are Schedule IV substances, meaning that in the eyes of the Drug Enforcement Administration, they have a low potential for abuse and low risk of dependence.

Col. Bob McLaughlin is the founder of the Mt. Carmel Veterans Service Center in Colorado Springs, the Colorado facility that provides assistance for veterans transitioning back to civilian life. “As a military, we were not prepared for the impact of combat operations for non-physical wounds,” he said. “When I was with the Marines and someone said they had PTSD, people said, ‘What the hell’s that? Dust yourself off and get back in the fight.’”

I met McLaughlin at Mt. Carmel on my last day in Colorado. It was the second and final time I would drive to Colorado Springs and I spent the first half of the trip trying to remind myself where exactly a colonel ranked in the Army hierarchy. It’s the highest rank for field officers, in case you were wondering.

Mt. Carmel sits, appropriately, on top of a hill at the end of a stretch of curvy roads off I-25. The building itself is mostly brick, although five tall sets of windows reach up to the third story, offering an uninterrupted view of the foothills from inside. An American flag swings proudly alongside the flags of Colorado State and each division of the Military—Marine Corps, Army, Navy, Air Force—and one honoring the country’s lost Prisoners of War. Signs with “Reserved for Veterans” and “Reserved for Purple Hearts” are posted in front of every parking spot at the front of the building. I pulled my car around to the back and walked through the glass doors to wait in the lobby.

An older man sat next to me in one of the cushioned chairs and stared blankly at a standee—a tall self-standing poster. The signage promoted Mt. Carmel’s new “Military Matters” sessions which involve the therapeutic use of ketamine, another alternative drug similar to MDMA that is quickly gaining attention. A Medicaid representative sat patiently behind a table next to the front door. To the left, a couple in their late 40s browsed the racks of the Civilian Clothing shop, picking up various t-shirts only to place them back in with the others after exchanging glances. Everyone had on a pair of medium washed jeans fastened tightly around their hips. It pleases McLaughlin that when people come into the building, for treatment or accompanying those who need it, “they can also see all this,” he said, leading me down the hall to his office. “It’s a one-stop center.”

He sat at the end of a long conference table covered with papers, absentmindedly brushing his fingers against a small patch of unshaven hair on his otherwise bald head. The heater hummed softly in the background.

McLaughlin started Mt. Carmel in 2017 shortly after retiring from the Army after 25 years of service. “We needed somewhere for veterans to have a place to go,” he said. “They want to go to someplace that cares about them and they don’t necessarily, in many cases, trust the institution like the VA.”

He modeled the center on the systems he helped put in place at Fort Carson, the army base located on the southern edge of Colorado Springs. During his eight years as Fort Carson’s garrison commander, he observed a dramatic change in the way mental illness and PTSD were understood. Having psychological issues no longer carried with it the image of visits to the psych ward on the seventh floor—now senior officers, stigma-free, could be seen strutting around the compound alongside their service dogs.

“We created an environment where it’s accepted, that if you are dealing with something, you’re getting the counseling that you need, you can still lead and do your thing,” he said, lowering his voice slightly as the heater clicked off.

When he made the decision to retire, McLaughlin wanted to make sure the same resources were available for veterans. “I personally had a stable family, a house, a job, and yet I felt the impact of transition,” he said. “So I thought to myself, ‘Okay, I’m a senior guy, I’m going through transition, I’ve got to make sure that everybody that we touch gets what they need, because they may not be as resilient as I am.’”

And while Mt. Carmel is not directly associated with the VA, its staff tries to work with the federal system as often as possible, coordinating appointment times and stepping in when needs go unmet. Because Mt. Carmel is not a part of the VA, it has more freedom to explore and employ alternative therapies. When I asked McLaughlin about the ketamine poster in the lobby, he paused for a moment.

“Very controversial,” he said, nodding his head slowly. “In the last three years, it’s become more mainstream, and people are accepting it. I’m not saying I took a risk, but I understood if it was a viable option, and people were using it, and it was administered in a professional manner, and it was safe, then why not?”

Unfortunately, the same freedom is not widely available to others. Mt. Carmel is one of only four centers of its kind nationwide, with the others in Denver, Houston, and San Francisco.

Outside of those four cities, there are few opportunities for veterans to seek alternative treatment. Congressional control over the VA restricts access, including to prescriptions for medical marijuana since it remains illegal at the federal level. Veterans have long relied on marijuana for the treatment of both physical and mental pain, which has repeatedly been successful in relieving chronic conditions and lessening the effects of mental illness. However, if veterans are also on medication to treat opioid dependence, such as methadone, for which the VA is a provider, they run the risk of losing access if they test positive for cannabis.

“The problem is that it’s a federal system,” said Suzanne Gordon, author of Wounds of War: How the VA Delivers Health, Healing and Hope to the Nation’s Veterans. “There’s a lot of VA and pain people who would love to prescribe those things but they’re just not allowed to.”

These barriers have similarly stopped the VA from encouraging the use of MDMA-assisted psychotherapy as a treatment for PTSD. If the intention is for MDMA to reach everyone who needs it, it would first have to be legalized nationally.

Dr. Ot’alora said MDMA may well be on its way to federal approval. “We need to finish Phase 3 and see,” she said. “The FDA might say, ‘Oh, you know, we want you to treat a few more people or you don’t need to treat anymore, and then we can start that process of applying for it to become a medication.’”

Back at the Rink, Phase 3 is where all of the last issues get ironed out. The formula for the medication gets locked down, the time spent at the clinics is set, the therapy technique is perfected. Researchers still pay attention to safety and efficacy, the two main focuses of the Phase 2 trials, but they’re acting more directly with the finalized prescription in mind. Though MAPS originally planned for this process to be complete by the end of this year, with legalization certified by 2021, the timing has shifted a bit.

MAPS founder Dr. Rick Doblin outlined the new timeline: “We think by the end of 2021, we’ll have all the data that we need, and then we hope to have it approved by 2022,” he said to an eager audience at a meeting of the Brooklyn Psychedelic Society earlier this spring.

MDMA is not the only psychedelic undergoing a research resurgence. LSD trials are happening in Chicago and Basel, Switzerland. At facilities across the US, ketamine is currently in clinical trials, and the FDA recently designated psilocybin a breakthrough therapy, as they did with MDMA in 2017.

Last summer, Denver became the first city in the United States to decriminalize psychedelic substances, specifically psilocybin mushrooms. Since then, Oakland has followed suit, with Portland, Dallas, and Washington D.C. close behind. But because MDMA is meant to be used in tandem with psychotherapy, requiring it to be an FDA-approved medicine, it can’t be legalized on a state-by-state basis.

Even if MDMA is legalized, it’s likely never to be available as a take-home drug. Instead, it would be offered in psychedelic clinics where patients take the drug under the direct supervision of a trained therapist before sitting down for their session. And these clinics won’t be restricted to MDMA. Doblin said the clinics “will end up being where ketamine is offered, MDMA is offered, and eventually psilocybin is offered.”

MAPS recently received FDA approval to operate with expanded access, a form of testing that happens alongside Phase 3 but without a control group.“Everybody who volunteers gets MDMA,” said Doblin, prompting a joyful stir in the crowd. “We’re just now choosing 10 sites around America where expanded access will take us, focusing on cities where we don’t already have Phase 3.”

As MAPS continues to produce positive results, Dr. Ot’alora and the rest of the MAPS researchers remain hopeful that MDMA’s legalization is imminent.

“When that time comes, if we can say, “Oh my gosh, MDMA is a prescription medication for PTSD’, that would be amazing,” Dr. Ot’alora said, her soft smile growing wide. “It’ll have a name, and a label, and side effects. I keep wanting a side effect to be increased empathy.”