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Rogers Masson, a 55-year-old veteran and music producer, used to have nightmares. These dreams weren’t occasional, run-of-the-mill sleep disturbances—they were night terrors, and he’d wake screaming.
They happened almost every night for decades. He’d spend the day worrying about them, then drink and stay up late to try to keep them at bay.
Masson was diagnosed with major depressive disorder in 2011, and later a psychologist changed his diagnosis to post-traumatic stress disorder, or PTSD. Masson attributes it to a series of traumatic moments in his life, including the deaths of family members and the violence he experienced while in the military.
What finally stopped the nightmares was not talk therapy or antidepressants, though Masson tried various combinations over the years. It was MDMA-assisted psychotherapy—the use of a drug recreationally known as ecstasy or molly—that finally brought him relief.
“From the age of 19 until I was 54, every single night, I worried about this thing,” he said. “Every single night. I just carried that weight the entire time. And then I was able to put it down.”
The National Center for PTSD estimates that 6 percent of the U.S. population will suffer from the disorder at some point in their lives. Raymond Turpin, a psychologist and the clinical director for The Pearl Psychedelic Institute in Waynesville, where Masson received his treatment, said it’s often underdiagnosed.
“Ninety percent of about everything I’ve ever treated can be traced back to some poorly integrated traumatic experience,” he said.
The medical community has a relatively solid understanding of how trauma impacts the brain. In normal waking consciousness—what Turpin calls “learning mode”—we take in information with our five senses and then, once our experience is categorized and language is assigned to it, it goes to our frontal lobes for long-term, normal storage. This can only happen if our amygdala, the part of our brain that senses danger, allows it. The amygdala is one of the first parts of the brain to receive information from our senses and assess what’s a threat.
Turpin describes it as a “smoke alarm” in our brains. When we experience a trauma, the amygdala shuts down higher-order processing and shifts into survival mode.
“We’re getting ready to either fight, take flight, or play dead,” said Turpin. “All that information that’s coming in is highly charged, emotionally. And all the imagery, the fear, all of this is fragmented because it hasn’t been organized.”
Rather than going through the normal processing, your brain “jams it,” as Turpin put it, directly to the hippocampus—an intermediate processing area for memories, not the place for long-term storage.
“So now you’ve got this information that’s … never been processed, and it’s stuck in an area of the brain that it’s not supposed to be in,” said Turpin.
What MDMA does in the brain is “almost the opposite of what happens in PTSD,” Turpin explains. The medication reduces amygdala activity by up to 95 percent, allowing traumatic material to resurface without the patient experiencing the fight-flight-freeze response.
MDMA also hyper-activates the prefrontal cortex, he said, allowing patients to bring higher-order functions online that should have happened at the time of the trauma.
“So all of this fragmented information has the opportunity to come up and be processed,” he said.
Indexing Trauma
In order to diagnose PTSD and assess its severity, mental health professionals use a single event, known as an “index trauma.” Masson’s index trauma took place in 1989, while he was serving in the 7th Infantry Division of the U.S. Army near Monterey, California.
Masson was out in the field with a medic on the day after the Loma Prieta earthquake, which killed 63 people in the San Francisco Bay Area.
“We’re shooting the shit by this wall and this wall falls on us,” Masson said. “I can’t move. He can’t move. I can’t get to him … I don’t know actually if he died or not, but I think he did because he stopped breathing. They wouldn’t tell me what happened to him.”
To be comfortable, Masson needs a seat facing the door—a hypervigilant habit that he still hasn’t been able to kick. He’s a large man, with thick arms and a shock of white hair. He’s almost always wearing a black shirt and cracking a joke. At first glance, he’s not the kind of person you’d expect to talk openly about his feelings, but he does.
“This is all pretty new stuff for me to talk about,” he said.
When Masson talks about his trauma, he uses the analogy of a locked box, in which each of his traumatic memories is displayed on a shard of glass—a pile of sharp, untouchable pieces in disarray.
“You reach in and it cuts you,” he said. “You want to figure it out and you don’t even know where to start. You don’t even know how to pick it up … I’d want to shut that lid and lock it.”
He struggled for years before he was able to seek help. When he finally received the PTSD diagnosis, it was both a relief and a crushing disappointment.
“It gave me this incredible amount of understanding, but it also told me that I was broken,” he said. “[My therapist] said there is no cure for this. None … the path forward is therapy and medication and that’s it.”
There are two FDA-approved treatments for PTSD: sertraline (known by the brand name Zoloft) and paroxetine (Paxil), both selective serotonin reuptake inhibitors, or SSRIs. These conventional medicines are effective for less than half of the people who take them for PTSD, and Turpin suspects that even that percentage isn’t very accurate.
“I would postulate that most of those folks … it’s not that they get cured from it [with the medications],” said Turpin. “They end up getting enough tools and they do enough work to where they can get out and function.”
It’s been more than 20 years since a new treatment for PTSD has been approved—which is why more clinicians have started to look at 3,4-methylenedioxymethamphetamine, or MDMA, as a viable treatment.
In the late ‘70s and ‘80s, therapists and couples counselors used MDMA legally to treat patients dealing with trauma. In the ‘80s, MDMA also made its way onto the recreational scene as a club drug. In these settings, MDMA could be adulterated or used in conjunction with other drugs, which resulted in overdose deaths. The recreational deaths attributed to MDMA use were often the result of hyponatremia, when the body retains too much water, and hyperthermia, or overheating.
The War on Drugs was already well under way when recreational MDMA became popular, as was the Reagan era of “Just Say No.” Psychedelics like MDMA, LSD, and psilocybin (psychedelic mushrooms) were the subject of widespread misinformation, often implying that they caused serious brain damage.
In 1984, the Drug Enforcement Administration announced plans to make MDMA a Schedule I drug, an extremely restrictive class that regards the drug as having no medical use and possessing a high potential for abuse.
Therapists who had been using MDMA as a therapy tool “went up in arms,” Turpin said. Over the course of several hearings in 1985, a community of health professionals argued that while MDMA may need regulations, it should be available for research.
The DEA administrative law judge Francis Young ultimately ruled that MDMA should be placed into Schedule III—a less restrictive class that makes the drug attainable with a prescription under medical supervision.
But the celebration among therapists was short-lived. John C. Lawn, acting administrator of the Drug Enforcement Administration, stepped in less than six months later and overruled the judge. Thirty-eight years later, MDMA remains a Schedule I controlled substance.
A Little House in Waynesville
Rick Doblin founded the Multidisciplinary Association for Psychedelic Studies in 1986 as a research and educational organization committed to proving the efficacy of using MDMA to treat PTSD. Headquartered in San Jose, California, MAPS has raised more than $140 million for psychedelic research since its inception. In 2014, MAPS incubated Lykos Therapeutics, a drug-development public benefit company, to sponsor and oversee the clinical trials for MDMA-assisted psychotherapy for PTSD.
By 2017, the FDA labeled MDMA-assisted therapy with a “Breakthrough Therapy” designation, a process designed to fast-track the development and review of promising drugs for serious conditions.
When new treatments show promise in this way, the FDA will sometimes approve the medication for expanded access. According to the agency, this allows “a patient with a serious or immediately life-threatening disease or condition to gain access to an investigational medical product (drug, biologic, or medical device) for treatment outside of clinical trials when no comparable or satisfactory alternative therapy options are available.”
In early 2020, Lykos announced that the FDA had agreed to allow 50 patients to be treated using MDMA-assisted therapy for PTSD. Lykos planned to distribute these patients among 10 different treatment sites, with about five patients at each site. More than 120 sites applied to participate, according to a MAPS press release.
Ultimately, the program took place at just two sites: 46 patients received treatment at Sunstone Therapies in Rockville, Maryland, and another four at Waynesville’s Pearl Psychedelic Institute.
“I think they thought if we were crazy or stupid enough to try to do this in rural southern Appalachia,” said Turpin, “then they ought to give us a chance to do it.”
The Pearl Psychedelic Institute, founded in 2021, is located in an unassuming beige house on a quiet backstreet in Waynesville. Hanging ferns adorn a spacious front porch with white rocking chairs, and the front lawn is neat and tidy.
“It had been empty and available for rent for several months and my wife and I kept driving by it thinking it might be a good place to do this,” said Turpin. His wife, Kim, serves as its development director, and the center has a five-person leadership team.
“We felt that it would be best to try and do this work out in a more rural area because those are the folks that typically know the least about these medicines,” said Turpin. “We wanted to bring the work to the frontier.”
Inside, nothing is reminiscent of a clinic: a series of treatment rooms are painted in earth tones with low lighting and furnished with deep, comfortable armchairs and futons. Macrovision images of mushrooms and colorful, wavy paintings adorn the walls. The Pearl also uses its rooms to treat patients with severe depression using ketamine-assisted psychotherapy, a Schedule III drug that is legal for use in a clinical setting.
The Pearl screened a dozen people before they found the first participant who qualified for expanded access, which had stringent requirements for medical and mental health documentation. The first person they approved was Masson.
‘Take You Where You Need to Go’
After he’d been accepted into the program, Masson had to taper off the daily doses of Wellbutrin and Lexapro he’d been taking for more than seven years.
“I had to get off of all of that, which was the scariest and the hardest—mentally and emotionally—the absolute most difficult thing about this entire process,” Masson said. “It was my safety blanket.”
While tapering, Masson felt anger and disconnection, as well as deep disappointment that he’d made little progress with years of medication and therapy.
It felt like all that “was just masking,” he said. “It was like nothing had changed.”
His new treatment protocol began with three 90-minute sessions with Turpin and his professional partner, Kim Skelton, where they develop a sense of safety and trust with the patient and also familiarize themselves with the patient’s trauma.
“We want to understand their trauma history,” says Turpin. “So that we have a context for when things emerge in the medication session.”
Only then did Masson begin his MDMA sessions. He arrived early on a Saturday morning in March for the first of three eight-hour days followed by a monitored overnight stay. In these sessions, the patient is given an 80-milligram dose of MDMA and encouraged to lie down, wear eye shades, and listen to a playlist provided by the therapists.
Therapists sit on either side of the patient during the session. When the patient chooses to “come out”—remove their eye shades and headphones and initiate communication with the therapists—they take vitals like blood pressure and oxygen, and serve as support and a sounding board. But they aren’t drawing the patient’s attention to any particular experience, traumatic or otherwise.
Turpin said the medication sessions rely on an “inner healing intelligence,” a concept popularized by American psychiatrist and psychedelics pioneer Stanislav Grof.
“Deep down, we all know what we need to heal,” said Turpin. “We just can’t access our ability to heal ourselves because of that protective mechanism. What [Grof] realized early on was psychedelics can weaken and, in some cases, temporarily dissolve the ego, and once you get the ego out of the way, the psyche knows where it needs to go to heal.”
Turpin admits this can sound mystical or even unscientific. Masson certainly thought so.
“A big thing that they said right from the beginning is that the medicine—and I did not believe this at all—the medicine is going to take you where you need to go,” said Masson. “I was like, ‘Bullshit.’”
After four hours, the patient is offered a 40-milligram booster if they want to lengthen what Turpin calls “the critical window” for therapeutic healing. The session usually lasts another four hours after the booster.
It was Masson’s first experience with any kind of psychedelic. He was “expecting euphoria,” he said—“Burning Man, rave kind of feelings.”
Instead, he described it as tingling sensations, a “positive hopefulness,” and a deep sense of safety.
“That one medicine session was like 10 years of therapy,” he said. “I was able to get that box, open it up, and when I did, all those shards of glass were complete and I could look at it from every angle.”
Each medication session is followed by three integration therapy sessions, during which the patient and therapists reexamine what came up during the treatment.
“The integration part of it was really where I came to terms with what had happened and why,” said Masson. “That’s where we went deep into talking about what was said, how did you feel, all the things you would have in a regular therapy session.”
In the second and third sessions, patients are offered larger doses of MDMA.
“Most patients felt like the larger dose may have allowed them to go deeper and to also have a longer period in which to do the most work,” said Turpin.
Masson’s treatment was completed in April, and he says that the more time that goes by, the more confident he feels about the remarkable healing he experienced.
“There is this clarity that the MDMA treatment has given me,” he said. “I cannot tell you how much that has changed my life. The further I get away from it, the more confident I am in saying those things.”
It worked. Masson no longer qualifies for a PTSD diagnosis. Neither do the three other patients treated at The Pearl.
Another FDA Setback
Masson’s healing is reflected in the results of the clinical trials—by the end of one Phase 3 study, more than 70 percent of the participants no longer qualified for a PTSD diagnosis. The validity of these results was heavily disputed, though, first in a March 2024 report by the Institute for Clinical and Economic Review, a nonprofit that evaluates clinical trials and drug prices, and then during an FDA advisory panel in June. Lykos announced on August 9 that the FDA had rejected its application for MDMA-assisted psychotherapy for PTSD.
The FDA requested an additional Phase 3 trial, listing concerns that aligned with those raised during the FDA advisory panel.
Of great concern was a 2015 case of sexual misconduct during one of the trials. A patient alleged she was sexually assaulted by her therapist, who openly admitted to the relationship. (There is video evidence of highly inappropriate conduct during the sessions, and it’s unclear why those tapes weren’t screened by MAPS in a more timely fashion.)
“It is an absolutely egregious violation,” said Turpin. “I’m floored that somebody would jeopardize not only the well-being of their patient but also all of the research that’s been done.”
Turpin felt that the advisory committee discussion about the case made it seem “like we’re all at risk for doing that kind of thing because of the nature of MDMA, and I don’t buy that for a second,” he said. “Once you go through the training, you’re well aware of the fact that these sexual feelings can come up…you have to be aware of the nature of the work and be able to have good boundaries.”
Another issue was the matter of “functional unblinding,” meaning that participants and therapists could easily tell who had been given MDMA and who had been given the placebo, and the fact that 40 percent of the study participants had used MDMA illicitly prior to the trial.
“It is difficult to understand the criticisms about the study design and conduct when FDA was closely partnering with Lykos for more than a decade to effectively address these criticisms, especially throughout Phase 3,” said Turpin in a response to the FDA’s decision. He argued that an alternative solution would be for the FDA to provide conditional approval, allowing further research to proceed and making the treatment immediately available to those suffering from PTSD.
The unusual structure and nature of this treatment—a psychedelic medication provided alongside and in conjunction with more traditional therapy—have complicated the approval process.
“They’re not in the business of evaluating therapies,” said Turpin. “They’re in the business of evaluating medications.”
Masson said the FDA decision inspired him to go back and look at his medical records from Veterans Affairs. He found that over a decade of trying to treat his PTSD, he’d consumed 2.6 pounds of antidepressants.
“The mental health crisis in this country is enormous and the status quo hasn’t worked,” he said. “The treatment has remarkable potential to heal those suffering from the devastating lifelong effects of PTSD.”
Both Turpin and Masson say this is just another delay, and approval is inevitable.
Still, “I feel a weight of sadness for those who won’t be saved by this treatment until then,” said Masson.
At the state level, there is still significant momentum in providing more people with access to psychedelics as medicine. Last year, the Health House Standing Committee of the N.C. General Assembly approved the Breakthrough Therapies Research and Advisory Act unanimously, which would allocate $5.4 million to support two psychedelic medicine studies in our state, one for MDMA and one for psilocybin. The bill is in limbo until the state budget is approved, and it’s likely to be addressed in the 2025 legislative session. Gina Giorgio, the director of strategy and development at Students for Sensible Drug Policy and the founder of the NC Psychedelic Policy Coalition, was a driving force in the bill’s creation.
“I still think that a lot of this comes down to proper education about what psychedelics are,” said Giorgio. “We’re trying to fit this newer type of therapy into a western clinical model that I don’t think has supported people’s mental health and healing journey in this way prior.”
The Pearl would not be eligible for these studies, which are designed to take place within colleges or universities. For Turpin, that doesn’t matter; he wants to broaden access to psychedelics as medicine, however that happens.
“This is coming, whether it’s me or the next generation,” he said.
Completing the treatment was significant for Masson in many ways, including professionally. Those pre-selected playlists he listened to? He found them awful, and he’s made it his mission to improve the audio component of psychedelic therapy through his start-up, PsySonics.
“PsySonics is focused on providing the best sound available for ketamine treatment, and soon for psilocybin as regulations rapidly shift,” he said. “MDMA will be the third market we establish once it’s approved.”
Free from the nightmares, MDMA-assisted psychotherapy provided Masson with a new life—one that’s defined by clarity and creativity rather than fear. It’s a profound healing that offers hope to the many who suffer from PTSD, but for now, remains just out of reach.
Emma Castleberry is a freelance writer and reporter living in Asheville. Her favorite day is one spent outdoors followed by lots and lots of food.