When Tony Macie returned from Iraq in 2007, he knew deep down something was wrong. The former Army sergeant, who served 15 months in Baghdad as a scout, struggled to readjust to civilian life.

“In Iraq I had to be hypervigilant, five steps ahead. Back home, I was still in the mindset for combat and my brain wouldn’t shut off,” he said. “I wasn’t sleeping, looking at everyone as the enemy.”

Macie went back to college, but his nervous system was stuck on high alert. He was irritable, moody and sometimes paranoid, reliving memories of buddies dying in combat. He drank heavily. He swallowed five or six pills at a time—oxycontin, Xanax prescribed by military doctors, and painkillers for his back injury. He stopped showing up for class.

He was formally diagnosed with post-traumatic stress disorder, or PTSD, but it would take him years to admit it. “At that point I was taking so many different drugs, I was zombied out. Looking back, I was actively seeking help,” he said.

Macie is far from the exception when it comes to combat-related PTSD. Since October 2001, approximately 1.8 million U.S. troops have been deployed to Afghanistan and Iraq, of which 20 percent are estimated to be suffering from PTSD. As PTSD is notoriously difficult to assess, diagnose and treat, the numbers could be much higher. A 2009 National Center for PTSD report states 41 percent of troops have chronic symptoms.

Macie tried therapy, but nothing worked. Then he discovered a clinical trial lead by Michael Mithoefer, using MDMA-assisted psychotherapy to treat chronic PTSD. MDMA is the active ingredient in Ecstasy, the popular dance drug. But due to controversial publicity over the decades, its credibility as a therapeutic tool has largely been ignored.

Macie joined the trial, and after only one session, stopped taking his meds. “It was a paradigm shift. I want all vets to have the same tool at their disposal.”

Macie isn’t alone. An increasing number of researchers, scientists and therapists who recognize MDMA’s beneficial use are pushing to medicalize it, seeing it as a viable option for those suffering from PTSD. Yet the military is slow to catch on due to MDMA’s decades-old stigma as an illicit substance. (The only place MDMA is mentioned on the US Department of Veterans Affair’s website is under substance abuse for veterans with HIV.) Macie, among others, is pressing for the military to overcome its institutional fear of MDMA and opt for a drug policy that helps heal its veterans.

Emotional Reaction

While MDMA is widely associated with the global electronic dance subculture that swept the '80s and '90s, and the image of blissed-out ravers waving glow sticks, the drug has a longer history. Before MDMA was classified as a Schedule I controlled substance in 1985, it gained traction in therapy circles for what psychiatrists and psychotherapists saw as its most salient effect—not euphoria, but empathy.

“MDMA induces powerful empathetic states and in a therapeutic context, this is a strong, positive predictor of a therapeutic outcome,” said Charles Grob, director of the Division of Child and Adolescent Psychiatry at Harbor-UCLA Medical Center. Grob, a longtime researcher of hallucinogenic drugs, received the first FDA approval to conduct MDMA research in 1992.

Grob’s research was sponsored by Santa Cruz, Calif.-based Multidisciplinary Association of Psychedelic Studies, the world’s only organization funding clinical trials of MDMA-assisted psychotherapy. MAPS is undertaking an ambitious eight-year, $18.5 million plan to make MDMA into an FDA-approved prescription medicine by 2021.

“What MDMA seems to do is decrease fear and defensiveness, which helps sufferers connect with their feelings without being overwhelmed,” said Michael Mithoefer, a psychiatrist practicing in Charleston who specializes in PTSD. MAPS also funded Mithoefer’s trial.

Mithoefer explains how MDMA works: the drug acts by quieting the amygdala, considered the brain’s fear center, while serotonin and dopamine (neurochemicals associated with pleasure) surge in the frontal cortex, promoting feelings of openness and therefore, safety.

One of the primary reasons traditional therapy doesn’t always work treating PTSD, Mithoefer said, is that patients are either overwhelmed by anxiety or emotionally numbed out, making it difficult to confront their pain. The irony is vets often feel too stigmatized or frightened to seek help, yet once they do, frustration and resistance sets in.

“Soldiers are quite vulnerable. What they have witnessed or done is overwhelming and when overseas, they’re not in a safe place to examine those feelings,” said Grob.

MDMA does two things. One, as an empathogen, it engenders trust between patient and therapist, lowering emotional barriers and kickstarting the therapeutic process. Two, MDMA, according to Grob, “has the uncanny facility to allow people to put their feelings into words.” Repressed feelings can lead to serious psychological damage. But expressed feelings can help shift perspective and heal.

This was what Macie experienced.

“MDMA grounded me. I was able to feel sadness and loss without blocking them out. It made me realize I had real issues to deal with, that I was stuck in a cycle that would only get worse. It brought back trust in me, which I had forgotten along the way.”

Rick Doblin, MAPS executive director, said, “MDMA is uniquely capable of opening people up, reducing fear and dealing with suppressed emotions; it stimulates oxytocin, which enhances nurturing, bonding love, forgiveness and acceptance. These are core aspects of being human.”

The Effects

While the effects of MDMA can include feelings of love, empathy and euphoria, within a therapeutic setting it’s not all bliss.

“Euphoria? I wouldn’t use that word,” said Macie of MDMA. “To me that means being irrational. I was the clearest I ever felt in my life, able to process whatever came up. I learned that though some memories are awful, you can always learn from them. I now feel like I’m constantly evolving.”

Perhaps it’s MDMA’s ability to dig deep but gently into the psyche, flooding the brain with compassion, that makes it so highly effective. In MDMA-assisted psychotherapy, MDMA is only administered a few times. In Mithoefer’s 2010 study, a pilot phase II clinical trial with 20 patients with chronic PTSD, 80% of participants no longer qualified for PTSD, though many had suffered an average of 19 years.

“From a clinical standpoint, this is a very appealing model,” said Mithoefer, who explains that because no drug is without toxicity, taking a substance a limited number of times, rather than on a daily basis for years, as with antidepressants, decreases that concern. “We think it’s very safe to use in this way. MDMA seems to act as catalyst that gets at the root of the problem. Once you get to the root, you don’t need the drug anymore.”

The Military’s Approach

In sharp contrast, the military is heavily reliant on prescription drugs to treat PTSD. According to the Department of Veterans Affairs, 89% of suffering veterans are treated with antidepressants like sertraline (Zoloft) or paroxetine (Paxil), the only two FDA-approved SSRI (selective serotonin reuptake inhibitor) medications for PTSD.

But being FDA-approved still leaves a lot to be desired. Take the case of the antipsychotic Seroquel, manufactured by the biopharmaceutical company AstraZeneca, which sold $340 million worth of prescriptions to the Armed Forces by pushing it as a sleep aid. AstraZeneca was sued for promoting the drug’s unapproved use (among others, to children and the elderly,) and had to cough up an estimated $1.9 billion to defend and settle personal injury cases and government investigations—peanuts considering that number represents less than five months of Seroquel sales.

Substance abuse with legal substances like alcohol and prescription drugs, (not to mention illegal ones), is widespread and playing an increasing role in military suicide. A 2010 report of the Army Suicide Prevention Task Force found that 29 percent of active duty Army suicides involved alcohol or drug use; and in 2009, prescription drugs were involved in almost one third of them. On average, 22 veterans commit suicide each day.

Clearly, it’s not working to numb mental wounds with prescription drugs while underlying issues fester unaddressed. And the costs are mounting as the military is throwing heaps of money at PTSD. The Veterans Health Administration spent $2.2 billion on patients with PTSD from 2004-2009.

According to MAPS spokesperson Brad Burge, there’s a waiting list of more than 400 veterans for Mithoefer’s next study.

“Once [veterans] learn about MDMA, their need for better treatment is so severe that any resistance [to the drug’s legal status] has gone away,” he said.

Decades of Stigma

While PTSD-suffering veterans might be lining up for MDMA-assisted therapy, the military is cautious. As long as MDMA stays in the same legal category as marijuana, heroin and LSD—drugs the DEA claims have no accepted medical use—the stigma persists. This is why MAPS hopes that solid scientific research will reverse the tide and clear up decades of misinformation, Burges says.

Interestingly, early research on the use of psychedelics in therapy proved promising. Studies using LSD in the early 1950s— such as in Stern Grove, Maryland, where alcoholics, neurotics and terminal cancer patients participated— showed that while LSD could be unpredictable, as a treatment it was greeted enthusiastically by patients and staff alike.

By 1965, over 2,000 papers describing positive results for 40,000 patients who took psychedelic drugs had been published.

Overseas in the Netherlands in the 1960s, psychiatrist Jan Bastiaans used LSD and psilocybin to treat concentration camp survivors suffering from symptoms we would now identify as PTSD. Unfortunately, Bastiaans had an unsystematic approach and never evaluated his work. But his theory was that a person could only be free once he embraced his trauma; otherwise, he was stuck in a mental concentration camp.

In the late 1960s, the widespread recreational use of LSD fanned fears of misuse and the government clamped down, making psychedelics illegal. Scientists distanced themselves. The pattern repeated itself with MDMA.

“It's odd that once some substances are seen as recreational, they're perceived as having no possible medicinal value—the same isn’t true for benzodiazepines, morphine or amphetamines,” said Joost Breeksema, president of Open Foundation, an Amsterdam-based organization devoted to stimulating research into psychedelics. “But so far, this has been used to justify banning studies on MDMA and classic psychedelics, even though indications of their potential value have been there since the fifties.”

Breeksema thinks the mistrust of psychedelics is due to the profound nature of the experience. “The taboo is not just on psychedelics, but on altered states of consciousness in general, at least in Western societies.”

Grob, who is currently investigating the effects of psilocybin on anxiety in cancer patients, attests that altered states lead to greater healing. “MDMA or psychedelics are not for everyone. They offer a powerful visionary experience,” said Grob. “A lot people would rather take daily antidepressants opposed to doing deep inner reflective work. But a mystical level experience seems to be profoundly healing.”

Funding Issues

“Our main challenge is fundraising. It’s the persisting stigma and residual fear attached to MDMA that make major foundations reticent to wholeheartedly embrace it,” said Burge. MAPS is actively funding clinical trials around the globe, in places such as Australia, Israel and Europe, hoping to spread the science of how MDMA works—though an enormous body of research already exists. In the past 25 years, over $300 million has been spent globally looking into the risks of MDMA.

Because MDMA’s patent has expired—a drug cannot be patented twice—it holds no profit potential for drug companies, which profit from exclusive selling rights. So if MDMA does prove effective in treating PTSD, the pharmaceutical industry could lose millions due to lost sales of antidepressants. The pharmaceutical industry is in no rush for that to happen.

“We are a nonprofit drug company,” said Mithoefer. “We would love other people to get involved, share our data and do their own research if they have the money to run forward with it. Ultimately, this is about helping people.”

According to Doblin, MAPS is in discussion with the VA about a possible collaborative study of MDMA-assisted psychotherapy, and while nothing is definite, he is optimistic. “We have the approval of the FDA and regulatory agencies around the world. We understand the risks extremely well and have now reached the point where we can demonstrate its benefits. But it takes time to get momentum. People in the early 1970s thought we were on the verge of legalizing marijuana, but 40 years later it hasn’t happened.”

Still Doblin thinks it’s not a matter of if, but when.

While the tipping point for MDMA-assisted therapy might be in the near future, it’s still far in the distance for those suffering from PTSD right now. Until the military embraces it, Macie believes politics is still trumping science.

“When I went to war, I put politics aside. I went to war and served people. Now that I’m home, politics is getting in the way of treating people. I was lucky. People who know me see the results, they see my life changing.”

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