Virgil Huston used to struggle to find the motivation to get out of bed every morning.
After his 2004-2005 tour in Afghanistan and Iraq with the National Guard, the 58-year-old from South Carolina suffered from crushing depression and anxiety — symptoms of the post-traumatic stress disorder that plagues more than five million Americans each year, including hundreds of thousands of war veterans.
Although he worked with a therapist at the Department of Veterans Affairs for six years and took "every anti-depressant known to man," he saw no improvement.
"I was desperate," Huston said. "Something had to give."
In January, he read an article about Dr. Michael Mithoefer, a Charleston, S.C., psychiatrist seeking participants for a new study on the effectiveness of using pure MDMA — often incorrectly equated with popular drug known as 'Molly' — in combination with psychotherapy to treat PTSD.
Mithoefer — who works under the umbrella of the Multidisciplinary Association for Psychedelic Studies — showed in a 20-person, 2010 study that 83% of PTSD patients treated with MDMA-assisted psychotherapy were cured, compared to 25% of those treated with psychotherapy alone. A follow-up study in 2012 found that the majority of those treated with the assistance of MDMA remained symptom-free, demonstrating the treatment may have long-term efficacy.
Results from Mithoefer's current study, in which Huston is enrolled, will not be published for several years. And the jury is still out on whether the potential therapeutic benefits of MDMA outweigh its associated health risks.
Huston weighed his options, then picked up the phone. He had his first session in February.
Today — after three day-long MDMA-assisted psychotherapy sessions and weekly non-drug sessions — he no longer exhibits symptoms of PTSD.
"I'm not perfect," Huston said. "But I know this: If there is a silver bullet for curing PTSD, then this could be it."
"Club drug" turned therapeutic tool?
Mithoefer's research shows that the same feelings of euphoria, emotional warmth and empathy that originally made MDMA popular at dance clubs in the 1980s could also give it therapeutic value.
Dr. David Nutt, a professor of neuropsychopharmacology at Imperial College London, said that the goal of any PTSD treatment — with or without MDMA — is to have people re-live and reprocess traumatic events in a safe environment so that they can come to terms with those memories.
Mithoefer said MDMA allows users to reflect on their trauma with emotional clarity.
"They were neither overwhelmed by emotion nor numbed from it," Mithoefer said of the participants in his 2010 study. "It's not just that people get blissed out. The psychotherapy is still difficult and can still be painful, but they have a sense that they can do it."
Huston said his first session wasn't easy: "I was nervous," he said. "I didn't know what to expect."
As he grew more comfortable with the Mithoefers — the doctor conducts sessions with his wife, Ann, a nurse — they moved from discussing the external to the internal, focusing on the processes of Huston's mind during the final session.
"I was more relaxed and trusting than usual," said Huston, who recalled several incidents in Afghanistan and Iraq, including a rocket blast. "But my head was always clear. I knew what was happening."
He emphasized that it wasn't the MDMA that made him better, but the conversation that the drug facilitated. He said the emotional openness that the drug inspired made sessions with the Mithoefers more productive than any previous ones had been.
At a follow-up visit in June, a third-party neuropsychologist declared Huston symptom-free.
More research needed
Brad Burge, the director of communications and marketing for MAPS, said the organization hopes MDMA is legalized for medicinal purposes, as marijuana has been in 23 states and Washington, D.C., by 2021. But scientists on both sides of the debate agree that more research is necessary.
The National Institute on Drug Abuse reports that MDMA users may experience short-term symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness and chills or sweating. The organization warns that on rare occasions, consuming high doses can lead to hyperthermia, which can result in liver, kidney or cardiovascular failure or even death.
Dr. Eugene Kiyatkin, a scientist at NIDA, wrote in an email that his June study in The Journal of Neuroscience disproved the "widespread belief that all of the health complications associated with MDMA are related to chemical contamination."
Kiyatkin's study determined that even moderate doses of pure MDMA can be lethal to rats in conditions that mimic the hot, crowded conditions of concerts. "Pure MDMA can be very dangerous," Kiyatkin said.
He said that although low doses of MDMA had mild effects on rats in solitary, cool conditions, any potential therapeutic benefits "must take into account MDMA's negative health effects."
Mithoefer said the most common side effects seen in a controlled setting with pure MDMA are slightly elevated blood pressure and pulse. He agreed that more research and larger studies are needed.
"Multi-center studies need to be conducted before we ask the FDA for approval," Mithoefer said. "But I think that legalization is very likely if research continues to show same results."
An important differentiation: MDMA vs. Molly
Those on both sides of the MDMA debate agree there's a lot of confusion about what exactly MDMA is.
Media outlets and anti-drug organizations, including NIDA, tend to group MDMA with Ecstasy and Molly without drawing any distinction between them.
But experts say that although Molly was touted as pure MDMA when it hit the market around a decade ago, today it could be any number of drugs.
Harvard Medical School professor John Halpern said Molly is no safer than Ecstasy — which earned a bad reputation in the 1990s as the number of adulterants in the pills increased.
"There's an enormous amount of drug substitution going on with Molly today," said UCLA professor Charles Grob, who conducted the first Phase-1 study of MDMA on humans in 1995. "You have no idea what you're really getting."
The Drug Enforcement Agency reported that only 13% of Molly seized in New York from 2009-2013 contained any MDMA whatsoever, and even then it often was mixed with other drugs. DEA spokesman Rusty Payne said that what is sold as Molly is often Methylone — a dangerous stimulant with hallucinogenic effects — or one of the up to 300 new "designer synthetic drugs" coming out of China each year.
"Molly is not one particular drug," Payne said. "This is a game of Russian roulette when you abuse this stuff."