At the end of 1989, Dr. Madriz was visited by an enthusiast in MDMA therapy
who provided him with 40 capsules of the drug plus books and 2 videos on
its use. The war was very hard then so he waited until January 1990 to try
out the drug. First he tried out half doses on 6 patients, but saw no
effect. Dr. Madriz or his staff did not try the drug themselves.
Next he called in 20 patients - all male soldiers who had previously been
diagnosed as having depression or anxiety disorders such as PTSD. They were
each given a capsule of MDMA simultaneously 1-5 days after admission. This
was administered following their standard hospital procedure - the patients
were simply asked to take the pill without being told what it was, and were
given a standard warning that they may experience giddiness and blurred
vision. There were about 8 staff present.
The first evaluation was made one hour later. Half said they felt better
and half reported side effects. 15 of the group spontaneously came together
and hugged one another, talking emotionally about how they wanted peace and
an end to war. They were relaxed, felt good, but not euphoric. They were
very communicative both to staff and to each other. Some praised the
doctors; others said they felt love for everyone, even their enemy. They
wanted a lot of attention from the staff, but were easy to deal with. There
was no come down; the effects wore off so gradually they didn't notice and
they felt positive for many days.
However, 5 separated themselves from the others. 2 of them panicked as
though they were reliving the trauma and were given tranquillizers; one was
at first paranoid as though he was being tricked. Of these, 3 were
depressed.
Second evaluation was made 5 days later. 2 had dropped out; 13 were better
of which 7 were regarded as needing no further treatment and were
discharged, while the remaining six were treated for side effects such as
tachycardia and anxiety. 5 were worse; 2 needing tranquillizers. Two were
suicidal. One of those who were not improved had become an alcoholic as a
result of his depression. Dr. Madriz and Sandino believed the symptoms
expressed were latent before the MDMA was administered.
Dr. Madriz regarded this trial as encouraging but not scientifically
significant. He introduced me to Dr. Estella Sandino who was present at the
first trial, and she added supportive comments (she was obviously also very
impressed by the effect of MDMA).
I asked why the patients were not informed what they were being given. Dr.
Madriz replied that the normal practise in Nicaragua was that doctors gave
medication and that patients accepted without question. They tended to be
uneducated, and if asked, might become suspicious which could influence
their response.
I also asked to interview some of the patients, but was told that they were
from distant parts and would be difficult to trace, most probably having
been discharged from the army due to their condition.
Dr. Madriz was now ready to start a scientific, double-blind trial with 100
patients, and he showed me 2 signed and sealed letters of authority from
the hospital heads. He was adamant that no other permission was required
since the government was independent from the army. He also showed me a
well-produced preliminary protocol (in Spanish) which I was impressed
appeared to comply with all of Dr. Grob's requirements except for Informed
Consent and Independent Review Board. There would be pre- and post-
physical tests; screening to choose patients with an identifiable problem;
standard diagnostic interviews; exclusion criteria; psychological
personality tests (MMPI and Beck Depression Inventory) before and after;
psychiatric clinical evaluation and consistent structure of sessions.
My overall impression was that Dr. Madriz is both able and keen to carry
out an acceptable trial, but that he needs considerable assistance from
outside. Fortunately he welcomes not only financial help but advice also,
as was shown by wanting a visit very soon from Dr. Grob. He appeared
unaware of the international legal situation, but may be able to get
government approval. He was not keen on the idea of obtaining informed
consent, but this may be a cultural difference.
Dr. Madriz says that this is the right time to do the trial; there is less
pressure so the hospital and staff have capacity. He has 12 years experience
of dealing with PTSD cases and has presented a paper on the subject in
Caracas (which says that the symptoms of PTSD manifest more when the
victims have poor support from family and peers).
The title is to be Efficacy of MDMA on Patients with Psychiatric
Manifestations After a Trauma. It will consist of 5 monthly groups of 20
patients, half receiving placebos. Follow-ups will be at one, three and six
moth intervals and altogether it will take exactly a year. The cost will be
some $16-18,000 and in addition he will need visits from experts;
literature on use; biochemical information; supply of MDMA; details of
other research. Also a fax machine, mobile phone and Video 8 tapes.
I expressed concern about those patients in the preliminary trial whose
symptoms became worse and were given sedatives or tranquillizers. Dr.
Madriz said that they were particular character types that he felt that he
could exclude from the trial.
As an example of the type of patients suitable for treatment, I was shown a
video of a diagnostic interview between Dr. Madriz and one of his PTSD
sufferers. The soldier had been travelling with his wife when guerillas
ambushed them. They were stripped; the wife brutally raped in front of him;
he was tortured by beating and having his hair burnt off and a piece of
flesh bitten out of one cheek, then was told that after he was beaten to
death his wife would be further raped and then killed. Dr. Madriz told me
that, after 15 years of war and bitterness, there were many such cases
awaiting treatment.
I also asked if he had experienced MDMA. He had not, but intended that he
and his team should take it together before the trial. I suggested that
they could learn more from this event if an MDMA-experienced therapist was
present.
