Breaking Barriers: Why Accessibility Matters in PTSD Treatment Beyond MDMA

Successful and viable medical treatments rest on three fundamental pillars of healthcare – safety, efficacy and accessibility. Post-traumatic stress disorder (PTSD) has become a critical area of need in the United States, impacting 13 million Americans, many of whom are women, along with a notable prevalence among veterans. PTSD develops after someone experiences a life-threatening or traumatic event such as assault, abuse, combat, illness, accident or natural disaster. 

Despite its prevalence, current standard-of-care therapies (SOC) for PTSD often fail many patients. Roughly 50% of patients do not respond to psychotherapy, while medications can have severe side effects. Even when effective, these treatments are out of reach for patients due to inaccessibility. Nationally, only 26.8% of mental health service needs are being met, and over 120 million Americans live in areas with a shortage of mental health care professionals.

As PTSD cases rise, so does its impact on society. The US currently spends an estimated $477.5 billion annually on avoidable and unnecessary expenses related to mental health inequities. Additionally, studies have shown that people suffering from PTSD or other mental disorders are more likely to develop chronic physical health conditions such as diabetes and hypertension, utilize emergency health provisions more often, are less productive in the workforce and are more likely to die prematurely. To alleviate this burden, we must explore innovative treatments that are accessible to all patients. 

MDMA-AT: An inaccessible pipe dream 

MDMA-assisted therapy (MDMA-AT) for PTSD sparked debate, primarily focused on concerns of safety and efficacy. However, accessibility was largely overlooked in the discussions that ensued. But no matter how novel a treatment may be, if it is inaccessible to the millions of people who need it, its relevance becomes insignificant. 

MDMA-AT treatment demands a significant investment of time and money, rendering the treatment inaccessible for most patients. The treatment protocol involves three preparatory 90-minute psychotherapy sessions, followed by a series of eight-hour sessions during which patients receive MDMA. Between each eight-hour session, patients attend integration therapy, amounting to nearly 40 hours of therapy within a 12-week period. 

For individuals like parents, teachers, caregivers, full-time workers or employers, setting aside eight hours for even a single session is demanding. Similarly, the 400,000 first responders in the US diagnosed with PTSD must remain available for emergencies, presenting them with significant barriers to access MDMA-AT. The financial cost of the treatment is equally prohibitive. In the phase 3 trial, treatment costs reached $11,537 per patient, a figure far beyond the reach of the 1.5 million veterans living below the federal poverty line, or the additional 2.4 million living paycheck to paycheck. This becomes even more challenging when factoring in lost wages due to time away from work. 

MDMA-AT presents challenges for clinics due to the formidable operational burden. Treating a single patient requires both the eight-hour time block with potentially overnight stay, as well as two trained therapists to administer the treatment. During this time, clinicians cannot see other patients, cutting into the clinic’s revenue. For smaller clinics with limited staff, the MDMA-AT treatment program is not only unsustainable but financially impractical. With the nationwide shortage of mental healthcare professionals, scaling MDMA-AT for widespread use would be nearly impossible. 

What’s next for PTSD treatment? 

While rejection of MDMA-AT was a disappointment for many, its limited accessibility made the setback less significant than it was portrayed to be. Psychedelics are here to stay. But extensive research is still needed to prove their safety and efficacy, and this will take time. Unfortunately, time is a luxury that many patients with PTSD cannot afford.

In recent years, the mental health industry has increasingly turned to FDA-cleared, neuroscience-based technologies that offer promising alternatives for PTSD treatment. These technologies, which meet all key criteria for efficacy, safety and accessibility, are emerging as valuable tools to fill the gaps in care. For instance, self-neuromodulation received FDA clearance for PTSD treatment and is in clinical trials to evaluate treating other conditions such as major depressive disorder, among others. And this is just the beginning. 

In the face of rising PTSD rates and its far-reaching consequences, innovation in this area is not only an opportunity, but a necessity. Scientists, researchers and medtech innovators have set their sights on developing treatments powered by novel technologies. These treatments should be scalable, cost-effective and easily integrate into existing workflows to help mitigate the mental health professional shortage. With increased investment and congressional backing to support further advancement in the field, we can ensure every American seeking PTSD treatment has access to effective, safe and affordable care, regardless of their location, background or socioeconomic class.

Picture: torwai, Getty Images

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