In the cold dark streets with tears streaming down his face, he sought them out, but he was really in search of something more solace from the post-traumatic stress disorder hed acquired while serving in a combat zone in the United States Army.

Until recently PTSD wasnt well understood. Until very recently it wasnt taken seriously. There werent many options for people like Lubecky, who had been home from Iraq for less than 60 days.

When Lubecky finally found the bells of Sacred Heart, the century-old neo-gothic cathedral was so full that he was turned away.

He lingered near the North Carolina Veterans Monument for a time, staring up at the solitary white obelisk of Mt. Airy granite topped by a dark bronze Lady Liberty hoisting a tobacco leaf high above her head.

He was trying to figure out the best way to kill himself.

Something from his training popped into his thoughts, so Lubecky hopped in his car and drove to the Womack Army Medical Center at Fort Bragg.

He told them he wanted to take his own life.

They gave him six Xanax and said not to take them all at once or he would succeed.

Instead Lubecky drove home, downed a fifth of vodka, put a Beretta to his temple and pulled the trigger.

More than 15 years later, an estimated 22 American veterans still commit suicide each day as thousands more are left searching for something Jonathan Lubecky couldnt find on that Christmas Eve.

Stigma associated with seeking mental health assistance and a general lack of education about PTSD both contribute to the death toll, as do palliative treatments that dont nearly help all of the people all of the time.

That may soon change, and Western North Carolina is at the tip of the spear thanks to a promising new treatment that involves an overlooked psychedelic compound called MDMA.

Jonathan Lubecky, seen here outside the White House in 2019, continues to advocate for increased access to psychedelics like MDMA for PTSD patients. Donated photo

Miraculously, Jonathan Lubecky didnt die on Christmas Eve in 2006. A manufacturers defect in the cartridge prevented the round from leaving the barrel.

You still get a bang, Lubecky said. And I did it in front of a mirror. I thought I was dead. And I was like, This is what dead is?

Born in Ohio, Lubecky reported to Marine Corps Recruit Depot, Parris Island nine days after graduating high school in 1995 and served as a C-130 loadmaster until he left the Marines in 1999. He returned after the Sept. 11 terror attacks, and was sworn into the North Carolina National Guard three days after the initial invasion of Iraq in 2003.

Iraqs Balad Air Base, where Lubecky was stationed in 2005 and 2006, was the target of thousands upon thousands of mortar attacks. Each and every day, Lubecky said, the dry desert air rained steel. Sirens blared. Soldiers scrambled. Defensive weapons roared as explosions peppered the base, leaving the distinct smell of cordite wafting over them all.

Theres also one specific incident Lubecky doesnt want to talk about.

Then, as he prepared to return home in late 2006, his life rapidly became a country music song.

His wife took their dog, sold his motorcycle and moved in with another man, leaving him only an empty house in Sanford, not far from Fort Bragg.

Occasionally you could hear helicopters flying overhead or impacts from artillery. When I started hearing those and they werent there, he said, I realized I was starting to have a problem. Things devolved rapidly from there.

Thats what led Lubecky, weeks later, to that lonely Christmas Eve at the bar and the church and the monument and the hospital and his face in the mirror with a gun against his head.

It was his first suicide attempt, and hed try four more times over the next eight years, all the while still searching.

They had me on I think a total of 42 pills a day for mental health and chronic pain and stuff like that, said Lubecky of his experience with the VA. And then on Nov. 4, 2013, I slit my wrists, which was my final suicide attempt.

The history of ineffective treatments for PTSD parallels the history of PTSD itself. First described by the ancient Greeks, PTSD has been known for millennia by different names shell shock, war nerves, combat neurosis, soldiers heart.

Its not limited to combat veterans or veterans in general and can affect anyone whos been through acute or chronic trauma, be it emotional, physical or sexual.

Roughly 12 million Americans are walking around with PTSD in any given year, according to the U.S. Department of Veterans Affairs .

Civilians experience comparatively less trauma than members of the armed forces. Studies from the VA suggest that 15% of Vietnam veterans, 12% of Gulf War veterans and somewhere from 11-20% of veterans from operations Iraqi Freedom and Enduring Freedom have PTSD.

In 2019, about 17 civilians per 100,000 committed suicide, while the rate for veterans was closer to 27.

Jonathan Lubecky may have continued on his path to becoming one of them, but after his last unsuccessful suicide attempt, someone at the Charleston VA slid a folded up note across the table, told him not to tell anyone about it and not to open it until he got home.

Published data suggest that MDMA has value as a post-traumatic stress disorder treatment. Multidisciplinary Association for Psychedelic Studies infographic

In his Waynesville office, the bearded, bespectacled Dr. Raymond Turpin sits behind a modest desk piled with papers, folders and a webcam. The place screams calm, with soothing natural light streaming through the partially drawn window shades, casting sepia hues over the rich wood trim.

Strewn about the high-ceilinged room are several chairs and couches where patients of the Pearl Psychedelic Institute come to discuss their trauma with Turpin.

A Georgia native, Turpin was an advertising major at the University of Georgia in the mid-1980s until he had his first encounter with psilocybin, the active ingredient in hallucinogenic mushrooms. The experience led him to change his major to psychology and earn a masters degree at West Georgia College, and then a PhD at the California Institute of Integral Studies. He moved to Waynesville in 2001.

All along, Ive been interested in psychedelics as medicines and being used for mental health treatment, Turpin said.

Psychedelics are a class of compounds that trigger dramatically altered states of consciousness. Natural psychedelics like peyote and psilocybin have been known to humans for thousands of years and were sometimes utilized in religious or spiritual ceremonies.

Recreational users also consumed them for the pleasant physical and emotional effects they can produce, alongside auditory and visual hallucinations.

More than a century ago, the pharmaceutical industry began to study these compounds and isolate or synthesize new ones, hoping to find some commercial use for the relatively potent substances.

Swiss chemist Albert Hoffman first synthesized LSD in 1938 but experienced the psychedelic effects firsthand on April 19, 1943 now called Bicycle Day , because of Hoffmans interesting ride home from work. Bicycle Day is also recognized as the dawn of the modern psychedelic age.

Wayne State University professor Dr. Calvin Stevens invented ketamine in the early 1960s, which ended up being a go-to surgical anesthetic on the battlefields of Vietnam. Now, its an FDA-approved nasal spray that treats depression.

MDMA, discovered by Dr. Anton Kllisch of Merck Pharmaceuticals in 1912, sat on a shelf until a Dow chemist named Dr. Alexander Shulgin rediscovered it in 1976, and began testing it on himself.

Through ever-increasing dosages, Shulgin eventually experienced the psychoactive effects of MDMA and suggested to his friend, Oakland psychologist Leo Zeff , that it might be good for psychotherapy.

Dr. Raymond Turpin sees hope in a new treatment for PTSD. Jeffrey Delannoy photo

At one time, Turpin said, there were around 4,000 mental health professionals legally using MDMA in their psychotherapy practices.

But MDMA had also been adopted by the early-1980s underground party culture, where it was used recreationally as a supplement to the loud music, colorful flashing lights and gyrating revelers.

Users reported feelings of euphoria, increased energy, sensory elevation and tactile stimulation that earned MDMA the moniker of ecstasy, or simply, X. More recently, its been called Molly.

Blowback ensued, and by 1988, MDMA was classified as a Schedule I narcotic by the U.S. Drug Enforcement Agency, along with heroin, LSD, marijuana, methaqualone (quaaludes) and peyote. Schedule I substances are defined as drugs with no currently accepted medical use and a high potential for abuse.

In the mid-1990s, Dr. Charles Grob of UCLA received FDA permission to conduct the first phase-one study on the physiological and psychological effects of MDMA in healthy volunteers.

Other than a temporary elevation in heart rate and blood pressure, and maybe body temperature, people could tolerate it well and there werent any adverse effects, Turpin said. That opened the door to phase two, which was where they actually started to look at it for PTSD. And there was a lot of evidence from the legal period there during those 10 years in the late 1970s/early 1980s that it might be very effective with people who had traumatic histories.

In 2017, Turpin returned to the California Institute of Integral Studies for a certificate program in psychedelic studies and research, where he met Dr. Michael Mithoefer and his wife Annie , a registered nurse. Mithoefer conducted one of the seminal phase two studies testing MDMAs suitability for treating PTSD.

The results were really pretty strong, said Turpin. These were folks that had severe chronic PTSD for an average of 17 or 18 years. One year after the protocol, 67% of the people that had entered the study with PTSD no longer qualified for [a diagnosis of] PTSD.

When Lubecky got home, unfolded the note and read it, it simply said, Google MDMA PTSD.

Once he did, he learned that the Multidisciplinary Association for Psychedelic Studies was conducting a phase two clinical trial, run by the Mithoefers. Founded in 1986, MAPS is a 501(c)(3) nonprofit focusing on the development of cultural, legal and medical shifts in the careful use of psychedelics for mental and spiritual healing.

Interestingly enough, I returned from Iraq on Nov. 22, 2006, and I took my first dose of MDMA on Nov. 22, 2014, Lubecky said. So, on Nov. 22 of this year, I will have been healed of PTSD as long as I had it.

But its not as simple as just taking a single pill and walking away feeling better.

Theres a strict screening process meant to weed out people who could experience an adverse reaction from MDMAs known side effects elevated blood pressure and heart rate. Then, there are three 90-minute prep sessions where therapists get to know the patient and answer questions about the treatment.

Next comes the dosing session, during which two therapists administer the drug via a pill and sit with the patient for between six and eight hours. Sometimes the patient will don eyeshades, or headphones, and listen to calming instrumental music. Other times, theyll talk with therapists as they go through the experience.

It kind of felt like I was in a tight wetsuit in a hot tub, Lubecky said. Its like doing therapy while being hugged by everyone in the world who loves you in a bathtub full of puppies licking your face.

The patient will go on to spend the night and then participate in an integration session following breakfast the next morning, trying to make sense of what was happening during the dosing session.

Typically, three dosing sessions followed by integration sessions will take place over the course of four to six months. After that, no further MDMA use by the patient is anticipated.

Whats actually happening during those dosing sessions is the untangling of complicated processes in the brain that have become dysfunctional due to trauma.

When somebody is undergoing an overwhelming psychological emotional experience, certain higher functions of the brain shut down, and the brain reverts to more primitive processing, Turpin said. The information thats coming in from the traumatic memory the things people are seeing, what theyre hearing, what theyre smelling they dont go through proper processing channels, like a normal memory would. It basically gets stuck in the brain in an improper area where it just sits there. And thats why people have intrusive memories, nightmares, flashbacks. Its all this highly charged, fragmented information.

That information tends to pop up randomly, or when external sensations trigger a re-experiencing of the traumatic event.

Its just kind of living in a state of fear, said Turpin. There could be a car backfiring. They could smell somebodys cologne that reminds them of the smell of the person that raped them. It tends to really throw the body into a state of shock almost.

Such episodes can leave those suffering from PTSD with hypervigilance, but they can also result in the desire for physical seclusion and mental isolation with or without the use of alcohol or other illicit drugs.

The only two FDA-approved drugs for the treatment of PTSD, Paxil and Zoloft, are antidepressants and dont really treat the underlying cause of PTSD. Theyre often prescribed in conjunction with other drugs to combat the effects of PTSD, like sleeplessness and nightmares.

A 2009 study pegged their effectiveness at between 20-30%, although Turpin said its maybe 50% at best.

What weve done for years in treatment is try to give people drugs that have tried to basically throw a blanket on those symptoms and to mitigate those symptoms so that people can go out and function, Turpin said. Unfortunately, we havent done a very good job with those drugs.

What MDMA does, according to Turpin, is shut down the amygdalae the fire alarm of the brain that triggers the normal fight-or-flight response to trauma. That allows the trauma to be processed by the prefrontal cortex, the way it should have happened in the first place.

The positive results from Mithoefers phase two trial, in which Lubecky was a participant, led to the third phase of trials conducted by MAPS .

I think theyre expected to probably do phase three through this year and then wrap it up and turn in hopefully a new drug application to the FDA early next year, Turpin said. The hope is that itll be approved, but theres a special program that the FDA has, called expanded access or compassionate use.

The FDA has approved 10 sites nationwide for the compassionate use program, effectively clearing the way for 50 people to receive the MDMA treatment. Four sites are expected to be up and running soon, but Turpins Waynesville practice has a bit of a head start on the other three.

Mithoefer was my mentor for that [certificate] program, and they were moving to Asheville, Turpin said. Thats how the conversation got started about maybe getting an expanded access site in Asheville, and since I was over here in Waynesville, I was kind of interested to see if we could pull it off in Waynesville, too.

Currently, two patients are in the screening process and on track for treatment later this year, which would make Waynesville the first expanded access site in the world for the compassionate use of MDMA to treat PTSD.

Ill be honest, Lubecky said. I didnt think this was going to work. Thats entirely why I volunteered. Im like, Im going to die any day, I might as well try this. And then it was a miracle.

Marine Michael Ferguson (left) rides out of Fallujah after 28 days of near-constant firefights. Donated photo

Lubecky hasnt taken MDMA since his initial doses in 2016 and continues to advocate for the treatment he thinks saved his life, which is good news for other veterans like Waynesville resident Michael Ferguson, who hasnt yet had the opportunity to go through the MDMA treatment process.

Ferguson joined the Marine Corps just before the terror attacks of Sept. 11, and became part of a FAST company Fleet Anti-terrorism Security Team.

After the invasion of Iraq, he spent 28 days fighting in the Battle of Fallujah.

Fallujah was kind of, firefight, break. Firefight, break. Youd hear morning prayer about 5 a.m. and youd know everybody was getting up and pretty soon they were going to come find where you are today. At times I remember being on rooftops and looking out over the city and it looked like the entire city was on fire, Ferguson said. Its hard for me to explain it or put it into words and grasp it. Its still odd to me that thats what I did.

Ferguson said he had trouble adjusting when he returned home and was fired from his first nine jobs for his quarrelsome behavior. He still sees snipers lurking in open windows and improvised explosive devices on the sides of Western North Carolinas roads.

Finally, a Vietnam veteran recognized Fergusons symptoms and encouraged him to visit the VA. From 2006 until he was formally diagnosed with PTSD in 2014, he went through several different therapy programs and was on 11 different medications.

I never really found one that even came close to working. Most of what I was given at the time had a side effect of suicidal ideation, he said. Thats the last thing that a person in my position needs is more encouragement towards that.

Ferguson stopped taking medications for PTSD several years ago. He said he still contemplates self-harm but continues to fight it, in hopes that one day soon hell find the solace that Lubecky found perhaps in the research and treatment Turpin and MAPS are currently conducting. When you deal with death that much at such a young age, once somethings on the table, its hard to remove it off the table, he said. Even today I definitely dont have an intent or a will [to commit suicide] but its still something I think about. Its always going to be on the table. The process is just keeping it on the table and not putting it into action. And every day that we do that, we win.

If you or someone you know is contemplating self-harm, call the National Suicide Prevention Lifeline at 800.273.8255. The work of MAPS and the Pearl Psychedelic Institute, both of which are nonprofits, is primarily funded through donations. To learn more or to help, visit pearlpsychedelicinstitute.org/donate.

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MDMA as medicine: Stemming the tide of veteran suicides in Western North Carolina - Smoky Mountain News