WHO OWNS ECSTASY?

SAN FRANCISCO--Dr. George Ricaurte's slides illustrating the effects of
MDMA on the brain look, well, psychedelic. Swirling green cross-sections of
monkey brains are followed by human PET scans, billowing shapes bathed in
purple and yellow. One brain burns bright orange with swirls of the
chemical analog for happiness, serotonin; another, serotonin-short, is a
muted, lava red. r The National Institute of Drug Abuse (NIDA), whose
funding helped rocket Ricaurte from promising grad student to Johns Hopkins
researcher with more than 100 published articles, has plunked these images
on a postcard labeled ''Plain Brain/Brain After Ecstasy,'' and made them
the centerpiece of a $54 million anti-club-drug initiative. Today, however,
a number of researchers, clinicians, and highly educated users are looking
at these pictures and asking if the government's interpretation is more
purple haze than perfect science. r All the tribes and high priests of MDMA
gathered in San Francisco last week for a State of Ecstasy conference, and
they are uttering the names of the drug as they have known it: ADAM, X,
entactogen (something that touches within), empathogen (something that
opens you to others), psychostimulant. Each name evokes a history and often
an expertise not shared by the others.

Sasha Shulgin, the legendary 75-year-old chemist who rediscovered MDMA in
the mid 1970s, is here. The Moses of MDMA folklore, Shulgin handed the
tablets to a therapist who in turn quietly initiated nearly 4000 others
before criminalization. Charles Grob, director of Harbor-UCLA Medical
Center's Division of Child and Adolescent Psychiatry, is here. Worried
about the way young people are using the drug and leery of even saying
Ecstasy (who knows what's in the stuff you buy on the street?), Grob seeks
to test MDMA in psychotherapy for patients with terminal illness.
Therapists make up a sizable percentage of the nearly 350 people attending,
but there are also party people in the house, among them researcher Paul
Dillon, who pioneered on-site purity testing of MDMA at gay parties in
Australia, and DanceSafe founder and rave risk reducer Emanuel Sferios.

At 22, Theo Rosenfeld runs a small contracting company and his own, very
deliberate horizon-expansion program through strategic X use. He tests his
pills with a kit he got from DanceSafe, has switched to pot for dancing,
and uses X sparingly at home. He has read every study published. ''There's
a definite chance that in high amounts it can do some nervous system
damage, and some chance that in small infrequent doses it can,'' he
acknowledges. ''But that evidence is still so vague compared to the real,
overwhelming experience of opening up on Ecstasy and wanting to share the
joy of my life with people close to me. That's worth a lot to me. If I can
grow up with those peak experiences, I think I will be a better person.''

Who owns Ecstasy? Marsha Rosenbaum, director of the Lindesmith Center-Drug
Policy Foundation in San Francisco, convened this conference precisely to
let these different experts speak to each other, and where necessary, duke
it out. She was the first federally funded sociologist to interview MDMA
users; her own research in the '80s left her impressed ''by the
heart-opening power of the drug'' and ''concerned about the many unknowns''
as MDMA moved from underground therapeutic agent to mass-marketed and newly
criminalized party drug. The DEA--reacting to blatant, growing Ecstasy
consumption and early neurotoxicity reports--had moved against MDMA in
1985. Overruling scores of psychiatrists arguing that the drug's
therapeutic potential merited classification as a prescription medicine,
the DEA condemned MDMA to Schedule I--their category for heroin, LSD, and
other drugs with high abuse potential and no accepted medicinal use.

This meeting is a resumption of discussions shut down by that DEA decision
15 years ago. While the government has focused on the drug's action in the
lab animal (or human subject in a lab), speakers here want to know about
the risks and benefits of MDMA as it is used in the world. If you take the
drug only a few times, are you safe? If you stay cool and quiet while you
do it--avoiding the hyperthermia and increased heart rate that are MDMA's
most immediate side effects--are you safe? Can the drug boost the
effectiveness of conventional psychotherapy, in treatment of post-traumatic
stress disorder, for example? Research into these questions has largely
been silenced by MDMA's Schedule I status and the neurotoxicity
allegations. ''Brain damage is the government's trump card,'' says
Rosenbaum, ''the thing that allows them to say, 'Never mind all that other
stuff.'''

As befits a conference on an empathy-producing drug, even those with
different perspectives seem receptive as Dr. Ricaurte leads them through
the evidence of neurotoxicity. The brains of monkeys injected with MDMA
show ''pruning'' of the long nerve projections, known as axons, used in the
transmission of serotonin. In monkeys, axonal damage and subsequent
serotonin depletion persists for years. While researchers can't cut open
human brains, their next best proxies--PET scans and spinal taps--show
human depletion of serotonin at least two or three weeks after the use of
MDMA. Finally, preliminary studies have shown differences in memory or
simple learning tasks, which might suggest permanent problems with memory
or cognition.

Today, though, speaker after speaker questions the neurotoxicity
conclusions. ''The difference between a medicine and a poison is the dose
and context,'' Grob points out, challenging whether Ricaurte's doses in
monkeys stand up to the scrutiny of interspecies scaling. An audience
member asks if the pruning is damaging brain cells or, as when he prunes
his garden, just reworking their growth. The question underlying his
question--how we might distinguish brain damage from brain change, perhaps
linked to the kind of psychological breakthroughs some MDMA users
report--goes unanswered. ''The so-called neurotoxicity phenomenon may be a
prelude to a neuroplasticity response,'' Grob says later. ''We don't know.''

What about the studies finding functional impairment in humans? Here, too,
Grob and others find that the studies raise as many questions as they
answer. The ''MDMA users'' had in fact used street Ecstasy and other drugs,
often repeatedly. Was the impairment the result of Ecstasy alone, or some
other more toxic drug--ketamine, for example? Given widespread reports of
bunk sold as Ecstasy, how do we know the users had even taken MDMA? Why did
studies on cognitive function match polydrug-using hard partiers against a
control group of squeaky-clean college students?

A reporter asks Ricaurte why, rather than looking retrospectively, he has
never done the ''prospective'' trials scientists usually prefer: dividing
two groups of MDMA-naive individuals, administering MDMA to one and a
placebo to the other, and charting cognitive or other effects. Ricaurte
pauses. Ethically, he says, ''Any study has to be conducted with an eye
toward risk versus benefit. I can't point to one study showing the
therapeutic benefit of MDMA.''

''Of course you can't,'' says Grob, ''because to date, none have been
permitted.''

As sponsor of more than 85 percent of the world's research on the health
effects of drug use, NIDA has funded only three research centers to test
MDMA in humans, and none to look at therapeutic use of the drug or how the
context in which it is used might change the risks. Like the government's
DARE program, which claims to help kids with drug decision making and then
says the only choice is to ''say no,'' NIDA's Ecstasy research purports to
be driven by science but offers an anemic range of options. ''There are
pockets of honest research,'' says Lindesmith executive director Ethan
Nadelmann, ''together with an overlay that is profoundly politicized and
corrupting of the research. Certain questions are not to be asked.''

Studies on the therapeutic use of MDMA are under way in Switzerland, Spain,
and Israel. The U.S., meanwhile, is hammering its science into armaments
for the drug war. In the last year, NIDA has used every opportunity to get
out the message that ''even one MDMA dose is toxic,'' distributing 330,000
Brain on Ecstasy cards, issuing mailings and alerts to 250,000 health
professionals, and launching a PR blitz. Predictably, sensational media
coverage has followed: On a recent 48 Hours, a doctor showed an
Ecstasy-abusing teen and her concerned mother a computer model of her brain
and declared it ''almost moth-eaten.''

The number of MDMA users in America--customs seizures, arrests, and scare
campaigns notwithstanding--continues to rise. ''Right now,'' says Grob,
''the only ones being controlled are the researchers.''