WHO OWNS ECSTASY?

Studying MDMA Is Shaping Up To Be The Latest Battle In The Drug War

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.

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.

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.

"Brain Damage is the Government's Trump Card."

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."