UNCLEAR VIEW OF 'ECSTASY' ARISES AS EXPERTS EVALUATE DANGERS, THERAPEUTIC
POTENTIAL

Ecstasy" has arrived - not just in the drug scene, or in the lives of the
rich and famous, but on the doorsteps of schools and neighborhoods across
the United States.

The drug is also knocking at controversy's door: As some experts emphasize
anecdotal evidence of ecstasy's potential therapeutic value, scientific
studies are beginning to reveal the risks of brain damage from long-term use.

Among all the partiers and psychologists, the naysayers and
neuroscientists, one thing is clear - far too little is known about the
trendy drug. Ecstasy is identified chemically as MDMA
(3,4-methylenedioxymethamphetamine). The substance was tested legally among
psychiatrists in the 1970s because its effects - feelings of euphoria,
friendship and a loss of inhibitions - helped patients overcome emotional
problems. But in 1985 the Drug Enforcement Administration put ecstasy in
the same category of drugs as heroin and cocaine, banning all use for
recreational or medicinal purposes.

Some psychiatrists fear that the DEA action has kept worthy patients from
receiving the benefits the drug has to offer. Dr. Lester Grinspoon,
professor emeritus of psychiatry at Harvard Medical School, has studied the
effects of using psychedelic drugs in psychotherapy throughout his career.
He says that very little research was collected on the benefits of MDMA
before the drug was restricted and that the existing evidence is mainly
anecdotal. But just seeing a few people who have been helped to overcome
emotional problems by using MDMA in therapy sessions impressed him enough
to push for additional research.

MDMA "makes the promise of helping people to achieve insight and
integration, which usually takes a very long time with talking therapy,"
Dr. Grinspoon says. "If this promise is true, it makes psychotherapy much
more feasible, cost-wise and otherwise, to people who need it."

Experimental use

Dr. George Greer, a psychiatrist in Santa Fe, N.M., used MDMA on an
experimental basis with about 80 patients in the early 1980s. He
administered the drug to couples who wanted to improve their relationships
and people trying to recover from neurotic behavior patterns. He also gave
it to people with terminal illnesses who were seeking pain relief. Dr.
Greer says the results included improved intimacy and communication in
relationships, recovery from chronic depression and less pain in terminally
ill patients.

"The drug reduces fear to any perceived threat in general, so that people
are not afraid of pain," he says. "A lot of the experience of pain is due
to fear and anxiety. It helps them gain a positive attitude so the pain
sensation doesn't scare them."

Despite these accounts, Dr. Alan Leshner, director of the National
Institute on Drug Abuse, is not impressed. "The plural of anecdote is not
evidence," he says.

"There has never been a clinical trial demonstrating MDMA's usefulness. ...
On the other hand, there's no question that MDMA is a dangerous substance,
in the short and in the long term - 15 years of research support that view."

A neurologist at Johns Hopkins University in Baltimore, Dr. George
Ricaurte, has collected much of this research. In tests last year of the
drug on animals, including nonhuman primates such as monkeys and baboons,
Dr. Ricaurte determined that MDMA depletes serotonin, a brain chemical that
regulates mood, memory, sexual activity, sleep and pain sensitivity. And in
a primate study completed in 1999, Dr. Ricaurte showed that serotonin
depletions caused by four days of MDMA exposure were still visible six to
seven years later.

Researchers running behavioral studies on humans have also found that heavy
MDMA use may lead to memory loss and impaired learning. Tests run at Johns
Hopkins show that frequent MDMA users had memory and concentration problems
and that their performance lagged on intelligence tests.

"Different investigators are finding some cognitive consequences, and I
don't think anyone can quibble about the fact that a number of different
laboratories have indicated that MDMA can damage serotonin levels in
animals and nonhuman primates," Dr. Ricaurte says.

Questioning the research

But proponents of exploring ecstasy use for therapeutic purposes - such as
Dr. Charles Grob of Harbor-UCLA Medical Center - do find reason to quibble.
He says that some researchers give animals unnaturally large dosages before
testing them and that there is not enough evidence that animal studies have
implications for humans. He also argues that studies done on humans use
multiple-drug users as their subjects. Tests run on multiple-drug users are
likely to show more damage than tests on people who were just using MDMA,
he says.

Dr. Ricaurte calls these kinds of criticisms irresponsible.

"Given that this is a drug being used by kids and others, to ignore or
misread or misinterpret the data that's available is less than responsible,
particularly coming from a group [of advocates] that believes that MDMA can
make this a better world," he says. "If this is about care for people and
their health, I think one would want to be cognizant of data showing that
the drug may be producing harm."

And, Dr. Ricaurte says, even if people are unconvinced by evidence of
long-term brain damage, all they have to do is look at short-term
statistics to understand how dangerous and abusable MDMA is.

MDMA-related deaths and emergency-room visits in the United States are on
the rise. According to the Drug Abuse Warning Network, from 1999 to 2000,
the number of emergency-room visits where MDMA use was reported rose 58
percent, from 2,850 visits to 4,511. More than 80 percent of the incidents
in both years were attributed to patients younger than 25.

Aside from physical risks, users say the six-hour ecstasy high leaves them
with depression that can last for days. Dayna Moore, a 16-year-old resident
of Phoenix House Rehabilitation Center in Long Island, N.Y., testified at a
Senate committee hearing last month that depression associated with ecstasy
use caused her to miss school, go days without sleep and stop eating.

"I fell into a deep, dark hole," Ms. Moore said. "It was a depression that
I couldn't stand, and I could only get out of it by letting time pass or by
taking more ecstasy."

Users say that while ecstasy is not physically addictive, the drug is so
psychologically addictive that it prompts them to go to extremes to get it.
Seventeen-year-old Philip McCarthy, also a resident of Phoenix House,
testified at the committee meeting that he became so addicted to MDMA that
he started breaking into homes and stealing televisions and VCRs to support
his $300-a-week habit.

"I was scared to death of breaking into houses, yet I wanted to get high so
badly that I was willing to risk it," Mr. McCarthy said. "By that time I
needed three to five pills a day to get high, and they cost $20 a pill.
Because of ecstasy ... I associated with criminals."

Growing market

The drug's newfound popularity among younger people is reflected in the
growing market for MDMA. A single dose, which can be swallowed in pill
form, snorted or injected, costs less than $1 to produce and ranges in
price from $10 to $40, making it incredibly profitable for dealers and
traffickers.

Dean Boyd, spokesman for the U.S. Customs Service, says seizures of MDMA
have corresponded with the drug's growing popularity. In the last few
weeks, major seizures occurred in Brownsville and in New York City.

Mr. Boyd also said that while most of the MDMA that U.S. Customs seizes is
pure, there is such great demand for the drug that agents have caught
people selling spray-painted breath mints and heartworm medication for dogs
as MDMA. In some cases, the bogus ecstasy could even be more dangerous.

"You could go out with any pill and claim it's ecstasy and sell it because
it's so popular right now," Mr. Boyd says.

But some clinicians and researchers still believe the benefits to one
person should override a drug's potential for abuse.

"There's no reason to shelve a medicine blindly when there are potential
benefits to individuals in society, even if the drug only helps one person
with a disorder," says Dr. Edward Cheslow of the AIDS Institute at Mount
Sinai Hospital in New York City. "The fact that the medications have a
potential for abuse is not a reason to forgo benefits."

Some proponents of therapeutic use say there should be a way to find a
balance. They suggest that the government emphasize safe use of a drug they
believe is dangerous only because it is abused.

Ecstasy becomes especially dangerous at raves, or all-night dance parties,
because the drug is known to cause a dramatic rise in body temperature and
dehydration. Raves are frequently held in overheated environments where
there is little access to water, and MDMA users are known to get
hyperthermia, a condition in which the body overheats and its organs fail.

"I like to point to the example of Holland, where the government sponsors
on-site drug testing to lessen the likelihood of someone taking a very
dangerous substance," says Dr. Grob, who is director of child and
adolescent psychiatry at Harbor-UCLA.

"They also have regulated temperatures in clubs, controls on crowding and
ventilation and easy access to free fluids," he notes.

Much study needed

Dr. Grob says if the U.S. government worked toward lessening risks this
way, that might allow for study of any therapeutic benefits of MDMA, and
then possibly the use of low doses of the drug in controlled settings with
certified psychiatrists.

But Dr. Grob, who in 1995 ran the first government-sanctioned tests of MDMA
since the drug was outlawed, notes that doctors still know very little
about the drug and that there is much research left to be done.

"At this point we must really study the phenomenon and work toward
approving clinical research settings," he says. "So far, there has been
tremendous resistance here to further testing."

But government officials say they have not stood in any researcher's way -
rather, no one has come forward to conduct further studies.

"I asked the National Institute of Mental Health and they said they've
never received a research proposal," Dr. Leshner says. "It's easy for
people to say the government won't allow studies, but an experiment really
has never been done."

Such experiments are just what is needed to resolve the issue, says Lynn
Webster, doctor of pain and addiction medicine at Alpine Medical Center in
Salt Lake City.

"Most clinicians don't know much about MDMA, and we really need this
information," Dr. Webster said.

"We need to understand where this drug fits in, whether it's another
marijuana, or if it's more like methamphetamines in terms of danger."

(SIDEBAR)

An ecstasy timeline

1914 - E. Merck, a German pharmaceutical company, creates MDMA (3,4
methylenedioxymethamphetamine, later nicknamed "ecstasy") as an appetite
suppressant.

1950s - The U.S. Army tests MDMA on animals, hoping to develop a
"brainwashing" drug for people.

1970s - Some psychotherapists start using the drug as a therapeutic aid for
patients.

1980s - College students start experimenting with the drug, mainly in Texas
and California.

May 1985 - Texas Sen. Lloyd Bentsen calls for a federal ban on MDMA because
of overuse in Dallas discotheques. A Drug Enforcement Administration-
appointed judge determines that MDMA may be medically useful and classifies
it as a Schedule III substance (meaning the drug is allowed for medical
use, but it does have a potential for abuse).

July 1985 - The DEA overturns the ruling, making MDMA a Schedule I drug,
like heroin or cocaine.

1994-2000 - The annual number of emergency-room visits attributed to MDMA
rises from 253 to 4,511.

July 30, 2001 - A U.S. Senate committee convenes a hearing to examine the
rising use "ecstasy."