ECSTASY: JUST SAY 'KNOW'

Like a lotus blossom opening ever wider, your soul lets loose its
anxieties, fears and defenses as an overwhelming sense of love and
acceptance rush in.

The world is exactly the way it is supposed to be - and it is wondrous.

This is the experience of Ecstasy.

No wonder, then, that the drug's popularity is skyrocketing in our
increasingly disconnected society.

From teenagers struggling to find their identity to mature adults seeking
personal growth and enhanced relationships, MDMA has broad appeal.

Unlike hallucinogens such as LSD, which strongly affect the mind, or
cocaine and methamphetamines, which rattle the body, Ecstasy seems to go
straight to the soul.

Many psychiatrists extol the benefits of a drug that can be administered
once or twice - rather than daily for life - to ease sufferers of Post
Traumatic Stress Disorder, terminal cancer, neuroses, addictions and other
ailments.

Yet on the other end of the spectrum, the National Institute on Drug Abuse
(NIDA) has issued a "drug alert bulletin" on Ecstasy. It likens MDMA's
risks to those associated with amphetamines and cocaine.

The U.S. Drug Enforcement Administra tion has, since July 1985, classified
MDMA as a Schedule I drug, deeming it as much of an addictive menace as heroin.

And the U.S. Sentencing Commission now proposes to increase sentencing
guidelines for MDMA manufacture and trafficking to align them with the
penalties for heroin.

What's the truth about Ecstasy? That search, alas, is complicated by
federal restraints on rigorous scientific research and by the onslaught of
all-night ravers whose polydrug and alcohol use muddy any clear assessment
of the drug's effects.

The real facts about MDMA are needed now more than ever, as millions of
youths worldwide use the drug regularly. Yet most scientific inquiry and
all pharmaceutical manufacture came to a screeching halt when the DEA
banned the drug in 1985.

Before that ban, psychiatrists and other therapists reported amazing
results with patients given small doses of the drug just a few times. Dr.
George Greer, a Santa Fe psychiatrist and medical director of the Heffter
Research Institute, administered MDMA more than 100 times to about 80
people. In followup questionnaires of patients much later, most reported
improved intimacy and communication with their partners and better
attitudes, mood and self-esteem. Half used fewer abusable substances, and
half exercised or meditated more.

Greer was not alone. Psychologists in San Francisco, who originated
therapeutic use of MDMA, had reported similar results.

Their work is retrospective, however, lacking many of the scientific
protocols applied to such experiments in recent years. Yet several more
recent reports echo such glowing claims.

Controversy has raged over those that don't - specifically research by
George Ricaurte of the Department of Neurology at Johns Hopkins University
School of Medicine, whose animal studies could be interpreted to suggest
that people may incur brain damage from MDMA.

"I start with a bias that any studies financed by NIDA are suspicious,"
responds Dr. Lester Grinspoon, psychiatry professor emer itus at Harvard
University. "NIDA, instead of staying with science, has become the ministry
of drug propaganda. Ricaurte is becoming the point man on (MDMA) toxicity.

"On the other hand, there may be toxicity. But one has to be very cautious
about it at this point. These votes may be being counted as they were in
Florida."

Ricaurte says a single dose of MDMA given to a primate can reduce levels of
brain serotonin, which is thought to help regulate mood, anxiety, sleep,
appetite, aggression, sexuality and temperature.

The single dose used in primates is in the same range as dosages ingested
by people.

"What the animal data does say, in my view, is that an individual who is
taking a single dose may be running the risk of incurring serotonin neural
injury based on these animal studies," Ricaurte says.

Still, he acknowledges, changes measured in the monkey brain may not be
permanent, and the effects on humans can't be generalized.

On that much, at least, he would win agreement from Dr. Charles Grob,
director of child and adolescent psychiatry at Harbor-UCLA Medical Center
and a psychiatric professor at the University of California Los Angeles
School of Medicine.

Grob critiqued Ricaurte's research in an article in "Addiction Research"
last year titled "Deconstructing Ecstasy: The Politics of MDMA Research."

Preclinical studies have shown that MDMA's acute depletion of serotonin in
rodents is reversible, Grob writes. While MDMA temporarily damages
serotonin axons, it spares the cell bodies so some serotonin axons regenerate.

Ricaurte notes, however, that such depletion is long-lasting in primates.

Questions About Study

Grob also notes substantial variances between different species'
susceptibility. And he questions why the primates studied were destroyed
after seven years without any reports being made on behavioral changes, if any.

Grob also questions why Ricaurte selected, for one study, MDMA-using
subjects from an old study who had the lowest levels of serotonin
metabolites in their spinal fluid, yet failed to report that pre-selection.
That alleged flaw does not, however, invalidate basic findings that MDMA
can lower serotonin levels in animals.

Similar concerns with Ricaurte's research are voiced by James O'Callaghan,
neurotoxicologist for the U.S. Centers for Disease Control and Prevention,
who has shown that using standard identification techniques, neuronal
destruction doesn't occur in rats that are given MDMA.

Three imaging studies cited by Ricaurte also should be reconciled with
findings from Switzerland.

The U.S. studies all were retrospective, comparing people who had used MDMA
and a lot of other drugs with a control group. While the MDMA groups had
somewhat lower serotonin levels on average, whether that was due to
pre-existing factors or imperfect controls can't be determined. These
studies all were peer-reviewed and published in major medical journals.

The prospective Swiss study used PET (Positron Emission Tomo graphgy) scans
and 1.7 milligrams of MDMA per kilogram of weight on subjects who never had
taken MDMA before. The yet-unpublished study, by a world-class laboratory,
found no detectible changes in serotonin levels.

As the scientific arguments rage on, and millions of oblivious teenagers
rave on, more extensive, objective research clearly is needed.

In the first major step in that direction, the U.S. Food and Drug Ad
ministration in recent years approved three basic Phase I prospective
studies on normal human volunteers, administering pure MDMA in hospital
settings, to examine psychological effects, physiologic response,
pharmacokinetics and neurotransmitter mechanisms.

A study at Harbor-UCLA Medical Center was completed, and work still is
under way at the University of California San Francisco School of Medicine
and Wayne State University School of Medicine.

Federal approval to use MDMA in controlled treatment protocols still hasn't
been granted. But next month, a research team from the Medical University
of South Carolina, funded by the Multidisciplinary Association for
Psychedelic Studies (MAPS), plans to submit a protocol to the FDA to study
the use of MDMA-assisted psychotherapy on patients with Post Traumatic
Stress Disorder.

The public health implications of Ecstasy are enormous.

Dr. Julie Holland, a psychiatrist at the Bellevue (N.Y.) Hospital
Psychiatric Emergency Room, suspects benefits could be extraordinary for
her patients, many of whom arrive in such a state of agitation that they
are sedated, fall asleep and awaken with little or no memory of what
spurred their traumatic episode.

If MDMA were administered instead, Holland believes, "We could get tons of
information from somebody, and they'd be comfortable, calm and relaxed."

Holland also predicts that Ecstasy someday may prove useful with people who
suffer schizophrenia, a hypothesis that Grinspoon and others doubt.

But many psychiatric researchers agree that Ecstasy may hold high potential
for effective use as a painkiller and as a psychotherapeutic catalyst for
victims of torture, war, rape and other assaults, for terminal patients,
for drug addicts and for those with severe psychological distress and
alienation.

MDMA's ability to evoke strong feelings of empathy is thought to greatly
enhance the relationship between therapist and patient as well as with
spouses and others.

The potential to regulate prescription use of MDMA is promoted by MAPS
President Rick Doblin in his Ph.D. thesis for Harvard's Kennedy School of
Government. Using three groups given placebos or high or medium doses of
MDMA, plus another group given the best alternative treatment, researchers
could determine optimum effect and devise prescription levels for MDMA use
through specially licensed psychiatrists.

MDMA May Pose Problems

No one wants to ignore Ecstasy's potential problems, however.

MDMA can have a powerful effect on blood pressure in vulnerable patients.
In addition, people with severe psychiatric problems could be at risk if
they take MDMA without the proper setting, preparation and guidance. And
the question of whether MDMA causes memory loss is still being debated.
Because Ecstasy holds enormous promise for psychiatry and medicine, its
risks and benefits deserve scrutiny in the most objective scientific
studies possible. The FDA's cooperation in this regard, and re search
grants from such groups as MAPS, are promising indicators that, in time,
science may be able to exercise real expertise to alleviate suffering among
untold numbers of patients. Such research also will give parents, law
enforcement, school officials and others a golden opportunity to give
teenagers the truth and nothing but the truth.