Joshua Shenk makes some excellent points about our arbitrary
distinction between licit and illicit drugs, but he is way off-base in
comparing the hallucinogen MDMA with antidepressants such as Prozac.
MDMA, commonly known as ecstasy, is dangerous.

The changes found in both human and animal brains after MDMA use are
not like those found after the use of selective serotonin reuptake
inhibitors (SSRIs), of which Prozac is an example.

The changes are quite like those seen as a result of the diet drug
dexfenfluramine, which was recently pulled from the market because it
caused heart problems.

Anyone taking MDMA as an antidepressant would wind up worse off: the
drug decreases in efficacy with continued use, and even casual users
report short-term depression following their "trips." In someone
already predisposed, this exacerbated depression can be quite serious.

And because of a liver-enzyme deficit and an unpredictable
overdose/allergic reaction syndrome, someone could take MDMA safely
one day and the next day die on the same dose. Avoiding heat and
drinking water do not prevent the problem, and in fact can, as in one
notorious death in England, make it worse. Unless the drug were found
to be a cure for cancer or AIDS, it could never be approved; the
risk-benefit ratio is simply unacceptable.

If we are to make changes to our drug policy, they must be based on
fact, and those who push for such changes must be as forthcoming about
the harms related to the drugs they like as they are about harms
related to the drugs they don't like.

Maia Szalavitz,
New York City