ECSTASY FOR AGONY?

A new study may prove that the party drug is effective in therapy. But will
ecstasy make the leap from club to couch?

On the street, rave-goers have labeled it "the love drug." Newspaper
reports have dubbed it a killer. But for Marcela Ot'alora, ecstasy was a
lifesaver.

Repeatedly raped when she was a teenager, Ot'alora spent years locked in
the grip of post-traumatic stress disorder (PTSD). "My whole body would go
into a panic," says Ot'alora, now 42 and a therapist in Lafayette, Colorado.

Desperate, Ot'alora took ecstasy - the drug scientists call MDMA - during a
supervised therapy session. That was 17 years ago, when therapists were
legally giving it to their clients in small doses to help emotional
healing. Those therapy sessions changed Ot'alora's life. For the first
time, she says, she felt safe to confront details she'd suppressed for years.

Now, Ot'alora is part of a growing movement to make ecstasy legal again as
a controlled medication. Working with the Multidisciplinary Association
for Psychedelic Studies (MAPS), a Florida-based nonprofit group that funds
research into therapeutic uses for psychedelic drugs, Ot'alora and others
are arguing that the drug has powerful healing potential particularly for
PTSD. And their cause is gaining steam: Last November, the U.S. Food and
Drug Administration approved a clinical trial of laboratory-made, purified
ecstasy for PTSD - the first such trial in almost two decades.

The federal government banned ecstasy in 1985, after it showed up on the
club scene. A group of psychiatrists sued to keep the drug legal for
research and medical use, but their suit failed. MAPS has revived the
debate: The group hopes to reverse the government's decision by funding the
controlled studies they say are necessary to give the drug a fair hearing.

The first real step toward that goal will happen later this year, when
South Carolina psychiatrist Michael Mithoefer, M.D.., and his wife, Annie,
a licensed psychiatric nurse, will give 12 patients a single dose of
ecstasy in a supervised setting. A second group will receive a placebo;
both groups will undergo conventional therapy afterward. Ot'alora is
consulting with the Mithoefers as they organize their trial and working as
a therapist for a similar MAPS-funded study already begun in Spain. Both
studies are part of the association's five-year, $5 million plan to gain
approval for ecstasy as a prescription drug.

"I call it Prozac-plus," says MAPS president Rick Doblin, Ph.D. "Prozac
gives people a greater comfort level in their own skin. MDMA takes this to
the next level." Like Prozac, the drug boosts levels of serotonin, a brain
chemical that regulates mood, sleep, and appetite. But while Prozac nudges
serotonin levels up just a notch, ecstasy sends them soaring. It also
hikes levels of another brain chemical called dopamine. The resulting
euphoria lasts about five hours.

"In the same way a glass of wine can loosen you up, a dose of MDMA can help
people loosen up to explore their inner selves," says Julie Holland, M.D.,
a psychiatrist at Bellevue Hospital in New York and editor of Ecstasy, the
Complete Guide: A comprehensive Look at the Risks and Benefits of MDMA.

Michael Mithoefer says the drug facilitates therapy by allowing patients to
face their traumatic experiences with less fear and shame. "MDMA increases
empathy for oneself," he says. "Many people with PTSD erroneously blame
themselves, and hat guilt is a barrier to healing." If studies like
Mithoefer's result in ecstasy being available as a medicine, its uses may
not be limited to PTSD. Before it was outlawed, ecstasy had been used in
couples therapy; psychologists believed it helped couples discuss their
hot-button issues without becoming defensive. Some experts also believe
the drug helps with depression. Doblin says MAPS would also like to study
the potential of MDMA therapy to help terminally ill patients face death
without anxiety and fear.

There are some problems with the push to take ecstasy from the clubs to the
therapist's couch, though. For starters, growing evidence suggests that
the drug might harm the cells that release serotonin in the brain. "The
data in animals are quite compelling," explains George Ricaurte, M.S., a
pharmacologist at Johns Hopkins Medical Institution in Baltimore. Ricaurte
says human studies imply the drug causes similar damage in people, though
scientists aren't exactly sure what the repercussions are. A few studies
have found moderately impaired memory in frequent ecstasy users, but
researchers can't conclusively blame the drug since most heavy ecstasy
users also take other illicit drugs.

Still, brain damage is only one potential problem. MDMA decreases the
body's ability to regulate temperature. "There are people taking ecstasy at
raves and ending up with heat stroke," Holland says. Ecstasy also elevates
a hormone that spurs water retention, so when users take in more fluid than
normal they can experience cramps, seizures, and potentially fatal brain
swelling. And even when ecstasy is taken in a controlled environment, the
day after can be tough: The initial serotonin rush seems to temporarily
deplete the brain's supply of this neurochemical, leading to a post-ecstasy
funk rave-goers call "the terrible Tuesdays."

Despite these potential side effects, Mithoefer contends that ecstasy is
safe when given in small doses under medical supervision. "We already have
a lot of evidence showing that there's no toxicity with this dose of
ecstasy once or twice in a lifetime in a doctor's office is hardly the same
as taking it every weekend at a rave. "like any potent medication," she
explains, "there's a dose that's safe and a dose that's not."

But Glen Hanson, Ph.D., the acting director of the National Institute on
Drug Abuse, says labeling any dose safe sends a perilous message. "Taking
it once a month isn't likely to do permanent damage," he says. "But it's
difficult and dangerous to generalize and say that one dose is never
harmful." Hanson worries that any endorsement of ecstasy by the government
would be interpreted to apply to street ecstasy. And because it's not
regulated, there's no way of knowing what's in the ecstasy pills passed
around at raves: Some contain amphetamines, for instance.

But these concerns don't soften the resolve of ecstasy's advocates. "I
don't want MDMA to be a street drug. I want it be a medication," Ot'alora
says. "I've personally seen how it can help people." For Mithoefer, the
movement to test ecstasy is an ethical issue. "I see people every day
whose lives are severely disrupted, and they're suffering because of
PTSD. A significant number of these people aren't helped enough by
existing treatments," he says. "If you don't allow careful investigation
into something that might help ease people's suffering, you're taking away
their rights."