PUTTING THE E IN HEALTH

Clubbers have long been convinced of the benefits of Ecstasy. But now
clinicians are raving about it too

With cannabis-based medicines due in the UK in two years' time, what next?
Ecstasy as a mainstream psychiatric drug? Well, maybe. In November last
year, the Food and Drug Administration (FDA), which regulates the licensing
and testing of pharmaceutical products in the US, astonished the research
community by approving a double-blind clinical trial of MDMA, also known as
Ecstasy, to treat post-traumatic stress disorder (PTSD).

At first glance, the decision seems baffling. Ecstasy is not just an
illegal drug, it's a byword for high-risk fun. Reports of brain and liver
damage, psychosis and other mental disorders as well as persistent stories
of deaths after taking a single pill, hardly suggest a reassuring
background to resolve a difficult-to-treat disorder that causes victims and
observers of violent attacks to persistently relive painful memories
against their will.

There are signs, however, that this exclusively negative view of the 'love'
drug we've learnt to hate could be outdated. A study at the University of
South Carolina, using Ecstasy in combination with psychotherapy, is due to
get the final OK next month. A second trial, also testing MDMA for PTSD, is
already under way in Spain at the Psychiatric Hospital of Madrid. This
trial, which will eventually treat victims of sexual assault, should be
ready for publication by early next year.

Coincidentally, an on-going trial in this country is testing a form of the
drug as a treatment for sufferers from Parkinson's Disease. The research at
the School of Biological Sciences at Manchester University, was prompted by
the experience of film stunt man Tim Lawrence who, at the age of 34,
developed Parkinson's so badly that he was either frozen into immobility or
twitching uncontrollably. A Horizon programme a year ago showed him
performing back flips and somersaults with graceful ease - after taking
Ecstasy.

But it's the psycho-therapeutic potential of Ecstasy that is currently
causing excitement. A new book Ecstasy: The Complete Guide, A Comprehensive
Look at the Risks and Benefits of MDMA (UKP 17.99, Park Street Press)
edited by psychiatrist Dr Julie Holland, of Bellevue Hospital in New York,
has contributions from the world's leading experts on the drug.

Holland, a recognised expert on street drugs, has campaigned for years
against a situation where MDMA has become inaccessible to research but
readily available on the black market - with a conservative estimate of
half a million Ecstasy tablets consumed every weekend in the UK. While the
book acknowledges there are dangers in the recreational use of the drug, it
aims to show that there is sufficient anecdotal evidence to justify further
research into a substance that 'makes painful psychotherapy easier and
faster - like anaesthesia given during surgery to allow for deeper
incisions and removal of more malignant material'.

MDMA (methylenedioxymetham-phetamine) was first synthesised and then
patented some time before 1912 by the German pharmaceutical giant Merck, as
part of a search to create a new 'styptic' medication that stops bleeding.

In the early 1950s, MDMA was briefly investigated by the US Army Chemical
Center as a potential 'brainwashing' weapon. But it was not until 1976 that
it began to be synthesised in considerable quantities by a West Coast
chemist with an interest in psychedelic medicines. An increasingly wide
circle of psychotherapists around the Esalen Institute in California began
to exploit the potential of a drug that works on two brain chemicals,
serotonin and dopamine, essentially a combination of the effects of
Prozac-type antidepressants and amphetamine.

By the early 80s, up to 4,000 therapists in the US and Switzerland were
using MDMA, known as 'penicillin for the soul'. A survey of therapists
using it at the time, carried out in 1990, found that over three quarters
believed that the drug had 'great overall psychological value'. Therapist
Dr Rick Ingrasci, a past president of the Association of Humanistic
Psychology, used MDMA hundreds of times with patients and reported that 'it
seemed to heal fear, to give people an opportunity to open up emotionally
and to communicate their inner life and their inner feelings in ways that
were really useful'. A New York writer described his MDMA experience as
being 'like a year in therapy in two hours'.

Marcella Ot'Alora suffered from post-traumatic stress syndrome for six
years following a series of rapes when she was 19, suffering flashbacks
which made her re-experience the painful events as though they were
happening in the present. She had twice attempted suicide and was under
24-hour watch when she heard of a therapist who used Ecstasy. She spent an
intense, painful, but overall positive eight-hour session, supported by two
therapists whose job was 'to guide me through a task that needed to be
accomplished' and says she felt safe for the first time in years. Ot'Alora
built on the MDMA sessions, learning with further therapy sessions to
recognise what triggered the flashbacks and how to manage them - and now,
at 43, is largely free of PTSD.

A year after Ot'Alora was treated with MDMA in 1985, the US Drug
Enforcement Agency placed it in the most restrictive category of controlled
substances. MDMA, the therapeutic tool, had 'leaked out into the general
community to become Ecstasy, the party drug'. West Coast practitioners
either gave up or went underground. Therapeutic use of 'Adam', the name
given to MDMA by therapists, signifying 'the condition of primal innocence
and unity with all life', seemed to have no more future than tie-dye T-shirts.

But the pro-MDMA lobby has been persistent. Dr Rick Doblin, a
psychotherapist who used MDMA therapeutically in the 80s, was so impressed
by the drug's impact on Ot'Alora and hundreds of other people that he has
set up Maps, the Multidisciplinary Association for Psychedelic Studies
(www.maps.org) to lobby for and fund research into the medical use of MDMA.
Both the PTSD studies are being largely funded by Maps - and there are
plans to investigate the use of the drug for people with end-stage cancer
and even for treating drug addiction and alcoholism.

Doblin's success in getting FDA approval for a clinical trial of a
scheduled substance has been supported, ironically, by the very experts who
drew attention to the risks of Ecstasy as a potential killer. Dr John
Henry, director of the National Poisons Information Service at Guys
Hospital in London, was one of the first researchers to catalogue the risks
of overheating at Ecstasy-fuelled raves - as well as the possibly greater
risk of drinking too much water with the drug.

But he says that the bad publicity that the rave drug has received
shouldn't rule out research into its therapeutic use. 'Intuitively we know
that the incidence of adverse outcomes is low, since emergency departments
are not being overrun each weekend by people dying from Ecstasy use. It is
the manner in which MDMA is used that poses the greatest danger to the
patient,' he says.

Dr Michael Morgan, senior lecturer in the Department of Experimental
Psychology at Sussex University, has shown that heavy recreational use of
Ecstasy may cause cumulative neuro-psychological damage, including problems
with memory and impulsive behaviour - but takes the same view. 'There's a
big difference between recreational use and administration of a dose in a
therapeutic setting,' he says.

Another supporter of the pro-MDMA campaign is Andrew Weil, founder of
America's National Integrative Medicine Council and author of eight
international bestsellers, including Eight Weeks to Optimum Health . He
says the drug is 'a unique pharmacological agent that with minimal
attention to dose, set and setting, creates a uniform state of great
relaxation, non-defensiveness and empathy in which meaningful communication
is easy.'

Optimism is, he says, 'a behaviour and an attitude that can be learnt - and
I think that it has many consequences in terms of how our bodies function
and how our minds work. Just having the experience of it, seeing that there
is a mental perspective from which things can look positive, is very useful
- - especially if you haven't had that perspective in a long time.'

Meanwhile Doblin predicts that MDMA could be licensed as a therapeutic
substance within five years. 'It's never going to be like Prozac - it will
never be a take-home drug,' he says. But he argues that 'every concern that
the DEA and the FDA can articulate regarding public safety associated with
therapeutic use of MDMA can be met in regulatory schemes that are legal,
practical and not too expensive, to obtain substantial medical, therapeutic
benefits with minimal health costs.'

So if this happens in the States, will its use in therapy ever spread to
the UK? 'If it's shown to be effective in treating difficult psychiatric
problems,' says Dr Morgan, 'then very clearly it should be considered for
use in this limited clinical context.'