Were there long-term mental health benefits even after effects of the drug had worn off?

Yes, definitely. Depending on how it was used, and whether there was a skilled therapist on hand who knew how to work within this treatment model, the outcomes were reported to be very impressive.

Now the problem was that by the time these therapists got their act together and started to organize research protocols and tried to get approval, the media had got a hold of it, and it became a sensationalized issue. Kids also started to hear about it, and if anything, the DEA scheduling hearings in 1985, and all the publicity that went along with them, really piqued the interest of young people -- and the marketers of drugs to young people. The whole Ecstasy scene just took off: initially here, and then in Europe. And then it boomed in Europe and came back here, and then it started booming here.

How does this compare with the controversy surrounding the medical uses of marijuana?

Well, I think, as far as medical marijuana is concerned, the charge is that people who support medical marijuana would also support the legalization of marijuana for recreational or personal use. With MDMA, I look at it as a very valuable potential adjunctive treatment, but on the other hand, I would say that there are serious risks involved with recreational use. So I am very reluctant to advocate that this drug be used in a recreational drug scene. It's a problematic drug in how it's used, and people are overdoing it.

You once testified in a congressional hearing about the potential application of MDMA as a therapeutic medication for clinical conditions.

Yes, right, but particularly clinical conditions that are refractory or nonresponsive to conventional treatments. The groups that we thought would be most amenable [to MDMA] would include patients with severe chronic post-traumatic stress disorder who hadn't responded well to conventional treatment. Also people with addictive disorders. And also we were interested in working with a population of people with terminal cancer who had severe anxiety and depression and were not responding to conventional treatment for their anxiety or depression.

What have you seen that might indicate MDMA's medical potential?

Mostly what we're working on is anecdotal accounts by therapists who were able to work with the drug prior to its scheduling in the mid-'80s. They had some very intriguing accounts.

It's a very different model from conventional psychopharmacology. Conventional psychopharmacology talks about treating someone every day for weeks, for months, for years. This involves using the drug on only one or two or three occasions, separated over long periods of time, within the context of psychotherapy. This is a very different model, a model, I might add, that the pharmaceutical industry is not going to be real eager to support because there's not going to be much in the way of profit margin in developing a drug that might only have to be utilized on one occasion.

Do you feel as if the pharmaceutical industry has been unhelpful?

Well, we could speculate, but they certainly don't go out of their way to attack the model because it hasn't been much of a threat. It's been so out on the margins that for most people, when they hear about this, they are not even aware that at one point it was once perceived as a promising adjunct to psychiatric treatment. To most people, it's just a recreational drug that is out of control among young people.

What about those who would question your motives?

I'm not going to ignore risks! There are serious risks with recreational Ecstasy. But those risks are compounded by an illegal and illicitly produced drug being marketed in massive quantities and utilized in an adverse environment.

What are the dangers that you associate with Ecstasy?

Let's talk about how it's used today. There are a number of problems. First of all, there is rampant substitution going on. The reliability of the drug Ecstasy is very poor. Whereas 10 years ago you could be pretty sure that all Ecstasy was MDMA, today that is not the case at all. Things have changed radically. Surveys are indicating that often more than 50 percent of surveyed Ecstasy turned out to be drugs other than MDMA.

Some of these drug substitutes are relatively innocuous, like aspirin or caffeine. Some are moderately dangerous like methamphetamine, PCP, dextromethorphan. Some are potentially lethal like paramethoxyamphetamine, or PMA, and you really have no idea what you're getting. In fact, that's the strongest argument I can muster when I talk to young people about the dangers of the youth recreational drug scene. Drug substitution with Ecstasy is like no other drug that I've ever seen. You really have no idea what is in the pill. So right off the bat, that makes it very problematic.

Other issues have to do with the fact that you can get into trouble with drug interactions. Not only illicit drug interactions, but you can also have interactions with prescription medications that people take to treat medical conditions.

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