What about the aftereffects of taking Ecstasy -- suicide Tuesdays?

You have to distinguish between how it might be utilized within a strict treatment setting: hypothetically, since it's not happening legally. If you take MDMA in a treatment context, you're talking about taking it only one time, or perhaps twice over several months, all within the context of an ongoing psychotherapy.

You would also be taking it in a relaxed environment: You wouldn't be dancing in a hot, stuffy nightclub. You'd be lying or sitting comfortably. You'd be taking fluids. So the context is key. And you're also talking about a very modest dose and one time only. I think in situations like that you are far less likely to have a dysphoric reaction a couple days later.

However, when you're talking about recreational Ecstasy users, one issue is that they are often taking a lot of different drugs -- it's kind of a poly-drug-use scene. They often take high dosages. They're up all night, they're sleep deprived, they're nutritionally deprived, they're basically taking the drug in the most adverse environment you could possibly imagine: Hot, stuffy, crowded clubs, not replacing fluids, exercising all night. That will accentuate the likelihood of an adverse response.

The only environment I can think of that's worse would be taking it in a hot tub.

So you are saying that MDMA could be safe if regulated.

When I talk about safe, judicious use, I'm talking about an approved treatment context. I'm not at all talking about recreational use. If I could have my way, I would call for a moratorium on use of this drug at raves.

Why?

Because, number one, they've made it excruciatingly difficult to get a fair hearing on [Ecstasy's] potential treatment benefits. Number two: I think there's nothing wrong with people who are taking a lot of a drug often to take a break and reflect on their lives, and on whether this is having a positive or negative effect on them.

What do you think of laws that seek to penalize clubs where patrons are thought to be using Ecstasy?

It's certainly unwise. What are they doing? Identifying that chill-out rooms and water are evidence of felonious conduct on the part of the proprietor? All you're going to do is drive the phenomenon further underground, and you're going to make harm-reduction efforts even more difficult to implement than they already are. And you're going to get more severe adverse phenomena occurring among young people.

I mean, if we follow to the letter this "Just Say No" mandate, and then if the kid isn't wise enough to follow the "Just Say No" edict, are we saying he deserves whatever adverse effects he experiences?

I think the drug war has yielded catastrophic laws. The laws are compounding the problem because they do not allow for human nature.

How is your opinion looked at by the rest of the medical community?

Oh, it's hardly looked at all -- it's not even on the board. There's hardly a dialogue on this. Even with hallucinogens, the dialogue has eroded seriously over the last few decades. But the feedback I get when I write, when I give talks, and now that I've published a book, has generally been very positive.

I'm not out to be part of a raging controversy. I just think this is a very important issue that has gotten very little attention, with a tremendous misunderstanding. And I think the medical profession and the people we are supposed to be serving are being deprived of a potentially valuable treatment model. I'm not convinced that our conventional treatment models in psychiatry are ideal models.

Such as the psychopharmaceutical revolution?

[Laughs.] Yes, SSRIs for everybody. But think about the Middle East for a minute. I mean you couldn't do this with Ariel Sharon and Yasser Arafat because I'm sure they are in terrible medical shape, but what about taking their children, who are adults, and get them together and provide a sanctioned, medically facilitated MDMA session? Let them have a mutually emphathogenic experience, get in the shoes of the other, feel the pain and the suffering that the other has gone through, and then take a few steps toward feeling what a mutual understanding could be like?

And have you yourself ever taken Ecstasy?

My response to that sort of question is usually along the lines of "I'm damned if I have and I'm damned if I haven't." If I have, then my perspective would be discounted due to my own personal use bias, and if I haven't, it would be discounted because I would not truly understand the full range of experience the drug can induce.

So does that mean you're not answering the question?

[Chuckles.] Exactly.

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