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Thursday, Jan 8, 2009
In Part 2 of Salon's series on Ecstasy, a controversial study on E's effects on the brain creates fear; a breakthrough moment in MDMA's therapeutic use sparks hope; and Generation X ponders its drug days ahead.
Jul 31, 2003 | Was the X getting worse? Alexander Shulgin, one of the drug's pioneers, says the question is "clouded by the fact that over 50 percent of stuff called Ecstasy is not MDMA." What else could it be? Caffeine, amphetamines, ephedrine, PMA (an Ecstasy-like drug that's particularly dangerous) or other foreign agents that have masqueraded as the real thing for decades.
MDMA itself has been on a wild ride, as illustrated by a timeline that details milestones in MDMA research. (It appears in the appendix of Dr. Julie Holland's "Ecstasy: A Complete Guide.") In 1953, for example, the U.S. Army Chemical Center gave MDMA to lab animals at the University of Michigan (an idea soon abandoned). Then there's Sept. 8, 1976, the day Shulgin took MDMA for the first time (16 milligrams, with no effect). There's MDMA's Schedule 1 status in 1985, and the government's $54 million effort in 1999 to educate the public about "club drugs." But since Holland's book was published, there have been two MDMA tipping points that aren't included in that timeline. They're huge.
The first was on Nov. 2, 2001. What Holland calls the "biggest moment" in terms of MDMA research had the misfortune to be announced two months after 9/11. But it was on that day that the FDA approved the first psychotherapeutic study of MDMA on humans, to be sponsored by the Multidisciplinary Association for Psychedelic Studies, (MAPS), a nonprofit organization that aims to develop MDMA into an FDA-approved prescription medicine. MAPS will study the use of MDMA and psychotherapy for the treatment of patients with post-traumatic stress disorder (PTSD).
Subjects in a Charleston, S.C., clinic will undergo two therapy sessions, three to five weeks apart, at which they will take a capsule of 125 milligrams of MDMA. Between the two capsules, patients will have three non-drug-assisted therapy sessions (pre- and post-administration of the MDMA). "What we're saying is that MDMA is not the therapy by itself, nor is psychotherapy the treatment by itself, but MDMA-assisted psychotherapy is the course of treatment," says Rick Doblin, who founded MAPS in 1986 and has a Ph.D. in the regulation of drugs from Harvard's Kennedy School of Government. "It's not 'Take the pill and then you're happy like a rave'; it's 'Take the pill and then go deeper into the pain,' which facilitates a cathartic process. In that sense what we are doing is the opposite of the way many people use the drug. One of the advantages of MDMA, why people really like it, is that it focuses on the moment. The idea is to work with post-traumatic stress disorder patients so that after the catharsis they can distinguish that the moment they are in is different from the moment they were traumatized -- that every corner they turn is not likely to hold the rapist or assailant."
After a number of delays, and some "stonewalling" by the DEA, Doblin says MAPS is optimistic that the clinical study will start this September.
The other major news in MDMA research was released last fall, blanketed the media, and scared a lot of people, including many of my friends. In the Sept. 27, 2002, issue of Science magazine, Dr. George Ricaurte, a neurologist at Johns Hopkins, published the results of a study called "Severe Dopaminergic Neurotoxicity in Primates After a Common Recreational Dose Regimen of MDMA ('Ecstasy')," aka the Monkey Study. Ricaurte, aiming to mimic human Ecstasy habits, gave five monkeys high doses of MDMA every three hours. He couldn't actually give all the monkeys three hits of E, because one monkey died, and another didn't look so good after his second hit, so they stopped giving the poor ape the drug. The drug damaged tiny branching fibers that allow the dopamine-secreting neurons to do their job. In other words, the monkeys lost dopamine cells, which affect thinking and movement. When you lose too many of these brain cells (a lot, like 80 percent), you may experience symptoms of Parkinson's disease (tremors and other body imbalances). "We know that it happens in monkeys and baboons," writes Ricaurte. "We don't know if it happens in human beings as yet."
"This is the first time anyone's shown dopamine reductions in primates, so everyone got really freaked out," says Holland. "What has never been proven is that there is any damage to the dopamine system in human MDMA users, even heavy users." What's more, Holland and many others argue, the doses used by Ricaurte were much higher than what people typically use.
What's clear is that no one -- not Holland, not Shulgin, nor any MDMA expert I talked to who feels the war on E is misguided -- thinks popping too many pills in one evening is a great idea. "Any drug has a recommended dosage," Holland says. "The reality is, the more E you take, the more you put your brain at risk."
"Nobody knows for sure if your brain would go to completely normal if you stopped taking Ecstasy after you'd been taking it for a long time," says Dr. Jean Lud Cadet, chief of the molecular neuropsychiatry branch of the National Institute on Drug Abuse (NIDA). "There are now a lot of papers showing that people who have taken Ecstasy for an extended period of time can have sleeping problems, be depressed, and have memory problems. But we need to do more studies to study people who have stopped taking the drug for a long time to see if these symptoms go away completely."
Cadet, one of the country's leading researchers on the clinical effects of drugs on the brain, has a tasteful office at a branch of the NIDA on the Johns Hopkins campus in Baltimore. A photo of his handsome, dreadlocked 15-year-old son sits on his desk.
"What do you tell your son about Ecstasy?" I ask him. He proudly explains that he shares his research with his son, who in turn gives talks on the effects of E at his high school.
Right now, Cadet is studying the effects of MDMA exposure on prenatal rats, an area that is no doubt of interest to my ever-growing group of pregnant friends. Cadet found that the babies of pregnant rats who were given MDMA showed changes in some genes in their brains when compared to the genes of babies from pregnant rats that were not given MDMA. While it's still too early to know if the behavior of the baby rats who were exposed to MDMA will be affected, the brains of the little rat pups definitely look different.
I like Dr. Jean Lud Cadet. He's an inviting man. Wearing a hipster short-sleeved button-down, he's comfortable explaining his complicated research in layman's terms. I like that he says, "These drugs are not going to fry your brain like an egg, but research shows that they are toxic." I like that when I ask him if despite the toxicity, many people feel that the upsides of the psychological breakthroughs, the empathy and the intimacy, are worth the potential downsides, he thinks about that for a few seconds and says, "Well, that's a decision someone should make personally, but you can't ask the FDA to approve it." I like that he's working on building better models about how MDMA affects the central nervous system, so if the worst fears about what MDMA does to your brain are true, through his and other research we'll come up with restorative treatments.
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