Pubdate: Tue, 16 Jan 2001
Source: Newsday (NY)
Copyright: 2001 Newsday Inc.
Page: C03
Contact:  235 Pinelawn Rd., Melville NY 11747
Fax: (516)843-2986
Website: http://www.newsday.com/homepage.htm
Forum: http://www.newsday.com/forums/forums.htm
Authors: Bryn Nelson And Dan Morrison; Staff Writers
Note: Part 1: http://www.mapinc.org/drugnews/v01/n092/a04.html
Part 2: http://www.mapinc.org/drugnews/v01/n093/a01.html
Cited: Multidisciplinary Association for Psychedelic Studies (MAPS) 
http://www.maps.org/
Bookmark: http://www.mapinc.org/mdma.htm (Ecstasy)

ECSTASY FROM OVERSEAS TO OUR STREETS

How Ecstasy Works

Studies Suggest The 'Hug Drug' Disrupts Nerve Cell Function, Perhaps
For Life

SOME PEOPLE who take the small white pills with logos borrowed
from Nike, Mitsubishi or Superman simply want to belong. It makes some
people want to dance all night, to talk all night, to have sex all
night. Some take it to fight depression, others to resolve fights.

But the pill dubbed the "hug drug" by its admirers may have a much
darker side, according to many scientists who know the drug by its
abbreviation, MDMA. Only within the past decade, however, have
researchers begun to understand the risks beyond the immediate one of
dehydration, which in extreme cases can lead to seizures or
convulsions.

"The issue with ecstasy is that it can cause long-lasting brain damage
and some people think it's permanent brain damage - we haven't
followed people long enough to know," said Dr. Robert Klitzman, a
clinical psychiatrist at Columbia University and the New York State
Psychiatric Institute.

Researchers have debated the merits of MDMA as a psychiatric tool
since the '70s, and that point of contention continues even today.
Within the past few years, however, the vast majority of research has
focused on the short and long-term impacts of recreational ecstasy
use. Dr. Alan Leshner, director of the National Institute on Drug
Abuse (NIDA), hopes the emerging picture will change the common
perception that ecstasy is a fun, harmless, club drug. "This is a
dangerous substance," he said. "Certainly for some people, it's an
extremely dangerous substance."

In September, NIDA launched a new antidrug campaign to drive home its
message. Less clear is how effective the strategy will be in
dissuading teenagers.

"It's an awkward age," Klitzman said. "When you're on ecstasy,
everyone loves you and you love them. It's just a great, great
feeling. Someone who took ecstasy once told me, 'Imagine if you just
won 100 million dollars in the lottery and everyone else around you
also won 100 million dollars. That's like ecstasy.'"

Like Prozac, ecstasy works by increasing the levels of serotonin, a
chemical messenger in the brain that plays a role in regulating
aggression, mood, sexual activity, sleep, and sensitivity to pain.

Unlike Prozac's moderate release of serotonin from nerve cells,
"ecstasy gives you a huge amount," Klitzman said, likely the source of
the bliss and euphoria that its users often report.

But too much of a good thing can quickly backfire. "The problem is
that basically it depletes the [nerve] cell of serotonin and starts to
destroy the cell as an after-effect," Klitzman said. "People take
ecstasy Saturday night and they feel great and then on Tuesday, they
crash," a phenomenon he calls "Suicide Tuesday."

The moniker may be a bit of an overstatement, since Klitzman concedes
that health officials have not witnessed spikes in suicides and
suicide attempts specifically linked to the drug's use. But he said a
period of depression after ecstasy use has been well-documented and
may lead to a host of other problems. To counteract the "bottoming
out," some users resorted to taking Prozac, St. John's wort-or more
ecstasy.

Meanwhile, animal studies have suggested that the damaged nerve cell
endings may grow back irregularly and interrupt key communication
pathways, possibly for life.

"It's like taking all of the phone lines in New York and ripping them
out and then replacing them haphazardly," Klitzman said. "The
communication is not going to be functioning as well."

Scientists have disagreed about whether the drug doses in the animal
studies correspond to doses normally associated with human
recreational use, but Klitzman said he has seen "evidence that even a
single dose of ecstasy may cause long-lasting deficits in attention
and memory."

In June, 1999, Dr. George Ricaurte of the Johns Hopkins University
School of Medicine and his colleagues released a report in the Journal
of Neuroscience in which they exposed red squirrel monkeys to MDMA for
four days. The monkeys' brain damage was evident six to seven years
later.

"The amount that produces toxic effects in brain serotonin cells in
animals is very close to, and sometimes even overlaps, the dose that
people take in the street," Ricaurte said in an interview.

Although ecstasy use has contributed to only two deaths in the New
York City area, it has been linked to thousands of emergency room
visits nationwide, commonly because of severe dehydration.

"The bodies are not piling up," said Dr. John P. Morgan, a professor
of pharmacology at City College of New York. "But there are short-term
dangers and there is fear that further down the line there will be ill
effects."

Morgan said he's concerned that most of the evidence is coming from
the same laboratory, weakening the scientific peer-review process.

"No one else has been able to gain the [NIDA ] funding to perform the
kinds of big studies that Ricaurte has," he said.

But some smaller studies have already begun hinting at other troubling
aspects of MDMA abuse. From interviews with 169 gay or bisexual men at
New York City dance clubs, Klitzman found that half had tried ecstasy
within the past six months and about a third used it at least once a
month. The research, published in July in the American Journal of
Psychiatry, suggested that gay and bisexual men who use the drug are
2.5 times more likely to have unsafe sex than those who don't use it.
"My sense is that with other people as well, it could lead to
high-risk behavior," Klitzman said.

And Klitzman said other dangers lurk in the drug combinations many
young people try, either intentionally or through pills tainted by
unscrupulous drug dealers. "If you buy ecstasy, who knows what
...you're getting?" he said.

Other researchers, however, contend that MDMA's legal status as a
prohibited drug with no accepted medical use has hindered research
that suggests it has clinical potential both as a psychiatric drug and
as a palliative for the terminally ill.

"I believe this substance is a potent, immediate-acting
antidepressant, and there is no such thing right now in psychiatry,"
said Dr. Julie Holland, an attending psychiatrist at Bellevue
Hospital's psychiatric emergency room in Manhattan. "Most of the
antidepressants take weeks to work, sometimes months, and if you're
really lucky, you may find a medicine that starts to help you feel
better in a few days, but there is nothing that works in an hour, and
this does."

Holland, who is critical of Ricaurte's animal research findings and is
writing her own book on the drug, believes MDMA could be prescribed at
low doses to psychiatric patients without causing long-term brain damage.

Klitzman and Ricaurte, however, remain unconvinced. "People have said
that ecstasy is like having a hundred therapy sessions," Klitzman
said, but he counters: "As a physician, the potential for permanent
brain damage, I think, is far more important than the potential to
improve your marriage."

[sidebar]

PSYCHOTHERAPEUTIC ROLE EXAMINED

SUE HUBSCHER KNEW that the drug ecstasy was illegal. And if she
had not met Shane Stevens, perhaps she would have had little reason to
try it.

But a week into their relationship, Stevens, a construction worker,
was diagnosed with renal cell cancer, and his terminal illness soon
changed everything.

"To make a long story short, his cancer almost killed the both of us,"
Hubscher said.

Nearly all research on ecstasy, abbreviated MDMA by scientists, has
addressed the harmful effects of recreational use. Nevertheless, a
significant number of doctors, psychologists and psychotherapists
believe the drug has the potential to treat psychological disorders,
facilitate psychotherapy sessions, and help terminally ill patients
deal with their impending deaths.

Hubscher is now a believer.

An airline employee and mother of three from Michigan, Hubscher, now
in her early 30s, used ecstasy with her dying fiance three times, a
decision she didn't make lightly. But she said in an interview she is
convinced the drug helped to break down the walls that had prevented
the couple from openly discussing his advanced kidney cancer. And
she's thankful that it provided them with a temporary reprieve from
the physical and mental anguish of his disease-a chance "to escape the
cancer and have a normal night."

First synthesized as a drug by-product in the early 1900s by the
German pharmaceutical company E. Merck, MDMA remained in obscurity
until it was rediscovered in the '70s by West Coast psychotherapists
and New Age seekers. In 1985, after the drug had been dubbed "ecstasy"
by clubgoers in Dallas and other cities, MDMA was classified as a
"Schedule 1" drug by the U.S. Drug Enforcement Administration. The
Schedule 1 category forbade the drug's use even for research purposes,
effectively ending studies addressing the drug's therapeutic potential.

But organizations such as the Multidisciplinary Association for
Psychedelic Studies (MAPS) are hoping to challenge the notion that
ecstasy is little more than a recreational drug. MAPS bills itself as
a nonprofit research and educational organization that helps
scientists "design, fund, obtain approval for and report on studies
into the healing and spiritual potentials of MDMA, psychedelic drugs
and marijuana."

One of Hubscher's friends told her about the organization and talked
with her over the course of six months about using the drug as a
psychotherapeutic tool to help her and Stevens heal the communication
chasm caused by his illness and prognosis.

"I remember it like it was yesterday," she said of the first time they
took ecstasy together, in 1997. "It allowed us to drop the barriers
and talk openly about his cancer for the first time in three years. We
talked about all our fears. He would never bring it up because I would
become a complete basket case. He had actually got to the point that
he was lying about his doctor's visits."

That night, the couple talked for nearly three hours about the disease
and how it had affected both of them.

"He made me realize that we were a team in this," she said. "After
that we would have little arguments, but before that we would have
knock-down-drag-out fights just because we didn't want to bring up
certain things. He had this huge wall up between us. From the time we
did that first session to the time we lost him, the wall was gone."

Although peer-reviewed research on the therapeutic potential of
ecstasy is virtually nonexistent, several studies are being planned or
are under way. For example, doctors at the Psychiatric Hospital of
Madrid are investigating the potential benefit of using MDMA
psychotherapy to treat post traumatic stress disorder. And researchers
at UCLA recently received conditional permission from the FDA to study
the safety of MDMA in terminally ill breast cancer patients in
preparation for future psychotherapy studies.

In the fall of 1997, Hubscher and Stevens wrote about their first two
sessions for the online MAPS Bulletin. Hubscher would later write two
more accounts reflecting on their experiences.

On Sept. 2, 1999, the couple tried ecstasy together for the last time.
By then, Stevens' daily morphine painkillers had dulled him physically
and mentally, Hubscher said. But he didn't take morphine that day.

"The night that we took [ecstasy], it took away all his physical
pain," she said. "By the time it had been kicked in for an hour, he
was hamming it up for the camera, doing toe touches and running to the
refrigerator."

That night, they didn't talk much about the cancer. Rather, she said,
it gave them a chance to escape the physical pain and the mental
anguish of the disease, if only for a few hours, and enjoy their time
together. "Let's drink in the night and enjoy it while we have it,"
she said.

"You also know that there is a real world you have to confront out
there. There is reality. We didn't think about going back into it [the
ecstasy high]," said Hubscher, who has since taken Stevens' surname.
"It was available. We had more. But we just snuggled up and went to
sleep."

Shane Stevens died one month later. He was 27.
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MAP posted-by: Richard Lake