Pubdate: Tue, 13 Feb 2001
Source: Village Voice (NY)
Copyright: 2001 Village Voice Media, Inc
Contact:  36 Cooper Square, New York, NY 10003
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Website: http://www.villagevoice.com/
Authors: Richard Elovich and Daniel Wolfe

WHO OWNS ECSTASY?

SAN FRANCISCO--Dr. George Ricaurte's slides illustrating the effects of 
MDMA on the brain look, well, psychedelic. Swirling green cross-sections of 
monkey brains are followed by human PET scans, billowing shapes bathed in 
purple and yellow. One brain burns bright orange with swirls of the 
chemical analog for happiness, serotonin; another, serotonin-short, is a 
muted, lava red. r The National Institute of Drug Abuse (NIDA), whose 
funding helped rocket Ricaurte from promising grad student to Johns Hopkins 
researcher with more than 100 published articles, has plunked these images 
on a postcard labeled ''Plain Brain/Brain After Ecstasy,'' and made them 
the centerpiece of a $54 million anti-club-drug initiative. Today, however, 
a number of researchers, clinicians, and highly educated users are looking 
at these pictures and asking if the government's interpretation is more 
purple haze than perfect science. r All the tribes and high priests of MDMA 
gathered in San Francisco last week for a State of Ecstasy conference, and 
they are uttering the names of the drug as they have known it: ADAM, X, 
entactogen (something that touches within), empathogen (something that 
opens you to others), psychostimulant. Each name evokes a history and often 
an expertise not shared by the others.

Sasha Shulgin, the legendary 75-year-old chemist who rediscovered MDMA in 
the mid 1970s, is here. The Moses of MDMA folklore, Shulgin handed the 
tablets to a therapist who in turn quietly initiated nearly 4000 others 
before criminalization. Charles Grob, director of Harbor-UCLA Medical 
Center's Division of Child and Adolescent Psychiatry, is here. Worried 
about the way young people are using the drug and leery of even saying 
Ecstasy (who knows what's in the stuff you buy on the street?), Grob seeks 
to test MDMA in psychotherapy for patients with terminal illness. 
Therapists make up a sizable percentage of the nearly 350 people attending, 
but there are also party people in the house, among them researcher Paul 
Dillon, who pioneered on-site purity testing of MDMA at gay parties in 
Australia, and DanceSafe founder and rave risk reducer Emanuel Sferios.

At 22, Theo Rosenfeld runs a small contracting company and his own, very 
deliberate horizon-expansion program through strategic X use. He tests his 
pills with a kit he got from DanceSafe, has switched to pot for dancing, 
and uses X sparingly at home. He has read every study published. ''There's 
a definite chance that in high amounts it can do some nervous system 
damage, and some chance that in small infrequent doses it can,'' he 
acknowledges. ''But that evidence is still so vague compared to the real, 
overwhelming experience of opening up on Ecstasy and wanting to share the 
joy of my life with people close to me. That's worth a lot to me. If I can 
grow up with those peak experiences, I think I will be a better person.''

Who owns Ecstasy? Marsha Rosenbaum, director of the Lindesmith Center-Drug 
Policy Foundation in San Francisco, convened this conference precisely to 
let these different experts speak to each other, and where necessary, duke 
it out. She was the first federally funded sociologist to interview MDMA 
users; her own research in the '80s left her impressed ''by the 
heart-opening power of the drug'' and ''concerned about the many unknowns'' 
as MDMA moved from underground therapeutic agent to mass-marketed and newly 
criminalized party drug. The DEA--reacting to blatant, growing Ecstasy 
consumption and early neurotoxicity reports--had moved against MDMA in 
1985. Overruling scores of psychiatrists arguing that the drug's 
therapeutic potential merited classification as a prescription medicine, 
the DEA condemned MDMA to Schedule I--their category for heroin, LSD, and 
other drugs with high abuse potential and no accepted medicinal use.

This meeting is a resumption of discussions shut down by that DEA decision 
15 years ago. While the government has focused on the drug's action in the 
lab animal (or human subject in a lab), speakers here want to know about 
the risks and benefits of MDMA as it is used in the world. If you take the 
drug only a few times, are you safe? If you stay cool and quiet while you 
do it--avoiding the hyperthermia and increased heart rate that are MDMA's 
most immediate side effects--are you safe? Can the drug boost the 
effectiveness of conventional psychotherapy, in treatment of post-traumatic 
stress disorder, for example? Research into these questions has largely 
been silenced by MDMA's Schedule I status and the neurotoxicity 
allegations. ''Brain damage is the government's trump card,'' says 
Rosenbaum, ''the thing that allows them to say, 'Never mind all that other 
stuff.'''

As befits a conference on an empathy-producing drug, even those with 
different perspectives seem receptive as Dr. Ricaurte leads them through 
the evidence of neurotoxicity. The brains of monkeys injected with MDMA 
show ''pruning'' of the long nerve projections, known as axons, used in the 
transmission of serotonin. In monkeys, axonal damage and subsequent 
serotonin depletion persists for years. While researchers can't cut open 
human brains, their next best proxies--PET scans and spinal taps--show 
human depletion of serotonin at least two or three weeks after the use of 
MDMA. Finally, preliminary studies have shown differences in memory or 
simple learning tasks, which might suggest permanent problems with memory 
or cognition.

Today, though, speaker after speaker questions the neurotoxicity 
conclusions. ''The difference between a medicine and a poison is the dose 
and context,'' Grob points out, challenging whether Ricaurte's doses in 
monkeys stand up to the scrutiny of interspecies scaling. An audience 
member asks if the pruning is damaging brain cells or, as when he prunes 
his garden, just reworking their growth. The question underlying his 
question--how we might distinguish brain damage from brain change, perhaps 
linked to the kind of psychological breakthroughs some MDMA users 
report--goes unanswered. ''The so-called neurotoxicity phenomenon may be a 
prelude to a neuroplasticity response,'' Grob says later. ''We don't know.''

What about the studies finding functional impairment in humans? Here, too, 
Grob and others find that the studies raise as many questions as they 
answer. The ''MDMA users'' had in fact used street Ecstasy and other drugs, 
often repeatedly. Was the impairment the result of Ecstasy alone, or some 
other more toxic drug--ketamine, for example? Given widespread reports of 
bunk sold as Ecstasy, how do we know the users had even taken MDMA? Why did 
studies on cognitive function match polydrug-using hard partiers against a 
control group of squeaky-clean college students?

A reporter asks Ricaurte why, rather than looking retrospectively, he has 
never done the ''prospective'' trials scientists usually prefer: dividing 
two groups of MDMA-naive individuals, administering MDMA to one and a 
placebo to the other, and charting cognitive or other effects. Ricaurte 
pauses. Ethically, he says, ''Any study has to be conducted with an eye 
toward risk versus benefit. I can't point to one study showing the 
therapeutic benefit of MDMA.''

''Of course you can't,'' says Grob, ''because to date, none have been 
permitted.''

As sponsor of more than 85 percent of the world's research on the health 
effects of drug use, NIDA has funded only three research centers to test 
MDMA in humans, and none to look at therapeutic use of the drug or how the 
context in which it is used might change the risks. Like the government's 
DARE program, which claims to help kids with drug decision making and then 
says the only choice is to ''say no,'' NIDA's Ecstasy research purports to 
be driven by science but offers an anemic range of options. ''There are 
pockets of honest research,'' says Lindesmith executive director Ethan 
Nadelmann, ''together with an overlay that is profoundly politicized and 
corrupting of the research. Certain questions are not to be asked.''

Studies on the therapeutic use of MDMA are under way in Switzerland, Spain, 
and Israel. The U.S., meanwhile, is hammering its science into armaments 
for the drug war. In the last year, NIDA has used every opportunity to get 
out the message that ''even one MDMA dose is toxic,'' distributing 330,000 
Brain on Ecstasy cards, issuing mailings and alerts to 250,000 health 
professionals, and launching a PR blitz. Predictably, sensational media 
coverage has followed: On a recent 48 Hours, a doctor showed an 
Ecstasy-abusing teen and her concerned mother a computer model of her brain 
and declared it ''almost moth-eaten.''

The number of MDMA users in America--customs seizures, arrests, and scare 
campaigns notwithstanding--continues to rise. ''Right now,'' says Grob, 
''the only ones being controlled are the researchers.''
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