ECSTASY: Penicillin for the soul?
Ecstasy: a lethal class-A drug responsible for numerous teenage deaths. Ecstasy: a harmless drug that provides entertainment for millions every weekend – and could save marriages. How can opinion be so divided?
Football hooliganism could hold the key to treating a range of common psychological disorders, such as chronic stress and depression. But the clue lies not with hooliganism itself but with its remarkable disappearance. Throughout the Eighties and early Nineties, the football season was a long history of violent days, with rival “firms” engaging in running battles, trashing city centres and causing severe, occasionally fatal, injuries to each other. And then, suddenly, that stopped.
Effective policing and other social factors may have played a part, but one controversial theory credits the sudden outbreak of peace to widespread use of the illegal drug Ecstasy. In his book E for Ecstasy, published in 1994 (and now available only on the internet, at http://www.ecstasy.org), Nicholas Saunders describes how, in the summer of 1992, “many of the hard-core lads, who had previously been beating each other up, had spent most of the summer dancing the weekends away to the sounds of house music at raves fuelled by the drug Ecstasy.”
In November of that year, the day before Manchester United were due to play Manchester City in the local derby, the two rival football gangs met in a club “after necking an E”. Instead of the normal violent confrontation, the young men smiled at one another happily, before adjourning to someone’s house for a few joints; one commented: “Well, who’d have thought that we would be stood side by side the night before a derby game, and there’s no trouble in any of us? It’s weird, innit? It could never have happened before E.”
At the time, no one took Saunders’s ideas seriously. But in recent months there has been a shift in attitudes to the medicinal as well as the recreational properties of the drug that apparently brought love and peace to the hearts of rival football fans. Not only does Ecstasy seem to be a relatively safe drug; it may also be a valuable tool for psychiatrists treating chronic stress and depression, according to new research.
If the story sounds familiar, it’s because very much the same transformation has already occurred with cannabis. Reviled until recently by police and medical authorities alike, cannabis is now set to be downgraded as a recreational drug from class B to class C. Organised clinical trials of cannabis as a painkiller and treatment for muscle spasms are likely to result in its legalisation for medicinal use in the next couple of years, says Professor Tony Moffat, chief scientist of the Royal Pharmaceutical Society. There are also promising signs of its medical benefits for glaucoma, asthma, anorexia and mood disorders.
Now there are signs that Ecstasy, known in pharmaceutical circles as MDMA (methylenedioxymethamphetamine), is due for the same treatment. In her new anthology, Ecstasy: the Complete Guide (Park Street Press, £17.99), Julie Holland, a New York psychiatrist, says that it has a substantial therapeutic history that pre-dates its popularity as a recreational drug.
First synthesised (and patented) by Merck in 1912, Ecstasy was briefly investigated by the US Army Chemical Centre in the 1950s as a potential brainwashing tool. It came into its own, however, in the late Seventies, when it became widely used by several hundred psychotherapists attached to the Esalen Institute in California, four out of five of whom believed that it had “substantial potential as an adjunct to the psychotherapy process”, according to subsequent research.
Known as “penicillin for the soul”, MDMA, which works on two brain chemicals, serotonin and dopamine (essentially combining the effects of Prozac-type antidepressants and amphetamines), “induces a gentle and subtle shift in consciousness”, says Dr Holland. It “makes painful psychotherapy easier and faster, like anaesthesia given during surgery to allow for deeper incisions and removal of more malignant material.”
The gathering of evidence of the drug’s major therapeutic benefits, however, came to an abrupt halt in 1984. At the beginning of the Eighties, “MDMA, the therapeutic tool, leaked out into the general community to become Ecstasy, the party drug”, and a worried US Drug Enforcement Agency overruled a substantial pro-MDMA research lobby and placed it in the most restrictive category of controlled substances. Medical research was banned. Meanwhile, in Britain alone, up to two million people partied on it every weekend.
But the therapeutic MDMA lobby is persistent. A key activist, Dr Rick Doblin, gained a drugs policy PhD at Harvard and set up the Multidisciplinary Association for Psychedelic Studies (or MAPS – http://www.maps.org) to lobby for and fund research into the medical use of MDMA. With one trial already under way in Spain, the American Food and Drug Administration approved the first US-based double-blind clinical trial of the rave drug to treat post-traumatic stress disorder in November 2001 – and there are plans in the pipeline to test MDMA’s potential to support treatment for marital problems, depression and even schizophrenia. Further research, testing a form of the drug as a treatment for Parkinson’s disease, is also under way at the school of biological sciences at Manchester University.
It’s a remarkable about-turn, considering that the US government has, in the past two years, stiffened legal penalties for possession and stepped up efforts to publicise the dangers of Ecstasy; according to New Scientist magazine, Ecstasy offences are now “being punished more harshly in the US than those involving heroin”.
A major focus of the pro-Ecstasy campaign has been to overturn the persistent media image of the drug as a potential killer and a cause of brain damage. Enthusiasts have no problem in finding evidence that refutes that graphically. Saunders used government statistics to substantiate his claim that taking Ecstasy – with around five related deaths a year at the time – carries about the same risk as fishing and horse-riding. Current figures of about 27 Ecstasy-related deaths a year are still lower than those for glue-sniffing and over-the-counter painkillers – and seem to be linked to a little-understood and extremely rare reaction called serotonin syndrome.
Intriguingly, the very experts who drew attention to Ecstasy as a potential killer have also supported the move to have it clinically tested as a therapeutic entity.
Dr John Henry, director of the National Poisons Information Service at Guy’s Hospital, was the first to catalogue the risks of overheating at Ecstasy-fuelled raves, as well as the possibly greater risk of drinking too much water. But he is critical of media coverage of the drug’s safety record. “The sensationalising of the deaths of two young women, one in England and another in Australia, which may have been related to hyponatremia [a low concentration of sodium in the blood] associated with drinking too much water after Ecstasy use, clearly illustrates a desire to sell newspapers rather than cogently inform,” he says in a piece included in Ecstasy: the Complete Guide. “Intuitively, we know that the incidence of adverse outcomes is low, since emergency departments are not being overrun each weekend by people dying from Ecstasy use. It is the manner in which MDMA is used that poses the greatest danger to the patient.”
One of the most effective weapons of the anti-Ecstasy lobby, used repeatedly on TV and in magazines, has been a set of coloured images taken from brain scans, which supposedly show that repeated use of the drug makes holes in the brain. But recently a detailed investigation has shown that the pictures are based on unreliable and inaccurate science. The original study from John Hopkins University, published in The Lancet in October 1998, used inaccurate measurement probes and was selective in the data it published. Subsequent tests of mental agility show that Ecstasy users perform as well as non-users.
So, if Ecstasy is largely safe, why criminalise it? That was the question posed at the Cheltenham Festival of Science last month, at which the “godfather of Ecstasy”, Alexander “Sasha” Shulgin, appeared alongside weighty academics such as the pharmacologist Les Iversen and Colin Blakemore, chairman of the British Association for the Advancement of Science, on a platform calling for a change to drug laws.
Shulgin is a chemist with an academic career at the University of California. His research work over the past 40 years has involved designing, synthesising and evaluating psychedelic drugs. He was the man who published the chemical formula for MDMA in 1965 and wrote up the first paper on its therapeutic use.
While Profs Iversen and Blakemore stressed the lack of scientific evidence to support the law against cannabis, Shulgin went further and called for a repeal of the criminalisation of all drugs, with better drug safety brought about by “getting honest information out there, openly available to everyone, to build up a public awareness of the health problems that might be associated with drug use”. Ecstasy, he said, “should be used only with access to medical advice”.
There are cogent arguments for using the drug only within a therapeutic setting. Its effect reduces with use, and the so-called love effect, achieved when it floods the brain with far higher levels of serotonin than Prozac-type drugs can, stops working if the drug is used regularly, because of changes to the brain.
As the psychiatrist George Greer, medical director of the Heffter Research Institute, points out in Ecstasy: the Complete Guide, people do not necessarily change while on MDMA. “There’s no guarantee that problems will be resolved. It all depends on the individuals and their intention, their willingness to work it out.” The role of the MDMA therapist (usually someone who has taken the drug) is “to guide the person through a task that needs to be accomplished”, says Dr Holland – “otherwise there’s a risk that you’ll just admire the beautiful wallpaper.”
A five-year MAPS plan to introduce MDMA as a therapy in the States envisages its use as a drug taken under the supervision of a therapist. Instead of following the conventional Western medical model, which treats healing drugs as something to be administered on a daily schedule, the therapeutic use of Ecstasy should be an experience “shared by doctor and patient together”, says the Californian psychologist Dr Ralph Metzner. “This model is much closer to that followed in traditional people’s healing ceremonies.”
In other words, if Ecstasy does follow cannabis on to the prescription pad, it could change the whole basis on which psychiatrist and client relate to each other. Anyone who says that couldn’t happen might do well to remember that Manchester football derby of 1992.