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SAN FRANCISCODr. 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.
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.
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.
"Brain damage is the government's trump card."
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 DEAreacting to blatant, growing Ecstasy consumption and early neurotoxicity reportshad 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 Itheir 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 itavoiding the hyperthermia and increased heart rate that are MDMA's most immediate side effectsare 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 proxiesPET scans and spinal tapsshow 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.