The People's Prozac

Dissident Scientists Question the Ban on Ecstasy

Consider the two dosing lines for America's young people—the one outside the club and the one in the school nurse's office. At the door to raves, kids stand with Ecstasy pills on their tongues, waiting for the weekly surge of empathy and good feeling that comes from the combination of hallucinogen and amphetamine. For this rush, which was legal before 1985, they risk jail terms and the loss of student aid.

But every day outside the nurse's office, roughly 2 million kids line up for their daily dose of stimulant, very likely Adderall, a prescription amphetamine that is quickly replacing Ritalin as the drug of choice for attention deficit hyperactivity disorder. For this high, which is said to help learning, teachers and parents lend encouragement.

The double standard, says neurotoxicologist Dr. James O'Callaghan, points to the nation's blind spot when it comes to Ecstasy, also known as MDMA. O'Callaghan says that chemical cousins Adderall and Ecstasy carry similar risks, but while one is considered safe for America's youth, the other is its scourge. Maybe the government's line—that MDMA causes brain damage—isn't so clear-cut after all. "You can buy d-amphetamine on the street, and that's bad, but you can give the same compound to a kid chronically—twice a day, every day for the rest of their lives," says O'Callaghan. "If you truly believe MDMA is bad, then why would you give [Adderall] to your kids?"

Illustration: Jo Tyler

In an America that has declared war on Ecstasy, O'Callaghan's is a lonely voice of dissent. This summer, Florida senator Bob Graham introduced the "Ecstasy Prevention Act of 2001," which would provide more than $22 million for stepped-up law enforcement, a "national youth antidrug media campaign," and the creation of a new test to suss out MDMA users. New York senators Hillary Clinton and Chuck Schumer are co-sponsors of the bill, which came on the heels of a two-day conference at the National Institutes of Health in Bethesda, Maryland, that presented some of the latest research findings.

Some scientists foresee a future where a few doses of Ecstasy replace a lifetime of couch sessions and serotonin manipulators like Prozac.

So why all the fuss about a little pill? Ecstasy, like a host of legal drugs on the market, affects the chemical serotonin, which regulates critical brain functions like mood, aggression, sexual desire, sleep, and sensitivity to pain. By decreasing serotonin, scientists can send you spiraling into despair; alternately, by increasing it, they can lift you out. Yet for all their tinkering, surprisingly little is known about the brain chemical—we still don't know, for instance, why serotonin affects mood; it just does.

As part of its campaign against club drugs, the National Institute on Drug Abuse is running ads that picture "your brain on Ecstasy" as a lump with dark blotches and holes. And the pitch goes, "Chronic use of MDMA can produce long-lasting, perhaps permanent, damage to the neurons that release serotonin."

Not necessarily true, says O'Callaghan, who works for the federal Centers for Disease Control and Prevention. He says these ads are misleading because they leap beyond what we already know—that administering the popular club drug, also known as MDMA, carries the aftereffect of temporarily decreasing serotonin. "It looks like a blank slate, but it comes back," says O'Callaghan. "I'm not saying that MDMA isn't bad. I'm just saying that there's no evidence that it destroys serotonin neurons."

While clinical trials treating mental disorders with MDMA have never been conducted, proponents say anecdotal evidence from before 1985, when the drug was still legal, looked promising. It appeared to help people open up during psychotherapy, and some doctors suggested it could aid trauma victims or people suffering from terminal illness. Now researchers are gearing up to try again. In late September, scientists at the Medical University of South Carolina will submit a draft protocol to the FDA for a study examining Ecstasy-assisted psychotherapy for the treatment of post-traumatic stress disorder.

Some even foresee a future where a few doses of Ecstasy, taken in a therapist's office, replace a lifetime of couch sessions and serotonin manipulators like Prozac. Those supporters include Rick Doblin, president of the Multidisciplinary Association for Psychedelic Studies. Despite its flaky-sounding name, the group has actually funded much of the current research—pro and con—on Ecstasy. Presently, it's backing a study in Spain that uses the drug to help rape victims recover.

"MDMA could be a tool to get you past drugs," says Doblin. "Prozac is a tool to get the pharmaceutical industry rich."

Ecstasy, like Prozac, primarily targets serotonin-producing nerve cells. It is inside the axons—the part of the cell that sends out signals—that the chemical is stored. Under normal conditions, the brain works on electrical signals that cause the axon to release some of its serotonin into the synapse, or the gap between neurons. Any excess is then either broken down or reabsorbed in a recycling process called re-uptake.

MDMA, however, can cause a neuron to dump its entire store of serotonin into the synapse, flooding the adjacent neuron's receptors. This time, excess serotonin is not recycled: MDMA causes the transporters responsible for re-uptake to flow out instead of in. It is this massive serotonin overload, combined with secondary effects on the brain's dopamine system, that produces Ecstasy's loved-up sensations.

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