Ecstasy for Agony?

Ecstasy for Agony?
A new study may prove that the party drug is effective in therapy. But will ecstasy make the leap from club to couch?
By Christie Aschwanden
Health Magazine
July/August 2002

In the street, rave-goers have labeled it “the love drug.” Newspaper reports have dubbed it a killer. But for Marcela Ot’alora, ecstasy was a lifesaver.
Repeatedly raped when she was a teenager, Ot’alora spent years locked in the grip of post-traumatic stress disorder (PTSD). “My whole body would go into a panic,” says Ot’alora, now 42 and therapist in Lafayette, Colorado.
Desperate, Ot’alora took ecstasy–the drug scientists call MDMA–during a supervised therapy session. That was 17 years ago, when therapists were legally giving it to their clients in small doses to help emotional healing. Those therapy sessions changed Ot’alora’s life. For the first time, she says, she felt safe to confront details she’d suppressed for years.
Now, Ot’alora is part of a growing movement to make ecstasy legal again as a controlled medication. Working with the Multidisciplinary Association for Psychedelic Studies (MAPS), a Florida-based nonprofit group that funds research into therapeutic uses for psychedelic drugs, Ot’alora and others are arguing that the drug has powerful healing potential, particularly for PTSD. And their cause is gaining steam: Last November, the U.S. Food and Drug Administration approved a clinical trial of laboratory-made, purified ecstasy for PTSD–the first such trial in almost two decades.
The federal government banned ecstasy in 1985, after it showed up on the club scene. A group of psychiatrists sued to keep the drug legal for research and medical use, but their suit failed. MAPS has revived the debate: The group hopes to reverse the government decision by funding the controlled studies they say are necessary to give the drug a fair hearing.
The first real step toward that goal will happen later this year, when South Carolina psychiatrists Michael Mithoefer, M.D., and his wife, Annie, a licensed psychiatric nurse, will give 12 patients a single dose of ecstasy in a supervised setting. A second group will receive a placebo; both groups will undergo conventional therapy afterward. Ot”lora is consulting with the Mithoefers as they organize their trial and working as a therapist for a similar MAPS-funded study already begun in Spain. Both studies are part of the association’s five-year, $5 million plan to gain approval for ecstasy as a prescription drug.
“I call it Prozac-plus,” says MAPS president Rick Doblin, Ph.D. “Prozac gives people a greater comfort level in their own skin. MDMA takes this to the next level.” Like Prozac, the drug boosts levels of serotonin, a brain chemical that regulates mood, sleep, and appetite. But while Prozac nudges serotonin levels up just a notch, ecstasy sends them soaring. It also hikes levels of another brain chemical called dopamine. The resulting euphoria lasts about five hours.
“In the same way a glass of wine can loosen you up, a dose of MDMA can help people loosen up to explore their inner selves,” says Julie Holland, M.D., a psychiatrist at Bellevue Hospital in New York and editor of Ecstasy, the Complete Guide: A Comprehensive Look at the Risks and Benefits of MDMA.
Michael Mithoefer says the drug facilitates therapy by allowing patients to face their traumatic experiences with less fear and shame. “MDMA increases empathy for oneself,” he says. “Many people with PTSD erroneously blame themselves, and that guilt is a barrier to healing.” If studies like Mithoefer’s result in ecstasy being available as a medicine, its uses may not be limited to PTSD. Before it was outlawed, ecstasy had been used in couples therapy; psychologists believed it helped couples discuss their hot-button issues without becoming defensive. Some experts also believe the drug helps with depression. Doblin says MAPS would also like to study the potential of MDMA therapy to help terminally ill patients face death without anxiety or fear.
There are some problems with the push to take ecstasy from the clubs to the therapist’s couch, though. For starters, growing evidence suggests that the drug might harm the cells that release serotonin in the brain. “The data in animals are quite compelling,” explains George Ricaurte, M.D., a pharmacologist at Johns Hopkins Medical Institution in Baltimore. Ricaurte says human studies imply the drug causes similar damage in people, though scientists aren’t exactly sure what the repercussions are. A few studies have found moderately impaired memory in frequent ecstasy users, but researchers can’t conclusively blame the drug since most heavy ecstasy users also take other illicit drugs.
Still, brain damage is only one potential problem. MDMA decreases the body’s ability to regulate temperature. “There are people taking ecstasy at raves and ending up with heat stroke,” Holland says. Ecstasy also elevates a hormone that spurs water retention, so when users take in more fluid than normal they can experience cramps. Seizures, and potentially fatal brain swelling. And even when ecstasy is taken in a controlled environment, the day after can be tough: The initial serotonin rush seems to temporarily deplete the brain’s supply of this neurochemical, leading to a post-ecstasy funk ravegoers call “the terrible Tuesdays.”
Despite these potential side effects, Mithoefer contends that ecstasy is afe when given in small doses under medical supervision. “We already have a lot of evidence showing that there’s no toxicity with this dose level administered in a clinical setting,” he says. And Holland points out that taking a small dose of ecstasy once or twice in a lifetime in a doctor’s office is hardly the same as taking it every weekend at a rave. “Like every potent medication,” she explains, “there’s a dose that’s safe and a dose that’s not.”
But Glen Hanson, Ph.D., the acting director of the National Institute on Drug Abuse, says labeling any dose safe sends a perilous message. “Taking it once a month isn’t likely to do permanent damage,” he says. “But it’s difficult and dangerous to generalize and say that one dose is never harmful.” Hanson worries that any endorsement of ecstasy by the government would be interpreted to apply to street ecstasy. And because it’s not regulated, there’s no way of knowing what’s in the ecstasy pills passed around at raves: Some contain amphetamines, for instance.
But these concerns don’t soften the resolve of ecstasy’s advocates. “I don’t want MDMA to be a street drug. I want it to be a medication,” Ot’alora says. “I’ve personally seen how it can help people.” For Mithoefer, the movement to test ecstasy is an ethical issue. “I see people every day whose lives are severely disrupted and they’re suffering because of PTSD. A significant number of these people aren’t helped enough by existing treatments,” he says. “If you don’t allow careful investigation into something that might help ease people’s suffering, you’re taking away their rights.”
Sidebar: Black market to supermarket?
If ecstasy is approved as a medicine, it may not be the only drug to go from the street to the pharmacy. Here are some others that may one day make the switch.

Marijuana

Street Name: Pot, Weed, Grass
The Buzz: A mellow, euphoric high

The Studies: A White House-commissioned report issued in 1999 concluded that marijuana has the potential to ease anxiety, stimulate appetite, calm nausea,and relieve pain. At least nine states have passed medical marijuana laws, though federal officials are reluctant to legalize it.
(LSD) Lysergic Acid Diethylamide

Street Name: LSD

The Buzz: Hallucinogen made famous by Timothy Leary’s motto “turn on, tune in, drop out”
The Studies Studies: in the ’60s hinted that LSD might lessen anxiety and depression in the terminally ill. Now the Orenda Institute, a psychedelic-studies organization in Baltimore, is hoping for FDA permission to test whether LSD can abate depression and anxiety in cancer patients.

Psilocybin

Street Name: Magic mushroom or ‘shrooms

The Buzz: Hallucinogenic effects much like LSD

The Studies: At the University of Arizona, an FDA-approved trial is under way to test the effect of psilocybin on obsessive-compulsive disorder. Swiss researchers are planning to test psilocybin’s power to treat depression.