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Utopian Pharmacology - Mental Health in the Third Millennium / MDMA and Beyond

Posted: Sat, January 26, 2013 | By: David Pearce



MDMA/Ecstasy

Can safe, sustainable analogues of MDMA be developed? There is an urgent need for non-neurotoxic empathogens and entactogens suitable for lifelong use. Alas no single “magic bullet” yet exists that replicates the subjective effects of MDMA on a long-term basis. Hence most of us are doomed to display the quasi-psychopathic indifference to each other characteristic of the MDMA-naïve state.

A brief history of MDMA 

(this essay was originally published in January 2007)

MDMA [3,4-methylenedioxy-methamphetamine: ‘Ecstasy’] was first1 synthesized in 1912 by the German pharmaceutical company Merck. MDMA was patented in Darmstadt, Germany on May 16th 1914, issue number 274,350; and promptly forgotten. Merck’s researchers had no idea of the significance of what they had done. Merck were searching for a good vasoconstrictor, a styptic to reduce bleeding. In 1912 two of their chemists, G. Mannish and W. Jacobsohn, created MDMA as a by-product while attempting to synthesise hydrastinin. MDMA is listed on Merck’s patent-application merely as a chemical intermediate “for products of potential pharmaceutical value”.

MDMA surfaced again briefly as one of a number of agents used in clandestine US military research during the 1950s. The CIA‘s Project MK-Ultra was investigating new techniques of brainwashing, espionage and mind-control. MDMA, code-named EA-1475, was tested at the US Army’s Edgewood Arsenal in Maryland. However, unlike LSD or the ill-named “truth drug” scopolamine, MDMA was used only on non-human animals: mice, rats, pigs, monkeys and dogs. Thankfully, MDMA’s military potential was not realised. For although MDMA is no infallible truth-serum, its effects on the human user might indeed be abused for sinister purposes by skilled interrogators. The heightened emotional responsiveness, lowering of defensive barriers, openness and sense of closeness to others induced by MDMA can promote an honesty of self-disclosure that might be manipulated for malign ends. Fortunately, this hasn’t yet happened on an organised scale.

MDMA’s parent and longer-acting metabolite, 3,4-methylenedioxyamphetamine [MDA] was first synthesized in 1910 by the same two unsung Merck researchers who went on to create MDMA. MDMA differs structurally from MDA only in its additional methyl group attached to the nitrogen atom. MDA’s own empathy-enhancing effect at low doses was explored by Chilean anthropologist-psychiatrist Dr Claudio Naranjo in his private practice. Dr Naranjo discusses MDA-assisted therapy in his classic The Healing Journey (1973). MDA was patented by drug company SmithKline French for use as a tranquilliser (1960) and appetite-inhibitor (1961). SmithKline were interested in MDA’s potential as an antidepressant and a slimming-drug. In 1958 human trials were conducted; unfortunately the compound was to prove too psychedelic for licensed clinical use. But MDA was popular as “the love drug” in the counterculture of the 1960s.

The identity of the first human being to take MDMA/Ecstasy isn’t known. The drug gained prominence only in the late 1970s. Tipped off by Merrie Kleinman, a graduate student in the medicinal chemistry group he advised at San Francisco State University, the legendary Californian psychedelic chemist Alexander (“Sasha”) Shulgin synthesized and taste-tested MDMA at incrementally ascending doses. Ironically, Dr Shulgin had himself synthesized MDMA in 1965, but hadn’t tried it, an error of omission he later did much to repair. The effects of a 120mg dose of MDMA are recorded in Dr Shulgin’s lab-notes (Sept 1976):

“I feel absolutely clean inside, and there is nothing but pure euphoria. I have never felt so great or believed this to be possible. The cleanliness, clarity, and marvelous feeling of solid inner strength continued throughout the rest of the day and evening. I am overcome by the profundity of the experience…”

In the first published scholarly paper [Shulgin,A.T. & Nichols,D.E.: Characterization of three new psychotomimetics. In: Stillman,R.C. & Willette,R.E. (Eds.) The Pharmacology of hallucinogens. New York: Pergamon, 1978] on MDMA use in humans, Dr Shulgin and Dr David Nichols describe the effects of MDMA on the human psyche as “an easily controlled altered state of consciousness with emotional and sensual overtones.” The well-connected stepfather of MDMA soon introduced the drug to the wider scientific community. Some of Dr Shulgin’s friends, notably the “Johnny Appleseed of MDMA”, Leo Zeff, were professional therapists. They in turn introduced MDMA to colleagues as a valuable adjunct to psychotherapy.

Later, in 1991, Dr Shulgin and his wife Ann published PiHKAL [Phenethylamines I Have Known And Loved]: A Chemical Love Story. PiHKAL describes the synthesis and systematic testing on human subjects of a range of novel or neglected phenethylamine research drugs. PiHKAL also offers a uniquely sophisticated methodology for human psychopharmacology and the scientific study of mind as an experimental discipline.

By the early 1980s, over a thousand private psychotherapists in the USA were using MDMA in their clinical practice. MDMA was commonly known as “Adam”, an allusion to “being returned to the natural state of innocence before guilt, shame and unworthiness arose”. MDMA was used discreetly; no one wanted a re-run of the 60s. Dr Shulgin himself reportedly felt MDMA came closest to fulfilling his ambition of finding the perfect psychotherapeutic drug.

Inevitably word leaked out. MDMA was profiled by the San Francisco Chronicle as “The Yuppie Psychedelic” (10 June 1984). In Newsweek, J Adler [“High on ‘Ecstasy”, April 15 1985] likened his MDMA experience to “a year of therapy in two hours”. Harpers Bazaar described MDMA as “the hottest thing in the continuing search for happiness through chemistry”. Unsurprisingly, MDMA use soon spread beyond the couch and clinic to the wider world. MDMA’s now universal brand-name, “Ecstasy”, was coined in 1981 by a member of a Los Angeles distribution network. The unnamed distributor, quoted in Bruce Eisner‘s Ecstasy:The MDMA Story (1989), apparently chose the name “Ecstasy” because “it would sell better than calling it ‘Empathy’. ‘Empathy’ would be more appropriate, but how many people know what it means?” Condemned by purists as a cynical marketing ploy, the brand-name “Ecstasy” isn’t wholly misleading [ecstasy: “an overpowering emotion or exaltation; a state of sudden intense feeling. Rapturous delight. The frenzy of poetic inspiration. Mental transport or rapture from the contemplation of divine things”]. Many first-time MDMA users do indeed become ecstatic. Some people report feeling truly well for the first time in their lives.

In the early 1980s, American production of MDMA beyond the research laboratory was effectively controlled by chemists known as the “Boston Group”. Somewhat incongruously, MDMA was especially popular in Texas, where the Southwest distributor for the Boston Group launched his own commercial operation. Mass-production of MDMA by the so-called “Texas Group” began in 1983; supply (and demand) soon mushroomed. Ecstasy was distributed openly in bars and nightclubs in Dallas and Fort Worth. It could be purchased via toll-free 800-numbers by credit card. The drug was even marketed via pyramid-style selling-schemes. Ecstasy could be bought in little bottles at convenience stores under the label “Sassyfras”, a tongue-in-cheek allusion to the botanical origins of its precursor.

The DEA reacted by petitioning to have MDMA banned altogether. In 1985 the drug-warriors succeeded in having MDMA made Schedule One. Schedule One is the most restricted of all drug categories i.e. MDMA had allegedly “no legitimate medical use or manufacturer” in the USA; it lacked safety for use even under medical supervision; and it carried a “high potential for abuse”. But by then MDMA’s fame had spread across the Atlantic. MDMA had metamorphosed from “Adam”, the psychotherapeutic tool, to “Ecstasy”, the party drug.

MDMA was first introduced to Europe via the sannyasins, disciples of the Bhagwan Shree Rajneesh. “Sannyasa” is a Sanskrit word meaning complete or perfect renunciation. Cult members slipped MDMA into the drinks of rich sympathisers to open up their hearts and their wallets.

Ecstasy became associated with the birth of Acid House music in the Spanish tourist resort of Ibiza. By the summer of ‘86, Ibiza was popularly known as “XTC Island”. Returning tourists and disc-jockeys took the message back home. The UK’s rave scene was born. Hundreds of thousands of tablets were consumed each weekend in the famous “Summer of Love” (1988). The Conservative Government and its allies in the British press were aghast. A moral panic set in at the threat to the nation’s youth. MDA, MDEA, MDMA and assorted psychedelic amphetamines had been outlawed in the UK since 1977. Yet the Criminal Justice and Public Order Act 1994 sought to criminalize an entire youth-culture by suppressing music played publicly with “sounds wholly or predominantly characterised by the emission of a succession of repetitive beats”.

Soon production and distribution of the world’s leading empathogen-entactogen fell into the hands of organised crime. By the turn of the millennium, perhaps 80-90% of the world’s MDMA was manufactured in Belgium and the Netherlands. Russian-Israeli syndicates and Eastern European chemists are now increasingly active too. The expertise needed in MDMA production varies according to the route of synthesis. Over twenty recipes have been described in the literature. Only seven are common. Clandestine production is easiest starting with MDP2P. MDP2P (3,4-methylenedioxyphenyl-2-propanone) is a commercial product used by the flavouring and fragrance industry. Groups with access to MDP2P can make MDMA via a simple conversion process. Otherwise, MDMA must be synthesized from piperonal, isosafrole, or safrole. These primary precursor chemicals of MDMA are produced in India, China, Poland, Germany, and increasingly elsewhere. Typically, safrole or isosafrole are first converted to MDP2P. The essential oil safrole occurs naturally as the primary constituent of oil of sassafras. Oil of sassafras is found in the root-bark of US East Coast tree Sassafras albidum and from the above-ground woody parts of the South American tree Ocotea pretiosa. Safrole is also present in nutmeg (Myristica fragrans), dill, parsley seed, crocus, saffron, vanilla beans, and calamus. If MDMA were on-patent, then today it might be marketed as “natural” or “naturally-inspired”; but Nature has not been so kind.

Early in the twenty-first century, an estimated several million people worldwide were taking Ecstasy and allied research chemicals each month on college campuses, in high schools and on dance-floors. Purity varies; perhaps 10%-15% of tablets consumed contain MDMA as the sole active ingredient. Illicit knowledge of the “penicillin of the soul” is spreading rapidly around the world, but in corrupt and contaminated form.

The MDMA Experience

Pure MDMA salt is a white crystalline solid. It looks white and tastes bitter. The compound is chemically stable. MDMA does not readily decompose in heat, air or light. The optimal adult dose of racemic MDMA is probably around 120-130mg [around 2mg/kg of body weight i.e. about 125mg] but optimal dose ranges from perhaps 75mg to as much as 250mg. Pills sold in clubs often contain less. There are gender differences in response; proportionately to body-weight, women are normally more sensitive than men to the sub-acute and longer-term effects of MDMA, so their optimal dosage may be lower. The preferentially metabolised (+)-enantiomer (“mirror image”) of MDMA is more active, more stimulating, more dopaminergic, more subjectively rewarding, and more neurotoxic than the (-)-enantiomer. MDMA is usually taken orally as a tablet, a capsule, or a powder. MDMA is readily absorbed from the gastrointestinal tract into the bloodstream. More rarely, the drug is snorted, smoked or injected.

Onset of action is normally within twenty to sixty minutes or so after administration. When MDMA is administered by the oral route, “coming up” is naturally faster on an empty stomach. Taking MDMA causes both an increased neuronal reuptake inhibition of the neurotransmitter serotonin (5-hydroxytryptamine, 5-HT) and also, critically, its increased synaptic release. The MDMA molecule is small enough to be taken up via the membrane-bound serotonin transporter into the presynaptic serotonin axon terminals. Here MDMA acts to reverse the normal direction of the so-called serotonin reuptake pump. Inside the nerve cell, MDMA alters the configuration of the transporter protein so it binds to cytoplasmic serotonin, after which the transporter dumps serotonin outside the cell, reversing the normal inward-bound direction of the transporter channel i.e. MDMA increases the rate of transporter-mediated serotonin outflow. The consequent additional flood of serotonin in the user’s synapses is soon followed by an increased release of dopamine especially in the reward centres of the striatum and nucleus accumbens. Release of oxytocin, the “cuddle hormone”, surges too via stimulation of the serotonin 5-HT(1A) receptors.

First-time MDMA users occasionally feel confused or anxious before the dose-dependent dopamine-release kicks in. A transient hint of nausea is common when coming up. Most of the body’s serotonin is found outside the brain, notably in neurons of the enteric nervous system, our “little brain” inside the smooth muscles of the gut. The user’s peak experience or plateau phase after the exhilarating dopaminergic “rush” doesn’t last much more than ninety minutes to two hours. MDMA’s primary effects wear off after some 3-4 hours. MDMA is more fat-soluble than its structural parent, so its speed of onset is slightly faster and its duration of action shorter. With oral MDMA dosing, peak concentration in the plasma follows after around two hours. Therapists then sometimes add(ed) a final 50mg booster-dose. Heavy recreational users are not always so restrained either in dosage [“stacking”] or top-up schedule [“piggybacking”].

The clarity and unique psychological effects of MDMA can be impaired by ethyl alcohol. Thus MDMA is best taken while completely sober, though a modest drink later to ease any comedown may be useful.

MDMA has a complex nonlinear pharmacokinetics. Taking higher and/or more frequent doses of the drug disproportionately increases levels of plasma MDMA. Higher levels substantially increase oxidative stress and magnify the risk of toxicity. MDMA is metabolised via N-demethylation to the active metabolite MDA; MDA can itself induce a state of sensual euphoria, though in humans the conversion rate from MDMA in the body is low. At least four other metabolites have been identified. MDMA is broken down mainly in the liver, primarily by the polymorphic cytochrome P450 enzyme CYP2D6. However, other enzymes are involved in its degradation beside CYP2D6; some of them, like CYP2D6 itself, are saturated at relatively low MDMA concentrations. MDMA metabolism seems to run up against such a metabolic saturation-point somewhere between 120 and 150mg. When the high-affinity enzymes are saturated, a disproportionately large increase in blood- and brain MDMA-concentrations may occur if the user then takes more of the drug. A large but variable quantity of the parent compound is excreted unchanged, especially when the drug is taken at higher doses; but the opportunities for MDMA recycling by the cost-conscious are normally wasted.

MDMA is sometimes described as a cross between a psychostimulant and a mild hallucinogen. Since it’s a methoxylated amphetamine, MDMA is indeed structurally related to mescaline. MDMA’s methylenedioxy (O-CH2-O-) group is attached to positions 3 and 4 of the aromatic ring of the amphetamine molecule. But hallucinations on MDMA taken at therapeutic dosages are extremely rare; and psychostimulants, unlike MDMA, don’t typically induce a profound sense of inner peace. Thus MDMA exhibits a different profile both from the prototypical “serotonergic” 2,5-dimethoxy-4-methylamphetime (DOM), with its psychedelic 5-HT2A-mediated mechanism of action, and also from the prototypical “dopaminergic” stimulant (+)-amphetamine.

MDMA is perhaps best characterised as belonging to a functionally unique class of “empathogen-entactogen”. These words don’t mean a great deal in the MDMA-naïve state. The term “empathogen” to describe MDMA and other closely related phenethylamine “empathy drugs” [MDA, MDEA, MBDB] was proposed by Ralph Metzner, Dean of the California Institute of Integral Studies, at a 1983 conference at the University of California at Santa Barbara. The term “entactogen” was coined in 1986 by Dr David Nichols, Professor of Medicinal Chemistry and Pharmacology at Purdue University and co-founder of the Heffter Research Institute, to refer to substances that generate a sense of “touching within” or “produce a feeling in one’s innermost being”. Both terms are quite apt, though neither will win any marketing awards. MDMA can promote an extraordinary clarity of introspective self-insight, together with a deep love of self and a no less emotionally intense empathetic love of others. MDMA also acts as a euphoriant. The euphoria is usually gentle and subtle; but sometimes profound.

Culture, set and setting inevitably shape the MDMA experience. Idiosyncratic responses to MDMA aren’t rare. MDMA has even been described as a drug that “could be all things to all people” (Dr Shulgin). Even so, MDMA’s primary effects on the user are surprisingly consistent, unlike the wilder psychedelics such as LSD, psilocybin, or DMT. MDMA may feel mystical, magical or sublime; but it doesn’t feel weird. The drug’s influence feels highly controllable. MDMA tends to enrich the user’s sense of self-identity, not diminish it. MDMA “provides a centering experience, rather than an ego diffusing experience” (Dr. Philip Wolfson), though it may also cause a “softening of the ego-boundaries”. Sometimes a degree of derealisation on MDMA may occur, but rarely depersonalisation in the ordinary sense of the term. On the contrary, users feel they can introspectively “touch inside” to their ideal authentic self with total emotional self-honesty.

As well as acting as a “gateway to the soul”, MDMA “opens up the heart”. Taking MDMA induces an amazing feeling of closeness and connectedness to one’s fellow human beings. MDMA triggers intense emotional release beyond the bounds of everyday experience. The drug also enhances the felt intensity of the senses - most exquisitely perhaps the sense of touch. The body-image looks and feels wonderful. Other people look and feel wonderful too. Minutes after dropping a pill, a lifetime of Judaeo-Christian guilt, shame or disgust at the flesh melt away to oblivion.

When MDMA is taken outdoors, the natural world seems vibrant and awe-inspiring, perhaps even enchanted. The experience of colour is gorgeously intensified. On MDMA, Dr Shulgin reported how mountains he’d observed many times before appeared to be so beautiful that he could barely stand looking at them. MDMA is not normally classed as an entheogen. “Entheogen” is a term proposed in 1979 by the scholars R. Gordon Wasson, Carl A.P. Ruck, Jonathan Ott, Jeremy Bigwood and Danny Staples for agents “generating the god or the divine within”, shorn of any speculative metaphysics. Yet MDMA is used by a variety of spiritual practitioners of widely diverse beliefs as a gateway to the divine. Some MDMA users undergo life-changing spiritual experiences. Nicholas Saunders, author of the book E for Ecstasy (1993), cites a Benedictine monk who finds MDMA “opens up a direct channel to God”. MDMA may not be “Christ in (al)chemical form”, but if it had been present in the Eucharist, then we would all still be devout Christians, possibly for ever. A minority of first-time MDMA users undergo what the inventor of the Shulgin scale christened a Plus Four…

“PLUS FOUR, n. (++++) A rare and precious transcendental state, which has been called a “peak experience,” a “religious experience,” “divine transformation,” a “state of Samadhi” and many other names in other cultures. It is not connected to the +1, +2 and +3 of the measuring of a drug’s intensity. It is a state of bliss, a participation mystique, a connectedness with both the interior and exterior universes, which has come about after the ingestion of a psychedelic drug, but which is not necessarily repeatable with a subsequent ingestion of the same drug. If a drug (or technique or process) were ever to be discovered which would consistently produce a plus four experience in all human beings, it is conceivable that it would signal the ultimate evolution, and perhaps the end of, the human experiment. (PiHKAL, pages 964-965)”

Plus Fours are rare, today. But on MDMA, even the most jaded and world-weary soul with a tin-ear for poetry may “see a world in a grain of sand, And a heaven in a wild flower, Hold infinity in the palm of your hand, And eternity in an hour.”

MDMA is sensuous and sensual in its effects without being distinctively pro-sexual. Although once dubbed “lover’s speed”, MDMA is proverbially more of a hugdrug than a lovedrug: “I kissed someone I was in love with and almost felt as if I was going to pass out from the intensity”, recalls one American clubber. However, MDMA’s capacity to dissolve a lifetime’s social inhibitions, prudery and sexual hang-ups means that lovemaking while under its spell is not uncommon. Superfluous clothes tend to get shed. In men, orgasm is more intense than normal but delayed: MDMA retains a residual sympathomimetic activity, triggering a detumescence of the male organ. To ease MDMA-induced performance difficulties, flagging Romeos increasingly combine Ecstasy with Viagra (’Sexstasy’). Unless carefully premeditated, this is not a recipe for safe sex. MDMA may sometimes cause “inappropriate bonding”. Prudence should be exercised before taking it with ex-girlfriends, boyfriends or culturally inappropriate love-objects. The effects of MDMA on bonobos (“pygmy chimpanzees”), our sexually uninhibited primate cousins, are unknown.

On pure MDMA, subjects feel at peace with themselves and the world. They discover an enhanced sense of self-worth, self-forgiveness and complete self-acceptance. Cynical thoughts and negative feelings disappear. Aspects of life normally too sensitive to talk about can be explored freely. Heightened feeling allows long-forgotten and repressed emotional memories from childhood to be retrieved with unusual ease. In some settings, painful, highly-charged and even hitherto unmentionable problems may be discussed with (rose-tinted) candour. On MDMA, a lifetime of accumulated psychological barriers and defence-mechanisms go down, somehow magicked out of existence with a pill. Anger, irritability and ingrained fear dissolve; the hostile amygdala is subdued, if only for a few hours. Ecstasy users tell each other affectionately what beautiful people they are; and they do so from the depths of their hearts.

Before the Orwellian-sounding Drug Enforcement Administration [DEA] placed MDMA on Schedule 1 of controlled substances, professional therapists in the USA found MDMA a valuable tool for counselling and marriage-guidance sessions. MDMA’s capacity to induce empathetic bliss, heightened introspection and an increased ability and desire to communicate feelings can create a rapport with the therapist and accelerate a successful outcome. MDMA acts to boost self-esteem and self-confidence, while paradoxically diminishing egotism. The user’s sense of social isolation vanishes. “I love the world and the world loves me”, affirmed one beneficiary of MDMA-assisted therapy.

On a more sceptical note, it’s hard scientifically to validate claims of long-lasting therapeutic success. For MDMA’s stunning short-term results make double-blind, placebo-controlled trials effectively impossible. Such a problem doesn’t always bedevil today’s lameantidepressants”, the results of whose trials often struggle to reach statistical significance. Investigational drugs are lab-tested by Big Pharma to discover whether or not non-human animals will self-administer them. Candidate compounds are normally discarded if the animals do so, arguably a perverse route to uncovering antidepressants with good clinical efficacy and high patient compliance. By contrast, MDMA is a warm, fast-acting, non-sedating mood-enricher that banishes social anxiety and physical pain alike. Unlike opioids or the anxiolytic benzodiazepines, MDMA doesn’t cloud consciousness even at relatively high doses. This doesn’t stop less cerebrally-inclined ravers from getting “cabbaged” by swallowing pills all weekend.

Explored in a controlled setting, MDMA can be therapeutic for victims of Post-Traumatic Stress Disorder (PTSD). A minority of subjects find they enjoy the experience too much to focus on the emotional baggage of the past. Sessions are most likely to be productive with an experienced MDMA therapist. In the Prohibitionist era, MDMA-assisted therapy-sessions are rare.

Dr David Nichols suspects that the related phenethylamine entactogen MBDB (“Eden”: 2-Methylamino-1-(3,4-Methylenedioxyphenyl)Butane), formed by extending the 3-carbon chain of MDMA to a 4-carbon chain, might prove superior to MDMA as an adjunct to psychotherapy. This is because Dr Nichols’ creation lacks significant dopaminergic activity. It’s thus less likely to induce a distracting euphoria. On the other hand, if and when the substrates of blissful self-insight can be sustained indefinitely, then who’ll need therapy? Perhaps some inner demons are better left to die of neglect, not awakened for exorcism. Either way, a case can be made that MBDB is indeed a “purer” entactogen than MDMA. Yet as an empathogen, MDMA is unsurpassed and possibly unmatched. MDMA’s residual dopaminergic amphetamine-like action contributes a euphoric warmth to the user’s intensified feelings and also the desire and ability to express them freely. MBDB’s chemical cousin beta-keto-MBDB (bk-MBDB, “Butylone”) is a more enjoyable and stimulating empathogen than MBDB. As of 2010, its human use is still extremely limited.

Against formidable odds, the Multidisciplinary Association for Psychedelic Studies (MAPS) has been seeking funding and FDA-approval for controlled trials of MDMA-assisted therapy for PTSD. If these trials are successful, then MAPS hopes that MDMA could eventually become a prescription-medicine. For on MDMA, many traumatized or seemingly emotionally frigid people who can never otherwise speak about their innermost fears and feelings find they can spontaneously open up. There is no compulsion to talk - just a dissipation of the social anxieties that make us normally tight-lipped.

Functional analogues of MDMA may one day be employed in other kinds of insight-oriented therapy as well. Safe, long-acting MDMA analogues may prove therapeutic in the treatment of social phobia, eating disorders and obsessive-compulsive disorder (OCD).

In December 2004, the FDA granted permission for Dr John Halpern‘s proposed study of MDMA-assisted psychotherapy for patients diagnosed with severe anxiety related to advanced cancer. The likelihood of DEA approval of the protocol is unknown. If the magic of MDMA could be replicated safely and sustainably, then the fear of death and dying could in principle be banished in the population at large. This would be a substantial payoff, though the fear of personal mortality is probably the prime mover of scientific progress in anti-aging research.

Dr Julie Holland, editor of the invaluable Ecstasy:The Complete Guide (2001), tentatively endorses “the judicious, supervised and single oral doses of MDMA as a psychiatric medicine…” In her introduction to the guide, Dr Holland notes that “Like any powerful tool, it should be used by people who are properly trained, educated and supervised. And like any powerful tool, it should come with an instruction manual. This book, I hope, will serve as that manual”. It may be testimony to the comparative safety of MDMA that millions of young people use MDMA in the absence of a manual or any training, education and supervision at all. Alas Prohibitionism puts the young and vulnerable at unnecessary risk; and squanders the therapeutic opportunities. In defiance of scepticism from medical orthodoxy, Dr Holland also provides supporting evidence to back up anecdotal reports that MDMA can induce temporary remission of symptoms in victims of otherwise intractable schizophrenia. Less controversially, it’s possible for victims of body dysmorphic disorder (BDD), or simply anyone with a negative body self-image, to view themselves in the mirror while euphorically loved-up on MDMA. The transformation can be magical, though it would be imprudent to repeat the experiment two days later.

MDMA can also be used just to have fun. Most commonly today, teenagers and young adults take Ecstasy to rave. Mozart sounds great on Ecstasy, but high-energy all-night dance parties celebrated with techno-pop house music are more standard. Raves are held in clubs, warehouses or more exotic outdoor settings and open fields. Often raves last a whole weekend. The music may be techno, hardcore, jungle, trance or form an improvised, eclectic mix of styles harder to categorise. The atmosphere is astonishingly friendly, the mood and ethos is well captured by the ravers’ motto P.L.U.R. [“Peace, Love, Understanding and Respect”]. In darkened clubs, the intoxicating atmosphere of the rave is enhanced with artificial fog, lasers, strobe lights, glow sticks, whistles and Vicks inhalers [on MDMA, aromas are fragrantly enriched]. In many cases, the product now passed off as “Ecstasy” is adulterated with other agents. Individual pills bought by the end-user typically cost between US$7 and US$25. The worldwide street price is falling. Tablets can be mass-manufactured for as little as 50 cents. Professionally-made tablets of MDMA are stamped with distinctive logos. This is because MDMA manufacturers and merchants seek to promote brand-awareness and customer loyalty. Alas counterfeit goods are still rife.

Sometimes “Ecstasy” doesn’t contain MDMA at all, but MDA; MDEA (3,4-methylenedioxyethylamphetamine: “Eve”); 2-CB (4-Bromo-2,5 Dimethoxyphenethylamine: ‘‘Nexus”, “Venus”, “Bromo”); 2C-I; PMA (paramethoxyamphetamine); amphetamine (“speed”); ephedrine; pseudoephedrine; caffeine; the dissociative anaesthetic ketamine (“Special K”); DXM (dextromethorphan); GHB (gamma-hydroxybutyrate: “liquid ecstasy”); or some combination thereof. This list is far from exhaustive. A minority of psychologically robust or reckless clubbers purposely mix MDMA with LSD (”candyflipping”) to impart a “warm, loving glow” to their acid trips. Or they “hippieflip” with psilocybin mushrooms; or “kittyflip” with ketamine. Cannabis is widely smoked as well. Ravers who want to dance all night may prefer Ecstasy laced with speed; a sub-neurotoxic dose of MDMA can be made toxic by adding (+)-amphetamine. To outsiders, Ecstasy-fuelled raving might seem mindless hedonism; its devotees have likened it to group-therapy or meditation. But either way, chronic heavy use of the methoxylated amphetamines or any other “club-drug” poses risks to the user’s health. 

To read the rest of the essay, click HERE for David’s blog, where it was originally published. 



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