Source : Newsweek
Date: 5 December 2003

Out of the Club, Onto the Couch

One researcher says the drug known as Ecstasy
might be an effective tool for psychotherapy

picture of tablets of MDMA/ecstasy seized by US Customs

By Jonathan Darman

Dec. 5 - Friends and foes of the drug MDMA, popularly known as Ecstasy, have always accepted certain truisms about the drug. “E” makes its users feel good, gives them a boost that makes them want to dance, among other things, all night long.

A less pleasant part of E-orthodoxy? The drug’s ability to eat away at the human brain. Yet evidence for the drug’s negative effects on the brain has been called into question. In September, Dr. George A. Ricaurte, one of Ecstasy’s most vocal opponents in the scientific community, admitted in the journal Science that a major study he’d conducted proving the drug was dangerous when used on primates was in fact severely flawed. Its problem? The drug Ricaurte’s researchers used on the primates wasn’t MDMA at all. Compelling evidence MDMA could permanently hurt the human brain could no longer be trusted as true.

Ricaurte’s revelation hasn’t provided complete vindication for glow-stick-wielding club kids. Experts warn that while Ecstasy’s long-term effects on the brain remain unclear, recreational use, in club settings remains demonstrably dangerous. Still, some in the psychiatric community say society could benefit from the destigmatizing of MDMA. Dr. Julie Holland, a psychiatry professor at New York University has long argued for the use of pure MDMA in controlled therapeutic sessions. Ricaurte’s work had long been an obstacle to her claim that physicians could safely prescribe MDMA to their patients in controlled settings. In an interview with NEWSWEEK’s Jonathan Darman, Holland said she hopes the attention Ricaurte’s retraction has garnered will help people to understand that while MDMA might not be right for ravers, it could help the mentally ill.

NEWSWEEK: What was your first thought when you saw Dr. Ricaurte’s retraction in Science?
Julie Holland: Well, it finally made sense to me. It didn’t make sense that these animals were dropping dead from MDMA, and it didn’t make sense that Ricaurte was finding dopamine damage when no one had ever found that. In hindsight, when the paper came out, he should have said, “Look, I’ve found something that no one else has found, and that’s a little bit odd and this study needs to be replicated.” He didn’t say that and he didn’t even admit that actually no one else has ever seen dopamine damage, and no one’s seen it in humans and this is unusual … He just went out and said, “Look what this does, look what this causes, you’d better be careful or Ecstasy’s going to give you Parkinson’s.”

How important was Ricaurte’s work in creating the perception that Ecstasy was dangerous to humans?
I think it’s the whole cornerstone. It was made illegal, back in the ’80s, based on his MDMA data. So he’s been involved in the public perception from the very beginning.

Should we assume then that Ecstasy is safe?
No. I am not coming out and saying Ecstasy is safe … What I’m saying is that a single dose of MDMA—known MDMA—when you’re not dancing and overhydrating but when you’re sitting in an office with a psychiatrist, talking about therapeutic material, that that is relatively safe. I’m not comfortable saying that the recreational [use of Ecstasy] is safe. It’s not safe. The recreational model is unsafe for several reasons, not the least of which is that you have no idea whether you’re taking MDMA or not when you buy a tablet of Ecstasy.

So what makes recreational use different from the way MDMA would be used in therapy?
The recreational model is unsafe because people don’t know what they’re taking, they’re taking more than they should and they’re taking it more often than they should. In the therapeutic model, you know what you’re taking, you’re taking a very small amount and you’re taking it once or twice in your lifetime and that’s it. That is safe. And the [U.S. Food and Drug Administration] has agreed, and that’s why they’re letting the study of MDMA’s effects on human subjects go ahead.

Is there any evidence backing up the claims that Ecstasy use can cause long-term depression by permanently depleting serotonin levels?
There’s no question that there’s temporary depletion. What’s not yet clear is how long it takes to come back and how much you have to do before it doesn’t come back? If you look at the Ricaurte data, it’s terrifying, what he’s saying. But then you look at other data—there’s a study that came out of Germany that showed that there was a pretty modest depletion that corrected itself over time.

Explain what the purpose of using MDMA in therapy might be.
Well, I think it’s important to remind people that, before this was a party drug and a drug of abuse, it was a drug used in psychiatry, used by psychiatrists, during therapy, to make the therapy go deeper and go faster and be less uncomfortable. Because it puts people at ease and makes them less anxious, they’re able to explore potentially painful psychic material and things that need to be processed.

Aren’t there other drugs that can do that?
The thing about psychiatry is, we try to give people medicine to decrease anxiety and typically you get a little less anxiety and then if you give more medicine, they just go to sleep because all of the anxiety medicines are sedating. MDMA is the only anti-anxiety medicine that isn’t sedating. And that makes it unique and useful to psychiatry.

And a person who’s taken MDMA is not only awake, that person’s also able to express him or herself quite clearly, right?
Yeah, there’s more of a drive to express yourself. Not only can you but you want to. There’s a drive to speak and connect with other people that isn’t typically there. It’s a useful tool to have between a therapist and a patient.

With what kind of patients would you use the drug?
Well, the work that came out of the ’70s and ’80s was either work done with couples or a lot of individuals who had a history of being abused sexually or physically. A lot of times people have a history of abuse, but it’s hard for them to talk about it and get to that place where they’re comfortable to open up and talk about it. You know, therapy typically takes a long time, and one of the things that can take a long time is being able to trust that your therapist really does want to help you and feeling comfortable enough to really expose yourself in that way.

How often, with an individual patient, could MDMA be used to help that process along?
Once or twice, typically, in the lifetime of a patient.

And at what point in therapy would it be appropriate to use MDMA?
Well, you definitely have to prepare the patient and talk about what’s going to happen. And then you would have one MDMA session and then a lot of sort of follow-up and then potentially a second [MDMA session] if you felt like you didn’t quite get it all. It’s like anesthesia during surgery. In the days before anesthesia, they had to be very quick about the kind of surgery they were doing because people couldn’t tolerate the procedures. Here’s something that really lets the procedure unfold in a way that’s not nearly as uncomfortable for the patient. It allows it to go deeper and get more of the malignant material out.

Isn’t there a danger that the MDMA sessions could be almost too enticing? That patients would reveal so much more when they’re on MDMA that doctors would be tempted to use the drug again and again in order to replicate those productive sessions?
No. What did end up happening back in the ’70s was that the doctor-patient relationship was really strengthened by the experience. There’s something called the therapeutic alliance and the bottom line is that the stronger the therapeutic alliance, the more effective the therapy is. The MDMA session would really strengthen the alliance because you’d get so much material from the session that you could really process it for months and months afterward.

So this isn’t like hypnosis where the patient might have trouble recalling what he or she brought to the surface in the session.
That’s the other thing that’s great. Not only does it enhance memory for the trauma, but everything that happens during the session you retain completely. So it is a little bit different from hypnosis in that way.

Won’t a lot of people have a natural aversion to using MDMA in therapy because they have such negative associations with Ecstasy as an illicit drug?
Yeah, obviously I wish it had a different name, and I wish there was different drug that worked as well that I could get behind because there certainly is a lot of baggage now with MDMA. But the bottom line is that it would be an incredibly useful tool to have in the field of psychiatry, and just because there is a large group of people who are abusing it, that doesn’t negate the fact that it has therapeutic potential.

But, hypothetically speaking, would it really be all that dangerous right now if recreational use of MDMA was not illegal?
I don’t know exactly how to answer that. You look to the Netherlands, [which has] much less stringent drug laws, and they have much less rampant abuse of most abusable drugs than we do. It’s possible that the repressive nature of our drug policy is making things worse instead of better.

How optimistic are you that MDMA will get approved for psychiatric use any time soon?
Any time soon? Not that optimistic. Long-term game plan? Fairly optimistic. The joke that I often say is, I’m watching my cholesterol, I’m exercising, I’m in it for the long haul.

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