Holland - Ecstasy: the complete guide: a comprehensive look at the risks and benefits of MDMA

ACKNOWLEDGMENTS

I am indebted to Rowan Jacobsen and Lee Awbrey for their incisive and invaluable editorial assistance and to the diligent Dillon Euler for his role as a contributing editor. Marcia Means and Janet Jesso have done a thorough and exhaustive job as copy editors, which I truly appreciate. Id like to thank Mark Kelly, my agent, and all the wonderful people at Inner Traditions International.

My sincere gratitude to Sasha Shulgin for patiently reviewing the finer points of all things chemical and historical, and to George Greer and Rick Doblin for providing details on the scheduling proceedings. Thanks also to Dave Nichols and James OCallaghan for assisting me with some details of chemistry and neurotoxicity, respectively. Simon Reynolds, Harry Sumnall, and Jos Carlos Bouso taught me a thing or two about the history of the worldwide rave culture, and John Morgan filled me in on some details of the history of MDA. A special thank you to Jerome Beck for his help with the epidemiological statistics of MDMA use. I also appreciate Ilsa Jeromes help in summarizing Charles Grobs research, and Judy Balls help with the statistics from SAMHSA. Thanks to Craig Bromberg and Joshua Wolf Shenk for their advice regarding the publishing industry and book publicity.

Jeremy Tarcher and R. E. L. Masters gave me assistance and encouragement early in the preparation of this project and I thank them for their belief in me and their advice. I also offer my humble gratitude to Dr. Carolyn Grey for her wisdom and guidance. MAPS and Rick Doblin have been a precious resource to me throughout the past fifteen years, and there is no doubt in my mind I would not be where I am today had Rick and I not met in the summer of 1985.

The following people were instrumental in helping me to assemble the chapter reviewing the MDMA laws throughout the world: Priya Narayanan, Brent Patterson, and Kiran Rao (India); Franco Landriscina, Livia and Alec Nicolescu (Italy); Jorge Gleser (Israel); Greg Duncan (Asia); Joanna Simon (Australia); Zephyros Kafkalides (Greece); Alex Mckay, Evan Rosen, and Adrienne Ward (United States); Harry Sumnall and John Henry (United Kingdom); Luc LeClair (Canada); and Tim Yuan (Brazil). Richard Glen Boire of alchemind.org was kind enough to offer eleventh-hour aid with the United States segment of that chapter.

Thanks also to the following people who donated their time to translate submissions from around the world: Sylvia Thyssen, Katrin Krollpfeiffer, and Chris Ryan.

I especially need to mention Joe Cosco, who originally gave me the idea of creating an MDMA book as a way to honor Nicholas Saunders, who died in 1998 and was an early and dedicated pioneer in espousing the therapeutic aspects of MDMA.

My friends, colleagues, and family have been attentive and supportive since this project began in the spring of 1998. A special thank you to my husband Jeremy, for his loving and playful care of our daughter while I was typing away.

Last, I wish to offer my heartfelt thanks to all the chapter authors, who donated their time and energy to make this book what it is. My biggest regret is that I could not include every submission that was requested, due to the publishers concerns about this books size. I humbly offer my apologies again to these authors, and have posted some of their chapters on my website for your perusal. I urge everyone to visit drholland.com to learn more, and also to make a donation to the Holland Fund for Therapeutic MDMA Research. All royalties from the sale of this book will go toward funding clinical MDMA research, and I thank you, the reader, for your contribution.

ABOUT THIS BOOK

This book is not about encouraging illicit drug use but rather about promoting mental health and physical safety. It is my belief that MDMA, when used as a prescription medicine in a therapeutic context, may have the potential to benefit various patient populations, and this warrants clinical research. My primary goal in organizing this book is to further that cause. However, I am also a firm believer in the harm reduction model. Because there are millions of people around the world using the drug Ecstasy in a dangerous manner, I feel obligated to educate them about how to reduce their risk of physical harm. Providing risk reduction information, which is a public health service, should not be interpreted as encouragement to abuse drugs.

Throughout this book I have tried to make the distinction when the authors are speaking of the known chemical MDMA versus the illegal, unknown substance called Ecstasy. All illegal substances are of unknown chemical makeup and purity. When a person buys Ecstasy at a rave, club, or from a dealer in any situation, there is no knowing what is being bought or ingested, thus increasing the risk of harm. There have been several reported deaths associated with PMA (paramethoxyamphetamine) sold in the guise of MDMA, and it is suspected that some cases of hyperthermia were due to dextromethorphan, alone or in combination with MDMA, as may occur with impure pills.

Due to the complex nature of MDMA several chapters in this book use fairly technical languagethe treatment section in the chapter Medical Risks Associated with MDMA Use and the neurotoxicity review found in the chapter Does MDMA Cause Brain Damage? in particular. It is my hope that lay readers will have no trouble reading the rest of the book.

Proceeds from the sale of this book will go toward funding clinical research with MDMA. Donations to the Holland Fund for Therapeutic MDMA Research can also be made at the Web site Drholland.com, or by sending your tax deductible check to The Holland Fund c/o MAPS, 2105 Robinson Avenue, Sarasota, Florida 34232.

INTRODUCTION:

Medicine for a New Millennium

Julie Holland, M.D.

Every weekend around the world, nearly a million people are taking a drug they call Ecstasy. They hear from friends and the media that this love drug is an aphrodisiac, capable of creating feelings of love and empathy with others, or that it induces a blissed-out state, marketed as euphoria. The British government estimates that more than half a million hits of Ecstasy are sold every weekend in the United Kingdom, and authorities calculate that the use of Ecstasy increased by more than 4,000 percent between 1990 and 1995. In the United States, hundreds of thousands of doses of Ecstasy are consumed weekly; in the first five months of 2000, over four million hits of the drug were confiscated.

Although some will take Ecstasy in small social gatherings, the majority of people are trying this drug in a setting known as a rave. These are large, all-night dance parties in secret locations or in clubs, where techno music is typically played. The rave scene has been growing since the late 1980s in the United Kingdom and the United Statesit has become a huge cultural phenomenon, eclipsing the LSD-inspired movement of the sixties in terms of the number of participants and the movements longevity. In Spain, Germany, Israel, and Australia, weekly raves attract tens of thousands of revelers, and the majority of those in attendance are specifically seeking out Ecstasy. Even India is experiencing a significant increase in Ecstasy consumption, as the new drug craze, now fifteen years old and still going strong, finally reaches that continent.

Almost everyone has heard of Ecstasy, the dance drug, but few know the whole story. Unknown to many, Ecstasy has a less recreational, more medicinal history. In the 1970s and 1980s, the chemical known as MDMA (methylenedioxymethamphetamine, or N-methyl-3,4-methylenedioxyphenylisopropylamine) was used secretly by a select group of psychiatrists and therapists in the United States and Europe. These private practitioners, some of whom called the drug Adam, had discovered a pharmacological tool that lowered their clients defenses and allowed them to open up more completely to the psychotherapeutic process. In doses smaller than those typically used in the rave setting, MDMA would induce a gentle and subtle shift in consciousness, enabling its users to give themselves over to a frank and thorough self-analysis. A New York writer described his MDMA experience as being like a year of therapy in two hours (Adler 1985). The effects of MDMA fostered introspection and verbalization of profoundly meaningful aspects of personality and life history. Unlike earlier psychotherapy sessions in the 1950s and 1960s catalyzed by LSD, MDMA-supported therapy allowed patients to remain centered, focused, and able to think and speak clearly.