ECSTASY:THE COMPLETE GUIDE A Comprehensive Look Benefits of MDMAat the Risks and JUUE HOLLAND M.D. Edited by Rochester, VermontPark Street mi Press PDF compression, OCR, web-optimization with CVISION's PdfCompressor Rochester,OnePark ParkStreet Street VermontPress 05767 www.InnerTraditions.comParkCopyright Street © Press 2001 is byJuliea division Holland, of Inner M.D. Traditions International AllNotestoragemeans, rights to the reserved.electronicand reader: retrieval NoThis or system,partmechanical, book of this iswithout intended book including permission may as be anphotocopying, reproduced informational in writing or fromrecording, utilixed guide. the publisher.inThe or any byapproaches form any informationor by and any professional.shouldtechniquesLibrary not of be describedCongress used to treat herein Cataloging-in-Publication a serious should ailment not be withoutseen as prioran Data endorsement consultation to with use a MDMA. qualified They healthcare also IncludesbenefitsEcstasy: bibliographical oftheISBN MDMA complete 0-89281-857-3 / edited referencesguide by : a Juliecomprehensive and Holland. index.p. ; look at the risks and cm. use--4nterview.theFactors—Interview. risks1. and Ecstasy[DNLM: benefits 2. Nervous (Drug) QV of1. MDMA.N-Methyl-3 102System—drug E194 II. 2001] Holland, ,4-methylenedioxyamphetamine—therapeutic effects—Interview. I. Title: Julie, Comprehensive 1965- 3. Risk look at Printed and boundR7v1666.M35615'.785—dc2l in the United E373 2001 States 2001002945 ThisText10 bookdesign9 8 7 was6 and5 typeset layout inby Janson Priscilla with Baker Morgan and Gill Sans as display faces 4 3 2 EighteenthHelentice"NatureUsing by MDMADwightof Ralph the St. MDMA NWinMetaner,Reid Healing, Washington, EducationalExperience Ph.D., Psychotherapy, andDC and Foundation. Sophia20036—1802. Its Role and Adamson inSpiritual PublishedHealing, Copyright reprintedPractice, Psychotherapy, by ©Heldref originallywith1988. the Publications, and permissionpublished Spiritual as of1319Prac- "The the

PDF compression, OCR, web-optimization with CVISION's PdfCompressor CONTENTS ACKNOWLEDGMENTS viii JulieABOUT Holland,INTRODUCTION: THISM.D. BOOK MEDICINE FOR A NEW MILLENNIUM xI LEIX=MDMAI JulieTHE Holland, HISTORY M.D. OF MDMA I I 2 GaryWHAT Bravo, DOES M.D. MDMA FEEL LIKE? 2 I 3 JessicaHOW Malberg, MDMA Ph.D., WORKS and Katherine IN THE R. Bonson, BRAIN Ph.D. 29 4 THEMDMADavid CHEMISTRY Nichols, MYTHS Ph.D. AND OF MDMA RUMORS DISPELLED 5439 5 AnTHEJulie InterviewHolland, GODPARENTS M.D. with Ann OF MDMA:and Sasha Shulgin 58 RISKS 7 JohnMEDICAL Henry, M.D., RISKS OFand MOMAJoe ASSOCIATED Rella, VSEM.D. WITH MDMA USE 71 S KarlMENTAL 1. R. Jansen, HEALTH M.D., Ph.D. PROBLEMS ASSOCIATED WITH MDMA USE 87 PDF compression, OCR, web-optimization with CVISION's PdfCompressor 9 DOES MDMA CAUSE BRAIN DAMAGE? Matthew Baggot and John Mendelson, M.D. I I 0 1* ITHE I LEGAL STATUS OF MDMA AROUND THE WORLDJulieAnMINIMIZING Holland, Interview M.D. RISK with IN Emanual THE DANCE Sferios COMMUNITY 146I 59 MDMA-ASSISTEO PSYCHOTHERAPY USING MDMA IN HEALING, PSYCHOTHERAPY, AND 182 13 EXPERIENCERalphSPIRITUAL Metzner, PRACTICEPh.D., WITH and SophiaTHE INTERPERSONALAdamson PSYCHEDELICS 208 14 CLINICALClaudloPSYCHOTHERAPY Naranjo, EXPERIENCE M.D. WITH MDMA-ASSISTED 222 POTENTIAL CLINICAL OSES FOR MDMA An Interview with George Greer, M.D. 15 JoséPOST-TRAUMATICUSING Carlos Bouso MDMA IN THE STRESS TREATMENT DISORDER OF 248 16 JuneUSING Riedlinger, MDMA R.Ph., IN Pharm. THE D., TREATMENT and Michael Montagne, OF DEPRESSION Ph.D. 26 I IS17 AnJulieUSING InterviewHolland, MDMA M.D. with IN THEAndrewALTERNATIVE TREATMENT Weil, M.D.MEDICINE OF SCHIZOPHRENIA 286273 MOMA19 RESEARCH AndrewCLINICAL Kleiman, RESEARCHM.D., and Julie Holland, WITH M.D. MDMA:A WORLDWIDE REVIEW 297

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 20 GIVING MDMATO HUMAN VOLUNTEERS IN SWITZERLAND 3I7 2 AnAlexUNITEDGIVING Gamma,Interview Ph.D.,MDMASTATES with Matthias TO Charles HUMAN F. Liechti, Grob, M.D.,VOLUNTEERS and M.D. Franz X. Vollenweider, IN THE M.D. 328 22MOMA ECSTASY: AND SOCIETY PRESCRIPTION FOR CULTURAL RENAISSANCEDouglas Rushkoff, Ph. D. 350 2423 MDMA'SMDMA AND PROMISE SPIRITUALITY AS A PRESCRIPTION MEDICINE An Interview with RickRabbi Doblin, Zalman Ph.D. Schachter 369358 APPENDICES JulieHISTORY Holland, M.D. TIMELINE 388 JulieSTATISTICS Holland, M.D. TIMELINE 392 TABLEMatthewFUNCTIONAL I: BaggotSTUDIES and CHANGES John OF Mendelson, LONG-TERM AFTER M.D. MDMA BEHAVIORAL IN ANIMALS OR 396 TABLEMatthewBETWEEN II: Baggot REPORTED ECSTASY and John Mendelson,NEUROFUNCTIONAL USERS ANDM.D. NONUSERS DIFFERENCES 400 TABLEHarry SumnallIII: MEMORY STUDIES OF ECSTASY USERS VS. NONUSERS 402 INDEXCONTRIBUTORSREFERENCES 448443405

PDF compression, OCR, web-optimization with CVISION's PdfCompressor ACKNOWLEDGMENTS I amainvaluable contributing indebted editorial to editor. Rowan assistance Marcia Jacobsen Meansand and to theand Lee diligent Janet Awbrey Dillon for theirEuler incisive for his roleand as Jesso have done a thorough MarkInternational.and exhaustiveKelly, my jobagent, as copyand alleditors, theMy wonderful which sincere Itruly gratitude people appreciate. atto Inner Sasha I'd Traditions likeShulgin to thank for patiently reviewing the finer chemistryDaveDoblinpoints Nichols of for all and providing things andneurotoxicity, James chemical details O'Callaghan on respectively.and the historical, scheduling for assistingSimon and proceedings. toReynolds, meGeorge with GreerHarry someThanks detailsSumnall,and also Rick toof epidemiologicalhistoryworldwideand José of Carios MDA. rave culture, statistics BousoA special andJohntaught of thankMDMA me Morgan you a use.thing to JeromeIfilled also or two appreciateme Beck aboutin on for somethe lisahis history Jerome'shelpdetails with ofof help thethe theirticsin summarizing from advice SAMHSA. regarding Charles Thanks the Grob's publishing toJeremy Craigresearch, Bromb industryTarcher andJudy erg and and Ball's R.book Joshua E. helpL.publicity Masters Wolf with Shenkthe gave statis- forme assistance and encourage- resourceforinment me her earlyand wisdom to their inme the throughoutadvice.and preparation guidance. I also the offerof MAPSpast this myfifteen project and humble Rickyears, and gratitude Doblin Iand thank there have tothem Dr.is been no forCarolyn doubt theira precious inbeliefGrey my mindof 1985. I would not be where I am today had Rick and I not met in the summer vllJ PDF compression, OCR, web-optimization with CVISION's PdfCompressor The following people were instrumental in helping me to assemble the Acknowledgments ix (Australia);NicolescuBrentchapter Patterson, reviewing (Italy); Zephyros and Jorgethe Kiran MDMAKafkalides Gleser Rao laws (Israel);(India); (Greece); throughout GregFranco Alex Duncan theLandriscina, Mckay, world: (Asia); PriyaEvan Livia Joanna Narayanan,Rosen, and Simon Alec and StatesofKingdom);Adrienne alchemind.org segment Ward Luc LeClairof (Unitedwas that kind chapter. (Canada); States); enough andHarry to offerTim Sumnall Yuaneleventh-hour (Brazil). and John aidRichard Henrywith Glenthe (United United Boire andsubmissions Chris Ryan. from around the world:IThanks especially Sylvia also need Thyssen,to the to following mention Katrin Joe Krollpfeiffer,people Cosco, who who donated originally their gavetime meto translate the idea aspectsinof 1998creating ofand MDMA. an was MDMA an early book and as dedicatedMy a way friends, to pioneerhonor colleagues, Nicholas in espousing and Saunders, family the therapeutic who have died been attentive and supportive typinghusbandsince this away. Jeremy, project for began his loving in the andspringLast, playful I ofwish 1998. care to offer ofA ourspecial my daughter heartfelt thank while you thanks toI was my to all the chapter authors, who againthegretdonated publisher's is to that thesetheir I could timeauthors, concerns notand and includeenergy about have thiseveryto posted make book's submission some this size. bookof Itheir humbly that what chapters was it offer is. requested, My on my mybiggest apologies website due re- to MDMAsearch.alsofor your to research, Allmake perusal. royalties a donation and I urge from I thank everyone tothe the you,sale Holland oftheto thisvisit reader, bookFund drholland.com for will for your Therapeuticgo toward contribution. to learn funding MDMA more, clinical andRe-

-¼ PDF compression, OCR, web-optimization with CVISION's PdfCompressor ABOUTingThisas mental abook prescription ishealth not THISabout and medicine physical encouraging BOOK in safety.a therapeutic illicit It is drugmy context, belief use but thatmay rather MDMA, have about the when promot- used potential to primaryofalsobenefit people a firmgoal various around believerin organizing patient the in world the populations, this harm using book reduction the is and drugto further this model. Ecstasy warrants that Because in cause. a clinical dangerous thereHowever, research. are manner, millions I am My I shouldharm.feel obligated Providing not be interpreted to risk educate reduction asthem encouragement information, aboutThroughout how towhich tothis reduce abuse book is a drugs. their publicI have risk healthtried of physicalto service, make the distinction when the au- situation,andsubstancethors are speaking calledthere is Ecstasy no of knowingthe All known illegal what chemical substances is being MDMA bought are of versus unknown or ingested, the chemicalillegal, thus unknown increas- makeup When a person buys Ecstasy at a rave, club, or from a dealer in any orpectedPMAing in the combination (paramethoxyamphetamine) thatrisk someof harm. cases with There MDMA.,of hyperthermia have beenas soldmay several inwereoccur the due reportedguisewith to impure ofdextromethorphan, deathsMDMA, pills. associated and it is alone withsus- terAssociatedfairly "Does technical MDMA with language—the MDMA Cause Use"Brain andtreatment Damage?" theDue neurotoxicity tosection thein particular. complex in the review chapter natureIt is found my "Medical of hope inMDMA the that Riskschap- lay several chapters in this book use Researchsearchreaders with will can MDMA.have also no be troubleDonations made atreading theto Proceedsthe Web the Holland siterest fromDrholland.com,of Fund the the book. for sale Therapeutic of this or by book sendingMDMA will go toward funding clinical re- Avenue,your tax Sarasota,deductible Florida check 34232. to The Holland Fund do MAPS, 2105 Robinson x PDF compression, OCR, web-optimization with CVISION's PdfCompressor JulieINTRODUCUON:Medicine Holland, M.D. for a New Millennium theyEvery call weekend Ecstasy. around They hearthe world, from friends nearly anda million the media people that are this taking "love a drug"drug ishsolders,is government an or everyaphrodisiac, that weekendit induces estimates capable in a "blissed-out"the that of United creatingmore Kingdom,than feelingsstate, half marketed a of andmillion love authorities andas hits euphoria. empathy of Ecstasycalculate Thewith areBrit- oth-that theconsumedthe drug1995. use were of Inweekly; Ecstasy the confiscated. United in increased the States, first five by hundreds more months than of of thousands 4,0002000, percentover of four doses between million of Ecstasy 1990 hits ofand are callynightpeople played.dance are trying parties The rave this in scenesecretdrug inhas locations a beensettingAlthough growing or known in someclubs, since as will awhere the rave. takelate techno These 1Ecstasy 980s musicare in in thelarge, small is United typi- all- social gatherings, the majority of Australia,participantseclipsingKingdom theandweekly andLSD-inspired the the Unitedraves movement's attract States—it movement tens longevity. ofhas thousandsof become the sixtiesIn Spain,a of huge revelers,in termsGermany,cultural andof thephenomenon, the Israel, number majority and of nowriencingof those fifteen ina significant attendance years old increase are and specifically still in goingEcstasyAlmost seeking strong, consumption, everyone outfinally Ecstasy. has asreaches heard the Even "new of that IndiaEcstasy, drug continent. is craze," expe- the dance drug, but few know the PDF compression, OCR, web-optimization with CVISION's PdfCompressor nalwhole(methylenedioxymethamphetamine,2 history. In or N-methyl- 3 story.Medicine Unknown for a Newto many, Millennium 1970s and 1980s, the chemical known as MDMA Ecstasy has a less recreational, more medici- ,4-methylenedioxy- thatsomeandphenylisopropylamine) therapistslowered of whom their in the clients' United was defenses Statesused secretly and allowedEurope. by a select group called the drug Adam, had discovered a pharmacological themThese to open private up more practitioners, com- of psychiatrists tool incallypletely thoroughconsciousness, to the self-analysis. psychotherapeutic enabling A Newits users Yorkprocess. to writer give In dosesdescribed his in the rave setting, MDMA would induce a gentle themselves over to a frank and smaller than those typi- MDMA experience and subtle shift inaspectsMDMAas thebeing 1950s of fosteredlike personality anda "year 1960sintrospection and catalyzed life and by verbalization LSD, of of therapy in two hours" (Adler 1985). The effects of history. Unlike earlier psychotherapy sessions MDMA-supported therapy al- profoundly meaningful lowedchictherapy patientstraumas have to oftenuncovered remain come centered, them.to the Underfocused,foregroundPainful the andand influence to repressedable be toprocessed think of memories MDMA, typically are not accessible and speak clearly.and analyzed in until years of these psy- oflaxed,ingone depression vulnerableintense nearly session. fearless,and and anxiety anxious The and greatestare show during replaced a stronger this with experience, sensea sense of ofself ease and purpose. difference, however, is that instead of feel- the patients remain re- and satiety Thera- Feelings bypiststhetients the scatteredterminally consistent with remarkable throughout ill, usefulness assisting results. the ofthem United this Some to new make States therapists drug peace and and evenwith were their giving families Switzerland were impressed conducted sessions with itto their pa- and them- thethemselvespain-killingselves reputation before pain-freeproperty. death.of being An forTerminal "penicillin added the duration and patients for unexpected the of who soul"the MDMAhad andeffect been a "psychic of session. in MDMA chronic is pain pain-reliever":Adam earned its potent found MDMAit offeredfields of as healing psychology a psychiatric to all and who medicine psychiatry. partook.The may Dr.judicious, be Mitchel a revolutionary supervised, Liester interviewed tool and to infrequent twenty use of single oral assist thedoses of PDF compression, OCR, web-optimization with CVISION's PdfCompressor potential85psychiatrists percent as an of adjunct those surveyed to the psychotherapy said they thought process. that MDMAA large percentagehas substantial of who were personally familiar with the effects of MDMA. Roughly Medkine for a New Millennium 3 weresixteenresultedthem presented spoke psychiatrists from of at MDMA psychologicala conference and use therapists (Liesterin or Bern, spiritual who Switzerland,et al. had benefits 1992). used in Thein 1990. their results Allown ofof lives the a survey twelvethat had of in their practices piespistsvalueAmerican and statedof MDMAthat and that the five their wasoverall Swiss "verypatients psychological clinicians positive." had improved felt More value that than greatlytheof three MDMAgeneral in fourths insight-based psychotherapeuticwas ofgreat these (Harlow thera- chotherapy.beand treated Beck 1990). more MDMA quickly is also and amore usefulAny profoundly psychiatrictool in the with fielddisorder MDMA-assisted of medicine, that can be helping ameliorated psy- by psychotherapy can pathyThisbetweenthose medicine generated with people. chronic can during Manyhelp pain anheal therapists or MDMA psychosomatica person, have experience. and been it illness alsoimpressed This can and makesstrengthen those by the MDMA who degree the are bonds espe- ofdying. em- oneto ciallyhave another's anuseful understanding emotions. for couple's of therapy whatLike theirand anesthesia family loved therapy,ones given are induringexperiencing which surgery patients and to need allowof for deeper incisions and anesthetics,psychologicalingremoval therapy of more orto material. toolsallow malignant to for help In a a more material,withfield thethoroughof medicine excavation MDMA examination withis requireda chemo-adjunct, no specialized offor deeper successful equipment, given layers treat- dur- of therapythement, armamentarium. a safeeasier and and versatile faster. Therapists new medication MDMAhad found had had a beenwaybeen usedto discovered make for overpainful and a decadeadded psycho- toas an adjunct to psychotherapy Overnight,medicaldrug.when, In in utilityeffect, 1985, what and,the was governmentDrug like once heroin Enforcement a medicine andwas cocaine, unilaterally used Administraton by it experiencedhad stating a high labeled that potential clinicians this it a drug Schedule for became hadabuse. no I PDF compression, OCR, web-optimization with CVISION's PdfCompressor tool,inan 4prison. had leaked The reason out into for the the generalillegal DEA's drug, community ruling its was to that become Adam, Ecstasy, the therapeutic the partyMedicine for a New Millennium punishable by a fine of up to $125,000 or fifteen years aresearchmovedrug. halt Buttoforward, anystudies. because legitimate and This the it becamedrugaction accumulation was allowed very placed difficult ofillicit in knowledge Schedule useto to continue I, no clinical unabated work but could put obtain permission for human about the drug. All hope practiceserimientulingfor its ofclinical MDMA,about and for andthis their atherapeuticspecial group patients. psychoactiveof physicians use Some evaporated. of substance banded those In therapists together responseand to fight toare to educate theforfeatured rapid the sched-on gov- the their clinical theoffollowing medicine. people pages. who It is can about benefit reclaiming most Thisfrom the book legacyits judicious, is of about MDMA supervisedthe importanceand giving use. itofThe back bringing con- to MDMA back into the fold patients.MDMAmanytributors years toresearchMembers this and volume in or ofsome psychiatrists the are ravecases people community decades. who have They the beenadministered clergy, are involved scientists and thosewithMDMA MDMA navigating to their for who perform factsalsothe regulatory are and represented. opinions waters concerning Thisin an book attempt this convenesOne controversialto purpose make multiple MDMA of thisdrug. experts abook prescription isweighing simple medicine and in with can be summed up in two words: iortakingandpain and this control. Ecstasy, how book to People aimsminimize and theyto have educate needany the harm to potentialboth be thatinformed groups. may to be comeMillions about hurt from andthe around riskshelpedit. For of the instance, bytheir world MDMA, behav- oneare ofshouldheated breaks,the greatest beenvironments takenand drinkrisks as a strong froma ismoderate heatstroke. unsupervised recommendation amount For use millionsof water.toof stayEcstasy of Clinicalcool ravers andat a researchdancingrave,worldwide, take inand plenty over- thishu- childgersman ofstudies is illicit more are Ecstasy determined essential use. inthan helping everWhen tous getlearn the to forbidden moreit. When about acookie drugminimizing is jar scheduled, is placed the dan- iton a high shelf out of reach, a PDF compression, OCR, web-optimization with CVISION's PdfCompressor goes underground. It becomes inaccessible Medicineto for a New Millennium researchers but readily avail- 5 erysupervisedunregulatedable week on the (for andblack and example, miseducated. use market. them alcohol), People in a When clandestine thethen millionsmedical buy illicitlyenvironment of community people made take substances where typically a legal they sponsorsdrug thatare un-ev-are mors,overstatessteadthorough innuendo, of scientific research the and dangers evidence goodand publicofcopy. drug about Theeducation. use. governmentthe The actual amountThis effects isitself not of loses misinformationoftrue MDMA, withcredibility MDMA. we get asbeing itIn-ru- sourcesstasyanddisseminated useralarming. and aboutprofessionals aboutAn MDMA—to important Ecstasy who are aim viaoffer familiar theof reliablethis media withbook and theinformation is complextheto educate Internet risk/benefit from theis irresponsible legitimateaverage analy- Ec- Webettersis of can this than offer drug. simply MDMA minimizing as a beneficial theThe harm secondmedicine. associated purpose We canwith of remind illicitthis book Ecstasy everyone is to use. present of the idea that we can do guidedThistheEcstasy's importance book MDMA earlier delineates experiencesof incarnation future the clinical possible as and a researchdrug emphasizes therapeutic once into known the advantages astherapeuticneed Adam, for furtherand to uses bewe clinical gainedcanofMDMA. stress re-by situationsstudies.search. All where proceeds its use from would the salebeLike helpful of anythis and otherbook other willmedicine, instancesgo toward MDMA where funding has its futureindicationsuse is and contraindications— therapyfrequencyneedsill advised. to forbe of Like cancer respected—adosing, any orotherand lithium many safepotent fordoseguidelines medicine, manic-depression, and a to dangerous thereprevent is amisuse. dose,therapeuticthis strong a As recommended with indexmedicine chemo- that vised.Thisshouldneeds Andbook, tobe belike usedI hope,carefully any by powerwill people administered serve tool, who as it thatareshould andproperlymanual. comemonitored. trained, with anLike educated, instruction any powerful and manual. super- tool, it

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These part sabotagingeating, from It manifests self-hatred. or escapist behaviors in self-destructive, behaviors,Self-loathing impede such progress is addictiveas universal; numbing toward patterns ityourself life's is hid- of Peopleingselfgoals. yourselfand MDMA are love scarred, to others seeincreases and andtriumphs accept they the ratioare overall scared.that of the love you anxiety MDMA toare fear. opens about Theoften the doing capacity allowspath just toward them,to that. love healing. Allow-for your- the Goodistheyfirst understanding, maytime, psychotherapy never to accept have accepting, themselvesexperienced. often works, and fullyloving A butmajor and ityourself takes markerto feel years. and ofa love successfulyour MDMA for place themselves psychotherapymarkedly in the world. that ac- growingfiedcelerates bond intoand with acceptanceintensifies the therapist. theand process. TheloveA feelings of fringe the people benefitof self-love around of the tend you,MDMA-assisted to and flow in outward,this way psychotherapy session is a forti- withoutaboutthe therapeutic the the patient drug, alliance and strengthening is istrying solidified. to Other thehelp, entireA subjectivecarriessense psychotherapy of over trust, effects into that subsequentof the process.MDMA therapist includesessions cares feeling less hopeless and more feelingsofwithsocially strength people ofconnected, hopelessnessand who a beliefare whichdepressed in that the arearise capacity twoor during suicidal. crucial to andeal episOdeBecauseissues with life'sin ofthere the depression problems, context is a renewed areof the workingquieted. typical sense PDF compression, OCR, web-optimization with CVISION's PdfCompressor butWhen the10 MDMA experience can provide a sense of belonging to a Letbiggerpeople XMDMA are suicidal, they often are lonely, with few social connections, andfectivelywhole, hope, of interrupt seeingbeing connectedyour feelings goals, of toand depression,all sensing ofOptimally, humankind your hopelessness, purpose. a sessionand nature. Your withand lifeisolation. MDMAMDMA makes can shouldsense; ef- include experiencing courage tionresultrience.you, andas of Thea providessuccessfulperson, beauty make the oftherapy incentivethis sense—these experience in advance; to pursue are is MDMAthethat it. componentsAt you the points come peak, outto ofyou know thethe are ecstaticproper andtransported feel direc-expe- the standingtheDr.to your peakClaudio goal; ofas whata Naranjo, you"brief, itget will fleetinga a guided taketherapist to moment tour arrive who of atyour ofhas this sanity." workedultimate place Youof with self-realized peace gain MDMA, ina clearerthe destination. future,referred under- and to youWiththe tosee experience,a returngood that you guideto that couldyou and place understand get careful of there love integration onthe and your changes acceptance. own, of that whatover are time,you necessary have without gleaned in yourthe drug. fromlife for

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JulieTHE HISTORY OF MDMA Holland, M.D. licAlthough spotlight MDMA only since (methylenedioxymethamphetamine) the mid-1980s, its history extends has back been to in the the begin- pub- newningtermediate1912. medicationof theThe twentieth Germanstep to in stop the pharmaceuticalcentury. synthesis.bleeding MDMA when On giantChristmas itwas Merck synthesized Eve was in attempting1912, some Merck time to beforefiledcreate the a stumbled across MDMA as an in- MDMAinpatent patentthe patentfor nowas this longer application received styptic can medication, bein as patented.1914 an intermediate and called Contrary has longhydrastinin; chemical to since the stories only MDMA (Beck, of most was 1997). reporters The expired. For this reason, included (methylenedioxyamphetamine,norpatentand waseven application. it some used scientists, in any MDMA way there duringwas was annever analogWorldno usemarketed Warandmentioned metaboliteI. as an for appetite MDMA of MDMA), suppressant, in Merck's how- Its chemical cousin, MDA properties;santever, in was humans patented this isin likely 1958.by Smith the It wascause Kline thenBetween of French theabandoned confusion. 1912 and because 1953, MDMA appears twice in the scientific literature. and tested as an appetite suppres- of its psychoactive MDMA,publishedBothCenter times forfunded and it their is received cited secret potential as withtestinga side as very espionageproduct of littlevarious offanfare. or chemical psychotropic "brainwashing" In 1953, reactions, thechemicals, weapons.Army news Chemical thatincluding These was formedtoxicity andat the behavioral University studies, of Michigan which were using declassified animals; inno 1969, human were studies per- II PDF compression, OCR, web-optimization with CVISION's PdfCompressor wereSome12 people mistakenly believe that the EA stands for "experimentalconductedLet agent," atXMDMA that time. MDMA was given the code name EA 1475. MDPEA.,dogs,thesized.but it reallyand MDA, monkeysEight abbreviates BDB, psychotropic (Hartnian DMA, Edgewood et drugs a!. 1973).Arsenal, were In studied wherelate 1952, the (mescaline, chemicalshuman studies DMPEA,were using syn- and MDMA) in rats, mice, guinea pigs, volunteerMDAhippieand died.were subculture was conductedMDA inadvertently became of atthe the Haight populargiven New anYorkAshbury before overdose State MDMA, area Psychiatricof thein San drugin the Francisco byInstitute, mid-1960s the researchers (Beckwhere in andthea MDAfacilitationthatRosenbaum1973), lastedwas reputedbut for of1994). the insightsix todrugto Nicknamed imparteight and was heightenedhours. adeclared high the Psychotherapeutic thatlove illegalempathy was drug described andin (Naranjothe the United studiesmellow as aet sensual al.States ofdrug MDA1967; of byeuphoria America, Naranjoreported the Con- lishedwastrolled obtained in 1972Substances in verified Chicago Act it inofwas 1970;1970. indeedAlthough it was MDMA finally MDMA (Gaston analyzed, did and not and Rasmussen become the results popular 1972). pub- until the early 1980s, a sample andlishedMDMA,Sasha another human Shulgin,did chemist,not study synthesize the of chemistDave MDMA Nichols,MDMA who appeared often untildescribed inisSeptember 1978.credited its In subjective thiserroneously8, 1976. article effectsThe Dr. for first Shulgin ascreating pub- "an pists,hadovertones"easily many introduced controlled friends (Shulgin MDMA in altered the and scientificto Nicholsstate a few of of1978). consciousnesscommunity his colleagues. Shulgin, some with who He of emotionallivedhad whom had in Californiawereexperiences and thera-sensual and theascouldwith Jacob effects many be inuseful psychedelicsMyronof MDMA to theStolaroff's psychotherapeutic that by thathe book came time The andout Secret feltprocess.of retirement that this One substance therapist, and began in referred particularto intro- to Chief was so impressed with troducedpistpsychotherapeuticduce Ann other Shulginto therapistsMDMA estimates work during to inthe the that Jacob'sdrug. late as Thismanyseventies tenure. led as tofour and a slow thousandearly spread eighties. therapists of undergroundPsychothera- were in- PDF compression, OCR, web-optimization with CVISION's PdfCompressor meetingferred to on their MDMA group at asthe Earth Esalen Metabolic InstituteIn in Design Big Sur, Laboratories, California.March Several sponsored of 1985 thera- Deboraha Harlow, Rick Doblin, and Alise Agar, who re- The History of MDMA 13 variouspistsexperienceGeorge who other Greerused inpsychedelics usingMDMA(1985), MDMA whoin weretheir attended during invitedpractices the the to past conference,andattend. several other According psychiatristsyears "The totaled combined to an overwhoarticle clinical aused thou- by mediahaderssand thought gottensessions." was discouraged waswind Because a ofvaluable it, mostfromof whattool spreadingMDMA buthad happened enthusiasts the word, with and LSD,agreed very which littleto keep manywas quiet. published research- The which was outlawed once too many people accountconditionabout MDMA of of the primal until Garden ainnocence story of brokeEden and (MetznerinThe unitythe name San with andFrancisco the all therapists life" Chronicledescribed had given inin Junethe to Bible's 1984.MDMA was Adam, signifying "the Adamson 1988). But MDMA acquiredsonacepted powerful, who thata newnamed the intriguing name name the among drug,Ecstasy name an recreational towas alleged chosen users simply of forthe marketingdrug. It is reasons.widely ac- It is attach to a psychoactive substance. The per- dealer who wishes to remain anony- wouldate,mous, but sell had how better this many thanto say:people calling "Ecstasy know it Empathy. what wasBy the it means?"Empathyearly 1980s, would recreational be more appropri- use of MDMA had begun in earnest. A chosen for obvious reasons, because it (Eisner 1989). isnametogroup aproduce chemical Sassyfras,of entrepreneurs and precursor distributea nod toin to theTexas, MDMA (Eisnerin small 1989; Collin and Godfrey naturally occurring essential oil of sassafrasknown that to most as the "Texas group," started brown bottles under the brand 1997). itBecause over-the-counteralsoby calling was MDIV[A available a toll-free was salesat certainnot number atyet the nightclubsa scheduled,bars and werepaying in orDallassubject forillegal, itand towith drug, Forttax. their peopleWorth,All creditof thiscouldTexas, MDMA-cards. It whereorder whoheardmentfueled sat Administration onnighflifeabout the impendingSenate got the (DEA)Judiciary attention legislation, to makeCommittee of Texas the they Democratic and stepped urged senatorup the production, Drug Lloyd drug illegal. When the Texas group Enforce-Bentsen, from PDF compression, OCR, web-optimization with CVISION's PdfCompressor tabletsestimates14 a day. In the few months before MDMA became illegal, it isLet possible of thirty thousand tablets a month to as much as eight thousand iteddrugthat 1989;for the onJuly every TexasCollin 27,application, groupand 1984, Godfrey made in thehas as 1997). Federal manynoThe recognized DEAas Register. two published million medical A Schedule tablets their use, of intention Iand Ecstasydrug cannot is prohib- (Eisnerto bedeclare MDMA a Schedule I RichardGreer,psychiatrists,prescribed Lester Cotton, by psychotherapists, Grinspoon,a physician.filed a letter and In withinJamesresponse and researchers Bakalar),the to thirty-day the DEA's together (Thomas period proposal, with Roberts, allotted their a group lawyer,Georgeby law of sasquestto the City, wasDEA and granted, administrator, Washington, and the D.C.DEAFrancisOn scheduled MayMullen, 31, hearings requesting1985, the in Los DEAa hearing. Angeles, announced The Kan- re- that it would not wait for the basis,hearingsOctoberthat the to DEAdrug1984 be completed was"scheduled"that beingallows before abused drugs MDMA, acting, to in be twenty-eight taking scheduled because advantage their for states. onerecent of year, Ona datalaw an without passedemergencyindicated hear- in theThethatings, longer hasemergency if there been administrative isscheduled enoughaction was concern in process thisan interim manner. for could public measure beThe safety.completed. ban to took MDMAcurb effectThe Ecstasy isDEA Julythe abuse onlyalso 1, 1985. initi-untildrug estingbecommitteeated placed efforts substance"(World in oftoSchedule thecriminalize World I but Health allurged aspects countriesOrganization of MDMA to "facilitate 1985).recommended internationally. The research chairman that in Anthis MDMA ofexpert inter- this wasdeferredgroup placed voted while in Scheduleagainst awaiting scheduling I datainternationally on the MDMAThe substance's DEA on and February hearings felt therapeutic that 11,took the 1986. placeusefulness.decision in February, should MDMA be June, and July of 1985. Many hancepsychiatrists,totook the insightpart. unique People researchand utility communication who ofscientists, had MDMA experience psychotherapists, to between catalyze giving the MDMAto therapeutic and, of patients course, process, testifiedlawyers to en- spouses, family members, and as PDF compression, OCR, web-optimization with CVISION's PdfCompressor thattherapist MDMA caused brain damage. Dr. Lewis and patient. Speaking on behalf of the DEA were those who felt Seiden of the University of The History of MDMA 15 substance.inChicago the axon presented Humans terminals data do of fromnot rodents take animal MDMAgiven studies by ofMDA, injection, these two drugs are very different in terms of their effects and injections of large amounts of that demonstrating changes but ingest it orally. howicityChemistry long data they seemed of last, MDMA" andto make they for anhavemore impactTo opposite details]. meet for the the activeNonetheless, criteria for Schedulethe MDA I,neurotox- the DEA had to prove that MDMA prosecution's side. optical isomers [see "The hadDEA'sstudiesthe no fact accepted moveexamining that no to medical scientistsschedule the clinical use thehad and drug. efficacyperformed a high There ofpotential MDMA double-blind,simply for washurt abuse. nothose proof, placebo-controlled challengingUnfortunately, the beyond the mendedcauseall,ofanecdotal, all Judge ofhe the tofelt thatFrancis theevidence that MDMA DEA Young, presentedthat did MDMAwhathanded at the the downtherapistsbe three placed an hearings, opinion said in Schedule it did.thirty-four on BasedMay III. 22, onwitnessesThis 1986.the wouldweight Be- in there was an accepted medical use for MDMA, he recom- Young'sphysiciansallow clinical recommendation to prescribe work and MDMA. research was ignored.The to proceedDEA's During administrator, unhindered the course and John of would an C. Lawn, permit was not convinced, and Judge appeal by pealswasperiodDr. Lesteragain in of Boston time unscheduled. Grinspoon, referred ruled that to (from affectionatelythe DEA December could as not the 22, use "Grinspoon 1987, the fact to Marchthat window"), MDMA 22, 1988,MDMA a Grinspoon won his case—the first circuit court of ap- did not issue.gumenthaveschedule Food Congress that anddrugs it hadDrug gave on no anAdministration the medically emergency U.S. Attorney accepted basis. (FDA) General, The use. approval Attorney not asthe General the DEA, basis wasthe for powerauthorized to There were other points at their ar- ingbeforeto delegate loopholethe the convictions Attorney that was authorityused Generalof successfully their to clientshad the formally DEA, by for several MDMAbut delegated attorneys possession that to power. argue and forThis trafficking, overturn- intrigu- the DEA acted against MDMA PDF compression, OCR, web-optimization with CVISION's PdfCompressor placedtheconvictions end16 MDMA of all the in Scheduletrials and I appeal, on March John 23, Lawn 1988. and the DEA permanentlyLet X=MDMA that took place before the permanent scheduling of the drug. At WestMedicine/Partygan Coastto be posed.shrinks? Drug Was Was Goes MDMA it aon killer Trial"anAs amazingdrug a resultran that the therapeutic ofcauses headlines. the trials,brain tool, Manydamage,the as media proposedquestions as gotpromul- windby be- the of the situation—"lVliracle Ihotfreegated remember story publicity by thein the feelingDEA? for summer the Everysorry drug of for magazine 1985.Ecstasy. the psychiatristsIndeed, Thearticle so-calledthat and was who every when hughad television drugbasedI first or heardtheir love news practices ofdrug story MDMA. was was a on it.riskMDMA-assisted seenBut their somethe licenses benefits continued, psychotherapy. and of itslivelihoods becoming proper use.How to"underground" Manyadminister hard itof must these an therapists.be illegalpractitioners, for them drug, As when Annceased not they Shulginwilling using had to northernwhendescribed you California it,see "MDMA what it made can is penicillindo" national (ShulginSome fornews theand time when soul; Shulgiti in theyyou the 1991). don'tearlyinadvertently give 1980s, up penicillina injected group of intravenous heroin users in unfortunateof"MDMAthemselves these individuals, Mythsproduct with MPTPand of aaRumors severe botched(1 .-methyl-4-phenyl- formDispelled" attempt of parkinsonism to for concoct more1,2 ,5,6-tetrahydropyridine), details.]a developed, synthetic In atopiate. with least shaking [Seeseven the thatpatientsmadetremors time, for andon amazing MDMA. theimpressive same copy, Because shows episodesand manyofthat this ofwere television syiichronicitynear explaining paralysis talk shows many (Ballardthe other airedpeople et popular images al. became 1985). ofdrug these This of con- tocalshownfused damage model and to be assumedfor dopamine-producing toxic mimicking to that dopamine-producing MDMA Parkinson's causedneurons disease. Parkinson's neurons or cause MDMA and parkinsonian disease. is has now usedMPTP symptoms. as hasa chemi- been never been shown veyedreflectedgrowing admitted this recreational trend—anywhere using the use drug of the [see from drug.With appendices]. 8 theSeveralpercent increased surveysto In 39 themedia percent ofearly collegecoverage ofeighties, those of EcstasyEc- during the mid-i 980s came campuses sur- PDF compression, OCR, web-optimization with CVISION's PdfCompressor Paradisestasy Garage, enhanced its cachet. British disc jockeys.use and in suchthe gay perform- club scene of New Cell and Boy George returned to England from trips to New York York, specifically at Studio 54 and The History of MDMA Il nentsShreeEnglandersCity as SoftofRajneesh, extolling MDMAfrom America. thean and Indianvirtues may There guru of the basedare drug. rumors in Couriers the thatPacific beganthe Northwest,followers ofwere Bhagwan propo- have helped lay the foundation for its interna- smuggling Ecstasy into ishlegaltional island until distribution, of 1988 Ibiza, (Collin whereparticularly and two Godfrey tablets into Somethe of 1997). Netherlands,Ecstasy researchers were where placeconfiscated MDMAthe beginning by remained police of in the rave movement on the Span- Thefueledstarted 1986summer by "spinning"(Capdevilla Ecstasy of 1987 and atwas 1995; thean huge eclecticnightclubs Gamella on Ibiza, mix and there of with Roldánmusic. in large the Paul1999). gatheringssummers Oakenfold, Certain of at 1985theDJs an discotecas Englishfrom and 1986.London DJ, growingcalledattried the to Project raves, import number beganClub that of (Reynoldsattendeessound to be andheld taking 1998).vibe in underground backEcstasy to London What locations followed during orthethereafter, in winter clubs, ofin with 1987,1988, a Afterward, large all-night dance parties, wasKingdom'ssands Britain'salleged in attendance. first to "Summer have Ecstasy-related taken Unfortunately, of Love," eighteen death: Ecstasy twenty-one-year-oldthat summer also brought Ian Larcombe, the United who when the raves were held outdoors with thou- tablets at once. sideredBones,1997), the a DJwaslargest and soon youthproducer, exported movement brought backThe in torave the Britain's the ravephenomenon United to history the States. United (Collinsweeping New States and York's the afterGodfrey United Frankie visit- Kingdom, which was con- Awakening),theboroughsing so-calledEngland of New inSeconda popular1989. York SummerHis andrave "STORMraves" eventually at ofthe Love. Manhattan took NASA began place club (Nocturnal inmonthly Shelter warehouses Audiothroughoutkicked in andoff the inSound 1992,outer July Franciscofromdebuted1992, five and Bay in thousand one1991 Area, of (Reynolds theand to first Oakland'sthirty large 1998).thousand U.S.version, Raves raves attendees. called are in Sanstill massives, Francisco,going strongbring Toon anywhere in the Town, San PDF compression, OCR, web-optimization with CVISION's PdfCompressor United18 Kingdom—fed off each otherThroughout and grew to become a substantialLet part XMDMA of the nineties, both rave scenes—in the United States and the uedtimesinglythe to youth grow common,the culture Ecstasyexponentially, spreading in supply each country. and inthroughout the raves United Worldwide of Europe,thousands States consumption Australia,and of thepeople United Israel, ofbecame Ecstasy Kingdom and increas-India. contin- was At evenbecomparedsporadic; flooded abandoned occasionally,with with Ecstasy. pharmaceuticalMDMA, there The but seemed sourcesat othercompanies, to weretimes, be an underground theinabundance Eastern European Europeanof labs marketmethamphetamine and possiblyseemed(former to Newark,tion.AmsterdamIron Curtain)Many New significantas countries Jersey,being a airports major (SaundersEcstasy relay have seizures 1993, point been 1995).for wellin EcstasyAmsterdam, publicizedThe DEAmanufacture alsoinLos the regularlyAngeles, past or distribu- several cited and hadyears.drug's increased Russian current byand distribution 450 Israeli percent. organized network, CongressBy crime theas haveheld late rings hearingsnineties,Hassidic have been governmentinJewish June implicated 2000couriers. seizures and in there- of Ecstasy in the United States "themillionfromported Bull" less thattablets than Gravano Ecstasy in five the hundredseizuresfirstwas fivecollared monthsbythousand the for Unitedof2 distributing tablets 000. States Also during EcstasyinCustoms 2000, 1997 andthe toService mobster moreadmitted thanhad Sammy torisen four fi- twelfth-gradersthatnancing he could sales ofunload intwenty-five the one United hundred thousand States,The thousand showstablets Monitoring a atablets steadyweek. the inAincrease Futuredealerforty-eight inStudy, Miamithe hours. percentage a claimedyearly survey of eighth-, tenth-, and gencypercent,twelfth-gradersof students room and who invisits 2000, reportedsay attributed they 11 percent haveusing to tried the Ecstasyof studentsdrug.Ecstasy. and In reported 1999Inreported 1996, the taking justnumberthrough over Ecstasy. jumpedthe6 percent DAWN Emer- to of 8 ing,4553,in (Drug1996 distribution, the toAbuse Club2,850 WarningDrug in and 1999. Anti-Proliferation abuse Network) in the Insurveying United May Act, 2000, States. system to Representativecombat Thisalso clubhavebill was drugrisen, Judy meant traffick- from Biggert to319 of Illinois introduced bill HR PDF compression, OCR, web-optimization with CVISION's PdfCompressor ketamine(ainclude hallucinogen)—according (an anesthetic), Rohypnol to the andNational GHB Institute(sedative on hypnotics), Drug Abuse and (NTDA). LSD a group of drugs that are known to be used at raves—MDMA, The History of MDMA 19 larssentencingThedistribution, inbill funding called guidelines and forto the usethe Public oftoU.S. Ecstasy.provide Sentencing Health forFurther, higherService Commission the penalties forbill school-asked forto for amend theand five manufacture, community- millionthe federal dol— "bogus"(paramethoxyamphetamine,based abuse Ecstasy and tablets),addiction and prevention arelated dangerousThe clubclub programs drugdrugs.and potentprovisions aimed ingredient at were Ecstasy, attached in certain PMA to the Children's Health Act of provisionmethamphetaminetencing2000, which provision that passed would thatwas in make wouldtheremoved. House it have a crime Also and equated Senate removedto distribute MDMA in wasSeptember ainformationpenalties particularly 2000. with about alarmingThe those sen- the of wordhavemanufacture, "teaching" made the acquisition, hadpublication appeared or of inuse this the Atof book original a controlledJuly a criminal 2000 draft DEAsubstance.of offense. HR conference 4553, Specifically, on club thedrugs, it was estimated that two which would callymentrisingmillion to statistics, hitseducatecrack of Ecstasydown in America's addition on were club toyouth coming drugs.several on intoA thedeaths website thedangers dueUnited was to of PMA, Statessetthese up caused drugs.everyby NIDA week. theSupporting govern-specifi- These cizingcareerthe Johnsclaims outthe Hopkins ofaxonalthat giving Ecstasy changes University large is adoses hedangerous hasneurologist of documented. MDMA drug George tois thelaboratory [For NTDA-fundedRicaurte, more animals information, who hasresearchand made publi- see of a Monitoringis "Doesthe media MDMA the coverage Future Cause ofstudy Brain Ecstasy statisticsDamage?"]A andfascinating itsfor effect 2000, consequence on a survey our nation's of of fifty the teens. government'sthousand The crackdown on club drugs someEleventwelfth-gradersstudents, time percent reflected intheir forof highlives. anythe druglargestschool class seniorsone-year in the in twenty-six-year percentagethe year 2000 point hadhistory increase tried of Ecstasy the among study. at PDF compression, OCR, web-optimization with CVISION's PdfCompressor user.lines20 forIt is safer well useknown or publicizing that overheating theBut specific and dehydration behaviors thatare realendanger risksLet X=MDMA en-theNIDA has chosen to demonize the drug instead of offering guide- associatedenactedfavorcountered of shortlyscare atoverheating a tacticsrave, after but andDr. at the ravesslogans.John government inHenry 1992.Contrast reported Inhas Januarythat opted withthe to 1993first theignore Britishcasesthe theseSafer of legislation Ecstasy- issuesDancing in "chillclubsharmCampaign wouldreductionout" wasareas, be launchedmonitored group) water, andand in for Manchester, theharm temperature, Manchester reduction with air information.city joint quality, council. backing and Thisthe from availability ensured Lifeline that (a of andtionedStates little andMDMA-assisted published around the research world. psychotherapy BecausebeyondAlso anecdotal MDMAwasdistressingcompletely reports ceasedismade the of lackillegal in cases the of Unitedin clinicalhas 1985, made States, sanc-research its of MDMA in the United frommissionway"psycholytic into1988 fromthe until literature. thepsychotherapy," 1993. government No One clinical research and to research conduct they group conducted onMDMAwas inresearch Switzerland MDMA-assisted on whatbeing did theyobtaindone sessionscalledin per- the whoallowUnited had Dr. States taken Charles at the all Grobdrug until before.to the conduct FDA His Sincefinally humanstudy that agreed,commenced studies time in twoof the MDMA, morein summer May research using1994. of 1992, people groups to in the United States have ob- rael(Multidisciplinarystudiestained in Augustpermission have been 1999, Association undertakento clinical give MDMA researchers of in Psychedelic this to countryhuman from Studies) aroundsubjects,yet. At theconferencea MAPS-sponsoredbut world no therapeuticmet held for in the Is- 2000,medicine.respectfirst time in to Spain, to Thereresearch, share a is doctoraltheir a andray findings, offuture candidate,hope plans totheir round Joséinassessments the out Carlos exploration this history.Bouso, of where of Onadministered this we November invaluablestand with the 9, veryticthefirst well, level."drug dose andto ofI treathope theMDMA patientpost-traumatic that thisin seemed a isresearch the tostressfirst have protocol in disorder. gottena long designed toline "The a of four-hourtreatment to test the sessionstudies. efficacy went of more therapeu- PDF compression, OCR, web-optimization with CVISION's PdfCompressor WHATGary0 1. DOESBravo, M.D. MDMA FEEL LIKE? Whyence are empathy, acceptance, closeness, do people take MDMA? Among the terms used to describe the experi- insight, lack of defensiveness, peace, ateddotaloneness—"ECSTASY." with reports MDMA in the are scientificcommon These literature.inAlthough termsfirst-person for MDMA the accounts state was of consciousnessoneand ofso-called the more anec-associ- intensely studied novel chemical emphaseswithhundredscompounds a secondary ofand publishedin the the focus 1985 1980s reports onscheduling andadverse was1990s, itsreactionsof allegedMDMAthe focus among toxicity as of part interest users. ofto serotoninthe Because for most most restricted neurons, of of these the haveencepotentialclass beenhasof regulated forbeen the abuse"), claims meager. drugs of clinical psychotherapistsAmid (those researchthe with furor "no into and accepted the medicinal nature medical of chemists the use" MDMA that and MDMA aexperi- "high about the dangers of MDMA abuse tificpsychoactiveingestion literature results or tells psychedelicin aus unique about anddrugs?the WThatsubjectiveuseful This stateis chapter this experience of state consciousness. focuses of consciousness? of on people what theunder Howscien- the is MDMA different from other utemadeinfluence to ofthe the subjectiveof acuteMDMA and experience. andless relatedsevereAs sidephenethylamines. with effects the traditional of MDMA In addition,psychedelics use, which mention contrib- (and allis psychoactive drugs, to some setting."extent), the"Set" MDMA refers experienceto the intentions, seems preparation, to be greatly and dependent mental and on "set 21 physical and PDF compression, OCR, web-optimization with CVISION's PdfCompressor 22capacities Let XMDMA of the user, and "setting" refers to the user's physical and interper- fromorcontextsonal in that an environment. ofofexperimental psychotherapya person usingThe laboratory experienceor the for drug spiritual setting. in of a a recreationalexploration Nevertheless,person who issetting, takesbound there MDMA or toseems inbe adifferent rave,to in be the a turesticuniqueguishes of relateda groupMDMA MDMA toof bothmethoxylatedprofile from amphetamines thatother is mind-altering phenethylamines,reliably and common mescaline-type drugs. which to This all havecontexts profile psychedelics. chemical is and characteris- distin- struc- The posed"entactogens,"thatchemicals they term inhave is this "empathogen," which beenclass meansareproposed so uniquely"to stemming touch to constitute different within" from from(Nichols theira new otherempathy-producing class 1986). psychoactive of Another drugs—the drugs pro- ef- methoxy-4,5-methylenedioxyamphetaminerelatedfects. MDMA are 3 ,4-methylenedioxyethylamphetamine is the prototype andAnother most studied drug (MMDA). known of these (MDEsince compounds. the or 1950s, Eve) Closely andMDA, 3- has been considered to have usedearlyempathogenic1974). aspublished a Ten generalized subjects effects description atprototypewho low were of doses the ofgiven qualities andthe MDAentactogenicpsychedelic of reported the MDA effectsexperience the experience following at high (Turek doses. couldeffects, et Anal.be as ion,andmeasured increased tranquillity,significance by awareness the feelingsofPsychedelic music, of ofthe feelings tenderness importance Experience of emotionaland of Questionnaire: interpersonalgentleness, closeness increase relationships, "feelings with in the the ofcompan- beauty feel-peace ingsstateofbeing ofinsightful joy,of at consciousnessa experience spiritual knowledge height, of experiencedoneness experiencedexperience in relation during of at pure anto part an intuitivebeing innerof the and world sessionlevel, pure within, awareness,feeling was moresense that gain real ofthe "Insummarizethan the normal right fromawareness circumstances, their experienceof everyday MDMAHow their reality, has reducesinterpretation andthe MDMAloss or sometimesof theof state how usual been MDMA eliminatessense characterized? of works: time." the Greer and Tolbert (1990) integrity.neurophysiological fear response to a perceived threat to . . . With this barrier of fear removed, a loving and forgiving emotional PDF compression, OCR, web-optimization with CVISION's PdfCompressor empathyawareness with others. EmpathyAnother is defined characterization in the psychiatric of the effects of MDMA is that of powerful seemed to occur quite naturally and spontaneously." What Does MDMA Feel Like? literature as the 23 other'stherefeels"capacity asframeis theno to fusion other ofunderstand reference person or identification what does, (standing another but recognizes inwith person the the other's ispatient" that experiencing shoes).other (Ayd feelings In from are 1995). Unfortu- empathy one within the possible; nizationnately,differs the andfrom subjective disintegration, the traditionala experience leavingpsychedelics of paucityempathy reality of byis research testing difficult rarely relativelyonproducing to this purported intact. ego quality of the empathogens. MDMA disorga- "As ontopelsgentler,compared intensificationany subtler, mental with highlythe or moreofemotional controllablefeelings familiar pathand psychedelicexperience self-exploration.that is which drugs, invites Theit [MDMA] user rather is notthan evokes forced com- a frightening or even uncomfort- allyShulginable" within (Grinspoon and half Nichols an and hour, (1978), Bakalar and who the1986).The pointeddiminishment first mention out the ofofrapid theMDMiVs onseteffects of psychologicalafter effects, another usu- effects was in a report by psychospiritualstudiesplacetwo hours. before of MDMA Early the exploration. DEAattempts sessions scheduling at thatquantifyingGreer focused of and the Tolbert drug, on healing were (1986) small,specific published uncontrolled problems a summary or case on the MDMA experience, which took citedfeelingstiveof the changes somesubjective of closeness cognitive in theireffects and attitudesbenefit, of intimacy MDMA suchor feelings within as twenty-nine an anyone expanded during present. subjects;the mental session Twenty-two all perspective, andreported increased subjects posi- in- clenching,monsight undesirableinto personal insomnia, effects patterns fatigue, during or andproblems,In decreased another or improved pioneering appetite. self-examination. study of MDMA's Com- acute effects, Downing (1986) and after the sessions were jaw tension, teeth tendonrate,sessionlooked and reflexesatand pupillaryphysiological found were that dilatation. enhanced. all parameters of them Appetite Some showed of subjectstwenty-one was elevations had subjects ataxia in blood (difficulty in a pressure,group walking), MDMA generally suppressed, and deep pulse PDF compression, OCR, web-optimization with CVISION's PdfCompressor 24physicaland and emotional energy, and heightenedmore than sensual half had jaw clenching.Let XMDMA Subjects experienced euphoria, increased three re- Inapprovedported one sexualof research,the arousal.more studies notable of studies the ForMDMA (Peroutka many experience years et afteral. 1988),were the limitedscheduling Stanford to surveys. under-of MDMA in 1985, before the FDA termnessreportedgraduates with"closeness" having otherwere people,triedasked is not it. about definedTheexperienced most their in common theMDMA by report; 90 acute percentuse; it is 40effect stated ofpercent the was only respondents. a of sense that the "the studentsof close- sub-The jectsheartbeatreport,interact thought which better (72 that emphasizedpercent), with they other were teeth adverse people."more grinding verbaleffects, Other (65 during were percent),acute jaw this effects tension timedry mouthdocumented and (75 werepercent), (61 percent),able in rapid tothis coldpalpitations,centand increasedflashes,to 42 percent increasedsweating, alertness of the sensitivity difficulty(50 subjects, percent). to concentrating, were cold, Other "luminescence dizziness effects, tingling, or experienced vertigo, of objects,"insomnia, visual by halluci-tremor,20 hot per- or usersnations,cent),muscle (in depression and theaches 24 blurred orto fatigability48 (21 hoursvision. percent), after Less(32 ingestion)tight percent), acute jaw effects muscles lingeringincluded of (21 MDMA sensedrowsiness percent), of experiencedcloseness (36difficulty percent), (22 bycon-per- one(1992),centrating to twenty-five who (21 surveyed percent), times. twenty and The headache psychiatristsmostA more common (17detailed percent).who acute structured each effects had usedinterview were MDMA altered was fromtime done by Liester and colleagues jectspercent),othersperception reported (85 and percent), (90 changesheightened percent), decreased in visual awareness enhanced defensivenessperception ofability emotions (55 to (80 interactpercent). percent),and less with Half aggression.decreased or of be these open fear sub-The with (65 mostgrindinglibidocent),subjects) common decreased(45 were(30 percent), adverse percent), diminished appetite higher effects and (65 desirelevels (notincreased percent), necessarilytoof perform restlessness/agitation jawanxiety tension mentalexperienced (25 or(50 percent). physical percent), as (35 adverse percent), Atasks diminishedlater by(70 study theteeth per- PDF compression, OCR, web-optimization with CVISION's PdfCompressor thetionnaires,(Davison Profile interviews,of Mood States and a(POMS), standardized to assess test of retrospective psychoactive self-reports drug effects, of and Parrott 1997) of the subjective effects of MDMA used ques- What Does MDMA Feel Like? 25 inglyvs.portedtwenty anxiety" unchanged feelingrecreational energetic, from Ecstasy baseline. elated, users Physiological agreeable, in England. and changes Onconfused. the describedPOMS, The "composure were faster scale and the "confidence vs. uncertainty" scale were surpris- subjects re- enedtionpils,heart andand perceptionrate, energy,tight higher jaw. warmthof body Psychological sound, temperature,and color, friendliness, effectsand sweatingtouch. were cahimess feelings and and dehydration, of relaxation, happiness, dilatedand exhilara- height- pu- experienceof1992) consciousness. attempted from to Inthat providethis of survey, amphetamines dataA the thatsociological following characterized and termshallucinogens:.study thedistinguished of oneunique hundred MDMAhappy, the EcstasyMDMA easy- state users in Australia (Solowij weredent,going, used and accepting, to carefree. describe sensual, the experience and euphoric.Grob were undertook The talkative, other the common open-minded,first federally adjectives approvedconfi- that study of the acute effects of POMSEcstasyMDMAand physiological and experiencein thethe UnitedState were andTrait States givenpsychological Anxiety (1996, placebo, Inventory1998). medium-dose,parameters Eighteen were administeredwere subjects or high-dose measured. with during previousMDMA, Both the the revealedperiodcantdrug increasessessions."of only acute a intoxication"lack on However, the of hedonic negative the but Altered and"proved symptomatology arousal States to becontinuum Graphic of mixed during Profile for value," the both showed experimental thesince medium- signifi- they subjectsperatureand high-dose hadand significantlymodest ranges. increases Subjects elevated in hearttended Ablood unique rate topressures). haveand double-blind, blood mild elevationspressure placebo-controlled (though in body two tem- laboratory study conducted andtheregivenby Hermle controls. were to fourteen noand significantThe coworkers volunteers. researchers differences (1993) On concluded severalin inGermany cognitive psychological that reportedMDE functions "produced theand between results cognitive a ofpartially subjects MDE tests PDF compression, OCR, web-optimization with CVISION's PdfCompressor 26controllable state of enhanced insight, empathy, and peaceful feelings,"Let XMDMA and drivethat "the with major pronounced effects ofpartly MDE euphoric were a andreduction partly ofdepressed anxiety, mood,an increased and an . hallucinations,processes,hallucinogenicimproved responsivenessnor withdrugs, the MDE exception in, neither and ofopenness disturbed one case." to, perception, Thatcommunication.. case norwas formal of a . volunteer thought and did not produce psychotic symptoms such as Unlike reactionwhohallucinations showed characterized signs (Gouzoulis of toxic by anxiety psychosis et al. Later,1993). with Vollenweider Another paranoia subject and and auditory had colleagues an and unpleasant visual (1998a) conducted a double-blind, Moodfounddoseplacebo—controlled Rating of that MDMA during Scale (1.7 andthe study mgpeakthe MDMAAltered ofeffects thirteen State perof MDMA, kgvolunteers of body Consciousness weight).subjects using aevidencedUsing typicalrating the scale, recreational Adjectiveenhanced they subsetdisorder,alizationmood and of (feelingandthe well-being, anxietyanxiety. that scale associatedthey,The relatedrating or their with of to surroundings, increased "thoughtfulness-contemplativeness,"moderate anxietyderealization were was not on andreal), a particulardeperson- thought cameenedalsoand subjects reportedopenness, more verbal, said experiencing and that althougha sensethey feltincreasedof a closeness fewno increase desired responsiveness to othertoin withdraw.subjective people. to emotions, TheMostanxiety. investigators subjects Subjects height- be- psychologicalconsistentresultsfound thatof the withthe S effects MDMA troopthose oftest,of MDMA.groupearlier a measure did prospective not of differ selective and from retrospective attention. the placebo These reports group results onin theare DoesTolerance MDMA lose its effectiveness with repeated administration? Early studies to the Subjective Effects of MDMA reportthedoseof the first, of thatpsychotherapeutic approximately to repeated extend dosesthe halfpeak do use the noteffects of original extend MDMA (Greerand or dose increasereport taken Tolbert the the two effects desired to1986). three of empathogenic a Mosthours "booster" users after PDF compression, OCR, web-optimization with CVISION's PdfCompressor nouncedeffect in proportion to the dose. In addition, a tolerance butto the that desired the unpleasant "amphetamine-like" side effects are more pro- What Does MDtIA Feel Like? 27 ofistrationsmoreeffects time interesting extendsthat tend elapses to for featureslead asbetween to long decreasingof theas doses. twenty-fourMDIVIA desired Beck experience and effects,to Rosenbaum'sthirty-six regardless hours. in-depth of Onethe amount ofinter- the is that repeated admin- viewsmessage,"usersance" of forto one be decreased in ahundred commonother words, use MDMA phenomenon, of theyMDMA users feel (1994) werethatthough after foundnot they universal. this use "cumulativeMDMA Reasons a few given toler- times by the following: (1) They "get the thereandstate isheadaches.less. of no consciousness more(3) They learningOne have study is moreto more comparedbe done,negative readily the subjects available. after novelty effects, who has(2) took Theysuchworn Ecstasy as enjoyoff, fatigue, and at athe weekendmalaise, new the high less weekendwereanddance significantly Travill club dance 1997).with club morethose Anotherwith depressedwho those reporttook who fivealcohol compareddid daysnot and take after subjects found the taking drug that who at the tookthe Ecstasy same Ecstasy club. users at a the drug (Curran goodfelttheResults club,"significantly tempered" showed but when thatthan more they all controls depressed,weresubjects assessed (Parrott reported abnormal, again and positive Laskyafter unsociable, two moods1998). days, unpleasantwhile the Ecstasy they andwere users less at MDMAdataSpiritual elude experiences scientificEffects are analysis. often described MDMA in frequently spiritual terms, is labeled and so as far a "heart-these whichtualthatopening" beliefs.MDMAis located drug. It opens refers in Those the the to heart thosewho"heart region; work energies chakra," withthey that asubtleemanate term make andthat upunconditional esotericcomesthe psychospiritual from energies acceptanceHindu believe spiri-body, unpredictableOtherthisof and is psychedelicunknown,strong connectionway. but drugs this to canseems others. produce to Thebe thea way unique same in which effect MDMA ofin athe somewhat empathogens. accomplishes more PDF compression, OCR, web-optimization with CVISION's PdfCompressor 28 The Let MDMA condition also has been likened to a state of advanced medi- succeededderfulminimaltation, toola orstate in fornonexistent. meditation ofteaching. peace and untilOneFor subtle example,ZenEcstasy teacher bliss removed I had inhad which a this verythe to blockdistracting keen say: caused "Ecstasystudent thoughts by who ishis a effortneverwon- are Thewhenscience"the utility trying drug of offacilitates experimentalto the meditate" MDMA the (Saunders 'awakenedmysticism. experience 1995). attitude' for spiritual A allBenedictine monks purposes seek" monk awaits (Eisner stated a 1989). truethat ConclusionHow do we generalize and characterize the MDMA state of consciousness? interpersonalTheentactogensas resultsthe prototype of closeness,the or empathogens—thatstudies of a acceptance newdescribed and unique here of reliablyself validate classand imbueothers, theof psychoactive classification thefeelings user withof ofMDMIA"oneness," a sense of drugs—the usefulnesstheofand consciousness short- a potent of and the sense long-term effects that of it well-being.of deserves risksMDMA of MDMAto to Enough be medicine, investigated use claims in psychiatry medicine have thoroughly. been andor psychotherapy madethe In science addition, for the ofterdisciplinaryprospectiveand this the unique effects studies psychoactive researchof its of nonmedical MDMA protocols, chemical. in use humanwill also begin populations,demand to provide careful using some investigation. creative understanding and Only in-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Jessica0'HOW MDMA WORKS IN THE DRAIN E. Malberg, Ph.D., toninTheand pharmacology and Katherine dopamine. of These MDMA R. neurotransn±ters primarilyBonson, involves helpPh.D. two nerve brain cells chemicals: communicate sero- reuptake,throughplexwith eachneural three inductionother systems main (as describedof neurochemicaland serotonin behavioral below) release, and mechanisms:responses. and each induction of themMDMA blockade ofhave dopamine acts their of in serotoninown the release. braincom- Withandfenfiuraminefluoxetine amphetamine, (Prozac), (Pondarnin), a dopaminethe serotoninthe serotonin releaser. reuptake releaser Additionally, inhibitor (and the MDMAand"fen" antidepressant; inthese "fen-phen");can directly actions, MDMA is essentially a combination of the effects of towardasinteracteach a monoamine ofhow with these these receptors different oxidase actions in mechanisms acan(MAO) variety ultimately inhibitor. of functionneurotransmitter affect This atbehavior the chapter cellular systems and will levelmood. explain and with can anhow act eye nervousMDMA,BeforeHow system readers functions may benefit in the from brain. a basicNerves orientation communicate to the with way eachNeurotransmitter that thewe attempt a complicated Systems discussion Function of the in neurochemicalthe Brain effects other of isby ofknown electrical one neuron,as a and synapse. chemicalthere Ais synapsea means.gap before caimot When the bean start bridgedelectrical of the with signalnext an neuron. electrical reaches This thesignal; endspace 29 PDF compression, OCR, web-optimization with CVISION's PdfCompressor synthesizedfrom30communication the presynaptic and stored inneuron. this presynaptic This chemical, space. Oncecalled released, a neurotransmitter, the neurotrans-Let isX=MDNA between neurons continues with the release of a chemical withmittercellron the tocommunicationfloats chemical,protein across structures itthe causes continues.synapse known the andinduction Neurotransmitters as can receptors. bind of apostsynaptically new When electrical also the can receptor signal, onbind the to andnextis presynap- occupied nerve neu- age,oftic morereceptors, release, neurotransmitter. andwhich reuptake function of in its Thea neurochemical.negative normal feedback functions We mode can of totheexplain reduce presynaptic this the concept release neurotransmitter cell are stor- usingcharacterizedSingleStorage the molecules simplyexample as means either of 5-HTserotonin that free-floating floating5-HT (5-hydroxytryptamine, is storedin or the cytoplasmic. cytoplasminside the cell, (the5-HT or influid 5-HT)alsoone in ofcan the neurons.two be cell) forms.found are toreleaseHTsequestered any of stored fourteen within 5-HT currentlythe into cell the in knownsynapse.storage serotonin packages The released occursreceptorcalled serotonin vesicles.when subtypes. a neuron thenRelease These can is of bindactivated, re-5- causing the presynaptic terminal to concentrationsHT2centratedceptors are by located subtype in the both frontal in particular postsynaptically cortex, regionsan area andof thethe presynaptically brainbrain. responsible Forreceptor, instance, and whichfor are higherthe con- is 5- stimulated by hallucinogenic drugs, is found in high threeandcognitive will things: become processing. (1) freeIt can again be recycledin theAfter synapse. into a certain the At presynaptic this amount point, of5-HT neuron time, can 5-HTthrough do one will ofa stop binding to the receptor (3)(MAO-A),(2)reuptake It can mechanismdiffusebe which degraded metabolizesaway (transporter) by out an of enzyme 5-HTthe synapse. sointo suchthat 5-H[AA(5-hydroxyindoleacetic it asAll can monoamine of be these stored actions oxidasefor future terminate subtype release. acid). the A presynapticprotein.effect of theThe cell,neurotransmitter. 5-HT facing transporter the synapse. isThe located Reuptakeserotonin on the beginsreuptake outside when mechanism membrane the 5-HT is ofin sometimes the called the transporter PDF compression, OCR, web-optimization with CVISION's PdfCompressor tosynapse the transporter, binds to the 5-HT transporter. Once a molecule of 5-HT is bound the transporter changes shape (or configuration) and moves How tIDNA Works in the Brain 31 tiontheintothe outside forthe 5-HT thecytoplasm surfacetonext the molecule inside of of the the ofpresynaptic cell. ofthe 5-HT cell,The Thetransporterwhere membrane net the effect 5-HT thento ofcontinue "fallsreorientsthe action off' its itselfanduptake of theis toward released func-5-HT cyclereuptakeporterstransporter serotonin on mechanism presynaptic is removal molecules. does serotoninof 5-HT notDrugs rely from membranesthat on a"block"the single synapse. throughoutthesite reuptakeat There a time, theare mechanism working brain,many so trans-to oc-the re- inhibitioncanHTcupy fromreattach the sitebinding essentially tothat a postsynaptictowould the prolongs transporter, normally receptor.the beeffect so occupied it Thus, isof left any aout released in the serotonin.synapse, where This isit by 5-HT Thisdrug prevents that causes 5- reuptake MDMAnmthe mechanism of action of many antidepressantsreuptake inhibitors known as (SSRTs). selective seroto- and the 5-HI Transporter weproduceadeHow have of uptakepreviously both separately,of these discussed effects MDMA the at twothe is unusualsamemechanisms time. pharmacologically, MDMA of 5-HT functionsdoes release MDMA because and similarly block- fit it into can to the function that we have just described? Although intoMDMAsitethe the antidepressantand presynaptic also prevent is taken 5-HT cell. fluoxetine up from Thisby the binding action intransporter that does to both the not transporter. afterdrugs occur it occupy iswith bound In fluoxetine contrast the and 5-HT is to becausedeposited fluoxetine,transporter of preventsitsthan relatively fluoxetine its entrylarge andintosize, therefore the which presynaptic allows is ableOnce it tocell.to enterinsideoccupy MDMA the the the cell presynaptic is5-HT ascloser if transporter it inwere sizecell, 5-HT. to MDMIAsite 5-HT but induces the release of 5-HT into1. MD]the synapse. VIA is releasedThis is a fromfour-stepMDMA thetransporter transporter process: falls off.undergoes into the cell a change when thein "configuration" (shape) and the PDF compression, OCR, web-optimization with CVISION's PdfCompressor 322. The transporter then has the correct configurationLet XMDMA to bind cytoplas- 3. The bound 5-HT is transportedmicoffwhen Out into 5-HT the of the transporterthe (the synapse. presynaptic serotonin changes in cell, the configuration and neuron, not theagain, synapse). the 5-HT falls 4. The transporter is then in theMDMAslide[For correct diagramsshow configurationthat on is theto available helpWeb explain siteto in bind www.dancesafe.org] the this moresynapse process, and please repeat refer the process.to the Ecstasy latedmalamphetamines, circumstances, in the brain. including Thus, 5-HT theis methamphetamine not main releasedMDMA's effects in oflargeability MDMA—inhibitionand amounts fenfluramine.to induce but 5-MTis tightly Under releaseof 5-HTregu- nor- is common to all substituted MDMAporaryapsereuptake with administration, depletion and atypically release of 5-HT largeof so 5-FIT much inamounts the from5-FIT presynaptic ofthe has 5-HT presynaptic been Withincell. released Additionally, neuron—floodthree that to there six MDMA hoursis athe tem- aftersyn- in- accountels.ofactivates new Since 5-HT, for the low theenzyme so levels transient that (tryptophancellsof serotonin mood cannot swings hydroxylase) make are associated thatenough follow that 5-FIT with isMDMA necessary to depression, reach use baselinefor in synthesishumans.this maylev- longHT5-MTWithin have periods levels twenty-four been return of seen time. toonly hours, normal Similar when (Schmidt highdepletions doses 1987). ofof MDMA 5-HT Longer-lasting also are aregiven seen depletions repeatedly with long- of for 5- new serotonin can be synthesized, and inDamage?"].term its brain—thisadministration is known of fenfluramine as a "transgenicScientists [see havemouse""Does created MDMAor "knockout a mouse Cause thatmouse," Brain does not have the 5-HT transporter ciallytestoutbecause ofhow whenthe thethe genetic it genesabsence is challenged makeup that of are a transporter ofresponsible with the drugs.mouse. affects forIn This regularthe a mouse transporterliving mice, isbiological useful MDMA have scientifically been system, will knockedproduce espe- to

PDF compression, OCR, web-optimization with CVISION's PdfCompressor How MDMA Works in the Brain 33 increasewhenLITan 5-HT in their transporter locomotion knockout (Bengelincrease mice 1998). in were the This amountgiventransporter, suggests MDMA, of movement that MDMA there without thatwas could a mice no5- not make get aroundinto the a cellcage. and But cause its various porterbecausemice,effects. bothis ofrequired In increasedgroups contrast, for showed dopamine).MDIVIA when an amphetamine increaseto Thus, exert itsit in was effects. locomotionwas concluded given to (this thatregular isthe thought and5-HT knockout trans- to be releaseMDMAMDMA ofalso 5-HT The release of DA appears to rely on the previous release of and Dopamine causes the release of dopamine (DA), but to a lesser extent than 5-HTThisthe increase principle transporter, in also DA in hasafter whom been MDMA MDMA borne administration out does in notgenetically cause (Nash hyperactivity altered and Brodkinmice (a that measure 1991). lacksince a blockade of the 5-HT transporter with fluoxetine suppresses HTreleasebeforeof dopamine the (Gudelsky administration action). and Conversely, Nash of MD1VIA 1996). giving It causesshould drugs an beonthat even notedDA increase gieaterrelease that 5-HTthe increase involves effect synthesis in ofthe DA 5- DA transporter as well, since inhibition of MDMA.the DA reuptake mechanism Thisalso willeffect prevent ofsince 5-HT activationDA on release DA release of in this response may site occurin tothe throughabsence the of 5-HT2MDMA recep- is known to in- MDMA,MDMA.inducedcrease DA Thesebut release,release. they antagonists did To5-HT2 not test affect whetherantagonists were the found the resting 5-HT2were to block givenlevels receptor the before of increase isDA involved administration before in DAin MDMA MDMA- from of dosenistsand(Schmidt DArelease MDMA.might et beal. useful1991).[see "Does in Given the MDMA prevention the connection Cause of Brainany between possible Damage?"], MDMA damage 5-HT2 neurotoxicity from antago- high-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 34AlthoughMDMA arid 5-HT Receptors Let XMDMA the primary effects of MDMA are on the transporter sites in 5-HT MDMAcauseand DAother the has systems, hallucinogenic receptors.a slight thereaffinity The isresponse mostevidencefor the intriguing from5 -HT2of thedirect receptor.classicwork interactions in psychedelics thisThis area is between interesting, has (such shown MDMA as LSD)be- that hastheerties been site (despite correlatedassociated the tolack with activation of the hallucinations); psychedelicMDMA of the 5-HT2 often experience it is site. characterizedtherefore is activated not bysurprising users to a assmall thathaving some psychedelic prop- lever,suggestsstudiesdegree they byto thatdo identifyMDMA. not the pressinternal when However, that experience they lever havewhen when ofreceived rats LSDclassic are is trained hallucinogensMDMAgiven toin by themdrug pressing is discriminationinstead. different a certainThis from whichingestionthat ofreport MDMA, may a distinction be in the agreement result between ofAdditionally, with5-HT2 these results activation,drugs. fromthe increased studies since stimulation of body human temperature beings, of this that is seen after MDMA MDMA-inducedis occupyingreceptorstrengthened with the by otherreuptake hyperthermia, the drugs fact sites that is knownis pretreatment suggesting not sufficient to cause that with hyperthermia.to preventing inhibitfluoxetine the 5-HT body doesThis releasetemperature notconclusion block by ducingbraineffects is offeelings the MDMA. 5-HT1B of calmness, site. This andAnother receptor drugs receptor thatis thought activate that to thismay be importantsite play are a knownrole in inpro- inthe action of MDMA in the tionMDMAhaspsychiatric shown with or 5-HT1A that research5-HT1B there or asisagonists 5-HT2 a"serenics." similar agonists are pattern given. Exploration is of notIn increased contrast, similar of this locomotionto the receptor that pattern from with in ofMDMA. rats locomo- MDMA when thelevel(that effects is,as theythey of do dida 5-HT1B not before respond drugagonist-_this behaviorally administration),When israts known to are a dosetheygiven as cross-tolerance. ofalso repeated MDMA fail to atdosesrespond the Cross- sameof toMDMA and become tolerant PDF compression, OCR, web-optimization with CVISION's PdfCompressor Flow MDMA Works in the Brain 35 agonists.geststiontolerance of that the Finally, MDMA5-HT1B drug sharesagonist discrimination a and common are subsequently studies mechanism have givenshown of action MDMA. that withrats This trained5-HT1B sug- to also happens when rats are made tolerant to repeated administra- TFMPPbeingtrifluromethyiphenylpiperazineidentify similarhas MDMA been to promotedMDMA will presswhen on underground combinedthe (TFMPP), MDMA with druga druglever a informationstimulant. with when S-HT1B they Web properties.are sites given as paroxetineItSelectiveMDMA (Paxil) and Interactionsor sertralinehas been shown(Zoloft), that for people at least who three have to taken four weeksfluoxetine for or other SS1Us,Serotonin like Reuptake Inhibitors (SSRIs) with Other Drugs MDMA.reportdepression1996a, aMost reduced 1996b). have (but a notorOurreduced completely all) new people response research whoeliminated tohas takeLSD found SSRIs and response that other for a asimilarhallucinogens tolong MDMA. period effect ofThisexists (Bonson time de- with transporteruses.causecrease Because SSRIsin response and occupyan cannot SSRI to MDMAthe be takensame in upsite people into on thethe who presynaptic5-HT have transporter taken serotonin SSRIs that occurscell. MDMA Since be- was there first, MDMA has nowhere to bind on the ingofall action,the any SSRIs psychoactive MDMA that aresimply effect.used diffuses as antidepressantsPeople away Outwho of are have the not synapse extremely under withouttreatment long everdurations for hav- depression also take fluoxetine in dosesthatitysingle with fluoxetine ofdoses neurotoxicological MDMA before can when bluntingestion it the is studies takenserotonin-damagingof MDIVIA. either using before rodentsThis practice or effectsand three monkeys is fromto based four repeated that onhours familiar- suggest afterhigh MDMA.ingestion,humans.dose) or As concurrentlyBut takingexpected, since fluoxetine the when witheffects fluoxetineMDMA, after of MDMA the it effectsis can taken have decrease of immediatelydissipated MDMA the MDMA haveby before four worn response hours (in off one afterwill in

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 36not interfere with the response to MDMALet XMDMA and may still produce the desired protectiveDextromethorphancontainIt has recently only effects. dextromethorphan been (DXM) reported that (DXM), what isinstead sold as of Ecstasy MDMA can (Baggott sometimes et aL MDMAgestsdealer2 000). both ineffect, When hopes DXM theyusers of and obtaining might discoverMDMA, be realinclined thatit is MDMA. thesepossible to tablets purchase Inthat a situationthisdo notEcstasy drug produce wherecombination from athe personanother desired in- could rhea,tionproduce is confusion, characterized what is agitation,known by muscleas incoordination,the serotonin spasms,The serotonin gastrointestinalsyndrome. shivering, syndrome This fever, problems canbehavioral and be sweating.brought and condi- diar- on by any combination of drugs hasmarilywiththat SSRTincrease combination thought properties. serotonin to beof anSSRTsThis availability NMDA means from (N-methyl-D-Aspartate) thatin different the there brain. cansources. It beseems an Although extra to beantagonist, increase especially DXM in itis likelysero- also pri- reliestonincanzyme onwhenbe that CYP2D6inhibited metabolizesMDMA for by is itsthe also MDMA metabolism, continued in the (cytochrome body. presenceif this It is enzyme P450noteworthy isozyme is not thatfunctioning, the liver both en- of MDMA. Since DXM also 2D6, or CYP2D6) ItincreaseMDMAMAO is well andthe known riskDXM of that mayserotonin the continue combination syndrome. to act in ofthe a brainMAO for inhibitor extendedInhibitors and periods an am- and pertensiveunconsciousnesslife-threateningphetamine crisis. can induce Duringlevels, and death a andthisdangerous areif hypertensive medical possible increase attention outcomes. reaction, in blood is not Since thepressure sought heart MDMA knownimmediately,will israce anas atam-hy- shouldpersonshibitor.phetamine, be takingThe noted it medical should that there neverliterature are be two taken has types reported by ofsomeone MAO severe inhibitors—those who reactions is taking to an MDMA thatMAO block in- in inhibitors since 1987, and several people have died It PDF compression, OCR, web-optimization with CVISION's PdfCompressor typicallythe antidepressant agents, such asA pheneizineform and those (Nardil), that blocktranylcypromine the B form of MAO. MAO-A inhibitors are How MDMA Works in the Brain 31 MAO-Acombination(Parnate), inhibitors, and with isocarboxazid MDMA,such as those leading (Marplan).Many found to the hallucinogen in It excessivethe is theseplants drugs increase Syrian enthusiasts that rue in are blood or dangerousare pegnalum pressure.also familiar in with natural forms of inhibitor,the(Peganum risk naturalof hypertensive harmala). or synthetic, It crisis. is important, shouldThere ever are however, alsobe taken MAO-B to with appreciate inhibitors—selegiline MDMA that because no MAO-A of (deprenyl) is the most com- MDMA.MAO-Amonlyever, known.to inhibitors be on These the whensafe drugs side, combined are it isnot advisable thoughtwith other not to havedrugsto take the or MAO-B certainsame risk foods. factors How- as inhibitors with AlthoughTheHallucinogens practice some of combiningpeople take MDMA both drugs with simultaneously, LSD is known as others "candy take flipping." them at after(eightmonseparate forthe to times.twelveLSD hasto Whenhours) be begun ingested the than todrugs MDMAtake first, are effect. sincetaken (two The ittoat has fourdifferentcandy-ifipping a hours).longer times, MDMAduration itexperience is moreis of ingested action com- has fects.lucinationseliminatingbeen described The interpersonal havethe experienceas subsided "mellowing "entactogen" hasof LSD. been out theTakingreported qualitieseffects MDMA to of bring of tripping MDMA after back LSD-inducedon hallucinatory can acid," merge without withhal- ef- sile.withdelicthe colorful There hallucinogenicbrandy." are aspects currentlyA related ofmushrooms—this LSD noexperience reports to create in is thewhat reportedinteraction medical has beenwhen literatureis knowndescribed MDMA or as in isanas thecombined "psyche-MX under- mis- predisposedbiologicalwithground LSD press orand to mushrooms. of psychologicaluntoward adverse physicaleffects Caution makeup afteror ispsychological advised,certainis different drug though, effectsand combinations. some since of combining people each person's may MDMA be

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 38ItSummary is unclear at this stage in scientific research just howLet XMDMAthe distinct psychoac- • fluoxetinetiveaction. effects Since at of the MDMA drugs transporter, thatrelate mimic tofenfluramine the the various individual pharmacologicalin releasing actions serotonin, of MDMAmechanisms amphet- (such of as effectsconcludedagonists)amines of in doMDMA thatreleasing not each produce to of emerge.dopamine, these the actions full LSDMDMA must at occurthe response 5-HT2 simultaneously by receptor themselves, forand the 5-HT1Bit uniquecan be

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 0'THEDavid CHEMISTRY OF MDMA Nichols, Ph.D. sheWhenThat replied, is I aasked somewhat "Explain Dr. Holland daunting the molecule what task, she becauseto wanted the masses. for me many to present people in who this attendedchapter, . . . Keep it elementary" leastThosetrycollege awarecourse of you or that mayuniversity, who it still instillshave have neverorganic a heardkind had of chemistryhorror the instinctive experience stories is afear aboutsubject of into a thebasic mostthat subject organicis non-chemistry best or forgotten.youchemis- are at Acidsimmuneinstillofmajors. its difficulty anda Inbasic to my suchBases understandingopinion, are attempts. greatly chemistry exaggerated. of chemistry itself Iis hope beautiful,into to those prove and formerly that legendary here thought and accounts to be even to tonbatteriesMost'AThere clothing, people is to a arestart?solutionand familiar dissolve Our of discussion sulfuricwith many these kindsacid. probably terms. Itof willmetals For should burn example, that thebegin are skin, theplacedwith eatacid acids throughinto in andmost it. Acid bases.cot- car nitrictratedair.rain acid,It is would torainfall theare sameknownhave that the strength.has as same inorganic,absorbed effectSulfuric diluted oras mineral,acid,battery sulfuric as acid wellacids, acidif as itbecause hydrochloric werevapors it they fromto be lack acidpollutedconcen- the and referredpresence to of as carbon "organic"molecules. atoms, and things There containing are, however, carbon a atomsgreat are generally 39 many organic PDF compression, OCR, web-optimization with CVISION's PdfCompressor mondilute40acids. acids (about that 3%) the solution of acetic acid. There are a PerhapsLet X=MDMA one of the most common is ordinary reader will recognize. For example, aspirin is number of othervinegar. com- Vmegar is a acetylsali- acidscylicatoms),erty—that acid,than and andmineral is, it vitamin theyis these acids, give C protons isthey off ascorbic hydrogennevertheless that acid.lead ions, toAlthough havethe or unique protons the same essential prop-these are much weakerchemistry of acids. (positively charged Figure 1. Ionization of a protozypical acid by loss of a proton H < Lines indicate chemical bonds. > therightrepresent hydrogen is shown any atomsort the ofloss organic of the protonAt the from left the of figure 1 is shown an idealized and a balancing negative charge on the oxygenmolecule atom or a group of inorganic atoms. On the acid, with a positive charge onacid, where the sphere can normallythepartners.(0) ofoxygen the one Whenacid atom. electron molecule. the It isproton is therefore contributed Each chemical one electronto the bond consists left the acid, however, it left both electrons with short ofbond being by electrically each of the neu- bonding of two electrons, and processtralinvolved,excess (and of henceof the isneutrality calledproton has a ionization.positive charge, +). The oxygen atom and henceleaving carries the acid, a negative because electric it creates charge charges (—). in the groups is one electron in This tractedincludingas we are to in MDMA,protons, their arethe organic bases.For the Bases purposes have of this discussion, we are not chemical counterparts, bases, because many drug shown in figure 1. Since acids give off really as interestedthe property in acids of being at- substances, and havearegetherbases exactly neutralized are there attracted equivalent, is an the "acid-base" to, acid weand with say interact thatreaction.the base with, orIf vicethe proportions versa. of "neutralization" has occurred. That is, we when the two are mixed to- the two species PDF compression, OCR, web-optimization with CVISION's PdfCompressor The Chemistry of MDMA 41 Morewhichdroxide relevant has (lye),the abilityto employedour interests,to chemically commonly however,There react in are witha drainthe and weaker cleaner dissolve organic marketed greases bases, andas which Drano, fats. are very strong and caustic inorganic bases, such as sodium hy- productoms.tureare ultimately where Everyoneis, in fact,a nitrogen chemically hasa weak no atom doubtsolution related (N) smelled of isto ammoniaattached ammonia. a bottle (bonded)gas Theof dissolved household gas toammonia three in ammonia. hydrogen has a struc-. That at- but the smell of ammonia gas is quite pungent. H H H chemicalH bonds. The twoFigure dots between2. Ammonia the N accepts and H alsoa proton denote to abecome completely an ammonium equivalent ion. Lines indicate H + H H neutralization reaction to becomeFigure an ammonium 2 illustrates ion, ammonia or ammonium reacting salt. with a protonbond, (from which an is acid) indicated in a this way only to show that the two electronsin one of the bonds both came from the nitrogen atom. centralthatThiselectrons arereaction nitrogen not arenormally occurs represented (N) atom.because involved Therein organic figure in is the a 2 bases strong formationas the (amines) attractionpair of of a blackhave chemical between adots pair adjacent bond. theof electronsnegative These to the fourcallychargecharacter hydrogen neutral. (+) of because these After atoms electrons theit attacheddoes neutralization notand to possessthe it asproton, reaction,well enough aswhich the the electrons positive bears central a positivechargetonitrogen make brought electronic itatom electri- has by fromderivedarethe proton,often sulfuric from given shown acid, ammonia, names as the the final ending + it iscompound called in "onium." ammonium. would Because be called Thus, this ammonium if new the protonproduct sulfate. came was If sign. Organic molecules that bear a positive charge PDF compression, OCR, web-optimization with CVISION's PdfCompressor 42acetate.the proton came from acetic acid,If onethe replacesproduct the H atoms ofLet ammonia X=IIDMA with would be calledsmall ammonium organic groups (units thatofsmell.or containamines.these In aminesfact, carbon The the as atoms),smell the fishof these fish slowly isresulting due to the low-molecular-weight amines have an ammonia-like, or decomposes. Arnines behave much like molecules areformation called organic of very bases, small amounts fishy, areammoniacallyare most usually named often in that water-soluble. afterwhite they the react amine with itself, protons followed to form by crystalline substances, which possess a bitter tasteSalts of amines with complex structures are typi- the name of the acid thatsalts. was Salts of organic bases and plexhydrochloricusedamine base,to prepare hydrochloride. such acid asthe gives amphetamine, salt. ammonium That is, whilewould chloride, the give a neutralization of ammonianeutralization with of a moresalt withcom- the name amphet- H CH3 The letter 0 represents an oxygenmethylenedioxymethamphetamine atom. Thesizes are exaggerated (MDMA) to emphasize the basic amine Figure 3. Methylenedioxyamphetamine (IVIDA) on straight lines represent chemical bonds,on the right. Relative molecular portion of the molecule. the left and and the vertexHydrogen of each angle atoms between have been the bonds omitted represents from these a structures except at nitrogen atom, for greater clarity. "Where is this going, and what has carbon atom. the answertratedit betweengot toin to dofigure that ammoniawith question.3, MDMA?"and andI hope We MDA ThethatseeBy thisasstructures nowone figure wherethe willreader a hydrogen may be wondering, atom here, on the left, the chemical of MDA and MDMA are illus- provide the beginning of an relationshipattached to PDF compression, OCR, web-optimization with CVISION's PdfCompressor atomjoinedammonia (N), however, are not substantially changed. It will still attract therings pro-. and extra chemical bonds. hasThe beenbasic replaced properties by of the the lightened nitrogen structure on the left with two The Chemistry of MDMA 43 bywheresolubleton a CH3, from the salt. hydrogena an methyl Similarly,acid, willgroup.atom MDMA,become pointing This is on"neutralized," thetoward the origin right, the ofis lower thesimplyand "meth" willright a modificationform has part beena of"metham-bitter, replaced ofMDA, water- MDAganicphetamine." and bases, the prototypicalbutIt is where still an did organicbase, all that Youammonia. base molecular may and now will stuff be behave thinking, on the quite left "Okay. comea bit likeIfrom see both that MDA and MDMA are or- ofticular,withis attachedwhich natural there have to products:are the been many N atom?"used plantsmolecules for The thatmillennia historyhavethat are characteristic as of produced herbs, organic spices, bychemistry smells living and and perfumes.things. really tastes, Inbegins many par- For Becausethatcomeexample, make from these figurea plants major plants 4 youillustratescontribution havewill recognize.characteristic the to structures the Inflavor most flavors of or cases,several aroma and these aromas,naturalof the substances natural molecules chemists product. are seek thatoils Thesechemicalkindsthe active substances of organic reactionsprinciples, then chemical that orserve "essentialchange products. as starting atoms, oils," One materials orfrom couldreplace them obtain for bonds,to amake variety the to oilnatural lead andof todifferent products.carry new or-out maycanganic be be viewed compounds.built. as a sort The of structurescaffold,The orof molecule template,the naturally safrole upon occurring which (seen new in materialfigure structures 4) thus was used for many years as a Figure 4. Molecular structures ofa few common,and naturally flavor molecules:occurring odor anethole (from anise) eugenol (from cloves) safrole (from sassafras) (cited from left to right). PDF compression, OCR, web-optimization with CVISION's PdfCompressor 44 Let XMDMA H MDA MDMA producerootflavoring bark, liver agent from tumors inwhich root in onebeer rats, makes and it was is the no majorlonger flavoravailable component for Figure 5. Safrole as the origin of MDA and MDIvIA. sassafras tea. After safrole was found to commercial fla- of sassafras wasvoring.chemicalderived a cheap Nevertheless, from and and pharmaceuticalsassafras plentiful many oil starting organic and companies safrole. molecules It made is perhapsare many still derivativesnot too surprising of material. Without trying to describe the made using materials safrole; it that Atandinintricate this a generalMDMA point, details thesense are ofreader organic the actualway should bases in chemistry which keep and two safrolereact involved, facts with evolved firmly acids figure into in to 5 formMDAwill mind. First, MDA suffice to showwater-solubleand MDMA. derivedsalts,property and, from second,called safrole, stereochemistry. the which greater comes portionThere 'While from ofis sassafraswe theone structureother root. issue of thesewith which we now need to deal. It concerns a have been drawing chemical struc- molecules is thetratesaretures three-dimensional,reader asa stereo-pairsets a ofthree-dimensional lines, view polygons, occupying of MDMA. and representation specificletters That is,on this a page, of MDMA. To achieve shapes in space. Figure 6 illus- figure can be viewed to give in fact, these molecules this PDF compression, OCR, web-optimization with CVISION's PdfCompressor The Chemistry of MDMA 45 This orientation is the same one illustrated in figure 7 asFigure the original 6. A three-dimensional, molecule rotated stereo-pairabout the representation axisnot below scaled theof to(+,)—MDMA. mirror size, soimage. as to showThe Mirroratoms the individual in this Image figure bonds are more clearly. Original Molecule aboutOriginal axis Molecule shown as Rotated dotted line molecule atleft the imagetopFigure right is a is7. mirror shown The concept image reflected of of the organicin aoriginal mirror molecules onmolecule. the left, that One soare that maymirror the rotate upper-images. the originalThe original moleculemolecule on the loweraround left. an Aimaginary comparison axis of (shown the upper as the mirror vertical image originaldotted with line) moleculethe rotatedto obtain below the it shows that the two molecules are not identical in their three-dimensional structure.

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 46areresult,the crossed, images you slowly will driftsee moreback together until Let X=MDtIAone must look at the figure while crossing your eyes. Whenthan your two eyesimages. Let your eyes relax so that there are only three images, then factdimensionalfocus that on therethe centralimage are really ofimage. the two MDMA If youOne are molecule. otherable to complicating do feature of MDMA that we types of MDMA molecules. Because chemical this, you should see a three- need to discuss is the imagesmirroratombonds with cannotimages. on fourthe easily left, Figurebonds thebreak, 7 canone shows the in thearrangement these panel mirror under of images. groups be represented in two ways, which prove to "mirror image" and the one Now compareconnected the totwo a carbon be thattheattacheddirectly paper, it projects belowwith while a it.abovedashed the They CH3 the line,are isplane not attachedmeaning the of thesame. by that paper. a dark,Init projectsthe In wedge-shapedmirrorthe image, bond, image theto below show H atom that, is how- back behind the plane of thatareattachedever, differentare the used twoto the groupsininterchangeably carbon that arethey atom are next for tomirror the N image atom is reversed. Thus, the spatial arrangement of the groups mirror images. There are two specific names organic molecules: "opticaldifferent, and the groups isomers"saltsomers, have andare the identical"enantiomers." same melting(for point,Although and they the chemicalhave properties of mirror image example, they have the same boiling point, the same water solubility molecules, or enanti- their preparesandenantiomersbeam the sameof a plane-polarizedsolution affinity will causeof for the protons),the light light through beamthey doto the rotate in salts of mirror image molecules and then shines a solution,have one it turnsunique out property. that the Iftwo one opposite directions and by Theleft,dependingthe same respectively.importance amount. on whether ofThus, Optical optical theyMDMA isomers rotateisomers exists plane-polarized are does either sometimes not as lie(+)-MDMA in or as light tocalled the right (÷) or totheir the simple chemistry or (—)-MDMA.(—) isomers, thetemshowever,example, most are madeimportantbut are in largely proteinstheir constituents interactions of that building are constructedof with mammalian living ofsystems, aminospecies, becauseacids of blocks that are optical isomers. Some of of only onewhich type. we are an all living sys- PDF compression, OCR, web-optimization with CVISION's PdfCompressor Thesedimensionaltural features framework. that are identical Indeed, inthe all proteins of them; of nearlythey have every the living same arething three- called on L-alTilflO acids (L for levo, or left), and they have core struc- The Chemistry of MDMA 47 wheremoleculesthis earth people that are only affectmade have upour exclusively biologicalright hands—notThe systems.of consequences L-amino a Imagineright acids. hand of forthis and a aremoment a profoundleft hand a world forbut the actions of drugs and other hands.takekeeponly isrightall made.Even those hands. thoughWhen hands Now thewewarm. suppose factoryknow But that startsthatsomewhere right we up, build handsit produces in a thearefactory designthe gloves mirrorto producedepartment that images fit gloves only aof mis- leftleft to imageright-handedhands, molecules, these left-handedworld. and it is glovesapt. If onedoOrganic not can fit generalize chemists the hands oftenthis of conceptthe use people this to analogy the in ideathat between hands to explain mirror tothemcanthat be appreciateall willabsolutely molecules interact the sure wellmadefact that withthat of this whenL-aminoproteins point molecules is inacids clear. the body.have Imaginehave aLet mirrorsort methat of extend images,"handedness,"there arethis only important analogy one one of receptiondruggloves.proteins that Let's in is themade call body these of mirrorthat places have image "receptors" cavities molecules shaped because that like somehowthey very receive, small resemble orleft-handed provide small a certain important messenger molecules. If we administer a onlyhandsof leftleft (meaningand hands hands small that thatandright willweright-handed hands), havefit into a it mixture theseis onlygloves receptors, ofthe moleculesfit molecules only just right thatas resembling left-handed hands.resemble The thesmall gloves mirror shape left fit placelittlelarimage receptors. rightin molecules the hands body That alwaysshapedwhere does nottherelikehave mean, small areno effectreceptors however,right athands all. shaped that Indeed,will the likenot molecules there fitright-handed into may these shaped be particu-another gloves, like differentalmostrorwhere image moleculesalways kinds molecules differentof shapedreceptors. may effects, like have left significantoccurring hands will in effects notdifferent fit. in In the systems,some body, cases governedbut both they mir- are by PDF compression, OCR, web-optimization with CVISION's PdfCompressor 48differentchemist synthesizes groups are attached,a new organic the productFinally, molecule is a with 50:50 a carbon atomLet to XMDMA one more thing to remember is that most times when an organic mixture of mirror images. which four "right"otherrotateHalf of Out,it molecules theto theand molecules right no is rotation (+).called rotate a isracemic observed.plane-polarized mixture, This or mixture lighta racemate. to of In a 50:50 mixture, these rotations exactly cancel each the left (—), half "left" and half If you have man- and half knowledgeagedproceed to stay to to awakea understandvery introductorythrough the this MDA discussiondiscussion,In andabout MDMA of1967, you how should the they molecule now known as 3,4-methylenedioxyamphetamine molecules well enough to interact with the body. have the basic containsness,"love(MDA) ofdrug," gainedloving a 5 because andpopularity of it seemedbeing as ato recreational produce in users substance. a 0:50 mixture of mirror image molecules. 'While loved. MDA is a racemic mixture and therefore feeling of emotional close- It was known as the mirror image waysmoleculesbothinactive. the mirror case interactIt was image that discovered differentlyonly molecules one about with of MDA ten certain years have receptors ago that in mirror image molecule is active and the other different effects that contribute to MDA is an example where the body, it is not al- believedthatpolarizedthe effectresemble to light of be racemic those dueto the to of activationleft, MDA.LSD (—)--MDA, and The of other a enantiomer type classicalwas of foundbrain of serotoninto have receptor hallucinogens. That action isMDA that rotates plane- long-lasting effects called the plane-polarizedstimulant.tion5-HT2A of action receptor. Its actions lightand Onnotto seem the theto right,have otherto be much relatedhand, of to an its ability to the enantiomer of MDA that rotates LSD-likewas found effect. to be shorter It is more in of a be taken up into brain dura- nmneuronsthatof both occurs that these releaseis notneurotransmitters. yet the completely brain clear. The mechanismandBut dopaminethe neurons of andaction have somehow to cause the neurons to chemicals, or neurotransmitters, called seroto- spill out their stores specializedthrough pro- which MDAthethoughtteins process called that whereby"reuptake the ability the pumps," to neuron be pumped and begins it is into tocurrently release the neuron believedits stored is an importantare carried part into the neurons by this uptake pump. Furthermore, it is that drugs neurotransrnitter.like (+)- of PDF compression, OCR, web-optimization with CVISION's PdfCompressor usualmethylenedioxymethamphetamine, and unique effects on theAbout human or psyche. MDMA, A andcomparison found that of MDAit had andun- ten years later, someone decided to prepare and sample some 3,4- The Chemistry of MDIIA 49 whennotthylMDMA profoundly group, compared is shown which change with inis figureattached MDA. the chemical 3. It Theto does the only propertiesnitrogenhave difference consequences atom. or the is This basethe presenceinmethyl strength terms group of ofofMDMA the does bio-me- sues.brainmakeslogical Inis theeffects, madegeneral, molecule largely however. drugs moreof that lipids, First, lipidhave MDMAadding (fat)greater soluble. a has solubilitymethyl a greater This group in means lipidssolubility to the thatand nitrogen inbecausean brainaction atom tis-the in inuctsBasedthe fact brain its onlywhat effects also onis haveobserved.fasterthis observation,a thanfaster MDA onset onebut of havecouldaction a predict shorterbut a shorter thataction MDMA durationthan MDA. should of action.This prod- is is tonineffect:confounded 5-HT2A it makes somewhat receptor the molecule bythat the is too responsiblefact Thelarge that different to the fit for N-CR3 comfortably LSD-liketimes has to onseta actions. secondinto and the Thatimportantdurationbrain recep- sero- of action for MDA and MDMA dopamine,reuptakeLSD-liketor is only pump effects.minimallyhowever. to transportThe It activated isN-methyl nearly MDMA by as groupMDMApotent into neuronsdoes as hence MDA not thatMDMA affectin thatutilize theregard. lacks serotoninability significant Recalling of andthe dopamine(+)-MDMAstimulantthat (—)-MDA effect, and retains serotonin.has we effectscan the see ability Remember, resembling that (—)-MDMAto cause LSDtoo, neurons thatbut lacks thatthese to LSD-like (+)-MDA releasedrugs, aseffectstheir has used more stores but on ofthatthe of a tionsmansMDAstreet, ofare ishave (—)-MDAan the equal equal result mixture mixtures andof the the of two neurotransmitter-releasingof(-i-)-MDA theirdifferent mirror and actions (—)-MDA,image of molecules. MDA, actionsand thethe That ofLSD-likeeffects (+)-MDA. is, instreet hu-ac- MDMAbywhereLikewise, the theN-CR3 streetLSD-like group,MDMA effects but is an ofthe equal (—)-MDMA neurotransmitter-releasing mixture ofessentially (+)-MDMA have and beeneffects (—)-MDMA, destroyed of (+)- are still intact. PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDA,tions,50 the due resulting to the (—)-MDA. effect is long It also Basedlasting has the and neurotransmitter-releasing has elements of LSD-likeLet XMDEIA ac- on this discussion, we can conclude that if one ingests a dose of effects muchshouldenhancementthat make less be intensefasterone that feel in isor onset characteristic stimulatedcompletely and shorter andabsent, ofMDA. probably acting; due By to the contrast,leadthe LSD-like inactivity to the the uniqueeffects of (—)-MDMA; ofemotional MDMA should be neurotransmitterwhileduces(—)-MDMA the effects stimulant has that should almost effectare nearly remain. noand effect the identical What mood-enhancing at ordinary that to racemicmeans doses, in effectsMDMA, whereaspractical due (+)-MDMAbut termsto atrelease only is one-pro- that of pureducedashalf potent of(÷)-MDMA. MDMA the as dose racemic mostly required MDMA, resembles for the racemate. the experience That is,one (÷)-MDMA would obtain is aboutif one twice and the effect of ordinary clandestinely pro- took storedsomekeys after way neuro administrationto transmitters,the ability of ofdopamine these MDAAnd orwhat and MDMA? serotonin.about theThis As"neurotoxicity" toxic we mighteffect predictis relatedthat is reported in rodents and mon- molecules to cause neurons to release their from in MDMAnals.isthe these preceding [See that (+)-isomers "Doesaffect discussion, the MDMA that uptake are becauseCause alsopump more Brainand it is"toxic" cause theDamage?" (÷)-isomersrelease to the neuron offor neurotransmitter, more of axons both details MDA it and termi- about and MDMAastimes a controlled brought neurotoxicity.] up—thesubstance fact was that theIt mayoriginal be germaneemergency at schedulingthis point to discuss one other point that is some- based on data that had been collected for MDA. ofMDMA ti-oiledthepresenceLooking scheduling, Substances againof the at CH3MDA figure Act unit andhad 3, attached wewasfor see someclassified thatto years the as two beena hallucinogen. molecules in Schedule differ Reports I ofonly the by in usersCon-• the the N atom of MDMA. At the time of neurotoxicitymilderofof MDMA MDMA effects suggested argueddataand aproduced shorter thatthat MDAMDMA duration by studieswas was veryof a actionof rather differentMDA thanbenign could fromMDA. substance, not MDMA Thus,be applied proponentswith and thatto the much the PDF compression, OCR, web-optimization with CVISION's PdfCompressor effects of MDMA to justify scheduling MDMA. From a chemical and phar- The Chemistry of tIDMA 51 haveamineWhilemacological generally itproduces is true standpoint, similar that subtle adding pharmacologic changes however, an N-CH3 in the those characteristics. effectsto amphetamine arguments on humans, are to difficult givethe two methamphet- tostructures defend. markedlyareMDA possessed to N-CH3-MDA, change by the ability or MDMA, ofAs the we substancesabolishes have seen the fromto hallucinogenic cause the earlierthe release discussion, effects of neu- that a similar transformation from the (.-.)-isomer within racemic MDA. It does not, however, reportedreleasingwillrotransmitters discover serotoninproperties from from reading neurotoxicity.brain of MDMA neurons, other arechapters Therefore,which at the is inheart duethis we toofbook, can theirits seeability the (+)-isomers. that neurotransmitter- to an produce extrapola- As youthe lecularwouldtems,tion from occur structurebut in the with other toxiccause MDMA cases, effects dramatic like was of this justified. changesMDA one, toa changeinSometimes a theirprediction mayactions smallbe that largelyon changes thebiological sameinconsequen- in effects sys-mo- theandtial structural inamphetamine. terms elements of a particular Now of MDMA, that property. theIt hasitreader may often behas been useful some said tofacility considerthat MDMA in understandingwhat is such a sort a of hybrid between mescaline theillustratesstatementthat middle, is seen themeans. and instructures methamphetamine.mescaline, Clearly, of (+)-methamphetamineMDMA on the right.This has thesimilarity same backbone,onis evident the left, in or (+)-MDMA figure framework, 8, which in I CH3 o I CH3 their stored transmitters. It is quite(÷)-Methamphetamine potent compared with is MDMA,also a molecule having athatFigure causes neurons to release 8. (+)-Methamphetamine on the left, (+)-MDMA in middle, and mescaline on the right. PDF compression, OCR, web-optimization with CVISION's PdfCompressor rangetypical52 from perhaps 75 Let X=MDNAtherapeutic dose of 5—10 mg, given orally. Typical doses of mg to more than 150mg. Methamphetamine is a stimu- MDMA neurotransmitterislant creasedgenerally of the appetite, central believed dopamine nervous and that a sense its system fromeffects of well-beingdopamine-containing and are produces mostly or dueeven increased to euphoria its neuronsability motor at tohigher in activity, releasede- thethe brain. doses. It Thisonebeingand is mightcocaine. a and property euphoriaview It is MDMAthat widely produce it shares inbelieved aelevated with otherthat levels drugs stimulants, of thatbrain produce dopaniine. such as In similar way. It also has the ability to cause the feelings of well- amphetamine that sense, towell-beingrelease itsdo actionsso of than dopamine and on methamphetamine. euphoria, dopamine from oneneurons, systems. might although imagine itthat is muchthose lesseffects potent also in are Because MDMA can produce feelings of its ability related isters alllittle from effects appreciation their of neurons,that substance of the including importance on Methamphetaminehumans. of MDMAeither of alsothese can possesses actionsbring about to the release of other neurotransmit- both norepinephrine and serotonin. There the ability to the over- releasetantrecognitionsystems to both the are overall norepinephrine lessat present potent effect. thatthan On this theand aspect serotonin. of its Its mechanism effects on of action the other hand, the ability ofeffects MDMA of tomethamphetamine, induce and there is no norepinephrine is impor- ofmethamphetamine.thegators much release haveof ofthe lookedthe research stored This so intensely intoneurotransmitterfeature the of pharmacologyat the action serotonin of of MDMA MDMA. is has been the the serotonin-releasing actions of MDMA enhanced over that of Indeed, investi- focus thatcontainably they plays have a phenyl in largely its actions. ring ignored (a ring the of importantcarbons)What is thetwo role relationship carbons that away between MDMA and mescaline? Both doparnine release prob- from the amino molecules tures,bothgroup,opinion contain there so theyis isthat oxygen notare the bothmuch comparison atoms else attached the betweentwo to the MDMA phenyl and rings. mescaline Beyond is not a phenethylamines (as is methamphetamine). And they molecules have in common. My own those fea- good

PDF compression, OCR, web-optimization with CVISION's PdfCompressor onone. the ring. 'While it is true that these oxygen atomsMDMA are largely is really responsible just a methamphetamine structure with oxygen atoms The Chemistry of MDMA 53 havethenofor evidence themescaline in ability the MDMA that of ring MDMAmescaline do structure. not to have inducehas the the the same same release effect. biological of Thus,neuronal consequences the serotonin,oxygen atoms thereas they on is nent,chemistry,chemical safrole, properties it are also of should concern of MDMA. be toapparent drug AlthoughIt is enforcement hopedwhy wesassafras that have theauthorities. not oil, reader discussed or its now majorIn the addition,has compo-detailed a general appreciation of the basic action.publishedmescalinethe comparisons This discussions should chapter help between is concerning byprovide no MDMA, means a howframework intended amphetamine,molecular for to structurebeappreciating comprehensive. methamphetamine, affects some biological ofMany the and videsimilarsignificantpeople rudimentary substancesare knowledgeinterested knowledge can in beof MDMA, based.organic upon whichchemistry. from afurther variety What understanding of I haveperspectives, tried ofto thesedo and is lackpro-or

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JulieMDMARUMORS Holland, MYTHS DISPELLEDM.D. AND ongoingEcstasytionThe onlycalled Drains researchway a lumbar toYour remove required Spinalpuncture, spinal Fluidspinal betterfluid taps fromknown on Ecstasy the as body a spinalusers. is with tap.It isa Insurgicalpossible the interven- mid-1980s, that fluid,rumorEcstasy but began Causes recreational because Parkinson ofEcstasy this Disease practice. use does not. MDMA research may drain your spinal known,Parkinson'sknownfluidly but asand diseaseitsthe causes effects substantia is a aare tremorneurological damagednigra. when MDMA dopamine illnessa person does that neurons isnot affects sitting damage inone's still. a partdopamine ability Its of cause the to neuronsmove is un- brain phenyl-heroinInin any1983, part called1,2, intravenous of 5,6-tetrahydropyridine) the China brain, drugWhite, and users, Ecstasy inadvertently believing intouse doestheir they injected notveins. were cause MPTPpurchasing Parkinson's (1-methyl-4- a formdisease. of tootionpropionpiperidine). lowto produce or the temperature MPPP. Specific In the is conditions eventtooDesigner high, of incorrect area meperidine contaminant, required synthesis, for(Demerol) MPTP,the where chemical is the sold reac- as MPPP (1-methyl-4-phenyl-4- formed. pH is withMPTP a severedamages Parkinson's-like dopamine neurons. syndrome. These Because intravenous MPTP drug and users Ecstasy were were 54 left PDF compression, OCR, web-optimization with CVISION's PdfCompressor gramspopular ran shows on so-called designer drugs that in the media at the same time (the summer of 1985), tIDMA Myths and Rumors featured videos of the im- many TV pro- 55 A riesmobilizedSingle became Dose MPTP of forever Ecstasy victims linked as in well the asminds segments of many about Americans. Ecstasy. These two sto- Causes Irreversible Brain Damage iescausesNoLike concerningevidence all any potent damage exists brainmedicines, that todamage the a single nervousMDMA involved therapeutic system. has repeated a recommended The dose high-dose widely of MDMA doseinjections, (roughlyand a giventoxic 125 dose.twice mg) publicized animal stud- studiesatratherdaily lower forthe show temperatures fourtail, that ordays. axon single The terminals, has oral changes been doses, ofshown reported the2.5 nerves. mg/kgto minimizedo Givingbodynot involve weight, these MDMA the given tocell test every body animals twobut changes. Animal muchweekssomebrain largeron structure.axonal four than occasionsdamage Onethe therapeutic study in to baboons. squirrel that used dose Themonkeys a used singleequivalent for yielded oral psychotherapy. dosedose no ofinadverse 5 mg/kg effects did causeon humans would be MDMAwas filed Waswaswhen by InitiallycreatedMerck the company inMarketed 1912a laboratory tried and as angrantedto Appetiteinsynthesize the inearly Suppressant1914. hydrastinin,1 900s; Merck a patent stumbled a vasoconstric- application across suppressantproducts.thistive synthesis.and No styptic (Beck mention The medicine. 1997). entireis made No synthesisMDMA clinical in the patentwastrials was merely were patented,of using performed an unplannedMDMA including at asthat by-product intermediaryan time, appetite and of confusionlittleMDMAented need by was forisSmith neverclear: an appetiteKline marketed.MDA, French suppressant the Also, analogand tested it isandin reasonable thein metabolite 1958 early on 1900s. to 180 assumeof human MDMA,The thatsource subjects therewas of pat- was theas an WhileEcstasytweenanorectic. MDMAIs lovers, an AphrodisiacThe can itsmedicine physical enhance was effects communication abandoned tend to due make and to its erectionsfeelings psychoactive of and closeness orgasm side effects. morebe- PDF compression, OCR, web-optimization with CVISION's PdfCompressor 56 Let XMDMA ness.hanceanddifficult This has their earnedmay appreciation be the one nickname reason of whytouch the Ecstasy"hug and drug." movement, use is so called kinesthetic aware- to achieve in most users. Some users do find that MDMA can en- popular in dance clubs Ecsta3yisThe drugs,one American that Is perhaps a rendersDate media Rapeto theinstill Drughas drug feara habit taker in theof unconscious labelingminds of most news and new watchers. therefore drugs Aas vulnerable date"date rape rape" drugto hancesingmayattack. of feel consciousness; Althoughattention a novel closeness andsome concentration. it peopleis tonot another a may sedative. person,loseThere theirIn is therapeutic typically inhibitions full doses, with retention MDMAMDMA of en- theor MDMA does not cause a cloud- control,BecauseeventsThere Is experienced Herointablets MDMA in sold Ecsta3y is under asillegal Ecstasy the and influence vary there tremendously is of no MDMA. government-regulated in content. Many quality street Pills itofsample (methylenedioxyethylamphetamine iswhich common analyses are often for somehave available beenpills on toperformed theContain Internet [Eve, methamphetamineby [seea harm chemical www.DanceSafe.org]. reduction cousin (speed) groups, to MDMAJ), or results WhileMDE the impuritiesinEcstasyor theirdecongestants. pills,pill. more It nor wouldoften would No are not survey thecaffeine, be effectscost-effective has everdextrornethorphan of heroin for mimicpill manufacturers the (cough effects suppressant), of to MDMA use heroin as yielded heroin as an adulterant in an EcstasycloselyofMTV polydrug Putsran as aHolesthe story abuse. other in of Your additives.aDuring woman Brain the with program, manic-depressive they showed illness a three-dimensional who had a history werewhichimageflow shown is ofwere aher measurement displayedSPECTas brain scan tissue. as of blank(single blood This spaces, flowpositron method in while the emission of brain. displayingthe areasThe computed areas of SPECT normal of tomography), lower blood blood flow results is PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMA does not destroy large areas of brain tissue. It does not cause neu- because the areas of low flow look like patches of missing tissue. MDMA Myths and Rumors Dispelled 57 Review"not0fMDMAronal shown cell for death. doto more causebe Charles permanent detail]. decreased Grob [see hasbrain shown, blood via flow SPECT in certain scans, areas, that singlebut this doses was "Clinical MDMA Research: A Worldwide ThereEcstasyofthe this brain is Turns simplyrumor. under Your no any Brainscientific circumstance. into Cartilagebasis for I havethis rumor. been unable Cartilage to discover does not thegrow source in

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 0AnTHEand SashaOODPARENTS Shulgin OF MDMA Interview with Ann JH:Julie Holland, What do you two think about MDMA as a medicine, versus its use as Ecstasy in M.D. theagent.aboutAS: rave It theshouldIt culture? didn't subject, be become pretty that MDMAwella street known drugwas by firstuntil now, discoveredsometime by anyone after as whoa itpsychotherapeutic had knows been anything used in self,fensemosttherapy. your people,against It dark is feelings anis side. thatinsight Itit of takesallows drug.self-rejection away That'sinsight the its and withoutfeelings main guilt. use. fear. ofYou self-hatredThe Therecan effect explore isn't andof theyourMDMA, condemna- usual shadow de-for topatientspsychotherapytion, try which to justdo soare to without looktakethe biggest soat what'sverynegative obstacles long. there, judgment It attakes to what insight. a and longthey're blame.That's time doing for whatFor theto reasons themselves,makes therapist ordinarywe todon't and get understand,thescene.SS: caseThere's It ofseems therapy, MDMAanother that MDMA it'sallowsaspect a matter peoplethat allows tiesof to accepting most thisdo this, togetherpeople typically yourself to a acceptlittle inand one bit othertherefore withsession. people. the being rave In Youable tocan speak explain to a where therapist you with are and a fair why amount you're of there, honesty and, and of course,less reserve. that's 58 PDF compression, OCR, web-optimization with CVISION's PdfCompressor reasonsacceptthe themselves. the drug is so There successful is also at the raves. acceptancewhole art of therapy, to get people to acknowledge that and be able to The Godparents of MDMA: An Interview with Ann and Sasha Shulgin There is no paranoia about revealing of others—that is one of the 59 AS:openanything As yourself Sasha about says,up yourself. to there Youis complete do it openly recall; and there honestly is no amnesia and with for recall. the event. You yourself and to others. feelingprocesses.sciousAlso, there fearthat With youthatis never don'tmosta lot any haveofpeople psychedelics, loss any haveof control, control, in taking and which that any is isdrug never probably that present affects the with main the MDMA. mentaluncon- especially at high doses, there can be a "bookkeeping"theyof the can't negative communicate mode.patterns "You that openly did theyMDM1A this anymore. might first, is setand also They'veup I only greatbetween did forgotten thatmarital themselves becauseinto therapy. what youso I thatIt calldid enables two people to step out andeachfirstso and lover,time other. so." in which That They'rea very drops may long able haveaway, time, to becomesee and recapture each a lost. other theirI've not seenoriginal as thatan enemy empathyhappen but very and as often.alove friend for couple who is having trouble can, for the abusecanof post-traumatic be in an childhood aid in the stress orcontext postwar disorder. of alltrauma. Onesorts This of ofMDMA isthe traumas, where most is itimportantthe really perfect should potential agent be for used. uses open- Itfor MDMA is in the treatment whether sexual or physical JH:geting Ann, ridup youtheseof a peiformed lot areas of the and MDIVL4symptoms really being -assisted of havingable p3ychotherapy, to lookrepressed at them, thedidn assimilatememory 'tyou? them, and for so long. memorieshalfthreeAS: Ia years, performeddozen of and couples.early I MDMA-assisted probably sexual About abuse.worked five Interestingly,ofpsychotherapy with these about people fifteen four ashad a of individuals laycompletely them therapist had and gone repressedfor maybe about into Theymemories.sciouslycareers had whereno to memorybecome they therapists.wereof their helping own MDMA abuse, children isbut superb they hadfor uncoveringbeen driven repressed uncon- who had been sexually abused. PDF compression, OCR, web-optimization with CVISION's PdfCompressor 60 Let X=MDMA JH:AS:justeach Oh, like other. I do.to spend IPeople think an thatwho evening it's have a lovely,together, no problems gentle just beingway inDo their for eitherloving people relationship ofyou toward to think connect each butthere other. wouldwith is any It use forMDMA outside psychotherapy? toagreeshouldSS: have There that bea sexual MDIVIAemphasizedis an incredible response, is not that a magic butsexualninety-nine it opens fordrug. the upItpercent first is the almost few ability of times theimpossible to people youfeel uselove. I'vefor MDMA, mostmet would and people AS:oftemptationthat I'vedrug magic been that tosometimes warningcannot go to bea peoplelarger usedis lost. frequently.dosethat People ifto they're try try to to recapturegoing recover to usethat it; thissometimes magic. material, It':s there's the first, kind a you'remost,tothey use shouldgoing but it more not tobe all,lose careful,than people. the four magic.because timesSome It ita people seems isyear. illegal. Iftocan you beSecond, go a useapretty year itI wouldmore permanentwithout oftenadvise taking thanloss them it forthat, andnot therapy.overusedthen come Many it, back it is people andvery revive difficult need that only to feeling. The getone back moreor Buttwo to you forthatsessions. usemost original it, people, Itthe isn't state. less somethingonce effective they have ityou is. That's why it is best used in MDMAwouldsacredOur takeparticular togetherjourney. every timewouldgroup you alwaysof go people to dothe awho therapist. blessing occasionally Andbeforehand. it isn't took something It's psychedelics considered casual. a or JH: Whatadulthood.tableSS: My formdo feelingyou of It's thinkbehavior abouta way about the ofof the ravebecomingpeople current culture who rave an areis independent thatculture? coming it is a into representation person—notadolescence of andhaving an younginevi- to onedon'tthatanswer overage care to group authority,for the of older fifteen to parents,generation. to twenty-five and As establishing the years, old saying youoneself are goes, asimmortal, an"Don't individual. trust and any-you In And I don't think it is unique to the rave community; it is PDF compression, OCR, web-optimization with CVISION's PdfCompressor humanspecific beings has experienced that same to that stage of development. Everyone through The Godparents of MDMA: An Interview with Ann and Sasha Shulgin rebellion against authority. It hap- the entire history of 6 I AS:usemightpened I thinkof betoMDMA jazzexpressSasha's music at absolutely itselfraves. at Goldenin this right, generationGate but Park I have [inas another raveSan Francisco]. culture, point tobut in Most raves, but not all, are held in or near large add about the another, it Thisallpeoplecities. know becomes In learn mostnot to to largemagnified be meet very cities the cautious ineyes athe place of Unitedand a strangerlike careful States New whenwhen andYork. inthey're we're We are outout cautious inin public. to Wethe other countries, young the streets. justfeelingswhetherpoint on theof ofnearit's edge. suspicion of paranoia. the The potential onlyand We caution time learn pickpocket these toand be distrustyoung extremely or of peopleis someone when careful can they whose and go alertto sanity a rave, and may aware,where be totally relax these theythey'vewavelength.you don'tfeel never that have People they met to canbebefore. can worried be touch trusting. Whether and hold this hands is wise and isbe not affectionate the important with peoplepoint; about strangers. Everybody is on the same tries,whenattention.SS: There soccerthere Whether iswere primarily. another sports it aspectstillIn contests the occurs, earlyof MDMAbetween days, I don't these Englanduse know. thatyoung Yearshasand sports neverother ago enthusiasts European receivedit did happen, coun-wouldmuch thetoertyend move entire updamage drinking toward flavor and intoxication ofalcoholinjuries. the post-game and And not getting then, with celebration. afteralcohol into manyfights, but This years, and phenomenon there would was be prop-writ- with MDMA. This changed there was a tendency JH: Iroomsten don't up werebyknow Nicholas possibly anSaunders evolutionary [1993]. tool in familiar with Terence McKenna's theory of how mush- early man [1975], but I'm wondering andwhetherteractionsSS: interpersonal MDMA between isn't interactions. some people sort is of an evolutionaryI thinkextremelyIt the blending tool healthy in modern evolutionaryand integrationman.certainly ofhas in- made people adopt a different attitude toward other people adaptation. PDF compression, OCR, web-optimization with CVISION's PdfCompressor Instead62 Let XMDMA of being defensive and protecting yourself, be cautious, but not nec- Thatmaychallenging.essarily bewas emulating somethingby putting I think the sharedit'sup use aan ofbarrier excellent bymarijuana people, that direction could over and theitbe inwas interpreted pastwhich shared couple to go. rather asof In beinggenerations. some than angry ways, used or it peopleJH: Thecompetitively. around other thething world. MDMAI think it's may mirroring be playing is the that Internet, role now. the interconnectivity of beenThedropped—notSS: Internet seen I hadn't before. is achievingthought physical MDMA of a orthat,unificationcan territorial do but this it's throughtoo. barriersa very communicationnice but parallel.communication The that barriershas barriers. never are thingAS:SS:can That'sOf inbe course,the misused the world. nature critics by ofpeople are humans. going who There's toare point damaged a out small that or percentage dangerous,MDMA and of but these the so Internet canpeople any- somethingThere'sAS:everywhere. In otherno thatsingle words, we thing have nothing thatalmost can is entirely filla cure that lostfor role. allin But thisthe themodernproblems idea world—atof ofcoimectivity humankind. least in is generation,hasandthe West.helpedpeople Thereand arethough isvery ispart a youngisolated, completeof the people answer. especially lack are MDMAof not the in the bigextended is only cities.also onesan familyI answerthink using thatliving for MDMA. thethe together, Internetyounger JH:withSS: Is thereMy MDMA? general anything response that you toregret that thatis that has Ihappened very seriously in the pastregret twenty the overallyears integrityismedicalapproach use and or of toabuse,a this spiritualdrug country thatuse issue. whichand and drugThe ouris legalbifurcationabuse constitution. and as illegal,a ofcriminal this is entire a issue,great area disserviceas into opposed that whichto to the a PDF compression, OCR, web-optimization with CVISION's PdfCompressor AS: There's another point, which also applies to other countries The Godparents of MDMA: An Interview with Ann and Sasha ShuJgin where the 63 authoritiesothercertainbecause countries music theyare desperate wasn'thave with total allowed authoritarian to hold because on to power and to distrust of their citizens. In the old Soviet Union dictatorships haveof thetried message to repress it conveyed. reli- China and control the population, fortheiremotions.gious the perceptions, freedom dictatorship. The and authorities and prevent I thinktheir expressionindividual it'stry the to maintainsame of emotions, expression of variousimpulse opinions here or eventhat makes the govern- control over people's thinking, which may not be healthy JH: Drugsingment and criminalizeare perceptions subversive. certain and They feelings make those of the in power kind of drugs. They're trying to control the think- people over whom they wield power. nervous. theythatnotSS: wishAlso, fromstand tohappening,those and do, how inbecause power they partly theythink.see out changing of their consciousness own fear and as will lose control. Therefore, they tend to bar inability to alter where something they do SS:AS:able It'sIn to othermore seize words,than and that,confiscate it's though.a projection things By havingand of theirarrest this fear people degree of and put their own unconscious. of control, by being people you don't leledandoverwhelminglike powerinto example prison, and ofdrivemoney you're a mechanism of as anybodygaining you can. for power, who Thedoing is war money,in just authority—toon that. drugs and is get as much control. And that is providingthe an unparal- control JH:AS: Whatthough,the I'm past isa yourmediaseveral just opinionwithin freak. years? Iaboutthe watch beginning the a waylot of the ofnews mediathis programs. century. has been The handling There has been a change, establishment media, MDIVIA over payingtheCloud'sdrug" non-cable moreEcstasy—they Time attentionshows, magazine wore never to coverboth themselves called sidesstory itMDMA— of(2000) Out the with issue. came anddocumentaries out the with rave a scene. on All of a sudden we were different article, ThenJohn"the killer

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 64getting Let XMDMA calls from the networks wanting to pursue the idea of MDMA in wisdom,someciallytherapy. horrifictook but They perhapsa stab stupiditiesweren't with because doing a insegment that it wouldout program. onof the48help Hours, goodnessAt boost least even theirthey of theirthough ratings.kept heartsthe they CBSSue or included Stevens espe-greater unthinkablewasdrugssection really in intact, thewell five main done.showingyears media Andago. an inthisI MDMA-assistedhaven't 2001. trend seen is absolutely any positivepsychotherapy new; mention it would session, of thehave war and been on that membersandences,SS: Onother in ofthe his theSouth othercountry press American hand, fromand inthe the Mexico, countries PresidentUnited at States which repealof Uruguay were he their recommended present drug gave atlaws. two that that press Evenspeech, his confer-thoughcountry no istheAS: onemaking important The in thisimportant the country thing rounds tothing ran Sashaon thetothe me is story.Internet. that is that no oneheAnd said reported that it andtakes it! he Buta intendslot the of reportcourage, to do at it, least be-but JH: Wedrugs.cause gave mosta billion of thesedollars countries to Colombia—they have become better dependent look as on American money. they're tough on orAS:SS: the SenatorRight. Democrats. And Dianne in our Feinstein, country, Iwho don't is know a Democrat who is worse,from California, the Republicans intro- moreducedpublishingAS: Feinstein severe a horrible information penalties. also methamphetamine attempted on drugs. to put bill, into which two different multiplies bills everything a penalty into for JH: ThatwithstruckAS: theThankinformation down. book?" heaven People ban weresomebody drove e-maiing me crazywith me senseandand madesaying, took me "Arethat very portionyou nervous still outgoing until of tothe it go was bill. ahead PDF compression, OCR, web-optimization with CVISION's PdfCompressor SS: And yet every even-numbered year, people have to The Godparents of MDMA: An Interview with Ann and Sasha Shulgin be elected to Con- the same 65 ful,thingsgress because in it. Onethe Black of these Caucus has Having gone to theand Shadow every Convention even-numbered in Los year Angeles, another I am bill very comes up with days it's going to pass. become more aware all of a sudden that hope- Johnconvention,men.the Conyers majority from includingof Michigan.people Congressmenin jailI don't on know Charles that they're Range!There from were New many people speaking out against the war on drugs at that nonviolent drug offenses are young black going to continue to York and whereSS:disenfranchised.go along You MDMA asked me stands how now?I feel aboutNo, I theam past quite twenty sad. Hereyears. is a with higher penalties if an entire generation of black men are being Am I happy about compound, an agent.certaingivingincredibly And pleasurepsychological safeyet, compound forto thepolitical problems.user when andand ofself-serving usedIt being is thusappropriately, of both medical reasons, an affirmative valuethat has to thosethe the authorities have de- and a curative potential of who have informationmonizedthussome effectively hand it and about in uncoveringmade unavailable its virtuesit a felony its toto bethose to made possess who available. could and benefituse. I am In fromeffect,proud it. to theyA good value, but I am sad to see it become illegal and have had forbid anal- thebecauseogyis police the he total state. happened ignorance It was to unavailable be shown a Jew by and toan histhose entire music who generation was might politically have of German music in Nazi Germany in the mid-thirties to early forties enjoyed it. forbidden by youth to JH: WhatmedicalSS: My are hopeandyour personal hopesis that for it arena—that bethe relocatedfuture regarding it frombe removed aMDIVIA? legal fromand criminal legal arena to control and be the That'sthere'sAS:placed I think whatain push personal thatwe for hopeMDMA marijuana control. will should happen. to be be made made available available as for a prescriptionpsychotherapy, medicine. just as PDF compression, OCR, web-optimization with CVISION's PdfCompressor PDF compression, OCR, web-optimization with CVISION's PdfCompressor PDF compression, OCR, web-optimization with CVISION's PdfCompressor

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MDMA. reminding Offering First, themsimple Therethere to advice is "justare no several guaranteesay to people no" areas is that whonot. of when concernare using someone when Ecstasy buysit comes to minimizing the risks thethattestinga tabletchapter either at ravesof are "Minimizing so-called more and otherdangerous Ecstasy Riskvenues atin than a canthe club MDMADancelessen or elsewhere theCommunity," or riskmix ofitbadly is,ingesting in Emanuelwith fact, MDMA. adulterantsMDMA. Sferios InPill aheadfrequentlypillsdescribes for from their are athis groupcontents.frightened group. called ByThis by DanceSafe, disseminatingthe is clearlyidea that whicha theircontroversial information setschildren up tables are subject,about being at howraves andgiven to parentsand mini- a go-tests notgroupmize better the probably injury when associated hasit comes saved to withcountless MDMA. EcstasyThe lives. secondLike use, any especially crucial potent message medicine,in the rave to beor setting, anypassed illicit this along concerns dosage. More is sameanecdotalsidedrug, effects maimer.there evidence isof a ThereMDMA dose suggests thatis someoccur, is safer evidencethat to aand the greater onedesired to supportthat extent, effectsis more what at higher do dangerous.can not be doses, increase called Alland "cumu- inof most thethe thelative less tolerance" they feel to the MDMA. euphoria This they means are looking that the for longer and thepeople more take they MDMA, notice 68 PDF compression, OCR, web-optimization with CVISION's PdfCompressor stillunwantedenon try alsoto chase the elusive high they experienced early on with MDMA, and has beenside referred effects, to such as "loss as jitteriness of magic." and Unfortunately, jaw tightening. some This people phenom- Introduction 69 ordosesandthey twice possible take of in MDMA. more a memory of Whenthe changesdrug. used The inall smallrisks have of doses,been depression, linked infrequently to ingesting (often hundreds only once of lifetime) in a therapeutic setting, reports of adverse effects have neurological damage, integratedsage,been minimal. hang into up everyAsthe Brucephone." day Eisnerof ourTheTaking lives,said in multiplewithout the 1980s, thetablets drug. "When of Ecstasy you get at onethe mes-time and dancing for hours with- lessons learned from MDMA need to be neydosesevatedout failure, rest of body or MDMA and fluids temperature even hasare death. takenbeen thatThe associatedin canlatestan overheatedlead animal withto seizures, reports environment, muscle of breakdown, hyperthermia kid- is research shows that when high hyperthermia, an el- possiblelostmorebe by learnedlikely drinking to drinkto is occur to about toostay than much cool,a literwhen water,take of the water breaks animalshowever, or from isotonic are and dancing,kept there sports cool. hasand drink been replace an at hour. least any fluidsItone is The third lesson to largeplex.reported Mostdoses, death data usually duehave to beentwice overhydration. gathered a dayThe for from debatefour studies days. surrounding inWhile which therapeutic the animals neurotoxicity were doses given associatedof with MDMA is com- thosesomeMDMA dosespeople never given whose have to recreationalbeenlaboratory shown animals. In useto the cause is practiceexcessive neurotoxicity, of to medicine, the point there whenthat are it probablydoctors offer a particular treatment to mirrors section,Ia havepatient,of the chosen medicationbecause they typicallyto Iplace want in question performtheit clearly risk are asection understoodrisk/benefit balanced of this against thatanalysis. book there the ahead The areexpected potentialindeed of the advantages. inherentbenefits pitfalls MDMArisks within MDMAhas too its high own use, a doseset as ofwith of therapeutic lithium anyLook other or tooinguidelines. potent any many medical medication.sessions textbook of radiation Just of as pharmacology there therapy, are and you will see that each PDF compression, OCR, web-optimization with CVISION's PdfCompressor 70medicine Risks of MDMA Use has certain indications for its use and certain contraindications, tionchologicaltheresituations of potential repressed inissues which medical to traumatic consider its use complications is asmemories, proscribed. well. Because fromit isSo possible MDMAit is for allows thatMDMA.use butthe for releasethere Notthe explora—areonly of psy.- thisare somepeople,psychological people especially become material in clubs,less can inhibited, trigger findAlso Ecstasy anxiety or of more concern toand be panic an is aphrodisiac the reactions. potential and for because sexual promiscuity. Because some enamored of others, there is a realmoreuse condomsrisk chances ofof transmissionEcstasy whileor refrain useusing isoffrom Ecstasycriminal sexually casual Last, prosecutiontransmitted sex because may diseases.andit is perhapsa People imprisonment. who usually make poorer choices or take Schedule I drug, a very notMDMAa intherapeutic question. administered Becausecontext. is appropriate, theIn therapy, patientThe isand resting least the qualityrisky comfortably way and to purity use during MDMA of the drug would are be under medical supervision in the setting is controlled, the amount of the session, MDMA'seventslesserthere is degree, reportednolong risk tenure there of among overheating, asis noa thecatalyst risk underground of and overhydrating.used because during therapists. fluids therapy, It shouldwould Itthere is be belikely were needednoted thatno that toadverse the a during much time ongoingClearlywaytaken toward to thepreparetherapy safest minimizing thewith way patients a to supervising usethe for MDMApotential what physician theyis for as woulduntowarda single or psychiatrist. be oral experiencing dose in the went context a long of psychological reactions. tobacco Estimated U.S. Deaths in 1998 attributed to: 400,000 alcoholprescription drugs 100,000I 10,000 aspirinMDMA and over.the-counter-painkillers 7,600 9

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 0WITHMEDICAL MDMA RISKS USE ASSOCIATED John A. Henry, M.D., and Joseph G. Rella, M.D. referstouseA criticaldate. is limitedto Morbidity deaths. evaluation by Mostthe refers typeof laboratory the toand morbidity the amount harm research andthatof mortality comesexamining to associated a the effects of MDMA information that has been reported patient and mortality with MDMA individualmans.hasexperience. been Much done cases of Theprimarily thethat major literature do onnot limitation animals; represent on the to onlyharm muchthese a infew morereports studies than is that, havecollective often,focused anecdotalno on toxicol- hu- humans consists of reports of theyforedrugsogy visitingstudiesare that Ecstasy were arethe physician.doneexposures,ingested using before The as the poison most patient's admittance that centers can bedefineto saidthe exposures,emergency about these since roomcases patients isor thatbe- blood or urine to identify all the feringmanufacturedwasreport never concentrations;having verified ingestedso-called by evenaEcstasy Ecstasy blood tablets buttest. contains withthe It ispresence the importanta range same of ofbrand toingredients name may of widelyhave vary- dif- MDMA within their bodies remember that illicifly someingdioxyamphetamine); concentrations pills contain of MDMA,ingredients or the stimulants othersThe (Sherlock pharmacological mayamphetamine et al. 1999). makeupsulfate (speed),of tablets caffeine, sold as Ecstasy varies widely. While contain MDA (methylene- or ephedrine;mixtures of or these the dissociative drugs and other anesthetics, ketamine or dextromethorphan; 11substances in differing amounts. The PDF compression, OCR, web-optimization with CVISION's PdfCompressor 72effects Risks of MDMAand Usetoxicity of what is sold as Ecstasy therefore may be quite distinct foundofthein differentthe contents toxicto contain reactionsplaces of the various andtablets, reported. at adulterants, different these But contaminants although times. there Because istablets little may soldsolid ofbe the responsibleas evidence uncertaintyEcstasy thathave for aboutmajormany been Consistentlychemicals,toxic effects mostly havereported resultedowing findings to from limitations include constituentsAdverse rapidin drugidentifying heartother reactions rate,than the highthe todrugs MDMA blood involved. pressure, groupwere first of reported in the mid-1980s. MDMAadrenalineBrydenacheteeth (Buchanangrinding, use et al. and(alpha-adrenergic 1995). tense occur1985; muscles,These evenGreer effects,after andnausea, activity), Tolberta singlewhich sweating, 1986; candose.may last difficultyHaynerresult Other from in andreported parthoursurinating, McKinney from to effects days andincreased 1986;head- after of psychiatricMDMAtionsHealth from useProblems complications.] haveusing included MDMAAssociated psychosis,Notare with teethsurprisingly, MDMA grinding panic, Use"andpeople or sweatingdepression. for whose further almost only [Seeinformation complica- never "Mental have on fects"experiencingofto gopeople to(Williams the who hospital. what do et go al.might toOne 1998). emergency bereport considered indicates, departments typical however, adverseare first-time that effects, a large users or proportion "side who ef-are ingHyperthermia life; it can be a cause of significant morbidity and mortality. The condi- is an increase in body temperature to the extent of endanger- usuallyspendsFahrenheit.tion usually timedancing Aoccursat commonlya fordance at many temperatures club, reportedhours where without scenariooverthe ambient 40 adequate degrees involves temperatures fluid Celsius an replacement.Ecstasy or may 104 user bedegrees high,whoThis examinationetbehavior 1981;al. 1993; Henry leads Tehanshows 1992b;to collapse etdilated al.Singarajah 1993; orpupils, convulsions Satchell and sweating Lavies and (seizures) (though 1992; Connaughton Logan in (Simpson severe et al.1994). cases 1993;and sweatingRumackClinical Maxwell PDF compression, OCR, web-optimization with CVISION's PdfCompressor corebeatsmay temperature per minute is not uncommon), hypotensionhave ceased),(low marked sinus tachycardia (a heart rate increase to 140—160 of 39—42°C (102.2—107.6°F). Cases such as this represent Medical Risks Associated with MDEIA Use blood pressure), and 13 tientscoolan acute down may arrive is blunted, at the hospitalpossibly Aswith owing the core body to body the temperature effectstemperatures of rises,MDMA. as thehigh normalThese as 109°F. pa-response to stopmedical activity emergency. and to rhabdomyolysis,whichure,At these kidney can temperatures, causefailure, which death. organ is One muscle dysfunction dangerous breakdown complicationensues that and damages may of include hyperthermiathe kidneys liver fail-and is and cerebral edema (swelling of the brain), any one of andOsterlohcan1992; leadMyerson Henryto1987; high 1997). 1992a;Chadwick potassium Another Screaton et levels al. commonly 1991; et a!. Campkin1992; reported Nimmo and Daviescomplication et al. 1993; 1992; Montgomery Fahal of hyper- eta!. that cause fatal heart rhythms (Brown and reasonestablished,disorderthermia for isthat disseminateddeath management can incause patients the intravascular is patientwithdifficult; hyperthermia to thisbleed coagulopathy complication to death. who (DIC),Once is the DIC a blood-clottingmost has common become have taken Ecstasy. tosometimesEcstasy have a ingestion very with fast seizures; appearedheart rate when inand theythe lowIn British werethe blood early examined literature. pressure 1990s, in and Theseveralthe body hospital, patients casetemperatures theycollapsed,reports tended of as fatal hyperthermia following (104.9°F)cordedtemperaturehigh as temperature43°C in the as(109.4°F). a survivors predictor in fatalities Attention (Miller of fatal was et was outcome 41.6°Cal. drawn1997). (1 in 06.9°F),toAlthough hyperthermia. the importance compared there is The ofa with single high mean 40.5°C bodycase re- stressgenerallyreport of a thesurvivorhigh body body whocannot temperature. had sustain a recordedHyperthermia the massivebody temperature cardiovascular seems to of be 42 a .9°Cparticularlyand metabolic dangerous complication of Ec- (109.2°F), heatstrokeuse.stasy,drinking It but seems it were enoughmay apparent bedue associatedliquid mainly that to casesto allowmore prolonged of closelyfor severe normal dancing with temperaturethe without behavior rest thatcontrol and follows without through hyperthermia and deaths from its PDF compression, OCR, web-optimization with CVISION's PdfCompressor Herience74sweating. concludes were people that theat crowded severe toxicityparties where of MDMA Ecstasy may was be used "due as mainly Risksa dance of MDMA to drug. the Use Henry (1992) writes that the most seriously ill patients in his expe- toacasecircumstances brief dancing reports or at at leastthat clubs in havewhicha partial(Brown been it isdescription andpublished misused." Osterloh thatsince This 1987; links 1992,conclusion Smilkstein ill sincepatients ismany well etwith al. of reflected 1987). them includeHyper- in the hyperthermia Also,crucialthermia1 990a). the factor has degree [Recent been in whether ofreported animalhyperthermia laboratory instudies laboratory has have animals been animalsnoted shown show that given totoxicthe correlate MDMAambient effects with (Schmidttemperaturefrom the MDMA. degree et al. is a manpsychotherapyof serotonin volunteers depletion do who not were insuffer rats not from(Malberg exercisingIt hyperthermicis commonly and vigorously Seiden reactions.noted 1998).—Ed.J did that not Onepeople report study whoany of sub-•have hu- undergone MDMA-assisted aseveralnotjects 1°F specifically with increase researchers complications in measured core produced temperature; of (Downing high the followingbody CamI/Farré1986). temperature, information: {Personal (Spain) though communicationGrob found temperature (UCLA) a slight found withwas in- StateVollenweidernocrease change University) in temperature in (Switzerland) core data thattemperature are was found not statisticallyno but change a decrease insignificant; temperature; in skinJones Tancer's temperature;(UCSF) (Wayne found ManagementareThe to main cool objectives ofthe Ecstasy-Induced body; toin facilitatemanagement Hyperthermia thermoregulation, of the patient withusually acute with hyperthermia intravenous epamcarefluid should replacement;(Valium), be provided, may and be to needed andprevent an ifThe anticonvulsant, thethe most patientdevelopment urgent is having prioritysuch of seizures.DIG.as isintravenous toFull restore supportive the diaz- blood volume, since extracellu- venouspercent)highlar fluid core pressure. volumeshould temperature betends If giventhis to has treatment be immediately, beendepleted confirmed, brings grossly without down byone the prolongedwaiting liter pulse of tonormal rate sweating. measure and saline raises centralOnce (0.9 the a PDF compression, OCR, web-optimization with CVISION's PdfCompressor blood pressure, another liter can be given, after which the central venous Medical Risks Associated with MDMA Use 15 Sedationlationreplacementpressure without shouldand usually active the be need measured achievescooling, for active such thermoregulationand moreascooling an fluidsice in bath, milder given,through should casesas sweating be of strongly hyperthermia. and consid-vasodi- required. The fluid mayveretionered develophyperthermia couplingfor more from serious(the muscle muscles' cases, contractions, mechanismthose with even temperatures of action), further above 106°F.heat production Since se- reduces the calcium requirement for excitation-contrac- in the absence of exertion, once maldantrolene,hyperthermiaEcstasy-Induced membrane which has in theactsdeveloped. muscle. as a calcium This antagonistcan be prevented at the level by administration of the sarcolem-. of Hyponatremia ThissodiumAnother125 complication mmolJL level due or tolower occurs dilution (13 among 7—147 of the patients blood mmol/L with who is water.a have normal Sodiumtaken plasma Ecstasy levels sodium andare range). oftenwho problem seen in Ecstasy users is acute hyponatremia, a low plasma hyperthermiamonlying.also This haveadvised raises drunk and bya theoretical large friendsdehydration. amounts to concerndrink ofThe plentywater for problem those without of fluids, users is losingthat possiblyof MDMA Ecstasy as much to whocausesguard fluid are byagainst secre- com- sweat- istrationkidneys.thattion ofinhibits antidiuretic Anof 40 experimentalurination mg hormone.of MDMA by studypromoting ADH, (a in very healthy also increasedlow known volunteersdose) as waterproduced vasopressin, has reabsorption shown a marked is thata hormone byadmin-rise the in ponatremialevelsanddium itof concentrationwas ADH has confirmed in been plasma, documented (Henry that which this et levela!.was in 1998). accompanied whichwas inappropriately the ADH by alevel small raised. was fall measured, Inin thethis so- case One case of MDMA-induced hy- fromthe normalADH elevated concentration range ADH is 1—2.5 was pmolIL. 4.5The pmollL. combination (Holden of andJackson excess water 1996), intake whereas and increased absorption of water may contribute to a dangerous decline in serum sodium. PDF compression, OCR, web-optimization with CVISION's PdfCompressor 16 Risks of MDMA Use edema,bemayThis very cause adifficult condition nausea, to cramps,wherecontrol. the weakness, Low brain levels cells fatigue, of swell sodium confusion,with in water. the canbody It islead alead major to to mute cerebralcause states, of headache, and vomiting. The low and seizures that may sodium also thesepeoplenotdeath have cases,in attending hyponatremia. elevated the patient ravetemperatures. parties;wasIn cases reported two ofThere Ecstasy-related people to arehave several experienced dnmk reportshyponatremia,copious seizures. of amounts hyponatremia patientsIn of many water, did inof whichareSatchell far likely oumumbered and contributed Counaughton by substantiallythose 1994; of patientsPatientsAjaelo to theiret withwho al. illness 1998).hyponatremiaexperience (MaxwellThese reports,show et signsal. however, 1993; of severe illness within twelve hours hyperthermia. sodiumsuddenlydiumof ingestion level as theand may result ofthe be Ecstasy, cells relatively of unrestrictedhave suggesting hadclose less to fluid normal,time that ingestion.to there adaptbecause is to an Thethe acute lowchangeresultant plasmadrop has lowin occurred osmola- serum so- litytrated,dium (a measure levels with raisedof of 130 dilution). osmolality mmolIL Severe or due less,Ecstasy-induced tosymptoms excessiveand the urinemay production developishyponatremia inappropriately of with ADH. plasma can concen-be so- compared to the syndrome of in- whendromeappropriate someone marked secretion who by dilutedhas oftaken antidiuretic blood MDMA and concentrateddrinkshormone excess (SIADH). urine; water, it SIADHwhich is typically contains is a syn-seen replace noductioninpriatelyfluid solutes the lost body secreted,(asof from ADH,isopposed disrupted. sweating, less it isto urine probableisotonic Sincewhich is excreted, MDMA sportsdoes that containthe drinks andhas syndrome beenthe suchthese overall shown as salts. ofGatorade), water-to-saltinappropriate toIf enhanceADH to is inappro- thebalance ADH pro- 2Aaspriatesecretion serotonin and ADH 2C is receptors mediated secretionreuptake (Liu alsobyinhibitors, the etis al.seenserotonergic 1996; andin people itSpigset may system. who be and mediated take Mjorndal[A antidepressantssyndrome through 1997).—Ed.] of serotonininappro- known

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Medical Risks Associated with MDMA Use 77 -_TableReasonshyponatremic I. Reasons for hyperthermia effects for the of acuteMDMA hyperthermic and ProlongedAmphetamine-like exertion, warm effect environmentPromotion of repetitive activity like dancing Mood-enhancing effect EuphoriaDisregard for body signals (thirst, exhaustion) Serotonergic effectIncreased muscleFeeling tone, of heatenergy production ReasonsHarm reduction for hyponatremia message to drink fluids Amphetamine-like effect RepetitiveDry mouth behaviors, and throat including compulsively drinking water SerotonergicMood-enhancing effect effect Reduced inhibitions and impaired judgment possibly leading to excessive water intake ManagementIn most cases stopping all fluid intake andReduced providing renal response supportive to water loadcare (SIADH) is all of Ecstasy-Induced Hyponatremia theandmentalthat diagnosis. hyperthermiais required. status changesFluid Patients never restriction but co-exist.with will Ecstasy-induced typicallyis Athe serum first be levelsodium cool hyponatremia of to treatmentlevel the touch;will assistfor will hyponatremia minor oftenin making cases have hyponatremia.severeofSIADH hyponatremia. cases, with or mannitol Dr. for Hypertonic Henryserious and recommends complications,diuretics, saline should but treatingDr. besuch Reila given as severe cautions treating intravenously Ecstasy-induced that this in treatment more seizures due to PDF compression, OCR, web-optimization with CVISION's PdfCompressor bemay78 experiencing. actually exacerbateRisks of theMDMA fluid Use and electrolyte problems the patient may PeroutkaThe 1990; Rudnick and Wall 1992), which canuse cause of MDMAtheSerotonin serotonin triggers Syndromesyn- an excess release of serotonin (McKenna and flexesThisdrome,ficulty syndrome and one walking, myoclonus of theis a moreincreasedrare, (muscle seriousdrug-induced sweating, jerks),complications event poor diarrhea, characterizedcontrol associated heightened of heart bywith rateconfusion, deep Ecstasy and tendon blood use.dif- re- syndromehyperthermiaaffectpressure, serotonin carries shivering and a metabolismdeath mortality and (Sternbach increased rate include of muscle about1991; amphetamines, 10Amestone to and15 and percent. rigidity, Wirshing cocaine, Drugs which and1993). known canmany This dif-to lead to rigidity;patientstheferent result kinds whoa ofcommon Ecstasyofengaged antidepressants. feature use in minimalmay of explainserotonin The physical occurrence some syndrome, exercise. hyperthermic of serotoninHowever,is not notedfatalities syndromesince in all muscleamong case as afterfromreports, Ecstasythose it can with use be hyperthermia(Brown difficult and to Osterlohdistinguish stemmingThere 1987;have frompatients beenSmilkstein exercising reports with serotoninet describing oral. dancing.1987; syndrome Henrypotential et cases of serotonin syndrome portsserotoninandal. 1992; Korey are Screatonbiased, syndrome, 1998). in Ofet that al. thefive 1992;they eleven died. cite Nimmo patientsIt only is important etthe al.in worst these1993; to casesstudies Tehanunderstand and etwho al.outcomes. reportedly 1993;that these Mueller When hadre- ingsupportallyserotonin areresolve theto syndrome prevent mainstays within progressive24 is hours,ofthe treatment result and ill ofthe effects drugsfor condition serotin orother death. syndromerequiresthan Sedation MDMA, only as withandgeneral its effectsactive hyperther- medical cool-usu- miationofoften fromhyperthermia. of have theoveractivity; patient.a rapid, Heat severeSince Patients production there course, with are andMDMA-associated canno medicaldeathbe stopped may personnel result by paralysisserotonin from at clubs complications and syndrome to ventila- ensure PDF compression, OCR, web-optimization with CVISION's PdfCompressor vereisthat too complications. late. Patients may people do not become ill, patients may not get medical attention until it Their clinical appearance also may be disguisedhave by thehyperthermia for a long time, resulting in se- Medical Risks Associated with MDMA Use 79 ing(dissociativeuseCardiac ofit was MDMA, anesthetics), such as or methamphetamine by another drug that or thedextromethorphan. user consumedother club believ- drugs, such as GHB (gamma hydroxyComplications butyrate) or ketamine bandal.systolicCardiac 1999), necrosis bloodcomplications cardiac pressure),(cell arrhythmias death include tachycardia of a specific (irregular hypertension (increases part heart of the(increases of rhythms), heart30 beats/minute) muscle), of and 40 contraction mm as (Masseen Hg inet Ecstasycatecholamine-inducedcardiogramtacks) has (Milroy been abnormality) known et al. 1996).to myocardial induce has A fatalbeencase injury cardiac ofreported QT-interval (such arrhythrnias (Drake as cocaine-related prolongation and(Dowling Broadhurst et (an al.heart 1987).electro- 1996). at- theAnotherLiver liver. serious Abnormalities There adverse have been reaction several to Ecstasy reported use iscases hepatitis, (Henry inflammation et al. 1992; of incitingstudiescauseDykhuizen agent,the in damagethe et and ratal. the1995),and has specific dog, not but beenFrith theymechanism described.and do notChang conclusivelyof action[In (1987) twenty-eight-day by did which define not MDMAreport MDMA any might as liver the toxicology hasbedamage been due toreported, from an idiosyncratic MDMA but it appears drugIn reactionto 1992 be unrelated a (Karchcase series 1996;to hyperthermia of Milroyseven patients et al. and 1996). withmay liver damage associated with Liver damage after Ecstasy use damageingDykhuizenbeenEcstasy of reported, the use has liver) etwas been al. including reported(Khakoo1995) reported and (Henrytwo et one fromal. cases case1995).et theal. of of 1992).Instituteacute acceleratedA series hepatitisSeveral of of Liver hepatictwelve isolated (Delentre Studies fibrosiscases cases et ofat al.also(harden- hepaticKing's 1994; have PDF compression, OCR, web-optimization with CVISION's PdfCompressor 80 Risks of MDMA Use lobularityincidenceCollege seems hepatitis ofto Ecstasy-inducedexist, to with features histologic of hepatitis massive changes was hepatic increasing.varying parenchymal from A spectrum mild collapse to moderate of sever- with Hospital (Ellis et al. 1996); it was suggested in this report that the beenpearsstasyareas seento use ofbe in nodularisthe Ecstasyunlikely most regeneration. likely users.to be causedose This dependent ofmeans,An the immunologic sporadic however, and also cases that ithepatitis is likely due to to Ec- mechanism of action ap- of hepatitis that have be highly riseunpredictable.galyleading with should time. to repeated be ItYoung isasked also re-exposure, people aboutpossible theirwho that possiblethehave with incidence unexplained the use current of of Ecstasy. cases jaundicedegree of liver of or Ecstasy damagehepatome- use, may general,anceThereThe to adverse it cannot events be predicted and will nowho longer will experienceexperience sideany Livereffects. Enzyme Whyare do no CYP2D6 reports that people who take MDMA repeatedly build toler- complications. In mayofsomeeveryone's the be peopledrug genetic while seemgenetic polymorphism, others to makeupbe moreseem differs. susceptiblerelatively which Since isresistant? to some people One possible have different explanation genes, how scientists describethe effects the of way even a single dose smallortheya break specific have percentage down, different enzyme drugs. of theenzymes in Scientists population.the liver and havethat therefore [CYP2D6 is found different is the enzyme abilities that to breaksmetabolize, down known to be genetically deficient in a that MDMA is broken down by AsianMDMA.shouldandof MDMA thatpeople.—Ed.] Itbe personis made mayinactive would lastclear In in longera that5personnot to 10thisbe in percentablewhothe is onlybody tois deficientdetectof a and Caucasiantheory thecause in deficiencyof the damage howand enzyme, 1a torare to beforehand.2 thepercentthe event effectsorgans, may of It arateoccur disproportionate and in thata very small small increasesincrease part of inin the MDMAtheA MDMA-taking recentdose plasmaof study MDMA hasconcentrations population. ingestedshown that can this(de translate liverla Torre enzyme to theory may not be accu- PDF compression, OCR, web-optimization with CVISION's PdfCompressor TOXBASE).et al. The lethal dose (LD50, 2000a). The half-life of MDMA is about eight hours (Ecstasy Medical Risksthe Associated with MDMA Use dose at which half the laboratory 3J tinalwhenofanimals administration. tract) administered die) and has 325 been Studies parenterally studied in inrats various (through have shownanimal routes themodels other drug's andthan LD50 by the various isgastrointes- 49 mg/kgroutes mg/kg when taken orally. Nonhuman primate studies primateeffectshumanshave shown LD50 of will MDMA doseanever LD50 be(Rochesteringestion carried of 22 haveout,mg/kg and serum approachedKirchner parenterally. levels 1999). or, assayed in While some in nocases, patients LD50 exceeded withstudies toxic the in investigatedTheNeurological in some detailComplications over the past ten to fifteenpotential years. These for neurotoxicity investiga- resulting from the use of MDMA has been in serotoninchemicaltionsmonkeys suggest serotonin.for remained up that to MDMAa Studiesyearaltered or poisons ofmorefor rats an after foundeven special they longer that nerveswere they period given hadin the lowerofthe braintime. drug. levels thatScientists The ofuse levels brain the keysdictableductedalso than found ways simulating in rats that in (Ricaurteboth some the species damagedway et al.some and 1992). nerves that people theseSome grew use effects of MDMAback these persistedand experiments and reorganized not longer in anwere ininartificial, mon- unpre-con- levelspurelyal. 1995; ofexperimental serotonin Ricaurte in etmanner, the al. cerebrospinal 1988a,c). suchAmong as using fluid the extremely (CSF—thefew studies high fluid involving doses that (Fischerbathes humans, the et one documented diminished inbrain) studiesEcstasyserotonin of peoplementioned (McCann levels who affect earlier.et used al. the1994). Ecstasy But way it This ispeople compared difficult is similar live to with and determine to thethinkpeople findings and howwho feel, thesedidin thebecause not changes animal use alityevaluatedthatthere foundtraits. is no its Previousstraightforwarddecreased subjects studies for serotonin pain testhave response that levelsassociated can and inexamine the forlower CSF impulsive itsserotonin of effects. Ecstasy and levels The hostile users same in humans person-further study PDF compression, OCR, web-optimization with CVISION's PdfCompressor 82 Risks of MDMA Use tionlowerwithcharacteristics. and serotonin impulsive levels, Researchers and theyhostile also hypothesizedpersonality might have traits. thesethat Theysince alterations foundusers ofinthat painEcstasy sensationsensa- and with impulsive and hostile personality there was have havenoserotonin difference been predicted. levelswere in pain actuallyin sensitivity;humans,This study less but hostilemoreover, therefore it did andnot was impulsiveconfirm able to any show than other amight difference Ecstasy users with lower levels of effects of this otherwise in intracerebral"Doesdifference. MDM1A [For hemorrhage Cause a thorough Brain (ICH, Damage?"] evaluation orOther bleeding serious of intothe reportedtheneurotoxicity brain). neurological One debate,report complications see of Ecstasy use include cited otherhavefourOf cases thesecausedpatients offour theICH were patients, bleeding, related said toone to haveand thewas another useduse found of MDMA, Ecstasy todid have not but a(Harriesactually congenital use was andtake never anomaly DeSilva confirmed that may 1992). Two ingand(Dowlingby a homewas blood electrocuted. fromet test. al. his 1987). Another physician's In In another one report officecase case, cites a whenuser a five twenty-five-year-old climbedhe deaths died ofan relateda electrical heart attack;to man MDMAutility wasno tower use infor- driv- personasthmaofmation MDMA citedisattack, offered while in theand atconcerning report the the fourth doctor's died whetherdiedfrom office. of a the suddenThe man third fatalwas man experiencingheart apparently rhythm. the The complications of a congenital heart prob- died of an effects fifth pressure.usereports,lem. in Levels the however, Whilepatients of MDMA it containbeforeis possible were theirany thatfounddata regarding in all of signsthese orpatients. symptoms None deaths, such as rapid heart rate or highthe blood effects of MDMA may exacerbate an of MDMA of these underlyingcannotreportssomething confirmonly condition, foolish, suggest a direct such sucha possible causal asas climbingheart relationship.association disease, an electrical or assist tower,an individual the data in in between death and MDMA and doingthese

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Medical Risks Associated with MDMA Use 83 MinorTable adverse 2. Effects effects (relatively common and generally short-lived reactions, which of MDMA PhotophobiaMydriasisoccur shortly (dilated (discomfort after pupils) taking when lookinga dose) at bright lights) Sweating,AnorexiaHeadache (diminished tachypnea (rapidappetite), breathing), nausea, tachycardia dry mouth, (rapidabdominal heart cramps, rate), palpitations, diarrhea tremor GaitTrismusBruxism disturbance, (uncomfortable(grinding ataxia of teeth) (difficultyrigidity of walking)the jaw muscles) HypertensionHallucinations,Serious acute (increased severe adverse anxiety, blood effects agitation, pressure) (uncommon panic attacks, reactions) paranoia SevereCardiac abdominalcentral arrhythmias chest cramps pain(irregular (probably heart due rhythms) to intercostal muscle spasm) Overexertion,AdverseUrinary retention effects dehydration, (due only to in alpha-adrenergic certaincollapse circumstances stimulation of bladder neck) (Bryden et al. 1995) RhabdomyolysisConvulsionsHyperpyrexia (seizures) (increased (muscle breakdown)body temperature) AcuteCerebrovascularDisseminated renal failure intravascular accident (stroke), coagulation intracerebral (blood clots hemorrhage throughout the body) DelayedFacialRoadPolydipsia traffic dermatosis reactions(excessive accidents (pimples) todrinking), exposure (Wollina low sodium et al. 1998) levels, and stupor ToothJaundice,Possible wear hepatotoxicity congenital(Redfearn etanomalies al. 1998) (McElhatton et al. 1999) WeightSleepPoor disturbance loss, concentration exhaustion and attention, memory impairment, depression

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Treatment84General Management of MDMA Toxicity Risks of MDMA Use of the symptomatic patient is mainly supportive. Gastric lavage vated(pumpingmumthe bloodcharcoal of thetwelve pressure, stomach) if the hours drug electrocardiogram, is was recommended.not taken within andthe previous body temperature hour. Monitoring for a mini- Diazepambut it is may advisable be given to giveto control oral acti- of Symptomatictheantipsychoticanxiety threshold and agitation. formedications,narrow seizures Chiorpromazinecomplex and should exacerbate tachycardia be avoided, (Thorazine) hypotension in sinceadults and they should (low haloperidol are blood likelybe treated pressure).to reduce with (Haldol), orally)treatedtherebeta-blockers is withor certainty alpha-adrenergic calcium (for that example, channel cocaine antagonists5—10 blockers was mgnot (for metoprololingested), (for example, example, andgiven 5—10 hypertension2—5 intravenously, mg mg nifedipine phentolaniine should only if taken be Anycases,rectalintravenously, period temperature dantrolene of onlytime canexceeds ifwasted therebe considered, 39°C isnot certainty actively(102 .2°F), that cooling rehydrationcocaine the was patient is not essential. risksingested). In severe If though its effects are not immediate. worsened the plasmacludetientend organ should serum potassium, damage be sodium paralyzed bloodand level, death. andfibrin liver ventilated. If degradation functionthese measures Laboratory tests, products creatinine are evaluations not to effective,test phosphokinase, for DIG, the pa- should in- and sodiumurine for bicarbonate. myoglobinuria. Acidosis should be corrected with intravenous Use TheAssessingincidenceers exact and cliniciansnumber of the adverse Risk of thinkMDMA effects of thatMDMA users of the MDMA overallremains therefore use unknown, of will though remain most unknown, MDMA is on the rise. The research- and nationmorbidityingany ofuseful ofdata safety andclinical from mortality of patients MDMAinformation can whouse be difficultwill difficultcome continue to as tomedical well. interpret, to attention. rendering The the reports rely on the accurate record- determi- of PDF compression, OCR, web-optimization with CVISION's PdfCompressor media, or researchers, are necessarilyThose biased by various factors. In 1985, the who assess whether MDMA is safe, such as the government, the Medical Risks Associated with MDMA Use 85 theatherapeuticgovernment drug public good. value. classified The This media MDMAdecision declared aswas a Schedulebased MDMA on limitedI todrug, be dangerousdatameaning concerning that based itstructurally hasMDA, partly no similar to MDMA, and presumably was implemented for relatedwomen,desireon their to toone hyponatremia make in England headlines. associatedand The another sensationalizing with in Australia,drinking tooof the much deaths water of aftertwo young Ec- interpretation of the extant scientific research and partly on their which might have been taintheinform.stasy medical confidentiality. use, These clearly literature cases illustrates are does unfortunately not a desire include to theunavailable proper names for critical of patients, review, to main-since sell newspapers rather than cogently aretively,influenced often that incomplete. is,by datavarious are For collectedfactors. example, Most afterScientific not humanthe all fact. serotonin research reports For this aresyndromeis reason, donegathered for collected cases theretrospec- publicrecord data good, though it, too, can be limitinformationerfulthe any bias conclusion aboutin the whether medical that may the literature bepatient drawn hadis fromthat been only the dancing. report. severe SuchAn or unusualespecially missing cases pieces pow- are muscle tone, and not all hyperthermia case reports included verythoseever sick who reported patients used in MDMA andthe firstexceptional and place. neverThere cases became is interestingnot ill. Researchers enough to consider write about, only nor will there ever be, a collection of case reports of reportslearnnmwhich who likely of morbidity wishes accounts to and know for mortality? the more fact thatabout The nearly data thesyndrome safetymay half notof of whose allbe MDMA patientsas goodcases based withas were we seroto- onwould reviewed the here died. What can the reader risksareincidencelike notit of to being Ecstasy-relatedbe, of but adverse overrun a few outcomes factseach problems stillweekend canis likely maybe by gleaned. peoplelow,be reduced since Intuitively,dying emergency by from encouraging weEcstasy know departments use.The that users, the

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 86 Risks of MDMA Use if• Do not take morethey than insist oneAvoid on relaxpill. taking dancing in a thecool drug,for place prolonged to for apply a while. periods the followingMany of time. clubs precautions: Take have regular"chill out" rests areas and for •• Wear light loose clothes.Drinkoverhydration.this purpose.electrolyte-rich Do not fluids drink to extrareplace fluids lost if fluid you butare avoidnot exercising. plications• sometimes associated withworryingSeekGiven Ecstasy medical the symptoms. manyuse, help it reportsearlyis easy if toofyou seethe begin thatunpredictable furtherto experience and unusualpotentially or lethal com- beforecontrolled(1992)safety any as mentioned studiesaconclusion therapeutic of aMDMA cansingle tool be incasedrawn are a controlled requiredof concerning a patient tosetting. define who its potential Dr.was its Henry effectsreported usefulness and on to colleagueshumans have and in- ishyponatremia.orgested useddrink fortyposes copious tablets the This amountsgreatest ofcase MDMA, supports dangerof did tothe notthe idea engagepatient. that thein vigorous manner in physical which MDMAactivity fluids, and never experienced hyperthermia or

PDF compression, OCR, web-optimization with CVISION's PdfCompressor M.ENTAL0' HEALTH PROBLEMS ASSOCIATEDKarl WITH MDMA USE 1. R. Jansen, M.D., Ph.D. ofpsychotherapyverseLike mental effects health when into problems. itthe was general first When introduced. community, MDMA itwas became usedother linkedas an mind-altering aid with to a psycho- variety drugs, MDMA was perceived as one with few ad- as its use spread from tacks,however,empathictherapy depression, therein understanding the have late mania 1970s,been (excessive reports for therapists others of excitation), confusion, and characterized a release suicide, anxiety, of the insomnia, emotions. effectsamnesia, asnightmares, Since panicfeelings then,at- of automatic(PTSD),ingsdepersonalization are unreal),paranoia or repetitive hallucinations, and(feeling other unreal), persistent flashbacks, derealization false beliefs, post-traumatic (feeling other types that stress theof psychosis,surround- disorder dissociative disorders, irritability and ag- nonspecificlemsgression with with list.other mood When drugs swings, widespread (McCann tolerance,The etconsumption al.reader dependence,1996; may Jansen of have a and drug1997; noted increased results Spatt that inetriskthis nonspe-al. ofis 1997). prob-a remarkably long, diverse, and lemstalhascific disorders happened have problems been that with attributed usuallyembracing MDMA, exist wrongly awe inlarge maythe to slicegeneral be consumption recording, of generalpopulation. to ofpsychiatric some the Some drug, extent, of andcomplaints, these the some, prob- of as men- healthcourse, problems have been are quite attributed correctly to use ascribed of a drug, to and drug the use. more The the more sample mental size 81 PDF compression, OCR, web-optimization with CVISION's PdfCompressor 88 Risks of MDMA Use assumptionsgrowsacteristicsdental. Some ofabout theof thesepersoncause reports and reporting effect. have themThe more association than to dowith any may to reflect the general population, the more wary we should be of false with the psychological char- particular effect of the be entirely coinci- effectsresultdrug upon in linked persistently the with mind MDMA orlow the serotonin brain.use inAnimal terms levels. ofstudies Attempts have toshown that taking large quantities neurochemical changes, however, explain the adverse of MDMA can ignorepsychotherapy,materialdrug. the MDMA rolefrom of thecould butpsychological unconscious. there upset may the be changes balanceThe some release risk dueof the oftoof accompanying suchmind material by releasing can bethe disturbing useful emotional in effects of the neurotic sylnp- justmaytoms,tirely onebe such highly falseor astwo attributionanxiety, relevant, modest insonmia, doses.since of symptoms many In addition, to the some drug. and nightmares. Psychological ofexplanations the adverse effects were reported after Widespreadof these reports use eventually cite an en- yearswouldquencyleads ofto be andpanica alack person the attacks, of reporting connection, who takes of half in some a pill cases,of Ecstasy between once attributed to taking the pill (which, if it had been tested neurotic symptoms. For example, a typical case the doseand size then and reportsfre- two Within somea a primarilylink between physical the cause, one usually may not even have development of symptoms and the dose size and fre- factors may be responsible for midweekcontained prob- a psychoactive dose ofMDMA). would expect to see at least lems,quency;an apparent such that as is, lowlink neurochemical moodbetween and its irritabilityThe 1 990s following saw general recreational use of Ecstasy, ingestion and a diverse range of mental health al.heavy 1996). weekend It was reporteduse. resulting in reports of problemsThenmthat largerelevance (McGuire doses of of these MDMAet al. studies 1994; repeatedly toKemmerling the situation levelsinjected andet ofinto damagedhumans the nerve terminals from which serotonin animals lowered seroto- taking one or two is released. vanlinkedtitiesdoses Praag to for occasionally depression 1994),several it days has (Maes always maybeen and behas Meltzerat been risk. doubtful, Because1995) and butlow anxiety persons serotonin (Lesch et suggested that heavy users may be at taking large quan- levels have been increasedal. 1992; PDF compression, OCR, web-optimization with CVISION's PdfCompressor serotoninrisk level is linked with aggressive behaviorof these (Cleare disorders. and Bond Against 1995; this theory are the observations that a low Mental Health Problems Associated with MONA Use 89 beMann1994). less 1995; aggressive Coccaro than et average,al. 1997),Explanations rather and yet than heavy more for Ecstasyadverse aggressive users reactions (McCannare believed to Ecstasy et al.to thus have focused on pos- tochodynamicleasesible the brainemotions waking chemical model consciousnessthat altermaintains changes, the psychodynamic that isoften repressed anxiety-provoking ignoring in balance thethe unconsciousfact of material that the mind.MDMA unacceptable and The thatmay psy— de- re- ahappenscharged.ing non-therapeuticfenses such areifMDMAmaterial defenses erected has tocontext? against the been surface it.useddisturbing The Some insoresults therapy typesthat material itwill of can topsychotherapy dependremove inbe theworked psyche partlysuch throughmay defenses. areon involve theremoved and set What bring-anddis- in throughmaterialthemselvessetting. Whilethewill as material not the no easily drug eventual or wears becontaining repressed. harm off, itmay it.is TherealsoFor result instance,possible may and be the thatiflittle adefenses someperson chance of were maythe of workingliberated torebuild real- nightmares,symptomstraumaticize that she todrugassociated had the use beenpsyche. in withthean effort Possiblevictim the neuroses: to of anesthetizeconsequences incest anxiety, in childhood,the moodmightpain, and disorders,include it woulddissociative the insorrmia,be range wholly or of behavioralvertedconversion into atolerance physical disorders toor (such thepsychological drug) as Thehysteria, following frequent symptom). where long-term, lack mental of lasting high-dose anxiety changes may injection be in con- animal behavior (other than a withreceivedplainof MDMIA theadverse usefrom alsoof effectspersons Ecstasy indicates probably who describe that have anis suffered ingestionmisguided.exclusive mental of focus Manyonly health on a of fewneurochemistry theconsequences doses. conmiunications Where tolinked psy- ex- high-dosealikelychosis manner that(delusions, similarneurochemicalEcstasy hallucinations,to use amphetamine and factors the developmentdisorganized are could important. lead speech) ofto The aa brieflink releaseis concerned, betweenparanoid of dopamine long-term, psychoticit is more in PDF compression, OCR, web-optimization with CVISION's PdfCompressor 90meillness, is thought to be involved in Risksas ofsometimes MDMA Use can be seen withproducing amphetamine paranoid itself. symptoms, An excess asof predicteddopam- andbyProblems the dopamine hypothesis of Consequences with Reports schizophrenia.of MDMA Use MDMAinterviews,Thecontrol group, group. single except (A case control that reports, the group controls and is short a grouphave case not that serieslimited is information we have is largely in the form of taken the drug. Matchingexactly the same as thein which there is no personal accounts, severaltheWas two the keygroups Drug issues Takenon to use bear Actually of inother mind MDMA? drugs when is consideringparticularly reports important.) There are of this type. Authors(N-methyl-atoxicological urine whodrug 1- allegetest). proof[3 ,4-methylenedioxyphenyl] Pills thatto supportmay a person this took claim MDMA (tests -2 -butanamine), of should the attempt to present contain other drugs, such as MDE, MDA., MBDB tablets taken or at least 2GB (4-Bromo- drine,2 ,5-Dimethoxyphenethylamine),actioncontain or (two other no psychoactivehours) pharmaceutical and is substancesmore agentsketamine, of a stimulant, at(Saunders all. MDE 1995, amphetamine, LSD, pseudoephe- with fewer emotional effects. has a shorter duration of 1997). Some pills MBDB2GBone.a greater MDA is moresimilar cognitive is morepsychedelic to MDMA, component than but astheMDMA effects but are less described so as psychedelic (LSD-like) and is considered to be more toxic. distinct from an empathogenic/emotional than MDA (Shulgin and less intense, with inchosisandShulgin the the Unitedare links1991). well betweenKingdom. establishedAmphetamine amphetamine It (Connellmay is be a verycloser 1958; use common and toBell a 1965).brief additive MDE in is very common amphetamine in its effects than period of paranoid psy- Ecstasy tablets, to hallucinogenictotermsMDMA experimental of adverseand may subjects (Janseneffects. possibly toKetamine,1993, producehave 2001). a The current tendency in modelanother schizophrenia; commonprofile additive, more it can similar has be profoundlybeen to givenamphetamine in the United PDF compression, OCR, web-optimization with CVISION's PdfCompressor Kingdom psychology of negative-effects reporting, which is in tothe attribute mind of problems the to MDMA rather than to other drugs is due Mental Health Problems Associated with MDMA Use 91 TheThemedia-influencedto majoritya Role of Polydrugof persons doctor Use who as welltake asEcstasy the patient. also use other drugs, a point that phetamine,usereportsrarely of islarge use emphasized forof amounts otherexample, drugs inof reports cannabis,often often is attributing ispushed LSD,dismissed into a disorder thein abackground. few to lines. MDMA The Many use. concurrent habitual In such alcohol, cocaine, ketamine, or am- Theandanweekend useimportant Ghodse of Ecstasycannabis 1992). factor users has Forto bearbeenare example, also in linked mind daily there to or relapse isnear a case daily in reportschizophrenia users ofof persistentcannabis. (Mathers deper-This is when conducting research in this area. MDMAofBoningsonalization daily 1993). alcoholin the syndrome caseIt and subsequently (Gouzouliscannabis after ingestion use, was 1994). and pointed seriousof only out doubt one that Ecstasy thiswas patientcast pill upon (Wodarzhad the a historyrole and of tions,ences"Set"The refersRole(includingattitudes, of to Set the andandprevious personality, Settingexpectations drug earlyexperiences), of imprintingthe drug temperament, user. and "Setting" learning, mood, referspast motiva-experi- to the Ancome,andconditions optimistic the while behavior, of set ause, fearfuland understanding,including pleasant set and thesetting unpleasant physical, and are empathy more social, setting likely of and theare to emotional otherhavemore a personslikely positive environment to present. haveout- a manyfluencenegativeless, who expectations of outcome. wantset and to dancesettingIn do general, play simply than an MDMA psychedelic becauseimportant effects they partdrugs, have are in lessbeenallsuch drugsusceptible conditionedas LSD.effects. Neverthe- to Thereto the asso- in- are fromcome.theyciate havedancingMD1VIA For swallowed.example, with are Ecstasyrare. from Expectations Nevertheless, a use, statistical irrespective sometimes aperspective, perception of the can actual onserious lead the contenttopart physical a negativeof consumersof theeffects out-pill PDF compression, OCR, web-optimization with CVISION's PdfCompressor of92that fear spread by the media. As a result, therethey has arebeen experiencing an increase such inRisks effects of MDMA has Use increased considerably in the wake the numbercalThe extremis. Probability of persons The of seeking areal Chance diagnosis treatment Association is withlikely the to falsebe panic. belief that they are in physi- Manythatratherjustified ofamong thanthe by published wasthe the data; associatedlarge thatreports group is, with—the they drawof drug conclude cause userssymptoms. and that within effect Ecstasy It the conclusionsis important consumptiongeneral population,that to recognizecaused—are not a meticproportiontaintyety areproperties that common will many become of conditionspersonsdrugs mentally (Poole who in andtheilltake regardless generalBrabbins. MDMA of will1996). any show supposed Depression signs psychotomi- of anddepression anxi- population. It is a statistical cer- symptomsforgeneralregardless women population associatedof(Gelder drug isuse. et 80—200 withal. The 1995). MDMA one-year per Anxiety, 100,000 use incidence also forpanic men attacks,of and major 240—600 and depression all ofper the 100,000 in other the have an incidence, sometimes lihoodsubstantial,PoorA poor Pre ofadjustment -morbid drug in usethe Adjustment andtogeneral life a worsecircumstances population. prognosis is whenassociated major with mental an increased illness devel- like- commonment.resultops. Drug ofPreexisting "self-medication"in use persons may mental be who a symptom show illness of distress,signs and a or it may be due to impaired of impending or actual mental illnessof psychiatric as a illness in apparentfamily asso-history of mental illness are judg- PreexistingciationEach year with Neurochemical, brings drug newuse. reports Genetic, linking and Personality inherited Differencesgenes to behavioral patterns, underfunctioningthating),including persons both alcoholismof whowhich oftake areserotonergic and drugsthought the mayneed to or haveinvolve for dopaminergic high preexisting, dopamine levels ofsystems, geneticallystimulationreceptors. and Itthis determined(thrill is lesspossible seek- than

PDF compression, OCR, web-optimization with CVISION's PdfCompressor studiescreatesoptimal anof theinner serotonin drive to and take dopamine drugs that systems provide in relief. long-term Thus, users retrospective of functioning increases the likelihood of depression and anxiety and Mental Health Problems Associated with MDMA Use 93 toninThisbydose preexisting isor Ecstasy,a its point metabolites differences thatcompared researchers and withbetween performing non-usrng taking the twocerebrospinal d-fenfluramine controls, groups may(Jansen fluid bechallenge seriouslyand measures Forrest tests confounded of 1999). rarely sero- TheThetake media Role into ofhaveaccount. the playedMedia a highly significant role in the psychology of adverse use.astonishingcationsdrug Psychiatrists effect in terms reporting. range were of of the asmental There influencedsituation isand the withphysical byhistorical the MDMA. disorders case In of the LSD,was 1960s attributed which and has1970s, to impli- LSD an emphasis on LSD as the thefrom(manic-depression),general use a traumaticof public. other drugsSometimes LSD dissociative were experience, diagnosed persons conversion neuroses, withas having disordersschizophrenia, and conditions problems (such as inducedbipolar stemminghysteria), disorderby PTSD LSD.from Althoughas1996;12 a major percent LSDPresident cause amonguse ofis of annow thefifteen- extended atCouncil very to twenty-nine-year-olds)listhigh 1998), of levels complaints. LSD in isthe no United longer (McMiller Kingdom generally and(10 accepted toPlant Itdrunkmedia rarely toohysteria was much pointed based water onoutafter Ecstasy. that swallowing theThe .Aactual 1990s single a riskpill, saw death, ofwas adeath remarkable front-pagethat fromof Leah all news rerun causesBetts, for in who months.thein asso- United had Kingdom of 1960s-style hol,riskanciation exposures andaverage morewith of takingthan(Saunders a thousand two MDMA thousand 1995, people was 1997). peoplein died the In fromregion thedied same the from of health 1week inthe 650,000 healththatconsequences Leah consequencesto 1Betts in 3 of milliondied, alco- stasy."murders.partof incigarette atThis Thereleast type smoking 30 was ofpercent amedia completein the of and Unitedreported politicalloss Kingdom.of motor perspective attention, vehicle In that regardlesson deaths,week, the "killer alcohol suicides, of thedrug played drug, andEc- a PDF compression, OCR, web-optimization with CVISION's PdfCompressor 94theandalmost drugby doctors in question. in the belief that they are suffering serious effects from takingalwaysRisks of MDMA results Use in an increase in the number of persons seen at hospitals persontheTheWhat use hasof MDMA recovered is unknown,from the acute but it is likely to be relativelyactual risk low that once a serious the psychiatricAre the condition Risks in will Numerical develop following Terms? effects of the drug. The relative risk of tive,sures).ofany outcomes particular but Many it is that necessarycase outcome occur reports byshouldto maketoleratethe totalbe no this attemptnumber deficiency, toof providedoses because consumed a statistical such (risk estimates perspec- expo- determined by dividing the total number atneverassociatedare all. very reported, difficult psychiatric and to evenprovide. disturbance more We inaccessible are treated are by the medical community but do not know how many cases of MDMA— those that are never treated ofMDMA-inducedone psychiatric clear conclusion: hospitals. mental the disorderThis drug pragmatic Anotherthat is to is tour investigationmethod emergency of gaining roomswill produce perspectiveand the at wards least on the general importance of principally associated with suicidal de- MDMAbeforeinpression, this societya singleis homicide, seen is case in alcohol, these cognitiveassociated institutions, by an deficits, withenormous consumption and schizophrenic even margin. longer of It toxicologicallyrelapse,is before often andseverala case psychosis isproven weeks seen peopleateistingthat and does psychiatric citedlong-term not highinvolve disorder. levelseffects other of (months Nevertheless, drugsreported and or adverse yearsa personal one after studypsychological oringestion) offamily self-reported history ineffects of immedi- (Cohen preex- five hundred percent,recurringanxiety1995). indepression Theeffects 16 percent,immediate included in 38 and percent,effects depersonalizationdepression reportedand flashbacks in 12 included percent,in 54 in percent, 27 paranoia while percent. insomniathe in long-terml 20 percent, in 38

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Mental Health Problems Associated with MONA Use 95 AsAdverse Psychologicalnoted, current research evidence is sparse and retrospective (which means Effects of MDMA ofResearchappeared,that people research also forrather is comparisongenerally carried than giving out is whouncontrolled by alooking haveperson not into the(there taken thedrug is thepast, noto drug) properlysee after what and the matched typicallysidewill effecthappen). group lacks has derlyingcometoldtoxicological what for schizophrenia thehappened person.confirmation next—the Follow-up or manic-depression, of thecourse is drugs very of important taken.the disorderfor Moreovei example, in termsand wetheeach of usuallylong-term of which are out- oc-not excluding un- oncontinuingrelatecurs single the in roughlycase presence studies. 1 ofpercent drug Nevertheless, metabolites of the population they in the frequently urine), and conclude they depend cause-and- heavily mental state to the toxicological results (for example, the worldwide. The studies rarely Psychosispossibleeffect relationships that there isfrom a cause-and-effect what may be chance relationship. associations, athough it is also doesfor(WilliamsMDMA more not maythanact et likeal. producea few1993; a hallucinogen days Kemmerlinga state and ofappears intoxication in etmost toal. be 1996),people, relatively that but mimicsit canthis rare. causedoes paranoid Although not hallucinations usually psychosis MDMA last collapseddrugs.deliriumon occasion, She afterseveral was especially taking completely times, no at injuring highermore disoriented, thandoses. 200 I havehad mg marked seenof pure a person difficulty MDMA in a andwalkingstate no of other toxic(she and spent several hours trying to encedferednotpick present. up from MDMA nonexistent depersonalization She user had and objectsno hadhistory fromnot disorder ofhad the psychosis, episodes floor (discussed and althoughof talking this later). nature herto She people motherpreviously. was anwho had experi- were suf-It is chosis.doseworth of noting Somefluoxetine that people this (Prozac). withperson schizophrenia had Ecstasyexperienced useor manic-depression maydepersonalization sometimes alter take with the Ecstasy; a clinicalsingle picture of a preexisting psy- PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMAexperimentation96the can induce with adrugs relapse is relatively of preexistingpeak common. age schizophrenia of Itonset is unknown of schizophrenia or whethermanic-Risks of HDMA is twenty Use to thirty; an age at which offoremotionaldepression, relapse this reason instressor. beyondboth alone these MDMAonethe illnesses. increasedwould experiences expect risk to of see arerelapse an typically association attached emotional withto any increased events,substantial riskand torsraise(Nichols report the riskand that ofOberlender theypsychotic have 1989);repeatedlyillness MDMA ifas used such, found over enhances these clear the drugs longlinks dopamine term.might between Some beavailability; expected investiga- toas do amphetamine and cocaine the onset of reportsnostudypsychotic toxicological is citing based symptoms the on confirmation sametwo and cases, effects the useotherof (Nufiez-Dominguiez, pill of substances Ecstasycontent. (McGuireHowever; were involved, 1994;thereand Fahy are Schifano and 1991). there This was several other 1991; lencesmall,gether,Winstock of given the Ecstasy 1991; evidence the incidenceuse.Williams is indicative withet al. which1993; of some itSchifano is risk reported of and psychosis, compared Magni 1994).though with Takentheit is preva- likely to- versebywho most can effects. personsdifferentiate If the who majority intoxicationhave taken of persons Decisionsthat (that drug) experience is, the aboutfrom effects psychosis aclassifying that are and experienced MDMA other ad-effects should be made by those particular effect when trueperson'salsogiven andimportant MDMA, possiblebeliefs; thisto delusionsin look effecta closely is must intoxication at be psychotic incompatible and beliefsnot an with adverse (delusions) what reaction. is held versus to It be isa particular culture or religious sect. nationtoms(1996) arising of have the indrugargued the and context that its metabolitesthis of termdrugCan shouldintoxication MDMAfrom thebe causerestrictedbody. but persistingaSuch true to a"drug-induced psychotic psychosis symp-should psychosis"? Poole and Brabbins beyond elimi- thatmanic-depression).outcomerecur a onlyspecific, from on reexposure theamphetamine-induced major The authors functionalto the godrug on psychoses and topsychosis state must that have(such meeting the a ascommon schizophrenia these assumptioncriteria has different course and and PDF compression, OCR, web-optimization with CVISION's PdfCompressor such(1958);been a syndrome. however a Connellclose reading showed of histhat work psychosis indicates occurred that heestablished only did notwith describe intoxi-is in doubt. The most often cited study is that of Connell Mental Health Problems Associated with MDMA Use 97 usuallyclears.Connell,cation, Whereconfirmedfind psychosis schizophrenia the bypsychosis wholly measures ordue manic-depressiondoes toof amphetamines amphetaminesnot resolve, ratherlong-term tends in the than to blood. resolve afollow-up condition According as the studiescaused urine to psychosiscretionmethamphetamineby amphetamine. of with the schizophrenia-likedrug However, inproduces the urine, Sato a lastingand hallucinations. (1992) reuse vulnerability hasof methamphetamine reported It extends to that paranoid beyondlong-term and delusional the alcohol, use of powdermatchingalong with intravenously the stressors, previous leads upmethamphetamine-linked to to four recurrenceI have times reported daily of psychosis for the six episodes. case months with of aclinical without person features experi-who injected 250 mg of MDMA shouldinjectingdataencing tobe anydextroamphetamineMDMA, cautious psychotic temptingin transferring phenomena. as Gansen this generalizations mayThis 1998). personbe. ItThis is became also finding based important acutely onsuggests amphetamine psychoticto thatnote we that on butduringcausedrug symptomatic. use ofthe maythat early distress.sometimes stagesThey also ofPeople psychosisbe may a signalmay be more ortry of a topsychologicalrelapse, likely medicate to so use the themselves drugs distress,drug usewhen ratheris with notthey causalthandrugs are a Anxietyofill, mania as Disordersa result and inof and psychosis.impaired Panic Attacks judgment; this is seen commonly in certain phases etWe 1996;1986;al. are 1993; 'Whitaker-AzmitiaJansencurrently McGuire 1997) limited of et adverseal. toand 1994, a Aronsonhandful Ecstasy Kemmerling 1989; ofreactions case Pallanti reportset categorized al. and1996; (Greer Mazzi McCann as and 1992;anxiety Tolbert Hermieet disor- al. portsdepressionencedders. inThe adverse which communications as aformseffects long-term of suggest anxiety outcome. I have that disorder receivedanxiety This currently is disorders fromconfirmed appearpersons are by tomore who thebe more common publishedhave common experi- than re- PDF compression, OCR, web-optimization with CVISION's PdfCompressor 98 Risks of MDMA Use tiallythosethatthan the affectprincipally serotonergic the former. involved terminals It is in more mood involved likely control thatin anxietyand the that realdepression, control MDMA explanation are may once distinct liespreferen- the in fromacute the effects of the drug have passed. It is possible anxiety-generatingpsychologicalDepersonalization effects and material ofMDMA Derealization in the in termsunconscious, of impairing as discussed psychic defensespreviously. against ings,Depersonalizationandglass not meaningless; wall. "real," Derealization unable refers surrounding to to feel is feeling a emotion,state people that in which onemayand isseparated bethe detached described environment from from as the cardboard-like. theappears world surround- byunreal a Theseotherfatigue,and Boningphenomena drugs, depression, 1993),such have as but anxiety ketamine,been there reported schizophrenia, are which many in association is other particularly epilepsy, possible with associated and, Ecstasyexplanations, most use likelywith (Wodarz suchthis of all, ef-as Depressionmayfect (Jansenoccur andspontaneously 2000, Mania 2001). Depersonalizationin and derealization disorder also the general population. A depressionthebrief1998). drug period Drugis also common of use lowhas may beenmood (Curran be reported associated a form and (Benazziof Travill self-medicationwith coming 1997).and Mazzoli downA oflonger preexisting1991;from lasting the McCann effects depression form et of al.of nals,nipredictedor latent however, depression, on theoretical generally rather grounds, show little owing difference to linksAnimals in between their behaviorwith mood extensively and relative seroto- damagedto cortical serotonergic nerve termi- than a cause of depression. Depression may be bers),appearscontrolet al. and 1989).animals to not alter thoseIt several onemay of type be a weeks secondthis of serotoninsecond later. system Itsystem isin possible the that brain controls that (the this "fat" is becausefibers) (Molliver MDMA terminal preferentially (the "thin" fi- mood, appetite, sleep, occurterntheand structural sexmatches for drive. a few thechanges Chemical days weekly after typically cyclechangesEcstasy of are use.findingslast not for seen a in week (Molliver humans, in this whereeta!. second 1989). low system, mood This pat- maybut PDF compression, OCR, web-optimization with CVISION's PdfCompressor inducedConductingCognitive problems good withresearch into persisting (as distinct from acute) drug- Deficits (Impaired Memory, Attention, and Concentration) Mental Health Problems Associated with MDMA Use attention, and concentration is very diffi- 99 effectsregularForcult. example, The of cannabis numberany moodit is ofsmoking essential disorderalternative andto that control explanationsexcessive affects for cognition. thealcohol for use any of consumption,It otherproblemis crucial drugs, is that always particularlyand all forclaims high. the habitualmetabolites,theof persistent subjects smokers. which are problems Itclear iscan not oftake bepossible all accompanied atdrugs least to and testfour theirfor weeks by alcohol metabolites, evidence to disappearuse inthat thisincluding the fromway, urine buturine cannabis tests liver in of Ecstasynabis.thatfunction are Krystal use,not tests accompaniedand shouldet thereal. (1992) show is a relatedby normalnoted published subtlereport results. memorybyParrotturine Reported test deficits etdata subtleal. may(1998). in memoryassociation be [Seedue deficitstoappen- can-with Thedowndices self-report forproducts more (metabolites)details of subjects on memory regarding havePersistent beenstudies.] personalcompletely problems drug eliminated use are isthose often from that inaccurate the are body. still present once all drug break- disappointandtions, isthen peopleunacceptable deny them often any or lapsebeuse for excluded to researchand the use experimenters, from variousof this the nature.study.drugs because whileIt Despite is not taking they enough the dopartbest notfor inof wishauthors studiesinten- to drugisto itsay enough tests that mustsubjects to say be that published,were urine asked tests along toWhen abstainwere with Icarried was thefrom studyingrest out.drugs of The the for long-term actualreport. several results weeks.users of of Northe high-dose Ecstasy, many of the beds—wherefewendocrineurine minutes; tests testwere theyon at positive mythe were laboratoryreturn, supposed for cannabis.I found one to Saturdaybethat I lyingrecall both still—and carrying morning.subjects out werehadI left a risensix-hour leaningthe roomfrom outneuro- fortheir the a contaminationlishwindow these smoking test results, of thecannabis. data owing from It to seemed thevariousIt is extent also better sources. important of science,the uncontrolled to ineliminate the end, variables the not possible to pub- and effects of depression, anxiety, PDF compression, OCR, web-optimization with CVISION's PdfCompressor thatand100 depression and anxiety impair memory;other attention, mental healthand concentration. problemsRisks on oftesting MDMA Usecognition. It is well recognized ingsignificantlyWhere takes investigators place, to the a withdrawal results have ofnot a syndromestudy.excludedIf subjects these may have resultfactors, been (going told they to may"cold abstain contribute turkey"), from all drugs before cognitive test- abstainingandexample,which impaired could even from confound function. stopping long-term regulartestsThere daily conducted is coffeecannabis some intake controversy during use. can Irritation this result concerningwithdrawal inand headaches, anxiety theperiod. are effect fatigue, some- For of othersubjecttimes drugs.noted. group. In manyIt is particularly drug studies, importantIt thereis essential is a to subtle match to have bias carefully fora control the controlfor groupthe usegroup that of is a genuine match for the toPersons Thehave Pandora's usedwho havefewer Box taken drugsSyndrome large and quantitiesto function of at such a higher drugs level as LSD, than MDMA,the subjects. and volvesketaminethat(Jansen usually a high for2000, a separatelevel prolonged 2001). of internalconsciousIt is period as if mental perforations mayfrom show imageryunconscious signs have but ofbeen no processes,a mental perceptualmade instate with the disorder that defensesmaterial in- percolatingconditionopened,found. I ithave isthroughproved not named serious. impossible the this conscious It syndrome does to notpush mind preventafter back where the in the legend everything it afflicted would of Pandora's notperson that normally flew from box: out. going beonce The lostduetionto work theirtoare failure impaired,or edge going to or attend aboutlack however, focus. tothe new normal and information. this business may lead ofThe to life. anperson Attentionapparently may beand poor said concentra- memory to have FlashbackssearchersFahyEcstasy 1992). users and who Post-traumatic Thehave use term thisdescribed term"flashbacks" Stress should flashbacks Disorder define is used(Creighton exactly widely what et but al. they rarely1991; mean. McGuiredefined. The term Re-and PDF compression, OCR, web-optimization with CVISION's PdfCompressor afterreexperiencescommonly an intervening some ofperiod the subjective of normality. effects This of is taking clearly the very drug in question, refers to episodes of a few seconds' duration in which the person Mental Health Problems Associated with MDMA Use different from 101 widerelivingsistentthe rangemedia-generated of perceptual theof possibilitiesfull drug disorder impression experience. and has should notthat The yetbea termflashback subdivided been flashback described is intoa complete, covers categories. in the a potentiallyliterature A per- in unprovoked sificationconditionconnection ofin with Diseaseswhich MDMA, flashbacks (lCD- as 10)opposed Weoccur: (World can PTSD.to learn LSD.Health more The Organization Tenthabout drug-relatedInternational 1992) flashbacks Clas- by considering another defines stressfultressceptionallyPTSD in as almost and a delayed threatening perceived anyone. and/or asA or smallcatastrophic. catastrophicprotracted number response Predisposing nature,of MDMA towhich a stressful factors, is likely suchevent to ascause of person- an dis-ex- experiences may be very cientmoreality problemstolikely explain or oraggravate it. a history its of course, neurosis,lCD-b but may make the development of PTSD describes the typical symptoms of PTSD as including episodes they are neither necessary nor suffi- casesriences.backs)of repeated cited or In dreams. abyreliving case Creighton Flashbacksseries of the ofet traumaEcstasy-associatedal. are (1991) more in the likely form after of flashbacks, intrusive very traumatic memories one of drug the (flash- threeexpe- described a woman who had been ab- thesuggestsinvolvedducted importance and mayheavy raped have of daily consideringwhile been cannabis underdue to polysubstance theuserssuch influence substanceswith LSD-like use of Ecstasy.inand the features,conducting The whichother drug twoCreighton analysis. cases pills. This underscores bedenyingchanges the extreme brainin the changes, brain.stress thatThere albeit produces is of Ita aviewis resolving unlikely,this that change some nature but rather formsnot (Stein impossible, than of et PTSD aal. neurochemical 1997). lead that Itto flashbacks may un- are due to persisting thathavemechanismseffect lingering been specific linked ofdrug to action theto quantities flashbacks. drug, in the since inbrain the Therea wide (forbrain is example,array nocause evidence of flashbacks. drugs LSD to withand support ketamine)quite the different notion also PDF compression, OCR, web-optimization with CVISION's PdfCompressor "converted"disorder102 (formerly into psychological known as hysteria), symptoms,Other where just anxiety as it maywith bea neurotic converted basisRisks into ofis MDMA Use drug-related flashbacks may be a form of psychological conversion somephysicaletysons andresemblance who symptoms, panic have attacks never to suchthe taken may flashbacks as aanydescribe "paralyzed" illicit described visualdrugs arm. butand by Itwho othersome is worthare prone noting to severe that per- phenomena thatdrug bear users. anxi- InsomniaSleepmon, butDisturbance that in apersists few cases for itseveral has lasted days for after months, taking Ecstasy is relatively com- with excessive dreaming and sufferingtory,tentsometimes reduction although from nightmares in sleepthe the subjects second disorders (McCann stagein orthis oftoand investigation sleepbe Ricaurte, in hasdistress been 1991a). were(Allen verified not Aet minorinal. a 1993). sleep but persis- considered to be labora- lowofTheEcstasy—A purposes, for sleep particularly (to "come down"to overcome from thethe drug)stimulant oruse to effects ofprolong Ecstasy of Ecstasyand may strengthen be and associated al- with the use Stepping-Stone to Other Drugs? of other drugs for a variety heroinhol,(minorthe stimulant and fortranquilizers, cannabis this effects purpose often suchand inare avoidasthe used. diazepam United sleep. There Kingdom, For which also the has isfirst also possiblybeen purpose, known a rapid owing asbenzodiazepines rise Valium), to in a smokingmassive alco- pleasureexcessively,used.increase There systemsin supply. iswhich a link in maytheFor between brain. thebe related second taking to purpose, Ecstasythe effect andamphetamines of athese desire drugs to smoke and upon cocaine dopaminecigarettes are asomeTheTolerance daily people, basis, andregardless there are of certainlytolerance, a fewfor prolongedpeople whouse of almost any substance can become and Dependence compulsive and excessive in periods (McGuirehave taken and Ecstasy on PDF compression, OCR, web-optimization with CVISION's PdfCompressor Eventually,250Fahy 250 mg taken orally had almostmg no effect at all (Jansen1991; Jansen 1998). 1998). It isof IMDMA have described powder intravenously,the case of a person up to four who times injected a day for six months. Mental Health Problems Associated with MDMA Use 103 volvehavedayfar moreconsumptionnight had common,untila reasonable Monday of however,20—40 amountmorning, pills for of ofwithhabitual sleep, the four drug not andrecovery in consumed troublingbinges days lasting Ecstasylargebetween. from quantities use IfThurs- peopleto in- of fourthquiteafterother takingsevere,drugs, day, with Ecstasy.and and relativenot irritability goneBy recoverythe "clubbing," third sometimes ofday, mood manyhowever, are on seen.feel the lowelevatedfifth This mood, day. continues in The which mood cycle intomaythe often daythe be tinuallyotherrepeats round itself,by the of with recovery.drug, Ecstasy even Thus, if use they some onThe take the personsso-called itfifth, only mayon love weekends. be effect said to fades be affected with repeated con- use, and the subsequent ef- sixth, and seventh days and an- initially,usersplainfects mayinare part nowvainly become some impossible attempting of more the escalationowingamphetamine-like to recover to neurochemical in dose levels (Peroutka andseen psychological in1990). recent This years: may changes some ex- the mental state that they experienced nalsreasonsin ofthe canthe brain fordrugresult escalating and and in mind increased the fact doseresulting that levels,use underfunctioningof from amphetamine-likeamong repeated use. of serotonergicThere substances are other for nerve pharma- termi- them, the substantial drop in price possible associateddrome,cological nor reasons,with is physical tolerance, as has withdrawal psychologicalbeen foundIt is essential.not in dependence, animalnecessary The studies possibilityto and take (Lyness withdrawal a drug that et every al. MDMAsyndromes 1981). day is to cause a dependency syn- amine"stacking"controlledwill surprise itself. group).circumstances In those the lateIn Apollonian this 193 context (asOs, distinctthe users it American is whovaluable from take Medicalthe to the Dionysian,recall drug Association the only history three-day occasionally approved of amphet- party in the foundusetionscompany of thirty-nineamphetamine had Smith,been found.licensed Kline for Between aand wideuses French for range 1932 amphetamine, and 1946, includingthe pharmaceutical the treatment industry reassured physicians that no serious reac-of disorders, and the pharmaceutical of PDF compression, OCR, web-optimization with CVISION's PdfCompressor 104schizophrenia Risks of MONA Use and tobacco smoking [for see Lukas 1985]. It was not psychosisthatuntil amphetamines was relatively were commonaddictive Theamong and extreme that heavy amphetamine-associated fatigue,users.the excessive sleeping, paranoid anxiety, insomnia,late and1 960s, depres- after numerous case reports, that it was officially accepted Ecstasy.pectsbonasion that fideof thisMDMA follow withdrawal clinical cessationhas picturean syndrome. effect of may long-term on dopaminergicbeIt hasshared notamphetamine byyet long-term systemsbecome use thatapparent users are is similarregarded of whichhigh-dose to asthatas- a becauseandpleasureof stimulants Oberlender systemsof the associated rapid1989). in a manner loss with of resembling theIt empathogenicwas once amphetamine believed effect that and with MDMAcocaine repeated (Nicholswould use be free of any dependency risk and it activates dopamine-based youngeramphetamine-likeolder(Peroutka group users 1990). of in people the Whilequalities dance who loss and takeculture of have this MDMA differentmayeffect forcome may expectations. its leadtoempathogenic appreciate to declining This group theproperties, use more rarely in an Becauseamphetamineexpecttakes pure amphetamine-like polydrug compounds or MDE, use is ratherand very effects may common,than have fromMDMA been manya pill, [for conditioned ofsince review, those many who see from pills partySaunders the are, throughout outset in 1995]. fact, to MDMAEcstasy.the weekend from This other deliberatelycreates pleasurable a milieu take instimulantsA amphetamine whichquestionnaire the are particular diminished.and administered other effects drugs that toin one additiondistinguish hundred to Ecstasy users in Sydney, thathowever.pendentAustralia, it was (Solowijet Forty-sevenfound possible that al.to 2 percent1992).becomepercent Theof ofdependent respondents the value sample of onsuch considered inMDMA. thea self-report study The themselves expressed animal is questionable, evidencetothe be belief de- tioniorterminalssuggests in has monkeys been a do dependency notlinked (Lamb result to and increasedpotential,in reduced Griffiths self-administrationand frequency 1987). presumed In offact, changesMDMA impaired of amphetamine, inself-injecting serotonergic serotonergic because behav- nerve func-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor sureof systems in a complex interaction the between serotonergic systemspleasure and centersdopaminergic (LynessMental plea- Healthet al. Problems1981). Associated with MDMA Use 105 ment.MostTreatment Where outside help is Ecstasy-associated problems resolve over time without special treat- sought, the approach should address biological, areandtakepsychological, aadvice. responsibility good long-termFor social,problems for andthemselves, that spiritual do not inissues. involve tandem People psychosis, with should professional drug-free be encouraged assessment treatments to investment in terms of remaining well, avoiding side lems;bookside.effects, It onthere should and overcoming are placing be many possible thesuchanxiety, locus forbooks. most panicof control literate attacks, inside persons depression, the at person least and to rather buysleeping a thanself-help prob- out- usingorder,to drug person which use—vastly or suggeststhe family, preferable something who may toIt isa more be best only fundamentalto tooavoid ready automatically to and make potentially an attributionaccepting uncon- the conclusions of the drug- diagnosis of schizophrenia or bipolar dis- maskedandsymptomstrollable. mania by It inthe is theany alsoeffects contextcase. worth of That theof bearing Ecstasy drug,is, they orin usemay themind maydrug have that be may an peoplemore inherent have prone whoprecipitated predisposition toshow psychotic a relapse un- schizophrenia state,andallof atypes psychosis.preexisting a misdiagnosis of drugs The condition. without reverse of schizophrenia stepping Most error people isvery also orfar can possible:mania over absorb the may in linesubstantial an between acutely quantities intoxicationintoxicated result in inappropriate of hospital.treatmentTo Talk Downwith antipsychotic or to Medicate? drugs and the risk of committal to a psychiatric recoverInbethree an established acute mainwhile situation, options: waiting that thewhiledoingto seeperson nothingthea doctor), person is physically (which is still is affectedsafethe usual and by hasapproach—people the not drug, taken there are may talking down, and medicating. It must unknown PDF compression, OCR, web-optimization with CVISION's PdfCompressor physicalIfquantities 106the person concerns, has taken which these may then involve psychological monitoring care and must nursing be secondary in an appro-Risks toof MDMA Use of sedating drugs, such as alcohol, GHB, opiates, or tranquilizers. possibly,treatedmostpriate persons care by administration placingunit seen to ensure theby healthaffected ofphysical lorazepam and person emergencysafety. in(Ativan, aPanic quiet services. isa room, fast-actingthe most Thiswith likely reassurancerelative diagnosis of diaz- and, of condition can be suranceflashbacksepam) if in the aand low-stimulationperson PTSD, has the not use already environment) ofBecause talking taken downsedatives.of requires the (nonjudgmental link serious between traumatic verbal reas- drug experiences and subsequent reevaluation. If a pleasanttoshouldperson relieve experiencewhobe anxiety,given has takento possiblyadministrationand a haspsychedelic withsought oral of professional orlorazepam diazepam dissociative toas help, follow.an drug intramuscular early is This consideration injection having a very un- will substan- doltionstially (Haldol), inlower a way the should that risk talking of not subsequent be down used,Antipsychotic does regardless PTSD not. and drugs,of other agitation suchanxiety-related asor chlorpromazinepsychosis. condi- It is (Thorazine) and haloperi- fectsperidolnotalso widely may be usually avoidedbe appreciated -additive take because several to that those their theweeks of antipsychotic anticholinergic MDMA to manifest. and effects whatever Antipsychotic and numerousof suchelse the drugs otherperson should side may ef- drugs as halo- havetheataken cause consumed.overheating is ofanother the rareThe argumentsyndromes neurolepticincreasing against associated likelihood malignant the use with that syndrome,of haloperidol. severalseveral Ecstasy-relatedsubstances Haloperidol have deathsbeenis also which may be linked to Psychotherapy(AmesFor some and conditions, Wirshing 1993). counseling, psychotherapy, and cognitive/behavioral person'sample,acutetherapy situation life"Let's is indicated.rather examine has than passed. This researchthe effectcan Denial be findings. that considered can taking be The dealtten fortherapist Ecstasy withpersistent using mightpills effects everyfacts say, weekendforonce ex- the from the PDF compression, OCR, web-optimization with CVISION's PdfCompressor Mental Health Problems Associated with MDMA Use 101 Wednesdayis afternoon .having on your studies.. . . . on youron life in general now that youyour finances.. . on the way you feel by have been pillsarrestedserotonergicdown." to save and This money.charged nerveapproach . terminals.with is intentbound Where to to supply be the more symptomsbecause effective you have than bought a discussions strongly a big bagneurotic about of . on your increasing tendency to smoke heroin to come onandconsidering.character, the a working drug-taking psychodynamic The through approach of difficult involvespsychotherapy psychic a gradual or material. formalexploration The focusof the isunconscious, not behavior itself. psychoanalysis is worth usually iViedicationanxietyunderlyingIt is possible disorder disorder that personality the thatperson should disorder,who be abuses treated or incipient Ecstasy separately, maypsychosis. such Ifas depression, be self-medicating an such a condi- sants,tionfor 1998).is depression,such identified asAs fluoxetine noted oranxiety; suspected,earlier, (Prozac) panic however, treatmentand attacks, paroxetine after and should the sleep acute be disorders crisisaimed has at (Windhaber it.passed, itis et (Paxil), can be useful treatments Antidepres- usually al. nondrugcangiene,best beto avoiding tryused methods nondrug for caffeine, a failshort approaches to andbringperiod eating results, first,to andtreat including but exercising these emphasizing drugs properly. are potentially good panic attacks and severe anxiety if Benzodiazepines sleep hy- addic- totive drugresolve and of are choiceafter best several notis olanzepine used drug-free for more (Zyprexa), Ifdays, itthan becomes an a fewwhich weeksclear is sedatingover at a thetime. andcourse can of time that psychotic symptoms antipsychotic drug is required; the be taken fail ofbecausebearonce psychotic inonly, mind a patientat symptoms night.that awith drug-inducedWhen psychosisto themaking use ofhaspsychosis an Ecstasy assessment,been using mayshould havedrugs. not the beIncorrect effect diagnosed of attribution however, it is important to withhold- simply medicationsphreniaingservices; proper or caremanic-depression.moreover, to preventand education their relapses families Theseabout and are theirdopatients not not illness appropriately avail are fromthemselvesnot prescribed persons educated. adequately ofwith schizo- Thelong-term result PDF compression, OCR, web-optimization with CVISION's PdfCompressor underlyingwithis108 relatives, psychiatric and avoid adisorder very jumping high that relapse tois associatedhasty rate. conclusions. It iswith thus drug important There use by may tochance. take beRisks aan A careful of MONA Use speak attributeitytionurine of with drugEcstasy symptomsdrug screen usersuse. is It essentialtoare is the alsopolydrug wrong important when drug.consumers, psychotic to note symptomsthatand thecare overwhelming must are seen be taken in associa- major- not to Meditation,areRelaxation widely available. exercisesRelaxation, Meditationmay Martial be useful Arts, involves forand persons Physical learning with Exerciseto attend anxiety to problems.a single stimulus Tapes concentration.strengtheningders,without particularly allowing theThey thePandora's "signal-over-noise" areattention demanding Box to wander.Syndrome. and ratio requireThis Martial and is usefula improving change arts for are ofa range alsolifestyleattention useful of disor- from and for psychostimulants.andendorphinweekend-long gym work rush, canraving. and be encourage valuable They can for self-control. also persons meet who high Most wish stimulus forms to stop of needs, physicalthe regular provide exercise use an of AntioxidantstoxicityandSome vitamin Ecstasy[see and E. "Does Food There users Supplements:MDMA is also evidence take Cause highTryptophan that Brain dosesfree Damage?"].radicals ofand antioxidants, Tyrosine may Theplay supplements sucha part as in vitamin neuro- ty- C personsandtophanrosine turkey and istaking severely tryptophanare MDMArich restricted sources maymay elevateprofitof in tryptophan, some from levels countries. eating of and serotonin, these it Bananas, is foods.a valid but Itchocolate, thesuggestion is also use possibleof milk,tryp- that nmserotonin,to obtain aand product 5-HTP called is actually "5-HTP one serotonic." stepin closerthe biochemical 5-HTthan tryptophan is another pathway to term thatseroto- forforms serOtonin. stasyTheConclusions are unknown. Many of the disorders that havetrue been levels reported of serious may adverse be psychological effects linked to taking Ec- PDF compression, OCR, web-optimization with CVISION's PdfCompressor relatedconclusions drawn by single case to both psychological that these studies should be disregarded. There is still a Mental Healthand neurochemical Problems Associated events. with MDMA The cause-and-effectUse studies must be viewed with caution, but 109 widespreadaspsychedelic-inducedthis does not tendency mean psychosisto diagnose when persons they are as suffering from manicdepression, borderline personality disorder, or prob- suffering from MDMA or such conditions canofamine.lems sufferers have related This some totendency to seek the usean isexplanation of control. strengthened by thedifferent natural drugs, inclination such onas alcoholthe part or methamphet- external to themselves, over which they

PDF compression, OCR, web-optimization with CVISION's PdfCompressor DOESDRAIN0 •MDMA DAMAGE? CAUSE andMatthew John Méndelson, Baggott M.D. The acute toxic effects of MDMA are well documented by hundreds of case MDMA,ingamphetaminereports how many inof general,adverse people (speed) appearsevents use with Ecstasy, reported torespect be similar serious toamong the to risks acuteillicitsuch of psychostimulantsadverse usersacute oftoxicity. eventsthe drug. Withseem as Consider- meth- trainedrare. searchtoringpersonnel,Indo not andwith present properlytreating MDMA. a strongadversescreened argument events, volunteers, these against and acute establishedcarefully risks seem conducted protocols to be modest forclinical moni- and re- thatdamage MDMA are more can difficultproduce tolong-lasting assess.On Numerous thedeclines other studies inhand, brain in the animalsfunctions risks associatedhave involving shown with possible long-term brain studiesdetectedLastingthe neurotransmitter of behavioral and Ecstasy are fairly users changes serotonin. subtle suggest in when MDMA-exposed a The strong they meaning areprobability found. of animals these Though that changessimilar seldom limited serotonergic is have inunclear. scope, been erschanges support occur an associationin many humans. between Studies modestly comparing lowered Ecstasy scores userson tests and of nonus- men- hO PDF compression, OCR, web-optimization with CVISION's PdfCompressor therenificanttal is no performance increased incidence impairments ofabilities clinical have not(cognitive been detected. performance tests), and Ecstasy use, but clinically sig- complaintsDoes or findings. Cause Brain Damage? In other words, I I I thoughpoliticallyies have fenfluramine led motivated some people and and to methamphetamine alarmist. dismissThe modestconcerns It is commonly findings generate of pointed MDMA out neurotoxicity in certain about MDMA neurotoxicity as similar changes, their behavioral stud- that even publishedsuresonablestatus are as to unknown.prescription studies note, however, have In medications investigated that the was trulywhether not long-term MDMA effects exposure can cause fifteen years of research on MDMA neurotoxicity; no affected by this finding. It is rea- of MDMA expo- sig- neurotoxicitycaltakennificant studies. into toxicity account Perhaps is that when the becomesthere singleconsidering may apparentmost be significant worrisomethe only risks with and impairment issue aging.benefits surrounding MDMA This fact must beof possible clini-associated with havepeopleserotonergicterm not adversehave been taken changes sufficientlyeffects. millions that Possible largeis of undetected doses to detect of Ecstasy, atany present. but controlled the most common adverse effects, such as a higher than normal Although millions of studies of users long- incidencethetions risks of ofMDMA in affective research neurotoxicity disorders, volunteers. like weBecause It depression, isbelieve hoped so that littlethat may it theis is haveknown important gone about to the possible long-term information presented clinical implica- unnoticed. minimize hereaction,ingassociated will of MDMA-induced factorscontribute with influencing MDMA to assessments serotonergicuse. the In severity this of chapter andchanges, of theseperhaps we theirdiscusschanges reductions the nature in, possible mechanisms of (such as dose, route and mean- the risks termscourseofon administration, the of of implications thethe behavioralchanges species andof and andrecovery animal strain, and environment), long-term MDMA-induced serotonergic changes in functional effects of these changes in animals. from them. Later in the chapter we focus and the time Westrategiesdatapersonality, also from discuss forclinical cognitive, limiting studies studies risk andcomparing in tofunctional which human EcstasyMDMA volunteers. assessments, users was to andnonusers we review administered and potential in terms of available PDF compression, OCR, web-optimization with CVISION's PdfCompressor 112 Limitations Risks of MDMA Use of space prevent a full discussion of every important article Seidenarticlesviewsabout andonMDMA and(McKenna aspect Sabol ofneurotoxicity,1996; and this Peroutka Spraguecomplex the 1990; ettopic. al.reader 1998;Steele For is aadvisedHegadoren etbroader al. 1994; to consult et Green al. 1999; other et al. Boot review1995; et sense of the range of Therededicatedal.Long-Term 2000; is also Burgess toan MDMA entire et issue al. neurotoxicity 2000; of the Morgan journal 2000;Neuropsychobiology O'Callaghan and (vol. Miller 42, 2000) 2001). Serotonergic Changes with MDMA tousedsaryBefore as toin"neurotoxic defineresearch a few that regimens." terms. produce In Neurotoxic long-termthis serotonergic regimens often changes consist of four todiscussing MDMA-induced changes and their meaning, it is drug doses and dosing patterns are referred neces- is chapter,ever,eightconsidered ainjections single any "long-term." changes injection of MDMA noted of MDMAMany givenat seven studies overalso or can themore examining coursegive days rise of after tothe these brainsdrug changes. administration of animals In this one to four days; how- nature.thatafter the longer MDMA-induced time periods (often changes atThe two, at termseven four, "neurotoxicity" days are primarily is more long-term difficult in tc) define. Although or eight weeks) have established no univer- whetherageshort-termsal definition caused MDMA alcohol-inducedby exists, theis neurotoxic drug most MPTP. definitions headaches is toA describemore are and useful broad the the nature approachpermanentenough and to to mechanjsms the question of of encompassnerve cell both dam- radicalsincomesaction the serotonin-containing ofevident (reactive the long-term that chemicals some changes neurotoxic thatnerve can cellsit damage can MDMA and cause. acutecells) regimens Using damageand thereby this cause to approach,the precipitate both brain changes by it lossfreebe- doses.inducedof nerve These damage,cell axons. long-term even This though changessuggests theMDMA consequencesinclude thatMDMAneurotoxicityis produces decreases of long-lasting this in damagebrain concentrationschanges to the serotonergic system at a type ofare drug- unknown. some PDF compression, OCR, web-optimization with CVISION's PdfCompressor laseproduct,of (TPH), 5-hydroxyindoleacetic the enzyme thatthe begins neurotransmitteracid (5-Hi[AA). the serotonin (5 -HT) and its metabolite, or synthesis of Does5-HT tIDMA within Cause the Brain sero- Damage? Levels of tryptophan hydroxy- breakdown I 13 studiesneuronsreuptaketonergic suggest thatnerve transporters recycle cell,that MDMAare (SERT), lowered primarily proteinsby MDMA. causes on theThere are released 5-HT by pulling it back into the cell. Most long-term changes in seroton-membrane of serotonergic also fewer serotonin thatdorsalergic serotonergic axons raphe that nucleus. have axons their are cell permanently bodiesLong-lasting in an lost, area decreasesor in these serotonergic markers suggest of the brain stemthat called some the type of "down- either torotoxictainingregulation" drug fewerstemseffects, has fromof occurred,whereasthe this markers. issue. meaning Down-regulationThe question that the ofnerve suggests cell is an axonal loss indicates that true damage may have whether MDMA is truly neu- makingand main-active adaptation mayfactors(Ramamoorthyoccurred. change can Determining ininfluence response et al. 5-HT 1998; whichto levels. Le really Poul Because happens et al. 2000).MDMA can be drugs, but this has been difficult to establish Similarly, diethas and beendifficult. other shown SERT to inac- density subsequentuntiltivate TPH the enzyme activity SERT TPHdown-regulation returns rapidly, to normal. diminished at Thus,first appear to 5-HT levelsdecreased would 5-HTbe expected synthesis and By examining the structure be a plausible explana- MDMASerotonergicoftion serotonergic for also MDMA-induced can Changes cause axons Accompaniedaxonal in MDMA-exposed serotonergic loss. by Structural changes. Changes to animals, however, it is clear that Axons changesAntochemistry,taching important involves a marker approach5-FIT staining to isthe stained, 5-HTtobrain understanding molecule slicesallowing from throughserotonergic a process axons MDMA-exposedMDMA-induced animals. By at- serotonergic called immunocy-and terminals to fragmentationbeof seen1988). MDMA under Later or ofa measurements, microscope.MDAfine serotonergic (Kalia This et taken al. axonstechnique 2000; two shortlyor O'Hearn four after et a weeks after neurotoxicshows irregular MDMA swelling and al. 1988; Scallet et al.neurotoxic regimen PDF compression, OCR, web-optimization with CVISION's PdfCompressor regimens,1988;114 Scallet et al. 1988; Slikker et al. 1988; 'Wilson Ct al. 1989). The initialRisks of MDMA Use also show a persistent decrease in stained axons (O'Hearn et al. in thatstainedswelling5-HT immunocytochemistry are axons suggests accompanied indicates some axon typeby cannotchanges loss.of axonal Somedetermine in thedamage, researchers axons whether while themselves. have measured the argued, later Because decreasedifferences however, of in taretechniquesthis limitation,and function. that itdo is Lastingnot necessary rely reductionson serotonergictoTransport confirm in axonal theof markers. materials apparent transport withinloss suggest of axons axons a isdrastic using crucial for maintaining cell struc- jectedbrainassessimpairment regions intoaxonal the of transportthatcortex axonal serotonergic (the functioning by outer measuring layer axons and, of the should themore movement brain) likely, connect. the oflossfluorescent compounds For of axons.example, dye Onebetween Fluoro- if canin- (FritschyregimensbrainGold shouldstem. etof Axonal al.beMDMA 1988;transported transport Haring(Ricaurte along studieset al.1992).et serotonergic al. have 2000) Thebeen and results axonscarried parachioroamphetamine intosuggest out cell after bodiesthat neurotoxic a loss in the of therelatedaxons vesicular takes drugs. place monoamine after at transporter least someAnother type neurotoxic method II (VMAT2). ofregimens assessing This of is loss MDMA a protein of nerve and on terminals involves measuring indirecttoBecausethe drug storage measure exposure the compartments, amount of (Vandernerve of VMAT2 terminals Borghtor "vesicles," does inet research al.not 1995), insideappear on itthe tosuch is be sometimes neurodegenerativeadjusted inused response as an axon terminals. regimenswould1997)disorders suggest have of as MDMA beenParkinson's that shown nerve (Ricaurte disease.to terminals decrease et al.In other2000) andVMAT2. axonswords, or methamphetamine Therefore, havediminished been at lost. levelsleast Neurotoxic(Frey some of VMIAT2 etneuro- al. clinetotoxic degenerate inregimens serotonergic and of thatMDMA markers. this explainsare Further associatedThese at evidenceleast data with someconsistently structuralof of axonal the MDMA-inducedindicate changesdegeneration that to cells.MDMIA de- can cause serotonergic axons comes

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Does MDMA Cause Brain Damage? 115 Why,apparentreasonfrom then, sproutingis thathas MDMAattempts and regrowth neurotoxicity to measure of axons been the subject studiesof in which recovery from MDMA neurotoxicity is associated with MDMA-induced cell damage itself yield (discussed in more detail later herein). controversy? One In Serotonergicambiguousgeneral, neural results. and cellAxonal damage Changes: can be Evidence detected of by Damage? two fibrillary acidic protein (GFAP). techniques: silver stain- Noting(Comminsations andall neurotoxic measuringonly atet dosesal. regimens the1987; higher expression O'Callaghan usingthan those ofMDMA glial neededand show Miller to increased affect 1993). serotótiergic Furthermore,expression. the These techniques seem to detect MDMIA-induced alter- silver staining or function whatMDMA-inducedarenon-serotonergic aredifficult likely toserotonergic cellinterpret. cells damage (Commins axonsSome detected (Scallet et al. by 1987;Jensen etsilver a!. 1988). staining etal.These appears 1993) inconsistencies toas occurwell as in in researchers believe that they are evidence 2001).thethatare serotonergic MDMA-induced simply Others insensitive have system argued serotonergic ratherto that than the changes techniquesdamage result (e.g., for fromO'Callaghan measuring down-regulation cell and of selective serotonergic damage (Axt et a!. 1994; damageMiller Bendottiergicstrong down-regulation evidenceet al. 1994; of WilsonMDMA-induced cannot and explain MolliverBecause axonalin full 1994). studies the long-term of axonal effects transport of and VMAT2 changes have damage, it appears that seroton- providedMDMA. benignthatweStructural are loss changenot of changes awareaxons in the that representsto nerve serotonergic cell a in non-neurotoxic response axons also to drugs. must form Non-neurotoxicbe of explained. neuroplasticity Although or this hypothesis has been advanced, one could argue (though resultnotage,to necessarily be ofspecifically more alterations likely, beneficial) damage inhowever, serotonin morphologic that levels these (reviewed in Azrnitia 1999). It appears involving oxidative stress. changes are, in fact,changes the result can of occur dam- in the brain as the

PDF compression, OCR, web-optimization with CVISION's PdfCompressor TheI 16 Role of Oxidative Stress in MDMA Neurotoxicity Risks of MDMA Use moleculestionspairedFree called electrons. to reduction carry Free out radicalsandtheir oxidation normal can damage cellular and thereby neuralfunction. altermolecules Neurotoxic theradicals ability through are regimens of highly thesereac- reactive chemicals that contain one or more un- searchersincluding"oxidativeof MDMA free stress" haveincrease radicals, examined is usedoxidative and to therefer the stressburdenMDMA-induced brainsto both in they the ofthe brain.placeMDMA-treated increase oxidative onIn cellular thisin reactive chapter, stress functioning. animals chemicals, hasthe beenterm for shown in two ways. First, re- researchersneuraletthiobarbituric al. lipids, 1997 have a;or Jayanthi acid—reactingfat perfused molecules et theal. 1999).in brainssubstances the brain Increasesof live (Spraguecells, animals in have these and withbeen substancesNichols eitheroxidized. 1995b;salicylate suggest Second, Colado thator mensofdihydroxybenzoicd-phenylalanine. these increase compounds, the These amount researchers substances of extracellular have react shown with hydroxyl hydroxylthat neurotoxic radicals radicals of MDMA tothe form striatum regi- 2,3 acid and d-tyrosine, respectively. By measuring formation - rotoxicity.two(Shankaran areas of Antioxidants et the al. brain 1999a,b) where are and substances serotonergic hippocampusThere isthat strong neurotoxicity inactivate (Colado evidence freeet occurs. al.that radicals; 1997b, oxidative the1999b), anti-stress plays a part in MDMA neu- thewhichwithoutoxidants addition suggests altering ascorbate of antioxidants that levels the and of nontoxic MDMAcysteine (Schmidt effects oreach andMDMA-stimulated reduceof Kehne MDMA MDMA 1990; are Gudelsky not neurotoxicity dopamine being 1996). altered release, in The byrats inducedlatterMDMA-inducedfree radical effect, high scavenger bodyhowever, hydroxyl temperature, N-tert--butyl-alpha-phenylnitronemay formation be ordue hyperthermia in and part MDMA to an (Che attenuationneurotoxicity et al. 1995;decreases of in ColadoMDMA- rats; both the et inducedicitydantal. 1998; aipha-lipoicand hyperthermia GFAPColado expression and acid (Aguirre Green. blocks in 1995; etboththe al. rat YehMDMA-induced1999). hippocampus 1999). Mice Pretreatment that without haveserotonergic been altering with genetically the neurotox- MDMA- antioxi- PDF compression, OCR, web-optimization with CVISION's PdfCompressor superoxidetions,altered probably dismutase because are ofprotected the from MDMA-induced to have large amounts of the human enhanced trapping of superoxide radicals (Ca- Does tIDtIA Cause Brain Damage?antioxidant enzyme copper/zinc dopamine deple- 117 neurotoxicantioxidantthesedet et geneticallyal. MDMA1994; enzymes Cadet modifiedregimen and et al. free (Jayanthimice 1995; radical are protectedet changes al. 1999). seen in normal Jayanthi et al. 1999). At the same time, from the acute inactivation of mice after a vatedStone in and rats colleagues at three hours (1989a), after whoEarly administration reactivated evidence that of MDMA causes significant oxidative stress came from TPH, which had been inacti- high-dose MDMA,showed by that acute in- Whiletainedellularactivationusing sulfhydryl-reducing brainoxidativea single of concentrationsTPH injection stress byMDMA appears ofconditions. ofMDMA was MDMAto duebe an intoThisto effect(orintracellular theexperiment a centrally brainof MDMA had no oxidative stress. Intrac- formed metabolite). that requires sus- effect on TPH activity,ofandduced MDMA Taylor enoughslow and1988).infusion oxi can dative The be of seen 1immediate stressmg/kg fifteen to MDMA reduce declineminutes TPHinto in after theTPHactivity activity is an administration (Stone etbrain al. over one hour pro-immediately (Schmidt early effect itythatdoses1989b). when MDMA (Schmidt the TPH brain'srapidly inactivationand freeTaylorinduces radical 1988; also oxidative scavenging can Stone be stress producedet al. systems but 1989a,b). only by non-neurotoxic It become overwhelmed.produces neurotoxic- therefore appears MDMA damage,serotonergicenzymes. when This anneurotoxicity increasedamage inseems freesince radicalsInto treatments summary; damages thatMDMA neuralcurb neurotoxicity involves an be part of the sequence of events causing initial period of oxidativeMDMA-induced oxida- lipids and inactivates dopaminergicregulationWhiletive stress MDMA also cannot neurotoxicitylessencan causebe the ruled long-termloss has out.of axons,led Research serotonergic some a certain researchers on degree to of changesmethamphetamine-induced (Aguirre et al. 1999). concludeserotonergic that long- down- isterm ergicsonunknown. dopaminergic et alterations al. 1996; For now, Harvey afterchanges it seemsMDMA et can reasonable exposure to indicate that a al. 2000). Whether this is also the case with MDMIA take place without significant axonal loss (Wil- conclude that long-term seroton- degree of damage has PDF compression, OCR, web-optimization with CVISION's PdfCompressor serotonergicoccurred,118 system to short-term drug effects and loss of axons. Risks of MDMA Use while remembering that one is also measuring the response of the Proposedand/orFirst,Several the impair Sources sustainedpossible energy of Oxidative sourceseffects metabolism of Stress MDMAneurotoxic within may oxidative the deplete neuron stressneuronal (Huether have energy been et al. proposed.sources 1997). Therecanquinone-likeSecond, form is not bothfree yet molecules.radicals,MDMA conclusive and Quinones areevidencedopamine thus arepotentially to can moleculesimplicate be metabolized damaging anythat of are these to often to neural highlypossible very molecules. reactive,reactive causes, Theproposedlites,and possible it and is possible thatdopamine roles 5-HT thatof metabolitesenergymetabolites some combination exhaustion orare increased discussed orof mechanismsimpairment, levels later ofherein. intracellular ofMDMA action It also ismetabo- hascalcium,at work. been littlestances)nitric support oxide, contribute orfor glutamate these to MDMA theories. (all potentialneurotoxicity;Cellular sources energy but of current exhaustion cell damage evidence or inimpairment otherprovides in- may cause MDMA neurotox- companiedmagnifyAicity. sustained Normal oxidative by increaseactivity increased stress. of in the neuronal energyMore neuron important, consumption causesactivity a increasedcertaintherefore that degree could neuronalwould eventuallyof oxidative be activity expected lead stress. is ac- to dna,thermore,thedepletion energy-requiring can be ofthe impaired neuronal most important by mechanismsenergy oxidative sources.source stress that of This maintainenergy(Crompton sequence in and each et repairal.of cell, events1999). theneurons. canMitochon-mitochon- impair Fur- neurotoxicitycellulardna produce processes. adenosine is not Insufficient yet triphosphateclear. MDMAATPWhether will (ATP), does lead energy enhancetheto cell exhaustionsource damage the of activity energyor or impairment death. of for the most en- actually plays a role in MDMA ingenergythatzyme have MDMA glycogen beenin the reported couldbrain. phosphorylase reduceMDMA-induced (Burrows glial (Poblete etstores al. 2000),alterations of and glycogen, Azmitiabut itin is mitochondrial annot1995), important yet whichclear iffunction- sourcesuggests these of PDF compression, OCR, web-optimization with CVISION's PdfCompressor ministrationalterationsfound that (HerviasATP levels et al.were 2000), are sufficient to impair unaltered up to three hours after MDMA ad-mitochondria andbut damagesince ATP cells. levels One at study later times were Does MDMA Cause Brain Damage? 119 MDMAriotpothetically, neurotoxicity, a given metabolite but it isMDMA may beexamined, breakdown toxic it remainsproducts, possible or that they difficult to investigate this possible role. Hy- metabolites, also may play a role in diminishonly inover the time. presence of MDMA, leadtions,hours,when to thereadministering ortoxicity. in are the high Thus,context concentrationsthe it toxic ofis hard to certain acute effects of MDMA.metabolite In such on itssitua- own would not necessarily ofinterpret the metabolite the results in the of brain many for studies several in toxicitywhichalpha-methyletal. an1992;Johnson was MDMA found dopamine, metabolite(McCann et al. may 1992; and was contribute Ricaurte Zhao et to administered and no evidence of neuro- al. 1992). The MDMA1991b; metabolite,neurotoxicity Steele et as al. it 1991; is metabolized Elayan intosubsequentlymay compounds be transported oxidized that can (Nashdeplete 1990;It also Schmidt has been suggested that some of by SERT into serotonergic axons (Faraj et 5-HT (Miller et a!. 1997). the dopamine released byMDMAand Kehne 1990; Sprague and al. 1994) and which,Nichols(Grahammetabolite in 1995b). turn, et also al. may The1978;may produce oxidation be Cadet formed, hydroxyland of with Brannockdopamine potential can to generate more radicals. A quinone-like dopamine1998). Among many other pos- form hydrogen peroxide, free radicals MDMAimpairsiblethere toxic mitochondrialis neurotoxicity. little effects direct on cells, evidencefunctioning Some dopamine dopaminergic to support (Berman oxidation the role drugsandof dopamine Hastings alter MDMA metabolites1999). neurotoxic- At present inproducts have been shown to toxicityrelease.ity,temperature but it Many throughis not dopaminergicclear(Malberg nonspecific that this et effectal. drugs mechanisms is are now 1996; Colado et al. 1 999a) or scavenging due to increasing or decreasing dopamine ofthought action, to suchaffect as MDMA altering neuro- body free rotoxicitylease,radicals1991; Shankaran(Sprague (Stone etand et al. al. Nichols 1988; 1999b). Schmidt 1995a,b; Sprague et does seem to play a poorly understood and Kehne 1990; Nash and Brodkin al. 1999). Dopamine re- role in MDMA neu- PDF compression, OCR, web-optimization with CVISION's PdfCompressor RouteDependence120 of Administration, of the Extent and of SpeciesNeurotoxicity on Dose,Risks of MDMA Use rotoxicitypsychoactiveTherats at doses studies (Commins approximately have used Ct al. regimens five1987; to O'Shea ten involving times et al.higher multiple 1998).extent than Mostdoses,of those neurotoxicity MDMA usually known neu- giv- to is be dose-dependent. Long-term changes occur in rotoxicadministeredingof eight MDMA (Battaglia doses repeatedly,carries over et al.aa four-daygreater 1988; a non-neurotoxic O'Shea risk period. of etneurotoxicity These al. dose 1998). studies of MDMAMultiple-dose than show single can that become "binge"doses. neurotoxic neu-When use thesultstonergicregimens same of multiple-dose changesinterval appear tobetween than produce studiessingle-dose doses more are can difficultprofound MDMAhave very to and(Battaglia compare different possibly acrosseffectset moreal. 1988). species,in lasting two The species sincesero- re- withoralergic different administration changes clearance has been of ratesMDMA investigated. of MDIvIA. produceThe effect In comparablethe of rat, the subcutaneous route 5-HT of MDMAdepletions injection administration in andthe on long-term seroton- tofoundyieldedhippocampus two thatthirds less repeated consistent as (Finnegan much oral 5-HTresults. administration et al.depletion In 1988). the squirrel asStudies of the MDMA monkey,equivalent of nonhuman resulted Ricaurte subcutaneous in primates etonly al. one(1988a) dose.have half apparentpalofIn MDMAcontrast, SERT differences activity in Kleven the rhesusas etwas between al. producedmonkey (1989) nonhuman reportedproduced by repeated primate that twice subcutaneous repeated thespecies decrease oral magnify injections. administration in hippocam- the These diffi- whentoxicity.cuky 25 of assessing For example, the risk Logan of oralet al. DifferentMDMA (1988) administrationwere animal unable strains to indetectand humans. species neurotoxicity differ in sensitivity tomg/kg MDMA neuro- of MDMA was administered to randomly bred albino rats. In animaldifferencesandcontrast, 10 housingmg/kg in alsodark of (Gordon may agoutiinjected be ratsinfluencedand MDMA 5-HTFogelson depletions (O'Sheaby 1994;differences et Dafters appearal. 1998). in 1995).ambientat a These threshold temperature apparent between strain and 4 PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMA1989; Ricaurte neurotoxicity; and McCann suffering 1992;Compared more Ricaurte damage et al. at 1992; lower with rats, nonhuman primates seem to be more sensitive to Does IIDMA Cause Brain Damage? Au etal. 1993; Fischer doses (Insel et al. 121 MDMAbetweenthresholdetal. 1995; neurotoxicity 2.5 dose see and also for 5 mg/kg producingDe studies Souza of oralhave et long-term al. MDMA. used 1990 squirrel for5-HT Two slightly depletionsweeksmonkeys as in this species is different results). Manyafter a single 5.0 mgI subjects. The nochangedinkg thelong-termoral hypothalamus MDMA in other serotonergic dose,examined and 5-FIT 79 brain percentlevels regions declined of controls (Ricaurte to 83in etpercent al. 1988a). In contrast, changes were seen in squirrel monkeys after 2.5 the thalamus but were not of control levels mglkg.—Ed.}mg/kgtherapeutic(Ricaurte of MDMA unpublished dose of was 125 observations, given rng of orally MDMA cited every in in a Vollenweidertwo 150-pound weeks forperson et al. 1 999a). [The four months equals 1.66 key.multiple-dosethis It species, is difficult since neurotoxic to all determine published regimens. theAnother studies threshold In one usingcommonly study, rhesusdose 1.25 forstudied monkeys 5-FITmg/kg nonhuman of oral MDMA primate species is the rhesus mon- have employed depletions in notloweredfordid fouraffectnot produce consecutivehippocampal levels inany six long-termdays. other5-FIT Similarly brain levels serotonergic regions (to repeated about changes 80doses percent of when 2.5 of mg/kg givencontrols) twice but after one month (Au et al. 1993). In of MDMA daily did siveintramuscularlyatanother sixteen(possibly experiment, to eighteenshort-term) to rhesus Insel hours monkeys 5-FIT et afteral. (1989)depletions twice found daily but forthat did four 2.5 not mg/kgdays produced of MDMA exten- the last drug exposure. Since SERT density alter SERT density given MDMAneurotoxicity,wasdespite unaffected, the 5-FIT the researchersdepletions. Frederick andIn associates a study that (1995) raises investigated interesting questions about possible concluded that axonal loss had not occurred, tolerance to the long- MDMAlartermdays MDMA effects at doseseach (0.1—20 of dose escalatingup tolevel, mg/kg)5.6 followed mg/kg.doses was of given Oneby MDMA three monthtwice dose-response daily after for the fourteen final regimens in rhesus monkeys. Intramuscu- dose-response consecutiveusing single PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMAmen,determination122 animals exposure were did sacrificed. not cause Few significant significant 5-HT serotonergic depletions effects in any were brain found. re-Risks of MDMA Use and twenty-one months after the initial escalating dose regi- pocampusoldaregion complex,dose and (notreducedfor long-term andin two perhapsSERT other 5-HT to all aboutbrain that depletions regions).60can percent be said appears Thus, ofwith control datatocertainty be onlevels above rhesus is onlythat 1.25 monkeys thein mg/kg the thresh- hip- of Reasonsoralin Animals MDMIA and Possible in this Justifications species. for High-Dose Administration of MDPVL4 usefulwhetherhigh-doseResearch information repeated onregimens MDMA injections about that neurotoxicity theare toxicityofcommonly 20 mg/kg ofsometimes single used. of MDMA oralSome has MDMA criticsinbeen rodents doses criticizedhave can ofquestioned 1.7—2.0provide for the actiontonergicdesignedmg/kg andin neurotoxicitytohumans. consequences. be clinically It is oftrue relevant MDMA that many but to werebetter of the intended understand neurotoxic to maximize its regimens mechanisms the are sero- not of includingtabolitesing. In general, in the greater proportionally smaller amounts species thanlarger excretelarger Comparinglivers species. anddrugs kidneys dose more This on isquicklyand thedue faster basis to andmany bloodon form body factors, circu- me- weight, however, can be mislead- hoursMDMAAslation a result timesin bya human ofhalfin suchsmaller is (Masabout factors, mammals et1.5 al. thehours 1999). time (Mordenti in aThisit rattakes (Chosuggests and to etlowerChappell al. that 1990) the small 1989; plasma and species aboutLin levels 1998). eightmay of doseshighlargerrequire doses tendspecies. higher commonlyto alter dosesThese the to considerations usedcharacter achieve in rodent drug of the exposurestoxicity drug exposure. studies. comparable Unfortunately, While to theythose lengthen seen higher in at least in part, the apparently curhigherthe timein larger peak smaller bloodspecies animals concentrations at lower are doses.exposedMany of techniquesdrug to the and drug, greater have they been acute also developed tendeffects to thanproducefor estimating oc- equivalent drug doses PDF compression, OCR, web-optimization with CVISION's PdfCompressor Mahmoodinterspeciesin 1999). scaling, One involvesof the mostdifferent administering commonly species aused (Mordentidrug techniques, to different and Chappell allometric species and1989; Ings Does IIDMA Cause Brain Damage? 1990; Lin 1998; 123 measuringships.dose.used to DrugEquivalent determine resulting exposure drug bloodthe in relationships exposureshumans concentrations then are of canassumed species of be drug. estimated weight,to These produce frommeasurementsdrug equivalent theseexposure, relation- aredrug and isinthateffects, commonhumans as little including if foras interspecies 1.28drugs neurotoxicity. mg/kg that doseare of MDMAnot conversions extensivelyRicaurte may causeand for metabolized. MDMAassociates long-term follow (2000) Estimates5 -HT a pattern estimateddepletions of thisthat doses,neurotoxicitysort are despite useful in thefor humans emphasizingseemingly maybe higher that withinSuch thedoses theMDMA estimates usedrange in of rodent requirecommonly studies. making administered assumptions about the mechanisms of dose required to bring about concentrationtheexperienceneurotoxicity. same. This comparable Forofmay drug example, not produced drugbe true. iteffects is In necessaryby addition, whena given blood to speciesblood assume concentrations concentration. may that differ different inof the drugIt species is brain notare morefenfluramineknowncaused extensive if bythis a (Campbellistoxic metabolism the metabolite,case with1995). of MDMAMDMA, as Furthermore, some thoughresearchers if it MDMAdoes have seem suggested,neurotoxicity to be true then for is the expected in smaller animals will lead searcherssearchentto increased species on speciesto is neurotoxicity.conclude difficult differences tothat predict, noFormation in nonhuman fenfiuramine and few of dataspecies metabolismare provides have a good led modelsome re- of specific drug metabolites in differ- available on MDMA. Re- ciesexposureal.possible 1995). before human may Because interspecies mediate fenfluramine current dose data conversions neurotoxicity suggest thatcan (Marchant beboth made MDMA withet al. any and1992; confidence. metabolite Caccia et more data are needed from more spe- shipone(Mas between of et the al. enzymes 1999; MDMA de in Iadose the Torre liver and et thatbloodData al. is2000). fromimportantlevels clinicalIt of appears theto MDMAdrug that and MDMA studies its metabolites inactivatesshow that there is a complex relation- its metabolism (cytochrome PDF compression, OCR, web-optimization with CVISION's PdfCompressor Whenresult,P450124 the small dose increaseswas increased in dose from can 125 lead mg to to large 150 mg,increases drug exposurein drugisozyrne exposure. almost 2D6Risks of MDMA Use or CYP2D6) (Brady et al. 1986; Wu et al. 1997). As a metabolitesdosedependentdoubled conversions in remained pharmacokineticshuman betweenvolunteersapproximately species. in (de humans constant,la Nonetheless,Torre amplify ethowever. al. 2000a).the these difficultyThese humanFormation complex, of studies estimating of dose- some with MDMAInfluenceedly elevated suggestof Environment, levels that doses of Especiallydrug above exposure 125 Ambient mg and may Temperature,therefore be associated risks of withtoxicity. unexpect- impaironperature,Several Neurotoxicity temperature studies animal havein core regulationRats exploredtemperature, and Mice in the a dose-dependent relationshipsand neurotoxicity. among manner In environmental rats, (Gordon MD.IVIA et tem-al. can toxicity;latorythrough1991; behaviors. Daftersalterations hyperthermia 1994, Resulting in the1995; increases functioning changesBroening and in ofethypothermia animal al.the 1995; hypothalamus temperature Colado decreases et andcanal. 1995), serotonergic thermoregu-alter neuro- perhaps mewithBroeningdepletions. depletions long-term et Thus, al.in 5-HT 1995;mice the (MillerdepletionsMalberg degree and ofand inhyperthermiaO'Callaghanl994). Seiden adult rats1998) (Colado has and been Inwith additionet foundlong-termal. 1993, to thecorrelate 1995;dopam- am- bientconductivity1994; temperature, Dafters of 1995).animal the degree housing of hyperthermia andThe hydrationmechanisms is status influenced of action(Gordon byby theandwhich thermal Fogelson temperature affects MDMA neuro- mitterencedbraintoxicity release levels by are changes unclear. mayof MDMA be in temperature-sensitivePlasma animal in mice levelscore (Campbell temperature. of MDMA (Sabol 1996) in MDMA-induced ratsand do (Colado Seidennot appear 1998), et al. neurotrans-to 1995) thoughbe influ- and nonspecificallyLaVoiedopaminestudies examining and release Hastings increases thehave temperature 1999).reportedthe rate It of conflicting alsodependence chemical may be reactionsfindings of that methamphetamine-induced elevated (Bowyer and contributes temperature et al. 1993; to PDF compression, OCR, web-optimization with CVISION's PdfCompressor showncreasedoxidative to blood decrease supply the (Globus number et or al. curb 1995). the Prolonged hyperthermia has been stress; this effect is seen in the neurotoxicity that accompanies de- Does MDMAfunction Cause ofBrain mitochondria Damage? in some 125 serotoflergic1999).brain regions, Hyperthermia system. suggesting on its diminished own,In spitehowever, energyof the does apparent stores not selectively(Burrows relationship between hyperthermia and MDMA and damageMeshul the termblockmianeurotoxicity, serotonergic ensures MDMA that itneurotoxicity wouldhumans be who a simplification (Broening have taken et MDMA al.to think1995). will that The not avoiding link experience between hyperther- long- tem- changes. Inducing hypothermia does not always completely peratureTimeremains Course and to beneurotoxicity of confirmedChanges and inhas Extent primates. been of investigated Recovery primarily in rodents and ofclines.causingHigh 5-HT doses For acuteleads example, of todeclines MDMA depletion after followed have aof single tissue complex by 10levels partial mg/kg effects of recovery5-HT dose on andofserotonergic MDMAand its metabolitethen in long-term functioning,a rat, 5-HTAA release de- withinsecond,notmately sustained. three six sustained hours About oflater, decline dosing twenty-four levels and (Schmidt begin remain hours to 1987; significantlyreturn after Stone to dosing, normal, et lower al. 1987b).but than this baseline Approxi-recovery two is 5-HT levels begin a decreasesdamage.weeks later. within This sustainedfifteen minutes reductionThe of drugintracellularis thought administration. to enzymebe associated ButTPH there withfollows isaxonal less a similar time course—activity tioninginactivatedcoveryshort-term ofalso TPH recovery byis altered.oxidation activity of 'When TPHappears rather activityrats thanto were synthesis compared given a of subcutaneous with new 5-HT enzyme. activity. dose SIERT of The 15 func- mgI re- involve regeneration of enzyme that was immediatebykgof of80 MDMA. MDMApercent 5-HT Schmidt and(Fleckenstein depletions sacrificed and colleagues are etan al.nothour 1999). necessarily (1986) It should reported produced be that noted by2.5 allthat mg/kg active significant ofMDMA doses the uptake of serotonin decreased PDF compression, OCR, web-optimization with CVISION's PdfCompressor HTratsdid 126depletionsthree hours inafter a long-term injection. EcstasyKish andnot user associates cause who an died (2000)immediate shortly did findafterdecrease striatal Ecstasy in 5-5-MTRisks of or MDMA 5-HIAAin Use Sprague Dawley tomansingestion. measure are sufficient This toxicity suggests to Many cause that other 5-MT at leastThis short-term depletions. somediscussion of neurochemical the focuses doses administered on serotonergic changes byoccur hu-changes because these are used ministrationandafter1999). dopamine MDMA MDMA of exposure. transporter high-dose also can For MDMAreuptakeincrease example, (Metzger dopamineactivity dopamine declines et synthesis isal. released 1998; within immediately Fleckenstein, (Stone one houretal. (Nash1986),of et ad- al. et haveneurotoxicityal.1994). 1990). been In Miceseen some (Stone inare studies,other selectively et al.species long-term1987a; vulnerable (such Logan alterationsas rats eta!. to MDMA-inducedin 1988; Commins in dopaminergic Miller et andal. dopaminergic 1987). O'Callaghan functioning fluoxetinetering antidepressant or(Prozac) citalopram and selective citalopramhas been serotoninThe shown (Celexa), time toreuptake courseblock after the inhibitorsofMDMA. damagingneurotoxicity Pretreatment (S Sills),events of MDMAsuch in with rats as can be assessed by adminis- MDMA.Fluoxetineal.(Schmidt 1999a), By remains1987; fourprobably Schmidthours almost byafter andobstructingfully administration, Taylor protective 1990; interactions if Battaglia givenmost ofthree of eta!. the MDMA to MDMA-induced1988; four withShankaranhours SERT. after et fatetrelease 1990;al. molecules 1997b; ofGough 5-HT Shankaran by et andfree al. dopamine1991),radicals) et al. and 1999a) (Colado hasincreases already and et al.lipidin takenextracellular1997a) peroxidation place can be(Hiramatsu free measured. (the radicals alteration and Never-(Colado Cho of protectivedepletionsextracellulartheless, the (Schmidtif administration oxidativegiven six1987; stresshours Shankaran of (Shankaran afterfluoxetine MDMA, et al. etat 1 al.999a).this but 1 point 999a)it Fluoxetinehas decreases andno protective long-term is still subsequent partially effect5-MT damagingtoxictwelve MDMA hours between after regimens administrationthree initiate and twelve a seriesSlow(Schmidt hours recoveryof eventsafter 1987). drug of that serotonergicThis administration become shows increasingly thatfunctioning neuro-in rats. can be seen following a neuro- PDF compression, OCR, web-optimization with CVISION's PdfCompressor toxic dose of MDMA. The extent of recovery is different in different species. Does MDMA Cause Brain Damage? 121 coveryetoneIn al.rats, year 1996; betweenthere after Sabol is drug extensiveindividual et exposure al. 1996), recovery animals of indicators of serotonergic (Battaglia et al. 1988;though Scanzello there et al.are 1993; significant Lew variations in(Fischer re- et al. 1995). In primates, there is functioning fore,exposureAlteredsome despite recovery serotonergic in one some ofstudy recovery,serotonergic axon of squirrel density MDIVIA-induced monkeys was still detectable serotonergic seven years changes after are MDMA likely function, but it is less extensive than in rats. (Hatzidimitriou et al. 1999). There- regrowthprimatesrelatedpermanent in comparedofpart in serotonergic thisto the primate withmore rats.axons. severespecies. It also initial This likely serotonergic apparent indicates damagea species usually difference seen in species difference may be lastingManyExposureBehavioral behavioral in orAnimals functional changes in laboratory animals. These studies have looked for evidence that MDMA neurotoxicity causes and Functional Correlates of MDMA MDMAanimalstheare summarizedlimited exposure to subsequent nature incan Tableof alter theirdrug 1neurochemical exposures,[seebehavioral but findings. functioningto date Itonly is clearandtwo thepublished that response neurotoxic studies of appendices] and are perhaps impressive for lastingDafterstionalsuggest impairments thermoregulatoryandthat LynchMDMA-exposed (1998)at seven impairment. found or animalsmore that days MDMA-exposed haveFourteen after their weeks last animals afterMDMA exposure experience exposure. to a behavioral alterations or func- whoneurotoxicperaturement. experience MDMA-exposed thanMDMA controlheatstroke or placebo rats. ratshave It hasregimen,had heightened been significantly knownrats susceptibilitywere for placed many inyears to a subsequent warm environ- larger increases in core tem- that individuals epi- phenomenonsodescause for cognitive some is time being impairment (Shapiro detected et inal.Another theserats.1979), rats. andstudy it seems has suggested possible that that the neurotoxic same MDMA exposure may Marston and coworkers (1999) found PDF compression, OCR, web-optimization with CVISION's PdfCompressor drug-free128 Risks of MDMA Use alterations in performance of a delayed memory task. In contrast, residualnavigationableRicaurte to ascertain effectsand memory associates of any MDMA tasks long-term (1993) in on rats. andthis effects Robinson, Robinsontask whenof MDMA however,and animals colleagues neurotoxicity weredid detect (1993)tested short-term on twowere spatial days un- neurotoxicityityafter in theiranimals last is inMDMA that humans, we exposure.should even not withThe expect extensivecautious gross interpretation serotonergicbehavioral effects changes.of behavioral ofMDJVIA It also studies of MDMA neurotoxic- maycultHTmust to allow be detect remembered more 5—HT--related focused that and we changes.hypothesis-driven do not completelyFindings infrom studies the understand studiesbrain of animals.(reviewed of theEcstasy role in usersof Lucki 5- 1998) and that this makes it more diffi- MoreinusersStudies Morgan to nonusers. 2000), Beforeit is worth discussing noting theirthe findings limitations. of these Retrospective studiesthan (reviewed studies thirty-five studies have retrospectively Comparingcompared illicit Ecstasy Ecstasy Users and Nonusers drugs.thatingare difficultdifferences frequent Thus, to oneusers interpret,between might of illicit evaluate thesince users drugs it is studiesand arealways nonusers. different by possible considering Itfrom is that almost those there to what trivialwho were extentdo to preexist- notsuggest they use guaranteeizethosedifferentiate that specifically Ecstasy that between Ecstasy users associated typical may purchased not withcharacteristics be onEcstasyingesting the street users. ofMDMA frequentcontains [It is atalso illicitall,MDMA. important since drug there users to isreal- and no useteerthesecognitive of groups,other studies testing drugs, reliance include results.—Ed.]including onpoorly self-reports ketamine described Other of andcommon drugrecruitment dextromethorphan, use, methodologic failure and matchingto separate limitationsmay of residualaffect volun- of comparingineffects several of recentstudies, Ecstasy drug and users use difficulty fromand nonusers.long-term in relatingDespite Findingseffects, serotonergic these use can limitations,of be thedifferences grouped same avolunteers few intoto toxic- conclusionsper- can be drawn from studies PDF compression, OCR, web-optimization with CVISION's PdfCompressor eas are discussed below. neurofunctional, and cognitive performance differences. These ar- Does MDMA Cause Brain Damage? 129 al.Gerraetal. 2000a; 1992; et al. Parrott Cohen 1998, 2000).1995;2000; CurranandTravillParrottBecause andReports depressed Lasky consistently 1997; 1998;mood Davison Morganis alink known repeated and 1999; residualParrott Gamma Ecstasy 1997;effect useet to depressed mood (Solowij depression,ers,useof other playsWilliamson psychostimulant a causalanxiety, et roleal. and (1997) in related drugsthis foundphenomenon. (Coffeyadverse effectset al. 2000), after cocaineit is likely compared that Ecstasy with that similar numbers of users reported In a survey of 158 polydrug us- orders2000).psychosis,MDMA. Givenin illicitdepression, that users, other and itpsychostimulants wouldpanic attacks, Innot addition, be in surprising areEcstasy thereassociated users are if thisseveral (reviewed with were psychiatric case also in reports McGuire true dis- of psychiatric disorders, such as McCannMDMA-relatedMDIVIA.can occur and For inRicaurte example, cocaine psychosis 1991 orit is methamphetamine alsoa; well McGuire have established been and publishedFahy that users 1991,stimulant-induced (Creighton McGuire 2000). et psychosisal. 1991;These (Angrist 1994). Reports of psychiatricbehavioralcussed in disordersthis disturbances chapter. need For resembling not example, be related psychosis methamphetamine to the in selective primates neurotoxicitycan using produce regimens chronic dis- that serotonergic systems (Castner and WhilePersonalityGoldman-Rakicare not Ecstasy neurotoxic Differences users 1999). to sometimes Betweendopaminergic Ecstasy have or Usersbeen andfound Nonusers to have personalities that reflectEcstasyMDMAare different preexisting usersexposure. from and differences.volunteersthose Many of of nonusers, the whoHigher reported do itlevelsnot is personalityordinarilynot of novelty use differences seeking illicit drugs(Gerra between et clear that this is an effect of likely al. withingin1998), Ecstasynonusers. differences. venturesomeness, users, Several For but example, thisauthors and can impulsivity Gerrahavebe expected pointedet al. (Morgan(2000) in out users the suggested 1998) ofpossibility illicit have that drugs beenof preexist- the enhanced comparedreported PDF compression, OCR, web-optimization with CVISION's PdfCompressor noveltyQuestionnaire)130 characteristic of Ecstasy users undergoing substance abuseRisks of MDMAseeking Use (measured with the self-report Tridimensional Personality tilitystancescorestreatment scores abuseon reflectedthe in treatment Buss-Durkeeuntreated a preexisting (Gerra Ecstasy Hostility et users trait.al. 2000) Index (McCannSimilarly, and (BDH1) the et the al. lower higherof1994) Ecstasy BDHI maydirect indirectusersbe aggression explained in hos-sub- sures,drugtively.in part use, orbyTo one one socialminimize couldcould circumstances compare the influence Ecstasymultiple-drug and ofthe userstraits values with generallyusers of differentthe with rave associated and subculture,total without Ecstasy with Ecstasy respec- illicitexpo- vidualsMDMA-inducedsuchexperience. comparisons are examined Findings alterations can fromat providedifferent the in personality.comparisons at time best points only Studies cited arelimited necessary here in supportwhich are ambiguous,to the examinefor same possible indi- thisand comparisonself-reportedissue properly. of impulsive more experienced behavior.There (more Morgan is than mixed (1998) thirty evidence tablets reported thatingested) that MDMA a postand use lesshoc is associated with increases in group.siveness,enedexperienced levels Parrott venturesomeness, of (twenty impulsivity (2000) to reported thirty (measured empathy] tablets a nonsignificant ingested)withquestionnaire) Eysenck's Ecstasy trend in self-report theusers toward more showed IVEgreaterexperienced [impul-height- IVE anfromimpulsivity(2000) average thirty found toofin one6.8polydrug-using that (onethousand) Ecstasy to twenty) exposuresusers Ecstasy exposures.with users comparedan average with Tuchtenhagen an with of average 93.4 a group ± of and119.9 371of colleagues users (varying(twenty with to increasedtrolssuredfive hundred) matched with experience the exposures forself-report other seeking drughad Barratt significantly use.(measured ImpulsivenessThe researchers with higher the scores Scale)self-report also fornotedcompared impulsivity Sensation-Seek- a trend with toward (mea- con- fiveingcontrolling(1994),compared Scale), to three who which with hundred) forcompared reached nonusers.other reporteddrug Ecstasystatistical These use). usersEcstasy findings significanceMcCann with exposures differan reported averageonly from when to ofdecreasedthose nonusers 94.4Ecstasy of ± McCann 90.6 usersimpulsivity (without (twenty- were et al. PDF compression, OCR, web-optimization with CVISION's PdfCompressor portedsonality(measured impulsivity Questionnaire) with a butsecond did notquestionnaire find significant (the self-report differences Eysenck in self-re- Per- as increases in the Control subscale of the Multidimensional Per- Does MDMA Cause Brain Damage? 131 volunteersbesonality different Questionnaire). as from in the self-reported Tuchtenhagen Thereimpulsivity (2000) are fewer report, (Evenden data Gouzoulis-Mayfrank examining 1999). Using impulsive the same et al.behavior, which is thought to interpretederscognitive(2000) made did moretest notas battery.evidence find errors evidence Inin of contrast,a increased of impulsivity Morgan impulsiveness. (1998) in Ecstasy reported Morgan users that suggestedundergoing Ecstasy thatus- a Matching Familiar Figures task, a difference he Neurqfunctionallevelhis cognitivebehavioral demands.Diffrrences findings indicatedBetween Ecstasy an impaired Users and capacity Nonusers to cope with high- in morealteredStudiesTable general 2 neurofunctioning. also[see haveappendices] measures, established such includeReported asan EEGassociationputative neurofunctional findings. serotonergic between While differences Ecstasymeasuresretrospective exposure summarizedas well studies, asand reported5-HIAAdifferencestechnically between levels correlatespeaking, (BollaEcstasy with cannotet exposureal. extent 1998), establish of and SERT Ecstasy such causality, density measuresexposure. (McCannmany asCorrelations ofcerebrospinal these et al. user/nonuser1998), have fluid brainbeen myo-inositoldo1999). not know A increasesprimary the real difficulty (Changmeaning etin ofal.At interpreting many 1999),a minimum, of and these the EEG weresults neurofunctional alterationscertainly of these can (Dafters studies concludedifferences. iset that al. that we the brains of these Ecstasy usersfunctioningsibility.serotonergic are differentSeveral between neurotoxicity studies from users those have hasand shownof takennonusers. nonuser differencesplace? volunteers.Two This groups in seems measures Does have the thismostreported of serotonergicmean likely dimin- pos- that Threemeasurementetished a!. of cortical1999), four studies thoughtechniqueSERT have binding there (Kuikkafound is in some cerebrospinalEcstasy and questionAhonen users fluid1999;(McCann about levels Heinz the et ofspecificity al.and 5-HIAA 1998; Jones Semple to2000). be of the PDF compression, OCR, web-optimization with CVISION's PdfCompressor areRicaurtelower132 consistent et al. with 1990; the unchanged results of animalin Peroutka et al. 1987). Thesein differences users thanRisks in of nonusersMDMA Use (decreased in McCann et al., 1994, 1999b; studies, in which neurotoxic MDMA selectiveexposure1989; Scheffel serotonergicsimilarly et alteredal. 1998).neurotoxicity these indicatorsSuch has parallel occurred, (Ricaurte findings but et it mustin humans be noted and thatnonhumans provide evidence that al. 1 988b; Insel et al. serotonergicunusualwhatall published Ecstasy serotonergic measures usersstudies were functioning in are humans like sufficiently before ishave the using new beenresult thatdrugs, retrospective. of we damage. we do cannot Unfortunately, knowonly Without guess the full knowing whether rangethese theAlternatively,of so-called valueskind of seen personnormal theyin Ecstasy whovaluesmay is be userslikelyfor simply them. are to truly ingestunusualThis abnormalmakes Ecstasy for itnondrug difficult andrepeatedly. indicative users to decide [Peoplebut of usual damage.whether with for typical(Meltzerbraindepression regions indicators 1990) have (Mann before beenof serotonergic et being shownal. 2000) treated to functionandhave with decreased a lower antidepressants.—Ed.]maybe densitylevels affected of of 5-HTby SERT influences and In in addition,5-HIAA certain other illustratedpsychostimulantsthan(Zuckerman neurotoxicity. using 1996; studies are LaviolaSome more that likelytheories etinvestigate al. to1999). havesuggest the-These unusual -amountthat interpretive serotonergicindividuals of hormone difficulties whofunctioning released abuse can be uncovereddrugafter isserotonergic one statistically way to drugtest significant for administration changesMeasuring user/nonuser in the in serotonergic differentthe djfferences amount populations. ofsystem. inhormone four This of sixreleased tactic stud- has in response to a serotonergic iessuchOtheret (differences al. as2000; -studies cocaine, no detected significanthave may established modulatein Gerra differences et this thatal. serotonergic1998, bothin Price 2000; personality et McCannal.measure. 1989; and et McCannPeople useal. 1999a; of who other et al.Verkes are drugs,1994). more pronegrouplarly,sponses to the ofsensation to cocaine-dependenthormone the partial seeking prolactin's 5-HT1A have individuals response beenagonist shown, toipsapirone was the tosignificantly5-HT have (Netterreleaser higher et fenflurarnine between in the a blunted hormone re- a!. 1996). Simi- PDF compression, OCR, web-optimization with CVISION's PdfCompressor first1999), suggesting recovery from cocaine-inducedand third alterations. weeks after One discontinuingcould ar- cocaine use (Buydens-Branchey et al. Does MDMA Cause Brain Damage? 133 ferentsolvedentgue serotonergicthat timeonly factors points.through other differences prospective than MDMA between studies neurotoxicity users that assess and nonusers. themight same Thisindividuals issue canat dif- be explain some appar- thatducetoxicity approximately 5-HT is simply depletions that similar estimated in squirrel doses Oneingestedare monkeys associated strong doses argument(Ricaurte with exceed similar that etthose al. many changes 1988a). known human in toGiven sero- pro- users experience MDMA neuro- assessmentMDMAsametonergic phenomenon indexesto thanhumans, toin iswaitnonhuman occurringit mayfor conclusive be species in more all species. and importantscientific in humans, proof to be it of conservativeseems neurotoxicity. likely that in Thisrisk the Furthermore, in administering isterednonuserssusceptibleis especially by suggest humans. to important neurotoxicity that MDMA neurotoxicity in light thanneurotoxicity of others.the may fact Studiesoccurthat and some itswhen comparing largely individuals MDMA unknown Ecstasy is may possible beusers more to self-admin- riskslong-termCognitive of clinical consequences MDMA research. must therefore be considered when evaluating the Between Ecstasy Users and Nonusers MayfranknitiveRepeateddetect tests. this Ecstasy et Tests al.decline 2000; ofexposure declarative (Parrott Morgan is associatedand 1999; verbal Lasky Reneman memory with1998, decreased etParrottfrequently a!. 2000a). et performance al. have 1998;However, been Gouzoulis- onused user!cog- to researchersnonuserand(McCann working differences ethave al.memory 1999b;suggested have may Gouzoulis-Mayfrank been explainthat detected specific the observed using alterations aet broad al.differences 2000; in range executive Rodgers (Dafters functioning 2000). et al. 1999;Some of cognitive tasks cannabisGouzoulis-Mayfranksive evidence. were compared et et al. al. 2000; with(2000). PerhapsWareingcannabis In this etthe usersstudy, al. most 2000), and users thorough drug-freebut of there both study is Ecstasyvolunteers. no conclu-published and so far was conducted by PDF compression, OCR, web-optimization with CVISION's PdfCompressor ofExtent134 tasks. Performance among Ecstasy-using volunteers remained, on aver-Risksof ofEcstasy MDMA Use use was correlated with impaired performance in a range ishedternsreassuring,age, at (1.4cognitive the ± low given0.9 end tabletsperformance that of clinically thesetaken users 2.4is annormal ± appeared 1.6effect times functioning. of to MDMA,per have month). fairly it is If likelycormnon modestly one use experi- pat- This is not particularly dimin- Many,Ecstasymance?enced but by usersThe notmany available allperform people.(e.g., dataMorganworse Does are on Ecstasy inconclusive,1998), many cognitiveusestudies cause but have teststheythis found poorthansuggest nonuserscognitive that that long-term this and perfor- is that so. Mayfranksureusers (Bolla with etmore et al. al. 2000). Ecstasy1998; Dafters exposure etIt al. isperform 1999;likely McCannthatworse there than et are differences between Ecstasy users and nonusers al. 1999b;those Gouzoulis- with less expo- todatathat dentshave predatetaken attendingused from illicit Ecstasy high less drug schoolacademicthan use. those Schifanostudents secondary attending in(2000) Italy; schools schools described these were with data 2.89unpublished aindicated more times more that survey stu-likely highly aca- dosesdencedemic and offocus. inverse both In lower another relationships schooling survey levelbetween ofThe 737 and association Italianlowerthe tendency family Ecstasy between income to users, take Ecstasy (Schifano higher there exposurewas Ecstasy 2000). evi- and lower cognitive perfor- ingmanceatsure, late-night these alsosuch possible may as dance repeated be factors events.caused sleep (Dinges Nonetheless,in partand nutrientbyand factors Kribbs the few 1991; scientific Kretsch studies et that looked deprivation associated with attend- correlated with Ecstasy expo- al. 1997; Cho particularlyonlyinet al.studies if2000) the of Ecstasy-using would hard-partyingEcstasy not users. lead volunteers lifestyle. Theseus to expect other Inin thethese possiblean first effect international published factors comparable are studystudies likely to that engagesignificant properly in a what we see themanceEcstasycontrolled previous scores users for twelve (with thanlifestyle, nonusers 73months. ± Verkes 68 reportedwho and had co-workersexposures attended a to similar(2000) Ecstasy) numberfound had thatlower of "raves"moderate perfor- in

PDF compression, OCR, web-optimization with CVISION's PdfCompressor formancefully explain in immediate the reported declarative cognitiveIt verbalperformance memory differences. tasks seemsdeclined Average unlikely by about per- that preexisting differences and effects of lifestyle can Does MDMA Cause Brain Damage? 135 percenttheetal.0.8 average standard 1998; of expected Ecstasy-using Morgan deviation scores, 1999; units volunteer Gouzoulis-Mayfrankbased in several on in the thesestudies comparison studies (Parrott et al.scored volunteers. and2000). Lasky in Thisthe 1998;Whilebottom means Parrott it 21 thatis thesememoriespossible, studies). it goseems on toimprobable use Ecstasy thatUse several the of fourthdrugs times otherof thea monththan population MDMA (and withparticipate has the not worst always in been taken into account residualThisoftenproperly is significant,have impairments in beenstudies found because of in Ecstasy cognitiveto use long-term more users. performance cannabis Incannabis particular, than (Popeuse Ecstasy-naive Ecstasy-usingcan and cause Yurgelun-Todd long-lasting volunteers. volunteers ciatedRodgersusers1996). of with cannabis 2000).Three cognitive Twostudies alone of performance these have(Croft comparedstudies et al. lower have2001; users suggested thanGouzoulis-Mayfrank of that both expectedthat Ecstasy MDMA withand etuse cannabis cannabisal. is 2000;asso- to nabistests.sociates(Gouzoulis-Mayfrank users Further (2001) and usersstatistical were of unable bothet analysis al. cannabis 2000;to detect suggested Rodgers and performance Ecstasy 2000).that performance on Indifferences a contrast, battery declinesof Croftbetween cognitive and were can- as- comparedtectedrelatedattempted lower more with tomemoryclosely controlEcstasy-naive to performance forcannabis the polydruginfluence than in Ecstasy-experiencedto users. Ecstasyof other However, use. drugs, In anotherMorganmatching polydrug study (1999) of users drug that de- aggeratednitudefutureuse between studiesof the by comparisonMDMA-associatedcannabis should control use. groups [None for usecognitivewas of theseof imperfect cannabis studiesperformance in and specifically this that study. decline the apparentItaddressed islikely clear ismag- that theex- tonergicandissue is of being ketamine, neurotoxicity investigated which or is toas frequently somea chemicalThe other used lower neurochemicalmodel at raves,cognitive for isdementia.—Ed.] known performance alteration. to affect It hasmemory,of Ecstasy been users may be due to sero- PDF compression, OCR, web-optimization with CVISION's PdfCompressor pairshown136 declarative verbal memory in healthy volunteers thatRisks acuteof MDMA serotonergic Use depletion (by dietary manipulation) can (Riedel et al. 1999). im- Threerelationshipin 1998;serotonergic studies Reneman of between Ecstasy measures et loweral. users 2000a; and cognitivehave decreased Verkes reported performance etcognitive correlationsal. 2000). performanceand This betweenMDMA-induced se- finding suggests a (Bolla et al.alterations rotonineffectmemoryloss of depletionsto serotonin beto detectedthe degree or neurotoxicity.damage readily suggested into prospectiveserotonergic On the otheranimal axons hand, studies.were if sufficient to by human studies, one would expect this MDMA-induced impair posuresto experiments,the volunteers' are limited and long-term, this(usually could explainIt seems the possible apparent that discrepancy the reported lower cognitive four consecutiverepeated days or fewer)patterns in of most Ecstasy animal use. MDMA ex- performance is related between these associatedSolowijtermstudies psychostimulant and 1999; with Ecstasy Ornsteinimpaired user use studies. etcognitive al.impairs 2000). Furthermore, functioning For example, it (O'Malley is well repeated established et al. cocaine 1992; B use catty cognitive performance (McKetin and that long- is but,produceet etal. likeal. 1995; 2000) MD.MA,deficits Bolla and (Bollaet cerebrovascularit al. can 1999), etcause al. 1999).both serotonergic Cocaine is (Littlenot a selectiveCt al. 1998; though cocaine use per se does(Bartzokis not necessarily et al. 1999; Herning et al. 1999) neurotoxin, Jacobsen withthisnitivealterations. cognitive effect functioning, is Since duedeficits. torepeated it repeated is This credible exposuresuggestion neurotoxic that torepeated otherleaves damage psychostimulants MDMAopen or theresidual use question drug can impair cog- might be associated effects. of whether improvetimeEcstasy course users more of to thesequickly serotonergic differences. than changes neurotoxicity ResidualSpecific due to drug evidence serotonergiccould effects come linking neurotoxicity. lower-level cognitive performance of might be expectedfrom to studies of the long-term Un- whofortunately,immediateconclusions. had not too andtaken Morganfew delayed Ecstasy studies (1999)recall havein more (of reportedlooked ideas than forfrom sixthat evidence months storiesa subset takenhadof ofrecovery threefrom theEcstasy to users significantly better Rivermead draw any

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Behavioral Memory Test) than users with more recent history of drug use. In Does MDMA Cause Brain Damage? 137 tentivesignificantcontrast, functioning Wareing abstinence-related tasks and whencolleagues ten improvement current (2000)volunteers Ecstasy were in who workingunable users reportedly towere memory find compared had evidence andnot usedexecu- withof Ecstasya in six months. It is there- geratedcognitivefore not byclear performance. limitations if there is in Therecovery published apparentIn from conclusion,studies, magnitude this lowerparticularly repeated ofcognitive the effectthe Ecstasy performance.confounding may exposure be exag- ef- is associated with diminished residualperformanceformance.fects of drug cannabis There witheffect abstinence. are [asor awellinsufficient frank as Itneurotoxicketamine is andata open toand change. decidequestion dextromethorphan—Ed.] whether whether there this is is recovery due on to per- a of HowandPossible severe MDMA are Significance these Neurotoxicity cognitive ofchanges? Cognitive They doDifferences not indicate impairment investigatorssmallyoung,in day-to-day in healthy magnitude noractivities. people the despite Ecstasy-using perform The their differences well. statistical volunteers Thus, are significance. seenthese themselves in differences cognitive In fact, appeared testsare neither generally in which to the be associatedteers2000).aware have ofThese any withexperienced studiescognitive more severeraise impairmentserotonergic questions symptoms. (McCann aboutneurotoxicity Such whether symptoms and Ricaurte thethat Ecstasy-usingcould eventually 1991b; become mightRodgers promi-volun- be degenerativeeasnent of as functioning Ecstasy disorders users may age. exist have Additionally, but led simplyStudies to two largerhave relevantof individual not impairments been concepts. discovered variation in First, specialized yet.inthere symptoms is ar- a associated with neuro- etdopaminergicsymptomsthreshold al. 1999; of develop. Di damage cell Monte loss This thatet and al. has must Parkinson's2000). been be Thereexceededinvestigated disease are fewerin (Calne someprimarily data brainet on al. with the 1985;systems serotonergicreference Brownell before to

PDF compression, OCR, web-optimization with CVISION's PdfCompressor ronssystem.(1999)138 was necessaryconcluded to that decrease a loss of more than 60 percent of serotonergic Risksneu- of InMDMA a rat Use study using the serotonergic neurotoxin 5,7-DHT, Hall et extracellular 5-HT levels in the striatum. Al- a!. mightterationsgic-relatedor more), speculate in behaviorpossibly behaviors, that asevenwere thethough smallerseen thewith depletions maximal slighfly serotonergicsmallerdo not affect depletions response many (51 serotoner- to percent drugs or result of regional variations in One whyreleaseother higher stimuli in MDMA-exposed education is likely toor beintelligence ratsreduced. wasSecond, documented (Reducedor greater the conceptelectricallybrain by Gartside size of iscognitive stimulated et al. 1996). reserve 5-HT has been developed to explain associated with normallesscessingCoffey severe aging etcapacity impairment al. (Graves 1999). that This et protectsin al. conditions cognitive 1996; a person Stern suchreserve againstet as al. mayAlzheimer 1996; loss be ofAlexanderseen functioning disease, as a surplus et AIDS, al. 1997; of pro- when that and undergoforfunctionalcapacity problem decreases.larger brain solving. cognitive tissue, Cognitive People density declines with reserveof less neural from cognitive could connections,MDMA be reservethe exposure result or could cognitive of than morebe users extensivestrategies with expected to Ecstasyandassociatesgreater vocabulary cognitive users (1998), with(measured reserve. who lower reported with vocabularySupport the a Wechsler significantfor scoresthis Adult showedinteraction Intelligence greater between Scale-Revised). deficits drug in possibility comes from Bolla and dose de- playhadlayedformance largely a visual role in preserved declinememory expression was performance, performance. small, of MDMA this while studyAlthough userssuggests the with absolute that higher cognitive magnitudevocabulary reserve of scores per-could orders.Ecstasylikely to Fromusers increase mighta neurochemical as haveusers aage. higher Some perspective,It riskis difficultresearchers of depression age-relatedto predict have and speculated whether otherdeclines affective symptoms that in aging of MDMA neurotoxicity are SERT dis- woulddensitychangescolleagues not appear (reviewedcause 2000), modest Ecstasy whileinMeltzer (estimated users 5-HT etto receptors al.exceedat 4.31998). percent a undergo hypotheticalOne perwould moredecade hope threshold complex by that van these forDyck age-related changes show- and PDF compression, OCR, web-optimization with CVISION's PdfCompressor ing symptoms of but we simply do not understand 5-HT or Does MDMA Cause Brain Damage? 139 factors,onsetaffective affective such disorders as disorderssocial sufficiently isolation probablyThese to and make arearecerebrovascular predictions influencedserious and withby legitimatedisease. many any confidence. nonserotonergic concerns, Late- and there is insufficient re- denceself-administeredevidencesearch has to toaddressbeen support published by them these humans adequately. suggestingconcerns. for more Neurotoxicthat On than methamphetaminethe sixty other phenethylamines years. hand, In there this or amphetamine time, is haveno no direct been evi- MPTP,increases1979;dopaminergic a Langston dopaminergic the risk axons. ofet Parkinson'sa!. neurotoxin, In1983). contrast, This disease, was the suggests discoveredlink despite between that the immediatelythere Parkinson'sfact may that be they (Davis fundamental disease damage et al.and MDMAlarly,adifferences subset concerns and of theotherbetween brain's about drugs neurotoxic axonsthe are selective notbut phenethylamines,fuelednot cellserotonergic by bodies, a toxic and neurotoxicitywhichsyndrome other selectively neurotoxins. identified induced damage Simi- in by consequences.inusers. Findingsindexes Instead, of serotonergic they are motivated functioning by the must intuition have that some the adverse dramatic behavioral decreases in Prospective Clinical MDMA Studies MDMAaresignificantlyFew in thestudies process relies for evidenceof on preparing unpublished of neurotoxic reports data onkindly changes. their supplied findings.peer-reviewed This bysection The researchers reader reportstherefore is arewho ad- available that examine volunteers in clinical Franzmorevised definitive toVollenweider consider peer-reviewed this and discussion colleagues publications.Preliminary as reportedlypreliminary retrospective has and found subject analysisno evidenceto revision of data that in from studies conducted by Dr. functioning,spectivelastingone or twocognitive analysis oral and exposures includeindexes or neurofunctional EEG, of of information upregional to 1.7 alterations.cerebral mg/kg processing, MDMAblood Measures flow,such is associatedasmood, event-relatedin this cognitive retro- with PDF compression, OCR, web-optimization with CVISION's PdfCompressor mimication).EEGspective140 potentials study Most in important, which six VollenweiderMDMA-naive and volunteers colleagues were conducted a pro-Risks of MDMA Use and pre-pulse inhibition (Franz Vollenweider, personal corn- administered a McCannistration.(PET)single oralmeasureseta!. No dose 1998) significant of of were1.5 SERT or madechanges 1.7 density mg/kg before were (using MDMA. and noted. four the PositronIt sameweeks would technique after emissionappear MDMA admin-that long-termemployedtomography by volunteers.thisserotonergicbefore technique this These conclusionchanges after data one either will can exposure needdobe madenot to occurtobe with up replicated toor confidence. 1.7are toomg/kg using small MDMAa largerto measure sample sizein healthy using interpret.carriedor more) Theseout of cognitiveup researchers to 2.5 mg/kg testing administered in Datafourteen collected two people doses by before Dr. Charles and Grob and colleagues are more MDMA to Ecstasy-experienced volunteers and (separated by two weeks approximately difficult to weretwoeightdecreases weeks detected volunteers after in regional(Charles study assessed participation. cerebral ten toblood twenty-one flow were days seen, after however, their last in a Grob, personal communication). MDMA-induced No alterations in cognitive performance MDMA ex- subset of posurebilaterallymagneticpositron (Chang emission resonance in et the a!. visual computed2000). imaging cortex, tomography (MRI), caudate, and superior (SPECT)significant parietal, scans and Cerebral blood flow was measured using single- decreases were found co-registered with dorsolateral wentfrontalcerebral repeated regions. blood SPECT Therefore, flow at scans two doses showedor threeIt as is low notweeks asclear 1.25 after how mg/kg drug long exposure. MDMA these declines may last. Two evidence of possibly increased cerebral volunteers who under- reduce MDMA,biphasicflowblood is flow respectively).either effect at a later(with subacute timeThisdecreases drugfindingpoints effectfollowed (forty-threesuggests of limited by that increases). andthe duration impairedeighty Chang or days part states afterof a cerebral blood that di-lastingtaking withminishedflowcovery. greater when regional In timeaddition,twenty-one sincecerebral thethe Ecstasy-experienced blood authorslast MDMA flow was exposure, generally volunteers providing less severe were in did not find differences in cerebral blood comparedevidence with of re- volunteers PDF compression, OCR, web-optimization with CVISION's PdfCompressor Ecstasysignificanttwenty-one at differencesleast one hundred between times) sixteen and Ecstasy seventeen users nonusers(most of whom when hadregional used nonusers (Chang et a!. 2000). Similarly, Gamma (2001) saw no Does t'lDMA Cause Brain Damage? 141 retrospectivenotFinally,cerebral detect it bloodshouldchanges analysis flow be in pointed wasregional of measureda study out cerebral that in during whichGamma blood a volunteersvigilance andflow colleagues using task received [H20'5]-PETusing reportedly [H20'5] 1.7 mg/kg in-PET. did a MDMALiesbethrebral blood(Alex Reneman flowGamma, is and suggested personal colleagues bycommunication).One (2000a,b).two possible preliminary These mechanism reportsresearchers of of action a usedstudy of SPECT by subacute Dr. alterations in regional ce- creasedsure.HT2Ascans Into corticalcontrast,measure S-HT2A corticala group binding, 5-HT2A of five which Ecstasyreceptors did users notand reach foundshowed statistical evidence a trend significance, of toward fewerreceptors in-5- in ten Ecstasy users 7 ±5 weeks after their last Ecstasy expo- sientofsuggestsat least5-HT2A down-regulation two that monthsreceptors. MDMA-induced after Indeed, of their these last 5-HTScheffel receptors reported release and exposure in may associatesrats haveafter (18 led± a(1992) 15neurotoxic to weeks). down-regulation reported Reneman regimen tran- apparentportregulationof MDMA.of this 5-HT2A of idea, cerebral Changes Renemandensity blood in andS-HT2A vesselet regional a!. (2000b) constrictionreceptors cerebral reported are (Noblerblood thought correlations volume et to al. play 1999). in thea betweenrole occipi-In sup-in the volunteersusingsubsettal cortex MRI. of andfiveand Thus, Reneman'sEcstasyglobus the pallidusdiminished users Ecstasy in (areas whom cerebral users involved cerebral may blood be inblood flow/volumevisionthe resultvolume and of movement) wasseentransient measured in Grob's 5-of a points.cerebralHT2A Given blood that flow this or volumetrend occurredThis seen hypothesis by in both very research does few not,volunteers, groups however, at it later explainmustdown-regulation time be the trends toward due to increasedMDMA-induced 5-HT release. increasesinterpretedonetheless, could thein with hypothesizecerebralduration caution ofblood untilthis non-neurotoxic possible flowit is confirmed have increase been mechanisms in isassociated acause more for detailed ofconcern.with action, serotonergicstudy. Even long-term None- though PDF compression, OCR, web-optimization with CVISION's PdfCompressor ratsa neurotoxic142at six to nine weeks Risks of regimenMOMA ofSpecifically, MDA Use heightened a rodent regional study byMcBean cerebral bloodet al. (1990)flow found that after drug exposure. It seems possible, therefore, in eitherThehadthat increasedonetwo 1.75 or volunteers moreor SPECT2.25 of themg/kg each in doses Grob's received in receivedanother study) 2.0 session.isby mg/kg sufficient these IncreasesMDMAtwo to volunteers (the twoproduce that neurotoxicity. in one sessionin and cerebral blood volunteersflowtopared consider after with MDMAin nonuserscarefullyGrob's may study (Changthe not did be etnot permanent, al. have 2000). enhanced Nonetheless, since cerebralthe risks and benefits of exposing volunteers to a drug MDMA-experiencedresearchers may wish blood flow com- thattofunctioning mayMDMIA have in isdetectable anot clinical likely effectscontext, to be significantlyeightyOverall, days preliminary later. altered by findings one or two from exposures clinical studies suggest that but there may be changes in cerebral blood cognitive months.nottheseflow be lastingchanges ruled Of course, several out has as not itaweeks mustpossiblebeen orinvestigatedbe longer.noted again Although directly, that the the MDMA numbers mechanism neurotoxicity of can- explanation for any changes lasting several volunteers inof action of thePotentialtentative. studies Strategies describedFurther for research Reducingin this sectionis Risk of are Neurotoxicity small and anyin Clinical conclusions must be Settings visedofpearsBecause neurotoxicity to be considerthe narrow range are strategies inof unknown, mostpsychoactive for researchers limiting but non-neurotoxic the and risk therapists of neurotoxicity. MDMA may species and the possible long-term consequences be well ad- doses ap- For ex- Intemperature,calample, addition, settings, although MDMA whichit is high probably is dose ambientassociated and worth temperaturefrequency with noting enhanced of that and administration these humidity factors are should may raise MDMA neurotoxicity in rats. unlikely in clini- be kept to body brain.measurablethesmall minimum Furthermore, increases neurotoxicity required. in thedose nonlinear Even theymay iflikelylead all pharmacokinetics toactive cause large dosesa increasesdegree of ofMDMA inoxidativeMDMA plasma do suggests notstressMDMA produce in levelsthe that PDF compression, OCR, web-optimization with CVISION's PdfCompressor icity.(Mas Administration of a small booster dose to lengthenet al.MDMA 1999; intoxica-de la Torre et al. 2000a) and, possibly, the risk of neurotox- Does MDMA Cause Brain Damage? 143 weighedMDMA.tion may against Thealso possiblemagnify this risk. benefitsrisk, givenAnecdotal of suchthe apparently booster reports suggestdoses saturable should that metabolism many be carefully Ecstasy of users already employ phar- protection5-HTPdentmacological MDMA (5 almost hydroxytryptophan). interventions studies. exclusively These that interventions have have Because used been several found includerodent to injections studiesantioxidants,be neuroprotective showing of high-dose SSIUs, neuro- in and ro- (Blanchardhasneuroprotectionneuroprotective saturable et absorptional. with agents, 1997; oral Graumlichit dosing.and is not increased Thisclear et is al.that particularly clearance 1997). humans Similarly, atcantrue high achievefor dosesinvitamin rodent comparable in C,humans studies which metabolismusingtion 5-HTP,of 5-HTP of another 5-HTP, in humans drug allowing typicallythereforeKeeping more alsomay to inis reachnot administeredmind achieve the the brain. almost adequate to Oral curbcomplete administra-brain peripheral levels.lack of controlled studies examin- ered.whenwarranting these Liechti subjective further interventions and consideration MDMAassociates in effects humans,when (2000a) designing have havesome become shown protocols.seem minimal sufficientlythat Administering pretreatment could promising be anwithconsid- SSRJI 40 to threetiondespitestudymg ofbetween showsto the the four SSRIfact that these hours that thesecitalopram compounds a afterprevious drugs MDMA canlessens case(Lauerma be co-administeredreport administration the eteffects describes al. 1998). of 1.5asafely couldpossibleThus, mg/kg in givingbe a adverse clinicalconsidered,MDMA. an SSRII setting,interac- This atif wiseMDMA(1999) contraindicated pharmacokineticsreported that intwice-daily the are relevant notAntioxidant administrationbeing patient measured or supplements volunteer of and high-dose SSRTs population. also aipha-lipoic are may not prove other- acid useful. Aguirre and colleagues antioxidantsnon-neurotoxicfordose two of days MDMA also completely MDMA may in rats. enhance doses Becauseblocked and recovery isthethe due acuteneurotoxicity tofrom oxidative inactivation even low stress,of aofMDMA subsequent TPHit is plausiblecan doses. occur single One that after PDF compression, OCR, web-optimization with CVISION's PdfCompressor Risks of MDMA Use Asidethatbicconsideration144 acid fromare (vitaminknown such possible to C), be may well pharmacokinetic alter tolerated urinary appearpH andinteractions, unlikelythus affect todoses excretion increase of with antioxidants is that high doses of some acids, such as ascor- antioxidantsof MDMA.the risk of unknown.ering,adverse the events appropriateIt would and bemay technicallydoses decrease andAlthough timingandthe risksethically of theseof their long-term difficult potentially administration totoxicity. establish neuroprotective are whether strategies are worth consid- largely neurotoxicitynotThesea given be interventionsused intervention to arereassure reduced. thereforehas potential should research be considered experimental and been successful in lessening MDMA neurotoxicity. volunteers that the risks of MDMA should TheofsearchPeople MDMA Need is who needed.for neurotoxicity Morehave More Researchread animalthis and far the studieslikely potential needcould influence little investigate convincing of the possible aging that processsymptoms more re-on morewouldtabolitesthese symptoms.accuracy. allow after us neurotoxic to There Measuringpredict is apotentialand particular blood non-neurotoxic neurotoxic and brain levelsexposuresMDMA of dosesMDMA in different in humans and itsspecies me-with need for primate studies to establish - nonhumanrats,Nowthreshold it would doses primates be forpossible toneurotoxicity the tosame design MDMA and drug measure plasma dose regimens MDMAconcentrations thatpharmacokinetics. MDMA that are pharmacokinetics seen have been characterized in humans and that expose rats or risksspecies.pharmacokineticsin humans of MDMASuch after studies commonlyneurotoxicity are wouldestablished, makeused toLong-term similarhumans.greatMDMA advances studies doses. follow-up could in Once our be understanding studiesnonhuman carried inout humans primatein of those the should investigate whether MDMA-assistedhigherMDMAtant population risk exposure of affective psychotherapy whois associated could disorders. be with assessed.in Thethe clinically 1970shundreds Prospective andsignificant ofearly patients 1980s symptoms, who are oneunderwent such impor- as a studies of Ecstasy users

PDF compression, OCR, web-optimization with CVISION's PdfCompressor nitiveare performance and whether abstinenceneeded to from establish MDMA definitively is associated the extent with to which MDMA impairs cog- Does MDMA Cause Brain Damage? 145 ship0fMDMA-inducedrecovery.Summary to serotonergic Both human changes functioning. and animal in regional studies cerebral should blood investigate flow and the itstime relation- course age.supportsinHigh- serotonergic The magnitudethe view and that axonalof these functioning serotonergicchanges, at in least changesanimals. in part, varies More are withand the moreresultdose, evidence species,ofor dam- repeated-dose MDMA regimens can produce long-term changes that'Whilecoreand theretemperature route a degree may of administration.be of of permanent recovery animals doescan changes Rodent increase occur, in studies a axonalor study decrease have indistribution squirrel shownMD1VIA monkeys that in neurotoxicitysome changes suggests areas in ofthe Theergyrotoxicitythe sustained brain. sources Oxidative though pharmacological and antioxidant the stress exact appears mechanisms effects defenses, to ofplay MDMA leading ofan actionimportant may to damage.are exhaust rolepoorly in Metabolitesneuronal MDMA understood. en- neu- of andmals,MDMAcorrelates changes despite are anotherof indramatic MDMA response possible serotonergic exposure to drugs.source have changes, Aof growingbeenoxidative foundalterations number stress. in drug-free Veryinof neurofunctioning, studies few laboratory behavioral describe ani- users,giclimitations,differences changes the few between butand controlled they cognitive Ecstasysuggest clinicalalterations. usersthat some trialsand In nonusers.Ecstasy with contrast MDMA users Theseto studies experience in studies healthy of illicit have serotoner-volunteers Ecstasyserious ministrationrisksbralreportedly blood of neurotoxicity flowhave of MDMA alterationsnot found must to evidencethathumans. be consideredwere ofdocumented cognitive when assessing changes,in one study. thedespite potential The the possible cere- ad-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JulieTHEAROUND Holland, LEGAL THE M.D STATUS WORLD OF MDMA PreventionIntrolled13, Substancessection and 813).Control Act The (GSA),Act GSA ofthe 1970titleplaces United II(United ofall States, thesubstances StatesComprehensive MDMA Code, that currently aretitle Drug 21, chapteris listed in Schedule I of the Con- regulated under Abuse recognizeddiction.theexisting substance's federalSchedule medical medicinallaw I intois use, reserved one andvalue, of Schedule fivefor harmfulness, theschedules. most V is dangerousthe andThis classification potential placement drugs for isthat abuseused based have for or upon theno ad- least dangerous drugs.Schedule(A) The drug or other substance has a high potential for abuse. I supervision.(C)States.(B)The There drug is aor lack other of substanceaccepted safety has no for currently use of the accepted drug or medicalother substance use in treatment under medical in the United Schedule(B)(A)The The drugdrugII oror otherother substancesubstance hashas aa highcurrently potential accepted for abuse. medical use in treatment in the United dence.(C)States Abuse or a of currently the drug accepted or other substancesmedical use maywith leadsevere to severerestrictions. psychological or physical depen- 146 PDF compression, OCR, web-optimization with CVISION's PdfCompressor Schedule Ill The Legal Status of tIDMA around the World 141 (B)on(A) schedulesThe drug orI and other II. substance has a currentlypotential foraccepted abuse medicalless than use the in drugs treatment or other in the substances United Scheduleor(C)States. high Abuse psychological ofIV the drug dependence. or other substance may lead to moderate or minimal physical dependence (B)substances(A) The drugdrug on oror schedule otherother substancesubstance Ill. has has a a currently low potential accepted for abuse medical relative use in to the the United drugs States. or other Schedulecal(C) dependenceAbuse V of the relativedrug or toother the substancedrugs or other may substances lead to limited in Schedule physical dependenceIll. or psychologi- substances(B)(A) The drugdrugin Schedule oror otherother IV. substancesubstance has has a a currently low potential accepted for abuse medical relative use in to the the United drugs States. or other changeule,The removed the schedule fromcal(C) dependence Abusecontrol, of ofa thedrug andrelative drug or rescheduled.or toother the drugssubstance substance or otherProceedings mayact substances lead mayalso to limited providesbe into Scheduleinitiated physicaladd, adelete, IV. waydependence by forthe or substances or psychologi- to be controlled, added to a sched- macycludingandDrug Human association,Enforcement the manufacturer Services a publicAdministration (HHS), of interest a drug,or by group a petition (DEA),medical concerned from bysociety the any withDepartment or interested association, drug abuse, ofparty, aHealth a phar- state in- uponceivedor local information by government the DEA, received the agency from begins Thelaw enforcementDEA its own also investigation. may laboratories, begin an investigation state and lo- of a drug at any time based a petition is re- orscientifictor,tion.cal other lawby Once authorityenforcement substanceand the medical DEA of shouldthe hasand evaluation U.S.collected regulatory be Attorney controlled and the agencies,recommendation necessary General, or removed or data, requestsother asthe sources fromto DEA fromwhether control. administra-of the informa- the HHS Thisdrug a PDF compression, OCR, web-optimization with CVISION's PdfCompressor request148 Risks of MDMAis Use sent to the assistant secretary of health of the HHS. Then the AdministrationHHStional solicits Institute information (FDA) on Drug and Abuse. fromevaluations the OnceCommissioner and the recommendations DEA has of thereceived Food from theand the scientific Drug Na- and medical evaluation from ationsandsionHHS, into about theare which administratorbinding whether schedule to to the propose will itDEA should evaluate With that be respectplaced.a all drug available ortoThe scientificother medical data substance and and and make medical scientific be a controlledfinal matters. evalu- deci- controlHHSThe recommendation recommends the substance. that on the scheduling substance notis binding be controlled, only to the theHistory DEA extent may that of not ifthe Scheduling of MDMA Inthepower50 Federaltypical to schedule processRegister aof entry drug lengthy [FR]forOctober onehearings 23118) year of toon in1984, givecasesan emergency Congressthe where U.S Attorneythe enacted public Generala healthruling is(Emergencythe at Scheduling Act, basis and to bypass risk.emergencytask Furthermore, to the DEA.basis for the one Attorney year. After GeneralOnJuly one year; has1, 1985, thethe option the DEAplacedMDMAin of delegating this Schedule Ion a temporary placement was extended by MDMA,tributorshadsix months basically they were (51 had jumped able FR not 21911).to been theescape gun. delegated It should theirBecause sentences thebe of notedtask this byin loophole,that thethe when mid-iAttorney severalthe 980s. DEA General MDMA scheduled and dis- tainsYoungpleted much [see announced more"The materialHistory his recommendation: ofabout MDMA"] MDMAOn May the than "Theadministrative 22, the 1986, record Agency once now was lawthe assembled awarethreejudge hearings ofFrancis when con- of the previous year were com- becauseMDMAit doesinitiated have ithas doesthis accepteda highproceeding. have potential asafety currently Thefor for use evidence acceptedabuse. under It medicalof cannotmedical record besupervision. usedoes placed in not treatment inestablish BasedSchedule and on that itthisI PDF compression, OCR, web-optimization with CVISION's PdfCompressor record it is the recommended decision of the administrative law judge that The Legal Status of MDMA around the World 149 ionMDMAcals/mdma1mdmajaw2 and recommendedshould be placed ruling, .shtml.]in Schedule seeOn docket November III." 84-48 [For 13,ata fullwww.erowid.org/chemi- 1986, transcript MDMA of wasthe opin-placed permanently in Schedule I wastionerUnited(51 not FRthat States an 36552). the FDA-accepted methodCourt This of of rulingAppeals deciding medication) was for currently appealed the wasFirst accepted inappropriateby Circuit Lester medicalagreed Grinspoon, and withuse ordered (saying the M.D. peti- the Theit I,was effectiveFebruaryDEA removed to remove on2 2,fromMarch 1988, the Schedule 23, thedrug 1988 DEA from I (53 effectiveadministrator ScheduleFR 5156), January Ion and again September this27, placed action1988 MDMA(53 18,was FR1987. not 2225). inappealed. TheSchedule Ondrug humantrolledillegal, Substancesconsumptionin an effort toAnalogue that stem were the Enforcement tidesubstantiallyAn of interesting so-called Actsimilar designer ofpiece 1986. in structureof drugs, Drugslegislation was andintended theeffect that Con- forpassed to after MDMA was made orschedulescheduleddrugs Eve) that was as drugwere placedthat itself already drug. in and Schedule Thus, inconsidered Schedule MDE I by to virtue(methylenedioxyethylamphetamine,I beor IIautomatically ofwere its similaritytreated placed as toif theyMDMA.into thewere same [For the www.house.govandmoreRecent Senate details MDMA bills on and scheduling,and www.alchemind.org] laws,Legal see seeManeuvers also "The History of MDMA." For Congress www.senate.gov, Children'storSenateThe Charles Anti-Ecstasy bill 2612,Health Grassley proposed Act (R)of 2000 byof SenatorIowa (Public which Robert Law was Graham106-310), modified (D) called of and Florida rolledfor the and into United Sena- the ration Act offensesuseprovideStates of SentencingEcstasy. for involving higher Those Commission penaltiesany penaltiesmethamphetamine associated to would amend with be the mixture. comparablethe federal manufacture, Furthermore, sentencing to the distribution, base guidelines the levels bill calls and to for PDF compression, OCR, web-optimization with CVISION's PdfCompressor ingfor of150 state and local law enforcementgTeater officials, emphasis and on adequate the education funding of young for Risksre- adults, of MDMA the Use education and tram- 2987,CongressmansearchThe Methamphetamine incorporatesby the National Christopher the Instituteand major Club Cannon's provisions on Drug Drug (R-Utah) Abuse. of the methamphetamine Club Drug Anti-Prolifera- bill, HR Act of 2000 sociatedamendoftion Illinois. Act the with(HR federalHR the4553) 2987 manufacture, sentencing sponsored calls for theguidelinesdistribution,by UnitedRepublican toStates and provide Congresswoman use Sentencing of for Ecstasy. higher Commission Furthermore,penaltiesJudy Biggert as- to atschoolthe Ecstasy, bill andcalls community-basedPMA for five (paramethoxyamphetamine), million dollars abuseThe andin Club funding addiction Drug toand Anti-Proliferation theprevention related public club health programs drugs. service Act aimed also for contained an information ban means,manufacturequisition,section. information It or isof usedescribed a controlled of pertaininga controlled as illegalsubstance, to, substance, "toin whole teachor to knowingdistributeor demonstratein part, or to having any to person, anyreason person by to anyknow the the manufacture, ac- facture,for,that orsuch in acquisition, furtheranceperson intends orof, use an to activityuseof a thecontrolledThis thatteaching, would constitutes have demonstration, made an offense." it a crime or information to distribute information about the manu- Specifically, the word unchangedHousemade"teaching" the Judiciary thepublication appeared punishment Committee ofin thethis provisions originalstruckbook a the criminal equatingdraft information of offense.HR Ecstasy 4553, ban On with from which July methamphet- the 25, would bill 2000, but have theleft 2000Proliferationamine. (HR 4365), Act of2and 000this wasversion incorporatedOn passed September in into the Housethe27, 2000, and theSenate. Methamphetamine The sen- and Club Drug Anti- Health Act of offensesusewastencing itsremoved. own provision and discretion stated Instead that that thewouldin Congress setting new have law the had equatedinstructed penalty a sense MDMA for thethat Ecstasy Sentencing the with punishment and methamphetamine otherCommission for "high- to club drug PDF compression, OCR, web-optimization with CVISION's PdfCompressor The Legal Status of MDMA around the World 151 tionbelevel increased. 3664 of Public Law 106-310),In JanuaryCongress 2001, instructed undertraffickers" thethe U.S. Ecstasy Sentencingof Ecstasy Anti-Proliferation was not stringent Act of enough2000 (sec- and penalties should ofonportation,Commission marijuana,marijuana or trafficking to equivalents.1 increaseg of heroin of the ForMDMA. equals penalties 1 Federal kg for of the marijuana, sentencing manufacture, and guidelines 1 importation, g of mescaline are based ex- example, 1 g of powder cocaine equals 200 g withlentonequals to1March kg35 10 (1,000g g 19of of marijuana.in marijuana. grams) Washington, of UnderThemarijuana, D.C.;new the proposal, oldDrs. was guidelines, Davidargued to equateagainst 1 g of 1 atMDMA gram a public of was MDMA hearing equiva- Nichols, Charles Grob, Rick heroinsentencingDoblin, in Julie terms commission Holland, of penalties. and as Richardto theIn inadvisability 1999 Glen there Boire, were among of equating4,705 others, deaths MDMA advised recorded with the attributed to heroin intoxica- posalmorediffertion; wasthan 9 markedly. people to500 equate todied 1 An MDMAto secondary averagea penalty with dose to ratio heroin,Ecstasy of of heroin, 1gram use. to 1. 5 Comparefor Further,to gram,10 milligrams, this their mortality dosage is substan- unitsratio of although the pro- mouslythanin,tially on for lesstoa perheroin.equate than dose 125 1On basis,gram mgMarch ofthe MDMA.MDMA 20,penalties the U.S. withWhen for Sentencing 500 Ecstasy adulterants grams are Commissionof five andmarijuana. times fillers more votedare The factored seriouscom- unani- 2001.submittedmission,UnitedPenalties an this independentStates forpermanent Possession federal rule to agency Congress,and Salethat setswhich of nationalMDMA went intosentencing in effect the May policy, 1, MDMIATheaboutquoted average MDMA "uppossession. tonewspaper fifteensince itsThis years initial article penalty in emergencyprison about has or MDMA been a scheduling$125,000 cited prior repeatedly fine" in to 1985. 2001 as the The frequentlyin penalty articlespenalties for PDF compression, OCR, web-optimization with CVISION's PdfCompressor minimumfor sentence exists for MDMA,MDMA as it does possession for some or other intent drugs, to distribute suchRisks of MONAare complex. Use No mandatory tors.guidelines,areas crack rarely It is cocaine.basically enforced. which The area Thepoint complicatedmaximum actual system, sentence which by many istakes aggravating into account and mitigating fac- penalties are found in the statutes, but they determined by federal sentencing the weight of the andthewomen,drug, sameavoiding the weapons, amountcriminal a trial of history or allowsMDMA serious offor will the injurya reduction notdefendant, orhave death inthe points,and weresame whether sentence.as does children, cooperating Pleading pregnant guilty with involved. Everyone with tion,ratherutethe oftenauthorities the than charge can the be behaviorin of based making trafficking on of other thethe and amountdefendant. cases conspiracy forof drugthem.With is in amoreMoreover, federalthe likely arrest intentthan and with to prosecu- distrib- a state defendant's possession, monthscreasecharge. the to likelymore thanprison five term years. for theUnderThe sale new the of sentencing 200old guidelines,grams guidelines a five-year to be prisonfollowed by federal judges will in- of Ecstasy from fifteen pills,newsentence11,500 amendment,would (levelto 46,000meet 26), theoffenses pills, would criteria based involvinginvolve for on a levela 2,857pill 100 26weight gramsoffense. of250 of Ecstasy, mg to 350or mg. Under the anywhere from 400 to 1,600 MDMAaverage possession penalty to was ten years.thirty-threeAlthoughBefore months. the there Thenew newissentencing a statutorylaw will guidelines, increasemaximum the the limit average of twenty prison years sentence for a first for fendertovolvingoffense, distribute can Ecstasy. there spend is arethe However, tencurrentlycharge, to sixteen thethere no offense federal ismonths a sentencing level mandatory in prisonbegins guideline regardlessminimumat 12, minimum:so a sentencesof the if weight intent in- first-time of- theyearsseized. Drug in prison Enforcement and $500,000 Administration in finesIn New forinvolves Orleans,staging using a a rave. local the federal DJ and "crack a concert house hail manager face up to twenty The prosecution by

PDF compression, OCR, web-optimization with CVISION's PdfCompressor The Legal Status of MDMA around the World 153 theture,signedlaw." case storage, to was punish not yet the settled. owners or operators of houses Passedused for by the Congress manufac- in 1986 to combat crack cocaine, this law was de- distribution, or use of illegal drugs. At the time of publication underMDMACaliforniaExamples the ofControlled State Penalties Substances Analogue Enforcement Act of 1986. A per- is not mentioned specifically, and state prosecutions are pursued prison.thefacesson moreconvicted Punishmenta maximum likely of sentence, possessing offor one possession year which a in theis of drug countyMDMA education jail with or state orintent rehabilitation prison. to distribute "Diversion" instead car- isof personal use amount of MDMA in California pendingthatries threatensa stateon the prison offenseto (1) term make level. of MDMA sixteen DiversionAs ofa months ScheduleApril is not 2001 or an Itwo controlledtheoption. yearsCalifornia or substance three legislature years, in Cali- was de- considering a bill (AB 1416) maximumpunishedfornia.fornia, andThose by of (2) aone convictedmandatorymake year it ina crime jail.of minimum being to be under "underof ninety-days the the influence influence" in county of MDMAof MDMA jail and would inup Cali- to be a receivePossessionADelaware law is a being mandatory of fifty proposed or moreminimum to increasedoses term would the of punishments beimprisonment considered for trafficking MDMAof three inyears and this would andstate. a mandatoryfinetory$100,000. of minimum $50,000. minimumPossession Possessionterm of termof imprisonment five of of hundredone imprisonment hundred ofdoses fifteen or or more ofmore years five doses would years would receive and receivea afine manda- ofa and a fine of $400,000. PossessionNewthea first-time amountJersey of offenderofMDMA drug seized. couldcarries serve a sentence less of three to five years in prison, than a year in county jail, regardless of but

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 54 Risks of MDIIA Use LessPunishmentTexasdays than in county1 gfor is consideredpossession jail, up to twoaof state MDMA years, felony, and in Texasawith fine a ofdependsmandatory up to $10,000. on minimumthe drug Possession weight: of 180 of minimumbutmum1 gless sentence,but than less sentence, 400than up gto4 upisg ten is ato second-degreeayears, twenty third-grade and years, a fine felony, and felony, of fine up with toofwith aup mandatory ato mandatory $10,000. two-year Possession two-year mini- $10,000. Possession of 4 g possiblesionof 400 with lifeg or thesentence. more intent receives to distribute a mandatoryThe are penalties determined five-year for distributionminimum by weight sentence, ofor themanufacture MDMA up to a of MDMA or for posses- minimum,Betweensentenceseized. Less of 1 up180and than to days 4 twenty g1 ising aiscounty second-degreeyears,a state jail, and felony up fine to twothat felonyof up years,carries to with $10,000. and a a mandatorya mandatory fine Between of up tominimum two-year $10,000. 4 g and imprisonment.ato400 person possible g is a gets first-degree life a imprisonment mandatory felony, ten-year and carrying maximum minimum a mandatory $10,000 sentence, fine.five-year For 400 minimum, g or more, up with possible life NarcoticThe11,International 1986. Drugs placed MDMA in Schedule I internationallyWorld Health on February Organization and the United Nations Commission on Law Regarding MDMA MisuseMDMAAustraliaa $2,000 Act is (approximatelyclassified 1990. Commonwealth as a Schedule $1,000 U.S.)penalties II "dangerous fine for for possession a small drug" quantity as are part two of(less yearsthe Drugs plus than half gram(approximatelya gram).quantity and Possession 500is over g.$50,000 500Possession of g.half U.S.) a gram fine.of 500 receivesA "traffickable" g gets twenty-five a life quantitysentence. years is Abetween half a and a $100,000 commercial

PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMABrazil arrived in Brazil in the early 1990s. Its cost at that time ($3 0—60 per The Legal Status of MDMA around the World 155 beganpillon in the toU.S. occur. currency) restricted itsThe use law to thatthe elite.regulates illegal drugs inlaw Brazil enforcement (Law No. radar 6368) screen went beginning into in 1995, when large seizures The drug was picked up miningpendence.referseffect toon which narcotics October Article substances 6and21, of 1976.substancesthat are law toIt doesbecharges thatcontrolled. not create the mention Ministry physicalMDMA any of orisparticular Health listedpsychological as with adrug, psycho- deter- butde- doestwoRDCtropic years notNo. substance mention 62for ofJuly users, that any 3,2000.and is quantities. prohibitedthree The to penaltiesfifteen A in range Brazil years are of in finesa prisonaccordance are term specified, ofwith six Resolutionwhichmonths are to for traffickers. The resolution Theinflation.Canadatied legislation to anA newindex that law defined governs is currently by MDMA, the beingjudge the discussed.according Controlled to currency Drugs and fluctuations Substances and Act,cocaineceedingtrafficking passed (Scheduleten on in years. May MDMA 14,I).It is 1997. ispunished a crime MDMA less liable isharshly listed to imprisonment inthan Schedule cannabis III.for (Schedule Importinga term not Ii) or ex- or aprisonTheChina fine. minimum plusThe aminimum fine. penalty The penaltymaximumfor possession for sentence is a sentenceis seven yearsof less to than life threein prison years plus in trafficking is seven years in prison plus a forplusfine.(which MDMA confiscationThe wasmaximum in written China of sentence property.largelyis "head-rocking about is MDMA fifteen opium) pills." yearswas on added toMarch life toin 14, theprison 1997. existing or The even drugslang death, law term useEcstasyGreece is illegal, even for has been classified as a Schedule I drug since 1987 (Law 1729). Its psychiatrists, without a special order from the Ministry PDF compression, OCR, web-optimization with CVISION's PdfCompressor theimprisonment.of penalty156 is up For to manufacture,ten years.Health. sale, distribution, importing or exporting,Risks of MDMA Use Possession for personal use brings a penalty of up to six months' years.larsTheHong (approximatelypenaltyThe Kong penalty for possession for US$1 trafficking =is a fine is aof fine 100,000—1,000,000 of HK$500,000—5,000,000 and HK$7.8) and imprisonment for three to seven Hong Kong dol- theimprisonmentTheIndia last Narcotics day of for Britishand three Psychotropics rule. years to life. Substances These laws Act were (1985) enacted has onJune two schedules, 30,1997, ing).mentsupdateever,which Ecstasy/MDMAAnyone supposedlyrelatedor if there tofound drughave are withupdated usebeenwas depend narcoticsnot any regularly. listed. prosecuted on ontheIt isAccordingtheir quantity unclear cases person involving whether(personal to isthe subject 1999 thereEcstasy. use version, tovs.has up All traffick-been to how-judg- ten an years'MDMAjudge'sIsrael imprisonment. has discretion. been considered Prosecution an illegal for possession drug since of 1991.less than In 19985 g is a up few to de-the twenty-fiveismethylenedioxyamphetamine).rivatives up to three were years' years' declared imprisonment incarceration. illegal, including The andSelling penalty trafficking MDA to minors for and possession up MIVIDAcarries to twenty a for penalty(3 years' personalmethoxy ofimpris- up use4,5 to onment.possessionThereItaly is no are law those that forspecifically Schedule coversI drugs MDMA.in that country. The penalties It seems for as thoughsale or cerationecuted.anthe international authorities Thefrom penalties eight are basis; much to possessiontwentyfor more sale years interestedor ofmanufacture, andsmall a infineamounts heavy of or 50,000,000 trafficking,ofimport/export MDMA to is especially500,000,000 rarely are incar- pros- on

PDF compression, OCR, web-optimization with CVISION's PdfCompressor The Legal Status of HDtIA around the World 157 Singapore5,000,000titylire (not considered to 50,000,000 lire (approximately(approximately $250 $2,500 to $25,000 U.S.). For possession of a smaller quan- trafficking), the penalty is one to six years and a fine of to $2,500). prisonmenttoEcstasy 1992.20,000 wasThe Singapore or citedpenalty both. as a Thefor "class possessionpenalty A controlled for and trafficking consumption dollars (approximately US$1 = drug" in the Misuse of Drugs Act in (possession of more than 10 g of MDMA is aS$1 fine of up .7) or ten years im- Spainandcane.of the fifteen Illegal drug) strokes isimport up to of or twenty the export cane. years' imprisonment carries a penalty of up to thirty years in prison and fifteen strokes of the largerpersonalhealth."In Spanish amounts, Nevertheless, use legislation, (less the than penalties MDMA since twenty forMay istablets) those considered 30, 1986,who has cultivate,not tothe been possession punished. In terms "cause serious damage to the manufacture, traffic in, of MDMIA for of withorarticlethree otherwise those times 368). aims promote, the are price a prison of the sentence amount of drugthree seizedto nine years or facilitate illegal use or (Spanish Penalwho possess Code, MDMA and a fine of drug."notSwitzerland'sSwitzerland a serious The Federal crime. Supreme Tribunal MDMA Court ruled remains ruled that in while June Ecstasy1999 that is dealingin no way in a illegal there but is considered a "soft Ecstasy isharmless usedsubstance,MDMAcriminal mostly thereforbehavior, by medical "sociallyis no saidevidence or integratedresearchthe court. that purposes,it Swiss people"poses druga seriousanddepending legislation does health not on allowscase-by-casegenerally therisk. use Theper-of lead drug to is MDMAUnitedmissionpossession Kingdomfromwas addedis the up Swiss to to seven the Federal 1971 years Misuse Health in prison of Office. Drugs and an Act in unlimited fine. The penalty 1977. The penalty for

PDF compression, OCR, web-optimization with CVISION's PdfCompressor forphetaminesBritain158 amended (including its Misuse MDMA, of Drugs MDA, traffickingAct MDE—anything to label is all up ring-substituted to lifewith in an prison amphet- am-andRisks an of MDMAunlimited Use fine. In 1977, Great noIclassamine acknowledgedof the A basic drugs.Misuse structure MDMA of therapeutic Drugs upon was regulations whichincluded use. Anchemical in ofamendment the1985, list substitutions thatof drugs ofis, theit specifiedis Misusehave considered been inof Schedulemade)Drugs to have as MDMAisAct drugslet.htm).interesting to include rather that anotherthan these their thirty-six drugsbasic chemicalare identified discussed structure substances in terms (www.homeoffice.gov.uk/ is of under their discussion.similarity toIt

PDF compression, OCR, web-optimization with CVISION's PdfCompressor MINiMIZINGAniN THE DANCE RISK COMMUNITY JH: WhatEmanuel does DanceSafe do, and what is your role there? Interview Sferios with philosophyES:and executive that also director. can be We referred utilize to a asharm a peer-based reductionDanceSafe and is a drug abuse prevention program, and I am the education model. We popular education of young people founder haveeducatorsabusedrugswithin chapters themselves,prevention the ravewithin in about and counselors,theirthough nightclub fifteen own some cities communities. harmcommunity, are now, reductionnot. which We many trainOur areworkers, of mainmadethese whom up are users volunteersactivityand health isto settingand be drugsafety up of dance counselingtheirarebooths used. peers at eventsWe teclmiques.in providediscussions where Ecstasy;These about methods ketamine, drug avoid use and by the GHB employing use of the harm reduction literature, and our volunteers engage (gammahydroxybutyrate) imperative"pop (should, ed" or peer usersshouldn't,healthabusing to reflectand do,drugs safety; don't) on so their thatand owntheyask open-ended can make more questions. informed Our drug use and the reasons they may be using or decisions about theirgoal is to empower JH: CanES: youWe tellprovide me about adulterant your pill-testing screening pro services, gram? '59 also known as pill testing. PDF compression, OCR, web-optimization with CVISION's PdfCompressor hasThere gained160 us a lot of media attention. It is a very effective outreach toolare as three branchesRisks of of this MDtIA program. Use One is onsite pill testing, which Theandadulterantswell usually volunteeras a harm byhand will usingreduction the measure pilla chemical over service. the to pill, onereagent. We scrape of screen the The sometrained supposeduser material harmwill approach Ecstasyreduction from the tablets the workers.pill booth onto for wetellchemicala meanwhite whether MDMA,ceramic reagent there plate, MDA, ontois an andthe Ecstasy-like or scrapings;handMDE, the though pillsubstance depending back MDE to in theison the very theuser. pill. colorrare. WeBy Itchange,"Ecstasy-like,"put is a droptest we for of can a U.S.testpuritythe despite marketpresence or strength. itstoday ofinability Therean that Ecstasy-like contain couldto detect be MDMA something puritysubstance orbecause MDAelse in thein domostthe tablet; not pill, of contain butitthe is it pillsnot is anything aa onuseful test the for sitequistainelse. [www.Dancesafe.org]. MDMA, reagent—theConversely, so they mostchemical won't of the inchange pills the testthat the kit—which contain appropriate something is availablecolor elseunder on do theour not Mar-Web con- JH:someES: How We don't? do have you knowanother that program some tablets for onadulterant the U S. marketscreening contain besides adulterants the onsite and substances.laboratoryhavetesting contracted and in theWe Sacramento, testing havewith aset kits. Drug up WeCalifornia, anEnforcement Internet-basedoffer a laboratorythat Administration is allowedprogram pill analysis to where handle (DEA)—licensed program. controlled We users or any- informationetryandone theelseThey lab can provideconcerning will send test usan the withunknown where pill a pictureusing the tablet pill gas of was tothechromatography the pill,obtained lab, the directly results and andthe ofand thedate anonymously, analysis, it and mass spectrom- was ac- ousoftwoquired. the compounds,weeks. tablet We This and post waylikebe all able PMA. theof thistouser, avoid information and tablets anyone that onelse, our have can web potentiallysee site, the usuallyactual ingredients in less than more danger-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH: Let's talk about P1 VIA Minimizing Risk in the Dance Community 161 wasunlikeES:one introduced who MDMA. most Approximatelylikelyinto the was Ecstasy trying eight to years ago PMAa large (paramethoxyamphetamine) batch of PMA tablets marketavoid in theEurope, penalties manufactured associated withby some- MDMA. is a halluéinogenic amphetamine, MDMAstrictlyprecursorAnother controlled, arereason chemicals avoided. why so PMAused Thethat theproblemto may make expense have itis arebeenthat and more PMA introducedrisk of is purchasingan extremelyon the market precursors dangerous is that to readily available and not as ingsomewhatationalcompound. at various drug, safe Itpsychoactive becausewas is belowexperimented some 50compounds, mg,people butwith died.at inbut doses the itThe never1970s, even dose became slightly when level people thata higher appears were than look- tothat, be popular recre- JH:heart AndES: rate temperature? and blood pressure can rise dramatically.And body temperature as well. So an Ecstasy user is unlikely to die or probablyever,theyexperience takethey more onlyare serotonin very onethan likely pill two syndrome that dozento havecontains deaths aor severe a PMA.heatstroke resulting If they from reaction take PMA three [hyperthermia] overdoses. or four, how- if adverse reaction. There have been JH: IssixAprilES: that in We 2000.Floridain theknow lastFirst, during thateight there there theyears? were summer. have Were three been theyAnd in ninethe clusteredthen spring deaths there aroundin was inthe the one, Chicagocertain United or dates? area States and perhaps two, in sincethen deathindeathsthe Europe Toronto or in more Australia and area inEngland. ain country. from the fall. Itthe seemsThese Insame the thatpills batèh,spring theare and of pillsvery 2000,before willdistinctively there causethat, werethere one marked. halfwere a high-profile deathsdozenThey Kleinforstampedare Ecstasythe CK, Mitsubishi on or pillsthe Mitsubishi's pill,to tablets—theyhave which corporate three is a populardiamonds, logos Ecstasysuch it should as thebrand. Nikebe made[While swoosh, clear it is common have the three-diamond logo of the company the Calvinthat these PDF compression, OCR, web-optimization with CVISION's PdfCompressor Ecstasy.companies162 Clandestine labs that stamp Ecstasy pills have co-opted these logos Risks of MDMA Use are in no way involved with the manufacture or distribution of JH:Mitsubishi Thereas a way was as to ana "brand" particularly article andin New gooddifferentiate York brand magazine of theirEcstasy. tablets.—Ed.J about I imagine three thatyears they ago capitalized naming oningbeenES: the onYes, copycat popularity the and ingredients pillsthat of isavailable. that a fairly logo of a whenAirresponsibletablet. brand making The name impetusPMA. article, absolutely forbecause thedoes information therenot have have any always in bear- this fakemgveryarticle of andlarge MDMA;probably adulterated batch this cameof Mitsubishi tabletsreinvigorated from wereEngland. tablets prevalent. the Back wasEcstasy introducedin the market mid-1990s thatbecause were in beforeEngland, about that150 a JH: IEnglandES: seem Right. to for remember There a period will hearingof alwaystime, thatthat be there ita wasbalance was hard a betweenlotto get more MDMA. themethamphetamine fake pills and appro- in comingtheprohibitionpriate profit therapeutic/recreational back potential and and an risking unregulatedof the fakemanufacturers. pills, market.dose because pills, And Basically, asenough that long is asbecauseyouof therethe need time itcontinues to will they keep optimize will people to get be soongooddowna real as pillsone.their they Whento use, becameget the thepeople manufacturers customerspopular, stopped there back. using realizedwere TheseEcstasy tons that happened of in they Mitsubishithe earlyhad to better benineties, copycats, Mitsubishis. put orout slowedinclud- some As JH: Whatingtablets these do in youthe PMA Unitedmake tablets. ofStates the DEl'scontain report adulterants. that less Why than would 1 percent they ofsay the something Ecstasy that irresponsible?totheyES: identify confiscate MDMA. are ones It also that could have be been that "sniffed theThere tactics out" used by bydogs the that DEA are or trained other are probably two reasons. It could very well be that the pills that

PDF compression, OCR, web-optimization with CVISION's PdfCompressor suadefederal them to turn on the higher-level dealers and then work their way up.agents are generally geared to apprehend Minimizing Risk in the Dance Community low-level dealers and per- 163 JH: MyI'mthan onlytake it is. onspeculating So it ifis anotherthat theabout drug DEA this.(or drugs) is responsible for some of wants to portray MDMA as more dangerous the casualties, they ES:wouldology,disingenuous. rather because have Perhaps theyit look provide as they though feelusers MDMA that with the awere testingsaferThat involved. way kits to are consume a threat the to their ide- would be my second reason, which is that they are simply being drug, and othercomesabstention-onlythey see drugs out anything of besides it tend model.The that to Ecstasy usepromotes simple drug on saferthe scarewar market anduse orthe thatreduces drug-prevention are producingharm as counter strategy deaths to and thatthe tactics. The notion that there may be landthediculousadverse government-funded and reactionsSwitzerland,claim. If youruns youlook counter pill see at testing ourvery to laboratory theirclearly programs that pill ain largeanalysis other percentage countries program of likeas the well Hol- pills as so they're making this ri- ketamine,suchlogosbeing asandsold methamphetamine colors—do dextromethorphanas Ecstasy—and not contain made (speed) (DXM), MDMA. to look phencyclidine caffeine, justYou like see ephedrine, Ecstasymany [PCP other tablets, and(angel compounds, so with on.dust)], Wethe JH:ishad Let'slargely one talk pill a aboutrumor. that wasDXI cocaine. VI for a Weminute, never because found I a think heroin that tablet, deserves though. separate That mention.Oakland,andES: onsite,When California, wewe firstcorrelated started rave the communityour majority adulterant with of screeningthe the heatstroke use of program dextromethorphan. emergencies both in in the lab the JH: ThesetheES: termYes. were usedEarly the greenwithin on, when pills the shapedwe rave were culturelike going a triangle? to to refer Oakland to a very large massives—"massive" is commercial

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 164 Risks of MDMA Use reaction,pillsdredrave, ofpills two so an thathundred evening it appeared wereonsite. fake. that Early itSome mighton it of might be them an have Ecstasy-likewould fivebeen have thousand that compound,a veryabout to strange twentythirty but thousand people—we would test about two hun- JH:ES:we What weren'tMDMA color sure. orshould MDA the will test turn substance black rightturn away. DXM it's MDIVIA? eventually turns black, andsequencebut it'sDXM.then a sloweritthat Thereturns really reaction.slowly were indicates some gray; There's green theafter difference a trianglesabout five- tothirty betweengoingten-second seconds, around an Ecstasy-likedelay it's that black. atgave the It'sthis beginning,compound the strange time JH: Andtoryreaction, wasthat itcontainedand a particularly we hadn't dextromethorphan, seen high them dose? before. we When became one aware. showed up at our labora- seevastofES: 1999, perhapsWell,majority of we two five ofdidn't themhundred to tenquantitatively were people pills the greenwe go testedtestto trianglethe it then.theremedical DXM At were the room pills. fortynext atTypically, rave, fakethese pills,in massives September we and might the in JH: IsOakland.ES: there some kind offirst aid tent at the massives?It depends on the promoter, but these promoters were responsible. They mightthreearehad no trainedgo or emergencies tofour the medical events, medical where staffthere room withwilla person because beoxygen a hasheatstroke they andto be area hospitalized.first emergency"freaking aid room. out" MaybeFive Typically, or to a once tenlittle people everytherebit withandthisoverheated medical particularthere were staff.or eventdehydrated, nine there people were so who they dozens had can to ofget be people fluids hospitalized. goingand cool to theWe off medical workand relax. closely room, At

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Minimizing Risk in the Dance Community 165 JH:AndwouldES: Yes. we ask would We them are say, whatthere "No. theywhen What had people didtaken. the are Theirpill seeking look friendsSo medicallike?" you wouldwere And assistance, obviously say,they "Ecstasy."would concerned and an-we about these bigger numbers. themnineDXMswer, people had"It pills wascombined withhospitalized a green the itmajority triangle."with that other evening of We brandsthe were heatstrokehad of taken Ecstasy, the emergencies. green and others triangles. Eighthad Somenot. of the of able to correlate the ingestion of tientsto eratureheatstroke taking of cases normalemergencies of dosesdextromethorphan-induced atof raves. DXMThis There ledwith us other are to investigate medications serotonin why that dextromethorphan are con- could be contributing examples in the medical lit- syndrome in pa- Problemsinhibitor,hastraindicated. the same likeAssociated DXIVI kindMDMA. of is withthermal [Seea mild MDIvIA "How deregulationserotonin MDMA Use" releaser for Works as details MDMA. and in onthe reuptake thisItBrain" is enzyme also inhibitor, and a CYP2D6"Medical required so it JH:its Itto metabolism. also metabolize is an NMDA MDMA.] [N-methyl-D-aspartate If combined with receptor] MDMA, antagonist, it similar in could interfere with ifdosesaction ES:they itto wereis a dissociative MDMA. Theseanesthetic. users expecting andThe looking for mood elevation, problem is that high-dose DXM tablets areat being higher sold doses. to peopleAt lower as doses it is a cough suppressant, but at higher contributestion.out-of-body,empathy, If they and greatly combine thedissociative warm, to itthe lovingwith number effect MDMA, experience with of medical losswhich of of MDMA exacerbatesemergenciesmotor arecontrol getting the at and raves.DXM a verydisorienta- Weeffect, trippy, will it andMarquistinguishsoon the be Ecstasy-likemarketing betweenkit, and a MDMAtwothird compounds. new reagent and testing MDA that kits: clarifies if aused anyin conjunction• ambiguity between with the DXM first secondary amine test that can dis-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH: 166 Is there a way to test Risks of MDMA Use Ically for PMA? adulterant.usefulThisES: has because been an it issue cannot that positively our detractors identify Ourhave PMA,brought the up, most that dangerousthe kit isn't reagent will not change color if the substance you're testing is PMA. JH: PMAthatES:But do have not containnot contained MDMA. MDMA. And all This the pillswasThat's unknownthat have beenby the found DEA to early contain on; it exactly right.doesn't The kit turn is auseful color, becausethen it has it atscreens least identified out all the a bogus pills pill. case.potentiallyhave,they were Theand theyPMAnot mixing networking thought tablets it with thathave with MDMApeople come health werefrom and organizations producing thereleasing same initial PMAit. in That'sother batchin thiscountries simply or country two. not as They andwethe try,trailslightlylook the ofthe dead dealers off-white,same, Ecstasy theywho and areusers.have theyMitsubishi bought When seem theya to tabletsfew be cause hundredcircling of high-profilethe samethousandthe globe size, deaths of leavingthey them in are one can'tbehind white coun- sell or a tomonthsbecausethem recoup anymore. and the their sellmedia losses. Everyonethe have pills publicizedto in someone that country these in another knowsdeaths. country, not So tothey buy because lay the low Misubishis, they for awant few JH:ES: Thisbunch has of been new going people on producing for eight years PMA now. Eight years, the same pills. The good news is that we are not seeing a and selling it. It's as if it was one mistake hopethemfrom that stillwhich we on won't wethe aremarket,see stillanother seeingand one. they repercussions. It'sThe will also bad be been croppingnews very Afteris there upirresponsible this for are batchyears probably toruns of come. thea out, lot media, ofwe law enforcement, the DEA, Ecstasy"drug.enforcementthe drug They czarJimor "justwill to be issuetheMcDonough describing newest statements designer PMA in Florida, calling as drug if it and itinwere "anothera the line simply Florida of deadlydangerous another department threats recreational variant to of your law of PDF compression, OCR, web-optimization with CVISION's PdfCompressor it, market.children,"unaware This that couldit's not very a very well pleasant lead people to start manufacturing and selling leading many to believe that FIVIA Minimizing Risk in the Dance Community experience and most people don't like has a demand and a recreational 167 JH:Asisthe creatingopposed feeling. moreto They harm harm willreduction, than be unaware they're in what preventing? that other it waysis very do dangerous.you think the government Kill"whichES:terproductive TheJust or took "VVinners off Say under in No many Don'tmodel, Nancy ways. Use theReagan, Drugs" Theabstention usehas and ofbeen modelthesuch a reliance miserable simplistic of drug upon abusefailure. messages these prevention, slogans "Drugs coun- aredon'tcologyand beingscare trust and liedtactics, theharm to,information, reduction thatas opposed they aretechniques, because to hearing providing they basicallyonly recognizeaccurate one turns information immediatelyoff young people. on thatpharma- Theythey side of the Even if the whenhavedangersinformation they a problem. andhear isnot about not Ifthe youan a benefits drug—Whyoutright don't answer or lie, the are if desirablethe youso primary many only effects peopleprovide questions of using informationthe that drug,this? people Whatyou on havewill isthe gers.theyathe moral appeal?—then won'tThey agenda willbelieve dismiss and instinctively the that informationit youas just are and more not immediatelyyou giving do give thempeople on know the risks that youand havedan- propaganda. For example, if you go to them all the information. Then panichundredsinformationthe National attacks, of drugs onInstitute depression, Ecstasy, in the on Physician it'sDrug and like so Abuse reading on.Desk (NTDA) Reference: a list of Web the nausea, potentialsite and paranoia, youside read effects seizures, their of JH:ES: There'sEcstasy, not is one left desirable wondering, effect "Well, of the why drug would listed.Right. anyone want to repeat this ex- The mother or father of the user, or someone who has never used theymation.repeatingperience?" look Obviously, thiselsewhere. In fact,experience. they're this They drug Insteadnot come affects left tothey'rewith peoplethe that, DanceSafe left differently because thinking Web they thatthan site,know this NIDA for is people misinfor- says. are example, So PDF compression, OCR, web-optimization with CVISION's PdfCompressor 168 Risks of MDMA Use readrisksdrug,where more. andthus harms. winningWe receive The their statistics approximately trust. onThen the they250,000web gosite onhits confirm to a readday, that withinformation they about do we tengo on firstonthou- the to list the desired effects that explain why people are using this 3H: Yourlengthsand uniquesite of isstay getting visitors for someonea quarter a day. milliononThe our most hitsWeb interestinga day.site isThat's sixteen statistic amazing. minutes. is Itthat sounds the averageas thereeducatedtheES: adulterantPeople are a aboutlot come ofpeople screening Ecstasy back who to and wantprogram the other siteto know to clubor look toabout drugs. order for the new Alltestingrisks oflaboratory and the kits, benefits Ecstasy as testwell of Ecstasypromoting results as to use. geton ofanti—clubatedthat the theimmense sixteen-minute government drugs interest campaign is visit indoing the isstarted, thatdrugright people overournow hits the inare theirhavepast reading year.mediaincreased the Since campaign information tenfold. April, has Thewhen that gener- point thewe proachofprovide, pictures. and because why It's alsothe our Just aWeb testament Say site No is Imodelvery towould the information-based. does successlike notto qualify ofwork the with harmmy There criticismteenagers. reduction are not of atheap- lot Just Say No model. I think it middleers.tryingdoes And work to school teenagersapply very anda well prevention arehigh for a completely school,grade-school model they designeddifferent start children. becoming animal.for Thegrade-schoolers Whenproblemresponsible; children is that tothey teenag-get we startinto are peopleseekingexperimentbecoming need genes inquisitive. withto inhave illicitour accurate gene Whiledrugs, pool, informationthea greatand majority many many and ofpeople teenagers youngharm are reduction people simplydo. We are curious.serviceshave not novelty-going Thesein or- to JH: Onederhave to reasonprohibition make that informed inyou this need country. decisions. to have Because an adulterant-screening of our drug policy and program because isthese that drugs we are murderscreeningillegal and for therefore impurities. are Isold heard on that the the"black government market," is no trying one isto regulating prosecute peoplethem and for they have sold Ecstasy to someone who dies of an adverse reaction. PDF compression, OCR, web-optimization with CVISION's PdfCompressor ES: Right. There's a law that allows a state to prosecute dealers, and by deal- Minimizing Risk in the Dance Community 169 lawanersgardless illicit theystates mean thatof whether youanyone can any be prosecuted money changed for murder. hands. There If you was supply a case someone with substance and that person happens to die after they consume it, this who might have supplied a drug to anyone else, re- in Florida buther.recentlyconsumed theyHe survived, wherechanged the aPMA but youngthe she chargestablets womandied. as toThe well; diedmanslaughter, state heafter wanted was taking the toin one prosecute PMA.part who because Her supplied him boyfriend herfor the parents pills had to prosecutedJH:would Thethe hospitalproblem not for support murder oris thatto get the peopleOnce medical murder againare attentiongoing charges the togovernment befor against even someone less their is likely creating daughter's to take more their boyfriend. harm friends than to they're worried about being WealsoES:they're have the reducing. drug drug itself. policies As that a society maximize we arethe allharmThe responsible to users of for psychoactive the public health. drugs. drug war ideology tends to scapegoat not just users and dealers but toduction.We girlscapegoat need who To to died,avoidaccept anyone when accepting responsibility they he can,himself that to responsibility, blameand almost change died. our the Their policydrug rationale warriors to one ofisare thatharm looking this re- is this death on the boyfriend of the ThisEcstasyangoing unregulatedis bad to or makesocial GHB someone market, science.or heroin there Economicsthink to anyone is twice who 101:before isdemand willing they sell creates to someonebuy it,a market. and else drugs aWith always going to be someone willing to sell drug.have foreEcstasyspreada high calling demand.of to Ecstasy. his an or ambulanceSo her thisIt's friends. notis a whengoing Instead, theto make friend it will someone starts make having someonethink an twice adverse about reaction, selling ridiculous notion. It is not going to slow down the think twice be- needswhochamberlike collapsing supplied to beor spendamnesty the on thepill,the for restdance because any of 911floortheir they call livesfrom canfor inheatstroke. any bejail prosecuted situation.if it comes People forout might murder.that it get was the gasThere they

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH:ES: 110And, again, the fear that is generated byI certainlyprohibitionist agree withdrug that. Risks of IIDMA Use policies is 3H: Thatwhichnot conducive brings is to defineus to to what harm health we reduction. neglectedand to do at the beginning of this conversation, safety. This is a very stark example. mightwithsocietalES: Most people result. drug basically, to Harm use help or reductionharm themother reductionmanage criminalized provides their is an an behavior behavior,alternative alternative and like approach tominimize prostitution.the "abstention to theharmdealing It works only" withthat mediateregardlesswithmodel. drug W7hile need use, of our tomany abstention minimize moral people stance isthese choose the on onlyharms. recreational not way to Harm abstain.to avoid reductiondrug As all use, long the programsit harmsas presents that's associated the provide an case, im- withutilizeexchangeaccurate information, to minimize and is the useful mostharm the information widelyrisksreduction and known theprograms on potential exampledrugs, provide information harmsof a harmsimilar from reduction that theirservices. use. service, NeedleAlong to drug users can JH: Anotherdiseases.limit the example spread ofis givinghuman out immunodeficiency condoms to teenagers. virus Another (HIV), way hepatitis, of looking and atother harmdrugs.howare reductiongoing to make to engageisany to potentiallysee inthings risky like dangerousbehaviors. seatbelts behavior Harmor motorcycle reduction less risky. helmets is Itabout doesn't as examples. have to People be about educating people in arethatety.ES: moreYou'reSeatbeltsdistributing educated right. and condoms Harmcondoms and realizereduction encouraged are thatperfect is isan premaritalnot examples.approach sex.usedFor Ia in thinklong many timethat areas now of people soci- the case. No one feels horny after people felt JH:seeingdrug But use, I athink condomwhich there is alsomachine. still silly. is the You idea either that shootneedle your exchange drugs, promotesor you don intravenous 't. People are PDF compression, OCR, web-optimization with CVISION's PdfCompressor forcedthe transmission of HIX not just among drug users but also amongto share their dirtysex part-needles because they are so dijficult to come by, which increases Minimizing Risk in the Dance Community Ill programsaaroundners. need There forato little exist harm has bit, and beenreduction slowly, doctors a recent in into some theprescribe shift Ecstasy-usingways, in theneedles.about harm I think reduction. our government Why would there be drug policy, allowing needle exchange community and is coming in the substancesusingES:rave community? Ecstasy sold is as not Ecstasy getting that what can you be morethinkWell, dangerous. you're getting. Another There risk are is manyheat- talk about the risks of Ecstasy use. The most common risk of arelatorystroke.environment, not system. MDMA, the result In thealong a of cold body MDMA with environment, can many overheat.alone. other Theyusers drugs, The arereport heatstroke inhibits feeling the emergencies, body'sreally cold;thermoregu- in a hot the result of a confluence of raves.beenenvironmentfactors from At thatraves, heatstroke, are that the more they're dance and closely in.thefloor The majority correlated may majority be of extremely heatstroke withof deaths the behavior after cases taking have of usersEcstasyoccurred and have atthe hot, the promoters may yourin dancingovercrowda hot body environment, forfluiuls, theirmany and venues hours takingengaging without trying a stimulant-type in replenishingto intense make aerobicmore lost money, bodyactivity, fluids. and not the So replenishing user when may you're be drug that can inhibit your ther- Youlapsedrugmoregulatory see fromon long the the distance dance equation floor runners and from stilldo heatstroke the have same heatstroke. whenthing. they We haven't have seentaken people any drug. col- you can get heatstroke. In fact, you can remove the JH: IsocietyES: noticed I think apartyou that use from theit gets drugword the "heatstroke"use. point I used across toinstead callthat itofthis "serotonin hyperthermia. is a common syndrome" Why occurrence is that? on the in fromingtheseWeb heatstroke occurringsite,heatstroke but Ion in gotemergencies the the drugfuture. feeling does If"Ecstasy we thenot don't kidsallow overdoses" lookwere us toat not theeffect orunderstanding confounding otherwise change to simply factorsprevent it. Calling blam- thatthis PDF compression, OCR, web-optimization with CVISION's PdfCompressor contribute172 Risks of IIDtIA to these deaths, we will have no way to prevent Use them. It is mis- importantleadingasand long behavior, and as reason: irresponsiblethey the in drug trying warriorsto tocall blame these are the givingdeaths drug youngEcstasy rather people thanoverdoses the the circumstances impression for one very take only one tablet, they will be okay. They won't overdose. that JH:subjectspeopleThese It is arenothave are notthe givendied deathsdrug, after pure fromhaving MDMA overdose; taken in a only relaxed these one areenvironment,tablet heatstroke of Ecstasy there deaths. are Moreover, no cases of the behavior. In clinical MDIVIA research, when the thehasn'thyperthermia.Grob rave been has setting. goneseen At souniformly.It the reallyfar most, as toisn't thesaySo smart bodyitthat isn't one temperatureto so be of much dancingthe worst the goes drugfor settings upeight as by the toto1 takedegree, raveten hours MDIVIAsetting. and in even Charliea would place that be youneedthingswhere addressed to youthat take can't the thebreaks. harmgetissue access They reductionof overhydration? toneed cold movementto water go to andSpeakingthe hasyou"chill-out done don't istake room" to aeducate break. and drink Ipeople think water one that ofHave they the of taking only one tablet of Ec- lamstasy,ES:related thinkingA one few ofto people theoverhydrationof Leahmost have famousBetts—she died, andEcstasy and tookhyponatremia there deaths only have oneis thought Ecstasybeen [low manyto blood tablet. be a medical casesodium]. emergencies People who of overhydration. yourarethemdrink brainall with tooat swells,risk. much water Drinking you water,instead can tooor haveof whomuch an seizures isotonic sweat water out orcan sports go all cause their drink your electrolytes that has water and and replace salt, into a coma and die. This has tissues to swell. When totionearlyhappened believe message on, when thaton was a if peoplenumber they"drink were started of occasions.having collapsing a bad One experiencefrom of the heatstroke, challenges the has harm been reduc- that drink water, drink water." This led some people they should drink lots andwayJH: Ilotsto think flush of people waterit out misinterpretedofyourto come system, down. thiswhich message, is inaccurate. thinking water was an antidote or a

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Minimizing Risk in the Dance Community 113 Ecstasyplode"ES: Right. was the tabloid movement in the After Leah Betts died and became the poster child for the anti- cover story. But it isn't true. United Kingdom, "Ecstasy makes your Drinking too much water brain ex- ing.beveragestionmakes This message leadsyour are brain intobecame better. theswell, whole Twodrink which to watersafe-setting four can butcups kill not an campaigntoo hour much is about water,that weright and started, ifisotonic you're follow- sweat-sports you. After Leah died, the harm reduc- ingtapslatebut the you the inmodel the alsorave bathroom of needindustry. other to countries.educateand There sell arebottledpromoters You promoters can water educateand at who clubthe users barwillowners forturn on up offand, their to the in behavior, cold-waterfact, regu- six dollars for JH:Kingdom,eight ounces, requiring as we'vepromoters seen. to have water availableMy free understanding of charge in isthe that clubs. there is now a law in Manchester, in the United passedcauseofES: access a they free to felt watercold it drinking ordinance; water. now They club wereownersWe resistant alsohave have to to provide thisworked legislation, some with formthe be- health department in San Francisco and would cut into their profits. Then we told them that if they forappreciatecouldput water on increase their in what apromotional hot the they're environment, cover doing. charge. literature It shouldwhere People that bethey they'rewillillegal need still everywhere come,providing it because freeto charge water,patrons people will for survival. they JH:ES:harm reduction? DepressionCan you think is ofsomea big risk. other The risks overuse prevalent of Ecstasyin the rave can community cause or thatexacerbate require nmsantsymptoms to be taken of depression over the long in some term. people. It is an acutereleaser,MDMA is it not a daily also depletes serotonin, and so it antidepressant.can As a seroto- produce symptoms of antidepres- JH:ersdepression are unconsciously between uses. self-medicating I am convinced their that preexistingI thinkmany so compulsive too. Ecstasy us- depression.

PDF compression, OCR, web-optimization with CVISION's PdfCompressor comfortableES: 114There's admitting that they are taking an antidepressant, but there is Risks of MDMA Use a stigma in our society about depression. Many people are not feltthatmenot that ainpeople stigma my I see life." who ina lot manyAnd are of takingtheyfirst-time youth want Prozaccultures Ecstasyto repeat or about Paxil users the taking say.experience. who "I Ecstasy.say feel exactly better It's thethaninteresting same I've thingever to willthatcological increase SSRTs effects serotonin. [serotonin of MDIVIA. We reuptake say Wethat Ininhibitors, tell ifour they're them peer suchthatcounselingusing it as isMDMA Prozac a serotonin practice, aand bit Zoloft]releasertoo we often,have also and educated users on the pharma- we'veanPerhapsthey SSRT, seenshould they manyand consider stopwould users taking thesubsequentlybenefit possibility Ecstasy. from It seekproper thatis also appropriatethey diagnosiscommon are self-medicating treatment,for and someone treatment. start depression.to cometaking In fact, up somethingpillsto don'tour that booth feel I wrongtook, anything. and andreport, with they'reI me?"used with toallAnd some feel rolling I'll Ecstasy,concern, ask really them, and"My hard. "Have now friends I iteven you doesn't all startedtook took work. two, thetaking andsameIs there an I siteSSRTsanyone.antidepressant?" where prevent They'll MDMA the ask,Usually, Ecstasy binds. "How they'refromAnd did thenworkingyou very know?"I'll surprised, askby blockingthem, And because I'll"Do the explain you serotonin they think to hadn't them youreuptake told willthat monthlyAndmedicationstop not taking orone weekly yourofand them themedication Ecstasy positivehas said experience. in impact yes. order They've toit hasexperience had all valuedon theiryour their Ecstasylives antidepressant more highs than again?" their JH:WeES: Are areThe there making international any otherT-shirts harm slogan that reduction have for Ecstasy this tips slogan you harm want on reduction the to frontimpart? andis "Less the Dancesafe Is More." reducetruth.logodoses on You the theless willrisk back. often. ofenhance Pharmacologically,neurotoxicity, You dothe not benefits build the up"crackedand with as minimize bigany out" apsychoactive tolerance feelingthe harm as that drug,quickly,by comes using that and lowerafter-is the you

PDF compression, OCR, web-optimization with CVISION's PdfCompressor hisward Time magazine cover story [2000], it may not be a (asgood users thing call to it), repro- and the potential for depression. As John Cloud said in Minimizing Risk in the Dance Community 115 sentedthinkduce there withthe best isany so experience sociallymuch abuse sanctioned of amongyourThis life ways youngleads too andoften. into people reasons the isnotion that to use theyof thebenefit are drug. not enhancement. Thepre- One of the reasons I recreaterespectlostdrug on becomes aforwith lot the ofillicit simply drug.young drugs Oura people. "party makes society drug." Theythem tells badhaveThe them people. therapeutic no that idea Using wanting about history drugs it, to and of becomesfeel MDMA they good lack oris causeisply a alarge rebellious I think part thatof act. the when Taking culture. young five peopleorI sometimes ten pills are taughtand call getting my harm as "high" reduction as they lectures can "respecting Ecstasy," be- responsible use informa- destructive.moderation.that,tion, youthey needare OurYou given to current canacknowledge respect use drug MDMA for policy, appropriatethe in potential suchand the a wayways drugbenefits that toculture enjoy you're of using promoted the not drug. thebeing drug byTo self- thedo in drinking,Americadrug warriors, especiallycompared denies onwith young college Europe. people campuses.A Americaperfect that model.In example hasEuropean a huge is thecountries, problem differences where with in binge teen- alcohol abuse by young people in wise,istableagers simply withinare the allowednot their United the parents, problem to States, drink they ofweand teenage learnutilize where socially responsiblebinge they havedrinking sanctioned a drinking glass in those ofways messages,wine countries. to atdrink. the because ThereLike- dinner shouldusesweat recognize theof drink alcohol.office as and and safelyWe provide, so call on.as itpossible. We social at leastdon't drinking. This totell adults, peopleis the It's sociallyway athat way that if tothey harm choose reduction to frames sanctioned recreationalrelax after a hard day drink, they possible."itsfrom messages. a harm The reduction DanceSafe organization mottoUltimately, is "Ifto ayou responsible choose we are to goinguse use, organization. useto change as safely the From as description of our organization

PDF compression, OCR, web-optimization with CVISION's PdfCompressor the176 nonaddicted user, for the recreationalvery beginning, drug user. we Like have alcohol, clearly definedpeople ourselvesRisks as harmof MDMA Use reduction for campaigns.Nonetheless,societycan use MDMAas well, I wesee sociallyandneed DanceSafe we to modelhaven'tand responsibly.not our startedmerely message toas We usean on are educational responsiblesuccessful trying to responsibleeducateorganization use messages drinking trying yet. the broader culture.marketingto educate individualtechniques users, to affect but socialalsoThat as behaviormay a marketing seem and radical createorganization to amany responsible people,using social drugbut if all it took were education to recreationaluseusedchange the to samesocialincrease drug marketing behavior and users. channel youThat techniques would means consumption not changingto limitsee advertising by self-abusive the the culture. population. today. behaviorsInstead Marketing We of need amongsaying tois andcouldwell"I'm these takerebellious, say, asare "These many the and appropriate, drugs I'm badhaveas I becausecan responsiblelegitimate and getI'm therapeuticwasted usingways tothis out use drug, ofand them." my recreational and mind," so I amight person uses, as

PDF compression, OCR, web-optimization with CVISION's PdfCompressor PDF compression, OCR, web-optimization with CVISION's PdfCompressor andtermSelf-love. pouring psychotherapy. ntrodJoy. over Forgiveness. u the ctio These most n arepainful Acceptance. the rewards details Peace. of yearsone's These oflife difficult arewith the a stranger,goalssoul-searching of long- who ade.givesexperiencedslowly Fear. the becomes user Think by access amany of partner MDMA to when these in making astheyemotions, an takeimmediately sense MDMAbecause of it all. actingitfor Thesehelps the "anti-neurotic" first removeare alsotime. theirthe The feelings block- drug. drug ismeltAll found. the away, defenses replaced that bytypically courage get toThere in take the isaway thoroughlittle of debateself-discovery inventory that good and psychotherapy sharedisclosure what works. Working in part- feelings,tanthurt,nership pieces to paraphrasewith confront of a yourtherapist, yourthe life's musician demons,digging puzzle. Peterin Taketackle the Gabriel, dirtthe your totime find coreis tobound the exploreissues, places to reveal andyour where you theinnermost you willimpor- got be theirPeopletimehealthier, tocurrent areripen. often behavior The fearful alliance patterns. of openingyou Typicalbuild up, with protectivepsychotherapy your therapist of their progresses matures old wounds gradually.in fits and and of lighter, cleaner. Good psychotherapy, like a fine wine, takes thetient,moststarts; years. painfultakes there the ismaterial, progress,longest whichto andunearth. canthen be Thethere causing layers are plateaus.significant of defenses Some problems have of builtthe for deepest, up the over pa- andmaketherapy practice therapy supervisor psychiatry, faster," was she intrigued. itsaid is quite encouragingly.On common"People hearing are toIn about seealwaysNew a MDMiVs therapist.York looking City, history Many forwhere ways adultsof I livepsychotherapeutic to use, my psycho- calwhatevertherapyare catalystin therapy, to it lastis for they usuallyforgrowth want, years. onceandthey Diverse change. wantor twice it New now, It a hastens week,Yorkers without andthe waiting.have ittherapeutic is onenot MDMA unusualcommon process, is fora desire:chemi- theirdigs deep, and brings about impressive results more easily. The idea of increasing 178 PDF compression, OCR, web-optimization with CVISION's PdfCompressor alsothe would appeal to those who have toefficiency undergo of therapy psychotherapy and especially appeals those to me tremendously, but I imagine it Using MDMA in Healing, Psychotherapy, and Spiritual Practice 119 haswhocarpet. been pay forgoingThis those pronounced through services. life effect sweeping doesConsider his not or go theher unnoticed effectown psychic of bya thorough therapist dirt under spring and the pa- cleaning on an individual who portedBloch,tient1988 alike. theandto 1993. following ASamuel group Peter Widmer,of results GasserSwiss (Gasser psychiatrists,conductedsurveyed 1994—95). these psychotherapy including psychotherapy In all, Juraj 121with Styk, patients patientsMDMA Marianne under- and from re- improved"describedyears.went a At total thethemselves (26 of time 818 of sessions. theas "significantly evaluation, The average more improved" than duration 90 (65 percent of therapy of the was patieni:s three percent). Typical reported benefits were improved self-ac- percent) or "slightly tionalpsychosomaticceptance, lives: enhanced 65 complaints. feelings of self-esteem,The impact ofand the reduced psycholytic levels sessions of fear wasand greatest on the patients' emo- percent of patients said the sessions were very important pleteRatedships,emotionally, love, andas very 49 which 56 percentimportant percent was stated reported tocited most that the peopleitby importanceproduced 71 percentwas theimportant to experienceof their the interpersonal respondents.biographical of unity and relation-insights.Fully com- 84 relationshipspercentcited a worsened ofof therespondents. withpatients quality family, noted Eighty-one of and life. an 3improved Betterpercent percent self-acceptance reportedquality of patients of worsened life, was reportedand reported onlyrelationships. improved3 percent by 82 holtineVirtuallyAbout bywas six2 used percent.no in patientsten more people On frequently reported the felt other less anby hand, fearincreased3 percent, of a death,substantial usecannabis andof drugs 2 number bypercent 2after percent, oftherapy.felt patients more and Nico-alco- fear. re- nopsycholyticportedcannabis psychiatric less usetherapyby hospitalizations. 7of percent, drugs. there Nicotinewere and noalcohol severe was byused adverse 20 less percent. incidents,frequently During no by suicides, the21 percent,course and of

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 180 MDMA-Assisted Psychotherapy ConnectionpsychotherapeuticMDMA acts as a catalyst process to the in four ways: exploreforempathicpatientMDMA patients relationship. safely.enhances rapport to trust MDMA that the the Studies coincidestherapeutic therapist, is notof psychotherapy withjust toalliance, believe asuccess mind-expanding which that (Hartley have they is pinpointedthe can 1985). basis drug, open ofIt it upthat isany is importantfuliy ait doctor- heart-is andthis andempathy.openingRecall to want one The toas freedomexplore well; it theirs,hasto let been go blossoms. andproposed to love, as toa pharmacologicalinvite people into facilitator your world of viewTheredousbeen make areableclarity. some themselvesto recallMemories reports childhood available that that people were events for once underreview. and laden traumatic the What withinfluence was anxiety episodes once of andMDMA cloudy with hidden tremen— or have toofrom remotewhichopen.painful repressed It tois exploreup to memories the is therapist like toan pull oldand house outpatient of withthe to closet.choose all its Inlightswhich addition on rooms and to toallenhanced examine, its doors memory the entire MDMA experience is intact, so therapyItInsight thatis not whatever enoughto be effective, toinsights remember conclusions are garnered well and must duringto be be able thedrawn tosession communicate and decisionsare retained. easily. reached. For gethersensebinationMDMA of and isselfof an drawingsharpened assistsexcellent profoundboth faculties, tool the for patient conclusions assisting enhanced and insight-oriented therapist concentration,from the in material putting therapy. and the broughta heightened piecesThe com-forth to- AcceptanceduringnessThe ultimatefor the others, session. goal so ofthat psychotherapy the burden of is hatred, to develop fear, compassionand resentment and isforgive- lifted. PDF compression, OCR, web-optimization with CVISION's PdfCompressor Using tIDMA in Healing, Psychotherapy, and Spiritual Practice 181 comeschotherapy,usAcceptance lighten out ourof it self-love,isload most and important grownot self-hatred. as tohappier, forgive For freer yourself. people individuals. Lastingto want Inbehavioral to successful tend their change psy-own of life circumstances, of previous traumas and "trespasses," helps defeatingesteem,deservegardens, acceptance, toto behavior. blossom.dig in the andThe dirt self-love greatestand pull thatgiftout theofhelps the weeds, catalyzeMDMA they lasting experience must believechanges is thatthe in self-they Enhancedceptancedifficult memorypsychologicalcan bring combined a sense issues. of withpeace. Heightened confidence All of these insight refines qualities assists the add abilityin learning, up toto aexplore uniquely and ac- lifetime.hours,lifetransformative of thebut patient. the discoveriesexperience The MDMA-assisted that and often decisions brings psychotherapy made about during significant session that timechanges lasts can just inlast four the a

PDF compression, OCR, web-optimization with CVISION's PdfCompressor USING MDMA IN HEALING, PSYCHOTHERAPY,RalphSPIRITUAL Metzner, Ph.D., and AND Sophia Adamson PRACTICE* Inapplicationences this chapter, with MDMAin we self-healing, describe (and otherobservations psychotherapy, empathogenic from andindividual substancest) spiritual and practice. relatinggroup experi- We to theiralso threetionalpistsoffer andsomeareas; societies, practitioners, guidelines, thus, such their as distilled ceremonies,for those the mostoffrom the including effectivethe Native experience Americans, usepeyote of of these rituals about do substances. ortwonot sweat separatedozen lodges, Tradi- thera- the and(spring*Thisare Its materialat Role1988): the in samewas 10,Healing, originallyno. time 4, Psychotherapy,59—72, worship, published under curing, in theRe and Vision:title Spiritualand "The problemThe Nature Practice."Journal solving.of of the Consciousness MDMA In modern Experience Change West- Purduepsychopharmacologist,dentlyfThe term proposed University. "empathogenic," for Nicholsthese and substances Davidsubsequentlymeaning Nichols, in "generating 1983—84 rejected a professor by athe stateRalph term of of medicinal Metzner, andempathy," now achemistryprefers psychologist was indepen- at and subcategoryare"empathogenic.""entactogenic," the phenethylamines of psychedelic meaning The substances MDA,"touching ("mind-manifesting") MDMA, we within,"include MMDA, infor this MDMA. drugs, andcategory. 2-GB. such We known asEmpathogenscontinue LSD to and usto atpsilocybin.use arepresent, the a term nomenclatureSee also the IVIAPS of MDMA. Bulletin, vol. 4, no. 2, pages 47—9, for an extended discussion on the 182 PDF compression, OCR, web-optimization with CVISION's PdfCompressor Using MDMA in Healing, Psychotherapy, and Spiritual Practice 183 emguilds, and their special interest groups maysocieties,societies be one theseexceptof the three for theendeavors Native functionAmericans, along have the found lines itof professional reasons why VVest- so difficult to psychicinducedeal with an separation psychedelicsexperience between that in ahas rational, spirit, theIt potential mind,is socially the primaryand for beneficial body dissolving thesis and manner.* that of the this therefore defensive chapter physi- intra-that the empathogenic substances inpeoples'usually calthe healing,context do,healing occur ofpsychological aceremonies, ritualat the shared same problem when bytime a curinggroup, in solving, the orwhichsame therapyand experience. alsospiritual takesis regarded awarenessplace, In traditional asit happensa sacred can, and Theschedulemodel,experience. records which and of This thenottreats sessionsasis healingveryan experience differentwith drugs empathogenic as fromto something be sharedthe conventional and tobetween bepsychedelic administered doctor Western substances and medicalpatient. on a daily encesindicateof indigenous, are that likely the toexperiencesshamanic be changes cultures. fit in naturallyThe attitude changes withintoward that the the occur integrative body, in awhich person's worldviews facilitate consciousness during such experi- Whenreframinglemthe body's asolving person ofown athathas belief healing aoccurs realization that and alsois regenerativealso may of themost be spiritual healing frequently processes. andcore have of aThe shiftbeing, spiritual psychological in there perspective, implications. prob- are often a attitudesisthehealing empowered; integrity and and therapeuticandchanges dependence responsibility can changes, be, on and the of oftendoctor,thealmost individual are, oras carried theby-products. medicine, is affirmed,over into Inis reduced.andall three the These a person's ordi- person areas, nonspecificthenary hypothesis, life afterward. psychic widely amplifiers accepted andThe bythat workersresearch the content inwith the of psychedelic field,a psychedelic that psychedelics drugs experience carried are out during the 1 960s led to zumlecular*ForConsciousness," inneren an Mysticism: elaboration Raum: inFestchrzftThe of Shaman this Role argument offür Psychoactive Substances in the Transformation of Albert Spring 1988. Thesee articlethe article alsoHoj9nann, byappears Ralph editedin Metzner Das by Tor Christian entitled "Mo-Ratsch. PDF compression, OCR, web-optimization with CVISION's PdfCompressor ity)is and184 setting (physicalprimarily and social a function context ofand set presence (expectations, intention, attitude,MDMA-Assisted and Psychotherapy and attitude of oth- personal- Nevertheless,feelings,forers, understanding including and resolutions athe certain the experiences commonality of problems with exists that MDMA occur in the as are kinds well: unique of feeling to the states usu- guide). This set-and-setting hypothesis is a useful model the specific insights, individual. long-standingtakingallygiveness, named: the substance healing,ecstasy, intrapsychic empathy,oneness, is serious conflicts andopenness, and caring. or therapeutic, interpersonal compassion, People areto problems use able,peace, the acceptance, statein to if their intention in relationships. resolve for- involvedter.describe The heart thein allexperience center interpersonal (or as chakra) being relationships, Teachersfundamentally is and especially practitioners an opening familial ofof meditation the and other forms of spiritual considered to be related to healing and and intimate heart cen- work heartnalones.(evenpects and Incenter above manypelvicpartially) is systems,and regardedlower the of centersbodilythis because as centerthe and and bridge instinctual isthe seen betweenthroat as natureandthe the foundationbrain mental and of its location midway between the abdomi- below. Thus, the opening higher centers, the for all further spiritual as- unravel;focusedherpsychospiritual first warmthexperiencesimultaneously, growth and with caring and sheMDMA, practice. attention was aware a Askind on anthat it, of example, it severalknot seemed in ofoneher literally her heartwoman personal center.to As observed, inloosen and relation- she tatestheseships therelationships.were dissolving somehow of being barriers healed. betweenOne At meditation the end, she teacher felt better has suggested about that the MDMA experience body, mind, and spirit—the same each of facili- Thus,pathicandseparation body instinctualattitude can within betoward awareness coordinated:the individual the body, as wellmind, which,that as is includingmental, seen in turn, in emotional, feels feelings, accepted andhas sensoryaand aware- as noted earlier. positive em- protected. Mind ofnessstructurescept, the can other. "above" all functionofSimilarly, thesomewhere; body together, spirit and instead theor self images oneis no sensesand longer felt as a remote rather than one being the focus at the expense attitudes of the mind.the Awareness presence of is spirit infusing the abstract con- PDF compression, OCR, web-optimization with CVISION's PdfCompressor Using MDMA in Healing, Psychotherapy, and Spiritual Practice 185 totalityreachesexpanded of of our experience, an access to forgotten truth. to spirit. include This permits all parts of the body, all aspects of the mind, and the higher a kind of reconnecting, a re-membering of the tors.ing,ger of solitude,In a the mind-opening case meditation of these experience experiences,practice, can Ina particularother thebe rhythmicchemical research piece drumming, catalyst on of alteredmusic, triggers hypnosis, statesor other a change of fast- consciousness,fac- the catalyst or trig- heardfeltordinaryof feeling withof in anda theirstate depth commonplace lives in and which up poignancy to insights the when time andtheyof of emotionthat perceptionsare firstafterward thatexperience. (though described often to others)appearing was for most people un- are andstances.not beheart-opening produced Obviously, or experiences arrivedmany people at without withoutThis have is the thenothad use useto and say of of continuethese anythat externalsimilar empathogenic to have or aid, identical empathic pharma- sub- changes of consciousness can- aheightened kindtionsceutical of without preview, or and other. externaldeepened asThose it were, catalysts peoplestate a oftaste who areawareness ofareto thebe able commended.possibilities facilitated to attain such by that For the insights existmost drug for people and much solu- the serves as continuingbearegreater convertedaware, emotional too,therapeutic into that opennessthe the ongoing drug and experience spiritualand reality relatedness practice—andof is everyday a temporary than consciousnessthey not state had with and imagined. the one continued only that They with can ruledbecomingten—ituse of Out, theis thought therepsychologicallydrug. isMost toa fairlybe people too high dependent intense, do degree not toowant onof sacred. consensus thisto repeat Although the that experience it theis not possibility addicting. very of- of or any other drug cannot be stancesbeenCases reported. of give tolerance one a andgood dependence indicationThe of with thefolklore largerbasic and natureor moreterminology of frequent the experience. that dosing have haveAs arisen a with respect to these sub- unconscioushasname,and a distinctly sensualityEcstasy reaction differentpoints almost toof feeltheuniversallyfeeling warmth,to it thethan samereported. well-being, "sympathy"; as someone The euphoria, theempathy latter else. pleasure, isso Empathy seen often joy,cited is as an PDF compression, OCR, web-optimization with CVISION's PdfCompressor Peopleyousympathy 186are, feel even that though they have you cantrue compassion, forgiveness, and understandingtIDNA-Assisted Psychotherapy with understanding, with consciousness; you do not forget who "feel within" (em-patheia in Greek) the other. termsforego.for those themselves, ofThe thewith relative therapeutic whom for absence theytheir implications, haveordinary, or attenuation important neurotic, they relationships. childish, struggling Most important, persona in or of normal anxiety and fear in thesehave empathy and compassion levelswithpeuticstates inner isnormally value. perhaps or outerPeople associated the issues single report thatwithmost being are those important otherwiseable issues. to thinkfeature avoided about, because talk about, of the anxiety with regard to their thera- and deal byoriginateddrogynous which is with meant ancestor. a group not TheAdam of therapistsfigure as Perhapsa ofman Adam on but the ratheris Westmost an important Adam-and-EveinterestingCoast, is symbolicthe code term asname Adam,thefigure foran- MDMA,in which seems to have Bible'stherepresentsgnostic condition accountand "primordial hermetic of of primal the writings, Garden man,"innocence oftheand Eden. "originalandC. G. unityFeelings Jung with wrote of all being extensively life, returnedas described about to a it.natu-in Hethe being," the "man of the Earth," energiesbondingmonral state in these ofofwith innocencethe Adam-like fellow natural humanbefore world. ecstasies, guilt,beings, Since shame, gnosis animals, and is direct plants,unworthiness experiential and all arosethe knowledge forms are com- and and so are feelings of connectedness and eascatalysts."of divine of psychotherapy, reality it would healing, not be Toand inappropriate illustrate the torole call of psychedelics MDMA and "gnosticother empathogens in the three ar- spiritual insight, we take quotes from the thedependingfirst-person1985). empathogenic The onaccounts general the individual's drug published finding operates is set,in that Through onlyor breakthroughs intention. within the Gateway the The context in psychocatalytic any of the of of theseHeart a prepared areas(Adamson action occur, and of fromhours,perienceattentive a withverbatim the attitude. littlehigh" transcript or areThose no likely intellectual who recorded to takeget just the insight.during that: drug aan The"forpleasant, MDMA followingrecreation" even session, pleasurable,account, or "just to ex- exemplifies edited few PDF compression, OCR, web-optimization with CVISION's PdfCompressor Thethe subject is a thirty-five-year-old process of attaining a new and enlarged perspective Using MDMA in Healing, Psychotherapy, and Spiritual Practice woman who is a graduate student and on the role of ego. 187 programmer: threatenedEgoThe egowants iswants thatto control, I'veeverything. lived and itIt's gets like threatened. The an octopus grabbing and grabbing. reason my ego is so isbe workhasthat more athe threatensvery perfect change tenuous and myin spiritual"—that'sme ego.hold. is Sothat Meditation I want threatens myso ego much tries of tomy take life hold not here.of it asThe its ego own. knows "I'll it my ego. What the ego has to know my ego. All my spiritual thatbe here; I want ego to does be here... not have to be threatened. I realize . I'm not my ego. to integrate, to incarnate. I want to . . . My ego is part of who I am, for the first time fromidentifiedWhat which is being withthe ego describedthe perspectiveego to herebecoming isbut I'mthe notlarger my Self ego. the a shift in identification—fromseen as limited being and fully fearful.This subject larger consciousness, amnesticdayssamewent after onsession. to review an have MDMIA The aof truly followingchildhood session, intense account describes experience by the a ofdifferent aftereffects, mystical subject, enlightenment written several in that trauma during the session: or results, of an an- sevenmehypnosisMaterial since years aboutsessionI heard old. a theseveralThesexual tape impact molestationweeks of the comes Adam fromincident session. the deepIn it I recognitionsounded of how ago has had much more meaning for— first reported during a as if I were numberRelivingbecausemany ways ofof this ways. the theincident distrust eventIt feels helpedmolded of as though tomy free responsethis to the world around my parents that was focused by the incident. up my energyprocess and will emotions be ongoing in a for some me, in part openingtime.doing, In general, ofwhere the heart I myam ratherjourneygoing. than The with affirmation Adam affirmed who I a deep intellectual understanding... was experienced through an am, what I am . In perceive,didplacethis a set fewthe receive,and contentweeks setting, ago.and of whichrespondwith empathy to love for in all was easily and deeply received. a much more openaspects way of than life, I learning took . . . I am able to

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 188 MDMA-Assisted Psychotherapy Aalsoexperience,compulsive derived hadsexual insight some masochist, thirdinto apprehension the example nature who, of ofafterthat therapeutic his he tasting compulsion: might the breakthrough become pleasure comes from the addicted to it. He ofexperience the MDMA of a perceivesenseI didn'tthe qualityof really beingthose of think asaddicted never addictions that actually Ito could precisely obtaining become because addicteda satisfying, of their to the whole,compulsive experience alcohol or to sexual excess with prostitutes. I pleasant expe- quality, in the rience.ofwaythat the compulsion. outsideWith infinite the all experience blissthe It reallytime, of being hasoutside of anMDMA, a entirelyconscious my on different the entity other quality; In hand, a very as I feelif it's none in some that every conscious being reallylife and wants my neuroses, literally a taste fundamental of haveofbeautiful,andsense, the needs. been unfulfilledit is whole, sweptthe We kind get awayand longings, ofa complete.sense experienceby the ofand sense our It all fulfilled true ofof whothe selves all feelingsI really of and my am.how ofchildhood limitation they are dreams, all andperfect, loss Theatedpisttherapy book herself,panic Throughof rapeattacks experienced victims, the and Gateway recurrent who complete were of thenightmares helped amnesiaHeart considerably.contains offor her a year.two attack, accounts OneShe as thenwoman, was a well as dissoci- of MDMA able tothera- twelvemove through months. the She trauma wrote: in a seriesAdam broke through the repressive/defensive network and took me of four MDMA sessions over a period of back Duringintosion,plunged the into theexperience into experiencewhat the was horror,of reported thewith attack then Adam, to movingthat me I movedtowas be into too almost in amuch andtransitional infantile, outfor ofmy the evenphase of regres- psyche to bear. attack: beingfetal, states. thanpresence—aexpansive, a fearful, physicallyvibrancy contracted andexhausted quality—and change but full with Atof lovetimes a beaming and I would a deep sort come feeling of aura. around with what was reported as of color, an expansive quality rather fragments ofexceptional of peace. I felt It lovingandsitizethehas attack, seemedI nowmyself way, tocan thatrather tore-experience move my Adam than surroundings. through haswith whatallowed more trauma I Theneededmemory me anddissociative to to comemove of re-experience, the outinto assault. episodes of the it in and an opento have ended, desen- and PDF compression, OCR, web-optimization with CVISION's PdfCompressor The successful therapeutic outcome of this and similar situations has impor- Using IIDMA in Healing, Psychotherapy, and Spiritual Practice 189 sufferingdisorder,thetant treatment implications from which breakdownof theaffects for aftereffects the the futurein victimswar ofapplications zones, trauma.The of physicaland torture of condition empathogenicand victims, sexual post-traumatic assault,has substances not soldiersfound stress in werepression.afteran effectivemethod,tortured The onlytherapeuticbecauseby the limitation administration of approachits abilityon its useas to of yet. accesswould psychiatric MDMA bememories in therapythe drugs cases blocked ormay of toxins, personsbe out the whoseby sought- who re- habits:changepeuticnegative experience.The of set attitude would thatpreclude involvedfollowing them post-session accountfrom participating illustrates changes ina in healinga drug-inducedlifestyle experience, and health thera- a I remind myself that I am becoming a home to the indwelling Spirit; it will . myproceedsee outlife. my toI intend askeyes, for toand guidance become it likesI had aandto perfect see alwayssupport beauty, temple felt for proportion, unconsciousintegrating for this God-consciousness.. and these and harmony. changestherefore . into cut off from my body.... . I healthfuldefinitefollowed,healingDuring foods thewithinincrease I havecourse and myself. observed in noof the longera singlegraceI re-ownedthe desirefollowing Adamwith which my session, behavioral body. I move, I Inexperienced thechanges. an twoinstinctive weeks I achoose deep, thatdesire natural have for fatty foods. There has been a Another subject, a forty-four-year-oldandorwater alcohol. lovingly and woman a Andmarked aware withfor ofincreasethe breast the first body timecancer,in dailyin inwhich myfluidreported life,I live.intake, I can and feel no myself desire consciously for caffeine ofcellsrepeatedlyan herexperience in body my toldbody in of need herself "dissolvingmoving of healing,to toward "let into go, she healing."tiny just said, cellslet "Igo, Placingthat was and were the as her healingIpart lethands go,of everything." andonI could various I witnessed feel parts Shethe reportedcondition.the healing." an unusually Her physician dramatic subsequentlyOne healing. man During whoreported suffered the an MDMA improvement long-term sessions, debilitating in her he pain from spinal arthritis PDF compression, OCR, web-optimization with CVISION's PdfCompressor 190 MDMA-Assisted Psychotherapy self-flagellation,"mentsquently,experienced of he the discovered hands seemed and, that later, alsohitting toa broom,loosenhimself up inwith thewhat repetitive crystals andsmall relieve flailing the move- pain. "arthritis crystals breaking up" as he moved his he described as "physical body. Subse- Theafterfrontedexpression flagellation which, and of releasedhe the wassaid, meaning the "Forhis treatmentfear the of offirsthis death disease. timefor andhis I felt Inconditionwent apain later through as MDIVIA anas ally, wella rebirth notassession, aas experience,symbolic an heenemy. con- empathydeeptheI can pain animosityuse with forit for himself, love insight will and enable his and understanding body, understandingme and to end his it."pain instead Inand was other not ofthe constantlyforwords, crucial self-destruction. the turning fightingdevelopment point it Using inwith his of andinapproach the intention, accounts to the these ofdisease—which MDMA experiences experiences. maywasExperiences occurpermanently Depending as ofthe spiritual result successful. on aof enlightenment a focused choice and or of discovery are commonplace background personalitytotally unexpectedly. and Self, human The following and divine:I allow, account invite, is surrender a description God intoof the my union own body. of God consciousness aches offor us, and at eagerlyany and awaits every moment.this moment . to enter me, as it longs to enter each . . Painlessly, in silent ecstasy; that which hasconsciousness. lived as my guest, We merge.my visitor, No longermy "higher" higher, self it isbecomes now inner, part mergingof my . . Anotherowy "guides" subject, would a woman appear, who found hadwithends grown thatin here the which afraidwith I thechose. to gladmeditate The marriage chooser because of becomes myself shad- and the my chosen. Self. . Adam session that her fear of the This phase someteninstructionsguides, of ofthem, and them hence dressedon were meditation of inmalemeditation, draped and that graysome shedissipated. garments, was female. able And Theytoand accept.her I could guides "There instead were gave about her felt like my real family. tell by feeling that theTheyof importance the spoke spine—Ed.] to me of meditationnot energy in words, phenomena for butVivid my in growth." mind-to-mindexperiences are not at ofall communication, himdaliniuncommon [the in potential about creative energy at the base PDF compression, OCR, web-optimization with CVISION's PdfCompressor Using MDMA in Healing, Psychotherapy, and Spiritual Practice 191 theyogaoutsessions, energy consciously.of her move body, through Oneforgiving subject her herself body:who wasfor "My pasta migraine body and presentdanced sufferer misdeeds.and first leaped found Then with herself she the let especially when the person is one who has studied and practiced ingKabbalah.andkundalini onestrengthened has energyThis already kind inI juststudied herof experience,worklet itor dance asa fresha therapist of and motivationgaining loved and a it." infresh to herLater pursue perspectivespiritual she a practice felt studies reaffirmedon aone teach-of hasthe paniedinspiredneglected, by to visual ispursue frequently sensations a path reported. with of which lights,Many It is he auras,much subjects or she lessor is images.report likelytotally feelings that Moreunfamiliar. someone often,of light, itwill issometimes thebe (though rarely) accom- protected.feelfusedemotional and by know a Theandspiritual thattheHoly physical,I presence. amSpirit the is eyes,kinesthetic myself.As oneears, Theresubject feelings awareness is wrote no of mystery the thatafter spirit. is the activatedany Isession: feel more. so and safe,We"I nowsuf- are so sciousness,"createdthroughhere to do,hang-ups. their to involving feel bodies exuberant." There and a senseare minds, also Others of no experiencesdissolving longer feel fiery being pain oneenergy confined mightor solvingand call radiance to this"cosmicmental, planet, coursing fear-con- or mushroomscommonat some universal with (teonanacati empathogens center. or These psilocybin). thanAn kinds withawareness of One psychedelics, experiences subject of being wrote are, here,such however,this: beyondas LSD here.much or magic Both. less Very deep, very far, gal- ingrapidlyaxies, through very changing. far existence. out Mostlythere. Infinite, Spacious, floating the like open, whole a babydark. universe.. through Thin lines the of universe. bright colors, Float- . . I remember what therapy,In all these and experiences, the spiritual it realizationis clearrestAugustine that in usuallythe God. physical said. I are felt Something interwoven thathealing, complete the about and psychological rest, connectedthe no heart searching, always finallyrestless home. until it finds toofandin anfacilitateexperience. professional inextricable the MDMA opening preconceptionsway Ourand of othercategoriesthe heart empathy-generatingand center, areare notmerely orretained the reflections intelligence medicines in the offlowing oursimplyof theacademic process heart, seem PDF compression, OCR, web-optimization with CVISION's PdfCompressor 192 MDMA-Assisted Psychotherapy knotsandconsciousness.Guidelines of past karma disentangled that havefrom repercussions this open point on many of freedom and awareness choices can be made for the Sacramental Use levels of and workenceofThe Empathogenic and of twentywho have to thirty based Substances therapists their methods on observationfollowing of guidelineshundreds ofhave been compiled from the collective experi- who have used these substances in their notlationamongindividual be ofconstrued the methods sessions.different as that encouragement Althoughpractitioners, have proven there efficacy.isof bythe no use meansTheir descriptionuniformity ofhere approach should the guidelines offered represent a distil- of illegal substances. Rather lesstheyallthe of are ofpractitioners how themapplicable it shareis generated. and tothe anytherapists integrative state of Wewhom heightened attitudeuse we the have term that empathic interviewed. "sacramental"we attributed awareness, To to earliera greatdescribe regard- toextent the the approach used by most of ingNativenotinterrelated of espouse the American body, anyaspects psychological andformal otherof areligious unified indigenous problem elementprocess. cultures—an solving, inEven andthose attitudespiritual therapists that awareness seeswho heal-would as their work with these substances wholeisandnevertheless for to this complexsupport reason tend thoseof thattodrug seeperspectives we use the have plus MDMA chosen set when and experience the setting they term arise with "sacramental" from in healing, thea spiritual client therapeutic, to or perspectiverefer patient. to and the It spiritualcontext,tically aspects.most with frequently no particular in what therapeuticAlthough might be orthe called use ofa hedonistic MDMA and or otherrecreational drugs of this family occurs statis- spiritual purpose in mind, these intentional,tobacco),ationaltypes of use, sessions does thoughtherapeutic, not will have probably not the and be intrinsic harmlessdiscussed sacramental interest (certainly here. useand It has.ishealing less our [See harmful potential the thansection that alcohol guided,"Risks or belief that such recre- PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMAof use.] Use," for Using HDMA in Healing, Psychotherapy,a fuller appraisal and Spiritual of Practicethe risks inherent in recreational 193 guide,tionThePreparation singleor What purpose. most is my importantOne purpose should foundationin ask entering oneself forinto and a thisbeneficial discuss altered with experiencestate the of awareness?therapist is inten- or and Set WhatspiritualTypically, is myquestions. people purpose approach These in life? questions the WhatThese experience is might theare nextquestions include with step fundamental thein that my following: all spiritual seekers existential Who path? have, am andand I? it is natural to want to ask thequestionsaddition,them past, in such the concerningthere ascourse early may of childhood bephysical an more encounter personalillness; and birth; with traumatic and andone's therapeutic unbalanced orsources conificted questions,of or inner experiencesunsatisfactory wisdom. including from In questionsexperienceandrelationships friends. people reviewing withIt is nothaveothers, uncommonand addressed particularly healing concernforinterpersonal parents, people work spouses,to spendrelationships.and career, lovers, major creativechildren, portions Other kinds expres-family, of the of recordedquestions,Somesion or therapists duringblocks which thein and that thensession. guides area, can beand encourage reviewed sometimes the just personinternational before to the make session and a globalwritten or perhaps issues; list of beforeleaseics, rather the ingestion questions than posing of orMDMA. intentions questions. In this to In Someone's way, either own peoplea approachperson higher prefer is selfi,notit isto too good declareor intentinner practice an guide,merely intention to just re-on to explore certain areas or top- butenceanproblem intention not unfolds asked. solving, has then If been thewhich, is experiencelikely declared on to occasion, answer and is a releasedperson's one'scan tend questions, infirst tothis limitone fashion, includingwithone's psychedelic experience.whatever those impliedexperi- medi-When withthepsychedelics,cines, thenature itguide is ofimportant orone's but sitter. not expectations to MDMA,If review there has itany based is been fearsequally on extensive orpast importantother experience expectationsprevious to review can experience be one them,understood. may sowith have that PDF compression, OCR, web-optimization with CVISION's PdfCompressor should194 be raised. If their relationshipThe is professional, the principle of no N DMA-Assistedquestion Psychotherapy of sexual feelings and expression between the two people sexual macyTheyarecontact not arefor lovers,should severalgoing be theirto hours. discussedbe feelings in Thisa state andstate of extraordinarily heightened emotional inti- for each other should be statedaffirmed. and clarified. If theallows two an people unusual are degree friends of who access to fears, useconcerns,actualguide that andstatesexual and the for frustrations contactvoyager the initiation to are inthe married the latter area partor lovers, of the itexperience, is probably because best to postponeit of an ordinary sexual encounter. Even if the of intimacy. But it is not advisable to would tional,substancestend otherwise sexual, wish and to to distractspiritual use a conjoint from intimacy, theIf sessiontwo exploration this people is to certainly explore who of otherare a deeper statelovers areas. in levelsand which who of Tantric areemo- experienced with empathogenic hightivitycanand beTaoist percentage and experienced. sensuousness eroticism of subjectsMany (which of accounts the isreport nonstriving,Adam a partial state. noncraving, (Itnumbing should ofbe and genitaladded nonpossessive) heresensations testify to the extraordinary tactile sensi- that a andencemoretheyfor a theconsequent experience withusual finding empathogenickind that,lack sensualityof session, offor erection some or where sensuousnesspeople, in the someone male. the Adam Itwithout is this experience genitalfact that arousal.) is responsiblethe first For time the medicines for the first time for purposes of is being initiated into an experi- canthetactpsychospiritual physicalisbe preferable. an important touch awakening, As of partsourcea hand of an this ofon agreement support thediscussion, heart, orthe understanding shoulder, the head,of no sexualor the con- and encouragement and signals em- it is important also to agree that hand pathyonediscussion oris familiarcompassion of intention or a butbasic notand relaxation sexual purpose,Another interest. is importantto practice part a meditation of the preparation with for the session, as part of procedure. The purpose is to enter into which the suchorteredthe have experience asand aread freedchosen aloud, from prayer, distractinga baselinefavorite a beautiful statepassageeveryday thatpoem, from isconcerns. alreadyor asimilar Somesomewhat inspirational people clear like writings.and to cen- personally meaningful text, read, PDF compression, OCR, web-optimization with CVISION's PdfCompressor Using MDMA in Healing, Psychotherapy, and Spiritual Practice 195 aFor beloved guru or teacher andothers the invocation the prayer of or a meditationparticular deity might or include guardian the specific invocation of tionshipcally"powerspirit. charged, objects," issues, to mightsuchthe session. as bring crystals, Others,photographsSome feathers, especially people orof anyparents familiar if itemthey or thatwantwith family has toshamanic beenexplore to contem- psychi- practicesrela- and rituals like to bring psychictheitplate is substance'srecommended or and photographs physical effect that purification. of with athemselves person a full fastThis stomach. to for willactivate at tendleast Fasting childhood tosix make hours also the ismemories.so part journeyas not of toa Finally,muchgeneral reduce AichemicalBecausemore productive theCatalysts goal andof alchemy pleasant. was the transformation of consciousness, sym- sionthatbodybolized facilitate here(the by vesselis the limited a biochemical transformativeor furnace), to the catalysts transformationsit is reaction appropriate that "aichemical generally to taking call these placeare catalysts." consideredchemical within The the substances todiscus-human have MDMA,nogens,empathogenic MMDA, such as effects. LSD,and 2-GB. psilocybin,We will ManyThe not orothers compoundscover havethe larger beenof this andsynthesized class more that varied have and foundhalluci-been used in therapy include MDA, mescaline.* nutmeghave.ofto bethese Ghemically, psychoactive, and compounds mace. they Structurally, butare are nonefound referred has inthey thetogained asresemble volatile phenethylamines. the widespreadoils dopamine, of certain Botanically, attentiona neurotransmit-plants, thatincluding some these psychologicalthethoughter; latter.mescaline, they areeffects aless potent arehallucinogenic not hallucinogen; unlike a thanblend and the of amphetamine,former mescaline and lessand a stimulatingamphetamine, stimulant. thanThe *Seeknown Metzner, in the "Molecular 1 960s, when Mysticism." it wasMDA called is the 3 ,4-methylenedioxyamphetamine; "love drug" among the hippies. this drug became fairly well PDF compression, OCR, web-optimization with CVISION's PdfCompressor especiallyItClaudio196 usefulNaranjo for called therapeuticis activeit the at"drug regression doses of from analysis" and 50 recollectionmg and to 200 reported mg. of Inchildhood that his bookit was The Healing Journey, Psychotherapy Becauseaphrodisiac,moreexperiences. stimulating, it has andIt hasbeen it or isa amphetamine—like,illegaldurationused in since some of action the circles late of thanassixtiessix a tostimulantMDMA. eight and otherhours Itsfor reputation dancingcompounds and is generally and is assex.with an dosesusefewer in ofsomatictherapy, 50 mg sideas to far 250 effects as mg, is known. havewith been150MDMA mg found, as is an3 it ,4-methylenedioxyrnethamphetamine;effective does not dosecurrently for the find average much the drug is active at twentytremorhours,adult. Itorand to differs jaw thirty in clenching.having fromminutes fewerMDA The after amphetamine-likeonsetin ingestion,its ofduration pharmacological and of there action,side effects,is effects whicha transient issuch is usually four asmoderate muscleto within five Naranjo'sthereofrise bodily in is blood a heatfeelingbook, pressure and where of greatly bodily and it is pulseincreased relaxationsaid torate. induce attentionSubjectively, and anease. experience and MMDA alertness;there ofisalso athe atsurge is "eternalthe mentioned insame feelings now." time in viewedsynthesis,apply(Both equally forthis it this hasdescription to chapter. not MDMA.) found and much Perhaps the descriptionuse amongbecause therapistsof of MDA the alleged given and researchers in difficulty that book inter-of could its mumMDMA,bromo-2,5-dimethoxyphenethylamine. dose. being Energy active tremors, in some jaw people Theclenching, onlyat 18—20 other This heat, mg;chemical drug and 25—30 increased is more used mg in potentbloodis thethe present maxi- pres-than series is 2-GB, which is 4- Psychologically,beginningitysure to are this the withsubstance, usual a lower 2-GBside so effects.dose is one empathogenic, and should There only isgraduallyat great all like times individual MDMA, escalating proceed variationthough to with higher it caution, inappears amounts. sensitiv- byto pathogenicfollowedmescaline.be somewhat three Some experience more to therapistsfour body-oriented; hours by theand later same researchers by it length 2-GB,also has have ofwhich mildtime. experimented servesvisual toeffects extend with not MDMAthe unlike em- PDF compression, OCR, web-optimization with CVISION's PdfCompressor dependent.amphetamine-like Jaw clenching stimulant andactionThe fine in side tosome gross effects people. muscular of They all oftremorsare these very mucharesubstances noticed dose- occur in response to the Using MDtIA in Healing, Psychotherapy, and Spiritual Practice 191 usuallyrnizementmost frequently.the(3 complete30—500 intensity Many mg),lossof these oftakenpeople appetite side just have effects before, during found or during,eliminatethe that experience a calcium-magnesium or them after altogether.MDMA,and even canfor There supple- amini- few is watervitaminpartlyhours should afterward.anddue mineral tobe the available reducedThe supplements person at foodall times,may intake. before experience because Itand is recommended afterthere fatigue the is considerableexperience. the next that day, Plentydehydra- perhaps of a person take Whensure;extensivelytion. inContraindicationshypoglycemia doubt, researched consult and a diabetes;forclinically,physician. the use seizure includeof these disorders; heart substances, disease and, ofwhich or course, high have blood pregnancy. not been pres- gensperceptionduce (unlike an intenseof theeveryday hallucinogens but transient reality is altered suchnotThese altered as statesubstances, LSD), appreciably of one'sawareness. unlike emotional with anyEven these other response though empatho- known one's to psychiatric medication, pro- downdesirableconverse,reality one's is greatlytoor reactions. doeven so. different. drive The Moreover, heightenedan automobileAlthough engaging state a during person of inemotional thesethese may activities states,be sensitivity able it to iswould walkobviously could takearound, slow not one Settingtheaway experience. and from Context the interior exploration of the psyche, which is the main point of andormodeGenerally, lie comfortable, downis a serene, theand preferred the andsimple, therapist a blanket setting comfortable or guide shouldfor sessions can room be sit available innearby.in whichthe therapeutic-sacramental inClothes the case person of should transient can be recline loose epi- andinnernature.sodes proximity purification A of fire chilling. in to the aand stream Itfireplace isthe best life-preservingor ifoceanserves there reminds asis aaccess reminderfire us of or of Spirit. proximity theof thewatery Fresh aichemical to waterorigins the elements to firesof drink our of of PDF compression, OCR, web-optimization with CVISION's PdfCompressor wouldsionlife.198 makebe close wonderful to the touch. companions. Trees or Crystals plantsIdeally, in or or other earthnear stones theand room its may natural of the forms—soil, ses-MDMA-Assisted plants, Psychotherapy trees, rocks, and wood— be brought theytheand settingcontemplated. involve is walking outdoors, or inpossible nature.A somewhatinteraction It is probably different, with bestpeople, thoughthat be such undertaken also sessions, profound, us- if experience may be had if previousexperiencetakeningences lower in can the doses be latter, extremely(50 milderwith full-intensity portion of theindoor session. sessions, For thosesuch outdoor who have experi- had to 100 mg MDMA);rewarding. alternatively, Characteristically, such excursions one maycan beexperience a withkindandthe empathogens of rocks,connectedness deep the emotional, animals, are with usually almostand all life-formstheminimal, visceral environment but is bonding often a deep in reported general. feelingwith the inof Perceptual land, suchappreciation sessions.the plants, changes for musicalpeutica profound processes selections. effect oron Typically, shamanicconsciousness, Thetherapists journeys music—usually as andcan personsbe undertaken selected working and during with played MDMA certain by the guide or sitter—can have with the psychedelics. Entire thera- sometimesandSimpleences. other Fast, gongs,empathogens referred rhythmic, bells, to aschimes, orhave "inner highly found and space" complex drums the music serene, aremusic mostalso peaceful, seems pleasingvaluable too meditative andin these centering experi- music dur- difficult to follow. ingIftremely suchthe guide experiences, influential. is the person's Thiswhether role therapist, oneshouldThe plays attitude be he themplayed or and sheor with merelybehavior should integrity listens haveof the and toa guidetherapeutic them. or sitter during the session is ex- owntopartner,agreement the best role it therapy is ofto best theexplore guide.to in have these any Most agreement areas states. people of Theyconcern. andprefer understandingwant and If the are sitter perfectly before ismerely a able to to do friend or even a the session as be there, their foragementlisteningonly example, by toand previous and relationships,reassurance recording arrangement ifthe sexuality, needed. remarks or at Intenseor theof birth therequest voyagerexplorationtrauma—should of the and voyager. ofproviding certain be undertaken encour- issues— PDF compression, OCR, web-optimization with CVISION's PdfCompressor discussioneasy for In the state the with the guide thatvoyager would take him or her away fromof the experi- emotional opennessUsing MDMA of these in Healing,to experiences, Psychotherapy, it and Spiritual Practicebecome caught up in an analytical, verbal mode of is extremely 199 inward.theence deepertwo of heartTheseis warm, intrapsychic center shifts affectionate, awareness. in attentionawareness and Even are trusting,that subtle if theis possible interpersonal andit still elusive. can when be interactionattentionThe a distraction wise is guidebetween focused from will iswatch agersandsufficient forwill whether signs refocus to center that they attention the theare voyager attention"corning toward is losing from"oncethat source. connectionagain.the heart Sometimes or to the the head deep simply in source the asking discourse within voy- odsThisProcess of individual therapy assisted by empathogens.is Psychotherapists not the place to enterand inter- Method into a full in Individualdiscussion Sessions of the processes and meth- withempathogens.Stanislavested LSD, in thisthe Grof topicinformation Inentitled theare remainderencouraged LSD is generally of tothis consult applicable the comprehensive to all psychedelics guide byand Dr. P.sychotherapy. Although we merely give a few sugges- the book deals mainly onethattions, shouldcould primarily be be proposed givenfor the the person asdrug, ethical whoorThere be guidelinesis persuaded undergoing are two for general to thisthe take kindexperience. principlesit, againstof work. longhis First, or accepted her no in psychedelic research withwishessessionno them.one—therapist or withwithout The these questions, full orsubstances disclosure layperson—should purposes, ofif hethe or possible sheagenda consider has risks notbrought administering had and personaltobenefits. the session, orexperience Second, guiding as a suggestthoughthediscussed experience thisto voyagers mayearlier, seems not thatset become to thethey be, tone go in apparent afirstof sense, the as experience.far untilan and answer much deeply Whateverto later. withinthose Most questions—evenas unfolds they therapists can, during to monandthisthe coretotally analyzefor people or centered ground the to usual feel of place, andbeing,problems report full to of theand tocompassion theHigh questions therapist Self—or andof that one's similar insight, all life.their directions. oneIt questionsis notcan uncom- review From and PDF compression, OCR, web-optimization with CVISION's PdfCompressor problemsdence,they200 are it feeling.is often helpfulEven in later such to an ask initial the questions state of totaland perhaps unity record one'sMDMA-Assisted Psychotherapyhave been dissolved in the all-embracing love and compassion that and transcen- traumaticofanswers the usual or memories comments fear or anxietyor onphobic tape reactions, reactions.Because it isOn the ideal, the MDMA other in one hand,experience sense, the for fear usually reaction involves almost total attenuation for post-session review. exploring itselfandsituation"I can't sometimes to associate get arose, in cannot touch hethe instructed present bewith explored the Adam the fear." inpatient state the One usual of to ecstatictherapist think manner. of well-being a notedSubjects fear-arousing that typicallywith it. situation Two say, or when such a feeling,patientthethree conffict, weeks thenwhich later,hewas led suggested ablein to regular the to dissolvingmerge that psychotherapy, she the evoke offear that complexthe entire when memory reactionthe with patientof the the pattern. ecstatic Adamagain broughtstate. up empathy The consciousnesstionalordinary affirmations state thatof consciousness ismade subsequently duringJust thewith reestablished. asAdam theseaffirmations state heightened applyIndividuals or tostatements states, the haveordinary so made canof intentionstate inten- state- are used to bridge one's of mentsoforcation lifestylethese of in intention statesrelationships, have is beenwithsuch regard decidedthatand creativeone to canquestions expression.think clearly Even about changes the various in diet, and later applied. The empathy characteristic of emotional attitude, communi- availableexercise, minimizechoosesions.options A withoutto person thesay defensive to canthe a partnerusualassess or distortions the hostileor probablefriend reactions. caused and emotional modify by A emotionalperson impactone's can expression of attractions hearthings things one soor asaver- mightwith- to patterns,Adamout becoming stateor "dis-identification." might hurt be or described angry and as canIf one these say of releasestatements from sound emotional too good to be true, we can respond things without fear or timidity. The identijicatioli only by banalAdamhundredssaying statements—such statethat of they is intelligent, striking. are based asPeople articulate thaton repeated one often only people. express experiences needs The lovethis profound andinand the allobservations form else simplicity fallsof into apparentlY of many of the place PDF compression, OCR, web-optimization with CVISION's PdfCompressor hapseasyor andthe greatestright. VVhat value these andthat potentialobservations coming of from this and substancethe experiences heart center lies in or the from training the source, of all other choices are Using MDMA in Healing, Psychotherapy, and Spiritual Practice imply is that per- 201 besideschotherapy.thepsychotherapists. patient their often ownPsychotherapists is learning, The regarded ability they as to thewhofrequently experience most have important alsoworked and have articulate withcriterion insights MDMA empathyintoof effective their affirm towardclient's psy-that peopleneys,problems. and who rebirthing have attempted breathing them canVarious have be performed found practices it most whileof meditation, effective in this state.to yoga, practice Most guided shamanic jour- consciousness—aremethods—whichtersuch half methods of a session either are enormously (after withessentially low-dosetwo or facilitatedself-initiated three MDMA hours). and (50—100 and amplifiedMany self-guided people mg) in theseor report explorationstoward states. that the Mostsuch lat- of compassionatestate,immobilityforms especiallyof meditation, may attitude forbe harda however, beginner. called to maintain for require On in amost forpositive a motionlessvery meditation longnote, in thesitting systems the kind ultrarelaxed posture, of can detached, be and attained Adam such yet recommendkindand maintained of foundation that effortlessly a personfor deeper remain with andMost empathogens—this quiet deeper therapists and states receptive and of guidesmeditative attitude during familiar then the absorption. session, serveswith these as to a substances probably would hand,physically,portantobtain for theapart small maximum sometimesof thepercentage therapeutic potential loudly of people andprocess benefit repeatedly. (perhaps to from express 20—3 theThese themselvesexperience. 0 are percent), the people verbally On it is the anwho and/or otherim- are perhapstheyfeelingsordinarily accept including readily. excessively and Theopenlythemselves. MDMA shy, affirm timid, Usually,session that or introvertedthey may such love be people the someone, and first whoneed time do orto in not severalbe their expressfree lives people,to ex- their that presssivetheir their behaviorexpression, feelings into perhaps intheir only everyday onebecause session.Various lives. they After haveforms incorporatedthat, of bodywork—suchthey can changes and do monitorin as expres- Trager or massage—also can be PDF compression, OCR, web-optimization with CVISION's PdfCompressor 202amplified MDMA-Assisted Psychotherapy in range and depth if the awareness has been sensitized bygreaterstatethat empathogens the in rangewhichrecipient and every (at of less low thebodily resistance. doses).bodywork movement The The who usual orhas response report taken fromMDMA such is experiencesin a very effects of finger pressure on the shoul- is carried out with a much relaxed is practicedfeet.der,client's for Body example, bodilytheir therapists art and might report emotional who be that havefelt their instate taken a sensitivity;flow is aheightened smallof connectedness amounttheir greatly. ability of MDMAall to the tune way in to the and then ProcessIninterpersonalgens, the most anda group Ritualforcommon interactions.of friends Group type ofsimplySession Thegroup interactions session with might MDMA include or sensualother activities, partake of the medicine and continue their empatho- erallyWefeelingsuch call as harmless oftouching,such affection usage and caressing, andofprobably the amiability medicine or benign, massaging, among "recreational," it does the and not participants there appear and is thoughtousually andfacilitate toward ita seemsheightened the others. kinds gen- individualofone deep kind, emotionally or the structured participants transformative group have sessions.There no experiences interaction appear to that have are evolvedpossible twowith basicguided approaches to group work. In with one another during the ormusicandsession—although sitters. experiences. with In earphones the otherEach before and kindperson andcommunicating of after exploresgroup, there there hisis ifsignificant or necessaryis her own sharing only "trip," with of listening intentionsthe to communication during the guides roomsexamplesession, or but ofayahuasca Centralin a scrupulously and [a psychedelic South ritual AmericanSome fashion.brew]. groups shamanic Because have culturesexperimentedthe onset that use with mush- nighttime sessions, following of normal fa- the Fridaypeopletiguethat can nightevening,have appreciably resortedin the talks same toandshorten daytime building.shares a session theirsessions. Starting intentions begun Typically, the in withthesession evening, aone group inanother, the assembleshowever, morning, and sleeps many on they a

PDF compression, OCR, web-optimization with CVISION's PdfCompressor sharingcontinue and celebration on the following (Sunday) morning. until the evening, sleep another night, and then meet for the final Using MDMA in Healing, Psychotherapy, and Spiritual Practice 203 followedrooms,different MDMA, three participants to or four ketamine. mayhours take later InThe different others, by particular 2-GB only substances, to MDMAsubstances prolong including is the used empathogenic oralso LSD, MDMA vary mush- from group to group. In some, bestcommonparticipantsstate. for Our participants and research in not the problematic, first shows to kindbe on that of the in group—theeven samethe second,though wavelength noninteractive theritualistic use in of terms kinddifferent group—is of sharinggroup, drugs fairly it the byis vidualstance.agreesame experience (orthat The very it first is similar) not totime participateadvisable a medicine.person for intakes a someoneMost group any therapists substance,experience who has and including withnot group had a particular leaders previousMDMA, seem sub- heindi- orto ior,ingonshe states,which one's may caneitherfirstengage be trip, orallyextremely in and intense or the through distractinggroup and loud ceremonyphysical processingto the movements.others, requires of usually previously participants This caimot kind repressed tobe of be stoppedbehav- able feel- to practicesusedmodulate is the ofand talkingseveral control Native the expression AmericanIn of tribes;the feelings. kinds these of tribesgroup followritual in a similarwhich talking for- is permitted, the ritual that is or talking stick. This method is adapted from the healingmatofcircle inthe peyote circlesthatexperience, is sessions notand interrupted. in in political ofwhich the Nativecase decision-making(Participants they American lie with may Ghurch councils.their lie down heads as The wellduring toward group as somein the nondrugsits center,phases in a fulwhenmakinggroup inner one membersaexperiences starhas thepattern.) attendstaff. and One respectfully.the contemplativespeakstalks or or singsThe sings combination attentionthe from song the ofone heart, ofthe haschanneling group and learned theis a otherpow-power- only Inmembersthrougherful, these almostinkinds choose a surprising of magnetic groups,not to manner.talk attractinga typical or sing Sometimes session forcebut simply that might when can to consist sharetheydraw have a of silent forty the meditation.staff, minutes group of expression

PDF compression, OCR, web-optimization with CVISION's PdfCompressor songsindividual204 and statements with the talking staff. A kind of MDMA-Assisted Psychotherapy inner exploration while listening to music, followed by a round of rhythm develops in Thisthatwhich anyone not internalized only says, protects does, experience theor ingests individuals alternates Andoes agreement notfrom with pass unwanted externalizedoutside of strict thegossip confidentiality circle expression. or ofpossible the group. in le- these groups is made: anything sousednarygal that consequences inrevelations theother people Native sometimes participatingbut American also serves occur groups,can to infeel build these suchcompletely trust. groups. as the As sweat aconfidentSimilar result, lodge trulyagreements that ceremony— extraordi- are what they touchthatshare this willand level notsexual ofbe trust divulged.behavior exists Itinin is thethe the Besidesgroupgroup. group are theleader's best agreement discouraged. responsibility concerning Even to ensurethe in theconfidentiality of communication, ioraenergy.case wouldhand of from couplesItbe should seen one's whoby be neighbor the understood,are rest participating ofcan the be though,group the together,most as that exclusive profoundly sometimes engaging and reassuring asthe in dissipating intimatesimple and corn-the touch of behav- moaning,seekstimesforiing tomake gesture. or make groaning the aOne mistakepainful needsis in experienceof need to assuming find of ahelp balance. go that or away—to comfort. someone Inexperienced placate—theWhereas who isparticipants crying, the personcomforter sobbing, some- con- peuticcatingexperiencecerned aidpresence is muchin deeply such andmore situations.buried support likely feelings ifto needed, want,Some for the need, istherapists first probably and time. cherish have Justthe mosta used simplethe effective opportunity guided touch, imagerythera- indi- to sequences or verbalized meditationsobservedresponsecharacteristic areto in such groups.retracing of theritualized MDMAThe of thestate inner pathexperience of fluidjourneys.from empathybefore seems Among conception toand facilitate theemotional sequences to andjust resonance deepenafter we birth, the have vertebrates,ouranwhich evolutionary evolutionary connects amphibians, onesequence ancestry; to spiritualreptiles, from and gaining andmammals,single-cell intrauterine an andawareness organism hominids, levels through byof tuning memory;which invertebrates, intocelebrates following the four PDF compression, OCR, web-optimization with CVISION's PdfCompressor Therearchetypalaichemical is not spacesymbols within that thisfunction essay in to an describe integrative these manner rituals within in more the detail. psyche. elements, which are basic principles of nature and consciousness, Using MDMA in Healing, Psychotherapy, and Spiritual Practice 205 ritualtatingcultures. power there These inobjects silence rituals that before peopleinclude and bring finding Someafter into the groupsan the session;outdoor center have ofhaving"power adapted the circle a spot" blanketother and and kindsletting with medi- of rituals from shamanic tribal beenrebirthingthethese four incorporatedobjects directions, breathing become into the work "charged" a nature group or movement spirits,ritual. during As the the patterns,stated ancestors, session; earlier, such and and theseas offering thetai kindschi,allies. prayersalso of Group ritual have to Follow-upmayactivities have usuallyanddifficulty Aftereffects work complying best in low-dose with complex sessions; at higher doses, participants verbal instruction. one'sIsinsightsAn it interesting possible everyday and changes to reality?question transfer of To such forthe put many learning,experiences this questionpeople the with concernsnewanother empathogens attitudes, way, the extentwhat and are kind feelingsto permanent. which of behav- into the sessionsconsciousnessior or personality with MDMAof the changes kind and described occurother Frominempathogens, inpeople Through reviewing after the onethe the Gateway deeplyis work led to chargedof the therapiststhe conclusion Heart? states and of guides who have witnessed haps,seenarethat no therein that discernible attitude arewhat two and they outwardmain in are emotional kinds doing changes of is responsesoutcomes. in in line behavior. with to For situations. their Theone true significantgroup spiritual of people, purpose. there They changes are per- proceedMDMAandThey true feel inexperience,understanding. confirmation a more or see less in thingsThe systematic their second in commitment; their mannergroup lives isthat to madethey bringthey have of wantabout people more to those change. compassionwho, changes. in They the Patternsgiousetary habits,or that spiritual people work practice, havehabits, altered andor fundamental attitudes haverangedSome people to basiccareer from have changes choices.physical only onein symptoms, experience di- with Adam and make major life worldview, reli- PDF compression, OCR, web-optimization with CVISION's PdfCompressor three,206changes four, or five sessions to clear out basic problems (usually interpersonalMDMA-Assistedas Psychotherapya result of such an experience. Others find that they need perhaps the"take"or spacesubstance, relationship anymore. of the and MDMA knots). There does experienceAfterward,isnot almost require a cankindthey the be majorofmay entered psychic find reorganizing atthat tolerance will, the without experience thator a feelingitingesting did doesn't the that duringexperiencesalsofirst crucialtime. the experienceThe induring terms intention, the of affect session,the oraftereffects. theset, and long-term of thethe Theintentions individual outcomes. intention acknowledged in before Intentiontaking the the seemssession andsubstance affirmed to affects fimc- is theempathogens,tion ability as a kind to recallof more bridge thethan betweenstate other of psychedelics consciousness—to statesIt is alsoof consciousness. the or hallucinogens,impression have a kind of leave manyof voluntary; one therapists with and observers that the somethatbepurposive asked feeling issue to flashback. ofinremember compassiontheir present One how therapist,and life.they well-being Somefelt for during haveexample, to lookanused Adam reportedat physical and session deal that anchoring with clientsand a thentrouble- could tech- use bythegerniques, choice. hearta momentary such center, as listening once reliving opened, toof thetheir stays music experience. open they or heard can It is be duringalmost opened theas veryif session, the easily doorway to againtrig- of A thattheperson directionone can can choose empathically of one's his lifeor hersense and direction one's theThere emotional relationships of is attentiona feeling consequences andorof workbeing focus orof empoweredof creativityone's awareness. choices. toand make conscious choices about Manyher—andheartOne possibilities woman center not and reportedjust liethat take open she thefeeling for couldone those shethat choose always whothere havewhich weretook, found onepathsthe traditional,wasthemselves that most went appropriate expected inout this from great path. thefor whichfromthesegateway which came remarks to major out the onof inner directions experiencesthe sacramentalrealms. are This withchosen uses senseMDMA is of expressed ofempathogenic theand heart with in centerthewhich substances following aswe a will crossroads poem, close

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Forward and Sixfold Using tIDMA in Healing, Psychotherapy,are the paths and at Spiritual the crossroads Practice of the heart left and right, upward and downward 201 The Thepath pathforward backward leads toleads the tofuture the past and andis called is called "Remembrance,"Imagination, or the Ancestors." or the Children." The left-handright-hand way way is is that that of of the the female male and is called "Eve, the the strong, the dynamic." the receptive." The downward path leadsThe to upwardthe world path of leadsMattei to and the isworld called of Spirit and is called "Embodiment,"Transcendence, or Involvement." or Liberation."

PDF compression, OCR, web-optimization with CVISION's PdfCompressor EXPERIENCEINTERPERSONALClaudio WITH PSYCHEDELICS THE Naranjo, M.D. InproposedIntroduction that she publish myresponse talk on to the Julie "feeling Holland's enhancers" invitation presented to contribute at to this volume, I have wherethe 1993 Ithere was Psychedelic washonored neither to Summit be a psychedelicthe opening atAs the one Unitarian movement speaker.who came Church norto the psychedelic inUnited San Francisco,States prohibi- in the mid-i 960s from a country menttion,of psychedelics Iand was psychedelic particularly in psychotherapy. enthusiasts aware of how interferedIt seemedthe American with to me research thatwar thebetween and refractoriness the the utilization govern- of the American establishment was notcontrollingofalso only psychedelic an aexpression response tendency prohibition toof initsthis the unfamiliarity implicitly isAmerican not simply anti-Dionysian character; with the the offspring psychedelicthere culture. is of also an Andingrained,experiencethe issue the intensity that overly but the allypsychedelictotalofficial control deregulation distribution movementdrugs and in channel. thehasthrough earlyvehemently Take, which1960s for LSDplusinsulted example, hismight ownthe Tim haveinstitutions disdain Leary's otherwise for romantic that the tradition-foundpsychiatric plea an for professionalsworld. One could were sympathizeto realize the with therapeutic him in viewpotential of how of LSD slow and mental the fact health that 208 PDF compression, OCR, web-optimization with CVISION's PdfCompressor some early medical investigators of LSD were sponsored by the Central Intel- Experience with the Interpersonal Psychedelics 209 anandligence his Agencymessianic Yet eagerness I have alwaysinterference to liberateThe American the in theworld adoptionwar has for and of againstLSD by drugs the establishment. was the background for my book thought that his all too heroic rebelliousness paradoxically resulted in sideredcriminalizedtoThe Healing "tamer" Journey,and psychedelics were published not likely thatpsychotropic in did to the be,not late for elicit sixties. substancesthey disturbances constituted I wanted that to hadinwhat thinking not were been con-or labeled dangerous or been draw attention psychotic-typeers"of these and substances,the "fantasy reactions. which enhancers." Also, I classified I Beforefocused I into turnon thetwo to thespecifically groups: specific the matter therapeutic"feeling of feelingenhanc- use enhancers I want to share my gainsones.ofoverall more have Whereas impression significantconsiderably psychedelic-induced thatimpact more the stabilityintherapeutic personal Moreover, evaluationaspects the of psychedelictherapeuticthan the wondrous process, experiences spiritualwhich are spiritual states are transient, therapeutic bringsfeelingcoveringentails them cleansingenhancers the closer ability the tohold psychetheto thelove, depth greatest of opens dysfunctionalof their promise. people spiritual up Iimprints consider in potential. a more from myself stable childhoodI think very manner thatfortunate and the and re- ofOntwothat Psychotherapy decadesI had the ago. opportunity Here I give to anopen overview the field of ofwhat therapeuticFeeling I application Enhancement some and the Facilitation have learned. outphenylisopropylamines.whoIn my introduced first psychedelic me to the I research was potential1962 on my project.I met thatway Sasha lay toI wasthe in Shulgin, investigatingAmazon, the where most the I inventivewassubstituted to carry of the psychedelic chemists, interested then in the jungle andanbrew awakening in known our "animal as of yage', the within." reptilian or ayahuasca, brainIf allthe psychedelics effects of which contribute I came to interpretthe undoing as of the ego—the Little Mind and a bestowal of sacredness on the body PDF compression, OCR, web-optimization with CVISION's PdfCompressor that210 MD MA-Assisted Psychotherapy the Big Mind—it could be said that the effect of the LSD-like calledthestitutespsychedelics nature "head" the of underpinning drugs.isa most"blowing By strikingly contrast, ofof thethe anthe mind,"ego. undoing harmala The and "ego ofalkaloids thus the death" cognitivethey such maythey as structure ayahuascabebring appropriately about that seemed con-is in species:explorationevento be at"gut" aa physical"heart" drugs—catalysts of MDA, drug. level. a drugIt is facilitating against that turned this the backgroundout flow to ofbe instinctuala psychotropicthat I embarked self-regulation, of aon new the IthadMDA: to do with the heartwas and obvious not so muchfrom thewith very the beginninggut or the head. that this With substitutedThe the Drug amphetamine of Analysis ingweresimpleexpression awareness, on thestimulant. emotional "feeling and anotherOne enhancer" facetsphere, was of anthisand I enhancedwanted enhancementthat these to inclination convey effects seemed that were to to itsexpress be notprimary increased those feelings, effects of feel- a malexpressionbut feeling, this was which that not is all.is avoided love. Today as I wouldnot Ourbeing call psychological scientific. it a "feeling Since heart'soptimizer" the subjectblood for is cannot the love, opti- butbe in academic life, love is an onlytermspositivequentlyavoided, the of emotionalelicitationthe derivehowever, academic from reinforcement. of it warm speechisthe regarded outfiowing feelings ethos. "Feeling as Itmorebut seemedof also enhancement"thetasteful theheart. appropriate happy to This talk feelingsseemed aboutquality to suggest empathy properthat was fre- notlater in or zation,preconditionemotionalemphasized an optimization problems or by foundation the name have in Ecstasyforourto do love—Iattitude with given a think wrongtoward to MDMA. that attitude pain. there YetI toward liesbelieve more another pain, deeply—asthat optimi- aall form our of a wardthehasdefensiveness "gatebecome pain, to another happiness,"ingrained. to early way experiences Consequently,of we being might face of say—lies painto much face that withofin we finding werepain. not Thisanother ready I consider attitudeto face to that to- be our learning to live right— PDF compression, OCR, web-optimization with CVISION's PdfCompressor thoughtsthe on the characteristics of MDA,most I turn significant to a story. aspect of the feeling enhancers. Experience with the Interpersonal Psychedelics Before sharing further 211 triedberatorynotes. useful it on ashimself Alles,a vasodilator withthe discoverer a platismograph (a medicineSasha of amphetamine, Shulginthat around lowers hadone bloodoftold his me pressure),fingers of some to testobservations this in Gordon Alles's labo- thought that MDA might and he hypothesis.ticularlynobodyusual. At was in Aftera view certainsmoking. some of thepoint timeThat fact he he wasthat sawfound suggestivethe a yellowishstructurehimself of becoming ofa smoke hallucinogenic the MDA ringmore moleculein talkative the property, room, is than a par-sortbut further.moreof hybrid medicine I wasbetween a forpsychiatrist amphetaminemy soul, workingandI was andso it at mescaline.forfell the the upon right Center meplace to for at Studiesthe right in time, Medical an eager seeker hoping to find explore the substance AnthropologyCzechoslovakia.Stanislavscandalsupport mein Grof, Chile,in at suchthe who InsteadIUniversity ventures.found was able ofmyself concentratingSinceof to Chile investigate in there a Medical position was on LSDneither School,LSD, very during a Imuch drugwhichwent the scene likein wassame other that norready years ofdirec-a drug toDr. in ayahuasca)thetions. exploration One wasand the of domainalkaloidsa South of Americanof the theFrom phenylisopropylamines, African early shamanistic psychotropictesting on concoction myself plant and and iboga. another on(yage, a few was or acquaintances, it was clear that nessMDAwasspecificaway without from fora drug, theinterferingthe processing unlikeordinary LSD, with worldof that unfinishedthinking. ofelicited Itsbusinesses an effect expansion in the of interpersonalemotional aware- world. objects and persons, but rather seemed did not take the subject report,discoveryeffectsIn retrospect, co-authoredare ofsimilar this I can different to saywith the that Shulginnow kind I wasmore of and exceedingly psychedelicwell-known Sargent (1967), lucky wasdrug published toMDMA, hit on MDA,Ecstasy.in a succinct for The its evaluating MDA as an universitypsychotherapy,adjunct to clinicpsychotherapy. such in Santiago. as I have Afterward, describedTheseI reported patients I inbecame The in given thatHealing involved bookMDA Journey. what wouldin MDA-assisted was travel found right in working with people at the PDF compression, OCR, web-optimization with CVISION's PdfCompressor backous212 rape. Freud to early childhoodMDMA-Assisted and to early Psychotherapy traumatic memories, discovered this same realm of experience at the beginning of particularly incestu- Thehiswell.the career undoing side In butofone parents, ofthen MDA childhood created session,not being aamnesia theory for ready example, to could toexplain believe involve a middle-aged it thataway. other they (I kindsbelievecould woman ofdo memory rememberedsuch as that he took things.) thatthiswindow eventresultedas a thechild was murder from true,she this had butof memoryher Ibeen believed father locked brought by it. herThein a mother'sabout understandingroom a and remarkable lover. had Iofwimessed could herself healing. not and throughprove her that a life mayreformulating—almostof thebe, spontaneousa still more essential age redigesting—the regressionIn The it induces Healing past. Descriptively andJourney the interestI referred appropriate it tostimulates MDA as as that thein "drug of analysis," because characteristic of MDA would be conveyed by stead,isothercalling not phenylisopropylamines) athere itdrug a truth is that a drug,concern leads in to viewfor the truth disclosureofcatalyzes. the and nondefensive a facilitationofUnlike information the openness truthof against serum it (as one'sof well fiction, will.as some this authenticity is the chief vehicle of therapies geared to self- In- applications,therapyknowledge,or the enhancers.experience MDA such as and Just ofthe theperinatal asinduction other psychedelicsfeelingstates, of mystical theoptimizers experiences,have specializedare impressive work therapeutic on psycho-dreams, feeling enhancers open up what mightisandthe the flamemanipulativebe ability termed of loveto aremain "way and,alive in ofina consequence, healthy love."the face This and of pain—rather islovingblind. a spontaneous Thechild gift ofthan of Paradise willingnessthe becoming feeling in spite optimizersdefensiveto keep of the nondefensiveabilitycontamination is supported attitude of the by thatpast a radicallyallows and pollution forSuffering different the transmutation of isthe stanceinextricably interpersonal in of the pain bound face world.into of to bliss.pain, earthly a existence, but it may be a nar- This ourcoticthatcompassion growth. or obstructs an awakener, Our and ourpain love. progress can according Thebe a and differencestimulus to one our that, towillingness isdefensiveness through like that skillfulto between take ituse in a ofand contrary the use sail, it per- and selfishness or to wind for PDF compression, OCR, web-optimization with CVISION's PdfCompressor mits us to advance somewhat against it. Experience with the Interpersonal Psychedelics Such willingness may be the fruit of 213 takerealmtransientan austerity them of Adamgift not ofto andhell,the feelingEve as in (as the optimizers. if case in reward of LSD-like They for openheartedness) may psychedelics, take users but directly or to theya worldly to may the developed along our psychospiritual journey, yet it is also the aisplace verythe ofrealm fortunate pain, of to psychotherapy one.the other side par ofI earthlyexcellence.think that Paradise, the name which Adam, is purgatory. with which This Leo Zeff baptized MDMA, was I was never happy with the overly academic and euphe- canlikedthemistic innerbe Adam, termrelated sense "entactogen"because toof the contact prenatalit indicates more(which condition appropriately earthly sounds paradise. like called Latin And "relationship").and if psychedelicGreek and suggestsI heavensalways of life in the womb, earthly paradise past,isechoes the itmore wouldthe postnatalsick follow people condition that who the have potentiallyAt of the thethe greatertime newborn. addictedof need writing to ones dealThe withHealing the painJourney, of the I thought it likely that since it would tend to have hypomanicavailable,sure."bad trips"When I anddisposition)MDMAhad little occasion (withenticement who to effects seemanage thatfor only the Ito wassubtly userepress wrong. of MDA pain There andas an experienceare escape people into instead(with plea- a different from MDA) became tohedonisticpaineuphoria paradise and andanger. bias remain warmth succeeds Instead a sort in aof inof way the directingopium thattherapeutic ofseems them the people,to topurgatory echo a paradise, atheir that customary though they need, their denial visitstheir of spiritual exaltation that onepersonIbecomes think during beforethat a substitutethe preparatory the session—can initial rather session—andpsychotherapy than make a remedya great therapeutic and difference.for the their therapeutic condition. readinessIn such cases, of a skill on the part of some- itsration,HereMMDA: animal I takeand and thisup The thehumanwas threadEternal to bepharmacological MMDA.of myNow story. By theI wascharacteristics time ready Sasha to Shulginmove in collaboration into and a Inew published explo- with PDF compression, OCR, web-optimization with CVISION's PdfCompressor I found214Sargent in MMDA—a sense of what I call "the eternal now"—was MDMA-Assistedsome- Psychotherapy(1973), I was using it in psychotherapy. The most important quality therapysourcething thatunder of frustrationI was MDA. particularly that I had readyI justwas to encountereda appreciate,budding Gestalt in in my view therapistattempts of an unexpected toin conductthose days, having come in recent thewhilebearcontact "there on I thetried withand psychedelic to then," Fritzhave peoplekeenlyPens, experience. and determinedfocus I had onI was theattempted tofrustrated here dwell and onto in bringtheir this endeavor,memories. Gestalt therapy because I must to they insisted upon toremarkableconfess the surface, that potential I thewas potential a littleof MDA ofslow MMDA is toitsFor catch ability this is an onreason increasedto to bring the MMDA factlong-repressed awareness that lent just itself of as the memories theadmirably present. more to Gestalt work, better than inhancersinvolvingMDA. the category Itbut not imagery—not personal only of fantasyfocused imagery, archetypal enhancers.) on as the in ordinary here imagery Furthermore, and dreams. now like butLSD (I putIalso foundand iboga enhanced the that andfantasy MMDAharmala work en- lencewiththisoften domain. Gestalt oftriggered MDA Alltherapy and psychosomaticin MMDAall, I helpedI think in thethatmany symptoms facilitation through people. the and Discoveringof use psychotherapy lent of itselfMMDA the to specificexplorationin was conjunction like excel- hav- of nowingclined twins becoming me in tomore thewidely thannew. known. an intellectual In Sashathose sense,daysShulgin's he but already theskill winds inhad the producedof synthesis adventure a num-of in-new psychoactive molecules is isopropylaminesturnberand of to analogsIcomparative (1969) that also and wereresearch publishedclosely waiting with related a for somesummary humancompounds. of these testing, report substances. andon the this testingShulgin, prompted of Sargent, various me to tialForMDMA: has been MDMA—which differs chemicallyme, the fromgreatest MDA news in sincethe same the discoveryway of MDA and its Ahealing Nontoxic poten- Alternative to MDA PDF compression, OCR, web-optimization with CVISION's PdfCompressor thethat same as those of MDA, though it hasamphetamine a somewhat shorterdiffers from duration nor-amphetamine. of The effects are essentially Experience with the Interpersonal Psychedelics 215 nottialaction ofa constant LSD, and it less haseffect of the the but serious toxicity. one thatdrawback Whilebecame ofMDA apparenttoxicity. is a therapyInevery my experiencenow enhancer and then thiswithout in was an the psychotomimetic poten- beanticipated.someunpredictable the patients case withThe wouldmanner. reasonsMDA. die InI from werehad this observed chloroformunknown,sense it is at andlike theanesthesia, somethingchloroform.time of butwriting similar this In theThecould seemed old Healing not days, be to Journeyurgingcoulda certain that them be once dosageattributed to testin awhile (abouta person'sto cerebral MDA 250 reactionmg), brought vascular some to about MDA peopleeffects. skin cautiously, became Irashes had warned and incoherent, starting that my beyond withreaders, which a heblessing.veryChile. administered low Given Adose. Chilean theI fortunately500 fact colleague mg that to about adid wasfriend not thirtyless havewho lucky people anyexperienced (and accidents took certainly the aphasia. drug,during less I careful),viewmy After work this that, for asin a highknownseveral blood anddeaths pressureused were widely orreported inappropriate for many in theWe years, United knowuse itand isthatStates. remarkabledespite with MDMAaccidents for its the attributedlack case of isdan- strikingly to different. It has been nitycaseenhancers.ger totoof healthy talkMDA) Myabout couldpeople. approach their be Ipastdescribed would to andMDMA-assisted saypresent as providingthat livesit is the andpeopletherapy champagne problems, with (just a specialas withof it thewas a opportu- viewfeeling in the to folded.thebecausedeveloping use ofMuch most LSD—that insight peoplecan beinto I gainedof know their listening relationships havefrom toused that music MDMAalone, and through personalities.but with essentially headphones a model I emphasizeborrowedthe while feeling blind- fromthis, en- engenderareofhancers the remarkable sense have to ofcommunicate to "I" fordo and withthe thegreater the sensebetter world openness Iof concerning alsoof "You" relationship emphasize that (which relationshipthey andare elicit this interdependent).with aspectand problems. the the enhancement becauseability They they at one of the Esalen ARUPA PDF compression, OCR, web-optimization with CVISION's PdfCompressor 216 H DMA-Assisted Psychotherapy votedbodywith(Association to my who an colleagues exchangespoke there in between theprofessed psychedelic MDMA to believe network.therapists, that Tothe I my foundbest astonishment, way myself to take at oddspeopleevery- for the Responsible Use of Psychedelic Agents) conferences de- peopleticrememberon Psychology)an MDMA and that listened Dr. trip and Rick tois I weretothem. Ingrasci urge the them only (past tooddballs president in of that Association meeting: weof Humanis-talked to withdraw into listening to music. I Ithemverbal would go interaction comedeeper back into as into their an theinvaluable difficult roomI also afterexperiences. vehicle use a brief music, for absence, guidingThis but becamefrequently andpeople a apparent patient andI prefer helping would when to begin a session without it. I see theback."say, kind "Oh, It ofis I thoughtnottalking the caseandthe effect thethat empathic talking hadAfter gone needs understanding some away, to timebe but a asworkingdistraction; onewe can with provide. it dependsMDMA on in individual and group situa- talk it is all coming ingIntions,ongoing this away mysituation the mainrelationships garbage" MDMAinterest so withbecamelends as to one itselfkeep itsanother, torelationshipsuse occasional within such asgroups healthy. sessionsfamilies of Ipeople geared andhave communities. worked towho "clear- had in whoarecernedthis wanted proneway with not toto the only undergokeep quality with their inassociatedof relationship thetheir course parmerships psychotherapists offree time. from in Typically,business the butdeterioration alsoand I would withwith goodpeoplethat mostfriends con- work with aforeachgroups spiritual example, of ofwhich community.fifteen a peoplefamily to twenty areof three, involved people four inconsistingpartners ongoing in relationshipsofa business a number firm, outside or the therapy, staff of of subgroups, in dividualpressionof group "analyticaltherapytherapy within thepsychotherapy" MDA way Iand haveOne MDMA, conducted incase connection report the kindit. might While with of groupconvey myI have approach therapy someused sensethe Ito have iflex- of the nature of an experience towardfeedback.ofdeveloped the group further I is not and one elaborationonly in in the whichcoordinate course Iof have theof and a experience. intervenedsession share myof retrospective little,own perceptions except sharingin the but preparation andalso group PDF compression, OCR, web-optimization with CVISION's PdfCompressor been to create an atmosphere of surrenderAn and spontaneity within the bound-important part of my role in preparing for the MDMA session has Experience with the Interpersonal Psychedelics 211 Itheallowsaries have case of witnessedfor aof simple withdrawal,MDMA astructure remarkableadministered protecting that coincidencelimits to everyone'sa group movement of between optimalexperience away the size from need fromand the ofcomposition, invasion. somegroup par- but In Sonsdelvingsuchticipants mothering.find into tothemselves regresspain Since(or and both),in the thebe effectitmotheredgarden is easy of of MDMAto earthlyand see the how canparadise availability it be is apossible whilepeak of experienceothers thatothers some undergo to giveorper- a taneouslylatter.catalyticthe fires Again organizing effectof andpurification—and ofagain MDMA system, I have upon for had thethe the the experiencegood participants, impression of all. of thethethat group former as the becomes resultis a gift of a tothespon- the larlythatof her can illustrative experience happen. of Itat howis a notgroup much an session,unusual canI nowhappen asreport turn an throughillustration to in a its personal content, appropriate of letterthe and kinds ingroupit whichis of particu- prepa-things one middle-aged woman tells me andstrategytherapistsration, supported without but will rather by knowone-to-one a a faith sort well inof that therapeuticgroupart ofthis "notand noninteraction individual doing"interactions. developed organic is I notthink throughself-regulation.a matterthat experienced experience of simple All addbecanin all,present bethat it prescribed is this not in particular thesomething rightmechanically, waygroup that with can had for sensitivitybe prepared itexplained seems forto easily, requirewhat the experience isnor anhappening. iseducated it something with abilityI haveseveral that to MDMA,asdays K ofwas and psychotherapeutic a J,member who did of take the exercises MDMA,groupAfter who swallowing isand a chose sex meditation. therapist. to the participate capsule, The woman Iwithout adopted identified taking an attitude of confidence—in lackingnecessary.thatloving scared and in air.strongIme, began This but presence I tomade had lose confidence me mymade very skin it afraideasiersensations; in you, offor whodeath, me. I wouldfelt I feltafraid cold strongassist ofand dissolving me palpitationsas if itI werewere or in life, before the unknown (which always scares me). Rachel's PDF compression, OCR, web-optimization with CVISION's PdfCompressor 218 Theningclosedthat came I in, realized andfrom within my that body, meI was I began soft a baby, and to MDMA-Assistedfeel or amore fetus, peaceful stillmyPsychotherapy heartunborn and wouldsecure. explode. I lay on my side as if folded upon myself, trembling, as if shivering from cold. and sent into A moan- intosidewasbeing veryandthis to caressedworld."realize "Being," Thisme. I was saw emerging certainthat it was to out me K, oflikeand nothing, Ithe told Thenher, "I somebody am covered me, and I felt afraidthat somebody of being born. was by my light of day. I was then solitude and cold. I being born manfeltgersable being, more andto let heratwho go ease, fingers, into gave I paincould me and and uncurl weeping, my body for aI feltlittle secure and talk before to Imuch felt my warmth teeth andwith tenderness. which I could I sucked bite. 'Whenmy fin- I her. I told her, another hu- what I knowangerwas"Don'tcoming going towardhow leave to throughto yet."own mybe with mother,itI and verycompletely. me." much only I did needed feel"She angry wasto talk nottoward to able her my toand dofather. to more; tell I her gave what I had lived through with my parents. I felt no pain; I said this with great conviction, as if she didn't him wayhearhard throughout it.words When for myshe so life.did,much I sawdamage her tears. thatI told he IK recited had that inflictedI hadother written poems on me a poem toin her,a to my inner child, and she wanted to alone for subtle but jacketthatathen little sheshe while,over leftwould me,me and return.alone which she wenta Forlittle.I could to the She firsttouch asked time and me I smell,whetherdid not and feelI could the alone. fantasy stay I of somebody who was calling her, assuring me had her could her remainedtheit,little,also integrating ground be for withwith after with myself. me. lettingit differentinto I felt Imyself.her understood happy, comeparts I forofhadinto mythat I muchmewas body. it and wassure need fillJ good cameof me,to her touchthat Iby, return,could sheand and leftnow Iand receivedpress me assimilate I against alone a him howhimtootuted as everythingI felta ofgift lovinglyHim. from from I was God.interwoven the sorry Ibeginning told that himwith in of what essence,our the "normal Iexperience was as if stateall andmy of cellsthe mind" deep were we abyss—' did not living. I felt him and told consti- He realizeIopeningassisted had thisbeen mepaths. Reality possessed with He histhat helped handsby we him are.release toward thus And far.myIt anwe was fatherintegration also in this talkedfrom moment ofmy about head, body, when heart, for you I came by, and I told you I was purgingfeltand assex, if PDF compression, OCR, web-optimization with CVISION's PdfCompressor melikedmyself he you needed to have to bestayed alone longer, a little, but that I didn't dare to ask you. Then J toldof my father. And so you smiled, in confirmation. I would have Experience with the Interpersonal Psychedelics afterward he would have to help 219 giftnorthatthemsomebody empty.fromwas that all GodI else Icouldright; continued that and itfind filled thatwas my to he notme feelspacewould bad.with nourished of Igladness—Icome continued aloneness back. to Iwaswhen thusfeel receiving learnedhappy,I needed neitherfrom much it and both alonewith- how of while by myself. It all seemed a whatseekingoutabsorbing having came of anotherto and seekme openingat (mothersit. the Yes, moment. upI andfelt to fathers)thatthe surroundings,I no but longer only needed to listeningopenK returned, up and to groupsandreceive in her of company I started to look around in the room, the compulsive momentwithpeopleexperience,an admonitionthe who toothers." remain conversed and that IBut withcould had Iand understoodmy listenbeen laughed. own introjectedto experience. him Forthat and a it momentletearlier was Afterwardhim more inin, I my camefeeling important J in clear touch atand withthat free life: "You must go told me of his ingundulatingmovedfrom all mymyself, along joy, my mywithit body upward living space and cells.and feelingfor downward.the I found other.successively my Then I feltbody I anthatstarted axis Arab, I dancedand to a dance Hindu,felt like that alone, a energygypsy—serpent, feel- Ihefull have were of juststrength going been to andborn." rape energy me. I was I told with him, him as in if a to group discourage inAt which several him, also "Hey, points was wait. J approached, as if seduced by me. I felt afraid, as if to manhaveaggressionwhose singing.liked peaceful totoward Whydance face men.don't likeI felt Whenyoua attracted.woman." dance masculine now,WithBut he andsinginghim said, I could "Preciselysounded, verbally I becausesaid, express "I would it ismy a you'll finish with your father furtherrationthisence way." and ofclosure. feminine Iautonomy. took it asstrength—and aI feltspecial as if challenge, in self-affirmation this destructive and I danced. history,Well, It was IClaudio, had an reached experi- I won't tell you more anecdotes, because this letter, I before my father, of sepa- thathavelackprofoundlythink, Ihasreturned amhas been comingreflected therapeutic tocovered this to the experience the andformost end me. that meaningful ofI itfeelmany a couldn't healing as times if thingssome have process to nourish of inbeen mythe with inarchaic,experience. myself, any a moreother primordial and lucid,Itway. I wasfeel I PDF compression, OCR, web-optimization with CVISION's PdfCompressor 220 theorganized,enjoy riches life I have more been and keepingmore. to myself.tIDMA-Assisted I continue Psychotherapy to write poetry, and creative mind, more confident, daring to teach and share and I I hopeandsingleof how the that experience. manysession this sessionissues as a The whole that report anonymous are may willdistinct be serve seen subject and toas separateconveya saysstep inthat a ina she birthingtheorygeneral process.commingle understanding Sepa- in a has just been born, selfoccursality,ration to she andregressin thedifferentiates union context through both have theherself supporta part from in of thisher others birthing.father; (the at therapist, Inthe same the group, of a mothering situation—one in which she allows her- asserting her individu- time the event and, regressionjustmoststepping-stone, as specifically, separation to progress, heras and itcompanions). were,union the allowingfor are self-expression. both ofpart a fetalof the state process, that thenso Yet regression is not all there is to birthing; there is here a becomes the specifically,ofis richthe attitudeenough an withto attitude bring which up of manythe confidence subject issues.I have embarks andAmongsaid even that onthese thea the measure contentissues experience—and is ofof the acceptancethe session more is not particularly special, yet it importance in siblethistheof face acceptance anthat MDMA of is "death,"in the ofexperience background ongoing or a sense experienceare ofof all animpending here: organic that awareness unfolding.makes "explosion." theof psychological Thedeep It classic issurrender the extent pain, pos- elements in- of tionshipstandingmovement,sight into between oflife andothers. and a grouprelationships,progression It is membersclear from from self-expression can the defensive be, account in the accusation injustsense verbal how of communication bothimportant mothering the toward an under- rela- and tiveintuitioncial form invention sharing of group of or, thepsychotherapy more twentieth generally,Carl than peer Rogers the therapy. skillful has claimed use of MDMA.that therapeutic I groups may be the most and I have not known a more effec- benefi- hope tionalapproach,futurethat this healthhealth glimpse for has authoritieswe becomeintocannot the afford to sonature give vital to more ofto squander thethe positive experiencehuman resources destiny.attention may in MDMAbe daysto athis stimulus when is an emo- ex- neglected for PDF compression, OCR, web-optimization with CVISION's PdfCompressor relationshipstremely in the context of dialogue. Yet the great gift that heaven seems valuable resource for processing past life experience and for healing Experience with the Interpersonal Psychedelics 22 I lievetorythereto be them and is an medicalto urgentbe research establishmentneed priorities.for collective considers mental these health. statements offeringGiven unproven,that us throughthe regula- I be-scientific know-how remains unused at a time when goodmenthadFor anot oflongor appearedall.the time Thelay Ipublic bookthought to stimulate seemed in that finding The theto have Healingoutinterest how been Journeyofto liked eitherput thesemostly had the beengiftsmedical by ainsiders,to failure, use establish- for forwho the it therapeutictoaneeded book fill avoid, aboutit least. catalysts topsychedelic someOver theextent,they years, therapy,are. giving Ihowever, hope and credibility that I think I ithave serves Theto been psychedelics Healing to surprised support Journey myasto thesee contention continues preciousscarcely remedyathat deadly we cannotthat police-minded we afford need asthe we luxury approach ofI believe wasting a new that theircollective it ispotential the absenceRed while Sea ofcrossing. we a channellinger in for the potential beneficial use for they constitute precisely the kind of goodcomesdisease,of psychedelics use. from with Of bad course,its that use,addiction isand the to thisberepressive and held has criininalization. beenresponsible quality the result of for government of Iour am restricted collective convinced withopportunity psychedelic thatrespect abuse for to becomeearlyzationdrug issuesPuritan and critical also is ancestors.an ofto expression theour prohibitionist very We survival ofare a livingrepressive leaningsthat through we bias gothat times,beyondin we the have veryhowever, the inherited structureoverly where stable fromof civili-it andhasour tionaltrainingernmentfossilized policy. of will spiritspecialists What rise of fromis the neededwho institutions its can slumber now use psychotropicis that beforenot we prohibition havelong substances created.and but reconsider true wiselyI trust expertise: andthat its skillfully. dysfunc-our the gov- forI amenedof our psychedelicshappy governmentindividual to see thatandby may the collectivewe perceiveestablishment seem to healing. beand coming put is underto useto a way, thetime potential andwhen I praya ofreconsidering psychedelicsthat enlight- PDF compression, OCR, web-optimization with CVISION's PdfCompressor CLINICAL EXPERIENCE WITHAnPSYCHOTHERAPYGeorge Interview MDMA-ASSISTED with Greer, M.D. JH:do.therapyGG: I'm practice,a psychiatrist and I inalso private work practice. half-time I haveinI thinka residential a smallthat I wouldoutpatient treatment like topsycho- startcenter by having you explain what sort of work you peractivityexperiencedfordepression post-traumatic disorder sexual and other stressor(ADHD), physical mood disorder anddisorders, abuse addictions. (PTSD), in childhood.eating mostly It's disorders, a very Theywith intense alsopatients attention-deficit generally patient who popu- havehave hy- lation.medications.hospitalhospitals They care. for come aboutI'm the to a our psychiatristmonth. program It's there, afrom residential alland around I evaluate program the countrypatients designed afterand for being prescribe after- in JH: GG:Tell That's my third job. I'm the medical director, secretary, and treasurer me about your involvement with the Heffier Institute. and raisingreviewof the Heffterandof research a business Research protocols. manager. Institute, We have and an I coordinateexecutive director all the whooperations does 222 fund PDF compression, OCR, web-optimization with CVISION's PdfCompressor Clinical Experience with MDMA-Assisted Psychotherapy 223 JH:sicGG: science We plan, areas, promote, to learn and how support the brain research worksAnd withand what howpsychedelic does the the mind Heffler drugs works, Institute in andba- do? aboutbuttions.in clinical there Theeight is science,research yearsalso somenow, to is usebeing andresearch psychedelics the performed fund-raising in the to mostlyUnited treat is goingmedical inStates. other well. andWe'vecountries The psychiatric beenmain at this workingprogram condi- time, JH:lam Itwe're soundscurious planning asabout howis at thatthe Universityinterest began of forZurich you. with Dr. Franz Vollenweider. dedicate some ofyour time to promoting psychedelic research. moresomeroommateGG: towardvery It began profoundsaid hefor had me learning learnedin college. experiences things It was from inthat takingmy changed sophomore mescaline. my outlook year, Then when on I hadlife my and I became involved in meditation. In medical California,therapeuticweekschool, program I learned Iuse met ofat with aboutEsalenLSD. Ralph theWhen Institute work Metzner I finished of in Dr. 1975[consciousness Stanislavmy to psychiatric learn Grof more researcher residencyand about I went andthe in to psycho-1979 a six- in synthesizedusedwastherapist], available by psychologists. who it to suggested physicians. I that began Then I conduct to I readlearned clinical the about regulations sessions MDMA, with and whichketamine, found was that which being if I I could prescribe and administer it to my own patients JH: WhenGG:if I had I didprobably peer you reviews first heard hear andabout about informed itMDI very VIA vaguelyconsents. and from in the whom? 1 970s, and in 19801 heard fortocontactedmore do a fewclearlyit. I years.alsoSasha from had IShulgin started psychologistssome usingtrainingand made it who atwith athe batchwere psychologistsend using inof his1980. it lab, in I therapy. whobecausethought had That's ithebeen was knew using whenimpor- how itI JH: Whattoleratetant tospecifically do risking it legally, myhad medicalyou so heardfromthat license people the by couldpsychologists? doing talk underground about Whatwere it freely. work. they I seeing? could not PDF compression, OCR, web-optimization with CVISION's PdfCompressor growth.224GG: It facilitated getting over neurotic hang-ups, gettingThey just more said in thatMDFIA-Assisted it was very Psychotherapyhelpful for psychotherapy and personal touch JH:speededwith Can the you upself estimate the in therapy a basichow processmany way, therapists and by relatingreducing you think moredefenses. were to partners. using It just sort MDIVIA in the of lateSanitGG: seventies?became FranciscoIn the much late Bay seventies, more area, prolific. probably it was There probably several were morejust several a inhandful. Los In the therapists using it Angeles,in the and a number early eighties, JH:scheduled,on There the Eastwere but EastCoast. that's Coast I awould therapistsballpark guess figure.engaged in MDIVIA -assisted less than a hundred by the time it was psychotherapy? I hadhavenomenonGG: never Therebeen heard to otherme. was for groups atsure least that who one there justgroup were didn't usingany; communicate it itseemed in New a purely Yorkwith theWest people Coast I knew. There may phe- JH:psychiatrists Itistration seemed scheduled ascame though forward MDIVIA the realthen. in 1985 on an emergency basis. Many psychologists broke when the Drug Enforcement Admin- and use.MinditsGG: recreational She Bulletin, My sent understanding him pioneeruse toand see ofthen is mythe that learned wife,consciousness a reporter Requa from forMarilyn Tolbert, movement] People Ferguson magazine about [editor itshad therapeutic heard of and me, and they spent Brain!about half-badwantedwrotethree daysa storyhim side. interviewing to but Then make never Newsweek it publishedhalf-bad us and andpeople and it. otherHe half-good, whosaid news hadthe magazines reasonandhad hesessions was could got that with notwind us. of the editors find the theHe schedulingBentsenbarsstory in followed Texas of Texasin placegot by askedplenty the in T\Tmid-1985. the of stations. DEApublicity to doThe After something, fact that, that I thesounderstand they drug put was the Senator being emergencY sold inLloyd

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Clinical Experience with MDMA-Assisted Psychotherapy 225 JH:GrinspoonGG:tried Yes. to point The and DEAout some to plannedthe other DEA people the that scheduling there and wasI became ain beneficial lateWere involved 1984, you side involvedI think. into MDMA?petitioning Thenin the Lestercountermovement, the among the group of therapists who JH:ing Weremergovernment happened of you 1984, present in toand 1985. place at then, any it of afterin the Schedule allhearings? the publicity III. That broke, effort thestarted emergency in the late schedul- sum- me.wentGG: There to the wereone in three Kansas different City hearingsand testified. in different The DEA parts lawyers of the country.examined I JH:had WhatGG: had Isort anysaid of serious that things I had negativedid givenyou say effects MDMA when from you to wereusingabout on it, eighty the except stand? people for some and anxiety that no or one peopleticulargoalspanic. for Thewantedpsychological the vast session, to majority take which itproblem. once of waspeople or twiceItusually could said and to bethat were learn a wideit nothelped about varietyinterested themselves them of achieveinthings. the or drug a Mosttheir par- in JH: Howatterms the did hearings.of you its addictivefeel when Judgepotential. Young That's made pretty a recommendation much what Ito laid the outDEA for that them thevalueGG:Schedule DEA It of was the IIIdo placement wonderful.drug.anything, It was was unfortunately, I a thoughtappropriate? great he reallybut it wasunderstood a great achievementand appreciated that thewe It didn't have the authority to make JH:DK4?a judgeWeregot our youmake word surprised a recommendationin and that were you understood.could and go then through see thatall these ruling legal totally motions ignored and byhave the

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 226 MDMA-Assisted Psychotherapy wasn'ttheonlyGG: statute a recommendation.regular is written, federal the court ItDEA did judge, notdoes have and not havethe statutes to I wasn't surprised. We knew that he was an administrative force of law per se. The way that follow his recommendation. said his judgment was law judge; he JH:We I understand knew that, that and there I don't was think an appeals we were process surprised and that thathim. once the DEA didn't agree again Schedule III inwas couldGG:Schedule recommended, It not was I. schedule a technical and the again drugmatter. on Anthe appealsbasis that court they in had. Boston They could not equate the DE4 made a move to place MDMA permanently said that the DEA Foodstandardhad andto use Drug but a differentstill Administration claimed standard. that it approval hadSo theno medicalDEA with saidaccepted use. they It was thenmedical kind used ofuse; a a it wasn't surprising. differentformal- they - JH: That wasn 'tparticularlyfrustratingforyou? It just seemed like a little coda? JH:frustratingGG: What No, was it but wasthe notmost all unexpected.very frustrating frustrating. aspect The for wholeyou? Was thing it that was you had overwhelmingly found an atheefficientGG: fringe paints It was andthing; were aseffective if Ibanned I was had tool usingdiscovered because in afield it legally people wherehow to theresniffed use weren't oil them. paints too All inmany along,my tools?art, I but in a huge sort of legal loophole. andknew then it all was thoughtitmustThere would be was verythat get no thisvery ontoFDA wouldn't rare.the involvement street, All ofhappen usand knewat things allor inthat using would weit was werethe change.a drug home therapeutically, I free. don't risk, in that sooner or later think I ever which JH:shut Youra7y? down did Even haveat some though afeeling point? it wasn't that the work that you were doing was somewhat did you have afeeling that you were going to teiflpO get

PDF compression, OCR, web-optimization with CVISION's PdfCompressor partiesGG: in New York City. At that point, I decided toI had start heard writing in late up 1982the that MDMA was being used recreationally at Clinical Experience with MDMA-Assisted Psychotherapy 221 hadif designedresultsit wereasked thatbeing everyone a similarI had used found toquestionnaireat fillparties, with out a theit complete very people that likely I could topre-session whomwould send Ibe tohad questionnaire; scheduled.people given afterit. II knewalreadytheir then ses-that I publishedthatdata.sions. part I Forstarted time insome late forcollecting people,1983, almost and it it,a wasthenyear assembling a itto couple was get publishedit it,ofin andyearsa format organizing in later the to that Journalbe printed.it,I got and of the PsychoactiveI Itworked follow-up was self- on JH: TellGG:Drugs me It inaboutwas 1986, organized the after conference. a conferencethrough the on Haight-Ashbury MDMA that summer. Free Medical Clinic by ationalMDMA—allconference,Dr. David use. Smith People in sorts Oakland, and ofmade Rickinformation, presentationsCalifornia, Seymour, from editorfor and toxicity people submittedof the to Journal. therapeuticpresent papers It information thatwas use werea totwo-day recre- pub- on JH: Thisence.lished took Someone in theplace Journal after from the ofthe scheduling?Psychoactive DEA was there Drugs. to present It was theira good, perspective balanced asconfer- well. JH: DidGG: people AboutMy cases present a year were anything after. mostly about people potential who therapeutic were functioning benefits? well, who had illness,manhadneurotic-type found who and had benefit his problemsepisodes family. with He oftheor psychosis,hadwanted drug. done Dr. a apersonal-growth eitherPhil family Wolfson schizophrenia session had andkind used presented orof schizoaffectiveitexperience with that.a young Theand logicalsentedforfamily a while, informationbondingfindings. but improved thereHe from also was ahad quite humanno given lasting a bit.physiology MDMA Theimprovement. patient to study a woman, himself, of Dr. vital Jacka I therapist think,signs Downing andwas who neuro- better pre- had

PDF compression, OCR, web-optimization with CVISION's PdfCompressor beencast.228 She had an MDIVIA raped. I rememberMDMA-Assisted that this story Psychotherapy appeared on a session, relived aspects of the rape itself, television news broad- and re- hadpsychotherapy.sion.solved dramatically Then a lot Dr. of it.improvedRick One Her Ingrasciof symptoms his after patients, presented a single and who flashbacks had terminal cancer, informationMDMA-assisted about using psychotherapy the drug for ses- essentially.disappeared. She appeared with JH:peacehim You've on with the mentioned Philherself Donahue two areas Show. I want MDMA to spend had more time on. and not be fearfttl or anxious or stressed. helped her greatly to come to The first is PTSD. physicalsessionYouGG: have or mightIt's psychic worked purely help trauma.specifically people theoretical, Canto process withyou but describepeople some my understanding withof how this this an trauma? MDMA of diagnosis, who have a history of PTSD is that the emo--assisted psychotherapy Besselego-integratedbraintional centers,impact van der of like Kolk's processesthe thephysical theories.)limbic in sensationsthe system, Thecerebral techniques andof cortex.the never trauma that (Somegets getshelp resolved by verbal or oflocked thisPTSD is infrom the involve lowerDr. the temcanreexperiencingdistress, bein anverbalized emotional increased and and cognitive loop,arousal, causing affectiveprocessing shutdown of the experiences. and inhibition, released, instead of cycling around in the limbic sys- flashbacks and emotional dysregulation— The memoriespanic attacks, balizefromprocessingthat sort the these oflimbic thing.[EMDR]memories, system The treatment theorywhich to the behindiscortex—people helpful.for PTSD eye-movement is thatstart itto desensitizationactivatesreexperience a connection and re- and ver- calThistoward content, makes experiencing itso very I imagine hard thefor that thetrauma MDMAit person also memories, would toreduces have remove a psychologicalwhich fear thereaction can be todefensesvery but probably in a cortical inhibitions different way. psychologi-unformed. They'reandthatego anxietycan'tdoor affective andget overload aallows handlememories, thatthat on. experiencingwould That'sbody sensationperhaps and re-traumatize memories, prevents the the person. why it can't be processed. MDMA somethingoverwhelming that fear The ner opens the

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Clinical Experience with MDMA-Assisted Psychotherapy 229 JH:VOUSand the way it could help others with PTSD.There'ssystem more comes of a into sense balance. of calm That and ismaybe the way a certain I think amount it helped of brave7ythis woman in GG:equzppedlooking at to an explore. event that the patient either didn't have accessRight. to or just didn't feel The content feels less threatening to the person in the moment. me.mightgetIf theyI'm anxious notstart start getting toorto thinkdistractthink anxious." aboutabout themselves itthe Soand eventthe say, orprocess withoutrepress"This canis itMDMA, okay. entirely.continue. This normally With is not MDMA, threatening they might they JH:whatthey It'sThere feeltherapy interesting ismore a senseis equipped all thatabout.that youI to getfromIt dig seemssay and that people to to be MDMAlook a whocombination at places tellhelps me where tooftheirMDlVlA of dampen calm they've and a been notfear experiencesquite hurt, response. fearless-which thatis GG:handleness, but what more you're like adigging strengthened up; it's sense not going of self to ofbreak confidence. you.Yes. You see that you can I think that the only thing it does is prevent the knee-jerk fear re- tudesgivesoccurssponse. peoplethat out The aren't of drugenhanced innate really only abilities turnstherecognitive offalready. that this abilities, the fear patient reaction, enhanced has. andI don't intelligence, everything believe orthat other MDMAhappens apti- JH: Ioutcouple think offear ittherapy makes of exposing toit easieran extent, oneself for peoplewhere are markedly theto express typical diminished. theirdefenses true andselves.People posturing Thiscan really comes that share may up in arisemore wetime—wasGG:of would who My they have first are.exactly beenexperience afraidthat. It withor was skittish myjust wife, easieror uncomfortable Requa—we to talk about weren't to things talk about.married that normally It atjust the JH:learnseemed That's with easy.something an MDMA Afterward, that -assisted deserves it was experience tostill be a underscored, lot or easier. whatever which skills isyou that acquire, whatever you you leave PDF compression, OCR, web-optimization with CVISION's PdfCompressor with230 them. You learn how toMDMA-Assisted communicate Psychotherapy and operate with less and you are youable discovered.higherGG: to incorporateYes, doses, I think say, that that's 200 into possible, mg, your people but canpeople get don't carried always away in It's not as forget how you felt or what decide to do that. At the euphoria. I notionshipveryhave guarantee; closeheard that and of weren't itcouples intimate, all depends resolved back inon and the did eighties not get who resolved in everyday and afterward they still had problems in their rela- the people and their intention, their willing- would take MDMA and get life. There's youJH:ness,to It'sdidn't veiy givework important MDIVIA it out. to as integrate part the skills that you uncover. I ofyour private practice. understand that mysionspatientGG: private I with had in myone me.patients. private patientI just Itfelt practicewhowas that ahad separateit who washeard toohad partabout experimental MDMA-assisted my use of to it, so of my work. recommend to any ofpsychotherapy ses- that was the only JH:GG: Itgrapevine, was Right, something andfriends with that of youpeople friends were whoor doing people had with heard I acquaintances.knew. about my work through the familyJH: YoueachGG: work? would Atother times, helpand thereleadwanted individual were to havesmall or a couples groupsdeepening sessions.of perhaps bonding Did four you experience. dopeople any group or who knew The one larrelationshipseeingpatient psychotherapy meI worked for difficulties—and depression with sessions. in therapy and She it neurotic greatly hadhad abouta speededverykinds three positive of up problems_self-esteemMDMA the transference, progress sessions. of our regu- andShe was was and progressregularmoreference, at therapy easewas and thatin reduced sessions trusting MDMA her between me facilitated defenses and thetalking so theMDMA that treatment about she sessions. could deal My with her core embarrassing thingsalliance, in our the positive trans perception of her issues PDF compression, OCR, web-optimization with CVISION's PdfCompressor thatmore she became a psychotherapist. quickly and more efficiently. I think she would say the Clinical Experience with MDMA-Assisted Psychotherapy same thing, in 231 scheduled?JH:GG: That's They were probably four to six weeks apart—at least a month but more interesting. When you say three sessions, how far apart were they JH: I'mdoseslikely assuming latersix weeks. in the that session? you used a dose of about 125 mg. Did you use any booster mg,AncouldGG: hour and We tellmostand offered us a wouldthathalf that,theyto take two wantedalways. it.hours a Welater, low, started medium,we would with or 75offer high to them125 dose mg, anwithin additionaland thatthe person 50 range. JH: HowdegreeGG: longI often in would psychiatric performed the sessions nursing, the sessionslast? and togetherwe would with be Requa,with the who person has afor master's six to doingthree-hourwitheight headphones, something hours. period The morethe lying first person like twodown psychotherapy. towould andthree wearingstart hours talking theWe eyeshades. person wouldand interacting talkwould During about listen withthe problems secondto music us and plete,theypersonand we issueswouldn't couldwould and takehave leave. work care to Wetravelthrough of themselvesusually afterward. difficult did andthe Occasionally feelings. thesession emotional Whenin itthe would processing person'swe thought be in home, ourwas that home. com-so the JH:GG:ion You on I howmentionedthink you that think thatall self-esteem, thoseone patient are self-acceptance,beliefs, had self-esteem so they and haveissues. self-love a Icognitive want are affected to get aspect your by MDMA. opin-and an tofeeling.beliefsemotional look are at it.basedaspect. I'm ontoo They're a scaredfear—such concepts to look as "I'm aboutat it, not and the good thatself. enough meansTo the because I'mextent not Ithat ahave worthy those this something bad inside me, and I'm afraid of it and don't want PDF compression, OCR, web-optimization with CVISION's PdfCompressor that232person.them there and is to something anyone they come MDMA-AssistedI'm Psychotherapy not a whole person"—the person bad inside them that is close to emotionally. With threateningfeels incomplete. and dangerous People to MDMA, they can feel Frequently,theylookbad feelmore or wrong.they're closely they ashamedwillMaybe and discover see there are things that areof atwhat a gut that level bad and thing see is. They can that there really is nothing throughunpleasant it and or call obsessive its bluff. or inside them that lookis at whatever bad—andcoreaddictive,as partbeing. of butdiscover these thatthings they're are not not themselves. That self-acceptanceWhen they can get in touch standing betweenafraid their of awarenessthem, they can just accept with all their feelings—good leads to a different feeling, "I'm and their them and JH: Iokay. thinkbliss There's andthat joy this thatnothing sort people wrong associate offeeling of self-acceptance and with me." with the drug Ecstasy. self-love really leads to the JH: GettingthereGG: When are back no people problemsto the issuetake that it cannot recreationally, I'm sure that'sof a dissolution true. offear or anxiety, be solved. Withhow MDMA, would that affectit fromGG: the Yes.multipleperception myeloma? ofpain? I know that you had a patient with chronic pain. Was JH: There'scanthe perceptionhave a bodya tremendous ofresearchofpain and that suggests fear of death. The fear of ego exacerbate the experience. I know that anxiety andfear ofpain can disintegration, the fear that terminal patients I was wonder- heighten of no longerbyGG:ing thewhere being, This multiple MDMApatient'scan play myeloma, fits intopain into the came this which isperceptions a form of ofbone their marrow physical cancer. symptoms.fromtheory. collapsed vertebrae that had been He was a caused verybeendevelopeding intelligent visualizingall of bythose man,Dr. thepsychological, Carl verywhite Simonton, blood insightful. He had beenself-hypnosis doing pain control cells attacking the cancerwho was one of his techniques,physicians. but He cells. Hevisualization, was as theyhaddo- PDF compression, OCR, web-optimization with CVISION's PdfCompressor were not working for him. He couldn't be very physically active—couldn't Clinical Experience with MDMA-Assisted Psychotherapy 233 somethinghasadditiongo even fishing, been toof reducing the measured sort, fear,that in is MDMAmice diminished. or hasrats; an thereIn analgesic fact, is ina "tail-flick" peopleor anesthetic who response, have effect. taken Thisor couldn't get around very well for a number of years, I think. In anestheticisMDMA reduced. and effect pinch and their the own euphoria skin,I think andthe for tactilereduction this responseman, of it fear. was is there,Ina combinationthe butsession, the pain heof the direct analgesic and/or thetwoweresaid pain-free made involved, he was him state; pain verybut free inthe euphoric other forfact the words,that infirst heitself. hetimeexperienced mentally He in fourdid ayears.connected noself-hypnosis pain I'm at sure his all pain-freefor allanchoring thosean hour factors ofor state hypnosis,niquewithpain-free imagery in hypnosis. he experience wasor thoughts able For to so weeks regainthat that he he afterward,that had could pain-free,during experience when the or session. relativelyhe it did again, He pain-control pain-free,"anchored" which is self- that a tech- state. anotherAftermuchThe MDMA amore fewsession pain-freeweeks, session of anchoring. the moreand pain able or gradually He lessto behad primed active about would hisagain three own increase, andsessions. technique, get and I think he would he had have a lot of his life back. so that he was two JH:would Whenseveralsessions anchor he weeks. would with the ushave pain-free and a session, then state a hesession sowould that or havehis two an on analgesic his own, effict? and each time he own technique was effective for 3H: ItotalGG: really pain-free wanted to state. have a chapter in this book about palliativeEach time the session would get him back to either a total care, about work- or an almost guideda person'stoing Write with imagery concentration it.the IVIDIVIA dying. experience. Unfortunately, does and seemthe capacity to be I haven'ta potent to have been analgesic, that able sort to and of find meditative,I believe anyone it whoalso hypnotic, enhancesqualified

PDF compression, OCR, web-optimization with CVISION's PdfCompressor intact;234GG: they can direct the mind and attention Yes, because at moderateMDMA-Assisted doses, Psychotherapy people's mind toward a mental task and com- and ego organization are JH:plete Iwith would it a relatively moderate even venture dose.well. to say that one attention and concentration are enhanced JH: IntrationGG: the Yes, same and I attention.waywould that agree. a low There's dose of less amphetaminedistraction. would enhance your concen- issue,MD1V.[AwhereGG: Exactly. Idopamine did definitely receive If you releasers phone thinkhas a calls similarofor itstimulants asfrom effect.a continuum AIDS Gettingenhance treatment centers. of attention deficitback disorder, to the focusingpalliative of care attention, They told me inwholegalthat lots somewere at of the distress medicallyof time, their andbut patients much pain.these sickerItwere centers was using thanimmensely were myMDMA using patient. init a valuable to help them come to undergroundThey were for terminallypatientstherapeutic ill, way. It was peacepeoplelife withwith who AIDStheir have lives, after used totheir MDMA session were To thesemy knowledge, AIDS patients. the relieve anxiety, to just have a much better quality experiencing benefits and found it sickest terminallyAnecdotally, ill these of JH:verycenters Theencouraging worthwhile. case reported reports and thatand heartwarming. themany anecdotal patients It evidence is were immensely about people helpful to have closure with the who are dying are so family,around toandGG: be they ableYes,you beforetohave exactly. open not you up 'Whencaught go.and I say think people up the with this things are iseveryone. invaluabledying, that you their It wantand helps lives really to the say to often are not complete, family andsoothing. everyone the people oneself,tento canlet a great gofacilitate whichand deal finish thatisabout helpful their greatly. unfinished unfinished to attend business to in the dying process. business. Elisabeth Kübler-Ross has with one's relations and also I think MDMA writ-with PDF compression, OCR, web-optimization with CVISION's PdfCompressor Clinical Experience with MDMA-Assisted Psychotherapy JH:areemotionally terminally andill or physically, markedly and sick. having First, some they respitegetI do a too. few from On hours theirmany of symptoms. levels, feeling I thinkbetter, It's alsoMDMA is appropriate for use with people who 235 possibleotherwise.aboutThe thethatfringe dying they benefits willprocess learn of canhaving to gomanage aclosure long their way with symptoms,toward their familiesrelieving their and physical their experiencing pain, pain, psychic better. less and fear JH:to, AreGG: then there I think other MDMA groups ofpatients can be helpful that we to haven't them. talkedI about that youthink think so, but they have to decide that they want to do that. If they wish populationGG:may be appropriate would not to benefitexplore fromin terms it? of Almost clinical all research? mentalI've disorders are been thinking about this, and I think the question is: What patient com- calsiveoutsideplicated defense disorders, themselves. by themechanisms andaffected personality Certainly are involvedthis disorders. is true in ofFear most all andthe every anxietypsychological, mental disorders, disorder. pathologi- depres- I've fear of things they perceive either inside or MDMAdisordersandthought manic enhances more and disorders, recentlythere the filtering are because that studies MDMA of the sensory with serotonin might pre-pulse information helpsystem inhibitiontreat is[see involvedpsychotic "Using that with MDMAshowdisorders those that phrenicpeoplein andthe TreatmentMark filter people Geyer sensory have of Schizophrenia"].(Vollenweider weakenedinformation pre-pulse betteret At a!. least 1999b) than inhibition one in hasstudytheir shownand bynormal haveFranz that state.deficits Vollenweider MDMA Schizo- in helpsfil- MDMA.itparanoidtering might information, This reducestate is or hypothetical,whatever a delusional but this fear capacitystate. butis creating let'sIf this is say enhancedperson or that resulting weresomeone in willing normalfrom is the lockedto people takeparanoid into taking de-a someoneceduralaroundlusions with it.and It paranoidethicalgivewould him beproblems, schizophrenia ora very her achallenging butbreak if for the from the patient and firstit and risky time. were more thingThere willing of to anare give andability a lot MDMAcompetent of to pro- think to PDF compression, OCR, web-optimization with CVISION's PdfCompressor 236 tIDMA-Assisted Psychotherapy all other treatments had failed, it would seem JH:worthto I absolutely trying. agree. I thinkgive informed consent and the pre-pulse inhibition data look enticing, worthwhile but it's toalso tomsotherexplore my is issuegut someone that feeling is in the someone who negativethat there symptoms. is isn't thinking or talking much. This person who has schizophrenia, in terms of such a lowering offear that it would be A schizophrenic patient with negative symp- their paranoia. The isn't connecting arewithantipsychotics,GG: all other thingsYou people could that and and start doesn't they're with have still25 mg, the way possibly could be combated in the short term. much emotional expression or motivation.because many people have taken all they are. I wouldn't see any problem These the JH:with I'mbefore startingglad going that with you to higher wouldn't25 mg doses. to see any make sure MDMA did not make them worse, problem with it. Unfortunately, every psy- morechiatrywas hesitant. very chairman interested or institutional in review Schizophrenics are such a vulnerable patient giving single oral dose MDIVIA to 1 was unable to find an institution toboard support that I've ever discussed this with is medicatedpopulation schizophrenic to research. I patientsconsent.GG:that. with It is stillnegative my long—term symptoms, goal but to see If they're not in a psychotic state, if it can help. they should be able to give informed JH:amine, Onering-substituted offenfluramine, my rationales amphetamine. and is ketamine, that I've so been in schizophrenics have consented to be given it's not so far off the beaten track to try touch with four people with schizophre- amphet— this symptomsbetterniaGG: who equipped Theyhave and used want to to have MDIVIA,deal perspective kindwith ofnottheir an so symptoms.on much it. to outsider's view: "That's my paranoia." These are my symptoms. This is not control their symptoms as toThey help wantthem to know that they are justme; be thisJH:stay Atis innotleast their reality. with inner two circle of these and four not peoplebe separated. That happens to many people MDMA has helped them let their familieswho are PDF compression, OCR, web-optimization with CVISION's PdfCompressor psychotic.those caretakers. They pull away from theirfamilies, but they need that Clinica) Experience with IIDMA-Assisted Psychotherapy support system and 231 JH:bottom ThereGG: lineMaybe are iscase that that reports there could arein thisbea lot publishedbook. ofpeople It's anwhosomewhere. area could that derive I would benefit like to from pursue. one The or two disorders,MDMAthatGG: IYes. -assistedthink but Getting has thenpsychotherapy no it backpotential might to yoursessions.help for question,benefitthe psychological from I don't MDMA. know distress Maybeof a mentalthat disorder some organic a person aboutJH:with One too an possiblemuch, organic is areasubstance mental where abuseillness MDIVIA disorders. has. So much of diminishing substance abuse would be helpful, which hasn't been spoken SomepeopleliesGG: in examining patients Right.who said I saiddidn't one they they be treat werehavior were any less patternsnot serious interested interested and substance seeing inin usingmarijuana what's abusers, cocaine working but afterthere and what'sMDMA. as much, but then were some not. high,here,abuseothers Ifor have histories,were the seen stimulation.more people including interested who It Ecstasy. hashave in it.no abused In therapeutic Their my tenwork drugs; at set the they PTSD have horrible drug reason for using Ecstasy is to get or setting whatsoever. treatment center using.wentsaidSome they backof I seethese functioned to only thepatients cocainepeople better said who or theyduring the are liked amphetamines stillthat it having time;a lot; thenthey severe or feltthey whatever better.problems, Maybe else rather they werethan ran out of it, and they a couple peopleJH: Thepeople who context are who probably ishave important. resolvedhaving Isome think their psychic that problems at benefits.the average through Ecstasy rave scene, there are some use. JH: InuseGG: general, situation. I would I think agree that from the benefitswhat I have are maximized read about by it. a supervised, judicious-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor and238GG: taking Ecstasy, because at many rave scenes, atI think a rave sceneMDMA-Assisted is more positive Psychotherapy than sitting at home drinking alcohol least there is a positive serotoninpotentialrecreational.mind-set problemtoxicityand It's a positivelycertainly from that MDMArising not oriented ambienta inmedical animals, setting, and setting. which bodycould temperatures apply to people increases danc-though the you could still call it Unfortunately, there is the JH:ing Onbonding at the raves other and and the hand, taking socialization recreation very high are is good. certainlydoses There's of therapeutic, a group Ecstasy. mind that can be developed and I think that this andwitharetic. cohesion Feelingreally chronic a and "hookedpart mental intimacy of it illnessin" and towith something—to is everyonethe feeling around of society isolation. you, or to that you're connected is very healthy. Part of the problem which I thinkThe is alsosickerthe the planet—feeling you rapeu- are, the more as ifyou whoisolatedotherGG: had Right. youpeople ADHD. are, One becauseand He ofI thinktreated the of lastthattheir people peopleadds attention to with thewe illnessproblemsADHD,gave and is very MDMA to was a psychologist and lackwho of feelempathy. very cut After off from unhealthy. benefitseemedhisPeople treatment, fordifferent, with people mentalhe morewent with illnesses emotionallybackADHD home, are from cut accessible.and MDMA, off people from whichHepeople, saw is a great commented to him that he because they're so dis- what you're saying. psychological JH:socially Right.tracted isolated. I bythink their that's June symptoms Riedlingeralso a major and has suffering.reason written why a chapter people for the book where she talks commit suicide—they're personanyaboutGG: sort becoming the Couples of potevt-ial couple more came therapy? to depressed use to haveMDIVIA MDMA as sort together, of an to and suicidal and so cut off Did you "interrupter" in the process of aimprove their relationship. specifically do weretheirfundamentalNone ability ableof these to to carryrelationship couplescommunicate over were the problems. in in the an middleintimate I think of allway a of them communication that went on during divorce or havingand serious in a lasting or way. said that it the sessiOflimproved They

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Clinical Experience with tIDMA-Assisted Psychotherapy 239 gone,justsexuallyinto let and go inhibited herof hersexual phobia after intimacy it offor getting several with herpregnant months. husband again.Aftertheir was the lives. Thatrestored. MDMA irrationalThere session,was fear one woman who had had an abortion and felt very wasshe JH:experience.ner,home. It justand In havingpointsterms You of tolearnless learning the fear that fact about youa that new can exposingwhat skill, expose onelike yourself one's learnsbeing self able during without to to that communicate the person, other it's with a learning a session, one can take person ridicul- a part- ingGG:trying does outyou. That's anot Younew carryexactly haveskill, aover, you positive what learn but happens. experience withthat it a has moderateThere's frompositive opening a theory doseresults, upof that and toMDMA, that state-dependentyou level take that's of it intimacy. with just learn- You you. JH: Iistrue. think that itthat is suchone of a subtlethe reasons shift ofwhy consciousness. this state-dependent It's not sofarfromlearning does a normal waking carry over not prettyGG:werestate. much takingRight.It is easyget MDIVIA. I there knowfor most without aYou psychologist people don't the toneeddrug. approximate to and keep hypnotherapist taking the feelingit over and that who over, they has becausehad conducted when you they can JH: Wherethatteredhypnosis state. do state you It on soundsand think people engage our somewhat whocurrent in thehad level kindsimilar MDMA of MDIVIApsychologicalto what the research processing is? Compare they thatwould so that they could re-create that al- cancer patient did. in whoblockadeGG:with have whereAt takenthe studies, you University Ecstasy. think with it should Hepeople of isZurich, bejust who or learning where haveFranz it never shouldtheVollenweider mechanism had be going.MDMA hasof howand done withit works. others receptor usedwasmacology,There anMDMA are international two at Wayiiein ongoing human Statemeeting research.studies and in at in IsraelU.C.Two the United psychiatristsSanof every Francisco. States group fromfocusing In in August Switzerlandthe world 1999, that and there has I, on basic phar- PDF compression, OCR, web-optimization with CVISION's PdfCompressor 240 MDMA-Assisted Psychotherapy Thewillgroupswho useFDA are it reversedjust with rapecourse victims. from stoppingI have used it in therapy, also participated. In planning projects to use MDMA to treat PTSD; think that research certainly is picking up. human research. Initially, they had Spain and Israel research in Spain they measurements.havebeforetold Dr. to he do Charles could any Thatmore work Grob was animal with of a UCLA cancer studies that patients. positive step. but that he neededhe concrete had to do outcome a lot of animal studies Then they said that he didn't JH: DoGG:easier.United you A yearsee States?In that ago,the perhaps United it became itStates may much become harder, now a matter of and then,easier more to do recently, MDMA it research became in the designing a trial that has softerdesignthinkoutcome it'sthan work. measurespossible, in otherAs you areas,thatbut know, areI thinkwhich concrete in psychiatry thatmakes it will matters the take outcome very a measures enough to be acceptable to the FDA. I lot of time andtricky. research My own thinking are much hasis Givingto chronic work MDMA with pain pain, whowith the doesn'tnarcotics symptoms have or other toof take drugs creates a ill and not terminally ill. The trick there is to chronic pain, among people who are other medications all the time. drug interaction issue. find someone who JH: It'spain,GG: not so goodMy there patient research. were with no It's drugmyeloma not interactionsan optimal was taking design that onlywe were aware acetaminophen (Tylenol) of. My thinking for is abuse,measures,athat person pain where usesis as easily opposed therebefore measurable. are to so many You variables. can measure The door and after a session. There arethe many situation with depression or anxiety or how much pain medication has been opened at possible concrete substance this point,shipsmanymatters and withyears; here.I thinkthem, he I thinkthathas which beenwhen seems things to be happen paying in off. Rick Doblin has been doing muchnetworking with the FDA and forming other countries, that work on this relation-will help for

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Clinical Experience with MDMA-Assisted Psychotherapy 241 JH:universityGG:maybe Yes, not andinresearchers the if Unitedthey are will States, published become but around andinterested. there the world. areIt positivedoes seem results, as though established there are little projects sprouting up here and there— pre—pulseJH:would Ithat was enhancebe speaking inhibitionan easily pre-pulse to measurable study.a schizophrenia inhibition,She wasparameter very researcherwhich interested, of is effectiveness. clearly the becauseother disrupted day, there and in schizophrenia.I mentioned the That are so few things JH:are IGG: havethat Exactly. weone need last question.Itto wouldkeep an Are even eye there onbe inanydouble-blind. the caveats? future—in Where terms do you of research, think the potentialpitfalls researcherGG:therapy, I haven't and living the thought inissue that of about world neurotoxicity? that every too day. much,Where There becausedo haveyou see been I amminefields so not ahead? many blockades; a professional rarehas,wepitfall haven't hyperthermiait would would even get be beenworse reactionsthat able a after patient to in takingget a researchwould on MDMA.a road get subject, worse.to Weexperience whichalso Whatever might would pitfalls. seeproblem be one Ivery guess of bad. those one a patient JH:GG:chanceswhere When I aagree. ofitperson comesthat The would is to not chances hyperthermia, bebouncing pretty are slim. offvery my the slim.assumption walls and gettingis that inhot a controlledand dehydrated, setting, the JH: OneGGhave of Therethe the enzyme issues also thatnecessarymust I think be individualto may metabolize not be genetic resolved MDIVIA, difference yet which is that could some in one bepeople dangerous.of a million may not or there'smakesso people. themnoa risk way proneTheirin to walking prevent tobodies hyperthermia-type out it and oryour tonervous screendoor every systemsforresponses. it day. that respond It'sI Ican think extremely think in there's a certainof. remote, You a risk, way could but that

PDF compression, OCR, web-optimization with CVISION's PdfCompressor pital,screen242 so we never gave MDMA to a person forMDMA-Assisted the siow Psychotherapymetabolizers. We weren't who had been incapacitated fromconducting our work at a hos- JH:a Whatmental sorts of tests did you use to screen disorder. Certainly their hearts needed to be interviews for a couple of hours, and ev- people? healthy. JH:eryoneGG: Wouldbefore We filled anytheconducted medicalsessions. out a seven-page conditionspsychological exclude a questionnaire. There was a lot of preparation patient? liverGG:reationalthyroidism Yes.disease, We Ecstasy andseizurewould any deathsexclude history,woman were anyone whodiabetes, due was to pregnant.arrhythmias; with heart disease, high blood hypoglycemia,pressure, glaucoma, or hyper- Apparently, some of the rec- people':s hearts stopped. researchpletetime,We didn't physicalbut subjectnow conduct Iexam—the would taking these recommend any exams, same drug. medicalbecause at assessmentnone you least an electrocardiogram and a com- of those reports existed at the would get for any JH: DoGG:structure you Yes, envision in absolutely. the United a time StateswhenIt's just Heffier a matter will createof an where clinical psychedelic research will be done? getting the funding, but now we institute, maybe a physical JH:have Iclinical look an forwardoutline science of to we ourthat. expect plan for to conduct.the sort of facilities and activities in basic and JH: IingGG: really in I this hopeappreciate interview. that itthe happens work that before you are I'm doing, too old and to walk. I thankyouforparticipat-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMAtopotent,Introduction work, immediately sometimes is a unique medication, unlike any months.acting antidepressant.If a person is lucky; Most aantidepressants medicine starts to other used in psychiatry. It is a take weeks help inventoryoneacutelyation, feel asbetter suicidal thatMDMA inworks a and does. inat anrisk, When hour they psychiatrists to cannot enhance afford are to few days, but there is nothing in the feelings of happinessworking and relax- with someonewait who four is to six weeks for an psychiatric medicinal anxiety,diateantidepressant interrupter like diazepam to of take depression, effect. (Valium) MDMA suicidal MDMAor alprazolam has feelings, theis also potential a non-sedating to anxiolytic, a drug (Xanax).hopelessness, Psychiatry and isolation. has few that lessens, or "lyses," be used as an imme- ever,hasbarbiturate,tools not andat beenits it disposal.is in broughtdifficult an effort Occasionally, upto toin therapy.relax them patients This enough medication will to calibrate the correct dosage such that the patient be given sodium amytal,divulge a information thatis quite sedating, how- is anxiolyticslessfearan inhibited anti-anxiety response cause and in medicinedrowsiness,more most verbal people. andbut Unlike notmost groggy. alsoevery disturb Allother memory; that does neither. MDMA completely known immediatelyanxiolytic, acting it is not sedat- but MDMA is ablates the whatdisorder,ing, and it feels full and likememory social to be phobia. is relaxed retained MDMA and Thereof less the is defended.are useful millions because Patients of Americans it can suffering from MDMA-assisted therapy session. anxiety disorders, panic shows the patient learn from this later,fleshpossibleexperience, without out tothe understandtheand sources drug. they ofcanWith specificdeep-rooted anchor the help triggers themselves offears MDMA that relatively causein taken easily. that feeling and tap into anxious feelings and to during therapy, it is Therapists who it phobias,haveinggether, experience of theinthe particular phobia.therapist with In MDMA-assistedoftenand the patient cancourse be can extinguished of reach discussingpsychotherapy the root in that one cause have connection in just oneMDMA session.and symbolic mean- noted that simple To- choanalysis,session, the phobiabut it tends disappears. to take longer.The same thing is 244 possible in standard psy- PDF compression, OCR, web-optimization with CVISION's PdfCompressor order (PTSD) who have been treatedThere effectively with MDMA-assisted psy- are powerful case reports of people with post-traumatic stress dis- Introduction 245 warlives.whochotherapy. all have Rape can undergone bevictims, helpedPTSD people animmenselyis aextreme particular who havebytraumatic MDMA-assistedanxiety-related been eventassaulted, that diagnosis psychotherapy. negativelyvictims ofgiven affectstorture MDMAto people theirand Uncoveringlowingworkallows through peoplefor a themeasure towhat repressedrevisit has of the occurredforgiveness memoriestrauma in with a and andnon-threatening much acceptance speaking less anxiety about to context,occur themthan for usualcalmlyperhaps the event.and and al- to usesityusingreportopenly of MDMA oneMDMASouth is research the Carolina to first in treat Chronic stepteam PTSD. in toward inCharleston SpainPTSD An clinical American currently patients. is alsoimprovement group performingplanningIf MDMA from into the PTSD.clinicalhasstudy Medical any theI research amchance potential Univer- happy ofin to peoplethisbeing clinical transformed gain indication.a less distortedinto an FDA-approved impressionMDMA also of medication, their may bodiesbe useful it and is inlikely more the treatmentto powerful be with of eating disorders, helping in scope,tion,feelingschanging improving that of that self-acceptancecan behavior. allowinsight people into MDMA under self-destructive to honestly theis a drug's tool, examine likebehavioreffects. a special theirIn is food one entiremirror ofand the drug-taking drugor first micro- addic- steps changeswithbehavior.history potent their in There people's psychoactive current is anecdotal addictive level drugs, of evidence behavior.functioning, such asthat MDMA LSD breakthroughand or thecan ibogaine, causes afford sessions thatforcan somelife-changingeffect augmented of lasting their psychedelics.causeeasierglimpse toit intoismanage shorter the bigMDMA's acting, picture witheffects of an less during reality a psychotherapeutic distortion than the session, stronger be- current situation, but it is much Givenphrenia,tion. One MDMA's which of every is ability characterizedone hundred to minimizeMDMA people by a waxingdefensiveness around may haveand the waningworldpotential and sufferssuspiciousness level as an offrom acutelypsychosis. schizo- and acting anti-psychotic medica- PDF compression, OCR, web-optimization with CVISION's PdfCompressor theorying246enhance people that whohas neverhave abeen chronic tested, but it deserves at PotentiaJ Clinical Uses forinsight MDMA into behavior and illness, it may be a useful adjunct psychotic illness like schizophrenia. This is a least one clinical trial in in help- peuticanpatients' effort alliance to insight between into their psychiatrist illness,With andimproved any patient major mental can mental illness, it is generally thought help the millions of people with this disease. be enhanced,health care along is the with result. that if the thera- MDMA-assistedsupportinsightsconcerning systeminto issues and psychotherapyof appreciation theof compliance patient can affordsof thewith severity the medication opportunity of the and illness. for treatment be enlisted more fully in a group or family important gainsMoreover, the and major e-mailsequentsession, from whereimprovement a registered empathy, in openness,nurse, theThere the andmother are acceptance numerous of four, arewho potential has medical uses for MDMA. I effectiveness of outpatient care. emphasized, with sub- lived with severe received an sheShethatpain hadforwas for amade mostablefew hours totheof hold herdecision she lifeher was duechildren to finally breakto rheumatoid andpain the feel lawfree and atfor arthritis. ease thetry inthisfirst her illegaltime in She wrote to tell me body—all because drug. She andfifteen years. monlyingI areother any infinitely accepted areaclinical to frustratedexplore research that anxiety is thaton the noand potentscientist stress analgesic can anywhere depress properties in immune effect on the immune system. It is com- the world is conduct- of MDMA. An- function, and findcusthe converse istouch shifted and may more movement well toward be totrue posturebe (Stone moreThere pleasurable.et is al. an 1996). enhanced This isawareness likely of the body in response to and deep breathing, and many whyMDMA; so many fo- people ing,instructorspeopletices. have enjoyMDMA reported of dancingthe helps Alexander good andstrengthen results cuddling technique, when the when mind/bodyincorporating which taking focuses MDMAconnection; on postureand MDMA into their prac- in some cases, alsoit why some and breath- derpinningshavebody.acts as a Many stronga person's times,of psychosomatic the introduction symptomspeople's medical component.with to the the complaints help To of identify MDMA and chronic the would pain idea that the mind can help psychological un- be an impor syndromes heal the PDF compression, OCR, web-optimization with CVISION's PdfCompressor tant step in treatment. Many people accept the idea that a person's mental Introduction 241 havetentiallystate,can chronicespecially be improvingconsidered pain one's or their levelillness,a tool level of to augmentinganxiety; teachof health. patients can affectMDMAtechniques how health alsoto like be(Cousins could more biofeedback, assist relaxed,1983). those MDMA guidedthus who po- ness,effectsimagery; one of often hypnotherapy,a single can affectdose. Throughthe and course anyMost mental other of important, a mind/bodydisease imagery; (RossmanMDIVIA relaxation, work tocan 1987). help and be usedintegrateinner in aware- the the field of palliative care, to ease Unitedtientsthatthe suffering is in stillStates, the in last of itsto those stagesinfancy.make who dyingof life.As are easier.the Wedying. baby have In Palliative boomersmedicine, a long way care age, we to is dothere go,a notbranch particularly will have beof many medicinemore in tools pa-the peoplefamilies.entat our way with disposalMDMA from cancer such isto or anassist drugs chronic effective us as in morphine.pain analgesiceasing syndromes this There that experience workswho are manyhave in afor taken completelyanecdotal patients MDMA reportsand differ- andtheir of byfree.forever,discovered morphine. This but is that forsometimes To atheir grantfew painhours, someonethe eases case under whenforrespite the five pain influence from or hassix pain nothours. of isbeen MDMA, a Itgift. treateddoes And theynot adequatelyto areaddress pain go away fullyforfamilies,the their explored,fears familiesalso of woulddying, appreciated, as well.likely the unfinished Theease or exploited.therapeutic the process business promiseof thatdying people ofnot MDMA only may for have has patients yet with to but theirbe

PDF compression, OCR, web-optimization with CVISION's PdfCompressor USING MDMA IN THE TREATMENTPOST-TRAUMATICSTRESS DISORDER OF JoséTranslatedIntroduction Carlos Bouso by Christopher Ryan Thestudythestudies first will and psychotherapeutic examine medications the possible(Agencia study benefits utilizingEspañola of MDMA del MDMA-assistedSpanish Medicamento) since government its prohibition. psychotherapyhas agency authorized inThis charge of the approval and control of clinical dosesregimen.sequenceamong will women Theof be sexual administered,study suffering assault, consists from all fromof of post-traumatic two whom 50 phases. mg have to In150failed stress the mg. firstat Eachleast phase, onesubject several will disorder (PTSD) as a con- other treatment different receive infindingeachonly the onegroup. subsequent study. dose This ofThe MDMA, istherapeutic dosage a double-blind, andlevel study, the that doses randomized, emergeswhere given it aswill will the and be bemost comparedplacebo-controlled increased effective with by will 25 be placebo. A mgwith dose- used candetailed be found description at the MAPSof the development, Web site (www.maps.org). design, and current status of this 248 study PDF compression, OCR, web-optimization with CVISION's PdfCompressor Post-Traumatic Stress Disorder Using MDMA in the Treatment of Post-Traumatic Stress Disorder 249 volvesatedPsychiatricThe whendeath, a Association theperson threat has of 1994),experienced death, defines or serious or PTSD witnessed bodily as Diagnostican ainjury anxiety stressful to disorderandthe event self Statistical that gener-or to in- Manual of Mental Disorders, 4th ed. (American referredPTSDfeelingsanother is of toa person disorderhelplessnessvariously and classically aswhich ortraumatic of causes terror associated neurosis, (Americanreactions with war characterized Psychiatricwar. neurosis, The syndrome Associationor by stress intense hadresponse fear1994). been and rangecansyndrome Psychiatric of groups, (de Paul Associationsuch 1995) as casualties before and thePTSD theof current traffic World no longer nameaccidents; Health wasis diagnosedOrganization. adoptedpatients sufferingby only the inAmeri- ex-combatants.from It is seen in a wide population.thetimsterminal incidence of sexual illness, Approximately ofassault PTSD physical (EchebunIa range abuse,13 percentfrom Or and 1.3any ofde percent type psychiatricCorral of violence;to1997). 9 patientspercent In and, fact, sufferof especially, estimatesthe from overall the vic-of Thedisorder ClinicalDSM-IV (van Characteristics sets der forth Kolk the et al.following 1995). diagnostic criteria for PTSD, charac- terized1. Persistent by the presence reexperiencing of three physicalrecurrentof types the traumaof distress nightmares,principal through when symptoms: flashbacks, intrusiveinternal or memories, andexternal intense stimuli psychological symbolize andor in 2. Persistent avoidance of stimulitrauma).numbingsome associated way Thisof remind general with can thebethe responsiveness seen traumapatient in attemptsandof the a (whichtrauma. to avoid did thoughts,not exist beforeactivities, the emotion,thereflectedand trauma,places andin that aan sensefeelings incapacityremind of ofdistance the a to foreshortenedpatient recall from ofsome others, the oftrauma.future. thelimited important It alsoexpression might details beof of

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 2503. Persistentpresent beforesymptoms the trauma.of anxiety These or increased symptoms arousal mayPotential that Clinical were Usesnot for MDMA include difficulty Thesede Rivera symptoms 1990) are with accompanied associated startleinemotionalby falling a kind response. or ofand staying cognitive affective asleep, dulling numbing, hypervigilance, (Gonzalez and an exaggerated which is fromseentrauma,of intimacyinPTSD the thus patient's to and loseleaving tendernessinterest inability them in socially toactivities (Corral express et in al. which 1992). they This participated leads those before suffering the isolated. For this reason, the social sup- and experience affection or feelings (thesubsequentport wayreceived the recovery. subject by the interpretsvictim after theIn the determiningtraumatic aggression experience) the cause andof the the syndrome, external both the internal variables plays an essential role in variablesof erallyotherexposure) (particularlypsychologicalstressful are considered. surroundings, the problems, intensity Vulnerability mayhistory and predispose severity of physicalfactors, of one the suchor to traumasexual the as drugappearance abuse,and use, the and historylevel gen-of the disorderPost-traumaticApproximately (Gonzalez Stress 25 percentdeDisorder Rivera of in 1990). theVictims victims of Sexual of any Assault crime show symptoms of victimsPTSDmon (Corralcrime ofof sexual domestic against et al.assault 1992). women;abuse (Corral Thisand it is etcanpercentage estimated al. go 1992). as high thatrisesSexual as15 to 50 toassault45 25to to 60 percent50 is percent percentthe most among com- of all women negativevictimhaveconfusion—which suffered of emotions,sexual some assault typecharacterized tends typically of sexualto end passes byassault after anxiety, firstabout during through fear, three their months. alives period (Koss Thereafter,of generalized 1983). The pho- stress, and mentbic(Kilpatrick behavior,l992a). after 3 to anxiety,1 6 992b), months andwith of other chronic no notable behavior symptoms differences alterations and after between tend four to years becomerates of improve-chronic (Kilpa trick

PDF compression, OCR, web-optimization with CVISION's PdfCompressor The probability that PTSD will develop in victims of sexual assault is Using MDMA in the Treatment of Post-Traumatic Stress Disorder 251 untiltheattackparticularly themost occursattack common high, hadin a been placeowingsymptoms considered that to thethe of fact victimPTSD safe that ishadby in anxiety the theconsidered victim. majority generalized Usually, safe. of these Indeed, to the places cases, symp- one thatthe of timssexualtomsguilt, continueof problems avoidance PTSD totend (Echebuniaexperience behavior to include in and someinterpersonal depression, de of Corral these loss1995).relations, symptoms of Fullyself-esteem, expression one80 percent year deficits, after of vic-the and feelings of feelingtimeevent—in (Corral is fear—fear fact, Ct al.these 1992). that symptoms her physicalWhen do not self a decline woman is in danger with suffers the and a simple sexualthat there passage attack, is little theof most immediate and lasting herHavinggethershe dignitycan with beendo suffers. tofeelings treated change Shame likeof the panic an situation.gives object and rise weakness,by Outto the hate. ofattacker this Thus,come sense who thehumiliation attackofignores vulnerability; creates her and feelings, shame.a storm to- theirsubsequentof destructive own lives. damage emotions Depressive to self-esteem that symptoms, did notThe erodes previously way of their course,a woman ability exist. are attempts tocommonFor exercise many to as patients,defendcontrol well. herselfover the from these emotions is by thatfollow.repressingseparating—dissociating—from are Aassociated whole the associated cascade with the of memories. traumatic avoidance them episodeBut can or wherever bybegin—from to limiting refusing she their tonms,avoiding discuss effects the memories situationsthe through event (increasedincreasedepisodeto numbing at anxiety arm'sarousal, its effects lengthand anxiety, other with requires psychological drugpacing, expending and and alcohol insomnia),symptoms: energy; abuse. whichphobias, depression,Keeping in hyperactivationturn the irritability, traumaticproduces fyingintegrationnervousness,experience this level of itself theand of experienceintegration, sowill on. have The direct throughwe symptoms can effects modifydissociation onare the the symptoms.symptoms. resultand repression. of theFocusing low By level onmodi- the of

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 252Treatment Potential Clinical Uses for MDMAof Post-traumatic Stress Disorder in Victims of SexualAssault posedCorraltheThe victim main of and exposure objectivesregain co-workers self-esteem and in cognitive (1995b)treating and foundPTSDareevaluation sense betterare of tosecurity results confrontwhen (Echeburtia comparedwith the a trauma treatment withet al. and a 1990). treat-com- help (Foapart,sexualment ettoof assaultal.the placebo 1991). fact rarely that and The theseseekrelaxation avoidance psychologicalvictims therapy. symptoms tend not assistance.It to hasalso see been interfere themselves This stated iswith due,that as the victimsat"patients" victim'sleast inof thisthematicability event time event. to inwithseek a One safe helpa higher ofcontext, becausethe levelmost where of commonof her control.the fear patient treatmentsof In recalling canthis experienceway is andto she provoke discussing also the cantrauma a reliving acquire the again, trau- of a livingachievingwhogreater are it amountincapable aan positive emotionally of relivingcontrol long-term safe overthe andtrauma outcome her supportive memory in such(Meichenbaum ofaenvironment context the trauma. have 1994), can moreThose alleviate because chance victims fear re- of Riverahypnosisin canthe bevictims 1994). facilitated or the (Echebunia administration more easily and dein ofCorralaltered some 1995).states psychoactive of This consciousness, reexperiencing drugs (Gonzalezsuch of as trauma de through concerningMuchexperience.MDMA its Greerpotential and for Tolbert, people pioneerswho have in suffered therapeutic some work type withof traumatichas MDMA, been written about theand therapeutic Post-traumatic uses of MDMA, Stress Disorder specifically tegrity,decreaseTheypublished write, leading the reports "Resultsfear to responseof a correctivetheir from patients' to eighty a perceivedemotional positivepatients threatexperience experiencesindicate to a that that with MDMA probably the substance. seems dimin- to emotional in- companiedcommunicate,Tolbertishes the 1990). pathological by fear andMoreover, andto remembereffects anxiety" "clients of previous (Greerthoughts found and traumaticit and comfortableTolbert feelings experiences" 1998). that to In beare a aware symposiumusually (Greer of, andac- to PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMAandheld sexual was reviewed, attack experienced one of the conclusions the most dramatic was that benefits""victimsat Esalen of (Greer childInstitute abuse1985). in 1985, where the state of knowledge concerning Using MDMA in the Treatment of Post-Traumatic Stress Disorder 253 andspeaksthroughGrinspoon post-war ofloss the and stressand effectiveness trauma." Bakalar syndromes" Peter (1986) of Stafford, MDMAand stated, discusses in in "MDMA his treating, P3ychedelicsspecific might "rape, cases also Encyclopedia, childhoodof peoplehelp in findingabuse,working also whostanding(1989)beneficial undergo discusses of results howMDMA-assisted these fromthe potential benefitsMDMA-assisted psychotherapy accrue.benefits In psychotherapy for addition, female as well some victims as (Stafford his first-person personalof sexual 1992). under-accounts assault Eisner processincludedof PTSD (Grinspoon MDMA sufferers (Adamson and have Bakalar described 1985). MDMA1990). how MDMA has they a uniquebenefited is both ability a fromfacilitator to treatment facilitate of psy- thatand accelerate the therapeutic tenttakeneffectschotherapy therapists, within that makeand a MDMApsychotherapeutic a thetype other ofbrings therapy aspects about in context,of aand the subjective oftherapy accompanied itself. stateeven That of more is, well-beingby it effective.trained,has therapeutic in compe- Whenwhich becomingdeeplyencespsychological of held openness. consciously feelings. defenses This The awareeasemakes introspective or of itdisappear muchthese easierdeep capacity entirely, feelingsfor the neededprovoking patient also foris to enhanced. intenseanalyzing cormnunicate experi- Theand maytheabsence breakevent.anxiety of throughThis fearand increased allowsnegative the emotional for capacityfeelings the reexperiencing numbing forthat accessing normally that of and is accompanythe characteristic expressing traumatic any eventdeep memoryof PTSDfeelings without of therapeuticPochmostpatients. predictiveand The Avila alliance development of 1998). clinical as wellBecause change, ofas inthe MDMA the thustherapeutic controlled is acceleratedassists alliance, reexperiencing in the (Feixas consolidation the variableand of Miró the thatof 1993;trau- the is activationavoidancemostmatic incapacitating episode, (with(with it the thewill symptomssubsequent subsequent probably of reductionhave reductionvictims positive ofin in sexualanxiety). phobiclong-term assault behavior) influence who have and over PTSD:hyper- the PDF compression, OCR, web-optimization with CVISION's PdfCompressor heldcapacity254 feelings, for gaining sometimes access feelings to, understanding,MDMA that were never and before communicating experienced. deeply These Potential Clinical Uses for MDMA has two main effects in humans. First, it creates an enhanced ofandeffects therapeutic communicate have been success called insight (Kernberg "entactogenic" likewiseMDMA et isa!. heightened, 1972).(Nichols also generates 1986). which The isfeelings a capacity good of predictor well-beingto gain and trust, which lead to effectcomfortableformerlyempathy. is described Itlost is with thisin fear, one'ssense as "empathogenic"to self,of communicate. being the moreat peace one (Adamson Thewith will moreone's accept and selfthat and Metznerthat one trust enables accepts others. 1988). a client,and ThisIt isis within(Alexanderportedcommonly aby mildly a understoodandtherapist altered Luborsky is state fundamentalthat 1986). of the consciousness ability These in ofestablishing two the unlike types client thoseof ato effectstherapeutic trust states andare produced producedfeel alliance sup- by enormouslyofthe self-control. classic psychedelics. helpful From in the bringing descriptionsIn this aboutstateOne thegiven psychological way patient here,of conducting experienceswe seehealing. that MDMA-assisted MDMAa greater can sense be psychotherapy is to center the provokingaexperiencetreatment more or exclusively lessa itself. "peak standard In experience" this on psychotherapeutic approach,the trauma. that themay Another substance be beneficialtechnique way is is not to inbut usedfocus and rather asof on anitself. asthe adjunct a MDMA wayIt con- toof substancethoughts,psychologicallysists of three emotions,and phases. the preparing types First,expectations, of thepatientseffects preparation that forand theythe fears phaseeffects expect they of of maytherapythe MDMA, substance have is orientedconcerning addressing to produce. toward the WebeinThis thatreflections can work the say, fearsis verythen, of thattheir important that the anxieties the women preparation and and have may symptoms aboutdetermine phase the relatedis MDMA thea way success to ofthe experience working traumatic of the treatment, indirecdymay episode. well thepurposewith resulting the ofpain facilitating experiences.associated the with reliving the Thetrauma. of thesecond traumatic phase episode corresponds and working to the administration with of MDMA with the PDF compression, OCR, web-optimization with CVISION's PdfCompressor intoand clientsthe daily focus life onof integratingthe patient. theIt is MDMADuring crucial experienceto keep in mind and the that insights these women gained the third phase, after administration of the substance,Using MDMAtherapists in the Treatment of Post-Traumatic Stress Disorder 255 phenomenonlowdohave victims self-esteem, greater of difficulties thatother and has types theynot in ofbeen also speaking trauma. wellexperience studied Theyabout have a theirbut feeling isdeep traumatic well of feelings knownbeing experiences stigmatized ofin shamethe clinic). thanand (a A theandbeingbrief traumatherapist treatmentrejected itself, during by that sothe tries that theclient. topreparationwhen confront It isMD1VIA very the phase, important traumatic is administered,without to experience build necessarily trust patients quicklybetween mentioning feel risks clientsuffi- typesfactorciently ofin comfortable PTSDtreating or victims patients to face of with sexualtheIt otherisepisode. crucialassault, disorders. Thisthat as opposed theis perhaps therapist's to peoplethe orientation most with distinct other is person-centered, rather than taininggruentexperiencesdirective, to with the so internalthisgenerated that sort the worldof byMDMA.work experience of of the the patient,If wouldtherapist MDMA thebe thetendsistherapeutic congruentfacilitation to cause focus experiences withof verbalization most the typecon- per- of pableworld;theof this interpersonal of internalwhen expressing the world. subject's(objective) this After experience experience all,world verbalization into in isthe contact clearer interpersonal is with tonothing her, the she world.internal other will thanAdditionally, be(subjective) more bringing ca- formtailedself-understanding,as this of descriptionexperience MDMA-assisted isof grows expressed each psychotherapy. asof well.the more three The clearly, phasesfollowing This the description that opportunity section make is givesup based forthe a insight, proposedmoresolely de- onor jectivethe author's experiences sense of that what patients may occur may have.during treatment and theOne possible sub- siveapproachpreparingThe firstfor many phase thepatients traumatic patients, of this to facetype episodeespecially theof MDMA-assistedexperience directly when inthere they brief hastreatmentwill treatment not have been iswith can orientedenough MDMA.be too timetoward inva- To to PDF compression, OCR, web-optimization with CVISION's PdfCompressor intofearsestablish256 their concerning internal the world, upcoming which experiencewill give important with MDMA clues helpsas to thethem ways enter in Potential Clinical Usesa forsolid MDMA therapeutic alliance. Exploring patients' expectations and aretheypatientswhich under will the to bethe traumagain more influence access ataffected ease to of andin MDMA. them.this communicate potentially This Moreover, phase thepainful serves thetraumatic therapist internal as a experiencessort isrealm of training when so theythat for deepening the willpatienttherelationship traumatic result might in with a experiencerespond more the effectivepatient, when has learning underaffectedtherapeutic the to effectsbetter intervention. understand of the substance. the ways All in ofwhich this and gaining an idea of how the underandprehensible, gain controlled greater the patientconditions,insight. will When theybe thesemore'When usually unknownmotivated she become sees negative that toless deepen her powerful, internalelements her participation and experiences are the faced per- are communicable and com- riormorepositiveson hasworld. authentic lessparts The difficulty and andmore integrates richer, thein accepting patients allowing the negative understands them. her aspects, moreAs the easeher patientthe process in interior negotiating actualizes of world self-knowing thebecomes exte- the more theacceptancesheand effects willthe greaterfeel ofand accepted the self-knowledge. her MDMA capacity and precisely understood to Shecommunicate becausewill and obtain the MDMA thismore knowledge, positivesheis a willcatalyst results gain the for in undermore self- acceptancePhaseDuring Two the andreliving self-understanding. of the traumatic episode under the effects of MDMA, negativeManystatepatients in intense which firstassociated will catharticit is note likely feelings. that experiences that they But none feel the of willthemselvesfreedom their take anxious fromplace, to fearbesymptoms with calm will both andhelp willpositive peaceful, the appear. patient and a beenchangesface,absence deniedaccept, in of feelings canfear and now is better toof be change guilt, owned: experience humiliation, completely to reexperience these the hate, emotions. frame andthe of traumaticshame. reference The patientThat episode of which the will episode.in hasseethe PDF compression, OCR, web-optimization with CVISION's PdfCompressor the resultant feelings can be better internalized, healing is well under way. Using MDMA in the Treatment of Post-Traumatic Stress Disorder 251 Ifvulnerability,again.We patients can This say can thattime, she gain in israthersome accompaniedcontrol way, than over the being patientbytheir feelingsin feelings,the has company walked of peace, it is the possible of control, same emotional that and theystrength. pathcan weakness, and willriencinggeneralize have better traumatic this long-termcontrol episodes to theirtherapeutic during dailyResearch lives. theresults. course into The PTSD of hypothesis psychological has shown is that that treatment reex- persons who are capable of reexpe- withthetientperiencing thereliving is trauma,in a the relaxedof traumaallowingevent and within in trusting forthree acceptancethe ways: atmosphere—deactivatespsychotherapeutic of the trauma. context—where MDMA the fear facilitates associated the pa- 2. 1.MDMA MDMA facilitates creates a introspection state of relaxationpeacetoms and accessof within anxiety a person,oneself. to traumatic and eliminating producing memories asymp- sense of well-being and of being at willmore,commonand be painfulas more the communication patient comfortablefeelings, becomes making with barriers more theirothers, comfortable andcommunication eliminating permitting with a clearer largeeasier. herself, part andFurther- she of easier the patientthesenseexpression therapeutic feelsof well-being safeof her withalliance feelings. in her which byemotions, Psychologicaldeepening she finds with theherself. the defensessense therapist, This of evaporate,trust process and between with solidifies and the the Luborskyispatient the one and 1986).that therapist.therapist, best predicts Amongthe therapeutic therapeutic all the processes alliance, change or taking(Alexander empathic place rapport,andbetween 3. During• the preparatory sessions patients have a chance to enter their ishappyinternal toprepared these ones, worlds, intense to and take toto emotions advantageget train in themselvestouch more of with MDMA comfortable, painfulin communicating. and emotions to more make effective, gainingas Thewell patient asaccess and

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 258 easier.and intense, thus eliminating the Potential Clinical Uses for MDMAThis helps make the reliving of the trauma safe, profound, fear and allowing better becomepearance aware of these of the effects physical often sensations. producesintegrationIt takes thirty Itsome ofis atheto goodanxiety forty-five trauma idea in as topatients minutes wellspeak as casuallyas betterfor MDMA long-term to take adaptation. effect. The ap- they pistbodilywith can the sensations. guide patient, her with inIf thea relaxationthe patient intention isThe exercise. especially ofeffects distracting of anxious MDMA the at attentionoftenthis point, appear from the quite thera- these rapidly. Suddenly, one notices a canfeelingmildslight get sense shift ofup euphoria. ofand consciousness—normallydrunkenness. walk Thearound person Thisthe thenroom, effect becomes interpretedsoon is quite accompanied as alert dizziness, and byfocused. similar an intense Sheto a exploring people or objects and be- peopleemotionaleverythingcoming around at intimacyeaseshe her sees with tends makeswith the to space.them.be her one feel SheHer of content. immediate feelssense comfortable of The well-being acceptance reaction and ofis inand sothe the profound apatient companyfeeling to ofthat the of herself)offriends. the experience.during The morethis phase, the therapist the more Aftercan comfortable help a few her minutes accept she will everythingof beintense during euphoria, (including the rest the effects decline slightly and feelstheNowstabilize. beginning, soshe good. Theis prepared personShe the probablypatient thento relive feelswill has the not calmnot trauma want felt and such to accepting—freeat talk herpositive about own speed.feelingsher suffering,of Itfear for is likelyanda long since at that ease.time, she at ofwhichceedand reexperiencing so bit she the by will therapistbit, beginalways begins. shouldto talkingtouch The not on aboutpatient forcea painful her themust emotions, conversation.subject. always From andcontrol will thisThe the arrivepoint, patient speed atthe awillat processpoint which pro- at traumaticthetionseasily. experience not Since events, only proceeds.she with but is inintensitythese a She relaxed emotions will but state,feel with willintense theobjectivity be patient discoveredinternal can as emotions well,live and through knowing communicated related these that to emo- thethey

PDF compression, OCR, web-optimization with CVISION's PdfCompressor psyche.patientform isThe able acceptance to relive theof the trauma, trauma communicate presages positive it, and therapeutic integratea part of itherresults. into life her and must be accepted. Using MDMA in the Treatment of Post-Traumatic Stress Disorder During the plateau phase, the 259 decideWeened suffer tous facewasfrom thethese the thought effort fears, of ofthey avoiding facing noThis longer the memories.process fears, exist. ismore aboutItAt is thethan as confronting momentif the that fears which in themselves.emotionswhich fright- we rather than fleeing from them. ingdiscusseddoPatients or not striking damage also with out.may otherthe We experience patient peoplemust allowbefore or negative property. all beginning these emotions. This types the is of something Theysession. actions, may It as feel thatis long possible likeneeds as scream- they to that be chomotorsuchofthese stimulant assensations palpitations, symptoms effect. are During more jaw(a desire clenching, likely the toplateau to move appear uncontrolled stage,around, in womencollateral for eye example). whomovements, effects experience Themay andtherapist appear, a psy-type atedcompleted,siblemust andgivefreedom returns clear the to signstherapist tothe the patientof stateacceptance should toof actualizecalm support and and permission—giving herpeacethe emotions.patient offered so Oncebythat the she this MDMA. feels process liber- The is the greatest pos- returnofplateau MDMA to phase baseline. begin of MDMAto The wane. therapist's normally Over approximatelyFinally, role lasts during betweenduring this half the two descent,an and hour, three aboutthe hours.patient three will hours after ingestion, the effects period is also very impor- life.totant. betterreassure Finally,The acceptance therapist her the that patient needs herof her experiencesreturns to painfulhelp with the memories, patient duringnewly integratethewon of session knowledge herself, and that of willthose lead around to everything she's gained,have relevance to her effectstientbeher. able Knowingmust of to thenothelp MDMA leavesomething integrate the have office theof disappeared. theinsights until inner all gainedofworld the psychological ofduring the patient, the experience. and the physiologicaltherapist The will pa- waned,AtPhase six Three hours but the after integration ingestion, and the "digestion" effects produced of these by experiences MDMA have continue probably at a PDF compression, OCR, web-optimization with CVISION's PdfCompressor substance260distinct itself. The incorporation of the experience and its complete and rhythm,Potential Clinical generally Uses forquite MDMA a bit more slowly than the metabolism of the short-termlastingcausequality assimilation the of integration returnthe experience. to require reality of the anywhere Somewas experience somewhat women from may maya abrupt.few depend feel days emptyOthers to severalsome or sad, extent weeks. perhaps on The the be- feel energized and hopefultotheythe sleep. end return about of the home, potential session they include change.should headache, relax, The secondarynot exhaustion, worry abouteffects and daily thatmild problems, may insomnia. appear and When at try cussedthehelp outer the openly. patient world It seeless is importanthow threatening. her insightsThe to explore Thestrategy indicate traumatic how for internalthesessions episode patient changes devoted isnow modifying canthat to integratingbe render dis- her the experience should onlyety;restfeelings ofsuch minor her related that life.Optimally, discomfort. situations to the event Thisthey the and willwomenhave howallow previously willthis patients experienceprocess avoided to canfeel progressively becanthat generalized bethe tolerated world isto lessthe less anxi- with fromconsciousenjoyablefrightening actual ofbefore and dangers.her willunconscious the leadtrauma.The themtraumatic fearsWe to can rediscoverand event say is thus that will morepleasantthe never patient able be situations to forgotten,has distinguish become that but morethemwere the self-control,associatedwhenpresent the experience event more generated was and of sufferedmore the by traumawith a inreduction athe contextwill current be in ofless anxietyfeelings helplessness tied to and of the well-being improved originaland terror. andemotional It greaterwill be experience, therapistwhenpsychotherapycompetency. treatment at any If has timethiswill been inisend, realized,later effective. so life that towe patients shareFinally, can whatbe have itcertain ishas thevery come opportunitythat important outthe of the toto experience.leavecontact open the MDMA-assisted

PDF compression, OCR, web-optimization with CVISION's PdfCompressor USING MDMA IN THE TREATMENT JuneandOF Riedlinger, R.Ph., Pharm.D. DEPRESSION*Michael Montagne, Ph.D. pharmacistofInIntroduction depression. in psychiatry The first author's wasthis the chapter personalfoundation we experiencediscuss for the the hypothesis anduse ofwork the that assubstance a MDMAclinical MDMA for the treatment viewdiscussingcouldExtent ofbe the a healinghow medical MDMA agent criteria formay thefor be life-threateningthe beneficial condition in treatingis illness warranted. depression,of depression. a brief Before re- and Nature of Depression AssociationformajorEpidemiological women depression and 1994). from in Thethe 5 percentadult occurrence population to 12 of percent depression ranges for from men appears 10 (American percent to be to unrelatedPsychiatric 25 percent to studies of depression have shown that the lifetime risk for *Thisethnicity, chapter education, is based in income, part on a orprevious Majormarital publication, depression status. "Psychedelic is twice asand common Entactogenic in women as in men (American theDrugs Journal in the of TreatmentPsychoactive of Drugs Depression," [1994; 26:41—55]. by Thomas and June Riedlinger, published in 261 PDF compression, OCR, web-optimization with CVISION's PdfCompressor inPsychiatricamong262 the 25- people to 44-year-old older age group, Potential Clinical Uses for MDMA Association 1994). Major depression tends to occur most than 65. This disorder is one and a half to three times while its rate of occurrence is lower often moremajorillness.in the common generaldepression A significant among population, several number daysindicating of beforewomen report first-degree relatives of persons with the disorder than that there is a genetic componentthe onset to of the menses. A higher inci- worsening of the symptoms of tumdencesion periods, ofcan depression be suggesting influenced also isby seen cultural duringThe backgroundexperience, the perception, and description of the symptoms that there is a hormonal component as well. perimenopausal and the postpar- (American Psychiatric Asso- of depres- andphysicalciation headaches.Mediterranean 1994). terms ratherIn In some Chinese cultures than cultures, emotional and people Asian depression states,may cultures complain such may as sadness or they may complain of weak-be experienced largelyof "an attackin of nerves" guilt. In Latino pressedness,ofas thea fatigue, problem asseriousness being or ofimbalance. "heartbroken." the of the condition. Cultures also may heart, and in some Native American cultures it is ex- In Middle Eastern cultures depression is viewed differ in their perception SymptomsClinical Features of a major depressive episode usually develop over of Depression days or weeks. Themoresymptomsloss primary of of interest the must diagnosticfollowing or exist pleasure forsymptoms requirements mostin nearly of all are activities either fora at also mustthe daybe present and for during nearly that every same day. two- Five or depressed moodleast twoor the weeks. These functioning:week• period of time, and theysignificant must represent weight gain a or weight loss (when not dieting) or a appetite nearly every day change from previous de- • psychomotorinsomnianesscrease that or or isincrease excessive noticeableretardation in sleeping by or others) agitation nearly (aevery bodily day slowing or restless- PDF compression, OCR, web-optimization with CVISION's PdfCompressor Using MDMA in the Treatment of Depression 263 • diminishedfeelingsfatigue or of loss worthlessnessability of energy to think or or excessive concentrate or inappropriate or indecisiveness guilt shouldPeriods• not of sadnessbe diagnosed are inherent as a majorrecurrent aspects depressive ofthoughts the humanepisode. of death, experience, The suicidal symptoms and ideas, theythat or a suicide attempt medicine,beoccupational,are duepresent to theor must to director a causeothermedical physiological importantclinically condition. significantareas effects The of symptoms functioning.of distress a substance, areor impairmentSymptomsnot such better as accounted a mustin drug social, not or less,ciationfor discouraged,by bereavement 1994). or "down after the in losstheThe dumps."of mooda loved Thein one a mostmajor (American serious depressive Psychiatricconsequence episode Asso- oftenof is described as sad, hope- logicalconsiderpeoplemajor depressionwithevidence major severe depression also ismajor attemptedindicates depression a potentially that or completedthere die bylife-threateningis asuicide. fourfold suicide. Thus, increase Up illness. it tois 15inreasonable Epidemio-death percent rates toof missionlastin persons for of six symptoms, withmonths major or and longer.depression normal InA thefunctioningmajor over majority the depressive age returns. of of cases, fifty-five. episode there varies is complete in duration; re- an untreated episode may in a signifi- maypersistdisabilitycant last proportionfor for months ortwo distress. years of to cases years or In more. (perhaps aand small may group 20 be percent), associated of cases, some withthe depressive major a substantial depressive symptoms degree episode mayof TheBiochemical possibility that Basis some formsof Depression of human depression are based on central Oxenburginforcedtryptamine,nervous system by 1969). or the 5-HT), deficienciesfindings Based was on of first his ofother suggestedlaterthe researchersneurotransmitter research, by van van (Coppen Praag Praag serotonin (1962) (1982)1967; (5-hydroxy-and Lapinconcluded then and re- PDF compression, OCR, web-optimization with CVISION's PdfCompressor 264that serotonin disordersPotential are implicated Clinical Uses formost MOMA clearly in a subgroup of phasizedapproximatelypotentiatingsecondary; that rolecompounds,serotonin 40 inpercent depression. disorders such of patients as Thisthe probably precursors afflictedis suggested play with5—hydroxytryptophan a causative, bydepression. the fact that He rather than a serotonin- (5-HTP)also em- pressiondepressionand L-tryptophafl, have (van serotonergic Praag an essential1981). activity. aminoIt is The significant acid, newest can class havethat manyofa of the drugs prescribed for treatment therapeuticantidepressants, effect in the of de- inhibitorsserotoninrotoninto varying reuptakebackprevent degrees, into theinhibitors presynaptic thebreakdown tricyclic (Prozac, nerve of serotonin Zoloft, endings. Paxil, by Monoamine the Celexa, enzyme MAO. antidepressants prevent the recycling of se- and oxidaseothers) and, (MAO) In ei- notAebither clear. case, 1983) more The specificserotonin mechamsm is availableThere of foractionis an binding entire of these toclass receptorsdrugs, of psychoactive however, is drugs that almost certainly de- (Spiegel and still Theserivestreatmentand its Aghajaniandrugs, main of effectthevarious psychedelics, 1973; from psychological Andenserotonin etare al.mediation disorders,reported 1974; Winter to(Freedman have 1975; positive et Meltzer al. 1970;effects et in including depression. We present al. 1978). Haigler the comeandPsychedelic discusstheoretical an efficacious the valueexplanations treatment of psychedelic for for one agents, specific with drug, a focus MDMA, on clinical that may reports Psychotherapy depression in the future. be- ropeThethousandchotherapeutic until about clinical 1950.process papers Between was describing virtually forty ignored thousand possibilityin the patients United that whoStates psychedelic had and drugs could help facilitate the modern psy- then and the mid-1960s, more than one taken Eu- chedelictherapyseveralpart in psychedelic dozenwere psychotherapy heldrelated (Grinspoon therapy books; were orsix described andother international Bakalar (Grinspoon 1983). conferences Two and different Bakalaron types 1979). research trials were published, as well as psychedelic drug of psy- One PDF compression, OCR, web-optimization with CVISION's PdfCompressor delicemphasized therapy); using high doses of LSD (more than 200 mcg) was thought to a mystical or conversion experience and its after-effects (psyche- Using MDMA in the Treatment of Depression 265 derstherapy);exploredbe especially using itthe low focused effectiveunconscious doses on of inthe LSD reforming treatmentin (100—150the manner alcoholics of neuroses mcg) of psychoanalysis and as and wellcriminals. psychosomatic as other The (psycholytic psychedelic other disor- type fears,specificdrugs. and amplifiers, other subjectivelyvarying drugs that projectBy (nonspecific)the into mid-1950s, consciousness psychological it was (amplify) recognized material memories, that that psychedelics function as non- venednogenicthishad beenhighlyby Drugs the repressed, significantWorld in Psychiatry," Health or findingwas Organization. unconscious. written was aby report a team AmongThis entitled of report international the "Ataractic first challenged announcements experts and the Halluci- con-pre- of terns.mayinducingvailing be On ideaa agrossthe model that contrary, over-simplification psychedelic of temporary experience drugs psychosis. suggests toare speak psychotomimetic, Instead, that of drug-specific the thesame team drug,that concluded,reactivity is, in capable the same pat- "It of (theHealthprecisedose, users' in interpersonalOrganization the expectations) same subject and 1958). motivational mayand Thus,settingproduce it (the situation wasvery environment made different in whichclear effects that itfor was theaccording given" drugissues experi-(World toof theset whenchotherapyence), using which psychedelics. is isthis: described at present, elsewhere psychiatristsAnother in thisimportant prescribe book, mustissue doses be to takenconsiderof mood into elevatorsin account a discussion of drug-assisted psy- phasized:tocurrentlyor alleviatestabilizers accepted"It psychic iswith a misunderstanding which modelsuffering. patients of one-timeThus, must to Grinspoon consider orcomply infrequent psychedelicand on aBakalar dailydosing basis. drug(1986) of medications therapy There have is em-as no a incorporatespharmacotherapyingform lithium of chemotherapy, or features phenothiazines." and of psychotherapy"which both. must Instead, be regarded (Grinspoon it is more in the andlike same Bakalar"a hybridway as 1990) betweenprescrib- that

PDF compression, OCR, web-optimization with CVISION's PdfCompressor DespiteLimitationschedelic266 early and reports psycholytic of success therapy in some have areas certain of limitations. Potential Clinical Uses for MDMA of Psychedelic Psychotherapy psychotherapy, both psy- These reports, thereportsarethough anecdotalpatient compelling,can and be or questioned therapist'slack area open biasesfor to question. in judging In improvement. most cases control group in their experimental design. Anecdotal several reasons, including placebo effects and these studies either The lack of con- proceduremusttrolof groups psychedelics include (psychotherapy) is alsothe presencearea problem; so unmistakable withoutof it a is group generally taking that the mostagreed drug in question. of subjects who undergo the entire researchers argue that using that a good study design The effects ofdelictationsthem depression drugseffectively acknowledged, turned as wellwould up aspromising however, ruleother out psychiatric a itresults, blindedis clear with disorders.thatstudy implicationshuman design. With research using psyche- for the treatment these few limi- lowconsumingor dosesmore havehours. to use, pronounced Clients despite claims psychoactiveAnother that they problemand accelerate behavioral is that almost all the classic psychedelics are therefore should be supervised throughout this pe- psychotherapy. Even effects lasting five time- tioddrugseffects,to andStrassman's is for low,"It several appears when (1984) hours individuals that review afterwardthe incidence of(both to normal minimize of adverse volunteers adverse reactions and patients) to are care- the literature on adverse psychedelic drug effects. According psychedelic whomaceuticalfully screened,use the quality drugs supervised, drug."with patients and followed mustIn addition themselvesup, and togiven the be judicioustime well constraints, doses another limitation is trained to effec- that therapists of phar- areclinically,bookstively available helppublished orguide to is allowbased between the session.therapists on original1950 Yet toand trainingresearch the mid-1960s, currently from that when is period. limited the No to train experientially. That psychedelics drugs were used articlesinternships and have thatuniquegreatto mainstreamincorporate anda degree dramatic ofthesepsychotherapists adjustment effects drugs in into psychotherapy and their ignore or reject is them. They accommodation. This is more or less truetherapy techniques would require too probably one of the reasonS believe that PDF compression, OCR, web-optimization with CVISION's PdfCompressor afor chemical subgroup referred to as "entactogens."the classic psychedelics. A more viable alternative may exist, however, in Using IIDMA in the Treatment of Depression 261 thatNicholsPsychedelic MDMA and Therapy's Oberlenderis both chemically Relevance (Nichols toand MDMA1986; behaviorally Nichols Therapy aand different Oberlender type of 1990) psychoac- noted tiontherapeutictive drugwith others,that dose deserves levelsaccompanied "seems to by involve positive enhanced changes closeness in feelings and and communica- attitudes" and Oberlender 1990), Nichols proposed the term "entactogens," its primary effect at phenylisopropylamines.andderived phenylalkylamines, from Greek and the Although Latin latter roots categoryOf the theconnoting behavioral two has major aan chemical abilityeffects chemical to ofsubgroup "touch typessome ofwithin."phenyl- called psychedelic drugs, indole derivatives drugsthedelic,isopropylamines case usedthey with inreportedly psychedelicMDMA. seem have MDMAdifferent and a similarpsycholytic does from chemicalhave those therapies: something of structure LSD, the thein patient activity.common prototype must This with bepsyche- is givenother not MDMAtanttialnot asexistsfactors. intense for individualas for a classic variance, psychedelic and set drug,and setting such as continue LSD, but to thebe impor-poten- under supervision of an experienced practitioner. The effects are ThatciatesMDMA's (1982), who introduced it in vitro to homogenizedMDMA rat brains is apparently and then serotonergic was first noted by Nichols Roleand asso- in the Treatment of Depression activity.gestingsynapsesmeasured that Subsequent that the serotonin storerelease neurotransmitters). research ofrelease serotonin maydescribed playfrom aElevated in therole Peroutka synaptosomes in MDMA's levels (1990) were pharmacological (vesiclesappears detected, to in con-sug- the mechanisminhowever,firm the the Brain" drug's the of specificfor action serotogenicity. a detailed ofmode MDMA.] discussionof action As with is of uncertain. serotonergicwhat is currently [See antidepressant "How understood MDMA drugs,Works of the PDF compression, OCR, web-optimization with CVISION's PdfCompressor clinicalsuch268 as opennessrole in treating and empathy, depression. wouldIn Riedlinger seem to (1985) any case, MDMA'sPotential Clinical use Uses for MDMA in psychotherapy to stimulate positive feelings, recommend it for a possible first proposed this in a synapse,serotonindiscussioneffective and in ofand becausethe MDMNs efficient brain. of Because itspositive as a drug itisomer isfor a thepotent activity medical treatment short duration of effect, MDMA seems to be both releaser of serotonin into theand consequent release of of depression. It worksingeffectivestead intervals. to of enhance weeks when This (asadministered serotonergic iscompares the case infrequently, favorablyfor function most prescription andto perhapsthe mood in a matter multiple daily dosing required antidepressants), andweekly it is or monthly dos- of hours in- fortoreuptakedepression most produce of inhibitors).the antidepressant(such currently as tricyclicThe available othereffects antidepressants, drugs drugs often that cantake MAObe several inhibitors, and frequently cause lasting troublesome prescribed for treating days or even weeks serotonin researchthesea,side evidence andeffects headaches).to establish (appetite of MDMXs clearlyCompassion and sleepserotonin-releasing whether changes, MDMIA sexual iseffect, dysfunction,indeed should an alternative for the victims of depression, in addition to compelsweating, further nau- antide- pressant.TheTreating Suicidal Depression with MDIVIA notion that MDMA might be useful in treating suicidal depression is (Hendinvarypsychoactivebased between on 1982;a comparison effects. differentAmerican Psychological of age psychological Psychiatric groups, characteristics Association patterns in suicidal1994). of suicidal Many cases seem cultures, economic classes, and gender people and MDMA's people tend to to betosufferthat manifestations deal of hardships awith person the ofin conifictsand alienation.exile. endless He or frustrationsThe she anguish feels totally alone. of the isolated,Such people and demands of interpersonal relationships. suicidal person is frequently singled out by fate to often find it hard They possibilitycase,feelwithdraw unworthy the isolation into of ever ofa private, love establishingtypically or lonelythat starts others meaningful world. to have Their abandoned contact justification with them other human feel irreversible. There seems to be no might be that unfairly.they In either beings. PDF compression, OCR, web-optimization with CVISION's PdfCompressor Using MDMA in the Treatment of Depression 269 mostis most1986), of common.the "Among association In theone betweenimmediate long-term depression According motivesstudy, hopelessness for and suicide, suicide, not alone and surprisingly, a accounted high level despair for of to the Harvard Medical School Mental Health Letter ("Suicide," inofhopelessness cidethe depressionMentalwould trywas Health again. were the strongestLetter, muchIntense lessby guilt, signal Beck adequate psychotic thatand aindicators."colleagues person delusions, who (1985),The hadand study attemptedeven reported referred the severity sui-that to followed(peoplecenthigh ofratings eventual who for on initiallyfive thecases to Beck ten ofwent suicide yearsHopelessness to the after in doctora sample taking Scale with ofthe successfully 165thoughts test. hospitalized A subsequentof predictedsuicide) suicide whoreport 90.9 ideators were per- re- nessrapidlygarding can bythe potentially specific study affirmed therapeutic improve that the interventions."because prevention hopelessness as well as thecan predictionbe reduced of fairly sui- . . the assessment of hopeless- maybetweencide" be the(Beck dysfunctionalroot et cause al. 1989). of suicide.attitudes HopelessnessInterpersonal To and that extent,itself attitudes might suicide mediate related might thebeto depression,considered relationship not hopelessness per se, also especially depression. oftivelybreakan suicidal act andout of ofmore people,interpersonal isolation safely, however, ("Suicide," by frustrationmeans is a of problem1986). guided that This seeks forpsychotherapy. goalconventional to maycommunicate be Thereached, psychotherapy. recalcitrance misery alterna- and inside.StrupptweenFor therapy theSomeone1993). patient to The work, who andpatient is athe consumedpositive, musttherapist be dynamic bywilling (Henry strong to interaction etfeelings communicate al. 1990; of mustalienation Talley what take et is andplace a!.going 1990;hope- be- on theitlessness is therapist.start frequently isof likely psychotherapy Time true to isresist that often patientsinterpersonal anda luxury need hesitate thatseveral contact suicidal to sessionstalk and patientsabout open before discussion.personal cannot they afford, problemswarm Of course, how-up toat ontheirtherapy,ever. such ownThey patients,but lives. may first Usually betheyand treatable evenmust this actively be meansover stabilized the restraininghospitalization, long or termotherwise them with keeping if conventionalprevented necessary. a suicide from psycho- watchtaking PDF compression, OCR, web-optimization with CVISION's PdfCompressor aneffects210 issue and of theramifications Harvard for guidedHere psychotherapy Potential Clinical Uses for isMDMA where MDMA can perhaps play a viable role, Medical School Mental Health Letter (Grinspoon and succinctly described in based on certain BakalarItaschiatric hasan aid now1985): application, to been Although taken a fewin MDMA a psychiatriststherapeutic has no settingofficiallyand other by approvedtherapists psychotherapy for more than fifteen years, in the 1970s and '80s. hundreds, if not thousands, had been usingmedical it or psy- provedalsoticof peoplealliance report mood, with changesby greaterfewinviting reported that relaxation, self-disclosure last complications. several heightened days and to Itenhancing severalself-esteem,is said toweeks trust. and or fortify the therapeu- Some patientsenhancedlonger—im- re- lationspeuticticgest interviews, that with results it others.might areor as besoPsychiatrists a helpful,far catalyst unpublished for for who insight have and in anecdotalused psychotherapy. MDMA and cannot example, in marital counseling, in diagnos- with patientsReports sug- of thera- be properly psychologicaltherapeuticevaluated without settings effects more are occur notsystematic irrelevant. consistentlyAnecdotal study. Their across reports testimonies a broad by the indicatespectrum hundreds of people who have taken that MDMAcertain in of usage. Thisandincludenies. is emotional Theevident such forward, wordsin bonding" Adamson's by as Ralph"ecstasy, in reference(1985) Metzner, empathy, collection to observes MDMA's openness, of that about effects. acceptance,these fifty These are firsthand accounts such testimo- forgiveness, the op- chotherapydrawal.anguish,posite terms Eisner alienation, in often which (1989) used recalcitrance, depression alsoto describe describes is rejection, thementioned psychologicalseveral blame, specificallycases guilt, distressof and as ofone of MDMA-assisted psy- emotionalsuicidal with- people: the Symp tomstheirtransporting that lives is alleviated. have them been into burdened a naive Thestate by value negativeof bliss. of MDMA Theythinking, are isaware have that beenit does not make its users feel of the fact that betterbased by on they(Greerseveralfears are and 1985;hours able anxieties. Greertoby look minimizing and MDMA at theirTolbert problemstheirseems 1986, defensiveness to 1990). morelend them objectivelyIt stimulates and a different fear and ofa process thus emotional injuryperspective for transcend a by which PDF compression, OCR, web-optimization with CVISION's PdfCompressor withfeeling their positive emotions. This sustains them as the therapeutic processof hopeless entrapment. At the same time, they feel more in touch Using MDMA in the Treatment of Depression 211 aredesiretionaltakes described its problemsto course.communicate in Adamson's and The the drug constructively. book gives (1985). them Numerousthe courage examples to confront of this their process emo- to work them out, often by enhancing their inglyusefulfor patients dark as an emotions, withinterventional less severe MDMA medicine. forms likelyThe of By depressioncanparticular providing help forestall valueis the twofold. relief of the MDMA fromactFirst, of overwhelm- itforsuicide might suicidal beor patients and, by extension, noted,thedrug'sotherwise patient's the second result alleviate trust major is anda thefortifying effect, by patient's inviting facilitating of sense theself-analysis therapeutic of psychotherapy hopelessness. and alliance disclosure. byThis helpingbetween buys As time topreviously patient enhance for the processthatcordingand therapist.in psychic five to Metzner hours materialFurthermore, of in one Adamson's that Adam would MDMA [MDMA] book normally does (1985): session so require in "One a clientsrelatively five therapist months could short has activate of estimatedtime. weeldy andAc- sessions."difference Needless between to lifesay, and such death accelerated for people therapeutic in imminent healing danger can ofmean suicide. the Use samplesfromThereRisks MDMA has ofof been known MDMA use. concern purityMost of aboutare these administered neurotoxicity adverse reactions in theand lowest other appear possibleeffective to be avoidable, healththerapeutic risks if MDMAtrialsThisdose is rangeof neurotoxicity consistent the and drug frequency, inwith psychotherapymay the have afterview been carefullyof Grob exaggeratedshould andscreening be colleagues resumed. and patients that (1990) [Mostrigorous for riskthatarticles clinical factors.fears that of neurotoxicoralprolongedallege dosing.—Ed.] neurotoxicity use. effects No study canhave be hasrecruited minimized beenAnimal published volunteers researchby the that withconcurrent with examines histories MDMA administrationinfrequent, of seemsexcessive to single indicate and of that even its high-dose PDF compression, OCR, web-optimization with CVISION's PdfCompressor fluoxetine272 Potential Clinical Uses for MDMA (Schmidt 1987; Schmidt et al. 1987). One report by McCann and mg,Ricaurteanddecreases does colleagues (1993) not post-session suggested (1990) insomniamaintains that fluoxetine and that fatigue. it ispretreatment, premature A cautionary to at pursue compromise therapeutic effects and, furthermore, editorialdoses by of Price 20 to 40 clinical trials theofandserved MDMA stabilization perhaps by inexploring conditionssuicidal and subsequent thedepression. thatpossible are treatment not use of MDMA of patients as an life-threatening. Both sides would be interventionafflicted drug for with severe ExistingbeenConclusionsCentral implicated drug treatments as a biochemical for depression basis of include at least somesome with nervous system deficiency of 5-hydroxytryptamine (serotonin) has forms of depression. serotonergic ef- indoleaniinesion.mayfects. indicateSuch Studies treatment andthat suggest phelylalkylaminethere has that is been a psychedelic attempted categories. drugsusing arepsychedelic Encouraging also results recom- role for psychedelics in the treatment of depres- serotonergic, which drugs in both the normativemendline.entactogens further They consciousness could research, or empathogens, be assimilated with than special classic more emphasis psychedelics, easily into on drugsexisting such inas which cause substantially less distortion of psychotherapy ap-the groupLSD called or mesca- ofcation.malproaches, psychotherapy. psychotherapeutic Their where usefulness their The function processgoals in such would wouldrather an application be bethan to to reduce toaccelerate serve would the as andbea maintenancemainly medi- at theenhance start the nor- fear response, whichanceorfacilitate significant oftenbetween the inhibits client's clientothers; the interpersonaland andability therapist. to to deal communications with repressed with traumatic the accelerate the formation of a therapeutic therapist, spouse, material; to alli-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor OFUSING SCHIZOPHRENIA MDMA IN THE TREATMENT JulieTheand purpose what Holland, is of currently this chapter M.D. known is toabout familiarize its symptoms, the reader their with chemical schizophrenia basis, and phreniawithevidencetheir schizophrenia management. deal to withsupport the who I theissueshave have idea also that thatused included ariseMDMA MDMA. when several may I confronting am help personal presenting some reportspeoplethis this disease. withfromanecdotal schizo- peopleIt is researchcanpowersymptomspossible help to thata fightis majority of necessary the thistheir effects illness ofillness people to of orexplore MDMAover help with the equip schizophrenia. thecanlong effects temporarily peopleterm. Itof with is Itsingle not isreduce schizophrenia clear clear oral somethat whether dose good of MDMA- thewith MDMAclinical acute the lightposedassisted on research this disease are miraculous and its pharmacological orI have met all management. kinds of people with schizophrenia. Thispsychotherapy disease has infasci- these patients. 'Whether the results of this pro- they nevertheless will shed more usuallynatedthesereason me homelessparticular I since went myto and patients.medical college acting schoolOnedays. bizarrely, percent Iand remember becamewho of the I thought noticingaworld's psychiatrist might populationpeople be was onill. to theThehas try street, schizo- mainto help ofphrenia, psychosis. a chronic Contrary mental to illness a widespread characterized misunderstanding, by a waxing and a waning person levelwith 213 PDF compression, OCR, web-optimization with CVISION's PdfCompressor earnedtween214schizophrenia thoughts the disease its name. The Potential Clinical Uses for MOMA does not haveand multiple affect—between personalities. one's inner world hallmark features of schizophrenia are di- The schism or split be-and outer behavior— videddisorganizedthe positiveinto two symptomscategories: thoughts andare positive auditoryspeech, symptomsImagine and that you believe that you are hallucinations (such as "hearing voices"), paranoid delusions.being monitored by theand FBI, negative poi- symptoms. Among withsonedthat imposters. everythingeverythingby your family, It isthat is a commonclue isor happening perhapsfor you for to thatyou to aroundinterpret you has or something a secret code to do for with you you, to trans-people you know have been replacedhave ideas of reference—thinking people'sthelate.others radio You canminds isare specifically hearconvinced and what they youto that can send are theread youthinking purpose yours. a message. as ofThe a welltelevised voices as the newscastin belief your headthat or ayou maysong can keep on read You may foster the belief that uptorogatory a helprunning ease names, commentarythe symptoms or Over the past fifty years, antipsychotic command you to do things. of schizophrenia.of what is going Auditory on around hallucinations you, or medications have been developed call you de- usually whilefragmented,theyrespond do a person notfirst alwaysperhaps to is this trying vanish. treatment;because to speak. Speech there the isvoices no longer Paranoid delusionsthen usually becomes stick aroundmore organized a and typically become competition from the voices though less symptomstobit abandon. longer, oftenbecause Eventually remain. they are stubbornAfter the positive symptoms have been they diminishAlthough in intensity they are as well.less disruptive, they can beliefs that take some time for adequately treated, the negative be quite people speechlation,choticdebilitating medication.talkingand thought").and less, are andTheymuch Also thinking takemore common the difficult less form are to (known in psychiatry asof "poverty a lackaberrations of motivation, in attention social eradicateand con- with typical antipsy iso- of staypatientsschizophreniacentration, to themselves at times usually have resemble and morereferred may negative people make to as withsymptoms autism. rocking or other"cognitive repetitive deficits." motions, Some patients than positive symptoms.Emotionally withdrawn, Theseseem- withthey PDF compression, OCR, web-optimization with CVISION's PdfCompressor facesflatteninging or voices also isof typical—ifthese patients. emotion is tofelt be at quite all, it disconnected is not conveyed from in thethe environment. Affective blunting or Using MDMA in the Treatment of Schizophrenia 275 sireingspeech, MDMAto speak motivation, use:with enhancedand and connect emotional sociability, to others,Contrast expression enthusiasm, and thisa sense with syndrome euphoria,theof openness syndrome of increasedparanoia, and trust. de-social It withdrawal, and decreased seen dur- schizophrenia,area.useis easy and MDMA to why see whythey targets and some are it enhances theeager people very for with componentsthe scientific functionschizophrenia research ofof behaviorthe have two to movebeen brain that drawn forwardarechemicals affected to MDMA in thatthis in toms,thattheare connectionwe implicatedand may its learn treatment between in more the disease.aboutby this learning medication the These biological more are and about two basis this compelling MDMA. ofillness. schizophrenia, It reasonsis quite its topossible explore symp- InThe the early phases of schizophreniaDopamine research, theTheory dopamine of Schizophrenia theory domi- pointedofnateda dopamine state the out in scientific thethat (Meltzer brain the literature.most of andtoo effective muchStahl This dopamine1976).antipsychotics hypothesis To or support statedoveractivity are those thatthis the hypothesis,that in disease the block transmission dopam-reflects it was wasandreceptorme felt receptorsits that effective blockade schizophrenia most treatment is potently known simply was as(Creese "dopamineto reflected antagonize et al. a1976;antagonism." state dopamine Seemanof too transmission. muchFor et al.many dopamine, 1976). years, More This it thetionsrecentan brain imbalanceand theories (thedelusions) subcortical aboutof dopaminergic reflect dopamine regions), a "hyperdopaminergic" andactivity. and schizophrenia negative The positive symptoms positstate symptoms thatin reflect certain there (hallucina-a partsmay"hypo- beof turaldopaminergic"1992; changes Dworkin in state the and brain in Opler other (neuropathologic 1992;partsAnother (theKnable prefrontal theory changes)and Weinbergeris orthat (Crowcortical the negative 1980). 1997).region) Supporting symptoms (Deutch may reflect actual struc- PDF compression, OCR, web-optimization with CVISION's PdfCompressor haveample,this276 theory problems people is the whowith observation haveinitiating undergone thatbehaviors, people frontal showingwith lobotomies frontal emotion, lobe or injuries,strokes, and interacting fortend ex-Potential to Clinical Uses for oftenMDMAtheappropriately front mentioned haspart been withof asthe shown othersabnormal brain to(Neylan also enhance in ispatients seen1999). blood in with Aschizophrenia flowdecreased schizophrenia. to some rate (Gur of of Inthe blood ethealthy same al. flow1989). areas nor- to poraltromedialwasmal volunteersincreased lobe, prefrontal the bilaterally medialgiven cortex, a occipital single in variousthe oral lobe,ventral dose regions and anteriorof in MDMA ofthe the entirecingulate, brain, (1.7 cerebellum mg/kg), including the inferior blood (Gamma the tem-yen-flow etIt Clinicalhasal. 2000b). become Studies: clear Giving over Dopaminetime that whileAgonists the to classic People antipsychotics with Schizophrenia that block yearstomsthedopamine paranoia,of that negative remain. receptors they symptom Some do can not researchersquiet research,adequately the voices, there have treat isstated organizethe still deficit nothat proven thedespite state speech, pharmacologicalor more negative and than diminish symp-twenty Medicationssuchthetreatment search as amphetamine. forcontinues that primary have for been Amphetaminenegative medications tried symptomsinclude towas ameliorate dopamine used (Carpenter in psychiatry these agonists etnegative al. as (enhancers),1995). early symptoms. asAnd 1936 so amphetamine,Hulseboschenhance(Meyerson their 1999). 1936). sometimes motivation It Some is widely called stroke and accepted a patients psychostimulant,hasten that havetheir long-term been recovery can given produce use (Goldsteinamphetamine of high-dose paranoid and to partpsychosis(Ritalin)1994). of the Amphetamine basisinand nonpsychiatric ephedrine, of the dopamine and have other patients been theory psychostimulants, used (Angrist of inschizophrenia schizophrenia 1994); such at(Snyder one researchas methyiphenidate time, 1973; as this "probes," Ellison was chemicallyeffecthindor provocative provocative at all and in the observingtests tests schizophrenia [see is to itsLieberman give effect a population. drug on etresearch that al. 1987causes Knowing patients for an a effect, review].yields how anythe important The probemeasureable idea works infor- be- PDF compression, OCR, web-optimization with CVISION's PdfCompressor vationmation to the prefrontal cortex (an areaOne oftheory the brain of negative thought symptoms to be involved posits in thatabout a failure the pharmacological of dopamine acti- basis of the symptoms and their treatment. Using MDMA in the Treatment of Schizophrenia 217 mightsmallthisexecutive syndrome doses,be helpful decision psychostimulants, (Dworkin in making) treating and explainsthe Opler such deficits 1992).as some the of dopamineschizophrenia.ofTherefore, the cognitive agonist it is Therebelieved deficits amphetamine, have seenthat been in mentionedhaveschizophrenicsome been studies several some showingpatients decrease other studies (Gunmanthat in amphetaminenegative of patientsand Sargantsymptoms with can 1937; schizophrenia,worsen with Angrist thea psychotic administration et however,al. 1980). episode thatThere of in toand amphetamineshow Boronow features 1988; (Angrist of affectiveMatthew et al. flattening and1982; WilsonOne Cesarec studyand 1989; cognitive andusing Goldberg Nyman patients deficits 1985; et with al. similar Van1991). schizotypal Kammen to pa- personality disorder, who tend withtiveontients (Siegela symptomscard-sorting with etschizophrenia, al. of 1996). testschizophrenia that Most establishedpatients amphetamine qualify with amphetamine-associated schizophreniathe studies statistically using typically patientssignificant improvement havewith results nega-trouble as severe"tivebust,partial, symptoms one but(Sanfilipo article not incomplete. cautions those et al. schizohprenics 1996). thatAlthough "amphetamine In reviewing the in results whom themay ofthis psychostimulant these modestly symptomatology studies improve were studies, isnot nega- more ro- a schizophrenia.psychoticdrugsfew trends are but given are rather Methylphenidate apparent:orally, is showing instead patients of reportedlyresidual, intravenously, are less attenuated islikely more and to likely if becomepositive the topatient bring psychoticsymptoms is on not a acutelypsy- if of the tonergicphrenia,chotic episode itsystem is important than affects is amphetamine tothe bear response inIn mind considering (Liebermanseen that with the amphetamine levelthe et al.use of 1987). ofactivity MDMA challenges. of the for sero- the In treatment or study of schizo- inLikewise,wereanimals, amphetamine-elicited lesioned the when results showed serotonin of various a activation strongeravailability tests in(Gersonresponse which was enhanced, andserotonin to amphetamineBaldessarii therewas depleted was1980). challenges. attenuation 'When or cells a PDF compression, OCR, web-optimization with CVISION's PdfCompressor serotonintion218 with amphetamine to subjects with Potential Clinical Uses for MDMA 5-hydroxytryptophan (5-HTP), was given in conjunc- schizophrenia, it prevented the in- psychoticandchallengesduction dopamine of symptomsthe acutein the psychotic inbrain, patients and symptoms withthis may schizohrenia. sometimesprevent an seen et al. 1987). MDMA immediately raises levels ofundesirable serotonin increase in with amphetamine SerotoninbeenSupport gathering in the literature since it was first for the involvement of the serotonergic system in and Schizophrenia observed almost forty years schizophrenia has melaritiesschizophreniaago hypothesisthat with lysergic serotonin in dominated normalacid (Gaddum controls the literature and and Hameed that for the the structure1954). next Although of LSD diethylamide (LSD) causes a syndrome evocative of three decades, further theshares dopam- simi- foundniacalevidence came superiority to havewhen to reassert potentclozapine, to chlorpromazine serotoninserotonergic the first receptor antipsychotic abnormalities (Thorazine, antagonism ina in dopamineforty patients (Meltzer years with to et antagonist), was schizophre-show clini- al. 1989; gicCanton1990) system, etand al. there anatomically 1990). is good reason closely Becauseto connected view these the (Tork serotonergic two 1991)neurotransmitter with system is functionallysystems interactive the dopaminer-(Kelland et al. mentin forebrainergictandem, the function dopamine as (Kapur opposed at bothandantagonist in Remingtonits isolation. origin effect in The 1996). theof serotonin midbrain Thus, systemit and may its be classic antipsychotics with a seroto- terminationinhibits dopamin-in thedesirable to aug- Thishowever,tivenm symptomsis a complex that many of areaschizophrenia of ofthe study. newer There (Leysenantipsychotics areagonist. etmany al. 1993).Serotonin differentare serotonin It receptor modulation may be beneficial in reducing should be noted, antagonists. the nega-subtypes nmfoundingactionof both and between serotonindopamine are the these changesand antagonists twodopamine, thatsystems (fortake and example, (Kapurplace there in andare theantipsychotics) likelyRemington brain several when 1996). dosesare modes administered ofAlso seroto- con- of inter- PDF compression, OCR, web-optimization with CVISION's PdfCompressor theseover same neurotransmitter systems,The coexistence as is ofthe illnesses long term known (versus the immediate effects Using MDMA in the Treatment of Schizophrenia to respond to the antidepressants that seen with MDMA). seen with acute agonists of 219 quiteschizophrenia.lendsare selectivehighsupport and toserotonin Theis the seen prevalenceidea throughout reuptake that serotonin of inhibitors depression the is involved (SSRIs), in people insuch the with as fluoxetine (Prozac), course of the disease. Approximately pathophysiology of schizophrenia is andpsychoticexperience25 Drake episode1989). a major One ("post-psychotic depressive study found episode percentthe depression"), baselineduring the incidence and of of schizophrenic patients experience depression after course of their illness (Bartels as many as 60 percent depression to be an acute leading13cent22 percent,percent) (Koreen cause andofis et tenpremature al.the times 1993). incidence the death The national over suicidein these rate patients for schizophrenic (Caidwell and patients (10 a five-year follow-upaverage period was(1 percent), 26 and suicide is the per- to metabolitehave(Dyck1990). the highestet A5-hydroxyindoleacetical. general 1988). relative populationMann risk (1987)of attempted study acid notes showed (5-HIAA) suicide,that that measuredwith people with a low level of the serotonin a risk ratio of 23:1 schizophreniain the cere- Gottesman attemptedphrenicphrenia.brospinal patients,One fluid suicide cerebrospinal correlates with(Cooper a furtherwith et fluid al. suicidal 1992). reduction5-HIAA behavior Clozapine study in noted depression low levels seen in those patients who had treatment of neuroleptic- and in schizo- in schizo- Okaylicompaniedresistant 1995). patients by improvements resulted in markedlyin Schizophreniadepression less andsuicidal and hopelessness obsessive-compulsive behavior and disorder show a high rate of(Meltzer and was ac- percentsignificantincoexistence, both of(Berman theseobsessive-compulsive perhaps psychiatricet al. 1995).reflecting diseases. Schizophrenia symptomsthe involvement One instudy and schizophrenic autism listedof the theserotonergicalso share similar occurrencepatients ofas 25 system Ritvobeenflattenedfeatures shown et al. (withdrawn affect,1983), to respond poora modified behavior, toeye treatment contact). amphetamine self-stimulation with Some fenfluramine ofwith these serotonin-agonist features (Geller of stereotypes, inappropriate or autism haveet al. 1982; actions PDF compression, OCR, web-optimization with CVISION's PdfCompressor in(Clineschrnidt280 et al. 1978)behavioral similar to models MDMA. and serotonin-depleting actionsPotential Clinical Uses for FIDMA in biochemical models hasasSeveralClinical adjunctive been Studies:studies shown treatment have Giving to improve used Serotonin serotonin negative Agonists reuptake symptoms to for medicated patients with schizophrenia. inhibitors,Schizophrenics particularly fluoxetine, significantly though blood Fluoxetine with(Silverfiuvoxaminelevels those of and antipsychotics ofNassar (Luvox) maprotiuine 1992). also were Inhas(Ludiomil, one elevated. been study shown a comparing(Spina to ameliorate et non-serotonergic antidepressant) in al. 1994; Goffthe et effects a!. 1995); of fiuvoxamine negative symptoms medicatedShmugliakovaffectivesignificant schizophrenicblunting improvement 1998). compared This patients, effectively in motor with the the retardation,factors patients group out given giventhe emotional withdrawal,possibility and that it is merelymaprotiuine (Silver and fluvoxamine showed anamine,effect antidepressant that three is ofresponsible eighteffect subjects for theshowedIn improvement a study in which medicated schizophrenic and suggests that it is specifically the serotonergic statistically significant improvement in negative symptoms.patients received fenflur- in andsimilarmentnegative placebo in topositive symptoms, MDMA, also symptoms tended and and rats threeto generalizetrained other patientsto discriminateto MDMA (Stahl et al. 1985). Fenfiuramine has properties showed significant improve- 90 percent of betweenthe time fenfluramine patientstients(Schecter (Soper were 1997). receiving)et al. Another 1990). of sertralineAnstudy open using trial(Zoloft) long-term (patients showed that it worsened negative symptoms in administered to patients stabi- fenfluramineand doctors treatment, knew what schizophrenic pa- patientstivelizedor symptomsplacebo) on norantipsychotics doctors found (Thakore noknew noted et whether al. some 1996), patientamelioration while was a of statistically significant improvement (Lee et al. receivingdouble-blind experimental study (neither drug both positive and nega- 1998). phrenia.inpiperazine an effort They (mCPP) to havetest astheproduced a assumptionchallenge mixedStudies test ofresults. (single serotonergic have In been normal done using the serotonin agonist dose) in schizophrenic patients involvement in schizo-subjects, mCPP infumetachlorophenyl PDF compression, OCR, web-optimization with CVISION's PdfCompressor Sian leads to an increase in body temperature, anxiety; and release of Using MDMA in the Treatment of Schizophrenia growth 281 itetyhormone, was response1991 shown Yale cortisol, into study patientsexacerbate ACTH, of unmedicated than psychotic and in controls prolactin schizophrenics, symptoms (Krystal (Murphy in et the al.mCPP patient 1991). caused Furthermore, et al. 1986, 1991). In a a larger anxi- provementpsychotogenesis(0.25et al. mg/kg1991). in symptomstaken Iqbal in schizophrenic by and mouth (by associates the [P0]). Briefpatients Kahn (1991) Psychiatric (1992),exposed corroborated however, Rating Scale) measured the findingof those of to an mCPP challenge group (Krystal an im- is simpleschizophrenicsnow a theoryanswer. of Whatundergoing imbalance: was once an too mCPPaWhat theorymuch challenge can inof toobe understoodmuch (0.35 dopamine mg/kg from P0). all of these results? Clearly, there is some areas and not enough in or serotonin no memittersothers.1994). turnover, Awith Becausefew symptoms. and theorists negative some go Positivepeople onesymptoms step withsymptoms further schizophreniarepresent torepresent match the opposite havethe levels (Rao of and Moller an abundance of dopam— more positive symp- neurotrans- nesses,researchersmedications,toms and othersnotwho simplyand think have others thatone more responddisease.schizophrenia negative Thisto differentsymptoms, may is mean medications. some that doresearch better There conductedwith certain a syndrome, or a group of ill- are some thesepredominantstudieson large data now groups is trythat groups. ofto decreasing subjectsfocus Perhaps on may eitheravailable the not positive-symptom-only be dopamine studying thing that theand same serotonin phenomenon. in the Many can be generalized from all or negative-symptom- provesPre-Pulsecertain,seems negative to that improve enhancing symptoms. positive available symptoms. serotonin It is and possible, dopamine though in the not nearly as Inhibition synapse im- synapse world.Thereandare known have Typically, less to haveof people a responsedeficits become in to the usedsecond way to they and viewthird andpresentations respond to of the the outsideis one more interesting piece to the puzzle. Schizophrenic patients a repetitive stimulus (habituation) same PDF compression, OCR, web-optimization with CVISION's PdfCompressor madestimulus.282 evident by a technique known as pre-pulse Potential Clinical Uses for MDMAThere is also a phenomenon known as sensory gating, inhibition (PPI). If a smaller which is beenastimulus personand prepared it is usually introducedknown by theas abefore first, deficit quietera largerin sensory tone.one—say, Ingating, schizophrenia two or tones a of would be less startled by the second, louder tone, having disruption in PPI. There escalatingthis volume—is not the case, schizophrenicsNicotinesubstancesare many ismedicines thatone smokedrughave thatbeen cigarettes does shown enhance heavily. to enhance PPI, which the inhibition may and drugs that make this deficit worse, but there are few explain why so many of the first pulse. hancereason PPI to (Vollenweider give single oral et al. 1 999b).Swiss researchers This may be have the discoveredmost that MDMA has thecan enhance PPI in the dose MDMA to people with schizophrenia. If general population, it is possible that it can capacity to en- compelling ussymptomenhance learn thePPI or pharmacologicalsyndrome in schizophrenic is worth patients. Any medicine that basis of that symptom,studying, so that if better for no medica- other reason than to help subjects have been ameliorates any tionsSzaracationsamine,given can LSD,1958; methyiphenidate, beon created. the DMT Itil symptoms et (dimethyltryptamine), Inal. the 1967; andpast, of ketamine,schizophreniaAngrist schizophrenic et to al. observePCP 1980,(Stol research 1947;the1982; effect (phenylcyclidine), amphet- BoszormenyiLiebermanl987; and of these medi- thatsymptomsMaihotrathe any illness. observable et for al. a1997; short change Lahti time. inet The symptomsal. 1995). Manyyields ofvaluable these rationale in performing these studies was drugs worsenedinformation the about reasonablehumans,ability of andserotonin to thatask theit andappears question: dopamine to enhanceCanGiven in it the help what sociality synapse, people we know andthatwith aboutmotivation, it strengthens MDMA, which is that it increases schizophrenia? The the avail-it seems PPI in misedpeoplenegative-symptomability intakingto schizophrenicconnect MDMA. to schizophrenic and Attention, patients communicate and concentration,patients; augmented with it othersis markedly andin people isinsight severely under all are compro- enhanced among impaired in the infiu

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Using MDMA in the Treatment of Schizophrenia 283 Testsubstitutedbeenence used to amphetamine try to ameliorate MDMA. negative of MDMA. In the same way that amphetamine and fenfiuramine have symptoms, so, too, should the ring- scribingwhofromThe have their their been MDMA experiences. diagnosed use. withThese schizophrenia andfollowing have found iialstestimonials are from people (their are edited excerpts from e-mails to me de- names have been changed) some benefit hadation.Robert auditory He was has and diagnosed been visual treated hallucinations, as a with paranoid olanzepine schizophrenicideas of(Zyprexa). reference, in his and early paranoid twenties. He ide- personalphrenia.I strongly sense believe but MDMA also in a has communal huge potential for the . . . Another commonality is a sense of well-being, not just in sense, a kind of belonging that can treatment of schizo- a feltmyselfbreakingmoremanifest rather talking more asdown freed more able for my of "connected"thoseto mostown talk of cyclewith(formerly few almost conversationsofwords. de-socialization. unrealized For me, with this people On was MDMA, a key factor I found in anyone about almost anything and or at least not admitted) or perhaps just withoutgiveshadofneuroses/psychoses sharing a melastingthe ause thoughtsrole effect of model external on andthat myfor feelingsnormally chemicals, whatown self-viewsort with plague of and people, personality andit gives woridview. direct I would proof In like that there me. Just this visceral experience even if only for a few hours, some sense, it to achieve John was diagnosed with schizophreniais a lot in of his psychological late flexibility in my own mind. teens. He had a history of paranoia,beendiagnosed"treatment misdiagnosed; he neverwith and no clozapineheard longer though voices.) took (Clozaril) he didany have antipsychotic and olanzepine. medication. Later (Hehe was a history of referential ideation and may have

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 284 Potential Clinical Uses for MDMA combating my psychosis. With theIonlysenseI wasvery reduced ofexperiencing first love, use,have compassion,my MDMA paranoia used was MDMAtemporarily completely temporarily; quite successfully the paranoia in came intimacy, and closeness. Please note that MDMA halted and replaced withchanged an immense my life. The paranoia that back later. But thefamily.phreniato insight be invaluable. Second,had that taken I gained I Forbecame that one, fromability a much these from moreprecious me. open,I became I truly had learned how to love—the outgoing,few hours andof clarity positive proved per- closer to my friends and schizo- pushingFinally,son.titratedsented Again, MDMA forwardthemselves. antipsychotic schizophrenia instilledon myWith drugs,road in the me tohelp and an recovery unrelenting ofa lotthe of positive no people matter had lobotomized these critical qualities in me. will to MDMAlive. A will effects, to keep carefullywho cared about me, I what obstacles pre- hospital.myslowly way began toThe the toway pointturn I see the it,tide I willon my never disease. have Overto go In fact, it's been more than two and a where I could live outside a psychiatric treatment half years sincetime, I leftI gradually theback, ever.worked James'Jamesteen.sions, first He signsideas had ofa history reference,schizophrenia one suicidebegan atattempt, of persistent auditory hallucinations, paranoia, aboutand the a psychiatricage of fourteen hospitalization. or fif- delu- singletheofI felt my bitterness as reservationsdose. is if myI felttowards mental like about a problemsmy real people, family, person. had all all ofwashedI remember ofthe it pent-up away. anger had been flushed out with awanted to initiate change,reflecting onAll my of life my in paranoia, all and frustration, wastowasdisgust beautiful,makemake. over, at myself My andhowl and wholeI didn't behavemoreright. crave on amore, day-to-day basis. I outlook on lifelike changed I was when that Inight. was on WhenIt "F.,"has givenI becausecame me down, I thought I wasn't disappointed that but I did remember the changes I wanted it freedomwisely.curefreedom for from anything,is present a disease [it even that after has the plagued drug wearsme for years, offers] only a new perspective that should be off. I do not think this is a and a bit of that used

PDF compression, OCR, web-optimization with CVISION's PdfCompressor ofphreniaI these whoseother also men.symptoms had During an interesting were a subsequent much telephone more phone severe conversation call, than he with Using MDMA in the Treatment of Schizophrenia a young man with schizo- were the symptomswas acutely para- 285 whyhetooknoid, thatthought MDMA and had he thathappened. wasfor it the eventuallywas first importantAnd time, I lostcould he for tofelt notfollow-up. doctors as agree if he and But scientists he told to do research were cured for a few hours,more. and me that when he on

PDF compression, OCR, web-optimization with CVISION's PdfCompressor USINGALTERNATIVEAnAndrew MDMA MEDICINEIN Interview with Weil, M.D. JH:AW:place I don't in medicine. know that I wouldn't I would putmake it ina distinctionalternativeDo you there. think For that me, MDIVL4 has any place in alternative medicine. I think it has a medicine? the interest- habitsbodyproduceing thing behaves can a is disappear.state that differently. ofif thegreat It set can relaxation andYou show setting see people thatand are chroniclackthat properly thereof defensivenesspain is a can attended to, MDMA can possibility that they're disappear and that in which the JH:not Let'sfigure obliged talk out about to other have relaxation ways certain to maintainfirst.symptoms. that symptom-free state. How Thedo experienceyou think that can MDIVIA motivate can them be helpflul to theirthere?AW:to be discomfortMany completely people is duerelaxed walk to that.around can Justshow in to states have ofan chronicexperience them that their experience of their bodies tension and much of of what it feels like JH: Onecan bething different. that also I thinkhappens many in an MDMA -induced state is people have never felt complete relaxation. helpful.that there is en- AW:hanced Right. attention to posture and breathing, which also can be very 286 PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH: You have emphasized the importance of deep breathing. Practitioners of the Using MDMA in Hea'ing, Psychotherapy, and Spiritual Practice 281 AW:Alexanderenhancing Yes. technique the ability are to particularly take deeper fondbreaths. of MDIVIA for opening up the ribs and JH:and,AW: Whattaking again,MDMA about an inventory thecan body give of image youtheir a bodies chanceissues—people in to a differenthave areally new way? lookingperspective at their on yourbodies body, part of breaking old habits. For that reason it can be a very or Anotherbutdisappearvaluable it shows area experience, during thatpeople I've an that MDMAassumingbeen there's very experience. athat interested relationship the experience Theyin betweenis allergies.may is structured comemental Allergies back state in at someand the often aller- end, way. JH:instances? Dogies. you This have can any motivate anecdotes them about to figure people Out using how MDMA to work in on any that. particular AW:remission.tookhad I rheumatoid haveMDMA one He about patientbegan arthritis once workingthat thatIa workedmonth had with required and withother felt for patients athatsome couple it time,putwho of him hadahand yoimg completely rheumatoid surgeries. man who into Hear- whoandgies,thritis. have digestive hay I dealt havefever—as problemssuccessfullyworked a result with as aof withpeople result the problemsMDMA ofwho using have experience. like MDMA. overcome chronic I have back allergies—cat seen and many neck peoplepain aller- JH:toadvancedAW: What a sort I haveis of yourcancer resolution less opinion experiencewho withfeltabout it their wasthewith use livesvery that. of andpositive MDMA I know complete forinof palliative somethem. emotional casesIt helpedcare? ofwork people them that come withthey JH: I[painkiller].had was to hoping do with to touchother onpeople. the potential for MDMA to be used as an analgesic PDF compression, OCR, web-optimization with CVISION's PdfCompressor changes288AW. your perspective about what is going on in yourA major body, component so it can ofPotential pain is Clinical the subjective Uses for MDMA experience of it. MDMA help JH:people Anddiscomfort. what develop about a thenew impact relationship offear and with anxiety chronic on painpain inperception? which it is less of a AW:experience.lessenerly, That's MDMA that a aspect huge induces component of pain. an extremely Often, of pain. there low If is anxietythe a greatexperience state, deal which of is carryover can dramatically after structured prop- that JH:standingis Dothinkused you in that ofseea psychotherapeutic couldself-defeating insight help as asomeone tool or to setting,self-damaging assist with inandhis physical ora personher behavior health healing? comes issues? in Foraway terms instance, with of a ifMD]VL4 better under— do you JH:ingAW: The it. Yes. integration? I think that gaining insight is the easy part; the harder part is apply- AW.thatence Yes. during doesn't Integration the just experience, get mayboxed require up one cansome gain work insights and help, into so the that nature the of and put into the past. But I definitely think experi- one's JH:problems.AW. Or potentiallyYes. the symbolism of certain physical symptoms? peopleJH:AW: What want I don't about to separatemake the recreational much the recreational of a ordistinction. the pleasurableand the I thinktherapeutic component recreational aspects of MDMA?experiencesof can MDIVIA. Most JH: I'meffectbe therapeutic.so ofplay glad you or joy. said that. I believe that as well—for instance, the therapeutic

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Using MDMA in Healing, Psychotherapy, and Spiritual Practice 289 selveswithofAW: peopleMDMA that they in experiences our had culture lost. I becomedon't think do that's childlike for themselves. I haveI think that's an important aspect of heath, and it's something that very valuable. But I don't have any recover an aspect of them- seen many people a lot JH: Ioffamiliarity think a rave that setting as with a cultural is MDMA the sense phenomenon, inof thecommunity. context it's impressive. Thereof is One of the salient features raves. a theme of connection—not just AW:onto toevery psychedelics,Right. oneself person Maybe or to on one andthefifteen other planet, we years hadperson the an ago"global butafternoon I to anvillage." entire devoted movement to MDMA. or community I was saying and was teaching a seminar that was partly even manytialcrowdto this of of theofgroup these people substance. that people and the blaringwere ideaA woman soccerof musictaking fromtoughs seemed this England whodrug would and said going be she out indoors disagreed beating with up and people. that to me to be a waste of the poten- a huge JH:It Onethoughtwas ofmuch the of things betterit that that toway, have I notice and them Iamong can engaged certainly p.sychiatric in this patients,kind of activity.which is I had see the value of that. very sad, is never feedssociety,havehow into disconnected a theand sense illness. the of effect self-acceptance, Then, and snowballs. sociallybecause Itheyisolatedor believe to feel theythat accepted itare. can I by bethink quite it's therapeutic unhealthy. for The people isolation are ill, they tend to be even more cut offfrom a group. to fromJH:AW: self-hatred. Self-love I agree. is also therapeutic. A lot of people's maladaptive behavior can come AW:andfeel Definitely. they"all right."drop a A Peoplelot common of their feel themejudgments.all right of withthe If MDMA themselvesthat could experience be and carried with is other that thingspeople, over into life, JH: Onenotes.I think of Bring theit could things something be I verysay out about useful. of the an experienceMDIVIA experiencewith you. is that you should take PDF compression, OCR, web-optimization with CVISION's PdfCompressor AW.290 Yes. Good. Potential Clinical Uses for MDMA JH: Theofcan anger bequality valuable. or offear acceptance Wouldor guilt? you or say forgiveness that people experience with MDIVIA that in some medical conditions, there is an element Awl..are markedly Definitely. lessened. I think What all isof your those kinds of Sostates it would translate probably into bebody therapeutic states. to have an experience where those emotions take on "psycho-neuro-immunology"? 'cades,AW:allvery sortsIt andlittle is a ofthere fieldimpact resonance isthat's a on vast thinkingvery withbody well the of researchestablished.general onpublic it. It's The asbeen problema result around ofis forthatbooks three it's and made TV and practice in conventional medicine. It's had de- theshows.it,of word asconnection opposedAt "psycho-neuro-immunology" the University betweento the actual ofthis Arizona day-to-daybody of in research theisn't application immunology even and mentioned. the in public'smedicine. course, There enthusiasmfor instance, is a for lack JH:AW. Dome. youAbsolutely. I can see imagine MDIVIA What taking I mentioned an allergic to patient you about allergies is so striking to having any place in that field? and doing, say, ten sessions with JH:any.decreasing Do Thisyou have is doses a anyway ofopinion to MDMA teach about patients until, the issue by to the ofMDIVIA last session, being the synthetic, person asisn't opposed taking unlearn their allergies. IAW: wouldto natural,a If natural thereuse init, were substance, termsbut therea oftotally its isn't butuse natural it'sone.in alternative got MDMA substance a slight medicine?is twist. semi-synthetic; that had the effect it's prettyof MDMA, close JH:AW: Meaningslight twist safrole, on a natural sassafras, molecule. nutmeg... That, to me, is not such a big deal. I wouldn't closest to safrole and myristicin and things of that sort. It's just a

PDF compression, OCR, web-optimization with CVISION's PdfCompressor make a major distinction there—and again, I wouldn't relegate MDMA Using MDMA in Healing, Psychotherapy, and Spiritual Practice 291 to JH:MDMA Ithe have world -induced heard of alternativeyou state speak is chock ofmedicine. optimism full of optimism. I think it as a healing tool. For most people,can the be used in medicihe generally. canMartinAW:the be Right.effect learned,Seligman Therethey and have whois Ia think psychologistonstudies health. that the it Optimism hasstates at themany of University helplessness isconsequences of Pennsylvania and in optimismterms of how a behavior and an attitude that named and tivecanexperienceour in lookbodies a long positive, offunctiontime. it, seeingThe is veryand basic that howuseful—especially pointthere our isis minds thata mental mental work. if perspective you I think haven't that from had just whichthat having perspec- things the states translate into physi- life.maticshowcal states. youresponses Andvery oneconcretely in yourof the body. great how Often, values this of the has MDMA significant experience is that a shift in your mental state can produce dra- carryover frito daily it can

PDF compression, OCR, web-optimization with CVISION's PdfCompressor PDF compression, OCR, web-optimization with CVISION's PdfCompressor PDF compression, OCR, web-optimization with CVISION's PdfCompressor tus,Introductionar-ma-men-tar-i-urn and so on, specifically (noun): an arsenal; an aggregate of resources,for work appara-in the field of medicine Thefulis oughly,justfield mirror such of astronomyorand a scopetool calmly in that thehas than allowsfield the ever telescope; of users psychotherapy. before. to biologyexamine Contrast has an It can themselvesbe likened tomore a power- fully, thor-MDMA-assistedthe microscope. therapy MDMA thetientinterview,session therapist. will with have a psychiatrist whatThe fewer problemcommonly inhibitions administers is that is calledand patients abe powerfulan able become to open up more "amytal interview." In this sort of tranquilizer so thatnearly the pa- unconscious. They completely to vitalinventorymemoryare sedated, participant of of the psychologicaltheir entire in words the event. process. are difficulties, but the patient MDMA slurred,lowers the they defenses nod off, to and allow they a thorough have almost no remains an active, alert, seriesandbetter paralyzed knownof mne as toprior "shocktwelve to an therapy."seizures electricallyAnother The inducedseverelycomparison seizure to consider in is with electroconvulsive spread out over several weeks, depressed depressed patient is sedated the brain. After a therapy (ECT), place.patientstimesconcerning The aretypically pointused events tois recover helpthat during desperatepeople to thea largerecover several and extent, potentially from weeks butmental overthey dangerous illness. A single oralwhich thera- the sessionshave took minimal memory methods some- psychicamytalpeutic dose interview material. of MDMA or an inECT a supervised session,Despite and setting hundreds certainly is no ofwill more anecdotal reports of impressive yield moreresults valuabledangerous in MDMA- than an ascertainassistedasgloup, a treatment psychotherapy,led the by benefits José for Carlos a of therethe Bouso therapeutic are precious use few of MDMA. teams doing At present, psychiatric disorder. Bouso's research (and his chapter in Spain, is examining the potential of clinical trials to only oneMDMA andfor this have volume) been the focuses victims on of women sexual whoassault. have 294 post-traumatic stress disorder PDF compression, OCR, web-optimization with CVISION's PdfCompressor bebefore done. therapeutic Before continuing, studies can I thinkbegin,In it basic best pharmacologicalto define our terms.the research UnitedIn clinical must States, the Food and Drug Administration has advised that Introduction 295 dosesofplethoraresearch, MDMA a day of the neurotoxicity byfor subjects injection, four days are studies usuallyin humans a row. using 10 The andto animals 20one not mg/kg, clinical animals. who often havestudy Currently, administeredreceived looking largeweat positron haveas doses two a jects.MDMAsearchersemission The was human tomographicdid performed not studies report in (PET) comparingany Switzerland evidence scans polydrug of byof humans neurotoxicityVollenweider's users given with ain nondrugsingle group.those human oralThese users dose re-sub-to of sumedpeople,makeon should assumptions MDMA, and itnot remains beand aboutconsidered at towhat how be proveddoses, MDMAclinical sincewhether studies.affects these thesememory, No studies MDMA Ecstasy birthwere was users defects,retrospective. given ever andto con- those so yearsto catch and up even quickly. though Even millions though ofThe MDMA people scientific havehas communitybeen usedfurther around it, widespreadcritique is for lagging twenty-fiveof this clinical behind issue, thesee rest"Does of MDMAsociety and Cause needs Brain Damage?"] ofgroupdoingresearch scientific clinicalperforming has datayet MDMA to are clinicalbe in performed. research.part research. financial. InIn thetheThe The UnitedUnited reasons U.S. Kingdom,States, government behind there this there are hasappalling fouris a onlylong groups onelackhis- riskever,studiestory ofreduction, our sponsoringare government funded or research harmby NTDA, does reduction, focusing not the even National onbecause likethe risks toInstitute it support isof feareddrug on research use.Drug this Typically, mayAbuse. looking send How- these the at iningstaclemessage Schedule Schedule to clinicalto theIII, I drug public whereMDMA research. thatit couldresearch the There governmentbe isprescribed isthe no difficulty question condones by physicians, and that controversydrug placement use. would Another ofsurround- enhance MDMA ob- ment.thanthe body receptive In ofhis knowledge mind, to the there idea more ofwas MDMA rapidly. Whensimply researchI toowas mucha psychiatric being controversy conducted resident, andin histhe too depart-chairman little of my program was less PDF compression, OCR, web-optimization with CVISION's PdfCompressor justificationin296 our facility was akin to a neighborhood's response to a halfway MDMA Research for it. His response to my request to do clinical MDMA research house or cateanswertherehomeless those be is than shelter:harm who to takereduction.test "Not theEcstasy inpromise myThe about backyard." of athe new But medicine, what better an "anti-neurotic"? justification could The medical community has an obligation to edu- potential risks of their behavior and theare waysoffendingstill reporting they agent.can casesmake The itand assumption safer. caseDespite series is that hundreds MDMA of is cases specifically of Ecstasy-induced to blame, hyperthermia, physicians where there is no determination of hyperthermiapotentialcologicalbut in many areastudies cases and for necessaryneurotoxicity.harm the emergency reduction to prove Malberg roomresearch that physiciansand MDMA is Seiden the effectwas are(1998) consumed. not of temperaturehavedoing shown theAnother toxi- that on in coretificciallaboratory toteamtemperature exacerbating has animals, published in termsor the alleviating temperaturedata of their on the MDMA-induced effect of the of animals' MDMA neurotoxicity. surroundings on research No subjects'is scien-cm- surrounding temperature. Typically, thera- havetheylarspeutic are havetwo research poured problems. a medication is into sponsored First,research that MDMA byhas and the the developmentwaspharmaceutical potential patented to beinif a1914,a companymoneymaker. and that believes patent Here that we Millions of dol- has twiceMDMA,bylong being since in the unlikethe expired. lifetime sole antidepressant provider No of companya patient. of this medication, couldThere medication. recoupis simply typically its The nolosses moneysecond is invested given toproblem be only inmade once is or research from that fromtica medicineendowed studies the sale willgiventhe of Holland havethis that book to Fundcome will for befrom Therapeuticdonated the private to this MDMA sector.fimd. Research.All To donations that end, All areI tax infrequently. For these reasons, funding for therapeu- proceeds have tions,theadddeductible Heifterthescientific Multidisciplinary and Institute, data will to go thethat toward anecdotal Associationare supporting funding data. for clinical There clinicalPsychedelic MDMAare MDMA also Studies atresearch least research. (MAPS) two that seeks to organiza- and

PDF compression, OCR, web-optimization with CVISION's PdfCompressor CLINICAL RESEARCH WITH andAndrewMDMAI Julie A WORLDWIDE REVIEW M. Kleiman, M.D.,Holland, M.D. Althoughfew reliable clinical studies looking at its effects. Many published articles MDMA has been available to researchers for decades, there are themtheirmates,concerning datawith such fromdata as MDMA squirrel frompeople non-Ecstasy monkeyswhocite animalare long-termor users. baboons.data, These using Ecstasy Most retrospective rats, of users mice,the humanand or studies thennonhuman studies compare are sus-take pri- bycalsstudypect these (specificallyfor participants aresearch number ketamine, ingested subjects,of reasons. was dextromethorphan, which First,MDMA. might we Second,have explain noand it idea anyismarijuana) likely ifdifferences the that chemical were other recorded ingested chemi- these psychiatrictakebetween drugs the often,diagnoses. groups. for Third,example, many diet,In variablesthis exercise, chapter are sleep we at specificallyplay habits, among and review peoplepreexisting only who recent prospective clinical tri- studiesperformedMDMAals of MDMA. and and at extend thenpresent. This observed our means We apologies are forthat grateful changes. people to the to hardworkingwere Thesethe researchers given are thea scientistsknown cleanest who amount described who studies were of being theirpure not results,included particularly in this chapter Dr. George owing Ricaurte'sto the nature work, of theirare reviewed work. Some elsewhere of their in 291 PDF compression, OCR, web-optimization with CVISION's PdfCompressor this298 book (see "Does MDMA CauseMDMA Brain Research Damage?"). Surveys of psychia- takentristselsewheregiven who MDMA MDMA have in this intaken to the book.patients contextMDMA Non-placebo-controlled (Harlow of(Liester therapy and et Beck(Gasseral. 1992), 1990), 1994-95)prospective psychiatrists and patients also studies arewho who found assess-have have TolbertingLike?" theEngland 1986)effects are of coveredMDMA in in Gary healthy Bravo's humans chapter (Downing "What Does 1986; MDMA Greer Feel and bodymiaseriesDr. (low temperature on hyperthermiasodium). in Discovering the but dancing also the andpopulation discovery publicizingJohn ofEcstasyusers ofMDMA-induced the occurrence has saved ofhyponatre- elevated count- group in England was the first to report not only a case leadslessCentredetails.] lives, to low and Dr.as sodium has DepartmentHenry reporting levels. and colleagues, [Seeofthe dangerthe section who of aredrinking on affiliated the risks too withofmuch MDMA the Drug for Controlmore King's College London, published which nonblindspecificallyHenrytwo MDMA andstudy, coworkers at studiesto secreted analyze in administered1998plasma and arginine 1999. 40 Invasopressinmg the of MDMA (also to called eight menADH, in or a physiological effects. The study looked first of these investigations, physiologyTheurineantidiurectic amount and so to causes ofhormone).the secreted plasma a dilution ThissodiumADH of substance in theconcentration, the blood blood inhibits and is an whichrelated increasethe kidneysis closelyan in indicator blood from in pressure.terms makingof fluid of plasmahormone.balance concentrationin the body, and of to ADH plasma unrelatedThe levels results of to cortisol, ofblood this MDMAanalysis which is concentrations.yielded a natural findings stress of a significantly increased ministrationpropriateA erbatedrapid rise withinby in ofother ADHthis normal physiologicalsmall and physiologicalfall dose in of plasma consequencesMDMA. sodiumftmctioning, The concentration,fluid of the wasimbalance use induced of MDMA,which can by be is the exac-inap-such as ad- PDF compression, OCR, web-optimization with CVISION's PdfCompressor fatalhormone,high brain cortisol.swelling Allas well as seizures and coma.body temperature, sweating, and increased secretion of the body's stress of these factors in combination can cause potentially Clinical tIDMA Research 299 teers.body,MDMA Thefollowing in structures humans oral at ofadministration its MDMA many stages Fallonand ofits of40 andbreakdown metabolism, mg colleagues MDMA product, orexaminedto eightbreakdown MDA, male the presentvolun-various in the structures and disposition of ofpounds).spectrometryin plasmaeach The and properties(toolsurine extractsused of to two wereanalyze specific analyzed the structures, presence by gas chromatography ofwhich certain are chemical mirror and images com-mass the so-called R- and the more active S-enantiomer, were de- MDMA.—Ed.]two.hastermined. about See [R-(—)-MDMA"Thetwice It Chemistrywasthe potencydiscovered is of almostof MDMA" racemicin this inactive study MDMA, for at thatmore ordinary awhich specificon doses.the is aenantiomersstructural mixture S-(+)-MDMA ofdis- the of uct,thelifeposition the compositionthan so-called theof MDMA 5-enantiomer area of MDMA existsunder andinthe and humans. differscurve. MDA Analyticalin Thein the plasma R-enantiomerconcentration-versus-time methodsand urine hasfor were determininga longer developed, prod-half- whichandposeshuman described.may of beings. twobe applicable specific MoreThus, studiestypesthe for manner forensic of looking MDMA in purposes which at in the the themetabolismin human the body detection bodymetabolizes of was MDMAof MDMA determined and in dis-inhu- ReferencesmansFallon, are J. planned. K., A. T. Kicman, J. A. Henry, P. J. Milligan, D. A. Cowan, and A. J. Hutt. Henryamphetamine1998.1999. J. Low-doseStereospecific A., J. (Ecstasy) K. Fallon, MDMA analysisin humans.A. ("Ecstasy") T Kicman,and Gun. enantiomeric inducesChem. A. J. Hutt, 45:1058—69. vasopressin disposition D. A. Cowan, secretion. of 3 ,4-methylenedioxymeth- and Lancet M. Forsling. 351:1784. MédicaTheSpain (IMIM) in Barcelona, Spain (MagI Farré,Pharmacology Rafael de la Research Torre, and Unit of the Institut Municipal di Investigación PDF compression, OCR, web-optimization with CVISION's PdfCompressor Jordiresearch.domized,300 placebo-controlled clinical trials to different groupsCamf), of healthy has carried maleMDMA outResearch three studies sinceIn 1996 these in studies, the field MDMA of MDMA was administered in double-blind, ran- volunteerspatedating. single The in oralfourwho first dose separate hadstudy previousof wasMDMA ten-hour designed experience experimental to compare taking Ecstasy sessions;the pharmacological in they a recreational were given effects set- one of with the effects of placebo. Eight men partici- placeboplacebo.pressure,of two on doses Levelsdifferentheart of rate, ofMDMA days.plasma and Boththe (75 cortisol diameter MDMAmg orshowed 125 of doses the mg) a pupilstatisticallysignificantly or amphetamine of the significanteye increased (40 increasebloodmg) or compared with someafter MDMAa detail; high dose theyadministration. of found MDMA. a nonproportional LevelsFarré of and the coworkershormone increase prolactin in reported MDMA increased on concentra- the metabolic only pathways of MDMA in ingested,ofistions referredMDMA in the as to foundblood that as "nonlinear amountafterin the high-dose blood steadily pharmacokinetics." is notadministration increases. proportional This In(125 to othermeans the mg amountwords, andthat 150 if the ofthere mg). MDMAamount wereThis studysequencesadverse the consequences interactions from ingesting betweenfrom three ingesting alcohol orTheir four one second andwould or MDMA. two bestudy, doses Awhich groupof MDMA, was of subjectspublished the con- re- only in part, was designed to disproportionately graver. formancestancessubjectiveceived simultaneously an of oral tasksfeelings dose related ofand or alcohol to emotions,placebo. driving, (0.8 Thesuch andg/kg) study asimmunological or reaction MDMAevaluated time (100 psychomotor andstatus. mg) coordination, orThe both results per- sub- pairment.timetionshowed inducedand Inthat coordination other MDMAby alcoholwords, ingestion rendered MDMAbut did decreased by notdoes alcohol, change not feelingsmitigate despite the measured of thethe sedation decreasedfact performance that and subjects reaction intoxica- im-felt moreareof CD4 analert. important T cells in part the of blood the body's immediatelyPacifici immune and after system colleagues dosing. and integralThesefound thatare to thecellsthe use that of MDMA reduced the number ability PDF compression, OCR, web-optimization with CVISION's PdfCompressor theimmimodeficiencyto body's CD4 T-cell virus count (HIV)fight as well, aredisease physiologically which and is infection part of unrelated, the effectively. process HIV that Although leads to MDMA and the human Clinical MDMA Research decreases 301 resultseffectthatthe many MDMA provided on CD4complications in theT-cell combination first count evidence of HIVcompared with inthat alcohol humans. recreational with produced MDMA This research use theor of alcoholgreatest MDMA group alone. suppressive also alone foundThese or tershouldin combination MDMA be noted, administration. with however, alcohol that alters theA thirdCD4the immunological study,count currentlynormalized status under several of way, the hours body.was designedaf- It to evaluate the pharma- protocoltwoiscological important, or more were aspects pillssince two, ofduring itfour, MDMAis well eight, recreational known when and twenty-four administeredthat use. more Intervals than hours. in half two of After ofadministration repeated Ecstasy the second doses. users indose, takeThis the afterduration.dose,the concentrations takingbut theMDMA the pharmacological second usersof MDMA dose,did not and ineffects report the no blood physicalwere any changedoubledsimilar effects, in inthose theterms such effectsseen ofas intensityafterheart of MDMA the rate firstand or MDMAdoseblood study pressurein humans showed changes, and some its were evolution.degree reported. ofFuture tolerance A group Theplans results ofto include therecreational ofpharmacological anthe examination four-hour Ecstasy repeated effects.users of the possible neurotoxic effects of willsuitsresponsesthrough be willfollowed neuropsychological, beand compared immunologicalover two with to three resultspsychiatric, parameters years, from and and a will groupthese psychological be subjects assessedof non-Ecstasy will astesting. well.be evaluatedusers. HormonalThese re- J. Cliii.methamphetamineCamI,References Psychoparmacol. J., M. Farré, 20:455—66. ("Ecstasy"):M. Mas, et al. Psychomotor 2000. Human performance pharmacology and ofsubjective 3 ,4-methylenedioxy- effects. Ann.MDMAde N.la Torre, YAcad.("Ecstasy") R., Sci. M. 914:225—37.in Farré, humans. P.J. Ortufio,N. Br. Roset, et et a!. al. 2000. 2000. Non-linear Pharmacology pharmacokinetics of MDMA in ofhumans. J. Clin. Pharmacol. 49:104—9.

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 302 tIDMA Research humans:tions:Hernández-Lopéz,Farré, Psychomotor Preliminary findings.C.,and M. subjective Farré, P. effects N. Roset, and pharmacokinetics.et a!. 2000. MDMA Br. M.,and J. Gun.P. alcohol N. Pharmacol.Roset, interac- A. Tomillero, et al. 2000. Repeated administration of ecstasy to J. Clin. Pharmacol. Special issue: 111. J. Pharmacol.Mas,effectsSpecial M., issue:M.and Exp. Farré, pharmacokinetics 111. R. de la Torre, of et 3 al.,4-methylenedioxymethamphetamine 1999. Cardiovascular and neuroendocrine in humans. 290:136—45. Pacifici,nitrogen-phosphorousmethamphetamineOrtuflo, J.,R., N. P. Pizarro,Zuccaro, and M.detection.its M. metabolitesFarré, Farré, etJ. et al. al. 1999.in 1999. plasma Quantification Immunomodulating and urine by of gas3,4-methylenedioxy- chromatography properties of with B. Biomed. Sci. 723:221—32. immunieMDMA alone system and in in humans. combination 3 Pharmacol. with alcohol: Exp. A pilot study. Lift Sci. 65:309—162000.2001. Immunomodulating Acute effects of MDMAactivity of alone MDMA. and inAnn. combination N. KAcad. with Sd. 914:215—24.ethanol on the 296:207—215. JoségunandMarcela Carlos Healthto investigate Ot'alora, Bouso Department andand the colleagues Mercedesefficacy of the Universidadof Matarranz) (Pedro therapeutic Sopelana, fromAutónoma administration the Maria Biological de Angeles Madrid of PsychologyMDMA Corral,have be- to Fundwomenateconsequence thefor suffering Therapeutictherapeutic of sexualfrom effectivenessMDMIA chronic assault. Research, post-traumatic The of study,MDMA has fundeda dualin stress a psychotherapeutic focus.by disorderMAPS First, and (PTSD)it will the evalu-context,Holland as a blind,atesuitableand to second, MDMA-assistedrandomized, evaluation it will determineandmethods, treatment. placebo-controlled and the Thisthemost psychotherapeutic dose-finding effective design. dosage Thepilot subjects strategieslevelsstudy hasof are MDIVIA,appropri-a double-twenty- ofnineough chronic healthy explanation PTSD women as of resultbetween the studyof sexualeighteen andAccording abuse.undergoes and sixty to the baseline years study of design,physicalage with on anda thediagnosis psychiat- first day the subject is given a thor- undergoespreparehasric tests. a one-hour betterOn the the for experimental therapysecond the experimental daysession and and toon therapeutic reinforce the session. third day theOn session therapeuticonethe fourthweek with later, MDMA dayalliance thethe subjectsubject orand pla- to PDF compression, OCR, web-optimization with CVISION's PdfCompressor oftainingcebo. a psychotherapeutic 50, 75, 100, 125, session or 150 formg one of MDMA or placebo. DayDuring five consists this session, the subject is randomized to ingest a capsule con- to integrate the experiences of Clinical MDMA Research 303 thetwelve daytreatment monthsbefore. results. afterFollow-up the conclusion sessionsOutcome areof theconducted study measurements to one, evaluate three, include the six, stability nine, several and of scales and inventories, among andtheScale,Inventorythem Hallucinogen a the modifiedthe Scale Rosenbergthe Beck of FearGravity Rating Depression Self-Esteem Scale ofScale, the with Symptoms Inventory;the Scale,a Pennsubset the Helping ofthe ofTJKU PTSD, Adjustment-Maladjustmentphobias sideAlliance the effectsState-Traitrelated questionnaire, rating to Anxietyrape. scale, A MAPS,Switzerlandandsemistructured1999 after as and well the is asexperimentalstill interviewDr. in Farré, process, forregarding session. no their results invaluable Because sexual are available. aggression thissupport study Mr. and isbeganBouso assistance.conducted inwishes November before to thank calhasGamma,Dr. changesbeenFranz Matthiasof Vollenweider's thehave utmost beenLie chti, detectedimportance Mark laboratory thusGeyer, in farasserting includes andafter others. single that the Theirno oralresearch abnormal doseswork of within neurologi-Drs. the MDMA thera- Alex neurochemicalsophisticatedterizepeutic the range. psychological andstate-of-the-artThese neurophysiological placebo-controlled, and behavioraltechnology changes effects including double-blind ofunderlying MDMA positron experiments andthem. emission the They associated charac-tomog- use MDMATheireffectsraphy research(PET) of naive. single scans subjectsTypically, oral and doses arepre-pulse they screenedof areMDMA universityinhibition psychiatrically in the students(PP1) range studies andof twenty 1.35 medically to toto measure 1.8thirty mg/kg.and years arethe rophysiologicalandof age. emotion Several using and of these psychologicalMDMA researchers' alone Thesealterations or studiesin combinationresearchers alsoin regular have have with assessed Ecstasy examinedvarious users.possible antagonists the neurochemicalneu- regulation of mood PDF compression, OCR, web-optimization with CVISION's PdfCompressor at304 the presynaptic 5—hydroxytryptamine (5-HT) uptakeMDMA Researchsite, the postsynap- healthychemicaltic• 5-HT2 humans.Their mechanisms and D2 receptors, completed of action topsychological, human ofstudy MDMA-induced thestudies neurophysiological physiological, include mood the following: enhancementand andshort-term neuro- in effects of MDMA • effectsbrainmagnetic activity of pretreatment tomography] via PET andwith after LORETA citalopram, a single [low-resolution dose ketanserin, of MDMA and brain haloperidol electro- • electriceffectson acute of and MDMA and perfusion subacute on PPIbrain responses activity to and MDMA mood state in Ecstasy users AReferences logicalfuture[See "Givingstudyand physiological will MDMA examine to responsesHuman the effects Volunteers to ofMDMA. a 5-HT1A in Switzerland" antagonist for furtheron psycho- details.] lowGamma,LocalizationFrei, resolution E., A.A., Gamma, A.brainof Buck,MDMA-induced electric R. T. D. Berthold, tomographyPascual-Marqui, electrical M. E. (LORETA). Liechti, brain D. Hell, activityand Submitted.and F. X. Ein X.Vollenweider.healthy Vollenweider. volunteers 2000. 2001. using 3,4- Liechti,Methylenedioxymethamphetamine23activity :3 88—96. M. as E., measured C. Baumann, by {H2 A. 01 Gamma, 51-PET (MDMA) inand healthy E modulates X. Vollenweider.humans. cortical Neuropsychopharmacology and2000. limbic Acute brain psycho- Liechti,logical22:513—21.attenuated effects M. E., by ofM. the 3 Saur, ,4-methylenedioxymethamphetamineserotonin A. Gamma, uptake inhibitorD. Hell, andcitalopram. F. X. Vollenweider. (MDMA,Neuropsychopharmacology "Ecstasy") 2000. Psychologi- are Liechti,effectsantagonistcal and M. ofphysiological E., MDMAketanserin and E ("Ecstasy")X. in effectsVollenweider. healthy of humans. after MDMA haloperidol2000. Neuropsychopharmacology ("Ecstasy") Acute pretreatment psychological after pretreatment in andnormal 23(4): physiological with396—405. healthy the 5-HT2 andhumans.14(3):269—74. vegetative Eur. Neuropsychopharmacol. effects of MDMA ("Ecstasy") 22:513—21 in healthy (in press). volunteers. J. Psychopharmacol.2000. The serotonin uptake inhibitor citalopram reduces acute cardiovascular

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Clinical MDMA Research 305 (Ecstasy)Liechti,subjective M. effectson E., prepulse M. of A.MDMA. Geyer,inhibition Psychopharmacology D. Hell, and habituationand E X. Vollenweider. (Berlin) of startle 154(2): in humans 2001. 161—68. Effects after pretreatment of MDMAM. E., A. Gamma, and F. X. Vollenweider. 2001. Gender differences in the Vollenweider,healthycardiovascularwith citalopram, volunteers. F. effectsX., haloperidol, Neuropiychopharmacology A. andGamma, short-term or ketanserin.M. Liechti, sequelae Neuropsychopharmacology and 19:241—51. of T MDIvIA Huber. 1998. ("Ecstasy") Psychological 24:240—52. in MDIVIA-naive and Vollenweider,MDMAof 3 ,4-methylenedioxymethamphetamine harmless? E X., [Letter]. S.A. Remensberger, Gamma, Neuropsychopharmacology M. Liechti, D. Hell, (MDMA)and and T M.Huber. 21:598—600. A.on Geyer.sensorimotor 1999. 1999.Is a single Opposite gating dose in effectsratsof Dr.versusUnited healthy humans. Psychopharmacology 143 (4):3Manuel 65—72. Tancer and Chris-Ellyn Johanson from the ResearchStates Division AsinvolvedWayneon part Substance Stateof in avarious studyUniversity Abuse, investigationsprogram Department School designed of examining ofMedicine Psychiatry to gain the (Detroit, a subjective andbetter Behavioral Michigan)understanding effects Neurosciences, of have MDMA. of been the selectivewithbehavioral those 5-HT pharmacologyof prototypical agonist; it stimulants is a compoundMetachlorophenylpiperazine and with that serotonin-releasing releases serotonin (mCPP) agents. into isthe a serotonin releaser and semi- they pian to compare the effects ofMDMA effectsonewidelysynapse study, asof and a MDMATancer probe produces ofand and serotonin colleagues effectsmCPP systems likein examinedgradually that in of a varietyserotonin. theincreasing physiological of psychiatric mCPP doses. hasand Five disorders. beensubjective healthy used In mg/70hourvolunteers sessions kg,kg) participatedor 175 placebosubjects mg/70 under inreceived kg)a three-session double-blindormCPP MDMA (17.5 experiment. (75 conditions, mg/70 mg/70 kg, Duringkg, in35 a110 mg/70balanced the mg/70 first kg, twoorder.kg,or 52.5 six-145 feelpressure;well-being in response a wereProfile to obtained. seventy-two of Mood These States, adjectives;At parameters baseline where ARCI, participantsand include hourly an inventory heart thereafter, indicate rate of andforty-ninehow several blood they parameters of functioning and PDF compression, OCR, web-optimization with CVISION's PdfCompressor participantsphoria,true/false306 somatic indicate complaints, how they and are sedation;feelinS—sedated, visual analogue downcast, scales, hungry, in whichstimu-MDMA Research questions that measure stimulant-like effects, euphoria, dys- and(createdlated, focuses high, by andonRick perception, anxious Strassman), for cognition, example; whichAll three volition,measures and doses the andHallucinogenof hallucinogenic MDMA intensity caused of Rating effects. symptoms a significant Scale increase in blood pressure mCPPidentifiedfromand heart any showed rateofas thea compared psychoactivemild mCPP hallucinogenic doses with drug placebo, on bloodby properties, MDMA but pressure there users, as were ormeasured heartand no significantboth rate. by MDMA themCPP Halluci- effects wasand all,al.sponses,nogen 1999a) Tancer Rating a aspattern reported well Scale. asthat thatin Subjects hascocaine MDNIA been addicts whoreported has ingested a(Buydens-Branchey unique in heavy mCPP subjective-effect MD1vIA had some et users al. euphoric1997). profile,(McCann Over- dif- re- et andfering1.6 its mg/kg, from subjective that and of 2.1 effects. mCPP, mg/kg Theseperhaps of MDMATancer include as a functionversusandJohanson a dose placebo run-upof its also pharmacology. and study have a comparison of many 1.1 mg/kg, ongoing of 1 studies concerning MDMA characterizedaimandmg/kg 0.5to describeand mg/kg 2 mg/kgdrugs, and the 0.75specific toof distinguishMDMA mg/kg qualities of versus mCPP.its of subtle MDMA10 These mg pharmacological and compareddrug-discrimination 20 mg ofwith d-amphetaminesimilarities other, studiesbetter- and bodyphetaminedifferences, to regulate or morein othertemperature. like words, mCPP. toOne determineStudies study will are whether plannedattempt MDMA to examine is more thethe like effectinter- am- of MDMA on the ability of the foundMDMAMDMA.action that ingestion betweenThis MDMA follows ambient at caused raves up on temperatureanda lossreports also of onthermoregulationof workandhyperthermia core by Seidenbody and temperaturein and rats. hyperpyrexia colleagues, Specifically, response afterwho if to Anotherministeredrats'MDMIA core study isbody at administered 30 will temperature degrees, examine rats'in theandeclines. core ambienteffect body ofOn temperature fluoxetine the other pretreatment hand,increasesof 20 ifdegrees MDMA significantly. on Celsius,the is sub-ad- PDF compression, OCR, web-optimization with CVISION's PdfCompressor effectshypothesisjective of mCPP, is that will blockade have no of effect the 5-HT on amphetamine, transporter will and blockwill shift most the of sub-and the physiological effects of MDMA, mCPP, and amphetamine. The MDMA Research 301 jectiveTancer,References effect M. E., of and MDMA C. E.Johanson. to that of1999. amphetamine. Subjective responses to MDMA and mCPP: A onReesehuman Problems doseJones, runof Drug Johnup study. Dependence, Mendleson, Paper presented 17 andJune, atMatthew Acapulco, the 61st Annual BaggotMexico. Meeting at the ofDrug the College Depen- effectsandstudyingdence subjective Research of MDMA MDJVIA, effects Center, and eight inits University humans.pharmacological, volunteers In of one each California, study, receivedpharmacokinetic, designed San a lowFrancisco, to dose evaluate physiological, (0.5 have mg/kg)several been canttion,ascending-doseor a moderateincreasesthe moderate indose cross-over blood dose, (1.5 pressure, butmg/kg) study. not the heartof When iowMDMA rate, dose,compared and or produced theplacebo cardiovascularwith statistically thein a placebo double-blind, indicator signifi-condi- hoursratethosesure. pressure, Theproduced results which by were isstimulants. calculated comparable Peak by multiplying inphysiologic terms of heartcardiovascular values rate occurred andafter blood response 1administration. to pres- 21/2 to The moderate-dose MDMA caused a number of ratesignificantthesome and so-called effects drug subjective liking. entactogens.typically Aeffects rise associated Risein with DHEA, in a peakcortisol with a atsteroid stimulant twocorrelated hours hormone drugs, afterwith that dosing,hallucinogens,an increaseis a includingprecursor in heart and hoursalsoto both after obtained testosterone dosing. plasma They and andfound progesterone, urine thatWith samples the themetabolism correlatedsame at regular study and with designintervals breakdown euphoria. as forthe ofMDMAforty-eightlatter study, this group of investigators weretantthepossible selectivearea indicators undermirror-image based theof on thecurve the metabolism structures. specific(the plotting structure Both and of dispositionmaximum concentrationof MDMA, plasma of favoring MDMA, vs. concentrationtime), one were oftwo the impor-higher two and PDF compression, OCR, web-optimization with CVISION's PdfCompressor forflectedselectivity308 in metabolite of the breakdown formation. of MDMAInitially,the based greaterR-enantiomer on plasma chemical thanand structure urine the reportedly concen- is re-MDMA moreResearch active S-enantiomer. The butMDMA"lenttrations (+)-MDAenantiomer of that the S—(+)-MDA(—)-MDA has in more later of urinehas werea stimulantmore samples. recorded; hallucinogenic effect {Recall R-(—)-MDA and from effectsis shorter "Thewas resembling the Chemistryin moreduration preva- LSD, ofof thatterminals.—Ed.}action. the Themetabolism (÷)-isomers and disposalalso are Inconsideredof anotherMDMA studyaremore dose-dependent. toxicthe Drug to the Dependence neuron's This means axon Research Center also reported centbloodmetabolizethat thewhen stream. larger the the doseForthe drug, doseexample, of andMDMA of theMDMA clearance fasterwas increasedingested, the decreased amount bythe a of longerfactorby MDMA approximately ofit takes3 (fromwill the rise 0.5 body65 into per- the1.5 to acteristicsincreasesmg/kg). This in of plasma findingMDMA concentrations suggests by using that quantitativeIn small ofanother MDMA. increases study, two-dimensional inthis dose research may result echocardio-group in examined large the cardiovascular char- comparedofmg/kg)graphy the heart orone placebowith andhour thosethe after in cardiovascular eightof one dobutamine, volunteers.of two systemoral a This medicationdoses in was general. of done MDMA that Theto predictably determine (0.5acute mg/kg effects theincreases orstatus were 1.5 rate,dependentamountheart myocardial rate, of oxygenbloodfashion, oxygen pressure, that 1.5 themg/kg consumption, heartand of myocardial utilizes MDMA and while theincreased oxygen rate-pressure pumping bloodconsumption, blood. pressure,product, In a orandose- heart thein- picdobutamine.effectsdicator effects wereof cardiovascular (strengthening comparable In contrast status,into magnitudedobutamine,the peakingcontraction to at MDMAthe 1 to ofeffects 21/2 the had heart of no20—40 muscle),measurable mg/kg/mL nor inotro- did IV it hours after dosing. These pharmacokineticparentcause any toxicity heart to wall properties the motion heart. of abnormalities. MDMA.More human One MDMA aim studies of futuredid are not planned research produce to is anyelucidate to bet-ap- the pharmacodynamic and PDF compression, OCR, web-optimization with CVISION's PdfCompressor theter entactogens, or whether its behaviorunderstand more closely whether resembles MDMA thatbelongs of other in a unique pharmacological class, Clinical MDMA Research 309 Everhart,Referencesphenethylamines. E. T., P. Jacob Ill, P. Shwonek, M. Baggott, R. T Jones, and J. Mendelson. Harris,U.S.humans.2000. Government D., EstimationIn M.Problems Baggott, Printing of of the R. drug metabolic TOffice. Jones, dependence, and disposition J. Mendelson.edited of by MDMA L. 2000. S. Harris. and MDMA MDA Washington pharmacokinet-enantiomers D.C.: in methylenedioxymethamphetamineLester,icsdence, and S.,physiological edited M. Baggott, by L. and S. S. Harris. l.A/elm,subjective Washington, (MDMA).et effectsal. 2000. in Ann. TheD.C.:humans. Intern.cardiovascular U.S. In Med. GovernmentProblems 133(1 effects of 2):969—73. Printingdrug of depen- Office. 3-4- logicaltwoconductedCharles different effects Grob various of doses and MDMA colleaguesstudies in a double-blind,in designedhumans. from the toEighteen placebo-controlled determineHarbor-UCLA subjects the psychological receivedMedical research CenterMDMA design, and have bio- at in volunteerspsychiatricsponsesan attempt towith totheand examinea drug.physicalhistory The psychological,of examination subjectsEcstasy use.involved and physiological, The could potential in the not study participate andsubjects wereneuroendocrine underwent inhealthy the study adult are- if werefivedisease,they taking womenhad seizure a anyhistory and medication disorder, thirteen of any men—wereormajor or substance who psychiatric were asked abuse. pregnant. toor Also abstainchronic The excluded from eighteenmedical using were illness,subjects— Ecstasythose heartwho or placebosessions.theother study illicit or Duringtook onedrugs part of each fortwo in one three session,different month separate each dosesbefore subjectrandomized, of the MDMA, studyreceived began.double-blind ranging one Subjectsof from three experimental 0.25 treatments:enrolled mg/kg in forebloodreationalto 2.5 receiving mg/kg.was doses drawn These ofthe Ecstasy.from drug higher the and subjectdoses twelveEach were at timesthirty-minute experimental chosen after. to correspondThe intervals, session subject's lasted tofour typical body times for eighttern- rec- be- hours. During each session,

PDF compression, OCR, web-optimization with CVISION's PdfCompressor perature,callytervals.310 responding Research to volunteers several different indicated test their measures. psychological Arousal andstate hedonic by periodi- MDtIA(that Research heart rate, and blood pressure were measured at thirty-minute in- mentProfile,is,Subjects pleasant of andmood. alsovs. anxiety unpleasant) Allresponded blood was measured samplesstatesto the wereProfile were with assessed ofassayed the Mood State-Trait with toStates, thedetermine Altered aAnxiety self-reported theStates Inventory.pharmaco- Graphic assess- stimulateswellkineticsological as concentration of andcortisolMDMA psychological release.(how in the its Subjects statesconcentrationblood after of experienced cortisol, ingesting varied prolactin, MDMA. invarious the blood and Mostchanges ACTH, over of the in time) physi-changeswhich as werethesubject'sand dose-dependent.dose response ingested.state, found which There in were the were greaterstudy. a few Thus,or nonlinearless there than relationshipswhatwere mightsome bechanges predicted in the by between dose heartingestionof MDMA rate, which also produced significantly was most a dose-dependent evident and dose-dependently Whenafter doses compared rise of in 1 body mg/kgincreasedwith temperature. placebo, or more. both MDMAsystolic Ingestion MDMA andproduced a moderate increase in MDMApleasurecompareddiastolic did bloodand withnot arousal, showpressure the effects an based whenenhancement of oncompared placebo, components of butwith anxiety they placebo. of thereported or Alterednegative Subjects increases States moodwho receivedGraphic inwhen both amood.surableProfile. little lessOddly, Subjectsfeelings, arousal the also with highest than experienced higher lower doses dosesdoses. of dose-dependent MDMA, producingSubjects more receiving more increasesthan euphoria 2.0MDMA mg/kg,in hedonic, and had produced positive plea- signifi- elsion,Thecantly of effectswith the elevated higherhormones of MDMA levelsdoses in onofthe MDMAthreehormone blood. hormones—ACTH, Increasedcorresponding levels occurred hormone to in greatercortisol, a levels dose-dependent increases correlated and prolactin. in fash-with lev- gravethroughthesechanges datahealth itsin that theeffects risks whilesubjects' whenon MDMA the psychologicalit cardiovascular is administeredingestion stateappears system, in over a controlledto time.posethe drug certainGrob setting. does concluded risks not This topose people from any inves- PDF compression, OCR, web-optimization with CVISION's PdfCompressor psychologicaltingtigation lead to elevationsdistress, at inleast mood in experienced and arousal users. and seem to cause little also established that therapeutic doses of MDMA in Clinical MDMA Research a clinical set- or no 311 endingsoutthe possibilityof the when data largethat from MDMA doses animal of use MDMAstudies damagesIn two that are separate administered.humanshow damage investigations,brains. In toThe serotonin question Grob, nerve along with collaborators, studied one study, highly arose bloodmatchedputedtechnical tomography)flow control inradiological the subjects,brain. scans, Intests, wereandanother called comparisonsdone study, onSPECT the differences brains were (single madeof positronEcstasyin theof thequantity emission of users and age- measures of com- sev- MR-Spectroscopyadults,anothereral chemical and radiological exclusion markers (MR method, SPECT).Theforcriteria neuronal calledwere (brain subjects similarproton cell) tomagneticfor thedeath these ones were studies used investigated in the dose-re- using resonance imaging or were healthy reports.year.studies,sponse Subjects and study. recreational in Peoplethe control who use group wasused defined hadlow neverdoses as occurring takenof Ecstasy Ecstasy, six were according sought forto self- these or more times per jectsrespectively).in forty-two enrolled people Each in this group (twenty-one study consisted firstIn underwentin the ofthe seventeenfirst study of MPJ thegroup men two and and studies, the four control blood flow within the brain and then SPECT scans. was women.measured Sub- group, terationswereintoCerebral account used bloodin to the baseline,spot flowbrain. relationships was post-MDMA,Key examined factors between included with and parametersvariouscontrol blood findings.models flow of MDMA inof Several theanalysis, brain, use methods and takingbrain al- volume,Bothspinal Ecstasy percentagecord), cumulativeusers of and cerebrospinal controls life exposure hadCompared fluid normal to (the Ecstasy, with MRIfluid baseline evaluations.thatand batheslast radiological dose the of brain MDMA. scans, and post-MDMA ingestion scans regionalWhileshowedin eight Ecstasy a ofblood slight ten usersflow Ecstasyreduction throughoutand users matched in cerebral who the controls hadbrain, blood just post-MDMA didflow received not in differmost two regionsingestionin dosesterms of of the baselineMDMA brain. scans (two PDF compression, OCR, web-optimization with CVISION's PdfCompressor toscansgional312 and blood when flow compared to certain to threeareas weeksof the afterbrain MDMAwhen compared was administered) with controlMDMA showed Research mildly reduced re- baseline scans of MDMA subjects. Reduction receivedwhoin scannedblood had flowlowerreceived nearly in doses. specific two higher monthsTwo areas doses of afterofthe ofthe ten MDMAdrug brain subjects administration was compared morewho receivedpronounced with (forty-three those MDMA in who subjects days were had and MDMAbraineighty compared ingestiondays after with scansMDMA scans indicated was performed administered,Because an increase at baseline.of the respectively),in lack global of differenceblood and flow their in in the post-the baseline scans between Ecstasy usersperimentalproduceappear and to controls, any alter administration lasting cerebral Grob changes concludes blood ofMDMA in flow. the that brain Thisdoes recreational suggestsorseem the to brain's producethatuse metabolism, transient changes but Ecstasy use doesof not Ecstasy does not twoafterTherein blood months MDMA is anflow apparentafter use, in certainusing perhaps return MDMA. regions with to normalsome of the signs patternsbrain of twoincreased of to blood three cerebral flowweeks in blood afterthe brain flowuse. themalitieseffects concentration of in Ecstasy Ecstasy ingestion inusers the wasbrain on sought. theofIn specific brain,the This second evidence wasbrain of accomplished chemicals,the of twoneurochemical studies or by markers, comparinginvestigating abnor- in the possibility of harmful logicalMarkersEcstasycreatine sign, usersincluded ratios. of compared brain NAN-acetylaspartate cellis awith chemicaldeath. the MIconcentrations (NA),compound is a compound myoinositol that found is that a(MI), inknown is non-Ecstasy a andmarker marker, myoinositol/ for users. or glial bio- withbrain,cell a proliferation,history similar of to Ecstasy a scaror gliosis, after use andan a processinsult thirty-sevenHealthy to that the adult takesskin. without volunteers place such after were a history.an enrolledinsult Both to in the the study—twenty-one people MRIEcstasyityand and measures damage users andof were the in levels controltaken. of No subjects chemicals differences in anyimportant were of the found inthree elucidatingand between evaluated NA brain regions values activ- ofin MR SPECT were performed in three distinct regions of the brain, PDF compression, OCR, web-optimization with CVISION's PdfCompressor covered,injurythe in however,these recreational between MIEcstasy values users. in brain.Ecstasy Significant Normal users differencesand NA control concentrations weresubjects. dis- suggest lack of significant neuronal Clinical MDMA Research 313 producesbrain,trols.Ecstasy as Grob evidenced greater users concluded had amounts by higher increases that of MI EcstasyMI levels in MI.certain useand Greater seems higher brain lifetime to regions,Mllcreatine impose exposure suggesting some ratios stress to than Ecstasycumu- on con- the ofagelative NA per effects. in se, all since regions Ecstasy both of usersuse the does brain.and notcontrolIn seemanother subjects to causestudy, possess any Grob neuronal comparable attempted or brain to amounts describe dam- the neuropsychological ef- usetoexcludefects wereensure of recruited Ecstasya thathistory their use. for of brains majorTwenty-fourthe study. were psychiatric freeSixteen people of anyor men withmedical lesions and an eightextensive illnesses,or structural women, history underwent abnormalities.screened of Ecstasy MR]I to designedThe(WATS-R),gence subjects was to assessmeasured in quantifying this attention, study through verbalcompleted memory, the and Wechsler performance a andbattery Adultcognitive of intelligence.Intelligenceneuropsychological performance. Scale—RevisedThe Digit-Span Intelli- tests MemoryOsterreithSymboland immediate Test, Test, Complex a subtestalso recall. a subtestFigure of Information the WATS, servedof the processing WAIS,asmeasured a measure and attentionwas the of measuredStroop constructional and Task.concentration with The the ability. Rey-Digit plexMemorytheVerbal Logical Figure memory Test. Memorythree-minute Visual was measuredsubtestmemory delayed-recall of was withthe assessedWATS, the Reytest, throughand Auditorythe theContinuous Warringtonthe Verbal Rey-Osterrieth Visual Learning Recognition Memory Com-Test, CardthroughScale.Test, andSorting Executive the the Stoop VisualTask, function Task, and Reproduction the Auditory (decision Controlled ConsonantTest, making Oral a subtest Word andTrigrams ofplanning) Association the andWechsler the was testWisconsin assessedMemory of ver- similarbaselinebal fluency. to and a recreational-use once after receiving dose.Fourteen theirAll other second of subjects the experimental twenty-four completed dose subjects the of tests MDMA, completed once. these tests twice, once at PDF compression, OCR, web-optimization with CVISION's PdfCompressor Afteranytest314 scoressignificant with differencespublished norms on the available for each test. scoring the subjects'MDMA Research performance on each test, researchers compared neuropsychological tests between the Ec- Analysis did not find normssubjectsdifferencestasy forusers asmost beforeaand whole of the theand controlperformed tests, after groupexceptMDMA at levels at for baseline.administration that fell within within or above the subjects.the published The the Wisconsin Card Sorting Task, There was also no appreciable verbalinhibition.frequencywhich recognition correlates ofLength Ecstasy tomemory ofdecision abstinence,use andscored making better worsein and onmonths, tests planningon measures of for mental the subjects ofspeed visual and was memory cognitive positively and Subjects with greater jectsvisualrelated performed memory. to performance Theon these longer on tests. tests the timeof Grobdivided without concluded attention, Ecstasy that use,working a single the better dose the of MDMAsub- does not produce any mea- and performancestakingsurableand memory,frequent deficit inon dosesbut attention, tests their of of MDMAperformance decision may making performis not and necessarily less planning well onbelow ability tests average. of are attention dimin- Only intelligence, or executive function. People stasyity.ishedcan According usersinreduce Ecstasy and function tothe users, Grob, general inthough this the public may frontal a single reflect or lobes.show dose preexisting evidence does not differencesthat further affect between this abil- Ec- chronic Ecstasy use stagementlatory cancer.of agencies the psychological to investigate distress theDr. safety and Grob refractoryand plans efficacy to paincontinue of MDMA his attempt in the treat- to secure approval from the regu- associated with end- MRTmethamphetamineChang,References L., C. S. Grob, [MDMA]) T Ernst, on et cerebral al. 2000. blood Effect flow: of ecstasy study.A co-registered (3 ,4-methylenedioxy- SPECT and Psychiatry Res. 98:15—2 8. J. Magn.Grob,ationsChang, Reson.C.in L., recreational5., T R.Imaging Ernst, E. Poland, C. 10:523 ,4-methylenedioxymethamphetamineS. Grob, L.1—6. Chang, and R.and E. T. Poland. Ernst. 1996.1999. PsychobiologicCerebral (MDMA, (1)H "ecstasy") MRS effects alter- of users. 3,4- PDF compression, OCR, web-optimization with CVISION's PdfCompressor Clinical MDtIA Research 315 Int.J.Grob,preliminarymethylenedioxymethamphetamine Drug C. Policy S. observations.1998. 9:119—24. MDMA Behav. research: Brain preliminary Res. 73:103—7. investigations with human subjects. in humans: Methodological considerations and patientsCarolinaMichael C. within MithoeferCharleston chronic andPTSD. are Kathleen planning They Brady submittedto study the potential at the Medical University of South a protocol to the Food and use of MDMA in ingaboutapprovalDrug therapeuticor relieving Administrationthe issafety pending. processing symptoms and efficacy inThis June of of pilottraumatic 2001,ofPTSD. MDMA-assisted study and Theexperiences, will at researchthe gather time psychotherapy ofpreliminary withsubjects, this the book's goal between information inofpublication stimulat-reduc- the receivemedicationsandages will of twoeighteen have oral and/or undergone doses and psychotherapy. sixty-five of at125 least mg years,one of TheseMDMA. unsuccessful will carefully meet The criteriadoses selected will for be volunteerschronic given fourPTSD will attempt at treatment with to chotherapypreliminaryofsix a male weeks psychiatrist sessionsandapart follow-up in anwill and open-label occur a therapyfemale approximately pilotnurse,sessions. study. will The performThefour two treatmentto MDMA-assistedsix twelve weeks team, ninety-minute composed apart. The psy- surements.fourScale,Clinician-Administered months administered after the at lastthe outsettreatment PTSD of Symptom the session, study andScalewill againbe and used atthe four Impact weeks of and Events as outcome mea- at stance,ManyConclusion MDMA seems to increase certain cardiac parameters, such asof blood the cited studies have supported one findings. For in- studiesnotpositionpressure been under andincorroborated, MDMA heart way. rate, For metabolism. apredictably,simply drug being because Other and used findingsthere by millions isare an by too enantiomer-specific these fewof people researchersclinical around MDMA have dis-the

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 316 MDMA Research world,astory a Scheduleof MDMA. I dnig, which One obstacle in the path to widespreadone research would is expect MDMA's more legal data statusto be makes many projects difficult to initiate. An- generated at this point in the his- opposedtunately,pharmaceuticalother problem to the benefit-oriented U. is companyS. that government because has research. any MDMA is interestmuch To was furthermore in patentedfunding interested the cause humanin the ofin benefit-oriented fundinglaststudies. century riskUnfor- noas makestudiesforresearch, Therapeutic a lookingdonation proceeds atMDMA atpotential ofdrholland.com. this Research. book'sbenefits salesIf ofMDMA-assisted you will are interestedbe donated inpsychotherapy, to seeing the Holland more clinical please Fund

PDF compression, OCR, web-optimization with CVISION's PdfCompressor VOLUNTEERSGIVING MDMA IN TO SWITZERLAND HUMAN andAlexMatthias Gamma, Ph.D., Franz X. Vollenweider, M.D. E. Liechti, M.D., }-Ialfview,"Ecstasy"Introduction aMDMA decade reached mainlyago, its public firstraised peak interest in Switzerland. because of itsFrom purported unique psycho- awareness of MDMA as a recreational drug called a researcher's point of orientedovertones"anlogical "easily effects. psychotherapy controlled and suggestedEarly altered scientific (Nichols that state MDMA investigations 1986;of consciousness might Shulgin be reported useful1986). with MDMAthatemotional MDMA and produces sensual as an adjunct to insight- tion,depression.ofas introspectiona relatively body image, Moreover, mild, and or short-actingintimacy sense it produced of along self drug minimal(Greerwith capable 1985; distracting of facilitating Downing alterations heightened1986; Greerin states and temporary freedom from anxiety and was described percep- andhallucinogensTolbertConsidering related 1986; drugs andGasserthese (for stimulants unique 1996).example, psychotropic Itwith seemedMDA, which MDE, effects,it shares and it MBDB) constitute to have few of the typical effects of was suggesteda common that MDMA chemical basis. a novel ingwithin")pharmacological (Nichols class 1986; termed Hermle "entactogens" etal. 1993; (from Gouzoulis-Mayfranketal. the Greek, meaning "touch- 1999). 311 PDF compression, OCR, web-optimization with CVISION's PdfCompressor 318 In animal studies,MDMA MDMAResearch has been shown to be a potent releaser of sero- mechanismmototoninof the (5and -HT)neurobiological Spanos of (Schmidt action 1988). of 1987) ItMDMAbasis appeared and, of humanin to humanstoa lesserus moodthat extent,might research and furtherof dopaminetheinto affective ourthe understanding (DA) disorders (Yama- in neurochemical risksitswhichcal, extensive to andthese Ecstasy behavioral neurotransmittersrecreational users. effects use, ofinformation had MDMA been implicated. seemed on the psychological,important Furthermore, to assess physiologi- in view possible of MDMAatseventy-four a broad and thecharacterization healthy concomitant volunteers neurochemical of the Based(fifty-four psychological on andthis men neurophysiological rationale, and and twenty behavioral we women), have changes effectsconducted aimed several studies in a total of of underlyingHealthpurposes,Swiss drug Office. them. depending legislation Our These studies on thatstudies case-by-case alsoallows werewere the madeapproved use permission of legally MDMA by the possible from forlocal medical the ethics on the committee.or basis research of Swiss Federal naiveforedose subjects admissionof MDMA in todouble-blind, (1.35—1.7 one of the mg/kg studies, placebo-controlledAll ofstudies allbody subjects wereweight) prospective were experimental to healthy, screened and mostly settings.byinvolved psychiatric MDMA- Be-the oral administration of a single alltheMDMAinterview subjectsexperiments administration. and gave by andtheirmedical the written possible Afterexamination consent. being risks informed toandParticipants minimize benefits of theany wereof MDMA procedurespossible mostly administration, risksuniversity involved related stu- into themeasures,study.dents, reader This ages sensoryis chapter referred twenty infonnation summarizes to thethirty, original processing, whothe effects hadliterature. a personalofand MDMA brain oractivity. on scientific psychophysiological For interestmore in the details WhendosepsychologicalPsychological identification. effects This were situation retrospective was partly and due anecdotal to the fact and that lacked using drug MDMAwe started our research with MDMA, most reports Effects of MDMA available on its and PDF compression, OCR, web-optimization with CVISION's PdfCompressor pounds,tabletsfor sold so that for theirrecreational effects could use often notprospective be contained ascribed clinical otherreliably studies psychoactive to MDMA was illegal alone.com- in most countries and that Ecstasy Giving MDMA to Human Volunteers in Switzerland 319 Todardizedof avoid pure theseMDMA, psychometric limitations we used ratings and prospective to obtainedobtainThe Alteredwithin-subject robust during dataStates the on peakof studythe Consciousness subjectiveeffect designs of thewith effects ratingdrug. stan- scale (OAV) is a visual-analog lessness),OAVofscale the thatconsists self/ego measures measures of and three derealization ofalterations dimensions.the environment in and mood, The depersonalization first (Bodmer thought dimension, processes, 1989; OB associatedDittrich (Oceanicand experiences 1998). with Bound- Thea positivealteredtarysion, and VR basic experience complex (Visionary mood hallucinations, and of Restructuralization), meaning.alterations synesthesia,The in the third sense refers dimension, facilitated of totime. visual The AEDimagination, illusions, second (Anxious dimen- elemen- and Ego the ingratingandDissolution), efficiency/activation, thoughtscale (AM) control measures (Janke associated andthought self-confidence, Debus with disorder, 1978) arousal consists egoheightened and disintegration, anxiety. of fourteen mood, The apprehension!scalesandAdjective loss measur- of Mood body version,emotionalanxiety; inactivation, depression, excitation. dazed thoughtfulness/contemplativeness, state, Thetiredness, subjective sensitivity; effects aggressionlanger, of MDMAextroversion, turned andintro- out to be highly robust, despite Analysis(LiechtiGammasome differences ofet et al.the al. 2000b; pooled 2001a), in Liechtithe data showed experimental of and all Vollenweider thatstudies, most settings including subjects 2000a,b; (Vollenweider seventy-fourunder Liechti MDMA et etal. subjects al.2000a,b). experi- 1998; asgeneral,andenced more sociability, a statesubjectspleasurable of heightenedprofound felt carefreethan well-beingusual. emotional and Therelaxed. andsensitivity;perception Physicalhappiness, andof sensations space increasedslight derealization. were extroversion described In and time was al- butceptualtered, elementary and changes. subjects hallucinations, felt dreamy such orThere lost as in distortedwas thought. only objects,a MDMAsingle flashesreport induced ofof sceniclight, few per- andor complex visual hallucinations, PDF compression, OCR, web-optimization with CVISION's PdfCompressor seemedsimpleof320 MDMA to move (mg/kg) closer positively or farther correlated away. The with dose the according intensity to of body perceptual weightMDMA patterns,al- Research were common. Colors appeared more lively, and sounds impairedterations,(Liechtiof 1.35—1.7 particularlydecision etal. 2001a).mg/kg, making, in produced MDMAwomen. accelerated alsoThus, more led higherhallucinogen-like thinking,to thought doses and disturbancesof MDMA,losing perceptual track in that the of changesincluded rangeone's MDMAatedablethoughts. withstate were anxiety ofThe notloosened slight experienced occurred depersonalizationego boundaries.in as a fewproblematic subjects Transient and ator mild onsetpsychotic dysphoric ego of the impairment but drug'sreactions as a action,pleasur- duringassoci- but werebaselinethis reassured mostly psychometric passed by the when experimenter. ratings subjects did Women becamenot differ generallyacquainted between showed thewith two the stronger genders drug effect responses (Liechti and to MDMA than men, though ementaryportedpersonalization,et al. 2001a). stronger hallucinations Women perceptualand altered had and significantly changes, opticalperception illusions. in higher particularof time Finally,ratings and a higherspace. for women positive frequencyWomen scored mood, also higher of re-el- de- ofdisturbanceslessnesson lossanxiety-related of and body defenselessnessalso control. were measures. more The women'spronounced andThese an increasesincreased increased in women, wereneed sensitivity due forparticularly protection.to feelings to MDMA greater Thought even fear of help- appetite.ing,extended difficulty to its concentrating, side effects: more dry Themouth, women psychological thirst, than menimpaired experiencedprofile balance, of MDMA jaw and clench- lack that of emerges from these studies is clubs.vatingpossiblyin agreement Perhaps effect one ofexception.with this MDMA isanecdotal a purely Inwas our reportspsychologicalmuch experimental less from pronounced recreational effect setting, of the thanthe Ecstasyrecreational stimulant, at raves users, or orsetting, dance withacti- fromingin sumedparticular, people. amphetamine, separately It the also infectious atmay whichraves. be effectthatBesides often the of is onlyactivationloud contained moderatetechno Ecstasy inmusic stimulant Ecstasy andusers thetabletseffects, report many orMDMA'S comes danc- con- PDF compression, OCR, web-optimization with CVISION's PdfCompressor hallucinogen-like effects were also very mild in our studies and consisted Giving MDMA to Human Volunteers in Switzerland 321 being,experiencedistortionmainly contentment, of intensified ofwas objects. a feeling and perceptionThe opennessof predominant,emotional of toward color, warmth typical touch,other associated people,andcomponent sound with which as enhancedof well isthe not asMDMA slightad-well- proposedthereforeequately confirmclassification described a uniqueas typical as an psychological entactogen. of Theeither clear-cut stimulants profile gender orof hallucinogens. MDMA differences and support Ourin the findings behavioral its responses to MDMA whichanmoodare increased striking disorders, may reflectwith sensitivity especially regard a sensitivity ofto womendepressionthe well-documented tO toserotonergic MDMA-inducedand anxiety. changesfemale Our serotoninfindings preponderance that arise may depletion, from signify for an Cardiovasculartonergiccreasedinternal susceptibility causealterations as well. are to Thisimplicated mood heightened disorders, in mood sensitivity since disorders. endogenously may manifest caused as an sero- in- Effects of MDMA MDMAmmsureeffect Hgafter that for MDMA was diastolic more was bloodpronounced about pressure. 30 mm in men. HgOne-third for The systolic peak of the increase blood subjects pressure in hadblood systolic and pres- 15 increased both diastolic and systolic blood pressure. This is the only valuesrateHg)blood bywithoutabove pressure about 180 other 13 mm valuesbeats signs Hg. per of Oneof minute.more hypertensive man than had 160a hypertensive crisis. mm Hg,MDMA and reaction also10 percent increased(240/145 reached mmheart AcuteAdverse adverse effects included jaw clenching, dry mouth,Effects and loss of ofMDMA appe- generallyrestlessnessflashes,tite. At theparesthesia considered onset were ofnoted (a themild tingling inMDMA and about were feeling), one-thirdeffect similar andsome to of dizziness. those thesubjects subjects. reported Tremor reported Sideby Ecstasyand effectsnausea, increased users. were hot PDF compression, OCR, web-optimization with CVISION's PdfCompressor There322 wereMDMA Researchno complications requiring medical intervention. Some acute thirdfatigue,mouth,effects of of andthemuscle MDMA increasedsubjects ache, lasted reported jawand upmuscleheadache to slightly the tension. next in depressed about day, Newly halfincluding mood, occurringof the lackincludingsubjects. aftereffects of appetite, Up emotional to wereone- dry theseupirritability, to adversethree lack days aftereffects of in energy; a few thanbrooding, men. and bad dreams. These side effects lasted Processes Associated subjects. Women reported significantly more of withHavingaspectsNeurobiological MDMA of the MDMAEffects experience, we used elucidated several important phenomenological and physiological different strategies to investigate actionquestionchologicalthe neurobiological of were MDMA, effects to examine ofto processes MDMAuse thefunctional neurotransmitters inthat humans. could brain beThe imaging responsible approachesinvolved to identify in for theto the addressing neurochemical brain distinct regions psy-this informationinvolvedEffectsIn animals, of inMDMA mediating MDMAprocessing. on Neurotransmittermainly its effects, releases and Systemstoserotonin investigate (5-HT) the effects (Schmidt of MDMA 1987) via on forinteractionReiddopamine the serotonergic1990). with (Yamamoto In the addition, 5-HT2serotonin and MDMA receptors Spanos transporter, has 1988) (Battaglia been and,and shown norepinephrine toet aa!. lesserto 1 have988a). extent, moderate [For(Fitzgerald it areleases affinityreview and HTinBrain."jof humansthe transporter-mediated pharmacological Based would on bethese primarily findings,action 5-HT ofdue release. weMDMA, to hypothesized its Thisprincipal see view "How that neurochemicalis supportedMDMA the effects Works by of action, the in MDMA find- the 5- giveninduceding1987; that the 5-HTHekmatpanahselective fact releasethat serotoninpostsynaptic or and the Peroutkabehavioral reuptake serotonergic 1990; inhibitorseffects Gudelsky 5-HT2 of MDMA(SSRTs) receptors and in Nashblocked animals have 1996). MDMA-(Schmidtbeen im- Second, PDF compression, OCR, web-optimization with CVISION's PdfCompressor Vollenweiderplicated et al. 1998b), we speculated that 5-HT2 receptor stimulation in the effects of classic hallucinogens (Sanders-Bush and Conn 1987; Giving MDMA to Human Volunteers in Switzerland 323 (Liebermaneuphoriasincemight dopaminebe producedresponsible et al. is1990; by thought for classic Laruelle the mild tostimulants, play ethallucinogen-like al. an 1995; importantsuch Schlaepfer roleaction inet ofal.the MDMA. 1997; mediation Volkow Third, of as d-amphetamine and cocaine MDMAtiveet moodal. 1997), (1.5 effects mg/kg increased elicited taken dopamine by by MDMA. mouthTo activitytest [P0]) these also in hypotheses, humans might contribute after we assessed to the the posi- psychophysiological effects of pretreatment inergicHT2ofwith theantagonist theD2 three SSRIantagonist studies ketanserincitalopram usedhaloperidol a (50(40 double-blind, mgmg (1.4 P0)IV) mg/kg inin fourteensixteen placebo-controlled, P0) subjects,in subjects, fourteen the and subjects. serotonergicwithin-subject the dopam- Each 5- Gammatreatmentingdesign. administration Thus,et plusal. 2000a),all MDMA. subjects of weplacebo, Asused participated in the ourpretreatment OAV other in and studiesfour the alone, experimental AM (Vollenweider MDMAscale to sessionsassess alone, et subjectiveal. and involv- l998a, pre- inducedMDMA,peak changes positiveas evidenced after mood drug by (OB), intake.similar thought reductionsThe SSRTdisturbances, in citalopram all scales and of reducedmarkedly the OAV. control reducedMDMA- most psychoactive effects of over ofcitalopramtenuatedthought MDMA and after also(Liechti body citalopram lessened (AED) and Vollenweiderthe as pretreatment acutewell ascardiovascular perceptual 2000b). (Liechti Italterations response thuset al. appears 2000a). to (VR) and that In side addition,the effects SSRI were all at- edlyeffectstherebyprevented prolonged of "buffered" MDMA the interaction after were the citalopram overall not of only MDMAIn MDMA pretreatment. attenuated,contrast withexperience. to butthe citalopram, alsoserotonin Ofat thenote, pretreatmenttransporter the subjective and with the 5-HT2 antagonist same time mark- thelucinogensexperienceketanserin perceptual resulted (Liechtisuch effects as inpsilocybin,et onlyal.of MDMA.2000b). a moderate however, Similarly These attenuation ketanserinresults to studies suggest of significantlythe with subjectivethat serotonergic stimulation decreased MDMA hal- of PDF compression, OCR, web-optimization with CVISION's PdfCompressor humans.3245-HT2 Finally, pretreatment with the dopaminergic D2 antagonistMDIIA Researchreceptors may mediate the hallucinogen-like action of MDMA in halo- mayrealization.peridolal. 2000a)contribute selectively Thesebut increasedto findingsreducedthe euphoric the theare negative euphoricin agreement effects (OB) withof effect MDMA, the of view MDMA such that as effects of MDMA. It is also notable that anxious de-(Liechtidopamine et Vollenweiderreceptorsserotoninhaloperidol mayand/or did2000a). be not norepinephrine,involved lessen It appears, cardiovascular in these then, or receptorthat responsesother sites neurotransmitters, other to MDMA (Liechti effects of MDMA. than dopamine D2 such as and throughchologicaleffects interaction of effects MDMA of ofmay MDMA MDMA be related in with humansIn sum,in the part 5-HTourlargely to pharmacologicaldopaminergic uptake depend carrier. on D2serotonin Positivestudies receptor described here indicate that the psy- releasestimu-mood D1,suchbelation. due and as Thetonorepinephrine, 5-HT1 5-HT2 mild receptors, hallucinogen-likereceptor and instimulation. of the recognition action perceptual ofThe sitesMDMA role sucheffects of remains otheras theof MDMAneurotransmittersalpha-2, to appear to be elucidated. dopamine jectsemissionEffectsTo identify (Gamma of MDMAtomography brain et al. onregions 2000b).Brain (PET) Activitymodulated A study single in oralby sixteen MDMA, dose healthy,of 1.7 we mg/kg conducted MDMA-naive a MDMA or pla- positron sub- fashion.teausuredcebo of wasby Regional MDMA [H2 administered 015] effectscerebral typicallyin blood a double-blind, flow is reached as an indexrandomized, of brain and activity was mea- -PET seventy-five minutes after drug intake, when the pla- (Vollenweider et al. 1998a). Rat- counterbalanced paralimbic,fourings hoursof subjective after and neocorticaldrug experience intake, areas. using duringMDMA Blood the theOAV flow PETproduced and was measurement the increased AM marked mood bilaterally were alterationsrating of brain activity in obtained limbic, scales.in the ventromedialanteriordecreasedtemporal and lobe, blood prefrontalposterior the flow medial bilaterallycingulate, cortex, occipital the inand ventralthe lobe, the pre- superior and anteriorand the paracentral entiretemporal cingulate, cerebellum. gyrus,cortex, the the insula, and MDMAinferior dorsal PDF compression, OCR, web-optimization with CVISION's PdfCompressor parahippocampalthalamus. formation and uncus. Furthermore, blood flow in the left Unilateral decreases were noted in the left amygdala and right Giving MDMA to Human Volunteers in Switzerland 325 varietybrainamygdala ofactivity brain tended regionsunderlie to correlate that the have subjective withThese been scores resultsshown effects for toshowanxious of be MDMA. involvedthat derealization distributed MDMA in mood changes(AED).affects regu- a in cerebral blood flow and ofalongparalimbiclation these withand sites (cingulate,theiremotional likely associated plays orbitofrontalprocessing—these a neocorticalsubstantial cortex, roleareas temporalinare in the the mood-enhancing frontallimbic cortex) lobe.(amygdala) brain Modulation structures and pro- and Ourresponseamygdala,social study properties and andin particular,its many conditioning of MDMA.previous has a well-established (MulanfunctionalWithin andthis imaging Penfleld network function studies 1959; of in brain mediating (SchneiderLe Douxregions, the1995). et fearthe a!. measures.true:activity1995; lower Ketterto Other be activity correlated et brain al. 1996;in imaging the with Kalin left higher studiesamygdala et al. scores1997) have correlated likewise infound anxiety-related that found with the pleasurablehigher reverse psychometric left also amygdala mood is moodafterbilitystates, taking that andincluding reducedwell-being. MDMA, euphoria activity may (Kettercorrelate in the etamygdala, withal. 1996). MDMA-induced as These found results in our enhancement raise subjects the possi- soon of etacousticWeEffects al. investigated 2001b). of startle MDIVIA Thereflex the on startle ineffectsInformation forty-four reflex of MDMA Processing issubjects a contraction on (Vollenweider pre-pulse of theinhibition et skeletal al. 1 999b; (PPI) and Liechti facialof the iselectromyographyInmusculature thehumans, unlearned the in eye-blinkresponsesuppression of the orbicularisto component aof sudden startle oculi intensewhenof the muscle, the startle stimulus, startling which reflex such stimulus circles is measuredas a the isloud precededeye. noise.using PPI nitivenoise.noiseby a weaker precedes PPIand issensory regardedpre-stimulus a louder information, as noise, a bymeasure 30there toand is500of ittypically sensorimotor ismilliseconds. a way a bluntedof measuringgating, For response instance, or filtering pre-attentional to theif aof loudersofter cog- PDF compression, OCR, web-optimization with CVISION's PdfCompressor deficits326 MDtIA Researchthat are frequently seen in schizophrenia and other psychiatric disor- serotonincludingstudiedders. The extensively MDMA, pharmacologicalreleaser MDE,fenfluramine, in rodents and effects AET(Geyer impair of(alpha-ethyltryptarnine), andMDMA-like PPI Callaway of the startle drugs1994). onreflex Entactogens, PPI as well inhave rodents, as been thein- humanshealthyand this volunteers,versusimpairment animals thus is reduced(Vollenweider having byan Surprisingly,pretreatmentopposite et al. 1999b).effect with we on In found SSRTs.sensorimotor addition, that thisMDMA gating effect (1.7 inof mg/kg P0) increased PPI in pearsinbyMDMA thehaloperidol thateffects was the attenuated ofeffect or MDMA ketanserin ofMDMAon by on pretreatment PPI(Liechti in PPI humans et in al. humanswith 2001 and the b).rats isSSRT The was observed citalopramunexpected. difference but It notap- due to MDMA-induced methodologicalofreleaseand the humans,functional of serotonin, since differences consequences asMDMA it is in or hasanimals. true of opposite the differences releasedIt is effects also serotoninwithinobvious, on PPI. the however, differIt serotonergic is unclear between that whether some sys- rats animalsthoseiestem indicate between in andanimals, that humans. rodents MDMA and and they might humans underscore have account effects the for inneed humansthis for discrepancy. comparison that are different studies from in These stud- ConclusionmissionMDMAOur throughare based an mainly interaction on an with enhancement the presynaptic of serotonergic neurochemical5-HT uptake neurotrans- site. investigations This indicate that the subjective effects of totonergicmodulationfinding be crucially is innervation in ofagreement brain involved andactivity withform in the thein an ourregulation interconnectedmarked PET study.limbic, of mood Thesenetwork paralimbic, and areas that emotion. arehasand rich beenneocortical in shown sero- Thus, it modulatingandappears associated likely serotonergic thatneocortical MDMA transmission, areas. exertsWomen its strongparticularly showed effects a markedly in on limbic mood increased and paralimbic subjective responsiveness to MDMA and emotion by PDF compression, OCR, web-optimization with CVISION's PdfCompressor thatcompared this gender difference may be related with men. It is an intriguing possibility deserving Giving MDMA to Human Volunteers in Switzerland to the fact that women are also further study 327 modelsPPIthemore 5-HTin susceptibleof rodents human system compared function to has mood been with anddisorders, implicated. emphasizehuman such beings The theas depressionpointoppositeimportance effects and anxiety, in which to the limitations of animal of human studies. of MDMA on 316.98.0686),grantsThese studies 31—52989.97), were and thesupported Heifter the Swiss in Research part Federal by theInstitute, Swiss Office ScienceSanta of Health Fe, (BAG Foundation (SNIF New Mexico. grant

PDF compression, OCR, web-optimization with CVISION's PdfCompressor GIVING MDMA TO HUMAN VOLUNTEERSUNITEDAnCharles Interview Grob,STATES IN M.D.with THE JH:sort IHarbor-UCLACG: think of work I would you do. like Medical to start byCenter, having and you I'mintroduce a ProfessorI'm of the director of the Division of Child and Adolescent yourself and explain what Psychiatry at the Psychiatry at MDMA.years.UCLAcinogens I've School had within aof long-standing Medicine. the field of I've psychiatry been a psychiatrist and, more for more interest in the history of research with hallu- recently, an interest in than twenty JH: BeforeLSDCG: in you psychiatry? had heard about MDMA, you were interestedAbsolutely. I feel that these substances have extraordinary perhaps in the use of potential to understandinghelpusedtive us treatments. under learn optimalabout of mentalI think the conditions. mind—the theyillness, have and I alwaysgreat mind/brain to develop potential stipulate interface—toinnovative that as value to psychiatry if they're the limiting factor, and more effec- improve our tweenthey be the used appropriate appropriately use withinand not a misused. It is essential to controlled328 investigation or a controlled distinguish be- PDF compression, OCR, web-optimization with CVISION's PdfCompressor Giving MDMA to Human Volunteers in the United States 329 factors.taking,aretreatment poorly and prepared, do not know do nothow understand to establish the proper nature safeguards of the substance and protective they're setting versus uncontrolled recreational use by people who often JH:CG:theinformed When procedure, youconsent peiformed what from sort your ofyour risks subj clinical didects you and research outline?explained with the MDIVIA potentialOur risksand and benefits of research subjects were all normal volunteers who had prior experi- you obtained effectssiveducedence discussionwith by of MDMA. theMDMA, drug, of what Whenboth so they wasimmediate we already knownobtained and understoodto their date long-term, consent, about the theestablished psychologicalwe potential conducted and for specula-stateadverse in- an exten- gettingwerenottive. looking Wesimply a reallybaseline tolooking didexplore setnot to of discuss establishthe physiological potential benefits a foundation benefits toand any psychological greatforof MDMAdoing degree, human in databecause this researchfrom study. we human andWe were severaltreatmentcausesubjects. protocols the It media,study. was to not We ondo a occasion,so,have treatment which not donehave study. sostatednot asThat's been yet, incorrectly approved. importantalthough that we to wehaveemphasize, conducted submitted be- a JH:young WhatwhichCG: peopleis isyour that oftenview there ofdo isthe not more risks know and of unsupervisedwhat more they drug are substitutionMDIVIA taking. Besidesuse?There with Ecstasy,the drug sosub- that are many dangers with the recreational model, not the least of settingdrugon.stitution And use is problem,thereoften that most occurs.are therethe people Theissues is often problemengage concerning an appreciablein with prolonged using the context degreea anddrug vigorous ofinlike polydrugwhich MDMA exercise this use in kind agoing ravein of a fluids.participantstion.place Therewhere At times, isinthe alsothese ambient the the marathonmanagement problem environment dances with of establishments fluidforgetis frequently replacement, to take hotbreaks where and in and has ravesthat replacepoor sometimes are ventila- taking body

PDF compression, OCR, web-optimization with CVISION's PdfCompressor greatplace330 deal of premorbid psychopathology; has not made adequateMOMA Research fluids available. Also, people who may have a specifically previous serious psy- JH:other Ischiatric it drugfair todisturbances, use say, may in your be atview,who risk getthat for involved theparticular risks associatedwith kinds MDMA of with adverse as clinical a simple side research effects. extension are of minimalever,textCG: ofI one believeand an needsapprovedcontrollable? that to itbe researchis wary possible of study to administer and to MDMA safely within the con- particular kinds of side effects. I'll explain that learn a great deal from that. How- placebo.ferentthreeby describing experimental doses These of a MDMA,sessionscouple sessions. of wereand clinical During onrandomized one examples. two occasion of and them In theydouble-blind,our subjects researchwere givenreceived model, so anneither inactivetwo we dif-the had perimentalingparticularsubject the northird session. occasion. my session, research He One hadafter staff person,tolerated about and I a anknew youngthe hour other what man,he twowassustained came withbeing to no aadministered us rapidproblems. for his third Dur-on anyex- elevation of hadotherquiteblood been alarmed,two pressure, administered occasions. but from I also I a knewMDMA. baseline realized that So ofthaton I about at askedsomething least 120/80 him one what ofhad to those toaroundwas be otherdifferent different 220/100. occasions this from I time. was the he themorning.close day beforeto the His hospital,the friend session hadso hethat a hadcat, he Hespent andcould replied apparenfly the get night thatto the athe he's researcha hadn't friend's allergic thought center house to cats. earlyitwho important in enough to let us know, but He had lived the hadinducednotfriend an thought allergic had by suggested thethis reaction interaction was thatimportant and he experienced between take enough some this asthmasome tomedicine respiratory medication. and the distress, TheMDMA so was a let us know earlier. What was subject had his however,downfairlyrisks seriousrapidly, of whattaking hypertensive andI thethought there drug were wasin reaction. a arecreational no relevant negative Fortunately, concern setting—that consequences. in his terms blood people of It pressure thedid who are came con- additionalhighlight,

PDF compression, OCR, web-optimization with CVISION's PdfCompressor currently on particular medications most likely are not aware of the risks of Giving MDMA to Human Volunteers in the United States 331 ritonavir,Medicine.interactions whichThis and was is thea a protease case likelihood of a inhibitor. man Anotherof whoincreasing He was example apparently being adverse of treated this took is with cited MDMA the in aHIV and1999 had article in the Archives consequences. oflnternal drug incytochromeritonavira dangerous his life was when P450 cardiovascularinhibiting he 2D6 was enzymethe not metabolism reaction,on system.any HIV which ofThis medicationsMDMA was attributed at the and level had to of the tolerated the fact hepatic that man had taken MDMA earlier it subjects,withoutabout potentialany eighteen problems. medication of whom The message went interactions. Goingthrough here backis the that toentire the questions study. After of our about study, we recruited a total of nineteen one has to be very cautious an environment.thatsession.hour, when the He one he became isHeother on told a subject verydrug us that distressedlike complained the MDMA, cause and for heagitatedof his becomesanxiety angst and during highly attributed hissensitized first it and only was that he was "picking to the fact to his nothospital,ofup the onhave allstudy toforthe return weresafetynegative forsuch reasons, the vibes that two inhebut subsequent the had that hospital." to he commit could sessions. I toldleave to spending Ithe made in subjectthe it morning. clearthe that night to the him He rules thatdid at the sinceto coursehethe had hehospital had hethe decided formallyoption and that ofto withdrawn hetake.dropping wanted He informed tofromout withdraw of the the mestudy, study fromthat we heatthe were thatwas study point,notable entirely. going to which break to Later, return isthe the ceboiscoveredblind never response.to seethatto underestimate how he had much been MDMA administeredthe power he had of ansuggestiontaken. inactive To placebo.and the power The lesson of the there pla- our great surprise, we dis- JH:expectationsandstayed I remember panic with reactions, me. about that It's what youimportant, and toldtheir I think meexperience because thisthat storya goodpeople is goingback part often when toof be. thoseask it happened, reactions isand just it people'sreally me about anxiety reactions

PDF compression, OCR, web-optimization with CVISION's PdfCompressor NewarticleCG:332 Speaking York in the City, American and it Journaldescribed of Piychiatry two young about people ten years ago? HDIIA Research of panic reactions, do you remember that there was a who had panic attacks It was from brief whichpotentialrotonergicafter taking the adverse panicmechanism MDMA. attack effects The for occurred, of panicauthors taking attacks but MDMA.speculated they and didn't Theywarned about makedid thatthe mention much panic implication of a se- of it.theepisodes The context two were in tureNewunderestimateyoung that York people you for don't weremanyyears,the importance needon a Newto andbe onofdrawing seta and upon setting. that Iexperience can tell you that I York City subway train. It is important never to mind-altering drug to have a panic attack Iwould conjec- lived in JH: Allaon supervised athis New really York clinicalunderscores subway. setting the versus... tremendous between using MD1I/IA in illicitPurduelatedCG: issue—thatmarket. University, This the MDMA was MDMA extremely was we originally were pure, provided unlike synthesized the with, drugThe byunder David a supervised setting markedly diminishes risks. We identified a re- often sold on the private con-Nichols of dealsayed"MDMA'stract of to as experience provide 99.98 Promise percent material with as a recreationalpure. Prescription suitable Our subjects, Ecstasy, Medicine"], particularlytold me and that his thosethe quality for preclinical toxicology studies [see product was as- with a great of their theirclearer"whatexperience blackthey altered weremarket during state, accustomed Ecstasy.the without experimental to.many They of drug thesaid side session that effects it was they aquite much were used to different from "cleaner and with JH: aversusOne rave of Ecstasy.setting, the things whereIt's always that anyone I'm important attentive can buy to to is when people talk about anything, I always insist they refer to it as the two. When people talk about MDI VIA certainandaboutEcstasy, polyd a abnormalities.lot which rug of publishedusers is a whogroup scientific take of unknownEcstasy articles and drugs. inmaking which• I think assertions researchers that you about andare MDI I are studying ravers VIA causing both irate PDF compression, OCR, web-optimization with CVISION's PdfCompressor ture,tors.CG: ThereOneand alsoproblem in the that media, has arisenis confusing repeatedly the apparent in the neuropsychiatric effects of recreational litera- are very poorly controlled studies conducted by some investiga- Giving MDMA to Human Volunteers in the United States 333 ravers50tution,Ecstasy percent ingest there with of a is thosevarietyEcstasy no assurance of ofisMDMA. foundother that drugs,on These Ecstasy assay somedays, to is beMDMA. ofbecause MDMA. which Atof have Also,somerampant very manyraves, drugpowerful hardcore less substi- than theismizecentral often Ecstasy the nervous extensive,significance they system are and oftaking effects.arethe polysubstanceinattentive is notIt concerns MDMA. to usethe me Therehistoriesstrong that someis likelihood alsoof their investigators a pattern subjects, that muchin whichmini-these of alsoingrisk-takingstudies factor tend of toattributingthat people ignore there solely theare the significancemany dysfunctionalto MDMA. other drugs ofThey lifestyles the that ignore fact these thatand the peoplebehaviorthese very peoplestrong are of taking. these contribut- often high-They are weekendtionalstrongly deprivation they identified subject andwith themselves ingest the rave a variety culture Ito believe prolonged of and different that engage itperiods is drugs.importantin a oflifestyle sleep to acknowledgewhereand nutri- every that many of these high-risk aspurportingtheypeople the would peer had toseverereview engage establish baseline processes in dangerousthis psychopathologicalkind that of hasconsequences lifestyle. supported Some vulnerabilities fromtheir of generousMDMA the research that use—as government predicted reports well MDMAultimatelypsychiatricfunding but and alsonot journals—are their only to restorepublication, to answer scientific in needquestions at times of credibility serious inrelated the reexamination.mostto to the the prestigious field. true range It medical isof important effects and of JH: tisticalmediaI agree attention,manipulations is severely of data, flawed. leading There to deceptive also have conclusions. been problems Some with of the serious memory sta- that much research, especially the projects that have received a lot of wasandstudiesCG: then that coming playing the MDMA out with are athe goodusers numbers. example. who had Researchers spinal taps are togiving measureOne a large the battery serotonin of tests of the first human MDMA studies is a good example. The claim PDF compression, OCR, web-optimization with CVISION's PdfCompressor 334 MDMA Research havechronicappropriatelymetabolite elevated pain, andappreciatedlevels it is of known 5-HIAA that that the in people controlstheir spinalwith for chronic thefluid. study I painthink were syndromes that patients was some- often with 5-HIAA in their spinal fluid had abnormally low levels. It was not MDMA;tonergicperformedwhat deceptive, function.even L-tryptophan though but They even there did worsechallenge werethis was test no tests,aonstatistically subsequent subjects an indirect whosignificant study hadmeasurement in awhich history findings, researchers of of thetaking sero- in- MDMA-usingvestigatorsthedamages heart had theof thesubjectssufficientserotonin problem were concernsystem. with not from randomlyThethe integritytheirreport findingsrecruited. did of not this to reveal—and Apparently,conclude research—that that thisthey MDMA gets hadthese to jects.trum.werebeen studied theTheyThis subjects iswere previouslyall preselected!right who insofarscored in the There atascerebrospinal theit mightwas a be fluidinteresting 5-HIAA to study,know andhow these two bottom, at the lower end of the spec- preselection bias in choosing sub- hadpriatedifferentone been ofin thisthe markersrecruited mostcase prestigiousthatof based serotonergic the onpublished previouspsychiatric function article testing. didcorrelate. Thisnot reveal article But that itwas was these published not subjects appro- in journals and has never been retracted JH:who Thereor haveeven is usedanothercorrected. Ecstasy problem two hundredwith these or studies.four hundred Ifyou're times, taking it pretty a group clear ofpeople that you someaboutdisordersare sortpreselecting of or serotonergic compulsive for some dysfunction. behavior sort of psychopathologic or They perhaps are depression. There isthese something people. At the very least, you could surmise that these are people dearly self-medicating and findingcharacteristics—impulse con 1701 with thatCG: taking a serotonin agonist repeatedly is what they needAbsolutely. to feel well. of JH: Isn'tgraduateings.CG: it true They students? that wereone of presenting the control groupstheir data in the on memory neuropsychologicalThis studies was a group deficits is what the investigators told us in England, at the Novartis meet- in PDF compression, OCR, web-optimization with CVISION's PdfCompressor Ecstasy users, and I asked who the controls Giving MDIIA to Human Volunteers in the United States were. The reply was that many of 335 thatevenD.C.the controlsit areasgraduate will bewho were to students participatedthe graduate same will degree tostudentsindulge make as the a infrom little hard-living,substance theextra Baltimore use, heavy-drug-taking but and I strongly Washington doubt sub- money. Now I suspect that JH: Also,mostjects part, whoyou it haveidentify is people to think so who strongly about consider who with themselves volunteers the rave to forhaveculture. studies good memories. of Was education memory. For the usedtendedCG:controlled a lotto minimizeof for other in these drugs. the studies? degree Wereto which the Ecstasytheir Ecstasy-using users graduateNot subjects students alsoalso? had likely. This was a very poor control group. The investigators also JH:bemethorphan, This used isin a veryrave which setting, important are known should point. to be interfere mentioned Certainly with specifically, drugsmemory like processing andketamine these and users and are shoulddextro- likely beto effect.EcstasyCG:excluded Most pillsfrom andofthe these studies.also seemdrugs to are be goingtaken to anhave increasing powerfulKetamine degree effects for their own and dextromethorphan have been substituted for MDMA in on central onlytributingketaminenervous obfuscate system alland identified dextromethorphan, the function. truth and and Disregardingsuspected further which erode pathologic is theconfidence what potential haseffects been in impact the to occurring, MDMAveracity of drugs of and these like at- use, will farJH: andIhavereports. certainly what an understanding your agree plans with areyou. of forwhat I would future kind like ofwork. researchto change Perhaps you gears havethe for way done a minute.to with lead MDIVIA Iinto want that to thus performingHospital,subjectCG: is toclinical in talk the about Divisionresearch how youwith of firstChild MDMA. learned and Adolescentabout MDIVIAI and became interestedfirst heard in about MDMA when I was working at the Johns Hopkins I remember PDF compression, OCR, web-optimization with CVISION's PdfCompressor moreARUPAthat336 information]. meeting [see He "MDMA's Promise as a Prescriptionone of the Medicine" other childMDMA psychiatrists Research at later told me about the meeting and the MDMA Hopkins attended an Esalen for intriguedMDMA.aboutexperience what Thisby what he particularhe had consideredhe hadwas doctor there.saying, to wasI bewasand fairlythe Iquite started potential insightful struck reading. bytherapeutic and how He intelligent, providedenthusiastic application meso Ihewith was was of JH:Whata fewWas I articles,this read before was and veryor Iafter did interesting. athe media attention began in 1985? literature search and found some other reports. CG:tocut myself off from and anyone did a lotwho of had reading an interest on in Yes, it was about then. At that time I was living in Baltimore and fairly training. I was primarily busy learning my the topic. My main focus at that time hallucinogens. I kept my interest wasresearchtimemycraft, completing training faculty. developing could at Concerning myJohns be my psychiatricpotentially Hopkinsskills MDMA as a very psychiatrist and important hallucinogens, and to child look psychiatrist. Iinto, felt thatbut thisI wasI finished area in no and stayed there for several years on the full- of MitchelsionpositionCalifornia that Liester, tothese do I gotso drugs we until to developed know had I moved an Gary unrealized a researchto Bravo California and study.role Roger in We psychiatry.1987. Walsh,interviewed At the who University psychiatristsshared the vi- Together with of whatwhomight(Liester had their havehad etexperiences al.personal sustained, 1992). experiences Thewere, both study positiveand waswithwhat and basicallyMDMA short- negative. and in to the long-termexamine We early felt and thatwhy sequelae this they mid-eighties would be took it, they patient.psychica subject Theirstates. population knowledge with wassome entirelyNone from of our their subjects, first-hand by experience.the way, had ever administered MDMA to a expertise in identifying and describing intra- Quite literaturebyconditions,a number the degree on of MDMA hallucinogen-augmentedthem to which told has profoundustheir that views implications on therapy MDMA as from werea treatment. the consistent 1950s I wasand with 1960s. they believed that when used under optimal also struck the old By PDF compression, OCR, web-optimization with CVISION's PdfCompressor hallucinogenthe research programs. This importantearly seventies, area of political investigation pressures has had forced the closure of established Giving MDMA to Human Volunteers in the United States 337 mannerleast,feltremained that shouldwhether literature virtually encourage those totaboo substancesbe very ussince to rich examinethen, could in with descriptive have in very a therapeuticmore limited material, systematic exceptions. action, which, and particularly I'vecontrolledat the always very JH: WhichCG:in conditions conditions that interested are refractory you in termsto conventional of MDIVIA-assisted treatment.The psychotherapy? protocol I eventually submitted to the Food and Drug Adminis- moderntialend-stagetration depression, medicine (FDA) cancer isolation, examined often patients can and the withdo physicalsafety very severe little.and pain. psychological efficacy We That were wouldof anot singledemoralization, lookingbe a dose to of treat MDMA existen- their in group for which theyhancementchologicalmedical were condition; often andof communication spiritual quite instead isolated suffering, we with emotionally.were to important helplooking facilitate When familyto alleviate Ia andwasrapprochement friends, insome medical of from their andschool, whom en- psy- Hisisteringinone the findingsof journal the LSD most wereInternational and inspiring quiteDPT impressive(dipropyltryptamine) articles Pharmacopsychiatry, I readand includedwas Stanislav toreporting improved terminal Grof's on mood, cancerhis article work reduction patients. in admin- 1972 potentialsEncountersbondingof anxiety, and of with thisdiminishedcommunication Death,research whichpain model andwith I found thatneed family. has forto been benarcotic I lateran too excellent read painlong Grof's control,neglected. description book and Humanenhanced of the JH: ICG:FDA. assume that you had similar goals when you handed Thein your protocol to the goal of our MDMA protocol submitted to the FDA was to conduct hoodcationovera similar of classic aand frightening study, articulation, hallucinogens but experience,we italso is like more felt LSD. dysphoria, that easily Itthere is controlled, shorter wereor general acting,advantages and ego itthere facilitates fragmentation. to is usingfar less cominuni- MDMA likeli-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH:CG:338 What aboutThere the potential analgesicMDMA Research orpain-killingproperties of MDMA? is an important case reported by George Greer. In the early pain.sionswitheighties, a Inthat man the before caused whocontext the had terrible drugof multiple this was pain; ongoing scheduled, myeloma. he wastherapy, on heThe high-dose was Greer man conducting hadadministered narcotics numerous psychotherapy toMDMA bone treat le— the to weeksthe severalman, and and evenhours he monthsexperienced when he afterward. was a underdramatic Greer the acutealleviation ended effects up treatingof of pain, MDMA himnot onlythreebut also during times for reduction in his need for narcot- JH:icsover Jamchotherapy" to about treatremembering boneeight for painmonths more that [see video information].and "Clinical found of the markedExperience 48 Hours program with MDIVIA-Assisted from the fall of2000 Psy- Suecancerreportsof howSue In and ofnicethis MDIVL4 Shane, videoit is to hea "not-induced couple says have that who analgesia? cancer" he used is pain MDIVIAfor free a night. during Are the there session any other anecdotal late in Shane's illness with kidney and mentions to on.thepublishedCG: lateIn that seventies clinicalstudy, animalsand cases early that given eighties, I know MDMA including of. wereThere one are thatsome SashaExcept animal Shulgin studies worked from for discussions in the MAPS bulletin,noted to have seemingly gTeater there aren't any other JH:morphinetolerance I have read toin painfulpersonalanimals. stimuli. testimonials Also, from MDMA family appeared members toof augmentcancer patients the action in the of MAPSeffectexperienceCG: bulletin. of MDMA. or I that have of also a family received member. e-mail Infrom these people accounts, describingI there the was analgesic alsoa severe have heard anecdotal accounts of people who describe their own tainedMDMA—oftenmedicalcondition alleviation condition as well. single-dose of with pain very and treatment—there anpronounced apparent improvement pain. was Following a fairly in dramaticthe treatment psychological and with sus- PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH:after the experience, at least there is less pain forI havethe three read orenough four hours testimonials that the that suggest that Giving MDMA to Human Volunteers in the United States relief is not sustained 339 MDMApotentpatienta unique painis keeps under medicine.medications youthe influenceclear. First, cause It it is isof drowsiness also aMDMA. non-sedating a non-sedating Thereand a analgesic; cloudingare twoanxiolytic things ofmorphine the that (anxiety-reducingconsciousness, make and many MDMA otherbut CG:deservescinesmedication), cause to be sedation and studied we have asas well.a nothingunique I think pharmacological like that that as inpsychiatiy. a result tool. ofWhen this All effect the anti-anxiety alone, MDIVIA medi- you're talking about using MDMA in treatment, I think that it is months,importantoftion single-dose administration or always even years,administration topoint as over a outtreatment the that orlife you're perhaps regimen.of the not patient. two talking Rather or three aboutyou're doses ongoing talking interspersed verymedica- often by JH:prepare WhatCG: isthe ongoing, patient andwhat to is process long-term, what though, arises out is the of thesupportive MDMA psychotherapy, -assisted sessions. to patient also was trying to use self-hypnosis exercises to treat his ArthursubjectsHispain, self-hypnosis Hastingsand who he found had wrote techniquesa that history an afterarticle of the became takingin MDMA which MDMA.more he session describedeffective He he put had inworking them alleviatingfar greater into with a hypnotichissuccess. a few pain. MDMAexperience.callytrance with experience,that regard heThis felt finding to thesewas inducing very peopleraises similar featuresinteresting were tomore reminiscentthe potential ableMDMA to be research ofstate. hypnotized, that Having earlierquestions specifi- MDMAhad that the I JH:a typeThat'sthink ofalteredrtate oneare worthof the thingspursuing.that one I remember can reproduce hearing later about without MDIVIA the drug, early as opposed on—that to itLSD. is message,commonnotCG: need statementyouto take can veryhang going oftenup around the or phone." for in thevery You mid-eighties long, don't maybe needThe was to only take"Once one it repeatedly.you time. get The the early model with MDMA was that it was a drug that people would PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH:340 I always liked that quote. I alsoMDMA wanted Research to cover what else you've studied, in- cludingpressure.fectsCG: ofthe MDMA SPECT We examined studieson vital (single signs—temperature, positron emission We ran eighteen subjects psychological effects using questionnaires. We used through the entire study. We examined ef- respiratory rate, heart rate, blood computed tomography). indwellingall,roendocrineassays of theof intravenouspharmacokinetics subjects, assays (howwe catheters, conducted MDMA and affectsSPECT every hormone thirtyscans minutes to we (how MDMA is metabolized) and also for neu- levels).look On at bloodsome, flowbut not in the took blood for severalbrain—abetweenSPECT weeks baseline(magnetic the afterEcstasy study the resonance lastusers, before MDMA with spectroscopy) drug an administration. administrationaverage Ecstasy and exposure a studies. We found no difference We also did baseline MR follow-up study of 214 times, JH: Didofand MDMA. youthe normalnotice any controls temperature on their changes SPECT with scan results administration of MDMA in a before administration clinicalcomfortablyexceededCG: setting? a degree, in bed whoeven were at the encouraged highest doses. to drink ButThere was a very modest elevation in temperature. I don't think that it fluids.these were people lying JH: decrementsCG:What, in blood flow in particular regions, butAt the two or three weeks after anything, did you see of significance on the SPECT MDMA administration, we found modest baseline values were scans? correlatedegenerationrectnormal. itself Whatever toover that. followed time. [See process Or "Doesby it axonalcould was MDMA occurring regeneration. Cause in theBrain That's parallel what you see with serotonin axonal short term seemed to cor-Damage?" for morespeculative, in- but it may flow]JH:formation.] Didn corrected 'tyou itself?also repeat the scans later on, to see the hypopeifusion [low blood

PDF compression, OCR, web-optimization with CVISION's PdfCompressor CG: Most of our subjects received only baseline SPECTs and then repeated Giving MDMA to Human Volunteers in the United States 34! showedforty-threeweSPECTs did seesigns threesomedays of increased weeks andchanges eighty after blood in days theblood flow. last after flow. drugIt shouldMDMA Twodose. be subjects Thewas noted changes administered, that were with were scanned MR modest, andSPECT, again they but youincludingstudiesinjury can identifyis that a methamphetamine compound have some shown neurochemical called reductions use.N-acetylaspartate We of factors. wereNA in very aOne variety interested[NA], of the of and markersclinical in there looking conditions,havefor brainat been that, findlackmarkerand ofa weslight significantfrom found increaseour thatcontrol neuronal with in myoinositol,population. theinjury Ecstasy in these A but users, normal recreational we're there NA not was concentrationsure Ecstasy no about difference users. the suggests signifi-We in did this JH: Whateighteencance about of patients? that the or neuropsychological whether it would data?hold upThat in datafuture derived studies. from these same JH: WhatstasybeforeCG: groupare and your after and future theMDMA controlresearch administration group plans? at baseline. within subjectsYes. or between the Ec- The neuropsychological data indicated no appreciable difference JH:with WhatCG: end-stage has been cancer. your experience getting permission fromThe the government to do main study we want to do is the clinical treatment study of patients athey'veCG:this bit. work? Initially, had constructive the FDA responseinput for wasthe treatmentsurprisingly protocol, I'vepositive. but Those let me were back the up had some very pleasant conversations with people at the FDA, and FDAWrightthedays hasneed whenleft approved to the openCurtis FDA, up two Wright hithertocommunication other was MDMAtaboo still areas there, administrationbecame of and study. more he wasUnfortunately, difficult. studies very pro-activeof Although normal after Curtisvol-about the PDF compression, OCR, web-optimization with CVISION's PdfCompressor becauseunteers,342 of the growing publicity of the MDMA neurotoxicity issue in theMDMA Research so far they have not approved clinical treatment studies. Last year, yearresubmitsivemedia [2001]. review and the by critiquing end-stage NIDA [National the cancer MDMA research Institute neurotoxicity study on Drug protocol field Abuse], [Grob to the I wrote2000]. FDA an laterI planexten- this to JH: I'mneurotoxiciiyage gladresearchers your issue.article in the Where hasfields been doofpsychiatry youpublished. see things and It's neuroscience goinga great in article the future?to and should Do you encour- see yourself reexamine the MDMA lectedinegivingCG: the MDMA groupssafety and ofto patients.patients? efficacy Besidesof MDMA, end-stage as well cancer as otherI patients, hallucinogens, thereremain are in two se- very determined to conduct an approved pilot study to exam- MDMAstresstionalother disorder prospective treatmentand other and methods.hallucinogenspatients groups thatwith These are refractory have oftenare greatpatients very substance potential difficult with abusechronic into thesetreat post-traumatic usingareas, conven- espe- problems. Both forJH: in theWhatcially field do ayahuasca of you clinical think MD]in the the pitfallsVL4 treatment research? are in of the drug future? addiction What doand we alcoholism. have to look out pingnoeredCG: longer fromany effective thehave turmoil the movementmodel of the of late Timothy in 1960s. the field? LearyHave I wethink reached First,we have. the pointWe need where to we be there is the question of the degree to which our culture has recov- hanging over our heads, stop- atric,intoable thislearn to and field.learn that neuroscience polarizingWefrom need the mistakesto political researchmake inroadsof issues communitythat time,intowill thehamper however. and mainstream establish our In capacity particular, medical,a dialogue to progresswe psychi- needwith hallucinogenspro-activetothem. conduct Once researchefforts more as agentsinfluential to safely explore of withhealing. investigators the these untapped Keep compounds, inperceive potentialsmind, we however,that will for it isMDMAsee finally that vigorous one possibleand of the andthe PDF compression, OCR, web-optimization with CVISION's PdfCompressor more substantial obstacles blocking the field from moving forward, particu- Giving MDMA to Human Volunteers in the United States 343 JH: Doandlarly you abuse. with think MDA'IA, that the rave has phenomenonbeen the persistent is hindering high the degree progress of recreational of the thera- use peuticfardrugCG: as research is to used say thatagenda?recreationally if someone tendsplans to exacerbatetake MDMA, potential aAbsolutely. rave would risks. beI've one gone of theso I think that is a major concern. With MDMA, the way the gated.recreationaladdressed.most dangerous Of course, Ideally, use placeof that onethe will to drug,would do never so. so almost That'sthathappen. the want an therapeuticThe enormous to bottompropose issuevalueline a moratorium is that canthat needsbe millions investi- on to the beof widespreadofandteenagers therapeutic taking andrecreational a variety younginvestigations of adults drugs—areuse makes taking forward. itputtingthe much drug These themselvesmore under are difficult hazardouspowerful at significant to tools, movecircumstances— and,the risk. field in This the canpeopletimallyhands be of withveryutilize people limitedhazardous. them, who knowledge theyfully I canhopeunderstand work whothat wonders.inare the the prone safety future Into parameterstherisk we hands taking,will see of and irresponsiblean how to op- evolution they developmenthallucinogen-augmentedelstoward of risk. more Concurrently, ofhonest safer andand effective moretreatmentthe acceptance effective drug models educationtreatment and in elaborationpsychiatry models.leading shouldof to the minimized MDMA-allow for lev- andthe

PDF compression, OCR, web-optimization with CVISION's PdfCompressor PDF compression, OCR, web-optimization with CVISION's PdfCompressor PDF compression, OCR, web-optimization with CVISION's PdfCompressor AsIntroductioncravecial beings. and create We are a community; expected tohumans, a commune network, one andwith of oura others. culture most It basicto is surround in defining our nature us. characteristics The to is that we are so- thenewlyandabout group. parametersformed expected These culture behavior toguidelines enhance provides and helpthe about structure, feelings define which withtheof actions connection group rules will informingand lead amongcreate to expulsion its boundariesmembers. members from At substituteweour isolate healthiest, forourselves the we family fromgravitate in the caring group.towardWhen for connection that an person, individual with helping others;member him at of orour a her groupmost feel ill,is in need, the community may acceptedonelaborprotected finds unions, behaviorsharedand neighborhoodnurtured. interests, and benefitsPresent-day there watches, willfrom examplesbe and membership. a communityeven includecrack The houses.creating church Internet Anywhere guidelinescommunities, is a prime that for nity;nectedareexample, another in toparticular, withothers. recent its Manymultitudeprovides testament would just of to chatsuchargue our rooms, auniversal thatcohesive the and club desire unite-mail scene,and to forums. culture.be the constantly rave Cell Like commu- phones people con- unity,aofaffected larger, a "group and withstronger, respect mind," group areandthe hysteria advertised communityperhaps or a healthier flockand of raversadhered of birdsentity. loses to. moving Theits sense tenets as one of of self to peace, the in favordictates love, of opposedmeaningfultenets, and to helpingandbeing happier "on maintain the life. dole" A the sense Beingand structure oftaking abelonging productive of from the andthegroup member community,giving can of tolead athe community, to cangroup, a morehelp as conforming to its mores and fromusweenhance off indeed others, from a person'sthrive the the rest subsequenton self-esteemof these society connections. isolation and and when sense compounds When the of shamepurpose. mental theand illnessWe effects guilt not ordrive only of drug the uscrave, use illness.to hidecuts but theOne sense of the thatmany we unique are not effects isolated, of MDMA that we is belonga feeling to of a connection clan larger to than others— our- 346 PDF compression, OCR, web-optimization with CVISION's PdfCompressor ourselves.The society as well. Tribal DanceThis has therapeutic implications not only for the individual but for Introduction 341 heartwithtogetherReminiscent aor beat a through resting not coincidentally fetus,the loss ravers of self are approximating into as bonded a redefined to theone whole. rhythmanother Dancing ofas anmembers exercising to music of a of the ancient Dionysian rituals, the rave brings its participants itsthispuritysingle indelible experience? oftribe being, dancingmark andThe on theeuphoricaroundall thosepresent. the sensewho fire.How join of They release,can the the rave.celebrate ofravers mass notlife, transcendence, be the transformed intensity leaves and by Andgettingthe pacifier although in touch worn many with around will their make "innerthe necksa distinctionThechild" symbolof as the they betweendancing of lose a lost themselves therapeuticravers. childhood, Truly in use ofthe they aand dance.desire rec-are to play or frolic, is evident in theyneverfulreational kind are felt ofat use so groupa rave.comfortableof the therapy. drug, itwithSome is fair themselves adolescents to say that and involvedat theirits best, place in the this in rave societymovement is a aswonder- have when media,ThedomOur drawnthe government, between what parents, may and be usefulteachers to simplysomesociety and advise harmful makes againstPolitics to few others.drug distinctionsof use EcstasyThe concerning illegal drugs. Lines are sel- in scarecollectiveafraidtoto. people, Fearof all of drugs, andthe unknownfear and makes this isfear great a potentis turnedcopy. dissuader. Theinto mediaaggression; At is heart, to our calm society society's is people go on the attack. The bottom line is that drugs frequently hysterical brainfullabout advantage damage.drugs, especially of this fear, a new citing drug.Often, claims Most use televisionthat of just a particular one coverage pill candrug of causeMDMA will deathbe takeslinked or to sex. The U.S. media, for PDF compression, OCR, web-optimization with CVISION's PdfCompressor "dateexample,348 rape drugs" or "truth serums." Some people believe that when weMDMA are and Society tags most new street drugs, such as GHB, rohypnol, or MDMA, as insiststellblissful, the that dirty we theare little publicvulnerable. secrets must that Whatbe protectedwe will areThe happenall experience from so ashamed if this we exposure.oflet Ecstasytodown harbor? our must guard, The be media aif sin. we In line with the puritanical tra- subjectneedsdrugdition topolicy toof be abuse."guilty outlawed, logic The pleasures," dictates popular for surely that it sixties mustif ita drugis be philosopherdangerous, bad causes for youeuphoria of Alan if no it feelsuse Wattsor pleasure to so anyone,spoke good. or ofCurrent bliss and the it orpoliticsdrug."taboo body-numbing Aof againstdrug complacency. that knowingdrug stimulates like Our whoalcohol discoverysociety you than are," is ormucha mind-manifestingwhichcreativity more may aptis somehowmore to condone threateningand -enhancingthreaten a mind- to our isden governmentdamaging. fruit than a form of opiumThe for hesitance the masses. to be MDMA happy and is like relaxed, the forbid- full of self-knowledgefrom and self- the Tree of Knowledge. Surely free access to self-knowledge ished.Wesubconsciouslove, believe comes And morethat from level we than our havewe that: comfortare done sureit is bad badthatwith things to we our shine, do inown not our to self-hatred. deservebelives proud, and love deserveto On takeand a happiness.verythe to betime deep pun- to beenment,Ecstasylearn taughtto and berests ofcomfortable that ouron we theown mustbedrock greatness, in have our of ownguilt this purity, skinwithfear—the and pleasure, tostrength. fearlove becauseof ourselves. self-love,In our we culture doThe of not enlighten- politics we deserve have of impactecutedpure pleasure. andon society punished, The will ecstatic because be from experience Ecstasy—and weeklyBut what isbacchanals proscribedof enlightenment—are the group with and ecstatic tens its adherentsof experience? thousands subversive. pros- of It remains to be seen what the worldwidewhobaleuphoric feel village there revelersrave through has movement, been loving tribal a cultural themselves dance with andresponseits tenets communion.and those already, of Peace, around MDMAhelping Love, them. solidify hasUnity There catalyzed and theare Re- glo-those the

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Introduction 349 ingthroughoutspect, us evolve the as world. a society and becomeIt is possible more caring that MDMA and attentive couldtouching towardbe of substantial oth-and perhaps use into someus, possibly way revolutionizing help- numerous cultures ourothers.nurturingers. potential,Within It istoward possiblea individuallytherapeutic ourselves it could and and make as more a us relaxed,more hopeful—about empathic, and ourselves connected and to framework, MDMA may help us become more culture.

PDF compression, OCR, web-optimization with CVISION's PdfCompressor ECSTASY:CULTURALDouglas PRESCRIPTION RENAISSANCE FOR Rushkoff psychedeliccalsEveryevery they major did orexcursions culturaldid not have.movement by eating While intheancient history mushrooms nomadic can be thattribes traced grew experienced back on tothe theculture dung regular chemi- ofand subculture gets the drugs that it deserves. In fact, almost chologyanslegethe cattletracing (and toward herdsspared the shift they thethe in developmenthazards)followed, value systems of early such and agrariantoward amaintenance drug-inspired property cultures of ownership,socialwere ego, denied toosystem. often and the Histori- inignore privi- psy- midnightfourteenthtures.the impact Similarly, oil—burning andthat fifteenththese the coffeenatural artisticcenturies beans psychedelics reverie gaveimported thatrise must tolaunchedfrom the have Moroccolate-night had what on weto discussionsthese Europe now early call in cul- andthe perspectivethetoRenaissance. stay foundations awake painting Youngafter of theirnormal as coffee their reality. working drinkers,apprehension They hours, developedempowered of embarked our everythingworld's by theon dimensionalityastimulant reconsideration from calculus beverage took toof ofgaina leap dimensionality. the forward. ability to reframeWhether many it's understanding facets of our existencethat the globe with itself a greater is a spheresense what a renaissance is—a rebirth of old ideas in a new context. We renaissanceinstead of a insight plane ormarks that anpaintings increase can in an have understanding depth and ofvanishing dimension. points, It is 350 PDF compression, OCR, web-optimization with CVISION's PdfCompressor byundera breakthroughs way in the popular inmoment relativity culture when and of we quantum the go West "meta." physics, since Just the this such1960s. leap a renaissanceForeshadowed in dimension- moment has been Ecstasy: Prescription for Cultural Renaissance 351 enon,brainwashingality finally led to ahit rebirth public of consciousness ancient ideasThe psychedelicin with a new, the escape revolution, of the thoughso-called limited CIA to an underground phenom- drug LSD into academic and subcultural circles. scientific context. Psycholo- insightstrance,gistsThe such Tibetan turned acquired as Timothy Bookto spiritualon of a thetransdimensionalLeary, Dead.systems eager This from to book comprehend visionthe chronicled East, quest thecouldthe natureprocess be incorporated of by the which LSD the such as those outlined in intoneersthree-dimensional a began to perceive reality the of planettheJust sphere as participantsa on which they in the walked, earlier psychedelic Renaissance pio- had come to grips with the daily existence through a "conscious rebirth" at living system, interconnected and inter- end. ofhypothesis"explaindependent. life. Meanwhile,this Biologists phenomenon.that credits mathematicians and the Jamesphilosophers planet Lovelock, with emerged thealike properties for strove fromexample, totheir of develop acame psychedelicself-regulating upnew with theories experi-a "Gaiaform to begantionshipstheyences worked. withworking between a new Systems with appreciation the long-detested members theory positedfor of thenatural nonlinear a new systems set equations, of anddynamic large discovering populations.mathematical "fractional People rela- dimensionality of the numbers with which weredimensionality,sion finally of formerly able to rather unfathomablereckon than with reducing its systems. it to By a simple granting sphere, a cloud mathematicians its fractional or fractals, which allowed for the previously untenable surface area. mathematical comprehen- tations.nologies,our newfound In which addition perspective, went to depictingeven the further, 1970sJust depth, as sawto the addthe sixteenth hologramdimensionality century can represent brought to our represen- with the pas-it a new technique for depicting the emergence of holographic tech- Moreitselfsagethat ofcan remarkably,forces time. move—a Asus the thewoman viewer holographic canmoves blink across plate her eyes,itself and stores a bird information can flap its in wings.a way reevaluate the nature of matter. If a holographic plate the holographic image, the image PDF compression, OCR, web-optimization with CVISION's PdfCompressor piececontaindepicting352 of the an hologram, image of the viewerentire bird, sees albeitthe bird blurry. from Througha distinct eachangle—as separateMDMA if and Society a flying bird is smashed into hundreds of pieces, each piece will withderthe allimageviewerscrutiny the necessaryis had inleft fields rubbed intact, information. as awaythediverse separate frost as The brainfrom images implication, anatomydifferent are resolved andparts which cultural of into isa window.currenfly aanthropology, single When imageun- cationswhole.is that each When technology: part properly of a systemthe networked, printing somehowThe press. the original containstotal Thanks picture Renaissance a tofaint ofGutenberg, realityrepresentation also is was resolved.the inspired,masses of the in part, by a new communi- provokedplayingthebecame upper literate.field aclasses religious in Theterms and Bible reformation theof the religiousand dissemination other known elite.texts wereasThis ofProtestantism. lednoinformation longerto an increasinglyto beand read eventually only level by merelyacrossto the with printingglobal access networks. press: to information the This personal markedBy but computer. the alsoa 1clear 980s, with dimensionalPeople ourthe currentability were torenaissanceupscaling empowered self-publish of found thenot its technological equivalent socialrelationshipofcomputer feedback impact linked of of andthe this toindividualiteration. new the Internethuman We to interactivity.society becameare still at a only nodelarge. beginning in Each a dynamic human to reckon system, being with capable thea ofparticular,increase early cyberculture in became dimensional the was drug thinking founded of choice asOurby wellpeopleamong computer as withtothe the newlynetworks psychedelic reason "networked." whygive experience. MDMA,us the Much best in It clue to the nature of our latest becametheseemed LSDyet uninvented that dependenttrip those were whomost onworlds Gratefulhad comfortable ofexperience cyberspace. Deadheads learning navigating As and the fledgling other languages the hallucinatorypsychedelics Silicon and confrontingAlley realmusers firms asof turevaluesprogrammers, to ofwhat 1960s was cyberculture psychedelia soon to become became foundAs America'sif new knownin an life effort as leading athey "cyberdelic"to actualizetrickled industry. up physically movement. from a subcul- and The experientially the networked PDF compression, OCR, web-optimization with CVISION's PdfCompressor fromdevelopedculture friends their who own had version traveled of the to Britainelectronic music parties they were building in cyberspace, young, hi-tech San Franciscans Ecstasy: Prescription for Cultural Renaissance and Ibiza. In Europe, the huge they heard about 353 gatherpartiesbasedthe throbbing incalled African abandoned raves beatAmericans. were warehouses of already"acid When house" commonplace. or theon music remotefirst imported recorded fields to raves were Thousands of revelers would originally by Detroit-dance until dawn to held in the "happenings"acidlutionarySan Franciscotests thrownagenda. on Bay whichby San area, Ken Francisco they however,Kesey were and raves based,they the were tookMerry a rave's on a music,more designed to be likePranksters. the famous Just like the 1960s self-consciouslylighting, evo- and ambi- bringTheenceof rhythm theare their fetalall tribesfine-tunedof heart the intomusicrate toanda wastrance the precisely same state. beat Through120 used beats by per elicit and augment altered states of consciousness. South Americandancing shamans together, to without minute, the frequency prescribedanraveconsciousness awareness was movementsto experience of on the a level group or a even they partners,had never rave experienced dancers sought to reality that went beyondorganism. the self. Inspired Ravers by aspired the holograms to and fractals before. The object of a reach group memberonassist their themcomputers,could in experience this quest wasthe essenceMDMA.Most of themthe whole. already had experienced LSD. But the they sought to create a dynamic system in which each The drug they chose to LSD trip was a per- orderizationconnectednesssonal, ofintrospective of an the intense onenesswith theexperience.spiritual ofuniverse reality insight. Althoughat is the a largelyFor peak themost of LSDan LSD trip intellectual revelation,people on the report a sensation of experience, thisis epic real- in structure, likeofrarily,ego-shattering themind. Homericand But the the foundationsepiphany arc trip of itselfa heroicof of self-realization.is ego spent journey. and challenging self A are risingEgo is destroyed, at revealed as artificial constructs and destroying these con-euphoria climaxes in an least tempo- backconsciousness,structs. into Eventually, an ego-defined clutching the tripper toexistence. the insightsMDMA, he whichor she gainedhas notoriety as an empathogen takes the long journey back to waking state garnered in the rebirth through its use by PDF compression, OCR, web-optimization with CVISION's PdfCompressor Ecstasy—whichofferedpsychotherapists354 a trip more most appropriate ravers simply to thecalled purposes E—provided of the arave. more Unlike even plateau LSD,tIDMA and Society before its reclassification as an illegal substance in the 1980s, usersreleasingencedof duration into its users fulla thanmild effects into theand free highly communicativein lessfall, arced time.Ecstasy LSD Instead cameeuphoria. trip. ofon Users risingmore Instead took subtly,to aof the crescendo journeying gentlydrug and coaxing and inward,experi- then its usersenhancementinglyE users dance more found longer predictable tothemselves an and eight-hour with onset venturing greater party. and energy durationoutward. Its amphetamine-like than Ecstasy'smade they itmight a flatter much sideotherwise, and more effects correspond- practical guar-helped LSDduringanteeing subjected the that group's its they users peakwould to moments.the be harsh outThe on crucibleclimaxNo the one floor of wantedof a self-analysis, groupwith to their E be experience leftnewfound E out. immediately is notfriends individual but collective. Where bonding"individual'sproved itself in obstaclesa romantica carefree, to setting,self-awareness, social it alsodrug. was it Rather melted just as awaythan celebrated burninga group's for throughobstaclesdeveloping anto Although MDMA became notorious for fostering "inappropriate bility,steadcant,group dissolvingof cohesionE's doing effect this at wasinhibitions a by larger to amplifying generate gathering. and acatalyzingan sense individual'sLike of alcohol, identification an almost sense E served oftribal powerbetween as sensibility. a socialand people. invinci- lubri- In- It ics,workadaywastively. marketing, as if Thea reality group sense and suddenlyof one's of people individualism own seemed taking fear of aE exposure.hollow andtogether personal illusion, Competitionbecame gain promoted empowered one between strove by econom- forcollec-people, in the shipsableusersand distractions cameoneven a level theto regard notion previously from such of the indiv-iduated personal realunimaginable. business strivings personhood, at hand: and associated forgingseemed intimatea anguish farce. On relation-as MDMA,laugh- headcialAlthough to space a group it andwas ofheartnot several space thousand of collectiveNothing strangers awareness.could hoping have The been to shift more itself aligned into thewith the rave's stated purpose. dosing with E was deemed extremely benefi- rave gathering of- PDF compression, OCR, web-optimization with CVISION's PdfCompressor networkingandfered depicted that by had holograms been practiced and fractals. only It onmade a virtual physical levelexperiential the throughsorts of evidencesocial the of the dimensional leap that had been calculated Ecstasy: Prescription for Cultural Renaissance 355 permittedmentsbonds,Internet. in the groupStripped otherwise. revelers dynamics of at Ecstasypersonal a rave beyond gathering seemed ambition what totheir were serveand egos enabledprovoked as and a fuel. inhibitions to topushWhile form their some wouldemotional experi- users have fromown,believed themore heart,that users the uncovered tendedMDMA to andmolecule identify activatedIt was their had aat anthree-partnew last almost sensibilityby the process.conscious drug's as catalyticcomingFirst, agenda Ecstasy directly power. of its stripped away the user's inhibi- pressiblenature.weaknessestions to Young self-expression. urge they to men express are who meant their hadOn to longE,anima, obscure lies repressed aretheir no inefficient, femalelonger their spirit.seemfeminine and likeVVhile the sidesoffenses peculiarities a fewfelt againstanexperi- irre- or fullsocialidentitymented spectrum roles. withthan In homosexuality,withand this without firsteradicating stage reservation. of it the overlyusually Ecstasy Olddetermined had trip, or less young, users to anddo experience gay with intimacy-restricting or definingstraight, themselves muscu-sexual in willthelar occur, orharrowing, nerd—everyone if it occurs hallucinatory at is all. okay Although nightmare andThis beautiful first it isof stage extremely a justbad is LSDexactlyalso minor thetrip, as time ahecompared difficultE orwhen she psychologicalis. withexpe- discomfort generally hiddennegativepersonalityrience traits typicallyexperiences before traits results them,he are or from shesodemanding rare has the is beenuser's that that repressing MDMIAresistance they give does allto voice thealong. not emotionalto parade them.The reason Instead,people's needs that or TheE theconstructsmakes user formerly ispeople so finally open-minded rejected feel rise so to opensentiments the and andsurface, emotionally accepting with where open thattheygiving arms. these can that Insteadmanifest orphaned he or ofshe without feelingpersonality welcomes shame. over- burningwhelmed,and one need seeksthe to user acceptto recognizegenerally more. ThisfeelsandOnce embrace isconsolidated when this the theprocess secondemotional and of whole stage self-acceptance needs beginsfor theand infirst personality earnest, istime. completed, the user still feels a PDF compression, OCR, web-optimization with CVISION's PdfCompressor which356traits they embraced themselves, users strive to acceptof the others. hearts, With minds,MDMA the same and Society openness and judgment—free enthusiasm with thizethroughexperiencingand withbodies the one same of anotherandthose non-prejudicial expressing around outweighs them. new eyes.every Theyparts The understandofother themselves overwhelming consideration. that and their seeingneed friends This to the isempa- are whyworld also careheralmost social about no status.onethemselves. on People Ecstasy are looks too busytoThis score isaccepting when sexual the andconquests third embracing stage, or theincrease each action other his of E orto most important to the group as dance.acceptinganda whole, one-to-one As finally thepart thousands oftakes contact the effect.collective, isof no Theother longer majorityten-thousand-armed people a sufficient ofpresent. the crowd meansThat's dancingsoon whyof realizes reaching mass,they thatturn everyone out speech to and the sense,ally,Everyonegains andthe they abilitymust has go liberated "meta."now to accept accept Like themselves and thequantum embrace totality personally, physicists the of totalitythe group accepted who of theitselfrealize groupone in they anothertheir simultaneously. cannot hearts. individu- make In a monthsrealizean observation that or even they years arewithout part afterward. offinding the very UnlikeThisthemselves thing is athe rockthey magicunder concert,are tryingthemoment magnifying which to accept.of unites the glass,rave its thataudi- ravers so many people talk about for fromrhythmaudienceence a remote inis inmutualmore mutual corner of adoration an adoration ofanonymous the room.for of theone shamanThe sexy another. stage singers than is The thea performer, ondisc dance stage, jockey floor, the mixing providing andrave the recordsunites stars the its tendedrevelersare the momentsravers into a themselves. state of group of collective awarenessThe groupThe consciousness. peak oftencelebrates of fall the into itself.E Descriptions experience cliché, but is they of when these are the pro- ex- drug and dance ritual brings the viduatedhimselfformachievefound, aor life-changing dynamicbeing. whatherself can But more system only in events lower-orderas be alike calledmemberfor athose coral "group hive ofwho reef,the minds,organism."have collective where experienced the each individualThatentity person is,them. than the members,experiences asTheindividuals an dancers mdi- PDF compression, OCR, web-optimization with CVISION's PdfCompressor theytionwhether inbelong the collective. has no purpose Their other service than is mutual instinctual. survival. The The collective collective to formed which bees or plankton, have little or no awareness of their Ecstasy: Prescription for Cultural Renaissance own participa- 351 ness.massformedpurposefully The spectacle fordancing no by purpose resultsF-charged mass inbecomes other a raversfleeting than a is single thebutthe sensibilityresultundeniable being of with a ritualof rush thousandsgroup self-consciouslyof collective mind of itself. pairs aware- ofThe per- matchedis eyes.as if eachTo the catch personsocial a fellow agenda is an extensionraver's of the glance Thesubculture of collective the is akinsame it cameto being, awarenessseeing to serve.encountering oneself achieved In intheir the itself. questthroughmirror. It mass MDMA use perfectly to levelssocialpenedfind a inhibitionsupondrugof emotional capablea chemical while bonding.of forging thatengendering exceeded But new the socialan theirintensity empathic originalbonds, of imperative these theexpectations. rave bonds, underground that augmented Ecstasy fostered brokehap- by new engineeredderstandingthe self-consciously for the themselves, relationship inclusive led of to and Like individualsan entirelyegalitarian a hologram, tonew theenvironment and larger the unexpected human groups that project they theway usersform. of itself had is understood as a collective un- natedresolvesolvedenterprise. and picturethe multidimensional pictureEach of personthat is to process—within bring contains being. those the Forindividuals entire thosehimself process—albeitkeen together or onherself. enacting into The a asingle a fuzzy,only renaissance coordi- unre- way to socialtoof acceptthis medicine. magnitude—and themselves, much hoping lessIronically, to one do soanother—MDMA before perhaps, human just beingsas served the hi-techhad as the a crucial Internetability tended to encourage what tribalmoleculetionsthe media andpeople aspawned theorist sense who, of afterMarshalla electronic similar ingesting networkMcLuhan Global various of Village, predicted tribal combinations communities. the would laboratory-born ofbe rain-forest "tribal"Like primitive MDMA affilia- psy- young,individuals,onchotropic the techno-savvy dance drugs, this floor powerful would andravers catalyzed dance findmolecule's theirin bya groupnewfound agreatest chemical. trance action tribal Althougharound imperativemight the beit shaman's ison actualizedingested the group. fire, by PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMA AND JH:An HowRabbi didInterview you first Zalmanhear about MDIVJA? with Schachter beforeILearyZS: really took thecan't lateme remember onseventies my first from oracid perhaps whom trip. I I got thefirst toearly heard MDMAIn 1956eighties. about viaI it.the I Itcan't other was remember inpsychedelics. the the read Aldous Huxley's Doors of Perception, and in 1962 Timothy not veryrecallgreatcircumstances smooth. delightwhether Since of surroundingthere loving that were thetime, anyuniverse the I've difficult first taken andopportunity aftereffects.itfeeling a few loved timesI had I think by towith thetake the myuniverse. it, transition wife.but I feltCer-I don't was the Ph.D.]givenfromtainly that over itonce enhanced is thethesaid counter.issue to mea senseof that publicI remember toof smoke deeppolicy sharing. grass thatMDMA Ram you The isn't shouldDass first something fa.k.a. have question toRichard thathave that should a Alpert,driver'scomes be topilot'slicense turn license sexualitythe same the intoas same for a sacramentaldrivingas for flying a Wmecar, act a and jet. originallyas forwell. acid This was you is turned shouldwhy in into haveJudaism a tosacramental have sex isa drink, and people wanted peyotemadequestioncalled sacramental? kiddushinrituals, is, why and haven'tand there I've in IhadCatholicism thehave thepsychedelic seen opportunity the it greatis substances,the valueto sacrament be withof making the Native of mood marriage. such Americans lifters, substances So been the at sacramental. Ayahuasca circles also are performed in sacramental settings. VVhen 358 PDF compression, OCR, web-optimization with CVISION's PdfCompressor provisogoodpeople wayis that to you create would a sacramental first make a feeling. brakhah. From You theknow Jewish that word? perspective, thego to raves and bring in MDMA, I have the sense that it might be a MDMA and Spirituality 359 3H: YoudecideZS:and sacramental.sayThat's ato blessing. go right. downtown. UnderYou bless those Ithe remember act,circumstances and the hearing fact that someone aboutit is blessed people would makes notdropping it take special it acidand JH: ProbablyZS:and When then not goingit the comes bert to see useto Yellowbreakthroughs, of their Submarine. time with the that "responsible tool. people" didn't want JH: I'mcourse,to takecurious is alwaysabout your a problem. own his'toiy. When was your rabbinical training? so the irresponsible people took risks. And that, of JH: WhenZS:Yes.ZS: I wasyou firstordained took MDIVIA in 1947. you were already a rabbi? JH:campusZS: And By did clergythat you time have and I as awas congregation a professor. past the congregationDuringat that time? the time phase, that I and took I MDMA,had served I was as JH: Canexperienceteaching you takereligion with me MDIVIA through at Temple to the the University.process point when from you when decided you firstthat youhad wanted to share it your personal ZS:with other people? haven't yet done that. . . the sharing with other people. There's always JH:congregation? theBefore circumspection it was made of illegal, the problems there was that no it cantimeI raise, that soyou I'm shared careful it withabout that. a

PDF compression, OCR, web-optimization with CVISION's PdfCompressor becauseZS:360 I anything that is kept under the table or under wraps assumeswould differ- tellMDMA my and students Society about it. I was not hesitant to talk about it, hadself-selectedtheent had proportionspeople some groupwith drug thanwhom thatexperiences. if hangs itI isspoke really out I nodded, withrecall seen me, oneand as so understood.manif often they who thesehad told experiencedI were found me thatpeople that he manyit. gotwho It's a ofa 3H: didstashI think this of I onlymisunderstoodMDMA with to friends. give your out history. to couples I thought for theirthat there honeymoon. was a time Of in course, Phila- he ofdelphia "vision where quest." you were sharing MDIVIA with It'sothers or leading them on some kindwonderful that I have such a reputation! I would do that vision quest forJH: instance,ZS: Someand all ofthose thethis other whobook have isthings about been but using traumatized not MDMA necessarily in in thep.sychotherapy—with pastwith or substances. who are depressed; individuals, or needs"withthinkZS: couples; ittheorist] could or be in onuseful.palliative a plane, care, and working we had with a good the dying conversationLet population, about where certain I really me talk about that. Years ago, I met Abe Maslow ["hierarchy of with'ATedemonstrateforms disdain. disagreed of psychology. It hiswould about description be that. Ilike said Itaking of feltsomething peak that a cable experiences.it's importantabout car up the to At Monttoability first domesticate Blanc. he of viewedpsychedelics It's peak not this fair.expe- idea to wentenceLaterberiences. ableto LSD.Paloon to If he replicate somebodyAlto. I had don't Hea heartit,remember hung hasand attack adrugsout wonderful with whether andare Ram greatretired experience heDass, facilitators. wrote from and inBrandeisabout eventually some He didn'tit, area, butUniversity didlike it ishadexperi- the good greatidea. and to wouldn'tgetbearing some on adviseLSD his move and it." he fromHe asked called humanistic his another doctor psychology Dodoctor, to yougive whoremember it to to transpersonal camehim. Hiswhenover doctor andAldous psychology. adminis- said, Huxley was about do die? He wanted to "I

PDF compression, OCR, web-optimization with CVISION's PdfCompressor namedence.tered Sushilla He had iswritten dying aof book cancer called of the Island. throat, At and the he end describes ofit toIsland him her soa that he could pass the last two hours of life under its MDMA and Spirituality womandeath-influ- 361 andthescenebed fearAIDS scene.that people centershe As had have he andwritten. was of so deathdying, on—that's That's can he abehad beautifulan overcome—those hisimportant wife, thing. Laura, thing, If you readbecausewho can him imagine it the deathbed that are in hospices reconciles JH:in HowpeopleSchedule did to you Ion their feelan emergency when the Drugbasis? Enforcement Did the scheduling Administration surprise placed MDI They aren't dragged kicking and screaming. you, or did it upset VIA you?establishmentthatZS: Did No, ifit anyonechange I wasn't the doesn'tcomes surprised.course upcontrol ofyour with Yes, oranythingactions it make upset in money anyme,that way? butgives from, I wasn't that surprised. the establishment I thought you euphoria, which the thatinLove?will India forcreate The someare Power an into people,interdiction. alcohol.of Wonder] it's Thea culturalI who think Brahmins once itthing. was told are TheGeraldme into that grass. theHeard warriors, He [author the of Kshatriya, What guys who are couch potatoes was pointing out Is withwhocollusion.greater drinkMDMA. sharing beer Politics So are ratherthe certainly is fear involved. than in notpeoplefor goingmore is thattightnessto like to havethe will consciousness experiences undermine that thatthe askcommon for comes JH:isZS: Itnot doesIt asis upsetting.seemalso fear as of It havingdoesn't to"take" give you.up, though I don't theknow noetic of anyone quality who of MDMA has had plays a large role, particularly fear of the unknown. JH:some limaginea bad people trip that onhave it.it hadapretty rough tricky time. to have They'refew a bad experience, and far between, butlhave aslunderstandit. heard that way.mayZS: seem as though it could drown a person.It It may be threatening mayin that be partly that the oceanic feeling that occurs is something that

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH:362 What you were talking aboutMDMA before, and with Society the couch potatoes, I just thought of ofabout.theZS: bodyphrase armor "ignorance feel threatenedis bliss. "MDIVIA by it. Thedoes armornot offerIt comes ignorance. loose That's on MDMA. notoffers what it'sa bliss that isn't ignorance. That's right. People who wear a lot JH:person Yes,I think it is does. theexperiencing masks The defenses come MDIVIA, off seem which to since subside, possibly there to canissurrender, that be frightening.sense and of the strength walls Maybe come and not calmdown. while and the security.somethingZS:"truth serum"But to it preparemight aspect. be people.frightening to someoneThe hearing about it, like the fear of the question is always, what is the psychoprophylaxis? There should be JH: Yes,abouthasto phrase beenI definitelywhere aboutthis—and religion psychologybelieve it's and thata large spirituality peopleand question—but psychiatiy should really be and prepared.fit most therapy.in with of Imy MDMA.don'tI haven't thinking know thought exactlyabout tooMDIVIA how much theGod,stances,ZS: medicine were and turning Icabinet. said tothis: Sothe "WhenSatan medicine came God cabinet, and saw said, that God 'Ifpeople,Someone that's made howinstead himself easy of availableit's turning going toin once asked me if I had a spiritual take on the chemical sub- theapplicationtobe, do.' I'mmind Andout does of andSatan a not job.'the becameexpand safeguardsGod said, toa pusher."wrap 'I and did itself sowhat You on. around I Moregethad theto whatthan do; idea thethat,you that soul do most the what knows. issueof youthe isWhat timehave the thatwithrecallthe soul they've their it, knowsbecause affect taken at andthey onefrom their haven'tmoment one actions. of taken thosebecomes Sothe experiences. theytime a fleeting haven'tto digest It's experience.assimilated itimportant with their People theto minds integrate insights can't and JH:mentthese Yes. insightstheories? afterward. Are you acquainted with Kohlberg's moral develop-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor youtheZS: go pathological to transpersonal realms. psychology Once a person or humanistic hasMost adjusted ofpsychology, the to timeouter psychology society, there isn't unless aand psychiatry talk about climbing out of MDMA and Spirituality 363 pathologicaldeadscale. people. You're conditionsoffIn thethe grossscale most foranatomy of theMuch lab,time. of that's medicineThe whatnotion beginsyou of healthdo. with You and going work weliness to with the pathology lab and working on awarenessaboutBentovonly recently how wrote in earth, people. ahas book inbeen ordercalled introduced to Stalking heal into the thisWild kind Pendulum, of thinking, in which right? he Itzhaktalked is "hothousing" certain levels of JH:times,ZS: Isinto this issuesreligion where ofpersonalgrowth religion deals with and spiritualitygetting and browniea higher come in? awareness?points,That's Once social you get brownie past pathology points fromand right. I want to say spirituality and not necessarily religion. Many Robertoquotheypeople with will in Assagioli annot your aura allow environment. of [the forholiness. foundertransformation. It's Most of not psychosynthesis] ofquite theThey're thereligious same there wrotething systemsto sugarcoat asa remarkable spirituality. have the said status book thatDr. JH:sis: Iabout sometimesA Collection psychological come of Basic across disturbances Writings]. a patient aswho a result is experiencing of spiritual a growth manic or[Psychosynthe- psychotic saint?"emergencyepiphany.episode, I also and It'sroomhave it the seems heardalong kind thevery of termlines debate much "kundaliniof "who thatlike getsa religious explosion" stirred "peakup to every describe experience" once a manicin a or while episode.a mystical in the to say this person isn't a seer or a mystic or a selvesZS: when somebody. Most doctors don't know how to handle that. They get anxious them- . . . How should I put this? Have you heard of a man encingentergocalled into into John things.a ward conversation Rosen? Friedawith schizophrenicHe Fromm was with doing peopleReichman, orwhat manic-depressiveon hethe who called level wrote "directat whichI Never patients, analysis." they Promised andwere Hehe experi- wouldYou a

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Rose364 Garden, did somethingMDMA similar. and Society It's difficult to help people, but, on the you'dgencepeopleother hand, like ofget everything. tointo if share you high don't with speed, It go them, into like butthose a mindnot places, with fever, the you in same can'twhich wind help they velocity.them. know a Iconver- feels and sounds like the kind of peak experience Very often, think a mentalbigtantthey mistake forwereinstitutions psychiatrists isin being that until psychotic made tothey byhave havepeople moment. spiritual sworn who That's offwill the notwhy insights release I feel that suchthat they it'spatients very and psychedelic experiences. That's had while impor- from you'rewhythatworld, they moment—feelinggoing you used to aren't workto call going with them that psychoticsto youpsychotomimetics.be worth still belongwithout much. within havingEmpathy They the visited circlemeantis what's your of to sayown human beings. called for at that if inner JH: It'sisolated.acteristicsthe important culture. Being of IVIDIVIA toOne disconnected commune of the is mostthat with from there pitiful them. the is arestproblems senseI think of humanity,of one connectednessofpsychiatric of the from most their patientsto important other families, is that people and to theywithout are char- friends,NobodychiatricZS: is utterly canpatients debilitating. follow is by you allowing One into of them the waysdeep to feel I recesses can reconnected.There envision of your MDMA experience. helping p3y- is a certain amount of solipsism in the effect of reg-ular psychedelics. With you,yourMDMAcome mindand up. it's there as It'sa much.different notis a only loving You're story. the warm You're out there; you're not in the recesses feeling.looking There at people,are also and some you noetic see them issues looking thatvisceral at stuff. I think that can lead to certain of JH:kinds TrustZS: of on trust what rebuilding level? and insight. Trusting other people, seeing that people are people. Everybody has a JH: Yes,connectionlonging, and alsoand with thateverybody others. everyone wants is basically to be loved.insecure on some level and needs that

PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMA and Spirituality 365 ourpersonwhetherZS: issues, says, it isbut "I'mokay so what?"open to stay to open,you, and and you then can theYou be reassurance opensee the to eyesme. shiftingBoth of aus little have bit when a person gets to the comes. The other question of JH:ZS: IMDMA suppose seems you could to be think on a of smaller, a rave asmore the ultimatemanageableThat's Havurah, level than right. or group sharing. some of the andshabbasZS:stronger experiencing p3ychedelics, [sabbath] MDMA,, afternoon in terms singing of thata nice songsopening. summer andThe sharing day, food? experience is also a little bit shorter lived. But can a group sitting outdoors you imagine on a JH:wonderfulZS: Itoday! was imagining ways in that, which and one I thought could that'sutilize what MDMAWe in are right back to what we talked about. I think that there could be we were going to talk about a group setting. I'll observantchildrenseventy-fivegive and and haveyears some a old; party who he withare wants less them. toobservant. bring There together are For yousome the an his children crowningexample. children who Take and agrand- man who called me a couple of weeks ago. He is moments of are more herthing—theandhis husband relationshiphave a tofeastwhole see withtogether. me. family hisHe family, wasItaking could of heaMDMAimagine—though very would brittle together. like kindto have IOnceof couldn't theological them becometell him unitedsuch a woman brought turn of a left"Whyasmind. nonverbally immediately. Hisdon't mind you communicative wassmoke How locked did some I intodare grass?" with amake way his He ofsuch wife. snappedthinking a suggestion?I dared back—recoiled—andthat to didn't say atallow that himmoment, they to be JH: Thatopennessthat there brings toare theseup some a question.sorts people of mind-alteringwho In your probably role substances.areas a taken rabbi, aback II thinkwonder that that you how have you broach the you must find any kind of

PDF compression, OCR, web-optimization with CVISION's PdfCompressor subject366 with them?MDMA How and Society would you introduce the idea? How do you allay their fear PrettyofZS: gothe into unknown? soon, a group you haveof people, conversations with theI people, andwouldn't they do it next time! I tell you, there is something very funny. You and you don't know who is Jewish and who isn't. drop a few JH:words. ZS:Itc as They want you to know. Andthey it's want the you same to know.thing with altering conscious- JH:ness.ZS: It's veryThe peopletrue. who want you to They talk about a mind move, a "flip," an insight. Then you know, "Aha, know find ways to let you know. JH: 1,that's too, ahave buddy. noticed that when I meet someone, I may make a casual mention just to gauge the person a water brother." reaction. of JH: Right!ZS: To Can ask, we "Is talk it safe?" about this? Right! JH:ZS: that?introduceLet's say MDI that VIA to a group ofpeople or to a congregation. Would you want to it were not illegal to do so, and if you wanted to, you could do JH: WhatZS: do you think would be your goals in havingThe aIt group session? would create a collusionanswer of ethics. is yes. Right A definite now the yes. ethics are dog eat workpeopledog. inwith There the in the communityyour is peoplea group—agape.Greek in andword the the groupthat kind To speaks aboutofcreate ethics about what an to agape thetrywill tolove communitybe bring thethat intoethics you the have and then to thatworld— will for the

PDF compression, OCR, web-optimization with CVISION's PdfCompressor I think that would be a very beautiful thing to do. I can imagine that the MDMA and Spirituality 361 JH: Isuchseder keep a comingthat wonderful, would back to happendeep the wordexperience. among love. That people is the who bottom have line—the had MDMA likely outcome would be ZS:andof sharea group with experience others. and what people would wantRight. to take away from the experience The question is how to digest that. I think the preparation of JH: There'sareimportant.people crucial. nobefore question I also the agree experiencethat thatthe setwhat andand is the learned,the setting, processing what as with is afterwardcommunicated any drug areexperience, goingbetween to thebe MDMA,participants,heavyZS: burdens would and thenmake of guilt. what a great Tois communicated be deal able of to difference. enter with a place Yes.others of all forgiveness, are important. assisted by Then there is the issue of guilt. There are some people who carry JH: IoneZS:ness think inor aboutitsthe application circle acceptance of humanity.to guilt.a lot, but And I don't then usually thereWhen think is a ofway it in of ternzs saying offorgive- "I forgive" you begin with acceptance first, you include yourself and the other JH:ZS: Itfrom does that seem place, very whichhealing, you the couldn'tideas of acceptancesay beforeI and acceptance. forgiveness.think the intergenerational use of MDMA would be a remarkable thing. JH:ZS: Onegroup of theof peopleoptimal whogoals are of mostdoing people's things therapies in one week Haveis to forgive in California their parents. that really you ever heard of the Hoffman Quadrinity Process? There's a parents.it old,openout—killing and the You it field goes get the for tofrom parents,areconciliation place the somatic where as it were—to youwith way are parents.of gettingangry a point I with didrid where ofit God when the you andanger I wasthendefend by sixty becomethrashing your years PDF compression, OCR, web-optimization with CVISION's PdfCompressor withreconciled.368 that, I went to see my mother. For the first time in years, I was MDMA and Society It's a remarkable process. A couple of weeks after I was finished able to JH:verysee There her helpful. inis sothe much present, anger not and as hurt an andogre confusion buried between family mem- who would eat me up alive. That was sereneonciliation,wardbers. sabbath. Iresolving imagine with thesean the MDMA family,sentiments -assisted and andperhaps familybringing even therapy about with God,asession sense seems offorgiveness.could like go a a long way to- This rec- and

PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMA'SPRESCRIPTION PROMISE MEDICINE AS A JH: DrAnRick Doblin, Interview how Doblin, did you first hear Ph.D. aboutwith MDI VIA ? Just devotefreshmanRD:as I wasI first myself supposedto heard study to integrating aboutpsychedelics, to start MDMA the difficult school after in 1982. having psychedelicyear, I wasI dropped learned going experiences outof back a ten month—long toyears collegeof mybefore own. as toa Iniqueworkshop heardthatarrange thatit about helps for atwas Esalenoff-campus MDMA. youa legal feelgiven alternative Mydeeper learning by first Stan emotions impressionand Grof.to thewent Stan use andto wasofwasthe get psychedelics. workshop."Whyteaching close bother?"to a people,While breathing I managed II waswasbut tech- tolditthere, tojust possibletheseemedcatalyzed depths like that of aby you mildyour LSD. could "feel—good" soul It seemedhave and anywrestle somehowdrug. powerful withIt didn't superficial yourtransformations, seem demons, as and if you notand suchcould profound. it didn't as dredge the seem ones up JH:smokeRD: Did Yes, it cigarettes. sound too easy.too easy?I generallyI wasn't interested don't use indrugs it. I todon't feel drink good. alcohol, and I don't JH: You use them to get work done? 369 PDF compression, OCR, web-optimization with CVISION's PdfCompressor RD:310 I'm more results-oriented. ItMDMA just seemedand Society as if it would be soft and sweet, JH:like Ofsubstantialhand, taking value several fora value.tranquilizer. what? people who I justhad didn'ttried it quite told seeme thatthe pointthey hadof it. found On the it to other be of municatingRI):and It takeIwas decided itof with with value that their my for I girlfriend.wouldsignificant understanding go Thereahead others. their wasand My emotionalaget degreeinquisitive some of MDMA,struggles excitement nature bring andtriumphed, and in it com- antici-home, velous.waspation,able in inOctoberbut We helping no had real 1982.a us greatsense blend To expectation of ourwith astonishment great each onother the at andday how talkwe little setat aaside deepdifference to level. try MDMA. Itthere was was mar- It surprise, the experience was quite valu- MDIvIAwascessesbetween completely ofexperience the thinking MDMA different—a orwas experienceour so perceptions. subtle, much and so more ourclear. It normal It didn't way really of being affect together. our pro- The gentlewasn't change—and in any wayyet it like was LSD. pro- This lovewasyetfound. how thatto Ieach utterlywaswe both other.amazed useful felt It wasatthat and how a itimportant drugwasn't easy that it the had Ihelped saw been it us for reach me tolevels dismiss of ourselves it earlier and drug talking; it was us, expressing our could be. The central point of it that wereartificial.to speak ablegenuine, to fromIt accomplish felt that that very represented depth; true. in specialthis our was moments,deeper a glimpse of our feelings. lATe weren't always ablebut it didn't seem in any way potential and what we JH: IandRD: think ourthen that love trying it for takes one to away another.act at a lotthat of depth the fear at thatother we times haveThere's inof expressingyour life, whenourselves a certain responsibility that comes from having that experience you're hardtion.worknot under toOne to bring be waythe that that influenceto honest, dealdepth with intoclear, of itthe your is and drug.to daily recognizeopen It life. takesabout The these apotentially lotother difficultiesof way, critical and to learning and a lot of psychologically informa- work PDF compression, OCR, web-optimization with CVISION's PdfCompressor Thatexperience,speaking—which was a drug and experience." I don't have Thento try to live is what a lot of people do—is to MDMA's Promise as a Prescription Medicineyou accept an easier, lower level of daily up to that because that wasn't real. say, "Well, that was a false 371 potential.thanI'mfunctioning. not to denyreaching the I wouldreality as the rather ofresult those live of moments limitationswith the thatknowledge that MDMA I have that shows there is to work on, rather are within our a depth that MDMJIJH:developed I'm veryexperience, one. glad What you as you said glimpse that. I inthink the midstthere of it is a completely Icial statean as MDIVL4opposed areto experience a many more peoplehighly is like who seeing discount the youizeultimate the that peakvision vision.self ofa couldand mountain,Another the be, motivation and way and maybe ityou is to you describedcan keep on ishiking. like seeing You get the a picture taste of on what the yourjigsaw see the path that evenwill takesee what you tosteps the youtop. haveIt gives to take to actual- product,verypuzzle subtle. andbox. it You've Youmotivates get described to andsee helpsthe it, way andIt the sois somewhathavepicture I, asshould enigmatic.akin to the This feeling is a afterpowerful a deep, tool, but the shift in consciousness is you try to construct that. come together, the finished you'reRI):gentle.cleansing notOne I dancingthink of breath. the that attragedies ina And club, a therapeutic I havethe of shiftthe had reallysetting, people is whentellthat mild. you're relaxed and it's quiet and war on drugs is that MDMA research could me that the experience can't be that saryhelpthat withemotions,oneus understand expresssomething we love would the that and processes haveaffects to accept hundreds those of andlove basic ofintegrate and psychologists emotions, deeply that doingpainful reduces their but feardisser-neces- to acceptance. You would think ego.honestyoutations reallyThere's way. on want MDMA. Youa whole to can hear—what MDMAempoweringaccept the helpspeople information of strengthen yourthink self,of without youthe an andacceptance having feel about it shatterof youyourself. inyour an ego so that you can hear— basicMDMNsThosethat psychological thereare therapeuticsuch would crucial processesbe potential aspectsa tremendous of of orhow being amount alive and of human.research, You not would so much think on on MDMA's neurotoxicitywe experience but into the love and how we build PDF compression, OCR, web-optimization with CVISION's PdfCompressor 312ego strength It's just so sad to see MDMA being portrayedMDMA inaccurately and Society in the media, and self-acceptance. None of that research is happening. yearshavedestructionand ofby been lostthe looked government,opportunities.and producing at through particularly, Fundamentalholes the in lens a person'sas of a areas MDMA,drug brain. whose and It's main substantialbeen effect more is thanamounts death twenty and of of human functioning could reduced.thathappened.productive they drastically It's therapeutic impossible outweigh work to quantify couldany harms have these that been lost the benefits,conducted, prohibition but butI of feel MDMAthis confident has hasnot JH:initialRD: Let's When MDIVIA talk aboutI first experience those learned twenty to about approach years. MDMA What the government? inwere 1982, the stepsit was you still took legal. after In your con- missedbeentrast,complete. madeI hadthe golden learnedillegal I was era,inand about the when the tail and government itend startedwas of possible the appreciating sixtiescrackdown to investigate generation, LSD on research in psychedelics and1971, I unfortunatelywas almost scien- after it had respectednourishingnarytifically. situation social, Whenthe inpsychedelic whichIacademic, learned there about community. and was MDMA,even a semisecret government I realizedI realized that positionsthat there this was werewho an peoplemight extraordi- be in underground river that was itmadewilling eventuallyfend illegal. the to usetry wouldIf theof they MDMA drug begin. had while valuablewhen So itI thebeganwas experiences, inevitable legal contacting but government would these these peoplenot sorts effortdo ofcouldso people. toafter criminalize help it was de- JH:ShapingGeneralRD: Who? In particular, ofa Global the United Spirituality.I got Nations. in touch The Hewith thesishad Robert written of theMuller, abook book the was called Assistant that New at the Secretary- Genesis: core of intolerancespect.ityeach that Yet religion is relativelythere that there areare asstill similaris deadly a many certain and and wars mysticalleads as thatcommon to are tolerance,understanding products as the warsunderstanding, of of based our shared on national- and human- re- religious hatred and PDF compression, OCR, web-optimization with CVISION's PdfCompressor anism. organization that represented the world's religions,Robert to Muller provide proposed a context that the United Nations be supplemented by MDMA's Promise as a Prescription Medicine 373 estedaboutsay.for them Here in the helping to importancewas find a promote commonperson of in research ground. a politically intoI was the powerfulvery spiritual impressed position potential with who of what psychedelics. was he talking had to I thought perhaps he might be inter- newweretoI wrote requestmethod tools a letter to thatof understand killIng he to extendhim gets saying his andvirtually analysis explorethat I unlimited was a spirituality.bit inspired to include research by I histhe mentioned money argumentsidea that from psychedelicsthat butthe every wantedmili- serteddeliccallytaries blocked.research?"around island theand I asked Iworld, feltwas ashim, throwing yetthough "Would psychedelic Iout was you a somebodymessage helpresearch out inin intowho atrying bottle spiritualitywas to strandedto support see was if onpsyche-anyone politi- a de- handwrittenwouldtant Secretary-Generalrespond. letter saying that of thehe agreedUnitedHere Iwith wasNations whatan undergraduate wrote I was proposingme back! at college, Heand sent that with a no credentials, and an Assis- awhatscholarshe little would I hadsubtext, of help. toreligion, say. whichHe I hadsent whom was discussed a list tohe send ofwanted several MDMA them me MDMA.people, toin contactthe letterChristian I contacted and and have read and athem intofewZen hisevaluateofmonks, theseletter drugs,thenpeople, report but and she back some was to of willing him, them which towere help theywillingMy me sisterdid. build to haveworked a case me for for send psychedelic a congressmanthem MDMA research. and and has never chosen to take any wouldpsychedelics,"drugShe helped czar."help. me He Idiscussed made contactresponded, an theDr. appeal political Carletonwhich to himsurprised suppression Turner, about me, thethe of Reagan-era andimportance research, referred and equivalent ofme asked studying to a ifcol- heof demicandThoseleague one institutions.werefor with further my the two U.S. discussions, main government. political though Icontacts, also not contactedinvolving one with variousactual the useUnited people of MDMA. Nations in aca-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH:314 Tell me about the ARUPA conferenceMDMA you and helped Society coordinate. Responsibleinvitation-onlyRI):came Every up withfew Use conferences yearsthe of namePsychedelic or so, ARUPA, atthe Esalen. psychedelic Agents. which Dick It's stands Price,community also athefor Sanskrit co-founder used word to have of meaning Esalen, small the Association for the thatincorporatedof"formless," IAldous had written Huxley. and since involvedto the RobertShe group spoke a Muller shifting organizing to Alise found cast Agar theitsof characters. way conferencesabout to it,Laura and A was AlisecopyHuxley, never ofinvited thethe formally letterwife me to Carletontogetherone help of the theseorganize Turner psychedelic Esalen evenanother conferences. sent community one a representative. in 1984, Alise After which is attending a At focused about one this in conference, time,part on Debby MDMA. I Harlow,worked remarkable woman who knit to- Dr. 3H:Alise research.Who Agar, attended Theand thatorganizationI established ARUPA conference? wasa nonprofit called Earth organization Metabolic to supportDesign Laboratories.psychedelic asfirstamongRD: you biomedicalDick know, others. Price, was Terence studyLeo very Zeff, of sympathetic andthe Sasha physicalI had Shulgin, an with effects important the Stan potentialof Grof,MDMA interaction and in Terence humans. McKenna, Terence, of plant medicines. that led to the JH: Iearth.behind know. MDIVIA—itHe and I had severalwas a synthetic conversations molecule about and why didn't he could come never directly really out get of the thousandstudytheticRI): Terence ofdrug. MDMA, dollars I askedwas for and talking fora westudy proof should about of and MDMA." do said, it now, "Terence, And while then it's weDick still should Price legal. arrangesaid, I'll put"I'll for up put a riskiness due to its being a syn- whichstudyupthe a thousand Journalof later the tookeffects of dollars, Psychoactive place of too." aunder single And Drugs the dose thatauspices [Downing of was MDMA the of genesisLeo1986]. on Zeff about for and Dr.twenty was published volunteers, in Jack Downing's

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH:RD: I was one of the helpers, not one of the subjects;Were Iyou was one there of the as subjectsone of the in that study? MDMA's Promise as a Prescription Medicine 315 MDMA,house1984.funders on Ibut hadStinsonand ones beencoordinators. Beach, thattrying could sincein It northern be was 1983 kept just to quiet California, aget beautiful studiesat first. onexperience. startedI wasthe ocean. worriedon the It tookThisbasic that place wassafetyif they in at of a JH:RD: Nextwere In inmadeJuly the 1984, timelinepublic, Sasha the came government[Shulgin] the Drug learned Enforcement would of act the precipitously AdministrationDEA's intention against trials. of MDMA.placing ascommentintentMDMA did toDebby incriminalize period. Schedule and I Alise.wanted I.MDMA The We to DEA put hadand my had beenannounced energy published doing into a lotlegallyfightingin theof proselytizing Federal required the DEA's Register thirty-day efforts, during its potentialattions—previous Harvard,1983—84, of allMDMA. sorts notpsychedelic just of We peoplethrough decided researchers, with Robert to whom organize Mulleracademic we ahad butformal experts,communicated through protest Lester all to sorts theGrinspoon about ofDEA's connec- the strategyWashington,toproposed pay thatfor scheduling someinvolvedRichard expenses, Cotton,gathering of MDMA. but who ahis respected might firmSasha tookbe suggested groupwilling the case of to peoplethat prowork Ibono. contact withwilling We us. a to outlinedWelawyer sign had a in a undergroundmoment.headquartersrequest for I latera hearing. therapeuticto learnedhand-deliver I gathered that use theof the MDMA DEAthose request hadpetitions and forabsolutely were a hearing.and taken then no totally knowledgeThatwalked was by into surprisea ofsweet DEA the to cientlybycriminalize our crediblepetition. MDMA people The DEAnot requesting only administrative in Oncethe a hearing United we gotlaw andStates the judge decided DEA but saw also hearing,to thatgrant internationally we ourit hadbecame request. suffi- clear that the DEA was trying zation]atRobert throughUNESCO Mullerand the the [United forWorld WHO help. NationsHeathin He Geneva, helped Organization Educational mewhere arrange I went Scientific[WHO]. to meetin February withThis and theCulturalwas 1985, crucial when bringing Organi- people I asked PDF compression, OCR, web-optimization with CVISION's PdfCompressor pertcoincidence316information Committee and synchronicityat WHO Stan Grof's MDMA and Society about the therapeutic use of MDMA. that was going to help decide the fate of MDMA brother was the head of the Ex- Through unbelievable JH: internationally.RD:Oh, God!Stan Grof's brother is a respected psychiatrist in Canada who has con- ulingthisducted Expert of more MDMA, Committee. traditional fearing Hepsychiatric that was it thewould oniyresearch. He was who was the scientific consultantimpede toresearch. themember In any who case, objected while I to the sched- appointed the chair of JH:meExpertwas With about in Geneva,Committee.MDA, George not I met MDMA. I discussed Ricaurte's neurotoxicity findings.Bob therapeutic potential, and he told onsomeRD: Schedule Right. small effectsBob ifi, Schusterwhich of wasn't alarmist; MDA on serotonin levels. He thoughtmade MDMA any nonmedical use criminal but still he simply noted that there were should be allowed physiciansandGeneva1980s, about intoSasha the February;administer upcoming and others there the DEA drughad was hearings. been legallystarting able to Forto topatients. be some dissuade the media fromseveral reporting years starting in the early Whenpublicity I came about back MDMA from Dr.meaon andRick asked Ingrasci, mehearing, to a psychiatrist media interest who startedhad to develop. The Phil help organize a panel to appear. I agreed and given MDMA to many patients.MDMA I Donahue Show contacted suggested media.alsozation recommended The is fightingcrucial difficulty thatfor therapeuticBob Schusterfor Thisme use, was took be butthatinvited place reporters atto a time when I was being what do you think about crimin- contacted quite a lot by the participate. asked, "Your organi- bolicMDMAcounterproductivealizing Design recreational criminal Laboratories was and use?" wise. that (EMD).IThatI feltdidn't causedcompelled feelSome athat of makingto say lot of tension within Earth Meta-the doctors and other people that the drugthe recreationalwar was use of

PDF compression, OCR, web-optimization with CVISION's PdfCompressor with established reputations and credentials MDMA's Promise as a Prescription Medicine were willing to be identified in 371 spokesplitDonahuepublic the aas littleorganization; supportingshow bit was about to medical Ithebe appeared taped,need use for I inbutdecided MDMA the not audience recreational to research, resign and from but from EMD the rather not onuse. the Rightprogram. before I the than JH: Becauseeventnot as thata ofmember ledSchuster? to theof the DEA's panel. emergency Unexpectedly, scheduling the Donahue of MDMA. show was the key floor and JH:at Wasn'tanybodyRI):all? Gene ityourfault from Elaslip the ofthat DEA the Schuster DEAhad heard was onabout the potential MDMA was on that show? Do you feel bad about that and that's the first time that neurotoxicity. wewasRD: were thatYou requesting MDMAcan't always shouldin the predict DEA be put what'shearings. in Schedule going I thought to ifi,happen. which that Schuster'shere was we the had samepoint an positioninflu-of view theshow?thatential DEAMDMA scientist About had should a not whoyear been waslater,be made delegatedworking the availableDEA's with the theauthority to Worlddoctors, byHealth the AttorneyOrganization General and emergency scheduling was voided, since so why not put him on the felt to JH: Isn'twithappointedschedule he MDMA? now drugs as working the on head an in emergency ofconjunction the National basis. with Institute MannyMoreover, Tancer Schuster subsequently on Drug Abuse (NTDA). to do clinical research was JH: Didletterslv07n3/07RI): Schuster speak 305 at tan the .html). DEA trials? Yes! You can read about it on the MAPS website (www.maps.org/news- JH: DidsityRD: you ofNo. Chicago, go Lewis to all Seiden, spokethe DEA on a research trials?the neurotoxicity associate of MDA.Bob Schuster's at the Univer-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 318RD:be able to keep MDMA legally available to Yes, we coordinated thatMDMA process. and Society I thought physicians and concluded that it likely that we would not dogsbeforeDrugthe only andAdministration I leftavenue rats, EMD, to that put I was initiated tous develop ingoing position twenty-eight-day to MDMA be leftto do wasas a human studies sanctionedworking prescriptionby the through medicine. the Foodtoxicity Shorflyand studies of MDMA in FDA.usedthousandto make I for contacted alla dollars—four kilogram the FDA-approved Dave of Nichols, dollars humana a gram! research This is MDMA for research purposes. We paid medicinal chemist at Purdue University, in the United States.the MDMA Raising that has been him four JH:money Andof people the for animals the in theanimal havepsychedelic to be killed. community studies was difficult, as you can imagine, because a don't believe in animal testing. lot JH:RD: HowRD: Idid felt you proud. feel at We the had end educatedof the DEA a lothearings?Yes, definitely. of people through the media about whobyforthe aboutMDMA'stherapeutic had legalseven therapeutic MDMA months,benefits experiences soofpotential. IMDMA felt satisfaction We in and that created time a delayed the criminalization ofMDMA in thinking of all thosewho people would not have done so public record of support JH:allotherwise. But the initiallytrials, I hadafter you never nearly won. thought Thetwo DEAyears that administrativeof we testimony would win anyway. and three separate court dates,law judge who presided over JH:ruledRD: When in Right, favor Judge of but Schedule Francis then the Young III. head ruled of the in favorDEA of overruled him. Schedule III, you were surprised? JH:RD: AndRD: Yes. youNot weren'tat all. It surprised always seemed when John to me Lawn as if we were overturned it? going to lose. We were PDF compression, OCR, web-optimization with CVISION's PdfCompressor nicatingin to the public the potentialthe Reagan benefits era; the of drugMDMA. war was escalating.MOMA's Promise But the as victorya Prescription was Medicinecommu— 3j9 JH:inRD: You the Exactly. longgot through run I feltthe to onlygreat me. wayI about hope MDMA that'sit. Then, something. was when going to be saved we finally lost, it was clear that was through the studiesnonprofitAssociationFDA. After to groupget forI leftdone, Psychedelic organized EMD, but whatI started and Studies I asked approved, a new [MAPS]. for organization, in and exchange It it took took forthe leavingMultidisciplinary EMD me a while to geta while a new for the animal was Masterthatthe the Drug Fileanimal Masteron behalfdata File become of for my MDMA ownthe Throughproperty grandmother. at the ofanFDA. MAPS. ironic She hadtwistI used had of that fate, data I needed to use the data in the Drug a recurrence of to open ingandtosevere fear numerousobtain and unipolar relief other afterdepression. medications. several This courses Underlyingtime of she electroconvulsive was her treatment-resistant depression therapy, and lithium, failed which I thought might be alleviated to some degree, ifwas debilitat- chiatristonlychiatrist, iffor I experiencedacould my short mother obtain period andinlegal ofpsychedelic mytime, permission by MDMA. research for the After and experiment. I consultingboth negotiated Although with herwith the a physician, agreed to go forward, but a psy- psy- SheappealmotherFDA, stopped we fromneeded met hereating with to and be irrationaland protectedher had family to resistance. from be stating force-fed, the riskher The ofwillingness but FDA neurotoxic still claimed the FDA effects, that prevented despite to accept that risk. my grand- anus MDMNScommittingtofrom no givingavail. therapeutic Afterhermyself MDMA. she evenpotential. died, Imore even with toappealed her opening depression to thethe doorAssistant still toin thefull Secretary fullflower, exploration forI coped Health, byof JH:intodoesRD: What the MAPSnot would risks happen is andyou supposed tobenefitssay anyone is the toof mission else.ensurepsychedelics It of isthat IVIAPS?designed what and marijuana.happened to We recruit research- support scientific research to my grandmother PDF compression, OCR, web-optimization with CVISION's PdfCompressor protocol380tactingers design,other scientists working to through establish thewho regulatory may be system,interested in these topics,MDMA and Society collaborative networks. Wè move as effi- and we offer them assistance in funding, and con- diseasesystemciently toasbut permitwe also can eventually legal in a strategicaccess for to broadermanner purposes, these substances, initially in the treatment of toward an opening of the regulatory leverage for MAPS meaning personal growth, is FDA- JH:tionapprovedcreativity, When to change did research spirituality,you laws, enter into since the medical The doctoral we point work applications. program of within greatest at We are not a the current regulatory system. Harvard? lobbying organiza- program,RD:gram, I started which for aat Imaster's havethe Kennedy just School of completed.in public When policy I started That at ledNew me College into the in 1982, Government in 1988 in a two-yearresearch. Since I first took LSD Ph.D. pro- ifinI was closeatnecessary,1971, all studying theseveral I had clinical But been psychology times, when psychologytraining Ibut graduated andwhen to become psychedelic I frommentioned a New my Ph.D. programs to which I applied. I got very psychedelic therapist, underground College in 1987, I was rejected desire to conduct MDMA rejection,apsychotherapy fewto study, faculty I realizedI might research thatas forsince my politics dissertation, was in I members, enough to remove me from the A-list. well study politics. During the DEA hearings, I the way encounteredof what I really resistance wanted among After my last had JH:tocreated Did the youKennedy a tutorial ever peiform School! in drug any policy; underground which fascinated me. MDIVIA -assisted Suing the DEA led me psychotherapy? majorRD:month-longresearch. Yes. focus In In withfact, workshopearly MAPS,it 1984,has provedat to before Esalen conduct to MDMA withbe MDMA the Stan was Grof thread that is now becoming myscheduled,post-traumatic I attended stress another disorder this one on spiritual emer- floodedtakenofgencies. mine, MDMA herThewho awareness dayasked together, after me I unexpectedly.to returned during consider whichhome, working This timeI had with past received a phone call from a friend disturbedhis her ex-girlfriend. so much that Theyepisodes had of sexual abuse PDF compression, OCR, web-optimization with CVISION's PdfCompressor suicide.she She had been suicidal and in andsubsequently Out of hospitals checked before herself he metinto her. a hospital so that she wouldn't commit MDMA's Promise as a Prescription Medicine 381 medicationsherotherShe most had horrible recent been that brutallyhospitalizationthings cover happenthe raped symptoms into had anher. earliergiven Thebut don'tpsychiatristsher period all deal theof with hertypical in life theher andantidepressantproblem. past also and had during had JH:cidalRD: I'm He andglad said hopeless you that mentioned after about she findingthat. was released the help fromshe needed. the hospital, He asked she still felt sui- me if I would structuredwhiletrepidation.try toyou're help a three-week withher, I spoke asme, a I'lllastto process. hertry resort. myand best She said,I agreed towas "If be under youtohelpful." try, promise round-the-clock with She a not substantialcame to commitdown, supervision amount and suicide of we lems,binationWeby me conducted butor LSDher they friends andan helped MDMA MDMA at school.her session session.start She Theseto for agreedfind PTSD. sessions a processto stopWe helped alsotaking to workdid her her a subsequentsubstantially. throughantidepressants. things. They didn't solve all her prob- com- therapistingoals.Because transpersonal She ofin is that Spainstudying experience psychology on to the become MAPS-funded sixteen at aNaropa licensed years Institute, MDMA!PTSDago,therapist, she and hasis in ischanged a working master'sproject. her asIt's career a that program co- thatmesort thattime, of in depth in her the lifeof short time those run, and experiences but experience over the have thatlong provedgives term. me She to a be lookslot valuable of backcourage. onnot her Shejust life tellsat see JH: Youchotherapy.www.maps.org/researchlmdmalmarcela.html.]and were identifies obviously that impressed as a turningwith the clinicalpoint. utility[For herof using personal MDMA account, in psy- hismovedhisRD: girlfriend mid-thirties into his asked parent's who me hadhometo conduct cancer so that anof hetheMDMA could esophagus. diesession near HeCompletely. withhis and family, them. his girlfriend Atand the he timeand had In 1984,1 also worked with a friend of mine, a musician in PDF compression, OCR, web-optimization with CVISION's PdfCompressor 382 MDMA and Society time.wasonwe massivedid so We strong worked amounts that with MDMA, and they had a the session, he couldn't eat and was being fed through a he really wasn't ofpresent; morphine, he was but nodding the pain outwas most still there.of the The morphine beautiful, life-affirming ex- tube. He was time.endeddiesperience. while Second, up It being wewas arethey so pain doingscary went free forthis?" throughand me, Hecompletely because wasa beautiful so I was near lucid review for an thinking, "Mydeath God, anyway. what if Firsthe of all, he of their relationship;extended period of walkedthattheyevery Iwere had outnight clearlytaken the until door the saying then. riskwas good-bye.I to"Rick, try to you help He under-dosed diedhim. six The days last me." later. thing remember leaving that night in elation. I was so glad He slept peacefullyhe said to me as I JH: I'mgoodtions.ment glad ofjob.Doctors thethat There dying youtalk is mentionaboutpatient. so much keeping Thisnot fear only ispeople surroundinga groupPTSD comfortable, but deathalso butpalliative that I think care it ofpatients with minimal treatment op- they don't always do a very exacerbates the and treat- pain.RD:sharedying And I have thesome of familiescancer.one MDMA more andMy storywith loved friend him.about ones was I areatalked friend'svery in pain toclose him father,too. to about her who dad,it wasahead and ofin time his andfifties thenshe and decided to makepeace,nowafterward. with me but diethe HeI'm helpsooner." said, wondering of "You MDMA, We know, talkedif I usedabout to that, deny and the together fact that we I was came up this acceptanceI've accepted of deathit. That is hasactually brought going me toa lot of dying, but with therience.preciateagainst idea that Hethe each increasedbytruth remainingaccepting of his his disease. momentdeath,ability heInsteadto of reallywas his nolife,he enjoy longerhad which the using timewould liberated his attention to ap- that he had left.his energyprolong to fight the expe- JH:patient MDMARI): but forcan the help family improve as well. the quality of lift you haveExactly. left, not And he felt that by virtue of enjoying every day... just for the

PDF compression, OCR, web-optimization with CVISION's PdfCompressor JH: He could make it last that much longer MDMA's Promise as a Prescription Medicine 383 wereMDMA-assistedRD:on, dying, Yes. fighting And people hebut didpsychotherapyin not relationships. survive denying. longer I withhave I thanknow people had people a severalmarried who thought had experiencescouple PTSD,he would. who performingcouldn't people who He hung becomingaboutaconceive half. their Under parents. a struggleschild. the TheinfluenceThey trying wife had felt oftonot getMDMA somethingbeen pregnant using one shift andnight,birth their somehow controlthey fears spoke for andinside aboutwith her each other anxieties about a year and body, JH: Thatthenand she bringsand had conceived. us an to intuition another Their potentialthat daughter she couldtherapeutic is nownow get pregnant.fourteen years They old.had sex right use, which is mind/body medi- breathwholecine. MDIVIA rightwork, arm andcould became from be a usefulLSD-catalyzed paralyzed. tool not I justhad psychotherapy for learned piychiatry fromI once but Stanthat also sat andthere for with medicine.others, is a doctor who took MDMA. During the experience, a mind! from his Andtheinbody the emergency he connection body. told meInstead room;a and story of that panickingabout psychological how and he hadsaying, issues "Oh, paralyzed," I said, "Okay, what does this mean?" a very conflicted relationship with can be expressed symbolically my God, let's get him to innear dadhisthe the father isfamily endnot and,reallyof to his pull in lifeconscious. fact, the and plug."that was he He's dying,And had just hehated the physically family his father. came pulled But to him thewhen plug.and his said, father "Your on life support, and we need somebody drew JH:thatcouldRID: With MDMA Withmove that that hishand. really hand.hand opens again. Once up. It'swe amazingtalked it allthe kind of mindlbody Out at the end of the session, he connections JH:regulateRD: What My do dissertationthe you use see of as MDMA thewas future about for just MDIVIA that. First, I believe that there is as a prescription medicine so that society will as aprescrzption medicine? a way to PDF compression, OCR, web-optimization with CVISION's PdfCompressor any384obtain number of ways substantiallyMDMA and Society more benefits than risks. I think we can through training requirements for psychiatrists, regula- control it in medicineregistries.tionsa five-million-dollar, for theto I believeaid facilities psychiatrists that in MDMA which and haspsychotherapists.it's tremendousused, reporting I think systems, it five-year research project. If we had no political ob- potential as a prescription would be about and patient That'sfinances,ceuticalstacles what and company we justMAPS could were could, ismake ableworking toMDMAI believe work toward. with into that thea in prescription FDAthat time the way frame medicine any and withother those pharma- for PTSD. JH:aboutRD: Is your Yes, the detailsdissertation they ofyourcan check online? proposal? it Isout there on somewherethe MAPS peopleWeb site can atgo to www.maps.org/ learn more MDMA.otherbedocs/doblindissertation.pdf. done. drugs EvenFirst, in thoughterms I think of it's the safety a same psychedelicI'll andjust standards efficacyvery drug briefly thatare and outline appropriatethe it has FDA how uses I think to it abuse potential, the for evaluating evaluate could JH: Otherothersame drugscontrolledbasic wouldstandards drugs? apply. of safety and efficacy that the FDA uses to evaluate JH: Orutility.RID: Percocet Yes, like [oxycodone], marijuana. which also has an abuse liability but some medical RID:canthattion Yes. prescribe.ismedicine no. The MDMA next inMDMA the question should way is thatnever isnot this: mostbe simplyCan other the a drugsdrug prescription be are used going to be like Prozac—it will never be a approved? My answer to drug that any doctorsafely as a prescrip- thinktake-hometherapists.cally there responsible needsdrug. However, Itto shouldforbe the athe medical doctors bepatient, taken doctoror but undertherapists non-physicians on thethe whosupervisiontreatment administer also team can of a MDMAtherapist. should I who is medi-be excellent PDF compression, OCR, web-optimization with CVISION's PdfCompressor MDMA's Promise as a Prescription Medicine 385 ingtweenpeutic,be to manage.the not doctor inherently and the but patient becauserequired that it requiresis part to have of sophistication a specialtherapeutic training. and relationship special The MDMA train- be- experience can be thera- willingnesstherapyself-disclosure that on the the and intimacy part trust. of patients There'sof theAnother relationship undera long-established issue the influence issometimes preventing awareness of shadesMDMA sexual intoin towardabuse psycho- sexual of patients. There is a certain relationshipsIpsychotherapy,the think patient. that safeguardsbetweenThat because particular patient need MDMA problem andto be helpstherapist established, is people relevant that open soare to that thenotup MDMAinregulationto verythe advantage intimate is notof MDMA used ways. of in therapygivesatethat forway. the this anywhere. regulatorsThere sort isof also treatment. an theeasier issue way If of you towhat controlrestrict kinds use theof facilities thanuse toif doctorscertain are most canfacilities, appropri- conduct it JH: ThattheRD:that models themethod government thatalso theallows is FDA always for has tighter worried increasingly control about. to comeprevent to diversion, relyIt's upon, which where I know they try also easier to track, easier to monitor. I think that we need to look at whichyouing.to limit areWithpatients thepast certain use thehave ofexperimental drugs certainto sign. there prescription One hasphase; of to the be there new drugswritten areinnovations to documents informedpeople withthat consent, has developed even once outlining the risks, particular train- anding.in the Congressplaces scheduling it increated Schedule of the a lawmedical I thatfor the criminalizesuse purposes of drugs GHB of abusenonmedical [gamma-hydroxybutyrate] is bifurcated use, and schedul- heavy in Schedule UI, whichpenaltiesand store.means apply. that But it's wheneasier it for is doctorsused as toa medicalgain access drug, to it; it's easier to ship . JH:kindRD: Right.of bifurcated It's possible scheduling. that MDMA Enforcement couldAnd againstbe peiform another the research. nonmedicalcandidate use for that of PDF compression, OCR, web-optimization with CVISION's PdfCompressor promised386MDMA, by the approval of MDMA for medical use. Every concern that theMDMA and Society as long as that is considered a priority by our country; is not com- practical,therapeuticDEAassisted and and thepsychotherapy use FDAnot of too MDMAcan expensive. articulate within can be Weour regarding met cancurrent in approve regulatory publicregulatory the safety medicalschemes scheme, associated use that within of areMDMA- with legal,the the cur- challengestantialthatrent inrange this medical, that ofkind powers MAPS of therapeutic tightly thatis working the regulated benefitsFDA to has.address. system, with We minimal also we willcan health prettybe able costs. to obtain That issub- the much guarantee

PDF compression, OCR, web-optimization with CVISION's PdfCompressor PDF compression, OCR, web-optimization with CVISION's PdfCompressor HISTORY TIMELINE 19141912 MDMADecember patent 24. is filed by E. Merck in Darmstadt, Germany, on 19531924 U.S.synthesis.PaperPatent Army isis publishedissued Chemical as numbermentioning Center 274350 (contract MDMA on May no. as intermediate DA-18-108-CML-5663)16. in chemical 1953 vertentlyNewofgives Michigan. YorkMDMA killed State (code with Psychiatric EAlethal 1475) dose Institute to of laboratory MDA clinical (450 animals research mg intravenous). at subject the University inad- 1960s1960 Latesynthesis.Paperdrug." in is the published decade MDAmentioning becomes MDMA popular as intermediateand is nicknamed in chemical the "love 197219761973 PublicationDr.ChicagoGaston Sasha publishes in ofShulgin 1970. Army street takesChemical sample MDMA, Center's identified 16 mg, findings, foras MDMA,the declassified first timefound on in in Septem-1969. 19771976 ShulginanDr.ber effect. 8,Sasha with introduces Shulgin no effect. takes "Jacob," 81 mg a therapist, of MDMA to MDMA.on September 27 and notes 19781977 MDMA.MisuseMDMASasha of Shulginis Drugs made andAct.illegal David in the Nichols United publish Kingdom, first addedpaper onto thehuman 1971 use of l980sl970s— MDMA The mid-1970s in psychotherapy. to the mid-1980s sees the legal therapeutic use of thePopular decade. use of MDMA begins in the United States in the early part of 1983 MPTPheroin causes abusers. a Parkinson's-like syndrome in several Californian IV 388 PDF compression, OCR, web-optimization with CVISION's PdfCompressor 1983/4 Proto-raves with Balearic music begin on the Spanish island of Ibiza. History Timeline 389 1984 inOnMDMA. Schedule JuneJuly 27,10, DEAI.the San publishes Francisco plans Register in the publishes Federal Regirter first big tostory put aboutMDMA hearingsRichardLesterOn September Grinspoon, Cotton,on the 10, scheduling send M.D.;Thomas a letter James ofRoberts, toMDMA. Bakalar,the DEA Ph.D.; Ph.D.; administrator George and theirGreer, requesting attorney, M.D.; mid-1980s19861984— MDMAEcstasy appears use grows on the in popularitystreet in Australia. in Spain. 1985 neysOn only, MarchFebruary no 10—15, witnesses). 1, DEA Earth holds Metabolic first hearing Design in Washington,sponsors conference D.C. (attor- on 1985 LloydEmergingMDMAOn May Bentsen. at recreational31,Esalen. DEA announces use in Texas plan capturesof emergency attention ban of to Senator place MDMA 1985 in effect.OnSchedule JulyJune 1,10 I emergency forand one 11, year.DEA scheduling holds second of MDMA hearing, as Schedulein Los Angeles. I drug takes 1985 UndergroundOn JulyOctober 10 and therapeutic8—11, 11, DEA DEA use holds holds of MDMAthird fourth hearing, hearing, continues in Kansasin inWashington, psychotherapy. City, Missouri. D.C. 1986 therapyGreertheOn FebruaryUnited and sessions. Tolbert Nations' 11, MDMA publish Commission is their placed results on in NarcoticSchedule from MDMA-assisted Drug I internationally Laws. psycho- by 1986 MAPSconference.OnFDA May president(no. 18—19, 6293). Rick Haight-Ashbury Doblin opens FreeDrug Clinic Master sponsors File for MDMA MDMA at PDF compression, OCR, web-optimization with CVISION's PdfCompressor 390 Appendices 1986 mendsOn May Schedule 30, MDMA ifi placement is made ofillegal MDMA. in MaySpain. 22, DEA administrative law judge Francis Young recom- 19871986 JudgeDowlingOn OctoberNovemberYoung. reports 14, 13, DEAon Schedule five publishes fatalities I status ruling associated for in MDMA Federal with Ecstasy takesRegister, effect. use. overruling 19871987 InHIAA.andPeroutka the sees summer, nocompares difference Ecstasy cerebrospinal in use the at level discos fluid of increasesthe of serotonin Ecstasy in frequency users metabolite and oncontrols 5- the 1987 inManchester, OnSpanishthe SeptemberFirst island Circuit England. 18,of Court Ibiza.the case of That Appeals of fall,Lester the in Grinspoon, partiesBoston, are with MD.,exported Richard v. DEA back Cotton begins to 19871988 window":OnDecemberas attorney. January MDMA 22, 27, 1987, the is brieflyDEA to March removes unscheduled 22, MDMA1988, owing marks from to theappealSchedule "Grinspoon process. I after court 1988 MDMAOnInmandate February, March in Schedule12/22/87. 23, the MDMA DEA I, starting publishes is placed March in in Federal Schedule 23, 1988. Register I, with the no intentsubsequent to place 19881988 Britain'sIanInappeals. June Larcombe, the "Summer United who Kingdom ofwas Love" alleged reports is markedto have its first bytaken Ecstasyincreased eighteen death, MDMA tablets 21-year-old at once. 19881989 UnitedInPsycholyticconsumption. the summer, Kingdom. psychotherapy large outdoor with dance MDMA parties begins gain in Switzerland.in popularity in the 1990 levelswhoHarlowRicaurte used in and Ecstasy MDMA demonstrates Beck users present in their versus a theirlowerpractices. chronic findings level back of from cerebrospinal pain surveying patients. fluid psychiatrists 5-HIAA PDF compression, OCR, web-optimization with CVISION's PdfCompressor History Timeline 391 1 990s youthRaves movement in Britain. continue to grow in popularity among members of a large 19961992—1991 WidespreadTown"One ofdebuts. the MDMA first large use U.S. is noted raves inis Spain.held in San Francisco: "Toon 1992 MDMZAEcstasyHenryOn July reports use. research. 15, FDAon cases meeting of hyperthermia allows Dr. Charlesand hepatitis Grob associatedto perform withclinical 1993 Psycholyticdiminish rave-associated psychotherapy injuries. ends in Switzerland. the United Kingdom adopts Safer Dancing Campaign to 19951994 InsubjectsOn May at 18,UCLA. Dr. Charles Grob gives first dose of MDMA to human Sasha Shulgin turns in his DEA license. 1995 removedEcstasyAnnaOn November use. five days 16, after England's her eighteenth Leah Betts birthday, dies. Herwhen life she support took one is schoolgirl in Sidney, Australia, dies as the result of 1999 FromEcstasyIntablet March, Augustof ring Ecstasy Sammy in 30 Arizona andto "the September drank Bull"that copious distributed Gravano 1, MAPS amounts is25,000 sponsorsarrested of pillswater. forIsrael per running week. MDMA an 1999 publicconference.announcesOn December about "cluba $54 2, drugs,"NIDAmillion launches includingbudget. multimedia website campaign to educate the and 2000 DancingOnCongress JulyMay 31,25,with (HR DEAthe Darkness.4553). Club sponsors Drug theAnti-Proliferation conference Ecstasy Act isand introduced Club Drugs: in 20002000 in OnClinton.PTSD NovemberSeptember study. 9,27, Spain's modified José Club Carlos Drug Bouso Act givesis signed first bydose President of MDMA PDF compression, OCR, web-optimization with CVISION's PdfCompressor STATiSTiCS1976 TIMELINE inRonald America Siegel in thatestimates year (Siegel that 10,000 1985). doses of Ecstasy were consumed 198019811977— MDMARick8 deaths Doblin had are beenestimates attributed consumed that to byMDMA. worldwide 1980, more (Rosenbaum than 11 million and Doblindoses of 1982 Harristheto31 1991). taking percentdrug opinion (HarrisEcstasy, of pollthe Research people forand the 67 between BBCpercent Center in the1982).reported agesUnited ofthat 16Kingdom their and 25friends reportsyears had admitted that tried 1985 AmericaStates.28Ronald emergency (Siegel Siegel 1985).estimatesroom visits that for 30,000 MDMA doses use areare consumedreported in per the month United in 1986 (Calvert8States.39 percent emergency 1987). of the room college visits students for MDMA at Stanford use are report reported MDMA in the use United 19871987 surveyed)39States. percentemergency (Peroutka of Stanford room 1987).visits students for MDMA report havinguse are used reported Ecstasy in the (369 United 19881987 having2015.5 percent percentused of Ecstasy undergraduates of Tulane (Accola(Patterson University 1988). at et the al. Universitystudents1988). (742 of Coloradosurveyed) reportreport 19911989 Lessdom;First thansignificant32,000 200 tablets emergency seizures are confiscated. of room Ecstasy visits are for reported Ecstasy in use the are United reported King- in 1992 States.236the U.S. emergency by DAWN. room visits for Ecstasy use are reported in the United 392 PDF compression, OCR, web-optimization with CVISION's PdfCompressor 1993 68 emergency room visits for Ecstasy use are reported in the United Statistics Timdine 393 1993 NIDA8States. deaths survey: are attributed2 percent ofto allEcstasy college in studentsEngland reportand Wales. Ecstasy use in 1994 250(1,26424.3the emergency past percent surveyed) year. ofroom Tulane (Cuomo visits University for et Ecstasy al. 1994). students use are reportedreport having in United used States. Ecstasy 19951994 421States.27 1emergency deaths death isare attributed attributedroom visits to to Ecstasyfor Ecstasy Ecstasy in in the Englanduse United are reported and States. Wales. in the United 1995 Nicholas610 deaths deaths Saunders are are attributed attributed estimates to to Ecstasy Ecstasythat 6 percent in in the England United of 1 5-year-olds and States. Wales. are using 1996 inuseEnglishEcstasy. British Ecstasy newspaper each weekend Guardian and estimates calls it the 500,000 "largest to 1youth million phenomenon people 1996 3198 deaths16 emergency deaths are areattributed attributedroom visits to Ecstasyto for Ecstasy Ecstasy in thein England useUnited are citedStates. and inWales. the United 1996 25,reportsU.S.States. 2.5 Department percentthat 1.1 ofpercent ofthose Health of26 those toand 34, Human12 and to 0.717, Services percent4.2 percent householdof those of those over survey 1835 to 1996 Monitoringpercent5.6admitted percent of theto the ofusing U.S. Future tenth-graders, population.Ecstasy Study at reports least and 6.1once 3.4 percent inpercent their of lives, of twelfth-graders eighth-graders, totaling 1.5 1997 States.637admitted11 emergency deaths to usingare attributedroom Ecstasy visits toat for leastEcstasy Ecstasy once in inEnglanduse their are lives.reported and Wales. in the United

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 3941997 Appendices thoseHousehold3 deaths 18 to aresurvey25, attributed 3.1 reportspercent to 1.3 ofEcstasy thosepercent 26in of theto those 34,United and 12 0.5States.to 17, percent 4.6 percent of those of 1997 graders,Monitoringover1.5 35 percent admitted5.7 thepercent of Futurethe to usingU.S.of tenth-graders,Study population. Ecstasy reports at andthat 6.93.2 percent twelfth-gradersof eighth- least once in their lives, totaling 1997 danceDrugsU.S.admitted Customs eventsand to dance using in reports London surveyEcstasy seizures reported indicates at least of use400,000once that of in84 Ecstasy. their hitspercent oflives. Ecstasy. of people attending 1998 theirpercentHousehold lives, of thosetotalingsurvey over18 reports 1.5to 35 25, percent admitted 2.6that percent 1.6of tothepercent using ofU.S. those Ecstasyofpopulation. those 26 to at 1234, to 17, 5.0 least once in and 0.5 19981998 Monitoringadmitted5.11,143 percent emergency to the ofusing Future tenth-graders, Ecstasy room Study visitsat reports least and for 5.8once Ecstasy2.7 percent inpercent their use of lives. of aretwelfth-graders eighth-graders, cited in the United 1998 olderHousehold9States. deaths have are triedsurvey attributed Ecstasy reports to at Ecstasyat least least once 3.4in the inmillion theirUnited lifetimes.Americans States. 12 years and 1998 UnitedBritishcombinedDEA reports KingdomCrime (Cloud seizures Survey aged2000). ofreports 16 750,000 to 29 that years hits 10 ofpercentold Ecstasy—tablets have of ever the triedpeople Ecstasy,and in powderthe and 19991998 Federal4 percent2,850tablets Drugemergency were had takenIdentificationconfiscated. roomit in the visits lastNetwork for year Ecstasy (RamseySeizures use etreportsare a!. cited 1999). that in the1.2 million United 1999 Monitoringadmitted6.0States. percent to the ofusing Future tenth-graders, Ecstasy Study at reports leastand 8.0once 2.7 percent percentin their of lifetimes.of twelfth-graders eighth-graders,

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 1999 powderDEA reports combined seizures (Cloud of 5.4 2000). million hits of Ecstasy—tablets and Statistics Timeline 395 20001999 thatDavidmillionFederal 750,000 Gauvin tabletsDrug hits Identification estimateswere of Ecstasyconfiscated. at DEA Networkare being club Seizuresdrugused conferencein New reports York thatin andJuly 12.1 the 2000 New 2000 JerseypercentMonitoringinto shore the ofUnitedcorridor tenth-graders, the StatesFuture every every Studyweekend, 11 week.percent reports with of 4.3 2 twelfth-graders million percent tablets of eight-graders, comingadmitted to 7.3 Drug2000 Abuse Warning Network (DAWN) data are found on the Web site U.S.using Customs Ecstasy atreports least once9.3 million in their hits lifetimes. Ecstasy were seized. foundareStatisticswww.samhsa.gov. in Healthin Dowlingdrug-related Statistics (1990).England deathsQuarterly, and database. Wales vol. 5, Firstdeath Spring results statistics 2000. for areEngland from theand OfficeWales, of 1993—97, National DAWN data before 1990 are

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lADLE I:StudiesofLong-term Behavioral or Functional Changes after MDMA Exposure in Animals byMatthew Baggot and John Mendelson, M.D.

Speciesand StrainNeurotoxic MDMA Regimen Significant Effects of MDMA Exposure Measures not Significantly DifferentReference

Rhesus Monkeys 10 mg/kg IM, twice a day, for 4 days Right shift in MDMA and d-fenfluramine dose-Drug-free performance on all tasks at Frederick et al. response curve for time estimation, learning post Imo. 1998 task, and motivation tasks at post I mo.

Rhesus Monkeys Escalating doses of 0.1, 0.3, 1.0, Right shift in MDMA dose-response curve Drug-free performance on all tasks Frederick et al. 1.75, 3.0, 5.6,7.5, 10.0, 15.0, and for time estimation, short-term memory, at all time points. 1995 20 mg/kg, IM,twice daily for 14 color and position discrimination, and consecutive days at each dose. motivation tasks post 5, 12, or 19 mo (2 of 3 animals "skipped" the 1.75, from chronic regimen (post 12 and 19 mo 7.5, and 15 mg/kg dose levels). measures were post 5 mo from a dose- Preceded by one period of dose response determination). response testing using doses up to 1.75 mg/kg IM and followed by three two month periods of dose- response testing using doses up to 5.7 mg/kg IM.

Sprague-Dawley Rats 20 mg/kg Sc, twice a day for 4 daysNone, although researchers note that 2 of 8 Acquisition of and behavior on a lever- Byrne et al. 2000 MDMA-exposed rats failed to acquire lever press responding task at post 14 days. pressing with 20 sec reinforcement delays during the 8 hr session at post 14 days.

Sprague-Dawley Rats 10 mg/kg Sc, twice a day for 4 daysSignificant pretreatment x treatment x Drug-free locomotion at 21 days; callaway and Geyer crossing times interaction, suggesting altered RU24969-induced behavioral activation 1992 S(+)-MDMA-induced behavioral activation at2I days. atpost2l days.

Wistar Rats 10 mg/kg Sc, once a day for 4 days Increased core temperature when placed in None. Dafters and Lynch either 22°c or 28°c ambient temperature 1998 at post 4 or 14 wks.

Long-Evans Rats 40 mg/kg Sc, twice a day for 4 daysNone Sexual behaviors at post 10 days; Dornan et al. 1991 spontaneous motor activity. PDF compression, OCR, web-optimization with CVISION's PdfCompressor

Sprague-Dawley Rats 20 mg/kg SC, twice a day for 4 daysDecreased cortical 5-HT release in responseElectrical-stimulated 5-HT release in MRN Gartside et al. to electrical stimulation in DRN at post or hippocampus at post 2 wks; number 1996 10-12 days. and firing pattern of classical 5-HT neurons and burst-firing neurons in DRN.

Sprague-Dawley Rats 20 mg/kg SC, twice a day for 4 days None. DOl-induced head twitch responses, Granoff and Ash by locomotion, and rearing activity at post 1998 I mo.

Sprague-Dawley Rats 20 mg/kg SC, twice a day for 4 daysIncreased conditioned place preference None. Horan et a!. 2000 response to cocaine in MDMA group at 2 post wks.

Sprague-Dawley Rats 5 mg/kg SC, once a day for 4 days, Increased motor stimulant effects of Basal DA in nucleus accumbens at Kalivas et al. 1998 or 20 mg/kg SC, twice a day for 4 5.0 mg/kg SC MDMA in both MDMA- post 2 wks.

days, followed by 5 mg/kg MDMA treated groups at post I days; increased 2 days later motor stimulant effects of 15.0 mg/kg IP cocaine in both MDMA-treated groups at

post II days; increased MDMA-stimulated DA release in the nucleus accumbens at post 2 wks.

Sprague-Dawley Rats IS mg/kg lP Loss of rate-dependence of response of Basal activity of nigrostriatal DA neurons;Kelland et al. 1989 nigrostriatal cells to either quinpirole or quinpirole-induced inhibition of apomorphine at post I wk. nigrostriatal DA cell firing for all cells at post I wk.

Sprague-Dawley Rats 6 mg/kg SC, twice a day for 4 days Leftshiftin MDMA dose-response curve None. Li et a!. 1989 on DRL task in MDMA group at post 4 wks.

Lister Hooded Rats Ascending regimen of 10, IS, and Decreased performance in operant delayed Spontaneous behavior, body temperature, Marston et a!. 20 mg/kg IP, each dose given twice match to nonsample task beginning at post and skilled paw reach ("staircase task") up 1999 daily for one day 12 days. to post 16 days.

Sprague-Dawley Rats 20 mg/kg SC, twice a day for 4 daysIncreased cocaine-induced dopamine release None. Morgan et a!. 1997 in nucleus accumbens in MDMA group at post 2 wks. PDF compression, OCR, web-optimization with CVISION's PdfCompressor

Species and StrainNeurotoxic MDMA Regimen Significant Effects of MDMA Exposure Measures not Significantly DifferentReference

Sprague-Dawley Rats 20 mg/kg SC, twice a day for 4 daysIncreased morphine-induced antinociception Drug-free behavior in tail flick test at Nencini et a!. 1988 (assessed by tail flick test) at post 2 wks. post 2 wks.

Sprague-Dawley Rats 20 mg/kg SC, twice a day for 4 daysDecreased inhibitory effects of DA and Inhibitory effects of GABA on glutamate-Obradovic eta!. SKF38393 on glutamate-evoked firing in evoked firing in nucleus accumbens cells 1998 nucleus accumbens cells at post 9—IS days. at post 9—IS days.

Sprague-Dawley Rats 20 mg/kg SC Increased 8-OH-DPAT-induced prolactin Basal ACTH and prolactin concentrationsPoland 1990 release at post 2 wks. Decreased 8-OH- and ACTH and prolactin response to DPAT-stimulated ACTH release at post saline injection at post 2 wks. 2 wks.

Sprague-Dawley Rats 20 mg/kg SC Increased d,l-fenfluramine-stimulated d,l-fenfluramine-stimulated ACTH at Poland eta!. 1997 prolactin release at post 2 wks and 4 mo. post 12 mo; d,I-fenfluramine-stimulated Decreased d,l-fenfluramine-stimulated prolactin at post 8 and 12 mo. ACTH release at post 2 wks, 4 mo, and 8 mo.

Sprague-Dawley Rats 20 mg/kg SC, twice a day for 4 daysIncreased d,l-fenfluramine-stimulated Saline-stimulated ACTH and prolactin Poland et a!. 1997 prolactin release at post 4 and 8 mo. release at post 2 weeks; d,I-fenfluramine- Decreased d,l-fenfluramine-stimulated stimulated prolactin release at post ACTH release at post 4,8, and 12 mo. 12 mo.

Long-Evans Rats 20 mg/kg SC, twice a day for 4 daysNone. Performance in a spatial memory task Ricaurte eta!. with entire regimen repeated using aT-maze (at post 7—10 wks) and 1993 I wk later scopolamine-induced changes in performance on this task (at post 15—16 wks).

Sprague-Dawley Rats 10 mg/kg IP, twice a day for 4 days None (increased time to find hidden Spatial navigation and learning set task at Robinson et al. platform in first trial of spatial navigation post 7—9 days, skilled reaching task at 1993 task at post 2 days). post 17—19 days, foraging task at post 26—29 days, with or without atropine pretreatment.

Sprague-Dawley Rats 20 mg/kg SC, twice a day for 4 daysDecreased discrimination of 1.0 mg/kg Discrimination of 0.5 or 1.5 mg/kg; Schechter 1991 MDMA from saline at post 13—15 days. conditioned place preference from MDMA at post 13—15 days. PDF compression, OCR, web-optimization with CVISION's PdfCompressor

Sprague-Dawley Rats tO, 20, and 40 mg/kg SC, twice a None. Food and water intake, schedule- Seiden, et at. 1996 day for 4 days controlled behavior, open field behavior, acquisition of one- and two-way avoidance, swimming ability, acquisition and extinction in 8-arm radial maze test, and morphine-induced antinociception at post 14—28 days.

Sprague-Dawley Rats 20 or 40 mg/kg lP, twice a day Decreased d-fenfluramine-stimulated None. Series et al. 1994 for 4 days 5-HT release in frontal cortex at post 2wks.

Sprague-Dawley Rats 10 mg/kg IP, every 2 h for Decreased behavioral, hyperthermic, and None. Shankaran and 4 injections 5-HT-releasing effects of MDMA atI wk Gudelsky 1999 after neurotoxic regimen.

Sprague-Dawley Rats 20 mg/kg SC, twice a day for 4 days Increased cerebral glucose utilization in Cerebral glucose utilization in neocortex, Sharkey et aI. 1991 molecular layer of dentate gyrus and in raphe nuclei, and some hippocampal CA2 and CA3 fields of Ammon's horn in areas at post 14 days. hippocampus at post 14 days. Slikker et al. 1989 Sprague-Dawley Rats 5 or 10 mg/kg P0, daily for 4 days None. Auditory startle, emergence from darkened chamber, complex maze navigation, response to hot plate, Fl 90 operant behavioral task at post 2 to 4 weeks. Virden and Baker Sprague-Dawley Rats 20 mg/kg, SC, twice a day for 4 daysDecreased S(+)-MDMA-appropriate None. responding after S(+)-MDMA and increased 1999 S(+)-MDMA-appropriate responding after saline at post 10 days.

Young Sprague-Dawley 10 mg/kg SC, every 12 hrs for 4 Decreased rate of ultrasonic vocalization Behavioral responses to the 5-HTIA Winslow and Insel 1990 Rat Pups or 7 injections measured up to post II days. agonist 8-OH-DPAT, the 5-HTIB agonist TFMPP, and the 5-HT2 agonist DOl at post 8 days.

Time from MDMA treatment is expressed as time from last exposure.

Abbreviations: DA - dopamine; DRN - dorsal raphe nucleus; DRL - differential reinforcement of low rate(behavioral task); Fl - fixed interval of reinforcement (behavioral task); IM - intramuscular injection. PDF compression, OCR, web-optimization with CVISION's PdfCompressor

TABLE II: Reported Neurofunctiona! Differences Between Ecstasy Users and Nonusers by Matthew Baggot and John Mendelson, M.D. Putative Serotonergic Measures

Selective for Serotonergic Relevant Animal Correlated with MDMA Evidence for Recovery? References Measure Differences? Literature? Exposure?

Decreased CSF 5-HIAA Yes Decreased up to 2 weeks No No Decreased in McCann et in 3 of 4 studies after MDMA in squirrel at.I 999b, 1994; Ricaurte monkeys (Ricaurte et at.I 988b) et at. 1990. Unchanged in and 14 weeks after MDMA in Peroutka et at. 1987 rhesus monkeys (Insel et at. 1989)

Decreased then Yes Decreased at 24 hr, normal Yes Not reported Increased in Reneman et Increased 5-HT2A at2t dafter MDMA in rats at. 2000a; Decreased receptor density in (Scheffel et at. 1992) then increased in I of Istudies Reneman et at. 2000b

Decreased neuro- Yes Increased at 2 mo. Yes in Gerra et at. 2000 No Decreased in Gerra et endocrine response to normal at 12 mo. in at. 2000, I 998; Verkes et serotonergic drugs, in rats (Poland et al. 1997) at. 2000; McCann etat. 4 of 6 studies I 999a. Unchanged in Price et at. 1989; McCann et at. 1994

Decreased SERT density,Disputed—ligand kinetics PET measures apparently Yes, though McCann Mixed (Yes in Semple; Semple et at. 1999; estimated with PET, in 2 may be altered by other decreased in one baboon included controls No in McCann) McCann et at. 1998 of 2 studies changes (Kuikka &Ahonen upto t4wks after 1998) MDMA (Scheffet et at. 1998)

Increased stimulus Disputed—5HT depletion Unknown No Not reported Tuchtenhagen et at. 2000 dependence for ERP EEGdid not change measure in NI 1P2 amplitudes in one study (Dierks et at. 1999)

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Nonspecific Neurofunctional Measures

Measure Relevant Animal Correlated with Evidence for References Literature MDMA Exposure Recovery

Increased brain myolnositol measured Unknown Yes Not reported Chang et al. 1999 as by IH MRS inI of! studies

Decreased total sleep time (non-REM and Unknown No Not reported Allen et al. 1993

stage 2 sleep) in I of Istudy

Altered cerebral blood flow or volume in Increased blood flow Yes Yes Altered in Reneman et 2 of 4 studies 6—9 wks after MDA in rats al. 2000a,b and in Chang (McBean et a!. 1990) et al. 2000 Unchanged in Chang et al. 2000 (user- nonuser study) and Gamma eta!. 2000b

Decreased cerebral glucose utilization Increased in some No No Obrocki et al. 1999 hipppocampal areas 2 wks in I of Istudies (Sharkey et al. 1991) after MDMA and 6—9 wks after MDA (McBean et a!. 1990) in rats

Increased alpha and beta EEG power Unknown Yes Not reported Dafters et al. 1999; in 2 of 2 studies Gamma eta!. 2000a PDF compression, OCR, web-optimization with CVISION's PdfCompressor

TABLE IlkMemoryStudies of Ecstasy Users vs. Nonusers by Harry Sumnall

Memory feature Studies finding Studies finding no Notes significant effects of significant effects of Ecstasy exposure Ecstasy exposure

ImmediateVerbal 1235121314 481518

DelayedVerbal I 235 13 14 15 45

Verbal learning 5 16

ImmediateVisual I 8 14 18

Delayed Visual I 2 14

Visuospatial 16

Visuospatial span

Working memory 2 3 5 9 17 18 9 McCann et al. (1999) administered more than one type of working memory assessment

Working memory span 4 5

Logical memory (delayed immediate) II

Prospective memory 6

Remembering techniques 6

Everyday memory 5

Other 5 7 2 I 5 7 9 'found no difference using the Wechsler Memory Scale—Revised which contains measures of immediate verbal control, logical memory, learning and visual memory information in this letter was ir,comolete but see Croft et al. (2000) PDF compression, OCR, web-optimization with CVISION's PdfCompressor

Reference Correlation with Self-reported Self-reported Polydrug users? past exposure? total Ecstasy abstinence (Urinalyis?)' exposure b period b

I. Bolla et al. (1998) Yes, although no differences Median 60 (25—300) doses Median 4 (2—36) weeks Yes (Yes) based on Ecstasy exposure over 4.75 ( 1—17) years per se at 2 (0—20) uses/month

2. Croft et at. (200 I) Not assessed 41.9 (SD49.3) tablets over >1 week Yes (No) lifetime (25.7 ± 4.7 years)

3. Curran and Travill (I 997)t Not assessed Not specified Not specified Yes (No)

4. Dafters et at. (1999) No 4.04 (1—60) doses in 7 days Yes (No) previous 12 months

5. Gouzoulis-Mayfrank Yes 934.4 (119.9) doses over 41(71.1) days Yes, only cannabis (Yes) et at. (2000) 27(18) months at 2.4 (1.6) uses/month

6. Heffernan et at. (submitted)Not assessed 10 or more times within Not reported Yes (No) a month

7. Klugman et at. (I 999)t Not assessed 235 (12—2600) doses 79 (2—400) days over 4.3 (2.6) years Yes (No)

8. Krystal et at. (1992) Not assessed 1.9 (1.7) doses over 66 (50) days Yes (No) 5.1(2.3) years

9. McCann etal. (1999b) Yes 215 (30—725) doses over 13.91 (3—147) weeks Yes (Yes) 4.52 (1—14) years

tO. Morgan (1998) Not assessed 35.6 doses over 2.12 (1.36) 20.4 (33.6) days Yes (No) years at 2.94 (0.93) uses/month

II. Morgan (1999) Not assessed 50 (20—I 60) doses 65 days Yes (No)

12. Parrott and Lasky (I 998)tNot assessed Not Not specified Yes (No)

13. Parrott et al. (1998) Not assessed >10 occasions; Not specified Not specified

Reference Correlationwith Ecstasy Abstinence Polydrug users? past exposure? exposure b period b (Urinalyis?)

Rodgers et al. (2000) Not assessed 20 uses over 5 years 2 months Yes (No)

Reneman et al. (2000a) Not assessed 218 (50—500) doses 4.6 (2—lI) months Yes (Yes)

Semple et al. (1999) Yes 672 (50—1800) doses 18 (6—28) days Yes (Yes)

Verkes et al. (2000) Not assessed 169 (SD 252) tablets over 15.7 (9.5) days Yes (Yes) 4.4 (2.4) years at 2.0 (I. I) tablets per occasion

Wareing et al. (2000) Not assessed Not specified. From drug 323.25 (130.05) days for Yes (No) use data provided, calculated "previous" users and to be 1280.91 for "previous" 8.2 (5.75) days for users and 1348.49 for "current" users "current" users

a While correlation analysis may tell us about the interaction between lifetime drugexposure and cognitive deficits, basing this on self-reported drug use or the mean content of Ecstasy tablets is problematic. First, individuals may not accurately remember their lifetime consumption.This may lead to overestimation. Second, numerous forensic studies suggest that the actual MDMA content of Ecstasy tablets varies and many tablets contain other drugs or no active component. b Mean (± SE) number of doses unless specified.

C Without performing qualitative urinalysis of samples obtained from volunteerson the day of testing it is not possible to reliably conclude that they are drug free, despite requests from the investigators or assurances from volunteers to the contrary.

t Subjects were tested during and after a Saturday night rave (in the case of Parrott and Lasky also before) and so these results reflectacute and residual drug effects rather than long term effects of Ecstasy per se. Space constraints precluded the publication of full test details. However, Croft et al. (2000) replicated the tests used in their later study 1 "Regular" subjects reported using 1.8 Ecstasy tabletson the test night compared to 1.45 tablets in the novice group. Abramovsky,REFERENCES A. 2000. Ecstasy prosecution: State or federal law better for enforcement? Adamson,Accola, S.J. ed.1988. 1985. MDMA: Through Studies the gateway of popularRockyNew of theYork Mountainillicit heart:Accounts Law drug Journal, raise of questions29 experiences November. about with effects. 4 March, 72. Adler,Adamson, J. 1985. S., and Getting R. Metzner. high on 1988.Ecstasy. The Newsweek,inMDMA naturehealing, andof psychotherapy, the 15other April.MDMA empathogenic experience and spiritual substances. and practice. its roleSan Re Francisco: Vision 1 Four0(4):59—72. Trees. Aguirre, N., M.S. Ballaz, Barrionuevo, B. Lasheras, M. J. Ramirez,andJ.drugs5-HT1A Del J. Rio.preventing Del receptor 1998. Rio, andMDMA5-hydroxytryptarnine density B. Lasheras. ("Ecstasy")and 8-OH-DPAT-induced 1999. enhances depletion. Alpha- Eur J.hypothermia: Pharmacol. 346:181—8.Blockade by Ajaelo, I., K. Koenig, and E. Snoey. 1998.ureticneurotoxicity.lipoic Severe hormoneacid hyponatremia prevents Neuroreport secretion 3 ,4-methylenedioxymethamphetamine and following 10:367—80.inappropriate ecstasy antidi-use. Acad. Emerg. Med. (MDMA)—induced 5:839—40. Alexander,Albuquerque, G. A.E., 1992.M. L. TratamientoFurey, C. L. delGrady,Avances Echeburáa.estrés et en postraumáticoa!. el 1997. tratamiento Madrid: Association enpsicológico ex-combatientes. of premorbid de los trastornos In de ansiedad, edited by E. Alexander, L., and L. Luborsky. 1986.psychotherapeutic Researchforintellectual the cognitive on functionthe process:Helping reserve with A Alliance. hypothesis. cerebralresearch Inmetabolismhandbook, TheAm. J. edited in Alzheimer's by L. Greenberg disease: and Implications W. Pinsof. 154:165—72. Au, S. F., G. D. Newport, A. C. Scallet,depletionmethvlenedioxymethamphetamineNew eta1. York: 1993. in Gilfordthe Oral nonhuman administration Press. primate. of Neurotoxicol. (MDMA)3,4- produces Teratol. selective 15:91—6. serotonergic All, S. E, G. D. Newport, R. R. Holson,decreaseenvironmental W SlikkerJr., methamphetamine temperatures andJ. E Bowyer. neurotoxicity or pharmacologic 1994. Low in mice. agents Brain that Res. produce 658:3 3—8. hypothermia 405 PDF compression, OCR, web-optimization with CVISION's PdfCompressor Allen,406 R. P., U. D. McCann,Appendices and G. A. Ricaurte. 1993. Persistent effects of(± )3,4- American Psychiatric Association. 1994. DiagnosticDisorders,methylenedioxymethamphetamine16:560—4. 4thand ed.Statistical Washington Manual D.C.: of (MDMA, Mental American "ecstasy") Psychiatric on Association.human sleep. Sleep Anden,Ames, D., N. andE., H.W. Corrodi, C.Wirshing. K. Fuxe, 1993. andJ. Ecstasy,phenylethylamines:malignant L. Meek. the syndrome:serotonin 1974. Hallucinogenic Interactionssyndrome, A possible and link?with neuroleptic JAMAserotonin turnover and receptors. Eur. J. 269:869. Angrist,Andreu, V.,B. 1994. A. Mas, Amphetamine M. Bruguera. psychosis: 1998.Pharmacol. Ecstasy: Clinical 25:176—84. A commonvariations cause of the of syndrome. severe acute In J. Hepatol. 29(3):394—7. Angrist, B.,J. Rotrosen, and S. Gershon.AmpneurolepticsCho hetamine 1980. and D. Differential andS. on Segal. itsnegative analogs: New effects vs. York:Psychopharmacology, positive of Academicamphetamine symptoms Press. intoxicology,and schizophrenia.pp. 387—414. and abuse, Psychopharmacology edited by A. K. Axt,Angrist, K. J., B., L. E. A. Peselow, Mamounas, M. Rubinstein,J.and M. E.macologyimprovement Molliver.72: Corwin,17—9. 78:128—30. 1994. andJ.in negative Structural Rotrosen. schizophrenic features 1982. Partialof symptomsamphet- after amphetamine. Psychophar- Ayd, F. J. 1995. Lexicon ofpsychiatry, neurology,Press.aminetoxicology, pp.neurotoxicity and315—67. the and neurosciences. abuse, in the edited brain. Baltimore:by In A.Amphetamine K. Cho Williams and andD. S. its Segal. analogs: New Psychopharmacology, York: Academic Baggott,Azmitia, M., E. C.B. 1999.Heifets, Serotonin R. T. Jones, neurons, et al. tissue.and2000. Wilkins. NeuropsychopharmacologyChemicalAnalysis p. 245. of Ecstasy 21 :33S—45S. Pills. JAMA and homeostasis of neural Ballard, P. A., J. W Tetrud, and J. W.Neurology Langston.due1:2 to I 35:949—56.-methyl-4-phenyl-1 1985. Permanent human ,2,3,6-tetrahydropyridine190 parkinsonism (MPTP): Seven cases. Bartzokis,Bartels, S.G., J., M. and Beckson, R. E. Drake. D. B. 1989.Hance, Depressionevidenceto et treatment. al. 1999. of in"silent" Psychiatr.Magnetic schizophrenia: cerebrovascular Q. resonance 60:337—57. Current imaging toxicity guidelines in cocaine dependence. Biol. Psychiatiy Battaglia, G., B. P. Brooks, C. Kulsakdinum,recognitionlogic45: 1203—11. profile and sites.E. of B. MDMA Eur.De Souza. J. Pharmacol.(3 ,4-methyldenedioxymethamphetamine) 1988a. 149:159—63.Pharmaco- at various brain PDF compression, OCR, web-optimization with CVISION's PdfCompressor Battaglia, G., S. Y. Yeh, and E. B. De Souza. 1988b. MDMA-induced neurotoxicity: References 401 logicalBiochem.Parameters performance Behav. of degeneration 29:269—74. of recently and abstinentrecoveryW. W., ofalcoholics V. brain M. serotoninKatzung, and cocaine V.neurons. J. abusers.Moreland, Pharmacol. Drug and S. J. Nixon. 1995. Neuropsycho- Beck,Beck, J., C.and "MDMA—Die M. Rosenbaum. fruhenJahre." 1994. PursuitAlcoholCollege Paperof Ecstasy.Depend. forpresented the 37:247—53.Albany: Study at a ofState meeting Consciousness, University of the Europeanof Bad New Boll, Germany, November 1997. Beck, A. T., R. A. Steer, M. Kovacs, andAm.J.Yorksuicide: B. Press.Garrison.Psychiatry A 10-year 1985. 142:599—63. prospective Hopelessness study and of eventual patients hospitalized with suicidal ideation. Bell,Beck, D. A. 5. T., 1965. G. Brown, Comparison and R. of A. amphetamine Steer. 57(2)309—10.atric1989. inpatients Predictionpsychosis by ofand clinical eventual schizophrenia. ratings suicide of hopelessness. inBr psychi- J. J. Consult. Clin. Psychol. Bengel,Benazzi, D., I., andD. L. M. Murphy, Mazzoli. A. 1991. M. Andrews, PsychiatricPsychiatry3 3 8:152 C. illness H. 111:701—7. 0. Wichems, associated D. withFeltner, ecstasy. A. Heils, Lancet R. Bendotti, C., S. Baldessari, M. Pende,Mossner, etserotoninand al. 1994.locomotor H. transporter-deficientDoesWestphal, insensitivity GFAP and mP.NA K. to P. mice.3 andLesch, ,4-methylenedioxymethamphetamine mitochon- Mol 1998. Pharmacol. Altered 53:brain 649—55. serotonin homeostasis ("Ecstasy") in Berman, I., A. Kalinowski, S. M. Berman,rat?anddrial Brain J. compulsive Lengua,benzodiazepine Res. Bull. and symptoms 34:3 A. I.8 receptor 9—94.Green. in chronic 1995.binding Obsessiveschizophrenia. detect serotonergic Compr Psychiatryneuronal degeneration 36:6—10. in Bishop,Berman, M. S. G. B., 1963. and TheT. G. discovery Hastings. of 1999.love:respirationfor A Dopamine psychedelic and oxidationinduces experience permeability alters with mitochondrialLSD-25. transition New in brain mitochondria: Implications disease. J. Neurochem. 73:1127—37. Bodmer,Blanchard, I. 1989.J., T N. Konstruktion Tozer, and M.des Rowland. FragebogensmegadosesYork: Dodd, 1997. OAVof Mead. Pharmacokineticascorbic zur quantitativen acid [see perspectives Comments]. Erfassung onAm. J. Clin. Nutr 66:1165—71. Bolla, K. I., U. D. McCann, and G. A.abstinentUniversity Ricaurte.aussergewoehnlicher MDMA 1998.of Zurich, Memory("Ecstasy") Zurich. Bewusstseinszustaende. impairment users [see inComments]. Thesis, Neurology Institute 51:1532—7. of Psychology,

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Bonson,408Bolla, K. R.,J. W Buckholtz, and D.of L. chronic Murphy. cocaine 1996a. use. ChronicJ. NeuropsychiatryK. I., administration R. Rothman, AppendicesClin. andJ.Neurosci.of L. Cadet. 11:361—9. 1999. Dose-related neurobehavioral effects Bonson, K. R., Murphy, D.L. 1996b. AlterationsassociatedNeuropsychopharmacologyserotonergic within antidepressants responses chronic administrationto14:425—36. LSD attenuate in humans the of tricyclicsubjective antidepressants, effects of LSD monoamine in humans. Boszormenyi,Boot, B. P., I. S. Z., McGregor, and S. I. Szara.and W. 1958. Hall.andoxidase 2000.Dimethyltryptamine communicating inhibitorsMDMA (Ecstasy) or the lithium. risks. experiments neurotoxicity: Lancet Behav. 355:1818—2 Brain with Assessing Res. 73:229—33. 1. Bowyer,J. F., B. Gough, W. SlikkerJr.,releasepsychotics. G.1993. W. in Lipe,Effects the J. caudate Ment.G. of D. a Sci. Newport,coldputamen 104:445—53. environment of and female R. R. orrats. Holson. age Pharmacol. on methamphetamine-induced Bioc/jem. Behav. 44:87—98. dopamine Brady,J. E, E. W. Di Stefano, and A.methamphetamine tionsK. Cho. of (±)-3 1986. ,4-methylenedioxyamphetamine Spectral (MDMA) and with inhibitory rat hepatic interac- microsomes. (MDA) and Life (±)-3 ,4 methylenedioxy- Sci. 39:1457—64. Broening, H. W., J. E Bowyer, and W.induceddioxymethamphetaminerats SlikkerJr. to the thermal long-term 1995. response. Age-dependent effects (MDMA) J. of Pharmacol. the sensitivityserotonergic correlates &p. of with neurotoxicant the magnitude (±)- 3of ,4-methylene- the MDMA- 275:325—33. Brownell,Brown,Brothers C.,L. A. 1996.andJ. L., Brain B.Osterloh. G. mechanismsJenkins, 1987. and Multiple of 0. socialingestion Isacson. cognition.severe of1999. MDMAcomplications J.Dopamine P3ychopharmacol. ("Ecstasy"). imagingfrom JAMArecreational 10:2—8.markers 258:780—1. and Bryden, A. A., P. J. Rothwell, and P. H.ofBiomed.predictive O'Reilly."ecstasy." Pharmacother mathematical 1995. Br. Med. Urinary J. 53:131-40. 310:504. models retention for progressivewith misuse degeneration in Parkinson's disease. Burgess,Buchanan, C., J. 1985.A. O'Donohoe, Ecstasy in theand emergency M. Gill.effectsFrancisco 2000. department. and Agony Bay toxicity. Area Clinical and Regional ecstasy: toxicology APoison review update Center. of 7. MDMA San Psychiatry 15: 287—94. Burrows, K. B., G.and Gudelsky, C. K. Meshul. and B. 1999. K.tionalters Yamamoto. High-doseof presynaptic mitochondrial 2000. methamphetamine GABA Rapid function and and glutamate following transient treatment immunoreactivity. inhibi-methamphetamine Neuroscience or 3 ,4-methylene- 90:83 3—50. Buydens-Branchey, L., M. Branchey,psychologicalThe dioxymethamphetamineP. meta-chiorophenylpiperazine Fergeson,J. responses. Hudson, Biol. andadministration. Psychaitiy C. McKernin. challenge 41:1071—86. Eur. test1997. J. Pharmacol.in cocaine addicts:398:11—8. Hormonal and PDF compression, OCR, web-optimization with CVISION's PdfCompressor Buydens-Branchey, L., M. Branchey, J. Hudson, M. Rothman, P. Fergeson, and C. References 409 Byrne, T., L. E. Baker, and A. Poling.McKernin. neurotoxicsequential2000. MDMA 1999. D,L-fenfluramineexposure andSerotonergic learning:in the rat. challenges. functionEffectsPharmacol. of in Biol.acute cocaineBiochem. and addicts: Behav. Prolactin66:501—8. responses to 45:1300—6. Cadet,Caccia, J. S., L., A. and Bergami, C. Brannock. C. Fracasso, 1998. S.Free25:1143—50.of Garattini, dexfenfluramine radicals and and B. the Campbell. and pathobiology dexnorfenfluramine 1995. of Oral brain kinetics in non-human primates. Xenobiotica Cadet,J. L., B. Ladenheim, I. Baum, E.effectssuperoxidedopamine Carlson, of systems.methylenedioxyamphetamine dismutaseand C. Neurochem.Epstein. (CuZnSOD) 1994. mt. CuZn-32:117—31. transgenic (MDA) mice and showof resistance to the lethal Cadet, J. L., B. Ladenheim, H. Hirata,usingbiochemicalmethylenedioxymethamphetamine et al. CuZn-superoxide 1995. effectsSuperoxide of methylenedioxymethamphetamine dismutase radicals transgenic mediate(MDMA). the mice. Brain Synapse Res. 655:259—62. (MDMA): 21:169—76. Evidence from Callaway,Caidwell, C. B.,W., and I. I. Gottesman. 1990.ingreview effects Schizophrenics of the of risk3 ,4-methylenedioxymethamphetamine factors kill themselvesfor suicide. too: A and a 5-hydroxytryptamineiB and M. A. Geyer. 1992. Tolerance and cross-tolerance to the activat- Bull. 16:571—89. Caine, D. B., J. W. Langston, W. R. Martin,317:246—8.afteragonist. MPTP: et J. al.Pharmacol. 1985.Observations Positron Exp. relating emission to thetomography cause of Parkinson's disease. Nature 263:318—26. CamI,Calvert, J., C. M. 1987. Farré, Psychedelic M. Mas, et drug al. 2000. useClin.methamphetamine up Human onPsychoparmacol. the pharmacologyfarm. Stanford ("Ecstasy"): 20:455—66. of Daily, 3,4-methylenedioxy- Psychomotor 3 March. performance and subjective effects. J. Campbell, D. B. 1995. The use of toxicokineticsandacting pharmacodynamics. in the for brain. the safetyMol. Neurobiol. Ann.assessment N. Y 11:193—216.Acad. of drugs Sd. 801:116—35.1996. Extrapolation from animals to man: The integration of pharmacokinetics Canton,Campkin, G., N. L. T, Verriele, and U. M. and Davies. E C. Colpaert. 1992.antipsychotics85:61. Another 1990. Bindingdeath to 5HT1c from of typicalecstasyj. and 5HT2 and R. atypical sites:Soc. Med.Clozapine potendy interacts with 5HT1c Carpenter,Capdevilla, W. M. T.1995. Jr., R.MDMA R. Conley, o el exstasis R. Desites.W. Marzo. Buchanon,quimico. Fur. J. Pharmacol. Barcelona: A. Breier, 191:93—6. Los and Libros C. A.Tamminga. De La Liebre PDF compression, OCR, web-optimization with CVISION's PdfCompressor 410 treatment1995. of schizophrenia. Am. J. PsychiatryAppendices 152:827—32. Patient response and resource management: Another view of clozapine Cesarec,Castner, S.Z., A., and and A. P.K. S. Nyman. Goidman-Rakic. 1985.Neuropsychopharmacology consequencesDifferential 1999. Long-lasting response of repeated to20:10—28. psychotomimeticamphetamine low-dose amphetamine in schizo- exposure in rhesus monkeys. Chadwick, I. S., A. Linsley, A.J. Freemont,coagulopathy3,4-methylenedioxymethamphetaminephrenia. B. Acta Doran, Psychiatr. and and hyperthermia. P. Scand.D. Curry. 71:523—38. J. 1991. R. Soc. (MDMA):Ecstasy, Med. 84:371. A fatality associated with Chang, L., C.T Ernst, S. Grob, C. S.T Ernst,Grob, etand al. R. 2000.users.ations E. Poland. 7. Effectin Magn. recreational of1999. Reson. ecstasy Cerebral Imaging3 ,4-methylenedioxymethamphetamine(3,4-methylenedioxy- (1)H10:52 MRS 1—6. alter- (MDMA, "ecstasy") Che, S., M.Johnson, G. R. Hanson, andJ.methylenedioxymethamphetamine-inducedMRImethamphetamine W study. Gibb. Psychiatry 1995. [MDMA])Body Res. 98:15—28.temperature on cerebral effect bloodacute on decreaseflow: A co-registeredin tryptophan hydroxylaseSPECT and Cho, A. K., M. Hiramatsu, E. W. Distefano,amineStereochemicalactivity in Eur vivoA. 7. S. Pharmacol.and Chang, differences in vitro: and 293:447—53. A D.in pharmacokinetic J.the Jenden. metabolism 1990. analysis. of 3 ,4-methylenedioxyrnethamphet- Drug Metab. Dispos. Biol. Cleare,Cho, K., A. A. J., Ennaceur, and A. J. J.Bond. C. Cole, 1995. andcognitiveFate The C. Chem. effectK Suh. deficits. 18:686—91.of 2000. tryptophan 7. Chronic Neurosci. depletion jet 20:RC66. lag producesand enhance- Clineschmidt, B. V., A. G. Zacchei, I.macologymentJ. Wishousky.A. onTotaro, subjective118:72—81. A. 1978. B. andPflueger, Fenfluramine behavioural J. C. McGuffin,and aggression brain serotonin. and in T.normal Ann. male N. subjects. Y Acad. Psychophar-Sci. Coccaro,Cloud, J. 2000.E. F., R.The J. lureKavoussi, of Ecstasy. T B. Time,Cooper,activity305:222—41. 5 June. andand R.aggression: L. Hauger. Inverse 1997. relationshipCentral serotonin with prolactin response to d- Coffey, C. E.,J. A. Saxton, G. RatcliffPsychiatryeducationfenfluramine, R. N. Bryan,154:1430—5. to brain butandJ. not size F. CSF inLucke. normal 5-HIAA 1999. aging: concentration, Relation Implications of in humanfor the reservesubjects. hypothesis. Am. 7. Coffey, S. F., B. S. Dansky; M. H. Carrigan,Neurologymood,tracted sleep andcocaine53:189—96. K. and T abstinencewithdrawalBrady. 2000. insymptoms. anAcute outpatient and DrugAlcohol pro- population: Depend. A prospective 59:277—86. study of PDF compression, OCR, web-optimization with CVISION's PdfCompressor Cohen, in humans. Frog. Psychopharmacol. Biol. PsychiatryR. S. 1995. 19:1137—45. Subjective reports on the effects of the MDMA (Ecstasy) experience References 411 Colado, M. I., T.and K. A. Murray, R. Green. and 1995. A.neurons.nitrone R. TheGreen. prevents spinEur 1993. J.trap Pharmacol. "ecstasy"-induced reagent5-HT loss alpha-phenyl-N-tert-butyl280:343—6. in rat brainneurodegeneration following of 5—hydroxytryptamine Colado, M. I.,J. L. Williams, and A.Pharmacol.fenfluramine R.3 ,4-methylenedioxymethamphetamine Green. 108:583—9. 1995. administration The hyperthermic and effects and of (MDMA),neuro- chiormethiazole p-chloroamphetamine and dizocilpine. and Br J. Colado, M. I., E. O'Shea, R. Granados,Br.J.intoxic the A. Phar,nacol.effects Dark Misra, Agouti of T"Ecstasy" 115:1281—9. K. (DA)Murray, (MDMA)rat, and a model A. and R. of Green.3 the ,4-methylenedioxy-amphetamine CYP2D6 poor metabolizer phenotype. (MDA) Colado, M. I., E. O'Shea, R. Granados,pregnancythe1997a. brains T K. AMurray,Brof study J.mothers Pharmacol. ofand the and A. neurotoxic neonates121:827—33.R. Green. following effect1997b. of In MDMAadministration vivo ("ecstasy") of the on drug 5-HT during neurones in Colado, M. I., R. Granados, E. O'Shea,followingtheevidence B. degeneration Esteban, administration for free and following radical A. R. of Green. involvementMDMA fenfluramine. 1998. ("ecstasy") Rolein Brthe J.of degeneration Pharmacol.and p-chloroamphetamine 121:889—900. of rat brain 5-HT but not Colado, M. I., B. Esteban, E. O'Shea,AR-R15896AR.inducedhyperthermia theR. Granados,neuroprotective neurodegeneration: in Br.J.theand protective A.Pharmacol. effect R. Green. Comparisonof action pentobarbitone 124:479—84. 1999a. of clomethiazole withStudies the on on novelMDMA-induced against NMDA MDMA channel ("ecstasy")- blocker Colado, M. I., E. O'Shea, B. Esteban,neurodegeneration. inducedevidenceR. Granados, degeneration against and Psychopharmacology clomethiazole A. R. of Green. rat brain 1999b.being 5-HT (Berlin) neuroprotective In nerve vivo 142:421—5. terminals against by a free MDMA radical ("ecstasy")- scaveng- Commins,Collin, M., andD. L., J. Godfrey.G. Vosmer, 1997. R. Altered M.ing Virus,London: mechanism.state: W. The L.Serpent's sto?yWoolverton, Neuropharmacology of Tail.Ecstasy C. cultureR. Schuster, 38:307—14. and acid and house. L. S. Connell, P. H. 1958. Amphetamine psychosis.Pharmacol.methylenedioxymethamphetamineSeiden. Institute1987. Ezp. Biochemical Ther.of Psychiatry 241:338—45. and Maudsley histological (MDMA) Mono- evidence is toxic that to neurons in the rat brain. J. Cooper, S. J., C. B. Kelly, and D. J. King.cerebrospinalgraphs340:940—1. 1992. no. 5-Hydroxyindoleacetic5. Oxford:fluid and Oxford prediction University acidof suicidal in Press. behavior in schizophrenia. Lancet PDF compression, OCR, web-optimization with CVISION's PdfCompressor Corral,Coppen,412 P., E. Echeburiia, B. Sarasüa, and I. Zubizarreta 1992. Estrés postraumáticoAppendices en A. 1967. Biochemistry of affective disorders. Br J. Psychiatiy 113:1237—64. Corral, P., E. Echeburila, B. Sarania, andconductualterapéuticas.ex combatientes I. Zubizarreta. delBol. trastorno Psicol.y en1995a. vIctimas 35:7—24. por Tratamiento estrés de agresiones postraumático cognitivo- sexuales: agudo Nuevas en vIctimas perspectivas de agresiones Corral, P., E. Echeburtia, I. Zubizarreta,sexuales:psicológico and B. Un unSarasua. delestudio trastomo 1995b. piloto.experimental. de Psicol.Tratamiento estrés Conduct. Andlisisypostraumático 3(2):195—210. crónico en vIctimas de agresiones de Conducta 21 (78):45 5—82. Creighton,Creese,Cousins, I., N. D.E 1983. J.,R. D.Burt, The L. Black,andhealing S. H.and heart. Snyder. C. E.Newclinical Hyde. 1976. York: and1991. Dopamine W. pharmacological W."Ecstasy" Norton. receptor psychosis potenciesbinding and predicts of flashbacks antischizophrenic drugs. Science 192:481—3. Croft, R. C., A. J. Macay, A. T. D. contributionsMills,(Berlin)[see Comments].andJ. 15 G. Jan.of H.ecstasy 153:373—79. Gruzelier.Br J. andPsychiatry cannabis 2001. 159:713—5. The to cognitive relative impairment. Psychopharmacology Crow,Crompton, T. J. M., 1980. S. Virji,Molecular V. Doyle, pathology N.process?permeability Johnson, of schizophrenia: Br andJ. Med.transition M. J. 280:66—8.Ward. pore. More Biochcin.1999. than The one Soc. mitochondrial disease Symp. 66:167—79. Cuomo,Cubells, M.J. F., J., S.P. Rayport,G. Dyment, G. Rajendran,and V.dependentneurotoxicity M. Gammino.and D. intracellular Sulzer. involves 1994. 1994. oxidativeIncreasingvacuolization Methamphetamine stress. use of of J. endocytic "Ecstasy"Neurosci. organelles 14:2260—71. and dopamine- Curran, H. V., and R. A. Travill. 1997.dioxymethamphetamine42:271—4.(MDMA) Mood and and cognitive other hallucinogens effects(MDMA, of 3,4- "Ecstasy"): on methylene- a college Weekend campus. "high" J. Am. followed College Healthby mid- Dafters, R. I. 1994. Effect of ambient Psychopharmacologyinducedweektemperature low. by Addiction 3 on,4-methylenedioxymethamphetamine hyperthermia 92:821—31.(Berlin) 114:505—8. and hyperkinesis (MDMA or "ecstasy") in rats. Dafters, R. I., and E. Lynch. 1998. Persistentinducedtemperature, loss by 3 ofwater ,4-methylenedioxymethamphetamine thermoreg-ulation consumption, and in chronicthe rat dosing.1995. Physiol. (MDMA Hyperthermia Behav. or "Ecstasy") 58:877—82. following but MDMA not administration in rats: Effects of ambient Dafters, R. I., E Duffy, P.J. O'Donnell,EEGmethylenedioxymethamphetamineby and fenfluramine. power C. Bouquet. and coherence.Psychopharmacology 1999. Level Psychopharmacology of use (MDMA (Berlin) of 3,4- 138:207—12. or (Berlin)Ecstasy) 145:82—90. in humans correlates with PDF compression, OCR, web-optimization with CVISION's PdfCompressor Davis, G. C., A. C. Williams, S. P. Markey, et a!. 1979. Chronic parkinsonism second- References 413 Deakin,Davison, J.D., F andW. 1996.A. C. Parrott.5-HI; antidepressant 1997. Ecstasypsychologicalary to intravenous (MDMA)drugs and in physiological theinjection recreational psychosocial of meperidine effects. users: origins Self-reportedHum. analogues. Psychopharmacol.of Psychiatry C/in. Res. Evp. 1:249—54. 12:221—6. de la Torre, R., M. Farré, P.J. Ortuflo,N. Roset,MDMA etdepression. eta!. al. 2000a. ("ecstasy")2000b. Non-linear Pharmacology in humans. pharmacokinetics of MDMA in of P3ychopharmacol. 10:31—8. J. Clin. Pharmacol. 49:104-9. Delentre, P.,J. Henrion,J. M.Jacques,literaturehumans. M.1994. Schapira,J. ToxicAnn.review. N. hepatitis Acta YAcad.M. Ghilain,Gastroenterol. due Sci. to 914:225—37. andJ. ecstasy Belg. M. administration: Maisin.57:341—5. Report of a possible case and Dede Paul,Souza, J. 1995.E. B., TrastornoG. Battaglia, por andEstrés T.Madrid: Postraumático.R.t'rastornospsiquiiItricos, Insel. Siglo 1990. XXI. InNeurotoxic Manual edited de effect psicopatologlay by ofV. MDMAE. Caballo, on G. Buela-Casal and J. A. Carrobles. Deutch, A. Y. 1992. The regulation ofcortex:studies.brain subcortical serotonin Ann.Interactions N.dopamine YAcad.neurons: of centralSci.systems Evidence 600:682—97; dopamine by thefrom prefrontal neurochemicaldiscussionsystems and 697—8. the and pathogenesis radioligand of binding schizo- Dierks, T., S. Barta, L. Demisch et al.tryptophanpotentialsphrenia.J. 1999. Intensiiy Neural (AEPs)depletion dependence Transm. as in biological healthy Suppi. of subjects. markerauditory 36:61—89. Psychopharmcologyfor evoked cerebral serotonin 146:101—7. levels: effects of Dinges,Di Monte, D. D.F, A.,and A.N. McCormack,B. Kribbs. 1991. G. Petzinger,dyskinesiasLangston. Performing A.2000. in while M. the RelationshipJanson, MPTP sleepy: primateM. Effects Quik, among model. ofand experimen-nigroscriatal W. Mov. J. Disord. denervation, 15:459—66. parkinsonism, and Dittrich, A. 1998. The standardized psychometricconsciousnessNewtally inducedYork: John assessmentsleepiness. (ASCs) Wiley in & humans.In ofSons. Sleep, altered pp. Pharmacopsychiatiy sleepiness 97—12states of 8. and peiformance, 31:80—4. edited by T H. Monk. Dowling,Dornan, W. G. A.,J.P. 1990a. L. Katz, Human and deathsG. A. Ricaurte. andBiochem.tration toxic of Behav. 1991.reactionsMDMA The39:813—6. on attributed effects the expression of to repeated MDMA of sexualadminis- and behavior in the male rat. Pharmacol. HealthMDMA,MDEA. Statistics In edited Ecstasy: byQuarterly. The S. J. clinical, Peroutka. 5: pharmacological Norwell, Mass.: and neurotoxicological Kluwer1990b. OnAcademic drug-related Publishers. deaths database first results for England and Wales. of the drug

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 414 Appendices Downing,Dowling, J. 1986. The psychological volunteers.ofand five physiological deaths J. Psychoactiveassociated effects with Drugsof theMDMA 18:335—40.use of on MDEA normal and MDIVIA.JAZVJAG. P., 257:1615—7. E. T. McDonough, and R. 0. Bost. 1987. "Eve" and "ecstasy": A report Dworkin,Drake, W. R. M., H., and and P. L. A. A. Broadhurst. Opler. 1992.Aft 1996.prefrontal Med.J. Simple QT-interval 86(2):180—1. schizophrenia,hypodopaminergia. prolongation negative Am. with j.symptoms, Psychiatiy ecstasy. S. and149(9): 1284—5. Dykhuizen,Dyck, R.J., R. C.S., Bland,P. W. Brunt, S. C. Newman,P. Atkinson,Ecstasypsychiatric and J. H.induced G. disordersOrn. Simpson, 1988.hepatitis in andSuicideEdmonton. mimickingC. C. attempts Smith. Acta viral Psychiatr.1995. and hepatitis. Scand. Gut Suppi.36:939-41. 338:64—71. Echeburüa, E., and P. de Corral. 1995.psicopatologla,postraumático. Trastorno de editedAnsiedad estrés by postraumático. yA. Ertrés Belloch, 3(2—3):249—64. B. In SandIn, Manual and 1997.de E Ramos. Avances Madrid: en el tratamiento McGraw Hill. cognitivo conductual del trastorno de estrés Echeburtia,Echeburáa, E.,E., P.P. de de Corral, Corral, I. B. Zubizarreta, Sarasua,revision.psicológico and and I.B. AndlisisyZubizarreta. Sarasua. del estrés 1995. postraumático1990. Trastorno Tratamiento de en estrés vIctimas de agresiones sexuales: Una de Gonducta 1 6(49):41 7—37. Elayan,Eisner, B. I.,J. 1989. W. Ecstasy:Gibb, G. The R. MDMAHanson,postraunidtico story. Long-termR. L. Berkeley, Foltz, crónicoalteration H. Calif.: K. en Lim, vIctirnasinRonin theand centralPress. M.Johnson.de agresi monoaminergic ones 1992. sexuales. Lasystems Corufia: of Fundación the rat by Paideia. 2,4,5- Ellis, A. J., J. A. Wendon, B. Portman, andecstasyortrihydroxyamphetamine 2-hydroxy-4,5.-methylenedioxyamphetamine.R. Williams. ingestion. 1996. Gut 38:454-8.Acute but not liver by damage 2-hydroxy-4,5-methylenedioxymethamphetamine and Eur. J. Pharmacol. 221:281—8. Everhart,Evenden,Ellison, G. J.E. L.1994. T, 1999. P. Stimulant-inducedJacob Varieties Ill, P. of Shwonek, impulsivity. psychosis,and M. Psychopharmacology the Baggott, habenula.the dopamine R. T.Brain Jones, theory Res. 146:348—61. and Rev. of J. schizophrenia, 19(2):223—39.Mendelson. Fahal, B. A., D. F. Sallomi, M. Yaqoob,U.S.humans.2000. and Government EstimationG. In M. Problems Bell. of Printing1992. theof drug metabolicAcute Office. dependence, renal disposition failure edited after of by MDMA L. S. Harris. and MDA Washington enantiomers D.C.: in Fallon,J. K., A. T. Kicman,J. A. Heniy methamphetamine1999.ecstasy.P.J. Milligan, Stereospecific D. (Ecstasy)A. analysis Cowan, in and humans.and enantiomeric A.J. Gun. Hutt. Chem. disposition 45:1058—69. of 3 ,4-methylenedioxy- Med.J. 305:29.

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Faraj, human lymphocytes: CorrelatesB. A., Z.with L. Olkowski,serotonin transporterand R. T.Jackson. 1994. Active {3H]-dopamine uptake by References Pharmacology 415 Farré,Farley, M., Christopher P. N. Roset, John. A. 2000.Tomillero, Rave etNewhumans:48:320—7. al. 2000.World. Preliminary Repeated Time, 5 findings.administrationJune. Br J. Clin.of ecstasy Pharmacol. to Special issue: 111. Finnegan,Feixas, G., andK. T, M. G. T A.Miró. Ricaurte, 1993. Aproximaciones L. D.Langston. Ritchie,tratamientos I.a1988. laIrwin, psicoidgicos.psicoterapia: Orally S.J. Peroutka,administered Barcelona:Una introducción andJ. Paidós.MDMA W. a los causes a long-term depletion of Fischer, C., G. Hatzidimitriou, J. Wios,ascendingserotonin J. (±)3,4-methylenedioxymethamphetamineKatz, and in 5-HT rat G. brain. Ricaurte.axon projectionsBrain 1995. Res. Reorganization 447:141—4.in animals (MDMA, previously of "Ecstasy").J. exposed to Neurosci.recreational 15:5476—85. drug Fleckenstein,Fitzgerald, J. L.,A. E.,and H. J. M.J. Reid. Haughey, 1990. R. psychostimulantstheEffects R. release Metzger, of methylenedioxymethamphetamine of monoamines et al. and 1999. related Differential from agents rat brain on effects dopaminergic slices. onof and serotonergic transporter J. Pharmacol. 191:217—20. Foa, E. B., B. 0. Rothbaum, D. S. Siggs,behavioralposttraumaticfunction. and T Eur B.procedures J.Murdock. stress Pharmacol. disorder and 1991. counseling. 382:45—9. in Treatment rape victims:Jour ofCons. A comparisonGun. Psych. between59:715—23. cognitive- Frederick, D. L., S.S. EF Au,Au, W.M. S]ikkerJr.,P. Gillam,amphetamine 1995.M.J. Gossett, P. Gillam,Behavioral (MDMA) W. R. Slikker, R.and Allen,treatment neurochemical and and M. in M. G.rhesus G.Paule. effectsPaule. monkeys. 1998. of chronicNeurotoxicol. methylenedioxymeth- Teratol. 17:531—43. Freedman, D. X., R. Gottlieb, and R. A.Acute 844:183—90.(MDMA)Lovell. effects 1970. before of dexfenfiuraminePsychotomimetic and after short-course, (d-FEN) drugs and high-doseand methylenedioxymethamphetamine treatment. Ann. N. Y Acad. Sci. Frei, E., A. Gamma, R. D. Pascual-Marqui,lowLocalizationbrain resolution 5-hydroxytryptamine D. Hell, of andbrain MDMA-induced F. electric X. Vollenweider. metabolism. tomography electrical Biochem. 2001. (LORETA). brain Pharinacol.activity Submitted. in healthy19:1181—8. volunteers using Frith,Frey, K.,C. M.,M. Kilbourn,and L. Chang. and T. 1987. Robinson. Toxicitymethamphetamine.transporters 1997. of methylenedioxymethamphetamine Reduced after Eurstriatal neurotoxic J. Pharmacol. vesicular but not monoamine 3 34:273—9. after behaviorally-sensitizing doses of Fritschy, J. M., W. E. Lyons, M. E. Molliver,nucleus:of(MDMA) p-chloroamphetamine andA retrograde inR. the Grzanna. dog transport and 1988. rat. on Fundam. study. Neurotoxicthe serotoninergic Brain Appl. Res.effects Toxicol. 473:261—70. innervation 9:110—9. of the trigeminal motor PDF compression, OCR, web-optimization with CVISION's PdfCompressor 416Gaddum, Appendices J., and K. Hameed. 1954. Drugs which antagonize 5-hydroxytryptamine. Br. Gamella, J., and A. Alvarez. 1999. juvenilesLasJ. rutasPharmacol.Barcelona: del(The Extasis: route 9:240—8.Ariel. ofDrogas Ecstasy: de sintesisy drugs of nuevas synthesis culturas and new youth cultures). Gamma,Gamma, A., A., E. A. Frei, Buck, D. Lehmann,T. Berthold, R. M. MethylenedioxymethamphetamineNeuroreportVollenweider.D. E.Pascual-Marqui, Liechti, 11:157—62. and 2000a. F. D.X. Mood Hell,Vollenweider. state and Eand (MDMA)X. brain2000b. electric modulates3,4- activity cortical in ecstasy and limbic users. brain Gamma, A., A. Buck, I Berthold, andactivation23activity E :3X. 88—95. Vollenweider. as measuredduring cognitive by 2001. [H2015]-PET Noperformance difference in healthy between in humans. Ecstasy Neuropsychopharmacology (MDMA) user and brain Gartside, S. E., R. McQuade, and T Sharp.3controls: ,4-methylenedioxymethamphetamineand 1996.release A {H2150J-PET Effects in the ratof repeatedbrain study. in J.vivo. administration Clin. J. Psychopharmacol. Pharmacol. on 5-hydroxytryptamine Exp. Ther21:66—71. 279:277—83. neuronal activity of Gasser,P. 1994-95. Psycholytic therapyNewsletter Katainnestischewith MDMA of the Multidisciplinaryand Erhebung. LSD in Shweiz.Switzerland. Association Arch. Neurol. for Psychedelic 1996.Psychiat. Die Studies 2:59—65. psycholoytische 5 no. 3: 3—7. Therapie in der Schweiz von 1988—1993. Eine Gelder,Gaston, M., I R., D. and Gath, G. and I Rasmussen. R. Mayou. 1995. 1972.Oxforddioxymethamphetamine. Concise Identification University Oxford Press. texbookof 3 ,4-methylene-Microgrampp ofpsychiatiy.149—50. 5:60—3. Oxford: Gerra,Geller, G.,E., A.E. R.Zaimovic, Ritvo, B. G. J. Giucastro, Freeman, methylenedioxymethamphetamineboys.onandet theal. A. N. 1998.effect Yuwiler. Engl.J. Serotonergic of Med.fenfluramine 1982. 37:165—9. Preliminary function on blood after ("Ecstasy")observations (±)3,4- in humans. mt. Clin. serotonin and symptoms in three autistic Gerra, G., A. Zaimovic, M. Fern, etPsychopharmacol. al.Psychiatrydioxymethamphetamine 2000. Long-lasting 47:127—36. 13:1—9. effects (ecstasy) of (±)3 on serotonin system function in humans. Biol. ,4-methylene- Geyer,Gerson, M. S. A.,C., andand C.R.J. W. Baldessarini. Callawáy. 1994. 1980.amphetaminenervous Behavioral Motor system. analogs.effects Lifepharmacology Sci.of In serotonin Amphetamine27:1435—5 of in 1.the and its analogs: Psychopharmacology, ring-substituted toxicology,central Globus, M. Y, R. Busto, B. Lin, H. Schnippering,intra-ischemicandof abuse, free radical edited and brain M.byactivity A.D.temperature KGinsberg. duringCho and transientmodulation. D.1995. S. Segal. global J. New Neurochem. ischemia York: Academic and 65:1250—6. recirculation: Press. pp Effects ofDetection177—208. PDF compression, OCR, web-optimization with CVISION's PdfCompressor Goff, D. C., K. K. Midha, 0. Sarid-Segal,J.placebo W. controlled Hubbard, trial and ofE. fluoxetineAmico. 1995. added A to neuroleptic in patients with schizo- References 411 Gold, L. H., G. F. Koob, and M. A. Geyer.methylenedioxyamphetaminebehavioralphrenia. 1988. Psychopharmacol. profiles Stimulant of 3 and ,4-methylenedioxymethamphetamine Ben. hallucinogenic in 117:417—23. rats. J. Pharmacol. Erp. and N-ethyl--3 ,4- Ther 247(2):547—55. Goldstein,Goldberg, T.L. E.,B., L.and B. C. Bigelow, E. Hulsebosch. D. R.and Weinberger, 1991.1999. haloperidol CognitiveAmphetamine-facilitated D. in G. schizophrenia. and Daniel, behavioral andJ. Am. E.effectspoststroke Kleinman.J. Psychiatry of coadministration 148:78—84. of dextroamphetamine Gollamudi, R., S. F. Au, G. Lipe, eta!.Neurotoxicologytherecovery. 1989. metabolism Influence Stroke 10:455—66. 30(3):696—8.in of vitro inducers and neurochemical and inhibitors effects on in vivo of MDMA. Gordon,Gonzalez C. de J.,Rivera, and L. J. Fogelson.L. 1990. El 1994. sindromePsiquiatrIa Metabolic de estrés legalyforense, and post-traumático. thermoregulatory edited byPsiquis S. responses Delgado. 11:11—24. ofMadrid:1994. ElColex. sIndrome post-traumático de estrés: lJna revisión crItica. In Gordon, C.J., W. P. Watkinson,J. P. O'Callaghan,3studies.the ,4-methylenedioxymethamphetamine rat maintainedPhysiol. and Behav. D. in B. acrylic 56:73—9. Miller. or 1991.wire-screen Effects on autonomic cages: of Implications thermoregulatory for pharmacological responses Gough, B., S. E All, W. SlikkerJr., andPharmacol.methylenedioxymethamphetamineof R. the R. rat. Holson. Biochem. Pharmacol. 1991. Behav. Biochem. Acute 39:619—23. effects Behav. (MDMA) of38:339—44. 3,4- on monoamines in rat caudate. Gouzoulis-Mayfrank,Gouzoulis, E., D.and Dorchardt, L. Hermle. E., B. aridThelen, 1994. L. Hermie. DieE."Eve" Habermeyer, Gefarhen 1993.(3 ,4-methylene-dioxyethylamphetamine). A von case et Ecstasy. a!. of 1999.toxic Nervenartz psychosis Psychopathological, induced 64:478—80. by Arch. Gen. Psychiatry 50:75. Gouzoulis-Mayfrank, E., J. Daumann,neuroendocrineogy(MDE), E Tuchtenhagen,142:41—50. psilocybin and autonomicandet al. d-methamphetarnine 2000. effects Impaired of 3 cognitive ,4-methylenedioxyethylamphetamine in healthy volunteers. Psychopharmacol- Graham, D. G., S. M. Tiffany, W R.versusNeurol. Bellperformance Jr., covalentNeurosurg. and W. inbinding F.drugPsychiatry Gutknecht. free of quinones users 68:719—25. 1978. of recreationalas Autoxidation the mechanism ecstasy of (MDMA) toxicity of [see dopamine, Comments]. 6- J. Granoff, M. I., and C. R. AshbyJr. vitro.hydroxydopamine,1998.the Mol. compoundThe Pharmacol.effect 3of ,4-methylenedioxymethamphetamineand the 14:644-53. relatedrepeated compounds administration toward of CI 300 on neuroblastoma the response cellsof rats in to the PDF compression, OCR, web-optimization with CVISION's PdfCompressor 8 Appendices Graumlich, J. F., T M. Ludden, C. Conry-Cantilena,M.(DOl).5-HT2A,C Levine. Neuropsychobiology 1997. L. PharmacokineticR. Cantilena 37:36—40. Jr., Y.model Wang, of ascorbic acid in receptor agonist (±)- 1 -(2 ,5-dimethoxy-4-iodophenyl)-2-aminopropane healthy male volun- and Graves, A. B., J. A. Mortimer, E. B.McCormick. Larson,tionteers with during A. Wenzlow,severity 1996. depletion Head of J. impairment D.and circumference Bowen, repletion. in Alzheimer's Pharmacol. as a measure disease. of cognitive reserve: Associa- Res. 14:1133—9. J. Psychiatiy 169:86—92. and W. C. Green,Greer, A. G. R., 1985. A. J. Using Cross, MDMA and G. inM. psychotherapy. Goodwin."Ecstasy").clinical pharmacology 1995. Psychopharmacology Adv. Review J. Inst. of of 3 Adv. the,4-methylenedioxymethamphetamine (Berlin) Health 119:247—60. (MDMA or pharmacology and 2:57—9. Greer, G., and R. Tolbert. 1986. Subjectivesetting.and neurotoxicological J.reports Psychoactive of the effects Drugs effects 18(4):319—27. ofof MDIVIAthe drug MDI in aVIA ,1990. The therapeutic use of MDMA. In: Ecstasy: The clinical, pharmacological edited by S. J. Peroutka. Boston: clinical tiveKiuwer Drugs Academic 30(4):371—9. Publishers. 1979.1998. PsychedelicA method ofdrugs conducting reconsidered. therapeutic New York: sessions Basic with Books. MDMA. J. Psychoac- Psychother. 40:393-404. 1986.1985.1983. Psychedelic'WhatCan drugs is MDMA? bereflections. used Harvard to enhance New Medical York: the Human Schoolpsychotherapeutic SciencesMedical HealthPress. process? Am. J.2(2): 8. Grob, C. S. 1998. MDMA research:MDMA, preliminarydrugs. In: edited Ecstasy: investigations by S.The J. clinical,Peroutka. with pharmacological humanBoston: Kiuwer and1990. Academicneurotoxicological Testing Publishers. psychotherapies effects of the and drug therapies: The case of psychedelic subjects. drug Grob, C. S., G. Bravo, and R. Walsh. mt.1990.8:549—88. J. Drug Second Policy thoughts 9:119—24. on 3,4-methylene-2000. Deconstructing Ecstasy: The politics of MDMA research. Addiction Res. Grob, C. S., R. E. Poland, L. Chang, andpreliminarydioxymethamphetaminemethylenedioxymethamphetamine T. Ernst. observations. 1996. Psychobiologic (MDMA) Behav. Brain neurotoxicity. Res.in humans: 73:103—7. Arch. Methodological Gen. Psychiatiy considerations 47:288. effects of 3,4- and Grof,Grob, Stanislav.C. S., Poland, 1980. R. LSDE. 1997. psychotherapy. MDMA.Baltimore:3rd In: ed., Pomona, Substance edited Williams Calif.: byJ.abuse: H. andHunter A Lowinson, Wilkins.comprehensive House. pp. P. 269—75.Ruiz, R. B. Millman, andJ. G. Langrod. textbook,

PDF compression, OCR, web-optimization with CVISION's PdfCompressor methamphetamine-induced depletion of brain serotonin. J. Neural Transm.G. A. 1996. Effect of ascorbate and cysteine on the 3 ,4-methylenedioxy- References 419 tions.J.methylenedioxymethamphetamine:103:1397—404. Neurochem. 66:243—49. Implications for serotonin-dopamineG. A., interac- and J. F. Nash. 1996. Carrier-mediated release of serotonin by 3,4- Guttman,Gudeisky; E., G. and A., W B. Sargant K. Yamamoto, 1937. Observations and5-HT2dioxyrnethamphetamine-induced J. E Nash. receptor on benzedrine. 1994. agonists. Potentiation Br Eur.Med. J. J. ofPharmacol. 1:1013—5. dopamine3 ,4-methylene- 264:325—30. release and serotonin neurotoxicity by Haigler,Gur, R. E., H. S.J., M.and Resnick, G. K. Aghajanian. and R. C. Gui; specificity.cerebral1973. et Mescalineal. blood 1989. Psychiatry flow Laterality and andRes. LSD: metabolism 27(3):325—34. and Directed frontality andin schizophrenia: ofindirect Relationship to symptom Hall, ES., A. C. Devries, G. W. Fong, S.assessedtryptamineeffects Huang, on andwith serotonin-containing depletion A. in Pert.vivo 1999.microdialysis: of tissue Effects serotonin neurons ofRelationship 5,7-dihydroxy- levels in the on tobrain. behavior.extracellular Eur. SynapseJ. Pharmacol. serotonin 33:16—25. in 21:53—60. the striatum Haring,J.Hardman, H., H. L.F., Meyerson,C. 0. Haavik, and and T L. M. Hoffman.Pharmacol. H.of Seevers.mescaline 1992.25:299—309. 1973. and Effects behavior Relationship of para- in five of species the structure of laboratory animals. Toxicol. Appi. Harlow, D., and J. Beck. 1990. SurveyBrain ofatchioroamphetamine the the Res. clinical MAPS 577:253—60. uses International of MDMA.upon the Conference Paperserotonergic presented on Psycholyticinnervation Psychotherapy,of the rat hippocampus. 29 Novem- Harris,Harries, D., D. M.P., Baggott,and R. DeSilva. R. T.Jones, 1992. andJ. "Ecstasy"Med.J.ber, Mendelson. in Bern,37:150—2. and Switzerland. intracerebral 2000. MDMApharmacokinetics hemorrhage. Scot. Hartley,Harris Research D. E. 1985. Center. Research 1982. onYoung the therapeutic byandpeople's L. physiological S. Harris.poll. alliance January; Washington, and in subjective psychotherapy. D.C.: effects U.S. in Ann. humans.Government Rev. In Problems Printing of Office. drug dependence, edited Harvey, D. C., G. Lacan, S. P. Tanious,substantiamethamphetaminePsychiatry and W. P.4:532—49.nigra Melega. cell inducedloss. 2000. Brain Recoverylong-term Res. 871:259—70. from nigrostriatal doparninergic deficits without Hatzidimitriou, G., U. D. McCann, andrecovery.innervation dioxymethamphetamineG. A. Ricaurte.J. Neurosci. patterns 1999. in19:5096—107. the Altered forebrainseven yearsserotonin of previously:monkeys treated factors with influencing (±)3 ,4-methylene- abnormal PDF compression, OCR, web-optimization with CVISION's PdfCompressor Hayner,420 AppendicesG. N., and H. McKinney. 1986. MDMA: The dark side of ecstasy. J. Psychoac- Hegadoren,Heffernan, T K. M., M., J. G. L. B.Ling, Baker, and andA.MDMA B.M.tive Scholey. Bourin. Drugs ("ecstasy") 18:341—7. 1999.Prospective users.3,4-Methylenedioxy Hum.memory Psychopharmacol. (in press) deficits in analogues Hekmatpanah,Heinz, A., and D.C. W.R., andJones. S. 2000.J. Peroutka. Serotoninof Comment].amphetamine: 1990. transporters 5-Hydroxytryptamine Br.J. Defining Psychiat7y in ecstasy the risks176:193—5. users uptake to humans. Neurosci. Biobehav. Rev. [Letter; 23:539—53. blockers Heizer, J. E., L. N. Robins, and L. McEvoy.generalamphetamineattenuate 1987. population: the 5-hydroxytryptarnine-releasing Post-traumaticand related Findings agents. stressof the epidemiologic catchment area survey. J. Pharmacol. 177:95—8. effect of 3,4-methylenedioxymeth- disorder in the N. Engi. Henry,Hendin, J. H. A.,A. 1982. 1992.K. J. Suicide Jeifreys,Ecstasy in and America. theS.J. Dawling. danceMed. New 317(24):1630—4. of York:1992.death. ToxicityWW. Norton. and deaths Med. J. 3 05:5—6. from 3,4- Henry,J. A.,J. K. Fallon, A. T Kicman,methylenedioxymethamphetamine351:1784. 1998.A.J. Hutt, Low-dose D. A. MDMA Cowan, ("Ecstasy")and ("ecstasy"). M. induces Lancet vasopressin 340:384—7. secretion. Lancet Forsling. Hermie,Henry, W. L., P., M. H. Spitter, H. Strupp, D. Borchardt, and T. E. Psychol.interpersonalK.Schacht. A. Kovai; 58(6):768—74. 1990. process,and Patient E. Gouzoulis. and and differential 1993. psychotherapy outcome. J. Consult. therapist introject, Psycho- Gun. Hemández—Lopéz, C., M. Farré, P. N.tivelogical Roset,tions: agents? effects Psychomotoret al.Neuropsychopharmacology 2000.of MDE MDMA and in normalsubjective and alcohol 8:171—6.effects and pharmacokinetics. Are entactogens a new class of psychoac- Br. J. Clin. interac- Herning, R. I., D. E. King, W. E. Better,inPharmacol. cocaine andJ. abusers.L. Special Cadet. Neuropsychopharmacology issue: 1999. 111. 21:110—8. Neurovascular deficits and Hiramatsu,Hervias, I., B.M., Lasheras, and A. K. and Cho. N. 1990.Aguirre. methylenedioxyrnethamphetamineneurotoxicity,nicotinamideEnantiomeric 2000. 2-Deoxy-D-glucose J.potentiatesdifferences Neurochem. 3 in ,4-methylenedioxymethamphetamine-induced 75:982—90. the prevents effects on extracellular monoamines and metabolites in ofserotonin 3,4- Holden, R. M., and M. A. Jackson. 1996.vasopressinogy29:269—75.the Near-fatal striatum over-secretionofhyponatraemic freely-moving after coma rats: "ecstasy" dueAn into vivo(3 ,4-MDIvIA). microdialysis Lancet study. 347:1052. Neuropharmacol-

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Horan, B., E. L. Gardner, and C. R. AshbyJr. 2000. Enhancement of conditioned place References 42 1 Horton, A. A., and S. Fairhurst. 1987.preference Crit.methylenedioxymethamphetamineLipid Rev. peroxidation responseToxicol. 18:27—79. to and cocaine mechanisms in rats (MDMA). following of toxicity. Synapse subchronic 35:160—2. administration of 3,4- Ings,Huether, R. M. G., 1990. D. Zhou, Interspecies and E. Ruther. scaling amphetamineserotonergic 1997.and comparisons Causes presynapses (MDMA, and inconsequences drug "ecstasy") eliciteddevelopment of byand thethe its andlossconsumption congeners. of J. of Neural 3 ,4-methylenedioxymeth- Transm. 104:771—94. Insel, T. R., G. Battaglia,J. N. Johannessen,terminalsMethylenedioxyrnethamphetaminetoxicokinetics. S. Marra,in rhesus Xenobiotica and monkeys. E. B. 20:1201—31.De J. Souza. Pharmacol. ("ecstasy") 1989. Exp. 3,4- selectively Ther 249:713—20. destroys brain serotonin Irwin,Iqbal, N.,M. R.,G. M.S. R.Asins, Marder, S. Wetzler, F. Fuentenbro, R. PsychiatiyMCPPS. Kahn, and challenge A. 30:770—7.S. YuwilerKay, testand A. inH. 1987.schizophrenia: M. van L-5- Praag. Hormonal1991. The and behavioral responses. Biol. Itil, T., A. Keskiner, N. Kiremitci, andchronicamphetamine.Hydroxytryptophan J. M. Holden. schizophrenics. 1967. attenuates Effect Can. Pschiatr. of positivephencyclidine Assoc. psychotic 3112:209—12. in symptoms induced by D- Psychiatry Res. 22:283—9. Jacobsen, L. K., J. K. Staley, R. T. Malison,Am.J.transporter et al. 2000. binding Elevated availability central in serotonin acutely abstinent cocaine-dependent Psychiatrypatients. 157:1134-40. - Jansen,Janke, W., K. andL. R. G. 1993. Debus. Non-medical 1978. Die Eigenschaftsworterliste use ofEifassung ketamine. der Br. Beflndlichkeit. Med.J. 306:601—2. Gottingen: Hogrefe.1997. Adverse psychological effects associated with the use of Ecstasy Em zur London:(MDMA) Neal's and Yard their Desktreatment. Top Publishing In Ecstasy Studio.reconsidered, 2000.1998.pp. 112—33. Ecstasy Aedited Review by(MDMA) N. of Saunders.the dependence.Nonmedical DrugAlcohol Use of Ketamine: Depend. Use, 53(2):121—4. Uses, and Conse- Jansen, K. L. R., and A. R. Forrest. 1999.Psychedelicquences. Toxic 31effect Psychoactive Studies of MDMA (available Drugs on 32(4):419—43brain from serotoninwww.maps.org). 3Ketamine: Dreams and Realities. Sarasota, FL.: Multidisciplinary Association for Jayanthi, S., B. Ladenheim, A. M. Andrews,causedhumanneurons andJ. bymethylenedioxymethamphetaminecopper/zinc [Letter]. L. Cadet. Lancet 1999.superoxide 353(9160): Overexpression dismutase 1270—1. inof (Ecstasy). transgenic Neuroscience mice attenuates 91:1379—87. oxidative stress

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Jensen,422 K.Appendices E,J. Olin, N. Haykal-Coates,J. O'Callaghan, D. B. damage with a cupricMiller, silver andJ. S. de Johnson, M., I. Elayan, G. R. Hanson, R.methylenedioxymethamphetamine.stain:Olmos. L. Foltz, A 1993.quantitative J. W.Mapping Gibb, analysis toxicant-induced of neural NIDA degeneration nervous Res. system 2,4,5-trihydroxymethamphetamine,induced by 3,4- 136:133—49; discussion 150—4. and H. K. Lim. 1992. Kahn, R. S., L.J. Siever, S. Gabriel, etEffectsandtwo al. dopaminergicmetabolites1992. of 3,4-dihydroxyrnethamphetaminemeta-chiorophenylpiperazineSerotonin of systems. 3 J. Pharmacol. Exp. in schizophrenicand Ther. 261:447—53. patients ,4-methylenedioxymethamphetamine, on central serotonergic function in schizophrenia: and healthy Kalia, M., J. P. O'Callaghan, D. B. Miller,fluoxetine,subjects.serotonergic and PsychiatryM. sibutramine, Kramer. nerve Res. terminals 43:1—12. sertraline using and serotonin dexfenfiuramine immunohistochemistry. on the 2000. Comparative study of morphology of Brain Res. Kahn, N. H., R. J. Davidson, W. Irwin,ofimaging858:92—105. etvenlafaxine. al. 1997. studies FunctionalJ. ofClin. emotional Psychiatry processing 58:32—9. in normal and depressed patients: Effects magnetic resonance Kapur,Kalivas, S., P. andW, P.G. Duffy, Remington. and S. 1996.R. White. Serotonin-dopaminechemicalto 1998. schizophrenia. sensitization MDMA elicits Am. ininteraction rats. J. Psychiatry Neuropiychopharmacology 18:469—79. 153:466—76. behavioral and neuro- and its relevance Kelland,Karch, S. B.M. 1996. D., A. Pathology S. Freeman, of drug and abuse. L.sivenessamphetamine-induced A. 2d Chiodo. ed. ofBoca nigrostriatal 1989. Raton, Fla.: changes dopamine in theneurons. basal activityEur J. Pharmacol. and pharmacological respon- (±)-3,4-Methylenedioxymeth- CRC Press. pp. 249—53. 169:11—21. Kemmerling, K., R. Hailer, and H. Hinterhuber.logical253 :803—11. responsiveness 1996. Das of nigrostriatal dopamine neurons.1990. Serotonergic J. afferent regulation of the basic physiologyneuropsychiatrische and pharmaco- Risiko Pharm. Exp. Ther Kernberg, 0. E, C. S. Burnstein, R.von Coyne,Foundation'sVoth. 3 ,4-Methylenedioxymethamphetamin 1972.D. A. Appelbaum,Psychotherapy Psychotherapy H. and Research psychoanalysis: Project. Bull. Final Menninger report of Clin. ("Ecstasy"). Neuropsychiatrie 10:94—i 02. Horwitz,the Menninger and T. J. 36:1—198. Khakoo,Ketter, T. S. A., L., P. C. J. J.Andreason, Coles, J. S. M. Armstrong, S. George,procaine-inducedaccelerated andet al. R. 1996. E. fibrosis Barry.emotional Anterior following 1995. and psychosensoiy 3 ,4-methylenedioxymethamphetamine experiences. Arch. Gen. paralimbic mediation ofHepatotoxicity and Psychiatry 53:59-69. ("ecstasy") Kilpatrick, D. G. 1992a. EtiologIa y factoresdevIctimasusage. ansiedad, J. predictivos Clin.de agresiones edited Gastroenterol. deby estréssexuales.E. Echeburüa. 20:244—7. In Avances Madrid: en Pirámide.el tratamiento psicológico de los trastornos postraumático en PDF compression, OCR, web-optimization with CVISION's PdfCompressor References 423 PinImide.t'ratamiento psicológico de los trastornos• de ansiedad,1992b. edited Tratamiento by E. Echeburija. psicológico Madrid: de las agresiones sexuales. In Avances en el Klein,Kish, S.J., Joe. Y. 1985. Furukawa, The drug L. theAng, call S. Ecstasy.P. Vorce,nm New and York,K. S. 20 May. is depleted in brain of a human MDMA (Ecstasy) user. Neurology 55:294—6. 2000. Striatal seroto- Kiugman,Kieven, M. A., S., S. W. Hardy, L. Woolverton, T Baldeweg, and produceandL.and S. J. Seiden. Gruzelier.subcutaneous serotonin 1989. 1999.neurotoxicity Evidenceadministration Letter thatto in therhesus both of Lancet methylenedioxymethamphetamine intragastric monkeys. in Brain Res. 488:121—5. (MDMA) Koreen,Knable, M.A. R.,B., S.and G. D. Sins, R. Weinberger. M. Chakos,J.schizophrenia.response 1997. Alvir, Dopamine, toD. McCann Mayerhoff, J. Psychopharmacol. the et al.prefrontal andJ. (1999) Lieberman. 11(2):Lancetcortex 123—31. 353:1269.and 1993. Kretsch,Koss, M. M.J.,P. 1983. M. TheW. Green, scope ofA. rape: K. Fong, ImplicationsGun.Depression N. Psychologist A. Elliman, for in thefirst 3 clinical8:88—91. andepisode H. L.Johnson.treatment schizophrenia. of 1997. victims. Am. J. Psychiatry 150:1643—8. Krystal, J. H., J. P. Seibyl, L. P. Price,Charney.Disord.Cognitive S. W. Woods,21:14—21. 1991.effects G. MCPP of R. a Heninger, long-term effects in andweight schizophrenic D. S. reducing patients diet. mt. before J. Obes. and Relat. after Metab.typical and Krystal, J. H., L. H. Price, C. Opsahl,neuropsychological ChronicatypicalG. A. Ricaurte, neuroleptic3,4-methylenedioxymethamphetamine andfunction? treatment.G. R. Am.Heninger. J. DrugAlcoholAbuse 1992. (MDMA) 18(3):33 use: 1—41. Effects on mood and Res. 4:3 5 0—9. Lahti.Kuikka, A. J. C., T, B. and Koffel, A. K. D.Ahonen. LaPorte, 1999. andketamineneurons ToxicC. A. Tamminga.effect[Letter; stimulate of Comment]. MDMA psychosis 1995. Subanestheticon inLancet brain schizophrenia. serotonin353:1269; doses Neuropsychopharmacology. discussionof 1270—1. 13:9—19. Langston,Lamb, R. J., J. andW, P.R. Ballard, R. Griffiths. J. W. 1987. Tetrud,humansdioxymethamphetamine Self-injection and dueI. Irwin. to a of product 1983. (MDMA)Chronic of meperidine-analog parkinsonismin the baboon. synthesis. Psychopharmacologyin Science 219:979—80. 91:268—72. 1-3 ,4-methylene- Laruelle,Lapin, I.M., P., A. and Abi-Dargham, G. F. Oxenburg. M. F. 1969. Kleinman.Casanova,process Intensification as 1993.R. a Toti,possible Selective ofD. the R.determinant Weinberger,central abnormalities serotonergic for andJ.the of thymoleptic prefrontalE. serotonergiceffect. Lancet receptors 1:132—36. in Laruelle, M. A. Abi-Dargham, C. H. vanofR.schizophrenia: Dyck, striatalM. Baldwin, W. dopamine Rosenblatt, A D.postmortem releaseS. Charney, Y. Zea-Ponce,after study. amphetamine P. Arch.B. S.Hoffer, S.Gen. Zoghbi, challenge. PsychiatryH. F. Ki.mg. J. 50:810—8. Nuc. 1995. Med. SPECT 36:1182—1190. imaging PDF compression, OCR, web-optimization with CVISION's PdfCompressor 424Lauerma,Laviola, G., W. Adriani, M. L. Terranova,inhibitor and 3,4-methylenedioxymethamphetamine?Appendices H., M. Wuorela, and M. Halme. 1998. and G. Gerra. 1999. Psychobiological risk Interaction of serotonin reuptake [Letter]. Biol. Psychiatry 43:929. LaVoie, M. J., and T. G. Hastings. 1999.models.factorsmodification forNeurosci. vulnerability associated Biobehav. to withRev.psychostimulants the striatal 23:993—1010. Dopamine quinone formationneurotoxicity and protein of methamphetamine: in human adolescents and animal LeLawn, Doux, J. C. J. 1986.E. 1995. Schedules Emotion: of controlledCluesmethylenedioxymethamphetamineEvidence against a role for extracellular (MDMA) into schedule I. from the brain. Ann. Rev. Psycho!. 46:209—35.substances: scheduling ofdopamine. 3,4- J. Neurosci. 19:1 484—91. Fed. Reg. 51:36552—60. LeLee, Poul, M. S., E., Y. C. K. Boni, Kim, N. S. Hanoun, K. Lee, and etJ. Cliii. adjunctiveK. Psychopharmacol. sertraline in haloperidol-stabilized patients 18:3 99—403. al. 2000. Differential adaptation of brainY. Suh. 1998. A double-blind study of with chronic schizophrenia. 5-HT1A Lesch, K. P., M. Wiesmann, A. Hoh, etresponsivityfluoxetine.and al. 5-HT1B Neuropharmacology in receptors panic disorder. and 5-HTPsychopharmacology 39:110—22. transporter 1992. 5-HT1A receptor-effector system in rats treated chronically with (Berlin) 106:111—7. Lester,Lew, S., R., M. K. Baggott, E. Sabol, S. C. Weim, Chou, et G.al. L.2000.Methylenedioxymethamphetamine-inducedmethylenedioxymethamphetamine (MDMA). serotoninAnn. Intern. deficits Med. are Vosmer,J. Richards, and L. S. Seiden. 1996. The cardiovascular effects of Ecstasy, 3-4- 13 3(12):969—73. followed by Leysen,J. E., P. M.Janssen, A. Schotte,phypartialInteraction studies. W. recovery H. J. Pharmacol.of overantipsychotic a 52-week .&cp. drugs period. with II. 276:855—65. neurotransmitter receptor sitesRadioligand in vitroLuyten, and bindingand A. A. and Megens. autoradiogra- 1993. Li, A. A., G.J. Marek, G. Vosmer, andPsychopharmacologyin L. depletions'vivo S. in relation resulting to1 12:S40—54. pharmacological from repeated administration and Seiden. 1989. Long-termclinical effects: central Role 5-HT of 5HT2 receptors. of MDMA enhances the effects Lieberman, J. A., J. M. Kane, and J. Alvir.drugsPharmacol.of single 1987. in schizophrenia. administration Biochem. Behav. Psychopharmacology of 3 MDMA3:641—8. on schedule-controlled behavior of rats. 91:415—33. Provocative tests with psychostimulant Lieberman,J.Liechti, M. A.,E., andB.J. EKinon, X. Vollenweider. and A. D. effectsidiopathicLoebel. 2000a. of 1990. MDIvIAand drug-induced ("Ecstasy") psychosis. after haloperidol Schizophr. pretreatment Acute psychological and physiological Bull. 16:97—109Dopaminergic mechanism in in normal healthy Psychopharmacol.humans.and vegetative Eur. Neuroprychopharmacol. 14(3 effects ):269—74. of MDMA ("Ecstasy")22:513—21 (in2000b.in The serotonin uptake inhibitor citalopram reduces acute cardiovascularhealthy volunteers. J. press). PDF compression, OCR, web-optimization with CVISION's PdfCompressor Liechti, bycal theeffects serotonin of 3,4-methylenedioxymethamphetamine uptake inhibitor citalopram. M.Neuropsychopharmacology E., C. Baumann, A. Gamma, 22:513—21. and F. X. Vollenweider. 2000a. Acute psychologi- "Ecstasy") are attenuated References 425 Liechti, M. F., M. 23(4):396—405.logical5-HT2 and antagonist physiological ketanserin effects in healthyof MDMA humans. ("Ecstasy") Neuropsychopharmacology after pretreatment with the A. Gamma, D. Hell, and F. X. Vollenweider. 2000b. Psycho- Liechti,Liechti, M. M. F., E., M. A. A. Gamma, Geyer, D.and Hell, E X. and Vollenweider. (Ecstasy)subjectiveF. X. Vollenweider. effectson 2001a. prepulse of MDMA.Gender 2001b. inhibition differencesPsychopharmacology Effects and of habituation inMDMA the (Berlin) of startle 154(2): in humans 161—68. after pretreat- Lin,Liester, J. H. 1998.M. B., Applications C. S. Grob, G. and L. limitationsBravo,sequelaement and ofR.with interspecies N.of citalopram, Walsh.3 ,4-methylenedioxymethamphetamine 1992. scaling haloperidol, Phenomenology and inor vitroketanserin. and Neuropsychopharmacology use. 5'. Nerv. Ment. Dis. 180:345—52. 24:240—52. Little, K. Y., D. P. McLaughlin, L. Am.J.Zhang,effectsextrapolation et al. on 1998. human in Cocaine,pharmacokinetics. midbrain ethanol, serotonin Drugand genotypeMetab.transporter Dispos. binding 26:1202—12. sites and mRNA levels. 155:207—13. Liu, B. A., N. Mittmann, S. R. Knowles,Assoc.J.selectiveof inappropriate et 155:519—27.al. serotonin1996. Hyponatremia secretion reuptake of inhibitors: antidiuretic and the syndromeA reviewhormone of associatedspontaneous with reports. the use Can. of Med. Logan, B.J.,A. S. R. C., Laverty; B. Stickle, W. N.D. O'Keefe,Sanderson,48: "Ecstasy" and1017—8. and H. Y. Hewitson. B.ingestion Yee. 1988.1993. with Differences Survivala peak temperature following between of 42 degrees Celsius. Anesthesia Lucki, I. 1998. The spectrum of behaviors44:151—62.Pharmacol.rats influenced and mice 152:227—34. byin MDMAserotonin. (methylenedioxymethamphetamine) Biol. Psychiatiy neurotoxicity. Eur. 5'. Lyness,Lukas, S. W. F. 1985.H., N. Amphetamines: M. Friedle, and Danger K.d-amphetamine E.tive inMoore. the drugs. fast 1981. Newlane. after Increased TheYork: destruction encyclopaedia Chelsea self-administration ofHouse 5-hydroxytryptaminergic of psychoac- Publishers. of (serotonergic) nerves. Maes, M., and H. Meltzer. 1995. ThePsychopharmacology: serotoninKupfer.Pharmacol. Newhypothesis Biochem. York: The Behav.Ravenof majorfourth 12:93Press. depression.generation 7—41. ofprogress, In edited by F. E. Bloom and D. J. pp. 933—44. Malberg,Mahmood, J. I. E., 1999. and Allometric L. S. Seiden. issues 1998. inserotoninlarge drug Small changesdevelopment. changes neurotoxicity in 3,4-methylenedioxymethamphetaminein 5'.ambient Pharm. and core temperature Sci. body 88:1101—6. temperature cause in the rat.J. (MDMA)-induced Neurosci. 18:5086—94. PDF compression, OCR, web-optimization with CVISION's PdfCompressor Malberg,J.426 temperaturedrugs that inprotect the rat. against J. Pharmacol. MDMA neurotoxicityAppendices E., K. E. Sabol, and L. S. Seiden. 1996. Evp. Ther. 278:258—67. Co-administrationproduces different of MDMA effects with on body Mandel,Maihotra, W. A. 1984. K., D. The A. yuppiePinals, C.psychedelic. M. Adlerschizophrenics.of psychoticetSan al. symptoms and cognitive impairment 17: 141—50. Francisco1997. Chronicle, Ketamine-induced 10 June. exacerbation in neuroleptic-free Mann,Mann,J.J. J. J., 1987. Y. Y. Psychobiologic Huang, and M. predictorsD.progress, Underwood. editedof by F. E. Bloom 1995. Violence and aggression. In and D. J. Kupfer. New York: Raven Press. Psychopharmacology: The fourth generationsuicide. of J. Cliii. Psychiatry 48:39—43.2000. A serotonin transporter gene Marchant, N. C., M. A. Breen, D. Wallace,promotermetabolismdepression et al. polymorphism and of '4C-(±)-fenfluraminesuicide. Arch. Gen. Psychiatry in mouse, rat, (5-H'ITLPR) and prefrontal cortical binding in major 57(8):729—38.1992. Comparative biodisposition and dog and man. Xenobiotica Marston, H. M., M. E. Reid,J. A. Lawrence,Behavioural22: 125 H.J.1—66. analysis of the acute and chronic effects 144:67—76. Olverman, and S. P. Butcher. 1999. of MDMA treatment in the Mas, M., M. Farré, R. de la Torre, et al.J. Pharmacol.effectsrat.1999. Psychopharmacology and Exp.pharmacokinetics (Berlin) of Ther. 290:136—45. 3,4-methylenedioxymethamphetamine in humans. Cardiovascular and neuroendocrine Mathers, D. C., and A. H. Ghodse. 1992.Psychiatrystate after 161:648—53. amphetamine R. J., and W. H. Wilson. 1989. Changes in challange in schizophrenic patients. Neurop sycho biology Cannabis and psychotic illness. cerebral blood flow and mental J. Maxwell,McBean, D. D. L., E.,J. M. I.Sharkey, Polkey, I. andJ. M. Ritchie, A. Henry.stupor21:117—23. and 1993.after P. A. taking "ecstasy." Br. Med.J. 307:1399. Kelly. 1990. EvidenceHyponatremia for a possible and catatonic McCann, U. D., and G. A. Ricaurte. 1991a.(±)353role 7:307—10. Lastingfor,4-methylenedioxymethamphetamine serotonergic systems in the control of ("Ecstasy") in recreational users. J. Cliii.cerebral blood flow. Brainneuropsychiatric Res. sequelae of McCann, U. D., A. Ridenour, Y. Shaham,notPsychopharmacol. mediate and G. A.its toxic 11:302—5. effects on 199 lb. Major metabolites of (±)3 brain serotonin neurons. Brain Res. 545:279—82. ,4-methylenedioxyamphetamine (MDA) do Ricaurte. 1994. Serotonin McCann, U. D., S. 0. Slate, and G. A.methylenedioxymethamphetamineAneurotoxicity Ricaurte. controlled study after in (±)3,4 humans. methylenedioxymethamphetamine Neuropsychopharmacology (MDMA; "Ecstasy"). Drug Saf 1996. Adverse reactions with 3,4- 10:129—38. (MDMA "Ecstasy"): 15:107—15. PDF compression, OCR, web-optimization with CVISION's PdfCompressor McCann, Positron emission tomographic evidence of toxic effect of MDMAU. ("Ecstasy")D., Z. Szabo, U. Scheffel, R. F. Dannals, and G. A. Ricaurte. 1998. References on 427 McCann, U. D., V. Eligulashvili, M. Merti,Altered3,4-methylenedioxymethamphetarninebrain D. serotoninneuroendocrine L. Murphy, neurons and and G.in behavioralA.human Ricaurte. beings responses(MDMA) 1999a. [see Comments]. users.to m-chlorophenylpiperazine Psychopharmacology Lancet 352:1433—7. (Berlin) in McCann, U. D., M. Mertl, V. Eligulashvili,users:performance147:56—65. and A G.controlled A. in Ricaurte. (±)3,4-methylenedioxymethamphetamine study. 1999b.Psychopharmacology Cognitive (Berlin) 143:417—25. (MDMA, "ecstasy") McGuire,McElhatton, P. 2000.P. R., LongD. N.Bateman, term psychiatric andLett. C. prenataland Evans112—113:153—6. cognitive ecstasyet a!. 1999.effects exposure. Congenital of MDMA Lancet anomalies354:1441—2.use. Toxicol. after McGuire,McGuire, P., P., H. and Cope, T. Fahy.and T. 1991. Fahy. Chronic 1994.("Ecstasy") Diversity paranoid [seeof psychosis psychopathology Comments]. after misuseBr. associatedMed. of J.MDMA 302:697. with1992. Flashbacks following MDMA. Br. J. Psychiatry 160:276. McKenna, D. J., and S. J. Peroutka. 1990.methylenedioxymethamphetaminethe Neurochemistry165:391—5. use of 3 ,4-methylenedioxymethamphetamine and neurotoxicity (MDMA, of 3,4- "Ecstasy"). (Ecstasy) 5'. Neurochem. Br J. Psychiatry 54:14—22. McKetin,McKenna, R., T K., and and N. D.Solowij. J. McKenna. 1999. Event-related1975.attentionPress. The inInvisible dependent potential Landscape. indicesamphetamine ofNew auditory York:users. selectiveSeaburyBiol. Psychiatry 45:1488—97. McNamara,McMiller, P., M. and G., M. J. Plant.P. Kelly, 1996. and Drinking, B.neurochemical E. Leonard.16 smoking, year olds1995. aspects andin Somethe illicit ofUnited subacutebehavioural drug Kingdom. use (±) among and3 ,4-methylenedioxymethamphetamineBr Med.15 and 5'. 313:394—7. Meltzer,Meichenbaum, C. C., G.D. Smith,1994. Tratamiento S. T DeKosky, traumático:administrationde clienteset al. 1998. Uncon in enfoque Serotonin trastomosrats. Pharmacol. cognitivo inde aging,estrés Biochem. conductual. late-lifepost- Behav. Rev. 52:479—84.Psicoterapia 5(1 7):5—84. Meltzer, H.I-i. Y. Y., 1990. and RoleG. Okayli. of serotonin 1995. in Reduction depression.Comments].depression, of Ann. suicidality Neuropsychopharmacologyand N. YAcad. during Sci. clozapine600:486—500. 18:407—30. treat- disease: The emerging role of functional imaging [see Meltzer, H. Y., and S. M. Stahl. 1976.review.Am.J. Thement dopamine Psychiatry Schizophr of neuroleptic-resistant hypothesis 152:183—90. Bull. 2:19—76. of schizophrenia: schizophrenia: A Impact on risk-benefit assessment. PDF compression, OCR, web-optimization with CVISION's PdfCompressor Meltzer,428 AppendicesH. Y., R. G. Fessler, M. Simonovic, and V. S. Fang. 1978. The-dimethoxy-4-methyl- effect of Meltzer, H., S. Matsubara, and J. Lee.Sci.amphetaminemescaline, 1989.antipsychotic 23:1185—92. Classification 3 ,4-dimethoxyphenethylamine on drugs rat plasma on the prolactin: basis of dopamine Evidence and D-1,2,5for serotonergic D-2, of typical and atypicaland serotonin 2 pKi values. mediation. Metzger, R. R., G. R. Hanson, J. W.J. Gibb,Pharmacol.Methylenedioxymethamphetamine-inducedfunction. and A. Erp.EurJ. Ther. Pbarmacol. 349:205—10. acute changes in dopamine transporter 251:238-46. E. Fleckenstein. 1998. 3,4- Metzner,Meyerson, R., andA. 1936. S. Adamson. Effect of 1988. benzedrine The natureneuroticin sulfate healing, persons. on psychotherapy, mood Arch. Neurol. and Psychiatry spiritual practice.8 16—22. of the MDMA experience and its roleReVision 10, no. 4. and fatigue in normal and Miller,Miller, D. N. B., S., and M. J. S. P. Gold, O'Callaghan. and D. E. 1994. Smith,aminesalterations Environment-, eds. in the 1997.in bodyC57BL/6J temperature mouse. affectJ. Pharmacol. the neurotoxicity Erp. of EcstasyTher. In Manual 2 70:752—60. of therapeutics drug- and stress-induced substituted amphet- Milroy,Milroy, C. C.M. M., 1999. J. C. Ten Clark, years and of ecstasyJ.A.for R.M. addiction. W. Gold. R. Forrest. Soc. New "Intoxication Med. 1996. York: John and Wiley Withdrawal and Sons. from pp. 52—4. Marijuana, LSD, and MDMA"Pathology by 92:68—72. of deaths associated Molliver, M. E., L. A. Mamounas, and M.withtoxicologyamines A. "ecstasy" Wilson. on of serotonergic 1989.andamp "eve"hetamine misuse. neurons: and related J. ImmunocytochemicalClin. designer Pathol. drugs, 49:149—53. edited studies.Effects In: byof Pharmacology neurotoxicK. Asghar andamphet- and E. De Souza. Montgomery;Mordenti, J., H., and and W. S. Chappell. Myerson. 1989. 1997. (MDMA,NII)AThe use Research of or interspecies "ecstasy") Monograph and associated no. 94. Baltimore, hypoglycemia. Md.: Nll)A, Am. J. pp. 3,4-Methylenedioxymethamphetamine scaling in toxicokinetics.Emerg. Med. 15:218.270—304. Morgan, A. E., B. Horan, S. L. Dewey,NewIn andtionToxicokinetics York: C.of R.3 Pergamon,4-methylenedioxymethamphetamine in new Press. drug pp.development, 42—96. edited augments AshbyJr. by1997. A. Yacobi, Repeated J. Kelly,administra- and V. Batra. cocaine's action on Morgan, M. J. 1998. Recreational use dopamineof impulsivity.331:R1-3."ecstasy" in the Neuropsychopharmacology nucleus accumbens: A 19:252—64.microdialysis study. (MDMA) is associated with elevated Eur. J. Pharmacol. Psychopharmacology (Berlin) 141:30—6.• 1999. Memory deficits associated with recreational use of "ecstasy" (MDMA). effects. Psychopharmacology (Berlin) 152:230—48.• 2000. Ecstasy (MDMA): A review of its possible persistent psychological PDF compression, OCR, web-optimization with CVISION's PdfCompressor Mossner, and locomotor insensitivity to 3 ,4-methylenedioxymethamphetamineR., H. Westphal, ("Ecstasy") and K. in P. Lesch. 1998. Altered brain serotonin homeostasis References 429 Mulan,Mueller, S., P. and D., W.and Penfleld. W. S. Korey. 1959. 1998. IllusionsAnn.serotonin Death Emerg. of by comparative transporter-deficientMed. "ecstasy": 32:377—80. Theinterpretation serotonin mice. Mol.andsyndrome? emotion. Pharmacol. 53:649—55. Murphy,Murphy, D. D. L., L., K. E. P. A. Lesch, Mueller, C. S. N. Aulakh, A. Arch.Garrick,agents et Neurol. al. inand 1991. the PsychiatryC. clinical S.Serotonin-selective Aulakh. assessment 8 1:269—84. 1986. of Use central of serotonergic serotonin function. J. Gun. Psychiatry 47:9—15. Naranjo, C. 1973. The healing journey: NewRandomeffectsarylpiperizines approaches in House.humans. to consciousness. with Pharmacol. neuroendocrine, NewRev. York:43:527—52. behavioral, temperature, and cardiovascular Nash,Naranjo, J. F.C., 1990. A. Shulgin, Ketanserin and T.pretreatment Sargent.releaseamphetamine 1967. attenuates in Evaluationthe striatum (MDA)MDMA-induced of as as3,4- measured an methylenedioxy-adjunct dopamine by to in psychotherapy. vivo microdialysis. Med. Pharmacol. Life Sci. 47:2401—8. Erp. 17:359—64. Nash, J. F.,E, andH. Y. J. Meltzer,Brodkin. and1991. G. MicrodialysisA. Gudelsky.tors.J.methamphetamine-induced Pharmacol. 1990.studies Effect on Exp. 3 ,4-methylenedioxy-of Ther 3 ,4-methylenedioxy- dopamine 259:820-5. release: Effect of dopamine uptake inhibi- Nencini, P., W. L. Woolverton, and L.inducedandmethamphetamine S. nucleusSeiden. analgesia accumbens. 1988. after Enhancementon 3 J. repeated,4-dihydroxyphenylalanine Neurochem. injectionsof morphine- 54:1062—7. of methylenedioxymethamphetamine. accumulation in the striatum Neylan,Netter, P., T. J.C. Hennig, 1999. Frontal and I. lobeS. Roed. function: 1996.sensationBrain Mr. Res.Serotonin Phineasseeking 457:136—42. andbehavior. Gage's dopamine famous Neuropsychobiology as injury. mediators J. Neuro. of 34:155—65. Nichols, D. E. 1986. Differences betweenMBDB,entactogens.Clin. the Neurosci. mechanismsand the J. classicPsychoactive of hallucinogens:action Drugs of MDMA, 18(4): Identification 305—13. of a new therapeutic class— Nichols, D. E., and R. Oberlender. 1989.drugs,likeBaltimore, Structure-activitysubstances. edited Md.:by In: K. PharmacologyNIDA. Asghar relationships pp. and 1—29. E. and De oftoxicology Souza, MDMA- NTDA of amphetamine Research andMonograph, related designer no. 94. Nichols, D. E., and R. Oberlender. pharmacological1990.Peroutka.and Structure-activityrelated Boston: compounds: and neurotoxicological Kiuwer relationships A Academicnew class effects ofPublishers. psychoactiveMDMA of the drugpp. 105—31.agents? MDMA, In edited Ecstasy: by S. The J. clinical, PDF compression, OCR, web-optimization with CVISION's PdfCompressor 430 Appendices Nichols, serotoninEffects of fromcertain rat hallucinogenic brain synaptosomes. amphetamine J. Med. Chem.D. E., D. H. Lloyd, A.J. Hoffman, M. B. analoguesNichols, and on G.the K. release W. Yim. of (3H) 1982. 25:530—5. Nirnmo,Nichols, D.S. M.,E., R.B. Yensen,W. Kennedy, and R. W. Metzner. M. Tullett,Drug-induceddebate. 1993 MAPS hyperthermia. Bulletin. 4: 47-49. Anaesthesia 48:892—5. A. S. Blyth, andJ..The R. great Dougall. entactogen 1993. empathogen Nobler,Nuflez-Dominguiez, M. S., J. J. Maim, L. A. and 1994. H. A. Psychosis Sackeim.Res.and cerebralRev.because 1999. 30:250—63. ofmetabolic ecstasy. rate in geriatric major depression and normal aging.Serotonin, Brain cerebral blood flow, Ad4icciones 6(3):301—7. Obrocki,Obradovic, J., T.,R. K.Buchert, M. Imel, 0. Vaterlein,and S. R. White.responsesmethylenedioxymethamphetamineR. Thomasius, 1998. to dopamine and (MDMA) alters nucleus accumbens serotonin. Brain Res. 785:1—9. Repeated exposure toW. Beyer, and T. Schiemann. neuronal O'Callaghan, J. P., and D. B. Miller.positron 1993.approach1999. Quantification Ecstasy:emission to neurotoxicity Long-term tomography assessment. effects [see Comments].on the NIDA Res. human central nervous system revealed by J. Psychiatry 175:186—8.of reactive gliosis as an 136:188—212. O'Hearn, E., G. Battaglia, E. B. De P.lengesSouza, A. Broderick. to M. the J. current New dogma. York: HumanaIn: Handbook Press. of2001. Neurotoxic effects of substituted amphetaminesneurotoxicology, in rats and editedKuhar, mice: by and Chal-E. MassaroM. E. Molliver. and 1988. O'Malley, S., M. Adamse, R. K. Heaton,MethylenedioxyamphetamineImmunocytochemical(MDMA) and E H. cause selective evidence ablation (MDA) for of and serotonergic methylenedioxymethamphetamine axon Gawin. 1992. NeuropsychologicalJ. Neurosci. 8:2788—803. terminals in forebrain: Ornstein, I J., J. L. Iddon, A. M. Baldacchino,impairmenttion in chronic et in al. chronic amphetamine cocaine abusers. and heroin Am. abusers. J. Quantification of 3 ,4-methylenedioxy- 2000. ProfilesNeuropsychopharmacology of cognitive dysfunc- 23:113—26. 18:131—44. O'Shea,Ortuflo, E.,J., N.R. Pizarro,Granados, M. B. Farré, Esteban, et withal. relationshipmethamphetamineM. 1999. nitrogen-phosphorous I. between and the its degree detection.metabolites of neurodegeneration J. in plasma and urine Colado, and A. R. Green. 1998. The B. Biomed. Sci. 723:22of 1—32. rat brain 5-HT nerve by gas chromatography Pacifici, R., P. Zuccaro, M. Farré, etNeuropharmacology al.terminals 1999. and the 37:919—26. dose and frequency of administration hnmunomodulating properties of pilot study. of MDMA ("ecstasy"). Sci. 65:309—16. immuneMDMA alonesystem and in inhumans. combination j Pharmacol. with alcohol: Evp.2000. Ther2001. A Immunomodulating Acute effects of MDMA activity aloneof MDMA. and in Ann. combination with ethanol on the296:207—215. N. YAcad. Sd. 914:215—24. PDF compression, OCR, web-optimization with CVISION's PdfCompressor References 431 Parrott,Pallanti,Padkin, A. S.,C. 2000.and D. Human Mazzi. research1992. MDMA onPsychiatiy MDMA (Ecstasy) 32:91—5. (3,4-methylenedioxymethamphet- precipitation of panic disorder.A. Biol. 1994. Treating MDMA ("ecstasy") Anaesthesia 49:2 59. Parrott, A. C., andJ. Lasky. 1998. EcstasyBefore,Neuropsychobiologyamine) (MDMA) during neurotoxicity: andeffects 42:17—24.after upon a Cognitive Saturday mood andnightand cognition:behavioural dance. Psychopharmacology indices of change. (Berlin) Parrott, A. C., A. Lees, N.J. Garnham,deficits.performance M.Jones,139(3):261—8. J. Psychopharinacol. and in recreationalK. Wesnes. 12:79—83. users1998. of Cognitive MDMA "ecstasy": Evidence for memory Peroutka,Perls,Patterson, F. 1969. S. E. J. W, 1987.Gestalt G. Myers,Incidence therapy and verbatim.of D. recreational M.college Gallant. Laffayete, campus:abuse 1988. Calif.: of A 3Patterns 14-year,4-methylenedioxymethamphet- Real People ofcomparison substance Press. study. abuse Am. on 5'.a DrugAkoholAbuse 14(2):237—46. Academicneurotoxicologicalamine (MDMA, Publishers. effectsEcstasy) pp. 5 of 3—63. on the an drug undergraduate MDM, edited campus. by1990. S. J.N.Recreational Peroutka. Engi. 5'. Med.Boston: use of317:1542—3. MDMA.Kluwer In: Ecstasy: the clinical, pharmacological and Peroutka, S.J.,S. J., H. N. Newman, Pascoe, and and K. H. E Harris. Faull.(MDMAcerebral 1987.1988. spinal "Ecstasy"). MonoamineSubjective fluid Res. ofeffects metabolites recreational Commun. of 3,4- Substancein usersmethylene- the of 3Abuse ,4-methylenedioxyrnethamphetamine 8:125—38. Poblete, J. C., and E. C. Azmitia. 1995.cultures:serotonindioxymethamphetamine Activation Involvement and of 3 glycogen,4-methylenedioxymethamphetamine of in the phosphorylaserecreational 5-HT2A receptor. users. by Neuropsychopharmacology Brain Res. in astroglial-rich680:9—15. 1:273—7. primary Poland,Poch, J., R.and E. A. 1990. Avila. Diminished 1998. Investigacidn corticotropinhydroxy-2Barcelona: en psicoterapia: and (di-n-propylamino)tetralinPaidós. enhanced La contribucio'n prolactin psicoanalItica.responses in methylenedioxymethamphetamine to 8- Poland, R. E., P. Lutchmansingh, J.TMDMA.prolactinpretreated McCracken, Psychopharmacology responsesrats. et Neuropharmacology al. 1997.to fenfluramine Abnormal(Berlin) 131:411—9. 29:1099—101: in ACTH rats exposed and to single and multiple doses of Post-traumaticPope,Poole, H.R., G. and Jr., C. stress and Brabbins. D.disorder. Yurgelun-Todd. 1996. 1996. Drug Harvard marijuanainduced 1996. Mental psychosis.The use residual Healthin college Letter,cognitive students June—July. effects [see Commentsj.JAMA of heavy 275:521—7. 5'. Psychiatry 168:135—8.

PDF compression, OCR, web-optimization with CVISION's PdfCompressor President432 Appendices of the Council. 1998. Tackling drugs to build a better Britain: The Price, L. H., G. A. Ricaurte, J. H. Krystal,Stationarygovernment'sand and mood Office. responses ten year strategy to intravenous for tackling L-tryptophafl drugs misuse. in 3,4- G. R. Heninger. 1989. Neuroendocrine London: Her Majesty's Price, L. H.,J. H. Krystal, and G. R. Heninger.Arch.methylenedioxymethamphetamineComments]. Gen. 1990.Psychiatiy Arch. Gen. 47:289. Psychiatiy (MDMA)46:20—2. users: Preliminary observations In reply [to Grob eta!. 1990]. [see Ramsey,Ramamoorthy, M., B. S.,Partridge, E. Giovanetti, and C. Y.Byron. Qian,273:2458—66.and 1999. and regulation R. D. of antidepressant-sensitive serotonin transporters. J. Drug misuse declared in 1998: Key Blakely. 1998. Phosphorylation Biol. Chem. Randall,Rao, M. T L.,1992. and Ecstasy-fueled H. J. Moller. 1994. "rave" resultsBiochemical youths.parties from JAAIA the British 268:1505—6. Crime Survey. Res. Find. 93:1—4. become dances of deathfindings for ofEnglish negative symptoms in Redfearn, P. J., N. Agrawal, and L. H.Neuropsychobiology Mair.useschizophrenia of1998. 3 ,4-methlenedioxymethamphetamine An and 30:160—72. their putative relevance to pharmacologic treatment. (ecstasy) and excessive wear of the association between the regular Reneman, L., J. Booij, B. Schmand, W.serotoninMemoryteeth. van Addiction den disturbancesneurotransmission. Brink, 93(5):745—8. in "Ecstasy" Psychopharmacology users are correlated (Berlin) and B. Gunning. 2000a. with an altered brain148:322—4. Reneman,Reynolds, L., S. J. 1998. B. Habraken, Generation C. Ecstasy: B. Majoie,MDMAfindings. J. Booij,("Ecstasy") Am. J. Neuroradiol. and its association 21:1001—7. with cerebrovascular Into the world of techno culture. London: Little, and G. J. den Heeten. 2000b. accidents: Preliminary Riba,Ricaurte, J., and G. M. A., Barbanoj. and U. D.1998. McCann. A pharmacologicalvolunteers.Brown, 1992. Neurotoxicand MAPS Company. study Bull. 8(3):2—15. amphetamine analogues: Effectsof ayahuasca in healthy Ricaurte, G. A., L. E. DeLanney, I.MDMA Irwin,frequencyin monkeys andj. on centralof W. and drug implications serotonergicadministration. for neurons Brainhumans. Res.in theAnn. 446:165—8. primate: N Langston. 1988a.K Toxic Acad. effectsSci. 648:371—82. of Importance of route and Ricaurte, G. A., L. E. DeLanney, S. G.inducedHydroxyindoleacetic Wiener,Brain Res. by I. 3 Irwin,474:359—63. ,4-methylenedioxymethamphetamine acid in cerebrospinal fluid reflects in CNS serotonergic andJ. W Langston. 1988b. 5- of non-human primates. damage

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Ricaurte, G. A., L. S. Forno, M. A. Wilson, et al. 1988c. (±)3,4-Methylenedioxy- References 433 Ricaurte, G. A., K. T. Finnegan, I. Irwin,metabolitesprimates.methamphetamine andJ. JAIVIA W. in Langston. cerebrospinal 260:51—5. selectively 1990. fluid damages of humans central previously serotonergic exposed neurons to MDMA: in nonhuman Ricaurte, G. A., A. L. Martello, J. L. Katz,neurons(±)-3,4-methylenedioxymethamphetaminepreliminary and in M. nonhuman observations. B. Martello. primates: Ann. 1992. N. NeurochemicalLasting YAcad. effects Sci. (MDMA) 600:699—708; ofobservations. on central discussion J. Pharmacol.serotonergic 708—10. Evp. Ricaurte, G. A., A. L. Markowska, G.Olton. L.[published Wenk, 1993. G. 3,4-Methylenedioxymethamphetamine,erratumHatzidimitriou, appears J.inj. Wios, Pharmacol. and D. Evp.S. serotonin261:616—22. and memory 1994; 268(1):529]. J. Ricaurte, G. A.,J. Yuan, and U. D. McCann.NeuropsychobiologyamphetaminePharmacol. 2000. (±)3,4—Methylenedioxymeth- Exp. ("Ecstasy")-induced 42:5—10.Ther 266:1097—105. serotonin neurotoxicity: studies in animals. Riedlinger,Riedel, W. J.,J. E.T Klaassen,1985. The N. scheduling E. Deutz,memoryTryptophan of A. MDMA: van consolidation. Someren, depletionA pharmacist's and Psychopharmacologyin H. normal M. perspective. van volunteers Praag. J. 1999. (Berlin) produces 141:362—9. selective impairment in Robinson,Ritvo, E. R., T. B.J. E., E.Freeman, Castaneda, E. Geller, and I. and Q.Psychoactive outpatientsWhishaw.A. Yuwiler. Drugs with1993. 1983. 17(3):the Effects Effectssyndrome 167—71. of of cortical fenfluramineof autism. serotonin J. Am. on 14 Acad. Child Psychiatry 22:549—58. Rochester, J. A, and J. T. Kirchner. 1999.amine):beforedepletion Ecstasy and History, induced after (3 ,4-methylenedioxymethamphet- additionalneurochemistry, by 3 ,4-methylenedioxymethamphetamine cholinergic and toxicology. blockade. Neuropsychopharmacology J. Am. Board Fam.(MDMA) Pract. on 12:137—42. 8:77—85. behavior, RofRodgers, Carballo, J. 2000. J., and Cognitive A. Gonzalez performance Morado.delPsychopharmacology ácidoamongst 1958. lisérgico Experiencia recreational (DAL). (Berlin) clInica BoletInusers 151:19—24. of con del "ecstasy." Institutola dietilamida de PatologIa Mddica, 8(1 0):2 71—280. Rudnick,Rossman,Rosenbaum, G.,Martin. M.,and and S.1987. C. R. Wall. Doblin.Healing 1992. 1991.yourself The InWhy molecular TheNew MDMA drug York: legalization mechanism shouldWalker. not debate, ofhave "ecstasy" been edited made byJ.[3,4- illegal.Inciardi. Newbury Park, Calif.: Sage. p. 15. Ruiz-Ogara, C., J. L. MartI-Tusquets, lisérgica.formethylenedioxymethamphetamineand MDMA-induced E. González-Monciiis. Revista de PsiquiatrIay serotonin 1956. release. PsicologIa Psicosis (MDMA)]: Proc. Médica, Natl. Serotonin Acad.2(6):566—590. Sci. transporters U. S. A. 89:1817—21. are targets

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 434 Appendices ring-substituted amphetamine RuttySabol, K. E., and L. S. Seiden. 1998.MDMA-induced Reserpineanalogue181:255—6. 3,4-methylenedioxymethylamphetamineattenuates transmitter releaseG. N., in and vivo: C. M.a consideration Milroy. (MDMA, 1997. of The dose, pathology core tempera- of D-amphetamine and "Ecstasy"). J. Pathol. Sabol, K. E., R. Lew;J. B. Richards, G.partialMethylenedioxymethamphetamine-inducedture L. Vosmer,and recovery dopamine and over L. synthesis. S. a 52-week Brain period. I. Synaptosomal serotonin deficits are followed by Res. 806:69—78. uptake andSeiden. tissue 1996.concen- Sanders-Bush, E., and P. J. Conn. 1987.generationConsequencestrations. Neurochemistry ofprogress,J. Pharmacol. of serotonin of edited serotoninExp. by Ther. receptor H. Y. 276:846—4. Meltzer. activation. New In York: Raven Press. pp. 95—103. neuronal systems: The third Sarró,Sanfihipo,Satchell, R. 1956. M., S. C., A.Fármacos Wolkin,and M. ypsiquiatrIa. Connaughton.B. Angrist, ofetMed. schizophrenia.al.1994. 1996.ClIn. Inappropriate 26(3):184—7.Amphetamine Psychopharmacology and 123:211—4. antidiuretic hormone negative symptoms Sato, M. 1992. A lasting vulnerability metamphetamineBrsecretionto psychosisJ. Hosp. and Med. in extreme patients psychosis.51:495. rises Inin Theserum neurobiology creatinine kinaseof drug and akohol following MDMA with previous addiction, edited Saunders, N. 1993. Efor ecstasy. London:byStudio. P. W. H. B. Kahivas p.Saunders. 121. and H. H. Samson. Ann. N. YAcad.1995. Sci. Ecstasy and the dance culture. London: Neal's Yard Desk 654:160—70. Top Publishing Scahlet,Saunders, A. N. C., E., G.ed. W 1997. Lipe, Ecstasy S. F. Au,reconsidered. R.ing 1988.R. Studio. Holson, NeuropathologicalLondon: C. Neal'sH. Frith, evaluation by combined immunohistochemistry and Yard Desk Top Publish- and W. SlikkerJr. Scanzello, C. R., G. Hatzidimitriou,Neurotoxicologydegeneration-specific A. L.1993. Martello, Serotonergic 9:529—3 j. L. Katz,methods: 7.recovery and Applicationafter (±)3 ,4-(methylenedioxy) to methylenedioxyrnethamphetamine. methamphetamine G. A. Ricaurte. Schechter, M. D. 1991. Effect of MDMAinjury:preference neurotoxicityObservations and discrimination. uponin rats. its J. Pharmacol. Pharmacol. Exp. Biochem. Ther1997. 264:1484-91.Behav. Serotonergic 38:53 9-A4. mediation of fenfiuramine discriminative conditioned place stimuli in fawn- Scheffel, U., J. R. Lever, M. Stathis,Neuropharmacologyhooded andof MDMAG. rats.A. Ricaurte. causes 31:881—93. transient1992. Repeated down regulation of serotonin 5-HT2 receptors. Sci. 60(6):PL83—90. administration PDF compression, OCR, web-optimization with CVISION's PdfCompressor Scheffel, long-term MDMA neurotoxicity: A positron emission tomographyU., Z. Szabo, study W. inB. theMathews, et al. 1998. In vivo detection of short- and References 435 Schifano, F. 1991. Chronic atypical psychosisLancetliving baboon33 associated 8:133 brain. 5. with Synapse MDMA 29:183—92. (Ecstasy) abuse.2000. Potential human neurotoxicity of MDMA ("Ecstasy"): Subjective self- Schifano, F., and G. Magni. 1994. ("Ecstasy")Neuropsychobiologycravingreports, for evidenceabuse: chocolate—a Psychopathological 42:25—33. from an case Italian series. drug Biol.features addiction Psythiatry and centre 36(1 1):763—7.and clinical case studies. Schmidt,Schlaepfer, C. J. T1987. E., G. Neurotoxicity D. Pearison, of D. the EdopaminePET Wong,psychedelic study S. receptors ofMarenco, competitionamphetamine in andhuman R. between methylenedioxy- F.subjects. Dannals. intravenous Am. 1997. J. Psychiatry. cocaine 154:1209—13.and ['1C]raclopride at Schmidt, C. J., andandJ. V. H. L. Kebne. Taylor. 1990. 1988.methamphetamine. NeurotoxicityDirecteffects. central Ann. N.ofeffects YAcad.MDMA: J. Pharmacol. of acuteSci. neurochemical 600:665—80; methylenedioxy- discussion 680—1. Ther 240:1—7. Schmidt, C. J., L. Wu, and W. Lovenberg.methamphetamine5-HT 1986. uptake Methylenedioxyrnethamphetamine: inhibitors. on serotonergic Eur J. Pharmacol. neurons. Eur181:133—6. AJ.1990. Pharmacol. Reversal 156:121—31. of the acute effects of 3,4-methylenedioxymethamphetamine by Schmidt, C. J., J. A. Levin, and W. Lovenberg.thecalpotentially rateffects brain. 1987. ofneurotoxic Biochem. methylenedioxymethamphetamine In vitro amphetaminePharmacol. and in vivo 36:747—55. analogue. neurochemi- Eur. on J. striatalPharmacol. monoamine 124:175—8. systems in Schmidt, C. J., C. K. Black, andG. M. V Abbate,L. Taylor.Brainhyperthermia andRes. 1 990b.V. 529:85—90. L. and Taylor.Antagonism neurotoxicity 1990a. of MDMA-induced the are neurotoxicity independently mediated by 5-HT2 receptors. Schmidt, C.J., V. L. Taylor, G.M. Abbate,nistsPharmacol.due to stereoselectively anda single 18T R.1:59—70. administration Nieduzak. prevent 1991. ofthe methylenedioxymethamphetamine. 5-HT2neurotoxicity antago- of 3 ,4-methylenedioxy- Eur. J. correlatereversalmethamphetamine by with L-dopa. emotional J.by Pharmacol. blocking self-rating: the Exp. acute A Ther. PET stimulation 256:230—5. study with of oxygen-iSdopamine labeledsynthesis: water.F, R. E. Gur, L. H. Mozley, et al. 1995. Mood effects on limbic blood flow Screaton, G. R., H. S. Cairns, M. Sarner,Psychiatry339:677—8.1992. M. Singer, Hyperpyrexia Res. Neuroimaging A. Thrasher, and rhabdomyolysis 61:265—83.and S. L. Cohen. after MDMA ("ecstasy") abuse. Lancet PDF compression, OCR, web-optimization with CVISION's PdfCompressor 436Seeman, neuroleptic/doparnine receptors. Nature 261:717—9.AppendicesP., T. Lee, M. Chau—Wong, and K. Wong. 1976. Antipsychotic drug doses and Seiden, L. S., and K. E. Sabol. 1996. Methamphetamineamphetamine neurotoxicity: and Possible mechanisms of cell destruction. NIDA 163:251—76. methylenedioxymeth-and E. C. Johnstone. Res. Series,Semple, H. D. G., M., P.J. K. Cowen,P. Ebmeier, and TM. Sharp. FMDIvIA Glabus,methylenedioxy-methamphetamine1999. 1994. ("ecstasy") R. Reduced E. O'Carroll, users.in vivo binding to (MDMA)the serotonin and transporterd-fenfluramine in pretreatment J. Piychiatry 175:63—9. p-Chloroamphetamine (PCA), 3,4- the cerebral cortex of Shankaran, M., and G. A. behavioral,attenuates(Berlin) 116:508—14. d-fenfluramine-evoked thermal and neurochemical release responses of 5-HT toin subsequent MDMA 1999. A neurotoxic regimen of MDMA suppresses vivo. Psychopharmacology adminis- Shankaran, M., B. K. Yamamoto, and G.methylenedioxymethamphetamine.serotonintration. A. Gudelsky. Psychopharmacology transporter 1 999a. inInvolvement the (Berlin) formation 147:66—72.Eur of J Pharmacol.hydroxyl radicals 385:103—10. induced by 3,4- of the Shapiro, H. 1996. Drug deaths. DruglinkWaterbridgestriatum.iinduced Factsheet formation Neurochem. House.no. 19, of ISDD. hydroxyl72:2516—22. radicals and long-term1 999b. depletionMazindol ofattenuates serotonin the 3,4-methylenedioxymethamphetamine- London: in the Shapiro,Sharkey, Y., J., A. D. Magazanik, E. McBean, R. and Ijdassin, P. A. G.Kelly.following1979. Ben-Baruch, Heat1991. repeated intolerance Alterationsin E. Shvartz, exposure in formerhippocampal and to the heatstroke amphetamine patients. derivative Ann. Intern. methylenedioxy- Med. 90:913—6.Y. Shoenfeld. function Sherlock, K., K. Wolff, A. W. Hay eta1.J. Accid.Implicationsmethamphetamine 1999. Emerg. Analysis forMed. clinical of("Ecstasy"). 16(3):194—7. illicit management ecstasy Psychopharmacology in the accident (Berlin) and 105:113—8. emergency tablets: department. Shulgin,Shulgin, A. A. T. T. 1986. 1990. The History background of MDMA. andneurotoxicological18:291—304. Inchemistry Ecstasy: ofThe MDMA.J. effects clinical, of pharmacologicalthePsychoactive drug MDMA, and edited by S. J. Peroutka. Boston: DrugsKiuwer Shulgin, A. T., and D. F. Nichols. 1978.AcademicWillette.metics. Characterization In Publishers. NewThe psychopharmacology York: pp. ofPergamon 1—20. three new Press. of ballucinogens, edited by R. C. Stiliman and R. E. psychotomi- Shulgin, A.,A. T.,and and A. Shulgin. T Sargent. 1991. 1967. PIHKAL:Press. Evaluation(MDA) A as chemical anof adjunct3 ,4-methylenedioxyamphetamine love to story. psychotherapy. Berkeley: Med.Transform Pharmacol. Exp.1 7:3 5 9—64. PDF compression, OCR, web-optimization with CVISION's PdfCompressor Shulgin, one-ring psychotomimetics. Nature 221:53 7—541.A. T., T. Sargent, and C. Naranjo. 1969. Structure-activity relationships of References 431 Siegel,Shulgin, B. A. V. T, Jr., T R.Sargent, L. Trestman, and C. S.Naranjo. psychopharmacologyO'Flaithbhearthaigh,(MMDA). 1973. Pharmacology Animal etofpharmacology al.3 10:12—8.-methoxy-4,5-methylenedioxyphenylisopropylamine 1996. D-amphetarnine and human Siegel, R. K. 1985. Written testimonyAdministration,personalitychallenge submitted disorder. effects on United behalf Schizophr. on Wisconsin Statesof Drug Res. Department Enforcement 20(1—2):29—32.Card Sort of Test: Justice, Performance Drug Enforcement in schizotypal Adminis- Silver, H., and N.A. Shmugliakov.Nassar. 1992. Fluvoxamine1998.chronictration Augmentation Law schizophrenia.improves Hearings, with negative fiuvoxamine docketPbarmacopsychiatiy symptoms no. 84—48. but notin treated 2 5:245. Simpson, D. L., and B. H. Rumack. 1981.Prychopharmacol.maprotilinedescription Methylenedioxyamphetamine: improves of overdose, 18:208—il. negative death, symptoms and Clinical review in oftreated pharmacology schizophrenia3. Arch. Intern. Clin. Med. Singarajah,Slikker, W.Jr., C., and S. N. E All,G. Lavies. A. C. Scallet,1992.Anaesthesia An141:1507—9. C. overdose H. Frith, 47:686—7. ofG. ecstasy: D. Newport, A role andJ. for dantrolene. R. Bailey. Slikker, W. Jr., R. R. Holson, S. E All,producedToxicol.1988. et al. Neurochemical1989. byAppl. orally Behavioral Pharmacol. administered and 94:448—57.and neurohistological neurochemical methylenedioxymethamphetamine effects alterations in the rat and(MDMA). monkey Smilkstein, M. J., S. C. Smolinske, andMDMANeurotoxicologyof B. orally H. interaction: Rumack. administered 10:529—42. Agony1987. MDMA Aafter case ecstasy. of in MAO the Gun. rodent inhibitor! Toxicol. and nonhuman 2 5:149—59. primate. Solowij,Snyder, S. N., H. W. 1973. Hall, Amphetamine and N. Lee. 1992.psychosis:ofcatecholamines. Recreational"Ecstacy" A "model" users Am.MDMA andschizophrenia J. Psychiatiytheir use experiencesin Sydney: 130:61—7.mediated A with profile by the drug. J. Addict. 87:1161—72. Soper, H. V., R. 0. Elliot Jr., A. A. Rejzer,neuropsychologicalschizophrenic et al. 1990. patients. Effects and J.communicative ofClin. fenfiuramine Psychopharmacol. functioning on 10:168—75. in treatment refractory - Spiegel,Spatt, R., and H.-J. Aebi. 1983. Psychopharmacology:Wiley("Ecstasy") & Sons. ingestion. An introduction. J. Neurol.J., B. Glawar, Neurosurg. New York:and PsychiatryB. John Mamoli. 62(4):41 1997. A8—9. pure amnestic syndrome after MDMA

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 438 Appendices Spigset, Psychopharmacol.serum sodium concentrations: 17:292—7. Relation to 0., and I Mjorndal. 1997. The effect of fiuvoxamine on serum prolactin platelet 5HT2A receptor status. J. Clin. and Spina,Sprague, E., P. J. DeDomenico, E., and D. E. Nichols.C. Ruello, 1995a.Psychopharmacol.ment eta1. Inhibition of1994. negative Adjunctive of 9:281—5. symptoms MAO-B fluoxetine protects in chronic in against the schizophrenic treat- patients. mt. Clin. MDMA- ergicmethylenedioxymethamphetamine-inducedinduced deficits. neurotoxicity J. Pharmacol. in the Ex'p. striatum. Ther Psychopharmacology273 :667—73. lipid 1995b.peroxidation The (Berlin) monoamine and 118:357—9. long-term oxidase-B seroton- inhibitor L-deprenyl protects against 3,4- Sprague,Sprague,J. J. E., E., S. I Worst,L. Everman, A. Kanthasamy, and D. NeurotoxicologytheE. Nichols. serotonergicD. E. Nichols, 1998. 19:427-41.axonal Anand integrated M.loss D. induced Kane. hypothesis 1999.by 3 ,4-methylenedioxyrnethamphetamine. Effects for Stafford, P. 1992. Psychedelics encyclopedia.inducedscience,of antisense 3d serotonergic ed.,Miami, expanded.oligonucleotide Florida. neurotoxicity. Berkeley, [Abstract] alteration Calif.: Paper p. 836. Roninof presented MAO-B geneat the expression Society for on Meuro- MDMA- Stahl, S. M., S. B. lJhr, and P. A. Berger.PsychiatryfenfiuraminePublishing. 1985. 20:1098—102. Pilot on study negative on the symptoms effects of in twelve schizophrenic inpatients. Biol. Steele, T.I D.,W. D., U. K. D. Brewster, McCann, M.and P. G. AssessmentJohnson, A.Pharmacol. Ricaurte. D. ofE.Biochem. 1994. theNichols, role 3 Behav.,4-Methylenedioxymeth- of and aipha-methylepinine 38:345—51.G. K. 'vim. 1991. in the neurotoxicity of MDMA. Stein, M. B., C. Hanna, C. Koverola,humans. M.changesamphetamine Torchia, Addiction in andPTSD: (MDMA,B. 89:539—5 McClarty.Does trauma "Ecstasy"): 1. 1997. alter Structural neuroanatomy? pharmacology Ann. and toxicologyN. Y Acad. inSci. animals 821:76—82. and brain Sternbach,Stem, R. A., H. S. 1991. G. Silva, The serotoninN. Chaisson, syndrome.ciencyreserve and D. virus-i Am.onL. Evans.neuropsychological J. infection. Psychiatry 1996. Arch. Influence 148:705—13. Neurol. functioning of 53:148—53.cognitive in asymptomatic human immunodefi- Stolaroff,Stol, W. 1947. M. J. Lysergaure-diatheyl-amid,1997. The secret chiefpsychedelic Conversations[LSD, em atherapy hallucinatory with movement.a pioneer agent of Charlotte, the from underground the N.C.: ergot MAPS. group]. Schweitz. Arch. Neut. 60. Phantastidum aus der Mutterkorngruppe. Stone, A. A., C. A. Macro, C. E. Cruise,induced7desirable VIed. D. immunologicalA.3:1-43. Cox,and undesirable andJ. M. changes Neale. daily mediatedevents1996. Are influence by stress- mood? salivary A closer IGA look antibody. at how mt. both J. Behav. PDF compression, OCR, web-optimization with CVISION's PdfCompressor Stone, D. M., D. C. Stahl, G. R. Hanson, andJ. W. Gibb. 1986. The effects of 3,4- References 439 Stone, D. M., G. R. Hanson, andJ. W.serotonergic(MDA)methylenedioxyrnethamphetamine Gibb. 1987a.on monoaminergic effects Differences of methylenedioxymethamphetamine systems in the central (MDMA)in the rat brain.and 3 Eur,4-methylenedioxyamphetamine J. Pharmacol. (MDMA) in128:41—8. mice and Stone, D. M., K. M. Merchant, G. R. inlong-termrats.Hanson, brain of andJ. rat.effects Neuropharmacology W. of Gibb. 3 ,4-methylenedioxymethamphetamine 1987b. Immediate26:1677—83. and on serotonin pathways 26:1657—61. Stone, D. M., G.M.Johnson, R. Hanson, G. andJ. R. Hanson, W.methylenedioxyrnethamphetamine.J.dopamine Gibb. andJ. 1989a. W.in the Gibb. In central vitro 1988. reactivation serotonergic Role of endogenousof Pharmacol. deficits rat cortical induced by 3,4- Ther 247:79—87. Stone, D. M., M.Johnson, G. R. Hanson,tryptophanmethylenedioxyrnethamphetamine. andJ. W. hydroxylase Gibb. 1989b. byfollowing amphetamine Acute inJ.inactivation Neurochem.vivo analogs inactivation of 53:572—81.involves by the oxidation of sulfhy- Strupp,Strassman, H. H.R. 1993.J. 1984. The Adverse Vanderbilt reactions psychotherapyture.J.dryl to sites. psychedelic Neru. Eur. Ment. studies: J. Pharmacol. drugs: Dis. A 172(1O):577—95.synopsis. A review 172:93—7. J. of Consult. the litera- Gun. Styk, J., and S. Styk. 1999. Review of presentedbasedPsychol.clinical on 61(3):43issues their at MAPS inuse 1—3. MDMA-assisted of MDIVIA MDMA Conference,with psychotherapy, patients August from 1988—1993 30 to September, in Switzerland. Dead Sea, Paper Israel. Tagaya,SwissSuicide: courtM., Part K. downgrades I.E 1986. Liu, B.Harvard Copeland,ecstasy Medical drug. et al.1999. School(The 1997. Associatedtranscript Medical DNA scission of HealthPress, this 21lectureafter June. focal can brainbe found is- at www.maps.org.) 2(8): 1—4. Talley, P. F., H. H. Strupp, and L. C. Morey.58(2):182—8.Patient-therapistcheniia: 1990. Temporal Matchmaking dimensions differences in psychotherapy:and in two their species. impact Stroke on outcome. 28:1245—54. J. Consult. Clin. Psychol. Tehan,Thakore,J. B., R. H.,Hardern, C. Berti, and and A. TBodenham. G. Dinan.themethylenedioxylmethamphetamine 1993. 1996.treatment HyperthermiaAn openof chronic trial ofassociatedschizophrenia. adjunctive with("Eve"). sertraline Acta 3,4- AnaesthesiaPsychiatr in Scand. 48:507—10. 94:194-7. Tuchtenhagen,Tork, I. 1991. Anatomy F., J. Daumann, of the serotonergic C. Norra,abstinentauditory system.et al. evokedecstasy 2000. Ann. (MDMA)dipoleHigh N. YAcad. intensity source users. Sci. activity Neuropsychopharmacologydependence 600:9—34. indicates of decreased 22:608—17.serotonergic activity m

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Tucker,440 methlenedioxymethamphetamine ("ecstasy")G.Appendices by T., debrisoquine M. S. Lennard, hydroxylase. S. W. Ellis Biochem. et al. 1994. The demethylation of Turek,U.S. I.Department S., R. A. Soskin, of Health and andA. A. Human Kurland.(MDA)Pharmacol. Services. 1974. subjective 47(7): MethylenedioxyamphetamineNational 1151—6. effects. Household J. Psychedelic Survey Drugs on 6:7—14.Drug Vander Borght, T, M. Kilbourn, T. Desmond,vesicularAbuse. D.1996, monoamineKuhi, 1997, and 1998. K. transporter Frey. 1995. is notThe regulatedJ. Pharmacol. by dopaminergic 294:577—83. drug treatments. van der Kollc,Kolk, B.B. A.A., 1997. 0. van The der psychobiologyHart, andofPsychiatry J. PTSD.Burbridge. of posttraumatic Lutherville,58(suppl 1995. 9): Approaches 16—24. Md.: stress Bookshelf. disorder. to J. Clin. the treatment van Kammen,Dyck, C. H., D. R.P., Tand Malison, J. J. Boronow. J. P. Seibyl,2serotonin 1:497—501. 1988. et Dextro-amphetamine al.transporter 2000. Age-related availability diminishes with ['231]beta-CIT negative SPECT. Neurobiol. Aging decline in central van Praag, H. M.M. I1981. 961 A Management critical investigation oftherapeuticsymptoms depression of in theprinciple schizophrenia. with significance serotonin in the mt.oftreatment precursors. MAO Clin. Psychopharmacol.inhibition of depression. Biol. as a Thesis, 3:111—21. University of Utrecht. van Praag, H. M. 1994. 5-HT-related,Affect.Psychiatry anxiety- Disord. 16:291—3andlor 4:275—90. aggression-driven 10. depression.1982. Depression, suicide and the metabolism of serotonin in the brain. J. Virden,Verkes, R.T B.,J., H.and J. L.Gijsman, E. Baker. M. 1999.S. M. Pieters,Disruptionmt.serotonergic Clin. et Psychopharmacol. al. of 2000. thefunction discriminative Cognitive in users 1:5—6. performance of ecstasy.stimulus Psychopharmacology andeffects (Berlin) 153: 196—202. Volkow, N. D., G. J. Wang, M. W. Fiscbman,icity:of effectsS(+)-3 protection et al.of ,4-methylenedioxymethamphetamine cocaine1997. by Relationship fluoxetine. and dopamine Behav. between transporter Pharmacol. subjective occupancy. (MDMA) 10:195—204. Nature by (±)-MDMA 386:827—30. neurotox- Vollenweider, E X., M.A. Gamma,F. I. Vollenweider-Scherpenhuyzen, M. Liechti,naivecardiovascular healthy and T. volunteers. Huber. effects 1998a. A. Neuropsychopharmacology and Babler, Psychologicalshort-term H. Vogel, sequelae andand D. of19:241—51. MDMA ("Ecstasy") in MDMA- Vollenweider, F. X., A. Gamma, M. Liechti,MDMAserotonin-2Hell. and 1998b.harmless? T. agonistHuber. Psilocybin [Letter]. action.1999a. Neuropsychopharmacologyinduces NeuroReportIs a single schizophrenia-like dose 9:3897—902. of 2 psychosis1:598—600. in humans via a PDF compression, OCR, web-optimization with CVISION's PdfCompressor Vollenweider, F. X., S. Remensberger,effects D. Hell, of and3 ,4-methylenedioxymethamphetamine M. A. Geyer. 1 999b. Opposite (MDMA) on sensorimotor gating References 44( Watson,Wareing, L., M., and J. E.J. Beck.Fisk, and1991. P. NewN. Murphy. Ageandin rats seekers: previous 2000.versus MDMA Working healthyusers of humans. use MDMAmemory as an Psychopharmacology ("ecstasy"). adjunctdeficits to in spiritual current 143(4): 365—72. J. Psychol. 91:181—8. Weil,Webb, C., and V. Williams. 1993. Ecstasyandpursuit. the intoxication: J.role Psychoactive of dantrolene. Appreciation Drugs Anaesthesia 23:261—70. of complications 48:542—3. and Winifred Rosen. From chocolate to morphine. Boston: Houghton 'Williams,Whitaker—Azmita, H., D. Meager, P. M., and P.T A.Galligan. Aronson.Am.J.Mifflin, Psychiatry1993. 1989. 1983. MDMA "Ecstasy" 146:119. (Ecstasy): (MDMA)—induced A case of possible panic. Williams, H., L. Dratcu, R. Taylor, J.M. Accid.fever":drug Roberts, induced Emerg. Ecstasy and Med.psychosis. A. related Oyefeso. 15(5):322—6. problems 1998. in"Saturday a London night accident and emergency department. J. Psychol. Med. 162:43—4. Wilson,Williamson, J. M., S., K. M. S. Gossop,Kalasinsky, B. Powis,A. I.Alcohol Levey,Adverse P. Griffiths,J. Depend. et effectsal. 1996. 44:87—94. Fountain,of Striatalstimulant andJ.dopamine drugs Strang. in nerve a community1997. sample of drug users. Drug Wilson,Wilson, M. M. A., A., and G. M. A. E. Ricaurte, Molliver. and 1994. M.serotonergicterminal E. Microglial Molliver. markers axon response 1989. interminals. human, Distinct to degeneration chronicGlia morphologic 11:18—34. methamphetamine of classes users. Nat. Med. 2:699—703. Windhaber, J., D. Maierhofer, and K.largepicof Dantendorfer. serotonergic drug doses 3 ,4-methylenedioxymethamphetamine. of 3 1998. axons,4-methylenedioxymethamphetamine Panicin primates disorder exhibit induced differential by Neuroscience vulnerabilityresolved 28:121—37. by paroxetine. to the psychotro- J. Winslow, J. T., and T. R. Insel. 1990. Pharmacol.vocalSerotonergicClin. development: Psychopharmacol. Exp. modulation Ther studies 254:212—20. 18(1):95—6. of with rat pup 3 ,4-methylenedioxymethamphetamine. ultrasonic J. Winter,Winstock, J. C.A. 1975.R. 1991. Blockade Chronic of paranoidthe stimulusmethamphetamine.antagonist. psychosis properties Archiv.after of misuseBr. mescalinemt. Med. Pharmacodyn. of J. 3,4-methylenedioxy- 302:1150—1. by a Ther 214:250—3. serotonin Wollina,Wodarz, N.,U., andH. J. J. Kammler, Boning. 1993. N. Hesselbarth Ecstasy-induziertesdermatosis.Syndrom. et al. Nervenartz Dermatology 1998. psychotisches Ecstasy 64:478—80. 197(2): pimples: 171—3. Depersonalisation A new facial PDF compression, OCR, web-optimization with CVISION's PdfCompressor 442 Appendices World Health Organization. 1985. Experta studysecond Committee group. report, Technical on series Drug 729. Report Dependence. Geneva: Series,Health World no. Twenty- Organization Health Organization. 1958. Ataractic pp. and 24-25. hallucinogenic drugs in psychiatry: Report of 152. Geneva: World Health Organization. Wu,World D., Health S. V. Otton,Organization. T. Inaba, 1992. W. Kalow, The lCD-JOOrganization.disorders: and E. classification M. Clinical Sellers. pp. 70—83. descriptions 1997. of mental Interactions andand diagnosticbehavioral of guidelines. Geneva: World Health Yamamoto, B. K., and L. J. Spanos. 1988.amphetamine148:195—203. The acute analogson effects dopamine with of methylenedioxymeth- human release liver in the CYP2D6. awake-behaving Biochem. Pharmacol.rat. 53:1605—12. 5'. Pharmacol. Young,Yeh, S. Y.F 1986. 1999. Opinion N-tert-butyl-alpha-phenylnitrone and recommendedmethamphetamine-induced ruling, protects findings against of fact, depletion 3 ,4-methylenedioxy-conclusions of serotonin of in rats. Synapse 31:169—77. law judge. Submitted in the matter of MDMA Zhao, Z. Y., N. CastagnoliJr., G. A. Ricaurte,Synthesismdmajaw2scheduling, T and Steele, .shtmldocket neurotoxicological and no. M.84-48, Martello. 22 May.evaluation 1992. erowid.org/chemicals/mdmal of putative metabolites of the seroton- Zuckernian, M. 1996. The psychobiologicalseeking:ergic[methylenedioxymethamphetamine]. neurotoxin model A comparative for 2-(methylamino)-impulsive approach. unsocialized Neuropsychobiology 1 -[3 Chem. ,4-(methylenedioxy)phenyl] sensation Res. Toxicol. 34:125—9. 5:89—94. propane

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PDF compression, OCR, web-optimization with CVISION's PdfCompressor ProfessorDouglas446 Douglas Rushkoff is the author of seven Contributors Rushkoff, Ph.D. www.rushkoff.com best-selling books on culture and Frontline.Ecstasytechnology;Interactivedelivers Club Hecommentaries including and Telecommunicationis currently Exit Coercion, Strategy. onProfessor National MediaHe writesProgram. of Virus,Public Virtual a column Cyberia, HeRadio, Culture has for been andPlaying the at makes Newstudying the Future, New York Times Syndicate, documentariesYork for University's PBS psychedelic subcultures and the novels Lubavitch-trainedRabbisince he Schachter,Zalnian became Schachter friends Professor rabbi whosewith of Timothy Religious belief in Leary theStudies universality in 1988. at Naropa of University;spiritual truth is anled him to elders, Catholic monks, ordained Fromauthorpsychedelicsandstudy humanistic Age-ingwith of Spiritual Sufi and to andMasters,Sage-ing. wrote Intimacy transpersonal about Buddhist and his Paradigmexperience psychologists. teachers, Shift, Nativein The Asand EcstaticAmerican such co-author he Adventure. also with He is experienced Ronald Miller of also the Mr.EmanuelAlexandernightclubharm Sferios reduction Sferios iscommunity. "Sasha"the [email protected] Shulgin, and current that Ph.D. promotes executive health director and safetyof within the rave DanceSafe, a nonprofit and J-{ispost-doctorateDr.earlyof Shulgin's newresearch work psychoactive academicwithwork studies MDMA for at thedrugs,background the last led University withforty to his special yearshas co-authoring ofbeen has Californiaconcentration inbeen chemistry the San design,first on Franciscoand human the synthesis,in studies psychedelic drugs. His biochemistry, with Medical School. describingand evaluation its Ms.Annillegal.action. ShulginShulgin Since worked [email protected] many for of threethe therapists years as awho lay discoveredtherapist, using the virtues MDMA, of MDMA before it was made before it was Hariytherapytoscheduled speak Sumnall in about theare mid-1980'sstill [email protected] useusing in ittherapy. and underground, can She,talk andon they write cannot openly appear about in it. public or in the other hand, stopped doing MDMA publications Liverpool,Mr.Ecstasyarticlesexposure Sumnall awaiting andUK. to is aother aHeneurotoxic Ph.D. publicationis "dance currently candidate regime drugs." concerning writing at of the MDMA. hisDepartment thethesis cognitive on ofthe Psychology; andbehavioral psychopathological consequences He is the co-author of several scientific University of effects of of researchUniversityDr.Franzfocused Vollenweider X. on Vollenweider, onHospital the basic neurobiology is research ofa psychiatrist, Zurich. M.D., addressing of He P.D.psychoses isresearch [email protected] the and behavioralscientist involved affective and inand disorders. lecturerboth neurobiological clinical at Since the and 1987 basic Psychiatric. effects of he has

PDF compression, OCR, web-optimization with CVISION's PdfCompressor Contributors 441 startleofPositronindoleamine information reflex. Emission processing Tomography such as (PET), the prepulse Electroencephalography inhibition paradigm (EEG), of the and acoustic measures hallucinogens, dissociative anesthetics and psychostimulants using Medicine,AndrewNationalnaturalDr. Weil Weil, and University Integrativeis thepreventive M.D. director drweil.comof Medicine Arizona. medicine of the Program CouncilHe and has diagnosis. a in general TucsonIntegrative Dr.practice and Weil Medicine the inis author Tucson,also ofthe of the eightfounderfocusing College books of on ofthe HealthincludingFurther and thecontact Eating international Well infonnation for bestsellers, Optimum can Health. Spontaneous be found Healing, at drholland.com Eight Weeks to Optimum

PDF compression, OCR, web-optimization with CVISION's PdfCompressor acids, 3 9-40 INDEX Bentov, Itzhak, 363 Agar,Alise,Adam.alcohol,AIDS, See 138, 5,Ecstasy; 13, 70 301, 374 234 in psychotherapy Betts,Bentsen,Bloch,Biggert, Leah, Lloyd,Marianne, Judy, 93, 172—73, 18—1913, 224179 391 healthandabuse Ecstasy;cognitive of,risks 175 of,300—301, deficits, 93, 94 99—100 106 Bouso,Bonson,Bones,bodywork, JoseFrankie, Katherine, 201—2 Carlos, 17 20, 29—38, 248—260, 443 294, 3 02—3, Alles,Alexanderaiprazolamallergies, Gordon, technique, 287, (Xanax), 211 290 246, 244 287 Bravo,Brady, GaryKathleen, 21—28, 315 298, 336,443 391,443 Alzheimer'samphetamine,amino acids, disease, 46-47 8, 29, 138and 32, addiction,71 103-4 cannabiscalamus, 8 and cognitiveaddiction, deficits, 237 99—100, 133, andhealtheffectschemical psychotic risks of, components 33,38 of, illness, 79 96—97,of, 51—52 129 cardiovascular problems,andmedicinal135, schizophrenia, 137 79, uses, 65, 91384 82, 242, 308, anxietyantioxidants, 108, 116—17,andas schizophrenia serotonin, 143—44 78 treatment, 2 76—78 citalopramchiorpromazineCD4 T cells, (Celexa), 300—301 (Thorazine), 126, 264, 84, 323 106, 278321, 330—31 Association for the ResponsibleEcstasy as for cause treating,Use of, of 88—89,Psychedelic 9,238,235,244,339 92, 94, Agents 97—98 (ARUPA), 215, 374 clozapine,cocaine, 278, 78, 79279, and283and cognitive addiction, deficits, 237 136 autism,attention-deficitasthma medications,279 hyperactivity 330 disorder(ADHD), 222, 234, 238 condoms,coffee, 350 distributing,and 170 psychoticdepression, illness, 129 96 ayahuasca,Baggot, Matthew; 209, 211, 110—145, 358396—401, 307, 443 DanceSafe,CYP2D6consciousness, enzyme, 68, 159—60, altered 80—81, states 167—68, 241 of, 185.175—76See also individual drugs bases,Bakalar, 40—42 James, 14, 23, 389 448 depression.depersonalization, See also 87, dopamine; 94, 95, 98 serotonin PDF compression, OCR, web-optimization with CVISION's PdfCompressor Index 449 267—68,Ecstasycauses of, for 129, treating, 263—64 9, 235, 238, 244, 270—72 S-enantiomer,R-enantiomer,and mirror image 299,299, molecules, 308308 46—48 symptomsand suicide,electroconvulsiveschizophrenia, of:, 263, 261—63 268—7 279 therapy, 1 294 asthmaalcohol,safrole, medications,300—3018, 43-44, 290 330 and drug interactions, 333 dextromethorphanderealization, 87, 98 (DXM)andtreating, cognitive 173—74, deficits, 264, 137,268 335 MAOLSD,fluoxetine,dextromethorphan, inhibitors, 37 33, 36—3735—36, 36 126, 272, 306 diazepam (Valium), sidehealthand84, 106,Ecstasyeffects risks 244 of, 36 163—65x, 79 (SSRIs),selectivepsilocybin,protease 35—36 inhibitors,serotonin 37 reuptake331 inhibitors dobutamine,Doblin,dipropyltryptaminedill, 8 Rick, 30813, 369—86, (DPT), 389, 337 392, 443 Ecstasy, effects of, medicinalEcstasy,196,2-CB, 309—11. health196, uses; 203See Ecstasy,risks also in psychotherapy Ecstasy, dopamine. See alsoEcstasy's serotoninand depression, effects on, 275—78, 16, 29, 33—35,281 89 psychological,psychedelic,ongender the immunedifferences, 34, 8—10, 306, system, 2308, 1—26,320, 3 300—301 321,19—21, 258, 326—27 318—21 232—34 drugDowning, addictions, Jack, 227 Ecstasy90, for 96, treating, 118—19, 238, 126,237, 318, 245, 323—34, 342 398 32sideand 1—22 renaissanceeffects, common, movements, 23—25, 351—57 27, 197, Earthdrug prevention Metabolic programs, Design Laboratories167—68, 347—48.See also Ecstasy, legal status of Ecstasy,tolerance362—67spiritual, to,27—28,health 26—27, risks 187, 60, of,190—91, 68—69, 72, 83, 102—3,358—59, 215. 185 Ecstasy,eating disorders, 8 238,as 245 empathogenlentactogen,(EMD), 22, 13, 28, 374, 61— 376—77, 62, 379, 389 andinresearchSee animal thealso brain, doparnine; studies;studies, 50, 55, 120—28serotonin Ecstasy, 69, 81—82, 110—19, andmisconceptionshistory sex, of, 55—56, 11—20, about, 60, 55, 70, 388—95 54—57180, 194, 182, 356 185—86, 254, 317 242,and cardiovascular308, 321, 330—3 problems,400—401 1127, 303—4, 79, 82, 3 11—13, 324—25, 340—41, vs.websites,53, amphetamines, 195, 32, 290 56, 160, 51—52 167—68,248, 316, 377 chemical components of, 8, 42 and174, dosagehepatitis,hyperthermia, 301, size, 308 79—80 68—69, 4, 34, 81,69, 120—24,72—75, 77 metabolizing,vs. 307—8,MDA1mescaline, 48—51331 51,80—81, 52—53 241, 299, 300, 298—99and298,79, 124—25,hyponatremia, 306 127, 171—73,75—78, 172—73, 241, 296, PDF compression, OCR, web-optimization with CVISION's PdfCompressor 450 and liver problems, 79—81, 123—24 Index Hong Kong, 156 minimizing,long-term,oxidative296, 306—7 110—19, 84—86,stress, 116—19, 127—28,142—44, 125 138—42271—72, lobbyingItaly,Israel,India, 156—5 156156 for, 7 227—28, 3 72—76, 389 Ecstasy, health risks,treating,statisticsand serotonin on, 84 3 92—95syndrome, 78—79 Anti-ProliferationMethamphetamineSpain,Singapore, 20, 157, 157 Act 390 ofand 2000, Club 150—51, Drug 391 anxiety,addiction,psychological,cognitive 88—89, 103—5, deficits, 87—95, 92, 185 94,99—100, 108—9 97—98 127—28, Ecstasy, medicinal uses.andUnitedSwitzerland, See psychotherapy Kingdom,also Ecstasy, 157 157—58 depression,depersonalization,173—74133—38, 388—89, 13—14, 87, 92,320, 94, 94, 402—4 95, 98, 98129, aspainallergies, prescription management, 287, 290medicine, 2, 232—33,286, 287—88,383—86 240, 246—338—39 47, hallucinations,flashbacks,andderealization, drug use, 94, 10287,100—102 95 98 andphysicalterminalrelaxation, psycho-neuro-immunology, healing, illness, 286—87 183, 228, 189—90 232, 233—35, 290—9 247, 1 hysteria,andmanic-depression,insomnia, the 102 media, 94, 10293—94, 95—97, 347—48 105 Ecstasy, in psychotherapy,medicinal287,59, 337, 2—3, 224, 341—42, uses267,8—10, 288. 381—8358 See also Ecstasy, post-traumaticparanoia,panic attacks, 94, 9592, stress 97—98, disorder, 129, 332101 aftereffects,and23benefits 1—32, consciousness of, 205—7,238—39, 178—81, 229—30 253,expansion, 183—86, 288—89, 186—87200, 369—71 209, Ecstasy, legal statusAustralia,schizophrenia,psychoses, treating,of 89—90,154105—8 91, 95—97, 129105 guidelinesinand groups,16,231 forgiveness 202—5, for, 192—95, work, 216—21, 367—68 197—202, 230—3 1 215 Children'sCanada,Brazil, 155 155 Health Act of149—50 2000, 18—19, Ecstasy, in psychotherapy,historyandconditions. the specific of, heart 3-4, chakra,See 12—13, also 184 depression; 224 post criminal65,DEAbanChina, 146—49, penalties, 155 on 224—26,in 151—54,U.S., 347—48,3-4,13—16,62 168—69 361, 375 anxiety,(ADHD),attention-deficittraumatic 9,235, 238stress 244, disorder;hyperactivity 339 schizophrenia disorder Greece,2000,149—15Ecstasy79, 3 89—90 155—56 Anti-Proliferation 1 Act of manic-depression,drugpaniceating addictions, attacks, disorders, 244237, 235245 245, 342

PDF compression, OCR, web-optimization with CVISION's PdfCompressor phobias, 244 and depersonalization, 95 Index 451 Ecstasy; recreationalSeepsychoses, suicide,use also of, x, 10,235, 1, 238,13—14. 245—46 244, 381 Ecstasy; health risks and Ecstasy,schizophrenia,LSD,depression, 35 33, 35—36,107, 279, 174, 126,280 264 272, 306 impureatand160—67, raves, personality tablets, 1,4,329, 17—18,56, 332—33 of 68, users, 7 20, 1—72, 60—61,129—31 90, 171—73,104, Gamma,freefluvoxamine, radicals, Alex, 108, 280303—4, 116—17 317—43, 443 risksrisk163—76237—38, prevention of, 4, 17, 289, 18, programs,346—49, 20, 329—30, 353—57 159—60, 343 Greer,Gravano,GHB (gamma George, Sammy; hydroxy13, 18,14,252-53, 39122, butyrate), 23, 338, 222—242, 339,19, 79 389,443 Ecstasy, research studies,Ecstasy;Seestatistics 297—98, also Ecstasy;on,in psychotherapy 396—404.1, 16—17, health 18risks of; Grob,Grinspoon, Charles, Lester, 20, 25, 8,328—344,225, 14,57, 389,15,240, 23, 390309—14,391, 149, 414 onflawedin England,humans,animals, data 20,120—28,in,298—99 333—3525—26, 294, 128—37, 297, 396—99 141—45, Harlow,haloperidolGrof, Stanislav, Deborah, (Haldol), 199, 13 337, 84, 106,369, 376,324 380 inobstacles223, Spain,37, 239—42, 342—43, 299—303to, 295—96, 37248, 1—72 294 297, 3 15—16, 335 Henry,Heifterhealing,Healing Research John,Journey, shamanic, 20, Institute, 71—86, 182—83, 222—23, 298, 192, 391, 195, 296, 444 198327 The, 196,209,21—112,221 empathogenlentactogenelectroconvulsivein therapy theSwitzerland, United drugs, (EC1), States, 303—5,22, 294 28,305—1 3 17—18 5, 379—80, 390 HIV,heroin,hepatitis,hepatic 138, cytochrome151 79—80 301 P450 2D6 enzyme, 331 essential oils, 43 317.61—62, See 180, also 182, Ecstasy; 185—86,2-CB MDA; 195, lvllvIDA, 197, 254, Holland,HollandHoffman Julie, FundQuadrinity 1—20, for Therapeutic Process,273—285, 367—68 297—316, MDMAResearch, ix, x, 296 Feinstein,fenfluramine Dianne, (Pondamin), 64279, 280 29, 32, 38, 123, Huxley;Humanholograms, Encounters Aldous, 351—52 360-61 with388—395, Death, 337 444 5-HT25-HT1B5-HT1A receptors, receptors,receptors, 33, 34—35, 34,399-400 34, 49, 304, 399304, 322—24, 399 hyponatremia,hypnosis,hyperthermia, 232—33, 75—78,4, 34, 239,69, 172—73, 124—25,72—75, 339 298—99 77—79,127, 171—73, 241, 296, 298, 306 fluoxetine5-hydroxyindoleacetic5-HTP (5 hydroxytryptophan), (Prozac), 279,8, 29,acid 334, 31, (5-HIAA), 390,38,108, 384 400143, 30, 264 Ingrasci,iboga,hysteria, 211, 102Rick, 245 228

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 452 Index isocarboxazidIsland,insomnia, 361 94, 102(Marplan), 37 Maslow,martialmarijuana.maprotiline, arts, Abraham, See 108280 caimabis 360 Jones,Johanson,Jansen, Reese, Karl, Chris-Ellyn, 87—109 307 305 MBDBmathematics,massage, (n-methyl-i 201—2 351 -[3,4 methylenedioxy-phenyl]-2-butanamine), 90 ketamine, 19, 79, 90ineffectsand groups, cognitive of, 98203 deficits, 100, 135, 137, 335 MDAMcKenna, (3,4 methylenedioxyamphetamine),Terence, as61, appetite 374 suppressant,90,182, 8, ii, 55388 kundalini,Kubler-Ross,Klieman, Andrew, 190—91, Elisabeth, 297—316 363 234 effectsDEAchemical ban components on, 50 of, 42-43, 48—51 of, 22, 210—11 Larcombe,L-tryptophan, Ian, 108, 17, 390264 recreationalinhealth psychotherapy, risks of; 15, 195—96, use of, 12 214—15 211—13 Liester,Liechti,Leary,Lawn, John,Timothy, Mitchel,Matthias, 15 2—3,208, 303—4, 342, 24 317—327, 351 444 MDMAMDE (3,4 (methylenedioxymeth- methylenedioxyethyl- amphetamine).amphetamine), See22, 90,Ecstasy 149 lorazepamliver (Ativan), enzymes,disorders,106 80—8 79—81, 1 123—24 meperidineMendleson,meditation, 108,John, 201 110—45, .396—401, 444 (Demerol), 54 307, LSD,Lovelock, 34, 90, James, 93, 182,351andas 199, addiction cognitive 351 treatment, deficits, 100 245 methyiphenidate,metachiorophenylpiperazinemescaline, 8, 51, 52—53 277280—81, 305—6 (mCPP), legalin effectsandgroups, status, Ecstasy, of, 203 19 191, 37 353, 355, 369 MMDAMithoefer,Metzner, (3-methoxy-4,5 Ralph, Michael 182—207, C., 315 270, 445 dioxyamphetamine), 22, 182, 2 13—14 methylene- andin psychotherapy, SSRIs,psychologicalschizophrenia, 35 208—9, disorders, 278, 282 264, 93 328—29 MPPPMontagne,Monoamine (i-methyl-4-phenyl-4 Michael, 261—236—37, 72, 264 445 oxidase (MAO) inhibitors, LSDMalberg, Psychotherapy, Jessica, 29—3 199and 8, terminal 444 illness, 337, 360—61 Muller,MPTP (1Robert, -methyl-4-phenyl-1 372—73,tetrahydropyridine),propionpiperidine), 375—76 ,2 ,5,6 16,54 54—55 manic-depressionEcstasy asfor cause treating, of, 95—97, 238, 235 105 Multidisciplinary Association296,Psychedelic for 303, 338, 377, 379—80, 384 Studies (MAPS), 20, 248,

PDF compression, OCR, web-optimization with CVISION's PdfCompressor myoinositol (Ml), 312 240, 252—60, 315, 342, 380—81, 384 Index 453 Naranjo,N-acetylaspartatemyoinositollcreatine Claudio, 10, (NA), 196, ratios, 208—221,312, 312 341 445 pre-pulse inhibition symptoms245,and(PP1) rape/incest248, 249, of, 249—50,250—60, victims, 251 294,187—88, 302—3 228, neurotransrnitters,needleNational exchange Institute programs, 29—30.on(NIDA), Drug See170—71 Abuse 167—68 also 281—83and325—26Ecstasy's schizophrenia, effects on, 83, 235—36, 235—36, 241, 241, 303, Nichols,New Dave, 12, 23,372—73dopamine; 39—57, 182, serotonin 267, Genesis: Shaping a Global Spirituality, psilocybin,protease inhibitors, 61, 182 331effectsand Ecstasy, of, 191 37 norephinephrine,nicotine, 282 322,378, 324 388, 445 psychoses,psycho-neuro-immunology; Ecstasy for245—46.in groups,treating, 290—91 See 203 238, also 235, individual conditions olanzepineobsessive-compulsiveoxidativeOakenfold, (Zyprexa),stress, Paul, 116—19, 17 disorder,107, 283125 279 raves.psychotherapy. See Ecstasy, See recreationalindividualand drugs conditions use of painoxycodone management, (Percocet),47, 2, 286,232—33, 384 287—88, 240, 3 24638—39 renaissancerelaxationReichman,Rella, Joe, exercises, Frieda movements7 1—86, Fromm, 108, 445 286—87 363 paranoia,panic attacks 94, 95EcstasyEcstasy as causefor treating, of, 92, 97—98,238, 244 129, 332 Ricaurte, George, 19,sixteenthand 297, psychedelicthe 376,Internet, 390 drugs,352—53, 351—57 357 350—5 1, 352 parsley,paroxetineParkinson's 8 (Paxil),disease, 35, 16, 139, 107,54—55, 388264 114, 137, Rohypnol,Roberts,ritonavir,Riedlinger, Thomas,331 19,June, 348 261—272, 14 445 phobias,phenethylamines,pheneizine Ecstasy (Nardil), for195,Ecstasy; treating,37 197. See MDA; 238, also 244 MMDA, 2-GB Rushkoff,Rosen,safrole, John, 8,Douglas, 43—44, 363 350—357, 290 446 placeboPMA response,(paramethoxyamphetamine), 331healthand drug risks prevention of, 160,x, 19, 62 19,programs, 161, 166—67 150 schizophreniaSchachter,sassafras, 8 Zalman, 358—368,and autism, 446 279 post-traumatic stressEcstasy222, disorder 228—29, foras cause(PTSD), treating, 245 of, 20,87, 59,101 188—89, 46,Ecstasycauses 273, of, asfor275, 91, cause treating, 275—28282—85 of, 91, 235—37, 1 95—97, 241, 105 245

PDF compression, OCR, web-optimization with CVISION's PdfCompressor 454 Index 241,and pre—pulseobsessive—compulsivenicotine,281—83, 325—26282 inhibition, 83, disorder, 235—36, 279 StalkingStolaroff,spinalsodium thefluid amytal, WildMyron, (CSF), Pendulum, 244, 12334—3 294 3635, 390, 400 treating,symptomsand spirituality;suicide, 276—85 of, 279 273—75 363—64 suicide,Styk,Juraj, 93 179Ecstasyand depression, for treating, 263, 268—7110, 238, 244, 381 selectiveSeiden,SecretSchuster, Chief Lewis, serotonin Bob, The, 15, 3 12 76—77 377 reuptake inhibitors Tancer,Sumnall, Manuel, Harry; 305—6 402—4,and 446schizophrenia, 279 Seligrnan,selegiline (Deprenyl),Martin, 291322.(SSRTs), 37 See also35—36, individual 143, 174, drugs 264, 279, 280, TibetanThroughterminal Book theillness, Gateway of the Ecstasy233—35, Dead, of the for,The, Heart,247, 228, 351 287, 186—91 232, 337, 341—42, 381—83 serotonin (5-HT). SeeEcstasy's alsoandselective depression,dopamine; effects serotonin on, 263—64, 29—33, reuptake 272, 78—82, 277—8inhibitors 88, 1 Turner,trifluromethyiphenylpiperazinetranylcypromine Carleton, (Parnate), 373,(TFMPP), 374 37 35 HIAA),and318,110—15, 5-hydroxyindoleacetic 322, 30, 120—22, 279,326, 334,400 125—27, 390, 400acid 13 1—33, (5- 267, 2—CB (4-bromo-2,5effectsand dimethyoxyphen- Ecstasy, of, 196 196, 203ethylamine), 90, 182 and 5-HTP,5-HT1A5-HT25-HT1 receptors, 108, receptors, 143, 33,264 34, 34, 49, 304, 304 322 B receptors, 34—35 tyrosine, 108 in psychotherapy,groups, 203 196 and24,(mCPP), 400serotoninmetachiorophenylpiperazine 280—81, syndrome, 305—6 78—79 Vollenweider,van der Kolk, Bessel, Franz,303—4, 26,228 223, 3 17—327, 239, 295, 446—47 shamanism,Sferios,sex,sertraline and Emanual,Ecstasy, (Zoloft), 182—83, 55—56, 68, 35, 159—176,192, 174, 60, 195, 264, 70, 198, 446 194,280 353 356 Woods,Wolfson,Widmer,Weil, Andrew, Anna, Samuel,Phil, 286—291, 391227 179 447 Simonton,Shulgin, Sasha,Ann, Carl, 12, 12, 232 16, 23, 58—70, 58—70, 446 209,213—14,213, 223, 338, 374—75, 388, 391, 446 Zeff, Leo, 213, 374

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