Ecstasy, the new prescription drug?

Health and medicine explained.
Jan. 23 2007 12:52 PM

What a Long Strange Trip It's Been

Ecstasy, the new prescription drug?

(Continued from Page 1)

John Halpern of Harvard Medical School, who is running the study on MDMA for cancer patients, has tried to avoid this problem by studying a group of ravers in Utah who took large quantities of ecstasy but rarely used other illegal substances or drank alcohol. (Apparently, the mores of this largely Mormon area allowed the ravers to conclude that X isn't as bad as drinking—Halpern isn't sure why.) He found that those who took the drug 60 or more times performed worse on a number of neuropsychological tests, especially those involving mental processing speed and impulsivity. But the heavy users still performed within the normal range. And those who used X fewer than 50 times did not show these effects. When Halpern combined data on all the users, regardless of the extent of their use, he found no significant differences between users and nonusers, including in their scores on memory tests. (The recent Dutch work that links low doses of X to small memory changes is, so far, difficult to evaluate.)

Minor and probably transient memory impairment may not be so bad. And MDMA would be safer in a clinical setting, where the patient's mind-set would be different and the drug's purity guaranteed. So can the anti-anxiety effects of ecstasy be harnessed to good effect under a psychiatrist's care? George Greer, perhaps the best known of the doctors who gave their patients MDMA in the 1980s, prescribed it to about 80 patients who suffered from mild depression, anxiety, or relationship troubles. He says they could more freely remember and discuss difficult events. A few felt tired, depleted, or anxious the next day. But according to Greer, none suffered lasting side effects. Other psychiatrists say that ecstasy has the potential to accelerate therapy and to enhance the therapeutic alliance, creating a closeness that carries over to future sessions. But neither Greer nor anyone else conducted any controlled studies to prove the point.

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In the Harvard and South Carolina studies, patients will be screened for physical and psychological conditions that might make MDMA dangerous to them. (High blood pressure and major medical problems are pre-emptive, as are psychoses.) The idea is to look for benefits in psychotherapy, but also to watch out for adverse reactions. The studies include two psychotherapy sessions with the drug and multiple sessions without it, so subjects and their therapists can integrate material stirred up under the influence. Both are designed as randomized, double blind, controlled trials—the gold standard of scientific research. And both have been approved by the Food and Drug Administration.

It's too soon to say what these trials will yield. But if all goes well, MDMA could help some patients, and also help build acceptance for parallel work on the potential therapeutic effects of psilocybin (found in 'shrooms) or even LSD. Even at this late date, it's possible to imagine for psychiatry a small psychedelic renaissance.

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