MDMA, PENICILLIN FOR THE SOUL OR DESTROYER OF YOUNG SOULS?

Drs.Erik Fromberg, Netherlands Institute for Alcohol and Drugs, presented at the A.I.S.E.L.-conference, Varese, Italy, 24-6-1994.

Introduction.

Of all psychotropic drugs, the hallucinogens are without doubt, the most interesting. Although many substances, when administered in high enough, often toxic, doses may cause illusions, hallucinations and other psychological effects, superficially not unlike the phenomena we observe in psychotic patients, these substances have as well strong physical effects. The real hallucinogens however, exert a strong influence on the human psyche in the absence of significant physical effects.

Chemists and pharmacologists have elucidated that many chemically distinct groups of substances, mostly known to humankind for countless centuries, have hallucinogenic properties:

• the dibenzopyranes, with THC, the active principle of Cannabis as representative;
• the indolamines, with DMT from the Virola species, used by the Waikas indians, bufotenin either from toad-skin used in European witch-potions or from the seeds and leaves of Piptadenia peregrina, the basis of the South American snuff Cohoba, the Mexican curanderos’ psilocybin and the synthetic LSD as examples;
• the synthetic arylcyclohexylamines, as PCP and ketamine;
• the beta-carbolines with harmalin and harmin, the active substances of the south american ayahuasca;
• the isoxazoles, with muscimol, the hallucinogen of the fly agaric used extensively by European and Asian shamans, as representative;
• the tropanes, active principles of the nightshade family like the thorn-apple and henbane, also components of European witch potions; and finally
• the beta-phenetylamines: ranging from the Mescalero indians mescalin from the peyotl to the present days synthetics MDA, MDMA and analogs, the subject of today’s discussions.

This list makes clear that humankind has made use of these naturally available substances for centuries and that the present days policy of prohibition is just an american imposed fad that will certainly pass like witchburning has passed and is now considered an inhumane medieval sign of malevolent ignorance.

Entactogens.

Now we are to discuss the properties of some substances, belonging to the last group, that have become such an important part of many young peoples leisure time: MDA, MDMA (better known as XTC) and MDEA. They are the best known examples of a class of drugs that in term of their effects are called entactogens by those that studied them most extensively Alexander ("Sacha") Shulgin and David Nichols (^14,17,18), because they induce an "easily controllable altered state of consciousness with emonional and sensual overtones without a significant hallucinatory component." They give an increased emotional contact with other people. These substances also have a light stimulatory effect, although no more than a twentieth as weak as amphetamine, the substance they are chemically derived from.

MDA (3,4-methylenedioxyamphetamine) that already became well known in the early seventies among the San Francisco subculture, causes weak "closed eyes" hallucinations, but cannot be compared in this respect with the strong hallucinogens like LSD, DOM and DOB. The same lightly hallucinogenic effects are also reported from MDMA, but these supposedly occur either when MDA is taken under the guise of MDMA (Ecstasy) or when very high doses of MDMA are taken, as there are indications that some conversion of MDMA in MDA might take place in the human body (¹⁹).

MDMA (3,4-methylenedioxymethylamphetamine) was first synthesised in 1898, patented by Merck in 1914 (although never used), was tested in experimental animals by the U.S.A. army for possible use as "thruth serum", and appeared as streetdrug in 1972. It was resynthesised by Shulgin (who actually described it as "penicillin for the soul" as used in the title of this paper) and got recognition by psychiatrists as an aid to psychotherapy: "one MDMA-assisted session does more than half a year two weekly sessions" wrote a psychiatrist (¹³). The psychiatric use was however not published, but a kind of samizdat developed between them, from fear that the moent the DEA would hear about it, it would become illegal and even legitimate medical research would become as impossible as LSD-research had been effectively outstamped by the antidrug zealots of the DEA. The first official publications on MDMA’s psychotherapeutic usefulness only appeared in the medical press when the DEA sought, unluckily sucsessfully, to ban MDMA (^7,8). In the intervening years MDMA got notoriety among lay people, especially in Dallas (Texas) where at the Southern Methodist University where alcohol was outlawed students bought legal MDMA paying by credit card as a substitute. MDMA was also used by the sanyassins, the followers of Baghwan, for emotional enlightenment. This made it’s use spread to Europe. Here MDMA-use got a different context, first at Ibiza, the balearic island where the combination was found of "XTC" and dancing on the loud electronic music in an exotic, exuberant holiday atmosphere.

From there it’s use spread to especially England and the Netherlands where it gave rise to a new youth culture, the "raves", culture that is spreading now over the whole of Europe: XTC with "Techno-music", "musique-techno", ou "techno-musica".

It turned out that those that grew up in the sixties and now occupy comfortably the plush of the seats of power, had not learned the lessons of the sixties. XTC was outlawed and the distribution of the relatively harmless MDMA was left to a mafia with all the related risks of adulteration. A new generation is threatened to be alienated from the mainstream culture, sacrificed in the name of the "just say no"-ideology.

It caused producers to switch to lesser known substances, not yet illegal like MDEA, the ethylated variant of MDMA, that were outlawed as quickly as it appeared, and stronger hallucinogenics like DOB on one hand, and on the other made them sell amphetamine as XTC.

The dangers of MDMA-use.

This raises two important questions. The first is what are the real risks of MDMA use? A number of medical publications, avidly sensationalised in the public press, have drawn attention to a small number of deaths among users.

To summarize the acute complications as described in the medical literature (^{1,2,3,4,9,10,12,15,16,19,20,21}):

• cardiac complications,
• hyperthermia (overheating) resulting in rhabdomyolysis, diffuse intravasal coagulation and renal failure,
• hepatotoxicity,
• psychosis.

The cardiac complications invariably occurred in persons with pre-existing, although generally unnoticed, cardiopathy. The hyperthermia with all its lifethreatening complications is already known for a long time as a relatively rare complication of amphetamine overdose, probably based on an individual "ideosyncratic" sensitivity (⁶). Hepatotoxicity is a new phenomenon in relation to amphetamine-like substances and psychoses are well known rather transitory complications in susceptible individuals.

Then there is some highly equivocal evidence from animal experimentation that MDMA might damage certain nerve terminals, the serotonergic ones to be precise. However as far as effects of repeated XTC use have been shown in humans, it showed that people that took XTC on the average 95 times in 5 years had significantly lower levels of a marker for brain serotonin function, but, according to psychological tests were significantly less impulsive and hostile and showed greater constraint and control than the non-using controls (¹¹). As the latter traits concern behavioural aspects thought to be mediated by serotonin, so this could be accepted as evidence for changes in brain serotonin, but whether these effects are to be considered negatively remain a matter of opinion. Moreover, many people are prescribed chronically related drugs as fenfluramine, an appetite depressant, which causes the same long term neurotoxic effects in experimental animals as have been described of MDMA, and as fluoxetine (better known as Prozac) whose long term effects have never been researched at all.

It is however clear that these complications, although when occurring are very serious on the level of the individual involved, are very rare when we relate their frequency to the estimated frequency of the use of XTC and related substances. To put this in perspective: the chance on such a complication is less than the chance of a serious automobile accident caused by a drunken driver on a saturdays night. Moreover, they tend mostly to occur only in individuals that have either preexisting pathological conditions or take extremely high doses of the drugs. This is not to deny risks related to drug use in general and to XTC use in particular, but to question the present international an national policies with regard to these drugs. Relatively risky behaviours as alpinism, scuba diving and racing are not prohibited, but regulated, not to talk about other luxuries as alcohol and tobacco, with their well known dangers. It only raises the next question, whether these risks seen in this perspective justify the prohibition, especially as we know that prohibition adds a significant number of unneccesary risks.

The dangers of prohibition.

Let us first discuss the additional risks due to prohibition. In the Netherlands, notwithstanding the close scrutiny by public health officials and the popular press, no cases have been reported of the hyperpyrexia. To my opinion this is mainly due to the widely advertised advice to organisers of raves, house parties as they are called in the Netherlands, to provide "chill-of rooms" and plenty of cold water, supported by most local government officials involved in the licencing of these kinds of events, in spite of the official prohibition. This approach, to provide user oriented services aiming at harm reduction, although scantily spreading in the U.K., is still unheard of in most of continental Europe. This is the more the case with our approach of another highly dangerous consequence of prohibition: adulteration and sale of other, often more dangerous, substances under the guise of XTC.

The Dutch Ministry of Public Health subsidizes my institution, the NIAD, for research into the chemical composition of the tablets being sold as XTC. This research indicated that no more than 25% of tablets being sold as XTC, really contain MDMA. This fact and the resulting dangers, led us to organise an on the spot testing service for users on raves. Here people that intend to swallow XTC can have the composition or their tablets identified, just by a small scrape off, which enables them to avoid taking unwanted drugs. These young users turn out not to be irresponsible as the prohibitionist governments suggests them to be, as most of them just throw away "bad" tablets, writing of their financial loss with a shrug of their shoulders. The real irresponsables are the governments that expose their citizens to unneccesary risks by refusing their real responsability: providing pure unadulterated drugs under government control, instead of maintaining the illusion of control by prohibition.

This may be taken as an unconditional plea for legalisation of XTC and other drugs, especially in the light of the following considerations.

Cultural considerations.

As I intended to make clear in the introduction of this paper, the use of drugs, especially both strong and weak hallucinogenics, has been an important part of most cultures. Cultural imperialism mixed with puritanism, specifically by the U.S.A., tries to stamp out savagely these practices, and only allows tobacco and alcohol, the drugs of choice of the western christian civilisation, although I hesitate to use the word civilisation in this context. I consider the use of psychotropic drugs as an important part of human culture, whether it concerns opiates, alcohol or hallucinogens. The important aspect is that it has to be part of the culture, that it supports the cultural values and is regulated by mainstream cultural norms and values. The use of Cannabis and LSD in the sixties shocked the older generation, perceiving its use as undermining the mainstream culture. In a way they were right, the sixties counterculture rejected a number of norms and attitudes of the mainstream. But who is to say that the sixties’ generation was completely mistaken? Sure, the idea that one was changing the world for the better by just smoking pot was a complete misunderstanding of the meaning of druguse, although no more than considering "just say no" as supportive to society is a misunderstanding. If the hippies unconsciously understood one thing about drug use, it was that drug use is a binding factor within a community, provided it is regulated by rituals. Who would deny that the communal ritualistic smoking of a joint is reinforcing the cohesion of individuals into a community? Again this is not to deny the existence of abuse, but to identify and stress the meaning of drug use as a symbol of cultural cohesion.

The mistake of the sixties was that the authorities generally did not support these positive aspects of the drug use of the younger generation, but savagely criminalised young people and thereby furthered abuse. As I explained elsewhere (⁵) we should accept drug use in younger generations, even as we do not know them, and guide them into responsable use as responsable citizens. As we observe now in the Netherlands where Cannabis use is a culturally accepted practice within a minority of people, young and old, regulated by the same norms and values as alcohol, without any subversive meaning.

In the same way we should consider the use of XTC, within the framework of the rave-culture, as an important rite of passage among young people, that earn to be guided in its use, as we guide them in the use of alcohol.

Conclusion.

When young people are approached as responsable citizens,we reinforce their responsability, even if they prefer to pass the weekend by dancing under influence of XTC, which is basically nothing different from their parents passing the whole week under influence of the medically available antidepressant Prozac.

References.