Ecstasy could be used to ease trauma victims' agony
(herald.com) - Somewhere in Charleston, S.C., in a safe bolted to the floor and protected by an alarm system, Michael Mithoefer keeps his supply of Ecstasy.
He is not a dealer or a user; he is simply following federal Drug Enforcement Administration rules requiring him to keep it secured in a secret place.
''You could probably go down to the local college campus and buy a lot more with a lot less trouble than breaking into the safe,'' he jokes.
Mithoefer, a psychiatrist, is one of a handful of people in the United States allowed to do human research with Ecstasy, which the government puts in the same legal category as heroin. He is studying whether Ecstasy can help trauma victims.
A small group of determined supporters -- among them researchers and doctors at Harvard University and the University of California, Los Angeles -- have spent more than a decade fighting for permission to do research. A few months ago, after years of wrangling, the DEA finally signed off. Mithoefer's study is the first trial of Ecstasy's therapeutic value in the United States. Advocates say the drug could help treat a range of psychological problems.
''I'd like to see it widely used in psychiatry,'' said Harvard psychiatrist John Halpern, a leading proponent. ``It is potentially a very valuable tool.''
But some scientists and officials question the research, saying the drug has been proven to cause permanent harm to the brain, particularly to memory.
''Let's not kid ourselves. The bulk of the evidence is on the side of risk,'' said David Murray, a policy analyst at the White House Office of National Drug Control Policy. ``The only question is how permanent and how extensive the damage is.''
The controversy echoes the long-running dispute between advocates and the federal government over the use of marijuana for a range of ailments, including glaucoma and nausea.
Although it has been illegal in the United States since 1985, Ecstasy, -- popularly called ''X'' or ''E'' -- is widely used as a recreational drug. More than 3 million Americans take the drug at least once a year, according to a 2002 government survey. Unlike heroin and cocaine, Ecstasy is not physically addictive. It has stimulant and hallucinogenic properties, and it generally gives users a sense of euphoria and contentment without impairing cognitive or motor abilities.
Mithoefer, Halpern and others think the drug, whose chemical name is 3,4-Methylenedioxymethamphetamine, or MDMA, could be particularly helpful for people with post-traumatic stress disorder. Many patients can't bring themselves to discuss the painful events that triggered their problems. Ecstasy, the theory goes, could help people confront these traumas.
''MDMA makes people comfortable with themselves. It brings them into the moment,'' said Rick Doblin, director of the Multidisciplinary Association for Psychedelic Studies, a nonprofit group funding Mithoefer's research.
Doblin, 50, says he has taken the drug more than 100 times. Though he has no medical degree, he has spent the past 20 years spreading the idea that Ecstasy and other hallucinogens have important medical benefits.
The South Carolina trial, which will cost $250,000, represents a milestone in his quest. If it goes well, Doblin hopes to fund larger national studies. His ultimate goal: persuading the FDA to approve MDMA as a prescription drug.
In Mithoefer's study, 12 subjects will take the drug, and eight will receive a placebo. Patients will take it twice during a 12-week course of psychotherapy. After taking Ecstasy, patients spend eight hours talking to Mithoefer and another therapist, trying to work through especially difficult problems. Early results are promising, Mithoefer said, but the study won't be complete until next summer.
MDMA therapy is not new. Before the drug was criminalized, a few hundred psychiatrists and therapists around the country were using it.
Between 1980 and 1985, George Greer used the technique with about 200 patients. The psychiatrist in Santa Fe, N.M., said almost all thought the therapy helped them. He finds it ''incredibly frustrating'' that he can't use the drug in his practice. ``I see patients every day who could benefit.''
Proponents of the therapy take pains to distinguish it from recreational use, which they see as potentially dangerous. Street users aren't in a controlled setting, they say, and often unknowingly take pills tainted with methamphetamine and other drugs.
What most concerns some researchers is the possibility that even a few doses could cause permanent brain damage. Some animal research has found that even small amounts harmed brain neurons that release serotonin, a key neurotransmitter involved in memory. In some studies, memory deficiencies persisted long after the drug was taken. Some human research on Ecstasy users has also found memory problems.
''There's a consensus that MDMA has the ability to damage brain serotonin cells,'' said Johns Hopkins University neurologist George Ricaurte, a leading MDMA researcher.
Proponents agree that those who take the drug many times may risk brain damage. But they say therapeutic doses -- one or two over a few weeks -- are far below potentially harmful levels.
''The neurotoxicity issue has been hyped,'' said Charles Grob, a UCLA psychiatry professor. ''The notion that one or two doses will induce irrevocable harm -- that's wrong.'' Grob and Halpern, the Harvard researcher, have studied the drug's safety and found that low doses caused no permanent changes to brain structure or memory function in humans.
Advocates argue that even if higher amounts do cause damage, that is no reason to ban all use.
''Most of the drugs we use in medicine can be dangerous or even lethal if you take too much,'' Mithoefer said.
Ricaurte agrees, and said Ecstasy may end up being seen as both a dangerous drug of abuse and a helpful treatment.
''Look at morphine,'' he said. ``It has potential for abuse, but it's also a great painkiller. MDMA is no different.''
By David Kohn
Aug 24, 2004
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