The Bitter Pill: Is ecstasy neurotoxic? Mmmmmaybe, maybe not...

Steve Robles, San Francisco Bay Guardian, February 12, 2001
     As he stood before giant windows offering a gorgeous view of Crissy Field and the Bay, Steve Heilig admitted he was a little bit nervous. With some coffee jump-starting my brain at the ungodly hour of 9 a.m., my eyes struggled to focus on the director of public health and education for the San Francisco Medical Society and cochair of The State of Ecstasy, a conference touted as the first comprehensive collective of experts on the oft-maligned entactogen known as MDMA. I was a bit nervous, too. I guess when you're a proponent of something as controversial as decriminalization of everything on the Drug Enforcement Agency's Schedule 1 (roughly any drug found by this laughable jury as having no medicinal value), hallucinogens in particular, it's easy to get into a counterproductive "underdog" mentality.
     Unfortunately, there are lots of questionable parties on our team, and sometimes their arguments can be simplistic or downright specious. After a while you start to distrust some of your most valuable allies in the cause. This was my concern over the Lindesmith Center's ambitious, daylong X-travaganza. In general, I feel the pendulum has swung so far in the direction of the drug war that a strictly biased (toward legalization) agenda could be easily defended. Nevertheless, the kind of touchy-feely anecdotalism that characterizes so much pro-legalization rhetoric is not likely to change the system.
     We need brainiacs, scientists, nerds: "normal" folks to usher in the tide of rational, commonsense policy that so many of us believe is more than an opium pipe dream. Flowery depictions of the world holding hands like some '70s Coke commercial is not gonna topple the powers of the DEA and the National Institute of Drug Abuse, or NIDA (which has been The Man's chief propaganda machine in the effort to vilify MDMA as a hoary beast hell-bent on devouring your children, all to the tune of bad techno). Luckily, Heilig and cochair Marsha Rosenbaum, who conducted the first fully funded pharmocological study of MDMA back in 1987, were thinking the same thing.
     The speakers seemed a little biased at first, but as the day wore on, listeners were treated to (gasp!) actual data on the effects of MDMA on the human brain. Which is not to say that politics didn't rear its ugly head. In our corner were heavyweights like Rosenbaum, legendary Dr. Alexander "Sasha" Shulgin (credited with rediscovering MDMA from a dusty old German patent circa 1914), and psychotherapists Ann Shulgin and George Greer (who were allowed to use MDMA on their patients before it was made illegal). Sue Stevens, the widower whose story of using MDMA to cope both before and after her husband's cancer death has been featured on CBS's 48 Hours and MTV, described how using ecstasy enriched her mate's final months and saved her from suicidal depression in the wake of the tragedy. The true meat of the conference lay not in its slightly pro-legalization slant, but rather in its scientific discussions, and the political issues which constantly bubbled beneath the wonky data.
     Despite the rigorous hoops scientists must jump through to get approval on research involving Schedule 1 drugs, it turns out that a fair amount of rat and monkey brains have been dissected in an effort to discover what effects (both "good" and "bad") MDMA has on our brain chemistry. The magic science word of the day turned out to be "neurotoxicity." This is a term which roughly translates into "fucking up your brain." In The Man's corner stood George Ricaurte, M.D., Ph.D., a researcher at John Hopkins University School of Medicine and overall NIDA lapdog. His research concerning neurotoxicity for NIDA has fueled much of its propaganda, despite (or because of) its controversial, hyperbolic nature. According to Ricaurte, it is generally an accepted scientific fact that MDMA has neurotoxic effects.
     MDMA does two things when it enters your brain's domain: it causes neurons (nerve cells) to release seratonin, a neurotransmitter associated with feelings of happiness and self-worth; and, it releases dopamine, which as you might infer from its name, causes the feelings of disassociation and euphoria that many equate with the term "high." As the terminals which release seratonin open to spew out their cargo, dopamine floods inside, wrecking havoc by bringing oxygen free-radicals with them. These oxygen free-radicals may eventually lead to the degeneration and eventual failure of seratonin terminals, which could impair memory.
     This all sounds very bad, but there are many problems with Ricaurte's findings. First, his test subjects (rats and monkeys) were fucking drenched in MDMA, over periods which human social restrictions would likely make impossible to replicate in the context of the average user. While he maintained that, through using interspecies scaling, he has proved that the range of these dosages fall into the area of typical recreational ecstasy usage, I (and others) ain't buying it. Ricaurte gave his monkeys about 40 milligrams per kilogram of the animal's weight of MDMA, while the average pill contains about 100 milligrams (if you're lucky enough to get that much pure MDMA in a capsule, which is an issue my esteemed colleague Amanda Nowinksi discusses in her column this week). By comparison, if I were to take that much MDMA, I'd be writing this article on a friggin' Etch-A-Sketch from the bowels of an asylum. Christ, if I took that much Equal sweetener, my brain activity would likely fall somewhere between an earthworm and an artichoke.
     Furthermore, despite his frightening brain scans of decimated nerve terminals, Ricaurte's data at this point is sound and fury signifying nothing. He has not factored in the effects of concurrent ingestion of 5-HTP supplements and Prozac, a popular practice among recreational users which may thwart the damage to terminals by dopamine. There is also no end data that demonstrates how these interactions affect the mind. Ricaurte's studies have been published into a virtual vacuum. There are no comparable studies which would be in a position to either confirm or deny his assertions.
     So, sure enough, charging out of our corner was Charles Grob, director of the Division of Child and Adolescent Psychiatry at Harbor-University of California at Los Angeles Medical Center (in my native Torrance!) and professor of psychiatry at the UCLA School of Medicine. Speaking in an excited tone, Grob immediately countered Ricaurte's presentation. "I'd just like to point out that [Ricaurte's data] is by no means the final word on this subject," Grob said. "A lot of these findings have yet to be substantiated, and I dare say I find it troubling that there are some scientists out there who seem to be politicizing their science." Grob's last statement (made more barbed by Ricaurte's service on behalf of NIDA, which regardless of his intentions makes his work inevitably political in nature) resulted in spontaneous applause by proponents in the audience and led the way for more assaults on Ricaurte's findings as well as his credibility. It was a nerdy version of the Rock getting kicked in the nuts and bodyslammed by the Undertaker. At one point, I thought John Mendelson (whose ruminations on the subject of nonlinear pharmacokinetics were fascinating, if a bit dense) from the University of California at San Francisco was going to crush some skulls with his handy wooden cane, but this was wishful thinking.
     During the Q&A session afterwards, Bay Area resident and psychedelic author Myron Stolaroff used his own experience to call into question the issue of neurotoxicity. "I'm 80 years old," Stolaroff said. "I've taken MDMA nearly 150 times over the course of the last 10 years. I just had a brain scan that my doctor said looked beautiful for a man my age. Now, Dr. Ricaurte, I ask you: where is my brain damage?" As someone who has probably wolfed down that number of dosages in about half the time, I had to admit I was impressed by Stolaroff's comments. They seemed to take Ricaurte aback for a bit, but his response was clearly welcomed by both sides and was probably the smartest thing the scientist said all day. "My answer, sir, is that we don't know," he said, then maintained that the bottom line is that there needs to be more research before these questions can be answered to anybody's satisfaction.
     And that's where we're at, kids. I personally believe that MDMA has therapeutic qualities. As a DJ and dweller in the psychedelic subculture, it's fairly easy for someone in my position to score a pill that's mostly (if not purely) MDMA. So, on a personal level, I could honestly give a pig's ass as to whether or not it will ever gain the Food and Drug Administration's approval. But somewhere out there, there are more Sue Stevenses, in even less of a position to obtain a drug that could maybe reinvest them in the sometimes painful process of living life. But we'll never know until we get the DEA to yank MDMA off of Schedule 1 status in order to precipitate more studies.
     Steve Robles (stever@sfbg.com) is the Bay Guardian's unoffical drug culture editor (and official assistant culture editor).

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