Ecstasy as Therapy: Have Some of its Negative Effects Been Overblown?

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Although ecstasy (MDMA) — a drug best known for enhancing feelings of empathy and love — has been demonized by parents and politicians, researchers have been quietly studying its potentially therapeutic effects, and they’ve discovered that the data is not bearing out the worst fears about the drug’s harmful effects.

Just this week, for example, a new study, which was funded by the National Institute on Drug Abuse and published in the journal Addiction, found that regular ecstasy use was not associated with cognitive impairment — contradicting some prior studies that did find lasting mental deficits associated with ecstasy use, such as problems with memory and attention.

The problem with those earlier studies, however, is that they had not adequately controlled for the fact that most MDMA users also take other drugs. Further, the control groups involved in past studies were not similar enough to the drug users for appropriate comparison.

For the new study, led by Harvard University’s John Halpern, researchers compared 52 long-term MDMA users, aged 18 to 45, with 59 nonusers. Unlike in prior research, both users and nonusers had participated in the “rave” subculture — meaning that they had all been exposed to potentially brain-altering experiences like dancing all night to repetitive music without adequate hydration. The MDMA users were also drug-tested before taking the cognitive tests, ruling out impairment from current drug use.

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Although the study found a small, possible increase in impulsivity in the ecstasy users, the researchers theorized that this is what initially prompted users to take ecstasy in the first place, rather than the other way around. In other words, ravers who are higher in impulsivity were more likely to take ecstasy than people who are less impulsive; ecstasy doesn’t seem likely to have made those who chose to use more impulsive. On all other cognitive measures, there were no differences.

Prior research on brain damage related to MDMA in animals is also notoriously problematic. Most famously, a study published in Science in 2002 purportedly showed that a single recreational dose of ecstasy could cause brain damage in monkeys that was extensive enough to lead to future Parkinson’s disease. That research had to be retracted, however, when researchers discovered that the drug administered to the monkeys had been methamphetamine, not MDMA. Ironically, some research now suggests that MDMA or similar drugs could help treat Parkinson’s.

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There is still the outstanding question of whether long-term regular MDMA use damages serotonin neurons, potentially affecting mood. Data from some animal studies and trials involving a drug that works similarly to MDMA have suggested these effects. Nonetheless, short-term use for the treatment of conditions like post-traumatic stress disorder is considered safe enough that the FDA has approved clinical trials and these are generating a great deal of excitement.

Oprah’s O Magazine this month has a fascinating feature on the experience of some of the participants in those trials; the article also includes a description of the writer’s own MDMA experiment. Here’s a preview:

Supporters of legalized MDMA therapy believe it can be applied in couples counseling and in treatment for depression, body-image disorders, chronic pain management, and end-of-life anxiety. But many advocates think its best chance at mainstream acceptance is as a tool for people with PTSD. Later this year, Michael Mithoefer, MD, a psychiatrist in Charleston, South Carolina, will publish the long-term follow-up results of the small pilot study that Sarah first heard about six years ago. The outcome: Seventeen of 20 subjects no longer met the diagnostic criteria for PTSD after just two or three sessions of MDMA-aided therapy led by Mithoefer and his wife, Ann, a psychiatric nurse.

The future of ecstasy seems promising.

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