Ecstasy between your ears

We don't know very much about the way the MDMA molecule interacts with our brain cells. What we do know, and what makes it so remarkable, is the consistancy of its effects. Just about everyone who ever tried it, and Ephidrina means everyone, gets the same experience, and with very few exceptions.

The urban myth has it that the first dealers wanted to call the new drug "empathy". Certainly, that's a very accurate description of what it can do. Central to the Ecstasy experience is that warm-hearted, connected, love-thy-neighbour feeling. It's not particularly sexual, (although, if you're so inclined, sex can be wonderful) it just allows you to open up in a particular way. This is what makes it such a popular recreation, and a valuable therapeutic drug besides.

Because it's consistant, and not at all frightening, Ecstasy is accessible in a way that previous so-called psychedelic drugs have not been. It opens up the doors of perception just enough to allow a little exploration, without the blinding, terrifying intensity of LSD. For many people, the experience is very spiritual. For others, it's a way to open up and express feelings for which they don't usually have words. And for the vast majority, it's just plain fun.

It doesn't take a genius to spot the possibilities in psychotherapy for this cathartic experience. The problem for most practitioners is the unorthodox approach. Since most are bound into a sixty-minute-session routine with their patients, and the peak effects of MDMA last from four to six hours, it's not a very appealing prospect for many doctors. But those few who were prepared to work with it and go the distance with their patients, have found it very useful. Some have gone so far as to say that a single session with MDMA can achieve more than months of therepy for a few patients.

A few interesting facts

Ephidrina does not wish to appear biased about drugs. Rather, she would like the facts to speak for themselves. It is very popular in some sections of the media to demoinize some drugs on the same pages as it advertises others. Newspapers have often been very quick to publicise the fact that ecstasy has caused reactions in a tiny number of people that have led to death. Nobody knows of a single factor that causes these fatalities, which occur at a rate of between five and ten per year in the UK. It has been conservatively estimated that this represents a single death per year for every 3.5 million users. Therefore, you are more likely to win the National Lottery jackpot than you are to die from taking an ecstasy tablet. And we all know how long those odds are.

Compare these statistics with the equivalent for the drugs we use legally. Every year, 125,000 people die from smoking tobacco. A further 20,000 die alcohol related deaths. This does not include those people who die in accidents or alcohol fueled violence. Emergency-room statistics for alcohol versus ecstasy show a similar trend - many more people get into trouble on alcohol than on ecstasy. Where are the news items publicising these deaths?

Ladies and Gentlemen - the evidence!

Ecstasy acts on the serotonin system - the part of the brain that controls our sense of wellbeing. Just how it does so, and whether it causes long term damage, is still unknown. We know that MDMA causes neurotoxicity in monkeys and rats, but this doesn't necessarily prove that it does so in humans. Still, a lot of evidence suggests that in the longer term, moderate and heavy users may be putting themselves at risk.

Most studies done in the last ten years seem to indicate the same thing: users demonstrate structural damage to their serotonin system proportional to their Ecstasy habit. Conclusive evidence is scarce, because human surveys have had to depend on external observation, rather than intrusive examination of brain tissue. As research has advanced, so new methods for measuring serotonin neurons have been developed, and with more and more people using the drug, there's no shortage of test subjects.

Studies on monkeys have shown that Prozac, taken concurrently or up to six hours after Ecstasy, may help prevent brain injury. This suggests that maybe it's not the drug itself that's toxic, but the chemicals the brain produces when MDMA is metabolised. It's also reported that Prozac used in this way can help prevent burnout - but Ephidrina wouldn't know, because she doesn't know anyone who's tried it. (Ephidrina reports that the best way to come down from Ecstasy is Shulgin's finest, 2CB - nice work if you can get it!!)

There's confusion surrounding exactly what all this means for the users. Serotonin depletion is usually linked with depression, memory loss and increased hostile and impulsive behaviour. This is not compatible with the evidence. Repeated studies have indicated that Ecstasy users are in fact less hostile and impulsive than control groups - differences that most of us would consider positive. These are the only functional and behavioural changes that surveys have confirmed, but we still don't know how alterations in brain chemistry will affect users in later life.

Meanwhile, many doctors point to previous Ecstasy use as a factor in mental health problems they're witnessing in their patients. In some people, it's been linked to anxiety, panic attacks, depression, and various psychotic symptoms. Naturally, these are not the kind of people who would volunteer as test subjects. But their problems are not necessarily related to serotonin depletion.

The Ecstasy experience is a very powerful emotional release. It penetrates the defences we build to protect ourselves from personal injury. It can bring to the fore all kinds of repressed thoughts and feelings. For disturbed individuals, taking Ecstasy outside a therapeutic environment, perhaps in threatening circumstances, may force them to confront personal demons, without the opportunity to work their emotions through with a therapist. These kinds of problems do not appear to be linked with dosage or duration of habit, which strongly suggests that in the main they're psychological, rather than physiological, in origin.

An important concept in the use of mind-altering drugs, particularly the psychedelics, is set (the state of mind of the subject) and setting (the circumstances in which she is taking the drug). More than anything, set and setting will determine the quality of her experience. For example, if she takes a pill before having dinner with the in-laws, she is more likely to have an unpleasant trip than if she had stayed at home and taken it with her husband, because the setting is wrong. Likewise, if she has a lot of unresolved issues in her life which make her emotionally vulnerable, (and she may not know it) her inappropriate mind-set affects her experience. MDMA is nowhere near as dangerous in this aspect as drugs like LSD, or even psilocybin, but Ephidrina thinks we're deluding ourselves if we pretend it's completely harmless.

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