Stephanie AltenhofMDMA for medicalization: a look at risk versus benefit

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Drugs are a common part of our society and scientific skepticism is important in determining if
various drugs deserve the portrayal that each of them possess. I will focus on a drug that has
quite the negative representation, MDMA, and compare its risk versus benefit. I will present a
general overview of the drug and explain its effects. I will take a look at public policy
surrounding MDMA and I will also look at its current scientific evaluation for medicinal use.
3,4-methylenedioxymethamphetamine, or MDMA, sometimes called Ecstasy, E, X, Molly etc.
It is a synthetic drug, meaning it is produced in a laboratory by scientists. It is also under the
classification of a psychoactive drug; when taken, neurochemistry is altered and therefore
perception, mood and consciousness are subsequently altered. Every sense we experience is
produced by chemical reactions occurring in the brain (neurochemistry), so when a new chemical
substance enters your brain (i.e. MDMA) and is able to influence these chemical reactions, what
is produced and what will be experienced (your senses, emotions) will thus change as well.
MDMA causes the release of the neurotransmitter (a chemical messenger) serotonin. Serotonin
is involved in the processes of sleep, cognition, perception and appetite. MDMA also increases
the hormones oxytocin, prolactin and norepinephrine. Following oxytocin and prolactins release
in the body is an increase in trust, bonding, and a reduction in fear. Norepinephrine release in the
body causes an increase in blood pressure, enhances attention, and enhances formation and
retrieval of memory. After a normal dosage of MDMA (75-150 mg or 0.8-1.9 mg/kg) short-term
effects include euphoria, increase in feelings of empathy, increase in energy, increase in sensory
awareness, and a feeling of closeness with others. Minor short-term negative effects include teeth
clenching, an increase in body temperature, increased blood pressure, sleep troubles, muscle
tension and headache.
MDMA is most commonly used at parties, nightclubs, raves and music festivals due to its
pleasant effects. A large concern with MDMA is hyperthermia, meaning the body is producing
more heat than it is expelling and thus the body temperature rises. In rare cases, this could
eventually lead to multi-organ failure and death. Hyperthermia is also the only known correlation
to neurotoxicity (damage to the nervous system) from MDMA. An exasperating effect is due to
the typical atmosphere MDMA is taken in; warm places where people dance. This in turn
increases body temperature even more and some people fail to be conscious of staying hydrated,
which is crucial when regulating body temperature. Laboratory studies in rats failed to show a
hyperthermic response when they were housed below 20oC.
Other reported deaths conclude a mixture of other drugs with MDMA. Basement chemists mix
possibly harmful and unknown substances together, and call it MDMA. Sometimes there may
not even be any MDMA in what these chemists are producing. These chemists are
essentially trying to make a substance that will create desired effects but with a high profit
margin, so the chance of buying legitimate MDMA from the street is highly unlikely.

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A part of the negative outlook on MDMA within the media and the public is a lack of scientific
understanding and ignorance within public policy. In 1985, the U.S made MDMA a schedule 1
drug, meaning it has a high abuse potential, no accepted medical use and no accepted safety for
use. In a skeptical science mindset, one must take a critical look at these statements. Firstly, there
were not many studies done prior to 1985 on the dangers of MDMA; one comprehensive study
concluded the side effects that were experienced by the subjects were minor. There were only a
few studies conducted on the benefits of using MDMA also. Scientific research should have been
conducted to conclude if it had the potential for abuse and if there were any medical uses. Of
course, research costs money, but so does paying for drug users and dealers to sit in jail.
Any drug taken in excess can have negative consequences or even kill you; caffeine, Tylenol,
alcohol etc. For example, in a 1996 study, subjects experienced no physical discomfort from a
single dose of MDMA. In a 1986 study, patients who took additional doses of the drug began to
experience adverse effects such as anxiety and restlessness. Any medicine bottle will indicate a
suggested and maximum dosage. The access to this crucial information is severely impaired
regarding illegal drugs. This important information is instantly accessible with over-the-counter
or prescribed medication, as opposed to a street drug. Regarding MDMA, it is important to have
the awareness of a safe dosage and the increase in risk for hyperthermia in order to regulate body
temperature and stay hydrated.
MDMAs most current promising medical research is its use in conjunction with psychotherapy
(talk therapy) for Post-traumatic Stress Disorder (PTSD) patients, and on a lesser scale, patients
with anxiety and drug addiction. The only funding for these types of clinical trials is from the
non-profit and educational organization, Multidisciplinary Association for Psychedelic Studies
(MAPS).
People with PTSD experience distressful symptoms from a traumatizing event, usually involving
death. They often report feeling emotionally disconnected and have trouble benefitting from the
social support from friends and family. The physiological effects from MDMA combined with
therapy can thus aid in reducing avoidance of these memories and patients will experience an
increase in trust with the therapist. The final goal is recalling the traumatizing incident while
remaining grounded in the present moment. MAPS has completed four studies and there are four
studies currently taking place.
Subjects from these studies received either MDMA or a placebo, there were different doses being
used between subjects and the drug would be administered during two 8-hour sessions 3-5 weeks
apart with weekly non-drug psychotherapy sessions.
The results have been positive; 83% of participants were no longer diagnosed with PTSD after a
two month follow-up. A long-term, 3.8 year average, follow up concluded that these benefits
were maintained. All subjects reported experiencing at least some benefit and there were no
negative cognitive effects. Another positive benefit of MDMA assisted therapy is that a drug is
only being used a few times, in comparison to medications currently being used that are life-long
or long-term.

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Promising progress seems it is being made; on November 29, 2016, the US Food and Drug
Administration (FDA) has approved phase three trials of MDMA for treating PTSD, meaning the
group size of the patients in the trials would be larger, at least 230 people. Once these trials are
completed, the data can be sent to the FDA for approval. If all goes well, MDMA will be
legalized for therapeutic use in the US by 2021.
In conclusion, there are risks to using MDMA and precautions should be taken if one were to use
it. Currently, there are no accepted medical uses, making MDMA a schedule 1 drug, although it
is promising that this may change in the future. The benefits seem to outweigh the risks for
PTSD patients. There is risk using this drug for personal experience, but a basic knowledge of
the science behind this drug aids in more a confident and safe use.

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