E is for Ecstasy by Nicholas Saunders

Appendix 1: Reference Section

1 Report of US Army tests on MDMA, from Rick Doblin president of the Multi-disciplinary Association for Psychedelic Studies in the U.S.

In the 1950's, MDMA was one of the analogs of MDA that were given to animals by the U.S. army at the Edgwood Arsenal, which was then investigating drugs for use in chemical warfare. There is no evidence in the public domain to indicate that MDMA, which was code named EA-1475 (Experimental Agent 1475), was ever given to humans or was tried as a truth serum.

2 PIHKAL (Phenethylamines I Have Known And Loved); A Chemical Love Story (book), by Alexander and Ann Shulgin. Published by Transform Press (Berkeley USA) at $18.95. Available from Compendium Bookshop, London

Shulgin describes himself as the stepfather of MDMA if not the inventor. "I made it in my lab [in 1965] and nibbled. It gave me a pleasant lightness of spirit. That's all. No psychedelic effects whatsoever. . . Just a distinct lightness of mood. And an indication to get busy and do things that needed doing," he recounts. Shulgin gave MDMA to a psychologist on the verge of retiring, who postponed his retirement and spent the next seven years training several thousand people, mostly therapists, to use it. Several methods of synthesising MDMA are given in detail.

The following is a review of PIHKAL that I wrote for the journal Social Inventions:

Whether you approve or not, the widespread use of drugs that alter consciousness has had a lasting effect on society - the sixties use of psychedelics not only gave birth to new fashions in music and clothing, but a change of values which resulted in today's concern with the environment and personal development. Now it is said that football violence is being replaced by a new culture, one where blows give way to hugs, due to the drug Ecstasy. This book reveals the origin and motives for designing many mind-altering drugs.

A giant chemical company takes on a brilliant young research chemist who immediately invents a profitable new insecticide. The company rewards him with his own lab and a free hand, but instead of further profitable inventions they are embarrassed to find themselves patenting more and more psychedelic drugs - including the infamous STP which had ravers raving uncontrollably for days. The chemist quits just before being sacked and sets up his own lab in a shed behind his house where he quietly carries on synthesising more and more new mind-bending drugs - meanwhile making a living (and no doubt earning immunity from prosecution) by working as a consultant helping the police to convict drug dealers. This delicate balance could be upset by his retirement, so before the authorities have a chance to suppress his life's work he publishes every detail of how to make hundreds of psychoactive drugs from available ingredients . . .

A far fetched plot? No, this is an autobiography of a man who, long before the Sixties, was fascinated by the possibility of using consciousness-changing chemicals as tools for the study of the mind and the treatment of mental disorders. His company provides him with the equipment complete with the means of testing the products: fighting fish whose behaviour is supposed to alter on psychedelic drugs. But there are problems: fish don't say when they are under the influence and, well, have you ever seen a fish that doesn't look stoned? To ensure a clear view of the fish, snails are brought in to keep the glass clean, but they invade the laboratory . . . There's an easier way to find out the effect of a drug: suck it and see.

In all, Alexander Shulgin describes the synthesis of 179 drugs and their effects. He starts out by taking a minute dose himself which he gradually increases until something happens, and if that is interesting without being awful he tries it out on his wife and then on his research group. This consists of about a dozen friends who meet about once a month for a weekend house party, when they all take the same drug together and report on the effects:

. . . It is now (0:00) hour of the experiment.

(0:50) Warmth in lower legs.

(1:10) Walked out to the highway for the mail.

(1:35) Warm all over. Effects developing nicely.

(1:50) Very real effect! Quite nice. No sense modality emphasised. Not yet, anyway.

(2:30) Sat outside and got the concrete bag to float above the ground for a moment [this was a bag of Portland cement with a logo on it that showed a bulging bicep]. Man on sack - Act of Power - but the act is not told, or it would only be a Tale of Power. Or at best, a Tale of an Act of Power. An Act cannot be saved, relived - only the Tale persists. The Act is past.

(2.33) How long does it take to assimilate an act? The act itself, an augenblick [quick glance], is like a drug effect, in that to assimilate it is to recall the wave of concepts that flooded over you. They must be sifted, reconstructed, as best as can be done from memory. . . Go through - don't just look through. Life is like a Tale of Power; to go through is an Act of Power. . . I am being invaded with 'concepts' which are coming too rapidly to write down. This is not a verbal material, ergo, tales cannot be told. . .

(2.45) Theo came over to the lab, and for a few moments we discuss the problems associated with vacuum pumps. It was a laborious exchange of words when what was needed was an exchange of concepts. I knew immediately what I wanted to impart, and was terribly impatient and not too sociable. . .

This makes fascinating reading and forms the core of the book, freely written in the form of an autobiography. Then comes his wife's story, delightfully written with her secret thoughts in italics, more concerned with their relationship than drugs:

Shura was smiling, "Do I detect a bit of disappointment?"

"Oh, of course you detect disappointment. It would be nice to keep this going for a lot longer."

"I'm glad it's been a good experience for you. Very glad."

He means it, he really is pleased. I wonder how much of the pleasure is because he cares for me or because he believes this stuff is good and wants it to be good for everyone. Maybe a bit of both. Doesn't matter.

Finally there are 500 pages of recipes telling precisely how to make the drugs and what effect they have - which will disappoint any would-be DIY drug maker as only a well equipped chemist could follow the instructions. The fact that he has reached retiring age in one piece is testament to his assertion that these types of drug are not physically addictive and only temporarily alter the state of one's consciousness. He is fortunate: some of the drugs mentioned have been available on the black market and have had disastrous effects, even resulting in death. He may well be accused of giving a dangerously unbalanced view by omitting to mention the known damaging effects of the drugs.

The book is delightfully readable throughout - even in the chemical synthesis section there are amusing asides such as that adding a certain chemical group makes no difference to the effect of a drug and so would enable pirate drug companies to get round patents. But the most disappointing aspect is that a lifetime's devotion to finding new and better psychedelics failed to produce the ultimate drug for self-realisation or a cure for mental illness. And though the descriptions of the drug effects are fascinating reminders of what many experienced in the sixties, they fail to break new ground.

3 Ecstasy the gentle mind bender? by Nicholas Albery, The Guardian 10/88

The San Franciso psychotherapist Dr. Philip Wolfson is quoted: "If a substance is desired by a human being, it is taboo to the psychiatric and governmental bureaucrats." He believes in its potential for therapeutic use: "No new clinical agent of importance has been placed in psychiatry's hands since the introduction of haloperidol almost twenty years ago." Albery also quotes the radical psychotherapist RD Laing as saying: "It made me feel how all of us would like to feel anyway," and says that an investigation into how MDMA acts toxically is being conducted by Dr. David Nichols at Purdue University, Indiana.

4 Meetings at the Edge with Adam: A Man for All Seasons? by Philip Wolfson from Journal of Psychoactive Drugs Vol. 18/4 1986

Wolfson introduces himself as an established psychotherapist who has been passionately involved with people experiencing painful altered states of consciousness for many years. He says that MDMA, when used as an adjunct to psychotherapy, opens up new possibilities for treatment of such cases.

To demonstrate the usefulness and limitations of MDMA, he cites the example of a man in his early fifties with a long-standing depression who saw himself as emotionally incompetent. The man was married with an adult son who suffered from severe paranoia, and the family spared no expense and effort in seeking a cure. The son's paranoia brought up old, unresolved differences between the parents, with the wife blaming her husband for their son's condition; soon they were constantly at each other's throats. At this point Wolfson decided to give MDMA to all three in order to lower their defensiveness and encourage them to communicate frankly and be sensitive to each other's feelings. This had a profound effect on the wife and son, making them close again but, shortly afterwards, the son reacted by distancing himself. After a second session the son felt he could see the way out of his psychological illness, but in fact he got worse and was hospitalised. The parents continued taking MDMA as part of ongoing psychotherapy. There were periods full of the glow of hope, and the husband had moments of relief from his depression, but these were interspersed by disappointments as deeper problems between the couple surfaced. Overall, Wolfson felt that gradual but definite progress had been made in unravelling the problems of all three. Nevertheless, the man came to the conclusion that the MDMA had "lied".

To explain this reaction, Wolfson asserts that MDMA can open people up and allow them to experience breakthroughs, but that these breakthroughs are temporary unless they are consolidated. It is the disappointment of a temporary breakthrough that may lead to a client feeling that the drug has "lied".

Wolfson says: "The fundamental truth is that MDMA provides in its totality unprecedented access to an experience that human beings value and may wish to have an opportunity to repeat at a future date. The second part of this truth is the almost uniform observation that those who have had the MDMA experience wish to share it with others and believe it has the power to alter lives, and even societies, positively. . . This is the completion of the fundamental truth: There are almost no critics of the experience itself. The stories told are of a compassionate evaluation of the self and others with a shift to a more positive outlook and behaviour". However, he warns of the following potential hazards: (1) Severe and potentially fatal reactions can occur unpredictably on occasions. (2) Seizures are said to have occurred. (3) MDMA may reduce resistance to infection. (4) MDMA causes increase in blood pressure. (5) A variety of short-term reactions may occur, sometimes persisting or recurring for several months, including anxiety and insomnia. A client's judgment can be interfered with by their heightened sense of excitement under MDMA. (6) MDMA has no established safety record - the necessary experiments have not been made.

He says that MDMA is unique because: 1. It offers a rapid and significant break with people's defence structures. 2. It can facilitate a shift from a state of self-hatred to one of love of self and others. 3. It encourages people to shift from isolation to contact and intimacy and from withholding to giving. 4. When MDMA has given them a more positive attitude, people find it easier to make decisions.

5 Ecstasy: The MDMA Story, by Bruce Eisner (book) published by Ronin Publishing Inc., PO Box 1035, Berkeley, CA 94701, USA. [new edition due out 1993]. My review of this book for International Journal on Drug Policy is reprinted here

English readers who assume this to be a book about the pills kids swallow by the million at raves will be disappointed - raves are not even mentioned. It is about Ecstasy use in a completely different (Californian) culture; one where people get into their feelings. The drug is the same chemically but the way it is used and its observed effects are barely comparable.

An Ecstasy session requires "careful planning and both physical and mental preparation are important . . .The experience is something like a retreat. The MDMA experience is neither trivial nor casual. It can be a life-transforming experience. . . The first and most important question to be answered is, 'Why do I want to take MDMA at this point in my life'." A typical session would be one person alone with a guide (a friend who has experienced the drug) acting as an helper or therapist. Choose a calm, comfortable room free of distractions and disconnect the phone. Bring along some objects of personal significance such as crystals and photos of family members to help trigger childhood memories.

Lying on cushions on the floor with eyes blindfolded, you look inside yourself with a sudden clarity as the drug comes on. Or talk and reveal thoughts that you had even hidden from yourself. "One may have a noetic perception of the world, now viewed in a completely fresh new light". "One suggestion for using the MDMA experience for later benefit is called 'future pacing'. Here you conjure up, while in your alternative state, a mental image of people or situations which you would like to experience in an open and empathic way. Then you construct an image, visual, auditory, and/or kinesthetic, of an experience of being in the MDMA state while with those persons or in that life situation. In the days ahead, your experience of the person or situation focused on might change as a result of this exercise".

Use in formal psychotherapy is mentioned (though this has been illegal since 1968 in the USA), both in group and individual sessions. One effect of the drug is to lower defensiveness so that patients express themselves more openly and honestly, which sometimes facilitates breakthroughs. In groups, participants feel able to express themselves without inhibitions and have empathy for one other [as do participants at raves]. Examples of therapeutic uses are conflict resolution between couples, particularly when intimacy has been lost and the relationship has become estranged over the years; and in cases involving traumas such as rape where the drug helps the patient to regress and to relive suppressed memories.

Also mentioned is low-dosage use for "creativity-enhancement-oriented sessions. . . There are two ways of using MDMA that may help elicit creativity. In the first, the creative task is attempted during the MDMA session. In the second, the MDMA session is used to generate ideas that later may be applied to the creative task". Painting, sculpting, writing and music are suggested for the first, while the second is suggested for overcoming writer's block.

Another section of the book consists of accounts of experiences taken from another book, Through the Gateway of the Heart31. Other chapters deal with the chemistry and toxicity of the drug. Eisner says that no major toxic effects have shown up in clinical trials of MDMA. This presumably applies to the suggested doses of up to 150 mg.

Eisner makes the interesting observation that "MDMA is a peculiar drug in that there is a small ratio between its threshold dose and a dose that is too large. A larger dose than 200 mg will produce an experience that is more like that of amphetamine - a jittery, anxiety-provoking stimulant high".

Finally, the book contains an excellent 50-page annotated bibliography by Alexander Shulgin. However, that like the rest of the book dates from 1989, and four years is a long time in this field. [Alexander Shulgin tells me that the annotated bibliography is to be omitted from the new edition.]

Other information referred to:

High Reliability: Even without prompting as to effects, at least 90% of those who try MDMA experience . . . a 'heart opening' and a lessening of stress and defensiveness . . .

Brother David Steindl-Rast, a Benedictine monk from the Immaculate Heart Hermitage in Big Sur, tried the drug at a conference on the medical uses of MDMA. Steindl-Rast, who was a psychologist before he entered the monastery, said the drug facilitates the search for the "awakened attitude" all minds seek. "It's like climbing all day in the fog and then suddenly, briefly seeing the mountain peak for the first time," he said. "There are no short cuts to the awakened attitude, and it takes daily work and effort. But the drug gives you a vision, a glimpse of what you are seeking.

6 Ecstasy Information, from Release, a London drug agency

According to these notes, it is not correct to call Ecstasy a designer drug. The term was coined by Dr. Gary Henderson of the University of California to mean 'substances where the psychoactive properties of a drug are retained, but the molecular structure has been altered to avoid prosecution'.

7 Xochipilli: a context for Ecstasy, by Laura Fraser, from Whole Earth Review, 1992

The author criticises two journalists at a party who said that Ecstasy causes a loss of spinal fluid and causes Parkinson's disease.

The journalists were grossly misrepresenting two reports. One concerned a study of MDMA by Dr. George Ricaurte at Stanford University, who examined subjects spinal fluid to determine whether there were residual effects of MDMA. No such effects were found. The other was of drug injectors who contracted Parkinson's disease after injecting a synthetic opiate from a bad batch sold on the street that contained the neurotoxin MPTP. Ecstasy was not involved in any way.

The side effects of Ecstasy were mild: perhaps the worst was a tendency to call up ex-lovers and casual acquaintances and tell them how much you love them. It could also induce inappropriate and unintended "emotional-bond imprinting". Fraser advises taking some calcium and magnesium before MDMA to prevent jaw clench and says MDMA should be avoided by those with heart ailments; glaucoma; hypertension; aneurism or a history of strokes, hepatic or renal disorders, diabetes or hypoglycemia.

8 Differences Between the Mechanism of Action of MDMA, MBDB and the Classic Hallucinogens, by David Nichols, from Journal of Psychoactive Drugs, Vol. 18/4 1986

In this paper it is claimed that MDMA is not a hallucinogen and that its classification as a Class One drug, which is based on it being regarded as a hallucinogen, is therefore incorrect. Nichols says that subjective human trials and tests on rats show MDMA does not have psychedelic properties and that it belongs to a new drug category that he calls "entactogens". He synthesised a new drug called MBDB with an added chemical group that cuts out psychedelic effects. It was similar to MDMA in effect but weaker and therefore also belongs to the new category.

9 Why MDMA Should Not Have Been Made Illegal, by Marsha Rosenbaum and Rick Doblin, from the book The Drug Legalisation Debate

In this article it is argued that with many claims of people benefiting from taking MDMA and few reports of the drug causing damage, its use should not have been outlawed in the US. The effect of making MDMA illegal was to curtail scientific research and to stimulate consumer demand for the drug. The article details the way the law was applied: after nearly 2 years of hearings a judge decided that the drug should be placed in Schedule 3, which is for less-dangerous drugs and would have allowed trials and research to continue. But the Drug Enforcement Agency insisted on MDMA being put into Schedule 1 in spite of widespread objections and challenges to the "dubious legality" of this move.

100 MDMA users were interviewed in depth between 1987 and 1989, i.e. after it was made illegal. The article concludes that the law has made no difference to recreational users' attitudes.

10 Alcohol and Drug Research, Volume 7: Neurotoxicity of MDA and MDMA

This paper argues that the dangers associated with MDA should be assumed to apply with MDMA unless it is proved otherwise. Evidence is given of the two drugs having a similar degree of lethality when they are tested on mice, rats, guinea pigs, dogs and monkeys. The tests used involved the classic test for poisons: trying larger and larger doses on groups of animals until 50% of the animals died within 24 hours. The paper also mentions that both MDA and MDMA killed more mice when they were crowded together, "a phenomenon long associated with amphetamine".

11 Ecstasy Revisited, by Bruce Eisner in Gnosis magazine, winter 1993

This article looks back on the research in the US into the neurotoxicity of MDMA. The idea that MDMA might be neurotoxic was first raised in 1985, when George Ricaurte and Charles Shuster at the University of Chicago performed an experiment in which rats were intravenously given very high doses (ten times the therapeutic dose) of MDA, a drug similar to MDMA, at four hourly intervals over two days. Changes were noted in the nerve terminals where serotonin interfaced with brain neurons, Eisner says. The US Drug Enforcement Agency used this as a pretext for putting MDMA in Schedule 1, the category for the most dangerous drug

12 The Background Chemistry of MDMA, by Alexander Shulgin, from Journal of Psychoactive Drugs, Vol. 18/4 1986

According to this paper, MDMA is less toxic than MDA but more so than mescaline. The lethal dose is between 20 and 100 mg per kilo of body weight depending on the species taking it. With mice, it is 5 times more toxic given in crowded conditions than in isolation. [20mg/kg is equivalent to an adult human taking about 12 Es.]

Shulgin says that research implies some functional role of serotonin in the mechanism of MDMA and that there is evidence that MDA and MDMA have different mechanisms of action. For example there is no cross-tolerance between the two drugs.

He notes that two studies commissioned by the US government on the abuse potential of MDMA showed that monkeys that had been trained to self-administer cocaine tended to "reinforce themselves with MDMA", indicating that MDMA has potential for abuse by hard-drug addicts. But he also points out that press reports and anti-drug usage material often [falsely] attribute to MDMA the effects and dangers of other drugs and that reporters repeat each others' mistakes.

13 Ecstasy, by Miranda Sawer, from Select, July 1992

A long article about the current club scene and Ecstasy users going on to more reliable drugs because of poor quality E. Sawer says that those who used to take multiple Es are now turning to amphetamine instead since the effect is much the same. She gives analyses of 7 samples which were mostly heavily adulterated. "Fantasy" Ecstasy contained 40% LSD, 30% amphetamine and 15% caffeine. "Passion" Ecstasy contained 60% sedative and 15% MDMA. "Californian Sunset" Ecstasy contained 20% amphetamine and 20% sedative. "Rhubarb and Custard" Ecstasy contained 50% barbiturate, 30% MDMA and 20% caffeine. 3 other samples contained no active ingredient at all. She quotes Andrew Bennett, of the Merseyside Drugs, Training and Information Centre, as saying that Merseyside has 20,000 serious abusers, i.e. people who take more than one E a week, and 30,000 who take one at weekends; and Mike Goodman of the London drug agency Release: "Ecstasy should not be a Class 1 drug in the same league as heroin with severe penalties. If you treat people like criminals, they are going to act like them"

14 Interview with Greg Poulter, advice team leader at Release, a London information agency for drug users, on 16/2/93

In the 1970s there was a scare in Britain about hallucinogenic amphetamines before they had even reached the country. The Government responded by classifying the entire chemical family as Class A drugs, before any other country had done so. The Home Office can issue licenses for research into MDMA. There is no pressure group lobbying to liberalise the law on MDMA, as there has been for cannabis.

The maximum penalty in a Crown court for possession of MDMA is 7 years and/or an unlimited fine. For supply of MDMA, the penalties in a Crown court, where such cases are normally heard, can stretch to life imprisonment, an unlimited fine and the seizure of all assets.

In line with Scotland's distinct legal system, the law on MDMA is applied differently there to the rest of Britain. In Scotland, anyone found in possession of MDMA is prosecuted, even if they only have very small quantities. But in England and Wales, and especially in London, the trend is towards cautioning. There is a big difference between 'possession' and 'supply' in the kind and severity of penalties imposed, but no fixed cut off point. People found in possession of only one E have been prosecuted for supply, on the strength of other evidence that they were dealers. Magistrates courts normally deal with possession cases. The usual fine is #15 to #100 for a first offence and for the lowest income groups; #25 to #200 for two different drugs and an increase of some 25% for a second offence. But courts vary in the penalties they impose. Country courts where drugs cases are uncommon probably give the highest sentences; city courts the lowest. Fines are now worked out on a Unit Fine System which is related to the offender's disposable income. Magistrates courts don't generally differentiate between Ecstasy and Amphetamine, even though they are in different classes, but Crown courts do.

Prosecutions on the grounds of supply are nearly always heard in a Crown court. As a general rule, imprisonment is the penalty for those found guilty unless there are mitigating circumstances. For small amounts, offenders are typically sentenced to 18 months to 2 years imprisonment; and for medium quantities the sentence may be 3-5 years. Sentencing also depends on the particular circumstances of the case: one person got 3 years for 3 LSD tablets but there was evidence that he had sold a tablet of LSD to someone who had died as a result of taking it.

The trend towards cautioning offenders is spreading throughout the country. Poulter's advice to those who are arrested is as follows: Ask for a solicitor. Legal assistance is free to people who have been arrested. Police often suggest that suspects admit that what they have been found with is a drug and offer, in exchange, to recommend a caution. However, they may not keep their word. A local solicitor who knows the police can help to avoid this. If police arrive with a warrant, cooperate or you will be charged with an extra offence. But you should ask them for a copy of the warrant and the reason why they are searching.

Police must have reasonable cause for stopping and searching a member of the public. This would not include simply being in a place where drugs have been on sale. They have the power to strip search. If police attempt to strip search you ask them why they are doing it. If their grounds were not legal, the evidence so obtained will be dismissed by the court. Never resist a search physically. Keep calm and negotiate with the police. Intimate search - which includes looking inside any part of your body including the mouth and ears - is only admissible when there is reason to suspect intent to supply class A drugs. If youare intimately searched in the genital or anal area on grounds that are not legal, you could charge the police with indecent assault. You cannot be compelled to give blood or urine for testing.

Recently Ecstasy has been on sale at #8-#12 per pill. In real terms, prices of illicit drugs have fallen steadily over the years without a fall in quality, with the exception of Amphetamine which is now far weaker than it was a few years ago.

Release operates a telephone help line for people accused of drug offences. The agency receives about 21,000 calls a year, of which some 14% are related to Ecstasy. 30% of calls come from non-users such as parents or professionals. About half concern legal matters, and the other half concern the use of drugs and their effects.

Poulter also told me, incorrectly, that Class A drugs cannot be prescribed by doctors and that the maximum penalties in a magistrates court for unlawful possession of MDMA or for supply of MDMA, are 6 months in prison and/or a #2,000 fine. In fact, doctors may prescribe Class A drugs, but may not prescribe Schedule I drugs, a category into which MDMA also falls, while the maximum penalty in a magistrates court is #5,000.

15 22nd report of the Expert Committee on Drug Dependence 1985, published by the World Health Organisation as part of its Technical Report Series

#729, para 2.28 3, 4 Methylenedioxymethamphetamine, [cited in full]

In mice, 3,4 Methylenedioxymethamphetamine (MDMA) increases locomotor activities and produces analgesia. In dogs and monkeys the substance has a pharmacological profile similar to that of other substances already controlled under the Convention on Psychotropic Substances. There are contradictory reports of the hallucinogenic activity of this substance in man. The substance is a potent serotonin-releaser in rat whole-brain synaptosomes. Its toxicological properties have been studied extensively in animals. The acute toxicity of this substance is about twice that of mescaline. No pharmacokinetic data are available.

3,4 Methylenedioxymethamphetamine has discriminative stimulus effects in common with amphetamine but not with 2,5-dimethoxy-4-dimethylbenzeneethanamine (DOM). No data are available concerning its clinical abuse liability, nature and magnitude of associated public health or social problems. The substance is under national control in Canada and the United Kingdom and its control has been proposed in the USA.

The substance has no well-defined therapeutic use, but a number of clinicians in the USA have claimed that it is potentially valuable as a psychotherapeutic agent. No data are available concerning its lawful production. Evidence of illicit trafficking in the substance has been reported from Canada and there have been extensive seizures of the drug in the USA.

On the basis of the data outlined above, it was the consensus of the committee that 3,4 Methylenedioxymethamphetamine met the criteria of article 2, para 4, for the control under the Convention on Psychotropic Substances. Since there is insufficient evidence to indicate that the substance has therapeutic usefulness, the expert committee recommended that it be placed in Schedule 1 of the Convention*.

It should be noted that the Expert Committee held extensive discussions concerning therapeutic usefulness of 3,4 Methylenedioxymethamphetamine. While the Expert Committee found the reports intriguing, it felt that the studies lacked the appropriate methodological design necessary to ascertain the reliability of the observations. There was, however, sufficient interest expressed to recommend that investigations be encouraged to follow up these preliminary findings. To that end, the Expert Committee urged countries to use the provisions of article 7 of the Convention on Psychotropic Substances to facilitate research on this interesting substance.

*One member, Professor Paul Grof (Chairman), felt that the decision on the recommendation should be deferred awaiting, in particular, the data on the substance's potential therapeutic usefulness and that at this time international control isnot warranted.

16 Living with Risk (book), published by the British Medical Association, 1990

This book contains statistics on and evaluations of various risks commonly taken by people in the UK. It includes a comparative list of the risk to an individual of dying in any one year from various causes:

Smoking 10 cigarettes a day: 1 in 200 All natural causes at age 40: 1 in 850 Violence or poisoning: 1 in 3,300 Influenza: 1 in 5,000 Accident on the road: 1 in 8,000 Playing soccer: 1 in 25,000 Accident at home: 1 in 26,000 Hit by lightning: 1 in 10,000,000

The chapter on drug use points out that deaths from illicit drug use in the UK total just over 200 a year compared to the tens of thousands who die annually from alcohol use and tobacco smoking.

It is also pointed out that "heatstroke is becoming a problem in long distance running events . . . In Canada, 1% are admitted to hospital during and after mass-participation runs [marathons]" and that parachuting and hang gliding kill about 3 in 1,000 participants per year.

Almost every psychoactive drug has been regarded by some society as a dire threat to public order and moral standards, while regarded as a source of harmless pleasure by others. Almost every society has one drug whose use is tolerated, while others are regarded with deep suspicion.

17 Ecstasy - The Arrival of a Consciousness-Raising Drug (book), by Arno Adelaars, published by in de Knipscher, 1991

This book is in Dutch only, but may soon be available in English. A new edition is due out in 1993.

It is about his own experience and the history of MDMA in Holland. The first dealer to bring 1,000 Es from the United States in 1985 couldn't get rid of them, even to people who had tried Ecstasy. The early 'E' parties in 1989 were exclusive. People made eye contact, let themselves go out of control and behaved in individually bizarre ways. But when taking E became a mass phenomenon, people started behaving according to others' expectations, and the true individuality and contact was lost. Adelaars sees two distinct types of uses and users: extroverts and introverts; Ken Kesey/Timothy Leary; entertainment/intellectual; party/home. His book contains interviews with both types of users and his advice about using Ecstasy is don't take it unless you are feeling good. He believes the aftereffect of mellowness spreads to other people who you are in contact with. He compares the effect of Ecstasy - feeling relaxed and loose-limbed - to being in love or being on holiday in a tropical country.

The author writes from his own experience of the drug and his knowledge of manufacture and distribution, having visited an MDMA 'factory'. He is also one of the few writers with personal experience of both home and party use.

18 Fax from Home Office, 23/2/93

The Entertainments (Increased Penalties) Act 1990 tightened up the penalties for infringement of the entertainment licensing laws. It increased to a fine of #20,000 and imprisonment for up to six months, or both, the maximum penalties magistrates can impose for certain offences against the entertainment licensing laws in England and Wales. The fine was previously #2,000 or three months imprisonment or both. The offences in question concern the use of a place for entertainment involving music and dancing without the necessary licence which places a limit on the number of people which may be present at the entertainment. In addition, the Criminal Justice Act 1988 (Confiscation Order) gives magistrates the power to make confiscation orders when the profits exceed #10,000.

19 Manchester RIP, Kaleidoscope, BBC Radio 4, 6/2/93

Ecstasy first arrived at the Hacienda club in Manchester in 1988. For ravers that year was a wonderful summer without media or police attention. It was the start of the rave scene which later spread to London and rest of Europe. The first Ecstasy club in London was Spectrum on Monday nights at Heaven. While straight Manchester was unsuccessfully trying to put itself on the map by bidding for the Olympic Games, a couple of bands and DJs had actually made Manchester the fashion centre of Europe for young people and the place where they all wanted to be. By 1991, applications to study in Manchester had risen by 30%. But 1991 was also the year that the atmosphere of peace changed to violence. Gangs started moving in, shooting each other in the battle for dominance in the drugs market.

20 Drug seizures: Britain's growing habit from The Times, 20/1/94

In 1993, 554 Kg of Ecstasy "worth 58m" was seized by customs, double the figure for 1992. The article was sub-headed: "Rave parties increase demand as shipments worth #519m are seized." [Figure refers to all illicit drugs.]

21 A visit to Arno Adelaars, a part-time purchaser of street samples of drugs for testing by the Dutch government. Amsterdam, October 1992

The Dutch government analyses street samples of Ecstasy and other drugs so that they can keep a check on what is being sold. The results are released 2 weeks after the sample was purchased so as to avoid helping dealers. Adelaars says he has never bought anything that turned out to be dangerous, and is sceptical about claims by another drug-purchasing agency that a sample of Ecstasy turned out to be Ketamine. Recently there has been a lot of MDEA sold as Ecstasy.

During the period January 1990 to June 1992, 156 street samples of "Ecstasy" were tested. 83% were tablets, 10% powder and 7% capsules. 61% were found to be MDMA, 4% MDA, 4% MDEA, 6% Amphetamine mixed with caffeine, 6% Amphetamine only, 3% caffeine only. In the remaining 16%, no active ingredient was identified, although the tests were only set up to detect amphetamine, methamphetamine, caffeine, cocaine, heroin, LSD, MDMA, MDA and MDEA.

Of the MDMA samples, 75% contained between 70 and 120 milligrams, though doses of as little as 15mg or as large as 208 mg were found. Generally, over half the samples turn out to be good-quality MDMA, but this has recently fallen to 39% because 18% of samples sold as Ecstasy are now MDEA. Some MDEA is stamped EVE. Adelaars says MDEA lacks the communicative quality of MDMA.

Adelaars has visited a clandestine production lab. Production was carried out by two people, neither of whom was a chemist, but one of whom had medical knowledge. The equipment consisted of an autoclave and a 14,000 rpm mixer. The 200,000 guilder required to set up the lab was provided from criminal sources. The first batch of MDMA took 6 weeks to make - it would take 10 days with the right equipment. Adelaars thought manufacturing Ecstasy was not an easy thing to do unless you had experience. In Holland, the wholesale prices of Ecstasy are: 1 kg (10,000 doses) for

7.50 guilders each; 1000 at 10-12 guilders each; 100 at 12-17; 10 at 20-25. Single tablets are sold at 25-35 guilders.

Tablet making is an art in itself - the right binders are needed to hold the pill together long enough to reach the stomach but not so long that it is shitted out undissolved.

Holland is the obvious place to produce Ecstasy because the law is lenient and the prisons nice. In November 1991, a consignment of 1,200,000 tablets was caught on the way to England concealed in furniture, and it was found to be just one of a series of regular shipments that had been going on for some time. The factory in England was raided - it had ordered enough material for some 50 million Es - but as very little was found it was presumed that most had been used and sold. See also above.20

Adelaars believes those with experience of other drugs have fewer problems with E. Problems arise among young inexperienced users who can't keep their trip under control.

22 Drug Abuse Warning Network (DAWN) figures, published by The U.S. National Institute on Drug Abuse, 1992

The NIDA collects reports of patients attending hospital emergency departments who are suspected of, or admit to having used illicit drugs from across the US. The institute also collects information from coroners and postmortems. As a result, it is able to provide nationwide figures on drugs which present problems. Annual DAWN publications contain analyses of reports of any drug mentioned more than 200 times a year or causing more than 10 deaths. MDMA has never been included in the reports, as it comes 136 in the hierarchy of drugs reported as causing problems. According to DAWN data, MDMA is not a significant drug abuse concern in the US.

The 1992 report also includes a survey of the use of illicit drugs by US college students who are within 1-4 years of leaving high school. There were about half as many illicit drug users in 1990 as in 1980. MDMA was only included in the survey in 1989, 1990 and 1991 and over these three years MDMA use among college students declined. In 1991, 0.2% had used MDMA in the previous 30 days compared to 0.6% in 1990 and 0.3% in 1989. In 1991, 15.2% of the sample had used an illicit drug in the past 30 days, implying that MDMA was used regularly by only 1.3% of illicit drug users.

Figures for drugs used in 1991 show that Ecstasy was used by 0.9% as compared to 2.3% in each of the preceding two years. 29.2% had used some illicit drug in the year; about half as many as in 1980.

23 Young People's Poll, by Harris Research Centre, January 1992

This poll was conducted for the BBC TV programme Reportage. It covered a range of drugs. Interviews took place as respondents entered nightclubs. Only regular club goers were included, i.e. those who said they attended at least once a month. 693 people were interviewed in 11 large cities in UK, 353 male; 340 female. 251 were aged 16-18; 333 aged 19-22; 109 aged 23-25. All social groups were included.

Overall 31% of respondents (men 35%, women 22%) said they had taken Ecstasy (47% in London/South East; 6% in Scotland). 6% thought Ecstasy was safe to use; 5% thought it should be legalised. 29% of 16-22 year-olds and 38% of 23-25 year-olds said they had used Ecstasy. The figure was 46% among married people and cohabitants. 49% said they used Ecstasy frequently and 22% occasionally, and this proportion was constant across all social groups. 33% of respondents said they had taken illegal drugs of some kind and 67% said they had friends who took drugs [this is interpreted by some people to mean that these respondents took drugs themselves but said "friends" so as not to incriminate themselves]. The most popular drug was hash (81%) followed by "LSD/speed/Amphetamine" (35%). [The fact that LSD was lumped together with speed shows the researchers were pretty green.] [A sociologist, Andrew Taylor, who is studying the activities of young people told me he believes that this confirms his observation that the majority of this age group take Ecstasy regardless of social group.]

24 Analgesic safety and efficacy of MDMA in modification of pain and distress of end-stage cancer, Charles Grob et al.

This is a proposal for a clinical investigation of the potential of MDMA as an analgesic for cancer pain. It involves 24 subjects and takes 2 years to complete. It focuses on gathering preliminary data concerning safety and tolerance, the drug's mechanism of action and its safety.

End-stage pancreatic cancer patients have been selected as the most suitable subjects. 24 subjects are needed, all with chronic pain as a result of end-stage pancreatic cancer. 12 patients used as controls are identically treated with placebos (to provide a double blind trial). All receive 4 sessions separated by at least 2 weeks. Dosage is up to 2.3 mg/kg.

25 Laing on Ecstasy by Peter Naysmith International Journal on Drug Policy 1/3.

Laing had taken MDMA at Esalen in 1984 where the drug was being used in couple counselling before it was made illegal.

When the drug was banned Laing said: "What scientists have always been looking for, as Arthur Koestler suggested, is a drug which is not a tranquilliser, an upper or downer, but a stabiliser, just a help to keep one's balance throughout the day. The Californian scientist who synthesised MDMA in the seventies, Dr. Alexander Shulgin, thought he had found such a drug. All I can say is that within the context of its use, among very responsible professionals and therapists in America, all direct reports, including my own, were positive."

"It's my opinion that government agencies, instead of slapping a total ban on this drug should explore it like they do others . . . There's definitely a place for it. It's a pity to see it being cut out like that." Asked to explain why is there a need for drugs such as Ecstasy, he said: "Most of us live within a sort of crypto-delusional structure as to our needs; we haven't quite got it right about love and loving and what other people feel about us . . . which is part of the popularity of this drug. It changes your feeling. But this can also be a danger . . . Under its influence it would be unwise to make [important] decisions there and then . . . as it would over a bottle of whisky."

26 Phenomenology and Sequelae of MDMA use by Dr. Mitchell Liester, Dr. Charles Grob et al., Journal of Nervous and Mental Disease, 180/6 1992.

A study of the immediate, short-term and longer-term effects of MDMA on 20 psychiatrists. The 20 psychiatrists were administered MDMA and then evaluated for side effects, insight gained, pleasure, and the intensity of the experience, taking into account the influence of set, setting and dosage.

The psychiatrists were selected for their prior knowledge of the drug. They all came from Southern California and had an average of six years practice. All had used MDMA at least once. Effects noted during the session (expressed in terms of the percentage of subjects who experienced a given effect) were:

Altered time perception (speeded up or slowed down)          90%
Increased ability to interact with or be open with others    85%
Decreased defensiveness                                      80%
Decreased fear                                               65%
Decreased sense of separation or alienation from others      60%
Changes in visual perception                                 55%
Increased awareness of emotions                              50%
Decreased aggression                                         50%
Speech changes                                               45%
Aware of previously unconscious memories                     40%
Decreased obsessiveness                                      40%
Cognitive changes                                            40%
Decreased restlessness/agitation                             30%
Decreased impulsivity                                        25%
Decreased compulsiveness                                     20%
Decreased anxiety                                            15%
Altered perception of spatial relationships                  15%
Decreased desire for sleep                                   10%
Increased libido                                             10%

Afterwards one member of a couple "focused on how they were defensive with each other" while the other "saw love underneath" actions which they had thought implied that the other partner didn't care. There was a shift away from materialistic values and toward interpersonal relationships. Aftereffects lasting up to a week (observed by at least two subjects):

Decreased sleep                                              40%
Decreased appetite                                           30%
Increased sensitivity to emotions                            25%
Decreased ability to perform mental or physical tasks        20%
Decreased desire to perform mental or physical tasks         20%
Increased ability to interact with or be open with others    20%
Decreased defensiveness                                      20%
Fatigue                                                      15%
Decreased aggression                                         15%
Decreased fear                                               15%
Cognitive changes                                            15%
Depressed mood                                               10%
Decreased obsessiveness                                      10%
Speech changes                                               10%
Increased restlessness/agitation                             10%
Altered perception of time                                   10%
Decreased anxiety                                            10%
Decreased libido                                             10%
Trismus                                                      10%

Effects lasting more than a week

Improved social/interpersonal functioning                    50%
Changes in religious/spiritual orientation or practice       46%
Changes in values or life priorities                         45%
Improved occupational functioning                            40%
Increased ability to interact with or be open with others    35%
Decreased defensiveness                                      30%
Changes in ego boundaries                                    30%
Decreased desire to use alcohol                              25%
Decreased fear                                               20%
Increased sensitivity to emotions                            15%
Increased desire to use hallucinogenic substances            15%
Improved family relationships                                15%
Change in career plans                                       15%
Decreased restlessness                                       10%
Decreased obsessiveness                                      10%

It was also found that there were no changes in the effects of the drug with repeated use, contrary to popular belief. Over half said they believed the drug had a "high potential for use as an adjunct to psychotherapy, particularly in regards to its capacity to enhance empathy".

In conclusion, the drug induced an alteration in consciousness that most subjects felt was pleasant and valuable.

The paper refers to Dowling's report on 5 deaths in which MDMA was detected in the victims' blood, and it is pointed out that in each case there were other potentially lethal medical factors, implying that MDMA may not have been the cause of any of the deaths. The clinical implications of changes in serotonin levels are unclear "inasmuch as there have been no documented clinical cases of MDMA-induced serotonergic toxicity". Fenfluramine "has a significantly greater degree of neurotoxicity."

27 Hands of Light (book), by Barbara Ann Brennan, Bantam, 1988

This book is a guide to spirit healing through the human energy field. In a case history Brennan says, "David came to his last session looking very different. His aura was twice as bright and much larger than usual. The cocoon had opened. I asked what had happened to him. He said that he had taken a drug called MDMA over the weekend. On closer inspection, I could see that the MDMA had opened the left side of the pineal gland. The mucus from the third eye that had been placed there partially from doing pot and LSD was cleared away on the right side. There was still work to be done, but the overall change in David's field was amazing. Since my observations had always shown Psychotropic drugs to have a negative effect on the aura, I asked Heyoan [her spirit guide] about it. He said, 'That depends on who takes it, and what their field configuration is at the time of taking it' Drugs . . . do not cure disease; they assist the individual to cure himself."

28 Subjective reports of the Effects of MDMA in a Clinical Setting by George Greer and Requa Tolbert from Journal of Psychoactive Drugs Vol. 18/4 1986.

This trial was carried out legally in California between 1980 and 1983 following recommendations of the State Medical Board and its findings are the best clinical evidence available on the effects of MDMA. "Because it [MDMA] had been patented in Germany in 1914 and was therefore no longer patentable, no pharmaceutical manufacturer could be found who was interested in sponsoring an Investigating New Drug application with the Food and Drug Administration or in sponsoring research, " the authors say. The primary purpose of the study was to assist the 29 subjects in achieving their particular goals rather than to evaluate MDMA and it therefore does not include 'double-blind' controls, independent evaluations or examination of the physiological effects of MDMA.

Subjects were screened by questionnaire, briefed on the possible side effects of MDMA, and warned not to take part unless they were prepared to deal with any disturbing experience they might have as a result. Those with hypertension, heart disease, hyperthyroidism, diabetes, hypoglycemia, seizure disorder, glaucoma and diminished liver function were not allowed to take part. Pregnant women and people with a psychiatric history were also excluded.

To ensure a secure atmosphere, the following agreements were made:

1. Everyone would remain on the premises until it was mutually agreed that the session was over.

2. The subjects would refrain from any destructive activity.

3. There was to be no sex between therapists and subjects.

4. The subjects were to follow therapists' instructions when they took part in a structured session.

Most sessions were held at people's homes, individually or in groups and couples. The subjects were asked to fast for the preceding 6 hours "to ensure rapid absorption and prevent nausea". Doses varied from 75 to 150 mg according to subjects' body weight and the type of session and a second dose of 50 to 75 mg was offered after about 2 hours in order to "prolong the session and provide a more gradual return to normal consciousness". Sometimes inner experiences on the higher doses were facilitated by instrumental music and eyeshades, with the therapists being attentive and responsive to requests.

About half of the subjects reported that they had minor psychological problems before taking part in the study, including feeling dissatisfied with themselves, being afraid of rejection and lacking self confidence. Some also experienced mild depression, anxiety, sadness at being alone, "normal existential despair" or difficulty in making life choices.

Benefits felt by the subjects during sessions.

All the subjects felt closer and more intimate with all others present and many reported that they were more communicative and were more able to receive both compliments and criticism. All the subjects experienced positive changes in their attitudes or feelings. Three quarters of them reported cognitive benefits such as enhanced mental perspective; insight into personal patterns or problems; and an enhanced ability to understand themselves and resolve issues. Half of the subjects felt warmer, fresher or more alive or reported euphoric or loving feelings. One third of them said that they felt more self-confident and another third felt that their defences were lowered. One quarter said that they went through a therapeutic emotional process during a session. One sixth of subjects said they had had a transcendental experience and a similar fraction reported fewer negative thoughts and feelings. Subjects also reported: feeling more aware more "grounded" and feeling "blessed" and at peace. All of those who tried low doses to improve their creative writing found it "quite useful", with some reporting clear thinking or greater presence of mind.

Undesirable effects felt by the subjects during or after sessions.

Three quarters of the subjects experienced jaw tension or teeth clenching during the session, sometimes accompanied by shaking. For a few subjects these side effects persisted into the following day. Most felt tired afterwards and for half of the subjects this lasted up to 2 days. One quarter felt nauseous for between 5 and 30 minutes. One third found it hard to sleep afterwards, but 10 per cent slept better. Subjects noticed that they sweated, felt cold and lost their appetites during the sessions, but did not regard these reactions as a problem.

In addition to these general side effects, some individuals had a strong negative reaction. A 74-year-old woman who had been given an extremely high dose of 350 mg because she had not responded to lower doses suffered most of the unpleasant effects mentioned above during the session and for two days afterwards. Tension in her jaw lasted even longer and she also experienced a visual illusion. Another subject's appetite increased and they gained weight. A third had difficulty coping with people and had anxiety attacks which caused him to miss work for a week. He said he was not receptive to the sensation of MDMA, though he stressed that the session itself was not the cause of anxiety: "Rather, I think it served to open up some tightly controlled emotions that spilled out in a frightening way." A year later he said: "It probably was a good thing. It speeded up processes that needed to happen". Side effects reported by individual subjects during sessions included: jittery vision, lip swelling, shakiness, numb hands and face, headache and fainting - this last effect occurred when a subject thought about a difficult relationship.

Half the subjects reported undesirable emotional symptoms. 15 per cent felt anxiety or nervousness during the session while 7.5 per cent felt mildly depressed next day. One subject felt paranoid for up to 3 minutes during the session and another felt lonely and sad. Others felt: more emotional, more vulnerable, had a racing mind, felt waves of "emotional crud" or confused about a relationship or indulged in "negative self-talk".

All but one of the subjects set goals for what they wanted to achieve in the sessions before they started. Half felt that these were completely realised, and another quarter felt they were partly realised. This group included subjects who wanted to understand themselves better and, of these, one third were fully satisfied but half made no progress. Of those seeking a mystical experience, three quarters were satisfied. Subjects looking for personal or spiritual growth, self exploration, fun and enjoyment, or closeness with their sexual partners all achieved their aims.

All of those who aimed to change their personalities or resolve particular inner conflicts or experience a different state of consciousness or increase their awareness of their feelings or become less afraid of rejection, felt they had achieved some degree of success.

After the session most subjects felt in a better mood and this typically lasted for a week. One third of them felt more calm and relaxed, while some felt more energetic.

80 per cent of subjects reported positive attitude changes, and for some this lasted for at least two years [the researchers last contact with the subjects was two years after the trials]. Of this 80 per cent, half said they had more self-esteem; half said they were more able to accept negative experiences and were more patient and half said the sessions had changed their beliefs in various positive ways, including seeing death as a change rather than an ending and therefore feeling less afraid of it. Other benefits claimed by subjects ranged from a greater acceptance of others to an appreciation of being alive and feeling they could be more warm and loving.

Nearly all the subjects reported positive, mostly long-lasting, changes in their relationships. This included those whose partners did not take part in the sessions. Two couples who had problems in their relationships before the trials, resolved significant conflicts under MDMA. Negative changes were experienced by the man mentioned earlier who had difficulty coping with people, and some subjects whose relationships were already in decline reported no improvement: one woman felt "more guilt around men for a while" and proceeded from a separation with her husband to a divorce. Many subjects reported that their feelings were stronger after sessions and some said that they now avoid superficial social meetings such as cocktail parties. Conflicts were also resolved with non-partners and a variety of other improvements including self esteem and empathy with others were reported.

Half the subjects reported positive changes at work for a week or so after sessions, such as: feeling less tense and driven, having more fun, having energy to spare and getting along better with others. 20 per cent of subjects reported new personal interests, from hobbies to creative writing and spiritual growth. Some of them said MDMA-like states occurred during meditation and one man who used to meditate before he took part in the study said that taking MDMA had improved his meditation.

Half the subjects said they used drugs less (including alcohol and caffeine) but ten per cent said they used more. Those who used less drugs, turned away from drugs per se: they did not swap one drug in favour of another. However one woman said she would take only MDMA in future "because she learnt from it".

Half the subjects changed some of their 'life goals' after sessions, and all of these implied the change was positive. Most involved a shift away from materialism and towards spirituality or wellbeing.

Half the subjects found they were released from attitudes that prevented them from actualizing their potential. Half of these said they had gained lasting insight into their psychological problems; three felt less guilty about enjoying themselves and two became less "self-limiting". One said he had got rid of "a load of rubbish he had been carrying around"; another felt less anxiety and another felt less self-conscious.

In the discussion, the authors conclude that MDMA may "predispose people to a recurrence of previous psychological disabilities". They also note that people "who want MDMA to cure their problems" make poor subjects, while those who want to use it to learn about themselves are most suitable. Their main conclusion is that "the single best use of MDMA is to facilitate more direct communication between people involved in a significant emotional relationship". They also recommended MDMA as an adjunct to insight-orientated psychotherapy, and for promoting self-understanding and spiritual and personal growth.

29 MDMA Reconsidered, by Robert Leverant, from Journal of Psychoactive Drugs, Vol. 18/4 1986

This paper reports views on MDMA expressed at a conference for informed lay users of the drug held by the Haight Ashbury Free Medical Clinic in May 1986. Conference discussion topics included how MDMA compares with hallucinogens and whether these drugs should be available for therapeutic use and, if so, under what conditions.

While extremely useful for psychotherapy, MDMA is deceptive for the spiritual therapy whose ends are complete freedom and autonomy as delineated by Buddhism, Hinduism and other mystic traditions. This necessitates the death of the mind. . . Unlike the stronger psychedelics, MDMA does not encourage glimpsing this last development of Love's unfolding. . .

Perhaps MDMA's greatest potential in therapy is nonverbal. [It could aid body therapies that utilize] the attention, the breath, sound, and hand pressure to open up and remove blocks that prevent contact with the life force within [the body] and hinder the =E9lan vital from flowing.

30 Visit to Dr. John Henry at the National Poisons Unit at Guy's Hospital, London, 11/12/92

The unit offers a 24-hour telephone enquiry service to doctors throughout the UK who are presented with symptoms that they cannot clearly identify. All telephone enquirers are asked to send blood and urine samples for testing, which is usually carried out using one of three types of chromatography. Most samples are taken from live patients, but some are taken during a post mortem. Some drugs are easier to detect through blood and urine samples than others. Cannabis "can be detected 5 weeks after a single reefer"; LSD is very hard to detect.

Recently, a large proportion of samples of Ecstasy sent in for testing have been found to contain MDEA instead of MDMA. Dr. Henry thinks MDEA is less toxic than MDMA because it produces less jaw clench.

Asked what advance symptoms people who have taken MDMA should look out for as signs of the onset of overheating, Dr. Henry said that excessive sweating, staggering, thirst and exhaustion were the main symptoms. He said that overheating was unlikely to occur if enough water was drunk. Dr. Henry said that he believes that MDMA stimulates opiods, a neurotransmitter that acts as an internal anaesthetic. Opiods go into action when people bruise themselves badly playing football. Dr. Henry compares dancing at a rave with running a marathon - it involves four hours of exhausting exercise.

Neurotransmitters such as 5HT and opiods can be stimulated either by chemicals such as MDMA or by feelings of excitement. Dr. Henry says that this could explain why people who go to raves without taking drugs pick up on the same mood: the environment may cause them to produce their own neurotransmitters and this affects their mood.

Asked about the dangers of Paracetamol relative to those of MDMA, Dr. Henry said that Paracetamol causes over 200 deaths a year, but is very safe in normal doses. Overdosing affects the liver, and can cause death at doses of between 15 and 200 tablets. He said that MDMA is broken down by the liver into MDA and metabolites, which are excreted by the kidneys into the urine.

I asked Dr. Henry what evidence there was of a link between liver damage and Ecstasy use, mentioning that liver damage associated with Ecstasy use has not been reported in the USA and suggesting that cases in Britain might be the result of parallel use of alcohol or other drugs. Dr. Henry said that he has no doubt that MDMA causes hepatitis because some patients have exhibited the symptoms of hepatitis after each of several ingestions of MDMA.

I also asked about kidney failure (or 'acute renal failure' as reported in the medical journals) associated with Ecstasy use. Dr. Henry said that he believes this is the result of muscular breakdown overloading the kidneys with myoglobin. Muscular breakdown can also be caused by intense bouts of physical exercise.

Dr. Henry explained the mechanism of heatstroke. Dissolute Intravascular Coagulation (DIC) - blood clotting in the arteries - occurs at 42-43 degrees C (c.108 degrees F) and tiny blood clots stick to the artery walls. This is harmless in itself, as the blood clots are too small to cause a blockage, but the process can use up all the clotting agent, with the result that the blood will pour out of any of the tiny haemorrhages which occur throughout the cardiovascular system as part of the normal process of breakdown and repair. Such internal bleeding can be fatal. Internal bleeding in the brain, combined with high, pulsating blood pressure can cause strokes.

Out of all the millions of brain cells only 10,000 hold the chemical serotonin which is affected by MDMA. Serotonin levels have a marked effect on mood and a statistically significant proportion of suicide victims have been found to have depleted serotonin. Antidepressants of the SSRI type such as Prozac (Fluoxetine) inhibit the re-uptake of serotonin.

I asked Dr. Sheila Dorling, a lab researcher at the National Poisons Unit, what had been found in samples of E besides MDMA and MDEA. She said some MDA had been found plus various available drugs such as paracetamol and codeine; other samples only contained amphetamine. None contained LSD. The poisons unit does not analyse many Ecstasy pills.

31 Through the Gateway of the Heart (book) published by Four Trees Publications, San Francisco 1985

This book is a collection of some 60 subjective accounts of positive experiences by users and "guidelines for the sacramental use of empathogenic substances". The accounts are divided into men's, women's and group experiences.

Typically, the accounts are by well educated people in their thirties who are 'into their feelings' and 'seeking awareness'. But there is also the story of a 45 year-old man who was deeply in pain from arthritis entitled: "Now I see pain as an ally, not as an enemy" and the account of a 33 year-old woman who had been raped 8 years previously. She took 65mg of MDMA, followed two hours later by 300 =B5g of LSD. The suppressed horror of the rape scene came back so vividly that she mistook the person she was with for the rapist, which, she says, helped her to get over the rape. She vomited a great deal then and later, as though getting rid of her disgust at the incident.

The guidelines section is compiled from the collective experience of about twenty or thirty therapists who have used MDMA in their work. Suggestions include that participants should agree to ban sexual contact (even between those who are already lovers) and that 'power objects' such as crystals or photos of relevant people be brought to sessions.

A serene and comfortable room is suggested and "a fire in the fireplace serves as a reminder of the alchemical fires of inner purification". Lower doses of MDMA could be taken outdoors. The slower baroque music of Bach or Vivaldi became favourites with therapists. People guiding others through an MDMA experience should conduct themselves with integrity and sensitivity and avoid being caught up in verbal exchanges, as "most people are able to do their own best therapy in these states".

It is suggested that practices such as making affirmations, yoga, "guided imagery" and "shamanic journey work" can aid the therapeutic process triggered by MDMA.

The guidelines present two models for group sessions. In the first, people stay separate during the session, but share experiences before and afterwards. They listen to music on earphones and communicate only with the group's guides.

In the second, users communicate during the session in a ritual fashion. These sessions are usually residential and some are held at night. Typically, the group will assemble on a Friday evening, when they share their intentions for the trip. The session will start on Saturday morning; the group will spend Saturday night together and get together on Sunday morning for a final sharing of their experiences. All participants have to agree to keep all the proceedings confidential.

Sometimes MDMA will be combined with either LSD, psychedelic mushrooms, Ketamine or 2CB by some or all of the participants. Most therapists say it is necessary for participants to have previous experience of taking the relevant drug on their own. A typical session lasts 40 minutes, starting with inner exploration accompanied by music, andproceeding to people giving monologues or singing into a conch shell.

Other rituals that may be drawn up include: each participant finding their own "power spot" before the session; offering prayers to the 4 directions; group "rebirthing"; breathing activities or movement disciplines such as Tai Chi. Rituals worked best on low doses.

32 A researcher reports from the rave by Russell Newcombe, Druglink, January 1992

Many take 2 tablets, optimal dose for maximum psychoactive effect at usual strength; a substantial minority take between 3 and 10 while a few 'more sensitive or smaller people' only half. . .

Many claim that regular raving and/or use of Ecstasy has improved their general mental state and their relationships with others. . .

Reports on people who have tried E in other situations often indicate somewhat different experiences, including more unpleasant aftereffects. It could be that increases in oxygen, endorphins and other substances in the body caused by vigorous activity interact with MDMA to produce experiences different from when the body is relaxed.

33 The Use of Ecstasy and Dance Drugs at Rave Parties and Clubs: Some Problems and Solutions, by Dr. Russell Newcombe, paper presented at a symposium on Ecstasy, Leeds, November 1992

Newcombe says the use of E, 'acid' and 'speed' has spread dramatically - and into most social groups - over the last 5 years, largely because of their popularity as dance drugs on the rave scene, the dominant subculture of the 1990s. About 2 million people are estimated to have taken dance drugs at raves including at least 750,000 who have taken MDMA. The aim is to partake in an altered state of group consciousness by dancing for long periods on E. The risks involved in using E are exacerbated at raves by the nature of the drug dealing that takes place, e.g. imposter drugs being sold, the setting, which can cause heatstroke, the response of the authorities, where clubs are closed leading to more illegal raves, and mass media coverage (implying drug scares promote drug use).

Reports of deaths and psychological disturbances related to Ecstasy use are becoming more common, although there is little evidence that taking Ecstasy is any more risky than alternative leisure activities.

Dr. Newcombe argues that the authorities should take a pragmatic policy towards the rave scene, which focuses on reducing the threat to public order and public health. At the local level, this implies setting up multi-agency groups to develop a model of good practice for rave events.

He says that four matters require urgent attention:

1. The development of an agreed policy towards rave nightclubs and parties

2. The regulation of security staff

3. The reduction of organised drug supply and

4. The development of healthcare services for ravers, particularly risk-reduction information and on-site outreach work.

The paper gives comparative figures - drawn from a 1992 Home Office bulletin - of the number of seizures and convictions involving dance drugs in the UK in 1981 and in 1991.

             number of seizures  quantity of seizures  number of convictions
             1981      1991      1981      1991        1981      1991

amphetamine  1,117     6,821     18kg      421kg       1,074     3,532

LSD            384     1,636      n/a       170d         345     1,200

MDMA             0     1,735        0       365d           0       559

(d -- thousand doses)

Newcombe estimates that over 100,000 young adults attend raves every weekend. A national survey of 24,000 secondary school children in 1991 found record levels of drug use. Among 15-16 year-olds, 10% had used cannabis; 7% LSD; 7% amphetamine and 4% MDMA (Balding 1992).48 Drug use is higher with older groups.

Dr. Newcombe suggests that the rave can be seen as a religious ceremony with the mixing desk as the altar and the DJs as priests. The DJs mix records in response to the dancers to build up to a high. This peak orgasmic 'trance dance' atmosphere is called 'kicking', 'mental' or 'happening'.

The raver's main aim is to dance and other activities such as conversation and sexual behaviour are correspondingly reduced. Raving can be seen as worshipping the god of altered consciousness. There is a virtual absence of aggressive or disorderly behaviour at raves, partly due to very low consumption of alcohol and partly due to drug use.

House music has developed into various styles: Techno music is favoured by those who like maximum chemical stimulation. Ambient music is more peaceful but just as powerful.

Relatively few harmful effects have been established as resulting from MDMA use, compared to other popular drugs such as alcohol, tobacco, prescribed drugs, Paracetamol and solvents, even taking into account the wider use of these. Statistically, the risk of death is no greater than that involved in other leisure pursuits.

Drug dealing at raves

Security staff cannot legally strip-search customers, so dealers can easily smuggle drugs in their underwear. Women are sometimes used to carry drugs in as they are less likely to be carefully searched because most security staff are men. A woman can carry several hundred Es in her vagina. There are two types of dealing organisations: 'mutual societies' which are groups who distribute to friends without making a profit; and organised gangs. The latter employ specialists: "smugglers" who get the drugs into the rave; "carriers" who hold drugs and money; "snarlers" who are the salesmen; "lookouts" who watch out for police; and "minders" who provide physical protection. Sometimes security staff are involved by offering protection to gangs for a percentage ("taxing"). This protection includes giving warnings and cutting out competition. It is gangs who are most likely to sell bad quality drugs, Dr. Newcombe says, and he suggests that the police should focus on these and ignore the mutual societies.

Safety and security problems

Minor problems such as bruised feet and fainting result from overcrowding; bad management creates problems such as locked fire exits, slippery floors, broken glass and poor ventilation.

However, illegal raves have a far greater potential for disaster due to: poor fire access, factors such as the absence of lighting apart from strobes, lethal substances being sold as drugs. Crushing due to panic from an emergency, police raid or a fire could cause a major disaster in an illegal rave.

The response of police and local authorities

Because the authorities close down clubs where drugs are used, customers are driven to other venues which are less experienced in handling ravers or to illegal events. This puts ravers at a higher risk. Police raids on large events could trigger a Hillsborough type disaster, Newcombe maintains.

The financial cost of a trial of 12 people who held an illegal rave in Warrington in 1990 was over #250,000. The average cost of policing a large illegal rave is #10-20,000.

Suggestions for new policies

Dr. Newcombe's main suggestion is to develop guidelines for authorities. "It would be unrealistic to expect any strategy to reduce substantially the use of drugs at raves," he says. Authorities should not close clubs on the grounds of drug use; instead they should cooperate with the management to reduce problems. Security staff should be regulated (this is done by some authorities). Police should focus their attention on drug-dealing gangs. Information should be provided on the content of the latest drug seizures.

34 Recreational MDMA use in Sydney: a profile of Ecstasy users and their experiences with the drug, by Nadia Solowij et al., in the British Journal of Addiction, 1992

100 Ecstasy users responded to a survey distributed through a 'snowball' peer network in 1991. The authors found that Ecstasy was mainly used for fun at dance parties and social gatherings and its perceived effects were a 'positive mood state' and feelings of intimacy and closeness to others. Secondary effects included: acting as a stimulant, giving insights and enhancing perception and sensuality. Side effects and residual effects were not consistent but no worse than for amphetamines and psychedelics. 80% of users agreed that Ecstasy was fun to use; 13% were neutral and 7% disagreed. 28% reported that they had had problems with taking E. Of those who had taken Ecstasy between one and three times, 75% described it as pleasant and enjoyable. 58% would recommend it to others.

The authors conclude that Ecstasy is not conducive to regular and frequent use because of tolerance to its positive effects while its negative effects increased. There had been few problems associated with Ecstasy use, but caution should be observed until the level of risk the drug poses to humans is established.

35 Fit for anything, by Sarah Champion, The Guardian, 12/4/93

A feature article about fitness culture and raving. Sheila Henderson, a researcher at Lifeline, the Manchester drug agency, is quoted as saying that young women who want to keep fit and look good can either go to the gym or go to a rave as the two have similar effects. However, while the gym is agony, raving is fun and as a result many young women are becoming ravers.

36 Nutrients for blocking phenethylamine damage, by Dr. Brian Leibovitz, in MAPS newsletter, Spring 1993

Studies in the last few years have established that phenethylamines such as MDMA can undergo 'redox cycling', a process that liberates copious quantities of oxygen free radicals. Excessive amounts overwhelm the system and damage ensues. "Phenethylamines are stored in highest concentrations in the brain and nervous system. Not surprisingly, these tissues are at the greatest risk for being harmed by free radicals (and associated oxidants) formed during the redox cycling of phenethylamines. Moderate intakes appear to be handled well. Excessive quantities, however, may cause oxidative damage. It would therefore be prudent for those taking large amounts of MDMA to take antioxidant supplements as well. These include vitamin C which is water soluble, and vitamin E which is fat soluble. The suggested preventative dose is 2-4 gms vitamin C and 1,000 IU vitamin E. Also recommended are S-Carotene (5mg); Bioflavonoids (2gm); L-Carnitine (1gm); N-Acetylcysteine (2gm) and Selenium (250 ug). Leibovitz recommends 3 times these doses for treatment.

37 The Phenomenology of Ecstasy Use, by Teresa O'Dwyer, Senior Registrar of Adult Psychiatry at St Thomas' Hospital, Morpeth, November 92

This paper is an account of a study of users' experiences on Ecstasy and the patterns and circumstances of their use undertaken by the Leeds Addiction Unit between January and September 1992. 33 subjects aged between 16 and 27 - mostly male - were referred by the LAU and given a questionnaire, part of which they completed themselves and part of which was filled in by researchers.

70% of respondents used Ecstasy on weekends only. Half had tried it only once. 31% had never taken more than one E at a time, but 12% had used over 7. During the onset of the drug, the apprehension felt by inexperienced users sometimes developed into panic. Many said it was essential to feel very hot to get the full effect of the drug. To this end, a group of friends once drove around in a car with the heater on.

All respondents described an increase in social interaction under MDMA, an increased ability to approach and relate to strangers, and an enhanced ability to express affection. The drug also seemed to produce an attitude of recklessness where users had little concern about the consequences of what they were doing, although only two had had accidents.

Thoughts about sex when on E were not always matched by real desire. Establishing a 'meaningful relationship' was felt to be an essential part of foreplay. Some found sex while on Ecstasy disappointing while for others it was enhanced.

The name 'Ecstasy' was regarded as appropriate by many respondents. Their comments on the mood induced by the drug included "I cried for joy", "It's the best feeling you could ever have", "Like I've just been woken from a dream to really experience life". Some felt privileged to have had the E experience, and one respondent expressed this by saying "We have a secret that no-one else has".

A depressed mood is reported by most users as the after effect of taking E and this sometimes lasted for a couple of days. Paranoia was reported by 85%. "For many, this began as an awareness of beingadmired by others. Gradually as the weeks passed, this admiring regard changed to critical scrutiny and ridicule. Increased sensitivity to comments and a tendency to interpret situations in a threatening way was described by some," O'Dwyer says. Most people experienced a hangover lasting from 12 to 24 hours, but for some this lasted for up to a week.

The thoughts most frequently reported on E relate to music, dancing and affection for companions. 60% felt E had changed the way they looked at their life. Over half 'felt that while under the influence of Ecstasy they could see a new significance in current and past events'. Over half reported losing personal interests including sport and drinking, but a third said they gained new interests, such as music and clothes. Thinking could become focused but was also sometimes distracted: "The most elaborate, complicated solutions are arrived at only to find that the initial problem is now forgotten," O'Dwyer said.

76% of respondents had lost weight averaging one stone through taking E. All frequent users reported that they became tolerant to Ecstasy. To maintain the effect, they had to increase the dose, but this also increased the side effects of nausea, cramp, depression and paranoia. Some took a break from using the drug for a few weeks for this reason. 58% of respondents said they had stopped using Ecstasy. The most common reasons given were that it was no longer providing enough pleasure; it had caused problems due to the associated lifestyle of all-night raving or it caused paranoia or concerns about health. 30% reported social problems such as losing their job or the break-up of a relationship following using E. Most felt that the quality of the drug had deteriorated.

38 Entry in Micromedex, vol. 75, a hospital database printout from the National Poisons Unit at Guy's Hospital, London

This entry says that evidence that MDMA is neurotoxic is controversial. Behavioural alterations have been observed in rats given high doses, but the rats' behaviour has returned to normal after 4 weeks.

It reports two cases of lead poisoning resulting from Ecstasy use, which are put down to toxic by-products of MDMA manufacture. Lead acetate is a component of one synthesis procedure.

Urinary excretion of unchanged MDMA and its metabolites is complete within 24 hours. 65% of the dose is excreted unchanged in the urine and 7% as MDA. Release of dopamine in rats is greatest with MDA, less with MDMA and least with MDEA. Dopamine release may relate to amphetamine-like side effects.

39 Drugs and Magic, edited by George Andrews, published by Panther, 1975

Andrews mentions that the reindeer hunters of the Middle Anadyr, Siberia, used Fly Agaric mushrooms and when there was a shortage of the mushrooms would drink cupfuls of each other's urine without inhibition to prolong the effect.

40 A visit to Lifeline, a non-statutory drug agency in Manchester, 3 August 1992

Lifeline is 21 years old and has 35 full time employees. All its funding comes from the government and most of its work consists of counselling opiate users. But when the rave scene started in about 1990, senior staff became interested in Ecstasy, and Lifeline now has five staff working on projects related to the drug.

Ian Wardle, the agency's acting director, guesses that a million Es are taken every week. He says the latest fashion is high doses of LSD and strong grass: until recently an LSD dose was 50-80 ug but the new 'high' dose is about 150 ug. [The normal dose in the sixties was said to be 250 ug.]

Mark Gilman, a Lifeline researcher looking at the way groups of football supporters in Manchester have converted from alcohol to Ecstasy, tells me that football supporters used to meet in a pub after the game to place bulk orders. He says they would have stayed with E but for the quality falling. The way they bought the tablets, such as meeting the dealer in a motorway service station, gave them no chance to test the quality.

Lifeline workers say that the following prices are the norm in Manchester: LSD #3 each or #1 each by the hundred. Ecstasy #15 each or 10 for #120; #8 each by the hundred; #3-#5 by the thousand. As with LSD, the price of Ecstasy has remained the same over the years, defying inflation. Likewise, Amphetamine Sulphate sells at #10/gm. a price that has remained the same for years. The bulk price has gone down: it is now #100/oz but the amphetamine is also more diluted.

The typical "weekend drug budget" for a working class northerner is 1 gm amphetamine plus 2 Es. Multiple E use - or "stacking" - occurs, but few people take more than 3 Es, and the maximum is 6. There has recently been a switch away from Ecstasy and towards LSD for health reasons, since E is believed to be toxic. Another reason for choosing acid is that the dose is so small that it is not possible to adulterate it. Lab tests to analyse drugs cost about #60 per hour, which is usually long enough for about 3 tests.

Gilman says that club owners are becoming more responsible and looking after clients who get into trouble, such as "spinners" - dancers that go out of control. These tend to be asthmatics.

There is a big demand for information from Ecstasy users. Gilman is often faced with questions such as "Why do I feel fucking weird after E but not after speed?" He tried to make a "Raver's guide to neurology" using 'pint pot' analogies, but it proved too difficult to combine easy-to-understand information with accuracy.

Dr. John Merrill, a consultant with the Regional Drug Dependence Service at Prestwich Hospital, says toxicity associated with MDMA is caused by overheating. This causes minute blood clots to form which can cause a stroke and internal bleeding. Body heat is increased by activity, so MDMA is probably not toxic when the user remains still. If someone is overheating, first aid should include cooling the body.

Amphetamine and Ecstasy delay male ejaculation in sex, but Ecstasy is reputed to enhance sexual pleasure after a trip. Many traditional working class men go out to raves without their partners, and although the women don't like this their compensation is good sex after the men come down. Dr. Merrill says that the hot sweaty environment found at raves, combined with fatigue and loss of appetite is conducive to the transmission of viruses.

MDEA is also now available in Manchester. Wardle believes it may have killed several people.

41 Women, sexuality and Ecstasy Use - The Final Report 1993, by Sheila Henderson, published by Lifeline, 101 Oldham St Manchester M4 1LW at #15+#1.50 postage.

From October 1991 to October 1993, Sheila Henderson conducted research into young women, sex and drugs in the 1990's popular culture for Lifeline in association with the North West Regional Drugs Training Unit and the Centre for Research on the Social Aspects of Health at Manchester University. The project is funded by the North West Regional Health Authority. The report includes The Main Study with sections on Nature and extent of drug use, Gender and drug use, Sexuality, Drugs and sexuality, Young women' cultural reference points. In addition, the report includes Luvdup and DeElited below (reference 41) and the Ecstasy Study (reference 182).

Henderson looks at the gender dimensions of recreational drug use and especially attitudes to and experiences of sex and sexuality. She is trying to identify the "cultural reference points" - from magazines to music - of young women who take drugs recreationally and focuses on "the rave phenomenon that is flooding popular culture".

Unlike previous work on illicit drugs, this study includes the possible benefits of drug use such as the pleasure and fun that may be had under the influence of drugs. The initial findings are based on 6 in-depth interviews, 47 questionnaires and 15 background in-depth interviews etc. The fashion among female Ecstasy users at the time was skimpy lycra as well as styles such as rubber, PVC and leather borrowed from the gay scene. Madonna was a strong influence in popularising music forms and was an example of a woman borrowing the fashion of the gay scene. Even negatively-biased media reports have been good publicity for Ecstasy, Henderson maintains.

Sex is not one of the foremost pleasures offered by Ecstasy. The motivation for raving is more likely to be sensations of the mind, body and soul. The pleasure of dancing with expression and empathy pushes sex into the background. Henderson says that the attraction of raves for women derives from being in a pleasurable group setting, from which the pressure towards and emphasis on sex from men has been removed, in contrast to alcohol-based night life. Interviews indicated that sex is the last thing women have in mind when going to a rave.

The sexual safety of raves is an attraction for girls, compared to alcohol-based clubs, which are seen as cattle markets. Girls sometimes enjoy kissing at raves because it feels good but is 'safe', i.e. is not going to involve sex.

People at raves are more tolerant of a display of homosexual affection. Most women said they had no casual sex on the night of a rave and others said less than when they used to go to alcohol-based clubs. A few women said that after an E trip was an ideal time to have "long, slow sex" along with some hash.

Women seemed more prepared to take risks over taking drugs than over having sex. After their first E, they were likely to take it frequently.

According to Henderson, one reason why women are not into sex at raves is that men on Ecstasy have less interest in sex and do not expect sex. Most men have the opposite to an erection: a shrinking penis. One girl reported being with other girls walking through a dangerous part of the city when they were approached by a gang of men. They were scared until they realised the men were on E, "then heaved a sigh of relief."

Drugs are an intrinsic part of rave culture. Most interviewees couldn't imagine going to a rave without taking at least one of the dance drugs. These included cannabis, magic mushrooms, LSD and amphetamine besides Ecstasy. Ecstasy was the drug of choice, though at only #2-#3 LSD was also popular.

One said: "When you're on E it's like you're dancing on the notes, and you just feel so up there it's like heaven. And you just feel so good, you love everybody, you look around and you think 'Oh you're all wonderful! DJ, you're wonderful!' If you get a good song on, you get vibes going through your body like rushes; it's fantastic. I've never felt anything like it!" Asked to rate the best experiences in her life, the same girl replied "First E, music and dancing, then sex."

Drugs were the primary reason given for involvement in the rave scene by only 6%. Another 6% were involved in the culture without taking drugs other than cannabis. 75% had used cannabis before getting involved, but only 2% had previously tried Ecstasy. 90% of a sample of women had been through periods of weekly use, frequently following their first experience.

Early in the study, alcohol drinkers were looked down on and referred to as "beer monsters". However, towards the end drinking alcohol was often combined with Ecstasy, in spite of worse hangovers.

Belonging to a wide family and feeling secure is another important attraction of raving. "The first time I took E, I was with this bloke and I just looked at him and I thought 'Oh I can't, don't wanna be with him any more' and that was it. 'Cos there were so many other people and I just felt so confident and you could tell them what you want and be/do anything." However, relationships also form on E as told by a 17 year-old girl: "The emotional impact of E is more of a problem than the physical [one] in my experience. It's frightening how close you become to someone you do Es with, but it's an exaggeration of what you already feel for them". Others describe strong feelings for someone met at a rave, who they do not find to be attractive when seen again elsewhere.

'Policing'. According to Henderson, an important factor determining extent of drug use was that individuals tended to monitor themselves and their peer group. By this she implied looking after and advising one another when to modify drug use.

Menstruation. A quarter of the women who used Ecstasy weekly for over six months reported lighter or less frequent periods and sometimes no periods at all for several months. There is no reason to suspect this is due to a direct effect of the drug, but is likely to be the result of indirect effects - suppressed appetite, sweating and all night exercise.

42 Luvdup and DeElited, by Sheila Henderson, researcher for Lifeline, a non-statutory drug agency in Manchester. A paper given at South Bank Polytechnic in May 1992

This paper discusses women and drugs. Information is based on individual and group interviews with 109 young women and 35 men.

Henderson says Ecstasy users are distinct from opiate users in several ways: for example, they take the drug in public, not private. They do not regard junkies as antiheroes.

Women on the rave scene are even less informed about drugs than men. They are also less likely to be body-searched on their way into clubs. Although in some ways women behave in a more liberated way in the rave scene, it is hard for them to become DJs, the pivotal figures in the rave scene, and they still use their appearance to get into clubs.

More liberated behaviour includes being less likely to be closely tied to a boyfriend. Instead women will come with a group of friends, often without any men. The atmosphere of the rave inspires confidence and independence, for instance it is common for women to mix outside their own group of friends. This has provided a way for young women to rise above being a visual/sexual object. Dealing in E has also provided status for some girls. Outside the rave scene, girls described as 'ravers' are often regarded as sexually available, mainly because of their dress, but within the rave they are not hassled except by men on alcohol. Girls don't feel threatened by men who approach them at raves and therefore are free to respond. "I used to go to indie clubs which are alcohol orientated . . . there was a definite pressure to cop off with people at this type of club. At house clubs it's much more just getting to know people," Henderson quotes one as saying. The general consensus is that "you don't go to a rave to cop [copulate]". This is based on men not getting erections on Ecstasy. Women generally feel far less sexual pressure at raves. They can be massaged by a strange man on the dance floor without it being a threatening prelude to a sexual advance. Flirting is not socially acceptable at raves and is not responded to. Even men encountered on the street are not perceived as a threat, if the women discover that they are on Ecstasy. However, women do not appear to feel less sexy on E and sometimes initiate sexual activity.

Sexual divisions are blurred at raves and displays of affection are accepted. Women are free to hug each other and gays and lesbians are accepted.

43 The Adam Experience, a guide for first-time users, by Starfire, 1985

A seven page pamphlet published anonymously. It gives the following advice: Plan the trip to be free of expectations, duties, tasks or interruptions. Saturday morning is suggested for those who work normal hours. Put aside the whole day and do not drive - it is said this is probably unnecessary but allows for strong reactions. Allow Sunday off too and regard the weekend as a retreat. It is best to take MDMA with someone who has taken it themselves and "above all, is loved and trusted by you". Emotional and psychic bonding can result, so be choosy. Prepare yourself by fasting if this feels comfortable, otherwise avoid solid foods for the preceding 4 hours. Get good sleep the night before. The better you feel, the better the effect.

Doses should be proportional to your weight: 125 mg is ideal for 150-180lbs. A booster 2hrs after ingesting the drug will prolong the plateau for upwards of 6 hours, but this is not really recommended on your first trip as the effect is usually very powerful anyway. The booster dose should be 1/3 of the initial dose.

Take MDMA as if it were a sacrament. Meditate on the fact that you are about to experience something special. During the first half hour it has no effect, so usethis time positively for intimate talk about your hopes and expectations. Focus on shelving or letting go of mundane concerns and trivial upsets.

With an empty stomach you will feel a definite rush, experienced as a clear certainty of your own perfectness and connectedness.

Focus on surrendering to the experience. Let go. Laugh, cry or hug your partner or yourself. Let it be easy and share what you are feeling with your partner, because that's what the experience is all about - sharing, healing, loving.

You will notice minor, harmless effects: dilation of the pupils; increase in pulse; sometimes jaw clenching and eye wiggle and a marked loss of appetite which may last 24 hours. Don't worry if these do not occur. The plateau phase gives you feelings of peace, calm and certainty and lasts from 1 to 6 hours. Use this time to experiment, touch and feel. Looking into your partner's eyes is a profound experience.

If appropriate, you may express your feelings with your partner sexually. The drug is not an aphrodisiac, but it does eliminate barriers. It can aid bonding between people. Sexual experience only occurs when it is appropriate on a heart level for both of you. There may be no desire for sex even with a lover. Know that whatever you choose to create will be a perfect and appropriate choice.

Ecstasy does not normally give 'stoned' feelings, distortions or disorientation. There is no delusion: everything experienced will be just as clear afterwards. Therefore MDMA is a learning tool of immense power. When they use E creatively people change: they get calmer, happier and less tense; more willing to be honest, laugh and to love themselves.

During the plateau phase, it is possible to communicate from a much deeper place. Make use of this: say what you feel. You will find it is OK not to censure yourself. This experience of unconditional communication is transformative at a very deep level. Feel this. Learn this. Talk about it, especially everything you couldn't talk about normally. And let your partner know of your acceptance of his or her thoughts and feelings as well. Suggest saying to each other from time to time: What are we learning? Try to fix in your mind the perfect simplicity of what you are learning. This will be available for you the next day and from then on.

You may not be aware of it, but your body is working harder. Look after yourself, drink plenty of water

Difficult trips may result from the release of unexpected emotions. Sometimes the whole trip will be a reliving of unexpressed negative feelings. This may be painful but it can be profoundly valuable. An understanding, patient and loving partner is needed, but there is no such thing as a bad trip on Ecstasy. There is often a release of negativity followed by relief and joy, although this may not follow until your next trip.

A unique effect of Ecstasy is its afterglow, which may occur from 6 hours to 24 hours after taking the drug. This is a cuddly sort of space and a good time to talk about the experience. Consciously work with your partner to maintain the sense of perfect love created on the trip. It is easy to do during the afterglow, and as this is an in-between state it is a chance to learn how to incorporate the experience into every day life.

A second trip should not be taken for several weeks to allow you time to absorb the experience. Discuss and plan the structure of your next trip to build on what you have learnt.

Do not use Ecstasy if you are pregnant or lactating.

44 MDMA and Human Sexual Function, by John Buffum and Charles Moser, from Journal of Psychoactive Drugs, Vol. 18/4 1986

This paper gives the findings of a survey carried out by distributing an anonymous questionnaire around the San Francisco area in 1985-6. Of 300 distributed, 76 were filled out and returned (25%).

70% of users had engaged in sexual activity while on MDMA. Of these, 88% of the women and 74% of the men said that the sensuality of the sexual experience was enhanced. They indulged in less, but the same type of, sexual activities on MDMA, with the exception of more 'heavypetting'. 81% of users said that the sensuality of the experience was enhanced and several commented that MDMA was a sensual, not a sexual, drug. Half the men said it was more difficult to have an erection and 62% said they had difficulty achieving orgasm, but, among women, as many found it easier to have an orgasm on MDMA as found it harder. 76% of users said MDMA had not caused health or emotional problems. Complaints included urinary tract infections, tiredness, colds, headaches and mild depression next day. While 85% of users said MDMA had no effect on their sexual desires, the rest felt like doing things, such as having group sex, that implied being free of inhibitions. No increase in users' willingness to initiate sexual activity was reported, but they became slightly more receptive. A third of users thought MDMA had helped them overcome inhibitions, making comments like "cleared pelvic blocks," "lessening of resistance," "better sensual communication" and "more relaxed". All the women and 87% of the men thought MDMA increased emotional closeness, and two thirds said this did not depend on the dose.

The researchers conclude that MDMA is not an aphrodisiac, but enhances the sensual aspects of sex. They note that, with half the men and a third of the women having felt more receptive to sex on MDMA, "it is curious that a drug which can increase emotional closeness, enhance receptivity to being sexual and would be chosen as a sexual enhancer, does not increase the desire to initiate sex".

45 A survey of MDMA use in London, by Adam Winstock, a senior house officer in respiratory medicine at the Hammersmith Hospital Royal Postgraduate Medical School (unpublished)

From October 1989 to February 1990, Winstock conducted a survey of Ecstasy use in London. Out of 250 forms distributed, 89 were returned and analysed. 64% of respondents were male and the average age was 23. The youngest respondent was 17 and the oldest 31. Nearly all were single.

Frequency of use:=09

less than 3 per week    2.2%
2 per week             14.1%
1 per week               18%
more than 1/week         28%
less than 1 per month    36%

52% of respondents had used Ecstasy more than 20 times; 5.6% had taken it more than 100 times and 27% had used it less than 10 times. 62% of respondents - including many of the heavy users - had stopped using the drug for some periods of time.

75% took it on Fridays and/or Saturdays only; a mere 2% reported midweek usage. Only 19% said they would take more of it if it were cheaper while 59% said they would definitely not take more if it cost less. 65% said the effect of the drug was variable.

59% noticed the build up of tolerance, but none experienced withdrawal symptoms. For 4.5 per cent of respondents, MDMA was the first illicit drug they had tried. Over 75% had experience of cannabis, amyl nitrate, amphetamine sulphate, cocaine and LSD. In combination with MDMA, 79% of respondents had taken cannabis, 57% alcohol and 51% cocaine.

The most pronounced effect noted by users was sexual arousal (89%), and increased sexual activity (67%). [These findings are in marked contrast with the results of other studies which show MDMA suppresses sexual arousal and activity41, 42, 33, 44]. Other reported effects were unremarkable. 17% reported having had a 'bad E', usually meaning the pill had no psychoactive ingredient.

46 Using Psychedelics Wisely by Myron Stolaroff in Gnosis winter 1993

This issue of Gnosis is devoted to 'Psychedelics and The Path' - various articles discussing the spiritual value of psychedelic experiences. The author says he speaks from several years of research involving psychedelics with some 350 subjects. He believes that "The great value of these materials is that they give us access to our repressed and forgotten material, . . to the archetypes of humanity, to an enormous range of levels of thought, and to the wellspring of creativity and mystical experience that Jung called the collective unconscious." He argues that for Westerners whose lives are intrinsically bound up with making a living, the use of psychedelics is a practical alternative to thelong-term commitment required by Eastern masters.

See reference 144 for Myron Stolaroff's latest work.

47 Phone call to Somerset House: population of Great Britain in various age groups 1991

14-15: 566,400
15-16: 591,400
16-17: 619,200
17-18: 638,400
18-19: 683,200
19-20: 727,400
20-24: 3,943,400
25-26: 832,700
16-25: 7,444,300

48 Young People in 1992, by Schools Health Education Unit, at Exeter University

Questionnaires were completed by over 20,000 pupils aged 11 to 14 in 132 schools in England in 1992. Results showed that, among 14 year-olds, 4.4% of boys and 4.1% of girls had tried Ecstasy.

49 The Normalisation of Recreational Drug Use Amongst Young People in North West England by Fiona Measham, Russell Newcombe & Howard Parker, accepted by British Journal of Sociology December 1993

This paper presents findings relating to a first cohort of teenagers in the study. The sample was designed to be representative of gender, social class and geographical area. 70% were age 14 and 30% age 15; 54% were boys; 88% white; 70% Christian; 84% had fathers in paid work and 68% had mothers in paid work.

Illicit drug use has risen to record levels among this sample. 59% had been offered drugs; 36% had tried an illicit drug; 32% had tried cannabis; 14% poppers; 13% LSD; 12% solvents; 10% magic mushrooms; 10% amphetamine; 6% Ecstasy and 1% other drugs. 20% had used a drug within the preceding month and 33% had done so within the preceding year. Girls were more likely to have been offered and to have tried a drug, in contrast to previous surveys that showed more boys had tried illicit drugs tan girls.

Drug use is generally related to alcohol use; those who drink more also have above average consumption of other drugs. However, those who use MDMA drink less alcohol than users of the more popular drugs above. 45% of respondents had had sexual experiences. Of these, 25% had been drinking before their last sexual experience.

Of those who had tried MDMA, nearly all had also tried cannabis, 80% had tried LSD, 76% amphetamine, 69% psilocybin mushrooms and 60% nitrites. But only 4% had tried cocaine and 7% heroin.

50 The Independent, August 92

"Soccer hooliganism fell last year to its lowest level for five years. Home office figures showed the number of fans arrested and ejected from grounds in 1991-2 dropped to 8,556 while attendances rose to 20,487,192"

51 Toxicity and deaths from MDMA from The Lancet by John Henry et al. August 1992

A report of toxicity and fatalities related to MDMA use picked up through a search of enquirers to the National Poisons Information Service in London and encountered directly by doctors at the National Poisons Unit at Guy's Hospital, London during 1990 and 1991.

There was a striking increase in the number of calls to the NPIS related to Ecstasy use. What was being sold as E usually contained MDMA but MDA and amphetamine were also found; mixtures were uncommon. Henry et al. say that co-ingeston of MDA with MDMA cannot be excluded by analysis of biological samples and that the pattern of toxicity did not seem to be a result of overdose. One analytically documented overdose showing plasma MDMA 7.72fmg/l - allegedly 42 tablets - resulted only in a "hangover" with tachycardia and hypertension.

Reports from the USA suggested MDMA was only mildly toxic. The main cause of death was cardiac arrhythmias; rhabdomyolysis and disseminated intravascular coagulation (DIC). Most cases the authors were consulted about had mild symptoms. There was a clear pattern of toxicity in the most severe cases. Death was probably due to heatstroke "in which severe hypothermia was accompanied by DIC". There was no evidence of drug impurity being responsible for toxicity. All fatalities occurred after the user had been at a crowded party or club. Sustained physical activity, high ambient temp, inadequate fluid replacement could all reduce heat loss and the direct effect of the drug may upset the thermoregulatory mechanism. The authors conclude that MDMA is capable of causing severe toxicity and that the pattern of acute toxicity witnessed in the series of cases studied may be due mainly to the circumstances in which it is misused.

52 Numbers of Ecstasy-related deaths between January 1988 and July 1992, held by the National Poisons Unit at Guy's Hospital on 8 March 1993

The deaths include those reported directly to the NPU by doctors seeking advice and those picked up by the unit from press reports. The list is not comprehensive. In particular, as knowledge of symptoms related to Ecstasy-use spreads among the medical community, doctors make fewer queries to the NPU. Ecstasy-related deaths are held to be confirmed if any amount of the drug is found in the patient's blood or urine during treatment or in a postmortem. In all the deaths picked up by the NPU, the level of MDMA present was very low. Unconfirmed deaths are those in which the patient or others have reported recent drug use verbally but no blood or urine sample has been taken.

From January 1988 to July 1992, there were 14 confirmed deaths, of which 13 resulted from overheating and one from asthma, and 4 unconfirmed deaths, including one from liver failure and one stroke.

Of these, 2 confirmed deaths occurred in 1988; 2 confirmed deaths and one unconfirmed death occurred in 1989; 7 confirmed deaths and one unconfirmed death occurred in 1991; and 2 confirmed and two unconfirmed deaths occurred in 1992.

In 1992 there was also one confirmed death related to MDA and one confirmed death related to MDEA.

53 A report of five deaths associated with the use of MDEA and MDMA, by Dr. G. Dowling, Journal of the American Medical Association, 1987

Three of the subjects had known medical problems before taking the drug, while one was killed by an electric shock apparently after having climbed a pylon. Two had preexisting heart conditions and one had asthma. MDMA was thought not to have been the primary cause of death in four of these cases, although it is suggested that people with cardiac diseases may be predisposed to sudden death by taking MDMA. The fifth death was not explained by other medical factors, but there was no evidence that it was due to taking MDMA.

54 Conversation with Dr. Les King, team leader of the drugs intelligence laboratory at the Forensic Science Laboratory at Aldermaston, part of the Forensic Science Service, a Government agency, 14/12/92

The drugs intelligence laboratory analyses suspected drugs sent by the police, that have been seized from people arrested on suspicion of being in the possession of controlled drugs. Dr. King points out that samples sent to the lab are not necessarily representative of what is being sold on the streets. No statistical analysis of samples is done at Aldermaston, but Dr. King related his impression of the overall pattern of findings, based on personal experience. The lab is not usually told what drug to look for and therefore runs a series of tests to see whether any controlled drug is present.

Impurities are not looked for. But the typical weight of a tablet sent to the lab is from 200 to 600 mg, so non-psychoactive filler is nearly always used. Dr. King has not come across or heard of poisonous substances present in samples of Ecstasy.

Nearly all samples are in the form of capsules and tablets. The lab consistently finds that about 90% contain an active ingredient, while the rest are fake.

When tablets contain MDMA, MDA and MDEA, there is not normally any other drug present. Typically, tablets or capsules contain about 100 mg MDMA or 60-70 mg MDA. Doses vary by 10-20% above or below this amount according to the 'brand' of tablet or capsule, but each brand is fairly consistent from one pill to the next. Recently, a lot of MDEA has been seen but not enough to establish a figure for a typical dose.

The trend in 1991 and 1992 was an increase in MDA but this has peaked and MDMA, MDA and MDEA are now found in roughly equal proportions. MDEA is still on the increase.

There has been a tendency over the years towards dilution of doses - a typical Ecstasy tablet today probably contains some 10-20% less MDMA than it would have contained a few years ago.

Each brand of Ecstasy isaround for 3 to 6 months. Dr. King says this short brand lifespan may be due to fake lookalikes giving the brand a bad name. Tablets composed of amphetamine-based concoctions may be sold as Ecstasy, when MDMA is in short supply. However, these are also sold under other names.

In the past year there has been a trend towards "amphetamine cocktails". One contained amphetamine and LSD, complete with ground-up paper (presumably the 'blotter' LSD is usually supplied on). Another, believed to be sold under the name "banana split", contained amphetamine, cocaine and LSD. Another recent cocktail is amphetamine and Tiletamine. Tiletamine is a vetinerary anaesthetic similar to Ketamine and is manufactured in England for export only. A few kilos were stolen but the source has now been cut off.

A reagent, known as Marquis, consists of sulphuric acid and formaldehyde. It turns orange when mixed with amphetamines and shows a black/purple colour when combined with MDA, MDMA and MDEA. However, it also turns black with various prescription drugs and even paper, so cannot be reliably used to test drug samples. [Someone doing such tests "day in day out" may build up enough experience to distinguish between the colour changes in Marquis when it is combined with MDA, MDMA and MDEA - various shades of brown and orange - but inexperienced users could not hope to do so.] Marquis does however serve as a fairly reliable test for opiates, which show purple.

55 Medicine Now, 9/3/92, BBC Radio 4

Alan Matthews, former editor of International Journal on Drug Policy, spoke on this radio programme. He said that Ecstasy allows people to examine areas that would normally result in pain or distress with a sense of detachment. It does all this without any loss of control or contact with reality. . . For these reasons it is used as an adjunct to psychotherapy, this gives us some insights into its enormous popularity at the moment . . . almost a spiritual experience. It drops the kind of emotional barriers that we all have built into our lives to cope with society and relationships and life in general. It seems to lower those barriers so that people feel more outgoing. In a sense it dissolves the individual into a wider group experience. If you've taken the drug in a club with a thousand other people who are also on the same level, it really does give a very powerful group experience.

Matthews also said that Ecstasy may cause minor psychological problems. Figures on deaths due to Ecstasy were never easy to unravel. Ecstasy may have been used in combination with other drugs; or there may be problems related to the setting - a very hot, overcrowded club with no drinking water may lead to dehydration, heat exhaustion or heatstroke. Taking Ecstasy in combination with another drug and being in such a club could lead to a serious situation. But taking Ecstasy is not the worst thing people can do. "The worst thing they could do actually is go out and drink alcohol and dance for eight hours; that would definitely kill them."

56 Phone conversation with Dr. Russell Newcombe, lecturer in social policy and social work at Manchester University, 19/2/93

Dr. Newcombe had read a couple of articles about people who have died of heatstroke where mention has been made that the victims used to get high temperatures as children. This could be a clue as to why some people are vulnerable to overheating.

Dr. Newcombe took part in a survey of clubs playing rave music in the North West in 1992 and estimates that there were about 30,000 people attending at weekends. He estimates that the proportion of people using E varied from 50% to 90% depending on the club.

57 Effects of MDMA on Autonomic Thermoregulatory Responses of the Rat, by Christopher Gordon et al., 1990

Rats were observed at ambient temperatures of 10 degrees , 20 degrees and 30 degrees C. Measurements were made of their metabolic rate, evaporative water loss [equivalent to sweating, but rats lick their fur instead], hyperthermia, hypothermia, motor activity, skin temperature, heart rate and 'lethality'. Each rat was measured after being administered plain saline and also after 30mg/kg MDMA in saline. The following results occurred when the rats were given MDMA but not when they were given plain saline: (1) The rats lost water through evaporation far more rapidly at 30 degrees ; (2) They increased their metabolic rate and maintained a higher ambient temperature instead of attempting to reduce their temperature; (3) They maintained the same activity instead of reducing it when the temperature rose; (4) They showed a sharp rise in body temperature instead of a fall in temperature at 30 degrees and a fall instead of rise in temperature at 10 degrees and (5) They increased their heart rates by varying amounts at 30 degrees . At the high temperature, the rats' core body temperature increased rapidly before they died. Rats' tail temperature did not increase. [Raising tail temperature is their normal way of getting rid of heat.] The cause of death was not examined but appeared consistent with overheating.

The mechanism of the effect was not studied but the changes in body temperature were presumed to be affected by the level of serotonin present in parts of the brain, which is altered by MDMA.

I spoke to Dr. Gordon on the phone and learned that he is a specialist in temperature control mechanisms. MDMA is one of the most effective compounds he has tried for making animals lose control of their body temperature. They actually seemed to prefer hot ambient temperatures when they were already too hot, although this had not yet been tested. Although MDMA inhibits heat loss in rats through their tails, they do "drool all over the place" trying to keep cool.

Dr. Gordon has made a long chamber 1 foot in diameter with one end kept hot and the other cool. Animals can be put inside so they can choose whatever ambient temperature they prefer.

58 Notes from meeting with Dr. John Merrill of NW Regional Health Authority

Dr. Merrill answers some of the most frequently raised queries about Ecstasy:

Allergic reactions: none are known.

Asthma: There is no pharmacological reason why asthma should be made any worse by E.

Diabetes: There is no known effect on blood sugar, but if you take E you are likely to be more energetic. If you are diabetic, you should adjust your sugar intake or insulin dose to allow for increased physical activity.

Epilepsy: E can cause epileptic fits if taken in overdose. If you suffer from epilepsy and take E you are more likely to have fits.

Liver problems: Recently several cases of jaundice have been reported in those who take E. Many of these have been very serious, leading to irreversible liver failure, liver transplantation or death. Its not clear why this happens. It may be that E is only toxic to the liver after many doses over many months. Or the liver failures could be due to toxic by products in poorly manufactured E.

Pregnancy: All drugs are potentially toxic to a developing foetus, and the younger it is the more dangerous they are. There are good reasons to believe that E may cause congenital abnormalities. It could cause miscarriage later in pregnancy. If you are pregnant, don't even consider taking E. [Experiments with animals show no damage.108]

Dr. Merrill added in conversation that people with hay fever and eczema who take E may also face higher risks.

59 MDMA - The Dark Side of Ecstasy, by Gregory Hayner and Howard McKinney, from Journal of Psychoactive Drugs, Vol. 18/4 1986

This paper concerns toxic effects of MDMA on illicit users who attended the Haight Ashbury Free Medical Clinic in 1986.

The authors note that both the doses taken and user's reactions were variable. Analysis of samples showed doses ranging from 16 to 165 mg. Acute reactions were rare and were usually confined to sensitive people taking high doses, particularly when they repeated the dose within a short period. Overdoses had unpredictable results: some effects lasted up to 2 weeks. Psychosis, including paranoia and hallucinations, usually resulted from very high dosages.

The paper includes two case reports:

1. A heroin addict who was adequately sedated had hallucinations and paranoia and was violent after a large dose of MDMA.

2. A normal 33 year-old woman who worked for a publisher took a large dose - estimated at 50 to 100mg - with 4 friends. The trip was normal, with the woman still remembering it as the best time of her life. But one month later she took a normal dose from the same batch and within 20 minutes experienced feelings of dread and had visual hallucinations of the sky turning black and a devastated landscape spiralling in on her "like a ton of bricks". She lost consciousness and was taken to hospital where she had to be restrained for several hours. After 3 days she was regarded as normal, but stayed off work for a month. She was depressed, had bouts of crying and was not her normal self for 6 months. Laboratory analysis showed the batch of MDMA to be 95% pure and no other substances showed up in her body fluids.

The authors conclude that this unexplained case is disturbing, as the woman nearly died in conditions that are normally regarded as safe.

60 British Medical Journal vol. 305 August 1992 letters in reply to Henry's article

These letters variously reported: a case of acute hepatitis associated with repeated use of E, a case of jaundice associated with use of MDMA; and 3 cases of people suffering from severe chest pain after taking Ecstasy with alcohol.

61 Use of MDMA to relieve symptoms in terminal cancer patients; phase one protocol, by Dr. Charles Grob. (Fax received 17/11/92)

This is a safety and tolerance study designed to determine the psychological and analgesic threshold level for MDMA. Six subjects in the health care industry will be chosen for these trials. They will take part in 3 experimental sessions separated by two to four weeks.

Each session will consist of oral administration of one capsule, which may be either 0.15mg/kg MDMA, 0.75mg/kg MDMA or a placebo. Grob predicts that 0.75 mg/kg will be the threshold dose.

Tests will be carried out on subjects' blood, psychological state, experience of physical pain and on neuropsychological effects.

62 Designer Drug Confusion: a focus on MDMA, by Jerome Beck and Patricia Morgan, from Journal of Drug Education, 16/3/86

Beck and Morgan give a Cook's tour of the effects and clinical value of MDMA. They quote Wolfson: "MDMA provides a positive alternative to the dark and negative experiences of people experiencing psychotic states," Grinspoon: "MDMA appears to have some of the advantages of LSD-type drugs without most of the corresponding disadvantages," Siegel: "MDMA has been promoted as a cure for everything from personal depression to alienation to cocaine addiction. . . It's got a lot of notoriety, but the clinical claims made for its efficacy are totally unsupported at this time," and Greer: "Because every therapist I know who has given MDMA to a patient has found it to be of significant value, I am convinced that it can be shown scientifically to be efficacious."

They say that continuous use of booster doses after the initial dose to prolong the high produces great fatigue the following day. Regarding deaths ascribed to MDMA, "later investigation revealed that the role played by the drug, if it was even involved, was questionable in most cases." But Beck and Morgan say that the potentially toxic interaction between MDMA and alcohol merits further investigation. "As with other stimulants, individuals under the influence of MDMA are often capable of ingesting large amounts of alcohol."

A delayed anxiety disorder has been observed in a few individuals. This problem typically occurs among novice users of MDMA, and the manifestations range from a mild anxiety to a full-blown disorder such as a panic attack with hyperventilation and tachycardia, phobic disorders, parathesias, or other anxiety states. Usually the drug was taken in a nonprofessional setting for quasi-therapeutic reasons.

On the basis of interviews with such clients, it can be inferred that through taking MDMA, much of their repressed anxiety, hostility, guilt, or other so-called negative feelings were released into their conscious minds. . . After the release of this material, they are undefended and conscious of what emotional and psychological work needs to be done. These initial findings underscore a growing number of unsuccessful attempts at 'self therapy' by individuals who run the risk of exacerbating their emotional problems with unsupervised episodes.

They conclude that MDMA's unique effect is desired by many people and interest will continue to grow. MDMA could have a much greater long-term impact on our society than all of the so-called designer drugs combined.

63 Risk assessment and the FDA, by Rick Doblin, 1988.

A lecture on the history and current status of neurotoxicological research into the effects of MDMA. Doblin is president of the Multidisciplinary Association for Psychedelic Studies.

Doblin asked whether changes observed in animals given MDMA were permanent, produced behaviour changes and occurred at doses equivalent to those taken by humans.

Experiments on monkeys showed that nerve endings were damaged two weeks afterwards but were partially repaired in 10 weeks. Serotonin levels were partially recovered over a period of months, while one study on rats showed total recovery after one year.

He noted that researchers failed to identify distinguishing characteristics between untreated primates and those whose serotonin had been reduced by 90% and that no cases of MDA toxicity in humans had been noticed even though MDA is twice as toxic as MDMA and was popular in the sixties. Neurotoxic effects on primates given MDMA are only observable at about twice the human dose.

Tests of the mental health of MDMA users showed that their IQ levels were well above average, even though they had consumed an average of 13,000 mg - 100 times more than the therapeutic dose of 125 mg.

64 Markers of Neuronal Injury and Degeneration, by Miller and O'Callaghan.

Damage to the brain occurred with both mice injected with MDMA and those injected with fenfluramine, although not in the hippocampus or cortex, this study found. The result is significant in relation to O'Callaghan's work on rats as it shows that mice and rats are affected differently, implying that species is relevant to MDMA poisoning.

65 Fenfluramine Hydrochloride, from Martindale Pharmacopeia

The potential for abuse is considered to be virtually nonexistent. However, single oral doses of 80-500 mg were "used to elicit a psychotomimetic state consisting of euphoria, relaxation and inane laughter, often accompanied by perceptual alterations including visual hallucinations. . ." More frequent and vivid dreams were reported in 13 of the 20 people studied.

A study of 53 cases of fenfluramine poisoning through overdose showed that the most common symptoms were mydriasis, tachycardia and facial flushing. Nine patients died "following cardiac and respiratory arrest. Death occurred 1 to 4 hours after ingestion." (1979 German reference).

Fenfluramine should not be given to patients with glaucoma or a history of drug abuse or alcoholism. Patients with mental depression should be treated carefully; "there may be mood changes during fenfluramine treatment, and abrupt cessation can cause severe depression." Avoid use with epileptic patients. Excretion is via the urine "in the form of the unchanged drug and metabolites".

The drug is used as a short-term treatment for moderate to severe obesity.

The dose is initially 20 mg 2-3 times daily, increasing after the first week to a usual maximum of 120 mg daily. The drug is sold in the UK as Ponderax.

66 The Neurotoxicity of MDMA and Related Compounds, by Dr. Molliver, in The Neuropharmacology of Serotonin, published in Annals of the New York Academy of Sciences, 1990

A paper on studies comparing the action of MDMA with fenfluramine. It was found that the action of both drugs on serotonin (5HT) levels was virtually the same. After administration, the levels dropped and recovered with both drugs on similar time scales.

67 Fluoxetine, from Martindale Pharmacopeia

Fluoxetine is an antidepressant which selectively inhibits the re-uptake of serotonin. It has been shown to be superior to placebo in relieving depression. The dose is 20-80 mg daily. Its proprietary name is Prozac. There are several other SSRIs (Selective Serotonin Re-uptake Inhibitor) available.

68 A Trip into the Unknown, by Alison Abbott and David Concar, in New Scientist, 29/8/92

The authors estimate half a million E's will be taken "this weekend alone". "It is hard to build up a convincing case against the drug when you can't say exactly how dangerous it is or what the consequences of long-term effects are," they say. They make the following points: Britain has no long term research programme; the consensus is that ecstasy's hallucinogenic properties render it wholly unsuitable as a medical drug; figures released in August 1992 from the National Poisons Unit at Guy's Hospital showed that the drug had killed 7 people since 1990; pathologists are sure of the cause: heatstroke; Dr. John Henry of the NPU told them that everyone who takes Ecstasy is a potential victim, but is most worried by contamination of MDMA with heroin and ketamine.

MDMA works by blocking the return of 5HT [serotonin] to neurons by occupying its binding sites on the transporter protein. Once inside the neuron MDMA cannot be stored so leaks out again. As a result, the levels of 5HT in the synapses rise sharply in the short term, and 5HT signalling between neurons is amplified. The 'high' eventually fades when neurons become drained of their stored 5HT. Antidepressants like fluoxetine are thought to work by boosting levels of 5HT in the same way as Ecstasy. Most of the amphetamine-like effects are probably caused by increased levels of noradrenaline. The observed rise in body temperature in rats in hot environments may be caused by increased levels of 5HT in the part of the brain that regulates temperature known as the hypothalamus. This may render the hypothalamus unable to respond appropriately to overheating caused by dancing.

Research on rats shows the drug causes the nerve fibres or axons, through which 5HT neurons communicate with the rest of the brain, to break and swell. "On top of that, Ecstasy appears to block the activity of an enzyme called tryptophan hydroxylase, which neurons need to synthesise 5HT," the authors say.

"It could be years before the health risks of chronic abuse of ecstasy show up in the statistics," they conclude.

69 The MDMA Neurotoxicity Controversy: Implications for Clinical Research, by Dr. Charles Grob

Grob says that investigations to establish neurotoxicity often contain flaws in methodology as well as in interpretation. Damage presumed to be caused by MDMA is surprisingly limited and is confounded by associated variables. Authorised use of MDMA in Switzerland is "without reports of adverse neuropsychiatric sequelae".

Cases of compulsive self-administration are very rare. MDMA is unique among recreational drugs in that there appears to be a disinclination to take it repeatedly. "We believe that a thorough yet dispassionate review of the existing data suggests that experimental use of MDMA in humans can be justified, " Grob says. But this should only take place in controlled therapeutic conditions.

70 Ecstasy Revisited, by Bruce Eisner, Gnosis Magazine, winter 1993

As soon as MDMA was made illegal, it began to be adulterated, Eisner says. This was due to criminals replacing users and idealists in the manufacture and distribution of the drug.

Eisner makes the following point: "The same experiment that Shuster and Ricaurte did with MDMA and MDA - giving huge and frequent doses to rats - was also performed with a prescription drug, fenfluramine, used in treating eating disorders. No adverse effects have ever been observed from its use, and people who took it frequently many years ago have no observed brain damage or other problems. Fenfluramine is still prescribed, even though MDMA was quickly banned."

"With millions of people having taken MDMA over a 20-year period, some more than several hundred times, there has never been a reported case of MDMA-caused brain damage. Not one single case," he adds.

He quotes Shulgin as predicting that new compounds will inevitably be invented: "teased out of other drugs such as MDMA," which would have still greater specificity in triggering human emotions such as the fear of death, awareness and suppression of anger, and feelings of guilt.

71 Assessing Neurotoxicity of Drugs of Abuse, by Dr. James O'Callaghan, NIDA monograph 1993

Dr. O'Callaghan was contracted to do some research to establish a method of assessing neurotoxicity - this was a $750,000 project over 3 years. He says that the term neurotoxicity has no precise meaning, but he is taking it to imply that physical damage has been done to the brain which affects its function.

He found that, with rats, "even when we increased the methamphetamine dosage to as much as 150mg/kg, twice daily for two days, we failed to see marked increases in Glial Fibrillary Acidic Protein (GFAP) at time points ranging from 2 to 9 days post dosing". Though "as little as a single administration of 20mg/kg to the rat results in long-lasting decreases in 5HT levels" he found that 30mg/kg MDMA twice daily for 7 days did not cause an increase in GFAP in the cortex, striatum and hippocampus although there was a decrease in 5HT. ". . . MDMA dosage regimen sufficient to produce a large and long-lasting decrease in 5HT was not sufficient to induce an astrocyte reaction characteristic of neural injury". When he increased the dose to 75-150 mg twice daily for two days, MDMA "produced a dose-dependent increase in the levels of GFAP in cortex and striatum at 2 days post dosing".

"Evidence for MDMA-induced neural damage . . . was not necessarily linked to . . . decreases in levels of 5HT".

O'Callaghan established Reactive Gliosis, a more direct and reliable method of testing for neurotoxicity. He also found that a method called silver staining produced reliable results.

[The relevant conclusion is that previous work on MDMA gave false results by assuming that damage was caused by a decrease in 5HT or serotonin. Extremely large doses, equivalent to someone taking 50 Es twice daily, did cause damage.]

72 fax from Rick Doblin, president of MAPS, 21/9/92

Doblin doubts that there is any neurotoxicity due to MDMA at normal doses. When primates were given oral doses of 2.5 mg/kg once every 2 weeks for 4 months (total of 8 doses) there was no evidence of neurotoxicity. But a single dose of 5 mg/kg did cause some slight reduction in the serotonin levels in two parts of the brain, the thalamus and the hypothalamus. So, it is possible that MDMA may be causing some toxicity in people who use especially high doses. Still, whether that toxicity is bad is not at all certain. In primates with 90% reductions in serotonin caused by massive amounts of MDMA (5 mg/kg injected every 12 hours for 4 days) there are no observable long term negative consequences. Still, damage may be too subtle to observe in primates.

73 Neurotoxicity of MDMA and related compounds: anatomic studies, Molliver et al. Annals of the New York Academy of Sciences, 1990

Axon degeneration is seen in fine 5HT axons (but not beaded axons or raphe cell bodies) within 48 hours after MDMA administration. Within six to eight hours, there is persistent serotonergic reinnervation of the frontal cortex along a fronto-occipital gradient in a simulating perinatal development of 5-HT innervation. Although the sprouting axons are anatomically similar to the damaged axons, it remains unknown whether a normal pattern of innervation is re-established.

74 Ecstasy: towards an understanding of the biochemical basis of the actions of MDMA, by Marcus Rattray, from Essays in Biochemistry, vol. 26 1991

Rattray reviews some of the complex biochemical actions of MDMA and discusses how these may relate to the psychopharmacological and neurotoxic effects of the drug.

After a single dose, 5HT depletion is rapid and remains low for 6-18 hours, recovering within 24 hours. This coincides with observed effects of MDMA. It is therefore likely that psychotropic effects can be ascribed to the post- and pre-synaptic effects of released 5HT.

Studies using brain slices pre-loaded with 5HT have shown that micro-molar concentrations of MDMA induce 5HT release. It has been proposed that the MDMA taken up by nerve terminals causes the displacement of 5HT from cytoplasmic binding sites, leading to 5HT efflux through the synaptoic membrane 5HT transporter. . . . this is taken as evidence that the neurotransmitter released is derived from cytoplasmic stores rather than from the 5HT stored in synaptic vesicles.

Drugs such as fluoxetine known to block 5HT uptake into nerve terminals are found to inhibit the release of 5HT induced by MDMA. Current evidence suggests that the primary action of MDMA is on the nerve terminals of neurons that synthesize and release the amine neurotransmitter serotonin or 5HT.

Answering the question: is MDMA toxic to man? Rattray says:

In all the studies that have found neuro-degeneration in animals, several large doses were administered over a very short time period, so it is difficult to extrapolate to humans. The route of drug administration (oral in humans) is a significant factor [ref. to Ricaurte 1989]. Nevertheless, it is likely that levels of consumption in man can produce brain concentrations that approach toxic doses. At the present time there are no reports of MDMA-induced neuro-degeneration in humans.

75 Letter from Jeremy Millar, Department of social work, Aberdeen University, 20/11/92

Millar reports on a young man, diagnosed as schizophrenic, who has been using Ecstasy for 3 years along with amphetamines and LSD. He prefers Ecstasy, and while on Ecstasy his behaviour and thought processes improve as witnessed by himself, his parents and his social worker. He can also communicate clearly.

76 MDMA - Non-medical Use and Intoxication, by Ronald Siegel, from Journal of Psychoactive Drugs, Vol. 18/4 1986

This is a survey of a representative sample of drug users who had used MDMA at least twice in the previous year alongside other drugs. 44 such drug users answered a questionnaire. Siegel found that 90% of hard drug users who had tried MDMA did not want to repeat the experience - most found little or no effect and the rest did not enjoy it - and that samples contained about 20% less MDMA than was claimed by dealers, but none contained active impurities.

77 Lifeline, Ecstasy, and the world, by Mark Gilman

Mark Gilman, a researcher with Lifeline, a non-statutory drug agency in Manchester, gives the agency's official view of Ecstasy: that it is neither all good nor all bad.

The dangers were:

1. Not getting a real MDMA tablet.

2. Taking too much too often. This may cause damage, but it is also dangerous to take depressant drugs to 'turn off' the unwelcome anxiety states that accompany taking 'too much [Ecstasy] too often'.

3. Risk of heatstroke.

Young people using E have their eyes opened to the world of illegal drugs and lose respect for the law. Makes young people into criminals. In this sense, E is to the nineties what LSD was to the sixties; the difference is that now many other drugs are available too.

Gilman concludes: "I suspect the environmentalist/green movement will benefit from the boom in E just as the sixties counter culture grew alongside LSD use. I also suspect that we will begin to see the popularity drugs grow and grow - a new psychedelic dawn? What is clear is that a lot of people's world views have been changed by their Ecstasy experiences. Comparisons with the sixties are in order here."

78 No more junkie heroes? by Mark Gilman, from Druglink May 1992

Gilman says that the up and coming users of illicit drugs regard them as an adjunct to fun rather than the organising force of their lifestyle. There are many more of them than in previous generations and they use amphetamines, cannabis, LSD, Ecstasy and, sometimes, cocaine. They do not inject and are not dependent on their chosen drug. The most pressing policy task is to keep this group as far apart from opiate users as possible. This should be relatively easy as many of the younger drug users hold strong anti-injecting and anti-opiate views and refer to junkies in highly derogatory terms such as 'old and smelly'.

79 Ecstasy and Recreational Drug Use in Wirral by C Toddhunter, Liverpool University

Between March and June 1992, 95 drug users participated in this survey. Of the 57 who had used Ecstasy, 52 were interviewed. The following conclusions were drawn:

First time E users tend not to be new to drug taking. Only 1 out of 52 respondents used E before they had tried any other drug and only 3% of respondents had used E prior to the age of 16/17.

Nearly 95% had a history of drug use which included LSD, cannabis and amphetamine prior to taking Ecstasy. Most of them commonly used more than one drug. 96% used E in conjunction with other drugs at raves. Use of Ecstasy took place almost exclusively at raves or where House Music was played.

A strong anti-heroin culture was found among Ecstasy users. There was a tendency for most of those interviewed to regulate and limit their drug use to avoid problems. A small minority who made little attempt to control their use faced serious problems as a result, including paranoia, weight loss and diminished mental activity. Most of these people took Ecstasy, LSD and amphetamine.

Ecstasy had fallen in price: it cost #9-#15 at the time of the survey. Whereas some respondents had a history of Ecstasy use but had drifted away from the drug, the total number of users had not fallen.

Among Ecstasy users, there is a strong rejection of conventional night life culture including even moderate alcohol consumption. Alcohol is perceived to be a bigger AIDS risk, as rave culture is less concerned with sexual gratification. Instead, gratification comes from the intensity of the music and dancing.

Ecstasy users are very keen to obtain factual knowledge about drug use in their own terms, as opposed to what they perceive as misinformation by the media.

"A minority of young people in Wirral shows a firm attachment to Ecstasy use. It is as acceptable and conventional to them as drinking alcohol is for the wider population," Toddhunter says.

80 Hansard 17/1/1992. Written answers by John Patten, then Minister of State at the Home Office

The number of deaths attributed to MDMA or MDA was one in 1988; three in 1989; one in 1990; and two in 1981 A note says that 1991 figures are up to September only and "deaths of this nature result in an inquest and thus delays of registration of up to one year may occur". Thus 1991 figures were incomplete.

81 Phone call to Mr R Allen, at the Home Office Statistics Dept., 1/3/93

The Home Office does not have recent statistics on drug-related deaths; the latest it holds are those reported in Hansard80. Allen says that the Home Office's only knowledge of deaths that have occurred in the past two years is from newspaper reports. [These are of course unreliable]. He said: "The truth is between 10 and 20 deaths so far are 90% suspected to be due to Ecstasy - but don't quote this as a Home Office figure. These are people who have either died from overheating or from a rare extreme reaction, just as some people have been known to have died from a bee sting."

However, an attempt is now under way to produce figures more on the lines of DAWN, the US system of monitoring drug-related deaths.22 "We have people going through wads of death certificates," Allen said. However, figures are unlikely to be ready before the end of 1993.

82 Deaths reported by the mass media related to raving and/or dance drugs, 1989 to 1993, from Rave Research Bureau, 25 Halkyn Avenue, Liverpool L17 2AH

This is a 3-page list of media-reported deaths related to use of dance drugs, giving victims' sex, age, area of residence, the drugs they had taken, the number of such drugs, the place of use and the date of death. The source of information is given for each victim.

30 deaths are listed, of which 16 are attributed solely to MDMA and one to MDEA, while MDMA is mentioned as a possible contributory factor in a further 5. Of the deaths attributed solely to MDMA, two were said to be due to liver and/or kidney failure while another was due to heart failure. No other possible contributory causes of death were given. With the exception of two cases, no details aregiven of whether MDMA was found in post mortems.

83 Licensed to Thrill, in New Scientist, 29/8/92

An article on safety at fairgrounds. There are 10,000 rides in Britain catering for 500 million passengers a year. The chance of death or serious injury was 6 in 100 million. Someone taking 100 rides a year would run a risk of death by accident on a ride of 4 in 10 million, which is more than being hit by lightning but less than dying of cold. They would be seven times more likely to die driving to the fairground than while actually there.

84 Skiing dangers, The Sunday Times, 24/1/93

Among nearly five million skiers in Switzerland last year, 11 people were killed and 3% were injured.

85 Rave- and Ecstasy-related admissions in West Lothian 1991-1992; a review by Dr. P. Freeland submitted for publication to The Annals of Emergency Admission

Dr. Freeland's review examines the frequency and nature of presentations to West Lothian hospitals in 1991 and 1992 following the ingestion of drugs in the context of rave parties, by means of retrospective analysis of case notes.

He found a total of seven cases; six having said they took Ecstasy and at least two having taken other drugs in combination with Ecstasy. Six were aged between 18 and 21 and the seventh was 27. Five were male. The invariable clinical finding was tachycardia - a racing heart. Complaints on admission included "buzzing sensations", anxiety and collapse. One patient admitted taking Ecstasy, Temazepam, cannabis and a cocaine-related drug in combination on the evening of admission to hospital. He had a high temperature (39.5 degrees C) and developed acute renal failure and coagulopathy - kidney failure and blood clotting. He recovered and was discharged after 18 days.

Another had taken Ecstasy, amphetamine and cannabis and complained of palpitations and a "buzzing sensation". He was discharged the next day. In addition, one patient had severe muscle spasms: this patient did not admit to taking any drug, but amphetamine was found in his blood (MDMA was not looked for).

The other patients, including all those who admitted to taking Ecstasy, discharged themselves. There were no fatalities.

The minimum hospitalisation rate is calculated to be 23 per 100,000 rave attendances, based on venue capacities.

"Although the study aimed to look particularly at MDMA, the high prevalence of multiple drug use and the absence of specific toxicological results on these cases make it impossible to pass any judgement on MDMA per se," Dr. Freeland concludes.

86 The Psychological and Physiological Effects of MDMA on Normal Volunteers, by Joseph Downing, from Journal of Psychoactive Drugs, Vol. 18/4 1986

This study examined the effects of MDMA on 21 healthy volunteers, including 13 men and 8 women, between the ages of 20 and 58. Their average age was 39. The volunteers had all previously used MDMA, an average of 8 times. All thought they had benefited from it and had recommended its use to others. Doses were chosen by subjects and ranged from 0.8 to 1.9 mg/kg of subjects' body weight, averaging 165 mg. There were no added doses.

Downing notes that oral doses administered in therapy are less than 1 per cent of the LD50 (the dose that kills 50 per cent of rats or mice given the drug), implying a high margin of safety.

80% of the subjects experienced jaw clenching, 60% headaches, and 60% eyelid twitches. None objected to these effects.

Blood pressure and pulse rate increased in all subjects. The peak was between half and one hour after taking the drug. Peak blood pressure was over 100 mg mercury, with one subject's blood pressure reaching "200/100" and their pulse increasing from 72 to 148 within 30 minutes, and subsiding to 128. Most subjects' blood pressure had dropped to below the level it was at before they took the MDMA after 6 hours. Some subjects' blood pressure was still below this level after 24 hours. This did not depend on dosage. Blood analysis yielded no significant results.

Subjects were examined before ingestion; in the second and the fourth hours after taking the drug and 24 hours after.Subjects' state of consciousness, measured by alertness and lucidity, was not impaired at any time. There was no evidence of confused thinking at any point. All reported their attention focused on the here and now.

Subjects' short-term memory was unchanged, but half the subjects had difficulty multiplying numbers, apparently because of difficulty in focusing on the task. Nearly half the subjects' judgement was impaired, implying that decision-making should be postponed or decisions should be re-evaluated after taking MDMA.

All subjects had dilated pupils and reflex to light was maintained. Nastygmus was present in nearly half the subjects, usually ceasing within 2 hours but lasting 24 hours in 2 cases. Half the subjects had jaw clench, which ended within 4 hours except with one subject who had it mildly after 24 hours.

Finger-to-nose testing was impaired in 2 subjects. Gait and coordination were affected in a third subject, suggesting driving could be dangerous. All the subjects' appetites were depressed over 24 hours.

Downing concludes that under the conditions tested, "MDMA has remarkably consistent and predictable psychological effects that are transient and free of clinically-apparent major toxicity".

87 Phone conversation with Mike Evans, at the Home Office 25/2/93

The Home Office can and does issue licences for research using MDMA, including trials on humans. Licenses are not issued for medical use, and in fact this is proscribed due to the drug being classified under Schedule 1, the category for drugs which are considered to have no medical use.

88 Statistics of Drug Seizures, up to the end of 1991 from Home Office Statistical Bulletin, published by the Government Statistical Service, September 1992

There were 1,700 seizures of MDMA in 1991, compared to 400 in 1990 and 770 in 1989. Only two police forces (both in Scotland) did not report seizures and in 30 per cent of police forces MDMA was the most frequently seized class A drug. The Metropolitan Police in London and the Merseyside, Lancashire, West Yorkshire and Strathclyde police forces each reported more than 50 seizures. The number of doses seized was just over 365,000 compared with about 44,000 in 1990. 1991 saw a substantial increase in the use of cautioning as a penalty for drug offences of all kinds. As in 1990, more drug offenders were cautioned than fined, which was previously the most common penalty. Between 1981 and 1991, the proportion of drug offenders receiving cautions increased from 1% to 45% and the proportion receiving fines fell from 65% to 30%. The proportion given prison sentences (with immediate effect) fell from an average of 15% between 1984 and 1987 to 7% in 1991. The likelihood of a stiffer penalty rose with the age of the offender: in 1991 80 per cent of males aged under 17 were cautioned, but only 25 per cent of males aged 30 or over. About half of unlawful possession offences resulted in a caution, with one third of such offences resulting in a fine, while between 30 and 40 per cent of most types of trafficking offences resulted in a prison sentence.

89 Interview with Detective Chief Superintendent Derek Todd, Drugs Coordinator with the No 9 Regional Crime Squad, at Spring Gardens, London, 16/2/93

On April 1 1993, Todd was promoted to assistant coordinator of the new South East Regional Crime Squad, an amalgamation of the No 9 Squad with the No 5 and No 6 Squads, with special responsibility for drugs.

Todd says he believes the way to control drug use is by reducing demand, rather than supply. If there is a demand, it will be supplied somehow. The answer is to try to prevent use. Instead of taking people to court who are caught with drugs for their own use, he would prefer to be able to force such offenders to attend counselling sessions aimed at educating them about the dangers of drug use. Compulsory attendance of such sessions would continue until tests showed that offenders were drug free. When I suggested that if counselling reflected the truth it would inform users that MDMA is no more harmful than alcohol, Todd agreed that alcohol was bad but said that two wrongs don't make a right. He accepts that young people will take drugs whatever is done by the authorities, but says that if no action is taken we will end up with a society where drug taking is normal. "I will fight to prevent that," he said passionately.

Todd believes that the reason that Ecstasy is so popular and has reached parts of the population that no other drugs have reached, is that it has been marketed better than other drugs.

Asked about his attitude to harm reduction policies, Todd replied that he is in favour of harm reduction in principle, provided it is first emphasised that taking the drug is against the law. He showed me a leaflet that emphasised the need to look after oneself when taking drugs, rather than the illegality of the drugs. Advice on what to do in relation to one drug may be harmful if applied to another drug, and this could occur because people were often sold a different drug to the one they thought they were buying. Harm reduction policies should directly promote healthy practices, and not encourage people to think they can safely use drugs which may cause casualties.

Todd said that he believes ideas about liberalisation are never thought through. Any changes in the law on drugs have to be international and simultaneous, or problems are created. For instance, Holland allows legal manufacture of MDEA and the growing of cannabis and these drugs are exported to England. The British police have been successful in finding MDMA factories in the UK, but this has only resulted in manufacturers moving abroad.

One clandestine factory was found in a garden shed in a garden centre open to the public. The operators had no qualifications but had been taught by chemists; they had instructions for making MDMA pinned up on the wall. They produced batches of about 20 kgs. Each batch took 24-36 hours to make and was then left to dry. Todd says that the ideal time to raid is when one batch is drying and another is being made, otherwise it may be that either no manufacture can be proven, or that there is none of the illicit product on the premises. The main way of catching manufacturers is through informers; but sometimes suppliers of equipment and chemicals will notify the police who then follow their deliveries.

Asked about penalties for Ecstasy use, Todd said that he "didn't advocate prison for popping an E". However, MDMA is a Class A drug and is in that category because it is regarded as dangerous. This view is upheld by respected experts such as Dr. John Henry. People have died as a result of taking the drug, and so others must be protected. In fact people caught with Ecstasy are often cautioned, but this is largely because the testing labs are 'snowed under' (or under-funded). In December 1992, the Metropolitan Police lab had a long waiting time for drug tests: if the charge was supplying drugs, the wait was 47 days; if only 'in possession', 50% of samples were tested within 71 days and the rest took up to 92 days. This made it preferable for the police to get an admission from a suspect that the substance found was an illegal drug and then to give a caution. Todd says that suppliers are generally not Mafia or Kray Brother types. Over the past four years there has been a trend towards the "standard British criminal", who 20 to 30 years ago would have done an armed robbery, turning to drug dealing or any other scam.

90 Phone conversation with Arno Adelaars, an Amsterdam-based part-time purchaser of street samples of drugs for testing by the Dutch Government, 25/2/93

Adelaars says the Netherlands Institute for Alcohol and Drugs in Utrecht produced a report in February 1993 recommending that MDMA be reclassified as a soft drug, but that this recommendation is likely to be ignored by the Dutch parliament.

91 Interview with Detective Chief Superintendent Tony White, head of the drugs and money laundering branch of the National Criminal Intelligence Service, which is under the control of the Home Office. At Spring Gardens, London 19/2/93

The drugs and money laundering branch of the NCIS collects and disseminates information for both the police and customs. White spends a large part of his time abroad coordinating activities with the police and customs officers of other Governments.

Over the past year there has been a 60% increase in the number of seizures without any increase in the number of doses seized (144,000), implying that the police were picking up dealers nearer the consumer end of the distribution network.

White gave me a copy of a chart from the winter 1992/3 edition of Drugs Arena, a glossy magazine published by the NCIS that is distributed exclusively to drug law enforcement officers. The chart showed seizures of MDMA, MDA and MDEA since 1990. He says that periods in which there were few seizures of MDMA saw increased seizures of LSD, indicating that LSD and MDMA were alternative drugs used by the same group of people.

I asked whether police policy varied according to the dangers of the particular drug, and what the policy towards Ecstasy was. White, who emphasised that he could not speak for the police, replied that policy for action against drugs was largely "political" in the sense that enforcement efforts against drugs had to be weighed against other interests such as education, health and community relations. Many drugs were associated with particular ethnic groups and the police had to weigh up the damage that might be caused to their relationships with these groups against the desirability of preventing use of such drugs. However, there are no such problems with Ecstasy, so police action is unfettered. The police response to particular drugs does not depend so much on the precise dangers of the drug in question as on the perceived public concern about the drug. Commander John O'Connor of the Metropolitan Police says in a recent report that the policy of arresting dealers has largely failed, and suggests going for the users instead. White gave some support to this idea by saying that dealers would find no market if there was no demand.

Asked for his predictions of future trends in Ecstasy supply and use, White said that British developments would depend on what happened in Holland. I asked what the effect on British Ecstasy users would be if the Dutch tightened up enforcement of their laws relating to MDMA. He replied that, in the short term, there would be a further rise in amphetamines being sold as Ecstasy and in the use of LSD and in the longer term, more manufacturing of MDMA in Britain. I asked whether that would be a good thing, and he replied that there was no easy solution: "It's like a war," he said. However, there was now effective international control of precursor chemicals. He also told me that anyone convicted of supply has all their assets confiscated unless they can prove other sources of income.

White says he believes it is a myth that Ecstasy users are a separate group from those who use addictive drugs. He says that once a market for any drug is established, users will switch to any other drug including addictive and dangerous ones. He also believes that dealers mix addictive drugs in with MDMA in order to get clients hooked. The best advice, he says, is "just don't do it".

Factories are set up in Britain and in Holland, typically by middle-aged English criminals who have been to prison several times for such offences as armed robbery. Dutchmen are also involved.

White says police action is misunderstood when it comes to stopping raves, as the use of drugs is a very minor motive. The reasons are, in order of priority, (1) Public safety. (2) Public order. (3) Public Nuisance. (4) Use of drugs. He believes that very little drug dealing goes on at raves, because Ecstasy "takes about 4 hours to have its full effect" and so users take it before they arrive at the rave. [In fact MDMA, MDA and MDEA reach their full effect within about an hour.]

92 Media Seminar held on 17th November in London 1992 as part of European Drug Prevention Week

The seminar was presented to "a thousand opinion formers to promote a coordinated long-term drug prevention campaign for Europe". [I asked to attend but was refused.]

The host was Emma Freud who stated that the object was to use the media to form attitudes in young people. She said the media has portrayed Ecstasy in a way that has created a wave of interest, and that there may be an argument for suppressing information. Nick Ross replied that the media does censure a great deal, but in the case of Ecstasy "It was all the rave, and the rage, before we knew about it". He added that politicians must not look to the media to manipulate society. Janet Street-Porter was then asked if she agreed, and replied: "Yes, I certainly don't think it's the role of the BBC to put across PR messages on behalf of the government. I think it is the job of Nick and myself to illuminate people"

The final words were an appeal from a bishop: "If the government says that Ecstasy is always dangerous, if the church says that it is sinful and doctors say that in many cases it is fatal, then we might change the situation."

93 'Ecstasy and intracerebral haemorrhage, by JP Harries and R De Silva, in The Scottish Medical Journal, October 1992

This paper reports on four cases of intracerebral haemorrhage related to the use of amphetamine or Ecstasy that presented to the Institute of Neurological Sciences at the Southern General Hospital in Glasgow over a ten week period in 1992. None of the patients were given blood or urine tests to confirm the presence of a drug or identify the type of drug taken. One patient, a 20 year-old man, died after a stroke, having had his soft drink spiked with Ecstasy in a pub at lunchtime. Doctors discovered a large frontal haematoma - or blood clot - in his brain when they gave him a CT scan and a left frontal angioma. They operated, but the patient was declared brain dead the following day.

A previously healthy 30-year-old woman who was brought to the unit suffering from a sudden attack of headache, dysphasia - a speech disorder - and hemiparesis (paralysis) affecting the right half of her body, informed doctors that she had taken a mixture of Ecstasy and amphetamine at a party just prior to the onset of her symptoms.

An anonymous phone caller informed doctors that a 22-year-old woman, who was brought to the unit after having an epileptic fit following a sudden onset of severe headache, urinary incontinence and agitation, had taken amphetamine sulphate just prior to the onset of her symptoms.

A sixteen year-old boy was admitted to the unit, who had a mild right hemiparesis with an expressive dysphasia and blood pressure of 130/70. He had been drinking cider with his friends and his drink had also been spiked with Ecstasy, the paper says.

They conclude: "The close timing of our four cases makes us suspicious that impurities in a batch of drugs may have been a major factor in the concentration of cases in Glasgow over such a short period."

94 Interview with Rick Doblin, president of the Multi-disciplinary Association for Psychedelic Studies in High Times, December 1992.

Doblin talks about the way MDMA was outlawed in the US.

When the Drug Enforcement Agency tried to get the World Health Organisation to place MDMA in the international drug treaties, a very fortuitous thing happened. The person appointed chairman of WHO's Expert Committee was Dr. Paul Grof, brother of Stanislav Grof, the LSD researcher. [Through him] I was able to send information about MDMA to Paul Grof. Though the committee did make MDMA illegal, they did so over the objections of the chairman, with the objections being formally noted in the committee's recommendation. Even more importantly, the committee explicitly encouraged the signatory nations to the international drug control treaty to facilitate research into MDMA, which they called a most interesting substance.

95 The Swiss Medical Society for Psycholytic Therapy. President: Dr. Med. Juraj Styk, Birmannsgasse 39, 4055 Basel, Switzerland

The society's address is that of the president's consulting room. There are some 30 members but only four are licensed to practise with MDMA and LSD.

96 Listening to the Heart of Things (book), by Dr. Samuel Widmer, a Swiss psychotherapist who uses MDMA with some clients, subtitled The Awakening of Love, published by Nachtschatten 1989

This book is in German but may soon be available in English, too. It covers the work of Dr. Widmer up to 1989 using LSD and MDMA in psychotherapy. The book has three sections: (1) The unwanted psychotherapy. (2) Beyond duality - the awakening of love. (3) Psycholytic psychotherapy.

[Some case histories from this book are summarised in chapter 9.]

97 Dancing and rave drugs, by Russell Newcombe, 1991

Newcombe suggests that clubs are safer than raves because of fire and other health precautions, and argues that police and local authorities should not therefore try to close clubs where drugs are used. Drugs are often taken before entering. "It would be no exaggeration to say that raving is now one of the main reasons for living for a huge group of socially diverse people aged between 15 and 35 years," he says.

98 Can drugs enhance Psychotherapy? by Grinspoon and Bakalar, from American Journal of Psychotherapy, 1986

The authors say that compared to LSD, MDMA is "a relatively mild, short-acting drug that is said to give a heightened capacity for introspection and intimacy along with temporary freedom from anxiety and depression, and without distracting changes in perception, body image, and the sense of self". These effects should be of interest to Freudian, Rogerian and existential humanist therapists, they argue.

MDMA strengthened the therapeutic alliance by inviting self-disclosure and enhancing trust. Psychiatrists suggested it was also helpful for marital counselling and diagnostic interviews. Patients in MDMA-assisted therapy reported that they were released from defensive anxiety and felt more emotionally open, which made it possible for them to get in touch with feelings and thoughts which were not ordinarily available to them. It was easier to receive criticisms and compliments. A patient said that the major difference in psychotherapy that included taking MDMA was "being safe. Nothing could threaten me". A patient who found she was more in touch with her feelings and could express herself more easily 18 months after her last MDMA session is cited as evidence that MDMA has lasting benefits.

The authors say MDMA may also help in working through loss or trauma, supported by the following anecdote. A patient said that after a session where she had grieved the loss of her boyfriend, she was surprised at feeling pleased with herself for having grieved so deeply.

Many MDMA patients claimed lasting improvements in their capacity for communication, such as getting on better with marriage partners. Increased self-esteem was also lasting.

The authors conclude that many pre-industrial cultures use certain psychedelic plants to enhance a procedure that resembles psychotherapy. MDMA was a far more suitable psychotherapeutic aid to substitute for this than the true psychedelics tried in the sixties.

99 Ecstasy: the clinical, pharmacological and neurotoxicological effects of the drug MDMA (book), edited by Stephen Peroutka, published by Kluwer Academic Publishers 1990

This is the classic serious work on MDMA but costs about #100. The book includes essays by a range of experts in the field: The History of MDMA by Shulgin; Therapeutic Use by Greer; Testing Psychotherapeutic Use by Bakalar and Grinspoon; Recreational Use by Peroutka; Toxicity by Dowling.

There are 13 chapters in all.

MDMA is unique among recreational drugs in that taking larger or more frequent doses reduces the pleasant effects and increases the bad effects. It is also unique in that the effects change with successive doses, the first being the most pleasant while further uses produce more uncomfortable side effects. [This view is challenged in a more recent report.26]

Therapeutic use

"MDMA seems to decrease the fear response to a perceived threat to a patient's emotional integrity, leading to a corrective emotional experience that probably diminishes the pathological effects of previous traumatic experiences," Greer says. Double-blind comparisons are not feasible in clinical settings because the MDMA state is easily perceived by both the patient and the therapist. Suggested therapeutic uses include family relationships and drug addiction.

The effect of MDMA was seen as secondary by the therapists: the drug assisted rather than caused the desired outcome. The goal of developing a more compassionate attitude towards oneself and others was easily achieved in MDMA-assisted therapy. Of paramount importance was the quality of the relationship between the client and therapist: enabling the client to feel safe to open up fully was seen as more important than the dose of MDMA taken. It was considered essential that the therapists tell the client that the client's MDMA trip had been helpful to them, in order to reassure the client. For therapists, "The experience of fearless communication and spontaneous forgiveness, or letting go of resentments, was particularly important in understanding how MDMA can be used effectively."

The screening of prospective clients is very important. Those with heart problems; those using psychoactive medication; epileptics; hyperthyroids; diabetics; hypoglycemics; hypersensitive people and those with liver disease or other risks of morbidity should be excluded. Although the drug was considered useful for those with psychiatric problems, therapists worked only with relatively well-adjusted people. They excluded those who aroused uneasiness on interview. Patients were warned about the possible adverse side effects, and this resulted in several opting out.

The therapists preferred to work as 'sitters' or assistants to patients who were exploring themselves rather than to become involved in a long term therapeutic relationship. Patients could ask for anything they wanted during sessions. [Agreements given under Greer.28]

Discussing unwelcome effects of MDMA, therapists mentioned the pain of unfinished grief or trauma associated with forgotten memories or repressed feelings, which often resulted in depression and/or anxiety. This was usually experienced as difficult but useful, and seldom lasted more than a few days. They had not heard of long-term problems resulting from such feelings.

Since the outcome of MDMA sessions cannot be predicted, patients were warned to be prepared to experience anything that might arise during or after their session. They had to have a conscious desire to be open to the most painful experience of their past so as to be able to work through it. "You are consciously taking a medicine to open yourself to whatever teachings you may need at this time. Neither you nor we know what these teachings are or how they may occur. We will provide a safe place for your explorations and be available to assist you with any difficulties, but all that you learn that is real comes from yourself or from the Divine that is within you - not from us or the medicine itself," one therapist would say. Preparation was seen as important. It was felt to be useful for clients to have clear expectations, which made it easier for them to let go. Clients were advised not to take alcohol and other drugs for the preceding few days, as this is thought to reduce the effect of MDMA, and to eat no food for the preceding few hours.

Patients were asked whether they wanted a low, medium or high dose. For men, this was 100 to 150; for women 75 to 125 - women were thought to be more sensitive to the drug, perhaps due to their lower body weight. Higher doses were advised for those focusing on themselves; lower doses for couples wanting to communicate with each other. The therapists' main role was to provide for physical needs and to offer interpretations as required. Dr. Greer advises clients to relate their experience afterwards, rather than have their therapist record the trip in process. If a monologue occurred, he suggested the use of a tape recorder to focus attention inward, rather than towards the therapist. After the drug wore off, patients usually sat up and talked about what had happened. Therapists did not routinely offer to interpret clients' experiences, but tried to facilitate a smooth transition back to normal.

About 90% of the clients had powerful and generally positive and useful experiences under MDMA. A third of these had had one session; another third, two and the rest, three or more.

The book also includes a report of a survey of Ecstasy use among students at Stanford University. 39% of students had used MDMA. 100 completed a questionnaire while under the influence. The results were unsurprising: 90% reported increased closeness with others.

Also included is a report of Ecstasy-related deaths involving heart failure and asthma that have been investigated in the US.

100 The Biology of Human Information Processing by Enoch Callaway from Journal of Psychoactive Drugs Vol. 18/4 1986

The paper starts with the premise that humanity's most pressing problem is to understand the human mind; to date, progress has been disappointing; and psychoactive drugs hold most promise. The most important use of psychoactive drugs, and MDMA in particular, is to help understand the human mind. No laboratory way of assessing love exists.

101 Research in Russia, from MAPS newsletter, Nov. 1991

"A collaborative working relationship has been established between MAPS, Dr. Evgeny Krupitsky, a psychiatrist in St Petersburg, and psychiatrists working on the MDMA protocol here in the US," it is reported. Dr. Krupitsky says it may be possible to do research on MDMA at the Leningrad Institute of Oncology. He hopes to receive permission to do research into the potential of MDMA for relief of pain and alcoholism.

102 Attenuation of Alcohol Consumption by MDMA in Two Strains of Alcohol-Preferring Rats, by Amir Rezvani et al., 1991, from Pharmacology, Biochemistry and Behaviour, vol. 43

Alcohol preference and manifestation of alcoholism in rats are thought by many to be associated with serotonin dysfunction in the brain. Since MDMA stimulates serotonin release, experiments were carried out to determine the effect of MDMA on alcohol consumption.

The rats, which were bred to be alcoholics, were given free access to food, water and 10% alcohol [similar strength to wine]. After being injected with MDMA for 3 consecutive days, they drank less alcohol and more water from the time of the first dose, with the effect diminishing to nothing 3 days after the last dose. No behavioural changes were noticed on MDMA, so the results are presumed to be the direct effects of the drug.

103 MDMA - The Psychoactive Substance for Therapy, Ritual and Leisure (book), by Weigle and Rippchen, published by Der Grune Zweig [no date]

This short book, available in German only, includes items on the pharmaceutical and legal aspects of the drug and its effects, dangers and therapeutic uses [chapter 9]. It describes circle rituals of the Native American Church in which MDMA is used in place of Peyote [chapter 10].

104 International Journal on Drug Policy, Vol. 2 Oct. 1989 Ethnographic Notes on Ecstasy Use Among Professionals by Rosenbaum Morgan and Beck

This is a study of a group of drug users whose lives are much more focused around their careers than around any drug. It includes 100 in-depth interviews. Typically, these tend to be people who used LSD in the sixties but have since led drug-free lives except, perhaps, for moderate use of alcohol and marijuana. Ecstasy presents them with an opportunity to be open and relaxed within the context of a professional lifestyle that is stressful and regulated. They use MDMA very sparingly (three or four times a year) because "they are too busy, too discriminating [they are concerned about the effect on their health] and a bit too old". They plan ahead and arrange a two-day event with a few close friends in a quiet location with comforts, music and refreshments well prepared, starting in the morning so as to get a good nights' sleep. Newcomers are well prepared and looked after. Some will even match the dose to body weight, using 1 mg per pound.

[100 mg for someone weighing 7 stone.]

"During the trip there is much warm, affectionate conversation, a feeling of bonding and closeness with friends. Generally, the spirit is positive and euphoric. There is much affirmation of life, of relationships," the report says.

The second day is spent quietly together, and is regarded by some as the most valuable part of the experience, when the "best interactive work can be done".

The report concludes that people who live highly stressed lives can condense the relaxation of a fortnight's holiday into a weekend.

105 MDMA use as an adjunct to spiritual pursuit by Watson and Beck in Journal of Psychoactive Drugs July 1991

New Agers typically believed that carefully planned experiences possessed significant material of lasting spiritual and/or therapeutic value. Although the aims of individuals within this group differed, the study showed how greatly social worlds influence the quality of MDMA experience pursued and valued.

106 Misuse of Ecstasy, letters in the British Medical Journal, 1/8/92

The letters related various symptoms relayed to Ecstasy use:

1. Recurrent acute hepatitis associated with the repeated use of MDMA. The patient admitted to using Ecstasy 8 to 15 days before each of 3 episodes of jaundice.

2. A 20 year-old student had been taking "one or two tablets of Ecstasy at weekend parties for the previous three months. He had ingested about 20 tablets over this period. . .Illness developed many days after use of Ecstasy."

3. Three normally fit teenagers came to the emergency department of a hospital complaining of severe chest pain. Had all danced for some hours. All discharged themselves after learning that their pain was not cardiac.

4. Two young men arrived at a hospital by ambulance. One had had a fit after taking Ecstasy. The second collapsed after complaining of a headache, and was kept in overnight. The next morning he said that the experience would not stop him using Ecstasy again.

5. Four patients between 16 and 30 had cerebrovascular diseases related to Ecstasy or amphetamine. Three made good recoveries, but the fourth had died. [The report did not say which drug was taken by the person who died].

107 Possible Interaction Between MAOI and Ecstasy, letter to American Journal of Psychiatry, 149:3, March 1992

A patient on the antidepressant monoamine oxidase inhibitor (MAOI) consumed some Ecstasy. The same drug had normal effects on her friends. One hour later she was delirious and agitated; five hours later she returned to normal. Another similar case is referred to. The conclusion is that there may be an interaction between these drugs, and this may be due to them both affecting serotonin levels in the brain.

108 Behavioural and neurochemical effects of prenatal MDMA exposure in rats, by St Omer et al., in Neurotoxicol Teratol, vol. 13

Groups of pregnant rats were administered varying doses of MDMA on alternate gestational days. Gestational duration, litter size, birth weights and physical appearance were unaffected. Behaviour and intelligence of the offspring were unaffected, except that subtle behavioural changes such as enhanced olfactory discrimination were noted.

109 The Placebo Effect in Healing, by Michael Jospe, 1978, pp 22-25 related to Ecstasy

Over 2,000 studies on the effects of LSD were carried out between 1943 and 1963. Jospe says: "The relationship between such drugs and what happens when placebos are administered in their place makes for interesting reading and points out some thought provoking results . . ."

33 volunteers were told they were being tested as to the effects of LSD, but were given tap water instead (Abramson, 1955). The symptoms of 25-60% of the sample corresponded in some ways to what would have been expected if they had taken LSD, though only 5% answered positively to such questions as "Are things moving around you?"

In another trial (Zegans 1970) the effect of LSD on creativity was tested. Some subjects were given LSD, others water. No differences were observed. However, it is pointed out that the subjects may not have been creative people in the first place.

A trial using male actors (Linton 1962) found that placebo subjects experienced maximum loss of control after 30 minutes, and this declined gradually. "After two hours, subjects reported feelings of having acquired new meanings and a more prominent general feeling of disinhibition." The researchers found that those who had taken placebos experienced similar types of symptoms at 2, 5 and 8 hours after ingestion, although the symptoms varied from strong to very weak.

With marijuana, some placebos were made by extracting varying amounts of the active ingredient THC. The symptoms reported by most subjects were consistent with strength, but the unexpected result was that chronic users felt stronger reactions from the placebo.

110 Psychedelics Encyclopedia, by Peter Stafford, 3rd edition published by Ronin, 1992

This edition has an added 26-page piece on MDMA. It describes how MDMA was scheduled in the most dangerous category of drug because of scares regarding a previous "designer drug" called China White which caused Parkinson's disease, and the false assumption that MDMA is similar to MDA which had already been scheduled. These drugs were confused in the press. Rick Doblin, president of MAPS, is accused of making well-meaning but misguided attempts to publicise the benefits of MDMA. The strong opposition to the scheduling of MDMA failed to prevent the drug being scheduled. It would be too expensive to challenge MDMA's status again.

MDMA has little abuse potential because it exhibits tachyphylquaxis - rapid build up of tolerance - so that repeated use over a short period leads to a loss of the desired effects.

A tiny proportion of people are hypersensitive to such compounds as MDMA and so it is best to try a low dosage first.

MDMA has an unusually consistent response compared to psychedelics. Set and setting are far less important. According to Claudio Naranjo, it gives a "brief, fleeting moment of sanity".

Stafford also mentions a meeting of therapists enthusiastic about Ecstasy in March 1985 at Esalen, a psychotherapeutic centre in California. The combined total clinical experience of using Ecstasy among those present was several thousand sessions, and they reported uniformly positive reports. The drug was found to reduce defensiveness and fear of emotional injury, thereby facilitating a more direct expression of feelings.

Problems encountered in using Ecstasy therapeutically were raised at the meeting. The main problems aired were that an Ecstasy trip would not fit in with the standard 50 minute therapy session, and that conventional psychologists might regard the ecstatic effects as pathological. Quick insights may not be absorbed as well as the slower approach. Stafford points out that when pure, MDMA consists of white crystals 2-3mm long. A brownish colour indicates incomplete synthesis.

112 Visit to August de Loor, administrator of a 'safe house' which offers drug sample testing and advice to the public - dealers included - from a basement office in AmsterdamAppendix 6

When I visited there were three people having samples tested. An ordinary white plate on the table had particles of various pills placed around the edge, and a drop of a clear liquid was placed on each from an eye dropper. The particles changed colour within a few seconds, but it was not obvious to me how to describe the colour except to say it was dark, some bluish and some brownish. de Loor would not reveal what the test was because, he said, a previous test for cocaine became useless when dealers added an ingredient to make it show positive without cocaine.

He showed me an American report called An evaluation of the potential for clandestine manufacture of MDA analogs and homologs - of which MDMA is one - that explains how MDMA is made and what equipment is required. August knew of one factory producing 250,000 Es a day. He also said that recently there was a party in Rotterdam attended by 22,000 people and there were only 3 casualties, all due to people falling over. Although presumably many people were on Amphetamine (because so much is sold as Ecstasy) these must have been affected by the 'contact high' and there was no violence. Pills made for export look different to those sold in Holland, so as to be less easy to trace back. Mistakes in manufacture could lead to overdoses - at the time there is some double strength MDA on the market.

113 Drugs Arena, National Criminal Intelligence Service, 1990

Seizures of tablets included fake MDMA consisting of prescription mianserin tablets, rubbed down to remove markings and to give them an 'illicit' appearance. Most Ecstasy is believed to originate in the USA or Holland, but there is some evidence to suggest UK manufacture.

Illicit synthesis of MDMA is usually achieved by reductive amination of 3,4 methylenedioxyphenyl-2-propanone which can be obtained from commercial sources. During MDMA synthesis, deliberate or mistaken substitution of the butanone for the propanone, followed by reductive amination, results in the formation of 3,4-methylenedioxyphenyl-3-butanamine (HMDMA). HMDMA does not have the phenethylamine moiety necessary to make it a controlled drug under the provisions of the Misuse of Drugs Act (1971).

None of the seizures of "Ecstasy" contained poisonous or addictive substances.

114 Ecstasy makers face 14 years jail, from The Daily Telegraph, 10/11/92

Changes in the law will make it illegal to manufacture or supply four key components known to be used to make E, with a maximum penalty of 14 years jail. They are methylenedioxyphenyl-2-propanone, piperonal, safrole and isosafrole. The changes to the law are expected to be in force by the end of 1992.

In 1990, 44,000 tablets were seized; in 1991, 365,000.

The article says that Ecstasy, selling for #30 a tablet [!], is "emerging as the biggest drug problem".

The Daily Telegraph's science editor, Roger Highfield, says legislation may backfire and encourage use of a plethora of more dangerous drugs. Dr. Russell Newcombe is quoted as saying that additional dangers could arise when manufacturers have to do without these raw materials.

115 Traffickers, by Nicholas Dorn et al., published by Routledge, 1992

The popular image of well organised gangs of drug dealers run by a "Mr. Big" is a myth, according to Dorn and his colleagues. Among drug dealers in Britain, there are "no cartels; no Mafia; no drug barons and relatively little corruption," although such forms of organisation may well exist in producing countries or to some extent in the US. Here, drug distribution is best described as 'disorganised crime'.

The authors interviewed 25 convicted drug traffickers of both sexes in prison and found that they had a wide range of motives. They also spoke to 55 people who had been active in the illegal drug market but had not been convicted. Some were still dealing.

They found that dealers fell into a number of main types:

1. Trading Charities: people who are motivated by ideological reasons rather than profit.

2. Mutual Societies: networks of user-dealers who are friends.

3. Sideliners: legal businesses that trade in drugs as a sideline.

4. Criminal Diversifiers: criminal businesses that also get involved with drugs=09

5. Opportunistic Irregulars: people who get involved in a variety of activities - legal and illegal - including drug dealing.

6. Retail Specialists: organised drug dealing enterprises with a manager employing a number of people in specialist roles to distribute.

7. State-sponsored traders: drug dealing enterprises that result from collaboration between the police and dealers, such as those allowed to trade in exchange for information.

The situation is fluid, so categories are loose and dealers change their methods. There has been a general shift towards the more overtly criminal type of dealer.

In the 1960s there was a greater number of hash dealers who distributed just to get free supplies and status.

Pubs are used as distribution points by 'sideliners' ."There are wholesale pubs and retail pubs," the authors say. In the former, deals of #5,000-#20,000 can take place "twenty times a day". It is quite common for dealers in stolen antiques to move into drug dealing.

Retail Specialists

Retail specialists, the most organised type of dealer, are on the increase. They organise distribution in a way that mirrors other commercial distributors: specialists work under a general manager. The specialists include buyers; accountants dealing with the 'washing' of money; "reps" negotiating with security staff at raves; sales reps finding customers but not carrying drugs; people looking after the drug stock; lookouts and people to provide physical protection. These last may prevent other gangs from poaching on the gang's territory, and help to create diversions to distract the police, by, for example, starting a fight.

The authors discuss various methods by which drugs money is laundered and the mistaken police policy, adopted from the United States, of trying to 'get Mr. Big'.

Widespread knowledge of police policies helps the dealers to adapt and to avoid being caught. Because the dealers are well-informed, flexible and constantly adapting, random methods would be more effective than current policies in tracking them down.

Undercover police operations

Police agents adopt an identity and lifestyle that is maintained on a 24-hour basis for a lengthy period. The authors give a long graphic account of a police operation to find drug manufacturers. A policeman poses as a buyer for a gang and negotiates a test deal in a pub and, later, a bigger deal. The suppliers get suspicious that the "buyer" is prepared to pay so much given the quality of the drug they are selling, but come to the wrong conclusion that he is part of a gang trying to get the drugs without paying. Arrests are made and the undercover agent head-butts a policeman and gets away, thereby hiding his true identity.

The authors say that the rise of Ecstasy and the return of LSD are not linked to crime in the same way as heroin, users of which are said to commit crime in order to pay for their habits, and crack cocaine, which is associated with violence.

A chapter on 'intelligence' includes a survey of what the police regard as 'good intelligence'. Curiously, intelligence that is 'current and detailed' scores twice as high as intelligence that proves 'right on investigation'. It is mentioned that the first seizure of 100,000 MDMA tablets resulted from police tracing a manufacturer through their materials suppliers.

116 High Time for Harm Reduction, by Russell Newcombe, Druglink, Jan. 1987

Newcombe says that it is too late to apply 'primary prevention' - education to prevent people taking drugs - to the present generation of drug users. In general terms, primary prevention has failed. However, it has been shown that education can slow the development of the more problematic forms of drug use, while leading to an increase in safer forms of drug use. This suggests that it would be prudent to divert some resources towards 'secondary prevention' or 'harm reduction' - preventing overdosing, accidents and infections which result from ignorance.

Policy makers should be giving serious consideration to the question: "Would it be preferable to reduce the incidence of illicit drug use while not promoting safer forms of drug use, or would it be more realistic to give greater priority to the reduction of harm from drug use?" According to Newcombe, the four main components of a harm reduction strategy should be: (1) rationale, (2) content, (3) implementation and (4) evaluation.

1. It should be acknowledged that people like to get high, and that this is not likely to change. Drug use may be rational, not deviant, Newcombe says. It should be acknowledged that many psychoactive drugs are no more harmful than prescribed drugs. "The message that drugs are unhealthy is akin to warning soldiers in battle that chewing gum can cause indigestion," he says. Harm reduction policies are based on a caring rather than a judgemental approach, and are therefore less likely to drive drug users underground.

2. The strategy must be based on knowledge. The focus should be on controlling use rather than seeking complete abstinence, which is out of character with modern life. Instructions should be given on suitable quantities, effects, safest methods of administration, obtaining help when needed, avoiding hazards and methods of controlling mental states.

3. The implementation strategy should draw on knowledge of how to maximise the probability of success. Drug use tends to follow on from heavy smoking and drinking, so smokers and pub goers are a suitable target, although there may be a risk of arousing an interest in drug use, and there may be objections from parents.

4. It will be necessary to do 'before and after studies' and long-term follow-ups using control groups to evaluate the effectiveness of harm reduction strategies.

117 The Reduction of Drug-Related Harm, a conceptual framework for theory, practice and research, by Russell Newcombe, from The reduction of drug-related harm, edited by O'Hare et al., (book) published by Routledge 1992

Assessing the harm that can be caused by a drug and the effectiveness of harm reduction policies is difficult because both the harm and benefits resulting from drug use - or abstention from use - must be taken into account and some of the benefits may not be evident in the short term. Risks and the effectiveness of risk reduction policies are easier to assess, and risk assessment can often be carried out through questionnaires. It is possible to separate the risk factors involved and to measure these by means of observation, interviews and questionnaires. Interpreting the outcome of harm reduction is complex and requires clearly defined objectives at the outset. Hypothetical examples are given.

119 Harm Reduction Courses

A leaflet advertising courses by the Atlantic Project, 20 Fir Road, Waterloo, Merseyside, L22 4QL (051-928 2234) included the one day course "Working at Raves and Clubs". A poster on Party Drugs is also available.

120 Rave Research Bureau, 25 Halkyn Avenue, Liverpool L17 2AH

This is the trading name of Dr. Russell Newcombe, lecturer in social policy and social work at Manchester University, under which he supplies information sheets and reports on Ecstasy use and related matters. Dr. Newcombe's consultancy work also includes organising surveillance of raves and nightclubs for their owners and producing reports on the presence of drug dealing and use.

His surveillance method conforms to a 10-point code of practice. (1) Researchers must be suitable, i.e. qualified social workers or similar care professionals. (2) Researchers must participate in specialist training and know the relevant legislation. (3) Work is voluntary. (4) Researchers should be familiar with rave conditions and hours. (5) While working, researchers' behaviour must simulate the behaviour of customers. (6) They should blend in but avoid making strong personal connections. (7) If drugs are offered for sale, they should inquire about the price only. (8) Monitoring should be kept covert, and notes should be written after the event. (9) Incidents involving the police should be observed at a distance. (10) Researchers must not to talk to the press, media etc. without permission.

121 Telephone interview with Marcia Ash of Dance Ambulance, a first aid service in Manchester for ravers, 6/2/93

Ash is a dietary therapist who used to go to raves and clubs and find that she was helping people who were feeling sick or paranoid, so she thought "Why not get paid for it?" Dance Ambulance is the result. The Parliament Club, which opened in Manchester in autumn 1992, introduced new safety guidelines from the outset - in line with a harm-reduction policy adopted by Manchester City Council - which required some security staff to have first aid training. Ash offered her services and now works at the club every Saturday night. She has recently applied to public and private backers for funding, and has received some encouraging responses. She also hopes to get funding from the Seized Assets Fund - money from seized assets of drug dealers. Ash uses a range of alternative therapies including homeopathic remedies, "polarity therapy" and "flower essence therapy". Various people have expressed interested in joining Dance Ambulance, including therapists, community drug workers and counsellors.

The work consists mainly of helping women in the toilets (far more women than men appear to suffer side-effects at raves). Many are paranoid or sick. Ash makes sure that sufferers have their friends with them and gives them homeopathic or flower remedies until they feel better or decide to go home. Ash joins in the dancing herself, but keeps an eye out for people needing help. Sometimes she sees girls "stuck in the corners" and asks what's wrong. A typical answer is: "Just fucked" - they feel rotten, perhaps paranoid, and can't move.

Ash believes that most problems come from being sold substitutes, including drug cocktails, instead of MDMA.

Ash is trying to recruit a number of helpers, who would be identified by their T shirts and to set up a permanent office for Dance Ambulance. All helpers would have to take first aid courses and learn about drugs and Lifeline, the Manchester drugs agency, has offered to help with training.

122 Marketing in 1992 and Beyond, a paper presented to a Royal Society of Arts conference in 1988 by E Nelson

Nelson reports that a market survey revealed the following change in values: "People have the need to feel their body in new and different intensive ways, the desire for frequent emotional experiences and the enjoyment of doing something which is just a little bit dangerous and forbidden".

123 Phone interview with a couple who use E for playing music

A couple living in California have been using Ecstasy for playing spontaneous music over the past 15 years with a few intimate friends in an unusual way. They take small doses of about 50 mg every hour or so for a whole day and have even gone on for several days, though the first couple of hours is the most creative for the woman. They have had several hundred such sessions.

There is more harmony between them, probably due to their increased empathy. They find no problems due to the E causing distractions, they can get right into it. But it can be helpful to start with a strong base note playing, to beat out a rhythm, as a basis to work into the music. She is too shy to play freely without, together they are more free to express themselves in creative ways without being self-judgemental.

Asked how music stood up to scrutiny afterwards, they answered well. It was more spontaneous, more inspired and freer without falling back on known routines though not basically different in character to the way they played without. However they have got bored with it over the years because it doesn't take them far enough into another space.

Asked whether E would work in same way with strangers, they said it would probably help, but they don't know others doing it.

The couple also like to go out on a lake in a canoe wearing wireless headphones connected via a home made electronic system that can produce various effects such as time delay or sound distortion which he can easily handle on E. They first used it to clear a lot of shit between them, and later to develop and get into nature. The experience is more on an emotional level than spiritual. They have no set goal, except to develop themselves and their relationship, and lately just to have fun. Once a regular monthly event, they have now cut down as they find the after effects are worse.

124 Interview with couple who use E while floating

This couple have their own float tank and say that E adds to the high produced by being in isolation in the tank. On E you can verbalise ideas about what's happening emotionally and bounce these off yourself. When you hit a button and can face up to it, then can you feel your body become more relaxed as that bit of tension is relieved. The tank alone can help relax the body releasing more energy for the mind, but this doesn't always work without Ecstasy.

125 'E'sy sex: a cultural myth in perspective paper by Andrew Thomson presented at Medical Sociology Conference, York University 1993

Preliminary results of Andrew Thomson's study (see Appendix 5) showed that some 80% of those interviewed had practised sex while under the influence of Ecstasy. Furthermore, some 18% claimed that Ecstasy use did impair their decision to have safe sex.

126 Albert Hoffman Foundation Meeting 12/10/93

Held at Oscar Janiger's house. Director's meeting from 7 till 9, then open to invitees including myself. About 25 came. There were none looking like old hippies, all smart well-off professionals such as real estate agents, established therapists and film directors.

Bob Forte will edit the Association's Journal. Says he wants to look at psychedelics as sacraments rather than as therapeutic agents. After the meeting, I spoke to Leonard Berne, a psychotherapist who used MDMA until it became illegal.

Dr. Berne says the benefits of using E are: 1. As an aid to the therapeutic alliance, 2. To increase introspection, 3. To lift the sense of shame and 'endangerment'. It is this state that is the cause of neurosis, and people find ways to constantly reinforce this fear of letting go.

He says it is important to work at the end of the MDMA session and over the next few days about the reality of the state, and to examine what are the client's beliefs that buttress the sense of endangerment.

He thinks that the greatest potential use in psychotherapy is not with clients but for training analysts. E would make them aware of their own neurosis and increase their empathy. Analysts tend to avoid close introspection and the E would help them to see their own state, thus helping to break down their Godlike attitude towards their clients. Of course the present cleft suits most therapists, but many recognize that empathy with clients is needed.

Asked whether he thinks E will become acceptable, says that he believes the revolution will come from top down, because there is a current trend towards recognising that empathy between client and therapist is a key to successful treatment, and that E is the obvious way of improving this.

127 Meeting with Dr. Charles Grob 13/10/93

Dr. Grob came to see me primarily to brief me about what to check up on and look out for when visiting Nicaragua and discussing their proposed trial. MAO inhibitors (commonly used on prescription) can be dangerous if taken with MDMA - can cause bounding pulse, severe headache and induce a stroke in people who were are predisposed. People with cardiac arrythma (uneven heartbeat) particularly at risk. Ayahuasca also has MAOI activity, and so should not be used with E. There is now a pill made up sold as a synthetic Yage; if this contains Harmine or Harmaline could be dangerous if used with MDMA. Dr. Grob has heard of sessions where these two are used together and so are potentially dangerous.

Asked about liver and kidney damage due to MDMA use as reported by Dr. Henry, Dr. Grob assumes this was due to impurities as a result of contaminants resulting from poor quality manufacture.

Asked why use MDMA with cancer patients. Dr. Grob believes that MDMA raises pain threshold, probably due to its effect on the neurochemical mechanism of the brain. In addition, it appears that MDMA enhances the effect of morphine. The second benefit is expected to be emotional: MDMA generally improves mood and provides patients with a greater sense of being in control.

His trials are being conducted in a pedantically correct and proper way with impeccable protocol within the system so as to provide a solid base. If the results show benefits from MDMA, then no-one will be able to dispute them. Although this approach was frustratingly slow, he felt it was worthwhile. He has learned from past experience of people such as Timothy Leary who ran ahead without protocol, and as a result gave psychedelic research a bad reputation. In fact, he believes that it was Leary's rash enthusiasm and uncontrolled trials that resulted in shutting down serious work on psychedelics for the past 25 years - to fly in the face of the establishment is counterproductive. However, to be fair to Leary, much research in the past was conducted in ways that would not now be acceptable.

Asked about other research, he says that there is very little. There is a little in Germany and one man in Holland, Dr. Bastious, but he is about to retire without successor.

Own story. In early 70's dropped out of college and decide that what he really wanted to do in life was serious work on psychedelics, so spent the next 7 years studying for qualifications to do so, thinking that by the time he had qualified their value would have become universally recognised since in 50's and 60's the use of psychedelics was at the cutting edge of psychiatric treatment, then abandoned in spite of promising results due to overreaction to the use of recreational drugs. So it has taken until now for him to get to the first step.

Dr. Grob also told me about his recent research on Ayahuasca in central south America (not yet published). He studied 15 long-term users (who were members of a church based on both Christianity and shamanism who used Ayahuasca at least twice a month) and 15 controls using structural psychiatric interviews, and found that the Ayahuasca users scored higher than controls on every count! He also had the Ayahuasca users use the drug with catheters in their veins from which blood samples were taken every 30 minutes. Analysis implies the drug has a serotonergic effect which is what he would have expected. Trials were surprisingly easy to do because the users seemed to be unusually calm and cooperative, possibly as a result of their Ayahuasca use.

Dr. Grob has now applied for a grant to do a similar study of Mescaline users.

128 Psychedelic Explosion, by Inner Astronaut, an unpublished manuscript

Sections are entitled Brief history of psychedelics; Psychedelic safety; LSD; Psilocybin mushrooms; San Pedro cactus; Ecstasy; 2CB; DMT; Harmala alkaloids; Ketamine; Multiple combinations; Further explorations and Bibliography. I have seen two versions, one typed and the other laid out as a booklet with 64 pages. I have spoken to the author and he tells me that the final version will be expanded and improved. Two publishers are currently interested, and it will probably be available by 1995.

If you are interested in exploring psychedelics other than Ecstasy, then this would be well worth having. I expect it will be sold by mail order catalogues (such as Books by Phone) or from specialist bookstores by the time this edition is available; I do not have an address. The book is the experience of a psychedelic explorer who lives in San Francisco and has a tripping room suitably equipped with everything down to a vomit bucket. I have shown it to several psychedelic explorers who have commented that it is excellent. Criticisms are that it is too biased towards Ketamine and that, apart from sex, he does not appear to value the social interactive enhancements of some drugs.

The author rates Ecstasy rather low (as do many people who are keen users of psychedelics), but the following are his views on combining MDMA with other drugs:

The addition of 2CB allows users to retain and develop their insights. It can be taken with, before or after the E. 80mg E taken 11/2 hours after 2CB can produce deep empathetic content. It can also help an E trip to become sexual, but he suggests that, in general, the way to make any trip sexual is to get sexually involved early on.

LSD and E ('Candyflip') produces a more intense E high rather than an acid high. Nitrous oxide on E is 'quite enjoyable'. "A blast of nitrous oxide always feels good, especially if you're already high. . .It can put an additional peak on your peak, and can be used to 'break up' a state of mind so you can switch to something else".

129 Interview with Jack, undergoing MDMA therapy with a guide

Jack is a 43-year-old man who was the scapegoat of a family of four children, having been blamed and beaten unfairly by his father and used by his mother to vent her frustrations - she would put him down as his father did to her. He was brought up to think of himself as the runt of the family and grew up without self respect, unable to look people in the eye and convinced of his own unattractiveness.

He went into investment banking and was very successful in making money through aggressive and sharp dealing. However, he always felt lost; disconnected from others around him and their affection. He had sexual relationships with men, but they were without empathy and unsatisfying. He also went into analysis, but even after 20 years of this felt there had been no real progress.

At the age of 43, he had become rich and respected as a dealer who would drive tough and judicious bargains but still felt unable to look people in the eye for fear they would see what a shit he was - he felt guilty, unworthy, someone who deserved to be kicked around. He then attended a Grof breathing workshop where he was profoundly moved, and saw Grof himself as the father he had not had as a child, and he cried for two and a half hours.

There he met an unqualified MDMA therapist or 'guide' who had been using MDMA with clients since 1980, and when interviewed he had just completed 6 monthly sessions with him. Sessions last from 12 to 6 and the dose is 125mg followed by 80mg 2 hours later, and he is advised to be spend the next day by himself if possible. He first reports on anything significant since the last session. Then he is asked about his intention for the session, and to concentrate on a good intention and to think of the pill as a sacred substance. After about 15 minutes, he lies down and takes the pill, then puts on a blind and listens to music.

As the drug takes effect, he sees something approaching a night time scene with lights and stars, while his guide will ask him to breath in the light and other such visualisations. He feels able to speculate about anything. His guide does not direct him so much as to ask questions to help him develop thoughts, and will point out such things as repetitions but without steering his direction. The guide gives him lots of comfort and holding when appropriate, and also encourages him to express anger by hitting with a bat.

The process that seems to him to be taking place is akin to 'rewiring his mind'. He explained that he feels that his traumatic childhood caused wires in his mind to become wrongly connected (his analogy for neurosis) that were now becoming untangled.

His guide originally suggested he should try 6 monthly sessions of which he has now had 5. He charges $300 for a session lasting from 12 to 6pm, which Jack thinks is very good value. Jack has never tried MDMA outside these sessions.

In the first sessions his intention and guided visualisation expressed a desire to heal himself. He was shocked and amazed by how much anger came out, which he related this to his father beating him as a child. On the third day following early sessions he would feel depressed and this depression turned to anger.

Over the months the anger has been got rid of leaving him calmer and space to develop. Outside sessions Jack is better able to relate to people, and at last is feeling both attractive to women and able to relate to them warmly for the first time. He is more able to look people in the eye without fear of them 'seeing through him'; he has become far more giving, self-loving and relaxed. His attention span has tripled and he feels more aware of the present. Jack also plays music, which has greatly improved and he has started primitive chalk drawings.

But in his work he has lost his ability to be super-critical and tough which was the secret of his success. He accepts the loss as a small price to pay for his improvement.

In addition to the MDMA sessions, Jack recently had an LSD session (also $300) with a different, but very expert, guide. The dose was 300ug. He experienced a more profound and deeper level of heart opening, and felt as though he was regressing to being a 4-year old girl. He feels that LSD can take him further and may go for another session.

130 Visit to Dr. Manuel Madriz at the military hospital in Managua, Nicaragua, 22-24 October, 1993

At the end of 1989, Dr. Madriz was visited by an enthusiast in MDMA therapy who provided him with 40 capsules of the drug plus books and 2 videos on its use. The war was very hard then so he waited until January 1990 to try out the drug. First he tried out half doses on 6 patients, but saw no effect. Dr. Madriz or his staff did not try the drug themselves.

Next he called in 20 patients - all male soldiers who had previously been diagnosed as having depression or anxiety disorders such as PTSD. They were each given a capsule of MDMA simultaneously 1-5 days after admission. This was administered following their standard hospital procedure - the patients were simply asked to take the pill without being told what it was, and were given a standard warning that they may experience giddiness and blurred vision. There were about 8 staff present.

The first evaluation was made one hour later. Half said they felt better and half reported side effects. 15 of the group spontaneously came together and hugged one another, talking emotionally about how they wanted peace and an end to war. They were relaxed, felt good, but not euphoric. They were very communicative both to staff and to each other. Some praised the doctors; others said they felt love for everyone, even their enemy. They wanted a lot of attention from the staff, but were easy to deal with. There was no come down; the effects wore off so gradually they didn't notice and they felt positive for many days.

However, 5 separated themselves from the others. 2 of them panicked as though they were reliving the trauma and were given tranquillizers; one was at first paranoid as though he was being tricked. Of these, 3 were depressed.

Second evaluation was made 5 days later. 2 had dropped out; 13 were better of which 7 were regarded as needing no further treatment and were discharged, while the remaining six were treated for side effects such as tachycardia and anxiety. 5 were worse; 2 needing tranquillizers. Two were suicidal. One of those who were not improved had become an alcoholic as a result of his depression. Dr. Madriz and Sandino believed the symptoms expressed were latent before the MDMA was administered.

Dr. Madriz regarded this trial as encouraging but not scientifically significant. He introduced me to Dr. Estella Sandino who was present at the first trial, and she added supportive comments (she was obviously also very impressed by the effect of MDMA).

I asked why the patients were not informed what they were being given. Dr. Madriz replied that the normal practise in Nicaragua was that doctors gave medication and that patients accepted without question. They tended to be uneducated, and if asked, might become suspicious which could influence their response.

I also asked to interview some of the patients, but was told that they were from distant parts and would be difficult to trace, most probably having been discharged from the army due to their condition.

Dr. Madriz was now ready to start a scientific, double-blind trial with 100 patients, and he showed me 2 signed and sealed letters of authority from the hospital heads. He was adamant that no other permission was required since the government was independent from the army. He also showed me a well-produced preliminary protocol (in Spanish) which I was impressed appeared to comply with all of Dr. Grob's requirements except for Informed Consent and Independent Review Board. There would be pre- and post- physical tests; screening to choose patients with an identifiable problem; standard diagnostic interviews; exclusion criteria; psychological personality tests (MMPI and Beck Depression Inventory) before and after; psychiatric clinical evaluation and consistent structure of sessions. My overall impression was that Dr. Madriz is both able and keen to carry out an acceptable trial, but that he needs considerable assistance from outside. Fortunately he welcomes not only financial help but advice also, as was shown by wanting a visit very soon from Dr. Grob. He appeared unaware of the international legal situation, but may be able to get government approval. He was not keen on the idea of obtaining informed consent, but this may be a cultural difference.

Dr. Madriz says that this is the right time to do the trial; there is less pressure so the hospital and staff have capacity. He has 12 years experience of dealing with PTSD cases and has presented a paper on the subject in Caracas (which says that the symptoms of PTSD manifest more when the victims have poor support from family and peers).

The title is to be Efficacy of MDMA on Patients with Psychiatric Manifestations After a Trauma. It will consist of 5 monthly groups of 20 patients, half receiving placebos. Follow-ups will be at one, three and six moth intervals and altogether it will take exactly a year. The cost will be some $16-18,000 and in addition he will need visits from experts; literature on use; biochemical information; supply of MDMA; details of other research. Also a fax machine, mobile phone and Video 8 tapes. I expressed concern about those patients in the preliminary trial whose symptoms became worse and were given sedatives or tranquillizers. Dr. Madriz said that they were particular character types that he felt that he could exclude from the trial.

As an example of the type of patients suitable for treatment, I was shown a video of a diagnostic interview between Dr. Madriz and one of his PTSD sufferers. The soldier had been travelling with his wife when guerillas ambushed them. They were stripped; the wife brutally raped in front of him; he was tortured by beating and having his hair burnt off and a piece of flesh bitten out of one cheek, then was told that after he was beaten to death his wife would be further raped and then killed. Dr. Madriz told me that, after 15 years of war and bitterness, there were many such cases awaiting treatment.

I also asked if he had experienced MDMA. He had not, but intended that he and his team should take it together before the trial. I suggested that they could learn more from this event if an MDMA-experienced therapist was present.

131 Psychological Effects of MDE in Normal Subjects by Leo Hermle et al. Neuropsychopharmacology 1993 8/2

A German study on MDEA (Eve) showed that MDEA produced an increase in responsiveness to emotions, but that these were experienced in a calm and relaxed manner without anxiety. Tests showed that sensitivity was not impaired - perception, formal though processes and memory were normal. MDEA has much the same effect as MDMA, although the two drugs were not compared directly.

132 Interview with Daniel Kaufman, 27/10/93

Mr Kaufman is an artist who has used both LSD and E to explore and delve deeper within himself. He found that his style, which is abstract, became more open on E, and that within his paintings images occurred as though spontaneously - he believed it was his subconscious emerging. The results seemed to him to be a real advance, to have more character than previously. While on E he finds that the images flow out with clarity, and that the themes are cosmic and profound. He feels contact "with that which is eternal within us - love". But he was upset that he could not get such good results except while painting on E. He is convinced that the source of his work is inside him all the time and it worries him that he needs a drug to 'break through' his own barriers to act his true self. So now he is trying extreme purification through meditation, fasting and clean living in order to try to achieve the same state of calm and fearlessness, but so far without success. He meditates, and in fact used to teach Transcendental Meditation, but even the combination of cleansing and meditation only gets him part of the way that E takes him. The only equivalent to the E state he has experienced is being in love.

He has used E with lovers, and his experience has taught him that it is a great mistake to do so before the relationship is established, as it can lead to an in-love state without the necessary foundations. But, after several weeks of positive development, it is the ideal tool for bonding a relationship.

133 Interview with Max Shertz, 27/10/93

Mr Shertz is an artist in his sixties who first took E in February 92. It was with his estranged wife, and it was the best experience of his life, spent in passionate kissing but without an erection. As he has high blood pressure, a friend monitored him the first time, and subsequently he has monitored his own blood pressure when using MDMA and found the increase was not excessive.

Mr Shertz told me he is an established artist with work in 40 museums and is known for his well-established style. However, after taking Ecstasy he made a breakthrough - his good, strict realistic style became fluid and abstract. He has never painted on Ecstasy, and does not directly attribute the change to its influence, although his artist friend Daniel Kaufman does. However, he has written poetry which he claims was greatly inspired by the drug.

134 Interview with Dr. Smith, a licensed psychotherapist

Dr. Smith is a pseudonym for a well-established and experienced Californian therapist with a private practice.

Dr. Smith is one of those psychotherapists who believe that MDMA is such a valuable tool that they are prepared to take the enormous risk of being prosecuted and of losing their licenses by administering MDMA to clients. However, MDMA often takes the therapy onto a deeper level, so its use may prolong rather than shorten treatment.

He believes that E is an ideal tool as an aid to psychotherapy in a wide area, and if it were illegal he would use it more widely. It can be used as a spiritual awareness tool, and in fact he sometimes meditates and breathes on low doses, or before the drug has taken full effect. MDMA is also an ideal tool for couples, simply by allowing them to talk. As it is, with the risk of being informed on and struck off the register, he uses it only with clients who he completely trusts and have no serious problems, such as towards the end of a long series of sessions.

Not all clients are suitable for treatment using MDMA. Suitable people should have a strong sense of themselves and a strong spiritual sense. Out of 35 clients treated, one reacted in a negative way, seeing herself and her surroundings (which was her home) as dirty and ugly. He is now far more careful in selecting clients for MDMA sessions, as he believes that there are a small proportion of people who may react badly. However, it was a matter of mis-diagnosis, as the client's neurosis was not obviously apparent.

Neurotic people are not helped by being opened up by MDMA, he believes, because their base problem is that they do not believe in themselves which is the cause of their defensiveness: to open up by the use of MDMA adds to this problem. For them, it is safer to remain defended as it feels so alien to be opened up that they may deny that the experience is real. This may result in them forgetting the experience a way of avoiding the threat of being undefended, and they may deny to others and themselves that they were ever opened up by the drug. To help remind them, Dr. Smith records their session on tape which he gives to them afterwards, and sometimes uses photos.

Dr. Smith also believes the dose is important, and that body weight must be taken into account, 2mg per Kg being about right. [He used to use 3mg/Kg plus a booster of 1mg/Kg. The 'normal' therapeutic dose is 2.5mg/Kg.] If the dose is too strong, some people become scared and fight off instead of yielding to the effect, whereas too weak a dose may not overcome their defensiveness.

Dr. Smith has experimented with a wide range of doses on himself. He does not find that high doses produce speedy effects, and thinks such effects may be due to impurities. But on high doses his "mind runs away, becomes too busy, and is unable to hold onto thoughts".

While administering MDMA to a client, Dr. Smith prefers to take a light dose such as 50mg MDMA, or better still, 6-8mg 2CB (he weighs about 50Kg). This makes it easier to join in and stay with the client. He prefers a non-clinical setting such as in the client's home with music and sometimes earplugs.

Dr. Smith, who is a neo-Reichian, starts by asking the client to identify what the agenda is for the session. He may then begins with evocative music or perhaps simple drumming, and may ask his client to breathe deeply with his hand on their belly. Sometimes the clients use earplugsand eye shades. He encourages them to tell him what is happening, and reminds them if they wander from their agenda but without condemning it, as he believes that clients tend to "go where it is rich for them" - ie, tend to get involved in whatever is their most important issue. This may not have been anticipated, as for instance someone focusing on a superficial issue may see a deeper one. For example, one client suddenly remembered being raped as a child. Towards the end of a session, Dr. Smith uses an anchoring technique borrowed from NLP: he asks the client to go over what happened and to relive the highlights with the intention of holding onto them. At the same time, he asks the client to squeeze together their finger and thumb, with the idea that this physical action will help them to remember the experience at a later date. He always holds a normal session soon after an MDMA session to integrate what was learned.

The primary effect of MDMA is to lift anxiety, but it is important to accept that it plays an important role in life and can't simply be dismissed. He sees anxiety as fear neurosis which produces defensiveness which can be useful in some situations, but can be an obstacle in others. Dr. Smith suggests his clients to "respect your anxieties but ask them to stand aside ready to be called upon when needed."

Asked whether he believes in self therapy using MDMA on one's own, Dr. Smith replied that this only works for people without serious neuroses who are pretty good at self direction, otherwise the session is likely to be wasted. It is also important to establish a clear sense of direction before a self-session, and one way is to use the I Ching. The advantage of a guide is to interact and to bring one back to the issue rather than allowing the mind to wander. However, the helper need not be a fully qualified psychotherapist as most of the skill required is instinct.

Dr. Smith is a specialist in sexual problems. He uses imagery (sometimes with hypnotic trance) such as sap flowing with women who have difficulty achieving orgasm, and to treat pre-ejaculation the image of a bow being slowly pulled back.

I asked Dr. Smith whether he thought that MDMA would become acceptable in therapy. He doubted it would be as freely prescribable as he would like in his lifetime, but thought that its acceptance would start with well defined hospital programs.

Asked about possible problems due to inappropriate bonding, he said it had never happened in his experience. If at all, it seemed to him more likely that the therapist would fall in love with clients since they become so attractive.

Exhaustion depends on the dose and also the amount of emotional work done. To reduce fatigue he avoids secondary doses, gives 20mg Prozac at the end of a session, and he also recommends calcium and magnesium. At the end of a session he encourages clients to eat simple food such as soup, bread and sweet tea.

Asked if he thought the E experience may be false sometimes, he said it could sometimes be 'tunnel vision' but was always true. However, ways of relating on E may not be appropriate in the real world and insights have to be tested to be of any value.

135 Interview with Dr. Debby Harlow, 30/10/93

As newly qualified psychologists, Dr. Harlow and a friend first tried MDMA at a conference at Esalen when it was still legal. They were both amazed by the clear view that it gave them of their own psychology and by how easy it was to express to one another what they saw. They talked enthusiastically about its potential as a therapeutic catalyst. In later practice, until it was made illegal, she administered MDMA to over 200 clients without any bad reactions whatsoever, though she did screen out 'borderline' cases, ie people without clear boundaries between reality and imagination or those having fantasies about the therapist. Most of her clients were 'normal' people, those who could manage a normal life but wanted to 'grow'. Another licensed psychotherapist who started using MDMA with clients in the early 80s became disillusioned by his role as a therapist, believing it was the MDMA alone that benefited clients. He followed his conscience by becoming a dealer, selling MDMA and explaining how to use it as a better alternative to psychotherapy.

Dr. Harlow was involved in the movement to try to prevent MDMA being made illegal.

She undertook research into MDMA at the university of Cambridge (USA), though eventually that was curtailed by the change in the law. Some of her research involved using the Rorsach ink-blot test. Volunteers' cognitive aspects remained the same with the exception that some subjects spontaneously made connections between images seen on the ink blots and their own self, demonstrating a unique quality of the drug. For example, a subject saw an image as "Father about to hit me when he was drunk", bringing back a forgotten memory. By contrast, on hallucinogens this test shows very different cognitive aspects.

Dr. Harlow also did work with Jerry Beck for NIDA on the use of MDMA in a wider context.

Dr. Harlow suspects that excessive use of MDMA suppresses the immune system.

She is critical of the neo-Reichian use of MDMA because of its analgesic properties, and thinks that 2CB is much better for body work it does not suppress pain.

She sees the best use of MDMA for "re-patterning dysfunctional object relationships" - usually transferring one's childhood relationship with parents to others later in life. Examples are 'having to please' in relationships, or having to revolt against others in order to define oneself.

Asked what she thought about self therapy using MDMA, Dr. Harlow believes that a helper is essential to accept, listen, acknowledge and give the support of unconditional love to the client, but not to control the session. It is easier to emphasise if the helper is also on MDMA, but it is not necessary. She suggests that MDMA could well be used in co-counselling-type sessions, where two people take turns at being therapist and client. Another use of MDMA is as a 'gateway' drug to psychedelics, as it clears up fear problems.

She feels very sad that the benefits of MDMA have been lost by prohibition.

136 Interview with Martye Kent, 1/11/93

Martye's first experience with MDMA was in 1982 when she went on a spiritual journey to an ancient Inca monument. She took the MDMA in a shrine where she meditated for 4 hours on her own. When she came out she felt everything was "holy ordinary", and was guided by an inner voice that directed her to discover an ancient pre-Inca statuette and made her aware that a huge snake she encountered was not hungry. She was also able to converse with Indians without any common language. Later she told the story to a priest who said that her description was that of being in a 'state of grace'. She attributes the experience to being without fear thus allowing intuition to flourish without needing to justify her insights. The event taught her to trust her intuition, and was a spiritual opening.

In 1985 she met Masaius who she considered a genius, being an Egyptologist, a mathematician and also an astrologer. He combined his talents to work out a spiritual path which he called The Lion Path, a system designed to activate each person to their highest level. "Originally, MDMA played a part by holding the gates open to the other worlds and raising the energy to help penetrate the delusions of everyday life".

Masaius believes that there have been 'open' periods in history at regular intervals, the last being the renaissance, when there is the opportunity for spiritual growth. The present open period is what some others regard as the New Age, and in March 1994.

Masaius claims he has interpreted hieroglyphics on 3 benches inside the tomb of Tutenkamen, and that they refer to 3 levels of consciousness. One is the everyday level, the next that experienced in altered states such as on psychedelics while the third is that achieved while following a practice such as The Lion Path. It is this state which is desirable for spiritual growth.

Using astrology, Masaius determines a series of dates for each individual, on lines similar to numerology, to coincide with planetary configurations. He chooses dates to match each individual's openness to that of the world, and it is on these particular dates that they should meditate in solitude. Originally, MDMA was used to facilitate the sessions, but since its prohibition Masaius supplies tones and vibrations on cassettes as a substitute. For the first 7 months meditations are about every 3 weeks and from then on every 4 months for the next 4 years. The doses of MDMA were specified, rising and falling in rhythm; reaching a peak of 150 mg and then reducing to a final dose of 25 mg. By this time the pattern should have become habitual to the point that the state can be achieved without drugs. Before each meditation participants fast and decide on their intention for the session - which may consist of a personal aim or acquainting oneself with the character of the ruling astrological power - lying down with eyes closed and "allowing the universal force to penetrate". This sets the pattern for individual spiritual growth "within a cosmic egg". There is no other dogma, and participants do not meet. However, Martye has organized meetings for participants and to teach new people the method (which has met with disapproval from Masaius). She found that, though each person reported positive changes, the benefits varied enormously. It seemed as though the method caused each person to develop differently and to flower as an individual, though it was definitely a spiritual path.

Recently Masaius has denied that he suggests the use of MDMA, though according to Martye he used to be open about it. In the book I was shown, numbers were shown without explanation that Martye said referred to doses of MDMA in mg.

Martye feels enormous benefit from following The Lion Path. She feels more alive, purposeful and able to resolve things.

137 Phone conversation with Dr. George Ricaurte, 16/11/93

Dr. Ricaurte's paper on the 5 year trial comparing 30 MDMA users with controls has been accepted for publication provided he can show that his subjects were telling the truth, and list other drugs they were using. I asked whether the toxicity he found may also be caused by fluoxetine. He replied that the differences in action far outweighed the similarities - though they both lowered levels of serotonin, fluoxetine blocks its re-uptake rather than reducing its production. The only specific similarity is the long-term reduction in serotonin.

I also asked about fenfluramine. Dr. Ricaurte said that some brands consist of a mixture of isomers, one of which is believed to have similar toxicity to MDMA and another less toxic. The Lancet published an article about this toxicity and then published letters defending the supposedly toxic brand. Dr. Ricaurte believes the defensive letters were from people who have connections with the manufacturers.

138 Meeting with Clive, 1/11/93

Clive is a Californian part-time dealer who sells at raves. He says there has been a shortage of Ecstasy, and that as a result 2CB has been used instead even for dancing. Though he finds it less good for dancing, he regards it as more profound and sees it as a stepping stone for E users into the world of psychedelics.

When in Taiwan experienced seeing work-stressed girls simply falling asleep as the E gave them a break from constant tension.

139 Interview with John, a dealer in California, 11/93

John is an E enthusiast and also a dealer, visiting his clients every few weeks. He is also a musician.

I asked him if he ever played on E and he said that he has tried but couldn't provide the necessary discipline - except for this it would be ideal as creativity is improved and it allows one to be in touch without the fear that normally makes one censure free expression - "If you are trying, then you're not where its at". He finds E good for playing drums, but 2CB much better for playing music.

John supplies some of the well-known names in Hollywood, and says that demand has doubled over the past year. He believes this is not due to a shortage but simply E is spreading to a wider clientele. As an example, he mentioned a well-known film director whose latest film had been trashed by the media and whose wife had been ousted from a charity she had founded. They were both devastated when John visited them, but a few days later phoned him to say that their Ecstasy trip had put everything in perspective and restored their self esteem, a change which lasted.

John's sister in her late 40s was dumped by her husband who she had been very dependant on, having no social life of her own. John and her had not been close before, but he persuaded her to spend a day with him on E although she had never before taken a psychoactive drug apart from alcohol. It was an amazing day of exchange of heartfelt feelings between them, going back over events in their lives and establishing that they really did care for one another, which gave his sister confidence that she was not completely alone.

As a Father's Day treat, John chose to spend the day with his wife and two grownup children on Ecstasy. It was a delightful reunion, reestablishing the family's closeness and intimacy.

140 Interview with Jonathan in San Francisco, 2/11/93

Although used to good experiences on E, Jonathan once had a paranoid experience on two capsules marked 70mg, a higher dose than previously, but according to his friends the quality was good. He had been invited to a party where there was Ecstasy for people to help themselves to, and a friend he had brought with him had taken several Es for later use. Jonathan felt that the host hated him for bringing someone who had taken advantage of his hospitality. Jonathan felt he could not only read the host's mind, but that the host could read his and see all of his weaknesses, and was taking advantage of this ability to torment him by a kind of psychic torture. Jonathan had no doubts about the validity of his experience until he met the host some time later when he appeared not to even remember the occasion.

141 Visit from Stuart Frescas of Purdue University, 11/1/94

Frescas is one of a team of 13 scientists who have been working under Dr. David Nicholls at Purdue University since the early seventies. Their work is backed by the US government health department and is devoted to understanding the human mind through the effect of psychoactive drugs. They not only test the effect of existing drugs but also synthesize new drugs for this purpose, and in this context have produced a psychedelic many times more potent than LSD besides drugs with very specific effects such as one that lowers pitch of notes by a precise amount.

Unlike Shulgin, they do not test new drugs on humans but use rats that have been trained to distinguish between various drugs - this is the established technique but is slow, expensive and does not show up subtleties such as the 'warmth' of MDMA. One of the team's major projects is to develop a new assay for psychoactive drugs based on electrodes planted in several specific regions of rats' brains. Computers will analyse information transmitted by the electrodes to produce comparable charts, allowing the effects of drugs to be compared objectively. This assay should provide a reliable way of assessing the psychoactive effects of a new drug by comparing its chart with those of drugs with known effects. This, along with new techniques of synthesis, is one of many developments that is likely to lead to the discovery of new psychoactive drugs.

A range of drugs act on both Dopamine and Serotonin in varying proportions. At the dopamine (speedy) end is Methamphetamine; then comes the Indan Amphetamines; then MDA, MDEA and MDMA and finally MBDB at the (warm) serotonin end. However, Frescas is intrigued by the empathy associated with MDMA, and thinks there is more to it than the known effects on serotonin and dopamine. He believes this subtle quality is also produced by Mescaline, which would explain why it is used in Peyote ceremonies. The similarity is confirmed by tests on rats that will substitute Mescaline for MDMA but not other psychedelics. While these two drugs 'close the gap' between people, the opposite is true of other psychedelics.

Frescas believes the effects of psychoactive drugs vary greatly according to the situation in which they are used, and quotes Dr. Nicholls as saying that in some situations, such as while dancing, users may not notice the difference between MDMA and methamphetamine. The full subtle effects of MDMA (and other drugs) can be best experienced when taken in isolation from external stimulus.

However, he says there is a possibility that LSD varies according to its 'brand'. This is because LSD decomposes into different active compounds in heat, air and light (in a few hours near a fluorescent tube). Thus "window pane" acid is protected from air but not light while blotters kept in the dark are protected from light but not air and so, after storage, may contain different active compounds.

Research done on monkeys, he believes, may have produced misleading results. They fight to avoid being injected, have to be chained to a chair and hate the researcher. In this restrained state they may well prefer the relaxation produced by MDMA, but this should not be interpreted as evidence of abuse potential (as it has been).

Toxicity. In animals, the axions (that produce serotonin) of some brain cells wilt and die back with high doses of MDMA. Although they regenerate, they appear to be more coarse than before, and this may be considered as permanent damage. Fenfluramine has almost precisely the same effect. However, no damage to brain functions has been observed associated with the damage to axions. Similar damage is also caused by methamphetamine, and Dr. Frescas is concerned that the use of MDMA together with methamphetamine may increase the toxicity to a dangerous level. He thinks the best hope of avoiding toxicity is to find a more potent substitute, since a smaller dose would be required. He doubts whether fluoxetine really has no effect on the MDMA experience (as has been claimed), and if taken afterwards thinks it would only prevent part of the toxicity.

Sex. Dr. Frescas mentioned that there has been much commercial research into trying to find a drug that will help people have satisfying sexual experiences, but without success. He thinks that good sex is the result of many components of which MDMA provides one and 2CB another.

Asked his opinion on reports that 1 in 12 Ecstasy users are at risk due to a genetic susceptibility, Dr. Frescas says these people would probably be aware of their sensitivity to amphetamine and non-prescription drugs such as Contac (for colds) and Sudafed, which would make them sleepless and agitated. Sensitive people should take smaller doses.

Dr. Frescas also mentioned that black current juice is a MAO inhibitor, and when one bottle (diluted) is drunk with MDMA or amphetamine the effect can be felt with increased blood pressure and heart rate. It should therefore be avoided.

142 Faxes from Rick Doblin

The Russian research project has been postponed indefinitely. The researcher, Dr. Krupitsky, says that everything is unpredictable in Russia at present, and gracefully agreed that the funds for his project should be used for the Nicaraguan research.

Nicaraguan research project status as at 2/94. David Nicholls has applied for an export license for the MDMA and the Nicaraguan ministry is expected to give official approval soon. More top people have offered to support the project, the latest being Dr. Bessel van der Kolk, a world expert in PTSD research. Sylvia Garma of the SF veterans administration, is interested in helping with PTSD throughout South America, has offered help. Rick's contact in the DEA was at first negative but eventually expressed support for the project on the grounds that it would end criticism that the DEA was blocking research into MDMA.

Prozac. "It seems that about a third of MDMA-using Prozac users report absent or diminished response to MDMA".

Telepathy. Rick once took E at a party away from home and at about 3am closed his eyes and used the emotional clarity of the E state to review his past relationships with lovers. On returning to his hotel, he found a telephone message: an ex-lover who he had not seen for 3 years, though not one he had dwelled on, had been woken by such a powerful dream about Rick at 3am that she had felt compelled to trace him even though that meant waking people up to find where he was staying.

143 Letter from George Ricaurte of Johns Hopkins University, 23/11/93

"As to your question of whether lower levels of serotonin in and of themselves can be considered "damage", I would say that in addition to low levels of serotonin, MDMA produces loss of several other markers for serotonin neurons. In particular, MDMA induces a loss of serotonin uptake sites, the serotonin metabolite (5-HIA), and tryptophan hydroxylase (the rate limiting enzyme in the synthesis of serotonin). This constellation of neurochemical deficits, in conjunction with morphological evidence of serotonin neuronal damage, strongly suggests that MDMA and related drugs are indeed neurotoxic."

144 Letter and manuscript from Myron Stolaroff 1/94

Since the early sixties, Myron Stolaroff has been involved with research into developing uses for psychedelics. He has published a number of papers on psychedelics including their effects on values, personality and behaviour; creative problem solving and therapeutic effects. Now in his seventies, he is still actively involved and has just completed a book Thanatos to Eros: Thirty-five Years of Psychedelic Exploration, and enclosed his draft chapter on MDMA.

"I am personally committed to promoting proper understanding and application of psychedelic substances."

From the manuscript chapter on MDMA: ". . . psychedelics are priceless substances. But MDMA stands out as especially unique, with outstanding characteristics exclusively its own. The most fitting description that I can give is that it is an outstanding Grace."

"The aftermath of MDMA was not the same as with established psychedelics such as LSD and Mescaline, which most often leave the body quite cleansed and rejuvenated. . . If one's psyche is relatively clear, the descent is quite euphoric, and the remainder of the day is spent in a very satisfying state of contentment. However, if there is unresolved material in the unconscious that did not get dealt with completely, the drop in the action of the drug seems quite sudden, and one is left physically uncomfortable and somewhat unsettled.

"To counteract this we thought, why not supplement with another, more powerful, psychedelic substance. This turned out to be a splendid idea. I particularly liked it, because what made the beginning of my explorations [with true psychedelics such as LSD] uncomfortable was the negative karma I had accumulated, which had to be expiated before I could thoroughly enjoy the experience. Now I could dispose of this with MDMA, which occurred, I felt, automatically and very pleasantly [enabling me] to soar into fresh spaces free of my usual psychic load.

"This worked so well that I embarked on a study to prove that every good psychedelic was better if first preceded by MDMA." Mr. Stolaroff and his wife Jean confirmed that LSD, 2CB, MEM, and 2-CT-2 were enhanced by MDMA. The psychedelics were either taken in place of a supplementary dose of MDMA (i.e. about 2 hours after the initial dose) or an hour or two after a supplement of MDMA.

Some MDMA experiences are described involving themselves and others. Old resentments towards an elder brother who used to bully were resolved on one occasion; on another a singer who was run down with a raspy throat was able to relax and sing perfectly.

Though most appreciated for communication, Mr. Stolaroff found that quiet leads to an experience far more like LSD. "It became clear that once one became proficient at utilizing a substance . . . it can be directed in other useful ways."

A technique called Focusing (from a book called Focusing by Eugene Gendlin) is described as "one of the most effective means I know to contact and release hidden feelings, and particularly to relieve body stress". Having chosen a feeling to examine, the technique is to alternate experiencing the feeling without resisting, with finding an appropriate 'handle' to describe the feeling such as a word or phrase. In the example given, a woman listens to her body and 'handles' suggest themselves such as 'tired', 'unlistened to' and 'pushed around.'

Another technique Mr. Stolaroff describes is to "find a place in the body that feels good, and to focus on increasing the good feeling". Later he discovers that it doesn't matter what he is focusing on as long as it is worthwhile: holding the mind steadily focused encourages the bliss inside to grow continually. In a letter he adds, "Subsequent experience has taught me that training in holding the mind perfectly still facilitates apprehending other levels of reality with their accompanying euphoria". The chapter ends: "Becoming familiar with the full range of possibilities offered by this exceptional compound would make it hard to deny that it is one of life's remarkable graces."

See also reference 46, Using psychedelics wisely.

145 The Times, 14/2/94

Under the heading "Drug culture grips heart of England", a full-page article claims that staff reporters visited several "ancient shires" and found drug use as widespread as in the cities. In villages, users order drugs to be delivered from phone boxes "almost like dialling a pizza" and pub landlords are quoted as saying they are unable to stop drug use unless they smell it. Rural Lincolnshire is now at the top of the list for drug seizures per head of population, and the only reason why inner cities usually come top of the list is "because drug squads aren't so likely to operate in rural areas". The drugs most often used were cannabis, LSD, magic mushrooms, amphetamine sulphate and Ecstasy. A government survey in rural East Sussex found that 20% of 14-15 year-olds had tried an illicit drug, about the same proportion as in cities.

146 Attend rave organised by Club Together, 12/2/94

Club Together is one of several private clubs that organise raves. Every month or two, a circular is sent out to members offering tickets for #10. I was told that the club was run by and for more mature ravers who were professionals, and was introduced to an architect, a computer animator, a conference organiser and a lawyer. Nearly all the 500 or so people were white, dressed as for a cocktail party and aged from about 25 to 35. The atmosphere was much like an office party with most people knowing one another. The event I attended was in a photographic studio which was more comfortable and better decorated than the usual warehouse venues, and was efficiently organised. It got going at midnight and carried on through the night.

Although I was told that 95% would be on E, it looked to us more like 20% showing obvious signs of E behaviour, with the great majority drinking beer (and a surprisingly large proportion smoking cigarettes). However, there were also quite a lot who drank alcohol and took E simultaneously. Behaviour was a blend of that associated with alcohol and E - chatting up and flirting but without aggressive behaviour with blissed out dancers and huggers completely accepted. However, the atmosphere was not conducive to create the magic group experience, nor was there any response between dancers and DJ.

147 Phone call to Health Development Club (+44 [0]594 844 991), 14/2/94

This company sells various remedies by mail order including Prozac. They tell me that under Section 13 of the Medicines Act, they are able to import prescription drugs legally from another EC country. The procedure is to send a cheque to their Welsh branch made out to their Irish branch when the drugs will be sent to you from France. Their price for 28 Prozac is #46.50.

148 Sunday Times 13/2/94

Article about Prozac quotes psychologist: "Prozac makes people see reality more clearly. It is not a happy pill, but it does for people's emotions and feelings what glasses do for people with blurry vision".

149 Letter from Kay Thompson on The Lion Path 12/1/94

"The sessions are a sacred ceremony of one's own higher growth and regeneration - a form of time surfing. The sessions build up and resonate with preceding and following sessions. All the powers that have been lying dormant within us, become activated and purified. By remaining open to love and trust, we can overcome limitations and receive aid to transform ourselves. . . The post-session interval then provides the opportunity to fill out and embody this higher destiny"

150 Ulster, from San Francisco Chronicle 26/10/94

"At the warehouse doors, noone asks your religion. . . The raves are the last meeting ground for the children of Catholic and Protestant violence. . . We've never known anything but hatred. . . It's always the same: them over on one side, you on the other, except at raves."

151 Sunday Times 9/1/94

"The American experience is that the profits from drugs are so immense, and the demand so enormous, that prohibition makes matters much worse.

"It makes drugs artificially expensive, thus forcing their consumers to commit even more crime to pay for them. Legalising drugs is in every sense a terrible admission of failure, yet it remains the only possible strategy for making a dent in the crime statistics. In neither Britain nor California will the mainstream politicians admit it"

152 Letter from Dr. John Henry of the National Poisons Unit, 13/12/93

Reply to my request for a list of contaminants in tablets and capsules sold as 'Ecstasy', referring to an article in Time Out saying that "Ecstasy" contained heroin, crushed glass and rat poison:

"I know of the following drugs (some of which represent 'active' ingredients, others being constituent of reformulated tablets):

Paracetamol Codeine Dihydrocodeine Amphetamine MDA MDEA Ketamine Tiletamine LSD

"We are not so interested in the non-pharmacological constituents, but have heard of fishbowl preservative tablets, camden tablets etc. being sold. These are not particularly dangerous."

153 X at the Crossroads by Dr. J Newmeyer of Haight-Ashbury Free Clinic, San Francisco, June 1993

"At present MDMA enjoys the greatest growth potential among all illicit drugs. I believe that MDMA will either gain de facto tolerance, or 'marijuana-like acceptance' to the larger society or will undergo a hostile 'LSD-like' rejection. The next 24 months will be decisive . . ."

Factors favouring acceptance:

1. Declining salience of the 'drug abuse problem'. Since 1985, the proportion of Americans citing drug abuse as the number one problem has declined steadily. This means that it would be difficult to open up another front in the war on drugs. To wage war on MDMA will require that public outrage be whipped up once again, . . . that people not of the 'criminal type' be jailed.

2. Low incidence of adverse reactions. Millions of uses result in only a handful of serious problems being reported. The dearth of MDMA horror stories leaves opponents without the ammunition needed for a campaign of suppression.

3. Articulate proponents. Unlike users of heroin or 'crack', many MDMA users are from the educated middle class who go on to obtain high qualifications and influential jobs. They will provide strong opposition to suppression.

4. Harm prevention campaigns. These will further reduce the number of mishaps, and thus the number of horror stories.

Factors favouring rejection:

1. Tendency for more use by people who are less educated and have more personal problems. This is likely to produce more adverse reactions, thus lowering the reputation of the drug.

2. Increased use in rave setting in more likely to produce adverse reactions. Use late at night among strangers in harsh surroundings is the opposite to the 'ideal setting' recommended by cognoscenti: well rested, during daytime in a calm environment with a few trusted friends.

3. Media coverage distorting problem. A few spectacular mishaps out of millions can mis-educate the public into believing the drug is more dangerous than, say, alcohol.

4. Puritanism. Deeply embedded cultural hostility to pleasure and idleness may be aroused by the behaviour of MDMA users. Newmeyer concludes that he is certain that by June 1995 there will be a striking swing in public attitude oneway of the other.

154 The Pursuit of Ecstasy - the MDMA Experience by Gerome Beck and Marsha Rosenbaum published Feb 1994 by State University of New York Press at $14.95

This 240 page book is a comprehensive look at the drug as seen by two sociologists who started their project less than two years after prohibition. Their style is authoritative and academic but easy reading, covering very much the same aspects as this book. I would recommend it as a present to a parent, teacher or anyone who may consider this book is biased by my own enthusiasm.

The main differences are in that they cover American usage more thoroughly (and even went to interview people involved in the Dallas scene), but have less on the British and European current usage. The other difference is that the book was already 10 months out of date when it appeared, time which I saved by publishing it myself.

They start out with three personal accounts, each representing a different type of user and how their experiences vary according to their expectations and beliefs. Most of the rest of the book is based on 100 interviews with users.

Particular points worthy of note include:

Attitudes. One is that the drug 'does things to you', so that the effects noticed are those of the drug itself. The other is that the drug allows the user free expression, so the effects reflect aspects of the user's personality that are normally suppressed.

Group experience. Some New Agers relate the MDMA experience to 'morphic resonance', a term coined by Rupert Sheldrake, as though the E allows them to tap into a field of cumulative collective experience. The forerunners of Raves were Grateful Dead concerts that have been going ever since 1965, and where a large number of people take drugs and feel a group-mind experience.

Acceptability. Ecstasy was used and accepted by straight people who saw it as 'safe' or 'not a drug', particularly before it was prohibited. Several examples of this are given, from the Dallas hedonists (who were well-off young professionals) to New Agers who see the E state as real, not a stoned state.

Truth serum: "I believe it lowers your sense of fear and you fall in love with yourself. When you do that, you're more willing to take risks, and one of the risks is telling the truth". It enables one to speak the truth, but does not prevent one from lying.

Sex. Prostitutes found MDMA helpful in creating a better atmosphere with clients, and a topless dancer was able to accept and feel less abused by gross behaviour, and to earn more tips as a result. Some people became open to new kinds of sexual experiences.

Creativity. One person described MDMA as an artistic 'flavour enhancer' and would use frequent small amounts to help study. A writer described how Ecstasy allowed him to engross himself more in the content, and to allow his description to flow more spontaneously.

Lasting effects. It was easy to integrate experience into everyday life. The most frequently reported spiritual effect was a profound feeling of connectedness with all of nature and mankind. It made marriage break ups easier. A psychotherapist believed MDMA helped him to know himself better, and therefore be more open with clients.

Bad effects. Recreational users seem to have hangovers, while therapeutic users would value the 'afterglow'. Users who tried more than 200 mg reported less good effects.

Addiction. Does not occur in long term. Although many users have binged, the after effects put people off and frequent users find they need a break to regain effects.

Toxicity. Fenfluramine has been approved for daily use although, at only 1.25 times normal dose, it produces a similar type of damage to MDMA overdoses.

p.176 has a table comparing usage of various other drugs by a sample of 100 E users. In order of popularity, they are: Marijuana 96%, Cocaine 84%, Psilocybin 82%, LSD 81%, Speed pills 66%, Mescaline 57%, Methamphetamine 48%, MDA 31% 2CB 24% and MDEA (Eve) 21%. The number who had quit usage was also given, and showed that only 9% had given up MDMA while a higher proportion had given up everyother drug: 15% Marijuana, 29% psilocybin, 44% Cocaine, 50% methamphetamine and 73% speed pills.

Another table asked users to say how much they liked various drugs on a scale from 1 to 5. Taking means, the most liked in order were MDMA, Psilocybin, Mescaline, 'other opiates', Caffeine, Marijuana, LSD and Alcohol while Methamphetamine, Speed pills Tobacco and Cocaine scored much lower.

Conclusion says the benefits experienced from Ecstasy can be seen as a measure of how stressful and isolating our society is.

155 An analysis of the potential for HIV transmission among stimulant-using ravers by Drs Hilary Klee and Julie Morris, Manchester Metropolitan University, June 1993

The study aimed to discover whether increased sensuality and social interaction due to drugs taken at raves may lead to greater sexual activity and spread of HIV. To assess this, two studies were undertaken in the North of England.

The results of the first study relating to amphetamine users were: Those attending raves made no more casual sexual contacts than non-ravers. Amphetamine (including Ecstasy) users were less likely to have sexual intercourse, and were more positive towards condom use. Their risk of infection with HIV was therefore less.

The second study concerned injecting polydrug users. Of these, 10% were regular Ecstasy users; two-thirds of who were under 25 applying equally to men and women. Ecstasy users were more likely to also use frequent and high doses of cannabis and amphetamine. Ecstasy users had more friends and were less likely to inject alone. Ecstasy users had greater interest in sex and had more sex with more partners. Although their attitude to condom use was similar to non-users, increased sexual activity also put them at greater risk of HIV infection.

156 Chronic MDMA use: Effects on Mood and Neuropsychological Function? by George Ricaurte et al. in American Journal of Drug and Alcohol Abuse 18/3, 1992

The object of this study was to see whether MDMA use may produce long-term psychological effects. Nine individuals were studied with extensive MDMA use (twice a month for 5 years).

None of the 9 reported current psychiatric problems although 7 reported previous periods in their lives when they suffered from anxiety or depression. Most had family histories of alcohol or other substance abuse. All sometimes also used other substances, although MDMA was there drug of choice.

"Mental status examinations did not reveal any clinical impairments in cognitive function, nor did neurological exams reveal any focal neurologic deficits."

"Performance in the Wechsler Memory Scale was subtly impaired in several subjects" - but the amount of impairment did not correlate with the amount of MDMA used. All but the heaviest user of MDMA showed at least mild impairment in at least one neuropsychological function. However, none showed affective or anxiety disorder or depression.

A note of caution adds that the sample was too small to draw definite conclusions from, but the overall result was that heavy MDMA users probably had slightly worse short-term memories, but were not depressed nor did they show any other problems that might effect their lives.

157 Serotonin Neurotoxicity after MDMA: A Controlled Study in Humans by George Ricaurte et al. 1994 Neuropsychopharmacology in press.

Whether or not MDMA is neurotoxic in humans has not been established, though it is known to cause damage to brain serotonin neurons in experimental animals.

30 MDMA users and 28 controls matched for weight, height, education and other drug use were admitted to a controlled inpatient setting after at least 2 weeks abstinence. On average, they had taken 170mg doses of MDMA weekly on 95 occasions over 5 years. As there is no method for detecting serotonergic neurotoxicity in the living human brain, an indirect method was used consisting of measuring the concentration of 5-HIAA in spinal fluid. Previous studies in monkeys had established a relationship between serotonergic neurotoxicity and concentration of 5-HIAA in spinal fluid. Assessments were also made of pain endurance since serotonin has been associated with pain. In addition, personality assessments were made and compared with the control group.

Results showed that MDMA users had lower levels of 5-HIAA, implying their serotonin levels were lower. However, there was no significant correlation between 5-HIAA levels and number of uses of MDMA; nor duration or frequency of use, nor time since last MDMA exposure. It is suggested that trials are made among users of fenfluramine, which is "taken by more people and more frequently than MDMA, and is highly toxic to 5-HT neurons in non-human primates" produces similar results.

There was no difference in pain endurance between MDMA users and controls. Personality measurements showed statistically significant differences between MDMA users and controls: MDMA users were assessed as "less impulsive, more harm-avoidant, and have decreased indirect hostility". This was unexpected, since it had been previously assumed that lower serotonin levels corresponded to increased impulsive aggressive behaviour. Alternative explanations for these findings were discussed and dismissed as unlikely.

Conclusions:

1. The finding that spinal 5-HIAA levels were lower in MDMA users, and therefore by implication also brain serotonin "may reflect MDMA neurotoxicity" in users. The supposed toxicity was greater in women, which may have been due to them having higher concentrations through being smaller or using the drug more frequently.

2. The findings that MDMA users were less impulsive, more harm-avoidant, and have decreased indirect hostility supports the notion that these personality characteristics are modulated by serotonin.

158 Survey among therapists with experience of MDMA-assisted therapy by Dr. Debby Harlow (unpublished).

Shortly before MDMA was made illegal, Dr. Harlow conducted a survey among 17 therapists who were using the drug to assist in their work. Therapists were asked to assess the effect of MDMA as an adjunct to psychotherapy in a series of questions.

The effect of MDMA in treatment of various disorders. Therapists were asked to score on a 7-point scale from "severely worsen" to "improve greatly":

[TABLE]

Overall psychological value. Based on their knowledge and experience, therapists were asked to assess the general psychological value of MDMA from no value to immense value. One replied "moderate value"; 8 "great value" and 7 "immense value".

General psychotherapeutic value. Therapists were asked to assess the general psychotherapeutic value of MDMA in clients they had observed from very positive to very negative; 16 replied "very positive" and one "positive".

Qualities and behaviours during session. Therapists were asked to what extent certain qualities and behaviours were modified during an MDMA-assisted session as compared to a non-MDMA session:

[TABLE]

Qualities and behaviours long term. Therapists were asked to what extent certain qualities and behaviours were modified six months or longer after an MDMA-assisted session as compared to a non-MDMA session:

[TABLE]

159 Raves threaten jobs in drinks trade, article in The Times, Oct 1993

"Jobs in traditional leisure industries are being jeopardised by the huge growth in 'raves', which have mushroomed into a #2 billion-a-year industry, according to new research. . .

More than one million young people attend raves per week, spending an average of #35 at each event. The parties tend to be alcohol-free but there is usually a heavy consumption of drugs. Raves have grown in popularity while the number of young people going to pubs has fallen by 11%. . .

To put this phenomenon in perspective, this figure is around the same size as the books or newspaper market and at least a quarter of the spirits market. . .

The #2 billion figure might underestimate the threat, as the survey covered only licensed raves. . .

They pose a significant threat to spending for sectors such as the licensed drinks retailers and drinks companies"

160 Dutch drug makers surrender bucketfuls of Eve from Reuters, 29/7/93

The drug was officially banned on July 27, but a 3-day grace period was granted to allow customers of a 'dial-a-drug' service to hand in their purchases. . . Producers had exploited a legal loophole by advertising door-to-door deliveries.

161 Meeting with Dr. Jerry Beck and Dr. Marsha Rosenbaum, 3/11/93

Dr. Beck has submitted a grant application proposal for a study of the use of MDMA, LSD and other psychedelics. It will consist of 200 in-depth interviews with users to find out patterns of use and associated problems. He looks out for newspaper items on drug use and has an impressive collection of clippings. However, he has not managed to find reports of 'rave deaths' in spite of widespread use at parties and clubs in the States. Later, we were joined by Dr. Rosenbaum who had some definite views about the benefits and limitations of the use of MDMA. On referring to my questionnaire, she believed that the longer people had used MDMA the more likely they were to say that it had not changed them, implying that the changes people feel are based on their initial enthusiasm and are short lived. She was doubtful about the E state being one of openness and honesty - the first time someone takes the drug they may "spill the beans", but experienced users can keep secrets, avoid hurting others and even lie. In couple therapy, her experience is that MDMA is more useful for making a split than for resolving problems. The best use, she believes, is in conflict resolution. Besides couples, this particularly applies to siblings who always carry "a lot of shit" from childhood. The trouble with using MDMA to solve problems is that it is too enjoyable - when having a good time, why concentrate on problems?

From Jerry's files: The last Pharmchem report was in 1985 (it has since ceased to test drugs sent in) and the results for drugs described as MDMA were: 52% MDMA; 19% MDA, MDEA or similar; 24% another drug and 5% no active component.

162 Killer paracetamol, Sunday Times 14/11/93

More than 500 deaths a year are associated with the drug, and as many as 40,000 people suffer serious overdoses. In a study of 54,000 emergency cases, 167 were due to paracetamol poisoning compared with 129 due to heroin overdoses. A study in Leeds last year found that the cost of treating 316 paracetamol overdose patients cost #750,000.

163 The Complete Book of Ecstacy by U.P. Yourspigs from Synthesis Books, PO Box 610341, Birmingham, Al. 35261, USA

This is a 36-page book devoted to the manufacture of MDMA (and MDEA). Four methods are given: chlorosafrole, bromasafrole, piperonyl acetone and sodium cyanoborohydride, piperonyl acetone and aluminium amalgamate. An accompanying letter says: "I am working on a second edition which will include more methods with greater detail. Methods that are well suited to the clandestine chemist." An illicit manufacturer, who had not seen the book before, told me that it was not as complete as implied and not as good as Secrets of Methamphetamine Manufacture [ref 189]. However, there were some details and alternative routes that may come in useful.

164 The Independent May 1993 and 3/3/94; The Guardian 14/5/94

In March 1994 The Independent published a series of articles about illicit drug use, all non-alarmist. Emphasised was that the trade is worth some billions of pounds a year, that a third or more crime is drug-related, that current users they tend to be middle class and do not fit the junkie image, that enforcement policies do not work and that change is necessary.

The leading article was headed "Let's crack the drug economy". It claims that the present policy is responsible for increasing violent crime without reducing drug usage. It is bound to continue to fail. The answer is decriminalisation. Cannabis should be treated in the same way as alcohol. There is no logical argument for discriminating between the two. Opiate addicts should be registered and supplied at low price. No mention is made of hallucinogens and Ecstasy.

In May 1993, the leading article argues for illegal drugs to be licensed. "The parallel with the prohibition of alcohol in the US in the twenties and thirties is exact. Slavery apart, no greater mistake was ever made in America's social history. . . If cigarettes were declared illegal, the story would be the same: soaring prices, pushers at street corners, addicts stealing to feed their habit and so on." Commander John Grieve, head of criminal intelligence at the Metropolitan Police called on the government to examine whether the supply and use of illegal drugs could be licensed. "This newspaper, along with The Economist and other publications, has long advocated the progressive legalisation of drugs."

The Guardian on 14/5/94 quoted Commander John Grieve as saying that licensing for illegal drugs including Ecstasy should be explored, perhaps on the basis of licensed cafes in Amsterdam. "Either we go to war with drugs dealers across the globe, or we have to come up with new options." About half the members of a working group of senior drugs detectives supported this view.

165 Letter from Clive 14/2/94

Clive is a part-time dealer in California who attends public events where E is used. Raves in SF started in 1991 and were additional to existing E users. Among cocaine users, use of E is a well-known way to get off coke as it seems to satisfy many of the urges to party in a coke kind of way. Then there's underground psychotherapists, plain ordinary recreational drug users, bonding couples who will "keep a small supply to torque the intimacy now and then." 'Rave' has a juvenile/media sound compared to the more usual 'House Party'. Other ecstatic trance-dance parties under the 'underground dance scene' heading includes the no-obvious-alcohol-or-drugs 'barefoot boogie', 'dance spirit' and 'dance jam' to Grateful Dead concerts; parties where people play worldbeat, Turkish trance, drumming, and 'urban-primitive trance dance experiences' where they play Gabrielle Roth's recordings designed to accompany her workshops such as 'Initiation', 'Bones', and 'Totem'.

At these functions, besides the weekend influx of suburban kids who don't much identify with this culture, there is 1) The street faction, well connected with drugs in general, familiar with being on the threatened/criminalised edge of society and being up all night, mixing with the 2) Computer people/Nerds who have the money and great desire for X, but are often not connected nor comfortable with the illegality vibe or sketchiness of those they have to deal with. "These types really love me".

Every now and then people say the scene is dying, but the house parties are still happening, still going, and don't seem to be changing much. One institution in the rave scene is the Full Moon Party which has been going on monthly since the beginning of it all 3 years ago and continues strong. It never has flyers, its always free and usually at a beach. This event is in many ways the soul of the scene as it was imported from England, and retains the DJs who are among the most popular.

After a dry fall and spotty summer, supply of good X is now plentiful and of good quality, and the parties are well fuelled.

"I went into the chill room to discuss something with a friend. Gradually I noticed a girl, semi-prone beside me, was moving her hand up my leg. She was also being massaged by someone else. She had shorts. I immediately went for her legs, and it gradually turned into a nonverbal multi-peopled sensual groping, squeezing, massaging, hugging kind of thing. Nearly all strangers to me. I thought (not too much) isn't it great to feel free to do something like this. This is the therapeutic aspect of these events which needs to be more fully recognised as such. Medicines and therapy for the ills begot by egoic barriers and repressive social conventions. This sort of spontaneous, sensuous body contact is, in my mind, the sign of a good X party. In Marin we call them puppy piles. I've seen flyers with special rooms set aside for this aspect of the X experience called 'feely feely' rooms or 'petting zoo'. I've also heard it called 'snake slithering'. Whether or not a special room is put aside, ambient or chill rooms serve the same purpose."

166 The Nature of the MDMA Experience by Ralph Metzner and Sophia Adamson in ReVision, Spring 1988

Psychedelics are nonspecific psychic amplifiers; i.e. the focus of the experience depends on the set and setting. In addition, MDMA produces predictable feelings including empathy, openness, peace and caring. With the right intention, individuals are able to use the MDMA state to resolve long-standing intrapsychic conflicts or interpersonal problems in relationships. "One therapist has estimated that in 5 hours of an Adam session, clients could activate and process psychic material that would normally require five months of weekly therapy sessions."

The state can be described as one of release from emotional identification patterns. This provides a preview or taste of the possibilities that exist for greater emotional openness, and the ability to deal with issues that are normally avoided due to anxiety. Psychotherapists using MDMA frequently gain insight into their clients' problems.

MDMA therapy may access memories blocked out by repression such as in Post Traumatic Stress Disorder (PTSD), the result of traumatic experiences such as rape and the result of war and torture. No other form of therapy is so effective.

The fundamental experience is an opening of the heart centre. A meditation teacher described the state as dissolving barriers between body, mind, and spirit - "one senses the presence of spirit infusing the body. . ."

The name 'Adam' for MDMA is related to the innocent man as in the Garden of Eden - "being returned to the natural state of innocence before guilt, shame and unworthiness arose."

Various practices may be greatly facilitated and the effects amplified including meditation, yoga, guided imagery, psychosynthesis, shamanic journey work and rebirthing. This is best done on low doses (50-100mg) or towards the latter half of a session. The detached yet compassionate attitude required for meditation is easy to attain, providing the foundation for deeper states - even though it may be difficult to hold a strict posture.

Massage benefits can be amplified using low doses. For the masseur, the drug helps tune in to the client; while the recipient's ultra relaxed state allows for much greater appreciation.

Group work. Two basic approaches. Each individual silently explores inwardly, sharing only with guides, though both before and afterwards there is considerable sharing. Guided imagery may sometimes be used. The other is to share during the session in a ritual fashion. The group may sit in a circle or lie with heads to the centre in star pattern. All are silent and attentive except the one with the 'talking stick' who talks or sings from the heart. "The combination of channelling powerful inner experiences and the contemplative attention of the group is a powerful force." Members may be silent during their turn, simply sharing a meditation. Confidentiality and no sexual behaviour is agreed.

Other group rituals have been adapted from shamanic tribal cultures. These include finding a 'power spot' and meditating there is silence; putting ritual objects in the middle of a circle and 'charging' them; offering prayers to the nature spirits, ancestors and allies. Group rebirthing and tai chi may also be incorporated. All these are best done on low doses by people used to MDMA; otherwise they may have difficulty following instructions.

167 Interview with illicit manufacturers of MDMA, 2/94

Three people who were psychedelic explorers themselves and enthusiastic about MDMA in particular decided to try to manufacture some. They spent about 3 years planning - reading up syntheses; finding equipment and buying materials. None had any previous laboratory experience apart from school chemistry, nor had they any connections with others making illicit drugs. Obtaining equipment without arousing suspicion was difficult. They found that laboratory suppliers would not sell anything more complex than a thermometer for cash over the counter, and asked them to open an account. This was tricky, as it required bank and trade references which would identify them, and they also found banks unwilling to open a new business account without details of who they were and the precise nature of their intended business. They were well aware that suppliers of equipment and precursors are asked to inform the police of any suspicious purchases.

They then looked for existing companies who had accounts with suppliers, and tried to make contacts so that orders could be placed and passed on to them. Approaching these people was risky in itself in case any should inform the police or blackmail them, and there was always the risk that suppliers would notify the police that these customers were ordering precursors for the first time. In addition, these 'middle men' would double the price. However, they found some pieces of equipment in theatre prop shops and even car boot sales. As syntheses were based on laboratory rather than production techniques, nearly all the equipment was glassware. This meant there were a lot of breakages which sometimes held up production for ages while replacements were sought.

Methods of manufacture were worked out from studying everything they could get hold of including chemistry textbooks; PIHKAL by Alexander Shulgin [reference 2]; Secrets of Methamphetamine Manufacture [189] and some patents from the Patent Office. They say that none of these were complete on their own and that every new description added valuable new information. Precursor materials were just as hard to get. Even solvents were not available without question, and some ingredients required a poisons license. In the end, they had to make many of the precursors themselves. Key precursors, such as safrole, had to be bought from black market sources at very high prices. Indian suppliers were the most likely to accept cash and ask no questions. In the end they managed to obtain or make everything they needed within Britain. In all they spent some #4,000.

Having obtained the equipment required, they looked for a suitable site to set up their factory. It had to have water, gas supply and ventilation besides being somewhere discreet where neighbours would not notice them bringing in equipment and materials, nor be alarmed by odd smells and sounds. Eventually they set up in a basement flat, with the plan to get the batch over and done with as quickly as possible.

At this stage it was all theory, so the first thing to do was to try out the various syntheses. This turned out to be much harder than expected - even following instructions to the letter, some reactions simply did not happen while others were so violent they that broke the apparatus. Recipes, including Shulgin's, appeared to have small but vital steps missing. It was only by reading several different instructions that they managed to overcome all problems, and they found that nearly every extra description of a synthesis contained more clues.

Over a period of two months continuous work they made two small trial batches to test the method before starting production. As enthusiasts rather than just in it for the money, they decided to go for the best quality by recrystallizing the end product to produce pure, white crystals. The process to manufacture one kilo of MDMA took about 2 weeks continuous work for three people because of the lack of ideal equipment - some processes could only be done in 50 gram batches and they had no fume cupboard. They used about 75 litres of solvents which they were unable to recondense, so all this was boiled off producing vast amounts of vapour. The fumes tended to be heavier than air and would fill up the basement, as they only had one small extractor fan - even that was a cause of worry as the fumes could be smelled miles away. At many points in the production there were toxic fumes, some highly poisonous, and many spillages. They worked in terrible conditions leaving them coughing and ill due to inhaling the fumes which caused giddiness and made their eyes smart, while working long hours and getting tired meant that accidents were frequent. They were worried about explosions which could be sparked off by motors such as on their vacuum pump. Sometimes they had to evacuate the basement and the fumes could be seen drifting out of windows. Once some ether exploded, and they rushed out into the garden where they tried to wash off poisonous chemicals with a hose pipe. They survived but one believes he damaged his lungs.

Selling was far more difficult than they expected. They wanted to find a single dealer to take all their product so as to avoid too many people knowing what they were doing, but only knew small time dealers. Eventually they found dealers who would buy by the ounce, but they were not prepared to pay a premium for their extra good quality product over the usual trade price of #40 per gram. They were afraid that dealers who could afford to buy in kilos would be connected to criminal sources, and that may mean being swindled or threatened with guns.

Although they sold the kilo without being caught, it was much harder than anticipated and involved far higher risks, with a worryingly large number of people into their secret. Although one of them found the danger exhilarating, it was sheer hell for the other and overall they concluded that it was not worthwhile.

They learned that they could overcome virtually any problem and produce a pure product, but such small scale production is not worthwhile. They reckon the risks would actually be lower on a larger scale because they would be able to pay someone else to obtain the equipment and materials and so reduce the number of people involved, also they would be able to pay for safer premises and better equipment. And they would be able to afford better security.

169 Manufacturers of MDMA in Switzerland

Chemische Forschung & Entwicklung, Im Latten Acker 5 8200 Schaffhausen, Switzerland tel. 053 25 72 72

170 Ecstasy by Nadia Solowij in Current Opinion in Psychiatry 6/3 1993

Review of papers to 1993. Makes the point that most fatalities in England were not among first time users, so it is likely that death was due to the conditions of use rather than individual susceptibility as has been suggested by Henry in Toxicity and Deaths from MDMA and Larner in a letter to The Lancet. In Australia the use of E at raves has been widespread without any reported problems. This may be due to variations in purity, ventilation, reporting or simply extent of use.

Direct attribution to MDMA in reported cases of psychiatric disturbance due to Ecstasy is questionable due to additional factors such as other drugs and previous vulnerability to psychiatric disturbance. However, two cases in Italy and one in South Africa imply that no other factors were involved. There may be particularly susceptible individuals.

"Large doses (acute or cumulative), history of psychiatric disturbance and preexisting disease appear to increase the likelihood of adverse effects."

171 Police to stop raves in The Guardian 25/2/94

Headline front page feature in early editions. "Police have launched an intelligence drive against New Age travellers and organisers of rave parties. . . Some forces have decided that 'raves will not happen, legal or otherwise.'" They aim to log 8,000 such people on computer including their nick names and vehicle numbers, and to deploy undercover police to mix with them. "Spiral Tribe, one of the largest groups organising rave parties, is the subject of particular attention." Police may ask fire safety officers to declare legal raves unsafe as an excuse to stop them. Another tactic being considered by police is obtaining blanket countryside injunctions against public events.

An organisation called The Advance Party is campaigning against provisions in the Criminal Justice Bill to extend laws against rave parties.

172 Ecstasy and Eve, leaflet by Lifeline

In spring 1993 thirteen tablets and capsules of Ecstasy were analysed for Lifeline. None contained more than tiny amount of MDMA. 4 were MDEA: Power packs, Triple Xs, Adam & Eves and White burgers/Saucers; 3 were MDA: 'Snowballs', 'MDMA Clear Caps' and 'White Caps'; 2 were decongestants: 'Love Hearts' and 'Splits'; 1 was antihistamine: 'White Cally' and 3 were Amphetamine and caffeine mixtures: 'California Sunrise', 'Green Burgers' and 'Red Devils'. The dosage of MDEA varied from 0.18 to 57 mg and MDA varied from 0.4 to 177.5 mg (Snowballs).

173 MDA and Snowballs, leaflet by Lifeline

Warning that 'Snowballs' were not MDMA but such strong MDA (177 mg). Most was sold as 'E'. MDA is twice as toxic as MDMA and effects women's genito-urinary tract. These were so strong (three would be close to the fatal dose) that many people overdosed on even one, especially women and smaller people. Overdose symptoms were extreme jaw clench, unable to move, feeling weighed down, having LSD-like trip, waves of paranoia, feeling overwhelmed. The drug is described as more speedy and coming on with more of a rush than MDMA.

174 Letter from Sheila Henderson, 26/2/94

The atmosphere [ie women feeling sexually safe and thereby more liberated at raves] has changed considerably. There are various reasons for this: alcohol has made a comeback, both used with and as an alternative to other drugs; the small chance of getting MDMA when buying 'E'; the wide range of drugs now available and mixtures consumed and other changes including the music.

175 Visit to The Fridge, a gay club in Brixton, 26/2/94

I was invited by a dealer who called herself Samantha to come on a tour of the gay clubs in London. With blond wig and false eyelashes, she could have been a transvestite, but assured me she was a woman. She has been selling E in gay clubs for about six months and has done very well, due, she believes, to giving a good deal. Having started by buying a few E's at a time from other dealers and selling in the same clubs, she has just reached the stage where she can buy in thousands (at #4.50 each rather than hundreds at #7.50 or handfuls at #10, and she also has two assistant 'runners' to cover other clubs. She always sells at #15. Although so well established and experienced, Samantha thought E was always mixture of LSD and other drugs.

Samantha explained that clubs need to have E easily available to develop a good atmosphere, so clubs have to allow dealers to operate and even encourage them. However, they also have to make a pretence at stopping drug dealing so their security staff would occasionally pounce on one who was new or they didn't like and throw him out having confiscated his money and E - which they discreetly sell back to the favoured dealers providing a bonus for the staff. Asked if dealers were ever arrested, she said that only happened if one got big enough to challenge established main dealers, who, she believed, who would set them up perhaps in cooperation with security and police, who would provide an undercover buyer. Asked if she had to pay off security to operate, she said she never had but other dealers had said they did. There were always a number of dealers in each club who knew each other and were supportive, helping each other out. Each had his own clients and sold on reputation. She was certainly welcomed and we were ushered in as honoured guests without queuing.

Nowadays Samantha doesn't mix business with pleasure; i.e. she finishes selling before taking E herself and dancing. This is a lesson learned the hard way: once she simply lost her entire stock but was having too much of a good time to care. On another occasion she stuffed a plastic bag full of E down between her breasts while dancing and sweated so profusely that the bag filled up and dissolved the pills into an unsaleable mush. To salvage it she added a bit of acid and speed (to make up for it being sweaty), bought some capsules of a proprietary brand medicine and replaced the contents with the mixture, then sold them as a 'new E just in'. They were so popular that she had people coming up to her for weeks afterwards asking for more!

The music at The Fridge was more pop than rave and the atmosphere was friendly, with perhaps a majority on E, though quite a lot were drinking beer and probably using other drugs too. The vibe was gentle but retained the sexual feelings of the gay pick-up scene - not the kind of atmosphere where the E magic takes over and people feel as one tribe. A lot of men took their tops off to show off their well built bodies, and one told me that he would often meet the same men as he saw in the gym earlier. Myself and my partner didn't feel awkward even though we were older and 'straight'. In fact, there were a lot of women there, and though some were gay others came because they liked to be able to have fun without predative men around. There was no chill out space, though there was a dark room upstairs for groping and sex - used by men who were looking for a sex partner but had decided to cut their losses, according to Samantha.

Afterwards we were invited to go onto Trade at Turnmills, open from 3.30 am until 11 am on Sundays. This she described as a chill out with techno music. The other main gay venue at present is Heaven on Saturday nights, and Turnmills on Sunday nights where they play light techno from 10.30 pm till 5 am Mondays.

176 Mapping Toxicant-Induced Nervous System Damage with a Cupric Silver Stain: A Quantitative Analysis of Neural Degeneration Induced by MDMA by Karl Jensen et al. 1993 in Assessing Neurotoxicity of Drugs of Abuse, NIDA monograph 136:133-149

This paper demonstrates the value of the cupric silver staining technique in determining the location and extent of brain damage caused by high doses of MDMA, and suggests that damage is not restricted to serotonergic neurons. It also suggests that the use of fluoxetine ('Prozac') reduces toxicity.

Rats were given 4 doses of MDMA at 12-hourly intervals. Doses varied from 25 to 150 mg/kg. The brains were then frozen, sectioned, silver stained and examined. The staining showed up where damage was caused, which was to particular parts of the brain.

Fluoxetine at 5 mg/kg did not produce staining on its own When given 30 minutes before MDMA, fluoxetine reduced by about half the volume of tissue stained "and dramatically reduced the intensity of staining throughout the affected regions".

Another substance, MK-801 at 1 mg/kg, "virtually eliminated evidence of MDMA-induced silver staining".

Interpretation is to some extent subjective, and the authors are developing an automated process for objectively determining the intensity and volume of staining.

177 Metabolic and Thermoregulatory Responses of the Rat maintained in acrylic or wire screen cages: Implications for Pharmacological Studies by Christopher Gordon in press Physiology and Behaviour 1994

Laboratory rats are normally kept in either plastic or metal cages. The two types differ greatly in the way rats are able to dissipate heat. With all other factors identical when given MDMA, Aluminium floors enabled rats to regulate their core temperature when they were unable to do so on acrylic floors. This is explained by conductive heat transfer between rat and floor.

This paper may imply that past research results on MDMA toxicity (and other trials) depends on the type of cages used.

178 Metabolism of 'ecstasy' by CYP2D6) by Tucker et al. published in abstract form in Br. J. Clin. Pharmacol. 36:144P, 1993

This paper suggests that about 8% of Caucasians are genetically deficient in a particular enzyme which helps metabolize MDMA, and that such individuals may be particularly sensitive to its effects and "at increased risk of acute toxicity". However, these same people "may be less susceptible to the chronic neurological effects of the drug".

[I asked two senior American researchers for their opinions on the paper. One commented "I think he has a point". The other said "It is a nice study in terms of showing a pathway of MDMA metabolism that can be applied to the human condition. Unfortunately, we cannot predict whether 'poor metabolizers' will be more (or less) susceptible to acute toxic (i.e. predominantly hyperthermia) much less the chronic neurological effects ('neurotoxicity'), because we do not yet know which metabolites are responsible for the acute and/or neurochemical (neurological) effects of the compound. Tucker et al. allude to this in the final paragraph. The data do show, however, that genetic differences in metabolism or MDMA may be responsible for differences in the response to the drug (toxic or therapeutic effects].

179 National Audit of Drug Misuse in Britain by the Institute for the Study of Drug Dependence 1992

Various statistics and regional surveys.

Graph shows that among school children in West Yorkshire, while solvents are most popular among younger kids, by the age of 17 Ecstasy comes second to cannabis closely followed by LSD.

Seizures by customs 1987-91. Number of doses of MDMA same as LSD by 1991. Increase in use of various drugs between 1990 and 1992 shows Ecstasy 650%, cocaine 200%, amphetamines 150%, hallucinogens 120% while heroin is slightly less.

Seizures by police 1987-91. In 1991, number of seizures of MDMA similar to LSD at 1500, but number of doses 274,000 MDMA compared to 83,000 LSD.

180 Ecstasy' ingestion: a case report of severe complications in J. Royal Soc. Medicine April 1993

A man consumed MDMA and Amphetamine. Though both were below toxic levels in blood, the combined level of .3 mg/kg was above toxic threshold of .2 mg/kg.

"The treatment of MDMA-related morbidity should be early and aggressive and includes: gastric lavage, chlorpromazine, adrenergic blockade, intravenous fluids and passive cooling". An afternote says "The National Poisons Information Service now advocates the early use of dantrolene in the management of severe complications following Ecstasy. Chlorpromazine may lower the convulsive threshold and is no longer advised."

181 Young People in 1992 by John Balding, University of Exeter

Questions were asked to a representative sample of over 20,000 11-15 year olds. Asked which drugs were "always unsafe", 14-15 year olds put Ecstasy in fourth place after Solvents, Heroin and Cocaine.

Asked which drugs they had ever been offered, Ecstasy came second only to cannabis (above solvents) among 13-14 and 14-15 year olds. Ecstasy came third just below solvents among 11-12 year olds. The highest figure was 15% among 14-15 year old girls.

Asked which drugs they had ever taken, Ecstasy came fifth at 4.2% below cannabis, solvents, natural and synthetic hallucinogens (Mushrooms and LSD?).

Asked if they know anyone who takes particular drugs, Ecstasy came second to cannabis in all age groups, above solvents and amphetamines.

182 The Ecstasy Study by Lifeline, 1993 published as part of Sheila Henderson's Final Report [see reference 41]

98 Ecstasy users between 16 and 31 in the Manchester area completed a questionnaire between August 92 and January 93. 93% had first tried Ecstasy in a rave setting. 87% of users paid between #10 and #15 per dose. Women composed 65%: more took half doses than men and they were more likely to try Ecstasy at a younger age.

Asked about frequency of enjoyment, 52% replied most times, 25% said every time and 18% said not as much as they used to. While the same proportion of men to women replied most times, more men than women said they enjoyed it every time. Half took one tablet per night; a quarter took 1-2 and 18% took half.

Asked what they liked about Ecstasy, two thirds replied in terms of 'happiness, joy, elation or euthoria' followed by 'energy', 'dancing', 'relaxation/release', 'group feeling', 'confidence' and 'escape'. Asked about worst effects just after use, 37% were physical and 40% psychological. During use, 17% said physical and 21% psychological. Asked about use of other drugs, 61% smoked tobacco daily, 52% drank alcohol weekly (16% daily), 40% smoked cannabis frequently, 40% amphetamine weekly. In addition, occasional use of other drugs included: 52% LSD, 9% cocaine, 4% magic mushrooms, 3% heroin or other opiates, 3% amyl nitrate and 3% ketamine. 94% of those who first tried Ecstasy at age 18-19 years still take it; 76% also smoke tobacco and 42% smoke cannabis daily. Of these, a third take E a few times each month and a third weekly. Though tobacco, cannabis and cocaine were more popular among women than men, more men than women used magic mushrooms and ketamine (also male were the only two who used heroin).

Asked about the future use of Ecstasy, 56% said it was here to stay in their own lives, while 70% said it was here to stay for young people generally.

183 Turn on, Log in, Reach out, leaflet advertising SFRAVES

Leaflet offers a subscription service to a database on Internet covering raves which includes a weekly event list, "a comprehensive guide to clubs and events".

"Simply send a message to the Internet address: sfraves-request@sfraves.stanford.edu and within a day or so you will receive a welcome message and all other SFRaves communications." Users can also take part in URave, "a round the clock, real time on line international virtual rave."

184 Reinforcing Subjective Effects of MDMA May be Separable from its Neurotoxic Actions by McCann and Ricaurte, J. Clinical Psychopharmacology 6/1993

Subjective trials show that the psychoactive effects of MDMA are not affected by taking fluoxetine first. Serotonin re-uptake inhibitors block MDMA neurotoxicity. Since fluoxetine is a serotonin re-uptake inhibitor, this implies that the desired effect of MDMA may be enjoyed without its neurotoxic effects.

Three were experienced MDMA users who took 20mg fluoxetine 40-60 minutes before large doses of MDMA, 300-450 mg including booster doses. The sense of euphoria and closeness was unaffected. There was a greater sense of calmness but less increase in energy. Side effects normally felt such as jaw clench were less than normal, though nausea was worse. Two found it easier to sleep afterwards. Next-day fatigue was considerably less than normal, even for the one who found sleep as difficult as usual.

The fourth was a woman who had been taking 20mg fluoxetine for the previous 10 days. It was her first MDMA experience and her description of it was typical, implying that fluoxetine did not effect it.

The paper concludes that these cases "argue against the view that serotonin release is the basis for MDMA's psychoactive action", since this is prevented by pre-treatment with fluoxetine. This is supported by the fact that drugs such as fenfluramine do not produce similar psychoactive effects to MDMA.

185 Effects of [MDMA] on acoustic and tactile startle reflexes in rats by Kehne et al. in. J Pharmacol Exp Ther 1/1992

Startle response to noise and touch was increased by MDMA in proportion to the dose given. This was prevented by fluoxetine.

186 MDMA-induced dopamine release: effect of dopamine uptake inhibitors by Nash and Brodkin in J Pharmacol Exp Ther 11/1991

MDMA increased the extra-cellular concentration of dopamine, but this was reduced when fluoxetine was given 30 minutes beforehand. Results also showed that MDMA increases the concentration of dopamine in the striatum via a mechanism independent of its effects on serotonin release.

187 Phone call from Clive 5/3/94

Clive is an actor and also part time DJ, living in London. He is interested in the arts and the effect of MDMA on both performance and perception. Clive and friends have put on several private events at which MDMA is taken by everyone present, performers and audience alike. The performances are multi media and allowed to develop spontaneously, and the results have been spectacular. The artistic experience becomes almost religious. He says that most great art comes after de-constructing and allowing oneself to flow, and that this is allowed by MDMA.

However, not everything can be done on MDMA, in particular the preparation. The idea is to get everything ready so that you can really let go when on MDMA. For music, he does the programming of the equipment beforehand.

188 Phone call from Graham 5/3/94

Graham is an American in his sixties who has been using MDMA for over 12 years. Originally, he was part of a communal group who routinely took Ecstasy together, but though the closeness and intimacy at the time was wonderful, they decided from experience that it was inappropriate to be so intimate with everyone in the wider group, and now they keep to couples or family groups. He says their living situation is that of about 100 people consisting of several extended households living as close neighbours and friends, along with children and grandchildren. There have been no divorces; all the couples involved have stayed together.

Since he started taking MDMA regularly at the age of 50, he has 'rehabilitated' himself both physically and emotionally. He used to be a pushy casino owner without social conscience or morals who thought the world was a jungle. Now he meditates, has not raised anger for the past eight years and is vegetarian. He still uses MDMA twice a week, on Wednesdays and Saturdays. He now uses large doses up to 400 mg as he has become tolerant, and is aware of other personalities inhabiting his body. He believes that his frequent use of MDMA has not only transformed his life but seems to channel chance in his favour - things have happened to him against odds of millions to one.

Graham asked me not to identify which animal species is involved, but told me about his involvement in racing. He has been involved in breeding animals for racing, and they are so highly strung that they sometimes get illnesses related to stress. A few years ago, with an animal in a critical state before and the vet not able to come straight away, he administered some MDMA and witnessed a miracle cure. Since then he has used it with a variety of animals from horses to birds. For instance, when he has found a wild bird with a broken bone, in the past he would set the bone but the bird would still die of fear, but given a 'couple of drops' of MDMA it would relax and survive.

He has also heard of horses being given MDMA before races, which he says helps them to overcome the shock of competition.

He had heard of athletes using MDMA as part of their training routine, but thinks it would not be useful otherwise.

His family has no medical insurance and have never needed a doctor. He believes this is due to their regular use of MDMA which he sees as a tonic, giving relief from flu and helping in almost every situation. He has even given it to one year olds 'in desperation'.

189 Secrets of Methamphetamine Manufacture, $24 from Loompanics and Books by Phone.

According to an illicit manufacturer on MDMA, the third edition of this is the most useful guide to manufacture. As of March 1994, the third edition of this guide is being sold by Loompanics while the earlier edition (which I am told is not so good) is being sold by Books by Phone. Recipients of books from Loompanics have received them marked 'opened by customs', while the Books by Phone packets, which are clearly labelled 'Books' have never appeared opened.

190 Effect of MDMA on sexual behaviour of male rats by Dornan et al. in Pharmacol Biochem Behav July 1991

Sexual activity was suppressed in most animals while on MDMA, but returned to normal after a week "despite a marked depletion of 5HT content in the striatum and hippocampus". In addition, rats who did copulate on MDMA, "ejaculation latency and postejaculatory interval were dramatically lengthened".

191 Effects of MDMA on sleep by Allen et al. in Sleep September 1993

23 MDMA users were compared to matched non users. MDMA users averaged 19 minutes less sleep and 23 minutes less non-REM [non rapid eye movement] sleep than controls. The reduction was due to an average of 37 minutes less stage 2 sleep, with no significant reduction in stages 1, 3 or 4 stages.

192 Illicit psychostimulant use in Australia by Dave Burrows et al. monograph, Australian Government Publishing Service, 1993

Use of MDMA in Australia seems to be limited to a small group at events such as raves. Prevalence is estimated to be between that of amphetamine and cocaine.

In a section entitled Pharmacologic Interventions, various drugs are discussed. L-Tyrosine and L-Tryptophan have been "postulated to promote bio-synthesis and thus to restore neurotransmitter function. Their use in open trials has produced unclear results. No controlled studies document their effectiveness."

193 Amphetamine Use among Young Adults in Sydney by Julie Hando and Wayne Hall, National Drug and Alcohol Research Centre, 1993

Study based on 231 in-depth interviews with amphetamine users between October 1991 and October 1992. Two thirds were male, average age was 24, all lived in Sydney with 39% in the inner city. 5% were aboriginals. 57% were unemployed. 58% had tried MDMA of which 24% had injected it. MDMA was not the drug of choice for any of the sample, and came 9th in popularity just below cocaine.

194 Letter from myself in New Scientist, 18/12/93

Sir,

Susan Katz Miller's article entitled How Ecstasy blows your mind (20 November) reports on the results of American research that, she says "may be evidence of the 'neurotoxic potential' of the drug".

She then goes on to report that, "In personality tests, the team found that the group who took Ecstasy were less impulsive and hostile, and showed greater constraint and control". However, she doubts that these characteristics were caused by their use of Ecstasy, quoting an American psychiatrist's view that "people who gravitate to this drug are often less hostile".

However, there is evidence to indicate that Ecstasy modifies user's behaviour in this way. An ethnographic survey by Mark Gilman, a researcher for the Manchester drug agency Lifeline studying a group of football supporters, showed that when they switched from alcohol to Ecstasy they gave up fighting. Simultaneously, statistics confirmed that the number of fans arrested and ejected from grounds fell to their lowest level for five years.

An interesting aspect of the American research not mentioned in your article is that peaceful behaviour was associated with lowered serotonin levels, contrary to general belief. This supports the findings mentioned in your article Does the aggressive gene lurk in a Dutch family? (This Week, 30th October 93) which links aggressive behaviour with high levels of serotonin.

When the World Health Organisation expert committee recommended that member countries of the Convention on Psychotropic Substances outlaw MDMA (Ecstasy) in 1985, they were sufficiently impressed by anecdotal evidence of its potential benefits to issue a directive urging member countries "to facilitate research on this interesting substance" under the provisions of Article 7.

As Britain is a world leader in Ecstasy consumption per capita, isn't it time that some serious research was carried out in this country?

Nicholas Saunders

195 Independent 7/3/94

A home office study by Prof. Alan Maynard et al. states that customs rarely achieved the 10% seizures of drugs consistently claimed, and that in fact the figure since 1985 has fallen from 1% to 0.3% in the case of heroin.

196 Letter from Fiona Measham, 2/94

Ms. Measham's research involves keeping track of a cohort of young people, now 16-17 years old (described in reference 49). She attends hard-core jungle clubs in the Midlands about once a fortnight including The Edge in Coventry and Institute and Q club in Birmingham, the latter being in a converted church holding 3,000.

"Regarding trends, the jungle scene is vibrant and buzzing at the moment, as evident by the opening of large new clubs. Last year people spoke to me of their personal experiences of 'snidey Es' leading them to choose other dance drugs instead, in particular LSD and speed. More recently, it seems that improved quality has led some to move back to Ecstasy as the preferred dance drug. Now, however, a lot of people are sticking to brands they know and trust, especially 'Doves', rather than the previous trend for wanting to try the latest E on the market.

"A small but growing number are using cocaine, which is increasingly available and at a lower price. Male friends say they quite often get offered a snort in the toilets at venues. . . There is also a race dimension, with young black men in Wolverhampton more likely to be doing speed, cocaine (crack and coke), cannabis and alcohol in various mixtures rather than E which is definitely still the first choice for young white men."

197 Letter from Kellie Sherlock, 3/94

Ms. Sherlock is conducting four research projects which concern the use of Ecstasy at the Department of Psychology, University of Leeds.

"My first study is a wide scale questionnaire examining various determinants of drug use. The main body of the questionnaire encompasses questions to do with; demographics, consumption variables, knowledge about drugs, as well as attitudes and beliefs about drug use." These survey forms have been distributed to 6,000 16-25 year olds. She hopes to follow up some of the respondents after a year to assess changes in answers.

"My second study is a series of semi-structured in depth interviews with young women drug users. In this I hope to gain some more qualitative data to supplement the quantitative data acquired in the questionnaire. I am interested in reasons for; starting, continuing and cessation of use, positive aspects of use and health related aspects of usage." Results will be analysed in two ways: first a very simple content analysis; the second according to the Leeds Attritional Coding System which relies heavily on Attribution Theory. Again, it is hoped to do a 12-month follow up. "I would like to administer a scale such as the Brown and Harris Events scale to see what role life events play in drug use."

The third study is a Behavioural Validation Study consisting of two components: a group testing of 40 subjects and a longitudinal study of 10 of these. "This involves the subject giving a sample of urine after taking an Ecstasy tablet and then completing a detailed questionnaire about the effects, what other drugs they have taken etc." There will be an attempt to match behavioural effects with the drugs found in the urine.

"My fourth study is still very much in the planning stages. I am hoping to work in conjunction with Dr. John Blundell from this dept. who did some preliminary work with Dr. McCann and Ricaurte on Ecstasy, eating and serotonin levels. We are hoping to conduct something similar on eating behaviours, probably in questionnaire format."

198 Session with therapy group using Ecstasy, 3.94

A reader invited me to attend a 'journey', an event which he and a few friends made fortnightly on Ecstasy. Without having met any of them, I turned up at an address in North London one Saturday afternoon.

The participants were old friends in their thirties who had previously been involved in rebirthing. They felt that spiritual paths were often a distraction from coming to know and change oneself. They believed that releasing their internal anger and other negative emotions would result in being able to let these go.

The session started by each person (including myself) taking the 'medicine' in a cosy room with lots of candles and a coal fire. Some took a whole tablet, others three-quarters.

When the drug came on, one member of the group started to talk about the knot he felt in his belly, and the rest of us focused our attention on him, encouraging him to feel it and interpret it. When he seemed to exhaust this route, someone else would take over the central role. Some would talk and reveal their secrets, others would 'regress' and describe situations they believed were from a previous life. One particular member took on the role of interpreting what was going on, and the others seemed to accept his 'insights'. For instance, he might say that someone was angry and that person would reply "I don't feel angry" to which he would suggest that this was because they were suppressing anger.

The atmosphere was intense without fun. I found myself identifying intensely with the pain being expressed, but this was exhausting and too much to take after the first couple of hours. I then became more detached and observed, with growing doubts that the process was really therapeutic and about their implied belief that there is "no gain without pain". At the end of the session we all shared a meal, and they considered it an important 'journey'. They planned to meet a couple of days later to go over it. I learned that they met at least once a week in addition to these fortnightly 'journeys'.

199 Attitudes and Ecstasy Use by Mark Conner and Kellie Sherlock, University of Leeds. Paper presented at a conference in Lisbon September 1993.

Anonymous questionnaires were used to study the extent and associated beliefs of a varied sample of 186 students aged 19-25 in the north of England.

Over half had tried Ecstasy, and the majority of these had taken it over 15 times. It was found that light users only used ecstasy on special occasions, while heavy users took it regularly, mostly once or twice a month. Heavy users tended to take Ecstasy at clubs while light users tended to use it among friends at private parties. Users were significantly more likely to take other drugs such as marijuana, amphetamines and hallucinogens, though less likely to use alcohol.

Enjoyment was the universal motive for taking Ecstasy - none answered addiction, habit, experience or boredom. However, there was a marked difference between the perceived outcome of use among users and non-users. Non-users were far more likely to evaluate the effects of Ecstasy negatively, such as being feeling lethargic, having mood swings, more frequent use and feeling run down. There was a tendency for heavier users to perceive more positive and less negative outcomes of use, although even heavy users had only moderately positive attitudes.

200 Phone call from Andrew Thomson, 3/94

Thomson is involved in a research project on Ecstasy users, originally to find out if the use of Ecstasy may promote the spread of AIDS. He reported some findings that have emerged to date.

Back pain. During his 50 in-depth interviews, he has included questions about fluids consumed and lower back pain after use. Those who consume large amounts of nonalcoholic drinks do not have back pain, and people who normally have pain can prevent it by drinking water. He suspects that lower back pain is due to the effect of dehydration on the kidneys.

Menstruation. When women report stopped or irregular menstruation, he asks about their eating habits. As a result, he believes that menstruation is not effected by consumption of Ecstasy but by poor or irregular diet that often accompanies Ecstasy use.

Sex. Some people can get turned on sexually while on E, but the important point is that the mood that existed when taking E continues and becomes exaggerated - "just like alcohol". But Ecstasy does lower inhibitions to some degree. It also depends on the social context in the widest sense, including the atmosphere and expectancy of the situation where it is used. Quite apart from the use of Ecstasy, sexual arousal is common at clubs but not at raves. Some women described getting randy on E in clubs and one stopped taking it in clubs so as to keep in control.

201 London Programme, ITV 27/3/94

Boring programme but had commissioned a survey among school children. This showed that about 35% of schoolchildren have bought or been offered drugs in London area schools. Trends suggest that the majority of kids will have tried drugs before they leave school. Typical starting age for trying drugs is now 14 while 5 years ago it was 17-18. 41% of school users are 14 or under. Drug use is more prevalent at 'public' schools (ie private fee-paying schools).

202 Interview with a Benedictine monk, 2/4/90

Brother Bartholemew is a monk who has used Ecstasy about 25 times over the past 10 years as an aid to religious experience. Normally he has taken it alone, but has also done so among a small group of like-minded people. While using Ecstasy he has experienced a very deep comprehension of divine compassion. He has never lost the clarity of this insight and it remains as a reservoir upon which he can call. Another benefit of his use of Ecstasy has been that the experience of the divine presence comes to him effortlessly. The effect manifests in its elemental form in the breath, the breath of divine God. After the awakening he began to discover the validity of all other major religious experiences.

He believes the 'tool' of MDMA can be used on different levels - as a research tool or as a spiritual tool. When used appropriately it is almost sacramental. It has the capacity to put one on the right path to divine union with the emphasis on love, vertical love in the sense of ascending. However, this gain only happens when you are looking in the right direction. It should not be used unless one is really searching for God, and is not suitable for hedonists such as teenage ravers. The place where it is taken should be quiet and serene, and you should have a close emotional bond with the others in your company.

The experience has to be pursued under a certain amount of supervision because the influence of Ecstasy produces a tendency for attention to drift off. There is also a danger of squandering the experience by being trapped in euphoric feelings rather than reaching into a spiritual realm. However, although it can be invaluable, its use should not be necessary as the need for a drug negates freedom.

203 Interview with a rabbi at the West London Synagogue, 5/6/94

After a talk which touched on the need to prepare for death, I asked a question about the value of MDMA in terminal patients (referring to Charles Grob's study in LA). He replied that MDMA was valuable for the dying as much as at raves in that it allowed the feeling of oneness and seeing life from a new aspect. Prohibition is not the best way to deal with substances that can be used in ways that are as sacramental as communion wine. They may arouse feelings of awkwardness which may be uncomfortable but are essential for deeper understanding of our selves. However, there are other methods such as are described in a book called Mind Aerobics.

At the end, the rabbi beckoned me to come up onto the stage. He took me into a fire exit staircase, out of earshot of his entourage, and told me that he could not afford to undermine his project by publicly supporting the use of illegal drugs, but that he had my book (which he praised) and he believed that MDMA and other psychedelics cold be used to immense benefit. Not only for personal awareness, but also for the sake of Gaia or the cosmic wellbeing of the planet. He hinted that the MDMA experience was of the same quality and potential value as other mystical experiences, and suggested that priests should take the drug themselves both in order to understand young people and to see the validity of spiritual experiences produced by drugs. He referred Masro's conclusion concerning 'peak experiences' that taking drugs was like reaching the top of a mountain by cable car instead of the toil of climbing - it can be seen as cheating, but it gets you to the same place. He ended by giving me a big hug and encouraging me in my work.

204 Visit from a Zen monk and teacher

Bertrand is a Zen Buddhist monk and teacher of meditation in his early seventies. Formerly an artist, he had an awakening experience on Mescaline which made him re-evaluate life and to seek a spiritual path, and when he was 47 he took up Rinzai Zen with a strict Japanese master. Though he found the training extremely hard, he eventually became the abbot of a Zen monastery.

Bertrand has taken Ecstasy about 25 times over 10 years. He has generally used it on the second day of a five day meditation, and finds that the drug allows him to give his wholehearted attention without distraction. As a student, he also once used the drug when undertaking a Zen exercise called Koans - such as the classic: "to understand the sound of one hand clapping". The master would name the task which the student would have to contemplate and then return to demonstrate his comprehension of it; normally after a considerable time and very often being told to try again. On MDMA, Bertrand zipped through the Koans with impressive ease. He has also felt enlightened on two occasions, although he is wary of accepting this as the highest level. He also knows a Swiss Zen Buddhist who uses E, but never told his own master. He feels that the experience would be of great value to some of his devout but stiff fellow Zen monks, although he knows only one other Zen monk who uses Ecstasy.

Asked whether the E experience was of equal value to 'getting there the hard way', he replied that MDMA simply allowed one to focus wholeheartedly on the task in hand, and that the result was in every way as real because it was the same. In fact, MDMA allowed him to go further than he was able to without it.

I pressed him to find negative aspects, and he told me that he once made the mistake of taking E just before leading a meditation. This opened his eyes to how strained and needy his students were. He expressed what he felt too freely: that they looked like corpses, all lined up in their black tunics! This was inappropriate and he did not use MDMA while teaching again. He felt his mistake lay in not respecting that his students were in a different space.

However, Bertrand believes that MDMA would be an extremely useful tool for teaching if the students were on it too. In fact he wondered if he would live long enough to be able to use it legally. Pressed for possible problems, he said that there were always people who came wanting to be given enlightenment on a plate, and that news of a new technique using a drug would attract those who expected it to 'do be done for them'.

The rave party was the first time Bertrand had taken E except while meditating, and he was surprised how different the experience was. Beforehand he said he could hardly stand the noise and volume, but after coming up said how he could see the value of the volume in drowning out distractions, and the monotonous beat was akin to American Indian ceremonies which also provide the feeling of tribal bonding by the use of a drug - although he felt the rave missed the Indians' cultural framework and focus. (Bertrand had been guest in an American Indian ritual, though without taking any drug.) He could see the value of his new experience to Buddhism as expansive - meditation was contractive, but both were essential.

His first reaction to coming up was sadness in his position as part of the establishment of a restrictive religion, and a realisation that the Zen training was not suitable for Westerners in its present form. Later, he got into the dancing and, as his face changed from severe to happy he exclaimed: "This is meditation - to be truly in the moment and not in your head". Next day, he said that he felt the experience had made an impression on his life and was not sure where it would take him. It had emphasised what he already knew: that his students were too contracted, and that the expansive experience of the rave was what they needed, and it was a pity that he could not advocate it in his position.

Next day he said this may be an important turning point in his life. He had to take time to digest what he had learned, but his immediate response was that he could not continue to be part of the establishment of his school in its present form. He could see that the contractive aspect of the training had been overemphasised in his school in the belief that Westerners were too expansive anyway, but in fact those who sought Zen masters in the West really needed the ability to be expansive - and the rave provided it.