q + a




newq + atestingarticlesbooksexperienceslinks
[Contents][Appendix 1]
[Reference 129][Reference 131]

E is for Ecstasy by Nicholas Saunders

Appendix 1: Reference Section

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.

[Contents][Appendix 1]
[Reference 129][Reference 131]
E is for Ecstasy by Nicholas Saunders (
HTMLized by Lamont Granquist (