textfiles/drugs/e4xtc.txt

E for Ecstasy by Nicholas Saunders.
Bibliography by Alexander Shulgin.
Published by Nicholas Saunders, 14 Neal's Yard, London, WC2H 9DP, UK.
ISBN: 0 9501628 8 4. Published May 1993. 320 pages. #7.95.

This is a revised version of the first edition. This is sold out in Europe,
but is still available in the USA from distributors: Book People and Inland
Books who supply bookstores and mail order companies such as Books by
Phone. The US shop price is $12.95. Single copies are also available from
the publisher for #10 Europe or #15 airmail worldwide if orders are paid by
Visa or Mastercard and faxed to +44 71 379 0135 or e-mail to
nicholas@neals.demon.co.uk. Include name, account number, expiry date,
address (must be same as account is sent to).

A German language edition will be published in September by Verlag Ricco
Bilger, Josefstrasse 52, 8005 Zurich, Switzerland. Title: Ecstasy. ISBN: 3
908010 12 8. Price SFr.38 plus SFr.10 including postage wordwide.

Copyright Nicholas Saunders and Alexander Shulgin 1994.

This material may be freely distributed electronically, but may be
printed for personal use only. Permission is required for any other use of
any of the contents. This will normally be given freely, provided prior
permission is obtained and the source credited in an agreed form.

The appendices can be found in the file "e.is.4.x.append".

Contents

1: Introduction

2: Own Experience
What I feel it has done for me; how I have experimented with it and researched

3: History of Ecstasy
first invented and patented; tested by US army; re-discovered by Shulgin;
used for psychotherapy; wildly popular available by credit card; alarm due
to previous impure drug causing Parkinson's disease; banning in US against
recommendation; media muddle; appeal overturned; rise of the rave in US,
Europe and then back to US; permission to use in Switzerland; permission to
use in US.

4: What it Does and How it works
Emotional effects: allowing the chi to flow, dissolving fear, allowing
memories to surface, being temporarily free of neurosis, feeling love,
removing defensiveness, allowing indulgence. Medical effects: effect on
brain with fairly full explanation including diagrams to show how brain
cells transfer info. Side effects such as blood pressure and temp rise.
What organs get rid of it. Effects of combining E with other drugs. Sex.

5: Who takes Ecstasy
Own survey results, references to other surveys. How many people take E
deduced from surveys and seizures. Welshpool and football supporters

6: Dangers
Reports of death here and in the US and why different. Overheating. Heart
failure, strokes. Neurotoxicity: the research that caused the fears and the
present assessment. Risk assessment compared to other activities as from my
article. Who should avoid taking Ecstasy. Psychological dangers: what kind
of people have been damaged by MDMA. Media overstatement.

7: The law, the media and the establishment
Times article

8: Psychotherapy in Switzerland

9: Popular uses of MDMA
Used for opening up and having fun; slimming/keeping fit; dancing; problem
solving; improving relationships; professional psychotherapy; amateur
psychotherapy; as an alternative to psychotherapy; in rituals; in place of
a quick holiday; for pain relief; for depression. . .

10: Suggestions for users
Ideal situation in town, in country. What to have with you and what to
avoid. When to take it. Who to take with and who not to. Describe Set and
Setting. How to be a guide.

11: Ecstasy and where does it come from
Tests for MDMA in the lab and at home. List of characteristics. What drugs
are sold as MDMA and how to distinguish them. Are other drugs more toxic?
Is MDMA cut with poisonous substances? Why it sometimes has a different
effect. Production and distribution

12: Discussion of establishment attitudes
edited version of Shulgin's chapter 42

13: Case histories
First-hand accounts edited to provide examples that the reader may be able
to identify with. Both positive and negative experiences.

Appendix 1: Reference section
Summaries of reports I have read.

Appendix 2: Annotated bibliography
by Shulgin

Appendix 3: Directory of Organisations in the UK
which deal with Ecstasy users

Appendix 4: Research projects
under way at present.

1	Introduction

A large proportion of young people, especially in Britain, are regular
users of the drug Ecstasy (E, Adam166, X or MDMA) for a simple reason: it
provides them with access to an experience which they value. Yet the
majority of first-time users have no access to reliable information about
the drug and rely on folklore for guidance, while little serious attention
is paid to the potential uses and benefits of MDMA. This book is intended
to satisfy Ecstasy users' thirst for knowledge, to help them to avoid its
dangers and make the best of possible benefits as well as to stimulate
further research into this fascinating drug.

The first part of the book is brief but complete in itself. Those who want
to know more on any particular subject should follow the little numbers to
the reference section; those who don't want to miss anything should also
read that section, as it also includes many fascinating items of additional
information. Then there are the personal accounts which are an easy read
and have been chosen to demonstrate most of the effects of the drug.
Finally, there is an annotated bibliography for serious researchers.

While the first edition was about and for British users of Ecstasy, this
edition includes a broader usage both in Europe, the USA and Australia, and
will be published in German. Much of the book has been rewritten to
incorporate the greatly increased volume of references.

In the summer of 1992 I held a meeting to bring together people who had
experienced a positive change as a result of taking Ecstasy. I was sick of
the rubbish put out by the media, and I wanted to see how many people, like
myself, felt the drug had done them good. Most of those who attended had
far more experience of the drug than myself, and it was hardly surprising
that nearly all credited the drug with improving the quality of their
lives. But what made a strong impression on me was that, although those
users desperately wanted information, they knew very little about the drug.
That decided me to produce this book.

In 1970 I wrote Alternative London, a guidebook for people living in the
city who, like myself, were exploring alternative lifestyles and other
levels of consciousness. As with MDMA now, media coverage of our lifestyles
consisted of horror stories and ridicule. As with Alternative London, this
book is based on personal experience backed up by extensive research.

2	My own experience with E

The seventies and early eighties was a period when I was energetic and
productive, enthusiastically involving myself in one successful project
after another, first a guidebook called Alternative London and then a
series of 'alternative' businesses which I had started in Neal's Yard, a
courtyard in central London. Yet by 1988 I felt disappointed because most
of the original ideas I had pioneered had been discarded. That year I did
start a new business, but more out of desperation to prove myself than
enthusiasm, and it was not a success.

I was in that strained frame of mind when a friend called Claudia offered
to take me on an Ecstasy trip. She is an extrovert actress who I've known
for years and, as rather an introvert myself, I wanted to keep my distance
to avoid being overpowered by her. We swallowed the capsules in her flat
and then headed off for Kew Gardens, a place I loved and where I thought I
would feel safe. On the way to the station I felt symptoms familiar from
taking LSD in the sixties - I would see something happening out of the
corner of my eye but it would return to normal when I turned my head. As we
got on the train Claudia took my hand. . . What a surprise! It felt
wonderful to be touched, and there was nothing threatening about her, she
was really warm and caring. Even the worn train seat felt good, and I
rubbed the back of my head on it like a cow does on a gate. I felt
Claudia's delight at seeing me opening up. "I could really get into this,
would you stop me if I go too far?" I asked. Claudia laughed and told me to
enjoy myself while she looked after me. I got into catlike stretching and
slid under the table to enjoy the space, laughing at how shy old me could
behave like that. When I sat up I found that I could 'ride' the train like
a horse, responding to its bumpy movement. I looked out of the window and
saw everything afresh; not only beauty but ugliness was accentuated, too.

When we got off the train I took deep breaths and the air felt wonderful.
It was good to be alive. But the intellectual part of myself asked "What is
different to normal? Why isn't life always like this?" I deduced that I was
simply allowing myself to enjoy what had always been there. I realised that
I had got into the habit of restraining myself. It was not this
drug-induced state that was distorted - it was what I had come to accept as
my normal state that was perverse. I then realised that over the past few
years I had been mildly depressed. And, what's more, I could see why: some
years before I had felt cheated by the person who took over the wholefood
shop, and I had carried that resentment like a burden ever since. This
realisation and the experience of a few hours 'freedom' was just the tonic
I needed; it got me out of the rut and I started afresh with new
enthusiasm.

Since then I have taken the drug three or four times a year. Only twice has
the experience been less than delightful, but on both occasions it
nevertheless provided insights. Once was when I took Ecstasy in a flat in
Holland with Anne and Afga, two woman friends who I had known since the
sixties, I became acutely aware of how the years had changed them. I could
see that Afga had suffered a great deal as a result of the men she had been
involved with, yet it seemed to me that the pain had matured her into a
strong and serene woman. I felt that Anne, by contrast, hadn't allowed life
to hurt her and was still playing the 'flower child' which simply didn't
fit the middle-aged woman she had become. As the trip proceeded, I found it
difficult to communicate with them. Afga became absorbed in her own
thoughts and ignored me, while I restrained myself from telling Anne how I
saw her. As a result I got a headache. The other occasion was with a tense
friend who suffered from crippling stomach cramps. When the drug took
effect her face opened up and she felt truly relaxed for the first time in
years, allowing her to slither around the floor like a snake - until it
wore off and her cramps returned with a vengeance. Altogether it was a
painful experience, but it did provide her with a valuable insight into the
cause of her cramps: the memory of being raped as an adolescent.

On one occasion I was on a walking holiday in the Himalayas. I was trekking
in Nepal with a Danish couple who I had met on the trail. Our trek took us
over a 17,000 foot high pass, an extreme effort and achievement for all of
us, and next day we took some E as we sat in the cold sunshine overlooking
Tibet with a glacier ice-fall behind us and the peak of Annapurna gleaming
across a wide valley. As we watched, clouds formed on the peak, then they
drifted across the valley changing shape into fishes, dragons and horses.
At one point an eagle swooped down over our heads, and we felt as though we
were carried with it across the valley below. Afterwards the reserved
French geologists at our hotel responded to our warm mood by bringing out
brandy and chocolates which they had reserved for a special occasion. There
were no insights, it was simply a wonderful day where the surrounding
magnificence was enhanced, but the shared experience formed a bond between
us and we travelled on together like old friends.

Another time was spent in the countryside with a lover whose Sufi master
warned that drugs damage the psyche and would undo hard-earned spiritual
achievements. As the drug came on her face lit up and she cried, "What
fools they are." Spirituality was right there for her, and she still
regards that event as a valid mystical experience. We found ourselves
utterly fascinated by a moorhen that was building its nest, as though the
bird had acknowledged our presence and was letting us observe its skills.

After all these experiences on E, I had still not been to a rave. It was
not that I didn't want to, but simply that, as a middle-aged man, I thought
I would feel conspicuously out of place. Then the opportunity came: a rave
where several of my friends would be, one actually older than myself. I
quite enjoyed myself thanks to the E putting me in a positive mood, but I
could not get into it. The dancers appeared to be lost in their individual
trips, facing the speakers without relating to one another. I was simply
amazed by the discomfort of the venue, with its rough concrete floor and
steel walls wet with condensed sweat; the unrelenting, aggressive music and
pulsing lights to match. It was not until I had spent several more similar
nights out that I was able to enjoy the true experience.

I was given a phone number by a friend to ring for tickets and was directed
to a dilapidated block with a sign saying 'Offices to Let for #50 a week.
Move in today.' It looked bare as though they had done just that. A girl
sold me the tickets and when I asked where the party was to be held she
scrawled the address on a scrap of paper. Half expecting I'd been conned, I
turned up at midnight just as the E I'd taken was coming on.

The venue was spacious and well-ventilated. The music was the usual Techno
House, although not as harsh as some, and I tried to follow a friend's
advice of moving with the bass and ignoring the rest. I got into dancing in
my usual rather self-conscious way, keeping an eye on what other people
were doing and well aware that I was much older than everybody else. Then,
imperceptibly, I gradually relaxed, melted into it, and knew I was part of
it all. There was no need to be self conscious; I had no doubt I was
accepted; there was nothing I might do that would jar because everyone else
was simply being themselves, as though they were celebrating their freedom
from the constraints and neuroses of society. Although everyone was
separately celebrating in their own space, when I looked around I would
easily make eye contact - no-one was hiding behind a mask. There was
virtually no conversation or body contact except for the occasional short
hug, but I experienced a feeling of belonging to the group, a kind of
uplifting religious experience of unity that I have felt only once before,
when I was part of a community (Christiania) that was threatened with
closure. It was as though we belonged to an exclusive tribe bonded by some
shared understanding, yet full 'membership' was mine for the #10 ticket and
#15 tablet. Not everyone was included; a few looked awkward, trying to fit
in or dancing with style but without spontaneity. I assumed that they had
not taken Ecstasy.

That experience was a revelation. I felt as though I completely understood
what raves are all about - including the music, which had always grated on
me. Harmony that I had found lacking was irrelevant: the music constantly
provided energy to lift one up without ever letting one down; it built up
more and more without ever reaching a climax. I found myself not only
dancing to the heavy beat, but breathing to it too, sometimes letting out
sounds along with the music. There was subtlety hidden in the change of
beat, a kind of tease that made me smile each time. And it felt so very
healthy, as though I was moving in a way that was a true expression of
myself, with every part of the body feeling free and flexible. I felt much
younger, almost reborn.

I danced continuously until 6 am without any effort, even though I would
normally be exhausted after an hour of such vigorous exercise. As the E
wore off, at about 4 am, I started to feel some tension in my stomach, but
the trance remained until the end. On the way home in a car with friends
the music carried on so clearly that we had to check that the stereo was
off before believing the sound was coming from inside our own heads! I
slept most of the next day and also right through the following night,
without any further effects apart from stiffness in the legs.

Problem solving

In 1992 I became interested in exploring Ecstasy's potential for solving
personal problems, and took MDMA with an old friend, Jill, with the
specific intention of resolving problems and examining relationships in our
lives. We each wrote down a list of subjects that we wanted to explore
beforehand, and spent the first hour after the drug came on concentrating
on one issue at a time.

I had snapped at an ex-neighbour a few days before. I was a bit shocked at
myself as I couldn't see why I had done it. But on Ecstasy it seemed clear:
I felt threatened by the people who had moved into his flat and he had
'caused' this problem by having moved out! Next I focused my attention on
one particular friend who I had always admired for what he had achieved in
the face of enormous difficulties. My image of him was shattered and
instead I saw him as a Chinese juggler spinning plates on bamboo sticks,
desperately rushing from one to the other to forestall a catastrophe. It
didn't seem like a revelation, more as though I had known it all the time,
and only afterwards did I realise that this was a viewpoint that I had not
seen before.

On later reflection, I assessed these insights on MDMA as valid but not the
complete picture. It was as though MDMA had provided me with a different
viewpoint, such as might be seen by a friend.
There was one occasion when the drug had virtually no effect on me, and
that was when I was in love. It was later that I realised the significance:
being on E is quite similar.132

3	History of Ecstasy

MDMA was patented as long ago as 1913 by the German company Merck. Rumour
has it that the drug was sold as a slimming pill along with comic
descriptions of its strange side effects, although it was never marketed
and the patent doesn't mention uses. The next time it came to light was in
1953 when the US army tested a number of drugs for military applications -
again, folklore says it was tried as a truth drug but there is no evidence
for this.1

The father of MDMA - or 'stepfather' as he describes himself - is Alexander
Shulgin.2 After obtaining a PhD in biochemistry from the University of
California at Berkeley, Shulgin got a job as a research chemist with Dow
Chemicals, for whom he invented a profitable insecticide. As a reward, the
company gave him a free hand and his own lab. Having had an exciting
experience on Mescaline, Shulgin used the opportunity to research
psychedelic drugs. An accepted test for psychedelic effects was to observe
how fighting fish change their behaviour. But there were problems: fish
don't say when they are under the influence and, well, have you ever seen a
fish that doesn't look stoned? His answer was to 'suck it and see'.

Eventually his company was embarrassed to find themselves holding the
patents of some popular street drugs and he was politely given the push.
Shulgin continued testing new compounds on himself and a select group of
friends for many years. Thanks to his remarkable personality - combining
openness without proselytising about his liberal and controversial views -
he has earned the respect of influential people and is able to carry on
with his research today, with the full approval of the US government. His
approach to psychedelics is similar to that of a botanist: he specialises
in the phenethylamines, and delights in recording the subtle differences
between each member of that family of drugs. His experiences are described
in his autobiography Phenethylamines I Have Known And Loved. MDMA is but
one of 179 psychoactive drugs which he describes in detail, and, although
its effects are less dramatic than many, MDMA is perhaps the one which
comes closest to fulfilling his ambition of finding a therapeutic drug.
Shulgin has now moved on to writing a book about another family of
psychoactive drugs, the tryptamines, due out in 1995.

However, it was only after hearing glowing reports from other experimenters
who had also synthesised and tried MDMA that Shulgin took an interest. He
describes how in 1977 he gave some to an old friend who was about to retire
from his career of psychotherapy.

He phoned me a few days later to tell me he had abandoned his plans for a
quiet retirement. I know none of the details of the increasingly complex
network which he proceeded to develop over the following decade, but I do
know that he travelled across the country introducing MDMA to other
therapists and teaching then how to use it in their therapy. They had all
began, of course, by taking the drug themselves. He believed (as I do) that
no therapist has the right to give a psychoactive drug to another person
unless and until he is thoroughly familiar with its effects on his own
mind. Many of the psychologists and psychiatrists whom Leo instructed
developed small groups or enclaves of professionals who had been similarly
taught, and the information and techniques he had introduced spread widely
and, in time, internationally.

It is impossible to ever know the true breadth of therapeutic MDMA usage
achieved during the remaining years of his life, but at his memorial
service, I asked an old friend of his whether she had a guess at the number
of people he had introduced to this incredible tool, either directly or
indirectly. She was silent for a moment, then said, 'Well, I've thought
about that, and I think probably around four thousand, give or take a few.'
Those first psychotherapists to use MDMA were keenly aware that they had
found a valuable new tool.3, 4, 135 As one put it, "MDMA is penicillin for
the soul, and you don't give up prescribing penicillin, once you've seen
what it can do". They were equally aware that if MDMA became a popular
street drug, it could follow in the footsteps of LSD and be criminalized by
the US government. They agreed to do as much informal research as possible
without bringing the drug to public attention, and did pretty well - MDMA
only gradually became known as a fun drug and it wasn't until 1984 that the
bubble burst.

If MDMA is so wonderful, why hasn't it been marketed by any of the big drug
companies? One reason is that the drug's commercial potential is small;
another was that the US Food and Drug Administration (FDA) prohibited
trials on humans. But perhaps the most significant obstacle to the
commercial exploitation of MDMA is that it has already been patented -
although the patent ran out years ago, a drug cannot be patented a second
time. Before marketing a new drug, a drug company has to show that the
safety risks are justified by the drug's benefits as a medicine, and this
involves long and expensive trials. The only way of recouping that expense
is by obtaining exclusive rights to sell the drug through holding its
patent.

Those years 1977 to 1985 are looked back on as the 'golden age' of Ecstasy
or Adam5 as it was then known. In psychotherapy, its use only appealed to a
few experimental therapists since it didn't fit in with the usual 50-minute
psychotherapy session, but they did include some of the most dynamic people
in the field, including some who claimed that a five hour Adam session was
as good as 5 months of therapy.166 There was also a select a group of
'explorers' who used the drug in various ways, but, surprisingly, they
never discovered its potential as a dance drug.

By 1984 the drug was still legal and was being used widely among students
in the USA under its new name 'Ecstasy'. (Rumour has it that a big-time
dealer called it 'Empathy', but, although the name is more appropriate, he
found that Ecstasy had more sales appeal.) In Dallas and Fort Worth, Texas,
Ecstasy was even on sale in bars where you could pay by credit card, where
it replaced cocaine as the drug of choice among yuppies and even spread to
people who normally kept well clear of drugs. However, it was this public
and unashamed use that resulted in the drug being outlawed.

A deeply-embedded puritan ethic seems to affect the response to drugs in
Western societies. To use a drug for pleasure is taboo3, yet to use a drug
to relieve pain is acceptable. In reality there is no sharp distinction: if
someone is 'suffering from depression' and a drug makes him feel happy, it
is regarded as a medicine and meets with approval. But if that person is
regarded as normal and takes a drug that makes him happy, he is indulging
in something quite unacceptable. Except, of course, if the drug happens to
be nicotine or alcohol.16

During 1985 Ecstasy got into the mass media because a small group of people
sued the US Drug Enforcement Agency to try to prevent them from outlawing
the drug. The controversy provided free advertising which made Ecstasy
spread like wildfire throughout the US. It was a case of bad timing - the
previous year there had been a widely publicised disaster that made the
authorities overreact to any new scare. A batch of 'China White', a
so-called designer drug6 which was sold to heroin addicts as a legal
substitute, had contained a poisonous impurity, and, tragically, it caused
a form of severe brain damage similar to Parkinson's disease.7 As a result
the US Congress passed a new law allowing the DEA to put an emergency ban
on any drug it thought might be a danger to the public. On July 1st 1985
this right was used for the first time to ban MDMA - what is more, MDMA was
put in the most restrictive category of all, reserved for damaging and
addictive drugs without medical use.8 The effect of prohibition was to
curtail research into the drug without changing the attitudes of
recreational users.9 However, the Agency's haste was at the expense of not
following the letter of the law, leaving the ruling to be overturned in
subsequent court cases.

The temporary ban only lasted for a year; meanwhile a hearing was set up to
decide what permanent measures should be taken against the drug. The case
received much publicity and was accompanied by press reports advancing the
kind of scare stories now current in Europe, which added to the pressure to
make the ban permanent. One widely publicised report referred to evidence
that another drug, MDA, caused brain damage in rats and concluded that MDMA
could cause brain damage in humans.10, 11, 12 The media indulged in horror
scenarios of 'our kids' brains rotting by the time they were thirty,
although there was no evidence that MDMA caused brain damage in rats at the
dosage levels used by humans. On the other side were the psychotherapists
who gave evidence of the benefits of the drug - but they had failed to
prepare their ground by carrying out scientifically acceptable trials, so
their evidence was regarded as 'anecdotal'.

The case ended with the judge recommending that MDMA be placed in a less
restrictive category, Schedule 3, which would have allowed it to be
manufactured, to be used on prescription and to be the subject of research.
But the recommendation was ignored by the DEA, which refused to back down
and instead placed MDMA permanently in Schedule 1. A group of MDMA
supporters made a successful challenge to this decision in the Federal
Court of Appeal, but their objections were overturned on 23rd March 1988.
The fight is still continuing on the grounds that the law is
unconstitutional, that the correct procedure was not followed and that the
DEA did not take all the evidence into account.

In most countries including the US, all new drugs are regarded as 'innocent
until proved guilty' unless they are substantially similar in structure and
effect to prohibited drugs, and this gives rise to the phenomenon known as
'designer drugs' - drugs which have been deliberately synthesised to avoid
the law. In Britain, however, whole families of chemicals - including
members that have not been invented - are treated as 'guilty until proved
innocent' under the law. Psychedelic amphetamines, which includes MDA, MDEA
and MDMA have been illegal in Britain since 1977, and, as in the US, MDMA
has been placed in the category that attracts highest penalties.13, 14
All member countries of the United Nations are signatories to the
International Convention on Psychotropic Substances (ICPO) and follow
recommendations laid down by the World Health Organisation Expert Committee
on Drug Dependence. In 1985, under American pressure, the ICPO asked member
nations to place the drug in Schedule 1 although the chairman of the WHO
Expert Committee disagreed with this decision, stating that "At this time,
international control is not warranted." A clause was added encouraging
member nations to "facilitate research on this interesting substance".15

The criminalisation of MDMA in America has had wide-ranging consequences.
The first was to prevent the drug being used by professional therapists,
except in Switzerland (see chapter 9). The second was to reduce the quality
of the drug as sold on the street, because demand was now met by
clandestine laboratories and the drug was distributed through the criminal
network. Although the number of users was dramatically reduced at first,
criminalisation did not prevent the drug's popularity spreading worldwide.

Ecstasy arrives in Europe

Ecstasy was favoured by Bhagwan Rajneesh, the Indian guru whose disciples
wore orange, and when his followers moved out of their ashram in Oregon
they brought the drug to Europe in the mid eighties.17

The rave scene started on the hippy holiday island of Ibiza in 1987, where
Ecstasy joined LSD and hashish at all-night dance parties. In England
'raves' took the form of both large outdoor and warehouse parties, well
described by Paul Staines in Appendix 3.

Warehouses were prepared secretly so as to avoid local people obtaining a
court order to prevent the raves happening. Tickets were sold in advance
without the address, but with a phone number to ring on the night for
instructions regarding a meeting place such as a motorway service station
from where a convoy would proceed to the venue. Opposition to raves was
fierce since people living up to two miles away could be kept awake all
night. By 1990 the British government had passed a law, the Entertainments
(Increased Penalties Act)18, which effectively put an end to these big
gatherings.

The result was to push ravers into dance clubs. The Hacienda in Manchester
led the trend in 1988 with the now prevalent style: DJs who never spoke,
but teased the dancers with their subtle 'scratching' establishing the
Manchester sound.19 From there clubbing on E came to London, the rest of
Europe and eventually back to E's native California, as reported in the San
Francisco Examiner:

The English ravers hit San Francisco in the winter of 1991. "We were
suddenly surrounded by these kids, moving here from England. They were
coming here in droves and bringing with them a new sensibility, a new style
of clothes."

By this time Ecstasy had reached nearly every corner of society in England
and by the winter of 1991-2 demand had outstripped supply, partly due to
some massive police seizures.20, 21 Dealers responded by selling any old
tablet as Ecstasy and no doubt made huge profits, but as a result people
had disappointing experiences and turned away from Ecstasy. Many turned to
LSD instead for the simple reason that the dose cannot be adulterated13 as
it is microscopic (a thousand times smaller than a dose of MDMA) and is
normally sold absorbed into a 'blotter', a tiny piece of paper too small to
absorb active quantities of any other popular drug.

The English pattern of use contrasts with the American one both in kind and
volume, which accounts for there being so many more casualties here. The
proportion of young people taking Ecstasy is many times higher in
Britain22, 23, and here it is nearly always used as a dance drug. Americans
generally use Ecstasy at home, although English-style raves are on the
increase.

Although the therapeutic use of MDMA has been outlawed in the US for the
past seven years, steps are being taken there towards MDMA becoming a
prescription drug. To comply with prerequisites for the licensing of new
drugs, a non-profit organisation called The Multidisciplinary Association
for Psychedelic Studies (MAPS) opened a Drug Master File for MDMA in 1986,
thus permitting research into the drug to be conducted. Recently, research
into the effects of MDMA in human volunteers has been approved by the FDA
itself, and trials began in 1993.24 I have faith in common sense prevailing
over prejudice in the long run; unless new evidence emerges that MDMA is
toxic or another drug appears that is even better, I believe that one day
MDMA will be an acceptable medicine.

4	What E does and how it works

What Ecstasy does is very simple, yet difficult to describe. It combines
two opposite effects, stimulation and relaxation, but in addition provides
a subtle quality of empathy.141 The radical psychotherapist RD Laing, who
took MDMA at Esalen, California, in 1984 when it was still legal, said, "It
made me feel how all of us would like to feel we are anyway . . . smooth
and open hearted, not soggy, sentimental or stupid".25, 3 Another
psychologist described it as providing a "brief, fleeting moment of
sanity".110 The most similar experience familiar to most people is being in
love.132

The most predictable feelings experienced are empathy, openness, peace and
caring.166 However, what people experience can vary from paranoia140 to
sleep138, depending greatly on other factors called 'set and setting'166
which includes their cultural beliefs, expectations and state of mind at
the time.153, 166 Even your genetic make up may affect your experience.178

Psychiatric effects

In 1992 researchers in the US attempted to identify the effects of MDMA in
psychological terms through studying its effects on psychiatrists.26 The
psychiatrists' experiences varied, but apart from losing track of time, the
most commonly noted effects were that they related to other people more
openly with less fear or defensiveness. Half said the drug had a lasting
positive effect on their 'social/interpersonal functioning', and nearly
half mentioned changes in their spiritual outlook and values.46

The effects are similar, though more intense, to the popular antidepressant
Prozac (Fluoxetine): it makes most people feel liberated and good about
themselves, less self-conscious and able to feel emotions more clearly,148
while a small minority become more depressed. A university lecturer who was
oversensitive to Prozac described how, as member of an examination review
board, she felt euphoric and unable to take the subject seriously, an
experience that sounds similar to MDMA. Both drugs lower serotonin levels,
though by different means.30, 67

I believe that the drug's various effects can be reduced to two primary
effects, one physical and one mental: the relief of muscular tension and
the dissolution of fear. People on Ecstasy feel able to move and to express
themselves freely, so the drug provides a taste of living without the
restraints we have become to regard as part of life. Users often compare
the effect to memories of early childhood when they would look people in
the eye, live for the moment and were free of inhibitions.

The ideas of Wilhelm Reich, a radical student of Freud who developed his
own theories, may be relevant. Reich developed the theory that children in
times of trauma brace themselves against pain by tensing their muscles, a
reaction which becomes habitual, and which develops into what he called
'body armour'. As adults, people prevent themselves from being hurt through
'being cool': avoiding expression of emotions or revealing weaknesses.
Reich believed that muscular tensions go hand in hand with emotional
tensions or neuroses, and the test for being free of the latter is the
ability to move in an 'orgasmic' way with spontaneous undulations flowing
smoothly from head to toe, a form of movement that often occurs
spontaneously on MDMA. It could be that the drug temporarily removes both
neuroses and the associated body armour.

Ecstasy is unlike most other drugs in that it increases awareness of touch
and sound, an effect that has been observed in laboratory rats.185 The drug
has also been described as allowing the life force, or Chi, to flow
freely.29 Traumatic memories, suppressed for years because they are too
painful to face, may emerge and be looked at without terror. Insights into
what is really happening in life can also occur. Pain may be reduced30, 31,
4, especially if it is based on fear, such as the fear of death.

Spiritual effects

It is also claimed that MDMA has some spiritual effects. Recently Alexander
Shulgin told the story of a Japanese poet who tried MDMA and said: "It has
taken twenty years of studying Zen for me to reach this clarity, but I'm
glad I did it my way". A Benedictine monk at a monastery in Big Sur,
California, tried to see if MDMA could aid meditation, and concluded that
the drug 'facilitated the search by providing a glimpse of the goal', but
that it did not replace the hard work required.5 A healer claimed that she
saw a client's aura brightened by MDMA27, and there are many reports of
people becoming more spiritually aware.28, 26

The Lion Path136, 149 is a road to enlightenment using MDMA as a tool. It
is based on the idea that throughout history there have been certain 'open'
periods related to astrology when there has been the opportunity for
spiritual growth. Such an opening exists now until 1988, and the most
'open' days for each individual are determined according to their own
astrological chart. On these particular days spread over 5 years, followers
meditated in isolation on MDMA. Officially, MDMA is no longer recommended
although it is still used by some followers.

Many spiritual practices "may be greatly facilitated and the effects
amplified including meditation, yoga, tai chi, guided imagery,
psychosynthesis, shamanic journey work and rebirthing. This is best done on
low doses or towards the end of a session.166

The effects of MDMA vary greatly according to the intention of the user and
external stimulation during the trip. In my experience, minimum stimulation
(such as isolation with ear plugs) in secure surroundings produces the most
inward-looking experience, while the direction, such as whether emotional
or spiritual, depends on one's intention.

Telepathy

Many people feel telepathic on E, or as one reader remarked, "Where does
empathy end and telepathy begin?" But although there are some anecdotes142,
there were no responses when I asked readers to test their telepathic
abilities with friends in another room.

Effects at raves

When MDMA is experienced at raves, it lacks some of the subtle effects
experienced in quiet surroundings, but has an extra quality not seen when
the drug is taken in private.32 The combination of the drug with music and
dancing together produces an exhilarating trancelike state, perhaps similar
to that experienced in tribal rituals or religious ceremonies.33

Ecstasy is often called the 'love drug', a name which suggests another way
of looking at its effects. MDMA opens the heart and allows love to flow.
This may extend to loving oneself, overcoming awkwardness and allowing
oneself to feel good.

Unpleasant effects

MDMA does not suit everyone. The most extreme example I have come across
was a few years ago, when a man I knew who suffered from severe stomach
cramps attempted to use the drug for self-therapy. During the trip he
experienced a wonderful release, allowing him to move freely and flowingly.
However, as the effects wore off the cramps returned with a vengeance. It
was a frightening experience; the following night he vomited until he was
exhausted and has never wanted to take the drug again.

Even people who normally enjoy Ecstasy can have very different experiences
including hallucinations, though these are usually due to another drug
(such as LSD) sold as Ecstasy.Appendix 2 But even with pure MDMA paranoia
is sometimes experienced.140

Less extreme reactions are more common. A woman friend who took E at a
party reported that Ecstasy made her feel unpleasantly out of control and
gave her a nasty headache, even though the pill appeared identical to that
enjoyed by her friends. She went home early and felt depressed for the next
two days.

Although I have found that Ecstasy temporarily stops pain such as
toothache, some people have reported headaches and nausea accentuated
without any of the pleasant effects. I believe it depends on what you focus
your attention.

Ecstasy can upset people's lives. There are many examples of young people
squandering ridiculous amounts of money on E and only living for their next
binge. One known personally to me is that of a 23-year-old art student who
used to live for the weekends when she and her friends took Ecstasy, and
spent the rest of the time in a state of depression. This lasted for about
a year until eventually she was thrown out of college, which made her even
more depressed. However, two years later she emerged again as her former
vibrant self, and looking back saw that her problems had resulted as much
from her parents' divorce as from taking Ecstasy through which, she says,
she made good friends.

In 1991, a survey conducted in Sydney34 found that 80% of those who tried
Ecstasy thought that it was fun to use while 7% did not (13% found it
'neutral'). Three-quarters of regular users in Manchester said they usually
enjoyed Ecstasy and most said it was 'here to stay' in their lives, but 18%
enjoyed it less than they used to.182 Another Australian survey among
amphetamine users showed that Ecstasy was not particularly liked.193 Much
of the effect depends on the setting - if you feel relaxed anyway you are
almost certain to enjoy it; although many tense people use the drug to help
them relax, not everyone can yield to its effects. Clients who have used
MDMA in psychotherapy - in which fun is not the object - tend to enjoy
their first experience but to get absorbed in their problems on subsequent
MDMA sessions.chapter 9

Although most people find the drug liberating and enjoy letting go, others
may feel uncomfortable to be without their normal defences. Even for the
same individual, a wonderful feeling of relief in a warm supportive
environment can be extremely unpleasant in other circumstances. Users may
come to bitterly regret having revealed their insecurity or longings when
under the influence of Ecstasy and some insights, such as realising that
your partner never loved you or that your dreams are not attainable, can be
extremely unpleasant. To remember a traumatic situation without support can
be devastating. When someone is 'on the edge' but just managing to keep
life together, any of these situations may push them over, resulting in a
'nervous breakdown'.

It is important to realise that bad effects are not due to the drug alone,
but to a combination of the effects of the drug and the situation at the
time. A guide who has introduced MDMA to many people over the past 18 years
assures me that none of them has ever had a bad experience, even though
some were difficult cases. He attributes this to him being able to give
whatever support was needed.144

Side effects

These can be uncomfortable, but hardly any users find that side effects
spoil the experience. Dry mouth and loss of appetite are almost universal,
and various muscular reactions are common, as though some muscles resist
the drug's demand to let go. These include holding the jaw tightly
clenched, eyes flickering from side to side, twitches, nausea and cramp,
especially as the drug first takes effect. Generally these soon pass. Side
effects are more pronounced with increased use.

Another more common but less serious problem with MDMA is that many people
resist the effect of the drug. This is uncomfortable, often manifesting in
a headache and nausea.

A long-term side effect experienced by ravers is weight loss which, for
some women, is a motive for using the drug.35 Weight reduction is
presumably caused by the combination of exercise and loss of appetite. Some
women find their menstruation upset since they started using Ecstasy, but
is probably an indirect effect.200 Some women also complain of urinary
tract infections, but these may be due to the effect of MDA which is often
sold as Ecstasy.173

Some people are concerned that a long term side effect may be to alter
personality. However, the only changes identified have been
improvements.157, 194

After effects

People often feel exhausted after taking Ecstasy. This 'hangover' is hardly
surprising considering that the mind, and usually the body, have been so
much more active than normal, and is similar to that experienced by users
of LSD and amphetamine.34

Hangovers can be reduced by avoiding other drugs such as alcohol and ampheta
mine and getting a good night's sleep afterwards. The antidepressant Prozac
(and presumably other SSRIs) reduces hangover and prevents toxicity184,
although regular Prozac use may interfere with the experience.142 Vitamins
may also help36, and so may drugs such as L-Tyrosine and L-Tryptophan.192
Other after effects are most commonly stiffness from exercise, though
depression28, 37, 44 inability to sleep191 and paranoia37 sometimes occur,
particularly among heavy users. Pain in the lower back may be due to
dehydration of the kidneys.200

Medical effects

When MDMA is swallowed, it is digested in the stomach and enters the blood
stream. From there, some of it reaches the brain, but any MDMA that passes
through the kidneys is removed and ends up in the urine - two thirds is
excreted unchanged while some 7% is 'metabolised' into MDA. Every 6 hours
the amount remaining in the body is roughly halved, so that after 24 hours
there will be only about 3% left.38, Chapter 9 Other psychoactive drugs are
excreted in a similar way, and this enables them to be 'recycled': Siberian
reindeer hunters who take fly agaric mushrooms to get high drink each
other's urine in order to prolong the effect.39

There are various chemicals called a 'neurotransmitters' naturally present
in the brain which alter our mood and activity level to suit our situation.
Serotonin and adrenaline are just two of many neurotransmitters that block
or allow the transfer of information between brain cells. Just as
adrenaline affects our activity, serotonin (or 5HT) affects our mood. The
mechanism by which they work is extremely complicated and is not yet fully
understood. All that is really known is that we have varying amounts of
these chemicals in our brains, and that the amounts vary along with our
emotional state.

MDMA causes a release of serotonin from particular brain cells, and this
produces a change of mood. It also affects aspects of the body's control
system such as blood pressure and pulse rate and, most importantly, body
temperature. It is this that has resulted in a number of deaths at raves,
which are discussed in Chapter 6.

Effects on animals

Some people have described to me the effects of Ecstasy on animals.
The first is from a laboratory researcher.141 He believes that they do not
enjoy any psychoactive drugs but feel confused, and that this is more so
with higher animals like monkeys. However, a man described how he took E
with a friend on the beach along with two German Shepherd dogs who had half
an E each! He was convinced that one dog, who tended to jump up clumsily
and too roughly for comfort, remained as affectionate as ever but became
more sensitive and gentle; while the other dog displayed unusual signs of
jealousy.

Thirdly, I have heard of Ecstasy being used as a cure-all for wild
animals.188 The theory is that many animals from birds to horses are
nervous, and it is this tension that makes them ill or prevents them from
getting well, especially when kept by humans.

Lastly, I have been told of race horse being doped with MDMA before racing,
which, like ravers, is said to make them calm as well as energetic.

Combining Ecstasy with other drugs

Ecstasy is often taken with cannabis, alcohol, LSD ('candy-flip') or
amphetamines at raves, and cannabis is widely smoked in the 'chill-out'
period afterwards. Although drinking has had a comeback41, most users feel
that alcohol reduces the effect of Ecstasy. Alcohol taxes the liver and
kidneys, causing dehydration, so taking it in combination with Ecstasy is
likely to result in worse after effects than taking Ecstasy alone.40, 60,
62 Similarly, when taken with amphetamine the toxicity is greater than when
the drugs are taken separately.141

Many users in the north of England particularly like to take Ecstasy with
speed (one E with half a gram of amphetamine)40, which adds excitement and
prolongs the experience. Home users in all areas generally prefer pure
MDMA. The view generally held among these groups is that speed
(amphetamine) spoils Ecstasy's subtle empathic quality.

Some ravers take Ecstasy alongwith LSD ('candy-flip'), with the
hallucinogenic qualities of LSD adding to the warmth of the Ecstasy. This
combination also extends the experience, as LSD lasts for about twice as
long as MDMA, and is often used outdoors at music festivals and in natural
surroundings.

Home users often refer to MDMA as a 'psychedelic amplifier' or 'catalyst',
enhancing the effect of psychedelics without changing their quality. This
has been tested with LSD, 2CB, MEM, 2-CT-2 and may apply to all other
psychedelics. The psychedelic is taken towards the end of the strongest
part of the Ecstasy trip.144 Some people use E to ensure against bad trips:
once the MDMA has established its usual positive effect, the course is set
for the LSD trip. Others find that LSD loses its usual effect and simply
amplifies the effect of the E.128

A popular combination among home users is MDMA with 2CB taken towards the
end of an E trip. As the 2CB takes over from the MDMA, the experience is
subtly changed towards a more intellectual viewpoint from which some people
find it easier to assimilate any insights gained.31 For hedonists taking E
with a lover, the 2CB provides the erotic component of love suppressed by
the Ecstasy.128

Nitrous oxide ('laughing gas') is said to be quite enjoyable while on E and
can help if you get stuck in a particular state of mind128.
Ketamine can also be used while on Ecstasy for self exploration31, and
sometimes also at raves though I have not heard of good experiences.

Drugs with similar effects

When you buy 'Ecstasy', it may not be MDMA but MDEA or MDA. These are all
'psychedelic amphetamines' with fairly similar effects and the amounts of
each sold are about the same. Connoisseurs invariably prefer MDMA because
of its empathic quality or warmth, but many users (and some dealers) can't
tell the difference. MDA lasts twice as long (8-12 hours) and has a rather
more amphetamine-like effect without producing much in the way of feelings
of closeness. MDEA (sometimes sold as 'Eve'), lasts a rather shorter time
(3-5 hours) than MDMA (4-6 hours) and is nearer to MDMA in effect, but
still lacks its communicative qualities.38

The effects of all these drugs wears off after a few successive days' use,
a phenomenon known as tolerance. However, there is no 'cross tolerance'
between MDA and MDMA. Someone who has taken so much MDMA that it has no
more effect on them can still get off on MDA.12

Future drugs like Ecstasy

The conditions are right for a flood of new and interesting drugs coming
onto the black market. There is increased demand from both explorers and
hedonists combined with new techniques which will enable drugs to be made
with the effects users want without unwanted side effects.

There is a considerable amount of research into new psychoactive drugs now
being carried out both legally (as basic research and in the search for new
medicines) and illicitly. To some extent it is now possible to design a
drug to produce a desired effect, while new techniques and equipment have
opened the way to creating whole new ranges of drugs which were previously
too difficult to synthesise.141

In addition, new methods allow the effects of new drugs to be assayed
safely and quickly, such as by implanting electrodes in the brains of
living animals. Recently drugs with very specific effects have been
produced, and hallucinogens that are even more potent than LSD.141
It has also been shown that the desired effects of Ecstasy can be separated
from the toxic effects.176, 184 The way is now open - and the search is on
(illicitly) - to produce something that has the empathic qualities of MDMA
without toxicity. One approach is to find a more potent drug so that a
smaller, and therefore less toxic, dose is needed.141

Future psychoactive drugs may well be tailored according to fashion. As
people become bored with the current fashion and move towards a new way of
behaviour (such as being more grounded, perhaps) drugs will be created to
produce the desired mood.

Sex

Although the media portray Ecstasy as an aphrodisiac, sexual arousal is not
an effect of taking MDMA. In fact the drug tends to inhibit erections in
men (and male rats190). However, people who are already feeling in a sexy
mood as the drug takes effect may become aroused.128 Many users never
become sexually aroused on E and find the state quite incompatible.
However, for others it depends on their libido at the time and this in turn
depends on who they are with and the surrounding atmosphere, so that a
place with sexual vibes such as a club may induce sexual behaviour while
this virtually never happens at raves.200 In general, there is a tendency
away from sexual desire but the drug allows one to continue on that energy
level165, although erections are inhibited and orgasms suppressed.44
Behaviour at raves during the first few years, at events where nearly
everyone was on E, was very different to that at alcohol-based clubs, and
seemed to follow from the lack of male sexual aggression. Hugging and even
caressing strangers was acceptable on a sensual level without implying a
sexual advance.41 Ravers would have a sense of belonging at any club or
event where others were on E.

According to Sheila Henderson writing in 1992, a researcher studying the
way young women use Ecstasy and author of papers entitled Women, sexuality
and Ecstasy41 and Luvdup and DeElited42, "Sex is not one of the foremost
pleasures offered by Ecstasy. . . Most men have the opposite to an
erection: a shrinking penis". Women can even enjoy snogging at raves
because it is 'safe' - not a prelude to having sex. They are less likely to
have casual sex following a night raving than after going to an
alcohol-based club. As one girl put it, "you don't go to a rave to cop". In
fact, sexual safety is an attraction at raves in contrast with
alcohol-based clubs which are seen as a cattle market. However, by 1994
Ecstasy was not the predominant drug used in most venues174 and this
atmosphere only survived in a few circles such as travellers' parties.

Other sociologists have noted that sexual behaviour at raves is less than
at other social activities33, and that, on Ecstasy, "thoughts about sex are
not always matched by desire". Though some found sex enhanced by the drug,
others were disappointed.37 However, some women said that the chill-out
period after raving was "the ideal time for long, slow sex".41 This view is
shared by the girlfriends of working class men in the north, where Ecstasy
has the reputation of being good for sex on comedown.40 An American
pamphlet claimed that: "Sexual experience only occurs when it is
appropriate on a heart level for both of you. . . Know that whatever you
choose to create will be a perfect and appropriate choice".43

The question whether Ecstasy use increases risk factors concerning sexual
behaviour is being examined in depth by Andrew Thomson. His study is not
due to be complete until 1996Appendix 5, but preliminary results show that
over three quarters of those interviewed who regularly used Ecstasy in
clubs had practised sex while under its influence, and that one in six of
these said that the effect of Ecstasy made it less likely that they would
practice safe sex.125

Two other studies have indicated that injecting polydrug users who take
Ecstasy have more sex than those who don't; but that amphetamine users who
took E were less at risk of catching HIV because they were more likely to
use condoms and no more likely to have sex.155

A group of Swiss psychotherapists (see chapter 9), who have experience of
some hundreds of people in group and individual sessions, tell me that they
have never come across a participant becoming sexually aroused while on
MDMA, although it does sometimes happen on LSD. They say that sexual
longings are sometimes expressed, but not the immediate desire for sex. The
Swiss therapists appear to take it for granted that MDMA suppresses sexual
arousal, and that men cannot have erections while on the drug.

However, a survey of users in the San Francisco area conducted in 198544
found that only half of the men who responded said it was more difficult to
have an erection on MDMA, though, of those who said they had had sex on the
drug, two thirds said they had problems in achieving an orgasm. While the
great majority of users of both sexes said that the drug had no effect on
their sexual desires, some reported a desire for sexual activities "that
implied they felt free of inhibitions, such as group sex". Most respondents
said that MDMA had made no lasting difference to their sexual pattern,
although some reported positive changes such as being more open and
relaxed. All the women and nearly all of the men thought that MDMA helped
them to become emotionally closer to others. A third thought that MDMA had
helped to overcome inhibitions, typically that it had "cleared pelvic
blocks". The survey also found there to be no increase in the initiation of
sexual activity, but slightly more receptiveness to it. In their
conclusion, the authors comment that MDMA is a curious drug in that it can
increase emotional closeness and enhance sexual activity, yet it does not
increase the desire to initiate sex.

Respondents to an Australian survey34 described the effects of Ecstasy as
'sensual' rather than 'sexual'. In contrast, an unpublished survey of users
in London45 found that 89% reported sexual arousal and 67% more sexual
activity on MDMA.

I believe the explanation for such contradictory reports is that the effect
varies considerably according to the user's expectations. Surveys may also
produce results which are biased towards those who are more potent on the
drug (or said they were), while those who felt that the questionnaire might
reveal them to be inadequate were under-represented. There may also be some
suggestion involved: the author of the London survey told me that he had
experienced a sexual advance from a woman on E, and that he would expect
increased sexual activity from users of a drug that increased energy and
reduced inhibition. Similarly, I surmise that the Swiss men who were
treated with MDMA were suggestible to their therapists' belief that men
cannot have erections on the drug. I also suspect that many people do not
make a clear distinction between sensuality and sexuality.

Women become sexually aroused more often than men, but find orgasm
suppressed. Couples who have had sex on E say that it is unusually nice
even without orgasm; they feel more loving than passionate and unusually
sensitive to each other. It seems that a universal effect of the drug is to
remove male sexual aggression, or, as one woman put it, "to bring out the
feminine qualities in men". People on Ecstasy become more sensual and less
lustful.

This sensual-rather-than-sexual aspect of the drug gives rise to non-sexual
orgies at some parties, referred to as 'feely-feely' or 'snake
slithering'.165 People indulge in group sensual delights through caressing
and slithering over one another, though I've only heard of this in
Australia and California.

The suppressive effect of Ecstasy on sexual drive has been a strong
influence on rave culture. On Ecstasy, small talk and flirting seem
ridiculously hollow, and so this sort of behaviour has become taboo in rave
culture. Women became truly liberated; able to let go and enjoy themselves
without fear of being taken advantage of by aggressive men, and this
allowed them to approach men who they don't know. Similarly, women who
didn't feel threatened by men felt free to respond warmly. The atmosphere
inspired confidence and independence so that girls didn't feel the need to
be under the protection of a boyfriend, often going to the rave with a
group of friends but freely mixing with other people.41 However, this
atmosphere has diminished in circles where alcohol and other drugs have
largely replaced Ecstasy. Even then, women are less bothered by men due to
group pressure to accept their liberated behaviour.

Another social effect of Ecstasy is to break down barriers between
homosexuals and heterosexuals. Women are free to hug one another without
being thought of as lesbian, and gays are as likely to be hugged by women
as men.42

5	Who takes Ecstasy?

How many people take Ecstasy?

No-one knows just how many people take Ecstasy, but there are some clues.
In 1993, British customs seized 554 kg, double the previous year's haul.20
That year E was in more plentiful supply than the year before, so the
proportion seized was probably less than usual. At 90 mg each, 554 kg is
enough for somewhat over 6 million doses. In spite of claims by customs
that they intercept 10%, the true figure may be nearer 1%195, implying that
several hundreds of millions of doses were imported, quite apart from
domestic production. This is no hard evidence, but does suggest that there
are several million British users. Seizures have increased each year.179
Another indication is the growth in rave attendances to over a million per
week and the ever-widespread use of Ecstasy in clubs.159, 146, 175

The only British national survey on usage was conducted by Harris Opinion
Polls for the BBC Reportage programme in January 1992. Interviewers asked
questions about drug use to people on their way into clubs in the 11
largest cities in Britain. The answers of 693 people aged between 16 and 25
covering all social groups who were 'regular club goers' - i.e. said they
attended at least once a month - were analysed. Overall 31% said they had
taken Ecstasy regardless of social group. 33% said they had taken an
illegal drug, but 67% said that their friends had done so.23

Andrew Thomson, a sociologist doing research among this age groupAppendix
5, believes that those who told the Harris interviewers that they did not
take drugs but that their friends did so were probably lying (because the
questions were asked in public), and that they actually took drugs
themselves. This would explain the discrepancy with his own impression, and
that of other observers, that the majority of this group use Ecstasy.
The total number of 16-25 year-olds in Britain is 7,444,300.47 Statistics
to show how many of these are regular club goers are not available, but
Andrew Thomson believes that the figure is about 90% among those he is
studying. If that were the case, and 80% of the age group live within reach
of cities, then the national figure would be 3.5 million, or 1.7 million if
only those who openly admitted taking Ecstasy are included. Recently, it
has been suggested that there are just as many users living in the country
as in inner cities.145

A survey of school children across the whole of England found that 4.25% of
14 year-olds had tried Ecstasy.48 This comes to 24,000. Another (regional)
survey found that 6% of 14-15 year-olds have taken Ecstasy.49 If applied
nationally, that would come to 70,000.

Further statistics depend on guesswork. Ian Wardle of Lifeline, a
Manchester organisation concerned with young people who use illicit
drugs40, estimated in 1992 that a million Es were consumed every week in
Britain. Other estimates are lower, for instance the number of people who
have tried Ecstasy at raves has been put at 750,000.33 There are a
considerable number of users outside the 16-25 age group who attend clubs,
so the total number of people who have tried Ecstasy in Britain probably
lies between one and five million. The fact that six million doses were
seized without causing a shortage suggests the actual figure is at the
higher end.

In contrast, the number of American users is small. A survey of a similar
age group in 1991 found that only 0.2%, or one in 500, had used Ecstasy in
the previous 30 days; while 0.9% had used E in the previous year.22 These
figures imply that Ecstasy use was far less among young people in America
than Britain that year, though that was before rave culture started in the
States. Though there was a shortage of E in California in 1993, by 1994 it
was plentiful again.165

As for frequency of use, a study of 89 Ecstasy users in London found that
46 had used the drug more than 20 times; 23 more than 40 times and 5 more
than 100. About one third used it at least once a week, while a minority
'binged' on 10-20 over a weekend. Many took other drugs along with MDMA.45,
182

What kind of people take Ecstasy?

MDMA is used by a wider variety of people than other illicit drugs, and has
been credited with bringing together types of people who would not mix
previously. Besides ravers, users include Hollywood stars139, New Agers154,
gays175 and psychotherapists. All over Europe and north America Ecstasy is
found in city dance clubs, and in Britain it has spread out to people
living in the country145.

Young people are the most receptive to E. Among British schoolchildren,
Ecstasy is the drug most frequently encountered apart from cannabis, with
girls trying it earlier than boys.181, 182, 201 But Ecstasy has spread to
some surprising quarters. Peter McDermott, editor of The International
Journal on Drug Policy, describes how it hit a group in Liverpool: "I went
down to the local pub, and some of the regular four-pints-a-night drinkers
were there - drinking orange juice and giggling: they had discovered
Ecstasy."

Another older group of users are those who used to take LSD in the sixties
and perhaps still smoke cannabis. An account is given below of how Ecstasy
was picked up by such people in a particular rural community, but a similar
trend has occurred all over the country. There are even some raves
organised by and for this age group, although the majority at those I
attended were in their twenties.

Arno Adelaars, a Dutchman who has written a book about Ecstasy17, says that
extroverts and introverts use the drug differently. The extroverts use it
for entertainment, to open up and relate to strangers at parties, while the
introverts take it at home with a lover or a few close friends to provide
intellectual insights. Arno, who is familiar with the English club scene,
says that there is also a difference between the way E is taken in Holland
and in England. In Holland no-one likes to lose control, especially in
public, but in England people like to show that they are 'out of it'.

Trends among ravers

When raving was new to Britain, ravers described it as one big happy family
and would feel at home at any event where people were using E. But over the
years, and particularly from 1993, the scene has divided up into distinct
subgroups - each with their own style of music and clothes, their own music
and drugs of choice. At one extreme are some younger Northerners who wave
white gloved hands and blow whistles, while at the other are the upwardly
mobile professionals who have absorbed Ecstasy and rave-type parties into
their lifestyle, dressing much as they would for an office party and
starting the evening with a few drinks.146

In 1993, alcohol made a comeback in Britain174 and other drugs such as
poppers were more popular in some circles, probably due to worsening
reputation of drugs sold as E.172 But by 1994 the quality of Ecstasy
improved and it became re-established as the dance drug of choice.197
Amphetamines have always been used along with E in the north40 and are now
frequently used in London too. Pure MDMA is seldom used as the main drug,
largely due to other drugs being sold as Ecstasy172, 173, but also out of
choice.

Along with these diversifications in consumption of drugs, the atmosphere
at events also varies widely and in general is less open-hearted. My
impression is that the key rave experience, as described in Chapter 2,
occurs much less often. The rave parties that still manage to create the
atmosphere from the good old days are those organised by and for
travellers.

Overall, it seems that, like all counter-cultures, raving has become
mainstream but in a diluted form. Rather than being the exception, it is
now normal to take E in a club, but the proportion of those on E is far
smaller and many of them have also had a few drinks. Clubs need E available
to provide a good atmosphere, so they encourage dealers on one hand while
pretending to try to keep them out.175

A new trend is commercialisation of chill out parties. Formerly, ravers
would invite others back to their homes for impromptu chill out parties.
This was very much part of the culture and still goes on, but now some
clubs cater for the same needs of somewhere to go while coming down off E
with comfort and ambient music. On Ibiza there is a club that opens daily
at 6am for the purpose.

Own Survey

Having read the published reports of surveys concerning Ecstasy, I felt
that none had asked the most important question: "Has Ecstasy changed your
life, and if so, in what way?" During December 1992, I distributed a dozen
4-page trial questionnaires and, as a result of the response, reduced this
to a 2-page questionnaire. During January and February 1993, I distributed
200 survey forms via various people with whom I was in contact through my
research. 46 were returned, though some respondents skipped several
questions.

The sexes were roughly equally represented (20 men to 18 women). Half of
the respondents were under 25 and the majority of these were 20-23.
Respondents tended to be either heavy users who had taken the drug an
average of 73 times, or light users averaging 5 experiences.

75% said they thought that taking Ecstasy had had an effect on their life.
The page of questions and answers on How your personality may have changed
as a result of taking Ecstasy is given opposite. The most pronounced change
was to enjoy dancing more. There was an increase in spirituality, being
more in touch with the spiritual side of oneself and closer to nature.
Another pronounced change was unexpected: an increase in caring about other
people. Seeing more friends, increased enthusiasm, increased happiness and
self-esteem were also frequently reported. Negative effects were less
pronounced, the most common being that Ecstasy had made ordinary life seem
more boring. Also reported by some were more depression and illness.

A question concerning paranoia produced the most surprising result.
Although several people felt much more paranoid as a result of taking
Ecstasy, others felt less paranoid. Four of those who felt much more
paranoid were women who had taken only half a dose or less. All had taken
the drug previously. Even more surprising was that none of these answered
that Ecstasy had, overall, been bad for her: three answered "good" and one
"neutral".

Many people added a few lines about the effect they felt Ecstasy had had on
their life. Most implied that the drug had enhanced their social lives, and
mention was frequently made of profound experiences varying from intimate
to philosophical.

So as to throw light on the theory of 'inappropriate bonding' versus the
theory that 'whatever you do on E will be right', I asked Have you ever
fallen in love on Ecstasy, and if so how did it turn out? There were 7
responses. 2 said they were still in a relationship started on Ecstasy; 2
said they were already involved but became much more in love with their
partners; one had a 3-day blissful romance that ended abruptly with a bump;
one said she had made several wrong choices on Ecstasy and one described
how both partners were embarrassed the next day about what they had said to
each other.

The sample was too small and self-selected to draw conclusions from, but it
does appear that many users experience changes well beyond the immediate
effect of the drug. However, a major obstacle to drawing conclusions from
such a survey is indicated by one comment, "I can't tell you what changes
are due to Ecstasy, as my life has changed so much anyway". To overcome
this would require comparison with an equivalent sample not taking Ecstasy.
I hope that this will encourage some further research on what I perceive as
the most fascinating and important aspect of the widespread use of Ecstasy:
How does it affect people's lives?

Raves in Northern Ireland

There have been a number of anecdotes about Catholic and Protestant kids,
brought up to hate one another, taking E together at raves and ending up
hugging.150 Just possibly this breakthrough from hatred to affection may
extend to relationships outside the rave, and could just spell the end of
hostilities.

I have been told that the IRA used to keep drugs out of Ireland by
kneecapping suspected dealers - a far more effective method than the law!
But in 1993, they dropped this policy with the result that Ireland enjoyed
a freshness of new-found Ecstasy experience long since lost in England.

E hits a rural community

In 1990 Ecstasy arrived at the Pennine town of Garston Bridge, midway
between Carlisle and Newcastle. This is one of those rural communities that
was deserted by farmers in the fifties in favour of better paid jobs in the
cities, leaving their old stone houses, barns and even schools to be sold
at rock bottom prices to ex-city dwellers in the sixties and seventies -
mostly ex-hippies in their late twenties settling down to start a family.
Typically these people got jobs or started their own businesses and lost
interest in drugs, apart from hash, until Ecstasy arrived. Their children
are now teenagers who, having been to school with the local farmers'
children, mix more with the indigenous population than the parents do.
There is plenty of social life since people think nothing of driving 30
miles to a party, and the generations mix freely - at any party you can
find all ages from 5 to 50.

Although country dwellers, these people kept up strong ties with their city
backgrounds, mostly in London, so they were not far behind when raves
became popular. At first these were mini-raves in their houses or larger
raves of up to 500 people in barns or marquees, usually far enough away
from other houses to avoid disturbing neighbours who might call the police.
Even though the harsh 'Tribal-techno' style of music was unpopular at
first, a core group of 20 or so enthusiasts quickly developed, who would
fix up a party every week or two where they would take E and dance all
night. Daniel, one of the rave organisers and a long-standing member of the
community, told me: "There's a great atmosphere, you could say euphoria
even, the ultimate party. The raves provide a safe environment where you
can be your true self and realise that you're OK. I always have a fabulous
time in a non-egotistical way."

Between parties, people would meet more often than before and communicate
more wholeheartedly. "Although we had known each other for so long, it took
Ecstasy to break through the very British taboo about hugging one another,"
Daniel said. But the new closeness also caused crises in couples'
relationships. "We became more open and truthful. If couples had stayed
together through habit, then it came out". Life was taken more seriously
and heartfelt: honest expression was valued more than easy, superficial
encounters. "Some people went too far and let go of the framework of their
lives. At one time there was a myth that everyone involved would lose their
jobs," Daniel said. But people would support each other through crises and
there was usually someone who understood the problem well enough to be of
help.

Up till then, this community had been strictly non-religious. But Ecstasy
brought about spiritual development in many of the individuals. "It brought
me closer to God", claimed one woman, and "I began to see myself as the
source of love" said another, while Daniel remarked that "Being able to
transcend the ego leads to self knowledge".

When looking back over the early days of Ecstasy use, people in the
community commonly said that the emotional agony of one member had been
felt by everyone else, as if it were their own. The community became very
intimate: people who had known each other as neighbours for 10 or twenty
years felt suddenly bonded in a far deeper way through the weekend raves.
For most people the raves were a joyful celebration, but some people did
experience paranoia and one man who took a lot of E and LSD smashed up his
own house. Others took some fairly drastic decisions during this period: a
long-term couple split up with the man giving away everything he owned to
"free himself of material things" so as to be able to develop his "inner
self". He was last heard of cleaning trains in Gothenburg. A single parent,
a woman in her mid thirties, felt that she had glimpsed her true destiny
and had to follow it. She left her two children with their grand parents,
said goodbye and disappeared.

Daniel said that some new serious relationships had formed, but these were
unlike the casual affairs that were the pattern before. "You can't seduce,
cheat or lie on E," he explained. The great majority of couples did stay
together and developed much closer bonds; even single people felt that
their quality of life was improved. The few outsiders who attended became
like old friends overnight - two men who had never met before spent the
next week travelling together.

The first ravers were of the parents' generation, but they were later
joined by their teenage children and the children's friends and, after a
year or so, by some younger members of the indigenous community. As more
people joined, the raves became less intense but instead began to be
accepted by the wider community, though the original group still set the
style. A series of raves were held in village halls until the police
clamped down and one was stopped by a court order. Since then they have
been held in farm buildings without being publicly advertised; tickets have
been sold at cost price - #5 to friends through the grapevine.

At least three quarters of the people at these parties take Ecstasy and
sometimes virtually everyone takes the drug. The most common dose is a
single E, but a half E is common and a few people take several Es at a
time. Many also smoke dope right through the night, but hardly anyone
drinks alcohol or takes amphetamine. In fact most have stopped social
drinking because, as Daniel put it, "Alcohol doesn't get you there, but E
does". These people don't use Ecstasy outside parties. "It isn't just the
drug, it's a package: Ecstasy, the company, the music, the lights, the
dancing. It's a tribal sort of experience, a ritual that depends on all of
these things combined," Daniel explained.

The police don't try to stop the parties but sometimes search people on
their way in, so some ravers cautiously swallow their tablet just before
they arrive. When on a couple of occasions people were found with cannabis,
they were taken down to the police station, cautioned and returned to the
party by police car. It seems that, in view of their limited resources, the
police regard the new rave scene as something to be tolerated. There has
been no shortage of good E via the old established connections for scoring
dope - friends club together to send someone to the city who buys in bulk
and covers his or her costs and own E consumption rather than making a
profit.

The conversion of Garston Bridge to Ecstasy was seen as overwhelmingly
positive by the people involved, but as destructive by observers in another
community some miles away. There the drug was enthusiastically taken up by
some while others saw it as shallow and negative, even dividing some
couples. Those in favour would point to the new sense of caring between
people, while the others pointed to the break up of long-standing
relationships that they felt were imperative for the welfare of the
children. Nevertheless, Ecstasy spread to this and other neighbouring
communities, albeit in a less intense way: parties typically have a few
people taking E while others drink or smoke hash, with some people doing a
bit of all three. A man who does not take E described how the 'openness and
honesty' seem paper-thin to him: "It's over the top, all this display of
affection and free expression. It doesn't feel real to an observer and
actually alienates people, especially if, like me, you happen to have been
on the receiving end of some pretty hurtful remarks". This view is
supported by an experienced doctor who believes that openness and honesty
only apply to new users.161

Looking back, it was commonly felt that Ecstasy had caused the biggest
upheaval in Garston Bridge since the arrival of the first freak settlers.
"I see it as middle-age crisis on a group level. We needed something to
fill our lives as our children had done, and along came E," Daniel said.

Football Supporters

Mark Gilman, a researcher who works for Lifeline, a non-statutory drug
agency in Manchester, is conducting a study of drug use among young
football supporters. Mark is using ethnographic methods, which involve
socialising with the football supporters, and he witnessed at first hand
their conversion from drinking alcohol to taking Ecstasy. His own account
is included below.

The derby football matches, in which two teams from the same city play each
other, are notorious for generating violent incidents. The Manchester derby
is no exception. There is a long tradition of encounters between Manchester
United fans and supporters of Manchester City resulting in trouble.
Even when they are not playing each other there have been some fights when
the two groups meet in the city centre. If United have been playing at
home, the 'lads' will meet up in a city centre bar to drink Saturday night
away. If City have been playing away, their 'lads' will also make their way
back to the centre of Manchester for a drink. It often happens that,
sometime in the course of the night, the two groups clash and trouble
follows. This occurs even though some of the men come from the same areas
and are known to each other during the week. Saturdays are a special time
when normal rules of behaviour are suspended.

The first derby game of 1989, which took place at Manchester City's ground
in the late summer, was eagerly awaited by both sets of supporters, because
Manchester City had been out of the first division for some time.
Manchester United's lads met in a pub early on Saturday morning and
proceeded to get 'steamed up' on alcohol in preparation for the events to
follow. After several false alerts the United fans finally moved off from
the pub at about 2.30 pm. By this time they numbered several hundred.
Standing on a bridge that the United fans pass over on their way to the
City ground, I looked back at the approaching horde. Their demeanour and
presence was similar to those pictures you see of American GI's in Vietnam:
they were moving at a semi-trot and psyching each other up for violence.
When they reached City's ground, the United fans infiltrated the City end
and the game was held up as police moved in to sort things out. Several
arrests followed. After the game, sporadic fights broke out on the road to
the city centre and in and around city centre pubs. All in all, it was a
particularly violent day in a long history of violent days.

The corresponding fixture took place on a Saturday in February 1990. During
the day a similar sequence of events took place, but this time the violence
intensified, culminating in a running battle between United and City fans,
which went on late into the night. During the battle, several pubs were
smashed up and one young man was very seriously injured. An even more
violent day in a long history of violent days.

The following season the kick off to the first derby game was brought
forward to 12 noon. Despite an early drinking start this seemed to cut down
on the trouble. By the time of the second derby, United had qualified for
the European Cup Winners' Cup Final to be played in Rotterdam and nobody
wanted to miss that by being arrested at the derby game, so it passed off
fairly peacefully. The timing of the season's games largely neutralised the
supporters' inclination to violence.

The first derby game in the 1991/92 season fell on a Saturday, but by this
time something quite remarkable had happened. Many of the hard-core lads
from both United and City had spent most of the summer dancing the weekends
away to the sounds of house music at raves fuelled by the drug Ecstasy.
They had done this together! They had got into a routine of meeting up at
rave clubs and taking Ecstasy in groups comprising both United and City
lads.

On the night of Friday November 15, 'derby eve', another traditional time
for preliminary skirmishing, a group of United's lads were preparing for
the game not with the traditional pub crawl followed by a visit to a beery
night club but by attending a low key rave at a smallish club in a nearby
town and taking Ecstasy. Having swallowed their tablets and gone into the
club, the United lads grouped in a corner of the bar. There were about a
dozen of them. As they sipped their drinks waiting to 'come up' on their
Ecstasy tablets, they noticed a small group of City lads with whom they had
crossed many a sword.

One young man who was very new to the Ecstasy/rave scene, but something of
a veteran of derby match violence, said that a shiver went down his back at
the thought of what he expected to happen. "I thought - Oh no! - I don't
believe this! Here I am, I've just necked an E; I'm just about to have the
time of my life and it's going to go off [there's going to be a fight] with
City," he said. "I'd only had E a couple of times then and I just couldn't
imagine fighting off it - no way! Anyhow, X [one of the City lads] comes
over and the last time I saw him he wanted to kill me and everybody like
me. I thought, 'Hello, here we go,' and he just stands at the bar at the
side of me and says; 'Well who'd have thought that we would be stood side
by side the night before a derby game and there's no trouble in any of us.
It's weird innit? It could never have happened before E'. Well I thought to
myself, 'Thank Christ for that,' and I had a can of Red Stripe to get back
into it. It wasn't a great night as nights on 'E' go, the DJ was shit and
the club was only half full and most of them were bits of kids, but it was
sound enough. The best part was when I went to the toilet to get a drink
and cool down. I'm stood at the sink pouring water over my head from a pint
glass and looking at the size of my eyes and up behind me comes X [the City
lad] and he's buzzing his tits off [on Ecstasy] and he says; 'This is
better mate. This is better!' And he was dead right it was better, much
better. They even came back to this house where we go for a smoke [of hash]
after the raves. I went home to bed about 5 am. and, as I lay there waiting
to get to sleep, I couldn't stop thinking how right he was this could never
have happened before E."

The next day the United fans met up around 9 am. as usual for the derby
game. Obviously, some of them had had very little sleep. In fact some
hadn't had any. They had just gone home for something to eat; a bath and a
change of clothes. Although drinking alcohol was again prominent in the
pre-match build up, it was challenged by, or combined with, taking hash and
amphetamines.

As United's fans moved off, there were, as usual, several hundred of them.
But from the vantage point of the same bridge I had stood on two seasons
earlier, I could hardly believe that this group was largely made up of
those same young men who had looked like they were about to go to war. This
time they looked more like they were going to Glastonbury festival! Despite
the protestations of some of the beer monsters who tried to drum up
enthusiasm for trouble, this was a loose passive grouping; a rag-taggle
army of Ecstasy-taking hedonists. They were looking forward to the night's
Ecstasy. The match went off with hardly any trouble and afterwards United
and City's lads once again danced the night away on, and in, Ecstasy. Just
as the City lad said, it could never have happened without E.

In early 1993 Mark told me that the latest trend for this group of people
is back to alcohol and, for the first time, cocaine ("You can hear the
chopping in the toilets"). He believes this is partly due to the poor
quality Ecstasy on sale [much contains no MDMA] which has put many users
off the drug, and also because of overuse resulting in less empathic
experiences. "E's mellow, there's genuine communion taking place, but
coke's a selfish drug and alcohol goes with violence." That good atmosphere
has been lost, but so many people miss it and hope it will return one day.
In fact, the level of soccer hooliganism dropped to its lowest level for
five years that year.50

6	The dangers of Ecstasy

The most likely danger from taking Ecstasy is consuming something else
instead. In Manchester in the summer of 1993, all 13 tablets and capsules
bought as Ecstasy turned out to be other drugs.172 Some people have taken
"Ecstasy" several times have never actually had MDMA. Although the quality
was said to be improving during 1993-4, you can never be sure what you are
getting unless it is from a batch that you know is good. Even dealers often
have no idea what they are selling, and may not even know that "Ecstasy"
means MDMA and nothing else.175 See Chapter 12 under Is it really Ecstasy.

What follows relates to MDMA.

There are several distinct ways in which MDMA can be dangerous, and as this
is a very important issue, I want to look at each in turn. These can be
divided into immediate, short term and long term medical dangers and
psychological dangers, giving four categories. There is also the question
of addiction.12

Immediate medical dangers

There have been frequent stories in the press about people who have died
from taking Ecstasy in Britain, and several cases are reported in the
medical journals. By July 1992 The British Medical Journal was claiming "at
least seven deaths and severe adverse reactions have followed its use as a
dance drug." Dr. John Henry of the National Poisons Unit (attached to Guy's
Hospital, London), who studied MDMA-related deaths in the period 1990 and
1991, found the cause to be heat stroke in every case. All the fatalities
occurred at crowded parties and clubs where "sustained physical activity,
high ambient temperature, inadequate fluid replacement can all reduce heat
loss and the direct effect of the drug may upset the thermoregulatory
mechanism."51 By March 1993, the National Poisons Unit listed 14 deaths
among people in whom MDMA was detected; 13 showed symptoms of overheating
and one of asthma.52 Fortunately, with widespread knowledge about the
danger of overheating and how to avoid it, this cause of death has been
nearly eliminated, while in America it is as yet unknown.161

In the United States, where the drug has been widespread for far longer,
very few deaths have been reported and none of them are believed to be due
to heatstroke. A study of five deaths associated with MDMA in the US showed
that there were other probable primary causes of death in four of the
cases, while the cause in the fifth case was not established. The report
suggested that "people with cardiac disease may be predisposed to sudden
death by taking MDMA."53 The implication is that, rather than being toxic
in itself, the drug made the users more vulnerable to preexisting
conditions such as a weak heart. No cases of death due to overheating have
been reported in the US.

Some people have attempted to explain this discrepancy by suggesting that
poisonous additives may be the cause of death in Britain. However, this is
not born out by Dr. Henry's studies or by samples analysed for the
police.54

Overheating

The most likely explanation is the way the drug is used: in Britain people
often take Ecstasy while dancing for hours on end in very hot, humid raves
without sufficient drinking water. The conditions at some raves could cause
heatstroke even without a drug.55 It has been suggested that a few
individuals are particularly vulnerable to heatstroke, possibly because
they have a tendency to develop a high temperature56, though it is more
likely that the conditions are to blame.170

Heatstroke is a well-known cause of death, but in other situations it only
affects people who are pushing themselves to the limit16 or are unable to
escape from the heat. What is peculiar about Ecstasy-related deaths is that
the victims appear to make no real attempt to cool down. This has been
explained by ravers being in a trancelike state, but experiments with rats
and mice show that overheating may be a more direct effect of the drug.57
Researchers have examined the way rats respond to Ecstasy in very hot
conditions. Without MDMA, the rats did their best to cool down by becoming
less active and losing heat through their tails. But on MDMA they became
more active and did not attempt to lose heat - as though they had lost the
sense of being too hot - until they died of heatstroke. Similarly, rats in
a cold environment made no attempt to keep warm when on MDMA. Experiments
on mice show that MDMA is five times more toxic in crowded conditions than
in isolation.10, 12 This may help to explain why ravers die of heat
exhaustion.

So how does overheating kill someone? Our body temperature (like that of
other mammals) has to be controlled very precisely for us to function,
which is why we use a thermometer to indicate when we are ill. If we get
too hot, above 42 degrees C (108 degrees F), our blood starts to form tiny
clots that stick to the artery walls. This is not usually a problem in
itself, but the process uses up the clotting agent in the blood, so that
there is nothing to prevent bleeding. There are always tiny cuts and
scratches inside the body and brain which are due to the body constantly
replacing worn out tissue with new cells, and normally these leaks are
blocked by the clotting of blood so that you don't even notice them. But
above 42 degrees bleeding is unfettered, and this is made worse by high
blood pressure due to the speedy effect of MDMA and exercise. People can
bleed to death in this way, and if bleeding occurs in the brain it can cause
a stroke. When someone is bleeding internally, blood may run out of their
mouth or anus.30 

There are other ways of dying through taking Ecstasy, but they are unlikely
to happen to normal healthy people. On MDMA, we can be more active without
feeling pain or exhaustion; our temperature, sweating, blood pressure and
pulse increase without the normal warning signs of feeling discomfort or
exhaustion. It is not surprising that there have been cases of people with
weak hearts or other medical conditions have died on MDMA, although there
is no known reason why the use of MDMA should particularly affect
asthmatics.58 There is also a well-documented case in America of a healthy
woman who took MDMA and nearly died for no apparent reason, implying that
certain individuals may react in extreme ways.59 Research suggests that
some one in 12 people may be particularly sensitive to the drug for genetic
reasons.178

Other adverse effects that have been reported in the press - such as chest
pain, confusion, memory loss and being unable to stand up - often originate
from staff working in the casualty departments of hospitals. However, one
doctor told me that he believes that drug users tend to say they've taken
Ecstasy when they ask for medical help because they believe they will
receive more sympathy, yet their symptoms often imply they have taken
another drug.

In addition, a possible minor danger has been suggested, that MDMA use
liberates 'oxygen free radicals'. These are normal in small quantities, and
the body has a protective system for controlling their level, but large
amounts may overwhelm the system and contribute to fatigue and 'mental
dysfunction associated with sustained amphetamine abuse'. The problem can
be solved by taking vitamins: 2-4 grams of vitamin C and 1,000 IU of
vitamin E along with the drug, or treble these quantities to treat the
effects afterwards.36

Medium term medical dangers

In 1982 there were several reports of people who had contracted hepatitis
or jaundice (both diseases of the liver) after taking MDMA several times60;
kidney damage has also been suggested.30 The reports are based on the
opinions of doctors without investigation or research, so they should be
taken as potential rather than as established dangers. It is not known
whether the diseases were caused by consumption of alcohol or other
drugs55, or whether the patients had weak kidneys or livers to start with.
None of the cases were fatal. Such damage is not found in animal studies,
and there have been no such cases reported in the US. The explanation may
be that such damage was caused by a contaminant in a bad batch rather than
the drug itself127 , or that the kidneys were effected by dehydration.200
There are, however, worries that Ecstasy may be harmful when taken with
alcohol62, 60 or amphetamine.141

Long term psychological effects

One of the worst fears about Ecstasy is that it may be causing permanent
brain damage to users without them being aware of it. It has been suggested
that the drug destroys nerve endings or synapses73, and that eventually
users will suffer from depression and senile dementia - the loss of memory
and confusion that affects some old people - but at a much earlier age.
These fears have not been established. The most damning evidence concluded
from a trial is 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.156 In another trial, the
researchers discovered to their surprise that long term MDMA users scored
better than non-users: they were "less impulsive, more harm-avoidant, and
have decreased indirect hostility".157 [More on this trial below under
brain damage.]

Some people argue that damage may not show until old age. Serotonin levels
decline with age, so MDMA use would exaggerate this decline. This assumes
that some negative aspects of old age are linked to lower serotonin, but
there is no evidence to support this hypothesis, such as MDMA having an
adverse effect on old people.

Long term brain damage

Evidence that MDMA causes brain damage is based on experiments with
animals, mainly rats, although mice, dogs and apes have also been used.
After the animal has been given the drug, it is killed and its brain sliced
into sections for examination. Because there are billions of brain cells
and they are very small, damage may be difficult to see, so various
indirect methods have been developed to indicate whether and where damage
has occurred.

The method most commonly used, because it is easiest, is to check the level
of serotonin (5HT) within the brain cells and nerves several weeks or
months after MDMA is administered. This is done by cutting out a section of
the brain, extracting the serotonin and measuring it. Many prescription
drugs lower serotonin temporarily. However, if the serotonin level fails to
return to normal, it is inferred that the cells have been damaged and have
allowed serotonin to escape. When serotonin levels take a long time to
return to normal, this was interpreted as meaning that the brain was
damaged but gradually repaired itself.63

Many trials deduced that MDMA was toxic because large doses lowered rats'
serotonin levels. Also, researchers gave monkeys MDMA and found that their
serotonin level was never completely restored, so assumed the monkeys'
brains were permanently damaged, and this led to concern that the brains of
humans may also be damaged.63 The doses given were somewhat larger than
normally used, but the effect of MDMA does vary according to the species64
and humans tend to be more sensitive than animals.

News of this brain damage to animals caused a scare and contributed to MDMA
being classified among the most dangerous drugs, but over the years doubts
have grown as to whether the results were valid because this observed
physical damage was not matched by psychiatric damage. There has not been a
single confirmed case in the scientific literature which conclusively links
MDMA neurotoxicity with behavioural or functional consequences; there is no
evidence of damage in psychological tests on MDMA users, and no damage has
been observed by psychiatrists using the drug on patients.69, 70, 141

In 1993, a chance discovery showed that much of the evidence about MDMA
causing brain damage was based on a false assumption. Dr. James
O'Callaghan, while trying to establish a standard way of measuring
neurotoxicity, needed some rats whose brains had damaged cells, so he gave
them MDMA. But, to his surprise, their brain cells were not damaged unless
he gave them really enormous doses (over 30 mg/kg, the equivalent of taking
20 Es), twice daily for a week! He then looked into the previous work which
showed nerve endings to be damaged by quite moderate doses, and discovered
that the results were flawed. Instead of actually observing the damage,
which involves a laborious procedure called 'silver staining', the
scientists had made an assumption which turned out to be wrong: that a
change in the amount of serotonin in the brain indicates damage. This
assumption was made on the grounds that serotonin exists within brain
cells, and that a reduction would occur if the cells were damaged. "It's
rather like a hose pipe full of water," explained a researcher, "the
scientists found it contained less water, so they jumped to the conclusion
that the pipe was leaking without actually finding the damage".71 Another
research project showed that the toxicity of MDMA on rats depends on the
type of cage they are kept in, casting further doubt on previous
research.177

However, in 1994, the results of a 5-year research project on humans was
published indicating permanent brain damage in people who consumed large,
but not unusual, amounts of MDMA for several years.157 The methods used
were again indirect and although unsupported, must be taken seriously. Apes
were given various doses of MDMA and their spinal fluid was examined, then
they were killed and their brains examined for damage. By this method the
researchers found 'markers' for brain damage in spinal fluid. Assuming
similarity between humans and apes, the spinal fluid of MDMA users
indicated that their brain cells that produce serotonin had died back. In
apes, most of these grew again, but did not produce as much serotonin. The
researchers then looked for signs of damage to those with supposedly
damaged brains through psychological tests, but to their surprise found
that MDMA users actually did better than non-users! In the media this was
either ignored or passed off as due to people with milder personalities
gravitating towards MDMA in the first place.

Other researchers have criticised the conclusion that there was physical
damage caused, saying that the assumption about spinal fluid indicating
damage was not justified. Also, there is an alternative explanation: that
the MDMA users had lower serotonin levels in the first place and that no
damage was caused. In conclusion, although there is strong evidence that
MDMA is physically neurotoxic143, any damage caused to the brain does not
appear to affect its function negatively, the only evidence so far being
that the change is beneficial.194

Other evidence that the damage to serotonin-producing brain cells is
unlikely to harm the brain's function is that the drug fenfluramine, which
causes similar damage to MDMA has been used as a prescription drug for many
years without reports of harmful side effects.26, 64, 65, 66, 70, 137, 141,
154, 157

Quite apart from physical damage to brain cells, another cause of concern
is that constantly lowered serotonin levels may eventually cause
psychiatric problems such as depression. However, drugs of the SSRI
(Selective Serotonin Reuptake Inhibitor) type such as Prozac
(fluoxetine)47, 137, 148, now widely prescribed as mood elevators, also
cause long term reduction in serotonin levels and are considered
harmless.30, 67, 68, 137

This is not evidence that Ecstasy is safe; only that some (widely
publicised) evidence against it is unreliable. My conclusion is that using
a lot of MDMA for many years probably does damage brain cells, but without
causing psychiatric problems and may actually have benefits. However, even
if the effects appear beneficial, there is obviously a risk in making any
permanent changes to one's brain, especially when the process is not fully
understood.

Contaminants

Another danger is that what you bought as E is mixed with a poison of some
kind, or an addictive drug like heroin. Although this is a possibility, it
doesn't appear to happen. Dr. John Henry of the National Poisons Unit looks
for poisons in the blood and urine of people who have died or are seriously
ill after taking drugs, and says he has not come across any such cases.51
However, he has come across Paracetamol, Codeine, Amphetamine, MDA, MDEA,
Ketamine, Tiletamine and LSD.152 Dr. Les King, who analyses suspected drugs
seized by the police at the Aldermaston forensic laboratory has never come
across (or even heard of) poisonous additives to Ecstasy, although he does
not specifically test for them.54

In Holland, where the government has a far more liberal attitude, people
are employed to buy drugs sold on the street in Amsterdam. They are
analysed and the results are then made public. Once again, poisons and
addictive drugs have not been found mixed with drugs sold as Ecstasy.21

So why do these rumours persist? Much of the Ecstasy sold is not MDMA172,
175 so that users get a different effect than they expected. Also, many
users are unaware that even pure MDMA can have unpleasant effects in some
situations. Most users just want to have a good time and don't believe they
have any psychological problems, so it is more acceptable to explain
unpleasant experiences as being due to poisons. They report a terrible
headache "like rat poison"; the media report it as being rat poison and
other users believe it.

Psychological dangers

In my opinion, there is a far greater risk of damaging the mind than of
damaging the body through taking MDMA. While scientists argue about whether
there is any evidence of physical damage, instances of mental damage are
easy to find. Just as I have witnessed people whose lives appear to have
been enriched by MDMA, there are others whose lives have got worse, if not
actually been ruined as the tabloid papers would have it. Ecstasy has a
profound effect on many people, and this is not always for the better.
People may be pushed into taking Ecstasy by peer group pressure, and be
made to feel inferior if they do not enjoy it. For instance, some people
will claim that Ecstasy can do nothing but to bring out your true
personality by removing 'blocks' or defences. While this may be true in a
sense, there are many perfectly sane people who do not feel liberated by
taking MDMA, and, for whatever reason, they do not enjoy it.

There are also those who do enjoy the drug but suffer from the
psychological effects. Very often this is from taking too much too often,
resulting in paranoia and depression. Others simply find that everyday life
is boring by comparison, and lose motivation.

It is difficult to identify these dangers without further research, as
there are always other factors involved with psychological problems, for
instance other drugs. The stories I have heard about people whose lives
have been 'screwed up' by Ecstasy have always involved taking large amounts
or taking other drugs as well. In addition, there are the stories of first
time users who have 'flipped'; I don't know of any personally, but it seems
likely that these were unstable personalities. More research is needed; the
results could prevent mishaps in the future.

Addiction

A drug is considered addictive if physical withdrawal symptoms occur when a
regular user stops taking it. MDMA is not addictive by this definition, and
in fact has a built-in barrier against frequent regular use - it rapidly
produces tolerance while providing more side effects.34 Whereas you can get
drunk every night on alcohol, MDMA soon ceases to work. The pleasant
effects become less and less, and after less than a week's daily use of
MDMA they disappear completely while the amphetamine-like effects
increase.37 It is then necessary to stop taking MDMA for several days
before you feel good on it again, and to get the full effect may take
several weeks. Frequent use is almost unknown in the States, where Ecstasy
has been noted as unique among recreational drugs in that it is not taken
repeatedly.69 However, many British users do, in fact, take MDMA every
weekend and try to overcome tolerance by increased doses while putting up
with the poor quality of the effects.

There are many regular users who rely on Ecstasy to make them feel good,
and who feel depressed and lacking in motivation except while enjoying its
effects. Others simply find that life is dull except when they are on it. I
have even heard of a man who can only function normally when he is on
Ecstasy.75

Most hard drug users do not like Ecstasy.76 However, the Drug Enforcement
Administration in the US carried out experiments which they interpreted as
indicating potential for abuse: they found that cocaine-addicted monkeys
would 'reinforce themselves with MDMA'.12, 141

Overdosing

The effect of taking several Es at once is to produce an amphetamine-like
effect - "a jittery, anxiety-provoking high".5 Some users take Ecstasy
specifically to achieve this sort of effect, but they are said to be
switching to amphetamines.13 It is likely that taking large and frequent
doses is bad for you77, although one man is said to have taken 42 tablets
yet only suffered a hangover51, and a personal account is included of a
woman who says she survived taking 100 at once.Appendix 2 Ecstasy and
amphetamine are more toxic when taken together.180

Although there is no specific evidence that overdoses cause permanent
damage, there is certainly a high risk that they do.12, 63, 74 This may be
reduced by taking fluoxetine (Prozac)147, 148, 176, even several hours
afterwards and perhaps also by taking vitamins.36

For medical treatment see reference 180 (or ring the National Poisons Unit
on +44 (0)71-955 5000)

Does Ecstasy use lead on to other drugs?

Ecstasy and opiates have little in common, hence junkies do not find that
MDMA satisfies their needs.76 Social workers with a broad experience of
drug users believe that it is unlikely that MDMA users will go on to
addictive drugs because junkies are a separate social group.42 Rather than
being regarded as romantic antiheroes, the typical Ecstasy user sees them
as "old and smelly"78, and is strongly anti-heroin.79 However, MDMA has
been referred as a 'gateway' drug to the hallucinogens135, and there is
some evidence to this effect.26, 40 One user has suggested that 2CB forms a
bridge for Ecstasy users to cross over into the world of psychedelics.138
Besides, Ecstasy users do generally take other drugs, especially
amphetamine, LSD and cannabis.78

Risk of death

There are two ways of looking at the risk of death from taking a drug.
The first is to compare the total number of people who have died with the
total number of doses taken. This gives you the risk of death per dose,
such as one in a million.

The second is to compare the number of people who have died in a year with
the number of people who consume the drug. This gives the risk of death per
year as a result of taking the drug.

In both cases, two figures are needed: the number of people taking the drug
and the number of deaths resulting. These are examined below.

How many deaths are due to Ecstasy?

Surprisingly, this is not easy to answer. The official British Home Office
figures are so out of date as to be useless, although officials guess that
the present total figure is somewhere between 10 and 20.80, 81

The National Poisons Unit put the present figure of known confirmed
Ecstasy-related deaths at 14 for the period January 1988 to July 1992.52
These are fatal cases where MDMA was found in the victim's blood or urine,
but it is not necessarily implied that MDMA was the cause of death. Their
list is not comprehensive.

Newspaper reports up to March 1993 blame Ecstasy for the death of 17 to 22
people82, but these figures cannot be trusted. The main reason is that
'Ecstasy-related death' is often mistakenly taken as meaning that MDMA was
the cause of death, rather than that the victim was known to have taken
MDMA but the cause had not been established. Even the 'quality' newspapers
and medical journals cannot be trusted (see chapter 7).

In the USA, an examination of the deaths of five people who had taken
Ecstasy showed that other potentially lethal medical factors played a major
part. Although MDMA was found in the victims' blood when they died and may
have contributed to their death in some unknown or indirect way, in four
cases there was an explanation for their death which was not related to
taking MDMA.53 The fifth death may also have been due to other causes.26

An organisation called DAWN (Drug Abuse Warning Network, part of the
National Institute of Drug Abuse) collects reports of illicit drug use from
hospital casualty departments all over the United States.22 Whenever
someone turns up at an emergency room and a drug is involved, either found
on the person or in their blood or urine, or even if a patient comes in
with a problem and mentions that it is drug-related, a report is sent to
DAWN besides reports from postmortem examinations when drugs have been
detected. These reports are analysed and figures are published for all
drugs that are reported over 200 times in the past year. Although 138 drugs
are listed, Ecstasy has never been included. DAWN publishes a separate list
of drugs that have caused more than 10 deaths, but again Ecstasy is not
included. The figures imply that there is no general medical cause for
concern over MDMA use: though there are mishaps, these are rare. Indeed,
there are well over a hundred other drugs that cause more problems. Even if
the number of problems due to MDMA were increased in proportion to usage in
Britain, there would still not be a significant number.

In conclusion, it seems likely that, apart from very rare incidents, the
deaths in Britain as a consequence of taking MDMA is limited to those who
died of heat stroke, of which 14 cases are known to date. The worst annual
figure was that for 1991 with seven confirmed Ecstasy-related deaths known
to The National Poisons Unit.52

The number of people in the UK who take Ecstasy has been discussed in
Chapter 5. An educated guess is that the number lies between one and five
million. How often users take the drug is also open to guesswork. A London
survey showed that a third of users took Ecstasy at least once a week,
while a minority binged on 10-20 over a weekend. This would imply that
average usage among this sample was somewhere in the region of 25 a year,
although this may not be typical.

Taking the worst figure of seven deaths in 1991 and assuming there were
only 1 million users, the risk of dying from using Ecstasy would have been
7 in a million or 1 in 143,000 per year. If users take an average of 25 Es
a year, then the risk of death on each occasion is 7 in 25 million or 1 in
3.6 million.

To put this into perspective, if you take five rides at a fun fair you run
a risk of 1 in 3.2 million of being killed through an accident.83 Some
sports are obviously dangerous, such as parachuting which kills 3 in 1000
participants per year. Even skiing in Switzerland is risky - 1 in 500,000
are killed.84 If you play soccer, every year you run a risk of 1 in 25,000
of being killed. But if you stay at home instead of going out you still
aren't safe, since the risk of being killed through an accident at home is
1 in 26,000 a year!16

Many prescription drugs carry a high risk, including some you can buy over
the counter without prescription. For example, over 200 people die from
taking Paracetamol in Britain each year, more than ten times as many as die
from MDMA.30, 162

Many people will argue that these figures are meaningless as they are based
on guessed statistics. Suppose the figures distort the results ten times
over, the risk of dying through taking Ecstasy is still smaller than taking
part in a wide range of acceptable activities. It has been said that more
people would die if alcoholic drinks replaced Ecstasy at raves.55 Moreover,
if ravers and organisers took the appropriate steps to avoid overheating
the risk would be negligible.

Permanent damage to health

It is often argued that MDMA has never undergone the rigorous trials
demanded of a prescription drug, and therefore carries more risk. The
counter argument is that MDMA has been tested by many millions of people
over the past twenty years, and that this is a far more stringent trial. It
is true this has been done in an indiscriminate way and without controlled
conditions, but with such an enormous sample, evidence should have come to
light by now if the substance is toxic. Since it has not, it seems fair to
conclude that, although there may be unknown damage caused, the risk is no
greater than taking a new prescription drug.

Temporary damage to health

Taking Ecstasy often causes fatigue simply because of the increased
metabolic rate - the body and mind 'live faster' and you wear yourself out.
To this must be added fatigue caused by whatever you are doing on E, such
as missing a night's sleep, dancing for hours on end and not eating. Taking
booster doses or any other drugs cause extra fatigue62, and the exhaustion
due to two drugs taken together may be greater than adding the effects of
taking the drugs separately. Again, for people who are not healthy this
extra exhaustion could affect them badly, and for someone on the verge of
being ill this might be the 'straw that breaks the camel's back'.
There are also indirect dangers of taking Ecstasy. These include taking
something else you thought was MDMA and taking depressant drugs to reduce
the effects of taking 'too much too often'.77

One study has put the risk of ending up in the casualty department of a
hospital at 23 per 100,000 rave attendances. The majority of the sample
studied discharged themselves after being given treatment for racing
hearts. None of those who had taken Ecstasy alone needed further treatment,
the rest having taken a variety of other drugs at the same time.85 This
compares to the risk of injury while on a skiing holiday in Switzerland,
which is 3% or 3,000 per 100,000.84

Catching colds and other infections

It's often said that taking Ecstasy affects your immune system, making you
more likely to catch a cold afterwards. I have not found any evidence to
support this, but it is common medical knowledge that you are more
vulnerable to disease when you are exhausted, and that a hot sweaty
environment is ideal for transmitting viral infections.40 Add to this that
many people make skin contact while on Ecstasy, and it is not hard to see
that while MDMA may not directly affect the immune system, its use drains
one's reserve of energy and this may indirectly make you more susceptible
to colds and other infections.

Social dangers

A very real danger of taking Ecstasy is that you may do or say something
you will regret, or that will upset someone else. This may be trivial, such
as embarrassing some member of the public by your lack of inhibitions, or
as serious as causing an irreparable rift; for instance, by telling your
father that you have never respected him. There is also "a tendency to call
up ex-lovers and casual acquaintances and tell them how much you love
them".7 Another danger is 'inappropriate emotional bonding', by which is
meant falling in love with the person you are with,43 although the same
source also claims that "whatever you choose to create will be a perfect
and appropriate choice." Acting on impulse while under the influence can
also be a mistake - although insights can be made on Ecstasy, so can
mistakes.86 A quite different kind of danger is that using Ecstasy makes
people into criminals just as happened with drinkers under Prohibition in
the USA, and reduces their respect for the law.77, 13

7	The Law

In the seventies, there was concern about a new type of drug,
hallucinogenic amphetamines such as MDA and MDMA, which had not yet reached
Britain. With a tradition of being more prohibitive than other countries,
the British government tried to forestall trouble by classifying the entire
chemical family as Class A drugs; the most restrictive category carrying
the highest penalties. This was effected through the Misuse of Drugs Act
1971 (Modification) Order 1977 (SI Number 1243). So, although prohibition
dates from 1977, MDMA is a controlled drug under Class A of the Misuse of
Drugs Act 1971. Class A includes all compounds structurally derived from an
N-alkyl-a-methylphenethylamine by substitution in the ring with an
alkylenedioxy substituent, and this includes MDMA and its salts. Parliament
may move drugs to other classes after consultation with or on the
recommendation of the Advisory Council on the Misuse of Drugs, whose
purpose is to keep under review the situation in the United Kingdom.

The British government is a signatory to the International Convention on
Psychotropic Substances which requires member nations to make laws to
control specified drugs. In spite of objections from the chairman of the
Expert Committee, the Convention issued a directive to outlaw MDMA in 1985,
but "urged countries to use the provisions of article 7 of the Convention
on Psychotropic Substances to facilitate research on this interesting
substance."15 Although the British law against MDMA was made before this,
the Act does allow for Class A drugs to be used for research.87

Penalties

The maximum penalties that may be passed by any court for drugs offences
are set through legislation. Courts have a wide discretion on what penalty
to impose provided that they do not exceed the maximum. They must act
judiciously and not arbitrarily, and they must take note of the Court of
Appeal's guidelines. It may be possible in practice to persuade a court to
pass a lighter sentence for an offence involving MDMA than the court would
have passed had a quantity of heroin of the same value been involved, but
the Court of Appeal has always held that no distinction should be drawn
between the various types of Class A drug, it being for Parliament (as
advised by the Advisory Council on the Misuse of Drugs) and not the courts
to classify drugs.

For offences involving Class A drugs, the maximum penalties are as follows:

1.	Life Imprisonment and/or unlimited fine for production, supply,
offering to supply and possessing with intent to supply besides confiscation
of assets (except for assets that you can prove were not the result of
supplying drugs).

2.	Fourteen years imprisonment for allowing premises to be used for
producing or for unlawful prescribing

3.	Seven years for possession.

For any of these offences, the Crown Court has power to impose an unlimited
fine in addition to or as well as imprisonment. If a magistrates' court
hears the case, the maximum is six months' imprisonment and/or a fine of up
to #5,000 for any offence in relation to Class A drugs.

All courts have power to impose sentences such as community service or
probation instead.

The Court of Appeal's guidelines (as laid down in the Aramah and Bilinski
cases) for offences other than simple possession involving Class A drugs
are, briefly:

1.	Fourteen years for importation involving a street value of over #1m

2.	Ten years for importation where the street value is between #100,000 and #1m

3.	Four years for the importation of any appreciable amount

4.	There may be a considerable reduction in penalty if there is a
confession of guilt coupled with considerable assistance to the police

5.	Three or more years imprisonment for supply.

The Magistrates' Association sentencing guidelines suggest a fine of 30
units for possession of a small amount of a Class A drug in contrast to a
Guidelines fine of 4 units for the possession of a Class B drug. The value
of a unit depends on the offender's means and can be between #4 and #100.
30 units represents a fine of between #120 and #3,000. When someone is
found in possession of more than a "small amount" of a drug (which is not
defined), the guidelines recommend a community sentence, custody or
committal to the Crown Court for sentence.

Precursors (chemicals that may be used to make MDMA) are controlled under
section 12 of the Criminal Justice (International Co-operation) Act 1990
which was enacted following the signing of the Vienna Convention Against
Illicit Traffic in Narcotic and Psychotropic Substances. This makes it an
offence to manufacture or supply a scheduled substance knowing or
suspecting it to be used in the unlawful production of a controlled drug.
The maximum penalty for this offence is 14 years imprisonment.

How the law is applied

The way you will be treated for a drug offence depends on whether you are
considered to be a dealer or carrying drugs for your own use. Dealers are
charged with 'supply' or with 'possession with intent to supply' while
users are charged with 'possession'. However, you will be considered to be
a dealer, and charged with supply, if you pass on drugs to other people. It
makes no difference whether you have made a profit, or if other people
asked you to obtain the drugs for them. Even a gift to a friend of a single
tab of Ecstasy makes you guilty of 'supply'.

The fact that MDMA is a Class A drug means that you will probably be given
a higher sentence than you would for a Class B drug such as amphetamine -
particularly if you are accused of dealing.

Possession

If you are caught by the police with one or two pills, what happens to you
depends very much on chance. The luckiest outcome will be if the police
happen to be overloaded or concentrating on arresting a gang, when they may
just confiscate the drugs and let you go. Normally, they will arrest you
and take you to the police station. About half those arrested for
possession are simply cautioned88 and let go, and this is more likely to
happen in a big city, particularly London. You are also more likely to be
cautioned if it is your first offence, if you have nothing else of a
suspicious nature on you and if you look innocent. You can only be
cautioned if you admit the offence (such as that you were in possession of
an illegal drug).

In Scotland, cautions are seldom given, but, if found guilty of possession
of a small amount and you have no previous convictions, you stand a good
chance of 'admonishment' - no penalty on this occasion, but more severe
penalties on a further offence.

Fines are applied following the unit system; the court first has to decide
on what fine to give in terms of a number of units, then work out the fine
according to your 'disposable income'. However, a lot depends on luck, with
small country courts giving the highest penalties whereas elsewhere fines
as low as #15 are not uncommon. For second offences, the range is about #25
to #130 and increases with further previous offences. People caught with
other drugs on them or who have committed other offences are likely to face
heavier fines or imprisonment.

Supply

If you are charged with supply, your case will almost certainly be heard at
a Crown Court. Imprisonment is the usual penalty on conviction unless your
barrister persuades the court that you are not a dealer but simply
supplying friends. Sentences vary from 18 months to 5 years in most cases;
again, chance plays a big part. Besides the quantity, being found with
several different kinds of drug or a lot of cash will go against you, so
will evidence that you were seen trying to sell drugs or that someone
suffered as a result. Image counts too - if the court sees your trade as
part of a ruthless operation rather than that of a naive individual, then
you are in trouble.

What to do if you are arrested

Do not resist, make notes of exactly what happens, and ask for a solicitor.
If you cannot make notes on paper, then memorise events as best you can
until you have the chance to write down what happened.

The reason for making notes is that the police quite often make mistakes in
procedure which can be used to your advantage by your solicitor. Resistance
may be interpreted as implying guilt, and you may also be charged for
another offence.

Assistance from a solicitor is free to suspects held by the police, but you
may have to wait in a cell, sometimes for a long time. The advantage is
that a local solicitor will know the police and will be able to give you
the best advice. This is particularly useful if the police are trying to
strike a deal with you.

This is quite common. A typical offer might run: "You confess that the
pills are Ecstasy, and I'll ask my supervisor to caution you and that will
be the end of it". The pledge will usually be kept, but it has been known
for suspects to be double-crossed. Once you have confessed, the policeman
may come back and say, "Sorry, but my boss has decided to charge you all
the same". The underlying reason for this is that if you confess, the
police need not have the drug analysed, which can take up to 3 months.89

Searches and warrants

Warrants. If the police arrive with a warrant, read it, ask for a copy and
note what they do on your premises. Don't resist, the only way you can help
yourself is to cooperate but object to any incorrect procedure later.
Search. The police must have 'reasonable cause' to search you, and that
does not include the mere fact you were in a place where drugs were on
sale. Ask what their reason is for searching you and note what they reply.
If the reason is not good enough, then the evidence so obtained should not
be used against you.

Searches may include a strip search.An 'intimate search' is only
admissible if there is reasonable cause to believe you are supplying Class
A drugs - intimate search is not allowed with people who are suspected of
possession. Possession suspects who are subjected to an intimate search
could charge the police with assault, or with indecent assault if the
police search the genitals or anus. 'Intimate search' means looking inside
any part of the body, including the mouth and ears.

Blood and urine tests

You cannot be compelled to give samples except in traffic cases. However,
the fact you have refused to give a sample may be used as evidence against
you.

Police policy trends

There is a trend towards giving cautions instead of prosecuting for the
possession of drugs; but this seems to be mainly due to pressure on police
testing facilities.89 What is worrying is that there still seems to be no
recognition in Britain that MDMA is far less dangerous than heroin, for
instance, whereas in Holland there has been a recommendation to move MDMA
to a lower category.90

Another worrying trend is that there is a movement within the police to
turn attention to users rather than dealers.91 The idea - expressed by
Commander John O'Connor of the Metropolitan Police in a recent report -
that the policy of arresting dealers has failed and should be replaced by a
drive on arrests of users, would involve thousands of arrests. It also
conflicts with recommendations of sociologists in the field.33 However, the
lack of resources may prevent this from becoming policy.

Raves, along with New Age Travellers, have come in for particularly
vindictive treatment, with some police forces declaring: "Raves will not
happen, legal or otherwise."171 Concern about falling alcohol consumption
and pub attendances by young people may put pressure on the authorities to
clamp down on raves.159

I was also worried by the lack of interest in harm reduction on the part of
the policemen I interviewed. I feel that it would earn the police a great
deal more respect if they were seen to show some caring for ravers instead
of being seen as persecuting them.

8	Ecstasy and the media

At an international conference on drugs sponsored by the British government
in 1992, the TV and radio presenter Nick Ross was asked whether he thought
the media got the right type of message across to young people.92

It depends what you mean by the right type of message. I think it puts a
very antiseptic message across. I suppose if we were to tell the truth, we
would point out that many drugs are fun. They give you an extraordinary
sensation of exhilaration, of excitement, of energy, of capacity, calmness,
insight, escape, relief and pleasure - above all, pleasure. That's why so
many people take them. Again, if we take a less antiseptic approach we
would say that very, very, very, very, very few youngsters who get involved
with drugs will become addicted to them or have serious problems with them.
Far more of them will die or become seriously injured through road traffic
accidents.

But you wouldn't allow us to say that. And I'm not sure that being honest
is really what society asks of the media. I think that what we are being
asked, under a rather fraudulent umbrella of being candid, is to carry a PR
message. My experience of doing programs in this area is that the closer
you get to the street and the more you talk to people who actually work in
the area, the less concerned they are to hear this PR message and the more
they want us to say the sort of things that, at the moment, I think we fail
on. We are not saying some of the true things.

Remember that the constituency of drug users is a very broad one. We are
not just talking to the one person who has one view of life. We are talking
to millions of people almost all of whom have dabbled with addictive
substances. Not only the substances that are illegal, but the substances
which are legal. This is the complexity of it. I'm not sure society wants
us to talk about it all that elaborately. It likes the simple message:
'Drugs are there, they are bad, they are criminal and you shouldn't go near
them'. I think that we do that message pretty effectively.

It is easy to justify this position by saying that the government made
Ecstasy illegal to protect its citizens. The argument goes: 'We, the
responsible media, should not encourage people to break the law or harm
themselves. However, there is a lot of interest in the subject, so we must
report it. Therefore, we will edit our material so as to cut out anything
that might encourage people to break the law.' This may sound alright, but
the fact is that you cannot tell the truth when you leave out one side of a
story.

Press scare stories

Even the 'quality' newspapers and medical journals do not report on Ecstasy
fairly. In October 1992, The Scottish Medical Journal (and later The
British Medical Journal) published an article entitled 'Ecstasy and
Intracerebral Haemorrhage', where a case is described in which a
20-year-old man died after 'his drink was spiked with Ecstasy', and three
others who had survived.93 As the symptoms appeared to me more typical of
amphetamine than of MDMA, I wrote to the author of the report asking how
much MDMA was found in the patient. He replied: "Unfortunately no assays
for MDMA or related substances were made in any of our cases." In other
words, he had done no tests and had no hard evidence that Ecstasy was
involved at all.

Despite the lack of evidence that MDMA was involved, the case was picked up
by various newspapers including the Glasgow Herald, whose medical
correspondent reported under the headline "Highlighting the dangers of
Ecstasy". The article had an authoritative tone and stated unequivocally
that the cause of death was Ecstasy, while implying that the drug was known
to cause serious brain damage. The article mentioned an "epidemic of use"
and referred to patients in psychiatric care as a result of taking Ecstasy,
inferring that psychological damage was due to a similar physical cause.

The Times

In October 1992 The Times commissioned me to write a front page feature on
Ecstasy for the Saturday Weekend Times. I warned the editor that my
conclusions were likely to be far more positive than any that had so far
been published, and made it a condition that I would only go ahead if I
could be sure that the piece would not be edited in a way that altered the
sense or made me look silly, and the section editor, Jane Owen, agreed. I
was very pleased as I felt sure that a positive article in The Times would
carry considerable influence.

Eventually I was told that the editors were very pleased with the piece I
wrote. It was a serious article addressing the question of toxicity based
on references to the latest research, and concluded that the case against
the drug is not proven. Yet it was never published - the paper seemed more
concerned with not upsetting their establishment readers than publishing
the truth.

Then, shortly after my article was due to appear, The Times included the
following piece by Dr. Thomas Stuttaford in the Medical Briefing column:

A thirst for Ecstasy

Ruthless rave promoters are allegedly restricting the supply of water to
dancers rendered overpoweringly thirsty by the drug Ecstasy, so that the
revellers may be persuaded to buy more costly drinks. At the same time, it
has been reported that several would-be nannies have been sacked from the
Norland Nursery Training College for experimenting with the drug.

Both ravers and emergent nannies should read the British Medical Journal
editorial by Dr. John Henry, consultant physician at Guy's, on the
pharmacology of Ecstasy, a drug first patented in 1913 as an appetite
suppressant - and rejected for this purpose. . .

This was particularly annoying as my article had contained the following:
Dr. Henry of the National Poisons Unit at Guy's Hospital, London, the
researcher most quoted in alarmist reports, has been accused by one of his
own sources of a misrepresentation of the facts. In a recent article in the
British Medical Journal (MDMA and the Dance of Death), Dr. Henry claims
that MDMA has no therapeutic potential. To support his argument he refers
to a study by Dr. Greer where 29 volunteers were given the drug by
psychotherapists and "All 29 experienced undesirable physical symptoms. .
." including nausea, stiffness and sweating.

In a letter in last month's BMJ, Dr. Greer accused Dr. Henry of omitting
the positive results of this study. "Eighteen of my subjects reported
positive changes in mood after their session; 23 reported improved
attitudes . . .

Subsequently, I offered the article to all the 'quality' national daily
papers, but each one refused it. Eventually, it was published in Druglink,
a 'trade' magazine for workers in the field. Though few people will have
read it there, I felt validated in that the editor satisfied himself of its
accuracy by checking up on the many references made in the article to
published scientific papers.

An idea of the attitudes of editors can be seen by the following
correspondence in March 1994:

To the Editor of Reader's Digest

Dear Sir,

Forthcoming article on Ecstasy

As author of the most popular book on Ecstasy, I was recently telephoned by
a researcher in connection with an article that you have commissioned on
the subject.

I saw the article you published last summer on Ecstasy. While the facts may
have been correct, the article was grossly misleading, giving the
impression that those who take the drug run a serious risk to themselves.
Of course all activities carry risk. But those who go skiing and horse
riding run a far greater risk to their life and health. The risk of taking
Ecstasy compares to that of going to a funfair, and is equivalent to that
taken on a short journey by car. Though only time will tell, evidence to
date indicates that Ecstasy users damage themselves less than those who
drink alcohol or smoke tobacco.

In fact, practically all of the deaths attributed to taking Ecstasy have
been due to overheating or mixing with other drugs (including alcohol).
Over the past year, while Ecstasy use has increased, the number of
casualties has declined markedly. This is due to information reaching users
via leaflets such as Lifeline's Peanut Pete series of comics, and Greater
Manchester's Safer Dancing Campaign which aims to save users from
overheating - and to a lesser extent, my own book.

I hope you will publish a more enlightened article, and one which contains
the information necessary for users to prevent damaging themselves. You
could well base it on the success of the Safer Dancing Campaign which has
undoubtedly saved several lives.

I suggest that you take note of the reasonable tone of the recent Newsweek
article (copy enclosed). I also suggest that you ask your researchers to
obtain a copy of the latest book on the subject written by a doctor and a
sociologist, just published this month. It is The Pursuit of Ecstasy by Dr.
Jerome Beck and Dr. Marsha Rosenbaum published by the State University of
New York Press, which gives an up to date overview of the topic.

I do not expect mention of my own book, but I would recommend that your
researcher reads a two-page feature on it in The Guardian 7/9/93.

Yours faithfully,

Nicholas Saunders

Dear Mr. Saunders,

I have received your letter and I have no intention of publishing an
article along the lines you suggest. I stand by every word in our timely
warning in the article "A Deadly Kind of Ecstasy".

Yours sincerely

Russell Twisk, Editor-in-Chief.

When the first edition of this book came out I was rang up by a breakfast
TV show and invited to talk about it. I was ushered in to the studio and
sat on a couch next to the parents of a boy who had died, so they believed,
from taking Ecstasy. Although he had committed suicide which seemed most
unlikely to be caused by Ecstasy, I was their scapegoat. I was put in an
impossible position: I could hardly accuse grieving parents of unfairly
blaming their own failure on a drug, and had to put up with the father
shouting at me: "Have you ever held a warm, dead body of someone you loved
from taking Ecstasy? Then you don't know what you are talking about." There
was no doubt who was the baddy; I was set up.

Then I was interviewed for a BBC London radio programme. The interviewer
encouraged me to talk about all the positive aspects of the drug, and an
assistant congratulated me afterwards for coming out with the truth. Then
he said he wanted some background, and as I didn't know what he meant I
dithered and contradicted myself - and this was the only part of the
interview that they broadcast! As a result, I insisted on going live on the
next interview (with Radio Leeds). I wrote down answers to questions and,
like a politician, said them even if they didn't fit the question!

Tabloid newspapers said the book should be banned, and a Dublin newspaper
used its entire front page to say so. But some papers did support the book,
and when The Guardian published a two-page feature in favour I felt
vindicated.

9	Psychotherapeutic use in Switzerland

The most extensive use of MDMA in psychotherapy has taken place in the
USA.135 However, when the US government outlawed the drug in 1986, this
practice was pushed underground.129, 134 The US Drug Enforcement Agency
also requested the World Health Organisation (WHO) to include MDMA in the
International Convention on Psychotropic Substances and so make the ban
world wide.94 The WHO appointed an Expert Committee to make recommendations
to member nations, and these included a recommendation to follow up
preliminary findings that MDMA had therapeutic potential.15 Although
Switzerland is not a signatory to the Convention, the Swiss government was
impressed by this clause and decided to be guided by its recommendation.
In December 1985, a group of psychotherapists in Switzerland obtained
permission to use psychoactive drugs in their work including MDMA, LSD,
Mescaline and psilocybin. They formed The Swiss Medical Society for
Psycholytic Therapy95, and besides treating patients with these drugs,
members take one of the drugs together at twice yearly meetings. The word
'psycholytic' means 'mind-dissolving'.

Originally five members, all fully qualified practising psychotherapists,
were licensed to use the drugs with their patients, and they were allowed a
free hand without government interference until the summer of 1990, when a
patient died while under the influence of Ibogaine, the psychoactive root
of an African plant. Although Ibogaine was not illegal, the therapist
involved was severely criticised for his conduct: he had administered the
drug in France, where his license was not valid, and he had failed to
screen his patients for health problems. The incident was a disaster for
the Society: all its members were subsequently banned from using
psychoactive drugs.

After a year and much diplomacy, permission was restored for the remaining
four therapists to use MDMA and LSD, but with severe restrictions. They
were only allowed to use these drugs with existing patients until the end
of 1993, and under the observation of a professor at the University
Hospital in Basle. The professor has made it clear that, although the
therapists appear to have treated many patients successfully, their reports
are regarded as anecdotal because treatment has not been conducted within
the context of a scientific study.

Comparative study

This has prompted Dr. Styk to plan a comparative study examining whether
psychotherapeutic treatment is more successful if it includes the use of
psychoactive drugs. If the results of this study are positive, he will use
them to support his application to extend licences.

The study will compare two methods of treatment: 'meditative' therapy
combined with psychoactive drugs and breathing techniques combined with
body work. Dr. Styk intends to use as subjects patients suffering from
lifetime depressive neurosis, obsessive-compulsive behaviour and, possibly,
eating disorders; conditions for which he believes treatment with MDMA and
LSD is particularly suitable.

He will take on twenty patients of each type and treat them all himself,
using a random method to select the ones to be treated with and without
drugs. He will then study and report on the progress of both groups for one
to two years. In addition, Dr. Styk will also present the authorities with
a dissertation on past case histories. This is being prepared from the
licensees' notes by a psychiatrist who has not used psychoactive drugs in
his work.

Dr. Widmer believes a more confrontational approach to licence renewal
should be taken. Rather than trying to appease the authorities, who he
believes make their decisions on political grounds rather than clinical
results, he wants to carry on giving treatment in whatever ways he sees
fit. He originally persuaded the authorities to give their permission by
being pushy, and he believes that a combination of insistence on being able
to practice with LSD and MDMA combined with keeping on friendly terms is
likely to work best. However, Dr. Styk also acknowledges that the decision
as to whether to extend the licenses depends on factors other than the
effectiveness of the treatment, such as whether giving approval might
benefit or damage the careers of the officials who make the decision.

In January 1993, I attended the Society's annual dinner where I met about
30 members. I interviewed each of those licensed to practice at their place
of work over the following few days.

Of the four licensees, only one, Dr. Bloch, uses MDMA on its own. I have
included my interview with her in full, as it is the one most appropriate
to this book and, I believe, gives a clear picture of how MDMA is used.
Both Dr. Styk and Dr. Widmer also use LSD, and Dr. Widmer runs a training
group for psychotherapists who want to learn the techniques. I have
included notes on the differences between the way they work and Dr. Bloch.
The fourth licensee, Dr. Roth, has stopped using psychoactive drugs, and I
include his reasons for making this decision. I also mention the activities
of some of the unlicensed members who I met at the dinner.

Interview with Dr. Bloch

Dr. Marianne Bloch graduated in medicine in 1970, then went on to train as
a Freudian analyst in the USA from 1974-76. From 1976-80 she trained as a
child psychiatrist in Luzern, and since 1983 she has had her own private
practice treating adults. Over the period 1980-90 she was trained in
Organismic Body Therapy by Malcolm Brown. Over the past decade she has
herself tried various psychoactive drugs.

Do you use LSD as well as MDMA?

No. Although I have permission to use LSD, and use it for myself, I have
decided only to use MDMA with patients. LSD lasts too long, both for the
patient and myself. In my own experience, I like LSD much better in a
one-to-one setting. I don't like LSD in a group, and therefore I don't want
my patients to use it in a group either.

What is the problem with using LSD in a group?

I become too sensitive. There were too many stimuli for me - I guess it
depends on one's personality. The more I was able to allow things to come
through, the more difficult it was for me to handle them. In a one-to-one
setting it was OK, but I don't want to do it with patients.

Do you do individual work with MDMA or just group work?

I do both. Mostly I use MDMA in a group, but when there is a patient who
needs complete attention I use it individually.

When did you start using MDMA with clients?

In 1989. At first it was with single patients, then later with groups.

What are the particular advantages of using MDMA? For instance, is there a
particular character type or problem that it is suitable for? Is it perhaps
only suitable when clients reach a block?

I use it with patients who are in an intense psychotherapeutic relationship
with me. I usually start after six months or a year of ongoing therapy.
Most of my patients come every week for individual therapy, and monthly to
my Grof holotropic breathing weekends*. Among them are a few who I select
for MDMA therapy as well. These are mostly patients who have difficulties
with their feelings - even with the breathing work and body therapy they
don't get deep enough into their feelings. So they are mostly
character-armoured people.

Aren't all patients character-armoured people?

Yes, but there are some who have much weaker armour. For instance, oral
people*. Their armouring is not as hard to get through.

So you use MDMA with the people with the hardest character armour.

Yes, I prefer to work with MDMA with people who have very hard character
armour. These are, for instance, women with bulimia and some compulsive
characters and depressive patients.

Are they extreme depressives?

I would say moderate depressives. And then there are the most rigid people
who have difficulties in contacting their feelings. Mostly they had some
symptoms beforehand but then during therapy, I mean body therapy, the
symptoms went away. They are left with hard character armouring which
prevents them getting to their feelings.

What about other groups such as people who have suppressed a memory of a
trauma? 

Yes, that is another group. For instance I had a woman patient whose
problem was Bulimia, but then it came out that she was abused by her
father, although she had no recollection of it beforehand. With MDMA she
said "Oh, there is some incest problem" and I was very surprised as she had
not mentioned it before, and now with the MDMA it comes out clearer and
clearer. This person is completely out of her body, how shall we say it,
yes completely detached from her body feeling and her emotional feelings.

Does the MDMA help her to become more integrated?

Yes, it helps a lot. It's the method that helps her most to integrate and
to get into her body. She is much less armoured in normal life than she was
before, but she is still armoured and this blocks her from feeling her
body. Very often she says "I can't feel my legs" but on MDMA she says "I
feel good, I can feel my body". It seems to have something to do with
energy flow.

If you had not used MDMA with this client, presumably she would have made
some progress just with the body work, massage, touch and expressing
emotions?

Yes, but I am not sure that I would have come to that deep knowledge about
her background, the incest problems with her father. It was so deeply
covered, she had no idea it existed.

Did it take a long time to come out? Was it in the first MDMA session?

It was in the second. She had MDMA sessions alone because she was so
frightened, and later she had sessions in the group.

How often do you run an MDMA group?

Twice a year.

That is very infrequent. Is that a policy or is that because it takes so
much time?

I decided that because of the toxicity patients should not take it more
than four times a year.

Now that new research shows that MDMA is not so toxic, do you think you
might give it more often?

No, for me it is enough. Actually I don't want to use more drugs than I
have to. I also get results with breath work and body work. With some
patients, these methods work well. It is the hard core ones who sometimes
need a push.

With what proportion of your clients do you use MDMA?

In 1990 it was forbidden and we were only supposed to complete our therapy
with patients who had already been given MDMA. I strictly follow this
ruling. There are only six patients now who continue and I am not allowed
to use it on new patients. I have done MDMA sessions with 20 patients.
Eleven of them could have continued, but only six really wanted to
continue, so now I continue the treatment with these six. I don't use it as
much as my colleagues, since I want to use the least chemicals possible.

Why did only six out of eleven patients want to continue using MDMA?

Two of them had become pregnant, and so could not continue. One thought
that the holotropic breathing work had brought her as much benefit as MDMA,
and decided to do without taking chemical substances. Another felt that
MDMA opened her up too quickly and this frightened her. She too preferred
the holotropic breathing sessions, where she had more control over the
process. The last found it difficult to integrate the MDMA experience into
everyday life, which, I believe, requires a certain intellectual capacity.
After discussions with this patient, we decided together to discontinue the
MDMA treatment.

Have you written any papers on your work?

No, I am not a paper writer. I recently gave a speech at the Luzern
Psychiatric Association. But I just like to do my work.

Before the restrictions were put on, how many people were there in your
MDMA groups?

Twelve. I didn't want to take more. And I always work with my colleague,
another woman therapist.

Widmer told me it is important to have a male and female therapist present
in a group.

Yes, I think it would be better to have a male and female therapist
present, but it just happens that my colleague who trained with me in
Psychotropic medication is a female. I did have problems with a man client
- his problems had to be thrashed out with a man. It was very clear that I,
as a woman, couldn't get to him any more, he needed a man. So he had to
switch to a male therapist, because he needed a father figure with whom he
could continue the therapy.

What doses do you give people?

125 mg.

You don't vary the does according to body weight?

Earlier, yes, there were some small patients and they got 100 mg.

Do you find MDMA is much stronger for some clients than others?

I don't find so much difference, no. Some take a longer time to get into it.

Do you give it in one dose?

Yes.

Do you take it yourself, or does your assistant?

No.

When you do the group work, can you describe how you do it, how formal it
is, if you have any ritual attached to it?

We meet at 8 o'clock in the morning. We all sit around in the circle; say
how we are feeling at the moment; if we have any news; how we feel about
taking the drug. Of course these people all know each other because they
have taken the drug several times together and go to the monthly breath
workshops. They really don't have to introduce themselves any more. Then we
do some meditation. We sit there in a circle, breathe and go deep into
ourselves. It's like Zen. Then after a while my colleague starts playing
the Monochord, a string instrument with only one tone. Then they take the
drug.

Do you take it in a ritual way?

We just pass it round and take it. And then we eat some chocolate.

Oh! Chocolate?

Yes, it speeds up the effect of the drug.

Really? How is that?

Albert Hoffman [the discoverer of LSD] told me about it with reference to
LSD, and he said that there are some receptors that it speeds up, and now
we do it with MDMA and it seems to me that it works. They always have to
take their orange juice, their pills and the chocolate. I think it has
something to do with endorphines.

How long does it take to come on?

About half an hour. After they have taken the pills they lie down and my
co-therapist continues to play the monochord.

Do you have any rules or agreements about how clients interact with one
another or with yourself? How do you run the group?

Mostly I say that the patients are by themselves. They lie on the
mattresses in their space; it's something that has to do with internal work
and they have to stay by themselves. But lately I have started to say "Why
don't you mix a bit?". Maybe they were looking around and would say "This
person seems to be very sad" and I would say "OK, if you feel like going
over to this person who you think is sad you can do so." I mean, I
encourage them to communicate with each other. But this is new, in the
beginning I wanted to keep each of them separate, just going into their own
space.

How do you deal with the situation where the person might be feeling sad
but actually not want someone to approach? Do they have to ask before
moving?

Yes. A patient who feels they want to go over to another has to ask: "I
would like to get closer to you, how is it for you? Do you want me or
not?", and the other person has to decide. I tell them that they all have
to be very honest. They have to feel for themselves what they want.
Does the problem come up that you get one or two clients who draw the
attention to themselves, and the others feel they have lost their
opportunity? Is that a problem?

Of course, this might evoke an old problem. Maybe a sibling has had more
attention and now it's a similar situation. They have to work with the
sadness and jealousy that comes up.

When I stay with a patient, I always watch my own feelings, because there
are some people who want to draw attention forever, they want to have me
forever, and I can feel in my body exactly how long it is OK for me to
stay. Suddenly I get the feeling it is no longer good for me and I just go.
And then the patient has to deal with the loss, not getting enough
attention, that's a very important experience.

So if it brings up these feelings it can be part of the therapy?

Of course, it is very important that it brings up feelings of
disappointment, and not getting enough, and jealousy. That's why I do
groups. Otherwise I could do it in a single session and they would have
'Mummy' all the time, but that is not life.

Do you ask people to keep their eyes closed?

Yes, when they start they mostly have their eyes closed, but later on they
sit up or they talk, and can walk around to ask someone if they can get
close to them. But sometimes I feel that they talk too much, so I say "You
are too much outside yourselves" and then they all have to go back to their
places. It just depends on how I feel the group is going.

Do you allow people to be alone in another room?

It depends. Very often people say in advance they will have to be in
another room since they can't be together with so many other people. I say
"OK, we will see when the drug is affecting you, then we will decide." So
far I've never experienced someone who wanted to leave the group and be
alone.

So after people have started opening up, what do you do next?

Then I play music on tapes. Mostly meditative music but also some with
bass, rhythmic bass - it stimulates some feelings and activity. It's
completely different to the music I use in holotropic treatment, because
there the music is actually the 'drug' that stimulates the activity. With
MDMA, the stimulus comes from the chemical substance, so the music has a
different intent in each setting.

Do you use different kinds of music to stimulate people in different ways?
To bring up aggression, for instance?

Yes, and sometimes also anxiety.

What kind of music stimulates anxiety?

It's some kind of dramatic music.

Film music from a thriller?

That's right. But people require different stimuli. I mean, it's not only
music which stimulates feelings, but also contact. Sometimes it's very
important that closeness between a patient and myself brings up a feeling
of anxiety, because they are afraid of closeness.

Even on MDMA?

Even more so. I remember an obsessive-compulsive character who was never in
touch with her feelings of closeness, and the last time with MDMA she
really got in touch by being close, having close body contact and also eye
contact. The first time she felt her panic by being close.

Do you use that as a technique, suggesting that people make close eye contact?

It depends, it depends on the situation. With this patient it was important.

The three of you who are practising using MDMA all seem to be doing body
work. Do you ever do purely verbal therapy using MDMA?

No, not purely verbal. As I see it, that would be to stimulate just one
level. But I believe it is very important that people use the MDMA to get
into the body and out of the head. There are people who only want to talk,
and after a while I just cut them off and say "No more talking".

Because it's separated from their feelings?

Yes. Of course. And from their awareness and sensitivity of the body, it's
very distinct.

Can you give me a few more examples of when MDMA has been particularly useful?

One patient was an extreme stutterer who had been in therapy for a long
time. With MDMA, she could really talk about her history for the first time
- because before she was only able to write things on a slip of paper. With
MDMA she spoke about her father, how she was held back and not accepted as
a child, and all of her emotional feelings came up in regard to this theme.

So on MDMA she was able to talk freely?

Yes, it was incredible. It was also incredible how her body opened up. She
started to breathe dramatically, and then sounds came out, and she could
talk without difficulty. But it was also significant that after the MDMA
session her stuttering came back. It was not as bad, but she continued to
stutter.

So MDMA didn't cure the stutter, but enabled her to talk about her pain
concerning her father.

Exactly, and this opened up a different area that could be worked with in
ongoing psychotherapy afterwards. Material came up that was not known about
before. And so this opened up certain feelings.

Couldn't she have overcome the problem by writing?

Although she seems to be of normal intelligence, she couldn't go to a
normal school because of her stuttering. So her writing is slow and it
would have taken too much effort to write everything down.

Do you think that she might be able to cure the stutter through MDMA?

She is a rather difficult person to treat. In the last session with MDMA
she used her new ability to talk in a very intellectual way. So talking
became a defence mechanism against feelings that were too painful for her
to admit. But we will see.

Can you tell me about one of the Bulimia cases.

The main theme of one of the Bulimia cases is her fear of closeness and
contact with her body. The Bulimia is cured, she doesn't eat and vomit any
more.

Was she cured without MDMA?

Yes, after about two years of body therapy and breathing sessions the
symptoms went away, but then she discovered different problems. She
realised that she was not in contact with her body in normal life. Through
MDMA she learned what it means to be in contact with her body.

How important do you think it is for people to have guidance from a
therapist to make these connections and to get in touch with feelings on
MDMA? What I am thinking of is the vast number of people who take Ecstasy
in England, do you think they are bound to get in touch with their feelings
anyway, or is the therapist's influence and therapeutic setting necessary?

The setting is important, and also a person who acts as a mirror. Sometimes
I am the mirror. When I work with someone, I get in contact with my
feelings and then I tell them exactly how I feel. If they have feelings
which they can't admit to or which they are not aware of, I have these
feelings, and then I become their mirror. For instance, I suddenly become
sad and I know, "Oh, I have no reason to be sad". Then I know it is not my
sadness, it's their sadness and that I am feeling it on their behalf, since
they are not aware of it. Then I tell them "There is something I have felt
that is not mine, can it be yours?" Then the person can go into their inner
space and find out. As soon as they become aware of their feeling of
sadness and express it, my sadness goes away. That is how I help them to
become conscious of their feelings.

Do you use a video camera or tape recorder?

No, but sometimes they bring their own tape recorder. If they go on talking
and talking I say "OK, you can use your tape recorder and continue, then I
will listen to it later".

You don't encourage that as a technique then. Do you think recordings can
be useful?

For some patients it might be quite useful, yes. I have one patient who
always talks a lot about his childhood memories. For him this talking is
also a defence mechanism, because he doesn't really get into his feelings.
Afterwards he forgets most of what he said, including the important things.
So I encourage him to use the tape recorder.

I think it is important to mention that I don't use any techniques in MDMA
sessions. I make use of my soul, body and intuition. My main intent is to
get into feeling contact with the patient and then see what emerges.
Sometimes I ask a question, or give some nurturing touch; sometimes
nothing. The other person always responds to my presence.

Do you ask people to bring things with them to the session?

Yes, sometimes I ask people to bring objects they like. One patient likes
to bring stones, small things like that. Last time I asked them to bring a
photo of themselves up to the age of three. This opened up the possibility
to work with this period of life. With some patients I used it, others not,
it really depends what they are about. I just give a suggestion and if it
comes up it's OK.

What came out of that?

We looked at the photos together, and then they started to talk about their
early childhood, because it brought up forgotten memories of that period.
It stimulated memories of that part of their life.

Is MDMA useful for bringing back memories from childhood, or memories that
have been suppressed because of pain, or just generally getting in touch
with feelings?

All of those. With one patient I mentioned it brought back this incest
problem, with another it brought back very early memories that as a child
he had been sick very often, which he had forgotten. The emotional stuff of
childhood came up, and he relived it again. Another patient realised for
the first time with MDMA "Oh I have a heart, there is my heart beating. I
never before could feel my heart beating" It was important for him to feel
inside his body, he said "Aaaarrrh! Now I feel inside." For others it is
important to get into their aggressive feelings. It's different for each
patient.

Can it be too much sometimes, the sudden getting in touch with aggressive
feelings?

I have never had any problems with it being too much.

That leads to another question. Have you ever had problems using MDMA and
wished you hadn't used it with a patient?

I once had a problem with one woman, and that was when the drug was
beginning to take effect. She was overwhelmed by the feeling of opening up.
She was overcome by fear, and she screamed and yelled and then it was
important that she had some body contact with me. That gave her enough
support, and then she was able to go through this period of fear, and after
that it was OK.

After what, half an hour?
It started half an hour after taking the drug, and lasted for ten minutes.
It was really just when the drug started to take effect, the opening up.
She was completely confused. Body contact with me made it OK.

You only use MDMA with a very few of your clients. Apart from legal
restrictions, would you still not use it on some clients, and if not why
not?

I would only use it with the more difficult ones. The ones I can't really
get through to using holotropic breath work. I really don't see why I
should use a chemical drug if I can achieve the same result without it.

Can you get the same result as easily without MDMA?

I would say with some, yes.

Is it that you believe the drug is somewhat toxic or habit forming, or by
using a drug the result is not going to be as permanent?

I am just against drugs. I mean, in my practice I don't use medication
unless necessary. I don't see why I should use drugs if I can get the same
result without. I can't really say that MDMA speeds up the therapy that
much. The patients who I use MDMA with are those who I have already tried
treating with other methods, but I was unable to open them up so deeply. I
would just be stuck, I would have to say "OK. That's it. You have to go".

Are there some people who are so armoured that MDMA makes no difference? Or
will MDMA always go to a deeper stage with them, even when your other
methods have failed?

I would say there are some patients with whom I'm not using MDMA because
I'm scared they can't handle it.

What would happen if they could not handle it?

Perhaps they could not differentiate between the outer reality and their
inner world, or they might mix the two states. For example, they may not be
able to differentiate between myself as the bad mother of their inner world
and myself as the therapist who wants to help them, and fight against me.
Maybe I would try it in an inpatient psychiatric setting, but not when the
patients have to go home afterwards and I can't follow them up closely. I'm
not willing to do overtime. I only choose patients who I believe will be
able to handle MDMA. I have my limits. I know someone who uses the drug
with far more critical patients and he invests more of his time and effort,
but I am simply not willing to do so.

Going back to your groups, what happens towards the end of the session?

After four and a half hours we have a break and I say, "OK, now we can go
into another room where you can have some food and drink tea. Then afterward
s you can go back and lie down again."

Do people want to eat? What do they like eating?

Fruit, and bread with honey. That brings them down from their altered state
of consciousness into the real world again.

Do they stay quiet?

Very quiet. Very often no-one talks. Then they come back and lie down for
half an hour. They see if there is anything else, any further effect of
MDMA. And afterwards they all have to draw a mandala, a drawing of their
experience.

When you say a mandala, can they draw anything, or has it got to be
according to a structure?

Yes, we give a piece of paper with a circle on it and say "Draw a mandala."
Of course they can also draw outside the circle. But it's also significant
who goes over the limits and who keeps within the circle. They are used to
doing this following the holotropic breath work, it's a method used by Stan
Grof.

Afterwards we form a circle again and they just put their mandala in the
middle, and then each of the patients talks about their experience. And
maybe they give some explanation of the mandala. They also bring it to
their next therapy session.

So what time does a group finish?

Usually it's around 5 o'clock. They go home by bus. They are not allowed to
drive.

Is their next appointment the next time you see them?

Yes. Mostly it's within the next week, except for some who come fortnightly.

When you do MDMA sessions individually, with one client, is it very different?

It's different in that the person has constant contact with me and really
doesn't have the experience of 'mother' going away. All those feelings of
jealousy or whatever produced by the group setting are missing. Of course,
they may gain in other ways such as having more body contact.

What sort of bodywork techniques do you use?

Massage, and I give some touch, nurturing touch. I also do some crania
sacral work with them.

And do you get people to hit a cushion with a tennis racket, that sort of
thing? 

I use these hard techniques only in individual body therapy sessions in
order to produce a feeling state. But with MDMA I never use any hard
techniques because the feelings get opened up by the drug. If a patient
gets into an angry state on MDMA, then I ask them to express the feeling by
movements with arms and legs on a mattress.

Do you think the things that come up on MDMA can sometimes be misleading
for a client?

What do you mean?

Well, they might have a realisation - such as the cause of some problem is
that they were abused as a child or something - but actually it's become
much more important than it is really. Perhaps they can see very clearly
something that isn't right.

It can happen that sometimes the interpretation goes in a wrong direction,
one that is not really the cause or the real root of the problem.

Do you think the real root of problems and true feelings come up more often
with MDMA than without it?

I would say yes, MDMA definitely produces more real feelings, but I would
say it is still possible on some level to project. And it is so important
for me as a therapist to realise when the patient is projecting. I then
feel an uneasiness in my body and I have to continue interacting with the
person until I feel that the problem has reached its root or the projection
has been resolved.

Do you think you are more sensitive to the patient as a result of your own
experience with MDMA?

Yes, definitely.

Do you think you would be even more sensitive if you were taking it with
the patient?

Probably. But I wouldn't dare to do so, because I also have to be able to
react in a clear way. I would never do it.

However, I just realise that I have become more and more sensitive through
my own therapy with psycholytic substances, and I guess this will continue,
and maybe at some time I will not even need it any more because this
openness might be a normal state for me.

Is the intensity of feelings increased under MDMA, or does it just increase
general awareness?

It depends. I have one patient who doesn't have any feelings in real life.
Only with MDMA can he get into his sadness or his aggression. It's not only
the awareness, with him it's really the capacity to feel. He's so stuck in
real life.

With someone like that, presumably he feels very good on MDMA?

Yes.

Is there a tendency for him to go and find it on the black market and take
it at home?

No, he is too straight. I couldn't imagine him buying drugs on the black
market! 

But as a general point, if you have people who only feel good on MDMA then
won't it become an addictive drug for them? What do you think about that?

It's astonishing, but I've never had this problem at all.

Don't any of your patients sometimes take drugs outside the sessions?

One of my patients used to take LSD when he was younger, but he says he
would never do this any more outside sessions. He is much more afraid, more
aware of what could happen. No, there are no drug users among my patients.

One thing that bothers me is that, well, bodywork is not completely
accepted as straightforward psychotherapy, is it, and that if people are
making body contact at the same time as taking a drug which is normally
illegal, I can see that the picture of it from a politician's viewpoint may
be that it is all rather dodgy. Do you see this as an obstacle to this type
of therapy becoming officially accepted?

I think so, because for a psychiatrist trained in psychoanalytic therapy,
well, this is really crude. Most psychiatrists are still not trained in
body therapy. This is why it is not more institutionalised, besides many
psychiatrists are afraid of body contact. So I don't think they will choose
this method.

What sort of reaction do you have from the psychiatric community in
Switzerland?

They show interest in hearing about it. I would also be prepared to work
with my colleagues with MDMA, but it is all too frightening for them. They
are too scared to use it on themselves.

Dr. Roth said he believed that MDMA was not worth using because the results
didn't justify the time and effort involved. What do you feel about that?

For me it has been worthwhile with the patients I have used it on.
Otherwise I wouldn't use it any more.

Have you taught any other psychotherapists to use it? Are they interested
in learning from you?

No, I gave a speech at the Luzern Psychiatric Association, and I talked to
them about Psychotropic breath work and about MDMA sessions. They said they
were interested and there was an animated discussion about psychoanalytic
and Psychotropic training, and about the ethic of opening patients up in
such a quick way. Meditation has the goal of opening up people towards
spirituality, and MDMA has a similar kind of effect, to bring people more
in contact with their spiritual being. So these psychiatrists discussed
whether it is acceptable to use these type of drugs for spiritual
enlightenment, or only meditation.

So they were more interested in the intellectual analysis of the method
than actually getting involved with it.

Yes, they were not interested in experiencing it themselves; they were not
really interested in doing anything, only in discussing it.

What do you really feel the basic effect of MDMA is?

I would say it takes away fear, it takes away the superego of the patients
- they allow themselves to feel more, to be themselves, to act the way they
are; it also helps them to get more into contact with their body, into
their physical body, to have more body awareness, and to get closer to
their feelings. And simply to feel their needs. I mean, very often they
have been totally unaware of their primal needs - needs of closeness, needs
of touch, needs of heart contact.

In the groups, is the atmosphere happy, or is it mainly feeling pain?

When you take MDMA the first time it's beautiful. It opens up everything
and you feel "Ah! That's great!", but later on it's much more difficult for
the patients because they get into their sadness, into their pain, they
realise where they are closed up, that they can't open their heart. So I
feel the deeper you get, the more difficult it is with MDMA. This beautiful
feeling of happiness goes away and you really get down to your deep
problems, and then you can work psychotherapeutically.

Have you ever come across bad effects such as paranoia?

No, I never have. Perhaps because I choose my patients carefully.

What about physical bad effects? Unpleasant effects that get in the way?

Sometimes their jaws get tense. But it doesn't bother them.

Do they ever suffer from difficult aftereffects?

One patient felt she had some energy running through her body for a while.
She could not stop the energy flow, she felt nervous and restless for about
six weeks. That was the most difficult aftereffect I have ever seen.

Once a patient suffered for about a week from nausea. In the following
individual session I discovered that the nausea had to do with unexpressed
feelings of anger. When this was resolved, the symptoms went away.

Did she have a particular character type? Do you think you could recognize
the type and avoid giving the drug to them in the future?

I would say she is not at all in the body. It was the first time and she
couldn't really handle this feeling of being in the body. It was so new to
her, and it was stress-producing. She couldn't handle the feeling of energy
flow.

Do you relate MDMA to energy flow, such as the Chinese 'Chi' or Reich's
'Orgone Energy'?

As a body therapist I work a lot with energy, and I realise that with MDMA
there is opening up especially of the block here [she put her hand on her
heart]. It opens the chest block, then of course the energy flow is better,
and it also affects the whole body.

So the energy flow is liberated. And do you think MDMA works by relaxing
the muscles that store the neuroses?

Probably, it just opens up the blocks. Usually patients have held back
feelings. When you have a block in the body it is because it is too painful
to allow the feelings to flow. MDMA is able to open up the blocks because
it also releases the feelings - or releases the feelings and then the
blocks open, you can say it either way.

So it works on a physical level in the same way as bodywork?

Definitely for me, yes.

But I also use MDMA because of its spiritual value. MDMA is the drug that
really opens up the heart, and in normal therapy I also work with opening
up the heart. That, for me, is the main goal. For me it's not important
that people are totally de-armoured, but that they get in contact with
love; love for themselves. That is why I really like to work with MDMA.
Do you think this is a separate effect to the release of neurotic tensions?

For me MDMA is the drug that opens up the heart, and is much more specific
than LSD. This is my main goal, to open up the heart and then to work from
the space of the heart.

So that's the goal of your therapy, or do you think it should be the goal
of all therapy?

That's my way.

So the goal of your method of working is to get in touch with the heart.
Does that mean helping people to be able to express love, or to feel love,
to know love in a non-sexual way?

Yes, I mean love for another person, love for themselves, love for the
universe. I would say it is my way of doing psychotherapy to get them in
touch with their heart. And whenever they are lost in some sort of anxiety
or some sort of struggle, then I bring them back to their heart and say
"Can you still feel your love in yourself?" This is just my way of binding
them back to themselves. If you are in harmony with yourself, then all your
neuroses just drop. If you are in the meditative state, then your problems
just go, you don't even have to solve them. I try to work so as to make
these neurotic things lose their value. And they very often get in contact
with this state with their first MDMA experience. "Oh, that's how it could
be. I could be open, I could be loving." And then I tell them "Do you
remember how it was on MDMA, how all the other things dropped away?" I try
to get them to be in touch with their heart again and with their feelings
when they have difficulties in their life. They become more centred, they
have more connection with their inner self.

Do you ask people to project into the future, for example if they have a
particular problem with their mother, do you ask them to visualize being in
that situation?

Sometimes, yes. I first put them in a good state, and then I say "OK, now
see how it would be confronting your mother in this state".

I've heard it said that you can't feel love until you have learned to love
yourself. Do you believe that?

I think so, yes. I believe in it. That only when you are really in contact
with yourself, are you open enough to let love flow out.

Do you have clients in the group sessions who fall in love, or get very
involved with each other? Is that a problem with MDMA?

It has never been a problem. Of course in the sessions they may have very
good feelings for each other, but they have never had affairs. Maybe it's
to do with the setting. There are only two women on the group, and they are
very much preoccupied with themselves and do not mix very much with the
others.

Do you think that people are suggestible on MDMA?

Not at all. I think they see things as they are more clearly. For instance,
the Bulimic client I mentioned had thought she had invented being abused by
her father, but on MDMA she saw it was true. She saw it very clearly.

Are there other problems with using MDMA? Perhaps patients get too close to
you? 

The transference problem is the same as with body therapy, but the
situation of transference becomes more clear to a patient on the drug. They
can see their projections more easily. When they come up to me during the
MDMA session and say, "I love you so much!", I respond by saying, "See
whether this love is something to do with you. Could it not be your newly
discovered love for yourself?"

Dr. Styk

Dr. Juraj Styk is president of the society and has a private practice. His
MDMA groups are similar to Dr. Bloch's, but his clients meet on Friday
evenings before the Saturday session. He believes this is valuable
preparation for reducing anxiety, and is especially useful for integrating
new members. His wife assists him in the group, and he feels that to be
seen as a couple is important when he is working with women. He also has
one or two young psychotherapists assisting the group who are undertaking
training with Dr. Widmer. There are usually eight to ten in his group.
Dr. Styk goes around giving out the drug in ritual fashion to create an
atmosphere "more like being in a church than a hospital", although he adds
that he tries to avoid being seen as either a priest or doctor who can
absolve or solve problems for the clients. While waiting for the drug to
come on, he plays soft music and sometimes reads poetry. He asks members to
close their eyes, breathe and let go. In order to make the group cohesive,
he reports what he observes, such as some members being tense.

Dr. Styk and his assistants only attend to people when asked, unless they
see that a client is stuck for hours on end: he prefers to allow people to
go through the experience without being led. Rather than being
goal-orientated, he encourages spontaneity and prefers clients to think in
images.

Clients are allowed to go to other rooms during the group session so as to
be undisturbed, but Dr. Styk says it's important to avoid the group falling
apart through members dispersing.

Towards the end of the session, Dr. Styk will ask each person to report on
how they are feeling. Then the group may all go out for a walk together if
the weather is nice. At other times they may do a psychodrama in which one
client acts out a revelation they have just had during the session, using
other group members to play roles such as members of their family.

After the session, at about 7 pm, participants sit around in a circle on
cushions and have a light dinner of such things as cheese, radishes and
fruit salad, prepared by Dr. Styk's wife. They are not really hungry, but
enjoy eating for its own sake. The situation of eating together sometimes
triggers further insights. After dinner, at about 10 pm, clients go home
and are asked to write a report to bring to their next individual session.

Dr. Styk says he always asks the men about sexual arousal during their next
individual session, and that although they may have sexual longings or
fantasies, none has ever had an erection on MDMA, although they may do so
on LSD. When I told him that men frequently say they have erections on
Ecstasy, he suggested it may be that they take amphetamine as well, or that
the Ecstasy was unknowingly mixed with amphetamine.

Dr. Widmer

Dr. Samuel Widmer has a background of experience with LSD stretching back
to when he was a student. From 1973-78 he was a member of a therapy group
which used LSD illegally. As a fully trained psychotherapist, he wanted to
use psychoactive drugs in his work, and in 1983 he wrote to the government
applying for permission to work with LSD and Mescaline. Permission was not
then forthcoming, so he searched for a suitable drug that was legal. He was
close to giving up the search when he discovered MDMA in 1986, two years
before it was made illegal.

Dr. Widmer works with larger groups than the Dr. Bloch and Dr. Styk, up to
35 people. He believes that large groups work better, and have the
advantage of spreading the cost more widely - for the same reason, he
avoids individual sessions. He frequently uses both MDMA and LSD in the
same session. Sometimes he uses half a dose of MDMA two hours before LSD,
and sometimes offers a small dose of MDMA at the end of an eight hour LSD
session to provide a smooth come down. At other times, he will give 100 mg
of MDMA at the height of an LSD session so as "to bring in the heart
aspect."

He believes that LSD has a stronger effect on a transpersonal level, but
that it has little or no effect on people who have done a lot of work on
themselves and are aware of themselves. He says that working with LSD is
tricky; you have to choose clients carefully to protect yourself and avoid
those who make problems. By contrast MDMA is good for anyone, as it opens
the heart and softens hard personalites. MDMA helps to clarify one's
situation in daily life and relationships, while LSD helps on another level
with questions such as 'Who are we?' The realisation that problems stem
from wider issues comes more readily with LSD.

Asked what kind of clients responded best to MDMA treatment, Dr. Widmer
replied that it was always tempting to think of the dramatic breakthroughs,
but these tend to occur with clients who need catharsis. Clients who were
on tranquillizers often found they could do without the tranquillizers or
found they needed lower doses after treatment with MDMA. Other patients
benefited by a gradual 'maturing' process. He said there is a category of
patients who do not benefit, however, and this includes those who just want
to get rid of a particular symptom without being prepared to work through
it. He tries to screen out such patients.

When I asked what problems Dr. Widmer encountered using MDMA, he told me
that there were few problems directly involving the drug itself. However,
there were sometimes problems with negative transference and with clients'
partners, who would accuse Dr. Widmer of putting ideas into the client's
head rather than accepting that they had had an insight.

Asked about trends in psycholytic therapy, Dr. Widmer told me that the
effect of the drugs was to open people up to greater awareness of their
personality. This leads to 'growth work', where clients have no major
psychiatric problem but wish to develop their personality, and so improve
their quality of life.

Dr. Widmer has written two books on his work in German, but which he hopes
will be translated into English.96

Here are the outlines of some case histories from one of Dr. Widmer's books:

1 Dr. Widmer was asked to treat a 14-year-old anorexic girl. Her father
showed no feelings, and her mother hardly existed for herself, only 
appearing to live through other members of her family. The whole family
only communicated to one another on a rational level, never expressing
emotion except for the youngest son, who the parents regarded as the
'difficult one'.

Dr. Widmer and his wife treated the girl and her parents, first in
separate sessions with Dr. Widmer treating the parents and his wife
treating the daughter. In spite of her young age, they decided to hold an
MDMA session with parents and daughter together, attended by both
therapists.

During the MDMA session, father and daughter talked about their feelings
for one another for the first time, while the mother became aware of the
fear she had of herself. For the daughter this was a breakthrough: having
focused on the cause of her problem she accepted becoming a woman and put
on weight, ending her treatment shortly afterwards. However, for the
parents this was the beginning of ongoing therapy.

Dr. Widmer commented that the breakthrough facilitated by the MDMA would
probably have occurred anyway, but that the drug speeded up the process.

2 A lifelong alcoholic came for treatment, a sensitive man of 44. During an
MDMA session, he experienced deep regression and found himself 'back in the
womb'. He felt neglected and deeply hurt, and realised that this pre-birth
longing was the basis of his addiction. The insight was realised so clearly
that his 'addictive personality' was dissolved, allowing him to build a new
personality based on love.

3 An intellectual working in the medical profession came for an MDMA
session out of curiosity. He did not see himself as having psychological
problems, despite the recent break-up of his marriage.

However, the effect of the MDMA was to uncover hidden narcissistic
feelings of which he had not been aware, including hatred for his parents.
The result was that he became more in touch with himself, but also to
realise that he could benefit from therapy.

Training Group

Dr. Widmer runs a group for training other psychotherapists in the use of
psycholytic drugs. Students all have to be fully trained psychotherapists
with clinical experience, and must be in individual therapy themselves. The
course lasts 3 years, and costs 6,400 Swiss Francs. In each year trainees
attend four weekends plus one week, which includes 15 sessions using
various drugs. They also have to assist in at least 10 group sessions with
Dr. Widmer's and Dr. Styk's clients.

Most of the students are German. The first group finished their training
last August, but none of them has yet obtained permission to use
psychoactive drugs in their practice. However, one is lecturing on the use
of psycholytic therapy at Tubingen university, although without actually
using drugs.

Dr. Roth

Dr. Jorg Roth is licensed to use LSD and MDMA, but has decided not to do so
any longer. I went to interview him in the hospital where he works to find
out why.

Could you tell me about the background to your use of psychoactive drugs in
psychotherapy?

Since 1977 I have been searching for the ideal drug to use as a tool in
psychotherapy - mescaline, DMT, LSD and MDMA. Now I have found it - Chinese
medicine.

Did you find that MDMA doesn't work, or did it have negative effects?

No, I have had some success using MDMA with major depression. I think MDMA
is a good tool, especially for non-chronic problems, although it is no
miracle cure - some revert just as with other kinds of therapy. I have
nothing against MDMA, but in my work the output is simply not justified by
the input. I always work with individual patients and the time required is
too long, and that means the method is usually too expensive for the
patient. And they can't drive afterwards, so they had to pay for a taxi
too. It simply wasn't cost effective.

Do all your patients have to pay the full cost of their treatment themselves?

Some have insurance that pays for part of the cost, but they have to pay at
least two-thirds themselves.

Chinese medicine has the advantage that it fits in with 50-minute sessions,
and can result in change even without the will of the patient.

Did anything else put you off using psychoactive drugs? Are they dangerous?

Not MDMA. LSD can be dangerous, but MDMA is always safe.

There are cases in England of people becoming psychotic or paranoid as a
result of taking MDMA.

I do not believe that psychosis could be triggered by MDMA except when used
it is used with alcohol or other drugs. I have never come across paranoia.
But it's possible there are some people who cannot metabolise it, just as
there are some who cannot manage alcohol.

Dr. Hess

Dr. Peter Hess is a German psychotherapist who used MDMA in 1984-5 (before
it was outlawed) at a German hospital at Frankenthal, Mainz, where he was
head of the psychiatric department.

Dr. Hess said that some of his patients were very difficult to treat
because they were caught in a vicious circle of low self-esteem, which they
reinforced by blaming themselves. "There was a hard core of about twenty
patients who failed to respond to any of the treatment available", he says.
"I tried MDMA with them, individually, and was astonished with the results.
They immediately found solidity and trust in themselves and made steady
progress. For most, a single dose was enough, although some had two
sessions."

Dr. Hess followed the patients up for two years after administering the
MDMA and, apart from three with whom he lost contact, found that none of
them had had a relapse.

When the drug became illegal, he tried - without success - to conduct a
pharmocological study of MDMA at the University of Tubingen. He also
applied to the German government for a license to use MDMA but without
success. He now uses musical techniques, such as drumming, to produce
altered states of consciousness in group psychotherapy. He says the effect
is similar to LSD but does not overwhelm the patient.

I asked whether there were any psychotherapists using the drug in Germany.
"Only illegally. There is a lot of interest but no-one has permission.
However, I have heard of it being used by a small number of therapists."
Dr. Hess did not approve of this. "I think that is stupid: you only have to
get one client going through a negative transference to report you, and
your career is ruined," he said.

Dr. Helmlin

Dr. Hans-Jorg Helmlin is conducting a pharmocological study of MDMA at the
University of Bern.

The study involves monitoring what happens to MDMA as it passes through the
body by taking blood samples. Dr. Helmlin started with a pilot study of two
patients in 1992, from whom 20 blood samples were taken over a 9 hour
period. In Spring 1993 he plans to conduct a more elaborate study, using
blood samples taken from 6 patients on the day they ingested the drug and
the following day. Dr. Helmlin has no license to prescribe MDMA, so he
performs his tests on patients who have been given the drug by Dr. Styk as
part of their therapy.

Provisional results from the pilot study suggest that MDMA has a
'half-life' of six to eight hours, i.e. half is left in the body after that
time. I commented that this was surprising since the effects of the drug
end after a much shorter time. "Yes, it surprised me too. I can only think
that there is some sort of 'threshold' effect whereby the drug only has an
effect above a certain level".

By means of this study, Dr. Helmlin aims to provide some basic data on the
drug, equivalent to that provided by drug companies seeking government
approval for a product. When the full results are available, they could be
used by lobbyists to overcome a common objection of governments to
licensing the use of Psychotropic drugs, i.e. that it would be
irresponsible to do so as the drugs have not been subjected to
pharmacological tests.

Dr. Vollenweider

Dr. Helmlin also told me about the plans of Dr. Franz Vollenweider, a
researcher at the University of Zurich Psychiatric Hospital. Dr.
Vollenweider has been using Positron Emission Tomography, commonly known as
PET scans, to study what is going on inside the brain while people are
under the influence of psychoactive drugs. A volunteer is given mildly
radioactive sugar compounds which enter the blood stream, and this
radioactivity is picked up by the scanner. The result is that the blood
flow to different parts of the brain can be monitored while someone is
experiencing the effects of a drug. The person can relate their experience
at the same time as the equipment indicates what is going on in terms of
brain activity. Dr. Vollenweider has already done PET scans on subjects
taking Ketamine, a veterinary anaesthetic, and Psilocybin mushrooms, and
intends to study MDMA in the future.

Dr. Benz

Dr. Ernst Benz has written a dissertation, in German only, on members of
the Swiss Medical Society for Psycholytic Therapy and their varied
backgrounds.

10	Other uses of Ecstasy

For large numbers of young people, Ecstasy is the drug that makes raves
happen and it has been said that, for many of them, raving is one of the
main reasons for living.97 Yet there are other regular users, particularly
in the United States, who have only vaguely heard of raves and certainly
have never experienced dancing on Ecstasy. Here are some of the ways MDMA
is used:

Psychotherapy

According to RD Laing, the radical psychotherapist,

What scientists have always been looking for is not a tranquilliser, an
upper or a downer but a stabiliser, and in the seventies Alexander Shulgin
thought he had found such a drug [in the form of MDMA]. In the context of
its use, among very responsible therapists in America, all direct reports,
including my own, were positive.25

Psychotherapists valued the way MDMA helped clients to become open and
honest in a way that allowed them to have insights which they could
remember afterwards.6 A broad survey among 17 therapists with experience in
the use of MDMA just before prohibition showed that they regarded it as of
immense value in many, but not all, situations.158

The therapeutic effects of MDMA are described in a paper called Subjective
reports of the Effects of MDMA in a Clinical Setting by Drs. George Greer
and Requa Tolbert.28

Of the 29 subjects, "18 reported positive changes in mood after their
session; 23 reported improved attitudes, such as towards self and life in
general; 28 reported improvement in interpersonal relationships, and three
of the five couples reported benefits lasting from a few days to up to two
years; nine reported improvements in their working life; 14 reported
diminished use of abusable substances (alcohol, marijuana, caffeine,
tobacco, cocaine and LSD); 15 reported beneficial changes in their life
goals; and all nine subjects with diagnosable psychiatric disorders
reported considerable relief from their problems. . ."

In general, the authors conclude that "the single best use of MDMA is to
facilitate more direct communication between people involved in a
significant emotional relationship". MDMA was also recommended as an
adjunct to insight-orientated psychotherapy, for enhancing
self-understanding and was found to be useful in spiritual and personal
growth.

According to an article in the American Journal of Psychotherapy98, the
effects of MDMA - heightened capacity for introspection along with
temporary freedom from anxiety and depression - 'should be of interest to
Freudian, Rogerian and existential humanist therapists'. It is said to
strengthen the therapeutic alliance between therapist and client by
inviting self-disclosure and enhancing trust. Clients in MDMA-assisted
therapy report that they lose defensive anxiety and feel more emotionally
open, making it possible for them to get in touch with feelings and
thoughts which are not ordinarily available to them.

Psychiatrists also suggest MDMA is helpful for marital counselling by
making it easier to receive criticisms and compliments. "There's less
defensiveness between us and more leeway for diversity", observed an
ex-client. Long-lasting increased self-esteem was also reported by clients.
Greer says that another use is in working through loss or trauma, because
the issue can be faced and accepted instead of being shut away through
fear.99 However, some therapists are doubtful about how permanent changes
may be.161

No special techniques are necessary, but some are particularly appropriate
such as 'focusing', which helps contact and release hidden feelings.144

Current use in psychotherapy

Since prohibition in the States and the ending of the Swiss license at the
end of 1993, there is no legally authorised use of MDMA in psychotherapy
except in research projects (see Appendix 2).

In California there is still a considerable amount of psychotherapy
involving the illegal use of MDMA. This is partly a continuation by
licensed therapists who used it before prohibition and have carried on,
even though some have lost their licenses as a result.134 They believe that
it is such an important tool that they are prepared to take the risk. Then
there are a growing number of lay therapists, with no license to lose, who
offer treatment, though of course this is also illegal.129 In Europe, where
lay therapists are allowed, I have heard of only a few using MDMA in
Germany and Britain.

Future use in psychotherapy

One of the most interesting trials is due to begin in Nicaragua in 1994 on
the treatment of Post Traumatic Stress Disorder (PTSD or War Trauma) - the
psychological damage resulting from torture and violent traumas. At a
preliminary trial, 20 'incurable' cases were given MDMA without being told
what it was. When it came on, most of them spontaneously formed a huddle
and talked about the horrors of war and how they never wanted to fight
again. A week later, each was interviewed by a psychiatrist and most were
declared cured.130, 142

As a result, a protocol is being worked out to begin a properly controlled
trial. If the results of this are as good, it should provide scientifically
acceptable proof of the psychological benefits of MDMA for the first time,
and pave the way for it to become a prescription drug.

Amateur psychotherapy

A commonly held view is that healing can only be done by the willpower of
the wounded person, and the therapist merely helps the client to see what
is going on inside him or herself. If someone can use MDMA to gain the same
insights and to retrieve and face memories of past traumas, then this is a
more direct approach.

Representing 'the informed lay user' Robert Leverant wrote:

The therapist is only the personification of the healing aspect within each
person. If an individual can tap this force directly from time to time, why
not? If by ingesting MDMA, a person can put on a therapist's thinking cap
for a few hours and see him/herself with new vision that is presumably
empathic to him/herself, why not?29

Interestingly, Freud was in favour of lay therapy and wanted to protect
analysis from both physicians and from priests (Bettelheim 1983). In fact,
he envisioned a profession of secular ministers of the soul, perhaps akin
to PhDs.

Some people believe that gain most benefit by taking Ecstasy alone with
earplugs and a blind on or even in an isolation tank.124 However, most
believe that it really helps to have a guide for support, but not
necessarily a trained psychotherapist. Dr. Roth, one of the Swiss
psychiatrists licensed to use MDMA clinically, believes DIY therapy with
MDMA is naive, since help is needed to make use of realisations gained,
while many professional psychotherapists say that to use untrained helpers
is dangerous and irresponsible. An experienced self explorer believes that
people can go a long way by themselves, but wise guidance can be valuable
in some situations. Two experienced American psychotherapists also thought
that a wise helper was essential, but not necessarily a trained
psychotherapist.129, 134, 135

If you should decide to use E in this 'self-help' way, there are two
approaches, i.e. with or without the guide taking MDMA as well. The
advantage of both people taking it is the very close communication made
possible; the disadvantage is that it's hard for the guide to remain
disciplined and devote him or herself to the task rather than go into
themselves. One solution is for the guide to take a small dose, about half,
as was done by Alexander Shulgin.2 The dose used for therapy is important
and should be about 2mg/kg (100mg per 110 pounds) - too little may not
overcome defenses, while too much may cause a defensive reaction.134

There are some worthwhile ground rules for such sessions:

1. The guide is there purely for the benefit of the subject and should take
the part of servant and protector during the session. It is the guide's job
to prepare the venue and deal with anything that might interrupt the
session.

2. The guide agrees to act in the subject's interest, while the subject
agrees to follow the guide's instructions. Both agree to avoid sexual
contact during or following the session.

3. The guide and subject should discuss beforehand what the object of the
session is, and agree how far the subject may deviate before the guide
intervenes. Sessions frequently take an unexpected course, and the subject
should say beforehand how deeply he or she is prepared to delve into new
areas during the session.

4. The guide's job to listen but not to interpret, and to recapitulate when
asked. It is also the guide's job to intervene when the subject deviates
beyond the limits agreed beforehand. For the subject to relate what is
going on to the guide throughout the session tends to keep the experience
superficial, but this may sometimes be appropriate.

One example of many described in Through the Gateway of the Heart31, an
American collection of positive experiences on Ecstasy, is a 32 year-old
man who was at a transition point in his life and career. His aim was "to
examine this transition and proceed as quickly as possible to the task at
hand".

I gained an important insight into the history and development of my
personality and character. My awareness, confidence, and self assurance
improved. The session provided me with one of the best opportunities I have
ever had for true self-examination. I felt refreshed, vigorous, alert, and
happy to an unusual degree. . .

I discovered and understood with a positive and profound conviction that my
identity and personality were intact. I had feared, I suppose, that I might
find that I had been damaged in some irreversible way. I felt tremendous
relief and joy when I learned otherwise.

He added that for him, the most beneficial effects of MDMA were greater
presence of mind and being able to talk with clarity.

Another example given in the book is that of a woman who had been raped
eight years before she took E. She had the help of two friends/guides.
Although LSD was the main drug involved, she was helped by a 65 mg dose of
MDMA given 2 hours after the LSD:

My friends asked me to keep silent for ten minutes and to think of and feel
what was happening to me. It took a long time before I could do this,
always fearing that I would simply go mad. When I finally accepted it and
did it, I could feel the pain take over my body so that the suffering was
physical as well . . .

I spoke of the rape. For eight years I have kept the most horrible aspects
of that day hidden in the back of my mind, and it was only then that I
realized that the little details I had wanted to ignore were eating at me
like cancer. The memories became very vivid in my mind and the suffering
became more intense . . . I started to feel the horror of that day and
started vomiting . . . getting rid of pain, of an evil that had been
destroying me.

Nine years later one of the helpers told me that "she is doing great these
days".

Self therapy

Some people claim that Ecstasy will help you to open up your heart and rid
yourself of neuroses without the need for a therapist, and that in fact it
is more direct because there is no transference, no-one else to look to
except yourself. An enthusiastic Californian therapist is said to have
believed in this so strongly that he gave up his practice and became a
dealer instructing his clients in self therapy!135 However, most
professional people feel that a guide is essential to give support, unless
the person is unusually good at self direction and without neurotic
problems, as neurotic people can be opened up to deeper problems by the
drug.134, 135

A well-known Hollywood director, who was used to constant attention and
praise, made a film that flopped and was ridiculed by the media; meanwhile
his wife lost her own high-status position. They were shattered. Taking
Ecstasy at home together, they saw their situation in perspective: they had
respect for themselves and each other which did not rely on media
flattery.139

A man wrote to me how about how he feels E helped him:

I could see myself so clearly as this pathetic person who always put on an
act of being the nice guy to cover up that I was really scared stiff of
people. But on E I wasn't scared. I didn't try to be the nice guy and found
that the people I was with liked me more as I was. This made quite an
impression on me, and gradually I experimented with dropping the 'nice' me
in everyday life. A few months later I had some E again and this time got
fascinated what was going on inside myself. I found that it went back to
being rejected by my mother who had me adopted: that made me distrust
people and look for approval. I can't say it was an instant cure, but I do
feel as though I came to terms with the past and now relate to people more
honestly.

Improving relationships

Very often couples become estranged over the years, relating to each other
in less and less open and intimate ways. This may have advantages, such as
providing a working relationship that avoids arguments, but it usually goes
together with an empty emotional life. Taking Ecstasy together has been
called a 'marriage saver'. The experience can break through barriers built
up over many years and, with these removed, restores intimacy to a
relationship.4, 5, 25, 26, 28, 99, 133, 134, 165, 188 On the other hand,
taking Ecstasy before a relationship is well established may be a mistake,
leading to bonding without foundations.132

A typical example is a couple who used to be very close, but, after 3 years
of marriage, argued about petty things such as who was doing their share of
the work. They spent their time looking out for evidence against one
another while ignoring what the other was contributing:

We were at each other's throats when Andrew said, 'Look, this is
ridiculous, let's take that E we hid away and try to enjoy life like we
used to'. I agreed, with some sarcastic comment about not being able to
face the situation without drugs, and after taking it we carried on pulling
each other to pieces. I remember saying to myself, 'No drug will make him
see sense, I'm going to divorce him.' But as I was preparing my next
onslaught I felt my aggression slide away and the intensity of my argument
became deflated until I felt a bit silly. Andrew was not yet hit by the
drug but, as he told me later, without my anger it felt like fighting a
sponge: he couldn't carry on without opposition. I had felt confused: on
one hand I was desperately trying to gear myself up to continue the battle,
but the ammunition kept melting. I gave in and laughed, and so did Andrew.
Soon I was crying, not out of sorrow for how I'd behaved but because we'd
wasted so much of our marriage blaming each other instead of enjoying life.
We both went through a lot of pain, but we ended up knowing we belonged
together, and even now when we row we can see how petty it really is. I
don't think we will ever get so bogged down again.

Two years later they were still together.

Taking Ecstasy does not always have an obviously happy ending. Another
estranged couple who took MDMA opened their hearts to one another, but
while the man expressed love for his wife, she confessed that she did not
love him and had never enjoyed making love with him. It was too much for
the man to accept and the marriage broke up. However, some therapists
believe that the best use of MDMA among couples is resolving a peaceful end
to a relationship.161

Parent-child

A woman, whose husband had left her, had become estranged from her
13-year-old daughter. It was a typical teenage rebellion with the girl
staying out all night and the mother feeling she had lost control;
conversation was limited to hurtful sniping. One day the mother was amazed
and delighted to find that her daughter wanted to curl up in bed with her
and talk about intimate secrets. Unknown to the daughter, the mother had
taken MDMA the day before - although the main effect had worn off, the
residual 'afterglow' must have made her approachable. Hostilities returned,
but so did these times of closeness.

Another woman took Ecstasy with her 20-year-old daughter at a party. They
were on good terms anyway, but the conversations they had under the influenc
e of MDMA reinforced the deep affection they felt for each other.

Brother-sister

"Siblings always have a lot of shit together".161 As adults, there are
always a number of unresolved issues relating to childhood, such as one
bullying the other or resenting more attention from parents. Taking Ecstasy
together as adults allows long-suppressed resentments to be looked at and
resolved, and the underlying love for one another to be expressed.139

Family reunion

As a Father's day treat, a middle aged man chose to spend a day with his
family on Ecstasy. The parents and two grown up sons all enjoyed the
occasion, and look back on it as one that bonded them together again as a
family of adults after the separation caused by teenage rebellion and
leaving home.139

Problem solving

This is best done on a normal dose within an hour of the effect coming on,
as this is when the effect is strongest. It is useful to write down your
problem before you start. For instance, you could decide to look at your
relationship with your mother and why you avoid her. Or why you don't enjoy
your job. Or to find out whether you really love someone (who is not
present). It's a good idea to have a tape recorder handy and record how you
see things. Failing this, have pen and paper ready, but you may find that
thoughts come so quickly that it is hard to write fast enough, and that you
are reluctant to make the effort.

This exercise can provide insights; described by some as an unobstructed
view, perhaps the way you might see your situation if you were looking back
a year or two later. However, studies have shown that judgement can be
impaired by Ecstasy86, so any new insights should be evaluated when you are
not under the influence of MDMA, before they are acted upon.

I myself have tried MDMA for problem solving, and the first time got
completely distracted into having fun - the exercise takes discipline.161
The second time I saw everything in a simple and clear perspective;
although there were no dramatic insights I felt that it cast a new light on
some issues.

There is a danger of getting bogged down in one's own emotional mess. A
good way to avoid this is to be with someone else who asks you what's going
on and who will keep your attention on the issues at hand. A guide who is
not taking the drug provides one way of doing this, but two experienced
users can help one another. It's said to work best during the first hour
when the effect of the drug is strongest. A lot can be covered in an hour,
so it's a good idea to plan to have fun for the rest of the trip, in order
to end up on a light note.

Picturing the future

Several techniques taken from Neuro Linguistic Programming (NLP) and
hypnotherapy can be used when on MDMA.

While on MDMA it is possible to address a problem you expect to face in the
future using proven techniques. For example, you may have a colleague at
work who you don't get on with, but whose point of view you can appreciate
on MDMA and with whom you could have a much better working relationship if
you could be as open and appreciative at work. The technique is to
visualize your work situation on E and how you would relate to him, then
try to apply the insight to the real life situation.5

Another technique is to visualize a situation in the future after you have
achieved a goal, such as getting the job you want or marrying the person
you desire. Imagine yourself settled in the new job or marriage and look
back at how you got there. From this perspective, maybe you can see what
was needed more clearly than looking forward, or perhaps you can see other
possible ways of achieving your aim.

The third technique is to check whether your goal will really satisfy your
needs. Imagine having achieved your goal in the example above and see how
it feels. After the initial excitement of the novelty and achievement has
waned, are you satisfied? Does it restrict you? What do you look forward to
- another goal, or developing this new position? Was it the right goal?

Mini vacation

For people with an intense and speedy lifestyle, Ecstasy can provide as much
relaxation in two days as a week on a tropical island. A London acquaintance
made the comparison: 

I like to work hard without a break, and then have a holiday. But if I go
away for a week I spend the first half of it winding down and the last day
getting geared up again, leaving only two days of actual relaxation. But
about a year ago I started to take MDMA with a friend who is also a
workaholic, and now it's become a 3-monthly event. We go to his cottage in
Kent for a weekend, sometimes with one or two others. On Saturday morning
we take the MDMA along with our first cup of tea, and just allow ourselves
to slump into a sumptuous state of relaxation, sometimes dancing a bit but
mainly just lying around blissed out. We sort of agree that we are not
going to talk much or do anything to distract the others during the first
few hours, but in the afternoon we usually go for a walk and talk quite a
lot about what happened for us, and how we saw each other. By evening we
are hungry and go to bed early, and next day get up late and sit around and
talk again. It's all very low key, but actually some of my best ideas have
occurred to me on those weekends.

There is an American report on similar use in the US, based on interviews
with 100 professional people who have hectic lifestyles.104 They tend to be
people who used LSD in the sixties but have led drug-free lives since. The
report describes a very organised approach with much advance preparation
and precise doses being matched to the person's weight. Some will rent a
house for the weekend and follow a well-worn routine, devoting the actual
trip to relaxation and personal insights, while the next day is reserved
for communication and reaffirmation of friendships.

A less structured way of using Ecstasy for relaxation is described by a 42
year-old English man who had not heard of the above paper.

I am one of those people who gets totally involved in my work (computer
animation) - it becomes my life until the project is finished, so I work
long hours without any let up. This suits me, but a time comes when I wake
up rigid with tension and really need to take a day off. Before I
discovered Ecstasy I tried country walks, weekend trips to Paris and
spending the day in bed with my girlfriend, but I never really unwound, I
remained tense and my mind was still on the project. But with Ecstasy I
relax completely. It's wonderful to spend a day totally with my girlfriend,
laughing and playing and indulging in gentle sex. I think that without
these special treats she would not have put up with so little attention
from me. I always feel great the next day, and, even though my mind has not
been occupied with work, often come up with a new angle on what I'm doing -
just like you might after a real holiday.

Keeping fit

For some women, taking Ecstasy and dancing has replaced aerobics because it
has the same effect but is more fun. Dancing for hours without eating or
drinking alcohol is an ideal way to lose weight and keep fit. According to
Sheila Henderson, who is running a research project on women Ecstasy users
in Manchester,

The motivations for raving and keeping fit are similar. They are about
pleasure-seeking, socialising, music and body image. The difference is that
one's naughty and the other's nice. One makes you feel virtuous, the other
you enjoy because it's a bit deviant. The combination of dancing all night
and burning up calories is attractive to figure-conscious girls. Lots of
women mess themselves up by going on crash diets. Many are now taking
Ecstasy to slim.35

However, she adds that the switch from the gym to the rave is not so much a
deliberate act - more that raving fulfils the same role as the gym, and
provides an alternative lifestyle with the same benefits.

Artistic expression

Ecstasy can also be used as an aid to drawing, writing, playing music123,
139, singing31 or other artistic activities. Very often the effect of the
drug is to open up the artist to a broader perspective, sometimes
uncomfortably.132, 133 There have been creative writing workshops where the
participants take a small amount of MDMA, about half a normal dose, and set
to work. Some find it good for ideas, others find the E overcomes 'writer's
block'.5 Another method for overcoming writer's block is to focus on the
writing while taking a normal dose, but to leave the actual writing until
afterwards.

There are some people who put on a private multimedia show with all
participants and audience on MDMA.187

A user who tried singing on MDMA told me:

It's like singing in the bath, but more so - my voice sounded quite
professional, although, mind you, I was the only one who commented on it.
Maybe it was awful really, I must try it again with a tape recorder.

And an artist who tried painting said:

I can't say I painted better on Ecstasy, but differently and more freely.
It was as though I was free to carry on with the interesting bits without
having to do the hard work. I think my style has become looser since then.

Yoga and Marshall Arts

I have had several reports from people who have used Ecstasy while
practising yoga and tai-chi besides one who has only taken Ecstasy while
doing kung fu and yoga.

I was very aware of soothing warmth permeating my body. I began to put more
energy into my form and experienced an increasingly heightened perception,
reaching a peak after about 45 minutes.

One of the major aspects that the E shed light on was the use of energy
(prana/chi) rather than a focus on muscular strength. My overall impression
of the benefits of E usage in Hatha Yoga was that the session overall had
its own distinct harmony and produced a highly balanced mode of perception
in which contradictions of body and mind were 'synthesised' into a very
pleasant equilibrium. The insights gained from the session have been
incorporated into my daily practice, so that now the sensations produced by
the E can be reproduced by the yoga - rather like a free trip.

The effect of Ecstasy on Kung Fu was to make clear that the user, who was
male, was good at the hard or yang movements but had neglected those that
were soft or yin:

I found that the softer 'feminine' touch counterposed the external,
physically athletic 'male' side of kung fu, the balance of the two working
in harmony improved the speed, power and insight into a given technique to
quite a considerable degree. . . though I am not sure I would wish to be
challenged to a fight under the influence.

Rituals

Some people use MDMA as part of a ritual, either with each individual
exploring inwardly and only sharing their experience later, or by
interacting as a group, perhaps speaking in turn using a 'talking
stick'.166 The group ritual effect is to produce a powerful force and may
include rebirthing and tai chi. Rituals are best done on low doses,
otherwise it may be difficult to follow instructions.

A community has been taking MDMA together or in family groups for some 12
years twice weekly, and report continuing progress.188 Others use it alone
on particular days.136 An example is given here from a German book on
MDMA.103

Some members of The Native American Church use MDMA in place of Peyote for
healing ceremonies. The results are described as remarkable, and white
people are easily integrated.

The ceremonies take place at night. Participants are asked to fast for
eight hours beforehand, and start by sitting in a circle with sage and
myrrh burning as incense. Each person expresses their wishes for the
session and takes 100 to 250 mg of MDMA with a small amount of distilled
water.

When the drug comes on, they perform three dances with a drummer beating
out a heartbeat rhythm. For the first dance, the dancers are asked to focus
on the animal spirit within. They go round stamping out the rhythm which
they feel connects them with the animal world and the earth.

The second is a circle dance, where each follows another round, focusing
attention on the circle of people and the cycle of life. This has the
effect of connecting individuals to the group.

The third dance is done with two rows facing each other. The dancers stay
on the same spot, and allow all their thoughts and feelings to flow.

After the dances, the participants sit in a circle and pass round water.
Each person takes a turn with the talking stick in one hand and a shaker in
the other. As holder of the stick, that person is allowed to talk, sing or
dance while the previous person accompanies them on a drum. The others
focus their attention on the speaker but without looking at them. When
everyone has had their turn (lasting three or four minutes), water is again
passed around the circle and more incense is burned. Finally, they meditate
while they watch the sun rise.

A white American participant who attended such an event described it as a
socio-therapeutic session. There were 23 participants in her group, and she
felt very much part of it all and that there was mutual trust. She felt
waves of energy from the others and says she felt in tune with the self,
the circle and the world.

Imaginary Journeys

This technique can be used purely for fun or to learn more about yourself.
Ask a partner to take you on a journey where you face various difficulties
and pleasures. The E state will help you to feel the situations and respond
to them emotionally. Your partner notes your responses and discusses them
afterwards.

I was told about someone who had decided to go travelling to the third
world for the first time. A friend who was a veteran traveller took him on
a fantasy journey based on some of his real-life experiences, from the
exhilaration of visiting an Amazonian tribe to the misery of being ill with
malaria. Even though the guide was not on MDMA, he said that he relived his
experiences just because he had such a good audience.

Treating addiction and alcoholism

Although there is no study to date, there are anecdotal reports that
Ecstasy can help coke165 and heroin addicts to break their habit, of which
a personal account is included.Appendix 2

Treatment of alcoholics is another possibility, and a trial is planned in
Russia depending on government approval.101, 142 A trial on alcoholic rats
showed that they consumed less alcohol and more water when given MDMA.102

Relieving pain

There is growing interest in MDMA's potential as a pain killer. This has
been stimulated by two commonly observed effects of the drug: that when
people injure themselves while they are under its influence they can easily
accept the pain30, that it appears to enhance the effect of morphine127 and
that it dissolves fear, which can include the fear of death.70 Dr. Henry of
the National Poisons Unit believes that MDMA stimulates opiods, a
neurotransmitter, that numbs people so that they do not feel pain, as
occurs when people injure themselves at sport.30

A trial of MDMA for the relief of pain in terminal cancer patients began in
1993 - the first trial involving humans to be approved in the USA.24, 127
Russian researchers are also interested in doing research on using MDMA for
pain relief, and, with funding from the west, hope to investigate MDMA for
the treatment of alcoholism, neurosis and also terminal cancer patients.101

Psychological research

According to Enoch Callaway, humanity's most pressing problem is to
understand the human mind, yet results of research to date has been
disappointing. MDMA, with its unique quality of stimulating feelings of
love, could be a useful instrument in psychological research.100

Training psychotherapists

Among mainstream therapists, there is a trend away from the Freudian idea
of the analyst acting as a blank wall, towards the realization that empathy
is important to therapeutic success. It is also becoming more recognised
that therapists not only learn an intellectual interpretation of their own
analysis but also understand their feelings. Several people have suggested
that MDMA would be an ideal tool for this purpose.126, 135

11	Suggestions for first time users

This chapter is not an encouragement to take Ecstasy. It is an illegal drug
and in some situations can be dangerous. These suggestions are included for
the benefit of those who have already decided to take Ecstasy, so that they
may get the best out of it and reduce the dangers to a minimum.

Health

First check on your physical condition. MDMA puts extra strain on the body,
so you should be healthy and rested. In particular, your heart, liver and
kidneys all have to work harder. If you have ever suffered from
jaundice106, you may have a weak liver. If you have doubts about your
body's ability to deal with the extra strain, then have a check up. Avoid
taking MDMA if you are on antidepressants of the MAOI type107, 127 (The
SSRI type are OK but you may feel no effect.142) You may want to follow the
more thorough screening code used in therapy by Dr. Greer.99 If you are
especially sensitive to other drugs (such as Contac, sold for colds), then
you may also overreact to MDMA and you should first see the effect of a
very small dose.141, 178

Your mental health is equally important, and rather more difficult to
assess. If you are unsure of this, or have doubts about being stripped bare
of your image, then you should avoid taking psychoactive drugs.

It's probably wise to stay off MDMA if you are pregnant58, although trials
show that it does not harm the offspring of rats.108

Situation

Find a situation where you feel good. If you enjoy large parties and clubs,
a rave could be ideal especially if you are with friends. Taking Ecstasy
with a lover can be wonderful, but avoid being with people you are not sure
of, especially someone you are emotionally attached to but have doubts
about unless you are prepared to use situation explore your relationship.
The ideal home setting for taking Ecstasy is a spacious room where you feel
secure and can let yourself go without arousing the neighbours.

Alternatively it can be nice to take E outdoors in warm weather and
pleasant familiar surroundings. It's important to feel free to express
yourself without inhibition or interruption, so choose a place where you
will not be seen or overheard.

Looking after yourself

If you have any doubts at all, take a very small dose and wait an hour (the
time it takes to come on) before deciding whether to take more. Half a dose
is quite enough for many first time users, especially women and small
people. Drink plenty of water or fruit juice (except black currant141) but
avoid alcohol and other drugs, and if you are dancing, realise that you may
be dangerously overheated even without feeling uncomfortable. Look after
friends and get them to look after you. The ultimate precaution would be to
use a forehead thermometer, a plastic strip that changes colour with
temperature, sometimes available free from Boots to promote their own-brand
medicines.

Taking vitamin C and E may help to reduce exhaustion.36 Get good sleep
afterwards.

Folklore has it that calcium and magnesium help prevent jaw clench (and
even toxicity). This was suggested in 1984 and has been repeated in popular
writings on Ecstasy7, but is not supported by medical evidence.

Guide

If you decide to take Ecstasy at home, choose a guide who is thoroughly
familiar with its effects, and who you can trust completely, to look after
you. Although a lover may seem the obvious choice, taking E with someone
you are intimate with carries risk that you may 'see through' your
relationship or reveal hurtful things to each other. The ideal choice is
someone who you know well and have no conflicts with; someone you feel you
do not have to impress, and to whom you are happy to reveal your needs and
failings.

Preparations

Ensure that you will not be disturbed by visitors or by the telephone. Make
sure there are comfortable places to sit or lie down. Have plenty of fruit
juice and plain water on hand to drink and some chewing gum to chew in case
of jaw clenching. Wear loose, light clothing but have extra clothes and a
downy or blanket to hand in case you need to warm up. Line up some of your
favourite music, both for dancing and as a pleasant background. Bring some
personal objects that you are fond of - things to handle and look at, or
perhaps some photographs of people you are fond of. A mirror could be
useful for looking at yourself. A tape recorder and camera or video camera
can be fun and help to you relive the experience later, but, if you don't
have access to these, have a pen and paper ready in case you have the urge
to make notes. Earplugs and a blind like the ones used by people who want
to sleep on planes can be useful, too. Finally, make the space attractive:
have nice things to look at, smell and touch - such as flowers, essential
oils and silk.

You really don't have to plan anything for the trip itself; just let it
happen and 'go with the flow'. But a guide can help you sample a range of
pleasant experiences that you would otherwise miss, as there is a tendency
to get absorbed in one aspect of the drug's effect and to be reluctant to
switch to something else.

Timing

The full effect of the drug only lasts for three or four hours, but you
should allow a minimum of eight hours and it is best to reserve a whole
weekend free of committments.43 This allows you time after the trip to go
over your experiences with your guide. This is usually really enjoyable and
can be particularly valuable if anything came up during the trip which
needs resolving.

If you can't take more than one day off, start reasonably early in the
morning so that you will have plenty of time with your guide after the trip
before going home to get a full night's sleep. If you can't allow yourself
a whole day, then start early one evening and make time to discuss the
experience the next day.

Rules

Establish with your guide a clear set of rules for the trip. You may like
to keep the rules used in therapy28, or you may like more relaxed rules
such as confidentiality, no sex and no activity that could be destructive
or draw attention from neighbours. It's a good idea to write down the rules
so as to be quite clear.

Notes for guides

To be a guide is usually a delightful experience, but it is a
responsibility that must be taken seriously. Take time beforehand to find
out the aims and expectations of the person you are to guide. You should
not only ask them whether they are sufficiently fit and free from emotional
problems to take Ecstasy, but also judge for yourself. It's not a good idea
to play the guide to someone who is looking for something to 'cure' them
unless your are an experienced therapist. But however well you vet people,
difficulties can still arise and you must be prepared to deal with them.
People used to taking E at raves may react differently when they take it
with only their guide for company.32

Obviously it is important to make the venue pleasant and free from
interruptions, but it is also important to show that you put care into the
preparations. As one person remarked, "When I arrived and saw how much care
and attention had gone into preparing for my trip I immediately relaxed as
I knew I was going to be well looked after". Present yourself as a servant
and as a committed supporter.

It is also important that you give the expectation of a wonderful time. If
you show signs of worrying, this may make your friend look for something to
go wrong with the trip; if you are enthusiastic and expect your friend to
have a wonderful experience, you will help to bring this about.109
Discuss beforehand what the purpose of the session is. If it is just for
fun and to experience the effects of the drug, you can offer to give a
'guided tour' of the effects from looking inside to dancing and perhaps a
walk outdoors. But maybe the person wants to explore something about
themselves, in which case the guide's job is to simply 'be there': to
provide security by giving reassurance when appropriate and to be available
to talk to, typically as the effects wear off. Side effects very often
manifest as a result of emotional problems, and it may be helpful to
suggest looking at the underlying cause. People who become 'stuck' can be
supported in what they are feeling, and if it is uncomfortable, reminded
that they will become unstuck as the drug wears off.

12	What Ecstasy is and where it comes from

Ecstasy is MDMA or, to give it the full chemical name, '3,4
Methylene-dioxy-N-methylamphetamine', pronounced 'Three-Four Methylene
Dioxy N Methyl Amphetamine'. To a chemist the name describes what the
molecule consists of. The word 'Methyl is sometimes abbreviated to 'Meth',
and the letter 'N' and numbers '3,4' are often omitted, leaving the more
usual 'Methylenedioxymethamphetamine'. (The 3,4 indicates the way in which
the components of the molecule are joined together, as it is possible to
produce an isomer which has all the same components joined differently.)
Similarly, the initials are sometimes reduced to MDM (although this is
old-fashioned) and of course there are the various popular names such as E,
Adam, X and Empathy.

Many people believe that the name implies a mixture of ingredients but this
is wrong - just as water is not a mixture of oxygen and hydrogen although
its molecule consists of oxygen and hydrogen atoms. Like water, MDMA is a
compound, not a mixture. So, although the name contains the word
'amphetamine' and the law refers to MDMA as a 'psychedelic amphetamine',
MDMA contains no amphetamine. The amphetamine-like effects may be related
to dopamine release.38, 186

Is it really Ecstasy?

What is sold as Ecstasy in Britain is just as often MDA (3,4
Methylenedioxyamphetamine) or ???MDEA (3,4 Methylenedioxy-ethylamphetamine,
also called MDE or Eve). Again, these are pure substances. But in addition,
'Ecstasy' often consists of various other drugs such as mixtures of LSD and
amphetamine or caffeine. In America, the last figures published by
Pharmchem (1985) show a similar picture - only half the samples were pure
MDMA, with nearly half the remainder being MDA or MDEA while the rest was
either another drug altogether or fakes.161

Why Ecstasy may not be as good as it was

Many regular users are convinced that the quality of Ecstasy is not as good
today as it used to be. Though this may well be true, a person's experience
on E depends on several factors quite distinct from the quality of the
drug.

The first is tolerance.34, 110, 37 If you had an unlimited supply of
absolutely pure MDMA and took the same dose each day in the same situation,
you would find that the most smooth, open, loving experience with the least
amphetamine-like effects would be on the first dose. Each subsequent
experience will have less of the loving feeling and more speediness until,
after 5 days or so, you might as well be taking amphetamine (speed). You
would then have to stop taking MDMA for a time before you could experience
the good effects again. After a week without MDMA, its effect will nearly
be back to normal, although to get the full effect you may have to abstain
for as long as six weeks. Even then, the experience may not be as good as
your first one - but that is probably due to being familiar with the
effect.99 Tolerance varies according to the individual, and to the size of
dose taken. But as a rough guide, tolerance is noticed by those who take
more than one E a week.

The second factor is your state of mind. Although this applies less with
MDMA than with many other drugs (particularly LSD), the effect is highly
responsive to your mood - in fact one of the drug's effects is to liberate
suppressed feelings. You may not even notice that you are uncomfortable
about something until the drug takes effect.

The circumstances where you take Ecstasy influences the effect, and it has
been suggested that dancing on E may also alter the drug's effect.32
Expectations also play a surprisingly large role in the effect - people get
what they expect. Everyone likes to believe that they won't be fooled, but
tests in which LSD and hash were substituted with a placebo show that, with
those drugs at least, nearly everyone experiences what they expect.109
Alexander Shulgin, who wrote a book on the effects of psychedelics2,
describes how he had an emergency operation on his thumb during the war.

Before the operation he was given a glass of orange juice with white powder
at the bottom which immediately sent him unconscious - later he was told
the powder was sugar!

Nevertheless, the overall quality of Ecstasy has gone down over the years.
When Ecstasy first hit England, it was brought by enthusiasticusers from
the USA for their friends, and so tended to be pure and strong. Now it
comes mainly from illicit factories in Holland and is distributed for
profit by entrepreneurs. It may be less good because:

1. It is weaker. Dr. Les King, who is in charge of testing samples of drugs
seized by the police, has the impression that the strength of tablets and
capsules has gone down by 10-20% over the past couple of years.54

2. It is MDA, not MDMA. There is as much MDA seized as MDMA54, and this
produces less of the warm, empathic feelings, although it is so similar to
MDMA that much has been sold as Ecstasy without anyone realising. The most
obvious distinction is that MDA lasts twice as long, 8 to 12 hours.

3. It is MDEA, not MDMA. MDEA appeared on the market in 1992 and the
proportion of street sales of Ecstasy that are actually MDEA is rising.54
MDEA is quite similar to MDMA but most people who have compared the two
drugs do not like it as much, saying that they are not able to communicate
as well or that they feel more stoned and less clear-headed. It lasts the
same time as MDMA, 3 to 5 hours.

4. It is a mixture of the above drugs. Many people believe that the effects
they experience are due to mixtures ("That one had a bit more speed in it")
but in fact mixtures involving MDMA-type drugs are rare.54

5. It is a cocktail of drugs designed to substitute for MDMA. When MDMA is
in short supply, dealers have been known to produce mixtures which they
hope will produce similar effects, such as LSD and amphetamine.54 The
effect of this combination lacks all of the warmth and empathy of MDMA and
the LSD component lasts for twice as long.

6. It is simply speed. In Holland, 15% of street samples of "Ecstasy"
consisted of amphetamine and/or caffeine.21

7. It is a fake. About 10% of 'drugs' seized by police turn out to contain
no active ingredient at all. This proportion has not changed over the
years.54

8. It has been contaminated by a poison. This is one of the ideas loved by
the tabloid press who have suggested that addictive drugs have been added
to pills, a variation of 'the dope peddler who gives the kids free samples
to get them addicted' shock horror story. Another variation says that rat
poison or broken glass has been found in pills. Lab tests on samples here
and abroad have found no such contaminants.54

9. The MDMA was badly manufactured and contains chemicals with nasty
effects. This is a possibility, but has not been supported by analysis of
samples.54

Another reason sometimes given is that, in addition to tolerance, the
effects of the drug change with repeated use, but this was not found to be
the case in trials of MDMA on psychiatrists.26

How can you find out what it is?

It is not possible to identify MDMA without equipment. Most people judge by
the appearance as some 'brands' have a good reputation, but beware of
fakes. Lookalike pills can always be distinguished when compared side by
side, but its hard to be sure later. Its a good idea to examine each pill
very carefully and remember features that are hard to copy such as precise
details of the design pressed into the pill. Capsules are obviously far
more dodgy, as the same ones may contain different powders which may look
similar. The only clue is then taste, and so its a good idea to get to know
and remember what good E tastes like.

In Holland, there are several 'safe houses' with which the police have
agreed not to interfere, where people can take drugs for analysis.112 (See
Appendix 6 on page 310.) The Dutch government even pays people to buy
samples of street drugs and send them in for analysis so that the results
can be published21. However, there is no legal way to have a pill tested in
England.

There is a laboratory reagent called Marquis that consists of sulphuric
acid and formaldehyde which I have seen used in Amsterdam for testing drugs
brought in by dealers (wrongly described in MixMag as a machine for testing
Ecstasy). It shows a dark colour with MDA, MDMA and MDEA, but also turns
dark with many prescription drugs and even some paper, so is not a reliable
test, especially when used by inexperienced people. However, regular users
of Marquis claim to be able to acquire the skill to distinguish between
several drugs including amphetamine, which shows orange, from MDMA which
shows a darker colour, or brown/black-purple.54

A drug testing kit is marketed by British Drug Houses and Merck (product
code 321761, price about #35). This consists of 40 ampoules of Marquis; to
use it you break off the neck of an ampoule and drop in a tiny bit of the
drug. The instructions say that within a minute the Marquis turns violet
with opiates and 'yellow/orange/brown' with amphetamines and MDMA-type
drugs. Absence of colour indicates none of these drugs are present, and
this is what it is used for - as a quick way to check whether a suspect
tablet does not contain an illicit drug.

Laboratory analysis

The method used to detect MDMA (and other drugs) is called chromatography.
The principle is akin to the coloured rings around a drop of ink as it
spreads out on a piece of paper: under controlled conditions, different
drugs form characteristic rings. Equipment is set up to test for various
drugs by seeing whether characteristic bands are produced, and the method
can be used to test samples of pills and to detect the presence of drugs
like MDMA in blood and urine. At the National Poisons Unit there is a fair
sized laboratory equipped with chromatography testing machines of various
types. Each machine is dedicated to looking for a particular drug or
poison. Some drugs, like cannabis, can be detected up to "five weeks after
a single reefer", while LSD is very hard to detect. MDMA can be detected
the day after it is taken and sometimes longer.30

Physical properties

Pure MDMA is a white crystalline solid. When the crystals are too small to
see it looks like a fine powder, but they are often large enough to sparkle
and its possible to grow giant crystals up to a gram. The powder tends to
stick to a dry finger but without forming lumps. It is chemically stable so
that is does not decompose in air, light or heat - i.e. it has a long shelf
life, unlike LSD.141 It dissolves in water but does not absorb dampness
from the air. MDMA has a distinct, strong and rather bitter, taste.

Manufacture

There is very little MDMA manufactured for medical use169, so that (unlike
amphetamine) what is sold on the black market is also manufactured
illicitly.

Most of what is sold as Ecstasy in Britain comes from Holland. The reason
is simple: the sentences for supplying drugs in Holland are lower than
other countries and the prisons are more comfortable. It is far less risky
to smuggle drugs into England than to set up manufacturing facilities here.
The trend is towards manufacture in Eastern countries where the materials
and equipment are more easily available and bribes will avoid imprisonment.
However, the methods are well known2, 163, 189 and there are small scale
manufacturers everywhere.

One group told me about the problems of manufacturing from their point of
view.167 Far from being an easy way to make money, it sounded like a
nightmare of problems from explosions to paranoia. Suppliers are meant to
inform police, so materials had to be bought at inflated prices for 'cash
and no questions', but this always left them open to blackmail. The
synthesis produced poisonous fumes and sometimes they had to evacuate when
things got out of control, returning to find their valuable product
dripping from the ceiling. Sometimes fumes billowed out in white clouds and
could be smelled miles away. Even selling it was a problem carrying far
more risks - and less money - than they had expected.

I have spoken to two people who have visited clandestine factories in
Holland.21, 112 One described a small operation producing MDMA in a private
home: the equipment was ex-industrial, consisting of an autoclave and a
14,000 rpm mixer. Neither of the two operatives were chemists, although one
had worked in a hospital laboratory. They had no previous experience, they
simply taught themselves from books and papers in public libraries. They
were cautious about buying the materials, so ordered them separately from
suppliers in different countries. The cost of setting up the factory -
about #70,000 - came from a criminal who wanted to get into the drug
business. It took the operatives six weeks to make a batch, with many
failures, but they said they could have done it in far more easily with the
right equipment.

Very few clandestine factories have been discovered in Britain. One, in a
shed in a garden centre, was found to be producing a batch of 20 kgs -
enough for 200,000 tablets - every 24-36 hours.89

The manufacturing process produces a raw substance of which between 80% and
95% is MDMA. Incomplete synthesis results in a brownish colour.110 A
filler, composed of an inactive compound such as china clay, is then added
to bind the pills and to make them bigger. Pills typically weigh between
200 mg and 600 mg each, of which only 100 mg is MDMA.54 Sometimes a colour
is added. Speckled effects are produced by mixing different colours of
filler, giving the false impression that the pill contains several active
ingredients.

Pill-making is an art in itself: if the pills are too solid, they may be
shitted out whole; if they are too soft, they may fall apart in the mouth -
the pressure and filler have to be well controlled. Commercial drug
manufacturers use a small piston which forces the ingredients against a die
at high pressure, producing a hard, smooth tablet. The die is engraved with
a logo or name and can be changed according to the type of pill. Like the
big drug companies, clandestine manufacturers use a die to identify their
'brand'. Word soon gets round that a particular brand is good, but before
long fake lookalikes are sold and the brand loses its reputation. Brands
therefore typically have a life of only three to six months.54 A single
factory will produce different brands for export so as to reduce the risk
of being traced.112

Because many Ecstasy pills are badly made, pills such as aspirin are
sometimes rubbed down to remove their markings and give them the look of
illicit manufacture before being sold as fake Ecstasy.113 Some Ecstasy is
also sold as a loose powder or in capsules; this probably comes from small
manufacturers who do not have the pill-making equipment.

As much MDA and ???MDEA is sold in Britain as MDMA. MDA is easier to make
since it is a half-way stage in one method of manufacturing MDMA, and
requires fewer controlled precursors than MDMA. The reason so much MDEA was
produced in Holland is because it was legal until 30th July 1993.160
Police action to prevent manufacture in Britain follows the principle of
encouraging the suppliers of precursor chemicals to inform the police of
suspicious orders. A new law making it illegal to manufacture or supply
precursor chemicals means the suppliers could also be prosecuted.114
Illicit laboratories raided to date have all been discovered by tip-offs
from informants.14

Distribution

According to the police89, the typical drug dealer nowadays is a
middle-aged criminal who has been in prison many times and probably
committed armed robberies when he was younger. Police say that the pattern
has changed, and that this kind of person never used to get involved in the
drugs trade. The Mafia and other gangs of organised criminals are not
suspected. This view is supported in a book called Traffickers by Nicholas
Dorn.115 Dorn says that, far from fitting the popular image of organised
crime under the direction of "Mr Big", in Britain there are no drug barons
and relatively little corruption. Drug dealing is, in fact, 'disorganised
crime'.

According to Dorn, there are seven distinct types of dealer, but the
situation is fluid; individuals change their method of operation, making it
very difficult for the police who, he says, are less flexible in their
methods.

At the top end are those who will organise production, such as the
criminals who put up #70,000 to set up a factory in Holland. Then there are
wholesalers, criminals who buy by the kilo for #20,000 or so (#2 per dose).
They sell on to the middle men who buy a thousand Es at a time for #3 to #5
each and re-sell by the hundred at about #8 per E to the dealers who sell
to the public at about #15 each, though often these are bought in batches
of ten or so at a small discount (such as one or two 'free' tablets).
Recently I've had reports of street prices as low as #814 and #9.79 The
price of illicit drugs does not bear the same relation to the cost of
production as does the price of legal drugs. Instead, prices seem to start
as high as the market will bear but then stay at that figure, defying
inflation, or actually falling over time.40

A large proportion of the retail trade is conducted by people buying for
their friends without making a profit, although usually gaining a few free
tablets for their own consumption. Then there are the dealers who are
trusted as connoisseurs of the drug, and will describe the subtle qualities
of the particular batch from personal experience. This type of dealer never
sells to the public but only to regular clients who respect them, so the
dealer cannot afford to provide poor quality.

Another variation, more common among working class men, is for friends to
arrange a meeting place, usually a pub, before a rave. One person knows of
a supply and collects money on behalf of the others, then returns with the
drugs which cost each person less than if they had bought separately.40
This method carries more risk, either of losing your money or of getting
poor quality. The person buying for the others also runs the risk of far
greater penalties, see chapter 7.

A more commercial form of supply is by individuals who buy 100 or so and
are either 'known' at certain clubs, or go around offering them for sale.
They may be honest, especially if they are known, but they may also be
selling fake Es. A new trend is for 'retail specialists' to sell in a club
or at a rave. These are organised gangs, but probably not part of a large
syndicate. They cooperate with security staff or the promoters of raves and
clubs, and occasionally, so I have been told, with the police. The club or
rave organisers put on a show of heavy security, searching people on their
way in so as to exclude dealers. This leaves the way open for the gang to
sell inside. Some members go around asking people if they want to buy drugs
without carrying stock themselves so that, if arrested, they will not be
accused of 'supply' and may get off with a fine. The stock and money is
carried by members who are well protected by body guards, and lookouts warn
of police activity inside and outside the venue. They have contingency
plans worked out in case of a surprise raid, for example members who are
free of drugs might cause a fight so as to attract the attention of the
police while those carrying drugs and money escape.

Regular ravers tell me that such an operation frequently exists when there
is tight security on entry and can easily be observed, yet the police
hardly ever attempt to arrest such gangs. I am told that drugs sold this
way are generally low quality and are sometimes fake.

A report by Dr. Newcombe of Manchester University suggests that "It would
be unrealistic to expect any strategy to substantially reduce the use of
drugs at raves", but he does suggest that police attention should be
directed towards such gangs. He also believes the gangs are responsible for
selling bad quality drugs.33

13	Official Attitudes and Harm Reduction Policies

There are a range of attitudes towards drug use. At one extreme there is
the view still widely held in the USA that all drugs (although,
inexplicably, alcohol is excluded) cause enormous damage to young people,
and must be stamped out by tough use of the law and campaigns such as "Just
Say No" rather than genuine education. The view is that drugs are evil in
themselves and that no sane person would choose to take any illicit drug
unless he or she had a perverse or inadequate personality. Drug dealers are
seen as ruthless criminals who have no respect for their customers, and
"give the kids free samples, because they know full well that today's young
innocent faces will be tomorrow's clientele." These were the satirical
words of Tom Lehrer some 40 years ago, but there are some people who still
believe in this view, including police in the drug squad.89

At the other end is the Dutch government. Although members of the United
Nations and therefore signatories to the Convention on Psychotropic
Substances15, the Dutch have decided not to prosecute people found in
possession of drugs for their own use, without actually changing the law.
Instead of trying to prevent people from taking drugs, the authorities in
Holland give drug users help and information so they can choose for
themselves. To this end they employ people to buy samples of drugs sold on
the street which are then analysed and the results published. Occasionally
there are warnings about particular pills that are very strong or are
adulterated: in one case 'Ecstasy' that turned out to be Ketamine.
Holland also has a "safe house" policy. This means that certain drug
agencies have assurances from the police and authorities that visitors will
not be raided or stopped on their way in or out. This provides a link
between the authorities and the dealers. The pact gives dealers an
opportunity to talk about their side of the trade and to have samples of
their wares tested, while it provides the authorities with detailed
(although anonymous) information about what is going on.

One might say that Britain is in between. My impression is that the
Establishment and police favour the official American view, while workers
in the field sympathise more with the Dutch. In researching this book, I
have come into contact with a number of people who are paid by the
government including social workers, teachers, doctors, psychiatrists and
researchers in the field of drug use. Many of them cannot afford to say
openly what they believe, but off the record have told me they believe that
Ecstasy has done more good than harm; several have admitted trying the drug
for themselves. At one drug prevention agency I was surprised to hear the
staff speak positively about Ecstasy just after their head had told me of
the importance of warning users about its dangers. The discrepancy was
later explained by the need to raise funds for the organisation.

Current trends

There are signs of attitudes softening. In Britain, the Independent and
Economist have launched a crusade to legalise drugs on the grounds that
prohibition is the route cause of about half the crime, and that present
policies simply do not work - a view also voiced by Commander John Grieve
of the Metropolitan Police.164 In America, the Just Say No campaign is
losing credibility and is being challenged by more and more critics
including the mayor of San Francisco. In Europe, Holland has been leading
the way towards liberalisation but faces pressure from other EC countries
to tighten up. A Dutch committee has also recommended that MDMA be
reclassified to the same class as cannabis.

Future change in attitudes

In June 1993, a paper called 'X at the Crossroads' predicted that E had a
high growth potential in the USA, and that public attitude to the drug will
change from its present disinterest to either 'marijuana-like acceptance'
or 'LSD-like rejection'. Which way it goes will probably depend on chance
rather than common sense, since the public are more influenced by media
horror stories than statistics.151, 154

In Britain, use has been steadily increasing while media coverage has
declined. This is partly due to far fewer casualties resulting from
successful harm reduction campaigns, but also media burnout. With polls
showing that nearly half the population favour decriminalisation of
cannabis, and some serious discussion of legalisation of all drugs, it
seems likely that attitudes will soften.151, 164

On the other hand, there has been concern that "Jobs in traditional leisure
industries are being jeopardised by the huge growth in raves which have
mushroomed into a #2 billion-a-year industry".159 The powerful brewery
lobby in Britain is likely to put pressure on the government to clamp down
on raves.

Harm Reduction

Harm reduction policies116, 117 are based on the idea that it is of greater
benefit to society to put effort into reducing the harm caused by drug
taking than to prevent drugs being consumed at all. This was first applied
to opiate (heroin) users in response to the AIDS scare by supplying free
syringes to prevent HIV being spread through sharing needles.

In relation to Ecstasy use, harm reduction has recently been adopted as a
policy by Manchester City Council118 in the form of a Safer Dancing
campaign. Before this, venues were being closed when the police found
illicit drugs, with the result that the clientele moved on to other venues
- often unlicensed premises. People suffered from heatstroke as a result of
taking Ecstasy in badly ventilated venues where water to the wash basins
had been cut off, forcing them to buy drinking water at exorbitant prices.
At the illegal raves there are frequently other risks too, such as small or
locked exit doors and poor fire access.

Instead of closing clubs where drugs are being used, 'harm reduction'
policies accept that people are going to take drugs, and that what is
important is to reduce the risk of harm. Dr. Newcombe of Manchester
University has been one of the main protagonists of this idea, and the
policy is now widely accepted by many people working in the field. Dr.
Newcombe offers courses on harm reduction including one related to Ecstasy
use119; under the name The Rave Research Bureau, he offers a consultancy
service to club owners who wish to have their premises monitored.120
Many club owners are becoming more responsible40 and some even employ
people to look after ravers who have problems.118, 121 However, at one
event I attended in 1993 in London the water had been cut off to all the
wash basins in the toilets and tap water was being sold at #2.50 a bottle;
at another, an illegal rave under a railway arch, there was only one
unlocked narrow exit for over a thousand people.

Safer dancing in Manchester

In Manchester, however, evidence of sharp practices on the part of a number
of night clubs has triggered the beginnings of a consensus that
harm-reduction is the way forward. Tony Cross, press officer for Manchester
City Council, said: "We had confidential information that a number of clubs
were turning off the cold water supply; charging #1.50p for a glass of
water; turning up the heating and switching off the air conditioning. A
couple of clubs were doing it every weekend". In neighbouring Bolton, a
club called the Pleasure Dome which deliberately switched off its water
supply on rave nights achieved notoriety when the local paper reported that
"drug crazed" girls had been seen drinking from toilets and was forced to
close in 1992.

Local authorities have responsibility under the law for issuing and
withdrawing clubs' entertainment licenses and ensuring that their premises
are safe. Manchester's response, following advice from Dr. Russell
Newcombe, of Manchester University's department of social policy and social
work, was to introduce a code of conduct which clubs have to conform to as
a condition of retaining their licences. A minimum code of conduct,
announced in December 1992 with the launch of the "Safer Dancing Campaign",
will be followed in 1993 by more detailed requirements.

The minimum code requires clubs to do the following:

1. monitor air temperature and air quality at regular intervals throughout
their premises and improve methods of ventilation if necessary;

2. provide adequate facilities for "chilling out" such as a room with a
quieter and cooler atmosphere and comfortable seating;

3. ensure that cold tap water is available in toilets and provide free
water at bars;

4. provide customers with up-to-date information about the risk of drug
use; how to avoid overheating and where confidential advice and help can be
obtained;

5. employ outreach workers to operate on site offering confidential advice,
first aid, and a referral service for customers.

There are about seven clubs in Manchester involved in the rave scene and
the council is concentrating on these in promoting and following up the new
policy. It met with the club owners in March 1993 to discuss the
implications of the minimum code and, in conjunction with the non-statutory
drug agency Lifeline, it has produced a series of educational posters about
E that have been sent to all Manchester nightclubs. By February 1993, one
club had been found - by a Lifeline volunteer - to have broken the code by
switching off its water. "An enforcement officer will visit that club to
review the situation; we will threaten to revoke their entertainment
licence and we could then do so," Mr. Cross said. However, Lifeline
researchers say that other clubs, notably The Pier in Wigan and The
Hacienda in Manchester, have been exemplary in introducing a wider range of
safety measures than required by the code. Meanwhile new clubs such as The
Parliament in Manchester provide even better facilities than the code
demands.

The council is also taking advice from Dr. Newcombe on what to include in
the extended code of conduct. He has suggested more stringent steps such as
requiring all clubs to cooperate fully with police drug squads and assist
with surveillance operations and intelligence; stationing security staff in
areas where drug dealing takes place; altering the internal structure of
clubs to aid surveillance and keeping a log of all incidents of violence,
drug use, drug dealing and other criminal acts.

The policy has aroused great interest from other authorities, private
individuals around Britain reporting similar sharp practices and the
Institute of Environmental Health Officers. It is likely to become the
model for authorities covering other centres of the rave scene.

14	Conclusion

There are several very different uses of Ecstasy: spiritual enlightenment,
psychotherapy, use in rituals and artistic expression, empathy with others
and for fun. The effects of the drug sometimes appear contradictory when
described by different categories of users. This is because the drug does
not produce any given effect, but rather allows the user to go further in
their own direction. It does this by its unique but subtle combination of
effects: dissolving fear, while simultaneously relaxing and stimulating. I
have always thought that ritual, religious experience and group elation
were valuable experiences missing from our sterile society, and I can
believe that raves fill the void. They provide a taste of a richness
lacking in normal life.122

Ecstasy and its effects are an important part of life for a large
proportion of people in Britain, and increasingly other parts of the world,
today. The establishment and the media have responded by trying to prevent
Ecstasy use by means of scare stories and heavy legal penalties, with very
little attempt to understand the attraction of the drug or to provide
genuine help and information. This has had the result of making Ecstasy
users lose respect for the media. There is a need for the media to report
honestly about illicit drug use, and this requires telling the whole truth.
There is no justification that I can see for the law preventing willing,
informed adults from consuming whatever they want to. However, even those
against legalization should support the reclassification of MDMA. The law
gives the wrong message by including MDMA among the most dangerous drugs,
discrediting the Class A category. Once having taken MDMA and found it to
be fun and not harmful, users are more likely to go on to try other Class A
drugs such as crack cocaine. The law should be changed to put MDMA in the
same category as cannabis.

There has been a disgraceful disregard of human life on the part of the
media and authorities who have been using rave deaths as ammunition for the
scare campaign against Ecstasy rather than informing users how to take
steps to prevent overheating. Manchester's lead in harm reduction policies
should be welcomed enthusiastically and similar policies should be adopted
throughout Britain without delay.

The police should change their tactics. Instead of trying to prevent people
using the Ecstasy by arresting users and user-dealers, they should
concentrate on eliminating violent criminals and protecting ravers from
exploitation. They should not tolerate the organised gangs who operate at
raves and clubs. These are liable to use violence and are obviously much
tougher to deal with than user-dealers, but for this very reason they
should be eliminated. The police should also help implement harm prevention
in areas where such policies have been made law.

MDMA appears to have great potential for use in psychotherapy, but this
requires further exploration. As a signatory to the Convention on
Psychotropic Substances, the government should act on the Expert
Committee's recommendation to facilitate research into the therapeutic use
of MDMA.