As a loyal soldier in the government's drug war, National Institute on Drug Abuse (NIDA) Director Dr. Alan Leshner has done his very best to scare the bejesus out of past, current, and potential MDMA (ecstasy) users. Leshner's efforts are part and parcel of the federal government's campaign to stir up panic about the feel-good drug's growing popularity. For example, Leshner is the man seemingly glued to the infamous, lurid "before and after" brain scan image of an Ecstasy user now widely reproduced on postcards, flyers and various government anti-drug web sites.
Never mind that, as reported in the British medical journal Lancet in 1998, the image comes from the brain of a long-term poly-drug user who took ecstasy hundreds of times, hardly the profile of the typical ecstasy user. As the federal government confronts rising ecstasy use, its response has been to wage war on the substance and its consumers, and if science must bow before the imperatives of future victory, so be it.
Leshner also organized last month's "MDMA/Ecstasy Research: Advances, Challenges, Future Directions" conference, held at NIDA on July 19 and 20. As assiduously as Leshner had stacked the scientific deck, however, he can't have been too pleased with the way the conference played out, nor the coverage it got. At the conference itself, speaker after expert speaker who actually studied real human behavior (as opposed to rats or serotonin receptors, for example) got up to denounce NIDA's and the federal drug control bureaucracy's effort to repress and demonize the drug out of existence. Instead of focusing on punishment and eradication, the social scientists said, authorities should undertake harm reduction measures that recognize ecstasy's popular acceptance.
And the only coverage the conference got was a critical op-ed piece by The Lindesmith Center-Drug Policy Foundation's Marsha Rosenbaum that appeared in San Francisco and San Diego newspapers, and a report in the Journal of the American Medical Association titled "Ecstasy Experts Want Realistic Messages." The JAMA article detailed the harm reduction stance of the social scientists but failed to even mention the clinical and neurological research presented.
It wasn't supposed to be that way. From the get-go, the conference was explicitly designed to focus on the "pathologies" of MDMA. No advocates of the drug's therapeutic uses were invited to present evidence, and the social scientists, tucked away in one session, were so effectively quarantined that Rosenbaum failed to notice them. NIDA advertised the conference as focused on "Ecstasy-induced risk behaviors, long-term behavioral consequences, cardiovascular and brain toxicology, drug interactions, patterns of abuse, perceptions of risk, and implications for prevention and treatment research."
Leshner himself set the conference's agenda in his welcome to the delegates. "The latest research shows that Ecstasy, despite its name, is not a harmless 'party' drug. In the short term, Ecstasy can cause dramatic changes in heart rate and blood pressure, dehydration, and a potentially life-threatening increase in body temperature," he said. "In the longer term, research shows that Ecstasy can cause lasting changes in the brain's chemical systems that control mood and memory. This conference provides us with an important opportunity to examine the latest scientific findings on Ecstasy and identify areas requiring additional research."
The conference indeed provided numerous studies along the lines of "Degeneration in Brain Following Binge Stimulants: All Dopaminergics Induce Degeneration in Fasciculus Retroflexus, but MDMA Also Includes Degeneration in Oral Pontine Serotonin Terminals" and "Are the Psychological Problems Associated With Regular MDMA Use Reversed by Prolonged Abstinence?" As Rosenbaum noted in her op-ed piece, however, the demonstration of actual harms to actual human functioning from ecstasy was lacking. "Claims of brain damage that fuel the government's 'Just Say No' message dominated," wrote Rosenbaum, "but the bulk of evidence at the conference produced far more questions than answers. The single most consistent message coming out of the research was that we need much more research," she noted. (Rosenbaum gracefully failed to note the utter predictability of that message.)
But a handful of researchers, including anthropologist Robert Carlson, social epidemiologist Patricia Case, and anthropologist-sociologist Claire Sterk, all of whom reported on field studies of ecstasy users, urged authorities to undertake harm reduction measures for ecstasy users. The researchers told their audience such measures should include providing water at raves, offering drug purity-testing to avoid contaminants and substitute drugs, and encouraging peer-led education programs.
"A lot of [ecstasy users] make clear decisions, despite the known or unknown risks, that the benefits outweigh those risks," said Case, the director of Harvard University's urban health program, who spent hundreds of hours researching drug use among New York City's gay community.
Carlson said that exaggerated anti-drug messages such as the before and after brain scan image do not work, and suggested less extreme education and prevention campaigns. "Ecstasy is seen as relatively benign," said Carlson, an addiction researcher at Wright State University in Dayton, Ohio. "Prevention messages are not getting across, and something needs to be done," he said.
"We need to stop exaggerating the negative consequences and stop using extreme cases," said Sterk. "I'm not saying there aren't consequences, I am saying we don't know what they are." Sterk, a professor of behavioral sciences at Emory University's Rollins School of Public Health had an idea that would drive Leshner wild. "We'd be better off having a campaign poster that says, 'Ecstasy can make you feel really good. It increases your sensory awareness. It makes you feel music.' It's okay to acknowledge that," said Sterk, "and then have a big comma and say, 'but there are consequences.'"
"We know people will continue to use," Sterk continued. "What we can do right away is come up with appropriate, targeted messages to reduce the risk."
(Visit http://www.nida.nih.gov/Meetings/MDMA/MDMAIndex.html to read the conference agenda, as well as research abstracts and biographies.)