One should start by putting things in perspective. The following background is necessary not only for all studies of psychoactive drugs, but for all studies of human behavior.
There were about 400,000 USA deaths due to tobacco, 100,000 each to alcohol and prescription drugs and about 7600 to aspirin and other OTC painkillers. Worldwide we can expect that the figures will be about 10 million for tobacco, 2.5 million each for others and about 200,000 for aspirin and OTC painkillers. There may be 1 million people in the world with fetal alcohol syndrome(severe brain damage due to maternal drinking) and it is the leading cause of mental retardation in most countries. There are also at least 15 million people who have fetal alcohol effect(lesser degrees of brain damage) with about 200,000 born every year. I suspect this is a gross underestimate.
None of the psychedelics nor cannabis are known to produce fetal injury when taken in normal amounts. All things considered, if you calculated the lifetime risks of death or injury from taking ecstasy, it is probably comparable to that of driving ten km and significantly less than that of putting on a pair of skis.
In addition, the young people who comprise the vast majority of the users are heavy risk takers, a very percentage of whom have personality disorders. There are about 60 million schizophrenics and the same number of manic depressives in the world. When you add the depressives, schizotypal disorders, anorexics, alcoholics etc it is clear that perhaps a billion people have major mental problems, nearly half of all those are in the prime drug taking ages. In addition nearly all of us have periodic mood swings, medical problems and personal crises.
Based on various data in this book and elsewhere, it appears that about 20 million people will take something like 200 million pills of ecstasy each year. In 1998 there were about 9 deaths POSSIBLY connected with ecstasy in the USA. These seem to actually be due to drinking too much or too little water and likely to taking large amounts of other drugs or alcohol. Ecstasy deaths(like those for marijuana and other psychedelics) are extremely rare and seldom if ever due to the direct toxicity--the psychedelics having some the widest margins between the effective and the toxic doses of any drugs in medicine.
The fact is there was enough data to prove the psychedelics were safe and therapeutically effective 25 years ago. If they were available OTC or perhaps even on prescription with the same general indications as say, antibiotics, the black market and adulterated drugs would quickly fade away.
It is not clear that anyone has ever had serious permanent mental problems due to taking ecstasy(though they often have serious permanent benefits) and its potential as a therapeutic agent are enormous. It has a long and remarkable history as a highly effective and safe therapeutic adjunct. Nevertheless, as with many other psychedelic drugs, the federal government has chosen to ignore medical advice and legal opinion and classify it with heroin as a Schedule 1 drug with no recognized medical value and the governments of many other countries have followed along like trained dogs.
This book aims to provide accurate information on all aspects of MDMA(ecstasy) and it accomplishes this quite well.
The authors mostly try very hard to be fair and balanced in their approaches and are mostly experts in the field. They caution about the difficulty of applying the data on animals to humans but they often do not go far enough in emphasizing the probable irrelevance of the animal data to humans. E.G., in the chapter on risks, not only do most of the animals get large amounts intravenously, but there are no good control data. We need to see what happens with the same animals with the same routes and relative doses with a variety of commonly used medicines(eg, antidepressants, mood elevators, asthmatics, appetite depressants, cold medicines, OTC pain pills etc etc. Will they, as one suspects, show similar changes in their brain chemistry, memory, blood flow etc? Nobody knows as the government sponsored studies almost never test them. We can only guess from scattered data in other studies which often show the same kinds of changes. Consequently, if we applied the same criteria used for Prozac, Elavil, aspirin etc we would either have to outlaw nearly all the drugs in current medical use or legalize all the psychedelics. However the government has no interest in being rational, fair or even sane and certainly none in allowing us the freedoms supposedly guaranteed by the Consititution, and the Bill of Rights.
Wantly badly to err on the side of caution, several of the authors repeatedly warn(eg, p111) of the possibility of subtle long term damage yet they seem unconcerned by some half century of massive long term use of antidepressants, amphetamines, etc to say nothing of alcohol, caffeine and nicotine. And only one bothers to mention(p 139) that a half century of studies on chronic users(often intravenous and multidrug abusers) of the closely related amphetamine and methamphetamine have failed to show evidence of Parkinsonism. And let us keep in mind that about 99% of all the MDMA fans use it only a few times in their lives in low oral doses. The same is true of most other psychedelics and so it seems likely that the only long term behavioural effects in the vast majority of users will be some increase in insight, less rigid personalities, broader interests in art, music, religion and a generally happier life.
The young people who comprise the vast majority of the users are heavy risk takers, a very high percentage of whom have personality disorders. There are about 60 million schizophrenics and the same number of manic depressives in the world. When you add the depressives, schizotypal disorders, anorexics, alcholics etc it is clear that perhaps a billion people have major mental problems - nearly half of all those are in the prime drug taking ages. In addition nearly all of us have periodic mood swings, medical problems and personal crises. In addition as some of the authors note (and as Holland often interjects in her editoral notes) the ecstasy users are usually taking other drugs before, during and after their ecstasy(and marijuana and other psychedelic experiences). These include, almost universally, alcohol, tobacco and caffeine(which are almost always ignored) as well as cocaine, amphetamine and methamphetamine, ketamine, dextromethorphan, asthmatics, and a wide variety or uppers, downers and prescription mood altering agents including birth control pills and Viagra, to say nothing of the steroids now approaching universal use in professional athletes in all sports(no the new ones cannot generally be detected). Yet as Holland and others note, these other drugs are usually not mentioned and a really good drug screen on the users appearing in clinics or used in studies is seldom done. The point of all this is that the claim that ecstasy is dangerous is not correct(and other psychedelics are mostly the same). It's probable that skiing kills and injures more people in one season(most in car accidents!) or tobacco or alcohol in one day, than all psychedelics combined have done since the beginning of recorded history. Thus the demonizing of them does not correspond with reality. In fact since more than 99% of all media on MDMA is negative it would be reasonable and desireable to remove all the comments on possible negative effects from this book and publish it as MDMA: miracle medicine for the 21st century!
Billions of dollars have been spent on studies ánd programs aimed at showing that psychedelics are bad and almost nothing on their many positive effects. In fact most of the world has(naturally) followed the poorly educated, deeply repressed, conservative Christians who control the US Govt. in outlawing, for over 30 years, any medical use and any research that might show benefits! The vast amount of practical experience with their benefits cannot even be published and the tens(maybe hundreds) of millions who have had major positive experiences cannot talk about them. Its clear as day that the only serious problem with ecstasy is that it is new and it triggers the control and maybe the contamination templates in the monkey mind.
The evidence presented here shows that MDMA is very safe, rarely illusionogenic(though most authors follow the common practice of calling visual effects hallucinations, which they defintely are not). Hallucinations-eg, seeing and hearing persons who are not there- are characteristic of schizophrenia, toxic psychoses, belladonoids(eg datura), and dissociative anesthethics(PCP, ketamine). They are so rare with psychedelics that one suspects that nearly all such cases are due to preexisting psychosis. MDMA probably belongs(with a variety of other drugs invented by Shulgin) in a new class called entactogens. These are unique in that in addition to catalyzing positive emotions and bonding, they are rapidly acting, nonsedating anxiolytics(decrease anxiety), anaesthetics(pain killers) and antidepressants(which take days or weeks to act in comparison with minutes for MDMA!) with remarkably few and mild side effects(in dramatic contrast with nearly all medical drugs which have severe side effects that are often fatal).
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