JUST SAY MAYBE

Can Ecstasy Replace Xanax?

A new study urges trials of MDMA to treat anxiety in autistic adults, and it's already being tested for PTSD. Is America ready to embrace Molly?

05.30.15 10:45 AM ET

In 1980, “Ecstasy” was “Empathy.”

That was one of the original street names for MDMA, now better known as Molly, and it speaks volumes about what the drug actually does: by increasing the amount of serotonin in the bloodstream, it acts like a turbo-charged SSRI (the leading form of antidepressant). Sure, it makes you feel happy—but equally important to its devotees, it makes you feel open.

Now, science is catching up. A study published this week in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry is part of a spate of research arguing that MDMA could have psychotherapeutic benefits: this time, to treat symptoms of social anxiety, particularly in autistic adults.

To longtime friends of Molly, this is about as revelatory as learning that a gin and tonic can relieve social anxiety. But this latest study is part of a larger trend that may mark a turning point in our culture’s relationship to this particular substance.

Consider: the data on marijuana (and two generations’ longtime familiarity with it) has helped mainstream culture evolve from Reefer Madness and “Just Say No” to medical marijuana in 23 states and recreational marijuana in Colorado. Will Molly be next?

Conceivably—though there are some important differences.

First, the scientific evidence is encouraging but early. MDMA was first synthesized by Merck in 1912, but had little commercial use, and apart from a 1950s U.S. military experiment, lay dormant until it was “rediscovered” by psychedelic pioneer Alexander Shulgin around 1970. Fascinatingly, therapists and psychiatrists explored the therapeutic use of the drug, but tried to keep its existence under wraps, fearing it would be banned. As indeed it was, in 1986.

That led to twenty years of scientific silence—apart from a handful of poor experiments whose results were widely exaggerated by Drug Warrors, as the new study also describes—while MDMA exploded in popularity, as Ecstasy.. Only it wasn’t really MDMA; in 2007, an analysis of drug shipments showed that only 3 percent of U.S. Ecstasy tablets were pure MDMA.

The doors began to creak open in the late 2000s. By now, MDMA has been administered to over 1,100 individuals in clinical trials, with no serious adverse effects. As legalization activists have long insisted, it seems as though most of the problems with Molly come from impurities, overuse (especially in combination with other drugs), and what aficionados would call bad “set and setting,” like overcrowded dance clubs, dumb frat boys, and plain old bad ideas.

Further, the paper’s abstract notes that “As in the case with classic hallucinogens and other psychedelic drugs, MDMA catalyzes shifts toward openness and introspection that do not require ongoing administration to achieve lasting benefits. This infrequent dosing mitigates adverse event frequency and improves the risk/benefit ratio of MDMA, which may provide a significant advantage over medications that require daily dosing.”

In other words, unlike Zoloft or Celexa or Abilify, you don’t need to take MDMA every day in order to experience the benefits. Thus, potential long-term risks—in extremely high doses over long periods of time, MDMA can cause brain lesions—are significantly mitigated.

That’s just the negative case, of course: MDMA appears not to be harmful in moderate, pure doses. What about the positive case?

Well, here’s where the “early” part comes in. Contrary to a raft of misleading media reports, the new study does not say that Molly is good for you. Its only goal is to “provide an overview of the rationale and to summarize the method for a pilot study.” It is a powerful refutation of some of the myths and exaggerations widely spread about MDMA, but it’s only calling for a study; it’s not the study itself.

To be sure, the researchers at the Los Angeles Biomedical Research Institute, affiliated with UCLA, do summarize the positive findings of animal experiments and the 28 studies of how MDMA works in the brain and body. But most of these are not clinical studies; they are neuropsychological ones. They also note that, thanks to the Internet, some autistic adults with social anxiety have already reported on their experiences with MDMA. In 2013, a graduate student surveyed this population, and 91 percent of respondents reported that they experienced “Increased Feelings of Empathy/Connectedness.”

That is truly impressive—but not the same as a clinical trial. Misleading media headlines like “MDMA in Ecstasy May Soon Be a Treatment for Social Anxiety and Autism” actually make matters worse, confusing the public into thinking that scientific opinion is far ahead of where it actually is.

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In fact, the most promising clinical research is investigating MDMA’s effect on Post-Traumatic Stress Disorder (PTSD). Based on two successful studies in Germany and Switzerland, four pilot studies are now underway, exploring whether MDMA can help veterans and police officers cope with PTSD.

If those studies return positive results, then, indeed, MDMA starts to look a lot more like medicinal marijuana: a matter of compassion, not kicks.

Still, there are important differences.

In addition to the much younger state of the research field, it’s important to note that MDMA’s purported benefits are psychological, not physical. (Technically, pain is a mental phenomenon too, but marijuana’s medical benefits are not emotional or psychotherapeutic.) This makes the case a little slipperier, since cognitive benefits seem closer to mood alteration which seems closer to drug use.

It also raises the specter of over-medicalization—as we reported last November, the anti-psychotic drug Abilify is now widely used for depression, even though the FDA says the way it works is unknown.

Of course, those of a conspiratorial bent would note that Abilify (annual sales: $6.9 billion) is the patented property of a large pharmaceutical company, whereas MDMA is not. The FDA does seem to treat drugs differently depending on who stands to make a billion dollars one way or the other.

Finally, Molly is a more powerful drug than marijuana. It’s nowhere near as psychologically destabilizing as LSD or mescaline, or as addictive as cocaine or heroin, but still, a roll is not a joint. It lasts longer, can affect perception more, and is highly concentrated. It’s also not as familiar, at least not to Baby Boomers. It’s easy to see Molly remaining viewed as a party drug even as pot brownies are baked in suburban kitchens.

Which is probably the real issue. Let’s face it: the supposed health risks of MDMA are not the reasons why people fret about Molly. That G&T is far more dangerous, both to your liver and to your fellow motor vehicle drivers. Nor are we really talking about “the children,” who are at far greater risks than this one.

No, people worry about Molly because it’s too much fun. Just like cannabis, MDMA is part of the unholy trinity of sex, drugs, and rock & roll (EDM, in Molly’s case). Underneath the pseudo-scientific hand-waving is an old fashioned conservative fear of sin. Or, as we might call it, fun.

That’s why these new and proposed studies are so important. In the same way that the face of marijuana legalization has become less Cheech & Chong and more Grandmas with Glaucoma, the poster children for MDMA legalization will not be ravers, but vets healing from trauma.

As a society, we still seem unable to let people alter their minds however they wish. But we have shown a willingness to help people heal. So remember, before MDMA was Ecstasy, it was Empathy.