E is for Ecstasy by Nicholas Saunders

Appendix 1: Reference Section

1 Report of US Army tests on MDMA, from Rick Doblin president of the Multi-disciplinary Association for Psychedelic Studies in the U.S.

In the 1950's, MDMA was one of the analogs of MDA that were given to animals by the U.S. army at the Edgwood Arsenal, which was then investigating drugs for use in chemical warfare. There is no evidence in the public domain to indicate that MDMA, which was code named EA-1475 (Experimental Agent 1475), was ever given to humans or was tried as a truth serum.

2 PIHKAL (Phenethylamines I Have Known And Loved); A Chemical Love Story (book), by Alexander and Ann Shulgin. Published by Transform Press (Berkeley USA) at $18.95. Available from Compendium Bookshop, London

Shulgin describes himself as the stepfather of MDMA if not the inventor. "I made it in my lab [in 1965] and nibbled. It gave me a pleasant lightness of spirit. That's all. No psychedelic effects whatsoever. . . Just a distinct lightness of mood. And an indication to get busy and do things that needed doing," he recounts. Shulgin gave MDMA to a psychologist on the verge of retiring, who postponed his retirement and spent the next seven years training several thousand people, mostly therapists, to use it. Several methods of synthesising MDMA are given in detail.

The following is a review of PIHKAL that I wrote for the journal Social Inventions:

Whether you approve or not, the widespread use of drugs that alter consciousness has had a lasting effect on society - the sixties use of psychedelics not only gave birth to new fashions in music and clothing, but a change of values which resulted in today's concern with the environment and personal development. Now it is said that football violence is being replaced by a new culture, one where blows give way to hugs, due to the drug Ecstasy. This book reveals the origin and motives for designing many mind-altering drugs.

A giant chemical company takes on a brilliant young research chemist who immediately invents a profitable new insecticide. The company rewards him with his own lab and a free hand, but instead of further profitable inventions they are embarrassed to find themselves patenting more and more psychedelic drugs - including the infamous STP which had ravers raving uncontrollably for days. The chemist quits just before being sacked and sets up his own lab in a shed behind his house where he quietly carries on synthesising more and more new mind-bending drugs - meanwhile making a living (and no doubt earning immunity from prosecution) by working as a consultant helping the police to convict drug dealers. This delicate balance could be upset by his retirement, so before the authorities have a chance to suppress his life's work he publishes every detail of how to make hundreds of psychoactive drugs from available ingredients . . .

A far fetched plot? No, this is an autobiography of a man who, long before the Sixties, was fascinated by the possibility of using consciousness-changing chemicals as tools for the study of the mind and the treatment of mental disorders. His company provides him with the equipment complete with the means of testing the products: fighting fish whose behaviour is supposed to alter on psychedelic drugs. But there are problems: fish don't say when they are under the influence and, well, have you ever seen a fish that doesn't look stoned? To ensure a clear view of the fish, snails are brought in to keep the glass clean, but they invade the laboratory . . . There's an easier way to find out the effect of a drug: suck it and see.

In all, Alexander Shulgin describes the synthesis of 179 drugs and their effects. He starts out by taking a minute dose himself which he gradually increases until something happens, and if that is interesting without being awful he tries it out on his wife and then on his research group. This consists of about a dozen friends who meet about once a month for a weekend house party, when they all take the same drug together and report on the effects:

. . . It is now (0:00) hour of the experiment.

(0:50) Warmth in lower legs.

(1:10) Walked out to the highway for the mail.

(1:35) Warm all over. Effects developing nicely.

(1:50) Very real effect! Quite nice. No sense modality emphasised. Not yet, anyway.

(2:30) Sat outside and got the concrete bag to float above the ground for a moment [this was a bag of Portland cement with a logo on it that showed a bulging bicep]. Man on sack - Act of Power - but the act is not told, or it would only be a Tale of Power. Or at best, a Tale of an Act of Power. An Act cannot be saved, relived - only the Tale persists. The Act is past.

(2.33) How long does it take to assimilate an act? The act itself, an augenblick [quick glance], is like a drug effect, in that to assimilate it is to recall the wave of concepts that flooded over you. They must be sifted, reconstructed, as best as can be done from memory. . . Go through - don't just look through. Life is like a Tale of Power; to go through is an Act of Power. . . I am being invaded with 'concepts' which are coming too rapidly to write down. This is not a verbal material, ergo, tales cannot be told. . .

(2.45) Theo came over to the lab, and for a few moments we discuss the problems associated with vacuum pumps. It was a laborious exchange of words when what was needed was an exchange of concepts. I knew immediately what I wanted to impart, and was terribly impatient and not too sociable. . .

This makes fascinating reading and forms the core of the book, freely written in the form of an autobiography. Then comes his wife's story, delightfully written with her secret thoughts in italics, more concerned with their relationship than drugs:

Shura was smiling, "Do I detect a bit of disappointment?"

"Oh, of course you detect disappointment. It would be nice to keep this going for a lot longer."

"I'm glad it's been a good experience for you. Very glad."

He means it, he really is pleased. I wonder how much of the pleasure is because he cares for me or because he believes this stuff is good and wants it to be good for everyone. Maybe a bit of both. Doesn't matter.

Finally there are 500 pages of recipes telling precisely how to make the drugs and what effect they have - which will disappoint any would-be DIY drug maker as only a well equipped chemist could follow the instructions. The fact that he has reached retiring age in one piece is testament to his assertion that these types of drug are not physically addictive and only temporarily alter the state of one's consciousness. He is fortunate: some of the drugs mentioned have been available on the black market and have had disastrous effects, even resulting in death. He may well be accused of giving a dangerously unbalanced view by omitting to mention the known damaging effects of the drugs.

The book is delightfully readable throughout - even in the chemical synthesis section there are amusing asides such as that adding a certain chemical group makes no difference to the effect of a drug and so would enable pirate drug companies to get round patents. But the most disappointing aspect is that a lifetime's devotion to finding new and better psychedelics failed to produce the ultimate drug for self-realisation or a cure for mental illness. And though the descriptions of the drug effects are fascinating reminders of what many experienced in the sixties, they fail to break new ground.

3 Ecstasy the gentle mind bender? by Nicholas Albery, The Guardian 10/88

The San Franciso psychotherapist Dr. Philip Wolfson is quoted: "If a substance is desired by a human being, it is taboo to the psychiatric and governmental bureaucrats." He believes in its potential for therapeutic use: "No new clinical agent of importance has been placed in psychiatry's hands since the introduction of haloperidol almost twenty years ago." Albery also quotes the radical psychotherapist RD Laing as saying: "It made me feel how all of us would like to feel anyway," and says that an investigation into how MDMA acts toxically is being conducted by Dr. David Nichols at Purdue University, Indiana.

4 Meetings at the Edge with Adam: A Man for All Seasons? by Philip Wolfson from Journal of Psychoactive Drugs Vol. 18/4 1986

Wolfson introduces himself as an established psychotherapist who has been passionately involved with people experiencing painful altered states of consciousness for many years. He says that MDMA, when used as an adjunct to psychotherapy, opens up new possibilities for treatment of such cases.

To demonstrate the usefulness and limitations of MDMA, he cites the example of a man in his early fifties with a long-standing depression who saw himself as emotionally incompetent. The man was married with an adult son who suffered from severe paranoia, and the family spared no expense and effort in seeking a cure. The son's paranoia brought up old, unresolved differences between the parents, with the wife blaming her husband for their son's condition; soon they were constantly at each other's throats. At this point Wolfson decided to give MDMA to all three in order to lower their defensiveness and encourage them to communicate frankly and be sensitive to each other's feelings. This had a profound effect on the wife and son, making them close again but, shortly afterwards, the son reacted by distancing himself. After a second session the son felt he could see the way out of his psychological illness, but in fact he got worse and was hospitalised. The parents continued taking MDMA as part of ongoing psychotherapy. There were periods full of the glow of hope, and the husband had moments of relief from his depression, but these were interspersed by disappointments as deeper problems between the couple surfaced. Overall, Wolfson felt that gradual but definite progress had been made in unravelling the problems of all three. Nevertheless, the man came to the conclusion that the MDMA had "lied".

To explain this reaction, Wolfson asserts that MDMA can open people up and allow them to experience breakthroughs, but that these breakthroughs are temporary unless they are consolidated. It is the disappointment of a temporary breakthrough that may lead to a client feeling that the drug has "lied".

Wolfson says: "The fundamental truth is that MDMA provides in its totality unprecedented access to an experience that human beings value and may wish to have an opportunity to repeat at a future date. The second part of this truth is the almost uniform observation that those who have had the MDMA experience wish to share it with others and believe it has the power to alter lives, and even societies, positively. . . This is the completion of the fundamental truth: There are almost no critics of the experience itself. The stories told are of a compassionate evaluation of the self and others with a shift to a more positive outlook and behaviour". However, he warns of the following potential hazards: (1) Severe and potentially fatal reactions can occur unpredictably on occasions. (2) Seizures are said to have occurred. (3) MDMA may reduce resistance to infection. (4) MDMA causes increase in blood pressure. (5) A variety of short-term reactions may occur, sometimes persisting or recurring for several months, including anxiety and insomnia. A client's judgment can be interfered with by their heightened sense of excitement under MDMA. (6) MDMA has no established safety record - the necessary experiments have not been made.

He says that MDMA is unique because: 1. It offers a rapid and significant break with people's defence structures. 2. It can facilitate a shift from a state of self-hatred to one of love of self and others. 3. It encourages people to shift from isolation to contact and intimacy and from withholding to giving. 4. When MDMA has given them a more positive attitude, people find it easier to make decisions.

5 Ecstasy: The MDMA Story, by Bruce Eisner (book) published by Ronin Publishing Inc., PO Box 1035, Berkeley, CA 94701, USA. [new edition due out 1993]. My review of this book for International Journal on Drug Policy is reprinted here

English readers who assume this to be a book about the pills kids swallow by the million at raves will be disappointed - raves are not even mentioned. It is about Ecstasy use in a completely different (Californian) culture; one where people get into their feelings. The drug is the same chemically but the way it is used and its observed effects are barely comparable.

An Ecstasy session requires "careful planning and both physical and mental preparation are important . . .The experience is something like a retreat. The MDMA experience is neither trivial nor casual. It can be a life-transforming experience. . . The first and most important question to be answered is, 'Why do I want to take MDMA at this point in my life'." A typical session would be one person alone with a guide (a friend who has experienced the drug) acting as an helper or therapist. Choose a calm, comfortable room free of distractions and disconnect the phone. Bring along some objects of personal significance such as crystals and photos of family members to help trigger childhood memories.

Lying on cushions on the floor with eyes blindfolded, you look inside yourself with a sudden clarity as the drug comes on. Or talk and reveal thoughts that you had even hidden from yourself. "One may have a noetic perception of the world, now viewed in a completely fresh new light". "One suggestion for using the MDMA experience for later benefit is called 'future pacing'. Here you conjure up, while in your alternative state, a mental image of people or situations which you would like to experience in an open and empathic way. Then you construct an image, visual, auditory, and/or kinesthetic, of an experience of being in the MDMA state while with those persons or in that life situation. In the days ahead, your experience of the person or situation focused on might change as a result of this exercise".

Use in formal psychotherapy is mentioned (though this has been illegal since 1968 in the USA), both in group and individual sessions. One effect of the drug is to lower defensiveness so that patients express themselves more openly and honestly, which sometimes facilitates breakthroughs. In groups, participants feel able to express themselves without inhibitions and have empathy for one other [as do participants at raves]. Examples of therapeutic uses are conflict resolution between couples, particularly when intimacy has been lost and the relationship has become estranged over the years; and in cases involving traumas such as rape where the drug helps the patient to regress and to relive suppressed memories.

Also mentioned is low-dosage use for "creativity-enhancement-oriented sessions. . . There are two ways of using MDMA that may help elicit creativity. In the first, the creative task is attempted during the MDMA session. In the second, the MDMA session is used to generate ideas that later may be applied to the creative task". Painting, sculpting, writing and music are suggested for the first, while the second is suggested for overcoming writer's block.

Another section of the book consists of accounts of experiences taken from another book, Through the Gateway of the Heart31. Other chapters deal with the chemistry and toxicity of the drug. Eisner says that no major toxic effects have shown up in clinical trials of MDMA. This presumably applies to the suggested doses of up to 150 mg.

Eisner makes the interesting observation that "MDMA is a peculiar drug in that there is a small ratio between its threshold dose and a dose that is too large. A larger dose than 200 mg will produce an experience that is more like that of amphetamine - a jittery, anxiety-provoking stimulant high".

Finally, the book contains an excellent 50-page annotated bibliography by Alexander Shulgin. However, that like the rest of the book dates from 1989, and four years is a long time in this field. [Alexander Shulgin tells me that the annotated bibliography is to be omitted from the new edition.]

Other information referred to:

High Reliability: Even without prompting as to effects, at least 90% of those who try MDMA experience . . . a 'heart opening' and a lessening of stress and defensiveness . . .

Brother David Steindl-Rast, a Benedictine monk from the Immaculate Heart Hermitage in Big Sur, tried the drug at a conference on the medical uses of MDMA. Steindl-Rast, who was a psychologist before he entered the monastery, said the drug facilitates the search for the "awakened attitude" all minds seek. "It's like climbing all day in the fog and then suddenly, briefly seeing the mountain peak for the first time," he said. "There are no short cuts to the awakened attitude, and it takes daily work and effort. But the drug gives you a vision, a glimpse of what you are seeking.

6 Ecstasy Information, from Release, a London drug agency

According to these notes, it is not correct to call Ecstasy a designer drug. The term was coined by Dr. Gary Henderson of the University of California to mean 'substances where the psychoactive properties of a drug are retained, but the molecular structure has been altered to avoid prosecution'.

7 Xochipilli: a context for Ecstasy, by Laura Fraser, from Whole Earth Review, 1992

The author criticises two journalists at a party who said that Ecstasy causes a loss of spinal fluid and causes Parkinson's disease.

The journalists were grossly misrepresenting two reports. One concerned a study of MDMA by Dr. George Ricaurte at Stanford University, who examined subjects spinal fluid to determine whether there were residual effects of MDMA. No such effects were found. The other was of drug injectors who contracted Parkinson's disease after injecting a synthetic opiate from a bad batch sold on the street that contained the neurotoxin MPTP. Ecstasy was not involved in any way.

The side effects of Ecstasy were mild: perhaps the worst was a tendency to call up ex-lovers and casual acquaintances and tell them how much you love them. It could also induce inappropriate and unintended "emotional-bond imprinting". Fraser advises taking some calcium and magnesium before MDMA to prevent jaw clench and says MDMA should be avoided by those with heart ailments; glaucoma; hypertension; aneurism or a history of strokes, hepatic or renal disorders, diabetes or hypoglycemia.

8 Differences Between the Mechanism of Action of MDMA, MBDB and the Classic Hallucinogens, by David Nichols, from Journal of Psychoactive Drugs, Vol. 18/4 1986

In this paper it is claimed that MDMA is not a hallucinogen and that its classification as a Class One drug, which is based on it being regarded as a hallucinogen, is therefore incorrect. Nichols says that subjective human trials and tests on rats show MDMA does not have psychedelic properties and that it belongs to a new drug category that he calls "entactogens". He synthesised a new drug called MBDB with an added chemical group that cuts out psychedelic effects. It was similar to MDMA in effect but weaker and therefore also belongs to the new category.

9 Why MDMA Should Not Have Been Made Illegal, by Marsha Rosenbaum and Rick Doblin, from the book The Drug Legalisation Debate

In this article it is argued that with many claims of people benefiting from taking MDMA and few reports of the drug causing damage, its use should not have been outlawed in the US. The effect of making MDMA illegal was to curtail scientific research and to stimulate consumer demand for the drug. The article details the way the law was applied: after nearly 2 years of hearings a judge decided that the drug should be placed in Schedule 3, which is for less-dangerous drugs and would have allowed trials and research to continue. But the Drug Enforcement Agency insisted on MDMA being put into Schedule 1 in spite of widespread objections and challenges to the "dubious legality" of this move.

100 MDMA users were interviewed in depth between 1987 and 1989, i.e. after it was made illegal. The article concludes that the law has made no difference to recreational users' attitudes.

10 Alcohol and Drug Research, Volume 7: Neurotoxicity of MDA and MDMA

This paper argues that the dangers associated with MDA should be assumed to apply with MDMA unless it is proved otherwise. Evidence is given of the two drugs having a similar degree of lethality when they are tested on mice, rats, guinea pigs, dogs and monkeys. The tests used involved the classic test for poisons: trying larger and larger doses on groups of animals until 50% of the animals died within 24 hours. The paper also mentions that both MDA and MDMA killed more mice when they were crowded together, "a phenomenon long associated with amphetamine".

11 Ecstasy Revisited, by Bruce Eisner in Gnosis magazine, winter 1993

This article looks back on the research in the US into the neurotoxicity of MDMA. The idea that MDMA might be neurotoxic was first raised in 1985, when George Ricaurte and Charles Shuster at the University of Chicago performed an experiment in which rats were intravenously given very high doses (ten times the therapeutic dose) of MDA, a drug similar to MDMA, at four hourly intervals over two days. Changes were noted in the nerve terminals where serotonin interfaced with brain neurons, Eisner says. The US Drug Enforcement Agency used this as a pretext for putting MDMA in Schedule 1, the category for the most dangerous drug

12 The Background Chemistry of MDMA, by Alexander Shulgin, from Journal of Psychoactive Drugs, Vol. 18/4 1986

According to this paper, MDMA is less toxic than MDA but more so than mescaline. The lethal dose is between 20 and 100 mg per kilo of body weight depending on the species taking it. With mice, it is 5 times more toxic given in crowded conditions than in isolation. [20mg/kg is equivalent to an adult human taking about 12 Es.]

Shulgin says that research implies some functional role of serotonin in the mechanism of MDMA and that there is evidence that MDA and MDMA have different mechanisms of action. For example there is no cross-tolerance between the two drugs.

He notes that two studies commissioned by the US government on the abuse potential of MDMA showed that monkeys that had been trained to self-administer cocaine tended to "reinforce themselves with MDMA", indicating that MDMA has potential for abuse by hard-drug addicts. But he also points out that press reports and anti-drug usage material often [falsely] attribute to MDMA the effects and dangers of other drugs and that reporters repeat each others' mistakes.

13 Ecstasy, by Miranda Sawer, from Select, July 1992

A long article about the current club scene and Ecstasy users going on to more reliable drugs because of poor quality E. Sawer says that those who used to take multiple Es are now turning to amphetamine instead since the effect is much the same. She gives analyses of 7 samples which were mostly heavily adulterated. "Fantasy" Ecstasy contained 40% LSD, 30% amphetamine and 15% caffeine. "Passion" Ecstasy contained 60% sedative and 15% MDMA. "Californian Sunset" Ecstasy contained 20% amphetamine and 20% sedative. "Rhubarb and Custard" Ecstasy contained 50% barbiturate, 30% MDMA and 20% caffeine. 3 other samples contained no active ingredient at all. She quotes Andrew Bennett, of the Merseyside Drugs, Training and Information Centre, as saying that Merseyside has 20,000 serious abusers, i.e. people who take more than one E a week, and 30,000 who take one at weekends; and Mike Goodman of the London drug agency Release: "Ecstasy should not be a Class 1 drug in the same league as heroin with severe penalties. If you treat people like criminals, they are going to act like them"

14 Interview with Greg Poulter, advice team leader at Release, a London information agency for drug users, on 16/2/93

In the 1970s there was a scare in Britain about hallucinogenic amphetamines before they had even reached the country. The Government responded by classifying the entire chemical family as Class A drugs, before any other country had done so. The Home Office can issue licenses for research into MDMA. There is no pressure group lobbying to liberalise the law on MDMA, as there has been for cannabis.

The maximum penalty in a Crown court for possession of MDMA is 7 years and/or an unlimited fine. For supply of MDMA, the penalties in a Crown court, where such cases are normally heard, can stretch to life imprisonment, an unlimited fine and the seizure of all assets.

In line with Scotland's distinct legal system, the law on MDMA is applied differently there to the rest of Britain. In Scotland, anyone found in possession of MDMA is prosecuted, even if they only have very small quantities. But in England and Wales, and especially in London, the trend is towards cautioning. There is a big difference between 'possession' and 'supply' in the kind and severity of penalties imposed, but no fixed cut off point. People found in possession of only one E have been prosecuted for supply, on the strength of other evidence that they were dealers. Magistrates courts normally deal with possession cases. The usual fine is #15 to #100 for a first offence and for the lowest income groups; #25 to #200 for two different drugs and an increase of some 25% for a second offence. But courts vary in the penalties they impose. Country courts where drugs cases are uncommon probably give the highest sentences; city courts the lowest. Fines are now worked out on a Unit Fine System which is related to the offender's disposable income. Magistrates courts don't generally differentiate between Ecstasy and Amphetamine, even though they are in different classes, but Crown courts do.

Prosecutions on the grounds of supply are nearly always heard in a Crown court. As a general rule, imprisonment is the penalty for those found guilty unless there are mitigating circumstances. For small amounts, offenders are typically sentenced to 18 months to 2 years imprisonment; and for medium quantities the sentence may be 3-5 years. Sentencing also depends on the particular circumstances of the case: one person got 3 years for 3 LSD tablets but there was evidence that he had sold a tablet of LSD to someone who had died as a result of taking it.

The trend towards cautioning offenders is spreading throughout the country. Poulter's advice to those who are arrested is as follows: Ask for a solicitor. Legal assistance is free to people who have been arrested. Police often suggest that suspects admit that what they have been found with is a drug and offer, in exchange, to recommend a caution. However, they may not keep their word. A local solicitor who knows the police can help to avoid this. If police arrive with a warrant, cooperate or you will be charged with an extra offence. But you should ask them for a copy of the warrant and the reason why they are searching.

Police must have reasonable cause for stopping and searching a member of the public. This would not include simply being in a place where drugs have been on sale. They have the power to strip search. If police attempt to strip search you ask them why they are doing it. If their grounds were not legal, the evidence so obtained will be dismissed by the court. Never resist a search physically. Keep calm and negotiate with the police. Intimate search - which includes looking inside any part of your body including the mouth and ears - is only admissible when there is reason to suspect intent to supply class A drugs. If youare intimately searched in the genital or anal area on grounds that are not legal, you could charge the police with indecent assault. You cannot be compelled to give blood or urine for testing.

Recently Ecstasy has been on sale at #8-#12 per pill. In real terms, prices of illicit drugs have fallen steadily over the years without a fall in quality, with the exception of Amphetamine which is now far weaker than it was a few years ago.

Release operates a telephone help line for people accused of drug offences. The agency receives about 21,000 calls a year, of which some 14% are related to Ecstasy. 30% of calls come from non-users such as parents or professionals. About half concern legal matters, and the other half concern the use of drugs and their effects.

Poulter also told me, incorrectly, that Class A drugs cannot be prescribed by doctors and that the maximum penalties in a magistrates court for unlawful possession of MDMA or for supply of MDMA, are 6 months in prison and/or a #2,000 fine. In fact, doctors may prescribe Class A drugs, but may not prescribe Schedule I drugs, a category into which MDMA also falls, while the maximum penalty in a magistrates court is #5,000.

15 22nd report of the Expert Committee on Drug Dependence 1985, published by the World Health Organisation as part of its Technical Report Series

#729, para 2.28 3, 4 Methylenedioxymethamphetamine, [cited in full]

In mice, 3,4 Methylenedioxymethamphetamine (MDMA) increases locomotor activities and produces analgesia. In dogs and monkeys the substance has a pharmacological profile similar to that of other substances already controlled under the Convention on Psychotropic Substances. There are contradictory reports of the hallucinogenic activity of this substance in man. The substance is a potent serotonin-releaser in rat whole-brain synaptosomes. Its toxicological properties have been studied extensively in animals. The acute toxicity of this substance is about twice that of mescaline. No pharmacokinetic data are available.

3,4 Methylenedioxymethamphetamine has discriminative stimulus effects in common with amphetamine but not with 2,5-dimethoxy-4-dimethylbenzeneethanamine (DOM). No data are available concerning its clinical abuse liability, nature and magnitude of associated public health or social problems. The substance is under national control in Canada and the United Kingdom and its control has been proposed in the USA.

The substance has no well-defined therapeutic use, but a number of clinicians in the USA have claimed that it is potentially valuable as a psychotherapeutic agent. No data are available concerning its lawful production. Evidence of illicit trafficking in the substance has been reported from Canada and there have been extensive seizures of the drug in the USA.

On the basis of the data outlined above, it was the consensus of the committee that 3,4 Methylenedioxymethamphetamine met the criteria of article 2, para 4, for the control under the Convention on Psychotropic Substances. Since there is insufficient evidence to indicate that the substance has therapeutic usefulness, the expert committee recommended that it be placed in Schedule 1 of the Convention*.

It should be noted that the Expert Committee held extensive discussions concerning therapeutic usefulness of 3,4 Methylenedioxymethamphetamine. While the Expert Committee found the reports intriguing, it felt that the studies lacked the appropriate methodological design necessary to ascertain the reliability of the observations. There was, however, sufficient interest expressed to recommend that investigations be encouraged to follow up these preliminary findings. To that end, the Expert Committee urged countries to use the provisions of article 7 of the Convention on Psychotropic Substances to facilitate research on this interesting substance.

*One member, Professor Paul Grof (Chairman), felt that the decision on the recommendation should be deferred awaiting, in particular, the data on the substance's potential therapeutic usefulness and that at this time international control isnot warranted.

16 Living with Risk (book), published by the British Medical Association, 1990

This book contains statistics on and evaluations of various risks commonly taken by people in the UK. It includes a comparative list of the risk to an individual of dying in any one year from various causes:

Smoking 10 cigarettes a day: 1 in 200 All natural causes at age 40: 1 in 850 Violence or poisoning: 1 in 3,300 Influenza: 1 in 5,000 Accident on the road: 1 in 8,000 Playing soccer: 1 in 25,000 Accident at home: 1 in 26,000 Hit by lightning: 1 in 10,000,000

The chapter on drug use points out that deaths from illicit drug use in the UK total just over 200 a year compared to the tens of thousands who die annually from alcohol use and tobacco smoking.

It is also pointed out that "heatstroke is becoming a problem in long distance running events . . . In Canada, 1% are admitted to hospital during and after mass-participation runs [marathons]" and that parachuting and hang gliding kill about 3 in 1,000 participants per year.

Almost every psychoactive drug has been regarded by some society as a dire threat to public order and moral standards, while regarded as a source of harmless pleasure by others. Almost every society has one drug whose use is tolerated, while others are regarded with deep suspicion.

17 Ecstasy - The Arrival of a Consciousness-Raising Drug (book), by Arno Adelaars, published by in de Knipscher, 1991

This book is in Dutch only, but may soon be available in English. A new edition is due out in 1993.

It is about his own experience and the history of MDMA in Holland. The first dealer to bring 1,000 Es from the United States in 1985 couldn't get rid of them, even to people who had tried Ecstasy. The early 'E' parties in 1989 were exclusive. People made eye contact, let themselves go out of control and behaved in individually bizarre ways. But when taking E became a mass phenomenon, people started behaving according to others' expectations, and the true individuality and contact was lost. Adelaars sees two distinct types of uses and users: extroverts and introverts; Ken Kesey/Timothy Leary; entertainment/intellectual; party/home. His book contains interviews with both types of users and his advice about using Ecstasy is don't take it unless you are feeling good. He believes the aftereffect of mellowness spreads to other people who you are in contact with. He compares the effect of Ecstasy - feeling relaxed and loose-limbed - to being in love or being on holiday in a tropical country.

The author writes from his own experience of the drug and his knowledge of manufacture and distribution, having visited an MDMA 'factory'. He is also one of the few writers with personal experience of both home and party use.

18 Fax from Home Office, 23/2/93

The Entertainments (Increased Penalties) Act 1990 tightened up the penalties for infringement of the entertainment licensing laws. It increased to a fine of #20,000 and imprisonment for up to six months, or both, the maximum penalties magistrates can impose for certain offences against the entertainment licensing laws in England and Wales. The fine was previously #2,000 or three months imprisonment or both. The offences in question concern the use of a place for entertainment involving music and dancing without the necessary licence which places a limit on the number of people which may be present at the entertainment. In addition, the Criminal Justice Act 1988 (Confiscation Order) gives magistrates the power to make confiscation orders when the profits exceed #10,000.

19 Manchester RIP, Kaleidoscope, BBC Radio 4, 6/2/93

Ecstasy first arrived at the Hacienda club in Manchester in 1988. For ravers that year was a wonderful summer without media or police attention. It was the start of the rave scene which later spread to London and rest of Europe. The first Ecstasy club in London was Spectrum on Monday nights at Heaven. While straight Manchester was unsuccessfully trying to put itself on the map by bidding for the Olympic Games, a couple of bands and DJs had actually made Manchester the fashion centre of Europe for young people and the place where they all wanted to be. By 1991, applications to study in Manchester had risen by 30%. But 1991 was also the year that the atmosphere of peace changed to violence. Gangs started moving in, shooting each other in the battle for dominance in the drugs market.

20 Drug seizures: Britain's growing habit from The Times, 20/1/94

In 1993, 554 Kg of Ecstasy "worth 58m" was seized by customs, double the figure for 1992. The article was sub-headed: "Rave parties increase demand as shipments worth #519m are seized." [Figure refers to all illicit drugs.]

21 A visit to Arno Adelaars, a part-time purchaser of street samples of drugs for testing by the Dutch government. Amsterdam, October 1992

The Dutch government analyses street samples of Ecstasy and other drugs so that they can keep a check on what is being sold. The results are released 2 weeks after the sample was purchased so as to avoid helping dealers. Adelaars says he has never bought anything that turned out to be dangerous, and is sceptical about claims by another drug-purchasing agency that a sample of Ecstasy turned out to be Ketamine. Recently there has been a lot of MDEA sold as Ecstasy.

During the period January 1990 to June 1992, 156 street samples of "Ecstasy" were tested. 83% were tablets, 10% powder and 7% capsules. 61% were found to be MDMA, 4% MDA, 4% MDEA, 6% Amphetamine mixed with caffeine, 6% Amphetamine only, 3% caffeine only. In the remaining 16%, no active ingredient was identified, although the tests were only set up to detect amphetamine, methamphetamine, caffeine, cocaine, heroin, LSD, MDMA, MDA and MDEA.

Of the MDMA samples, 75% contained between 70 and 120 milligrams, though doses of as little as 15mg or as large as 208 mg were found. Generally, over half the samples turn out to be good-quality MDMA, but this has recently fallen to 39% because 18% of samples sold as Ecstasy are now MDEA. Some MDEA is stamped EVE. Adelaars says MDEA lacks the communicative quality of MDMA.

Adelaars has visited a clandestine production lab. Production was carried out by two people, neither of whom was a chemist, but one of whom had medical knowledge. The equipment consisted of an autoclave and a 14,000 rpm mixer. The 200,000 guilder required to set up the lab was provided from criminal sources. The first batch of MDMA took 6 weeks to make - it would take 10 days with the right equipment. Adelaars thought manufacturing Ecstasy was not an easy thing to do unless you had experience. In Holland, the wholesale prices of Ecstasy are: 1 kg (10,000 doses) for

7.50 guilders each; 1000 at 10-12 guilders each; 100 at 12-17; 10 at 20-25. Single tablets are sold at 25-35 guilders.

Tablet making is an art in itself - the right binders are needed to hold the pill together long enough to reach the stomach but not so long that it is shitted out undissolved.

Holland is the obvious place to produce Ecstasy because the law is lenient and the prisons nice. In November 1991, a consignment of 1,200,000 tablets was caught on the way to England concealed in furniture, and it was found to be just one of a series of regular shipments that had been going on for some time. The factory in England was raided - it had ordered enough material for some 50 million Es - but as very little was found it was presumed that most had been used and sold. See also above.20

Adelaars believes those with experience of other drugs have fewer problems with E. Problems arise among young inexperienced users who can't keep their trip under control.

22 Drug Abuse Warning Network (DAWN) figures, published by The U.S. National Institute on Drug Abuse, 1992

The NIDA collects reports of patients attending hospital emergency departments who are suspected of, or admit to having used illicit drugs from across the US. The institute also collects information from coroners and postmortems. As a result, it is able to provide nationwide figures on drugs which present problems. Annual DAWN publications contain analyses of reports of any drug mentioned more than 200 times a year or causing more than 10 deaths. MDMA has never been included in the reports, as it comes 136 in the hierarchy of drugs reported as causing problems. According to DAWN data, MDMA is not a significant drug abuse concern in the US.

The 1992 report also includes a survey of the use of illicit drugs by US college students who are within 1-4 years of leaving high school. There were about half as many illicit drug users in 1990 as in 1980. MDMA was only included in the survey in 1989, 1990 and 1991 and over these three years MDMA use among college students declined. In 1991, 0.2% had used MDMA in the previous 30 days compared to 0.6% in 1990 and 0.3% in 1989. In 1991, 15.2% of the sample had used an illicit drug in the past 30 days, implying that MDMA was used regularly by only 1.3% of illicit drug users.

Figures for drugs used in 1991 show that Ecstasy was used by 0.9% as compared to 2.3% in each of the preceding two years. 29.2% had used some illicit drug in the year; about half as many as in 1980.

23 Young People's Poll, by Harris Research Centre, January 1992

This poll was conducted for the BBC TV programme Reportage. It covered a range of drugs. Interviews took place as respondents entered nightclubs. Only regular club goers were included, i.e. those who said they attended at least once a month. 693 people were interviewed in 11 large cities in UK, 353 male; 340 female. 251 were aged 16-18; 333 aged 19-22; 109 aged 23-25. All social groups were included.

Overall 31% of respondents (men 35%, women 22%) said they had taken Ecstasy (47% in London/South East; 6% in Scotland). 6% thought Ecstasy was safe to use; 5% thought it should be legalised. 29% of 16-22 year-olds and 38% of 23-25 year-olds said they had used Ecstasy. The figure was 46% among married people and cohabitants. 49% said they used Ecstasy frequently and 22% occasionally, and this proportion was constant across all social groups. 33% of respondents said they had taken illegal drugs of some kind and 67% said they had friends who took drugs [this is interpreted by some people to mean that these respondents took drugs themselves but said "friends" so as not to incriminate themselves]. The most popular drug was hash (81%) followed by "LSD/speed/Amphetamine" (35%). [The fact that LSD was lumped together with speed shows the researchers were pretty green.] [A sociologist, Andrew Taylor, who is studying the activities of young people told me he believes that this confirms his observation that the majority of this age group take Ecstasy regardless of social group.]

24 Analgesic safety and efficacy of MDMA in modification of pain and distress of end-stage cancer, Charles Grob et al.

This is a proposal for a clinical investigation of the potential of MDMA as an analgesic for cancer pain. It involves 24 subjects and takes 2 years to complete. It focuses on gathering preliminary data concerning safety and tolerance, the drug's mechanism of action and its safety.

End-stage pancreatic cancer patients have been selected as the most suitable subjects. 24 subjects are needed, all with chronic pain as a result of end-stage pancreatic cancer. 12 patients used as controls are identically treated with placebos (to provide a double blind trial). All receive 4 sessions separated by at least 2 weeks. Dosage is up to 2.3 mg/kg.

25 Laing on Ecstasy by Peter Naysmith International Journal on Drug Policy 1/3.

Laing had taken MDMA at Esalen in 1984 where the drug was being used in couple counselling before it was made illegal.

When the drug was banned Laing said: "What scientists have always been looking for, as Arthur Koestler suggested, is a drug which is not a tranquilliser, an upper or downer, but a stabiliser, just a help to keep one's balance throughout the day. The Californian scientist who synthesised MDMA in the seventies, Dr. Alexander Shulgin, thought he had found such a drug. All I can say is that within the context of its use, among very responsible professionals and therapists in America, all direct reports, including my own, were positive."

"It's my opinion that government agencies, instead of slapping a total ban on this drug should explore it like they do others . . . There's definitely a place for it. It's a pity to see it being cut out like that." Asked to explain why is there a need for drugs such as Ecstasy, he said: "Most of us live within a sort of crypto-delusional structure as to our needs; we haven't quite got it right about love and loving and what other people feel about us . . . which is part of the popularity of this drug. It changes your feeling. But this can also be a danger . . . Under its influence it would be unwise to make [important] decisions there and then . . . as it would over a bottle of whisky."

26 Phenomenology and Sequelae of MDMA use by Dr. Mitchell Liester, Dr. Charles Grob et al., Journal of Nervous and Mental Disease, 180/6 1992.

A study of the immediate, short-term and longer-term effects of MDMA on 20 psychiatrists. The 20 psychiatrists were administered MDMA and then evaluated for side effects, insight gained, pleasure, and the intensity of the experience, taking into account the influence of set, setting and dosage.

The psychiatrists were selected for their prior knowledge of the drug. They all came from Southern California and had an average of six years practice. All had used MDMA at least once. Effects noted during the session (expressed in terms of the percentage of subjects who experienced a given effect) were:

Altered time perception (speeded up or slowed down)          90%
Increased ability to interact with or be open with others    85%
Decreased defensiveness                                      80%
Decreased fear                                               65%
Decreased sense of separation or alienation from others      60%
Changes in visual perception                                 55%
Increased awareness of emotions                              50%
Decreased aggression                                         50%
Speech changes                                               45%
Aware of previously unconscious memories                     40%
Decreased obsessiveness                                      40%
Cognitive changes                                            40%
Decreased restlessness/agitation                             30%
Decreased impulsivity                                        25%
Decreased compulsiveness                                     20%
Decreased anxiety                                            15%
Altered perception of spatial relationships                  15%
Decreased desire for sleep                                   10%
Increased libido                                             10%

Afterwards one member of a couple "focused on how they were defensive with each other" while the other "saw love underneath" actions which they had thought implied that the other partner didn't care. There was a shift away from materialistic values and toward interpersonal relationships. Aftereffects lasting up to a week (observed by at least two subjects):

Decreased sleep                                              40%
Decreased appetite                                           30%
Increased sensitivity to emotions                            25%
Decreased ability to perform mental or physical tasks        20%
Decreased desire to perform mental or physical tasks         20%
Increased ability to interact with or be open with others    20%
Decreased defensiveness                                      20%
Fatigue                                                      15%
Decreased aggression                                         15%
Decreased fear                                               15%
Cognitive changes                                            15%
Depressed mood                                               10%
Decreased obsessiveness                                      10%
Speech changes                                               10%
Increased restlessness/agitation                             10%
Altered perception of time                                   10%
Decreased anxiety                                            10%
Decreased libido                                             10%
Trismus                                                      10%

Effects lasting more than a week

Improved social/interpersonal functioning                    50%
Changes in religious/spiritual orientation or practice       46%
Changes in values or life priorities                         45%
Improved occupational functioning                            40%
Increased ability to interact with or be open with others    35%
Decreased defensiveness                                      30%
Changes in ego boundaries                                    30%
Decreased desire to use alcohol                              25%
Decreased fear                                               20%
Increased sensitivity to emotions                            15%
Increased desire to use hallucinogenic substances            15%
Improved family relationships                                15%
Change in career plans                                       15%
Decreased restlessness                                       10%
Decreased obsessiveness                                      10%

It was also found that there were no changes in the effects of the drug with repeated use, contrary to popular belief. Over half said they believed the drug had a "high potential for use as an adjunct to psychotherapy, particularly in regards to its capacity to enhance empathy".

In conclusion, the drug induced an alteration in consciousness that most subjects felt was pleasant and valuable.

The paper refers to Dowling's report on 5 deaths in which MDMA was detected in the victims' blood, and it is pointed out that in each case there were other potentially lethal medical factors, implying that MDMA may not have been the cause of any of the deaths. The clinical implications of changes in serotonin levels are unclear "inasmuch as there have been no documented clinical cases of MDMA-induced serotonergic toxicity". Fenfluramine "has a significantly greater degree of neurotoxicity."

27 Hands of Light (book), by Barbara Ann Brennan, Bantam, 1988

This book is a guide to spirit healing through the human energy field. In a case history Brennan says, "David came to his last session looking very different. His aura was twice as bright and much larger than usual. The cocoon had opened. I asked what had happened to him. He said that he had taken a drug called MDMA over the weekend. On closer inspection, I could see that the MDMA had opened the left side of the pineal gland. The mucus from the third eye that had been placed there partially from doing pot and LSD was cleared away on the right side. There was still work to be done, but the overall change in David's field was amazing. Since my observations had always shown Psychotropic drugs to have a negative effect on the aura, I asked Heyoan [her spirit guide] about it. He said, 'That depends on who takes it, and what their field configuration is at the time of taking it' Drugs . . . do not cure disease; they assist the individual to cure himself."

28 Subjective reports of the Effects of MDMA in a Clinical Setting by George Greer and Requa Tolbert from Journal of Psychoactive Drugs Vol. 18/4 1986.

This trial was carried out legally in California between 1980 and 1983 following recommendations of the State Medical Board and its findings are the best clinical evidence available on the effects of MDMA. "Because it [MDMA] had been patented in Germany in 1914 and was therefore no longer patentable, no pharmaceutical manufacturer could be found who was interested in sponsoring an Investigating New Drug application with the Food and Drug Administration or in sponsoring research, " the authors say. The primary purpose of the study was to assist the 29 subjects in achieving their particular goals rather than to evaluate MDMA and it therefore does not include 'double-blind' controls, independent evaluations or examination of the physiological effects of MDMA.

Subjects were screened by questionnaire, briefed on the possible side effects of MDMA, and warned not to take part unless they were prepared to deal with any disturbing experience they might have as a result. Those with hypertension, heart disease, hyperthyroidism, diabetes, hypoglycemia, seizure disorder, glaucoma and diminished liver function were not allowed to take part. Pregnant women and people with a psychiatric history were also excluded.

To ensure a secure atmosphere, the following agreements were made:

1. Everyone would remain on the premises until it was mutually agreed that the session was over.

2. The subjects would refrain from any destructive activity.

3. There was to be no sex between therapists and subjects.

4. The subjects were to follow therapists' instructions when they took part in a structured session.

Most sessions were held at people's homes, individually or in groups and couples. The subjects were asked to fast for the preceding 6 hours "to ensure rapid absorption and prevent nausea". Doses varied from 75 to 150 mg according to subjects' body weight and the type of session and a second dose of 50 to 75 mg was offered after about 2 hours in order to "prolong the session and provide a more gradual return to normal consciousness". Sometimes inner experiences on the higher doses were facilitated by instrumental music and eyeshades, with the therapists being attentive and responsive to requests.

About half of the subjects reported that they had minor psychological problems before taking part in the study, including feeling dissatisfied with themselves, being afraid of rejection and lacking self confidence. Some also experienced mild depression, anxiety, sadness at being alone, "normal existential despair" or difficulty in making life choices.

Benefits felt by the subjects during sessions.

All the subjects felt closer and more intimate with all others present and many reported that they were more communicative and were more able to receive both compliments and criticism. All the subjects experienced positive changes in their attitudes or feelings. Three quarters of them reported cognitive benefits such as enhanced mental perspective; insight into personal patterns or problems; and an enhanced ability to understand themselves and resolve issues. Half of the subjects felt warmer, fresher or more alive or reported euphoric or loving feelings. One third of them said that they felt more self-confident and another third felt that their defences were lowered. One quarter said that they went through a therapeutic emotional process during a session. One sixth of subjects said they had had a transcendental experience and a similar fraction reported fewer negative thoughts and feelings. Subjects also reported: feeling more aware more "grounded" and feeling "blessed" and at peace. All of those who tried low doses to improve their creative writing found it "quite useful", with some reporting clear thinking or greater presence of mind.

Undesirable effects felt by the subjects during or after sessions.

Three quarters of the subjects experienced jaw tension or teeth clenching during the session, sometimes accompanied by shaking. For a few subjects these side effects persisted into the following day. Most felt tired afterwards and for half of the subjects this lasted up to 2 days. One quarter felt nauseous for between 5 and 30 minutes. One third found it hard to sleep afterwards, but 10 per cent slept better. Subjects noticed that they sweated, felt cold and lost their appetites during the sessions, but did not regard these reactions as a problem.

In addition to these general side effects, some individuals had a strong negative reaction. A 74-year-old woman who had been given an extremely high dose of 350 mg because she had not responded to lower doses suffered most of the unpleasant effects mentioned above during the session and for two days afterwards. Tension in her jaw lasted even longer and she also experienced a visual illusion. Another subject's appetite increased and they gained weight. A third had difficulty coping with people and had anxiety attacks which caused him to miss work for a week. He said he was not receptive to the sensation of MDMA, though he stressed that the session itself was not the cause of anxiety: "Rather, I think it served to open up some tightly controlled emotions that spilled out in a frightening way." A year later he said: "It probably was a good thing. It speeded up processes that needed to happen". Side effects reported by individual subjects during sessions included: jittery vision, lip swelling, shakiness, numb hands and face, headache and fainting - this last effect occurred when a subject thought about a difficult relationship.

Half the subjects reported undesirable emotional symptoms. 15 per cent felt anxiety or nervousness during the session while 7.5 per cent felt mildly depressed next day. One subject felt paranoid for up to 3 minutes during the session and another felt lonely and sad. Others felt: more emotional, more vulnerable, had a racing mind, felt waves of "emotional crud" or confused about a relationship or indulged in "negative self-talk".

All but one of the subjects set goals for what they wanted to achieve in the sessions before they started. Half felt that these were completely realised, and another quarter felt they were partly realised. This group included subjects who wanted to understand themselves better and, of these, one third were fully satisfied but half made no progress. Of those seeking a mystical experience, three quarters were satisfied. Subjects looking for personal or spiritual growth, self exploration, fun and enjoyment, or closeness with their sexual partners all achieved their aims.

All of those who aimed to change their personalities or resolve particular inner conflicts or experience a different state of consciousness or increase their awareness of their feelings or become less afraid of rejection, felt they had achieved some degree of success.

After the session most subjects felt in a better mood and this typically lasted for a week. One third of them felt more calm and relaxed, while some felt more energetic.

80 per cent of subjects reported positive attitude changes, and for some this lasted for at least two years [the researchers last contact with the subjects was two years after the trials]. Of this 80 per cent, half said they had more self-esteem; half said they were more able to accept negative experiences and were more patient and half said the sessions had changed their beliefs in various positive ways, including seeing death as a change rather than an ending and therefore feeling less afraid of it. Other benefits claimed by subjects ranged from a greater acceptance of others to an appreciation of being alive and feeling they could be more warm and loving.

Nearly all the subjects reported positive, mostly long-lasting, changes in their relationships. This included those whose partners did not take part in the sessions. Two couples who had problems in their relationships before the trials, resolved significant conflicts under MDMA. Negative changes were experienced by the man mentioned earlier who had difficulty coping with people, and some subjects whose relationships were already in decline reported no improvement: one woman felt "more guilt around men for a while" and proceeded from a separation with her husband to a divorce. Many subjects reported that their feelings were stronger after sessions and some said that they now avoid superficial social meetings such as cocktail parties. Conflicts were also resolved with non-partners and a variety of other improvements including self esteem and empathy with others were reported.

Half the subjects reported positive changes at work for a week or so after sessions, such as: feeling less tense and driven, having more fun, having energy to spare and getting along better with others. 20 per cent of subjects reported new personal interests, from hobbies to creative writing and spiritual growth. Some of them said MDMA-like states occurred during meditation and one man who used to meditate before he took part in the study said that taking MDMA had improved his meditation.

Half the subjects said they used drugs less (including alcohol and caffeine) but ten per cent said they used more. Those who used less drugs, turned away from drugs per se: they did not swap one drug in favour of another. However one woman said she would take only MDMA in future "because she learnt from it".

Half the subjects changed some of their 'life goals' after sessions, and all of these implied the change was positive. Most involved a shift away from materialism and towards spirituality or wellbeing.

Half the subjects found they were released from attitudes that prevented them from actualizing their potential. Half of these said they had gained lasting insight into their psychological problems; three felt less guilty about enjoying themselves and two became less "self-limiting". One said he had got rid of "a load of rubbish he had been carrying around"; another felt less anxiety and another felt less self-conscious.

In the discussion, the authors conclude that MDMA may "predispose people to a recurrence of previous psychological disabilities". They also note that people "who want MDMA to cure their problems" make poor subjects, while those who want to use it to learn about themselves are most suitable. Their main conclusion is that "the single best use of MDMA is to facilitate more direct communication between people involved in a significant emotional relationship". They also recommended MDMA as an adjunct to insight-orientated psychotherapy, and for promoting self-understanding and spiritual and personal growth.

29 MDMA Reconsidered, by Robert Leverant, from Journal of Psychoactive Drugs, Vol. 18/4 1986

This paper reports views on MDMA expressed at a conference for informed lay users of the drug held by the Haight Ashbury Free Medical Clinic in May 1986. Conference discussion topics included how MDMA compares with hallucinogens and whether these drugs should be available for therapeutic use and, if so, under what conditions.

While extremely useful for psychotherapy, MDMA is deceptive for the spiritual therapy whose ends are complete freedom and autonomy as delineated by Buddhism, Hinduism and other mystic traditions. This necessitates the death of the mind. . . Unlike the stronger psychedelics, MDMA does not encourage glimpsing this last development of Love's unfolding. . .

Perhaps MDMA's greatest potential in therapy is nonverbal. [It could aid body therapies that utilize] the attention, the breath, sound, and hand pressure to open up and remove blocks that prevent contact with the life force within [the body] and hinder the =E9lan vital from flowing.

30 Visit to Dr. John Henry at the National Poisons Unit at Guy's Hospital, London, 11/12/92

The unit offers a 24-hour telephone enquiry service to doctors throughout the UK who are presented with symptoms that they cannot clearly identify. All telephone enquirers are asked to send blood and urine samples for testing, which is usually carried out using one of three types of chromatography. Most samples are taken from live patients, but some are taken during a post mortem. Some drugs are easier to detect through blood and urine samples than others. Cannabis "can be detected 5 weeks after a single reefer"; LSD is very hard to detect.

Recently, a large proportion of samples of Ecstasy sent in for testing have been found to contain MDEA instead of MDMA. Dr. Henry thinks MDEA is less toxic than MDMA because it produces less jaw clench.

Asked what advance symptoms people who have taken MDMA should look out for as signs of the onset of overheating, Dr. Henry said that excessive sweating, staggering, thirst and exhaustion were the main symptoms. He said that overheating was unlikely to occur if enough water was drunk. Dr. Henry said that he believes that MDMA stimulates opiods, a neurotransmitter that acts as an internal anaesthetic. Opiods go into action when people bruise themselves badly playing football. Dr. Henry compares dancing at a rave with running a marathon - it involves four hours of exhausting exercise.

Neurotransmitters such as 5HT and opiods can be stimulated either by chemicals such as MDMA or by feelings of excitement. Dr. Henry says that this could explain why people who go to raves without taking drugs pick up on the same mood: the environment may cause them to produce their own neurotransmitters and this affects their mood.

Asked about the dangers of Paracetamol relative to those of MDMA, Dr. Henry said that Paracetamol causes over 200 deaths a year, but is very safe in normal doses. Overdosing affects the liver, and can cause death at doses of between 15 and 200 tablets. He said that MDMA is broken down by the liver into MDA and metabolites, which are excreted by the kidneys into the urine.

I asked Dr. Henry what evidence there was of a link between liver damage and Ecstasy use, mentioning that liver damage associated with Ecstasy use has not been reported in the USA and suggesting that cases in Britain might be the result of parallel use of alcohol or other drugs. Dr. Henry said that he has no doubt that MDMA causes hepatitis because some patients have exhibited the symptoms of hepatitis after each of several ingestions of MDMA.

I also asked about kidney failure (or 'acute renal failure' as reported in the medical journals) associated with Ecstasy use. Dr. Henry said that he believes this is the result of muscular breakdown overloading the kidneys with myoglobin. Muscular breakdown can also be caused by intense bouts of physical exercise.

Dr. Henry explained the mechanism of heatstroke. Dissolute Intravascular Coagulation (DIC) - blood clotting in the arteries - occurs at 42-43 degrees C (c.108 degrees F) and tiny blood clots stick to the artery walls. This is harmless in itself, as the blood clots are too small to cause a blockage, but the process can use up all the clotting agent, with the result that the blood will pour out of any of the tiny haemorrhages which occur throughout the cardiovascular system as part of the normal process of breakdown and repair. Such internal bleeding can be fatal. Internal bleeding in the brain, combined with high, pulsating blood pressure can cause strokes.

Out of all the millions of brain cells only 10,000 hold the chemical serotonin which is affected by MDMA. Serotonin levels have a marked effect on mood and a statistically significant proportion of suicide victims have been found to have depleted serotonin. Antidepressants of the SSRI type such as Prozac (Fluoxetine) inhibit the re-uptake of serotonin.

I asked Dr. Sheila Dorling, a lab researcher at the National Poisons Unit, what had been found in samples of E besides MDMA and MDEA. She said some MDA had been found plus various available drugs such as paracetamol and codeine; other samples only contained amphetamine. None contained LSD. The poisons unit does not analyse many Ecstasy pills.

31 Through the Gateway of the Heart (book) published by Four Trees Publications, San Francisco 1985

This book is a collection of some 60 subjective accounts of positive experiences by users and "guidelines for the sacramental use of empathogenic substances". The accounts are divided into men's, women's and group experiences.

Typically, the accounts are by well educated people in their thirties who are 'into their feelings' and 'seeking awareness'. But there is also the story of a 45 year-old man who was deeply in pain from arthritis entitled: "Now I see pain as an ally, not as an enemy" and the account of a 33 year-old woman who had been raped 8 years previously. She took 65mg of MDMA, followed two hours later by 300 =B5g of LSD. The suppressed horror of the rape scene came back so vividly that she mistook the person she was with for the rapist, which, she says, helped her to get over the rape. She vomited a great deal then and later, as though getting rid of her disgust at the incident.

The guidelines section is compiled from the collective experience of about twenty or thirty therapists who have used MDMA in their work. Suggestions include that participants should agree to ban sexual contact (even between those who are already lovers) and that 'power objects' such as crystals or photos of relevant people be brought to sessions.

A serene and comfortable room is suggested and "a fire in the fireplace serves as a reminder of the alchemical fires of inner purification". Lower doses of MDMA could be taken outdoors. The slower baroque music of Bach or Vivaldi became favourites with therapists. People guiding others through an MDMA experience should conduct themselves with integrity and sensitivity and avoid being caught up in verbal exchanges, as "most people are able to do their own best therapy in these states".

It is suggested that practices such as making affirmations, yoga, "guided imagery" and "shamanic journey work" can aid the therapeutic process triggered by MDMA.

The guidelines present two models for group sessions. In the first, people stay separate during the session, but share experiences before and afterwards. They listen to music on earphones and communicate only with the group's guides.

In the second, users communicate during the session in a ritual fashion. These sessions are usually residential and some are held at night. Typically, the group will assemble on a Friday evening, when they share their intentions for the trip. The session will start on Saturday morning; the group will spend Saturday night together and get together on Sunday morning for a final sharing of their experiences. All participants have to agree to keep all the proceedings confidential.

Sometimes MDMA will be combined with either LSD, psychedelic mushrooms, Ketamine or 2CB by some or all of the participants. Most therapists say it is necessary for participants to have previous experience of taking the relevant drug on their own. A typical session lasts 40 minutes, starting with inner exploration accompanied by music, andproceeding to people giving monologues or singing into a conch shell.

Other rituals that may be drawn up include: each participant finding their own "power spot" before the session; offering prayers to the 4 directions; group "rebirthing"; breathing activities or movement disciplines such as Tai Chi. Rituals worked best on low doses.

32 A researcher reports from the rave by Russell Newcombe, Druglink, January 1992

Many take 2 tablets, optimal dose for maximum psychoactive effect at usual strength; a substantial minority take between 3 and 10 while a few 'more sensitive or smaller people' only half. . .

Many claim that regular raving and/or use of Ecstasy has improved their general mental state and their relationships with others. . .

Reports on people who have tried E in other situations often indicate somewhat different experiences, including more unpleasant aftereffects. It could be that increases in oxygen, endorphins and other substances in the body caused by vigorous activity interact with MDMA to produce experiences different from when the body is relaxed.

33 The Use of Ecstasy and Dance Drugs at Rave Parties and Clubs: Some Problems and Solutions, by Dr. Russell Newcombe, paper presented at a symposium on Ecstasy, Leeds, November 1992

Newcombe says the use of E, 'acid' and 'speed' has spread dramatically - and into most social groups - over the last 5 years, largely because of their popularity as dance drugs on the rave scene, the dominant subculture of the 1990s. About 2 million people are estimated to have taken dance drugs at raves including at least 750,000 who have taken MDMA. The aim is to partake in an altered state of group consciousness by dancing for long periods on E. The risks involved in using E are exacerbated at raves by the nature of the drug dealing that takes place, e.g. imposter drugs being sold, the setting, which can cause heatstroke, the response of the authorities, where clubs are closed leading to more illegal raves, and mass media coverage (implying drug scares promote drug use).

Reports of deaths and psychological disturbances related to Ecstasy use are becoming more common, although there is little evidence that taking Ecstasy is any more risky than alternative leisure activities.

Dr. Newcombe argues that the authorities should take a pragmatic policy towards the rave scene, which focuses on reducing the threat to public order and public health. At the local level, this implies setting up multi-agency groups to develop a model of good practice for rave events.

He says that four matters require urgent attention:

1. The development of an agreed policy towards rave nightclubs and parties

2. The regulation of security staff

3. The reduction of organised drug supply and

4. The development of healthcare services for ravers, particularly risk-reduction information and on-site outreach work.

The paper gives comparative figures - drawn from a 1992 Home Office bulletin - of the number of seizures and convictions involving dance drugs in the UK in 1981 and in 1991.

             number of seizures  quantity of seizures  number of convictions
             1981      1991      1981      1991        1981      1991

amphetamine  1,117     6,821     18kg      421kg       1,074     3,532

LSD            384     1,636      n/a       170d         345     1,200

MDMA             0     1,735        0       365d           0       559

(d -- thousand doses)

Newcombe estimates that over 100,000 young adults attend raves every weekend. A national survey of 24,000 secondary school children in 1991 found record levels of drug use. Among 15-16 year-olds, 10% had used cannabis; 7% LSD; 7% amphetamine and 4% MDMA (Balding 1992).48 Drug use is higher with older groups.

Dr. Newcombe suggests that the rave can be seen as a religious ceremony with the mixing desk as the altar and the DJs as priests. The DJs mix records in response to the dancers to build up to a high. This peak orgasmic 'trance dance' atmosphere is called 'kicking', 'mental' or 'happening'.

The raver's main aim is to dance and other activities such as conversation and sexual behaviour are correspondingly reduced. Raving can be seen as worshipping the god of altered consciousness. There is a virtual absence of aggressive or disorderly behaviour at raves, partly due to very low consumption of alcohol and partly due to drug use.

House music has developed into various styles: Techno music is favoured by those who like maximum chemical stimulation. Ambient music is more peaceful but just as powerful.

Relatively few harmful effects have been established as resulting from MDMA use, compared to other popular drugs such as alcohol, tobacco, prescribed drugs, Paracetamol and solvents, even taking into account the wider use of these. Statistically, the risk of death is no greater than that involved in other leisure pursuits.

Drug dealing at raves

Security staff cannot legally strip-search customers, so dealers can easily smuggle drugs in their underwear. Women are sometimes used to carry drugs in as they are less likely to be carefully searched because most security staff are men. A woman can carry several hundred Es in her vagina. There are two types of dealing organisations: 'mutual societies' which are groups who distribute to friends without making a profit; and organised gangs. The latter employ specialists: "smugglers" who get the drugs into the rave; "carriers" who hold drugs and money; "snarlers" who are the salesmen; "lookouts" who watch out for police; and "minders" who provide physical protection. Sometimes security staff are involved by offering protection to gangs for a percentage ("taxing"). This protection includes giving warnings and cutting out competition. It is gangs who are most likely to sell bad quality drugs, Dr. Newcombe says, and he suggests that the police should focus on these and ignore the mutual societies.

Safety and security problems

Minor problems such as bruised feet and fainting result from overcrowding; bad management creates problems such as locked fire exits, slippery floors, broken glass and poor ventilation.

However, illegal raves have a far greater potential for disaster due to: poor fire access, factors such as the absence of lighting apart from strobes, lethal substances being sold as drugs. Crushing due to panic from an emergency, police raid or a fire could cause a major disaster in an illegal rave.

The response of police and local authorities

Because the authorities close down clubs where drugs are used, customers are driven to other venues which are less experienced in handling ravers or to illegal events. This puts ravers at a higher risk. Police raids on large events could trigger a Hillsborough type disaster, Newcombe maintains.

The financial cost of a trial of 12 people who held an illegal rave in Warrington in 1990 was over #250,000. The average cost of policing a large illegal rave is #10-20,000.

Suggestions for new policies

Dr. Newcombe's main suggestion is to develop guidelines for authorities. "It would be unrealistic to expect any strategy to reduce substantially the use of drugs at raves," he says. Authorities should not close clubs on the grounds of drug use; instead they should cooperate with the management to reduce problems. Security staff should be regulated (this is done by some authorities). Police should focus their attention on drug-dealing gangs. Information should be provided on the content of the latest drug seizures.

34 Recreational MDMA use in Sydney: a profile of Ecstasy users and their experiences with the drug, by Nadia Solowij et al., in the British Journal of Addiction, 1992

100 Ecstasy users responded to a survey distributed through a 'snowball' peer network in 1991. The authors found that Ecstasy was mainly used for fun at dance parties and social gatherings and its perceived effects were a 'positive mood state' and feelings of intimacy and closeness to others. Secondary effects included: acting as a stimulant, giving insights and enhancing perception and sensuality. Side effects and residual effects were not consistent but no worse than for amphetamines and psychedelics. 80% of users agreed that Ecstasy was fun to use; 13% were neutral and 7% disagreed. 28% reported that they had had problems with taking E. Of those who had taken Ecstasy between one and three times, 75% described it as pleasant and enjoyable. 58% would recommend it to others.

The authors conclude that Ecstasy is not conducive to regular and frequent use because of tolerance to its positive effects while its negative effects increased. There had been few problems associated with Ecstasy use, but caution should be observed until the level of risk the drug poses to humans is established.

35 Fit for anything, by Sarah Champion, The Guardian, 12/4/93

A feature article about fitness culture and raving. Sheila Henderson, a researcher at Lifeline, the Manchester drug agency, is quoted as saying that young women who want to keep fit and look good can either go to the gym or go to a rave as the two have similar effects. However, while the gym is agony, raving is fun and as a result many young women are becoming ravers.

36 Nutrients for blocking phenethylamine damage, by Dr. Brian Leibovitz, in MAPS newsletter, Spring 1993

Studies in the last few years have established that phenethylamines such as MDMA can undergo 'redox cycling', a process that liberates copious quantities of oxygen free radicals. Excessive amounts overwhelm the system and damage ensues. "Phenethylamines are stored in highest concentrations in the brain and nervous system. Not surprisingly, these tissues are at the greatest risk for being harmed by free radicals (and associated oxidants) formed during the redox cycling of phenethylamines. Moderate intakes appear to be handled well. Excessive quantities, however, may cause oxidative damage. It would therefore be prudent for those taking large amounts of MDMA to take antioxidant supplements as well. These include vitamin C which is water soluble, and vitamin E which is fat soluble. The suggested preventative dose is 2-4 gms vitamin C and 1,000 IU vitamin E. Also recommended are S-Carotene (5mg); Bioflavonoids (2gm); L-Carnitine (1gm); N-Acetylcysteine (2gm) and Selenium (250 ug). Leibovitz recommends 3 times these doses for treatment.

37 The Phenomenology of Ecstasy Use, by Teresa O'Dwyer, Senior Registrar of Adult Psychiatry at St Thomas' Hospital, Morpeth, November 92

This paper is an account of a study of users' experiences on Ecstasy and the patterns and circumstances of their use undertaken by the Leeds Addiction Unit between January and September 1992. 33 subjects aged between 16 and 27 - mostly male - were referred by the LAU and given a questionnaire, part of which they completed themselves and part of which was filled in by researchers.

70% of respondents used Ecstasy on weekends only. Half had tried it only once. 31% had never taken more than one E at a time, but 12% had used over 7. During the onset of the drug, the apprehension felt by inexperienced users sometimes developed into panic. Many said it was essential to feel very hot to get the full effect of the drug. To this end, a group of friends once drove around in a car with the heater on.

All respondents described an increase in social interaction under MDMA, an increased ability to approach and relate to strangers, and an enhanced ability to express affection. The drug also seemed to produce an attitude of recklessness where users had little concern about the consequences of what they were doing, although only two had had accidents.

Thoughts about sex when on E were not always matched by real desire. Establishing a 'meaningful relationship' was felt to be an essential part of foreplay. Some found sex while on Ecstasy disappointing while for others it was enhanced.

The name 'Ecstasy' was regarded as appropriate by many respondents. Their comments on the mood induced by the drug included "I cried for joy", "It's the best feeling you could ever have", "Like I've just been woken from a dream to really experience life". Some felt privileged to have had the E experience, and one respondent expressed this by saying "We have a secret that no-one else has".

A depressed mood is reported by most users as the after effect of taking E and this sometimes lasted for a couple of days. Paranoia was reported by 85%. "For many, this began as an awareness of beingadmired by others. Gradually as the weeks passed, this admiring regard changed to critical scrutiny and ridicule. Increased sensitivity to comments and a tendency to interpret situations in a threatening way was described by some," O'Dwyer says. Most people experienced a hangover lasting from 12 to 24 hours, but for some this lasted for up to a week.

The thoughts most frequently reported on E relate to music, dancing and affection for companions. 60% felt E had changed the way they looked at their life. Over half 'felt that while under the influence of Ecstasy they could see a new significance in current and past events'. Over half reported losing personal interests including sport and drinking, but a third said they gained new interests, such as music and clothes. Thinking could become focused but was also sometimes distracted: "The most elaborate, complicated solutions are arrived at only to find that the initial problem is now forgotten," O'Dwyer said.

76% of respondents had lost weight averaging one stone through taking E. All frequent users reported that they became tolerant to Ecstasy. To maintain the effect, they had to increase the dose, but this also increased the side effects of nausea, cramp, depression and paranoia. Some took a break from using the drug for a few weeks for this reason. 58% of respondents said they had stopped using Ecstasy. The most common reasons given were that it was no longer providing enough pleasure; it had caused problems due to the associated lifestyle of all-night raving or it caused paranoia or concerns about health. 30% reported social problems such as losing their job or the break-up of a relationship following using E. Most felt that the quality of the drug had deteriorated.

38 Entry in Micromedex, vol. 75, a hospital database printout from the National Poisons Unit at Guy's Hospital, London

This entry says that evidence that MDMA is neurotoxic is controversial. Behavioural alterations have been observed in rats given high doses, but the rats' behaviour has returned to normal after 4 weeks.

It reports two cases of lead poisoning resulting from Ecstasy use, which are put down to toxic by-products of MDMA manufacture. Lead acetate is a component of one synthesis procedure.

Urinary excretion of unchanged MDMA and its metabolites is complete within 24 hours. 65% of the dose is excreted unchanged in the urine and 7% as MDA. Release of dopamine in rats is greatest with MDA, less with MDMA and least with MDEA. Dopamine release may relate to amphetamine-like side effects.

39 Drugs and Magic, edited by George Andrews, published by Panther, 1975

Andrews mentions that the reindeer hunters of the Middle Anadyr, Siberia, used Fly Agaric mushrooms and when there was a shortage of the mushrooms would drink cupfuls of each other's urine without inhibition to prolong the effect.

40 A visit to Lifeline, a non-statutory drug agency in Manchester, 3 August 1992

Lifeline is 21 years old and has 35 full time employees. All its funding comes from the government and most of its work consists of counselling opiate users. But when the rave scene started in about 1990, senior staff became interested in Ecstasy, and Lifeline now has five staff working on projects related to the drug.

Ian Wardle, the agency's acting director, guesses that a million Es are taken every week. He says the latest fashion is high doses of LSD and strong grass: until recently an LSD dose was 50-80 ug but the new 'high' dose is about 150 ug. [The normal dose in the sixties was said to be 250 ug.]

Mark Gilman, a Lifeline researcher looking at the way groups of football supporters in Manchester have converted from alcohol to Ecstasy, tells me that football supporters used to meet in a pub after the game to place bulk orders. He says they would have stayed with E but for the quality falling. The way they bought the tablets, such as meeting the dealer in a motorway service station, gave them no chance to test the quality.

Lifeline workers say that the following prices are the norm in Manchester: LSD #3 each or #1 each by the hundred. Ecstasy #15 each or 10 for #120; #8 each by the hundred; #3-#5 by the thousand. As with LSD, the price of Ecstasy has remained the same over the years, defying inflation. Likewise, Amphetamine Sulphate sells at #10/gm. a price that has remained the same for years. The bulk price has gone down: it is now #100/oz but the amphetamine is also more diluted.

The typical "weekend drug budget" for a working class northerner is 1 gm amphetamine plus 2 Es. Multiple E use - or "stacking" - occurs, but few people take more than 3 Es, and the maximum is 6. There has recently been a switch away from Ecstasy and towards LSD for health reasons, since E is believed to be toxic. Another reason for choosing acid is that the dose is so small that it is not possible to adulterate it. Lab tests to analyse drugs cost about #60 per hour, which is usually long enough for about 3 tests.

Gilman says that club owners are becoming more responsible and looking after clients who get into trouble, such as "spinners" - dancers that go out of control. These tend to be asthmatics.

There is a big demand for information from Ecstasy users. Gilman is often faced with questions such as "Why do I feel fucking weird after E but not after speed?" He tried to make a "Raver's guide to neurology" using 'pint pot' analogies, but it proved too difficult to combine easy-to-understand information with accuracy.

Dr. John Merrill, a consultant with the Regional Drug Dependence Service at Prestwich Hospital, says toxicity associated with MDMA is caused by overheating. This causes minute blood clots to form which can cause a stroke and internal bleeding. Body heat is increased by activity, so MDMA is probably not toxic when the user remains still. If someone is overheating, first aid should include cooling the body.

Amphetamine and Ecstasy delay male ejaculation in sex, but Ecstasy is reputed to enhance sexual pleasure after a trip. Many traditional working class men go out to raves without their partners, and although the women don't like this their compensation is good sex after the men come down. Dr. Merrill says that the hot sweaty environment found at raves, combined with fatigue and loss of appetite is conducive to the transmission of viruses.

MDEA is also now available in Manchester. Wardle believes it may have killed several people.

41 Women, sexuality and Ecstasy Use - The Final Report 1993, by Sheila Henderson, published by Lifeline, 101 Oldham St Manchester M4 1LW at #15+#1.50 postage.

From October 1991 to October 1993, Sheila Henderson conducted research into young women, sex and drugs in the 1990's popular culture for Lifeline in association with the North West Regional Drugs Training Unit and the Centre for Research on the Social Aspects of Health at Manchester University. The project is funded by the North West Regional Health Authority. The report includes The Main Study with sections on Nature and extent of drug use, Gender and drug use, Sexuality, Drugs and sexuality, Young women' cultural reference points. In addition, the report includes Luvdup and DeElited below (reference 41) and the Ecstasy Study (reference 182).

Henderson looks at the gender dimensions of recreational drug use and especially attitudes to and experiences of sex and sexuality. She is trying to identify the "cultural reference points" - from magazines to music - of young women who take drugs recreationally and focuses on "the rave phenomenon that is flooding popular culture".

Unlike previous work on illicit drugs, this study includes the possible benefits of drug use such as the pleasure and fun that may be had under the influence of drugs. The initial findings are based on 6 in-depth interviews, 47 questionnaires and 15 background in-depth interviews etc. The fashion among female Ecstasy users at the time was skimpy lycra as well as styles such as rubber, PVC and leather borrowed from the gay scene. Madonna was a strong influence in popularising music forms and was an example of a woman borrowing the fashion of the gay scene. Even negatively-biased media reports have been good publicity for Ecstasy, Henderson maintains.

Sex is not one of the foremost pleasures offered by Ecstasy. The motivation for raving is more likely to be sensations of the mind, body and soul. The pleasure of dancing with expression and empathy pushes sex into the background. Henderson says that the attraction of raves for women derives from being in a pleasurable group setting, from which the pressure towards and emphasis on sex from men has been removed, in contrast to alcohol-based night life. Interviews indicated that sex is the last thing women have in mind when going to a rave.

The sexual safety of raves is an attraction for girls, compared to alcohol-based clubs, which are seen as cattle markets. Girls sometimes enjoy kissing at raves because it feels good but is 'safe', i.e. is not going to involve sex.

People at raves are more tolerant of a display of homosexual affection. Most women said they had no casual sex on the night of a rave and others said less than when they used to go to alcohol-based clubs. A few women said that after an E trip was an ideal time to have "long, slow sex" along with some hash.

Women seemed more prepared to take risks over taking drugs than over having sex. After their first E, they were likely to take it frequently.

According to Henderson, one reason why women are not into sex at raves is that men on Ecstasy have less interest in sex and do not expect sex. Most men have the opposite to an erection: a shrinking penis. One girl reported being with other girls walking through a dangerous part of the city when they were approached by a gang of men. They were scared until they realised the men were on E, "then heaved a sigh of relief."

Drugs are an intrinsic part of rave culture. Most interviewees couldn't imagine going to a rave without taking at least one of the dance drugs. These included cannabis, magic mushrooms, LSD and amphetamine besides Ecstasy. Ecstasy was the drug of choice, though at only #2-#3 LSD was also popular.

One said: "When you're on E it's like you're dancing on the notes, and you just feel so up there it's like heaven. And you just feel so good, you love everybody, you look around and you think 'Oh you're all wonderful! DJ, you're wonderful!' If you get a good song on, you get vibes going through your body like rushes; it's fantastic. I've never felt anything like it!" Asked to rate the best experiences in her life, the same girl replied "First E, music and dancing, then sex."

Drugs were the primary reason given for involvement in the rave scene by only 6%. Another 6% were involved in the culture without taking drugs other than cannabis. 75% had used cannabis before getting involved, but only 2% had previously tried Ecstasy. 90% of a sample of women had been through periods of weekly use, frequently following their first experience.

Early in the study, alcohol drinkers were looked down on and referred to as "beer monsters". However, towards the end drinking alcohol was often combined with Ecstasy, in spite of worse hangovers.

Belonging to a wide family and feeling secure is another important attraction of raving. "The first time I took E, I was with this bloke and I just looked at him and I thought 'Oh I can't, don't wanna be with him any more' and that was it. 'Cos there were so many other people and I just felt so confident and you could tell them what you want and be/do anything." However, relationships also form on E as told by a 17 year-old girl: "The emotional impact of E is more of a problem than the physical [one] in my experience. It's frightening how close you become to someone you do Es with, but it's an exaggeration of what you already feel for them". Others describe strong feelings for someone met at a rave, who they do not find to be attractive when seen again elsewhere.

'Policing'. According to Henderson, an important factor determining extent of drug use was that individuals tended to monitor themselves and their peer group. By this she implied looking after and advising one another when to modify drug use.

Menstruation. A quarter of the women who used Ecstasy weekly for over six months reported lighter or less frequent periods and sometimes no periods at all for several months. There is no reason to suspect this is due to a direct effect of the drug, but is likely to be the result of indirect effects - suppressed appetite, sweating and all night exercise.

42 Luvdup and DeElited, by Sheila Henderson, researcher for Lifeline, a non-statutory drug agency in Manchester. A paper given at South Bank Polytechnic in May 1992

This paper discusses women and drugs. Information is based on individual and group interviews with 109 young women and 35 men.

Henderson says Ecstasy users are distinct from opiate users in several ways: for example, they take the drug in public, not private. They do not regard junkies as antiheroes.

Women on the rave scene are even less informed about drugs than men. They are also less likely to be body-searched on their way into clubs. Although in some ways women behave in a more liberated way in the rave scene, it is hard for them to become DJs, the pivotal figures in the rave scene, and they still use their appearance to get into clubs.

More liberated behaviour includes being less likely to be closely tied to a boyfriend. Instead women will come with a group of friends, often without any men. The atmosphere of the rave inspires confidence and independence, for instance it is common for women to mix outside their own group of friends. This has provided a way for young women to rise above being a visual/sexual object. Dealing in E has also provided status for some girls. Outside the rave scene, girls described as 'ravers' are often regarded as sexually available, mainly because of their dress, but within the rave they are not hassled except by men on alcohol. Girls don't feel threatened by men who approach them at raves and therefore are free to respond. "I used to go to indie clubs which are alcohol orientated . . . there was a definite pressure to cop off with people at this type of club. At house clubs it's much more just getting to know people," Henderson quotes one as saying. The general consensus is that "you don't go to a rave to cop [copulate]". This is based on men not getting erections on Ecstasy. Women generally feel far less sexual pressure at raves. They can be massaged by a strange man on the dance floor without it being a threatening prelude to a sexual advance. Flirting is not socially acceptable at raves and is not responded to. Even men encountered on the street are not perceived as a threat, if the women discover that they are on Ecstasy. However, women do not appear to feel less sexy on E and sometimes initiate sexual activity.

Sexual divisions are blurred at raves and displays of affection are accepted. Women are free to hug each other and gays and lesbians are accepted.

43 The Adam Experience, a guide for first-time users, by Starfire, 1985

A seven page pamphlet published anonymously. It gives the following advice: Plan the trip to be free of expectations, duties, tasks or interruptions. Saturday morning is suggested for those who work normal hours. Put aside the whole day and do not drive - it is said this is probably unnecessary but allows for strong reactions. Allow Sunday off too and regard the weekend as a retreat. It is best to take MDMA with someone who has taken it themselves and "above all, is loved and trusted by you". Emotional and psychic bonding can result, so be choosy. Prepare yourself by fasting if this feels comfortable, otherwise avoid solid foods for the preceding 4 hours. Get good sleep the night before. The better you feel, the better the effect.

Doses should be proportional to your weight: 125 mg is ideal for 150-180lbs. A booster 2hrs after ingesting the drug will prolong the plateau for upwards of 6 hours, but this is not really recommended on your first trip as the effect is usually very powerful anyway. The booster dose should be 1/3 of the initial dose.

Take MDMA as if it were a sacrament. Meditate on the fact that you are about to experience something special. During the first half hour it has no effect, so usethis time positively for intimate talk about your hopes and expectations. Focus on shelving or letting go of mundane concerns and trivial upsets.

With an empty stomach you will feel a definite rush, experienced as a clear certainty of your own perfectness and connectedness.

Focus on surrendering to the experience. Let go. Laugh, cry or hug your partner or yourself. Let it be easy and share what you are feeling with your partner, because that's what the experience is all about - sharing, healing, loving.

You will notice minor, harmless effects: dilation of the pupils; increase in pulse; sometimes jaw clenching and eye wiggle and a marked loss of appetite which may last 24 hours. Don't worry if these do not occur. The plateau phase gives you feelings of peace, calm and certainty and lasts from 1 to 6 hours. Use this time to experiment, touch and feel. Looking into your partner's eyes is a profound experience.

If appropriate, you may express your feelings with your partner sexually. The drug is not an aphrodisiac, but it does eliminate barriers. It can aid bonding between people. Sexual experience only occurs when it is appropriate on a heart level for both of you. There may be no desire for sex even with a lover. Know that whatever you choose to create will be a perfect and appropriate choice.

Ecstasy does not normally give 'stoned' feelings, distortions or disorientation. There is no delusion: everything experienced will be just as clear afterwards. Therefore MDMA is a learning tool of immense power. When they use E creatively people change: they get calmer, happier and less tense; more willing to be honest, laugh and to love themselves.

During the plateau phase, it is possible to communicate from a much deeper place. Make use of this: say what you feel. You will find it is OK not to censure yourself. This experience of unconditional communication is transformative at a very deep level. Feel this. Learn this. Talk about it, especially everything you couldn't talk about normally. And let your partner know of your acceptance of his or her thoughts and feelings as well. Suggest saying to each other from time to time: What are we learning? Try to fix in your mind the perfect simplicity of what you are learning. This will be available for you the next day and from then on.

You may not be aware of it, but your body is working harder. Look after yourself, drink plenty of water

Difficult trips may result from the release of unexpected emotions. Sometimes the whole trip will be a reliving of unexpressed negative feelings. This may be painful but it can be profoundly valuable. An understanding, patient and loving partner is needed, but there is no such thing as a bad trip on Ecstasy. There is often a release of negativity followed by relief and joy, although this may not follow until your next trip.

A unique effect of Ecstasy is its afterglow, which may occur from 6 hours to 24 hours after taking the drug. This is a cuddly sort of space and a good time to talk about the experience. Consciously work with your partner to maintain the sense of perfect love created on the trip. It is easy to do during the afterglow, and as this is an in-between state it is a chance to learn how to incorporate the experience into every day life.

A second trip should not be taken for several weeks to allow you time to absorb the experience. Discuss and plan the structure of your next trip to build on what you have learnt.

Do not use Ecstasy if you are pregnant or lactating.

44 MDMA and Human Sexual Function, by John Buffum and Charles Moser, from Journal of Psychoactive Drugs, Vol. 18/4 1986

This paper gives the findings of a survey carried out by distributing an anonymous questionnaire around the San Francisco area in 1985-6. Of 300 distributed, 76 were filled out and returned (25%).

70% of users had engaged in sexual activity while on MDMA. Of these, 88% of the women and 74% of the men said that the sensuality of the sexual experience was enhanced. They indulged in less, but the same type of, sexual activities on MDMA, with the exception of more 'heavypetting'. 81% of users said that the sensuality of the experience was enhanced and several commented that MDMA was a sensual, not a sexual, drug. Half the men said it was more difficult to have an erection and 62% said they had difficulty achieving orgasm, but, among women, as many found it easier to have an orgasm on MDMA as found it harder. 76% of users said MDMA had not caused health or emotional problems. Complaints included urinary tract infections, tiredness, colds, headaches and mild depression next day. While 85% of users said MDMA had no effect on their sexual desires, the rest felt like doing things, such as having group sex, that implied being free of inhibitions. No increase in users' willingness to initiate sexual activity was reported, but they became slightly more receptive. A third of users thought MDMA had helped them overcome inhibitions, making comments like "cleared pelvic blocks," "lessening of resistance," "better sensual communication" and "more relaxed". All the women and 87% of the men thought MDMA increased emotional closeness, and two thirds said this did not depend on the dose.

The researchers conclude that MDMA is not an aphrodisiac, but enhances the sensual aspects of sex. They note that, with half the men and a third of the women having felt more receptive to sex on MDMA, "it is curious that a drug which can increase emotional closeness, enhance receptivity to being sexual and would be chosen as a sexual enhancer, does not increase the desire to initiate sex".

45 A survey of MDMA use in London, by Adam Winstock, a senior house officer in respiratory medicine at the Hammersmith Hospital Royal Postgraduate Medical School (unpublished)

From October 1989 to February 1990, Winstock conducted a survey of Ecstasy use in London. Out of 250 forms distributed, 89 were returned and analysed. 64% of respondents were male and the average age was 23. The youngest respondent was 17 and the oldest 31. Nearly all were single.

Frequency of use:=09

less than 3 per week    2.2%
2 per week             14.1%
1 per week               18%
more than 1/week         28%
less than 1 per month    36%

52% of respondents had used Ecstasy more than 20 times; 5.6% had taken it more than 100 times and 27% had used it less than 10 times. 62% of respondents - including many of the heavy users - had stopped using the drug for some periods of time.

75% took it on Fridays and/or Saturdays only; a mere 2% reported midweek usage. Only 19% said they would take more of it if it were cheaper while 59% said they would definitely not take more if it cost less. 65% said the effect of the drug was variable.

59% noticed the build up of tolerance, but none experienced withdrawal symptoms. For 4.5 per cent of respondents, MDMA was the first illicit drug they had tried. Over 75% had experience of cannabis, amyl nitrate, amphetamine sulphate, cocaine and LSD. In combination with MDMA, 79% of respondents had taken cannabis, 57% alcohol and 51% cocaine.

The most pronounced effect noted by users was sexual arousal (89%), and increased sexual activity (67%). [These findings are in marked contrast with the results of other studies which show MDMA suppresses sexual arousal and activity41, 42, 33, 44]. Other reported effects were unremarkable. 17% reported having had a 'bad E', usually meaning the pill had no psychoactive ingredient.

46 Using Psychedelics Wisely by Myron Stolaroff in Gnosis winter 1993

This issue of Gnosis is devoted to 'Psychedelics and The Path' - various articles discussing the spiritual value of psychedelic experiences. The author says he speaks from several years of research involving psychedelics with some 350 subjects. He believes that "The great value of these materials is that they give us access to our repressed and forgotten material, . . to the archetypes of humanity, to an enormous range of levels of thought, and to the wellspring of creativity and mystical experience that Jung called the collective unconscious." He argues that for Westerners whose lives are intrinsically bound up with making a living, the use of psychedelics is a practical alternative to thelong-term commitment required by Eastern masters.

See reference 144 for Myron Stolaroff's latest work.

47 Phone call to Somerset House: population of Great Britain in various age groups 1991

14-15: 566,400
15-16: 591,400
16-17: 619,200
17-18: 638,400
18-19: 683,200
19-20: 727,400
20-24: 3,943,400
25-26: 832,700
16-25: 7,444,300

48 Young People in 1992, by Schools Health Education Unit, at Exeter University

Questionnaires were completed by over 20,000 pupils aged 11 to 14 in 132 schools in England in 1992. Results showed that, among 14 year-olds, 4.4% of boys and 4.1% of girls had tried Ecstasy.

49 The Normalisation of Recreational Drug Use Amongst Young People in North West England by Fiona Measham, Russell Newcombe & Howard Parker, accepted by British Journal of Sociology December 1993

This paper presents findings relating to a first cohort of teenagers in the study. The sample was designed to be representative of gender, social class and geographical area. 70% were age 14 and 30% age 15; 54% were boys; 88% white; 70% Christian; 84% had fathers in paid work and 68% had mothers in paid work.

Illicit drug use has risen to record levels among this sample. 59% had been offered drugs; 36% had tried an illicit drug; 32% had tried cannabis; 14% poppers; 13% LSD; 12% solvents; 10% magic mushrooms; 10% amphetamine; 6% Ecstasy and 1% other drugs. 20% had used a drug within the preceding month and 33% had done so within the preceding year. Girls were more likely to have been offered and to have tried a drug, in contrast to previous surveys that showed more boys had tried illicit drugs tan girls.

Drug use is generally related to alcohol use; those who drink more also have above average consumption of other drugs. However, those who use MDMA drink less alcohol than users of the more popular drugs above. 45% of respondents had had sexual experiences. Of these, 25% had been drinking before their last sexual experience.

Of those who had tried MDMA, nearly all had also tried cannabis, 80% had tried LSD, 76% amphetamine, 69% psilocybin mushrooms and 60% nitrites. But only 4% had tried cocaine and 7% heroin.

50 The Independent, August 92

"Soccer hooliganism fell last year to its lowest level for five years. Home office figures showed the number of fans arrested and ejected from grounds in 1991-2 dropped to 8,556 while attendances rose to 20,487,192"

51 Toxicity and deaths from MDMA from The Lancet by John Henry et al. August 1992

A report of toxicity and fatalities related to MDMA use picked up through a search of enquirers to the National Poisons Information Service in London and encountered directly by doctors at the National Poisons Unit at Guy's Hospital, London during 1990 and 1991.

There was a striking increase in the number of calls to the NPIS related to Ecstasy use. What was being sold as E usually contained MDMA but MDA and amphetamine were also found; mixtures were uncommon. Henry et al. say that co-ingeston of MDA with MDMA cannot be excluded by analysis of biological samples and that the pattern of toxicity did not seem to be a result of overdose. One analytically documented overdose showing plasma MDMA 7.72fmg/l - allegedly 42 tablets - resulted only in a "hangover" with tachycardia and hypertension.

Reports from the USA suggested MDMA was only mildly toxic. The main cause of death was cardiac arrhythmias; rhabdomyolysis and disseminated intravascular coagulation (DIC). Most cases the authors were consulted about had mild symptoms. There was a clear pattern of toxicity in the most severe cases. Death was probably due to heatstroke "in which severe hypothermia was accompanied by DIC". There was no evidence of drug impurity being responsible for toxicity. All fatalities occurred after the user had been at a crowded party or club. Sustained physical activity, high ambient temp, inadequate fluid replacement could all reduce heat loss and the direct effect of the drug may upset the thermoregulatory mechanism. The authors conclude that MDMA is capable of causing severe toxicity and that the pattern of acute toxicity witnessed in the series of cases studied may be due mainly to the circumstances in which it is misused.

52 Numbers of Ecstasy-related deaths between January 1988 and July 1992, held by the National Poisons Unit at Guy's Hospital on 8 March 1993

The deaths include those reported directly to the NPU by doctors seeking advice and those picked up by the unit from press reports. The list is not comprehensive. In particular, as knowledge of symptoms related to Ecstasy-use spreads among the medical community, doctors make fewer queries to the NPU. Ecstasy-related deaths are held to be confirmed if any amount of the drug is found in the patient's blood or urine during treatment or in a postmortem. In all the deaths picked up by the NPU, the level of MDMA present was very low. Unconfirmed deaths are those in which the patient or others have reported recent drug use verbally but no blood or urine sample has been taken.

From January 1988 to July 1992, there were 14 confirmed deaths, of which 13 resulted from overheating and one from asthma, and 4 unconfirmed deaths, including one from liver failure and one stroke.

Of these, 2 confirmed deaths occurred in 1988; 2 confirmed deaths and one unconfirmed death occurred in 1989; 7 confirmed deaths and one unconfirmed death occurred in 1991; and 2 confirmed and two unconfirmed deaths occurred in 1992.

In 1992 there was also one confirmed death related to MDA and one confirmed death related to MDEA.

53 A report of five deaths associated with the use of MDEA and MDMA, by Dr. G. Dowling, Journal of the American Medical Association, 1987

Three of the subjects had known medical problems before taking the drug, while one was killed by an electric shock apparently after having climbed a pylon. Two had preexisting heart conditions and one had asthma. MDMA was thought not to have been the primary cause of death in four of these cases, although it is suggested that people with cardiac diseases may be predisposed to sudden death by taking MDMA. The fifth death was not explained by other medical factors, but there was no evidence that it was due to taking MDMA.

54 Conversation with Dr. Les King, team leader of the drugs intelligence laboratory at the Forensic Science Laboratory at Aldermaston, part of the Forensic Science Service, a Government agency, 14/12/92

The drugs intelligence laboratory analyses suspected drugs sent by the police, that have been seized from people arrested on suspicion of being in the possession of controlled drugs. Dr. King points out that samples sent to the lab are not necessarily representative of what is being sold on the streets. No statistical analysis of samples is done at Aldermaston, but Dr. King related his impression of the overall pattern of findings, based on personal experience. The lab is not usually told what drug to look for and therefore runs a series of tests to see whether any controlled drug is present.

Impurities are not looked for. But the typical weight of a tablet sent to the lab is from 200 to 600 mg, so non-psychoactive filler is nearly always used. Dr. King has not come across or heard of poisonous substances present in samples of Ecstasy.

Nearly all samples are in the form of capsules and tablets. The lab consistently finds that about 90% contain an active ingredient, while the rest are fake.

When tablets contain MDMA, MDA and MDEA, there is not normally any other drug present. Typically, tablets or capsules contain about 100 mg MDMA or 60-70 mg MDA. Doses vary by 10-20% above or below this amount according to the 'brand' of tablet or capsule, but each brand is fairly consistent from one pill to the next. Recently, a lot of MDEA has been seen but not enough to establish a figure for a typical dose.

The trend in 1991 and 1992 was an increase in MDA but this has peaked and MDMA, MDA and MDEA are now found in roughly equal proportions. MDEA is still on the increase.

There has been a tendency over the years towards dilution of doses - a typical Ecstasy tablet today probably contains some 10-20% less MDMA than it would have contained a few years ago.

Each brand of Ecstasy isaround for 3 to 6 months. Dr. King says this short brand lifespan may be due to fake lookalikes giving the brand a bad name. Tablets composed of amphetamine-based concoctions may be sold as Ecstasy, when MDMA is in short supply. However, these are also sold under other names.

In the past year there has been a trend towards "amphetamine cocktails". One contained amphetamine and LSD, complete with ground-up paper (presumably the 'blotter' LSD is usually supplied on). Another, believed to be sold under the name "banana split", contained amphetamine, cocaine and LSD. Another recent cocktail is amphetamine and Tiletamine. Tiletamine is a vetinerary anaesthetic similar to Ketamine and is manufactured in England for export only. A few kilos were stolen but the source has now been cut off.

A reagent, known as Marquis, consists of sulphuric acid and formaldehyde. It turns orange when mixed with amphetamines and shows a black/purple colour when combined with MDA, MDMA and MDEA. However, it also turns black with various prescription drugs and even paper, so cannot be reliably used to test drug samples. [Someone doing such tests "day in day out" may build up enough experience to distinguish between the colour changes in Marquis when it is combined with MDA, MDMA and MDEA - various shades of brown and orange - but inexperienced users could not hope to do so.] Marquis does however serve as a fairly reliable test for opiates, which show purple.

55 Medicine Now, 9/3/92, BBC Radio 4

Alan Matthews, former editor of International Journal on Drug Policy, spoke on this radio programme. He said that Ecstasy allows people to examine areas that would normally result in pain or distress with a sense of detachment. It does all this without any loss of control or contact with reality. . . For these reasons it is used as an adjunct to psychotherapy, this gives us some insights into its enormous popularity at the moment . . . almost a spiritual experience. It drops the kind of emotional barriers that we all have built into our lives to cope with society and relationships and life in general. It seems to lower those barriers so that people feel more outgoing. In a sense it dissolves the individual into a wider group experience. If you've taken the drug in a club with a thousand other people who are also on the same level, it really does give a very powerful group experience.

Matthews also said that Ecstasy may cause minor psychological problems. Figures on deaths due to Ecstasy were never easy to unravel. Ecstasy may have been used in combination with other drugs; or there may be problems related to the setting - a very hot, overcrowded club with no drinking water may lead to dehydration, heat exhaustion or heatstroke. Taking Ecstasy in combination with another drug and being in such a club could lead to a serious situation. But taking Ecstasy is not the worst thing people can do. "The worst thing they could do actually is go out and drink alcohol and dance for eight hours; that would definitely kill them."

56 Phone conversation with Dr. Russell Newcombe, lecturer in social policy and social work at Manchester University, 19/2/93

Dr. Newcombe had read a couple of articles about people who have died of heatstroke where mention has been made that the victims used to get high temperatures as children. This could be a clue as to why some people are vulnerable to overheating.

Dr. Newcombe took part in a survey of clubs playing rave music in the North West in 1992 and estimates that there were about 30,000 people attending at weekends. He estimates that the proportion of people using E varied from 50% to 90% depending on the club.

57 Effects of MDMA on Autonomic Thermoregulatory Responses of the Rat, by Christopher Gordon et al., 1990

Rats were observed at ambient temperatures of 10 degrees , 20 degrees and 30 degrees C. Measurements were made of their metabolic rate, evaporative water loss [equivalent to sweating, but rats lick their fur instead], hyperthermia, hypothermia, motor activity, skin temperature, heart rate and 'lethality'. Each rat was measured after being administered plain saline and also after 30mg/kg MDMA in saline. The following results occurred when the rats were given MDMA but not when they were given plain saline: (1) The rats lost water through evaporation far more rapidly at 30 degrees ; (2) They increased their metabolic rate and maintained a higher ambient temperature instead of attempting to reduce their temperature; (3) They ma