E for Ecstasy by Nicholas Saunders
Appendix 1: Reference Section

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.