Dancing with Molly: The evidence about MDMA

HAVE you seen Molly? She makes me want to dance. The posters plastered on walls around Melbourne are often met with a nudge and a wink by club goers. "Molly" is the slang term for MDMA, better known as ecstasy. And it makes a great number of Australians want to get on the dance floor.

Taken mainly as a party drug, ecstasy causes the user to be more energetic and alert. It lowers aggression and anxiety, leads to euphoria and creates increased empathy and a sense of intimacy with others. According to a 2010 government report, one in 10 Australians over age 14 has used it, the highest per capita rate in the world.

At first glance, this seems alarming – hundreds of thousands of people using a drug that carries the same classification as heroin or crystal meth. But is this alarm warranted? If ecstasy were a legal and available alternative to alcohol, would the social and moral and health consequences be cause for concern?

Many experts Fairfax Media spoke to for this story say there is overwhelming evidence ecstasy is significantly less dangerous than alcohol for the user and society generally. And the word from users is when it is available, they choose it over drinking. The most comprehensive study of the top 20 recreational drugs was carried out in 2010 by the British Independent Scientific Committee on Drugs (ISCD), which ranked them from most to least harmful using a range of weighted criteria.

The results were published in the medical journal The Lancet and have been reported worldwide. Alcohol was found to be most harmful to society and fifth most harmful to users, making it the most harmful drug overall. Ecstasy, on the other hand, causes almost no harm to society and scored very low on the harm done to the user, coming in at 17th overall. Cannabis (legalised in two US states last month) came in eighth.

"The present drug classification systems have little relation to the evidence of harm," wrote ISCD researcher Professor David Nutt, former chief adviser on drugs to the British government until he was dismissed in 2009 after controversially stating that using ecstasy is safer than horse riding.

These findings are no surprise to think tank Australia21, which has released two reports condemning the so-called "War on Drugs".

"What Australia21 is about is laying out the evidence," says chairman Paul Barratt, a former head of the Defence Department. "And there's evidence that there are drugs that are less harmful than alcohol or tobacco."

Australia21's latest report, "Alternatives to Prohibition" contains a proposal by Professor David Penington, that ecstasy (along with cannabis) be decriminalised and made available in controlled doses to those who are willing to be put on a confidential national users register.

"If [ecstasy] could be handled in a controlled manner rather than just by arresting people for possession and use, we might have a basis to deal with it more effectively with education as a health issue among young people," Penington says.

So why are people being criminalised for possessing and using a substance that experts claim causes little harm to users and virtually none to society? In Victoria, possession of ecstasy carries a maximum penalty of a $4200 fine and imprisonment for one year.

Several ecstasy users agreed to speak to Fairfax Media on the condition of anonymity. All have professional jobs, which may be at risk should they receive a drug conviction.

"I'd have to say MDMA has given me some of the best experiences of my life," says user "Malcolm". "But also a lot of frustrating times that all seem to come from it being illegal: worrying about the police, sourcing the product, the quality, whether it'll actually even be MDMA or if I'll be robbed or hurt or killed buying it."

Professor Alison Ritter of the National Drug and Alcohol Research Centre says arguments against legalising ecstasy are not based on the available evidence about the drug. "The policy debate is much more about ideology and beliefs about drug use than it is about research evidence" she says.

The most common objection is that legalisation would increase the uptake of the drug by young people. Ritter emphasises there is no current evidence to support this assertion.

But even if it is true it would be naive to think prohibition will prevent people from turning to other drugs. Indeed, the Australian Institute of Criminology has reported a correlation between the unavailability of ecstasy and a rise in crystal meth use. Experts say others will resort to alcohol, which Nutt's research shows causes greater harm.

David Penington's studies over the years have led him to a similar conclusion. "It is an anomaly that ecstasy, which causes far fewer problems than alcohol, is seen as criminal." He believes young people are aware of this and therefore, "these issues have no credibility among young people when we preach about them on moral grounds".

All users who spoke to Fairfax Media say they drink less when using ecstasy, mainly because alcohol lessens its effects. "I used to think I was happy when I was drunk but I realised that wasn't the case. The euphoria associated with alcohol just doesn't measure up to Molly," says one user.

Dr Alex Wodak, who was director of the Alcohol and Drug Service, St Vincent's Hospital, Sydney, for 30 years says adverse health events from MDMA are uncommon but nonetheless receive saturation media coverage when they do occur. This, he says, compares with adverse health events from alcohol which are "regrettably common" but receive little coverage.

"For every person seen with a problem with MDMA there would be hundreds, if not thousands, seen with an alcohol-related problem," he says. He doubts that there have been "more than a handful" of deaths directly related to MDMA in Australia.

David Nutt's research also found ecstasy lowers levels of aggression.

"George" concurs. "After a few too many [beers] , if someone bumps into me I get angry. When I'm on ecstasy I just laugh and apologise. You never ever feel like getting into fights on ecstasy."

Criminal barrister and spokesman for the Australian Lawyers Alliance, Greg Barns agrees. Of his clients who wind up in jail after a big night out, he says alcohol always plays a part, but ecstasy never does.

"If police wanted a quieter Saturday night make sure there's a plentiful supply of ecstasy, rather than alcohol. Because ecstasy is not a drug that is known to be associated with violence," he says.

While there is little risk of harm in using MDMA, the greatest health risk comes from not knowing what (non-MDMA) adulterants are in black market pills. For some, this has been alleviated by the emergence of online illicit drug marketplaces, which have vendor feedback and user reviews confirming the purity of the drug. "It's been a godsend," says "Malcolm".

Another cause for concern, says Penington, has been a rise in synthetic drugs that mimic the effects of ecstasy. The impact on users' health from these unregulated research chemicals is unknown, whereas more than 30 years of research has found MDMA to not only be relatively benign, but may have medical and therapeutic benefits.

After serving with the Australian Army for 15 years, including a war in Somalia in 1993, Steve McDonald, 50, was diagnosed with post-traumatic stress disorder (PTSD) and hospitalised in a psychiatric ward. "I went through all the mainstream treatments," he says. None of them worked.

Some years after his first breakdown, McDonald developed an interest in work being done by US group MAPS (Multidisciplinary Association for Psychedelic Studies) into psychedelic-assisted therapy. He is now the association secretary of PRISM, a non-profit association of Psychedelic Research in Science and Medicine, which is seeking approval for a clinical trial of MDMA-assisted psychotherapy for PTSD sufferers.

US studies found that in 2010 more than 80 per cent of subjects who received MDMA-assisted psychotherapy for treatment-resistant PTSD no longer met the diagnostic criteria for PTSD following the trial.

Those who were successfully treated said the MDMA produced a state of mind that allowed them to feel and talk about their trauma without being overwhelmed by it.

McDonald is frustrated that he and other Australian war veterans do not have access to a therapy he says has been proven to be beneficial in overseas trials.

"I think there's a great deal of scientific evidence coming from around the world right now that many of the drugs that we have on Schedule 9 here in Australia, including psychedelics, are extremely promising medicines which can open up new approaches to healing."

Progress on the Australian trial has been disappointing. Such studies need to be approved by an ethics committee and the MDMA trial was refused, mainly because PRISM has been unable to secure the services of a psychiatrist with both the credentials and availability to run the study.

Greg Barns says there is also a final compelling argument to legalise ecstasy on economic grounds alone.

"As an exercise of public policy and judicious use of taxpayers' money, this should be regarded as not only a failure but a scandalous waste of money by law enforcement agencies and governments around the world," he says.

Not only is the enforcement of the ban on ecstasy draining scarce government resources, it is diverting potential government income from ethically sourced or manufactured drugs into the hands of organised criminal gangs.

"I don't know of any other area of public policy where we not only run counter to the evidence but in fact we knowingly support criminal enterprises," Barns says.

Paul Barratt has requested a Productivity Commission inquiry into the "War on Drugs" with independent analysis to determine the economic impact of current policy. The response, he says, has been "deafening silence". "We've spent billions on drug law enforcement [and associated costs]," he says "Why is it completely off the agenda to take a look at whether we're getting value for money for those things?"

Experts say decriminalising ecstasy would allow resources currently spent identifying and prosecuting users to be diverted into other areas. Actually legalising it could bring money in through a government-owned supply or taxes on regulated supply from private manufacturers.

Despite overwhelming evidence that prohibition is expensive, ineffective and potentially dangerous neither of the major political parties is interested in entering into a debate on drug reform.

"It's just political caution," Barratt says. "Most people think drug law reform is a good idea, but those who don't are much more passionately committed to their view." For them, he says, it is a vote-changer.

"[The parties] are in thrall to conservative tabloid media, some Christian groups and marginal seats," Barns says. "It's a classic case of putting short-term political gain in front of the long-term health of Australia."

Penington thinks any impetus for change has to come first from the broader community. "The general community attitude is that taking alcohol is not seen as a moral failure, while taking any amount of ecstasy is seen as a wicked, dangerous thing to do".

But Steve McDonald believes there is a grass roots change under way overseas and remains hopeful. "I think once there's a very clear signal that the majority of the Australian public support drug law reform, you'll see the politicians changing their minds."

Read more: http://www.theage.com.au/victoria/dancing-with-molly-20121203-2ar04.html#ixzz2EAuWmkqN
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