The Return of MDMA

Some doctors are itching to prescribe ecstasy again. How do we avoid the regulatory mistakes of the '80s?

I Feel Love MDMA and the Quest for Connection in a Fractured World, by Rachel Nuwer, Bloomsbury, 384 page, $28.99

In 2006 a Florida man named Zulfi Riza reached out to Rick Doblin, the founder of the Multidisciplinary Association for Psychedelic Studies (MAPS). Riza was suicidal. He was suffering from PTSD, anxiety, depression, and anger issues. He had tried countless remedies, and he felt that Doblin was his last hope. Riza had heard that an underground network of psychiatrists practiced therapy using the illegal drug MDMA, better known as ecstasy or molly. And Doblin knew of such a therapist.

But Riza also suffered seizures. Should a medical emergency take place during a session, the therapist would be exposed and could lose their license, or worse.

Doblin told him he couldn't help. Riza killed himself the very same morning.

The Drug Enforcement Administration (DEA) had unilaterally outlawed MDMA in 1985 under emergency powers granted to it by Congress. To back up the ban, the agency cited flimsy evidence about MDA, another drug entirely. It was a catastrophic case of government overreach. Zulfi Riza was just one of many people whose lives may have been saved had they not been forced to seek help in secret.

The DEA isn't the only villain in this story. In 2002, a senator from Delaware named Joe Biden proposed the Reducing Americans' Vulnerability to Ecstasy (RAVE) Act. This eventually passed, in somewhat watered-down form, as the Illicit Drug Anti-Proliferation Act. It basically made party organizers liable for drugs consumed on the premises. This made it much more complicated to organize services such as testing partygoers' drugs for dangerous ingredients, as it would implicitly admit there was drug-taking on-site.

At a time when Americans are dying in record numbers from accidentally ingesting substances such as fentanyl, a de facto ban on drug checking in places where Americans take drugs—clubs, festivals—seems especially criminal.

Now that the war on weed is all but lost—federal legalization of marijuana feels like a matter of when, not if—the next battlefront will be over MDMA and other psychedelics. This year Australia allowed licensed therapists to give patients the drug. (It did the same as well for magic mushrooms.) Meanwhile, the Biden administration expects MDMA and psilocybin to be approved therapeutically within the next few years.

Rachel Nuwer's book I Feel Love arrives just in time for the debate. It exhaustively chronicles MDMA's journey from a therapeutic tool to an underground party pill and back to therapy. Although many drug books dwell on the criminal element—killer kingpins, sophisticated smugglers—Nuwer, a respected science journalist, mostly prefers to explore the positive potential of ecstasy and the forces, such as MAPS, seeking to unleash it.

As illicit narcotics go, ecstasy is relatively benign. It does not, as an infamous episode of Oprah suggested, turn your brain into Swiss cheese. Instead, it floods you with an overwhelming sense of love, joy, and empathy—the kind of feeling you get, as Nuwer puts it, "if you were suddenly reunited with a good friend that you hadn't seen in years, and you stayed up all night talking because you were so happy to see each other."

It's precisely these properties that make MDMA such a useful tool for addressing trauma, anxiety, and other mental health issues. Since it's virtually impossible to feel bad while on it, patients can dive deep into traumatic events without being overcome with emotions, and open up to their therapists about things they'd normally keep bottled up.

But as any seasoned tripper will tell you, it's not just the drugs; it's how and where you use them—the set and setting. Someone undergoing MDMA-assisted therapy will get support and guidance from trained professionals. Likewise, someone spending all night pumping his fist in the air at a warehouse party in Brooklyn is unlikely to walk away with any psychological breakthroughs.

Rick Doblin's quest to legalize ecstasy features prominently in the book. Doblin has been fascinated with psychedelics ever since his time studying at New College in Florida, in those days an open-minded institution where students took acid and hung around a clothes-free swimming pool. When the DEA announced its intent to outlaw ecstasy in 1984, Doblin led the counterattack, rallying lawyers, shrinks, and scientists. When that failed and the ban was soon to go into effect, Doblin sold ecstasy pills that had been donated by one of the drug's first kingpins, Michael Clegg, to fund experiments on rats and dogs. Doblin then enrolled at Harvard and interned at the White House to become an insider in government policy.

MAPS has been behind several promising studies showing MDMA's potential in treating combat veterans, sexual assault survivors, and others. Less happily, Doblin and MAPS have been criticised recently for how they handled a sexual abuse case during one of their clinical trials. While creepy therapists are hardly unique to psychedelics, tossing mind-altering chemicals into the mix leaves patients particularly vulnerable. Doblin also has a reputation as a psychedelic evangelist who sometimes gets ahead of himself, which has hurt the cause at times. To her credit, Nuwer doesn't shy away from Doblin's flaws, which will likely get more attention as the debate around psychedelics heats up.

Although Nuwer does an excellent job of breaking down the scientific studies of ecstasy and how exactly it works on the brain, there are still gaps in the research. Some experts have questioned whether enough is known about those for whom MDMA-assisted therapy doesn't work. Could it actually make things worse? Certainly, there are accounts of patients feeling suicidal after a session, a point which Nuwer perhaps covers a little too briefly.

Still, most people aren't taking ecstasy in a clinical setting to cope with survivor's guilt after surviving an IED blast in Fallujah. They're doing it to let loose at boisterous jamborees like Coachella and Burning Man. Nuwer feels no shame describing herself rolling on molly at house parties.

As for ecstasy's alleged dangers: Millions of people have taken the drug since the late '80s, but there hasn't been a corresponding epidemic of brain damage. An infamous study that seemed to show that it caused brain damage in monkeys turned out to be bogus after it was discovered the monkeys had been injected not with molly but with meth.

That isn't to say ecstasy is harmless. Nothing is—even caffeine can kill you in heroic doses. But most of the drug's dangers exist precisely because of the DEA's decision to ban it all those years ago. Nuwer tells the story of Martha Fernback, a 15-year-old English schoolgirl who died in 2013 after swallowing half a gram of 91 percent pure MDMA powder. Like almost everyone else who wants to feel the euphoric bliss of molly, she purchased her gear from an underground pusher, not a licensed pharmacist. She had no idea what dose she was taking, or even if it contained MDMA at all.

Imagine if we played the same stupid games with liquor or beer. Actually, you don't have to imagine. Certain parts of the world have banned booze, so the people there aren't sipping fine wine; they're drinking moonshine or bathtub hooch. Many of them then go blind or die. Rather than crusade against the evils of drugs, Martha's mother joined a campaign called Anyone's Child, calling for a reform of British laws and the legalization of ecstasy.

The ancient Greeks had a word, pharmakon, that can mean either "poison" or "medicine." It's too bad we can't always tell which is which.