Nature 430(6998): 399
July 22 2004
Keeping a Clear Head on Effects of Illict Drugs
Alex Gamma PhD.
View PDF version of letter.
Sir – It is surprisingly hard to find a levelheaded, fact-based discussion of issues related to illicit drugs, as is unfortunately illustrated by your recent Editorial Think harder about ecstasy and News Feature The ups and downs of ecstasy about MDMA or ecstasy (Nature 429, 113 & 126128; 2004).
According to your Editorial, MDMA can cause psychosis, hyperthermia and even death in some people who take the drug recreationally. But there is no research to indicate whether or not this will be a problem in the controlled settings of a clinical trial. This last statement ignores many published phase I studies, including some mentioned in the News Feature.
At least five independent research teams around the world have administered MDMA to more than 200 human subjects in controlled experimental settings, and neither hyperthermia nor psychosis let alone death has ever been a problem (see ref. 17 from your News Feature, and others available on request). Increases in body temperature in clinical settings have never exceeded 1 ° C, with some studies failing to find any significant increases. Likewise, no cases of psychosis have been reported in controlled clinical trials with pre-screened subjects. Although there may be low levels of individual symptoms (such as thought disturbances or perceptual illusions reported by Vollenweider, myself and colleagues in 1998; see ref. 13 of the News Feature) that can also occur in clinical psychoses, these disappear completely after drug effects have subsided, and they are a far cry from full-blown psychotic states.
It therefore seems misleading for your Editorial to mention only the 12 documented cases of psychosis related to recreational ecstasy use, and for the News Feature to list only moderate thought disorder when citing findings from our 1998 study concerning the psychological effects of MDMA. In fact, this study, like others, found that MDMA produced several effects, including positive mood, perceptual alterations and slight anxiety over loss of control that was not psychotic.
Non-selective reporting of factual information is the basis for responsible decisions on drug issues, and is in the interests of both sides of the debate on the therapeutic use of MDMA.
University Hospital of Psychiatry,
8029 Zurich, Switzerland
Response to the Nature editorial entitled ‘Think harder about ecstasy’.