Ecstasy and Psychedelic Substances: Research, Intervention and Perspectives
Bologna, Italy, November 18-19, 1996

Marianne D'Amore

In general, the speakers at this conference came from the perspective of addiction and toxicity. Dr. Charles Grob was the first speaker at the conference to introduce the possibility of therapeutic uses for MDMA in a clinical setting.

It would be appropriate for the governments of the world to follow the lead of the Italian government and adopt an attitude of scientific curiosity towards this important frontier of neurochemistry.

On November 18 - 19, 1996 the government of Regione Emilia-Romagna hosted an International Conference on Ecstasy and Psychedelic Substances: Research, Intervention and Perspectives at the Royal Hotel Carlton in Bologna, Italy.

The heavy and frequent use of MDMA by the young people of Italy, to the tune of 10,000 young people each weekend in the discos of Rimini, a resort town on the Adriatic coast, has raised the interest and concern of government officials. MDMA use throughout Europe has, in fact, reached such proportions, with an estimated 500,000 to one million users each weekend in Great Britain alone, that it is being described as the largest youth movement in history.

Experts in MDMA use and abuse were invited to share their findings. Gianluca Borghi, the Assessore of Social Politics of Emilia-Romagna, gave the opening address. The conference was chaired by Celeste Giannotti, Emilio Sternieri, Flavio Bonfa and Sergio Semprini Cesari. The presenters from Italy were Fabrizio Schifano, Edoardo Polidori, Andrea Vendramin, Augusto Palmonari, Marcella Ravenna, Emanuela Vezzali Bergamini and Umberto Nizzoli. Charles Grob and George Ricaurte were invited from the United States to present the results of their research and investigations, as were Julio Bobes and Juan Jose Llopis from Spain, Christian Sueur and George Lapassade from France, Harry Shapiro from England and Eric Fromberg from Holland.

The conference was open to the public. Over 1,000 people attended. Health professionals such as psychotherapists, medical doctors, hospital and emergency room staff, nurses, social workers and law enforcement personnel were present. Only a handful of young "trippers" attended.

Perspective of the conference

In general, the speakers at the conference came from the perspective of addiction and toxicity. They spoke of the need to educate the young people to the dangers of regular use, the dangers of dehydration, the dangers of mixing MDMA with other substances and the dangers associated with the operation of motor vehicles after a long night of dancing and tripping. Most of the studies presented were retrospective studies on social aspects, prevalence of use, mortality, morbidity and purity. In the discos of Rimini, the MDMA was found to be 90% pure with each tablet containing between 40 to 85 mg. MDMA. Because of the variance in dosage the young people titrate their own dosages based on personal feedback. It was stated that in the course of one evening an individual might eat eight tablets while waiting for the MDMA to take effect. As MDMA may take up to 45 minutes to produce the desired result self titration can lead to serious overdosing. There are reports of some individuals taking between 10 and 20 tablets per evening. Harm reduction policies were discussed but as so little is understood at this time each country must create the most efficacious policy possible based on theory and minimal experience. It was of great interest to see that many of the European countries recognize and are curious about the lack of observable toxic effect among the young people despite the high usage.

Alternative view

Dr. Charles Grob presented the results of his Phase I safety and dose- response study of MDMA in human volunteers to a rapt audience. As this is one of the only studies done to date on human subjects, interest in the results of his study was high. His lecture was fully attended. Dr. Grob gave a dynamic discussion of his findings and was the first speaker at the conference to introduce the possibility of therapeutic uses for MDMA in a clinical setting. Most attendees of the conference seemed unaware that MDMA had originally been coined with the name "Empathy." Initial clinical studies of MDMA yielded positive results in the areas of relationship counseling, insight into behavioral patterns and increased flow of communication between individuals. These studies occurred prior to MDMA becoming popularized as "Ecstasy." There was a ripple of interest and surprise in the audience as this alternate view was introduced. Dr. Grob emphasized the importance of controlled studies and expressed concern that the dosages taken by youth in some cases far exceeded the recommended normal human dosage. He quoted Paracelsus by saying "The difference between a medicine and a poison is in the dosage." The attendees expressed interest in Dr. Grob's continuing research. A Phase II efficacy study would significantly further the level of understanding as to the beneficial or deleterious effects of this popular substance. The results from a clinical trial are anxiously awaited by scientists throughout the world.

Pharmacology and toxicity

The pharmacology and toxicity of Ecstasy was presented by Andrea Vendramin of Italy. Aspects of neurobiology were addressed by George Ricaurte. Although his studies indicate neurotoxicity in that the neuronal axons are destroyed by excessive use of MDMA, data shows that the cell body is not destroyed. When asked what long-term behavioral changes were seen in his subject animals who were given 160 times the human equivalent dose, he replied that he saw no behavioral changes and had little interest in that line of questioning.

Sociological aspects of use

The sociological aspects of MDMA use and the psychopathology of abuse as presented by Fabrizio Schifano, Edoardo Polidori, Augusto Palmonari and Marcella Ravenna of Italy indicated that the young people participating in this movement generally maintained a relatively high degree of functionality in daily life. They were employed at 40 hour per week jobs. They showed up for work on time Monday morning and acted responsibly in their daily lives. The cost of attending an all-night disco, including the purchase of the MDMA and travel expenses, is estimated to be approximately $100 per weekend. This high expense reflects a significant dedication by the young people towards participation in this dance scene. Abuse issues presented indicate that increasing use of MDMA results in a decrease in sensitivity to the drug so that in time the individual becomes inured to the experience. Ingesting MDMA too frequently will not produce the desired result. Too frequent use seems also to result in depression, fatigue and a lack of interest in life. In a certain percentage of users the individual isolates themselves from family, relationships and social groups after excessive use of MDMA.

Prevention issues

Prevention issues were discussed by Julio Bobes and Juan Jose Llopis of Spain, by Harry Shapiro of Great Britain and by Christian Sueur of France. France has maintained the most repressive laws and penalties against illegal drug use in Europe. Chirac's government is insisting that the European Union's drug policy be harsh and unrelenting. As a condition for membership in the EU, Chirac is placing pressure on the government of Holland to replace its current drug policy with a harsher, stricter policy more in line with the United States' punitive approach towards governmental regulation of personal freedom. Spain's approach is more relaxed, as is Great Britain's approach. However, the impression given was that of a 'wait and see' attitude. There continues to be a rising awareness among the authorities that MDMA use reduces violence and that the number of deaths associated with MDMA use is far less than that associated with alcohol use by the young. As an example, at a typical rave or disco with 6 - 10,000 people present, the number of law enforcement officials required will be half a dozen or less. Whereas, at a pub with half a dozen young men consuming alcohol, the likelihood of a violent episode is extremely high. However, if an increase in automobile accidents, deaths or other toxic reactions should occur or if political pressures increase, these more relaxed stances may change.

Harm reduction

Harm reduction was addressed by a number of speakers. Eric Fromberg spoke of Holland's public service approach of providing on-site analysis of the purity of the tablet, water and counseling services at the raves. Transportation services are also provided in some cases. Determining the amount of MDMA in any given tablet remains a difficult issue as the tablet is sacrificed in the analysis. Until standardized production of MDMA begins, the threat of overdose will continue. Emanuela Vezzali Bergamini discussed ideas of transportation to and from discos for the young. She spoke of the possibility of providing bus services to Rimini as a means of preventing automobile accidents.

A successful conference

The government of Emilia-Romagna provided an excellent opportunity to share information about this important topic. All talks were translated into English, Italian, French and Spanish. The conference was free to any interested parties. In fact, as an audience of 500 people was expected, the conference had to be videotaped and shown in another theater to accommodate the additional 500 attendees. The organizers of the conference requested that all presenters provide a copy of their papers. A conference abstract will be published and made available to interested parties.

It was inspiring to see the level of openness, curiosity and objectivity in an area that is all too often fraught with reactivity, fear and misinformation. It would be appropriate for the governments of the world to follow the lead of the Italian government and adopt an attitude of scientific curiosity towards this important frontier of neurochemistry.

Marianne D'Amore
D'Amore Natural Healing Center
20301 Acacia St., Suite 100
Newport Beach, CA 92660