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LA Times 27-MAY-85
Psychiatrists Defend New Street Drug for Therapy
by Miles Corwin - Times Staff Writer
SAN FRANCISCO - Kathy Tamm was walking to her car following a meditation
class in Menlo Park when she was abducted, taken to a wooded area, tied up,
beaten, and then tortured for several hours. For six months after the
incident she underwent intensive therapy, but she showed little progress.
She had terrible nightmares. She was terrified to leave the house. Every
unexpected noise, every shadow assaulted her senses and brought back visions
of the attack.
Tamm, 39, a San Francisco marriage and family counselor, said she was
"suicidal, at the end of my rope." As a last resort, Tamm and her
psychiatrist decided to treat her with MDMA, and experimental drug that some
psychiatrists had found to be effective with traumatized patients.
"I've taken it several times, and each time I felt a little less fearful,"
Tamm said. "The drug helped me regain some measure of serenity and peace of
mind and enabled me to begin living a normal life again.
"For the first time, I was able to face the experience, go back and piece
together what had happened. By facing it, instead of always burying it, I was
able to sort of slowly discharge a lot of the horror."
Tamm's psychiatrist, Dr. Joseph Downing, and other physicians will testify at
Drug Enforcement Administration hearings in Los Angeles on June 10 and 11 in
an attempt to persuade federal authorities that MDMA has great benefits and
should be kept available for therapeutic use. The drug, which is now legal,
may soon be outlawed by the DEA.
At the hearing, other health professionals will talk about MDMA as a popular
and dangerous new street drug. They will warn that MDMA has not been
thouroughly tested and is a source of increasing abuse and will argue that
its availability should be highly restricted.
The hearings in Los Angeles will bring to a head the division between a small
but not vocal group of psychiatrists, therapists and professors who claim
MDMA is a useful therapeutic tool and those health professionals who see the
drug as dangerous.
The drug, known on the street as Adam or Ecstasy, is a chemical cousin of
MDA, an illegal psychedelic drug popular in the 1960s. Users say MDMA offers
a slightly altered state of consciousness without hallucinations, heightened
sensibility without anxiety. And some psychiatrists contend that the drug is
valuable because it dissolves emotional and psychological barriers, enhances
communication, and relaxes inhibitions.
During the last few years, MDMA has become one of the most sought-after drugs
on college campuses. The non-medical use of the drug has increased from about
10,000 doses in all of 1976 to the current 30,000 doses a month, estimated by
Ronald K. Siegel, a psychopharmacologist at the UCLA School of Medicine.
At the Haight-Ashbury Clinic in San Francisco, several patients a month who
have taken high doses of MDMA seek treatment for symptoms similar to
"amphetamine psychosis" - paranoia, anxiety and delusions, said Darryl Inaba,
director of the clinic's drug detoxification project.
Inaba recently received a call from a San Mateo College official who said
there was a "major outbreak" of the drug at the school and that many students
were having "panic attacks."
Classification Protested
The DEA has been aware of the increasing abuse, but unaware that the drug
also is being used by about 100 psychiatrists throughout the country as an
adjunct to therapy, according to Frank Sapienza, a DEA chemist. Last July the
DEA announced plans to list MDMA as a Schedule I controlled substance, the
classification for drugs with no therapeutic use and a high abuse potential,
such as LSD and heroin.
"After the announcement," Sapienza said, "all hell broke loose."
The DEA was deluged with letters from angry psychiatrists and therapists who
challenged the DEA's research and classification procedures. They were
outraged that the DEA plan would virtually eliminate all research and
clinical use of the drug, and they demanded a public hearing.
A Berkeley research foundation and a group of physicians and therapists
retained a Washington law firm to challenge the proposed classification of
the drug.
The DEA decided it was "obligated to listen to some other views," Sapienza
said. After the Los Angeles hearings, there will be others in Kansas City and
Washington, and the DEA will make a decision by 1986.
Psychiatrists are uncomfortable discussing how they obtain MDMA. Most work
with chemists and make their own supply, and a few tell their patients to buy
it on the streets. The drug is readily available for about $30 a dose and is
now sold by many cocaine dealers in San Francisco, where the drug is more
prevalent than in the Los Angeles area, said a Haight-Ashbury Clinic
spokesman.
Use in Treatment Defended
The "street misuse" of the drug should not "keep it from being used
rationally in treatment," psychiatrist Downing said. Most psychiatrists who
are familiar with MDMA, Downing said, agree that some controls are needed and
suggest a classification comparable to a prescription drug like Valium.
Dr. Philip Wolfson, a San Francisco psychiatrist who will testify in Los
Angeles, agreed that extensive testing is in order, but he believes the drug
is so useful in therapy that it should continue to be used during the years
of testing.
"My patients didn't suddenly stand up and throw their crutches away, but I
saw some positive developments after a few sessions," he said. "Patients who
had seen only a negative, tortured world had a shift in perspective, and a
lighter, friendlier reality was momentarily available to them. For most, the
positive experience carried over after taking the drug."
Most drugs used in psychiatry are "downers," and MDMA is unusual because it
"lightens" moods, Wolfson said. And in addition to aiding the patient, he
said, it facilitates the work of the psychiatrist. Sometimes after patients
have taken MDMA, Wolfson said, he has "accomplished the work of 20 sessions
in one afternoon."
Defended by Monk
Brother David Steindl-Rast, a Benedictine monk from the Immaculate Heart
Hermitage in Big Sur, tried the drug at a conference on the medical uses of
MDMA. Steindl-Rast, who was a psychologist before he entered the monastery,
said the drug facilitates the search for the "awakened attitude" all monks
seek.
"It's like climbing all day in the fog and then suddenly, briefly seeing the
mountain peak for the first time," he said. "There are no shortcuts to the
awakened attitude, and it takes daily work and effort. But the drug gives you
a vision, a glimpse of what you are seeking."
Siegel of UCLA, who has provided the DEA information about the street use of
MDMA, said he is skeptical when he hears of any new "wonder drug."
"My reaction is 'Here we go again,' Siegel said. "We heard the same kinds of
things during the early days of LSD and mescaline. When PCP first came out,
it was known as the 'peace pill.' Now we know it as more of a 'war pill.'
"in the early '70s when people were using very low doses of cocaine, a lot of
researchers had never seen a case of coke psychosis and didn't think the drug
was a health problem. Then the doses increased and so did the problems."
Known as "Love Drug"
Health problems associated with MDMA have been escalating as users have been
taking increasingly high doses, Siegel said. Extensive research is needed
before the drug is made available by prescription, he said, because little is
known about its long-term effects and toxicity. And, he said, MDMA has a
fairly narrow "index of safety." The dose of MDMA "that gets you high and the
dose that kills you is narrower" than many drugs, including LSD.
MDMA (3,4-methylenedioxymethamphetamine) has a chemical composition that is
related to both amphetamine and mescaline. It is known as "the love drug" in
college campuses where it is considered to be an aphrodisiac, but users who
were interviewed said it precipitates emotional, not sexual, feelings.
"You can't sleaze with it," said student Jeff Manning who has taken the drug
several times for "the experience." "Your true emotions come out, and
nobody's going to do something they don't want to do. It's not a scary,
trippy drug. It won't take you someplace you don't want to go."
DEA officials should not be mislead by the "love drug" and "ecstasy" labels,
said Tamm, who used the drug several times in therapy after being assaulted.
If the drug is outlawed because of street use, she said, the harm will be
irreparable.
"I'd hate to think that others who have gone through an experience like mine
wouldn't be able to use MDMA," she said. "I don't know what shape I'd be in
now without the drug."