Into the Land of Love with Dr Holland

What can science tell us about MDMA? Hint – not much, yet.

text by Noam Auerbach / image via NYPost

Every weekend millions of people around the world take a little pill that takes them into a few hours of what some describe as “the land of love.” Users describe feelings of freedom, energy, openness, acceptance, and a euphoric admiration for all they come into contact with. Its use has become extremely popular, and has even reached our small and peaceful campus. Some of you reading this article smile to yourself knowing the feeling; others regard this article with skepticism associating danger and drug abuse with the pharmaceutical in question. Regardless of where you are on this spectrum, how much do you actually know about ecstasy? Whether you use it or not, are you aware of the potential costs and benefits of this 125 mg pill?

Ecstasy is the nickname given to the solid state of MDMA. Often times, speed is added to the MDMA generating a spike in energy levels for its users. MDMA, like many other recreational narcotics, was not intended for its current use. It was first synthesized in 1912, as an intermediate chemical. For the next 40 years MDMA was forgotten until it was repurposed by the American Army as part of their attempts to create “brainwashing” drugs. The 1970s brought about civilian and therapeutic uses for the drug, increasing in popularity during the 1980s with the rise of electronic music.

While we know a lot about its history many of its users do not have a full understanding of what the drug actually does in terms of the physical effect on the human brain. Ecstasy is a psychoactive drug and is categorized as a stimulant. It effects the brainvia two main neurotransmitters: serotonin and dopamine. These two neurotransmitters monitor the feeling that we experience as happiness. Ecstasy effects brain function in three ways: it stops serotonin from being absorbed, and then releases high levels of serotonin and dopamine. The combination of these neurological occurrences is not exclusive to ecstasy; most antidepressants have a similar effect. While we do have baseline understanding of Ecstasy’s effect on the brain there is a lot we still don’t know. In fact, this question has been a prominent area of scientific research for more than 30 years.

Dr. Julie Holland is a world-leading expert in the field of psychopharmacology, who dedicated her life to the research of MDMA. In the growing field of recreational drug research Dr. Holland is a superstar; publishing numerous scientific papers and books, involving herself with patient treatment in New York city, and advocating for an open, factual, and scientific discussion on MDMA. Dr. Holland asked us to include why she agreed to be featured in our unparalleled publication explaining that she wanted the chance to have an impact on young people and that she’s a “huge fan of the Netherlands and Utrecht”.

What made you decide to go into this type of research?
“I remember seeing homeless schizophrenics on the street as a kid and I really wanted to help them, to reach out to them and figure out a way to make a difference in their lives. Also, I was very interested in drugs and how they worked in the brain, how they affected people’s behaviors. From a young age, I was sure I wanted to become a doctor and help people, and I was fascinated by the brain, abnormal behavior, and drugs, so psychiatry was a good fit for me and my interests. When I was in college, I started reading about ecstasy and the Texas dance scene, and more importantly, about psychiatrists who were using MDMA with their patients and having tremendous results, especially with PTSD. I contacted these psychiatrists and stayed in touch with them over the years, eventually assigning them chapters to write in Ecstasy: The Complete Guide. I tried to get an MDMA schizophrenia study going when I was at Mount Sinai Hospital, but it was impossible to get permission at that time. It’s still something I’m hoping someone will do some day. In the meantime I’m the medical monitor for MDMA PTSD studies.”

Here in the Netherlands ecstasy is a very popular drug among students, assuming most of them are healthy normal people, what dangers are they taking upon themselves when using it?
“It’s a simple question with a very complicated answer. There are no perfect before and after longitudinal studies of people only using pure MDMA, so we can’t say for sure. There are a lot of imperfect studies suggesting there are changes to the serotonin system, and others saying that panic and depression are risks of heavy sustained use.”

And still, can we point out specific problems with long-term use?
“The problem is you have no idea what they’re taking every time they do. People do studies of ecstasy users, but it’s impossible to control for other drugs. The one study of people who used it and didn’t use any other drugs, which was a group of Mormons in Utah, didn’t show a lot of problems, but there are an awful lot of studies suggesting there is damage in heavy users. The question remains, what were they using?”

In this sense, would you say MDMA is addictive like other drugs?
“For most people, pure MDMA is less addictive than many other drugs, though I won’t say it’s not addictive. One issue is a lot of people aren’t taking pure MDMA and the drugs they are taking that are substitutes may be addictive. There are many anecdotal reports of people taking Ecstasy repeatedly where it seems to feel less good. The negative side effects outweight the potential benefits. It’s called cumulative tolerance. It just starts feeling less good. So in that way it’s almost like MDMA has a built-in deterrent against chronic use. But there are outliers who get addicted. “

Some users base their use on the 3 month rule (taking breaks of 3 months between each taking), where does it come from and does it have a basis in reality?
“There are no studies on how long you should wait. The three month rule was proposed by Sasha Shulgin’s wife Ann, and is informally supported by other educators, but there really are no studies looking at what optimal spacing might be.”

What influence does it have on our long-term ability to be happy?
“I have no idea.”

Are there any benefits of recreational use of ecstasy?
“I do think that people dancing together, joining together in a group experience of cohesion is therapeutic. That sense of group transcendence and unity. That’s good for your soul, I’d say, and it may also be good for the planet, a reminder that we’re all in this together. So, yes.”

It was mentioned extensively in your book, ‘Ecstasy – the Complete Guide’, that MDMA can, and should, be used as a therapeutic tool under proper guidance, can you please elaborate on that?
“Clinical research studies are underway to show just how beneficial MDMA assisted psychotherapy is on various diagnoses like Post Traumatic Stress Disorder and Autism. It’s early to tell for autism and Aasperger’s spectrum disorders, but for PTSD the data is looking very strong that this can be an effective way to process trauma and get sustained symptom relief.”

If you could suggest a political change in regards to MDMA, how would you shape an actual legal framework?
“Well, the trials in the United States where the DEAs administrative law judge heard days of testimony recommended Schedule III, which means a doctor would be able to prescribe it. MDMA is in Schedule I right now, meaning it has no accepted medical value and a high potential for abuse. It will take a lot more research before the scheduling changes here in America.”

In case I see a person who is not feeling well under the influence of MDMA, what should I do?
“If they seem feverish, dehydrated, or confused in any way, or if they are vomiting or having seizures, they need prompt medical attention and you should bring them to an emergency room. It’s always wise to take breaks, cool down, and drink water but not overdo it on drinking water. MDMA can cause water retention, so you don’t want to drink more than you lose through sweating.”

Lastly, how do you see the future of ecstasy? Both scientifically and socio-culturally?
“Well, it’s been a part of our culture for quite a few decades now, but it’s still a fairly small percentage here. One of the problems with a drug getting more popular is there is lower purity or veracity in what’s available. Drug substitution can be really dangerous, so when we go through these waves where it’s getting more popular, it becomes a public health issue. “

Thank you Dr. Holland for your time and willingness to share with us your knowledge!
“Thank you”

Ecstasy is unlikely to disappear from our culture or campus. As with many other things, people engage in certain activities even when they don’t know the precise outcomes of it. It is important for young people anywhere in the world to be aware of the facts, and at least know what they don’t know. At the moment the scientific community cannot give a concrete answer on the long-term impact of MDMA. Nonetheless, assuming the effect is minimal, it can have dangerous repercussions. One thing users should bear in mind is that most of the information they have on a drug, any drug, is usually based on experience and not on scientific evidence. In that sense people ought to base their knowledge on actual neurological and pharmacological understandings, and not on their best friend who used it twice before them. On the other hand it seems that there are positive aspects of MDMA use. It is easy to think in black and white terms (drugs are bad!), however in doing so we might be preventing ourselves from moving forward; as a society and as individuals.

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