Journal of Psychoactive Drugs
 

                           Ecstasy: The Complete Guide   Reviewed by Steve Heilig, MPH

                                 The literature of all types concerning MDMA is quite vast; just take a
                          glance through the excellent, but not exhaustive, 37-pages-of-small-print
                          reference list in "Ecstasy: The Complete Guide."  One might think that the
                          most important questions about this drug would be fairly well settled after
                          all the decades of investigation, both sanctioned and otherwise.  Yet
                          concerns about acute and long-term risk, harm reduction, therapeutic
                          potential, and more remain hotly debated.  Which makes volumes such as
                          these valuable contributions to, if not resolution, wider understanding.
                                  Julie Holland, MD, a psychiatrist with longtime interest in the
                          therapeutic use of MDMA, has pulled together something of an all-star cast
                          to contribute to her weighty work.  Anyone with even a passing familiarity
                          with the published work on MDMA should recognize many of the names here:
                          Nichols, Grob, Shulgin, Doblin, Jansen, Metzner, Weil, and many others are
                          included.  And as a whole, they have impressive credentials, and cannot be
                          assailed on the grounds of underqualification.  Some of the first figures
                          to address the many issues surrounding MDMA have contributed new articles,
                          summaries, or interviews.  Thus the history, chemistry, known risks,
                          legality, psychotherapeutic potential, cultural considerations and much
                          more are presented here in largely concise, non-professional
                          reader-friendly formats.
                                  Holland does not hide her intentions here:  she wishes to
                          "medicalize" the use of MDMA, "giving it back to the people who can  benefit
                          most from its judicious, supervised use."  For her and some of the other
                          authors included this particularly means patients with post-traumatic
                          stress disorders, with terminal disease involving unresolved pain and
                          psychological problems, and - in speculations which might strike many as
                          ironic - "patients with refractory substance abuse problems."  As it is
                          stressed that such clinical use would entail few MDMA sessions at most, in
                          medically supervised settings, from a risk/benefit perspective these
                          authors are persuasive.   And it should be noted that most seem to already
                          feel that MDMA's therapeutic use is proven for some indications note that
                          the book's subtitle posits "benefits", not potential ones - which might
                          discredit them in the eyes of some readers, who could find further
                          ammunition in the more speculative proposals to use MDMA for depression and
                          schizophrenia.  So be it.
                                  The risks, known and putative, of MDMA are also extensively and
                          fairly presented.  Here at least three groups of users might be discerned
                          from these collective discussion:  Patients with possible medical
                          indications, for whom the limited, supervised use is less "risky" than
                          their diagnosed condition;  illicit users who just try MDMA a few times or
                          infrequently, for either or both recreation or insight; and the committed,
                          repeated user, likely to fit at some point into the broad, ill-defined
                          "raver" category.  For the first two, the risks as presented here seem
                          minimal, as long as the user does not have "heart disease, high blood
                          pressure, liver disease, seizure history, diabetes, hypoglycemia, glaucoma,
                          or hyperthyroidism or any woman who was pregnant."
                                  For those in the third, hard-partying contingent, which includes
                          vast number of former and current young people, the bets are still off.
                          The first issue is the high probability of impurities and substitution in
                          street "ecstasy," which seems to be an ever-growing problem.  Reports of
                          some level of dependency and rebound depression are increasing.  The
                          hazards of heat dehydration at raves are still with us.  And the spectre of
                          longterm neurological damage resulting from heavy use has yet to resolved
                          to most observers' satisfaction.
                                  These issues receive fair attention here.  There are welcome
                          sections on harm reduction, clinical treatment of bad reactions, and useful
                          charts for many of the more worrisome concerns.  The book concludes with a
                          section regarding spiritual aspects of MDMA use, and a "Prescription for
                          Cultural Renaissance" which already reads as a dated, dot.com-ish flight of
                          fancy.   The chronological timeline, research summary, and aforementioned
                          bibliography are all most useful consolidations of available knowledge
                          through the year 2000.
                                  "Complete" or not, Holland has provided a real service in
                          collecting, and warmly summarizing and introducing, all of this material,
                          and her book is indeed the best single volume on MDMA to date.

                          *San Francisco Medical Society, 1409 Sutter Street, San Francisco, CA
                          94109.  heilig@sfms.org