I am disappointed in the mainstream, and not so mainstream, media coverage of the Mithoefer et al, 2010 paper on MDMA-assisted therapy for Post-Traumatic Stress Disorder. I had been holding off reading any of it because I suspected it might distract me from actually discussing the paper.
After writing up my thoughts on the paper, I went strolling around the Google News hits for MDMA to see what had been written about this paper. There was a whole lot of of really bad journalism. Sure, for the most part they got the basic facts right, but I noticed a consistent issue having to do (I assume) with journalism’s penchant for selling a story they’d like to tell over the story that exists.
Let us start with the more venerable news organizations.
ABC News Ecstasy may help traumatised veterans
See the title? Pretty common to see something abut veterans or combat PTSD in the title as well as in the article body.

found that the drug seems to improve the effects of therapy in military veterans

No, there was one combat stress case. I noted that this stuck out as odd in my post on the paper. Well, now you can see why the authors might have been so keen to include this single warfighter subject. They enjoyed much wider press and nobody called them out for this scientific distraction
(This part of the ABC report caused me to laugh though:

The researchers, led by Dr Rick Doblin of the Multidisciplinary Association for Psychedelic Studies

Of course this is true, the driving force behind getting these studies rolling is the recreational legalization Trojan outfit MAPS. It looks better though, if you ask me, when they credit the therapist Mithoefer as being the leader of the project and MAPS as only providing support and assistance. )

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ecstasypills.jpgMy readers will recall that I have blogged now and again about ongoing efforts to get 3,4-methylenedioxymethamphetamine (MDMA), the psychoactive compound preferentially sought as Ecstasy in recreational users, approved as a medication to be used in psychotherapy. The initial attempts have focused on the treatment of Post-Traumatic Stress Disorder. PTSD is a seriously debilitating condition and we may not have sufficient resources and knowledge to deal with, e.g., an anticipated uptick due to the current wars that the US is prosecuting.
I introduced the MDMA/PTSD Phase I clinical trials here, noting

The short version of the theory is that the subjective properties of MDMA (empathic, inhibition lowering, etc) are consistent with helping people in difficult psychotherapeutic situations (such as for post-traumatic stress disorder (PTSD) and, supposedly, end stage cancer anxiety) make therapeutic breakthroughs during a limited number of treatment sessions of talk therapy. This is not proposed as a chronic medication like a selective serotonin reuptake inhibitor (SSRI). The funny thing is, I approve of the concept of moving forward with clinical trials based on the available evidence.
Why not? I mean PTSD can be a very devastating psychological issue and if there are treatment-resistant cases that can benefit from a limited number of MDMA exposures, great.

I concluded that particular post with this observation.

As is general practice in medicine, sometimes there are going to be risks associated with therapy. Sometimes quite substantial risks can be acceptable if the alternative is bad. However we get ourselves into a world of trouble, sometimes even losing a perfectly helpful medication, if we are not as honest as possible, up front, over the actual risks.

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From the LA Times we learn that the Los Angeles edition of the Electric Daisy Carnival held this past weekend resulted in about 120 emergency room visits. An estimated 185,000 persons attended the event.
As one might predict, at least one person died from taking Ecstasy. LA Times:

At 15, Sasha Rodriguez did not meet the minimum age requirement of 16 to enter the event without a legal guardian. Family and friends said that she attended the party with a 16-year-old friend and that doctors told them she had the hallucinogenic drug Ecstasy in her system when she was taken by ambulance to the emergency room.
Rodriguez … died at California Hospital Medical Center downtown before 5:30 p.m. Tuesday after her family decided to remove the comatose teen from life support.

Yes it is the MDMA.
Are teenage girls at particular risk? I don’t know the answer to this.

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The CDC has an interesting report out in their Morbidity and Mortality Weekly Report (MMWR).

Ecstasy Overdoses at a New Year’s Eve Rave — Los Angeles, California, 2010

This bit overviews a report from the Los Angeles County Department of Public Health which sought information on Emergency Department visits and other fatalities involving people who attended a New Year’s event Dec 31, 2009-Jan 1, 2010. The investigation determined that

18 patients visited EDs in LAC for MDMA-related illness within 12 hours of the rave. All were aged 16–34 years, and nine were female. In addition to using MDMA, 10 of the 18 had used alcohol, and five had used other drugs. Three patients were admitted to the hospital, including one to intensive care. A tablet obtained from one of the patients contained MDMA and caffeine, without known toxic contaminants.

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ResearchBlogging.orgA recent paper set out to examine automobile driving skills in people who had previously used Ecstasy (presumptively 3,4-methylenedioxymethamphetamine; MDMA) but were currently not using. Dastrup and colleagues (2010) used a driving simulator task in which the job was to maintain a set distance behind a lead vehicle (LV) displayed on the computer screen. The job was to stay abut two car lengths (given as 18 meters) behind the LV while accelerating to 55mph. My Google U conversion calculation makes 55 mph out to be about 25 meters / sec. I would therefore estimate the closing time between the cars as about 0.4-0.5 seconds, depending on car length and how much space you assume between these lengths. Thereafter the LV changed speed as depicted in the Figure 2 from the paper.
Dastrup10-fig2.pngThe horizontal line sits at the 55 mph point and you can see that the speed of the LV varies up to about 59 mph and down to about 51 mph with the maximum change taking place over about 18-20 seconds. .

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My readers are no doubt becoming a little bored with this but I assure you I do not bother to blog every one that pops up. Yes, another tragedy. A life cut short at 19 years of age because of the recreational drug MDMA, aka Ecstasy.

Friend Darren Anscombe said: ‘Me and him took some.
‘We were having a laugh at that time. I went into the kitchen and heard Danny’s girlfriend scream.
‘I went into the front room and he was lying on the floor, lifeless.’
Mr Anscombe dialled 999 and under instruction from the operator, carried out chest compressions until paramedics arrived.
Mr Anscombe said Daryl had been ‘happy’ that night but starting ‘acting strangely’.

Here is what I like about the reporting on this. They head off much speculation this way:

Dr Barbara Borek, forensic pathologist, said: ‘Toxicological analysis has detected the presence of a potentially fatal concentration of MDMA, commonly known as ecstasy.’
Tests showed there was 4,491mg of the drug per litre in his blood.

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1805_lg_obama.jpgSome random news report popping up in my Google Alert seemed kind of interesting, seeing as how it was referring to an “Obama pill” and Ecstasy and whatnot. There was also a reference to a DEA agent being interviewed.

the discovery of about 200 Ecstasy pills Monday during a traffic stop in Palmview is something of an anomaly, given how infrequently investigators in the region come across MDMA, as the drug is also known.
“We know that it is here, but it’s not here in large quantities in the way that it is in some other metro cities in the country,” said Special Agent Will Glaspy, who heads the U.S. Drug Enforcement Administration’s McAllen office.

The DEA should know some stuff, right? They collate a great deal of drug seizure info, do they not?

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This is what passes for a publishable opinion piece from one of their professors?

I’ve been following the work of Professor David Nutt even before the newspapers took interest, since sitting on a working party on drug regulation for the Academy of Medical Sciences. As a newcomer, I wanted to find the “facts on drug harm”, and read Nutt’s A tale of two Es – ecstasy and ethanol (alcohol) – published in 2006.

Well surely the good Professor Wolff means he started here. Right? ….right?

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A recent bit in the Vancouver Courier touts another clinical trial for MDMA as adjunctive therapy for Post-Traumatic Stress Disorder. If you haven’t been following along some of my prior observations are here, here, here. If you want everything I’ve opined on this drug, click the MDMA link under the archive.
I was just talking about main stream media accounts and how they generate an inaccurate impression by making comments that are, in isolation, more or less true but add up to an incorrect impression. In this case it was two quotes from the psychiatrist in charge of the Vancouver clinical trial.

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I am grateful to occasional reader and commenter Klem for putting me on the track of an older story. Klem was trying to argue that the authorities in Canada have long been issuing warning about non-MDMA content of “Ecstasy” and about the methamphetamine in particular. This is not news to me, of course. I am not unaware of the problem of non-MDMA psychoactive content of putative “Ecstasy” obtained on the illicit market. What I attempt to address, of course, is the seeming default assumption in the news reporting and subsequent reader comments that every case of Ecstasy fatality must have been caused by something (anything) other than 3,4-methylenedioxymethamphetamine.
Klem cites some 2005 reporting out of Vancouver and I was struck by this comment in the story.

A 13-year-old girl died in September when she took what she and friends believed was ecstasy they bought from a street dealer in Victoria.
Richard Stanwick, chief medical health officer for Vancouver Island, said an amphetamine overdose was suspected in Mercedes-Rae Clarke’s death.

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Canada. Again. This time in Whistler:

A 20-year-old male had been found unconscious by friends. When police arrived, Whistler Fire Rescue Service and Emergency Health Services personnel were performing CPR, but failed to revive the victim, who was pronounced dead a short time later at the Whistler Health Care Centre, Wright said.
A second male who was at the same home was hospitalized after he, too, suffered an apparent overdose of MDMA (methylenedioxymethamphetamine). He is expected to make a full recovery, Wright said.
Both men had ingested the drug in powdered form.

aaaand…

Earlier last week, a 17-year-old Fernie male who had also ingested MDMA in powered form almost died, Wright said, emphasizing that there was no connection between the two incidents.

Three overdoses requiring medical intervention, one death.

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nutt.jpgWhen I last took up the quixotic campaign of David Nutt, Ph.D., Professor of Psychopharmacology, Univ. of Bristol and former Chair of the UK Advisory Council on the Misuse of Drugs, it was to point out his belief that MDMA should be downgraded to a lesser harm category. He had issued opinion pieces comparing MDMA’s propensity for causing harm favorably with alcohol and waxed enthusiastic about the current clinical trials. The trigger for my post was his absurdist essay on the unfortunate harms to public health that are associated with addiction to “equasy”.

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Hey, here’s another one! The University of Cincinnati school paper has a bit entitled “Ecstasy might be linked to mental deficits” by one Gin A. Ando.

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I ran across an article in a college newspaper, I think via a Google news search for “MDMA”. Cause I do that. The article is “Rocking and Rolling: An Inside Look at SoCal’s Rave Culture” in the University of California, Irvine paper under the byline of one Stephanie Vatz. My original response was via a Twitt:

drugmonkeyblog So completely full of FAIL that I don’t even know where to start. http://tinyurl.com/yz6gmlg #MDMA

I then started wasting my time Twitting one-liner objections but then a comment by @dr_leigh (who you really should be following) started me thinking about the changing nature of college journalism.

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A topic that arises every now and again, particularly when I am discussing Ecstasy-related medical emergency and death, is the nature of the psychoactive ingredients in Ecstasy tablets. For definitional purposes, I consider 3,4-methylenedioxymethamphetamine (MDMA) to be what is considered by the vast majority of consumers to be canonical “Ecstasy”.
It is reasonably well-established in the peer reviewed literature and the ecstasydata.org harm reduction effort that some fraction of Ecstasy that is distributed contains non-MDMA psychoactive compounds either in addition to, or replacement for, MDMA. There are, however, some nagging questions because the published data are spotty. One topic of interest to me is that of selection bias. Tablet analyses are published either from samples turned in by Ecstasy consumers or those obtained by law enforcement seizures. In the former case there is a reasonable case to be made that perhaps Ecstasy found to result in suspicious subjective effects on the user are submitted to harm reduction sites preferentially. In the case of law enforcement seizure, well, the ones that got caught are by definition not on the street for sale. And you can make up a whole list of other caveats about why the published analyses might not accurately reflect the picture of what is actually being consumed.
A recent paper doesn’t nail down every complaint but at least it compares samples submitted willingly and unwillingly by the consumer.

Vogels, N., Brunt, T., Rigter, S., van Dijk, P., Vervaeke, H., & Niesink, R. (2009). Content of ecstasy in the Netherlands: 1993-2008 Addiction Epub ahead of print Oct 5 2009; DOI: 10.1111/j.1360-0443.2009.02707.x

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