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The two faces of MDMA: Drug of abuse, and promising therapeutic and research tool

I didn't know if it was day or night
I started kissin' everything in sight
But when I kissed a cop down on 34th and Vine
He broke my little bottle of Love Potion Number 9.

Thus read the final lines of what has to rank among my five favorite tunes of all time: "Love Potion Number Nine," written in 1959 by the legendary pair Jerry Leiber and Mike Stoller and first performed by The Clovers, then The Coasters, and then The Seekers.

As life imitates art, so science doth flatter music by serving up substances some find worth singing about. But when it comes to naming those substances, I think I'd have stuck with Leiber and Stoller's appellation. The term "3,4-methylenedioxymethamphetamine" is a mouthful, is it not?

It takes a lot less than a mouthful of this stuff — more commonly known as MDMA or, in street and party parlance, "Ecstasy" — to get you blowing kisses to everybody you lay eyes on.

Just watch out who you kiss. MDMA is a Schedule I drug, meaning it has no currently accepted medical value and high potential for abuse. Its use can land you in jail. Drugs of pleasure are all too often drugs of abuse, as I wrote a few years ago in my Stanford Medicine article, "Neuroscience of Need: Understanding the Addicted Mind."

Yet veteran Stanford brain researcher Rob Malenka, MD, PhD, says there's no compound with more potential than MDMA for teaching neuroscientists about empathy. "Its actions of enhancing positive social interactions and empathy are entirely unique, making it unlike any other known psychoactive substance," Malenka and co-author Boris Heifets, MD, PhD, another Stanford brain scientist, write in a commentary in Cell.

In the commentary, they call for rigorous inquiry into MDMA's potent psychological effects on humans, where in the brain the drug's activity occurs, and precisely which cascade of molecular interactions it triggers.  They also propose its judicious clinical use.

"What is more important," the authors write, "than elucidating the mechanisms in our brains that generate empathy, openness and the most positive of social experiences?"

The drug pipeline for psychiatric disorders is near exhaustion, they continue. Putting MDMA through the paces of closely monitored, scientifically rigorous clinical trials "will pave the way for developing new therapeutic agents that target previously unidentified brain mechanisms."

MDMA has already been used in a small, carefully controlled clinical trial among people suffering from treatment-resistant post-traumatic stress disorder; it showed a breathtakingly beneficial and remarkably rapid effect. Plus, Malenka and Heifets note, "social dysfunction... occurs in a wide range of other neuropsychiatric disorders" including depression, schizophrenia and autism spectrum disorders.

In addition to proposing that MDMA be taken seriously by neuroscientists, clinicians and regulators, Malenka and Heifets provide an entertaining history of the compound's ensconcement in the social-drug pantheon as well as of its halting entry into the more sober world of clinical research.

MDMA, they write, "may be among the most promising lead therapies for psychiatric disease and a powerful probe of important brain functions."

Kind of gives a new twist to the phrase, "experimenting with drugs," doesn't it?

Previously: Step by step: Study pinpoints brain connection required for performing serial tasks, Obscure brain chemical implicated in chronic-pain-induced "Why bother?" syndrome, and Better than the real thing: How drugs hot wire our brains' reward circuitry
Photo by Barney Moss

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