MDMA is certainly damaging after 25 years of empirical research: a reply and refutation of Doblinet al. (2014)

Abstract

Human Psychopharmacology recently published my review into the increase in empirical knowledge about the human psychobiology of MDMA over the past 25 years (Parrott, 2013a). Deficits have been demonstrated in retrospective memory, prospective memory, higher cognition, complex visual processing, sleep architecture, sleep apnoea, pain, neurohormonal activity, and psychiatric status. Neuroimaging studies have shown serotonergic deficits, which are associated with lifetime Ecstasy/MDMA usage, and degree of neurocognitive impairment. Basic psychological skills remain intact. Ecstasy/MDMA use by pregnant mothers leads to psychomotor impairments in the children. Hence, the damaging effects of Ecstasy/MDMA were far more widespread than was realized a few years ago. In their critique of my review, Doblin et al. (2014) argued that my review contained misstatements, omitted contrary findings, and recited dated misconceptions. In this reply, I have answered all the points they raised. I have been able to refute each of their criticisms by citing the relevant empirical data, since many of their points were based on inaccurate summaries of the actual research findings. Doblin and colleagues are proponents of the use of MDMA for drug-assisted psychotherapy, and their strongest criticisms were focused on my concerns about this proposal. However, again all the issues I raised were based on sound empirical evidence or theoretical understanding. Indeed I would recommend potentially far safer co-drugs such as D-cycloserine or oxytocin. In summary, MDMA can induce a wide range of neuropsychobiological changes, many of which are damaging to humans.

Clinical applications of hallucinogens: A review.

“…While some concerns may remain about possible neurotoxicity or adverse cognitive effects associated with chronic abuse of ‘Ecstasy’ (Parrott, 2013, 2014), such effects have not been observed in individuals undergoing limited exposure to pure MDMA in controlled settings (Doblin et al, 2014). Nevertheless, ongoing clinical MDMA research should continue to address these concerns through rigorous monitoring of acute and persisting adverse effects as assessed in previous studies (Mithoefer et al, 2011).…”

The Potential Dangers of Using MDMA for Psychotherapy

“…There are other issues which need to be mentioned, although they have been debated more fully in two earlier articles (Parrott 2007;2013). For instance, one key question is the neurochemical model thought to underlie therapeutic improvement.…”

Fatal and non-fatal health incidents related to recreational ecstasy use

“…Based on two ecstasy sessions per year (one pill per session), the number of 27 MRDs in Scotland gives an estimated risk of MRD of 0.03% (one death per 3300 pills). Considering that in 2017 solely MDMA was involved in only three MRDs (NRS, 2018) (in 2014, the estimated risk of MDMA alone in 2017 (per session) is 0.003% (3/(2×45,000). Table 4 also depicts the yearly risk of fatalities per user related to chronic alcohol use in the UK (0.01-0.02%), and to heroin+morphine use (0.35%), cocaine use (0.05%) and amphetamine use (0.005%) in England and Wales.…”