The Politics of Medicine: the Scheduling of MDMA
By Richard Glen Boire
(c) 2000 CCLE
“The
first casualty in war is truth,” wrote the Greek playwright and poet Aeschylus around
500 BC. In the war on drugs, Aeschylus’ proposition is surely realized. Drugs that
patients and medical professionals have found beneficial are decreed to have “no
accepted medical use” by the nation’s top drug cop—the Administrator of the DEA—and are declared off-limits for use in treatment of any kind. This ugly
politicized process is clearly illustrated by the procedural history surrounding the
scheduling of the drug MDMA.
First
synthesized by the Merck pharmaceutical firm in 1912, but never marketed by the company,
MDMA resurfaced in the early 1970s. With its short duration and unique characteristic for
reliably heightening the capacity for introspection and self-acceptance, coupled with the
easing of communication anxieties, MDMA soon caught the ear of psychotherapists who
quietly began using the then-legal (but unapproved) drug as an adjunct to therapy.
One
such psychiatrist was Dr. George Greer. Colleques of Dr. Greer discovered that MDMA
facilitated the therapeutic process. After spending a few months researching the laws and
regulations, Dr. Greer concluded that if he manufactured the MDMA himself, and had peer
review and informed consent, that he could legally administer MDMA to his patients. He
proceeded to synthesize a batch of MDMA with the assistance of Dr. Alexander Shulgin,
Ph.D., and administered it to about 80 people over a five year period.
Although
none of the patients to whom Dr. Greer administered MDMA suffered from disabling
psychiatric conditions (Dr. Greer excluded such patients for safety reasons), well over
90% reported benefits that they considered significant. These included improvement of
communication and intimacy during the sessions with spouses, and a general decrease in
psychological problems afterward. Interpersonal relationships, self-esteem and mood also
generally improved. Many patients reported that these improvements in their lives lasted
from weeks to years, even after only one or two sessions utilizing MDMA.[1]
At the
same time that Dr. Greer and a growing number of other psychotherapists were finding MDMA
useful as an adjunct to therapy, recreational use of the drug was growing. In 1981 an
underground manufacturer of MDMA gave it the marketing moniker “ecstasy” and
recreational use ballooned. Word of MDMA soon reached the DEA which, in 1982, opened a
file on the drug.
In the
July 27, 1984 issue of the Federal Register, the
DEA announced that it was moving to add MDMA to the list of Schedule I substances. The
notice stated that MDMA had no legitimate medical use or manufacturer in the USA, was
responsible for an undisclosed number of trips to emergency rooms, and had a high
potential for abuse.[2]
Dr.
Greer and other psychiatrists who were using MDMA in therapy were alarmed when they
learned of the DEA’s intention to place MDMA in Schedule I. Dr. Greer and fifteen
other medical professionals wrote the DEA explaining that in their professional
experiences MDMA had proven to be a tremendous aid to therapy, and could be used safely
under medical supervision. Placing MDMA in Schedule I would make it all but impossible for
anyone—medical professionals included—to use the substance in therapy. Not one
person wrote to support the DEA’s intention to place MDMA in Schedule I.
As a
result of the doctors’ letters, the DEA was forced to hold hearings on the matter of
MDMA’s proposed scheduling. Nine days of hearings were held in three cities during
1985. At the hearings, thirty-three witnesses testified and ninety-five exhibits were
received into evidence. Psychiatrists testified that the drug was an invaluable
therapeutic adjunct that was safe when used under professional supervision. Witnesses for
the DEA countered that the psychiatrists were basing their testimony on nothing but
anecdotes—that no controlled scientific studies existed to support their claims.
Shortly
before the first hearing date, President Reagan appointed a new Administrator of the
DEA.
The appointee, John Lawn, had a long history as an upper-level special agent in the FBI
but, like all other DEA administrator’s, absolutely no medical training or
experience. In a remarkably unabashed slap to the hearing process that was already
underway, the new Administrator, acting under emergency scheduling powers, unilaterally
decreed that effective July 1, 1985, MDMA would be a Schedule I drug.[3] Administrator
Lawn stated that notwithstanding the ongoing hearing on the issue of MDMA’s
appropriate status, emergency scheduling was “necessary to avoid an imminent hazard
to the public safety.”[4]
Over
the next ten months however, the facts about MDMA were heard by Judge Francis Young, who
presided over the hearings. After receiving and considering all the evidence admitted
during the hearings, Judge Young issued his findings and recommendation on May 22, 1986.
In a comprehensive opinion, Judge Young found that MDMA did not meet a single one of the
three criteria necessary for placement in Schedule I. Judge Young reported that MDMA had a
safe and accepted medical use in the US under medical supervision. Furthermore, he found
that the evidence failed to establish that MDMA had a high potential for abuse. Based on
his thorough examination of the evidence, Judge Young recommended that MDMA be placed in
Schedule III, which would allow doctors to use it in therapy and prescribe it, while still
keeping it unavailable to the public at large.
Administrator
Lawn refused to accept Judge Young’s recommendation. In Administrator Lawn’s
opinion, because MDMA was not an FDA approved drug it ipso facto lacked both any currently accepted
medical use in treatment and an accepted safety for use under medical supervision.
Administrator Lawn also averred that Judge Young gave too much weight to the testimony and
evidence of doctors and patients, and not enough consideration to studies on rats, or the
lack of FDA approval. In a flat rejection of Judge Young’s recommendation,
Administrator Lawn decreed that effective November 13, 1986, MDMA would be permanently
placed in Schedule I, not Schedule III.[5]
The
medical community fired back. Lester Grinspoon, an associate professor of Psychiatry at
Harvard Medical School sued the DEA, seeking to invalidate MDMA’s Schedule I status.[6] The federal
circuit court that heard the case succinctly summarized the competing arguments: “The
[DEA] Administrator reads “accepted [medical use]” to mean that the FDA must have approved the drug for interstate
marketing. Dr. Grinspoon, on the other hand, prefers to interpret “accepted” as
meaning that the medical community generally
agrees that the drug has a medical use and can be used safely under medical
supervision.”[7]
Calling
Administrator Lawn’s argument “strained” and “unpersuasive,” the
federal court rejected Lawn’s argument and sided with Dr. Grinspoon.[8] The court vacated
MDMA’s Schedule I status, and remanded the case to the DEA for
reconsideration—prohibiting Administrator Lawn from making the lack of FDA approval
the basis for his decision.[9] Remarkably, in a perfunctory final rule decreed less than a month later,
Administrator Lawn claimed that he had reconsidered the evidence and once again (but this
time without absolute reliance on the lack of FDA approval), concluded that MDMA belonged
in Schedule I.[10]
Thirty days later (on March 23, 1998), despite clear evidence that MDMA showed promise in
treating mentally suffering people, MDMA became a Schedule I “hallucinogen.”
Possession of the drug, for any reason, remains a federal offense.
