Science Vs - MDMA: Can Ecstasy Cure Your Agony?

Episode Date: November 23, 2023

Molly, ecstasy, MDMA: whatever you call it, this drug is blowing up. Some say MDMA can be a legitimate medicine to treat conditions like PTSD. But others reckon it's a dangerous drug that can fry your brain, and even kill you — from just one bad pill. Who's right? That's what we're snorting up today. We talk to psychiatrist George Greer, public health researcher Prof. Joseph Palamar, former DEA special agent James Hunt, and neuroscientist Prof. Harriet de Witt. Find our transcript here: https://bit.ly/ScienceVsMDMA2023  This is an updated version of our MDMA episode from a few years ago.  Chapters:  In this episode, we cover: (00:00) Chapter 1: Cops and club kids (05:02) Chapter 2: Therapists try MDMA (09:05) Chapter 3: Your brain on MDMA (15:34) Chapter 4: Can MDMA cure racism?  (20:32) Chapter 5: Can MDMA Cure PTSD?  (23:13) Chapter 6: Is the MDMA comedown real?  (26:40) Chapter 7: Can MDMA damage your brain?  (30:04) Chapter 8: Can MDMA kill you?  (33:23) Chapter 9: Buying MDMA on the street (37:01) Chapter 10: Conclusion This episode was produced by Heather Rogers and Wendy Zukerman, with help from Shruti Ravindran, Kaitlyn Sawrey, Rose Rimler, Joel Werner, Nick DelRose and Michelle Dang. Edited by Blythe Terrell. Fact checking by Michelle Harris, Ben Kuebrich and Diane Kelly. Sound design by Martin Peralta, Haley Shaw and Bumi Hidaka. Music written by Bobby Lord, Peter Leonard, Emma Munger, So Wylie and Bumi Hidaka. Thanks to all the researchers we reached out to for this episode, including Prof. Jerrold S. Meyer, Prof. Niamh Nic Daéid, Dr Brian Earp, Dr. Carl Roberts and Dr. Matthew Baggott. An extra thanks to Lucy Little, Johnny Dynell, Jesse Rudoy, Joseph Lavelle Wilson, and the Zukerman family.  Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus. This is the show that pits facts against MDMA. Ecstasy, E, X, Molly, whatever you want to call it, it's all the same thing. And people are saying that this party drug should be seen as a legitimate medicine. So are they right? Well, that is the question we're snorting up today. Hello. Joseph.

Joseph Palomar was a club kid in New York City in the late 90s and early 2000s. Reporter Heather Rogers and I went to chat to him in Manhattan. My prime year was probably 2000. I mean, I never missed a week at Sound Factory except the week of 9-11 where clubs were shut down. So you were there when Sandstorm came out. I really remember that. Yeah.

You have a very big smile on your face right now. That was a good summer. But anyway. And Joseph wasn't your likely club kid. When he finished high school, he was actually really square and wanted to be a cop. I was ready to become a police officer here in New York City. I passed their physical and psychological. I just wasn't old enough yet to start.

While waiting to join the police force, Joseph discovered a world that he hadn't known before. Nightclubs and after-hours dance parties. And he remembers that MDMA was huge at the time. You know, week after week, just people having the times of their lives on it. And people were there hugging, people making friends. And that's exactly what MDMA can be like.

You could feel like the best version of yourself, like the stresses of the world are out of your head. And all you want to do is fall in love with your friends, with the world and just dance. And these days, headlines are screaming that this drug is so powerful, that it can do even more, that it can heal anxiety and cure PTSD. MDMA could have real medical benefits, even helping people cope with the worst of traumas. Soldiers with PTSD using the illegal drug known as MDMA, cured the condition within weeks.

And just this year, Australia became the first country in the world to make prescribing MDMA legal under certain circumstances. Psychedelics will soon be used as medicine in Australia. MDMA can now be prescribed in Australia to treat some complex mental health disorders. But despite all of this excitement, over in the US, MDMA is still very, very illegal. It's actually a Schedule 1 drug right up there with heroin. And it's been this way for decades.

In fact, Joseph told us that back in the 90s, from time to time, the clubs he was at would get busted. Like one night at this famous club in New York City called The Tunnel. The lights flick on, the music still blasting. We're there, it was probably three, four in the morning, something like that. And dozens and dozens of police officers start rushing in, like everybody out. And finally finally the music goes down. And they were frisking, checking for drugs. And this takes us to the other side of the MDMA story. You see, for years we've been hearing that this is a dangerous drug

that can hurt and even kill us. You can go out in the night, take something, and die from it. This is Special Agent James Hunt, and when we first interviewed him several years ago, he was in charge of the Drug Enforcement Administration's New York division. He's now moved to the private sector. And James was very worried about people using MDMA. So it's like Russian roulette. I mean, you can keep on going, taking it, and maybe you'll never OD.

Maybe take your first one, and you'll die at one of these concerts. Back in 2017, we at Science Versus first took a look at what is up with MDMA. But with the hype about this drug just growing and growing, we thought we'd better dust off our glow sticks, grab a fresh pack of chewing gum, and take a new look at the science. To find out, could MDMA really be a powerful medicine that can cure stuff like PTSD? Or is it a dangerous drug

that could kill you from just one pill? When it comes to MDMA, there are lots of just people having the times of their lives on it. But then, there's science. Science Fest's MDMA, there are lots of just people having the times of their lives on it. But then there's science. Science Fest's MDMA is coming up just after the break. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist? And where is Jan 11?

I'm here, astrophysicist and co-host, ready for anything. That's right. I'm bringing in the A-team. So brace yourselves. Get ready to learn. I'm Jan 11. I'm Steve Strogatz. And this is...

Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. What does the AI revolution mean for jobs, for getting things done? Who are the people creating this technology and what do they think? I'm Rana El-Khelyoubi, an AI scientist, entrepreneur, investor, and now host of the new podcast, Pioneers of AI. Think of it as your guide for all things AI, with the most human issues at the center. Join me every Wednesday for Pioneers of AI. And don't forget to subscribe wherever you tune in. Welcome back.

On today's show, we're getting high on the science of MDMA. And while MDMA might feel like a modern drug, it was actually first cooked up more than 100 years ago by the pharmaceutical company Merck. They were trying to create a medicine to stop people from bleeding and in the process made MDMA. Now, as far as we know, back then, scientists never gave it to people. But that was until the 1960s and 70s,

where some researchers, like the so-called godfather of ecstasy, Alexander Shulgin, started experimenting with MDMA to help their patients. George Greer, a psychiatrist in San Francisco at the time, says that he remembers those days quite well. Particularly, he remembers the very first time that he took some MDMA with his girlfriend. It was quite lovely. And we were both impressed at the ease and directness

of our communication style. It's not like we hadn't had communication like that before, but it was just so easy. What did you say that then you thought, oh my, I can't believe I just said that? Well, it's like we would say, some of it's just too personal for me to talk about in a radio interview.

But things like, were you upset when I did this? And normally I would have said, oh, no, no, no, no, that's fine. It was no problem. And I said, yeah, I was upset. I was like, wow, well, that's not the way we would communicate before we would, you know, protect each other's feelings by not directly just saying, yeah, I didn't like what you did. The fact that George could open up so much made him think that MDMA could be really useful for people during therapy. And some of George's colleagues were thinking this too.

So in the early 1980s, George decided to give it a try with his patients, which meant he needed a supply of MDMA. Now, even though back then it wasn't explicitly illegal, it existed in this sort of grey area, so you couldn't just buy it at the local pharmacy. And so instead, with the help of a chemist, George made it. And he told us about the lab that they used. There was a little stone fireplace. There were shelves with, you know, coloured bottles with handwritten labels of different chemicals.

And so they got to work. You know, throw in a dash of piperonilacetone, a pinch of sodium hydroxide, and a thimble full of hydrochloric acid. And we just let it react and kept stirring it. It would get warm. And so we sort of started bubbling and went through a coil. After a couple of hours, he had the goods.

So we ended up with a white powder, pure white powder. George gave that powder to his patients, and he said that they opened up, and it really helped them with their therapy. It was medicine, and it was used for healing purposes. George published a study on what he was doing. He followed 29 people, checking in with them over the following months.

And people said that after taking MDMA and having therapy, they had more insight into their personal problems. Some felt more relaxed and calm, even long after the effects of the drug had worn off. And George was impressed. So it was completely, there was never a drug like it before. He and his colleagues thought they had stumbled on this amazing new medicine, but... Around 1983 was when I first heard that it was being used at cocktail parties in New York City. I said, okay, the end is near.

And he was right. Congress started to get antsy about MDMA, and in 1985, the Drug Enforcement Administration made it illegal. They said that the drug, quote, presents a significant risk to the public health, and that it had, quote, no legitimate medical use. And that hit George hard. Oh, absolutely. It was very disappointing because we couldn't help people with it anymore. So George stopped his work with MDMA just as he was getting started. But more recently, researchers have been sinking their teeth into MDMA once more, you know, really grinding away at it. And one big question that they have is why does MDMA make us feel so good?

That is, what is happening in our brains when we take it. So to find out more, we asked a real party girl. My name's Harriet DeWitt. I'm a professor in the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago. Harriet first became interested in MDMA one day at a science conference when some researchers told her that they'd had life-changing experiences on the drug. Yeah, a couple of colleagues actually, and they were people that I didn't see as drug users at all. And then was it then when you thought, I kind of want to study this more? Yes, yes, definitely. So she dove in, she started reading all about MDMA. And what she learned is that the high that people can feel on this drug,

it can feel a bit like taking speed. And that makes sense because chemically, MDMA is similar to amphetamines. In fact, MDMA stands for methylene-dioxymethamphetamine. Get it? MDMA. But there's something different about MDMA. It does something unique and it produces a behavior that you don't see with any other drugs. The unique thing that MDMA does is it makes you feel a real closeness with other people, like what Joseph felt like on the dance floor. And a wild and very cute image is that when you give MDMA to rats,

it even helps them bond. So it makes rats lie together side by side, as though they were sort of bonding, as though they were sort of connected. So Harriet's big question was, why does this happen? Well, you may know that MDMA can affect your serotonin levels. And one of the ways that it does this, it's really interesting, MDMA can latch onto this protein that normally removes serotonin from your brain. And so basically, without that protein hoovering up serotonin, it gets to stick around. And so this seems like a pretty

clear-cut explanation for how MDMA works, right? I talked to Harriet about it. The story that you hear is just, well, it's serotonin. Serotonin makes you happy. Put them together, it sounds like that's the feeling of being high. It's a nice story, but there's no way there's going to be just a little bump of one neurotransmitter that corresponds to feeling high or feeling good or feeling... I mean, it's just much more complicated than that. So, for example, MDMA can affect other neurotransmitters like dopamine and norepinephrine, as well as this hormone that's linked to bonding called oxytocin.

So Harriet told me about this one study that she did where... The MDMA produced a very large increase in oxytocin. So Harriet told me about this one study that she did where the MDMA produced a very large increase in oxytocin. But Harriet reckoned there must be even more to this story. So to unlock the mysteries of MDMA, much like the researchers before her, her next step was to score some. Heather Rogers and I asked Harriet about this. And I guess like you find it through just researchers in the know.

Yes, exactly. Kind of like how you find it on the street. No. So where do you get it from? There's one chemist who has now actually retired, and he produced a fairly large quantity of it that he has made available to researchers. So now that Harriet had the goods, she got a bunch of participants, gave them a pill,

and she wasn't shy about the dosage. People compare it to something that they might get in a rave situation. And it's a fairly, they wouldn't want more, put it that way. In her first experiment with MDMA, which was published in 2009, Harriet gave nine people the drug. And then she showed them pictures of faces with various emotional expressions, like a person smiling or someone frowning. And she repeated the experiment, but giving them a placebo. And what she saw is that when people were high, their brains had a

stronger response to seeing happier faces. And curiously, their brains also weren't so affected by the angry pictures. So it sort of makes them less able to detect negative emotions. So they're less responsive to angry faces. One way that MDMA might be doing this is by dampening the activity in this part of the brain associated with fear called the amygdala. And Harriet reckons that this superpower of MDMA to make you care less about negative stuff around you. It's one of the things that makes this drug unique. You can feel good because you aren't distracted by what you think are negative expressions in your friends around you. And you can just enjoy your mates. You can imagine if the people are at a party, then they're going to be less sensitive to kind of judgmental expressions or, you know, in a social situation, you're feeling a little bit

like people are looking at you and their people are judging you. That is amazing. It's kind of a mechanism or a process that we would never have thought of otherwise until we had done these studies. And other research has come along showing similar things. And just this year, Harriet published a study where she gave MDMA or a placebo to two strangers and then got them to have a chat. And she found that MDMA... Makes them feel that the conversation is more meaningful and that they feel more connected with the other person that they're talking to and they like the other person that they're talking to, and they like the other person that they're talking to.

And to Harriet, the fact that MDMA can do all of this opens up a lot of possibilities. Like to go back to the idea that MDMA could help you during therapy. Well, if you think about it, if they're less responsive to negative emotions in other people, then to the extent that the therapist has some negative expression or the person perceives some negative expression in the therapist, if that's taken away, then the patient is more likely to be able to address negative things in their own lives or reveal more negative things. And just a few years ago, Harriet wanted to know if maybe MDMA wasn't just affecting our brains, but maybe also our sense of touch.

There'd been some research suggesting that when our oxytocin levels rise, it can make some types of touch feel nicer. And Harriet knew that MDMA bumps up our oxytocin levels. So she got people into her lab, gave them MDMA or other stuff like a placebo. And then a colleague grabbed a soft brush made of goat's hair and slowly stroked their skin. It's kind of a consistent rate that kind of rate that you might pat your dog or that you might stroke someone if you're calming them. Interesting. Were you involved in the study? Did you put yourself up to be a guinea pig? I should have. No, I didn't. Good idea.

Would have been so nice, the goat hair, soft goat hair. It would have been, yeah. And she found that it was nice. In fact, people on MDMA said that that soft touch was nicer on average than the people who were on a placebo. But something happened in that experiment that really freaked Harriet out. So these participants are coming in, getting MDMA and filling out forms, saying how pleasant it all is. And this was going on as expected until this one guy. This was a regular participant in that study. And at the bottom of his form, he said, in capital letters, he said, now I know what I have to do.

Yeah, he wrote, quote, this experience helped me sort out a debilitating personal issue. Google my name. I now know what I need to do. And Harriet was like, what? Google my name? So we did that. And it turns out he was the leader of a white supremacist group in Illinois. Yeah. So Harriet had just given a powerful drug to a guy who headed up a notorious white supremacist group.

And he just left her a note saying, I now know what I need to do. So that made me really worried. You know, I was alarmed by it, I have to say. So what did you think? Well, I thought he'd have to, if he's already got these beliefs, racist beliefs, he might think that he has to go and, I don't know,

shoot someone. You know, the drug somehow had made him angrier. So I sent the research assistant in there to ask the subject a little bit more. He was still, so the subject was still in the lab at that point? He's in the room, yeah, right. Oh gosh, so it was like happening in real time. It was in real time.

So the research assistant went in there and said, you know, what did you actually mean there? And how are you feeling? And the guy said, I realized that what's really important is love. Love. After getting a single dose of MDMA, he said he felt a transformation and that, quote, love is the most important thing. So this is somebody, he reported that he sort of had gotten his values wrong and that there are things that are more important in his life than worrying about what race people

are or whether immigrants are coming in. That's not something to focus on. Focus on something that's important, like your connection with other people. And he said it really did change his life. Harriet wrote this up in a case report. This story made headlines around the world. I know. MDMA pill completely rehabilitates a Charlottesville white supremacist leader.

Harriet DeWitt, who led this whole research, said this. It's what everyone says about this damn drug, that it makes people feel love. Did you really say damn, Harriet? Probably. And have there been other cases? I mean, so many people who have racist views must have taken MDMA and not had a complete transformation.

Yeah. I don't know why did he experience love and other people who use the drug don't. Do you think maybe it was the goat hair that did it? The lovely soft goat hair? There you go. There you go. Could have been. And Harriet told me that this guy wasn't completely cured. He did have some racist and anti-Semitic thoughts. But still, in the future, she wants to do a study where she gets people into her lab with different political views and gets them to take MDMA

to see if perhaps conversations go a little smoother. But no matter what, it doesn't look like MDMA is some anti-racist cure-all. So our next question is, what can MDMA cure? Because researchers are looking to see if MDMA can help with all kinds of things, from different kinds of anxiety to alcohol use disorder. But the best evidence that we have comes from research on post-traumatic stress disorder. So let me tell you about this one study that was published just a few months ago. About 100 people with PTSD were split into two groups, half given MDMA, the other a placebo. And they take the drug or a placebo and then talk to a therapist

for a session that lasted eight hours. I talked to Harriet about this. Eight, for eight hours. I know. I know. So long to talk to a therapist. I guess that's what the MDMA helps with. They did this once a month for three months. And after all that, on average, both groups had fewer PTSD symptoms as measured by this questionnaire. But Team MDMA were doing better. In fact, around four months after the whole experiment began, almost half of the people who got MDMA had improved so much

that they were considered in remission. That was compared to around 20% in the placebo group. So in a therapy situation, the patients with PTSD are having to face very negative things about themselves, often shame and often terrible things that they've had to do or that they've witnessed. So those are very negative thoughts. And so there's a possibility that the drug makes them better able to, that suppresses some of those negative feelings

and self-judgments. Now, of course, not everyone had a huge improvement here. But like we mentioned, the results of these kinds of trials are so promising that over in Australia, certain psychiatrists can now prescribe MDMA for PTSD. And from what we know from animal research and human clinical trials, MDMA isn't very addictive. So all of this is making this drug sound pretty good, like great even. But is MDMA really all love and soft touches from goat hair brushes? I don't know why she takes it.

She always gets so depressed coming down. Because growing up, this was the message that I kept hearing. I didn't know how many health problems it could cause. He just wanted to try something new. Ecstasy. You don't know what it'll do to you. After the break, the calm down. Welcome back. So we just found out that MDMA is proving to be a really promising treatment for PTSD.

But now the sun is up, the high is gone, and we feel like s***. And we're asking, is MDMA dangerous? First, let's talk about the days after. Because some people say that they feel low and depressed. In fact, this phenomenon is so commonly known that it's got nicknames like the Tuesday Blues and even Suicide Tuesday, which could be pretty concerning, particularly if we're about to give this drug to people who are struggling with their mental health. So, is it true the MDMA come down? Well, there are studies that find, yes, some MDMA users can feel a bit down

or depressed in the days after taking the drug. And a lot of the scientific literature on this seems to blame serotonin. So we asked Harriet DeWitt from the University of Chicago about it. So what about this idea that you take it, you get this serotonin burst, and two days later, your brain doesn't have enough serotonin so you feel sad. Yeah, right. Well, it's a nice story to tell, but it's been questioned a certain amount. And there are a few good reasons to think that this idea

that MDMA maxes out your serotonin, giving you a comedown, isn't quite true. So, for one, as part of Harriet's research, she asked about 40 people about their moods two days after taking her MDMA. And? And we don't see this crash. They were totally normal.

Yeah. You go to Harriet's lab, take some MDMA, no comedown. Plus, a small trial looking for the comedown effect on people who were taking MDMA to help with alcohol use disorder also didn't find any evidence of it. In fact, they wrote, quote, we found that rather than a comedown, participants maintained a positive mood during the week after each MDMA session. End quote. The recent clinical trials on MDMA and PTSD also didn't find that MDMA increased your risk of having suicidal thoughts.

So, what do we make of all this? Well, Harriet has a couple of ideas about why recreational users might feel this, but the people in research studies mostly don't. You see, unlike partygoers, the people in her study... They're well-rested. They're told to eat before they come in. They're hydrated, so we make sure that they drink water while they're here. We control the temperature in the room.

We might not be producing the experience that they're getting in their party situation. Yeah, you're not drinking alcohol either. This could also be a dose thing, like Harriet gives people enough MDMA to get high, but maybe she doesn't give them enough to have a big crash later. And finally, it's possible that the MDMA comedown just isn't as common as we think. Because in one of the PTSD clinical trials, out of 46 people who got MDMA, one person did bow out of the trials, partly because of what sounds a bit like they got the Tuesday blues. So that is what we know about the comedown a couple of days later. But what about the long-term consequences of using MDMA? Like, say, if you take it every weekend for months or even years.

Will it fry your brain? This is your brain. This is drugs. This is your brain on drugs. Any questions? Well, just a couple. You see, this idea that MDMA could break your brain has been around for decades. But it really caught fire in the early 2000s when a study in monkeys suggested that MDMA could kill brain cells. But in one heck of a whoopsie, the researchers later realized that they accidentally gave the monkeys meth instead of MDMA.

Don't you hate it when you do that? The researchers retracted their paper, but the idea that MDMA can fry your brain stuck around. So away from monkeys and meth, what do we know here? How bad is MDMA for us? Well, to find out, several years ago, a big review paper analysed studies involving more than 1,000 people who had taken a lot of MDMA. And I mean a lot. Averaging almost 350 pills. And after all that partying, how were they doing?

Well, for the most part, these people were actually fine, but there were a few things to worry about. So heavier users tended to find it trickier to move from one task to another, and their memory could also be worse. In fact, there is one case study of a guy who took an estimated 40,000 ecstasy pills over about a decade, and years after he stopped the drug, his concentration and memory still sucked. Here's Harriet. People can use a lot. If they keep using it, yes, it's almost certainly damaging to their brains. So, for example, in one study, researchers found that it was more common for heavy users of MDMA to say things like, I forgot what I wanted to say in the middle of a sentence. But still. Yeah, I forgot what I was going to say. Oh, the researchers said that the effects were small, mostly. We're still working out why MDMA in high doses might affect our cognition.

Some studies in animals suggest that the drug could damage or turn down the activity in neurons. So that could be part of what's going on. Now, so far, we've been focusing on the real party animals. But for some of us, we're just dabbling, you know, take an MDMA during a therapy session or three, or perhaps just pop in some while the kids are asleep. So what about these people?

If they use it occasionally, chances are we don't have very good evidence. We don't have very strong evidence. And certainly I wouldn't be giving it in the laboratory if I had any inclination, if I had any belief that it was producing any kind of brain effects, lasting brain effects. So here's where we're at. Taking a lot of MDMA can probably hurt your brain and particularly your memory. But we don't have good evidence that taking a little bit once in a while can cause brain damage. Except, well, there is one very big caveat. There are times when it can kill. On a November night in 1995,

a young woman in the UK was celebrating her 18th birthday. Her name was Leah Betts and she was partying with friends at home. She popped some ecstasy and seemed totally fine. But as the night went on, things got bad. And what happened next got tons of media attention around the world. And Leah became a kind of poster child for how dangerous MDMA could be. You see, Leah had started drinking water. A lot of water.

News reports at the time said that she was downing glass after glass of it. She started to feel sick and then she lost consciousness. And her stepmom called the emergency. The call was later broadcast on the BBC. Ambulance emergency. Our daughter's at a party and she's taken ecstasy along with alcohol. How old is she? She's 18. We've given her water. She's been sick, but she just stopped breathing. Is she breathing again? She's 18. We've given her water. She's been sick, but she's just stopped breathing. Is she breathing again? She's not breathing. I've got the ambulance on the way to you now.

Have you got a flat on the back of the floor? I have some tuna now. A few days later, Leah died in hospital. So what happened here? Well, it's thought that Leah died from drinking too much water. You see, your body needs a perfect balance of salt and water to keep you alive. And when you're on MDMA, it can mess with that salt water balance. Now, this partly happens because MDMA can trigger the release of a hormone that stops you from peeing. So you're basically retaining all of this water. And then if you're drinking a lot, that can make the situation worse. Basically,

your body just gets too much fluid, your cells can start to swell, and the cells in your brain can swell too, which can ultimately kill you. Now, what happened to Leah does not happen often. In fact, one review paper looking for cases like this found only around 20 instances of people dying like that. And that was over almost three decades. And while this story of drinking too much water on MDMA got a lot of attention, deaths from hypothermia or overheating are actually more common. And that's because MDMA can drive up your body temperature. But just generally, even considering that,

deaths from MDMA are rare. We couldn't find a number from the US on how many people died from taking just MDMA. But in England and Wales, on average, 43 deaths each year have been linked to taking MDMA. That's out of roughly a million ecstasy users each year. That's not good, but to put it into perspective, one scientist has said that it's safer to take the drug than to ride a horse. And the thing is that these deaths, they might not all be MDMA's fault.

Because the vast majority of people who take MDMA, they don't get it from guys like Harriet's chemist. They buy it on the street. Here's what former DEA officer James Hunt told us about that. These guys are not skilled chemists. If you're not a skilled chemist, you just start throwing stuff in there. Bad things could happen. So to find out more about what's actually being thrown into our MDMA, we talked to Joseph Palomar. My prime year was probably 2000. Yeah. Remember our club kid from the beginning of the episode? That was a good summer. Well, he's not a club kid anymore. He's all grown up, and he's a public health researcher at New York University,

researching what you really get when you think you're buying MDMA on the street. Joseph and his team stand in front of New York City clubs, asking people what drugs they're using, and then they collect hair samples. And we don't mention the hair usually until they're maybe halfway done with the survey. Good move. Yeah. They're collecting hair samples because traces of what's in MDMA and other drugs can show up in your locks months after you've taken a drug. And when he did this study back in 2015, he got samples from more than 170 people. And after analyzing all that, what did he find? Well, a lot of MDMA, as he was expecting.

But then he found something perhaps unexpected. Bath salts. Now, bath salts aren't actually bath salts. That's a slang term for a group of chemicals that can feel a lot like amphetamines when you take them, so they can make you panic, hallucinate, and feel paranoid. There's been reports that they can turn you into a cannibal, but that was after this creepy case in Florida where a guy chewed off a man's face, but he actually wasn't on bath salts. That's just like a regular Tuesday night in Florida. So of the 34 people in Joseph's study who said that they had never used bath salts or similar stuff, more than 40% of them had evidence of it in their hair. And so what does that tell you?

Tells me that they're using drugs that are potentially more dangerous than ecstasy without knowing it. Or they're lying to you. Yeah. Well, some people would lie, but a lot of these kids have no idea what they're taking. Joseph just published a study this year showing that these days MDMA in New York is way less likely to be cut with bath salts. But there's a new concern, fentanyl. Back in 2019, Joseph found evidence for it in someone's hair, even though they told him that they only took MDMA. And across the US, we don't have good numbers on how often MDMA is getting cut with fentanyl.

In Mexico City, a study of 22 MDMA samples taken from a music festival found that just over half of them had fentanyl inside. And research has found that MDMA can be mixed with other stuff, like ketamine or caffeine, which Joseph says might be dangerous or it might not. We don't know how these drugs work at the same time. It might be quote-unquote good effects that are increased, or it might be really bad effects that are increased,

or you never know what that's going to do to your brain, your body, a combination of drugs that we don't know about. Bottom line, it is hard to know the chance that when you buy MDMA on the street or at a music festival, it's going to be pure or not. Studies from the UK, Spain, and Australia suggest that roughly one in five samples are adulterated. Roughly. So I guess it's just best to score your MDMA from the scientists. All right. So when it comes to science versus MDMA, where does this leave us? Well, the funny thing about MDMA is that there's always this feeling behind it that there has to be a bad consequence for feeling so good.

I mean, surely you can't have this much fun and not break your brain. But chemicals don't work like that. They don't decide to punish you for having too much fun. They're not your Catholic grandfather. And from what we're seeing, this drug, MDMA, it's actually pretty safe. And for some people, it could be a really powerful medicine. That's Science Versus. Hey, Joel Wenner, supervising producer at Science Versus. Hey, Wendy. Do you want to take a guess at how many citations are in the MDMA episode?

I sure do. I reckon we have definitely cracked 100. Got a century, notched up a century. Yeah. Look, there's 180 citations in this week's episode. What? What? Are you sure?

Did someone double up on a couple? I't think so i don't think we have because i guess i was updating the science so we already had a lot of citations in there that i i i guess i added a bunch oh goodness if people want to read about about md, bath salts, the man in Florida who was a cannibal. If you want to know more about all of this stuff, go to our show notes and there is a link to the transcript. You might need some MDMA to get through the whole lot. So just, you know, talk to your local psychedelics dealer. Next week, we're sticking with the drugs theme

and we're exploring the science of caffeine, which is super interesting and I am very, very invested. I drink so much coffee. This could be really bad news for me. Because it could be great. It could be great news. See you then. Bye.

Bye. This episode was produced by Heather Rogers and me, Wendy Zuckerman, with help from Shruti Ravindran, Caitlin Sorey, Rose Rimler, Joel Werner, Nick Delrose and Michelle Dang. We're edited by Blythe Terrell. Fact-checking by Michelle Harris, Ben Kebrick and Diane Kelly. Sound design by Martin Peralta, Hayley Shaw and Bumi Hidaka.

Music written by Bobby Lord, Peter Leonard, Emma Munger, So Wiley and Bumi Hidaka. Thank you to all of the researchers that we reached out to for this episode, including Professor Gerald S. Meyer, Professor Nied McDade, Dr. Brian Earp, Dr. Carl Roberts, and Dr. Matthew Baggett. An extra thanks to Lucy Little, Johnny Dinell, Jesse Redoy, Joseph Lavelle-Wilson, and the Zuckerman family. Science Versus is a Spotify Studios original. Listen to us for free on Spotify or wherever you get your podcasts. Yes, you can find Science Versus anywhere. If you

are listening on Spotify, follow us and tap the bell icon for episode notifications. And if you like the show, then give us a rating, a five-star rating. Yes, do it. I'm Wendy Zuckerman. Back to you next time.