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1999 Morgan MDMA Memory Study
Response Letter
by Rick Doblin
Congenital anomalies after prenatal ecstasy exposure,
by P.R. McElhatton; D.N. Bateman; C. Evans; K.R. Pughe; S.H.L. Thomas
The Lancet Volume 354 (No 9188) October 23 1999

Correspondence to: Dr P R McElhatton

Dr McElhatton,

I imagine you are getting lots of inquiries regarding your Lancet paper. I direct a non-profit organization, the Multidisciplinary Association for Psychedelic Studies (MAPS, that supports research into the psychotherapeutic use of MDMA, as well as research into the risks of MDMA. All our proposed human protocols exclude women who are pregnant or are not on birth control. Still, the issue of the risk of MDMA to the fetus is important both for non-medical users and for the possible extension of the psychotherapeutic use of MDMA to pregnant women.

Your research suggests risks that I have previously discounted, due to several cases I have seen in which prenatal use of MDMA did not lead to problems, to the absence of cases that I have heard of that raised this issue, and also due to an animal study I cite below. My first reaction is to try to find the weaknesses in the argument linking MDMA to birth defects, especially after seeing press accounts of your study that also link MDMA to Parkinson's, which even the most fervent proponents of MDMA neurotoxicity do not claim since Parkinson's is due to reduced dopamine levels which MDMA does not reduce (it impacts serotonin levels).

I'd appreciate any assistance you can offer in helping me understand your findings. I have a few questions for now and will probably have more as I continue to think about your paper. I hope you have time to respond.

  1. You wrote that there are " no published teratological studies in animals." What do you make of the study by :

    St Omer VE; Ali SF; Holson RR; Duhart HM; Scalzo FM; Slikker W Jr (1991)
    Behavioral and neurochemical effects of prenatal
    methylenedioxymethamphetamine (MDMA) exposure in rats.
    Neurotoxicol Teratol (UNITED STATES) 13 (1) p13-20.

    Which has been summarized by Dennis McKenna, Ph.D. as follows:

    "Prenatal exposure to MDMA

    An important consideration for the human users of MDMA concerns possible adverse effects on the fetus. Relatively few studies have addressed this issue, however, a recent paper by St. Omar, et al. 1991 has done so. Groups of pregnant rats were administered varying doses of MDMA on alternate gestational days 16-18. Gestational duration, litter size, neonatal birth weights and physical appearance at birth were unaffected by MDMA treatment.

    Pregnancy weight gain was significantly reduced by MDMA. Progeny growth, maturational parameters, surface righting reflex, swimming performance, forelimb grip strength, milk induced behavior, passive avoidance behavior, figure 8 maze activity, and the density of 5-HT uptake sites, 5-HT, and 5-HIAA levels were unaffected by MDMA treatment. Olfactory discrimination was enhanced in both male and female progeny, and negative geotaxis was delayed in female pups. In the dams, MDMA caused significant reductions in 5-HT and 5-HIAA levels in discrete brain areas. It was concluded that prenatal exposure to MDMA causes only subtle behavioral changes in developing rats, while the dams are at risk for the characteristic spectra of serotonergic changes.""

    Does this study, which showed no birth defects from MDMA, count as a teratological study in animals? I have cited this study to several women who contacted me concerning their use of MDMA while pregnant. Am I misleading them by doing so?

  2. Do you have any data about how much exposure to Ecstasy the various women had? Are we talking about a single dose or repeated exposures over time, or is this data that was not available from the women?

  3. Ecstasy users are very frequently poly-drug users. Yet in your sample more than 50% of the women reported only the use of Ecstasy. This seems surprising to me. Do you think this data is reliable?

  4. How do you factor that a substantial percentage of Ecstasy tablets or capsules do not contain MDMA, but various other substances such as amphetamine and methamphetamine, ketamine, ephedrine, caffeine, dextromethorphan, DOB, 4-Methyl-thio-amphetamine, (According to the London Toxicology Group, about 25,000 tablets of 4-Methyl-thio-amphetamine were seized in London last November) etc. Have any of these compounds been linked to birth defects?

  5. Of the 12 abnormal births, how many were from women who reported taking only Ecstasy and how many were from women who had taken Ecstasy in combination with other drugs?

  6. People who attend raves often engage in vigorous exercise and get quite hot, often without sufficient hydration. Diets are often poor. Could elevated temperatures, poor diets etc have something to do with birth defects? Basically, I'm asking if the rave-going lifestyle itself could contribute to birth defects?

  7. I know nothing about the UK National Teratology Information Service (NTIS). Are the inquiries you receive (302 for Ecstasy) considered to come from a representative sample of all women who have taken Ecstasy while pregnant, or perhaps from those most concerned about the link between their drug use and the health of their baby, perhaps being a subsample of mothers with more risk factors than average? Could you make the opposite argument that by mentioning their use of Ecstasy to their health practitioner that this is a sample of women who were most concerned about the health of their baby, therefore they may have fewer risk factors and/or take greater care?

  8. Similarly, what can be said about the more than 50% of the women lost to follow-up. Are they likely to be a random sample of women or different in some important way from the women who remained in the study?

  9. You mentioned that the evidence for birth defects from amphetamine and related compounds has produced conflicting results. MDMA is chemically similar to mescaline, the active ingredient in peyote cactus, which Native Americans have been using for thousands of years. The use of peyote by pregnant women is not uncommon, and no reports from a link between peyote and birth defects has been reported, though no systematic study has been conducted of which I am aware. Is this in any way reassuring regarding the risk of MDMA? I presume only slightly since every drug is unique.

Well, that's certainly enough questions for one e-mail message! Thank you in advance for any time you can spare to respond to these questions.

Rick Doblin