Over the past century, we have had repetitive drug "epidemics", Opium,
alcohol, marijuana, amphetamines, LSD, powder cocaine, and crack cocaine. Before we go crazy about another epidemic, that of MDMA (ecstasy), a few points are in order.
    America has survived all these cycles and scares quite well. The sky
didn¹t fall, we won two world wars, the American lifestyle took over the
world, and our youth grew up to become us or our ancestors. We were
appropriately frightened by the epidemic rhetoric and duly elected the
politicians that promulgated these mostly imaginary monsters. Some were
harmed by use and overindulgence of the various drugs but history reveals
that cycles like this are absorbed by all societies and the human cost,
though tragic, is not particularly great.
     In a recent TIME magazine article, "It's All the Rave" (Time, 3/13) John Cloud addressed the recent upsurge of MDMA (ecstasy) use in the US and the fact that law enforcement couldn¹t prevent its use. One of the truisms about a prohibition policy is that all hope of regulation is abandoned.
    Cloud addressed the controversy over whether long term MDMA use could cause brain damage even though no behavioral abnormalities are observed in chronic users, at least yet. Interestingly, the same neurological changes can be seen with long term use of Prozac. Which is the evil molecule? Besides, we¹ve documented that long term use of alcohol causes both brain damage and secondary behavioral abnormalities (e.g., dementia) and we¹re not about to resurrect a failed alcohol prohibition policy that resulted in exactly the same suffering that our drug prohibition is causing now.
    One thing Cloud could have but didn¹t mention was a simple piece of
education that MDMA¹s most common serious (and potentially lethal) side
effect is dehydration. A simple recommendation in the article to drink
plenty of water or juice could save lives.
    But sensationalism takes precedence over substance in modern journalism, especially when dealing with the "new" drug epidemic. The public eats it up.
In our War on Drugs, the standard mantra is to absolutely condemn illicit
drug use, lest one be accused of condoning drug use. Drug Czar McCaffery
wouldn¹t want a major newsweekly to mention a health-oriented fact and a harm reduction recommendation. He might ask to edit the piece.
    When will we ever learn that drug use always was, is now, and always
will be public health issue that needs to be addressed by health care
personnel, not by generals or the police? No amount of military force can
stop drug use (e.g., illicit drug use is rampant in prisons). And for those
that believe the police can deal with public health issues, a challenge. The
next time you or a loved one becomes seriously ill, call a cop.
    We need to end this drug war now.

Gene Tinelli, MD
Addiction Psychiatrist
Department of Psychiatry and Behavioral Science
Upstate Medical University
State University of New York
Syracuse NY 13210