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The research section cites Andrew Parrott's 2014 paper. Of particular concern is the line "A review of the safety and efficacy of MDMA as a treatment for various disorders, particularly PTSD, indicated that MDMA has therapeutic efficacy in some patients;[18] however, it emphasized that MDMA is not a safe medical treatment due to lasting neurotoxic and cognition impairing effects in humans.[18]" The lasting neurotoxic and cognition impairing effects in humans was specifically addressed in Danforth et al 2015. It was shown that the literature Parrott cites takes data from users of street Ecstasy (not pure MDMA and not taken in controlled environments) who have used hundreds of times and then wrongfully applies the harms from this literature base to MDMA assisted psychotherapy (which it's only taken 6 times at most per the current literature base). Additionally, the street populations that he cites often "stack" doses which greatly increases harm and all are polysubstance abusers which confounds the source of harm found in these studies. This polysubstance abuse statistic comes from his own data, see Wu et al 2009 which he's one of the authors (full ref in Danforth paper). He curiously leaves this confound out of his 2014 paper even though he's an author on the study which overtly shows that essentially all ecstasy users are polysubstance abusers. Here's a copy and paste of the section I'm referring to from Danforth.

"The Ecstasy user literature base also contains multiple factors that limit the generalizability of naturalistic studies of street Ecstasy to clinical settings in which pure MDMA is administered from one to several times within a psychotherapy paradigm. The most substantial of these limitations are the high quantities of doses taken in nearly all publications on recreational Ecstasy users, often on the order of several hundreds of doses. Critics of MDMA-assisted psychotherapy use this data to suggest a higher level of risk than logically can be inferred from no more than six exposures reported in MDMA-assisted psychotherapy clinical trials (e.g., Parrott, 2014). Additionally, “Ecstasy” refers to MDMA obtained from street sources which currently is almost always cut with other drugs as seized shipments from 2007 show only 3% of tablets destined for North American markets containing pure MDMA (Hudson et al., 2014) (https://www.ecstasydata.org/stats.php). Authors commonly cite Ecstasy user data and use it to draw conclusions about MDMA without citing the above purity limitation (Grob, 2000). Furthermore, Ecstasy users are also almost always polysubstance abusers as indicated in the 2007 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093) ( Wu et al., 2009), and high polysubstance abuse rates confound nearly all of the Ecstasy correlations found in the medical literature to date. Other common notable hazards include adverse environmental conditions, polydrug use in dangerous combinations, and ingestion of high doses or stacking multiple doses to prolong drug effects. Therefore, research on recreational Ecstasy use has limited applicability to determining the safety of clinical investigations of MDMA-assisted therapy."

Please note that Meyer JS (2013) is a much better paper than Parrott (2014) but any data cited would still suffer from the same lack of generalizability to MDMA assisted psychotherapy research populations as nearly all of the research in humans we have showing cognitive or memory impairments is done with street users who've taken hundreds of doses and therefore suffers from the limitations above. Also, the term "neurotoxicity" is a vague term that seems to be used to hyperbolize risk. — Preceding unsigned comment added by 68.135.33.8 (talk) 16:40, 11 December 2015 (UTC)[reply]

Yes, I think this section needs to be updated. Personally, I think Parrot is rather biased, but then we all are and it is a reliable source. I'm working my way through the history section (albeit rather slowly) so I will eventually get to this. Feel free to take a stab at it yourself (unless you have a COI). Sizeofint (talk) 20:55, 11 December 2015 (UTC)[reply]

Link to Danforth et al 2015 Sizeofint (talk) 21:01, 11 December 2015 (UTC)[reply]

Parrot's paper is a review so technically it should be given higher weight than Danforth's. Are there any newer reviews? Sizeofint (talk) 21:07, 11 December 2015 (UTC)[reply]

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Stashing this here. Has some new details about Clegg and corroborates some of the details of the Austin Chronicle article. http://www.playboy.com/articles/ecstasy-was-legal-in-1984-and-it-was-glorious Sizeofint (talk) 04:40, 28 January 2016 (UTC)[reply]

The images of the highlighted brain and the dilated pupil seem calibrated more for anti-MDMA propaganda than encyclopedic description of MDMA. To be clear, I'm not saying whoever put them there did so in bad faith. But I think there is an understandable tendency to take drugs of abuse and present them in light that is more cautionary than encyclopedic. Like, normally images from government publications or educational materials are great for Wikipedia. However, when the publishing body has an interest in effecting behavior change, the neutrality of its output becomes questionable. School health textbooks, I think it's fair to say, include anatomical pictures to convey a sense of bodily harm. That is understandable and perhaps appropriate if you want schools or the government to inculcate healthful behaviors. But Wikipedia is not a medium for inculcating sentiment or effecting public health or public morality outcomes.

Like, take the brain pic. It provides little information the text does not. If the article contained details about how MDMA acts on different regions of the brain, this might be a useful adjunct. But as it is, it is basically just This is your brain on drugs with rave-like coloring. Articles on other psychoactive drugs, even potentially harmful ones like haloperidol and methylphenidate do not include such imagery, and I think they'd be strictly worse if they did.

Or take the dilated pupil. Lots of things cause dilated pupils. There is nothing different about pupils dilated by MDMA, and certainly nothing that picture shows that tells you anything more than the text. Again, it has a "look at what drugs do to you" flavor that is decidedly un-encyclopedic.

I'm totally pro images that show the negative consequences of an action like the tooth decay in paan or meth mouth. But the images should be narrowly tailored to convey information, not a general "look at what drugs do to you." The overall presentation and aesthetic should have the same dispassionate, scientific flavor as articles on more respectable substances. I think this is a pervasive problem on article on illegal drugs, and one that maybe should be addressed more comprehensively. Acone (talk) 22:17, 3 February 2016 (UTC)[reply]

I put the dilated pupil image there following the lead of the Spanish Wikipedia (see es:MDMA). The image of brain I found while searching for some appropriately licensed content for the article. I thought it provided a convenient visual summary of the content. I personally don't perceive their presence as putting MDMA in a negative light, but then I have been working on this article for a while so I may be overexposed. I am neutral on the matter. If you see this as a POV issue feel free to remove them. Sizeofint (talk) 02:17, 4 February 2016 (UTC)[reply]

I added a bit to the "Medical" section and an expand template in the medical section. Sizeofint (talk · contribs) and Seppi333 (talk · contribs) noted that current medical consensus does not indicate MDMA, and respectively removed the new text and the expand template.

I understand how it is important to separate established clinical practice from speculative research. But the term "medical" does not necessarily connote "scientific consensus among medical researchers and approved by regulators." For example, trazodone has many off-label uses, some with much evidence (like insomnia), some with very little (like OCD). The article clearly distinguishes the consensus uses from the investigational ones. This seems more natural and fairer than if they had banished the other uses to a "research" or "investigational use" section at the bottom of the article.

There is a such things as medical scientific consensus, and it does matter, but it does not monopolize the concept of "medical" to the point that anything less can't go in the same section. I would like to add a section for unsanctioned uses. Such a section would describe (and cite!) how MDMA is in fact used psychotherapeutically, even if not in an above-board clinical setting. It would not describe clinical research into that matter, which is, I agree, better reported in a separated section. Acone (talk) 22:54, 3 February 2016 (UTC)[reply]

For the material that is supposed to go in the medical uses section, see MOS:PHARM#Sections. MDMA has no current medical indications and no regulatory approval in any country, hence nothing else should go in that section.
There's no "off-label" for MDMA because MDMA doesn't have a "label" to begin with (again, because it lacks a medical indication). At the moment, MDMA is an experimental drug, which basically just means it's a compound that is/can be used in research. Seppi333 (Insert 2¢) 23:30, 3 February 2016 (UTC)[reply]

Seppi333 (talk · contribs) MOS:PHARM#Sections doesn't state that there needs to be a scientific consensus or regulatory approval for a drug to be described there. If someone uses the drug for something clinical, that is a clinical use, and from my reading of it, nothing in that guideline says it can't there. Whether MDMA is "indicated" is an interpretive judgment. There may not be a scientific consensus or regulatory approval stating that something is "indicated"—and that is important and should be noted—but if it is routinely used to treat a medical problem, well, then those people think it's "indicated." I don't think Wikipedia should be a platform for a given paradigm to assert its monopoly on the right to categorize something as medical. Acone (talk) 00:28, 4 February 2016 (UTC)[reply]

Anyway, Seppi333 (talk · contribs), my proposal was to add a new section. Unsanctioned medical uses are still uses, and even forgetting my view that "medical" is the right section, they are certainly not "research," "recreational," or "spiritual" uses. When vets or rape victims take MDMA to address their PTSD, this fits into none of those sections. If I can't put that information in the medical section, why not add another one? For example, Mitragyna speciosa simply has a "Uses" section, with subsections describing how it is in fact used (regardless of whether there is scientific consensus about the clinical validity). How would you feel about adding a comparable section here? Acone (talk) 00:28, 4 February 2016 (UTC)[reply]

Let me put it this way: "Medical uses" is basically just a more layman friendly section title for "Indications". When pharmaceuticals get approved, they've been evaluated for an indication as well as for contraindications: these terms basically just mean "a medical reason to use / not use the drug" respectively. Has any medical research been done in this area? Are we just going to ignore it if not, even though the list is probably extensive like it is for this drug? I have no idea how to go about writing those two sections in a manner that's not half-assed for drugs without a label. In any event, if a research section only covers clinical trials, then just rename it "Clinical research" like Lisdexamfetamine#Clinical research; otherwise, cover clinical and preclinical there in subsections. Seppi333 (Insert 2¢) 01:02, 4 February 2016 (UTC)[reply]

Perhaps add a section called "Underground psychiatric use" to "Society and culture". I think this use should be discussed somewhere in the article. I also think we need to be consistent in what we call "Medical uses". This might be a topic to raise at WP:Medicine. I don't think we have a guideline for handling unapproved medical uses of drugs that lack indications. Ibogaine suffers from the same problem and we lump everything under "Medical uses". Sizeofint (talk) 02:40, 4 February 2016 (UTC)[reply]

I will add there is a blurry line between "Research" and "Unapproved medical use". We'd have to discuss how to differentiate between the two. Sizeofint (talk) 02:48, 4 February 2016 (UTC)[reply]

Sizeofint (talk · contribs) I like the header underground therapeutic use because I think it correctly communicates what is going on. The user understands the use as therapeutic (some would say medical or psychiatric, others might reject that). And I prefer "underground" to "unapproved" because the matter is not just one of regulatory approval, but clinical and cultural acceptability. As for where it should go, I say under "uses" not "society and culture." If we want to talk about the societal or cultural contexts in which various use occurs, then sure, society and culture. But not the how and wherefore of the use itself. Personally, I do not find the line between "Research" and "Unapproved/Underground Medical/Therapeutic Use"' blurry. Research is about efforts to learn more, their methods, and their results. If a notable underground use is being researched, it may be a appropriate to discuss it in both sections. For example. people use MDMA to treat their PTSD. Sometimes they do this in the context of a research study. Use in the context of a study should go in "research," while use that is not in such context should be noted in "Uses," even if such use is itself the subject of research. I take your point about Ibogaine and general policy in re WP:Medicine. For now, I'd like to just settle on what makes maximal sense here. Acone (talk) 21:38, 9 February 2016 (UTC)[reply]

I think unless we get a general guideline at WP:PHARM or WP:MED this will wind up in an edit war. I wouldn't revert you if you add it, but after so many days or weeks a medical editor is going to come by and delete the content. I note this article is in the scope of WP:Alternative medicine. What about adding a subsection in "Uses" called "Alternative medicine" and placing it there? The content might find better reception in that setup. Sizeofint (talk) 22:39, 9 February 2016 (UTC)[reply]

IMO, "Alternative medicine" is the probably most appropriate heading for a section covering this content, so I'm happy with the current layout. Seppi333 (Insert 2¢) 18:29, 24 February 2016 (UTC)[reply]

Alternative medicine has a clear meaning that isn't really the same as implied by the section. I have changed it to something more neutral, although we can argue over whether "therapeutic" would be better than "medical." Nick Cooper (talk) 10:30, 18 March 2016 (UTC)[reply]

Alternative medicine states "It consists of a wide range of health care practices, products and therapies, ranging from being biologically plausible but not well tested, to being directly contradicted by evidence and science, or even harmful or toxic." To me, this seems to fit with our use of the term in this article. Yes, we have a handful of pilot studies and it seems probable that MDMA has medical applications, however currently MDMA is not well tested. Sizeofint (talk) 16:49, 18 March 2016 (UTC)[reply]

Big blocks of content should not be hidden in "note" but placed in the body of the article IMO. Doc James (talk · contribs · email) 20:20, 30 March 2016 (UTC)[reply]

I'm of the opposite opinion in this case. Seppi333 (Insert 2¢) 00:06, 31 March 2016 (UTC)[reply]

I think the note allows us to include the relevant identifiers in the lead while not cluttering up the opening paragraphs explaining all the other names. We should probably have a general discussion about this since this is done at amphetamine, methamphetamine, and heroin. Sizeofint (talk) 01:04, 31 March 2016 (UTC)[reply]

Psilocybin is the drug article where this convention (adding a synonyms note to the first word, the drug name, in the lead) was first used; it's one of Sasata's featured articles (see [1]). Seppi333 (Insert 2¢) 01:46, 31 March 2016 (UTC)[reply]

Okay adjusted to more closely match Psilocybin.

Most of these alternative names should go in the infobox which they currently do under "Synonyms"

Will start a general discussion at WT:PHARM Doc James (talk · contribs · email) 10:44, 31 March 2016 (UTC)[reply]

The current setup is really weird. There's a hatnote pointing to ecstasy (disambiguation) at the top of the article. With a hatnote to a dab page, I'd expect to see the undabbed term in bold somewhere in the lead. "Ecstasy" is first bolded (in a table) the 15th time it's mentioned in the article, and first explained and bolded as a common/slang term the 19th time it appears (as a "Note" at the very bottom of the article). The lead probably shouldn't include a comprehensive list of common terms, but explaning the term "ecstasy" in a note at the very bottom of the article is ultimately confusing and unhelpful. Creating a section for "Etymology" or "Nomenclature" or something else along those lines and putting it immediately after the lead seems like the best way to deal with common/slang terms for recreational drugs. Plantdrew (talk) 05:01, 2 April 2016 (UTC)[reply]

That hatnote template shouldn't have been used since the term isn't the page title and doesn't redirect here, hence it didn't need to be disambiguated in this article. Seppi333 (Insert 2¢) 05:54, 2 April 2016 (UTC)[reply]

Text should not be in the lead only. Thus we need a section on names in th body. Doc James (talk · contribs · email) 13:17, 2 April 2016 (UTC)[reply]

Question: How big should the "note" be after the first sentence?

• Propsal one: Keep the note small. And put the rest of the content about naming in the body. List ecstasy as the common name in the lead. Example here Note below

MDMA contracted from 3,4-methylenedioxy-methamphetamine also known as ecstasy (shortened to "E", "X", or "XTC"), Mandy, Molly^[1][2]

• Proposal two: Have a bigger note and do not have the content in the body. Do not mention ectasy as the common name in the first sentence but instead stated MDMA is contracted from 3,4-methylenedioxy-methamphetamine Example here Note below

MDMA has become widely known as ecstasy (shortened to "E", "X", or "XTC"), usually referring to its tablet form, although this term may also include the presence of possible adulterants. The UK term Mandy and the US term Molly colloquially refer to MDMA in a crystalline powder form thought to be free of adulterants.^[1][2] "Molly" can sometimes also refer to the related drugs methylone, MDPV, mephedrone or any other of the group of compounds commonly known as bath salts.^[8]

Support option 1 (short)

• Support If we use "notes" at all they should be kept small. We should not be filling the lead full of hidden text and the lead should not contain content not also in the body of the article. Doc James (talk · contribs · email) 13:33, 2 April 2016 (UTC)[reply]
• support per reason given above--Ozzie10aaaa (talk) 15:15, 2 April 2016 (UTC)[reply]
• Support simple version with the common names rather than longer version. QuackGuru (talk) 16:56, 2 April 2016 (UTC)[reply]

Support option 2 (long)

Discussion

I don't really have a preference either way. It would be nice for the reader to understand what the term "ecstasy" generally refers to at the beginning. Studies often focus on ecstasy tablets rather than MDMA and the health effects can differ based on the presence of adulterants. Perhaps move the "Names" section up to before uses? Sizeofint (talk) 18:45, 2 April 2016 (UTC)[reply]