The Dangers of Hormone Replacement

The recent media blitz on the negative effects of conventional hormone replacement therapy (cHRT) has, understandably, fostered reactions from bewilderment to outrage. With good reason, women should be alarmed that what they have been sold as the fountain of youth could instead be the kiss of death.

For decades, cHRT has successfully treated menopausal symptoms such as hot flashes, vaginal dryness, night sweats and insomnia. Although not life-threatening, these symptoms can be detrimental to health and quality of life. Several recent articles I've read, condemning cHRT, have entirely trivialized these problems. I suspect the authors to be men who may regret having called insomnia trivial when their prostates swell and nature calls, awakening them all through the night. Women have also started cHRT hoping to prevent the diseases of aging like heart disease, osteoporosis, Alzheimer's and even some forms of cancer.

More than 16,000 women were enrolled in an eight-year study to determine the risks and benefits of various forms of cHRT. One of the studies was terminated after only five years because of conclusive evidence that Prempro, a combination of an estrogen and a progestin, causes more harm than good. The study using an estrogen alone is still in progress.

In this study 30 out of 10,000 women who were given a placebo and 38 out of 10,000 who were taking Prempro developed invasive breast cancer. In other words, Prempro increased a woman’s chance of developing breast cancer by 27 percent. For every 10,000 women using Prempro, eight more had strokes, seven more had heart attacks, and 18 more had complications from blood clots than among those taking a placebo. This means strokes increased by 38 percent, cardiac complications (mostly nonfatal heart attacks) increased by 23 percent, and blood clots or thromboembolisms, particularly injurious to the lungs, brain and heart, increased by 52 percent.

Favorable findings of the study included six out of 10,000 fewer colon cancers and five out of 10,000 fewer hip fractures for those taking Prempro compared to placebo. In the final analysis, there were 30 more negative outcomes per 10,000 women from taking Prempro than from taking a placebo. These are not acceptable side effects or risks to achieve some greater good, especially considering many of the complications were what women tried to prevent by taking cHRT in the first place. When the cure increases one’s chances of developing the disorder, something has gone tremendously awry.

Prempro is a combination of Premarin and Provera, the two most commonly prescribed and widely researched hormones used in cHRT. Premarin is extracted from pregnant mare’s urine, which is how it gets its name (pregnant mare’s urine). It is composed of equine estrogens, which are foreign to humans and problematic for us to metabolize. Because of this, Premarin often increases an undesirable form of estrogen known to be carcinogenic. It also contains some estrogens found in humans.

Provera, or medroxyprogesterone, is a synthetic version of progesterone; its actions bear little resemblance to the natural hormone. Most physicians mistakenly call Provera progesterone, so it’s not surprising that the media doesn’t understand, let alone emphasize, the difference either. Comprehending the available information on cHRT requires an extensive understanding of hormone physiology. Unfortunately, very few physicians and even fewer in the media can explain cHRT or converse intelligently about the variety of viable and healthy alternatives to cHRT already in existence.

Even more disturbing are many of the "solutions" or alternatives to cHRT offered in popular magazines. No one has mentioned using the real ones to combat hormone deficiencies. Instead, recommendations include Prozac for depression, Lipitor for cholesterol, high blood pressure drugs to treat hot flashes and, of course, the recently patented (and profitable) designer estrogens and biphosphates to treat osteoporosis. The side effects of these are alarming.

Conventional medical doctors have known for decades that progesterone counters the negative effects that excessive estrogens can cause throughout a woman’s system. With consistent use of inappropriate hormones like Provera, however, this knowledge dwindled to the myth that progesterone only protects the uterus and is therefore unnecessary if a woman has had a hysterectomy. The entire foundation of cHRT has been faulty from the beginning because of misinformation like this.

It’s not the least bit surprising that using mismatched and artificial hormones has delivered less than optimal results. What is surprising is that it has taken medicine this long to figure that out. Almost everyone intuitively understands that using diesel truck parts in a finely tuned sports car would hamper performance, if not stop it altogether. Yet, we’re repeatedly given the equivalent of diesel parts for our finely tuned human bodies.

Patent laws in this country favor the creation of synthetic artificial chemicals to the exclusion of anything natural. Since anything that occurs in nature cannot be patented, it will never be astronomically profitable. This simple fact has affected medical education and practice since its inception.

It is in the drug company’s interest to convince medical doctors and the public that natural herbal remedies and bioidentical hormones are either useless or extremely dangerous and uncontrolled. Never mind hundreds, and in many cases thousands, of years of safe and effective herbal use by humans. As for the hormones, I’ll put my money on three million years of human evolution over 50 years of questionable pharmaceutical research.

Estrogens refer to an entire class of hormones, some of which occur naturally and many of which do not. This critical distinction is often blurry to both modern medicine and the media as well. Estrogens promote secondary sexual development in women. Estrogens are more dominant in the first two weeks of a woman’s menstrual cycle and prepare her body to get pregnant. The prominent estrogens in women are estradiol, estrone and estriol. Estradiol is the most potent of these hormones and the one most likely to be prescribed after Premarin. Even estradiol has proven to be problematic because it has been prescribed in isolation or with Provera.

Neither of these regimens provides the proper hormonal balance. Progesterone is not the name of a class of steroid hormones like estrogen is, but is a single specific hormone. Progesterone promotes gestation, in other words it maintains a healthy pregnancy, and thus its name pro-gest-erone. Progesterone’s other beneficial effects include protecting against fibrocystic breasts, acting as a natural diuretic, helping burn fat for energy, protecting against endometrial and breast cancer, and protecting against and even reversing osteoporosis. Progesterone acts to both balance and enhance the effects of estrogen.

Labeling estrogens bad and progesterone good would be as ridiculous as labeling the brake in your car good and the gas pedal bad. One without the other would either be a disaster or a standstill. The balance between these two hormone classes is as important as their actual levels. This applies both to hormones generated internally and those acquired through replacement therapy.

Too much estrogen relative to progesterone creates a host of problems which include weight gain, PMS, endometriosis, uterine fibroids, breast tenderness, headaches, leg cramps, gallstones, high blood pressure, blood clots, nausea, fluid retention, and an increased risk of endometrial and breast cancer. Too much progesterone relative to estrogen causes it own set of problems, which include depression, fatigue, somnolence and breast tenderness as well.

An optimal ratio ranges from 35 to 75 times more progesterone than estradiol. Be careful when evaluating lab tests because many report the hormones in different units. Estrogens are often reported in picograms (pg) and progesterone is often reported in nanograms (ng). In order to normalize them progesterone must be multiplied by 1,000. Then just divide the number for progesterone by that for estradiol and you will have your ratio. For menstruating women, this ratio will fluctuate throughout her cycle.

Luckily, many options are available to women today besides choosing between inappropriate hormones or none at all. Bioidentical estrogens, progesterone and testosterone are available from compounding pharmacies. Bioidentical is the term that most accurately describes these hormones. Since they are synthesized in a lab from wild yam or soy they are not, technically, all natural. Unlike conjugated estrogens and Provera, however, which are also derived from soy or wild yam, bioidentical hormones are exact replicas of those found in humans. Premarin, on the other hand, is all natural but is far from bioidentical for women.

Women who feel hormone replacement therapy is still appropriate should seek out a practitioner knowledgeable and experienced in the use of bioidentical hormone replacement therapy (bHRT). For those women who would rather never use HRT in any form, or who want to discontinue the ones they are on, several other options exist. Herbs have been used safely and successfully for generations to ameliorate the problematic symptoms menopause can often trigger. Both Western and Chinese herbal traditions have numerous solutions for climacteric women.

Women whose diets have included a wide variety of legumes including soy, lots of vegetables (especially cruciferous ones like broccoli), and healthy fats like fish and flax seed oils, have often sailed smoothly through the change. This is especially true for many Asian women whose diets are especially rich in phytoestrogens. Phytoestrogens, the most well-known of which are the isoflavones from soy, are not technically estrogens or steroid hormones at all. They do, however, have an estrogenic influence within the human body. How safe these are is currently in question,s since some studies have found excessive amount of these may fare no better than the estrogens themselves.

Why some women seem to glide through menopause while others travel a rocky road would fill an entire article itself. Genetic variation is certainly one reason, but would not explain why your mother or grandmother may have had such a different experience. That we do not live in the pristine world of our ancestors but instead in a world saturated with toxins, many of which have potent and troublesome estrogenic activity, may better explain some differences. Women need to pay particularly close attention to the animal products they consume. Estrogens are often given to commercially raised chickens and cows to fatten them up so they weigh more when sold. Choose organic produce and free range animal products whenever possible.

Finally, the fact we start many women in their teens or early twenties on the kiddy version of Prempro, otherwise known as birth control pills, nearly ensures them a lifetime of hormonal problems. These pills are entirely artificial versions of both estrogen and progesterone, whose list of side effects parallel the problems found with cHRT.

With millions of women worldwide reconsidering their use of cHRT, it is essential they receive accurate, untainted and ultimately useful information on alternatives to cHRT. Remember the conclusions drawn using incompatible and artificial hormones do not automatically apply to the authentic ones. Bioidentical HRT is still a very viable option. Next month we will explore, in-depth, bHRT as well as nutritional and herbal remedies for menopause.

Menopause is neither a disease nor an event, but a process women go through as they cease to menstruate. Although all arrive at a common destination, the paths that get them there are as unique and numerous as the women traveling them. Each woman’s experience is likely to be influenced as much by her psyche and society as by her biology.

In cultures where the Goddess still resides in heaven, women are lovingly midwifed through menarche and menopause. If the prevailing cultural myth about women is a negative one, as ours is, the menopausal archetype of the wise and powerful crone deteriorates into a weak, withered and worthless old woman. Instead of something to celebrate, menopause becomes something to medicate. The negative impact of this perceptual shift on women stretches from the cradle to the grave.

As last month’s article discussed, many other inventions of our modern world are also detrimental to one’s menopausal journey -- nutrient-deficient diets, hormone-laden animal products, environmental toxins like pesticides, and a long history of using synthetic hormones such as birth control pills. Our fast-paced, high-pressure lifestyle has been particularly injurious to menopausal women. All these factors have made finding viable solutions to menopausal symptoms much more urgent. Until recently, the only options readily available to women in this country were conventional hormone replacement therapy (cHRT) or nothing at all.

Conventional HRT has, however, been quite ineffectual. Besides being given the wrong hormones, all women were given the same amount. Imagine going into a department store looking for a comfortable pair of cotton pants and being told the only ones they had were a spandex polyester blend four sizes too small. You wouldn’t think twice about walking out and shopping somewhere else. Yet for decades, women have been offered a one-size-fits-all synthetic blend as the only solution to extremely varied hormonal needs. It’s a frightening idea for clothes and should be for HRT as well.

Fortunately, things are changing. Every aspect of menopause is being reexamined. Women are demanding options and they’re getting them. Some women have realized the only problem they have had during menopause is everyone pressuring them to take hormones. They feel fine and probably don’t need them. Some are thriving by improving their diet and starting to exercise. Many more are exploring the world of herbs. Others have chosen to give bioidentical hormone replacement therapy (bHRT) a try.

Bioidentical HRT not only provides the correct hormones, but can also be individualized to provide only the hormones a woman needs in the doses that she needs them. Not every woman needs every hormone. Such specific formulations are created by compounding pharmacies, which also provide them in a variety of delivery forms. Hormones can be made into capsules, creams, lozenges, liquids and suppositories.

A thorough medical history helps determine what hormones may be needed. Information from laboratory tests more precisely determines one’s hormonal needs.

If a woman is already on cHRT, testing won’t be able to determine much. Most of the hormones used in cHRT aren’t the ones being tested for and they alter the values for the hormones that are. Hormonal adjustment can be made based on persistent or newly emergent symptoms. Additional laboratory testing after starting the hormones helps determine whether the hormone ranges and ratios are all optimal, or if the dosages need adjustment.

Although exhaustion of the ovaries heralds menopause, one’s adrenal glands function is likely to determine one’s experience. These small triangular glands sit atop the kidneys and share a close common ancestry with both the ovaries and the testicles. These glands make all the steroid hormones, and the differences lie in the quantity of these hormones produced.

The adrenal glands produce mostly cortisol, DHEA and small amounts of other hormones including testosterone, estrogens and progesterone. Once the ovaries retire, the adrenals are largely responsible for producing the hormones that remain in circulation. Although western medicine only acknowledges the most extreme cases of adrenal failure as a problem, adrenal exhaustion is epidemic.

The adrenals are our body’s shock absorbers. They are called into action to help us cope with stressful situations. If one’s adrenals are overworked and exhausted, they may not make enough cortisol, DHEA, and other hormones. Caring for the adrenal glands is, therefore, essential for ensuring one’s menopause go as smoothly as possible. It should be paramount for those who would rather not use any form of HRT.

Short-term stress does us little harm, but we are not meant to endure the chronic, unrelenting stress that so many experience today. When this happens, the adrenal glands go on overdrive, which eventually exhausts them altogether. Adrenal stressors include skipping meals, insufficient sleep, prolonged infection, trauma, chronic pain, stimulants like caffeine, and constant anger, fear, worry, or guilt.

Symptoms and signs of adrenal dysfunction include fatigue, nervousness, anxiety, unrefreshing sleep, frequent infections with prolonged recovery and hypoglycemia. A simple saliva test, requiring four samples collected throughout one day, can help evaluate how well the adrenals are actually functioning. Treatments can include using bioidentical cortisol and DHEA, vitamins, glandulars, acupuncture and, of course, herbs.

Herbs known as adaptogens can be particularly important in helping menopausal women respond to stressful situations. Adaptogens are unique in that they can calm an overactive adrenal system or rejuvenate and energize an underactive one. Adaptogens include the well-known herbs like panax ginseng, Siberian ginseng and astragalus. Ashwagandha is an ayurvedic herb with adaptogenic qualities; it’s reported to be less stimulating than the ginsengs. Licorice root is a specific for low adrenal function and contains substances very similar to some adrenal hormones. Herbs used to address the specific needs of menopausal women include dong guai, false unicorn root, sage and wild yam. Herbs which research has confirmed to have potent estrogenic influence include black cohosh, red clover and alfalfa.

Chinese herbology has a large repertoire of formulas to address both adrenal imbalances and most menopausal concerns. These will often include the kidney qi tonics and herbs to strengthen kidney yin or yang. Although the media’s bold announcement of "HRT, the end of an era" has put some into mourning, many more celebrate it as an exciting development that may help usher in an era where women’s bodies are their own, their voices are not silenced, their experiences are not discounted, their feelings are not repressed, and the transitions through which their bodies go are not treated as diseases. If you’re one of the many women entering menopause, sit for a moment and ask yourself what feels right. When you get a sense of direction, seek out the best advice to get you where you want to go.

Todd Mangum, M.D., of the Web of Life Wellness Center, is a holistically oriented physician practicing in Salt Lake City. To reach him, see the Community Resource Directory, under"Physicians."

Another Reason to Go Outside

It's confusing, isn't it? On certain days when the air pollution is bad, people with respiratory problems are encouraged to stay indoors. But according to studies conducted since the 1980s, most U.S. citizens are likely to have the greatest contact with potentially harmful toxic pollutants in their own homes, offices, and automobiles.

According to Wayne Ott and John Roberts, leading researchers on exposure to pollutants (Ott served in the EPA for 30 years), the chief sources are apparently ordinary consumer products such as cleaning compounds, air fresheners and various building materials including:

-- Dry-cleaned clothes which contain tetrachloroethylene, a known carcinogenic agent

-- Moth repellant, toilet disinfectants and deodorizers which contain paradichlorobenzene, which is also carcinogenic in animals

-- Chloroform, which causes cancer in animals in high concentrations; chloroform is a gas that comes from showers, boiling water and clothes washers as a result of the chlorine in our water supplies

-- Fine particles in the air that most of us stir up in our "personal clouds" as we move about; most of the particles form through combustion such as smoking, cooking, and burning candles, incense or firewood.

A disturbing statistic came from the results of two studies of indoor air contaminants, in which pesticides were found to be more concentrated (at least five times but typically 10 times or more) inside than outside. And pesticides that break down quickly outdoors may last for years once they get inside your carpet. For example, researchers found DDT, outlawed in the U.S. in 1972 due to its toxicity, in the carpets of 90 of the 362 Midwestern homes they examined in the early 1990s.

Toxic house dust can be particularly problematic for small children who are often on the ground and place their hands in their mouths. Their growing systems are even more vulnerable to toxic pollutants. The average urban infant ingests an estimated 110 nanograms of the highly toxic aromatic hydrocarbonbenzo(a)pyrene a day -- equivalent to what the child would get from smoking three cigarettes a day.

House dust is a major source of exposure to cadmium, lead and other heavy metals. Carpets are most troublesome; they act as deep reservoirs for these toxic compounds, even if the rugs are vacuumed regularly in the normal manner.

Wiping your feet on a good doormat reduces the amount of lead in a typical carpet by a factor of six, according to the researchers. Removing one's shoes before entering is even more effective in lowering indoor levels of the toxic pollutants that contaminate most homes.

"Of the hundreds of air pollutants covered under existing U.S. laws, only ozone and sulfur dioxide remain more prevalent outdoors," Ott and Roberts write. "If truckloads of dust with the same concentration of toxic chemicals as is found in most carpets were deposited outside, these locations would be considered hazardous waste-dumps." But the Clean Air Act focuses primarily on outdoor pollution, while most Americans spend 95 percent of their time inside.

Is too clean dangerous?

If reading this inspires you to do a deep spring cleaning, remember that cleaning compounds themselves can be a major source of toxicity in the home. Go natural whenever possible.

Not only does the attempt to sterilize our homes give rise to toxins from cleansers, but the cleanliness itself may throw a wrench in the delicate works of our immune systems. This hygiene hypothesis arose from researchers' inability to explain the rising incidence of asthma and allergies in many developed nations. In fact, the hay fever many suffer in the U.S. does not exist in many other countries. The prevalence of asthma is 1.75 times greater today than it was as recently as 1980, and for young children, the incidence is 2.6 times as great, according to Science News Online.

Some researchers hypothesize that these diseases, as well as autoimmune diseases such as rheumatoid arthritis and lupus, may arise when the immune system lacks practice fighting bacteria and viruses. Others greet this theory with skepticism; more research is certainly needed.

Ironically, the cleanest environments may be the best breeding grounds for allergies and asthma. One study reported that children who enter daycare younger are less likely to suffer from allergies than their counterparts who begin at a later age.

Additionally, researchers reported that children who had received oral antibiotics by age 2 were more susceptible to allergies than children who had no antibiotics. And at the Weizmann Institute of Science in Rehovot, Israel, researchers found that rats raised in a sterile environment are more susceptible to arthritis and diabetes than rats raised with normal exposure to germs.

What can you do?

To start with, recognize your own power. Don't feel helpless. You have a great degree of control over the toxic pollutants in your own home. Consider the following:

-- Become a shoe-free home. Remove your shoes upon entering to keep floors cleaner and to avoid tracking dangerous substances such as lead and pesticides indoors.

If you don't want to go completely shoe-free, at least get a high quality door mat and get into the habit of wiping your feet well.

-- Consider getting rid of your carpet. Jules Verne hypothesized at the turn of the last century that carpet would be made illegal by 1900 due to its hygiene risks. Vacuums were subsequently invented -- but carpet is still a breeding ground for mold and mites, and a storehouse for toxic dust, pesticides, and other toxic materials. Yuck.

-- Consider investing in an air purifier, keeping in mind that they are rarely silent and do require upkeep.

Or opt for the natural version -- plants. Spider plants, philodendrons, scheffleras, chrysanthemums, ferns and dracaena are excellent air filters.

-- Use natural household cleaners. You can buy them at local health foods stores. Or better yet, make your own. "The Natural Home" by Rosamond Richardson, and "Nontoxic, Natural and Earthwise" by Debra Lynn Dadd have recipes. Also check out the Seventh Generation catalog.

-- Buy natural materials rather than synthetics whenever possible. Find nontoxic alternatives to common toxins like paint, solvents and pesticides. Avoid particleboard furniture.

-- Avoid plastics. "All soft plastics leach harmful molecules into food, and when heated, release plastic molecules into the air," writes Laurel Vukovic in "14-Day Herbal Cleansing." Consider glass food storage containers. Drink filtered water or spring water. Install a carbon filter showerhead to cut down on the toxic chlorine gas.

-- Open your windows. Allow fresh air to circulate. Many health professionals recommend sleeping with the window open an inch or two even in cold weather.

-- Get outside and enjoy the seasons. Hang out on your porch. Picnic at a local park. Hike in a nearby canyon. Walk instead of drive. Most of all, enjoy being alive.

Erin Geesaman is a writer for Catalyst in Salt Lake City.

Treatment Centers Versus Jail Time

When the Drug Enforcement Agency raided Jill Bartschi's home on November 11, 1999, her first thought was one of relief -- relief that her two-year-old son JT was with his dad for the weekend. The relief didn't last long. Jill was taken to jail on methampethamine charges. She was afraid Child Protective Services would take her son away from her. Not knowing how long she would have to stay in jail, Jill called her parents, asking them to pick up JT and keep him until the ordeal was over.

JT stayed with his grandparents for the remainder of the week while his mother served her jail time.

During that week of incarceration, after her live-in boyfriend who was on parole was sent back to prison for operating his garage meth lab, Jill was still thinking about her son. Concerned, she stayed with her parents for almost a month after her release. But the prison scare wasn't enough to kick Jills habit, and three weeks after the raid she was back in the meth house with her toddler son.

For the next four months, between the everyday routine of mealtime, naptime and playtime, Jill used meth.

A type of stimulant, meth directly affects the central nervous system, increasing wakefulness and physical activity and decreasing appetite. Although the effects differ slightly for everyone, Jill says that she and her friends liked meth because of its ability to make them "go, go, go."

Meth's endless energy seems attractive until the user comes down from the high, gets irritable and needs excessive amounts of sleep. Eventually, the desire to keep moving at such as fast past makes people get high again, propelling them into an extremely addictive, daily habit. Jill says that some days she was using at least three or four times. Yet, the feeling of being powerful and invincible that comes with being high on meth convinced her that she was a competent, responsible mother.

When she wasn't high, Jill found herself conflicted by her varying roles of addict and stay-at-home mom. To make up for her inconsistencies, she enforced rules that a normal mother would. "I never let anyone smoke cigarettes in the house and we never used drugs in the house; not while JT was awake, anyway."

But the true test of motherhood came in the early hours of March 7, 2000, when the Salt Lake County, Utah Sheriffs Office and the DEA pounded down her door in another raid, this time with JT in the house. Lying face down on the floor, Jill couldnt see her son, but remembers him crying "Mom, mom, mom." The police wouldnt let Jill hold JT and only took off her handcuffs when it was time for him to be taken by the State Division of Child and Family Services.

"All I could do was pack [JT's] little suitcase, give him his teddy bear and a kiss and tell him that his Mom loved him. I didn't know when I would see him again. "

Mandated by the court to check into a residential treatment program, Jill served three days in jail and then lived in her jeep while on the waiting list for the House of Hope.

Finally, on May 9, 63 days after the raid, and three weeks into the House of Hopes residential treatment program, Jill got to see her son again. The Division of Child and Family Services allowed JT to move in with his mother as long as she continued the residential treatment. Although Jill didn't regain custody of JT from the state of Utah until October 2000, she says that having him with her made such a difference in the treatment process. They were both able to get help dealing with the effects of Jill's substance abuse.

Jill, who says that she never imagined doing treatment before her arrest, says now that she couldnt have gotten sober without it. Treatment programs, unlike jail time, address issues of self-esteem, anger management, emotional stress and decision-making skills issues that help people stay sober.

While their parents are in treatment sessions, children attend a program designed to help them deal with the traumas of substance abuse, targeting issues that may eventually cause them to become abusers themselves one day.

Cornerstone Counseling Center, a nonprofit organization and Salt Lake City's first formal drug treatment center, has a similar program. Drug-addicted mothers and their children receive treatment together, working on trust, separation issues and building healthy relationships.

These programs are effective, says Cornerstones executive director Gary Baker, because they approach substance abuse in its larger context. Simply providing detox does not enable a person to find alternatives to help cope with the life problems that originally brought them to depend on a substance.

Jill, who says she was resistant to treatment at first, agrees. Part of the House of Hope program involves teaching people basic life management skills such as cooking, cleaning and caring for their children. Jill admits that she was arrogant when she entered the program because she felt like she had been performing those daily tasks adequately the last two years. Her attitude quickly changed, however, when she realized that if that were true she would not be living in a drug treatment facility. Now, more than a year after graduating from a four-month residential program and almost a year of day treatment, Jill is still sober, has full custody of her son and says that she will never again risk her son or herself to the meth world. In that frame of mind, she continues to attend weekly after-care meetings and hasn't had any relapses. Jill is just one of the estimated five million people arrested last year with a severe drug or alcohol addiction. She is luckier than most. Because she had a dependent child, Jill was able to go through treatment instead of spending time in jail. For most drug arrests, jail is the standard sentence.

Last year the Office of National Drug Control Policy estimated less than two million of those five million arrested addicts received treatment a gap of almost 60 percent. Instead, those drug offenders were sentenced to extended prison or jail time, entering as addicts, and after their time was served, leaving with the same addictions.

Welcome to the war on drugs. A war waged by America on American citizens. Citizens like Jill Bartschi who find themselves, regardless of their desire to be good parents and neighbors, pulled into the world of addiction. Citizens being punished instead of helped.

Approximately 85 percent of people who are incarcerated have a substance abuse problem, says Dr. Barbara Hardy, director of the Salt Lake County Division of Substance Abuse. "And addiction is one of the primary reasons...people go back to jail or prison. Studies show that incarcerating people instead of mandating treatment simply funds the social costs of recidivism, ultimately putting the same criminals back on the street to commit the same crimes."

Considering that it costs society an estimated $18,400 to $26,000 to keep a person in prison for a year and only $1,800 to $4,700 for a year of treatment, treatment seems to be the obvious option for most drug offenders.

Yet, the government continues to send people to jail for substance abuse, even though Dr. Hardy maintains that "you cannot punish [substance abuse] out of someone."

What about the person who receives treatment and, six months later, relapses? Should they then be sent to jail or prison? "Not necessarily," says Dr. Hardy. "It makes much more sense [in terms of societal cost and recidivism] to put someone in treatment, even though it may take several repetitions, than to just lock them up."

Looking back over her own experience, Jill comes to similar conclusions. Although she admits that the first time through treatment doesn't always work for everyone, she is proof that treatment can work. Now, a sober mother who might still be in jail if she received a typical sentencing, Jill teaches four-year-old JT the truth about drugs. And while JT will be the first to tell you that drugs will ruin your teeth and rot your life, hes just glad to have his mother there.

Sarah O'Leary is Catalyst's editorial assistant and a senior in the English department at the University of Utah. She can be reached at

The Truth About Ecstasy

Imagine it. A sudden welling up of pure joy. That sense of deep peace and relaxation you get after days of vacation. Everything looks crisp, clear, new. You have an overwhelming sense of awe at simply being alive. Communication is effortless. You can't not tell the truth in your heart. You have that feeling of being innocent and vulnerable, like you were as a bright-eyed child. A feeling of ease. A willingness to accept all the love that is around you. A willingness to express all the love you feel without any defenses or egotistic hesitations. A sense of purpose and sacredness in everything. It's like the best moment of your life. Ecstasy.

One way to achieve this state is with a $20 pill. Or so say the pill's proponents. The drug is appropriately named Ecstasy. Also known as E, X, and Adam, this semi-synthetic drug's proper name is MDMA (methylenedioxy-n-methyl amphetamine). It has a chemical structure similar to molecules found in nutmeg, mace, crocus and dill, as well as over-the-counter Sudafed. It is similar to an amphetamine, but has a "paradoxical effect." That is, it inspires a feeling of peace and calm rather than excitation.

MDMA was first synthesized by the Germans in 1914 and patented by the Merck Pharmaceutical Company. It was largely forgotten for the next four decades. In the 1950s, the Army Chemical Center began to test it on animals to examine its toxicity. Another 20 years passed and in 1976, the first report of the psychoactive effects of MDMA in humans was published. People, including many psychotherapists, experimented with this "new" drug, and some research studies on its therapeutic benefits were begun. Dr. Ralph Metzner coined the name "empathogen" (meaning empathy-generating) to describe the effect of MDMA. He had used it in his practice of family therapy and couples counseling. With a simple signature, the Drug Enforcement Agency (DEA) criminalized the use, possession, and manufacture of MDMA on July 1, 1985, placing it in the category of Schedule I, the most regulated class of substances for drugs that have a "high potential for abuse and no medical use." (Even cocaine is in Schedule II, due to its use as an anesthetic.) On that day, the dissemination of this empathogen moved from the hands of licensed professionals to potential felons.

Even though the DEA's own judge had ruled to classify MDMA in Schedule III so that research into its therapeutic value could continue, the administration ignored his 90-page decision and volumes of testimony by experts. Many are wondering why. As Peter Stafford eloquently states in the introduction to Ecstasy: The MDMA Story, "Driving this marvelous tool to underground usage guarantees an increasingly perverse edge to the delicate but robust potentials it once had." It also has cultivated a market for badly fashioned look-alike drugs, with much more potentially serious side effects.

Whether authentic or imitation, the use of what people think is Ecstasy is on the rise. According to Salon magazine, in the first eight months of 1999, U.S. Customs seized more than one million doses. Compare this to the previous year when only 375,000 pills were confiscated. Dean Boyd of U.S. Customs quipped, "What Colombia is for cocaine, the Netherlands is for Ecstasy."

Don Mendrala, head of the Utah DEA, says Ecstasy use is on the rise in Utah as well. Although there seems to be a prevalent attitude that MDMA is a harmless, casual drug, he says, the DEA does not view it that way. They pursue MDMA as aggressively as they do any other Schedule 1 substance. They are currently working on a few cases.

But is it truly a $20 magic bullet to bliss? Why not try it?

Due to its classification in Schedule I, it is nearly impossible for scientists to obtain permission to do research on human subjects to determine its toxicity. Some studies have been done on animals in recent years, but experts disagree on how to interpret the results. Some say using MDMA even a few times can cause permanent damage to the human central nervous system. Some say it can lead to memory loss and, ironically, depression.

In interviews published in the 1997 book Ecstasy Reconsidered, two doctors expound on their opposing views. Dr. George Ricuarte is a top medical researcher at Johns Hopkins; Dr. James O'Callaghan is a senior researcher for the U.S. Environmental Protection Agency. Both are highly respected in their field. Ricuarte believes MDMA is highly neurotoxic and can lead to long-term problems for users. He gives this vivid image: "It prunes the axon field." Axons are the terminal ends of nerve cells.

On the other hand, Dr. O'Callaghan believes it is not neurotoxic even when taken in large doses. Dr. Charles Grob of UCLA School of Medicine agrees. No studies are conclusive. But one certainty is that the real thing is has become virtually impossible to find. "I haven't seen it in Salt Lake since the '80s," one well-traveled aficianado mourns. "And what passes for Ecstasy is an insult to the name. They should stop calling it Ecstasy," he says.

The person who first named MDMA Ecstasy said he considered naming it Empathy, which would be more appropriate, but that it wouldn't sell as well. It is commonly experienced as more of a "hug drug" than a sexual stimulant. It causes more of a "diffuse, general sensuality." Some of its most commonly noticed effects are an increase in ease of communication and a depth of interpersonal relationships. And it has none of the common effects of psychedelics like LSD, psilocybin or mescaline. It does not cause the user to hallucinate, nor does it impair cognitive functioning. Its effect is diminished by alcohol, marijuana, and food. The "trip" lasts only three to four hours.

Exactly how it works is unclear. Serotonin is a major neurotransmitter associated with mood and sleep; the effect of MDMA is thought to be similar to that of SSRIs (selective serotonin re-uptake inhibitors), such as Prozac. MDMA also affects the cardiovascular system causing a mild increase in blood pressure and heart rate. For this reason it is contraindicated for those with hypertension, cardiac arrhythmias (irregular heart beat), heart disease, hyperthyroidism, diabetes, hypoglycemia, glaucoma, diminished liver function, actual or possible pregnancy, and breastfeeding women. (This list was compiled by Dr. George Greer, M.D., who worked specifically with MDMA when it was legal.)

For those who choose to take MDMA, it is recommended that they take supplemental potassium, magnesium, zinc, the amino acid tyrosine, and afterwards eat a high-protein meal. Some people experience mild, unpleasant side effects such as jaw clenching, tooth grinding, nausea, anxiety, increased sweating and fatigue. Most of these side effects dissipate within 24 hours, if not within the first hour of the "trip." Compare this to the common side effects of Prozac as listed in the Nurses' Drug Guide: "Anxiety, drowsiness, headache, insomnia, nervousness, diarrhea, excessive sweating, pruritus (itching) and tremor." Almost all synthetic drugs have some unpleasant side effects. According to Bruce Eisner, author of Ecstasy, between 1977 and 1981, the first four years of its "street use," only eight people in the whole country sought treatment in emergency rooms for reasons related to MDMA. As Eisner notes, more people are admitted to hospitals for alcohol-related problems in any two hours of a single day.

The most dangerous problem facing users today is that what they're buying as Ecstasy may be any number of other drugs. They may be getting speed, ketamine, PCP, baby aspirin, or some combination of MDMA and these drugs.

What do the users say? Although I personally have never taken ecstasy, I've been to a few "E-parties" where most everyone was under the influence. I remember one guy saying, "I wish my mom could take this." One woman called her experience "a year of therapy in two hours." Amy (not her real name), a recent graduate of the University of Utah School of Medicine, uses it on a regular basis. Tomas (not his real name), a 23-year-old art student who has taken Ecstasy four times, called it "the best experience of my life. It was total magic." I asked him if he would recommend it to his mother. He said he would if he could be there to share the experience with her. He hasn't taken it in awhile because he's heard rumors that it is bad for his spinal cord. But he would probably do it again. Nate (not his real name) has taken Ecstasy about a dozen times, both at raves and at home.

Ecstasy plays a central role in rave culture. At a rave, Nate says, the experience is more social. It has led to some of his greatest dancing. At home, the atmosphere is "more intimate, more people making out or just touching." He too has opted to stop using it because of rumors about bad side effects. A few times, he has found himself depressed afterward. "But if you realize [the depression] is coming, it can help." He feels his experiences have affected his life in a very positive way, and that he's been able to incorporate his drug-induced insights into his normal consciousness.

Jackie Pratt, a 53-year-old small-business owner in Salt Lake, has taken MDMA four times. She hasn't done it in years but said she would "absolutely do it again." The first time she took it, in 1986, she received a 25-page booklet with her dose explaining how to use the drug sacredly and suggesting specific nutritional supplements to take to reduce its toll on the body. She has always used it in a natural setting and said she doesn't understand how people could use it in dance clubs or raves. She took it less as a recreational drug and more as a sacrament. "It made everything twinkly, you know? It lets you see all the crap you normally surround yourself with. It allows you to see the truth. It removes all the layers so you can be your vulnerable, innocent self." Her partner, Stephen Paul, Ph.D. has also used Ecstasy a number of times. "I loved it. My heart was open. I felt surrounded by, permeated with, full of, and releasing love. But I knew I had a strong chemical in my body. It was a life-changing experience." Now that he is older, he believes the toll on his body would be great. But if he found it difficult to get into that "heartspace" (he laughed, "Which I do") he may do it again. He feels that it is important to use the drug sacredly, and not to use it as a crutch, but to "start a process." I asked if he would recommend it to others. He said that if people were looking to use it consciously, to really prepare their intentions, he would have recommended it in the past. But now, he would recommend meditation or being in nature to achieve that state.

I interviewed two professionals about MDMA. One was Dr. Karen Thompson, M.D. (not her real name) a holistic family practice physician from San Francisco. The other was Richard Glade, LCSW, a local therapist.

Dr. Thompson has used Ecstasy a number of times, but less often in the last decade because she says it's nearly impossible to get the real thing these days. "There is nobody I wouldn't recommend it to. I would recommend it to my siblings and my mom. Everyone deserves an experience of unconditional love." She spoke with a passion. "As a doctor, if I had to choose just one synthetic pharmaceutical to use in my natural practice, MDMA would be it." She spoke of MDMA's naturally built-in anti-addictive mechanism. The more you take and the more frequently you take it, the less pleasant and less intense will be your experience. There is a serious lack of evidence to justify its placement in Schedule I, the "high potential for abuse" category. Karen ponders why as a society we sanction the use of antidepressants, such as Prozac, for daily use while MDMA is banned. She believes the use of MDMA once every six months has the same potential for healing depression as daily Prozac. She notes, "In our society people are depressed because we are living nonsustainably in an insane society and mostly nobody does anything but medicate our desire to do anything about it." She wonders if on some level, the reason Ecstasy use was criminalized is because it threatens the very fabric of our society. It is a drug that supports insight. "When your heart is open and you are in that truthspace, you cannot be manipulated by ads that say 'Buy this and it will make you sexy.' Rather than numbing ourselves to the way our lives aren't satisfying, MDMA can inspire you to change your life." She suggests using the drug with an experienced guide, either in a therapeutic or a natural setting. She would like it to come with instructions: "It is not appropriate to use recreationally." According to Dr. Thompson, it should not be used with alcohol, marijuana, or on a full stomach. If more than 150 mg are taken, unpleasant side effects are likely. It shouldn't be taken many times in a row, perhaps every 3 to 6 months at the most. As with any substance, it can be used properly or not. "Take sugar, for example. I call that 'the other white powder.' More people have a sugar addiction than a drug addiction. It destroys health, but it is both legal and promoted." Anything in excess can be toxic. But used safely, she believes MDMA to be a profoundly useful substance.

As a graduate student in Canada, Richard Glade, LCSW, was involved in research using LSD therapeutically. He found it to be an incredibly useful adjunct to therapy. But he offers some insights into the pitfalls of any drug use.

"Mimicry is different from authentic experience. Say someone wants to relax their muscles. You can do the hard work of learning, through some type of autogenic training or progressive relaxation technique, to relax your muscles. Or you can take a sedative. Both people may have relaxed muscles, but to mistake those two states for the same is highly problematic. One person is self-regulating. The other is drug-dependent." The same is true for contriving states of bliss.

"There is usually a match between a person's capacity and what arises in his or her consciousness. A drug can let you leapfrog, allowing a new state of consciousness. The gradient for one's capacity to deal with this state just got a lot steeper. Imagine you wanted to start lifting weights. If you decide you don't need to spend any time with five- and 10- pound weights and skip to the 50-pound weight, your work is much harder. It is much better to work up to that level. The more powerful the method, the more discipline and skill are required for good to come from its use." Are most users willing to cultivate the discipline, skill and time to integrate their experience in a way that would be of benefit?

Glade notes a particular problem for people on a spiritual path who consider using a drug. "You cannot move down a spiritual path with a drug. At best, the drug can show you a glimpse of your potential. At worst, it can show you this potential and let you believe that this potential lies outside yourself." A 1985 article in the L.A. Times stated, "Brother David Steindl-Rast, a Benedictine monk from the Immaculate Heart Hermitage in Big Sur, tried the drug at a conference on the medical uses of MDMA. Steindl-Rast, who was a psychologist before he entered the monastery, said the drug facilitates the search for the 'awakened attitude' all monks seek. 'It's like climbing all day in the fog and then suddenly, briefly seeing the mountain peak for the first time,' he said. 'There are no shortcuts to the awakened attitude, and it takes daily work and effort. But the drug gives you a vision, a glimpse of what you are seeking.'" Many people note the fact that psychoactive substances have been used by indigenous peoples for eons. But as Glade points out, "These substances were a small part of a larger system of training. The training could stand on its own without the support of the substance, but the substance use would never be independent of the training."

Is it worth risking brain damage to glimpse this state? Is it worth the hard work of a spiritual path?

In the past weeks, I've had many sober ecstatic experiences. Witnessing the birth of my friend's first child. Listening to a Sufi saint chant the zikr. Making love with my boyfriend. Simply walking through the Avenues neighborhood late at night and taking the time to appreciate the variety of flowers in bloom. There are many paths to ecstasy and the awakened state. Some believe MDMA is one. Whichever method you choose, the path to ecstasy and awakening is definitely worth walking. u

Erin Gessaman teaches yoga and tai chi, and is pursuing a degree in Integrated Somatics at the University of Utah. She can be reached at


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