Talk:MDMA/Archive 8

Archive 5

Archive 6

Archive 7

Archive 8

Archive 9

Cognitive impairments from long-term MDMA use

Since I know this is going to come up again, I figure I might as well just address it now. As noted in my recent edit summary, this review (the full text can be accessed in this link) is examining the neural correlates of cognitive impairments in MDMA users. In other words, using fMRI, it's examining the functional differences in specific brain regions between healthy individuals and chronic MDMA users that correlate with specific cognitive impairments. The ref states that these cognitive impairments - in particular, those related to learning and memory - have been consistently documented in humans. It also states that fMRI studies which examine the neural correlates of these cognitive impairments have produced inconsistent results. In plain English, this means that the research which has attempted to identify the neurotoxic/neurodegenerative effects of MDMA that correlate with specific cognitive function deficits is not consistent.

Inconsistency in findings that link MDMA-induced neurotoxicity to MDMA-induced cognitive impairments is not the same thing as inconsistency in findings of MDMA-induced neurotoxicity or inconsistency in findings of MDMA-induced cognitive impairments. Consequently, the source is not contradicting itself and the current article content on deficits in cognitive function that is cited by this source does not contradict this source; rather, that content is directly supported by the quote in the citation. Seppi333 (Insert 2¢) 22:44, 11 January 2017 (UTC)

References

Semi-protected edit request on 16 March 2017

Replace citation [21] in the following sentence "Researchers are investigating whether a few low doses of MDMA may assist in treating severe, treatment-resistant posttraumatic stress disorder (PTSD).[12][21]" with this citation: Amoroso, T., & Workman, M. (2016). Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy. Journal of Psychopharmacology, 30(7), 595-600. 2601:18B:8200:61D8:7CB6:AB0F:5BE5:4F54 (talk) 00:12, 17 March 2017 (UTC)

 Done Sizeofint (talk) 00:31, 17 March 2017 (UTC)

Paste

The following has some useful references but I think it is redundant with current content and too loose on efficacy. Sizeofint (talk) 20:37, 18 May 2017 (UTC)

MDMA is known to improve sociability, friendliness, extroversion, to increase empathy and feelings of closeness with others, and to reduce interpersonal defensiveness. These effects are relevant to people with social anxiety and a group of researchers find that MDMA has therapeutic benefits for alleviating social anxiety.

Why do you think this content which is humanizing straight research is redundant?--TMCk (talk) 02:35, 19 May 2017 (UTC)

We already have a section on effects. I don't think it is necessary to repeat them in the research section. "A group of researchers find that MDMA has therapeutic benefits for alleviating social anxiety" has some weasel wording issues (which group?). Additionally, at least one of the sources was a bit more nuanced (I haven't closely examined the others yet) with the authors saying it "may" have therapeutic benefit, not that they believe it certainly does as this wording implies. Sizeofint (talk) 06:33, 19 May 2017 (UTC)

With respect to the sentence – "MDMA is known to improve sociability, friendliness, extroversion, to increase empathy and feelings of closeness with others, and to reduce interpersonal defensiveness." – WP:MEDRS sources are required since these are clinical claims of drug effects. Among the cited refs, only this ref is a MEDRS-compliant source (i.e., a medical review). In any event, if others think that this is worth covering, I don't think that it should be too difficult to find other reviews that cover the effects that aren't supported by the cited review. There's plenty of medical sources which state that amphetamine increases sociability and self-expression, so MDMA is not unique in that regard. The non-empathogenic effects of MDMA on social behavior are likely derived from its amphetamine-like dopaminergic effects. Seppi333 (Insert 2¢) 09:01, 19 May 2017 (UTC)

Section references

References

"As of 2017, MDMA has no accepted medical indications."

Neither of the two provided sources actually support this weird statement. The first suggests that MDMA should be removed from its "no medical use" status and the other says that its use for therapeutic use is rare these days. --86.50.81.67 (talk) 02:41, 23 May 2017 (UTC)

If the authors are arguing its status should be changed then it currently must have no accepted medical use. Sizeofint (talk) 04:14, 23 May 2017 (UTC)

I agree with Sizeofint. The lack of medical indications logically follows from the fact that it has "no medical uses"; in any event, the source that was recently added to that sentence explicitly states this. Seppi333 (Insert 2¢) 18:55, 23 May 2017 (UTC)

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Oddly phrased sentance.

"There are numerous methods available in the literature to synthesize MDMA via different intermediates.[98][99][100][101]" seems this sentence is worded very poorly. It's redundant, essentially stating "There are many ways to make MDA" twice. I also don't think it needs the qualifier "in literature". I think a better sentence might be "There are numerous methods available to synthesize MDMA.[98][99][100][101]"

--173.66.69.186 (talk) 01:56, 26 August 2017 (UTC)

I think the 'different intermediates' portion is to emphasize the different precursors (safrole, isosafrol, etc.). The "in literature" part can be cut. Sizeofint (talk) 08:15, 26 August 2017 (UTC)

Provenience

I had this crazy idea... How come people don't tell the truth and save everyone of the troubles arising from lies. Like: Mdma is extracted from sea shells... plain and simple.

• see also cocaine from ivory

Rgb.trouw (talk) 00:26, 8 September 2017 (UTC)

US data in the lead

As the US is the largest EN speaking country in the world IMO this "In the United States, about 0.9 million people used ecstasy in 2010." belongs in the lead.

The Persian version of the article should have the prevalence of usage in Iran the lead. Doc James (talk · contribs · email) 19:25, 22 September 2017 (UTC)

I feel that this marginalizes the rest of the English speaking population by making Wikipedia seem US centric on articles that have a global scope. The 0.9 million number reflects a use level of ~0.3% which is in line with the global number we give. Sizeofint (talk) 23:21, 22 September 2017 (UTC)

References

Source for history section

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

Has blurb on current usage. http://www.bbc.co.uk/newsbeat/article/36503623/danger-from-ecstasy-greater-than-ever-say-drug-experts Sizeofint (talk) 18:59, 8 November 2016 (UTC)

Additional source for history/spiritual uses to add if I can track down the original Guardian article. http://csp.org/practices/entheogens/docs/saunders-ecstasy_rel.html Sizeofint (talk) 20:29, 8 December 2016 (UTC)

Roger-Sánchez, Concepción; García-Pardo, María P.; Rodríguez-Arias, Marta; Miñarro, Jose; Aguilar, María A. (April 2016). "Neurochemical substrates of the rewarding effects of MDMA". Behavioural Pharmacology. 27: 116–132. doi:10.1097/FBP.0000000000000210. Sizeofint (talk) 08:35, 18 December 2016 (UTC)

French, Larry G. (June 1995). "The Sassafras Tree and Designer Drugs: From Herbal Tea to Ecstasy". Journal of Chemical Education. 72 (6): 484. doi:10.1021/ed072p484. Sizeofint (talk) 02:48, 10 January 2017 (UTC)

DSM-5 content can be expanded. 10.1176/appi.books.9780890425596.dsm16 Sizeofint (talk) 06:02, 28 September 2017 (UTC)

Can hone some points britannica makes https://www.britannica.com/science/Ecstasy-drug Sizeofint (talk) 20:33, 28 September 2017 (UTC)

Content deleted from John Lawn page, mostly redundant but some may be integrated here

References

Role in the Criminalisation of MDMA

In January 1984, worried about increasing recreational use of MDMA, the DEA prepared a document for scheduling MDMA as a Schedule I substance, a classification for drugs seen as having a high potential for abuse and having no accepted medical use. Because MDMA was already in widespread use by psychiatrists, a group of psychiatrists and their lawyer filed a request for a hearing. The request was granted, although MDMA was scheduled on an emergency basis by the DEA before the hearings were heard anyway. On the basis of multiple witnesses testifying that there were medically accepted uses of MDMA in treatment, the administrative law judge in charge of the hearing, Francis L. Young recommended that MDMA be classified as Schedule III, a scheduling that many researchers, including Alexander Shulgin were willing to accept. However Lawn disagreed with the recommendation and ultimately MDMA was scheduled as Schedule I. The events were later echoed in 1988 when Lawn again overruled Justice Young who recommended for the reclassification of marijuana from Schedule I to Schedule III.

However, in 1987 the Harvard psychiatrist Dr. Lester Grinspoon sued the DEA, and the federal court sided with Grinspoon, calling Lawn's argument "strained" and "unpersuasive", and MDMA was unscheduled. However, less than a month later Lawn claimed that he had reconsidered the evidence and again classified MDMA as Schedule I. In his ruling Lawn claimed that evidence psychiatrists gave that they had administered MDMA to approximately 200 patients with positive effects should be dismissed as "merely anecdotal" as they were not published in medical journals.

References

Non-breaking spaces

I've just weeded out numerous misuses of the non-breaking space ( ). MOS:NBSP explains appropriate uses and the general principle in normal running prose is that when the browser wraps onto a new line, the starting word of the next line should not be something that makes no sense on its own, such as a unit abbreviation or part of a set of co-ordinates. The table "General guidelines on unit names and symbols" at MOS:UNITNAMES makes explicit how this applies to unit names and symbols, but it should not need saying that we don't use a non-breaking space in a phrase like "6 hours", as it serves no good purpose. Of course, we may want to control more tightly how words wrap in tables and infoboxes and therefore use {{nowrap}} and   is often used more liberally, but that is a different consideration from use in running prose. --RexxS (talk) 14:14, 9 October 2017 (UTC)

@RexxS: MOS:NBSP doesn't state circumstances where non-breaking spaces should not be used with units and numbers; it only indicates where it should be. Line break handling is almost entirely up to editorial judgement ("It is desirable to prevent line breaks where breaking across lines might be confusing or awkward." - see the examples in MOS:NBSP that follow this statement), except in cases where the MOS explicitly states that it should or should not be used. The only 2 cases where the MOS explicitly states not using it are after ellipses and where en dashes should be unspaced. I put non-breaking spaces between all numbers and full unit names because I think line breaks like the following two cases look equally bad:

MDMA users report feeling the onset of subjective effects within 30–60

minutes of ...

MDMA users report feeling the onset of subjective effects within 30–60

min of ...

In any event, I don't care to argue about how non-breaking spaces should be used in this article, but I don't intend to change how I use them in the future. FYI, you changed "3 hours" to "3 hr" without a non-breaking space. Edit: you also removed the non-breaking space between "29 million" (MOS:NUMERAL). Seppi333 (Insert 2¢) 16:50, 9 October 2017 (UTC)

@Seppi333: I don't care to argue with you either. The control of line breaks has been the subject of typographical convention well before Wikipedia was thought of, and we don't need amateur revisions to what has been established practice.

Of course MOS:NBSP doesn't state circumstances where non-breaking spaces should not be used. Common sense tells us that wherever it isn't indicated as useful, we don't use it. It makes lines breaking unnecessarily stilted and pollutes the wikitext. It's simple: if there's no good reason, don't use them. Editorial judgement needs to be subject to at least that. Phrases like "15 human volunteers" are ludicrous, inept and worthless, and no amount of protesting will make them so.

I think it's obvious that where en-dashes are to be unspaced, you don't use a space, either normal or non-breaking, so that's not very relevant, is it? We do use a non-breaking space before both spaced en-dashes and ellipses, for exactly the reason I gave previously: we don't want to start a line that has been wrapped with an en-dash or an ellipsis that has a preceding part.

If you think that breaking "30–60 minutes" looks as bad as breaking "30–60 min", you're entitled to your opinion. The consensus on MOS:UNITNAMES and all prior typographical convention disagrees with you, so I suggest you adjust your styling in future, despite your own personal preferences.

I apologise that when I reverted your misuse of   I inadvertently restored the incorrect "3 hr", which should have been "3 hours". I've now corrected that.

Of course I removed the non-breaking space in "29 million": it's not useful as there is nothing confusing should a line begin with the word "million". What would cause confusion is when you write something like "he sold the company for £70 million", which has currency units before the figure. If it broke after the 70, then the line would read "he sold the company for £70" with the "million" disjointed. In cases where the break would leave a fragment that would convey a different meaning, of course it's sensible to use a non-breaking space to prevent the potential confusion. But tell me what would be the purpose of a non-breaking space in the phrase "between 9 and 29 million people"? There's no altered meaning if the reader sees "between 9 and 29" at the end of one line and "million people" at the start of the next line, because the reader has to take in the whole phrase to get any meaning. I hope you can see the difference. --RexxS (talk) 18:12, 9 October 2017 (UTC)

• If you think that breaking "30–60 minutes" looks as bad as breaking "30–60 min", you're entitled to your opinion. Indeed, I am.
• Of course I removed the non-breaking space in "29 million": it's not useful as there is nothing confusing should a line begin with the word "million". – I quote MOS:NUMERAL: Other numbers are given in numerals (3.75, 544) or in forms such as 21 million. Markup: 21{{nbsp}}million
• The consensus on MOS:UNITNAMES and all prior typographical convention disagrees with you, so I suggest you adjust your styling in future, despite your own personal preferences. No, you disagree with me. Notice how the corresponding cell in the "Unacceptable" column for the row entry you cited in your edit summary is empty.

General guidelines on unit names and symbols
[Notes on highlighting: yellow → "do this"; lime green → "don't do this"]

Aspect	Guideline	Acceptable	Unacceptable
Numeric values	Do not spell out numbers before unit symbols ...	12 min	twelve min
	... but words or figures may be used with unit names.	twelve minutes 12 minutes
	Values with no accompanying unit are usually given in figures.	Set the pointer to 5.	Set the pointer to five.
	Use a nonbreaking space ({{nbsp}} or  ) between a number and a unit symbol, or use {{nowrap}} ...	29 kg (markup: 29 kg or {{nowrap|29 kg}})	29kg
	... though with certain symbols no space is used (see "Specific units" table below) ...	23° 47′ 22″	23 ° 47 ′ 22 ″
	... and a normal space is used between a number and a unit name.	29 kilograms (markup: 29 kilograms)	THIS CELL IS EMPTY
	To form a value and a unit name into a compound adjective use a hyphen or hyphens ...	a five-day holiday a five-cubic-foot box a 10-centimeter blade
	... but a non-breaking space (never hyphen) separates a value and unit symbol.	a blade 10 cm long	a 10-cm blade

Lastly, these four "examples" from MOS:NBSP are arbitrary because they're not specific instances of a generalized statement in the MOS about where non-breaking spaces are used:

• Boeing{{nbsp}}747
• 123{{nbsp}}Elm Street
• World War{{nbsp}}II
• Pope Paul{{nbsp}}VI

The point here is that the MOS does not limit the use of nonbreaking spaces between words and numbers precisely because the statement about avoiding "confusing or awkward" line breaks is entirely subjective. You don't think it looks awkward. I do. Therefore, I add  . Seppi333 (Insert 2¢) 20:49, 9 October 2017 (UTC)

The point is that common sense limits the use of non-breaking spaces to where they perform a useful function. I've already questioned the markup at MOS:NUMERAL. Expect to see some progress on that. The examples you quote from MOS:UNITNAMES simply reinforce my point: "Use a nonbreaking space ({{nbsp}} or  ) between a number and a unit symbol ... and a normal space is used between a number and a unit name." By your logic, you accept you don't use a non-breaking space between "15" and "kilograms", but you do want to use it between "15" and "volunteers" – can't you spot the inconsistency there?

I have no issue with "World War{{nbsp}}II" or with "a 10 cm knife" for the usual reason that line-breaking would create an awkward start to the next line. I do have an issue with "100 tablets" because it is redundant, messy and has no support in any convention. I note a singular lack of rationale for any of your proposals.

If you think something looks awkward and I don't, we'll end up in an edit war if we don't have a third opinion. Perhaps it's time to seek that? --RexxS (talk) 21:24, 9 October 2017 (UTC)

I do use non-breaking spaces between "15" and "kilograms" because line-breaking would create an awkward start to the next line (NB: this is my rationale; it's also yours with a different word/number pair) and the MOS does not say not to do that. "Volunteers" are also a unit for "15" in your example, so I similarly would add a non-breaking space there. Unless the MOS explicitly states not to do something that I think would improve article formatting, I generally won't avoid doing it.

This is sort of tangential, but there isn't any statement in the MOS about using a non-breaking space between a word and a roman numeral, a number and a street name, or a word and a number that form a noun, and yet those are examples of when to use non-breaking spaces in the MOS. It's also a bit ironic that the FA-rated Boeing 747 article and GA-rated World War II don't conform to the MOS in this regard; the Boeing 747 article never uses non-breaking spaces between "Boeing" and "747" and the World War II article inconsistently uses non-breaking spaces between "War" and "II".

We're not going to get into an edit war unless you revert that formatting in articles where I've already systematically/consistently applied it, since that would be like changing every DMY date in an article that consistently uses DMY to an MDY date (or American English to British English). That's not the case for this article, so I really don't care enough to revert your edits. Seppi333 (Insert 2¢) 22:56, 9 October 2017 (UTC)

MOS:UNITNAMES does in fact say not to do that. In the table, Aspect "Numeric Values": "Use a nonbreaking space between a number and a unit symbol... a normal space is used between a number and a unit name." The examples given are "kg" vs "kilograms". An abbreviation is a symbol. "Kilograms" and "volunteers" are not. Simishag (talk) 00:33, 10 October 2017 (UTC)

@Simishag: See #General guidelines on unit names and symbols, which I copied from MOS:UNITNAMES and stylistically modified to clearly indicate the table cells I'm referring to. That MOS table states, in active voice as an imperative/command, to use a non-breaking space between a number and an abbreviated unit. It then goes on to state what not to do in the rightmost row cell (i.e., omit a space altogether; the bottom row also states that a hyphen should never be used between a number and a unit abbreviation). Two rows down, that tables states in passive voice that regular spaces are used between numbers and full unit names. In the rightmost row cell, it does not indicate what not to do in this circumstance (e.g., use a non-breaking space). Moreover, there is no statement elsewhere in the MOS that a non-breaking space should not be used between a number and a full unit name. So, if the MOS is intended to prohibit the use of non-breaking spaces between numbers and full unit names, it should explicitly state this and not include 21{{nbsp}}million or £11{{nbsp}}billion as examples of when to use non-breaking spaces. Seppi333 (Insert 2¢) 06:49, 10 October 2017 (UTC)

"Million" and "billion" are not units. They are numbers or parts of a number. The proper MOS style would be e.g: 21{{nbsp}}million (normal space) kilograms. See MOS:NUMERAL. Also, I think this stuff about "active/passive voice" and the lack of "unacceptable" examples is really begging the question. Your particular example may not explicitly and exhaustively spelled out as incorrect, but RexxS and I have pointed out the contradictions between your style and the MOS. Simishag (talk) 14:59, 10 October 2017 (UTC)

@Simishag: "Million" and "billion" are units of scale. You seem to be thinking of units of measurement. Both of those scale units have standardized unit symbols, so the MOS guideline on units does apply to these. In any event, I don't see a contradiction; I just see two people telling me they don't like seeing non-breaking spaces between numbers and units, so I'm not going to do anything differently. If you have a problem with it, change the MOS. Seppi333 (Insert 2¢) 17:26, 10 October 2017 (UTC)

In MOS:NUMERAL, under "Numbers as figures or words", bullet 3: "Other numbers are given in numerals (3.75, 544) or in forms such as 21 million. Markup: 21{{nbsp}}million". There is no mention of "units of scale", and the WP:UNIT section name is specifically "Units of measurement". I'm not going to make any edits, and maybe you're right that this can be dismissed as a personal preference, but I don't know why you keep saying "change the MOS". It's spelled out clearly. Simishag (talk) 20:32, 10 October 2017 (UTC)

Trivia?

"The term flip or flipping is used to describe the combination of MDMA with another drug. Usually makes the other drug more intense and produces friendlier effects:

• MDMA + (psilocybin or magic mushroom) + Cocaine = Hippie/flower-flipping on a string
• MDMA + (psilocybin or magic mushroom) = Hippy flipping (or flower flipping)
• MDMA + (psilocybin or psilocybin mushroom) + LSD = Jedi flipping
• MDMA + (mescaline or mescaline cacti) = Love flipping
• MDMA + 2C-B = Nexus flip (or honey flip)
• MDMA + 2C-E = Sparkle flip
• MDMA + 2C-I = Science flip
• MDMA + 2C-T-7 = Lucky flip
• MDMA + DMT = Shaman flip
• MDMA + DMT = Time flipping
• MDMA + DXM = Robo flipping
• MDMA + GHB = Gamma flip
• MDMA + LSD + (psilocybin or magic mushroom) = Twilight flip
• MDMA + LSD = Candyflip
• MDMA + PCP = Elephant flipping
• MDMA + alcohol = Tipsy flip
• MDMA + any opiates = Poppy flip
• MDMA + cocaine + LSD = Candy-flipping on a string
• MDMA + cocaine = Sugar flip
• MDMA + ketamine = Kitty flipping
• MDMA + methadone = Chocolate-flipping
• MDMA + methamphetamine = Trailer flip
• MDMA + sildenafil = Sextasy (or hammerheading)"

IMO this is trivia and not encyclopedic. Others thoughts? Doc James (talk · contribs · email) 12:50, 16 October 2017 (UTC)

Neither encyclopedic nor RS. I would support removing the whole thing. If there is not enough support for that, at least remove the items that have no source at all. Rgr09 (talk) 13:40, 16 October 2017 (UTC)

Most of these are rare. It would probably be better to just note that combining MDMA with another drug is called 'flipping' and mention the ones most prominent in the literature. Sizeofint (talk) 17:48, 16 October 2017 (UTC)

Sure, would be happy with Sizeofint's suggestion. Doc James (talk · contribs · email) 08:51, 17 October 2017 (UTC)

References

Non-use in first paragraph

Doc James, could you explain why we should emphasize that MDMA is not used medically in the intro paragraph? There is nothing substantial in the preceding sentences that hints at medical applications - that information isn't provided until the fourth paragraph - so the abrupt statement that MDMA has no medical use seems out of place to me. At that point in the lead the reader has no context in which to understand the non-use statement. I think it makes more sense to state this after the reader has learned about the ongoing trials. Sizeofint (talk) 23:02, 22 September 2017 (UTC)

The lead often follows the same layout as the body of the text. We talk about non medical uses and than we mention that their are no medical uses. Flows very well IMO. Doc James (talk · contribs · email) 23:07, 22 September 2017 (UTC)

Hmm, I see. Anyone else have thoughts about this? Sizeofint (talk) 23:27, 22 September 2017 (UTC)

Some are promoting it for medical uses. Thus mentioning that these are not accepted upfront is IMO important. Plus this is similar to the layout of heroin and cocaine were we discuss both medical use and recreation use in the first paragraph. Doc James (talk · contribs · email) 23:31, 22 September 2017 (UTC)

The difference between this and cocaine or heroin is that those drugs are actually approved for medical use, at least in some countries. If MDMA is approved I have no problem including this in the first paragraph. We could also compare this article to LSD or psilocybin which also have proposed medical uses but do not include a mention of non-use in their first paragraphs. Sizeofint (talk) 23:38, 22 September 2017 (UTC)

Agree with Doc James that the the non-use statement fits well. The first sentence of the article introduces MDMA as a recreational drug. Whether it has accepted medical uses is therefore a very natural question that should be clearly answered in the lead as well. Rgr09 (talk) 00:02, 23 September 2017 (UTC)

I don't really see that by virtue of being a recreational drug the question of medical use becomes immediately paramount (if that is what you are saying). We have hundreds of articles on recreational drugs with no accepted medical uses on en:wp. This may be the only in which we have decided to place this non-use in the lead paragraph. The non-use mention is warranted - in my view - because of this particular drug's history and current research efforts, not because the medical usage status of every psychoactive drug is of utmost importance. The connection between this drug's history and its current non-use status is why I suggest this statement be placed in the last paragraph. Sizeofint (talk) 01:45, 23 September 2017 (UTC)

THC has medical uses, so does cocaine, alcohol, and heroine. So in contracts to those MDMA does not. Doc James (talk · contribs · email) 03:22, 23 September 2017 (UTC)

When we say "medical use", we're actually referring to "medical indications", which is a slightly different concept. In the context of drugs, a medical indication for a drug is a form of medical use for treating a condition that has been deemed to have sufficient treatment efficacy and an adequate safety profile, particulary in relation to any existing alternative pharmacotherapies for the condition. For example, amphetamine is a very effective nasal decongestant and it was used several decades ago for treating nasal congestion under the brand name "Benzedrine". Nowadays, amphetamine isn't indicated for nasal congestion and I doubt that any doctor would prescribe it for that condition given that there are alternatives treatments available, like pseudoephedrine, which have comparable efficacy and much fewer side effects (NB: the decongestant effect of amphetamine-type stimulants is mediated peripherally in the sinuses by noradrenaline).

Since medical indications are listed in drug labels following regulatory approval, non-indicated uses are typically called "off-label uses". MDMA has no drug label since, internationally, it's not approved by any government for medical use. At the moment, MDMA is just an experimental drug which is currently undergoing clinical trials (i.e., an experiment) for the treatment of PTSD despite also being a globally banned substance. In other experimental drug articles, we don't say that the experimental uses of the drug are actual "medical uses", so we shouldn't do this with MDMA either until it receives regulatory approval for treating a condition (e.g., PTSD) and consequently acquires its first "medical indication". Seppi333 (Insert 2¢) 01:50, 26 September 2017 (UTC)

This is true and I completely agree Seppi333. However, this is tangential to the point I am trying to make. My objection is to stating MDMA has no medical uses in the first paragraph. I am imagining a reader completely naive to to this topic. As they read they see 3,4-Methylenedioxymethamphetamine (MDMA), commonly known as ecstasy (E), is a psychoactive drug used primarily as a recreational drug. Desired effects include increased empathy, euphoria, and heightened sensations. When taken by mouth, effects begin after 30–45 minutes and last 3–6 hours. It is also sometimes snorted or smoked. So far so good. In the next sentence they read As of 2017, MDMA has no accepted medical uses. At this point the reader might think to themself, "well obviously it has no medical uses, MDMA is a recreational drug. Why would anyone think it has medical uses?" It is not until the fourth paragraph discussing current research and history that this statement can have any meaning to the naive reader. My proposal is to move the sentence there so when the reader first encounters it they can immediately understand its significance. Sizeofint (talk) 16:49, 26 September 2017 (UTC)

Oh, my bad. In that case, I agree with you. Putting medical indications in the first sentence/paragraph is only relevant to drugs that actually have one. Moreover, it's more coherent to place that statement in the fourth paragraph because it provides context. Seppi333 (Insert 2¢) 08:37, 28 September 2017 (UTC)

We always discuss medical uses before research. Please get consensus before moving. The no medical uses has been in the first paragraph for a while. Doc James (talk · contribs · email) 15:57, 28 September 2017 (UTC)

I agree. This obviously doesn't apply to compounds with no medical uses though; I mean, we don't go into the hydrochloric acid article or more obscure compound articles like castalagin and say silly things like "HCl/Castalgin has no medical uses", right? Seppi333 (Insert 2¢) 16:20, 28 September 2017 (UTC)

This is not an obscure compound. Restored the lead to follow the body of the article. Doc James (talk · contribs · email) 16:43, 28 September 2017 (UTC)

I think it's fine to put things slightly out of order if it reads better that way. The order of content coverage in the lead isn't required to follow the same order as the body. It's just supposed to summarize it. Seppi333 (Insert 2¢) 17:12, 28 September 2017 (UTC)

I think it flows better the way it was before so restored it. It had been in the prior layout for a long time. Doc James (talk · contribs · email) 17:14, 28 September 2017 (UTC)

I like how we present the lack of medical indications in Ibogaine. We place it immediately before the discussion on current research in the same paragraph. This puts the medical information first while also placing it near information that gives it context. Sizeofint (talk) 20:26, 28 September 2017 (UTC)

Break

• I came here from the note at WT:PHARM. I think that it's very appropriate to say that it has no medical use/indications, where it says that in the lead. This is a very prominent drug of abuse, and the distinction about medical uses is an important as well as informative one. (For example, in the US it's the distinguishing factor between Schedule I and Schedule II.) --Tryptofish (talk) 20:53, 4 October 2017 (UTC)
• Thank you for the message on WT:PHARM. To not mention MDMA's lack of federal approval for any medical indication in the lead would be akin to tacitly claiming that it has one. However, I would change "accepted" to "approved," and clarify the identity of the approver. It may not be clear to the reader as to what regulatory bodies are formally responsible for accepting the intended medical use of a drug. Notably, the source cited for the statement in question specifies that MDMA "is listed in Schedule I of the United Nations 1971 Convention on Psychotropic Substances," and is "under international control." As a side note, there are no references to 2017 in the cited source, which should be updated. For the USA, the DEA keeps an updated list here (last updated July 17, 2017). ―Biochemistry🙴❤ 23:19, 4 October 2017 (UTC)

Tryptofish, Biochemistry&Love, thank you for your input.

Trypotofish, I am curious about how you would apply your reasoning to other prominent recreational drugs. We do not currently do this on LSD, psilocybin, dimethyltryptamine, Phencyclidine, 3,4-Methylenedioxy-N-ethylamphetamine etc. Do you think we should? If not, what makes MDMA different such that we should include this statement in the first paragraph?

Biochemistry&Love, By "lead" do you mean the first paragraph or the lead section? No one here is opposed to making this statement in the lead section. We're discussing where this statement should be place within the lead section. Sizeofint (talk) 00:53, 5 October 2017 (UTC)

Just saw your response below. Sizeofint (talk) 00:57, 5 October 2017 (UTC)

To not mention MDMA's lack of federal approval for any medical indication in the lead would be akin to tacitly claiming that it has one. Following the same line of questioning as I ask Tryptofish, do you (Biochemistry&Love) think we should make a statement about non-medical use on the pages of other recreational drugs? Sizeofint (talk) 01:10, 5 October 2017 (UTC)

We comment on the medical uses of cocaine in the first sentence. Should we comment on it for the other ones? Yes I think that would be good. Doc James (talk · contribs · email) 01:51, 5 October 2017 (UTC)

I really don't think the cocaine comparison is valid because cocaine has approved uses. That a property is notable does not necessarily imply the lack of such as property is also notable.

So it should become general practice that for any drug the absence of medical use is so notable as to merit mention in the first paragraph? I find it concerning that we are elevating medical information to such a level of pre-eminence for drugs that are not notable for their medical use. Sizeofint (talk) 08:21, 5 October 2017 (UTC)

Yes, of course it is important to set the context in the opening paragraph of an article. For a drug that has medical uses, we should say so right there, as that is an important piece of information to set the scene for the detail that will follow later in the article. Similarly, for a drug that has no accepted medical use, we should state that equally prominently, for exactly the same reason. Notability is not the bar for inclusion of a fact in an article; it is the bar for an article on that topic to exist. WP:WEIGHT is the guideline that helps us determine how much importance we should give to a fact, and the EMCDDA source looks pretty solid to me, and especially its reference to the UN Convention on Psychotropic Substances.

It's important to differentiate between omitting a negative and omitting an unknown. If we do not know whether a drug has medical uses, then that is the time to stay silent on the issue; whereas if we have a good source telling us that a drug has no medical uses, then that needs to be stated with the same sort of weight that we use for drugs that do have medical uses, because the sourcing makes it of equal importance. --RexxS (talk) 17:38, 5 October 2017 (UTC)

Thanks for the ping. Overall, I think that it would be appropriate to provide similar information at pages of other drugs of abuse that have no recognized medical use, but I also think that there is a WP:OTHERSTUFF argument that what we decide here need not be the same as at all other pages – this is not a MOS-level issue. I also agree with RexxS that this is a case where leaving it out is omitting a negative rather than an unknown. I'm unconvinced that there is any harm in including the information. --Tryptofish (talk) 20:58, 5 October 2017 (UTC)

• I saw the note at WT:MED. I don't support saying "It has no medical uses". Outside of the tiny fraction of people who understand medical jargon, this means "it doesn't work". We don't know that; in fact, we have some suggestive evidence that it might be useful for some cases of PTSD (enough that the US FDA just approved a Phase 3 trial on that question). I would, however, support a more precise statement: "As of 2017, no governmental drug regulatory agency has approved the use of this chemical as being a safe and effective treatment for any medical condition. I'm also willing to just omit this information from the lead.
  On the OTHERSTUFFEXISTS question of whether to say this in other articles, I'll note that Alcoholic drink doesn't say that "there are no medical uses", even though that recreational drug (a) also has physiological effects that could be favorable to a small number of medical issues, and (b) also has no approved indications. The same can be said about Nicotine. WhatamIdoing (talk) 18:34, 5 October 2017 (UTC)

And I'll note that Alcoholic drink is a poorly summarised article and competes with Alcohol, Ethanol, Alcohol (drug), Alcohol and health and Alcohol (medicine), the last of which is pretty clear about the medical uses of alcohol as an antiseptic, disinfectant, and antidote. The risk/benefit is not clear-cut and we have sources such as http://alcoholresearchuk.org/downloads/finalReports/AERC_FinalReport_0015.pdf that contrast benefits and harms. It's not susceptible to a single-sentence summary. Perhaps the lead should state that.

As for nicotine, its use in Smoking cessation is not only well-documented, but stated in the lead. None of that applies to MDMA. Apples and oranges, I'm afraid. --RexxS (talk) 19:57, 5 October 2017 (UTC)

About "no medical use", I think that the underlying logic of MEDRS (that we do not want to mislead readers about health-related information) means that it's OK to imply that "it doesn't work" as a therapeutic agent, even if it does "work" as a recreational drug. But I also think that there is a sort-of WP:CRYSTAL-like case to be made that this phrase should really mean "no known medical use", and it actually might be a good idea to add the word "known". --Tryptofish (talk) 21:05, 5 October 2017 (UTC)

In this case, it sounds like it would be more accurate to change "no known medical use" to "no accepted mainstream medical use". And I still think that if we're going to include it, we should date the statement and specify that we're talking about regulatory approval rather than whether or not some psychiatrists in some places actually prescribe(d) it for medical conditions. WhatamIdoing (talk) 21:23, 5 October 2017 (UTC)

It's fine with me to say "accepted" instead of "known" (in fact, I almost suggested that myself). I tend to think that adding "mainstream" would become overkill, unless we have WP:MEDRS-compliant sources that say that some non-mainstream psychiatric uses have actually been therapeutically beneficial (and MEDRS-noncompliant sources won't be sufficient). --Tryptofish (talk) 22:40, 5 October 2017 (UTC)

Break 2

• Lots of sources recommend it as alternative medicine. I think that it is correct to say that that no government recognizes any medical benefits. It also seems appropriate to say that various special interest groups, like Emmasofia or others, do advocate for medical use. The lack of government recognition in this space is unlike a pharma company's drugs in clinical trials or like homeopathy, because there really are politically suppressed conversations. A few years ago cannabis was deadly in the United States, and then overnight by voter process it became a treatment and a legitimate channel for financial investment. Medicine is not just science, it is also finance, politics, voter opinion, and other social factors. This article should not mislead about the parts which are science but neither should it diminish the medical advocacy movement around the research. Blue Rasberry (talk) 19:10, 10 October 2017 (UTC)

I would want to be careful about wording that, because we are in the realm of medical information, and WP:MEDRS really matters in terms of not causing harm to readers. It's OK to talk about alternative medicinal uses, but they need to be clearly labeled as such, and kept separate from overall statements about medical use. If the situation changes in the future, then the page can change in the future. --Tryptofish (talk) 21:29, 10 October 2017 (UTC)

I agree, there can be no ambiguity. There is no accepted medical use. At the same time, the substance cannot be understood outside of its context as alternative medicine. The lead should concisely state both the mainstream and alternative medicine use, and leave no possibility for confusing the two. Blue Rasberry (talk) 18:11, 11 October 2017 (UTC)

As far as I am aware its use in underground therapy/alternative medicine is not very prominent. I think it is undue weight to discuss this use in the lead section. Sizeofint (talk) 19:18, 11 October 2017 (UTC)

Sizeofint This is the "exception that proves the rule". Wikipedia would not be saying that MDMA is not approved as a drug unless MDMA were one of the few chemicals among countless which people routinely try to use as medical treatment. If it is worthwhile to say "do not use as medicine", then the fact of the prohibition suggests that there must be a prominent need to say so. A simple Google search returns many contemporary and historical discussions of MDMA as therapy. The original source text, PIkhal, establishes that from the beginning of its administration in humans there have been advocates for its use as therapy. Do you feel that it is undue to say, "not approved as medicine" in the lead? Blue Rasberry (talk) 19:00, 14 October 2017 (UTC)

If it is worthwhile to say "do not use as medicine", then the fact of the prohibition suggests that there must be a prominent need to say so. And we do have such a reason: the history and research content in the fourth paragraph of the lead. Do you feel that it is undue to say, "not approved as medicine" in the lead? No, I think it should be in the lead. However, as I have expressed several times, I think it is more logically placed in the fourth paragraph. Sizeofint (talk) 19:10, 14 October 2017 (UTC)

Sizeofint Okay, if I understand correctly, you do agree that the lead should talk about its use as alternative medicine, but think that both the discussion of alternative medicine and the note that it has no government-approved use should be at the end of the lead. I agree with that. As an aside, I do not think that the current medical text in the lead is a good summary, because I think that it over-emphasis recent and United States government-based discussion, when in fact the alt med history of the drug dates from its earliest described human use and that the discussion is international. Blue Rasberry (talk) 16:12, 15 October 2017 (UTC)

You'll have to clarify what you mean by alternative medicine. If you mean its historical use in therapy, I agree that should be in the lead. If you mean its present use by a small number of underground therapists, I think this is a minor use and it should not be in the lead. Sizeofint (talk) 18:47, 15 October 2017 (UTC)

Sizeofint What is the word for the kind of use which conventional medicine discourages when it says, "no accepted medical uses"? My position is that if there is a reason to make a prohibition in the lead, then there is a reason to state what and why something is being prohibited. Blue Rasberry (talk) 20:44, 15 October 2017 (UTC)

Bluerasberry, I think the idea is just to inform the reader that while there is ongoing research on potential medical uses of MDMA and historical use by therapists in the 1970s and 1980s, this does not imply MDMA has medical use. I don't believe the small underground therapeutic use of MDMA is the intended target of this statement. By my understanding, the lead includes the information needed to make sense of the "no accepted medical use" statement (though the information is not presented in the right order IMO). Sizeofint (talk) 23:00, 15 October 2017 (UTC)

Sizeofint I might agree... but is it not correct to say that now moreso than in the past, more sources and authorities of all types are promoting MDMA as alt med? I do not think that the alt med interest has declined with time, but rather, more governments etc have approved research than ever before. It has never been more legitimized. Blue Rasberry (talk) 12:15, 16 October 2017 (UTC)

Bluerasberry If alt-med is more prominent use now then that might justify a mention in the lead. When I last looked, alt-med uses were not given much attention in the literature. Our alt-med coverage is currently a single sentence. Do you have sources in mind we could use to expand on this? Sizeofint (talk) 17:35, 16 October 2017 (UTC)

Sizeofint "Alt med" can mean all sorts of things; to me, it means every use not accepted by science, including government sponsored clinical trials, new age magic, illegal drug distribution mixed with healthcare, or whatever else. I think there is some end subjectivity on how Wikipedia interprets the many sources and there are lots of sources which could be used. I do not see a great need to summarize all proposed uses in the lead, and just saying that some people want it for mental health therapy is enough. I think that Pikhal is a fine source to cite because of its historical significance. "There is no accepted healthcare use for MDMA in conventional medicine. As alternative medicine, various communities including physicians doing clinical research, proponents of psychedelic drugs, and pseudoscience enthusiasts make claims that MDMA can treat psychological problems such as PTSD or advance mental health therapy goals." I think that various papers from Multidisciplinary Association for Psychedelic Studies, perhaps this 2013 one, are fine to establish that alt med advocacy for MDMA as treatment is established enough to merit a mention in the lead. Blue Rasberry (talk) 18:13, 16 October 2017 (UTC) 

I think mentioning that some people claim MDMA can treat psychological problems is redundant because the existence of clinical trials implies this. If we add content to the lead I would prefer it be about prominent actual uses. Sizeofint (talk) 19:05, 16 October 2017 (UTC)

Sizeofint Currently the lead describes one contemporary US-based clinical trial. To what extent do you feel that the summary of this one clinical trial is a summary of the significant thought and research on the drug which have occurred internationally over the past 70 years? To me, the trial seems like an arbitrary blip in the history. I would favor saying something general like "there is a history of research and social speculation as a therapy" rather than present a particular study without social context. Blue Rasberry (talk) 12:44, 17 October 2017 (UTC)

Bluerasberry, We do state more more generally that Researchers are investigating whether a few low doses of MDMA may assist in treating severe, treatment-resistant posttraumatic stress disorder (PTSD). I believe this gives social context to the following statements. Also, I put the relevant research efforts at about 40 years.

To me, the trial seems like an arbitrary blip in the history. It isn't an arbitrary blip in my opinion. This phase II phase III trial has been the result of years of research and bureaucratic navigation on the part of MAPS. This is (IMO) the most high profile development in MDMA research in decades. MAPS is based in the US so most of the research MDMA PTSD research is done there, resulting in an emphasis on US developments. I am not aware of similar prominent developments internationally, but if there are I am not opposed to adding them.

I don't think "there is a history of research and social speculation as a therapy" adds much to the current lead. We currently say more concretely that it was used in therapy before being banned and that researchers are now investigating use in PTSD treatment. I think this largely encompasses that statement. Sizeofint (talk) 17:33, 17 October 2017 (UTC)

@Sizeofint: I favor a short, simple, general statement over any proposed particular statement just because it is easier to make correct general statements than correct specific statements. I can agree that there are problems with the general statement but I see more problems with the proposed specific statement. Here are some challenges I see with your proposed text:

1. I am not seeing sources which give as much importance to this clinical trial as you are asserting. The trial is significant, and it got popular media attention, but for example the NYTimes article does not say that it is particularly high profile. That article also puts this trial in the context of history since the 70s. The MAPS publication I described earlier also frames this PTSD trial as one of many therapies for which they advocate.
2. We generally do not talk about clinical trials in wiki articles on drugs. If we do, we do it with caution because too many readers (including physicians and scientists) interpret the mention of a clinical trial as evidence of some treatment efficacy, when that is not something to communicate based on that kind of evidence. There is nothing to be inferred about treatment with a drug from a clinical trial. This particular trial is enrolling 10 people. I agree with you that the trial is the result of years of bureaucratic navigation, but whereas I feel like you are suggesting that the significance of this is medical or scientific, I think that the significance is social and that it is not possible to get any conclusive science information out of a 10-person short term study like this. Emphasizing this trial in the lead sets a foundation for misunderstanding of the implications.
3. This is not even the first MAPS clinical trial. If you like MAPS clinical trials, then why not the previous, larger one? Why not both? Why not Emmasofia's European studies of MDMA on single patients? I prefer to avoid highlighting individual studies in the lead and instead let that be sorted in the body. None of these trials will be a scientific breakthrough regardless of the results just because of their small size and the social context.

I like your statements "Researchers are investigating whether a few low doses of MDMA may assist in treating severe, treatment-resistant posttraumatic stress disorder (PTSD)" and "it was used in therapy before being banned and that researchers are now investigating use in PTSD treatment" but again, I think it would be useful to give a date range for this (decades) and expand on saying that the research is part of a broader, advocacy movement. Typical medical research comes without the context of an alt med advocacy movement and to suggest that the research is typical pharma research without a social context over-emphasizes the rather low-impact science and under-emphasizes the highly unusual, highly vocal non-science, well documented non-medicine involvement in this research. MDMA as therapy has gotten an extraordinary amount of press attention for years as compared to conventional medicine and clinical trial data is not the key to understanding the situation. Blue Rasberry (talk) 17:38, 19 October 2017 (UTC)

We generally do not talk about clinical trials in wiki articles on drugs. This has not been my experience. In articles I have seen we talk about relevant clinical trials in the research section. The existence of a clinical trial can be notable information, particularly those in phase III (though obviously statements of efficacy are subject to MEDRS).

why not the previous, larger one... This one is a phase III clinical trial, the existence of which is IMO more notable than the prior phase II study or the individual European studies. Also this one involves 200 to 300 people.[1] My understanding is this is larger than prior studies. I think my typo above may have mislead you about the scale of this trial. If this were a small scale trial I would agree it certainly should not be mentioned.

None of these trials will be a scientific breakthrough regardless of the results just because of their small size and the social context. The news reports suggest this is a final step before FDA consideration for approval.[2][3]

whereas I feel like you are suggesting that the significance of this is medical or scientific I am not. It is simply the most notable event in the research area thus far. Sizeofint (talk) 18:04, 19 October 2017 (UTC)

Sizeofint Okay, I have looked at this a few times. I understated what the sources say about the importance of this trial, so I was incorrect and you were right on that point. You convinced me about that. I am not entirely convinced about listing only this trial because I thought that there were more discussions about other research, but I cannot find anything, so the evidence points to you being right on that point also. I am also totally convinced about norms in describing clinical trials in the lead. For most trials, it is a definite no because there is no media attention, but again, you provide evidence about the media attention to this trial, so you are correct on all that. I am persuaded on all points you raised based on the evidence I have, and after having sought more sources and evidence. Thanks for talking this through. Blue Rasberry (talk) 18:14, 3 November 2017 (UTC)