Volume CXXXIII, Number 9 November 9, 2001 f

Ecstasy: How dangerous is it?
JEFF BENSON, M.D.
STAFF WRITER

Dear Dr. Jeff: A friend of mine has tried Ecstasy, and really liked it. I've also heard that it can be dangerous. Where can I find reliable information about it? L.C.

Dear L.C.: MDMA ("Ecstasy", "X", or "Lover's Speed") is perhaps the most popular of the "club drugs," often taken at the all-night dance parties known as "raves." Others include GHB ("Grievous Bodily Harm", "G", or "Liquid Ecstasy"), Rohypnol ("Roofies", "Roche", or "Forget-me Pill"), ketamine ("Special K", or "Cat Valiums") and methamphetamine ("Speed", "Meth", or "Crank").

Much has been written about club drugs. A substantial body of research is accessible on-line. Take a look at the websites listed under "Alcohol and Drugs" in the "Health Issues" section of the Health Center web pages.
I'd like to focus on two issues.

First, with club drugs, you never know exactly what, or how much, you are taking. Ecstasy, for instance, comes in an amazing array of colors, shapes and imprinted styles. None comes in a designated dosage. None has been manufactured legally, with quality control measures in place to regulate purity and concentration. Street Ecstasy has been found to contain anywhere from 0.1 to 200 mg. of MDMA per pill. While there may be risks associated with moderate dose MDMA, higher dose MDMA is unquestionably dangerous and lethal in overdose.

How can you know how much MDMA there is in the Ecstasy you're buying? You can't.

Test kits can tell you whether or not there's MDMA in the "Ecstasy" you buy. They can't tell you how much MDMA there is, or which other ingredients may be present, or in what quantity. An organization called "Dance Safe" offers both this kind of onsite testing at raves, and more complete analysis of pills in their laboratories. Results are posted on the Web. This past September and October, for instance, people sent 54 samples of "Ecstasy" to Dance Safe for laboratory analysis. Only 30 pills actually contained MDMA. Six had caffeine and Sudafed, while two contained no drugs at all. All of the rest, however, nearly 30 percent of the samples, contained ketamine, methamphetamine, or metabolites of GHB. The dangers of all of these agents are increased very significantly when they are combined.

You may buy only from friends, but how do your friends know? You just can't be sure, so you just can't be safe.

Second, several club drugs are being used as "date rape drugs." Rohypnol, a tasteless, odorless, Valium-like sedative, dissolves quickly in carbonated beverages. Legally manufactured Rohypnol turns pale liquids blue. Within 5 - 20 minutes, Rohypnol causes somnolence, confusion, and amnesia. These effects last 4 - 6 hours. Traces of the drug remain detectable in urine for 72 hours.

GHB comes as a clear liquid (odorless but somewhat salty), or a white powder or tablet. At "lower" doses, GHB causes euphoria, exaggerated self-confidence and disinhibition. At "higher" doses, it causes drowsiness, prostration, and amnesia. For a given individual, however, dose-related effects cannot be reliably predicted, especially if GHB is taken with alcohol. Overdose can result rapidly in loss of consciousness, loss of reflexes, impaired breathing and ultimately cardiac arrest. GHB's intoxicating effects begin 10 - 20 minutes after ingestion, and typically last up to 4 hours. Traces remain detectable in urine for 12 hours.

Ketamine is an anesthetic used legally for humans and animals. At lower doses, it causes a PCP ("Angel Dust")-like dissociative state, inattention, and impaired judgment. At higher doses, it causes vivid hallucinations, disorientation, inability to communicate and to move, loss of consciousness, and amnesia. The effects of ketamine begin quickly and can last up to 12 hours.

It is important to be informed about these substances. We all need to do our part to protect ourselves and our friends against "date rape" predators.
A few preventive suggestions: Don't go alone to a party. Don't accept a drink you haven't seen poured, don't share or exchange drinks, and don't leave your drink unattended. If you're feeling very intoxicated after only one or two drinks, get help, and watch out for each other.

Jeff Benson, M.D.
Dudley Coe Health Center