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Volume CXXXII, Number 19 |
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Could be either ecstasy or agony
JEFF BENSON, M. D.
Dear Dr. Jeff: I keep hearing contradictory things about the safety of Ecstasy. What're your thoughts? L.C.
Dear L.C.: Ecstasy ("MDMA," "3,4-Methylenedioxymethamphetamine," "X," "E," "Adam," "XTC,"or "Lover's Speed") is still the most popular of the "club drugs". It is a synthetic, psychoactive drug with both stimulant and hallucinogenic properties, and belongs to a family of substances known as "entactogens," which means "touching within." Users describe a relaxed, euphoric state, with heightened feelings of empathy, pleasure, self-understanding and self-acceptance.
MDMA was discovered in 1914 by the German pharmaceutical company Merck, as a synthetic byproduct of the styptic hydrastinin. Merck patented the new chemical, but found no use for it. In the early 1950s, the U.S. Army rediscovered MDMA, and used it in "animal experimentations." In the 1970s, a group of psychiatrists in California experimented with MDMA, and published studies on its effects and therapeutic utility. Psychotherapeutic use of MDMA spread, and as its euphorogenic qualities became more widely known, purely recreational use of the drug spread as well.
By the early 1980s, you could freely buy MDMA in bars across Texas, California and the Pacific Northwest. In 1985, prodded on by Texas Senator Lloyd Bentsen, but before formal hearings had been completed, and certainly before any compelling scientific data had been considered, the F.D.A. outlawed MDMA.
Currently, studies are underway in Europe and Israel to assess MDMA's therapeutic efficacy in Post Traumatic Stress Disorder. In this country, MDMA remains extremely popular, especially among all-night dancers at "raves."
MDMA acts on the brain by stimulating the release of large amounts of the neurotransmitter serotonin. Serotonin is thought to play a direct role in regulating mood, aggression, sexual activity, sleep and sensitivity to pain. The most commonly prescribed class of anti-depressants, for instance, like Prozac, Zoloft, or Celexa, are thought to work by boosting serotonin levels.
The National Institutes of Health/National Institute on Drug Abuse state unequivocally that MDMA is neurotoxic. Animal studies link MDMA to long-term damage of those parts of the brain which play a critical role in thought and memory. In one study, in primates, continuous exposure for four days caused brain damage that was measurable six to seven years later. Human brain imaging research, using PET and SPECT Scans, have demonstrated injury to serotonergic neurons from high-dose MDMA.
Critics argue that no studies in humans have been undertaken to evaluate the short- and long-term impact of small or infrequent doses of MDMA, especially in otherwise healthy subjects with no other substance use or abuse problems.
Everyone agrees, however, on a number of key issues. At higher doses, MDMA can cause hyperthermia, a sharp increase in basal body temperature. If this temperature spike is very high, it can result in muscle breakdown, clotting problems, and all too quickly, kidney and heart failure. Obviously, prolonged, energetic dancing increases one's chances of overheating.
Ironically, drinking too many fluids on MDMA can also get you into trouble. MDMA increases Anti-Diuretic Hormone levels, and so causes you to retain fluid. In combination with substantial water intake, your electrolytes, especially sodium, can quickly become overly diluted, resulting in brain swelling and seizures.
The whole issue of dosing with Ecstasy is highly problematic. In the 70s and 80s, psychiatrists prescribed 125 mg. of MDMA to their patients. Street Ecstasy 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 mg. to 400 mg. of MDMA per pill. And remember, whatever the risks associated with moderate dose MDMA, higher dose MDMA is unquestionably dangerous, and overdose can be lethal.
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 is some MDMA in the Ecstasy you've bought. They can't tell you how much MDMA there is, or which other ingredients may also be present, and in what quantity.
An organization called "Ecstasydata.org" posts results of onsite testing at raves as well as more complete laboratory analyses. This past January and February, there were 42 different samples of Street Ecstasy tested. Only 15 pills actually contained MDMA: five at the "accepted psychotherapeutic" dose, one very low dose, and nine high-very high dose-anywhere from 215 mg. to 354 mg./pill. Eight samples contained methamphetamine ("Speed" or "Crank"); five some combination of the cold preparations Benadryl, dextromethorphan, guaifenesin and Sudafed; nine had caffeine, one contained Valium, one was pure ketamine (the cat anesthetic and date-rape drug), and two had no active ingredients whatsoever.
You may buy Ecstasy only from friends, but how do your friends know what they've bought? The bottom line: they can't be sure, you can't be sure, so I'm not sure you can be safe.
Jeff Benson, M.D.
Dudley Coe Health Center
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