Source: The Times
Date: 19 December 2006

The Ecstasy and the agony

Anjana Ahuja

As the first wave of Ecstasy users reach their forties,
research suggests that the drug can cause long-term brain damage

This Christmas and New Year, thousands will celebrate with a disco biscuit, a shamrock, a sweetie, a tulip or a love drug — in other words, an Ecstasy tablet. A surprisingly large number will be respectable members of the community in their late thirties and early forties — doctors, teachers, bankers, lawyers — keen to recapture the euphoria of the Eighties, when they danced until dawn with strangers in fields.

But, two decades after Ecstasy energised the social lives of the rave generation, its biological legacy remains unclear. Long-term use has been linked to reports of brain damage, depression and memory loss.

None, however, have been wholly conclusive. As a result, views remain polarised. Supporters claim that Ecstasy, a Class A drug, has been unfairly demonised as part of the Government’s war on drugs, and point out that alcohol causes more proven harm. They argue that it may be better to accept that people take drugs and provide data that allows them to make an informed choice. Anti-drugs campaigners, on the other hand, insist that illicit drugs can never be considered safe and that brain damage to users remains a sinister possibility.

Somewhere in the middle of the rumpus sits the science. Ecstasy, or 3,4 methylenedioxymethamphetamine (MDMA), floods the brain with serotonin, a feel-good chemical. Serotonin helps to regulate memory, sleep, libido, appetite and temperature. The main focus of research has been, what happens after the serotonin rush? Does the serotonin system shut down temporarily to recover; does it ever recover fully? Does repeated ingestion wreck this balance? If there is long-term damage, is it related to mood or cognitive ability? And can it be reversed?

Some of the earliest research, according to a forthcoming Radio 4 programme that talks to the E-generation, was conducted by Valerie Curran, of University College London. She set up a makeshift lab at a London club, and compared ravers on MDMA to party-goers on alcohol. Professor Curran found that, while the drinkers suffered hangovers, the drug-takers suffered a deep mid-week low. A similar, delayed bout of the blues was found in other studies, too, and the midweek low acquired the grim nickname Suicide Tuesday.

What was needed, however, was a detailed look inside the brain. And this led to a major drawback — animals are much easier to study than humans. Many studies found that in animals, MDMA was neurotoxic (it killed brain cells). But critics suggested that results could not be extrapolated to human beings. “In most animals,” Professor Curran says, “Ecstasy is toxic when it is injected in very high doses. In human research, the evidence for neurotoxicity is scant.”

Not only that, but researchers also reported the deaths of animals. If the toxicity applied to people, clubbers should have been dropping like flies, which was patently not the case. During the mid-Eighties, when an estimated one to two million people were taking at least one E a week, there were around 20 related deaths a year. Most were attributed to overheating, hypothermia (through drinking too much water which lowers body temperature) or by adverse reactions between E and other drugs. Ecstasy interferes with pain regulation, and some clubbers carried on raving when, in normal circumstances, they would have stopped. Nonetheless, the deaths of young, middle-class adults, such as Leah Betts, struck a chord with the media, which seized on stories showing Ecstasy’s supposed lethality.

One widely publicised paper claimed in 2002 that recreational doses could kill monkeys and cause diseases similar to Parkinson’s. It was later discovered that the monkeys had been given methamphetamine, not MDMA (the lab vials were mislabelled). The paper was subsequently withdrawn.

Ecstasy is not addictive in the crude way that heroin or cocaine is, but many users would find it hard to party without it. The biggest recorded user is thought to have consumed 40,000 pills over nine years. Earlier this year, doctors who examined Mr A reported in the journal Psychosomatics that his memory loss was so severe that he couldn’t remember what was in his supermarket trolley and had trouble working out the time of day. Extrapolating from this, however, is fraught with pitfalls, not least because Mr A had also taken cannabis, LSD, heroin, amphetamines, solvents and cocaine. Nonetheless, the psychiatrist studying Mr A said that “it might be an indication that daily use of Ecstasy over a long period can lead to irreversible memory problems and other cognitive defects”.

An inkling of this is found in the work of Dr Michael Morgan, a psychologist at the University of Sussex, who has found that two years after giving up Ecstasy, some users still show memory loss similar to early-stage dementia. Longer-term studies are needed, he says, but “if people who quit ten years ago are not OK, then this could have major implications for society”.

Exaggerated scares have served only to cloud the debate. “It’s media misinformation and it’s been very much influenced by the whole political approach of saying no to drugs, which doesn’t work,” Professor Curran says. “Drug use is almost normative nowadays in the 18-30 age group. Most will take the drugs for a while and come through at the end and have no problems. They are a completely different population to drug addicts.”

Instead of taking a moral view on Ecstasy, Professor Curran says: “We should accept that people are going to take drugs and say: ‘Here is the science. Here is the risk-benefit profile. It’s your informed choice.’ Instead, we’re in this crazy world where everything is pushed underground and drugs are put in the hands of criminals. I’m not saying we should legalise Ecstasy — that’s a big step — but in Holland, where there are coffee shops, there haven’t been any major disasters through making cannabis available.”

Work by Professor Curran shows that volunteers given Ecstasy perform about 10-15 per cent worse on memory tasks than those given a placebo, but the impairment vanishes after six hours. “If you look at people who have given up for a year, there’s very little evidence of damage that persists.” She adds that studies trying to link cognitive damage to Ecstasy face a substantial hurdle: because users also tend to use other drugs, researchers have to be sure that any cognitive deficits are not due to those other drugs.

Professor Curran says: “Ninety-nine per cent of people who use Ecstasy use other drugs. If you want to study memory loss due to Ecstasy, you have to find a control group that takes all those other drugs, such as cannabis, but not Ecstasy. It’s difficult — we had to go to South Africa. Hardly anyone in the UK who has taken Ecstasy has not used other drugs, and that makes other studies problematic.” Because of these attempts at finding controls, Professor Curran is pretty comfortable that her results — that there is little proof of long-term damage through recreational Ecstasy use — are reliable.

Interestingly, Dr Morgan thinks that the ambiguous findings on the drug’s long-term effects may be due to a simple study flaw — not separating out men and women. He says that early indications suggest that women may be more susceptible to psychosis after the long-term use of psychostimulants such as Ecstasy; in contrast, men may be more susceptible than women to psychosis after prolonged cannabis use.

Nonetheless, many scientists are frustrated that, as the rave generation heads into middle age, the scientific picture on prolonged Ecstasy use remains unclear. Professor John Henry, Professor of Accident and Emergency Medicine at Imperial College London and a renowned toxicologist, says: “I wanted to start research on the effects of Ecstasy years ago and they told me, ‘don’t be an idiot’. I really think that if we had studied schoolchildren and found out who used E and then followed them up to see what happens, we’d have the answers by now.

“I think the consequences are that you have got 1-1.5 million people who’ve been using Ecstasy who have lost one or two or three IQ points, whose memories are not as good as they were, who are not employable in the same jobs. This is serious stuff. This is big. A million people with less cutting edge is an enormous belly-blow to the country.”

E-Generation at 40 is on Radio 4 on January 3, 9pm

Ecstasy: the facts

  • People often use MDMA to mean the pure drug, whereas Ecstasy tablets are usually cut with another powder, such as caffeine or ketamine.

  • MDMA was discovered by two German chemists in 1912 and patented in 1914 by the pharmaceutical company Merck (this patent has now lapsed).

  • During the 1950s, the American military experimented with it and therapists used it in couples counselling to encourage empathy. [?]

  • It was banned in the US in 1985 after some tests on rats indicated that it might damage the brain.

  • In the UK it was made illegal in 1977 and labelled a Class A drug.

  • The maximum penalty for possession is seven years’ imprisonment plus a fine; for supplying, it is life imprisonment plus a fine.

  • Short term physical effects can include dilated pupils, tightened jaw, brief nausea, sweating, and dry mouth and throat. Blood pressure and heart rate increase and loss of appetite is common.

  • 200 people have died from MDMA-related deaths in the last 15 years — these are not a result of the drug’s toxicity, but of respiratory failure due to heatstroke, too much fluid or heart failure.


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