Pelican
UWA Student Newspaper

The Ecstacy Debate Part 1: the Effects

1. Introduction
2. Long-term Effects
3. Flawed Studies
4. Further Effects
5. Conclusions

Introduction

Many studies have pointed to potentially damaging and dangerous effects on users. In the short term this includes an increase in blood pressure, pulse rate and body temperature, and may involve overheating, dehydration, vomiting, tremors, jaw-clenching, and eye movements. Overheating is exacerbated by the environments in which many use ecstasy namely hot, overcrowded situations where water is irresponsibly expensive. In extreme and rare cases deaths have resulted from ecstasy, often due to heat stroke, organ failure, exhaustion, or deadly adulterants in tablets sold as ecstasy. It is also possible to have a bad reaction, as with any other powerful drug.

The negative short term effects pass quickly, and can be reduced or eliminated through fluid replenishment and using ecstasy sensibly and safely. For example, given that ecstasy places the human body under enormous strain, it would be foolhardy for a person with a chronic heart condition to take ecstasy. Despite this, ecstasy remains remarkably safe, a recent European study finding that your chance of dying is 1 in 3.4 million, compared with a risk of 1 in 84,500 when skydiving.

Long-term Effects

Of greater concern is the question of long term negative effects. Since the drug is illegal it is hard to establish how ecstasy affects the brain. Investigation is frustrated by a general lack of understanding of exactly how a normal human brain works, leaving some the world's best neuroscientists unsure and thus engaged in debate concerning the existence or otherwise of damaging effects.

There is shaky consensus on ecstasy's neurotoxicity, in that it damages and reduces presynaptic serotonin (5-HT) neurons in human brain tissue (Gouzoulis-Mayfrank, 2000). In acting on serotonin in this way it also causes euphoria. Studies divide into those which consider neuroanatomical changes in the brain and others that focus on memory and cognition, which posit that ecstasy users are poorer than nonusers at various psychological tests. A link is then assumed between the apparent physical differences in the way users' brains work and their poorer test results.

The most significant studies into physical effects on the brain include McCann's 1998 Lancet article using PET scans and Hatzidimitriou's 1999 article looking at effects on monkeys' brains. McCann's study valiantly claims to "show direct evidence of a decrease in a structural component of brain [... serotonin] neurons in MDMA users," and concludes that "people who use MDMA as a recreational drug are unwittingly putting themselves at risk of developing brain neural injury." Hatzidimitriou, in looking at monkeys, argues that "MDMA-induced [serotonin] neural injury in nonhuman primates lasts for at least seven years and may well be permanent." This is concerning as the role of serotonin is not yet fully understood. It is thought that serotonergic systems are involved in numerous brain functions, including the regulation of mood and drive, cognition, memory, speed of information processing, sleep cycles, vegetative function and pain. Of the numerous cognition and memory studies, the most recent by Gouzoulis-Mayfrank (published in June 2000) concluded that "ecstasy use over a period of months or a few years may cause long term impairment of cognitive performance even when ecstasy is taken in typical recreational and not necessarily very high doses."

Flawed Studies

It is worrying that the effects of ecstasy are so subtle only a battery of specifically targeted psychological tests can detect them. Users may think ecstasy is not affecting them and continue using, thus causing cumulative damage (McCann, 1999). Its long term effects, in conjunction with the ageing process, could lead to depression, anxiety and cognitive dysfunction, as serotonin neurons have been implicated in some psychiatric illnesses (McCann, 1998). Other studies have argued that long term effects may include attention deficits, nervousness, irritability, demotivation, inactivation and ecstasy craving. Particularly worrying is an observation by Dafters in his 1999 study of brainwave patterns that "the pattern of MDMA related increased desynchronisation of the EEG activity we find here [in users] mimics the effects of ageing in normal populations." Recent media reports are largely based on the foregoing studies.

Both types of study are deeply flawed. Most use excessively small sample sizes (eg 15-30 users), and extrapolate to the general population. All human studies are retrospective rendering them unable to prove links between individuals' past ecstasy use and the mental impairment at issue. The studies use unreliable data because they rely on subjects' honesty and guesses as to their past ecstasy consumption, their promises of abstinence in the lead-up to the tests, and often provide a financial incentive for their participation.

The studies frequently fail to control for multiple drug use in their subjects, perhaps one of the most frequent criticisms of the important Lancet study (Reed, Klugman, Jansen, 1999). Ecstasy users are likely to be users of other drugs, especially other psychoactive substances such as marijuana, LSD, psilocybin, amphetamines and cocaine. None of the studies can control for the effects of these drugs. These other substances may have caused the alleged impairment in users. Meaningful statistical analysis is further frustrated by the fact that users often take ecstasy in conjunction with these other drugs, with their combined interactive effects not being fully understood, or even considered.

Researchers cannot match dosages across subjects because tablets sold as ecstasy will have varying amounts of ecstasy in them, nor can they rule out mental injury from other harmful chemicals frequently found in tablets: "what investigators have shown is a difference in serotonin activity between a group of individuals who thought they had taken MDMA in the past, compared with a group of people who said they had never taken MDMA before"(Jansen, 1999).

A further problem is that institutional and government funded studies usually set out to prove that ecstasy is bad for you and then to no-one's surprise publish their findings confirming this. Nor can the studies eliminate from their data the mental effects of the typically unhealthy lifestyles of users. Users of ecstasy are more likely to have suffered sleep deprivation over long periods which has also been linked with poor psychological performance. They may also have poorer diets, and have lower levels of education. They may not use or exercise cognitive and memory skills as much as better educated individuals, so it is unsurprising that psychological test results are poorer than those of controls. Lower levels of education in user groups was acknowledged in the Gouzoulis-Mayfrank study.

Then there is the issue of whether neurological dysfunction is the cause or effect of ecstasy use (Gamma, 2000), as individuals with pre-existing psychological deficiencies may use ecstasy at greater rates than others. Most of the studies' subjects have had over 100 tablets in recent years, a large dose well beyond that to which many moderate users would be exposed. The environment in which ecstasy is used can also contribute to its neurotoxicity, as heat and dehydration "have been shown to affect the neurotoxic effects of MDMA in laboratory animals" (Holland, 1999).

Adequate longitudinal studies into the effects of ecstasy have not been undertaken, so the extent to which the human brain regenerates serotonin and recovers has not been determined. Hatzidimitriou demonstrated that some degree of serotonin recovery occurs: "seven years after treatment, abnormal brain [serotonin] innervation patterns were still evident in MDMA-treated monkeys, although [serotonin] deficits in some regions were less severe than those observed at 18 months." Provided that these results for monkeys can be extrapolated to humans Hatzidimitriou's study appears to show that the brain recovers in some areas, but not in others. This recovery is abnormal in nature, and it is unclear how this abnormality affects mental functioning. Even the enthusiastic and excitable anti-ecstasy campaigner McCann concedes that "MDMA-induced changes may be reversible" (1998).

A further problem is the time between a user's last intake and the tests administered in the studies. If one accepts Hatzidimitriou's finding that abnormality in serotonin systems lasts for some time after use, then one can expect that users will continue to suffer negative effects of ecstasy but that these will diminish with time. Some of the studies, including the Gouzoulis-Mayfrank study, leave as little as seven days between the last intake of ecstasy and complex psychological tests, rendering poorer performance amongst users unexceptional. Most of the foregoing studies are honest in their acknowledgement of their limitations. McCann concludesz that "it is not possible to definitively establish a cause-and-effect relationship between cognitive decline and MDMA use" (1999), though not for want of trying.

Further Effects

Ecstasy's short term positive effects on an individual are remarkable and hard to describe, as they vary from person to person. Generally, rushing waves of exquisite, delectable euphoria, exhilaration, empathy, and wellbeing do not even begin to convey the strength and power of the experience. In his detailed book Phenethylamines I Have Known And Loved (1991) Shulgin compared the effects of 179 different psychoactive chemicals he'd synthesised, and wrote of ecstasy's uniquely transcendent effects:

I feel absolutely clean inside, and there is nothing but pure euphoria. I have never felt so great, or believed this to be possible. The cleanliness, clarity, and marvellous feeling of solid inner strength continued throughout the rest of the day, and evening, and through the next day. I am overcome by the profundity of the experience, and how much more powerful it was than previous experiences All the next day I felt like 'a citizen of the universe' rather than a citizen of the planet, completely disconnecting time and flowing easily from one activity to the next The woodpile is so beautiful, about all the joy and beauty that I can stand. I am afraid to turn around and face the mountains, for fear they will overpower me. But I did look, and I am astounded. Everyone must experience a profound state like this. I feel totally peaceful. I have lived all my life to get here, and I feel I have come home. I am complete.

Effects are dose related, and in milder doses they include calmness, wellbeing, concentration, emotional bonding and a feeling of satiety and completeness (Holland, 2000). At higher doses varying levels of euphoria are experienced, and the sense of wellbeing transforms into a feeling of enhanced self-esteem. Ecstasy is variously classed as an entactogen, empathogen, and euphorogen, its psychological effects including a sense of acceptance and love for others, and most importantly empathy, defined as the power of identifying oneself mentally with (and so fully comprehending) a person or object of contemplation. All manner of physical experiences are amplified and heightened whilst under ecstasy's influence, especially tactile sensations. Everything becomes fascinating, users' thoughts turn to the profound, and their memories remain intact for the duration of the experience.

Other effects can include decreased anxiety and defensiveness, truthfulness, the dissolution of fear, and a sense of centredness and focus. The experience lasts three to five hours, with sensations trailing off in a gentle comedown. Users often feel like sleeping afterwards. The post comedown phase can involve deep, intense relaxation, with positive emotions persisting for some time after the experience. For these reasons ecstasy was popularly used in psychotherapy before it was outlawed and promising research was conducted into ecstasy's potential as an interrupter of depression, suicidality, hopelessness, isolation, anxiety disorders and phobias (Holland, 2000). For therapy ecstasy's bonding effects were particularly useful, with subjects opening up and revealing their feelings to each other.

The extent to which ecstasy may positively alter a user's long term perception and psychology is also contentious. Many of the empathic and subtle effects users experience arguably persist for years afterwards, perhaps reflecting medium term neuroanatomical changes. Ecstasy's potential for allowing inner psychological and possibly spiritual discovery often remain for the rest of the individual's life.

Subjective experiences include descriptions of ecstasy as being a nurturing and maternal drug, bringing individuals closer to a sense of ongoing contentedness and wholeness even years after they have ceased using it (Sweet, 2000). Peripheral effects include a distinct lack of violence and aggression at dance parties and raves, and a far healthier, more accepting and enjoyable atmosphere where ecstasy is the drug of choice, especially in comparison to the obligatory drunken fights and machismatic mindlessness to be found where alcohol is involved. Ecstasy is also non-addictive, as users build up a tolerance to it very quickly and must undergo periods of abstinence to re-experience its effects, although some contend that it may be psychologically addictive.

Conclusions

There are competing factors in deciding whether or not to try ecstasy, and as yet there is no simple answer to the question, 'is it bad for you?' Individuals must weigh up all of the aforementioned considerations in order to decide. Given its potency its use must be kept to a minimum and plenty of time must be left between sessions. What can be deduced from the studies is that frequent use, high doses and exacerbating circumstances are all going to cause some sort of harm. More physically and psychologically dangerous than the effects of ecstasy are the dangers of taking an adulterated tablet. Death is a dismissible risk if it is used safely, and no study has proved a conclusive causal link between ecstasy and any mental impairment in humans whatsoever. The studies generally echo the desperate need for more research into ecstasy, especially given its increasingly widespread use. As has been demonstrated, experiencing ecstasy at least once is an intensely valuable learning and personal growth experience beyond description or compare, and to this extent the potential benefits of ecstasy arguably well outweigh any risks which may be involved.

[Details of references can be provided on request, but for the studies cited and others see http://www.erowid.org/chemicals/mdma/references/mdma_research_summaries.shtml , and for general information see http://www.erowid.org/chemicals/mdma/mdma.shtml ]

1. Introduction
2. Long-term Effects
3. Flawed Studies
4. Further Effects
5. Conclusions

Credits for this Edition

Editors: Gawain Davies and Henry Skerritt Arts Editor: Gabrielle Holly Film Editor: Simone Mossenson Music Editor: Fancy Dave Bower Eardrum Bleeder Editor: Marty Blum Sub-Editors: Alistair Duncan, James Devenish, and Nick Tapper Cover Art: Christopher Mann, Phd Student, Australian Neuromuscular Research Institute, QEII Medical Centre. Design: Paul Killbot, Emma Wynne, Fancy Dave Bower, Gabrielle Holly, Simone Mossensom, Marty Blum, Gawain Davies, Cliodhna Quigley and Henry Skerritt Artwork: Edward J. Grug III, Chris Stokes,Annemarie Blades,James Anstey,Tom Cleave and Victor Wycocomo Photography: Christopher Mann, Davros, Ben Larson, Gawain Davies, and Gabrielle Holly Contributors: Tim Huggins, Edward J. Grug III, Ryan Batchelor, Ivor King, Grug, Matt Langfield, Jeremy Jones, Matt Geary, Grug, Christopher Mann, Nicola McDougall, Grug, Elena Jefferies, Paul Killbot, Grug, Cliodnha Quigley, Nick van Allen, Grug, James Devenish, Giovanni Torre, Davros, James Hos, Grug, Robert Forrest, Michael Winlow, Alison Jensen, Justin and Damon Wolfe, Christine Goh, Grug, Saraa , Imogen Saunders, Kael Driscoll and anyone that we may have forgotten or spelt incorrectly.