Dear Dr. Jeff: I've heard contradictory things about the safety of Ecstasy. What's your opinion? G.P.
Dear G.P.: Ecstasy ("MDMA," "3,4-Methylenedioxymethamphetamine," "X," "E," "Adam," "XTC,"or "Lover's Speed") is still the most popular of the "club drugs," and a small number of students here continue to try it at least once. MDMA has both stimulant and hallucinogenic effects. 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 an unrelated drug they were developing. Merck patented the new chemical, even though they found no use for it. In the 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, recreational use of the drug spread as well.
By the early 1980s, one could freely buy MDMA in bars across Texas, California, and the Pacific Northwest. In 1985, under the prodding of Texas Senator Lloyd Bentsen, the FDA opened hearings about the drug. Before the hearings were completed, however, and in fact before any compelling scientific data had even been considered, the FDA jumped ahead and banned MDMA.
Currently, studies are underway in Europe and Israel to assess MDMA's therapeutic efficacy in Post Traumatic Stress Disorder. In this country, although MDMA remains fairly popular, especially among all-night dancers at "raves," it is illegal.
The National Institute of Health and the 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 that 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, has 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 while on MDMA can also get you into trouble. MDMA increases Anti-Diuretic Hormone levels, which 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 street 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, imprinted styles, and doses.
None, however, 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. That's a big problem.
Whatever the risks associated with moderate doses of MDMA, a higher dose of 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 at least some MDMA in the Ecstasy you've bought. They won't tell you how much MDMA there is, or what other ingredients may also be present, and in what quantities.
An organization called "Ecstasydata.org" posts results of onsite testing at raves as well as more complete laboratory analyses.
This past January through March, there were 41 different samples of street Ecstasy tested. Only 12 pills actually contained pure MDMA: none at or below the "accepted psychotherapeutic" dose of 125 mg, six at double that dose, and one at nearly four times that dose. Sixteen pills contained MDMA plus some other active ingredient, like caffeine, Sudafed, or methamphetamine. Thirteen"E" tablets contained no MDMA at all (11 of those contained some combination of cold medications or caffeine). Two pills simply had no active ingredients whatsoever.
You can 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