Ecstasy

In recent years, Ecstasy -- also known as "E," "X," "Adam," and "lover's speed" -- has sped to prominence, both in clubs and in medical journals. Known chemically as MDMA (short for methylenedioxymethamphetamine), Ecstasy is a psychoactive drug similar to both the stimulant amphetamine and the hallucinogen mescaline. It's also a chemical cousin of the drug MDA (methylenedioxyamphetamine).

The use of ecstasy became widespread at "raves" (all-night dance parties) in the 1990s. And according to Listverse.com, it remains the fourth most popular illegal recreational drug in the world. Ecstasy's speedy quality keeps users awake, and its apparent ability to make users feel close to other people -- emotionally and physically -- make it a favorite with dancing club-goers. The drug has become increasingly popular among youth. In a 2007 survey, 6.5 percent of high school seniors and 2.3 percent of 8th graders reported having tried ecstasy. Its relative youth as a popular drug, the dramatic increase in emergency room cases (up from 68 in 1993 to 16,749 in 2006, according to the Drug Abuse Warning Network), and its potentially dangerous effects on the brain have sparked studies and debates among medical experts.

What are the effects of Ecstasy?

MDMA is sold illegally as tablets or capsules and taken orally. Within 20 to 40 minutes after taking MDMA, the user begins to feel invigorated and euphoric (some people feel nauseated as well). Feelings of love and empathy are common, making it a very social, communal drug. The effects last about 3 to 6 hours.

What are the risks with taking Ecstasy?

  • Adulterated Ecstasy. Sometimes Ecstasy pills contain a variety of ingredients other than pure MDMA, including dextromethorphan (DXM is a common ingredient in over-the-counter cough syrup), heroin, LSD, amphetamines, and other stimulants. Reactions to tainted Ecstasy can include trouble breathing, paranoia, confusion, and even death. Ecstasy laced with DXM is particularly dangerous because it stymies sweating, increasing the likelihood of heat stroke. DXM, like MDMA, also elevates body temperature.

Quality control is such a large issue that an Albuquerque, New Mexico, group called DanceSafe formed to conduct on-the-spot purity tests at raves. They also offer a pill-testing kit and a mail-in service.

  • Brain injury and memory loss. Much of the scrutiny of Ecstasy involves serotonin, a brain chemical that influences memory, mood, sleep, and other brain functions. MDMA triggers the release of serotonin, which generates the drug's euphoric high. However, these spikes in serotonin levels are toxic to the brain, and habitual use can cause chronic serotonin depletion, resulting in long-lasting problems with memory and learning. The larger the dose of MDMA, the greater the serotonin depletion.

Not only does Ecstasy exhaust serotonin supplies, but extensive use can damage or destroy the very neurons that release the chemical, according to 15 years of animal research. Because of difficulties in conducting this type of research in humans, conclusive evidence of the impact in humans has not yet been established, but studies have shown that some chronic heavy users have verbal and memory impairments. Depending on use, memory problems can last at least a few weeks after taking MDMA, and preliminary research suggests that the effects may last far longer. In a Johns Hopkins University study, conducted with monkeys exposed to MDMA for four days, the neurotoxic effects of MDMA were evident in the animals six to seven years after the drug was administered. According to Dr. Amanda Gruber, associate chief of substance abuse in the biological psychiatry laboratory at the Harvard-affiliated McLean Hospital, the present scientific information singles out Ecstasy as one of the most dangerous street drugs available today.

  • Depression. The depression often reported by users after taking ecstasy is very likely linked to the brain's serotonin-exhausted state. The short-term effects may seem mild, and the user's mood is likely to bounce back fairly quickly. But Gruber says the long-term effects of damaging neurons that affect mood regulation are potentially serious. A long period of use may alter these neurons permanently, and preliminary clinical reports suggest that individuals may experience depression and other serotonin-deficient problems years after their last hits of Ecstasy.
  • Hyperthermia and dehydration. Dancing on Ecstasy for a long stretch of time in warm, crowded rooms with poor ventilation is a recipe for overheating and dehydration because the drug increases the body's temperature. Dehydration and/or overheating may cause a person to pass out from the hyperthermic effects of MDMA. This can be fatal in rare cases if the person does not receive prompt medical attention. Ecstasy's stimulant effects can increase heart rate and blood pressure, which can potentially lead to heart failure. Ravers on X have also experienced strokes, kidney failure, and seizures.
  • Dental Problems. Ecstasy's speedy effects often make users clench their jaws and grind their teeth, producing an array of dental woes, including worn teeth, cracked enamel, and jaw problems. A study at Britain's Maryland Center found that 60 percent of Ecstasy users had ground through the enamel on their teeth, and that decay among users was nearly five times worse than that of the average patient. Making matters worse, X-ing clubbers often cool off with sugary, carbonated beverages and the vomiting that sometimes occurs after ingestion of MDMA can also contribute to decay.

Is Ecstasy addictive?

While the scientific jury is still out on the extent of Ecstasy's addictive traits, research to date suggests a definite risk. According to Gruber, the drug shows definite reinforcing properties, which are earmarks of other addictive drugs. However, Ecstasy differs in that users develop tolerance so rapidly that they quickly burn out on the drug, unable to achieve the same levels of intoxication use after use.

The upside: the cycle of dependence is usually very short. But Gruber says the accelerated tolerance may suggest something frightening: irreversible neuron damage that hampers the brain's ability to produce the serotonin needed to deliver the high. Also, the post-X depressed mood, fatigue, and irritability many users report (sometimes lasting several days) indicates a form of withdrawal, another red flag of addictive drugs.

Are there any prescription drugs that can be dangerous if taken with Ecstasy?

  • Monoamine Oxidase Inhibitors (MAOIs) such as Nardil, Parnate, and Marplan. These anti-depressants prevent the breakdown of monoamines. Serotonin is a monoamine. With MDMA flooding the brain with serotonin, and MAOIs acting at the same time to prevent its breakdown, the effect can produce "serotonin syndrome," which in mild cases causes diarrhea, hypertension, hyperthermia, dehydration, dizziness, and occasionally abdominal cramps and muscle spasms. In severe cases, the syndrome can cause delirium, coma, and even death. Combining Ecstasy and MAOIs can also cause hypertensive complications that may lead to stroke or death.
  • Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil. The use of MDMA can hamper the effectiveness of SSRI antidepressants. Prozac, which prevents the release of serotonin, may actually protect the user from neurotoxic damage.
  • Ritonivar, a protease inhibitor used to treat HIV, stops a liver enzyme, CYP2D6, from breaking down MDMA which can lead to dangerously high levels of MDMA in the bloodstream.
  • Other drugs that interfere with the function of the liver enzyme include codeine and DXM in cough medicine.

Are there any illnesses that predispose users to adverse effects?

  • Cardiovascular conditions. Since Ecstasy is a stimulant, any user with high blood pressure or other heart problems may be putting themselves in danger.
  • Kidney or liver disease. Combining physical exertion and MDMA (particularly at raves) can cause hyperthermia and dehydration, which in turn can break down muscle fibers. The kidney and liver must process the products resulting from this break down, which can severely tax and damage these organs.
  • Mood disorders. People with preexisting serotonin-related depression and other mood disorders may be more susceptible to Ecstasy-related depression.

How can users prevent dehydration and hyperthermia?

The group DanceSafe is working to warn ravers about the potential dangers of X and about simple precautions they can take to stay safe. Their recommendations:

  • Drink two to four cups of water per hour to stay hydrated while on Ecstasy.
  • Drinking a sports drink such as Gatorade while drinking water -- or eating a salty snack -- can help you avoid "water intoxication," a potentially fatal problem that occurs when the body loses too much salt to the combination of drinking too much water while sweating profusely.

Just be sure to avoid sports drinks with any stimulants such as caffeine (and its herbal form, guarana) or ephedra (ma huang).

  • Avoid alcohol because it dehydrates the body.
  • Take frequent breaks from dancing to avoid overheating.
  • Get some fresh air or go to a cooler environment if you start feeling too hot.

References

U.S. Department of Health and Human Services. Drug Abuse Warning Network, 2006: National Estimates of Drug-Related Emergency Department Visits. August 2008.

"Top 10 Most Popular Recreational Drugs," August 12, 2009, Listverse, authors of "The Ultimate Book of Top 10 Lists" http://listverse.com/2009/08/12/top-10-most-popular-recreational-drugs/

Volkow ND. Years of Animal Research Proves MDMA ("Ecstasy") Can Damage Neurons; MDMA's Effects on Human Brain are Being Studied. National Institute on Drug Abuse. June 4, 2007.

Ricaurte GA, McCann UD. Experimental Studies on 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") and its Potential to Damage Brain Serotonin Neurons. Neurotoxicity Research. 2001; 3(1): 85-99.

National Institute on Drug Abuse. MDMA (Ecstasy). August 2008.

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