Ecstasy: The E-ssential facts
Everybody's heard about ecstasy - you can't open a newspaper without reading about it. Large numbers of young people take it, though, and especially those involved in the dance scene. But few people know what ecstasy is, what it does - and what it doesn't. Here are some questions and answers that give the facts.So what is E?
Ecstasy, or 'E', is a synthetic, amphetamine-like drug known chemically as 3,4, methylenedioxy-methylamphetamine - or MDMA for short. It belongs to a group of drugs called 'phenethlyamines'.
MDA is the 'parent' drug of this group, and its several offspring have varying degrees of potency: MDEA, MDBD and MDMA are relatively mild; next comes MDA itself; and the strongest of them all are DOM and PMA, which, fortunately, are not seen much in Britain.
Where did 'E' come from?
MDMA was first synthesised early this century by Merck, a German pharmaceutical company that was investigating the use of amphetamine-like drugs in suppressing appetite in overweight patients. But MDMA was never marketed, and it was largely forgotten about until the 1960s, when it was rediscovered by Dr. Alexander Shulgin, an American research chemist working for Dow Chemicals. Dr. Shulgin always tested experimental drugs personally, and when he tried MDMA he found that it had a special quality: it made the user feel very positive, or empathetic, towards other people.
During the 1970s, some marriage counsellors gave MDMA to their patients before the therapy sessions began, claiming that the drug helped each partner see the other's point of view and made both partners less hostile. At the same time, 'ecstasy' - as it became known - become a street drug in America, taken legally. In the main, its users were young, middle-class professionals who were looking for some form of transcendental experience, although 'E' is not hallucinogenic, as LSD is. But ecstasy was banned in America in 1985, after experiments with rats provoked fears about brain damage.
How did 'E' become so popular in Britain?
In a word: 'dance'. In Britain, there has been a link between all-night dancing and the use of stimulants for many years - since the days of cocaine use in the pre-war London club scene, in fact. Then, in the 1960s, mods stayed up all night, dancing on amphetamines, and in the 1970s the same thing happened when northern soul and punk were all the rage. All these sub-cultures involved relatively small groups of people. But when dance culture took off again in the late 1980s, it drew in not thousands but hundreds of thousands - even millions, perhaps - of young people. And ecstasy came along, too.
From the user's point of view, it was the right drug in the right place at the right time. The reasons were simple. Ecstasy:
- helped you stay up all night;
- being an amphetamine, it propelled the body into repetitive and exaggerated movement - which is what dance music was and is all about;
- given its unique empathetic qualities, it helped create a friendly non-aggressive atmosphere at raves and dances that clubbers wanted to experience time and time again.
But there's no such thing as a free lunch. With the 'ups' come the 'downs'. And the first one involves the law of the land.
You mean I can be arrested for taking ecstasy?
Exactly. Ecstasy is classed by the Misuse of Drugs Act as a Class A drug - and that puts it in the same category as heroin and cocaine. If you're caught with one or two tablets, you might be lucky and just get a ticking off, or maybe a formal caution - in which case you won't be fined or appear in court, but you will have a criminal record. Of course, you could end up in court. Whether you will depends on the attitude taken by the police force in your area - some are much tougher on possession than others.
But if you're caught with several tablets, you could be in big trouble. As far as you're concerned, you might just have collected some money from your mates to buy on their behalf. But as far as the police are concerned, you're a dealer - and that could mean prison.
What other downs are there?
Because ecstasy is an illegal drug, there's no quality control involved in its manufacture. A tablet might cost between £10 and £15, but who knows what's in it? There are various possibilities - you might get:
- a drug that actually is MDMA;
- one that also contains one of the close analogues, such as MDA or MDEA;
- or a drug that is entirely fake, comprising a combination tablet or capsule that could contain amphetamine, LSD, ephedrine or other drugs. Such a drug may not necessarily be life-threatening, but you might have a drug experience very different from the one you were expecting. And if the drug is actually ketamine or LSD, you could experience some very distressing and disorienting hallucinations that would definitely spoil your night out.
So how can you tell if it's 'E'?
You can't. At the moment, the popular kinds of 'E' go under names such as 'doves' and 'apples' - the names usually refer to the design stamped on the tablet. But just because it looks like an 'E' it doesn't mean it is one.
OK. But what does ecstasy actually do to you?
The answer to that one is more complicated. But it can be split into four parts: the effects on the body; the possibility that you'll die; the effects on the mind; and more indirect and longer-term effects.
Effects on the body
Ecstasy works at a fairly moderate single dose of 75-100mg, which is the amount you get in an average tablet. The effects are experienced between 20 minutes and an hour afterwards, and can last for several hours: the pupils of the eyes enlarge; the jaw tightens; and there is usually a brief bout of nausea, then sweating, a dry mouth and throat, some rise in blood pressure and heart rate, and a loss of appetite. There can also be some difficulty with bodily co-ordination, making it dangerous to drive a car.
Once the most obvious effect of an ecstasy tablet wears off, there may be some residual effects, similar to those experienced by amphetamine users. These include muscle pain and fatigue, and a depression that can last for several days - sometimes users refer to this feeling as being 'cabbaged'. If the dose taken was higher than average - more than 200mg, say - or if ecstasy has been used repeatedly over a few days, all these effects may be experienced more acutely.
Ecstasy deaths
Since 1988, around 70 deaths have been associated with the use of ecstasy in the rave and club scene. It seems that nobody has died directly from the toxic effects of the drug - meaning that they haven't been poisoned - or suffered an allergic reaction - as happens when people die from wasp stings or peanuts.
Many questions remain about ecstasy fatalities. For example, it is unknown why a group of around seventy people have died from taking the drug, when so many thousands of others have also tried it in exactly the same circumstances. It may simply be down to individual metabolism.
Also, there doesn't seem to be an obvious danger level for the number of pills that might cause an overdose. Some people have died taking just one pill, others have taken several in an evening with no apparent problems.
The deaths can be classified into three groups: death from heatstroke; death from too much fluid; and death from heart failure.
Heatstroke
Most ecstasy deaths fall into this category. Taking 'E' without water can push your body temperature up even if you're just sitting in an armchair. The drug also causes a certain amount of hyperactivity in users, with the result that they sometimes don't realise that they are becoming dangerously dehydrated. If you combine ecstasy use with vigorous dancing in a humid and probably overcrowded venue for hours on end, and don't drink enough fluid, the result can be that your body temperature rises above the danger limit of 40 degrees C. Early symptoms of the problem are a lack of sweating and an inability to urinate. They're followed by dilated pupils, very low blood pressure, an accelerated heart rate and convulsions.
The actual cause of death is the collapse of respiration, which itself results from something called 'disseminated intravascular coagulation', or DIC. What seems to happen is that somehow ecstasy reacts with the chemicals that control blood clotting. As a result, blood clots in places where it shouldn't, such as the lungs: air can't get through, and death follows. Conversely, if all the blood clotting chemicals have been used up in places where they shouldn't be working, blood might not clot in places where it should: there's a risk that bleeding will start from the internal lesions that the human body normally copes with without problems.
Too much fluid
By now, most people who go to clubs have got the message about reducing the risks of overheating by wearing loose clothes, 'chilling out' regularly and drinking fluids. But at least three deaths have been recorded that have been caused by drinking too much water - possibly in a mistaken belief that simply drinking lots of water will offset any side-effects of the drug. The trouble is that the actual intake of water couldn't be described as excessive in all these cases.
In this case, death results from something called 'dilutional hyponaetremia'. What happens is that ecstasy seems to affect the workings of the kidneys by triggering the production of an anti-diuretic hormone, which prevents the excretion of fluids, when it shouldn't. So water is retained in the body, and especially in the highly water-absorbent cells of the brain, and eventually its pressure shuts down primary bodily functions, such as breathing and the beating of the heart. The symptoms include dizziness and disorientation in the first place, leading to collapse and coma. Not all of those affected die, and a number of young people who have been admitted to hospital in this condition have survived.
Heart failure
Ecstasy causes a significant rise in blood pressure and heart rate, but a fit young person can usually sustain this. However, a few young people have succumbed to these stimulant effects, sometimes as a result of an undiagnosed heart condition.
Effects on the mind
As with LSD, whether an ecstasy experience is 'bad' or 'good' often depends on a number of factors: what mood the user is in before the drug is taken; what the user expects to happen; and the friendliness or otherwise of the immediate surroundings.
At moderate doses, most users report a euphoric 'rush' followed by feelings of serenity and calmness, and the dissipation of anger and hostility:
'When you're like first coming up on an E ... like the intense feeling that you get. I mean the rush of it ... it's like ... you remember when you're a little kid, and it's the night before Christmas. But it's sort of like mixed with the first time you kissed your girlfriend ... really like the most you can be in the limits of any one emotion.'
Most of the bad experiences with the drug have been reported by those using higher doses over a period of time, and include anxiety, panic, confusion, insomnia, psychosis, and visual and auditory hallucinations. Generally, these effects disappear once the drug is stopped, but they can leave the user in a weakened mental and physical condition for a while:
'I was in this club one night and I just lost control of myself completely. I was just like, shaking constantly all night ... it seemed like hours. Everyone was looking at me, I was twitching.'
Indirect and longer-term effects
Users develop tolerance to the effects of ecstasy, so after a while repeated doses will have little or no effect. But there's no physical dependence, no heroin-like withdrawal symptoms, nor any evidence that ecstasy is used compulsively on a long-term basis.
Some long-term users have reported an increased susceptibility to minor ailments, such as colds, flu, sore throats and so on. And one researcher has noted that, for unknown reasons, MDA-type drugs 'seem to be especially hard on women and will activate any latent infections or problems in the female genito-urinary tract'. A number of young women have reported that their periods have been irregular and heavier than usual after using ecstasy, while others have reported that their periods stop while they're using the drug.
On the basis of a 1995 study of seven UK ecstasy deaths and other data, there is evidence of a link between ecstasy use and liver damage. This may be because ecstasy in the body breaks down into a number of different chemicals ('metabolites'), one of which is MDA, which is known to be more toxic to the liver than ecstasy.
We keep hearing about ecstasy and long-term brain damage. Is it true?
'The reality at the moment is that we have a huge uncontrolled clinical trial going on out there ... we might have a whole generation of youngsters who have some chemical changes to their brains, the consequences of which we don't understand.'
'Brain damage' is a very emotive expression. It conjures up images of people sitting in a corner, dribbling and mumbling to themselves. There is no reason to think that this is a likely scenario for ecstasy users.
Even so, on the basis of animal studies, there seems little doubt that ecstasy does cause changes in brain chemistry. But what is still very unclear is what these changes might mean, if anything, for the current ecstasy-using population in the years ahead.
It's known, for example, that ecstasy reduces levels of a brain chemical called serotonin, and that a lack of serotonin is associated with depression. Users often experience bouts of depression, often in the middle of the week when ecstasy's taken at weekends. And if serotonin levels are permanently reduced by ecstasy use, one possible long-term outcome is that there may be a higher incidence of clinical depression among former ecstasy users, aged 35-years-old, say, than would be normally found in the general population of 35-year-olds.
The trouble is that to prove this one way or another, you'd have to conduct a study of users, and a control group of non-users, over perhaps 20 years. Ecstasy has already been around as a recreational drug in America for that length of time, but nobody can say now whether it has increased the rate of depression in those who were using the drug in the mid-1970s.
Overall, the scientific literature indicates that people should not take ecstasy if they suffer from heart disease, high blood pressure, glaucoma or epilepsy, or are in poor physical or mental condition. And women who have a history of genito-urinary tract infections shouldn't use the drug. There's no evidence that ecstasy has any effect on a foetus, or causes problems in the newborn, but given its effect on the circulatory system it would be advisable not to take the drug if you're pregnant.
