ECSTASY

Medical examiner says five deaths here show the drug's effects on judgment
can be fatal.

On an April night last year, Mattie broke a tab of ecstasy in half and
swallowed it.

Trusted friends had persuaded the woman, who always considered herself a
bit of a prude, to try this drug with its promise of euphoria.

Mattie -- a pseudonym -- said it lived up to that promise and more.

"Before I took ecstasy, I was prejudiced against blacks, Hispanics, gays,
anyone who was different than me in any way. That's how I was raised.

"But that night, I learned to love people like I never loved them before.
And the feeling's stayed with me since. I no longer care what color anyone
is, and I never thought that would happen to me."

If the impact of ecstasy pleasantly surprised Mattie, it jarred the region
when high doses were discovered in the bloodstreams of five Vietnamese
immigrants found dead in a car April 29 in St. Louis.

The men, ages 19 to 21, died of carbon monoxide poisoning from the car's
exhaust as they listened to music with the engine and air-conditioning
running inside a closed garage.

Authorities ruled the deaths accidental. But the question is whether the
ecstasy fatally impaired the men's judgment.

To Dr. Michael Graham, the St. Louis medical examiner, ecstasy was the
obvious culprit.

"If you're looking for a reason why these men died the way they did, you
don't need to look any farther than ecstasy," Graham said.

But to Mattie, blaming the drug is unfair.

"That doesn't connect with people like me, who take ecstasy on special
occasions and have learned to enjoy life more fully with it," she said.

It's only the latest in a long series of controversies about ecstasy, a
drug that's been around for nearly a century but remains veiled in mystery.

X: A brief history

The chemical name for ecstasy, known as on the street as X, is
3,4-methylenedioxymethamphetamine, or MDMA. It has structural similarities
to amphetamine and mescaline.

The drug was first synthesized in 1912 by Merck Pharmaceuticals in Germany.
Whether the drug was designed for a purpose or discovered accidentally
remains unclear. One of many unsubstantiated rumors is that X was intended
as an appetite suppressant.

There is little evidence of further experiments with the drug until the
early 1950s, when the U.S. Army tested it and other drugs such as LSD on
animals to determine its effects.

Instances of recreational use of X cropped up in the 1960s. Late in that
decade, Alexander Shulgin, a chemist from Berkeley, Calif., began testing
it -- on himself.

In his book, "PiHKAL: A Chemical Love Story," Shulgin described an X
experience:

"The woodpile is so beautiful, about all the joy and beauty that I can
stand . . . I feel totally peaceful. I have lived all my life to get here,
and I feel I have come home. I am complete."

Not all of Shulgin's subsequent experiments with the drug proved as
fulfilling. The pill sometimes made him feel dull and tired. Nevertheless,
he felt the positives outweighed the negatives.

Shulgin published glowing accounts of MDMA in academic journals. He
introduced the drug to a close friend, Leo Zeff, a prominent and respected
psychologist.

Smitten with it, Zeff shared it with hundreds of his colleagues across the
country.

The drug's reputation blossomed. Some mental health experts called MDMA
"penicillin for the soul." It chopped months off talk-therapy and got
neurotic patients to drop defensive barriers and increase intimacy and
communication.

Dr. George Greer, a psychiatrist with a private practice in New Mexico who
also treated prisoners in that state, tested X on 75 patients from 1980 to
1985.

He documented his findings in The Journal of Psychoactive Drugs in 1986:

"In general, it is reasonable to conclude that the single best use of MDMA
is to facilitate more direct communication between people involved in a
significant relationship. Not only is communication enhanced during the
session, but afterward as well. Once a therapeutically motivated person has
experienced the lack of true risk involved in direct and open
communication, it can be practiced without the assistance of MDMA."

By the early 1980s, however, ecstasy had spread far beyond the confines of
mental health care. From major cities to college towns, hundreds of
thousands of tabs a month were being consumed recreationally.

When the drug began sweeping through nightclubs in Texas, it drew the
attention of Sen. Lloyd Bentsen, D-Texas, who led a movement to ban it out
of health concerns.

In 1985, the Drug Enforcement Administration made MDMA a Schedule 1 drug --
in the same class as heroin -- banning its manufacture, sale and use.

That didn't stop its spread.

Black market X

Once the drug was banned, its manufacture became unregulated. Therein lies
a primary danger, according to Graham, St. Louis' medical examiner.

"You never really know what you're getting when you buy X on the street,"
Graham said. "It's often contaminated with other substances and isn't even
true MDMA at all."

However, St. Louis police said recent tests of pills confiscated here
revealed them to be almost pure MDMA. In fact, city narcotics officers have
warned students returning to the area that local versions of the drug may
be stronger than they expect.

The long-term effects of taking ecstasy remain unclear.

In June 1999, Dr. George Ricaurte of the Johns Hopkins University School of
Medicine published a report in the Journal of Neuroscience that showed
long-term brain damage in red squirrel monkeys exposed to MDMA for several
days.

Dr. Julie Holland, a psychiatrist at Bellevue Hospital in New York City,
was among numerous critics to dispute Ricaurte's methods and findings.
Holland believes that MDMA can be prescribed at low doses to psychiatric
patients without causing brain damage.

So far, the drug has not been cited as the cause of a single death in the
St. Louis area.

At Barnes-Jewish Hospital, the few ecstasy-related emergencies treated
there have been related to dehydration or body overheating. Generally, the
patients are people who dance too long without a rest or water break.

"One or two ecstasy emergencies in a weekend would be a lot," said Dr.
Michael Mullins, an attending physician in the emergency room. "Most are
treated and released."

Perhaps no other doctor in the country has had as much firsthand experience
with ecstasy complications as Dr. John Hayes, chief medical examiner of New
York City.

Two ecstasy deaths have been confirmed in his city, but Hayes does not
believe that MDMA is cause for panic.

"Ecstasy probably isn't as dangerous as parents are led to believe," Hayes
told the Post-Dispatch last week. "But it's more dangerous than kids think
it is."

Hayes has lectured extensively about ecstasy, from cultural as well as
medical angles.

A self-described teetotaler who said he has never experimented with drugs,
Hayes also is a free-lance critic who has written extensively about the
rave, nightclub and dance music scenes for the last 10 years.

"I've followed the ecstasy phenomenon from both ends," said Hayes, 40. "I
spent plenty of time at nightclubs and raves."

Records about the drug have not been well-kept. But Hayes said he believes
that the best estimate of X-related fatalities worldwide since 1985 is
about 300. Many of those were early cases of ecstasy-related hyperthermia
- -- body overheating. It is a problem that decreased markedly when word
spread about the danger of dancing too long without a water break.

By comparison, 62 people in St. Louis County have died of heroin overdoses
in the last three years -- about as many in an average year as ecstasy
deaths estimated worldwide.

"It's true that a large amount of ecstasy is being consumed and that there
have been a relatively small number of deaths," Hayes said. "That said,
it's not rare if it happens to you."

What is harder to measure is how the drug affects judgment.

"We have seen X present in a number of fatal traumas -- falls from heights
and other injuries -- and we're not sure if the drug led to an increase in
risk-taking behavior," Hayes said.

The most pressing concern, he said, is ecstasy's long-term effect on the brain.

"There is almost an epidemic of depression in some heavy X users, whose
seratonin nerves are so damaged that they can't produce the chemical
associated with happiness or contentment in the brain," he said. "Every
drug is going to have its casualties, the people who never know when
enough's enough. They're the type at the clubs who wear T-shirts that read,
'Rehab is for quitters!'"

Tim Schimweg of Brentwood has tried ecstasy and says the drug's brief
euphoria wasn't worth the hangover. "The high was fine," said Schimweg, 21.
"But it wasn't worth it to feel like a zombie the whole next day for the
four hours of fun the night before."

Schimweg said he experimented with the drug a few times and that was enough
for him. He's seen harmful effects in a longtime acquaintance who is a
frequent user -- multiple doses several times a week. "I used to enjoy
having conversations with this guy," Schimweg said. "Now he's just there
physically, but that's about it."

The rave

Raves -- mass dance parties -- have come to be synonymous with ecstasy. The
host of a recent one freely predicted that some of its revelers would be
under the influence of the drug.

By midnight, several hundred people were packed into an old repair shop in
St. Louis. The rumble of "techno" music poured from the entrance, where two
exquisitely dressed men greeted visitors.

"Good evening, sir," said one, tipping a fedora that matched his
cream-colored suit. "The rave's inside. Have a nice time."

Most who attended appeared to be in their 20s; at least one couple were in
their 50s.

Inside, lights skipped around walls and through flights of elaborate paper
butterflies strung from rafters that in another era supported heavy machinery.

After midnight, a cheer rose as a DJ perched on a balcony queued up a
drum-and-bass selection by the act High Lonesome Sound System.

A lithe blonde dressed in black from head to toe weaved her head, arms,
torso and hips in a graceful motion as the tempo accelerated to a dense
howl. Cary McQueen, 22, was dancing with utter abandonment like this for an
hour and would not stop until dawn.

A cluster of revelers away, Terry Hoffman, 46, dressed in a
medieval-looking costume, contributed to the light show by flashing a laser
pointer around the room. Like McQueen, Hoffman bobbed about the club for hours.

Where did they get all that energy?

In McQueen's case, the truth was reflected in the normal-size pupils of her
blue eyes.

"I've never taken ecstasy in my life," said McQueen, who recently graduated
from Washington University. "I'm not afraid to. I don't think it's wrong. I
just enjoy myself so much anyway that I don't feel the need to," she said.

Hoffman, on the other hand, was "rolling" on the drug this night, his
pupils dilated like black saucers.

"I've taken ecstasy five or six times," Hoffman said. "It puts me in a good
frame of mind. Keeps me upbeat."

Hoffman is honest about his past experiences with drugs. He said he has
tried LSD, cocaine, marijuana and mescaline.

"About the only thing I've never done is shoot up drugs," he said. "I don't
like needles. I've tried crack, but I don't know why people would even
waste their time with that.

"Ecstasy, to me, is a trip down memory lane, like when I used to get high
years ago and watch the laser light show at the planetarium. On ecstasy,
the colors become vibrant, the music sounds fantastic.

"In my experience, it doesn't turn people into sex maniacs. I still know
what I'm doing, where I'm going. I'm able to function perfectly fine. It's
not something I feel compelled to do all the time, but I do enjoy it
occasionally."

Authorities in Missouri and Illinois report that the drug's popularity is
booming even as authorities prosecute its sellers.

Last fall, police broke up the biggest ecstasy ring in the region's
history. Seven men eventually pleaded guilty to distributing thousands of
doses of the drug, most of which is made in Europe and smuggled into this
country where it's sold on the street for $20 to $35 a tablet.

"Ecstasy is everywhere," said Sgt. Michael Muxo, supervisor of the St.
Louis police narcotics undercover street unit and a steadfast enemy of ecstasy.

And who's taking it?

"Doctors, lawyers, honor students," Muxo said. "It's not confined to teens
at raves anymore."