THE HEIGHT OF ECSTACY

In recent years there has been a considerable increase in the
recreational usage of the psychoactive drug ecstasy.

Its increasing popularity has been due in large part to its
association with rave and club culture, where it has long been the
intoxicant of choice. Lately, the headlines of local newspapers have
been dotted with stories related to ecstasy.

There have been reports of overdoses at raves, and drug busts large
and small. Earlier this month, Canada Customs and Revenue Agency
officers seized 104,606 tablets of ecstasy at the Vancouver
International Airport. According to CCRA communications officer Faith
St. John, "This is the largest seizure of ecstasy that customs has
ever made, not just for Vancouver, but in all of Canada. We have had
several smaller seizures of ecstasy, but this is certainly the
largest." Corporal Scott Rintoul of the RCMP Drug Awareness Group
reports that there has definitely been an increasing trend in ecstasy
seizures by the RCMP.

But amidst all the hype, it can be easy to lose perspective about the
facts on the drug. BCTV's news coverage of a recent ecstasy seizure
featured an interview with an unidentified man claiming simply that
ecstasy was one of the most toxic substances known to man. Despite
this marvel of exemplary journalism, many ecstasy users and non-users
alike are often unclear about important details pertaining to the drug.

The drug most people refer to as "ecstasy" is usually
3,4-methylendioxymethamphe-tamine (MDMA) - a ring-substituted
derivative of amphetamine. It was first introduced in 1914 and
patented as an appetite suppressant. Later, it was realized that MDMA
could be a useful adjunct to psychotherapy. It facilitated
interpersonal communication, enhanced insight, increased self-esteem,
and actually decreased the abuse of other illicit substances. However,
the increasing popularity of MDMA use as a recreational psychoactive
substance eventually prompted the law to step in.

In Canada, ecstasy is a Schedule III controlled substance. According
to Corporal Rintoul, a person charged with possession of it can
receive up to a year in jail and up to $2,000 in fines. Penalties,
especially for first offences, are typically less than that - no jail
time, just a fine. Regardless of how lenient the penalty may be, any
conviction results in a criminal record; and that can cause a number
of difficulties for someone seeking to travel, or obtain employment in
certain fields.

There are more severe penalties if one is convicted of possession for
the purposes of trafficking. The distinction between the two charges
isn't merely a function of the quantity of drugs in possession.
"Circumstances dictate the offence, not the quantity," says Corporal
Rintoul. A person going to a rave with 10 capsules of ecstasy is
probably not going to use them all that night, whereas a person with
three likely could. Identical quantities found under different
circumstances could result in different charges being laid.

The two individuals arrested in connection with the record airport
seizure are facing the prospect of even stiffer penalties. Charged
with importation of a controlled substance, they could each receive up
to 10 years in jail - this according to Constable Ian Slaney of the
RCMP HQ Drug Section.

So what is it about ecstasy that is causing an increasing number of
people to risk an inauspicious meeting with Constable Slaney and his
colleagues?

"E [ecstasy] accentuates all five senses . . . especially touch. You
get really empathetic - you can totally understand what other people
are feeling and bond really deeply. It really varies from person to
person, but you feel really happy, and movement is very natural and
fluid, and you really want to move.

Especially, in my case, to dance music," claims SFU student Adam
Gomez*. Or, as Emily Carr Institute of Art and Design student Chundrit
Jugjev* succinctly puts it, "It's fuckin' rad!"

Their claims are more or less corroborated by the scientific
literature regarding this topic. Four to eight hours after ingesting
MDMA, subjects typically feel increased closeness to people, increased
sensory activity, a feeling of openness to new ideas, increased depth
of emotion and decreased appetite. This is in addition to the
aforementioned therapeutic benefits of the drug.

However, there appears to be some costs associated with all this
happiness. One of the most prominent debates in the scientific
literature regarding MDMA has centred around the drug's apparent
neurotoxicity. Numerous studies on non-human subjects have suggested
that significant doses of MDMA can result in damage to neurons that
contain the neurotransmitter serotonin (5-HT) and there is the
distinct possibility that the drug can have similar effects in humans.
The serotonin system is thought to be integral in the regulation of
most, if not all, complex behaviours. The functional consequences of
such lesions currently remain unknown. However, some researchers
believe that these lesions are responsible for the widely reported
feelings of depression and memory loss experienced by ecstasy users
several days after using the drug.

A study published in the journal Addiction indicates that users of
ecstasy report feelings of depression some time after coming down from
taking ecstasy. Initially, their depression scores rated similarly to
the depression scores of alcohol drinkers after a night of drinking.
Later in the week however, their depression scores were higher than
those of the drinkers. Even so, the author of the study - Valerie
Curran - admits that "there was enormous variation." Mr. Jugjev, for
example, reports when experiencing the after effects, he "feels good.
It's like an afterglow that lasts for several days."

There is also preliminary evidence suggesting that sustained ecstasy
use could lead to hepatotoxicity (liver damage). The liver is largely
responsible for processing any potential toxicants which may be ingested.

More disconcerting are the reports of deaths associated with ecstasy
use. Corporal Rintoul expressed considerable concern that the increase
in ecstasy use in Vancouver could lead to fatal consequences. He
reports that although no deaths have occurred here yet, Vancouver
emergency room doctors are quite alarmed by the number of people
admitted after taking ecstasy. In Britain, where ecstasy use has been
more prevalent than in Canada, the New Scientist estimates that
perhaps six people have died after taking ecstasy over the past
decade. A study published in the medical journal Lancet examined the
circumstances surrounding the deaths of nine individuals in 1991 and
1992. For seven of the deceased individuals, heatstroke (severe
hyperthermia and disseminated intravascular coagulation) was indicated
as the likely cause of death. The other two deceased individuals died
in a head-on motor vehicle accident. All of the fatal cases involving
heatstroke were at crowded parties or clubs. The high ambient
temperatures, inadequate fluid replacement and sustained physical
activity which typify raves and dance clubs were thought to potentiate
a direct effect of ecstasy on the body's thermoregulatory mechanisms.

All these findings demonstrate that there is some cause for concern.
But it is important to retain perspective when examining this data. A
New Scientist editorial proposes that all scientific studies regarding
ecstasy should be accompanied by the following warning: "DANGER!
Hyping these findings can lead to intoxicating headlines and unhelpful
bouts of moral panic."

In light of the evidence about ecstasy's harmful effects, and in our
current moral atmosphere, it can be very difficult to express sensible
views about the drug. It seems that either you condemn ecstasy out of
hand, or you risk being labelled as someone who advocates the deaths
of young people.

There have been considerable experimental difficulties in the studies
involving humans, in addition to the inherent problems with the
reliability of extrapolating non-human data to predict effects on
humans. Controlled experiments involving humans are often unfeasible.
There are numerous ethical problems associated with slicing people's
brains open before they're finished using them. As a result, much of
the human data relies on unreliable self-reported information on the
part of users.

One of the difficulties inherent in studying the effects of ecstasy on
humans is that "ecstasy" tablets are not always what they purport to
be.

Corporal Rintoul believes that only about half of "ecstasy" tablets
are actually real MDMA. A study published in Lancet corroborates his
thesis. Questioning why most people take the drug regularly without
significant harm while others die or experience severe toxic effects,
the researchers examined the contents of "ecstasy" tablets acquired
from locations throughout the UK. Some of the tablets had no
hallucinogenic substances. Others contained a range of substances
including amphetamines, ketamine (a dental sedative and veterinary
anaesthetic), paracetamol, and methamphetamine. Some other substances
known to be found in "ecstasy" include dextromethorphan hydrobr-omide
or dxm (also found in the cold medication Benylin DM) GHB, PCP, and
ephedrine. Because ecstasy is illegal, there is no quality control or
legal recourse for individuals buying bogus ecstasy. This can lead to
problems for users and researchers alike.

Research about ecstasy toxicity doesn't necessarily reveal the true
risks involved in taking it. Neither do reports about ecstasy-related
fatalities. It is true that ecstasy or MDMA can have toxic, even
lethal effects. But it is not commonly acknowledged that any
substance can have toxic or lethal effects. Critically important
factors relating to toxicity are dose, and route of administration.
Much of the toxicity research on MDMA pertains to doses much higher
than those experienced by typical users. Also, researchers have often
administered MDMA to their subjects through routes which do not
simulate those of real users (i.e. intra-venous (i.v.) or
intra-peritoneal (i.p.) injections).

Any information acquired from ecstasy research should be placed in a
greater context.

The results of toxicity studies, for example, have revealed that the
LD50 (dose at which 50 per cent of test subjects are killed) for MDMA
in mice is 97 mg/kg i.p.. On the other hand, the LD50 for legally
available nicotine is 9.5 mg/kg i.p. for mice - nearly ten times as
toxic per unit mass. And while six people in Britain are thought to
have died each year from ecstasy, it should be noted that at least
500,000 people have taken ecstasy and around a million tablets are
consumed in that country every week. At the same time, hundreds of
thousands of Britons die each year from long-term alcohol and tobacco
abuse. Approximately 600 Britons die each year in accidents caused by
drunk drivers.

Any deaths or injuries as a result of ecstasy are unnecessary and
tragic, but overhyping ecstasy's dangers will only serve to exacerbate
the gap in understanding between those who use the drug and those who
don't.

Presenting anything less than an a completely honest portrayal of
ecstasy's risks and benefits can only break any strand of trust that
exists between would-be educators and the users and would-be users of
ecstasy alike. Already, ecstasy users are generally very cynical about
any drug information presented to them. Currently, very little
information exists as to the potential long-term effects of ecstasy
use. Should any catastrophically important information be discovered,
what good is it if it is received merely as another cry of "wolf"?

Many users of ecstasy will continue to use it regardless of the
potential dangers presented to them.There are ways of minimizing the
risks, and there should be avenues open to communicate them to any
person considering or using ecstasy. Corporal Rintoul suggests that
vigilant security and first aid staff have been largely responsible
for preventing fatalities at Vancouver raves. Persons wishing to avoid
necessitating their services should keep a few tips in mind:

Evidence suggests that hyperthermia is a significant factor in ecstasy
toxicity. Keeping cool and maintaining proper hydration can reduce
ecstasy's neurotoxic effects. Also, laboratory studies indicate that
serotonin re-uptake inhibitors such as fluoxetine (Prozac) can block
MDMA neurotoxicity without inhibiting MDMA's subjective effects. This
suggests that MDMA's psychoa-ctive effects may be separate from its
neurotoxic action. Many ecstasy users already use fluoxetine to chase
or prevent the post-ecstasy blues. Now, it seems that it may prevent
MDMA toxicity as well.

Taking ecstasy is not without its physical and legal risks. Most users
consider the short term risks to be relatively small - a perception
that appears to be supported by available statistics. But it should be
incumbent upon anyone even considering taking ecstasy to educate
themselves on the potential dangers and benefits, as well as on ways
to maximize their safety.

No two individuals react in exactly the same way to the same substance
- - a fact that people should keep in mind if they decide to take
ecstasy. Or, they could follow Corporal Rintoul's advice and simply
leave the drug alone: "You don't need it - period."

*An asterisk appears adjacent to names of people who wished to be
identified only by a pseudonym.