ECSTASY USERS FACE CONSEQUENCES OF NEUROTOXICITY

The recreational drug methylenedioxymethamphetamine (MDMA; Ecstasy) is a
human neurotoxin, and one dose may be enough to damage serotonergic
neurons, scientists reported last week. The functional consequences of such
lesions remain unknown, but may include mood disorders and memory
difficulties, according to experts who met at the Novartis Foundation
(London, UK) on Dec 4.

A decade of research has shown that MDMA causes a deficit of brain
serotonin in every animal species tested, said George Ricaurte of Johns
Hopkins School of Medicine (Baltimore, MD, USA). Most experts now agree
that such lesions, which have persisted for up to 7 years in some animals,
represent selective destruction of serotonergic nerve endings, and several
strands of evidence indicate that similar deficits occur in people (Lancet
1998; 352: 1433-37 ). Ricaurte is concerned that neurotoxicity occurs in
non-human primates with doses of the drug that are in the range of human
use--even one dose may be sufficient to damage neurons, he warned.

But what are the functional consequences of such lesions? "There is a
general consensus appearing that people taking a lot of Ecstasy are
experiencing a range of problems", noted Andy Parrott (University of East
London, London, UK). Fabrizio Schifano (Padova, Italy) added that
individuals who had taken more than 50 MDMA pills had a strikingly
increased risk of psychiatric disorders--particularly depression,
psychoses, cognitive impairments, and eating disorders--compared with drug
users who had taken fewer than 50 pills.

But, "the human data are fraught with experimental difficulties", noted
Parrott. Observed problems might represent premorbid factors that
predispose individuals to take Ecstasy, for example.

And Ecstasy users tend to take other drugs and have other factors that can
confound observations. Longitudinal studies are badly needed to determine
which conditions develop with MDMA use, and whether they are reversible.

Una McCann (National Institute of Mental Health, Bethesda, MD, USA)
speculated that the risk of neuropsychiatric problems will increase as MDMA
users age. But Shane Collins, drugs spokesperson for the UK Green Party,
warned that young people tend not to respond to scare messages,
particularly when scientific uncertainties exist.

Nevertheless, until key questions are resolved, science may be able to
provide some practical advice for those who continue to use Ecstasy --keep
cool and avoid alcohol.

Ricaurte noted that, in animals, the degree of neurotoxicity is closely
correlated to body temperature, and Schifano reported that the concomitant
use of alcohol increased the likelihood of psychiatric symptoms.

- - Kelly Morris

Checked-by: Pat Dolan