RECREATIONAL DRUGS

The Agony And The Ecstasy

A Scientific Row Has Broken Out Over The Effects Of Ecstasy

WHAT with angry parents, alarming headlines and crusading politicians
proclaiming the dangers of MDMA-a recreational drug more commonly known as
Ecstasy-it takes a brave, or foolhardy, individual to go against the grain.
Jon Cole, an addiction researcher at Liverpool University, in England,
denies that he is either, but his unorthodox views about the long-term
effects of Ecstasy are still kicking up a storm. In this month's issue of
the Psychologist Dr Cole and his colleagues argue that experimental
evidence suggesting a link between Ecstasy use and problems such as nerve
damage and brain impairment is flawed, and that using this
ill-substantiated cause-and-effect to tell the "chemical generation" that
they are brain-damaged when they are not creates public health problems of
its own.

Over the past decade, Ecstasy has become the badge of youth subculture in
Europe and America, and a weekend favourite with night-clubbers looking to
boost the high of a night on the town. Perhaps as many as 3m people in
Britain and more than 6m in America have tried the drug at some point, with
an estimated 500,000 being regular consumers in Britain alone.

Overdoses of Ecstasy can kill, in part by causing ravers to overheat and
drink too much fluid-which lowers the level of salt in their blood and
throws their hearts out of kilter. Some 40 people died of Ecstasy- related
causes in England and Wales last year, twice as many as in 2000. For all
this, many users consider Ecstasy to be a soft and sociable drug, along the
lines of cannabis or alcohol, rather than a dark and dangerous substance
like heroin.

Drug researchers such as Andy Parrott, at the University of East London,
beg to differ. They point to a range of studies showing that regular
Ecstasy use can alter the levels in the brain of a molecule called
serotonin. This substance carries signals between certain sorts of nerve
cells. The result is an undermining of memory, sleep, appetite and (perhaps
most worryingly for clubbers) sex drive. It can also lead to concentration
problems, anxiety, impulsive behaviour and depression.

In America, those who advocate the use of MDMA in clinical practice have
long questioned this experimental record. Now the challenge has come to
Britain; indeed one of Dr Cole's co-authors, Charles Grob, a psychiatrist
at Harbor-UCLA Medical Centre in Los Angeles, is a leading exponent of
using MDMA as a therapy.

The review carried out by Dr Cole finds fault with much of the evidence on
the effects of MDMA. He is particularly concerned about research that shows
long-term mental changes in Ecstasy users. He argues that these studies are
flawed because they fail to control for other factors, such as pre-existing
psychological complaints or other drug use. These, not MDMA, he suggests,
may be causing the problems observed.

Furthermore, he reckons that research which questions the long-term damage
of Ecstasy is being suppressed by scientists keen to accentuate the
negative. Not so, according to Dr Parrott, who describes Dr Cole's views as
irresponsible and accuses him of the same sin of selective publishing. He
cites a ream of studies which refute Dr Cole's points in his response to
the paper in the same issue of the Psychologist.

Other experts are not quite so dismissive. Michael Morgan, an experimental
psychologist at Sussex University, admits that there are holes in the
experimental record that need to be filled before the link between the drug
and nasty long-term effects moves from correlation to causation.

For example, animal tests are a good way to see the effects of MDMA
unsullied by the presence of other drugs. Dr Cole argues that, though
animal studies routinely show brain damage from MDMA, few have demonstrated
that this actually has any effect on an animal's daily life. But as Dr
Morgan points out, the sorts of complex traits, such as impulsive
behaviour, that MDMA is thought to produce in people are hard to examine in
animal experiments.

Improvements in imaging technology, which can show how the brains of
Ecstasy users change over time, could help. So could more sophisticated
ways of measuring drug use, such as sampling people's hair. This lays down
MDMA as it grows, and thus provides a record of exposure that is more
reliable than users' own recollections. Dr Morgan hopes to put some of
these new approaches into practice by embarking on a three-year study of
1,000 university students to deal with some critical unresolved questions,
such as whether light users of the drug, who take it seemingly without
side-effects, are actually storing up problems for the future.

As advocates of drug liberalisation have found, the deadweight of popular
opinion admits of little dissent. Yet such dissent should act as a call to
clarify the science involved-which even those who are convinced of MDMA's
dangers should surely welcome, since they seem so confident of the outcome.
Until the uncertainties are cleared up, however, you pay your money and you
take your chance.