Biology 202
2003 First Web Paper
On Serendip

Ecstasy has been glorified by countless Brit-pop drug anthems, condemned by staunch anti-drug foundations and even caused a controversial media debate when the post-mortem picture of eighteen year old Lorna Spinks was splashed across every newspaper in the United Kingdom, her Ecstasy-related death rendered in full gruesome color. The long-term effects and temporary consequences of Ecstasy have been a subject of heated debate in the past ten years as the pill has seen a surge in popularity. What exactly does Ecstasy do to the brain? What creates the euphoric effects? Why has it been used in therapy? And does the media's portrayal of Ecstasy rely on the facts of the drug, or skew the information to instill a sense of fear into citizens, parents, and teenagers?

Ecstasy (Methlenedioxy-methamphetamine, MDMA for short) is a synthetic, psychoactive drug with amphetamine-like and hallucinogenic properties. It shares a chemical structure with methamphetamine, mescaline, and methylenedioxyamphetamine (MDA), drugs known to cause brain damage (1). MDMA, in a simple explanation, works by interfering with the communication system between neurotransmitters. Serotonin is one of a group of neurotransmitters that carries out communication between the body and the brain. The message molecules travel from neuron to neuron, attaching to receptor sites. This communication activates signs that either allow the message to be passed or prevent the message from being sent to other cells. However, when MDMA enters the nervous system, it interferes with this system. After serotonin is released, the neurotransmitters are retrieved into the nerve terminal where they are recycled. MDMA hinders this process so that the serotonin is not drawn back in. This allows for an accumulation of serotonin, and also an increase in serotonin synapses (2). This surge of serotonin creates an emotional openness in the Ecstasy user. A sense of euphoria and ecstatic delight envelop the user. Some users report thinking clearly and objectively, and often claim to come to terms with personal problems or various other skeletons in the closet (3).

This is the reason Ecstasy resurfaced in the 1980s (after being developed in Germany in 1912 as a dieting drug due to the fact that amphetamines are appetite suppressors) as a tool in experimental psychotherapy, particularly regarding relationship and marital problems (4). In 1984 the drug was declared illegal in the United States after it started being used for recreational purposes. However, in June of 1999, Swiss courts ruled that dealing Ecstasy is not a serious offence. Ecstasy remains illegal in Switzerland but is now regarded as a "soft drug" rather than hard. The Swiss courts stated that Ecstasy "cannot be said to pose a serious risk to physical and mental health and does not generally lead to criminal behavior." Switzerland already had quite a liberal background regarding the use of Ecstasy. Between 1988 and 1993, long after psychotherapeutic Ecstasy use had been curtailed in the US, therapists in private practice were permitted to use Ecstasy within psychotherapy (5). Shockingly enough, this past November, the Food and Drug Administration approved the first ever U.S. study of Ecstasy as helpful medicine, claiming that previous testing has not focused on the drug's benefits, but on issues of toxicity (6).

However, the use of Ecstasy in psychotherapy is still hazy. If MDMA merely ups serotonin levels, and serotonin is responsible for making the individual feel just plain Good, is this really solving marital problems? If brain=behavior, and the brain is regulating the behavior through an artificial source, is this really genuinely therapeutic? Or is it a trick of the brain, flooding itself with neurotransmitters and depleting the euphoric sensation as levels return to normal in the next few days?

The idea of serotonin levels returning to normal in "a few days" seems idealistic, as well. What are the long-term effects of Ecstasy use? The serotonin absorption in the blood is refurbished in 24 hours but serotonin tissue levels are found to decline for weeks after Ecstasy usage. The receptors and neurons within the system are also found to degenerate over a period of time. Animal studies done by Dr. Karl Jansen have concluded that MDMA is far more toxic in primates. Studies done on rats revealed that the loss of serotonin in rats was four times less than in monkeys. Jansen declares the drug potentially hazardous for human use and also drew comparisons between serotonergic axons damaged by Ecstasy and those seen in Alzheimer's disease, where the most common receptor modification is a loss of presynaptic serotonergic receptors (7).

Finally, what to make of the highly publicized deaths claimed by the media to be "Ecstasy-caused"? In 1995 the English media championed the tragic story of teenage Leah Betts, posting the country with billboards claiming that, "Just One E Tablet killed Leah Betts." The country went ballistic over the story, but failed to mention that Betts had not died from the Ecstasy, but from brain swelling due to drinking too much water. The media opted to keep the message straightforward: Leah died from taking a single E pill. To say she died from excessive water consumption is not a good story (8).

I spent last year living in London. One day I looked out my window to see a huge billboard covered in deviant-looking pills with the caption "Which one is the killer? 1 in 100 E tabs can kill you." The amount seemed strikingly high to me, especially because studies had been done in Britain previously reporting that there were well over a million regular Ecstasy users in England alone. The number of deaths related to Ecstasy in the UK is about seven per year. The numbers didn't match up. If a million users are understood, this works out at 1:143,000, implying the risk is "Minimal", according to British Government Risk Classification developed by Sir Kenneth Calman, Government Chief Medical Officer. This means a citizen would have a greater chance of dying in a fishing accident than from taking an E pill (9).

Perhaps one of the biggest problems with Ecstasy is the aura of mystery surrounding it and the media hype of "the killer pill." One ray of light surrounding the tragic E-related deaths of young people in Britain (and other countries around the globe) is the November decision by the FDA to delve into the effects of Ecstasy. The only way these deaths will not be in vain is if more education and knowledge of MDMA and Ecstasy is brought to light.

References

1) National Institute on Drug Abuse

2) Seratonin and the Brain

3) Erowid.org, the Sensory Effects of MDMA

4) Therapeutic Uses of Ecstasy

5) Switzerland and Ecstasy

6) The Return of using Ecstasy for Therapy?

7) Adverse Psychological Effects of Ecstasy use and Their Treatment

8) The Leah Betts story

9) British Government Risk Classification


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