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Hermit
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Ecstasy's long-term effects revealed
« on: 2009-02-14 14:00:58 » |
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Ecstasy's long-term effects revealed
Source: New Scientist, Issue 2695
Authors: Graham Lawton
Dated: 2009-02-11
THEY called it the second summer of love. Twenty years ago, young people all over the world donned T-shirts emblazoned with smiley faces and danced all night, fuelled by a molecule called MDMA. Most of these clubbers have since given up ecstasy and are sliding into middle age. The question is, has ecstasy given up on them?
Enough time has finally elapsed to start asking if ecstasy damages health in the long term. According to the biggest review ever undertaken, it causes slight memory difficulties and mild depression, but these rarely translate into problems in the real world. While smaller studies show that some individuals have bigger problems, including weakened immunity and larger memory deficits, so far, for most people, ecstasy seems to be nowhere near as harmful over time as you may have been led to believe.
The review was carried out by the UK Advisory Council on the Misuse of Drugs (ACMD), an independent body that advises the UK government on drug policy. Its headline recommendation is that, based on its harmfulness to individuals and society, MDMA should be downgraded from a class A drug - on a par with heroin and cocaine - to class B, alongside cannabis. Read the full report
Nobody is arguing that taking ecstasy is risk-free: its short-term effects are fairly uncontroversial. MDMA is toxic, though not powerfully so - an average person would need to take around 20 or 30 tablets to reach a lethal dose. And for a small fraction of people, even small amounts of ecstasy can kill. For example, around half a million people take ecstasy every year in England and Wales, and 30 die from the acute effects, mostly overheating or water intoxication.
What has been unclear, however, is whether ecstasy use causes long-term health problems and if so, how much you would need to take to be at risk.
In animal studies the drug has been shown to inflict lasting damage to the brain's serotonin system, which is involved in mood and cognition. Imaging studies have found signs of similar damage in human users, but there are debates over whether this is caused by ecstasy use and whether the damage has any real-life consequences.
The ACMD based their review largely on a study they commissioned from Gabriel Rogers and Ruth Garside of the Peninsula Medical School in Exeter, UK. They pulled together all the research from around the world that attempted to assess the health of people who have taken ecstasy, and reanalysed the data from the 110 studies that dealt with long-term effects.
They found that compared with non-users, people who took even a small amount of ecstasy at some point consistently performed worse on psychometric tests, which measure mental performance, especially memory, attention, and executive function, which includes decision-making and planning.
The most pronounced effects are on memory, mainly verbal and working memory. While the ability to plan is somewhat affected, other aspects of executive function are not. Focused attention - the ability to zoom in quickly on a new task - suffers too, though sustained attention does not.
It is a similar story with depression. "There's a small but measurable effect," says Rogers.
These effects appear not just in current users but also in ex-users who haven't touched the drug for at least six months, suggesting that the problems are long-lasting. Strangely, there seems to be no link between the quantity taken and the severity of cognitive problems, suggesting that even a few doses can lead to these deficits.
Superficially, this adds up to a pretty depressing outlook for the e-generation, especially those who dabbled years ago but have since quit. Not so, says Rogers. Subtle differences in lab tests do not necessarily translate into real-life problems: "They're statistically significant, but whether they are clinically significant is another matter." [ Hermit : What Iolo was attempting to communicate on the Cannabis thread ] .
For example, there is little evidence that people are actually affected by the memory and attention deficits picked up in the lab tests. "They don't seem to be very big and it is not clear that they have much effect on day-to-day functioning," he says.
Meanwhile, people who have taken ecstasy are, on average, still within the normal bounds on standard depression tests. Although they score worse than people who haven't taken ecstasy, the scores aren't bad enough to warrant a diagnosis from a doctor. "There's no indication that they are drifting out of normal functioning," says Rogers.
He also warns that his results need to be taken with a pinch of salt because most studies are based on self-reports of ecstasy use, often combined with other drugs and alcohol, from people who have volunteered to take part. These confounding factors make it impossible to determine whether you have a representative sample of users, whether people's reported use correlates with how much they actually took and what effects can be blamed on MDMA.
Psychopharmacologist Val Curran of University College London says Roger's analysis "is about the best you can make of the overall mishmash". She agrees with his conclusion that on average there seems to be no evidence of any meaningful effects on daily life.
Others have a different take on it. Andrew Parrot of the University of Swansea, UK, who has been studying the health of ecstasy users since the mid-1990s says: "We see users who have taken bucket-loads and they have very severe problems." These include memory deficits, sleep disturbances, depression, weakened immunity and sexual dysfunction, he says.
Based on his own studies, he believes that almost everyone who has taken 20 tablets in total, or more, reports niggling problems in daily life. "All fairly minor on their own, but you're ending up with someone who is not as healthy as they ought to be," he says.
Rogers admits that because he took averages of such large numbers of users, his analysis may have "ironed out" some of the effects Parrot describes.
Parrot also calls ecstasy a "gateway" drug. "Former users are often heavy users of alcohol, tobacco and cannabis. When you move off ecstasy, you look for other drugs. Ecstasy use leads to other, more problematic drugs."
Despite this, however, results from the first "prospective" studies are more encouraging. These studies follow a group of people over many years and watch the effects of ecstasy unfold over time. Crucially, they are more reliable than "retrospective" studies because they don't rely on people remembering what they did in the past.
In 2002 a group in the Netherlands recruited 188 young people who had never taken ecstasy but were likely to in the future. When they retested them on a battery of psychometric tests three years later, 58 said they had taken ecstasy at least once, giving the researchers an opportunity to compare cognitive performance before and after ecstasy.
They found that on all the tests except for verbal memory, ecstasy users performed just as well as before, and on a par with abstainers (Archives of General Psychiatry, vol 64, p 728). The results chime with Rogers's conclusions: because the effect was so small - a difference of a quarter of a word on average from a list of 15 - the real world implications are questionable. Brain imaging revealed no changes to the serotonin system, although there were signs of damage to white matter and blood vessels. The practical significance of this is not yet known (Brain, DOI: 10.1093/brain/awn255).
On all the tests except those for verbal memory, ecstasy users performed on a par with abstainers
Rogers cautions that it is too soon to give ecstasy the all-clear in the long term, not least because some effects on health might simply kick in even later. "It's possible that ecstasy has horrific consequences later in life. Only time will tell." [ Hermit : Knowing many ecstasy users as well as people practicing transcendental meditation (and more than a few who do both), I would say that the neurological impact of long term meditation is significantly more harmful. ]
The low-down on ecstasy- Ecstasy usually refers to a compound called MDMA or 3,4-methylenedioxymethamphetamine.
- MDMA was first synthesised by German firm Merck in the early 20th century but only started to be used as a recreational drug in the 1980s.
- There are around 450,000 regular users in the US; half a million people take it each year in the UK. A seriously heavy user might take up to 40,000 tablets in a lifetime.
- Drug dealers originally wanted to call MDMA "empathy" because of the powerful feelings of "loved up" warmth it induces. MDMA is also a stimulant and a mild psychedelic.
- Recent research suggests that most ecstasy pills on the market contain MDMA as their only active ingredient. Toxic impurities are often said to be common, but there is very little evidence that this is the case.
- Most of the ecstasy on the market is in pill form, with each pill containing around 40 milligrams of MDMA. But very pure MDMA powder accounts for around 30 per cent of drugs seized, which is worrying because of the potential for taking very large doses.
- A single ecstasy tablet used to cost £15. Now they cost just £2.30.
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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Fritz
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Re:Ecstasy's long-term effects revealed
« Reply #1 on: 2009-02-21 22:22:53 » |
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I knew I had read another spin on ecstasy and finally found it
Cheers
Fritz
Ecstasy
Agony and ecstasy
Source: The Economist
Author: The Economist
Date: Dec 18th 2008
Ecstasy may be good for those who can’t get over something truly horrible
image by Craig Ward
“I’VE been shot in the leg. I’ve been beat up. But that’s pretty minor,” says a 41-year-old American security contractor who spent four years in Iraq. “But when you get a vehicle blown out from under you and ambushed by six or eight al-Qaedas, it does tend to affect one a little bit.”
With a broken back, two broken feet and neurological damage, the man, who asked that his name not be used, spent the next three months in hospitals in Iraq, Germany and America. But though he was physically on the mend by the start of this year, he found himself incapacitated. “I was having nightmares right off the bat,” he recalls. “I couldn’t do anything. Mostly, I’d just retreat to a room and not leave.”
Post Traumatic Stress Disorder, or PTSD, is the persistence of debilitating psychological symptoms. It can include flashbacks and nightmares, increased arousal in the form of insomnia, anger and an inability to concentrate, and impaired personal relationships. Although lasting psychological damage from horrific experiences has been recognised since time immemorial, it is only since 1980, when veterans were still experiencing stress from the Vietnam war, that PTSD has been a formal psychiatric diagnosis.
By 2005 72,000 American veterans were receiving disability payments for PTSD. A study two years later estimated that 12% of American veterans from the wars in Iraq and Afghanistan suffer from PTSD. Thus far, 1.8m Americans have been deployed in those two theatres, implying 216,000 eventual cases.
Yet most PTSD sufferers are not drawn from the ranks of those for whom trauma is an occupational hazard: 5% of American men suffer from PTSD at some period in their lives. For American women, the rate is double that, mostly from exposure to such crimes as domestic violence and sexual abuse. Two in five rape victims are diagnosable with PTSD six months after the attack. “It can go on for ever”, says Kathleen Brady, a professor of psychiatry at the Medical University of South Carolina who studies the disorder, “but even after 30 years, PTSD is treatable.”
Treatment usually includes drugs and antidepressants such as Zoloft, sometimes combined with psychotherapy. “There is a lot of evidence supporting exposure-based therapy”, says Dr Brady, “which means re-living the events in a safe setting so patients can separate the inappropriate effect from the trauma.” Yet in at least a quarter of cases chronic PTSD is resistant to all treatment.
Gail Westerfield, a writer who lives in South Carolina, was sexually abused by a neighbour when she was a child, and later raped by an acquaintance when a university student. She suffered a range of symptoms including memory problems, bouts of depression, crying fits and tremors.
She was diagnosed with PTSD a decade ago when she was in her 30s. But she found this knowledge cold comfort. “I was probably on half a dozen different kinds of antidepressants over the years”, she says, “and they never worked for me. I’ve had this my whole life, pretty much.”
So the results of a clinical trial recently announced by Michael Mithoefer, a psychiatrist in Charleston, South Carolina, are encouraging. Twenty patients with PTSD who had resisted standard treatments—including both Ms Westerfield and the security contractor—were given an experimental drug in combination with psychotherapy. After just two sessions all of them reported dramatic improvement. The compound, methylenedioxymethamphetamine, or MDMA, is not new. Known as Ecstasy, it is illegal nearly everywhere.
Dr Mithoefer’s study is part of a broader resumption of research into the therapeutic uses of psychoactive compounds. Scientists in North America, Europe and Israel are studying the use of MDMA, LSD, hallucinogenic mushrooms, marijuana and other banned psychoactive substances in treating conditions such as anxiety, cluster headaches, addiction and obsessive-compulsive disorder. They are supported by private funds from a handful of organisations: the Beckley Foundation in Britain; the Heffter Research Institute and the Multidisciplinary Association for Psychedelic Studies (MAPS) in America.
This avenue of research—as opposed to research into the damage done by recreational drug use—came to a halt in the 1970s when drug prohibition became politically popular first in America and then in the rest of the world. Though the “war on drugs” continues, the approach is gradually becoming less dogmatic and more pragmatic. Even so, research into therapeutic uses of banned drugs is fraught with political considerations, often with bizarre results. For instance, though medical marijuana is now recognised in many parts of the world—in California more than 20,000 people are registered to use it—there are few studies into its benefits.
Fun has its uses
MDMA was first synthesised almost a century ago but was little noticed until the 1960s when young American chemists began to ingest it. Alexander Shulgin, a chemist at Dow Chemical in California who had invented Zectran, the first biodegradable insecticide, had been experimenting—in every sense—with mescaline and its chemical relatives. Then one of his students suggested that he try MDMA. “By golly”, he recalls, “she was absolutely right: this was an interesting compound.”
Mr Shulgin left Dow to pursue psychoactive chemistry full-time. Over a couple of decades he synthesised hundreds of chemicals, all of which he tried first on himself and a small group of volunteers. One of his collaborators was his wife, Ann. In the late 1970s the Shulgins introduced MDMA to Leo Zeff, a Californian psychotherapist who had developed LSD therapies in the 1960s when that drug was still legal. Dr Zeff was so impressed that he postponed retirement and became an enthusiastic proponent of the drug (which he called Adam), introducing it to hundreds of other therapists in America and Europe.
But in the 1980s MDMA, which at the time was still unregulated, escaped its semi-underground psychotherapeutic milieu and began to be taken by young people for the sheer fun of it. In a panic, America’s Drug Enforcement Agency (DEA), unaware of the therapeutic MDMA network, made an emergency classification in 1985 that placed MDMA in Schedule I—the most restrictive category for drugs with “a high potential for abuse” and “no currently accepted medical use”.
Schedule I also includes marijuana, LSD, psilocybin, mescaline and heroin (though rules vary widely: heroin, for example, is available by prescription in Britain and some other countries). Cocaine, amphetamines, opium, morphine and others are in Schedule II and can be prescribed by doctors under DEA supervision. Although 500,000 doses of MDMA had by this point been used in therapeutic settings, the compound was thereafter banned worldwide.
Some therapists went underground, continuing MDMA treatment illegally, using illicit supplies. “It’s a very simple compound to make,” remarks Mr Shulgin.
Ironically, once it became illegal, MDMA’s recreational use exploded. The UN estimates that at least 9m people—compared with 12m heroin and 16m cocaine users—consume round about 100 tonnes of MDMA and related compounds worldwide each year. The criminal nature of the business makes it difficult to assess the dosage or purity of the MDMA being consumed and it can have lethal effects. But millions of people, rolling about on fake fur pillows or waving glowsticks to electronic music, attest to feeling good. “The first time I ever did it was literally the first time in my life that I felt good in my body,” says Ms Westerfield, who took MDMA recreationally in the 1980s (half the study participants had swallowed the drug occasionally in the past).
In 1986 Rick Doblin, one of Dr Zeff’s students, founded MAPS with the goal of ushering MDMA through the formal drug-approval process of America’s Food and Drug Administration (FDA) and so bringing about its rescheduling. Drug approval often takes big pharmaceutical firms a dozen years at an average cost exceeding $1 billion. But Mr Doblin, then a student, had time and enthusiasm on his side.
“Our whole approach is based on the idea that science matters at the FDA,” he says. No studies had been performed on the effects of banned psychoactive drugs on humans since 1971 (though a thaw came in 1990 with a study to assess the relationship between schizophrenia and dimethyltryptamine or DMT, a potent hallucinogen that occurs naturally in the brain). Mr Doblin explains that since the FDA insists that psychedelics should be treated like any other drug, “we had to start with a Phase I safety study, where the drug is first used on humans—even though millions of people had taken MDMA by then.” The study got going in 1992 at the University of California, Los Angeles.
The results were positive but by the mid-1990s, when the study was complete, MDMA had become even more controversial. It was not until 2000, when Mr Doblin met Dr Mithoefer, another of Dr Zeff’s former students, that the opportunity arose to propose a Phase II study on the efficacy of MDMA in treating PTSD. Treatments began in 2004.
Dr Mithoefer’s Phase II research, which used MDMA from the only legal source—a chemist at Purdue University licensed by the DEA to distribute controlled quantities from a supply synthesised in 1985—is directly descended from the first generation of LSD psychotherapy. Subjects were given MDMA while attended by Dr Mithoefer and his wife, a psychiatric nurse. They rested on a futon, listened to music and were encouraged to revisit their trauma.
“I was blown 15 feet through the air, and forgot the ride upwards”
“I remember feeling incredibly safe and very motivated,” says Ms Westerfield of her first session. The security contractor from Iraq concurs. “It helped me put the pieces of the puzzle together,” he says. “I was blown 15 feet through the air in a vehicle, and I forgot the ride upwards. It made me remember it.”
The patients who received MDMA showed statistically significant improvement of their PTSD symptoms compared with those who received the same day-long therapy sessions with an inactive placebo. “All the major approaches involve revisiting the trauma in therapy”, says Dr Mithoefer, “but patients may be overwhelmed and retraumatised.” He believes the fear and defensiveness that characterise PTSD are obstacles to treatment, and that it is MDMA’s attenuation of these emotions that permits concurrent psychotherapy to be effective. He will publish the study shortly.
Several additional Phase II studies organised by MAPS are about to start in Israel, Switzerland and Canada. A Phase III trial, in which the methodology is extended to many more therapists and several hundred patients, is still more than two years away. But eventually, if two Phase III studies are successful, the next step would be rescheduling MDMA. Dr Mithoefer is cautious, suggesting that looking that far ahead is premature. “There’s reason to think this may be an exciting new treatment at some point,” he says. “But it’s a long way to proving it in larger trials.”
“We don’t have failures”, says Mr Doblin, “because we’re working with drugs that have been tested in the underground, and work.” Government research into the harmful effects of these drugs has, curiously, helped his cause: “There are over 3,000 papers on MDMA that have cost more than $200m to produce,” he says. He estimates that, thanks to these bodies of formal and informal knowledge, MAPS can take MDMA through the approval process for only about $10m.
While the bureaucracy rolls on, a few people are watching the results with personal interest—and impatience. “There are other things that I would still like to work on,” says Ms Westerfield, whose last MDMA-assisted therapeutic session was four years ago. “That’s why I hope it gets approved sooner rather than later.”
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Where there is the necessary technical skill to move mountains, there is no need for the faith that moves mountains -anon-
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letheomaniac
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Re:Ecstasy's long-term effects revealed
« Reply #3 on: 2009-02-25 12:52:41 » |
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Quote:| I wonder how the long-term effects of SSRIs compare... |
[letheomaniac] Anything is possible. Drug manufacturers are not known for putting public safety ahead of profits, so the potential long-term effects could range from a mildly annoying ailment to psychosis to death. And then the drug companies will sell you yet more drugs to treat all the new symptoms that they have helped you develope.
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"You can't teach an old dogma new tricks." - Dorothy Parker
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the.bricoleur
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making sense of change
 
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Re:Ecstasy's long-term effects revealed
« Reply #4 on: 2009-03-14 04:01:52 » |
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Thanks for posting this Hermit.
All I would add is this, MAPS, for those who wish to research it further.
-iolo
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