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From: an13187@anon.penet.fi (H-Man)
Subject:  MDMA article #3
Message-ID: <1993Jul3.005612.5414@fuug.fi>
Date: Wed, 30 Jun 1993 02:05:55 GMT

[some bs deleted -cak]

                       Arch Gen Psychiatry 1989; 46: 191
 
                                 February, 1989
 
SECTION: LETTERS TO THE EDITOR
 
LENGTH: 623 words
 
TITLE: ' Ecstasy' : A Human Neurotoxin?
 
AUTHOR: STEPHEN J. PEROUTKA, MD, PHD, Department of Neurology, C-338, Stanford
University Medical Center, Stanford, CA 94305
 
 TEXT:
   To the Editor. -- 3,4-Methylenedioxymethamphetamine ( MDMA; "ecstasy" ) is a
ring-substituted amphetamine derivative that is chemically related to both
hallucinogens and stimulants.  The drug appears to have unique psychoactive
properties and has been advocated by certain therapists as an adjunct to
psychotherapy. [n1] However, due to findings in laboratory animals [n2] of
neurotoxicity caused by  MDMA  and related compounds, the drug was placed on
Schedule I by the Food and Drug Administration in July 1985.  Significant
controversy exists concerning the legal status of MDMA, its potential
clinical efficacy, and, most importantly, the possibility that it may cause
irreversible neurotoxicity in human users. [n3]
 
   In addition, undocumented reports have suggested that the recreational
use of MDMA has been increasing at university campuses in the United States
during the past few years.  Although no formal epidemiological studies have
been performed, a recent informal survey found that a significant number of
students on an undergraduate campus reported taking at least one
recreational dose of MDMA.  [n4] The median amount of MDMA usage was four
doses, while the mean number of doses taken was 5.4.  The amount of drug
taken in a single dose ranged from 60 to 250 mg (approximately 1 to 4
mg/kg).  Similar dosage patterns have been reported to be neurotoxic in
primates, [n3] and at least five deaths in humans have been attributed to
recreational use of MDMA and related compounds. [n5]
 
   Presently, there are no data to indicate that recreational doses of MDMA 
permanently damage the human brain.  However, it should also be stressed 
that no scientific studies have addressed this problem.  Nonetheless, based
on informal discussions with approximately 100 recreational users of MDMA, a
number of personal observations suggest that MDMA is much different from
other recreational drugs, as described below.
 
   1.  Recreational users of  MDMA  frequently state that they usually wait at
least two to three weeks between doses of the drug.  The reason given for this
unusual pattern of recreational drug use is that the "good" effects of the drug
appear to diminish while the "negative" side effects of the drug appear to
increase if the drug is taken too frequently.  For example, taking a double
dose of MDMA does not double the supposed good effects of the drug but
simply increases the negative effects of the drug.

   2.  The majority of people who have taken more than five individual doses of
 MDMA state that the good effects of the drug change with successive doses.
As stated by one college student, "Freshmen love it; sophomores like it;
juniors are ambivalent, and seniors are afraid of it." These observations
are of concern, since no other drugs are known that, when taken at very
infrequent intervals (ie, every month or so), cause different effects with
successive doses.
 
   3.  MDMA is not "addictive." It is extremely rare to find individuals who 
have taken large quantities of this drug.  Again, this is quite different
from many recreational drugs, which tend to be either psychologically or
physically addictive. To my knowledge, there are simply no reports of
individuals who take frequent and large amounts of MDMA for an extended
period. 
 
   In summary, these completely informal anecdotal observations are consistent
with the belief that there is a long-term, and potentially irreversible, effect
of  MDMA  on the human brain.  Obviously, a definitive assessment of the human
neurotoxic potential of MDMA must await the completion of formal clinical
[n6] and epidemiological studies.  However, a reasonable and informed
conclusion would be that recreational use of  MDMA  should be avoided.
 
 REFERENCES:
[n1.] Greer G, Tolbert R: Subjective reports of the effects of  MDMA  in a
clinical setting.  J Psychoactive Drugs 1986;18:319-328.
 
[n2.] Schmidt CJ: Neurotoxicity of the psychedelic amphetamine,  MDMA.   J
Pharmacol Exp Ther 1987;240:1-7.
 
[n3.] Barnes DM: New data intensify the agony over  ecstasy.   Science
1988;239:864-866.
 
[n4.] Peroutka SJ: Incidence of recreational use of
3,4-methylenedioxymethamphetamine ( MDMA, 'Ecstasy' ) on an undergraduate
campus.  N Engl J Med 1987;317:1542-1543.
 
[n5.] Dowling GP, McDonough ET, Bost RO: 'Eve' and ' ecstasy' : A report of
five deaths associated with the use of MDEA and MDMA.  JAMA
1987;257:1615-1617. 
 
[n6.] Price LH, Ricaurte GA, Krystal JH, Heninger GR: Neuroendocrine and mood
responses to intravenous L-tryptophanin 3,4-methylenedioxymethamphetamine
( MDMA) users: Preliminary observations.  Arch Gen Psychiatry
1989;46:20-22.