This is a revised version of the first edition. This is sold out in Europe, but is still available in the USA from distributors: Book People and Inland Books who supply bookstores and mail order companies such as Books by Phone. The US shop price is $12.95. Single copies are also available from the publisher for #10 Europe or #15 airmail worldwide if orders are paid by Visa or Mastercard and faxed to +44 71 379 0135 or e-mail to nicholas@neals.cityscape.co.uk. Include name, account number, expiry date, address (must be same as account is sent to).

A German language edition will be published in September by Verlag Ricco Bilger, Josefstrasse 52, 8005 Zurich, Switzerland. Title: Ecstasy. ISBN: 3 908010 12 8. Price SFr.38 plus SFr.10 including postage wordwide.

Copyright Nicholas Saunders and Alexander Shulgin 1994.

This material may be freely distributed electronically, but may be printed for personal use only. Permission is required for any other use of any of the contents. This will normally be given freely, provided prior permission is obtained and the source credited in an agreed form.

The appendices can be found in the file "e.is.4.x.append".

Contents

1: Introduction

2: Own Experience What I feel it has done for me; how I have experimented with it and researched

3: History of Ecstasy first invented and patented; tested by US army; re-discovered by Shulgin; used for psychotherapy; wildly popular available by credit card; alarm due to previous impure drug causing Parkinson's disease; banning in US against recommendation; media muddle; appeal overturned; rise of the rave in US, Europe and then back to US; permission to use in Switzerland; permission to use in US.

4: What it Does and How it works Emotional effects: allowing the chi to flow, dissolving fear, allowing memories to surface, being temporarily free of neurosis, feeling love, removing defensiveness, allowing indulgence. Medical effects: effect on brain with fairly full explanation including diagrams to show how brain cells transfer info. Side effects such as blood pressure and temp rise. What organs get rid of it. Effects of combining E with other drugs. Sex.

5: Who takes Ecstasy Own survey results, references to other surveys. How many people take E deduced from surveys and seizures. Welshpool and football supporters

6: Dangers Reports of death here and in the US and why different. Overheating. Heart failure, strokes. Neurotoxicity: the research that caused the fears and the present assessment. Risk assessment compared to other activities as from my article. Who should avoid taking Ecstasy. Psychological dangers: what kind of people have been damaged by MDMA. Media overstatement.

7: The law, the media and the establishment Times article

8: Psychotherapy in Switzerland

9: Popular uses of MDMA Used for opening up and having fun; slimming/keeping fit; dancing; problem solving; improving relationships; professional psychotherapy; amateur psychotherapy; as an alternative to psychotherapy; in rituals; in place of a quick holiday; for pain relief; for depression. . .

10: Suggestions for users Ideal situation in town, in country. What to have with you and what to avoid. When to take it. Who to take with and who not to. Describe Set and Setting. How to be a guide.

11: Ecstasy and where does it come from Tests for MDMA in the lab and at home. List of characteristics. What drugs are sold as MDMA and how to distinguish them. Are other drugs more toxic?

Is MDMA cut with poisonous substances? Why it sometimes has a different effect. Production and distribution

12: Discussion of establishment attitudes edited version of Shulgin's chapter 42

13: Case histories First-hand accounts edited to provide examples that the reader may be able to identify with. Both positive and negative experiences.

Appendix 1: Reference section Summaries of reports I have read.

Appendix 2: Annotated bibliography by Shulgin

Appendix 3: Directory of Organisations in the UK which deal with Ecstasy users

Appendix 4: Research projects under way at present.

1 Introduction

A large proportion of young people, especially in Britain, are regular users of the drug Ecstasy (E, Adam166, X or MDMA) for a simple reason: it provides them with access to an experience which they value. Yet the majority of first-time users have no access to reliable information about the drug and rely on folklore for guidance, while little serious attention is paid to the potential uses and benefits of MDMA. This book is intended to satisfy Ecstasy users' thirst for knowledge, to help them to avoid its dangers and make the best of possible benefits as well as to stimulate further research into this fascinating drug.

The first part of the book is brief but complete in itself. Those who want to know more on any particular subject should follow the little numbers to the reference section; those who don't want to miss anything should also read that section, as it also includes many fascinating items of additional information. Then there are the personal accounts which are an easy read and have been chosen to demonstrate most of the effects of the drug.

Finally, there is an annotated bibliography for serious researchers.

While the first edition was about and for British users of Ecstasy, this edition includes a broader usage both in Europe, the USA and Australia, and will be published in German. Much of the book has been rewritten to incorporate the greatly increased volume of references.

In the summer of 1992 I held a meeting to bring together people who had experienced a positive change as a result of taking Ecstasy. I was sick of the rubbish put out by the media, and I wanted to see how many people, like myself, felt the drug had done them good. Most of those who attended had far more experience of the drug than myself, and it was hardly surprising that nearly all credited the drug with improving the quality of their lives. But what made a strong impression on me was that, although those users desperately wanted information, they knew very little about the drug.

That decided me to produce this book.

In 1970 I wrote Alternative London, a guidebook for people living in the city who, like myself, were exploring alternative lifestyles and other levels of consciousness. As with MDMA now, media coverage of our lifestyles consisted of horror stories and ridicule. As with Alternative London, this book is based on personal experience backed up by extensive research.

2 My own experience with E

The seventies and early eighties was a period when I was energetic and productive, enthusiastically involving myself in one successful project after another, first a guidebook called Alternative London and then a series of 'alternative' businesses which I had started in Neal's Yard, a courtyard in central London. Yet by 1988 I felt disappointed because most of the original ideas I had pioneered had been discarded. That year I did start a new business, but more out of desperation to prove myself than enthusiasm, and it was not a success.

I was in that strained frame of mind when a friend called Claudia offered to take me on an Ecstasy trip. She is an extrovert actress who I've known for years and, as rather an introvert myself, I wanted to keep my distance to avoid being overpowered by her. We swallowed the capsules in her flat and then headed off for Kew Gardens, a place I loved and where I thought I would feel safe. On the way to the station I felt symptoms familiar from taking LSD in the sixties - I would see something happening out of the corner of my eye but it would return to normal when I turned my head. As we got on the train Claudia took my hand. . . What a surprise! It felt wonderful to be touched, and there was nothing threatening about her, she was really warm and caring. Even the worn train seat felt good, and I rubbed the back of my head on it like a cow does on a gate. I felt Claudia's delight at seeing me opening up. "I could really get into this, would you stop me if I go too far?" I asked. Claudia laughed and told me to enjoy myself while she looked after me. I got into catlike stretching and slid under the table to enjoy the space, laughing at how shy old me could behave like that. When I sat up I found that I could 'ride' the train like a horse, responding to its bumpy movement. I looked out of the window and saw everything afresh; not only beauty but ugliness was accentuated, too.

When we got off the train I took deep breaths and the air felt wonderful.

It was good to be alive. But the intellectual part of myself asked "What is different to normal? Why isn't life always like this?" I deduced that I was simply allowing myself to enjoy what had always been there. I realised that I had got into the habit of restraining myself. It was not this drug-induced state that was distorted - it was what I had come to accept as my normal state that was perverse. I then realised that over the past few years I had been mildly depressed. And, what's more, I could see why: some years before I had felt cheated by the person who took over the wholefood shop, and I had carried that resentment like a burden ever since. This realisation and the experience of a few hours 'freedom' was just the tonic I needed; it got me out of the rut and I started afresh with new enthusiasm.

Since then I have taken the drug three or four times a year. Only twice has the experience been less than delightful, but on both occasions it nevertheless provided insights. Once was when I took Ecstasy in a flat in Holland with Anne and Afga, two woman friends who I had known since the sixties, I became acutely aware of how the years had changed them. I could see that Afga had suffered a great deal as a result of the men she had been involved with, yet it seemed to me that the pain had matured her into a strong and serene woman. I felt that Anne, by contrast, hadn't allowed life to hurt her and was still playing the 'flower child' which simply didn't fit the middle-aged woman she had become. As the trip proceeded, I found it difficult to communicate with them. Afga became absorbed in her own thoughts and ignored me, while I restrained myself from telling Anne how I saw her. As a result I got a headache. The other occasion was with a tense friend who suffered from crippling stomach cramps. When the drug took effect her face opened up and she felt truly relaxed for the first time in years, allowing her to slither around the floor like a snake - until it wore off and her cramps returned with a vengeance. Altogether it was a painful experience, but it did provide her with a valuable insight into the cause of her cramps: the memory of being raped as an adolescent.

On one occasion I was on a walking holiday in the Himalayas. I was trekking in Nepal with a Danish couple who I had met on the trail. Our trek took us over a 17,000 foot high pass, an extreme effort and achievement for all of us, and next day we took some E as we sat in the cold sunshine overlooking Tibet with a glacier ice-fall behind us and the peak of Annapurna gleaming across a wide valley. As we watched, clouds formed on the peak, then they drifted across the valley changing shape into fishes, dragons and horses.

At one point an eagle swooped down over our heads, and we felt as though we were carried with it across the valley below. Afterwards the reserved French geologists at our hotel responded to our warm mood by bringing out brandy and chocolates which they had reserved for a special occasion. There were no insights, it was simply a wonderful day where the surrounding magnificence was enhanced, but the shared experience formed a bond between us and we travelled on together like old friends.

Another time was spent in the countryside with a lover whose Sufi master warned that drugs damage the psyche and would undo hard-earned spiritual achievements. As the drug came on her face lit up and she cried, "What fools they are." Spirituality was right there for her, and she still regards that event as a valid mystical experience. We found ourselves utterly fascinated by a moorhen that was building its nest, as though the bird had acknowledged our presence and was letting us observe its skills.

After all these experiences on E, I had still not been to a rave. It was not that I didn't want to, but simply that, as a middle-aged man, I thought I would feel conspicuously out of place. Then the opportunity came: a rave where several of my friends would be, one actually older than myself. I quite enjoyed myself thanks to the E putting me in a positive mood, but I could not get into it. The dancers appeared to be lost in their individual trips, facing the speakers without relating to one another. I was simply amazed by the discomfort of the venue, with its rough concrete floor and steel walls wet with condensed sweat; the unrelenting, aggressive music and pulsing lights to match. It was not until I had spent several more similar nights out that I was able to enjoy the true experience.

I was given a phone number by a friend to ring for tickets and was directed to a dilapidated block with a sign saying 'Offices to Let for #50 a week.

Move in today.' It looked bare as though they had done just that. A girl sold me the tickets and when I asked where the party was to be held she scrawled the address on a scrap of paper. Half expecting I'd been conned, I turned up at midnight just as the E I'd taken was coming on.

The venue was spacious and well-ventilated. The music was the usual Techno House, although not as harsh as some, and I tried to follow a friend's advice of moving with the bass and ignoring the rest. I got into dancing in my usual rather self-conscious way, keeping an eye on what other people were doing and well aware that I was much older than everybody else. Then, imperceptibly, I gradually relaxed, melted into it, and knew I was part of it all. There was no need to be self conscious; I had no doubt I was accepted; there was nothing I might do that would jar because everyone else was simply being themselves, as though they were celebrating their freedom from the constraints and neuroses of society. Although everyone was separately celebrating in their own space, when I looked around I would easily make eye contact - no-one was hiding behind a mask. There was virtually no conversation or body contact except for the occasional short hug, but I experienced a feeling of belonging to the group, a kind of uplifting religious experience of unity that I have felt only once before, when I was part of a community (Christiania) that was threatened with closure. It was as though we belonged to an exclusive tribe bonded by some shared understanding, yet full 'membership' was mine for the #10 ticket and #15 tablet. Not everyone was included; a few looked awkward, trying to fit in or dancing with style but without spontaneity. I assumed that they had not taken Ecstasy.

That experience was a revelation. I felt as though I completely understood what raves are all about - including the music, which had always grated on me. Harmony that I had found lacking was irrelevant: the music constantly provided energy to lift one up without ever letting one down; it built up more and more without ever reaching a climax. I found myself not only dancing to the heavy beat, but breathing to it too, sometimes letting out sounds along with the music. There was subtlety hidden in the change of beat, a kind of tease that made me smile each time. And it felt so very healthy, as though I was moving in a way that was a true expression of myself, with every part of the body feeling free and flexible. I felt much younger, almost reborn.

I danced continuously until 6 am without any effort, even though I would normally be exhausted after an hour of such vigorous exercise. As the E wore off, at about 4 am, I started to feel some tension in my stomach, but the trance remained until the end. On the way home in a car with friends the music carried on so clearly that we had to check that the stereo was off before believing the sound was coming from inside our own heads! I slept most of the next day and also right through the following night, without any further effects apart from stiffness in the legs.

Problem solving

In 1992 I became interested in exploring Ecstasy's potential for solving personal problems, and took MDMA with an old friend, Jill, with the specific intention of resolving problems and examining relationships in our lives. We each wrote down a list of subjects that we wanted to explore beforehand, and spent the first hour after the drug came on concentrating on one issue at a time.

I had snapped at an ex-neighbour a few days before. I was a bit shocked at myself as I couldn't see why I had done it. But on Ecstasy it seemed clear:

I felt threatened by the people who had moved into his flat and he had 'caused' this problem by having moved out! Next I focused my attention on one particular friend who I had always admired for what he had achieved in the face of enormous difficulties. My image of him was shattered and instead I saw him as a Chinese juggler spinning plates on bamboo sticks, desperately rushing from one to the other to forestall a catastrophe. It didn't seem like a revelation, more as though I had known it all the time, and only afterwards did I realise that this was a viewpoint that I had not seen before.

On later reflection, I assessed these insights on MDMA as valid but not the complete picture. It was as though MDMA had provided me with a different viewpoint, such as might be seen by a friend.

There was one occasion when the drug had virtually no effect on me, and that was when I was in love. It was later that I realised the significance: being on E is quite similar.132

3 History of Ecstasy

MDMA was patented as long ago as 1913 by the German company Merck. Rumour has it that the drug was sold as a slimming pill along with comic descriptions of its strange side effects, although it was never marketed and the patent doesn't mention uses. The next time it came to light was in 1953 when the US army tested a number of drugs for military applications - again, folklore says it was tried as a truth drug but there is no evidence for this.1

The father of MDMA - or 'stepfather' as he describes himself - is Alexander Shulgin.2 After obtaining a PhD in biochemistry from the University of California at Berkeley, Shulgin got a job as a research chemist with Dow Chemicals, for whom he invented a profitable insecticide. As a reward, the company gave him a free hand and his own lab. Having had an exciting experience on Mescaline, Shulgin used the opportunity to research psychedelic drugs. An accepted test for psychedelic effects was to observe how fighting fish change their behaviour. But there were problems: fish don't say when they are under the influence and, well, have you ever seen a fish that doesn't look stoned? His answer was to 'suck it and see'.

Eventually his company was embarrassed to find themselves holding the patents of some popular street drugs and he was politely given the push.

Shulgin continued testing new compounds on himself and a select group of friends for many years. Thanks to his remarkable personality - combining openness without proselytising about his liberal and controversial views - he has earned the respect of influential people and is able to carry on with his research today, with the full approval of the US government. His approach to psychedelics is similar to that of a botanist: he specialises in the phenethylamines, and delights in recording the subtle differences between each member of that family of drugs. His experiences are described in his autobiography Phenethylamines I Have Known And Loved. MDMA is but one of 179 psychoactive drugs which he describes in detail, and, although its effects are less dramatic than many, MDMA is perhaps the one which comes closest to fulfilling his ambition of finding a therapeutic drug.

Shulgin has now moved on to writing a book about another family of psychoactive drugs, the tryptamines, due out in 1995.

However, it was only after hearing glowing reports from other experimenters who had also synthesised and tried MDMA that Shulgin took an interest. He describes how in 1977 he gave some to an old friend who was about to retire from his career of psychotherapy.

He phoned me a few days later to tell me he had abandoned his plans for a quiet retirement. I know none of the details of the increasingly complex network which he proceeded to develop over the following decade, but I do know that he travelled across the country introducing MDMA to other therapists and teaching then how to use it in their therapy. They had all began, of course, by taking the drug themselves. He believed (as I do) that no therapist has the right to give a psychoactive drug to another person unless and until he is thoroughly familiar with its effects on his own mind. Many of the psychologists and psychiatrists whom Leo instructed developed small groups or enclaves of professionals who had been similarly taught, and the information and techniques he had introduced spread widely and, in time, internationally.

It is impossible to ever know the true breadth of therapeutic MDMA usage achieved during the remaining years of his life, but at his memorial service, I asked an old friend of his whether she had a guess at the number of people he had introduced to this incredible tool, either directly or indirectly. She was silent for a moment, then said, 'Well, I've thought about that, and I think probably around four thousand, give or take a few.' Those first psychotherapists to use MDMA were keenly aware that they had found a valuable new tool.3, 4, 135 As one put it, "MDMA is penicillin for the soul, and you don't give up prescribing penicillin, once you've seen what it can do". They were equally aware that if MDMA became a popular street drug, it could follow in the footsteps of LSD and be criminalized by the US government. They agreed to do as much informal research as possible without bringing the drug to public attention, and did pretty well - MDMA only gradually became known as a fun drug and it wasn't until 1984 that the bubble burst.

If MDMA is so wonderful, why hasn't it been marketed by any of the big drug companies? One reason is that the drug's commercial potential is small; another was that the US Food and Drug Administration (FDA) prohibited trials on humans. But perhaps the most significant obstacle to the commercial exploitation of MDMA is that it has already been patented - although the patent ran out years ago, a drug cannot be patented a second time. Before marketing a new drug, a drug company has to show that the safety risks are justified by the drug's benefits as a medicine, and this involves long and expensive trials. The only way of recouping that expense is by obtaining exclusive rights to sell the drug through holding its patent.

Those years 1977 to 1985 are looked back on as the 'golden age' of Ecstasy or Adam5 as it was then known. In psychotherapy, its use only appealed to a few experimental therapists since it didn't fit in with the usual 50-minute psychotherapy session, but they did include some of the most dynamic people in the field, including some who claimed that a five hour Adam session was as good as 5 months of therapy.166 There was also a select a group of 'explorers' who used the drug in various ways, but, surprisingly, they never discovered its potential as a dance drug.

By 1984 the drug was still legal and was being used widely among students in the USA under its new name 'Ecstasy'. (Rumour has it that a big-time dealer called it 'Empathy', but, although the name is more appropriate, he found that Ecstasy had more sales appeal.) In Dallas and Fort Worth, Texas, Ecstasy was even on sale in bars where you could pay by credit card, where it replaced cocaine as the drug of choice among yuppies and even spread to people who normally kept well clear of drugs. However, it was this public and unashamed use that resulted in the drug being outlawed.

A deeply-embedded puritan ethic seems to affect the response to drugs in Western societies. To use a drug for pleasure is taboo3, yet to use a drug to relieve pain is acceptable. In reality there is no sharp distinction: if someone is 'suffering from depression' and a drug makes him feel happy, it is regarded as a medicine and meets with approval. But if that person is regarded as normal and takes a drug that makes him happy, he is indulging in something quite unacceptable. Except, of course, if the drug happens to be nicotine or alcohol.16

During 1985 Ecstasy got into the mass media because a small group of people sued the US Drug Enforcement Agency to try to prevent them from outlawing the drug. The controversy provided free advertising which made Ecstasy spread like wildfire throughout the US. It was a case of bad timing - the previous year there had been a widely publicised disaster that made the authorities overreact to any new scare. A batch of 'China White', a so-called designer drug6 which was sold to heroin addicts as a legal substitute, had contained a poisonous impurity, and, tragically, it caused a form of severe brain damage similar to Parkinson's disease.7 As a result the US Congress passed a new law allowing the DEA to put an emergency ban on any drug it thought might be a danger to the public. On July 1st 1985 this right was used for the first time to ban MDMA - what is more, MDMA was put in the most restrictive category of all, reserved for damaging and addictive drugs without medical use.8 The effect of prohibition was to curtail research into the drug without changing the attitudes of recreational users.9 However, the Agency's haste was at the expense of not following the letter of the law, leaving the ruling to be overturned in subsequent court cases.

The temporary ban only lasted for a year; meanwhile a hearing was set up to decide what permanent measures should be taken against the drug. The case received much publicity and was accompanied by press reports advancing the kind of scare stories now current in Europe, which added to the pressure to make the ban permanent. One widely publicised report referred to evidence that another drug, MDA, caused brain damage in rats and concluded that MDMA could cause brain damage in humans.10, 11, 12 The media indulged in horror scenarios of 'our kids' brains rotting by the time they were thirty, although there was no evidence that MDMA caused brain damage in rats at the dosage levels used by humans. On the other side were the psychotherapists who gave evidence of the benefits of the drug - but they had failed to prepare their ground by carrying out scientifically acceptable trials, so their evidence was regarded as 'anecdotal'.

The case ended with the judge recommending that MDMA be placed in a less restrictive category, Schedule 3, which would have allowed it to be manufactured, to be used on prescription and to be the subject of research.

But the recommendation was ignored by the DEA, which refused to back down and instead placed MDMA permanently in Schedule 1. A group of MDMA supporters made a successful challenge to this decision in the Federal Court of Appeal, but their objections were overturned on 23rd March 1988.

The fight is still continuing on the grounds that the law is unconstitutional, that the correct procedure was not followed and that the DEA did not take all the evidence into account.

In most countries including the US, all new drugs are regarded as 'innocent until proved guilty' unless they are substantially similar in structure and effect to prohibited drugs, and this gives rise to the phenomenon known as 'designer drugs' - drugs which have been deliberately synthesised to avoid the law. In Britain, however, whole families of chemicals - including members that have not been invented - are treated as 'guilty until proved innocent' under the law. Psychedelic amphetamines, which includes MDA, MDEA and MDMA have been illegal in Britain since 1977, and, as in the US, MDMA has been placed in the category that attracts highest penalties.13, 14 All member countries of the United Nations are signatories to the International Convention on Psychotropic Substances (ICPO) and follow recommendations laid down by the World Health Organisation Expert Committee on Drug Dependence. In 1985, under American pressure, the ICPO asked member nations to place the drug in Schedule 1 although the chairman of the WHO Expert Committee disagreed with this decision, stating that "At this time, international control is not warranted." A clause was added encouraging member nations to "facilitate research on this interesting substance".15

The criminalisation of MDMA in America has had wide-ranging consequences.

The first was to prevent the drug being used by professional therapists, except in Switzerland (see chapter 9). The second was to reduce the quality of the drug as sold on the street, because demand was now met by clandestine laboratories and the drug was distributed through the criminal network. Although the number of users was dramatically reduced at first, criminalisation did not prevent the drug's popularity spreading worldwide.

Ecstasy arrives in Europe

Ecstasy was favoured by Bhagwan Rajneesh, the Indian guru whose disciples wore orange, and when his followers moved out of their ashram in Oregon they brought the drug to Europe in the mid eighties.17

The rave scene started on the hippy holiday island of Ibiza in 1987, where Ecstasy joined LSD and hashish at all-night dance parties. In England 'raves' took the form of both large outdoor and warehouse parties, well described by Paul Staines in Appendix 3.

Warehouses were prepared secretly so as to avoid local people obtaining a court order to prevent the raves happening. Tickets were sold in advance without the address, but with a phone number to ring on the night for instructions regarding a meeting place such as a motorway service station from where a convoy would proceed to the venue. Opposition to raves was fierce since people living up to two miles away could be kept awake all night. By 1990 the British government had passed a law, the Entertainments (Increased Penalties Act)18, which effectively put an end to these big gatherings.

The result was to push ravers into dance clubs. The Hacienda in Manchester led the trend in 1988 with the now prevalent style: DJs who never spoke, but teased the dancers with their subtle 'scratching' establishing the Manchester sound.19 From there clubbing on E came to London, the rest of Europe and eventually back to E's native California, as reported in the San Francisco Examiner:

The English ravers hit San Francisco in the winter of 1991. "We were suddenly surrounded by these kids, moving here from England. They were coming here in droves and bringing with them a new sensibility, a new style of clothes."

By this time Ecstasy had reached nearly every corner of society in England and by the winter of 1991-2 demand had outstripped supply, partly due to some massive police seizures.20, 21 Dealers responded by selling any old tablet as Ecstasy and no doubt made huge profits, but as a result people had disappointing experiences and turned away from Ecstasy. Many turned to LSD instead for the simple reason that the dose cannot be adulterated13 as it is microscopic (a thousand times smaller than a dose of MDMA) and is normally sold absorbed into a 'blotter', a tiny piece of paper too small to absorb active quantities of any other popular drug.

The English pattern of use contrasts with the American one both in kind and volume, which accounts for there being so many more casualties here. The proportion of young people taking Ecstasy is many times higher in Britain22, 23, and here it is nearly always used as a dance drug. Americans generally use Ecstasy at home, although English-style raves are on the increase.

Although the therapeutic use of MDMA has been outlawed in the US for the past seven years, steps are being taken there towards MDMA becoming a prescription drug. To comply with prerequisites for the licensing of new drugs, a non-profit organisation called The Multidisciplinary Association for Psychedelic Studies (MAPS) opened a Drug Master File for MDMA in 1986, thus permitting research into the drug to be conducted. Recently, research into the effects of MDMA in human volunteers has been approved by the FDA itself, and trials began in 1993.24 I have faith in common sense prevailing over prejudice in the long run; unless new evidence emerges that MDMA is toxic or another drug appears that is even better, I believe that one day MDMA will be an acceptable medicine.

4 What E does and how it works

What Ecstasy does is very simple, yet difficult to describe. It combines two opposite effects, stimulation and relaxation, but in addition provides a subtle quality of empathy.141 The radical psychotherapist RD Laing, who took MDMA at Esalen, California, in 1984 when it was still legal, said, "It made me feel how all of us would like to feel we are anyway . . . smooth and open hearted, not soggy, sentimental or stupid".25, 3 Another psychologist described it as providing a "brief, fleeting moment of sanity".110 The most similar experience familiar to most people is being in love.132

The most predictable feelings experienced are empathy, openness, peace and caring.166 However, what people experience can vary from paranoia140 to sleep138, depending greatly on other factors called 'set and setting'166 which includes their cultural beliefs, expectations and state of mind at the time.153, 166 Even your genetic make up may affect your experience.178

Psychiatric effects

In 1992 researchers in the US attempted to identify the effects of MDMA in psychological terms through studying its effects on psychiatrists.26 The psychiatrists' experiences varied, but apart from losing track of time, the most commonly noted effects were that they related to other people more openly with less fear or defensiveness. Half said the drug had a lasting positive effect on their 'social/interpersonal functioning', and nearly half mentioned changes in their spiritual outlook and values.46

The effects are similar, though more intense, to the popular antidepressant Prozac (Fluoxetine): it makes most people feel liberated and good about themselves, less self-conscious and able to feel emotions more clearly,148 while a small minority become more depressed. A university lecturer who was oversensitive to Prozac described how, as member of an examination review board, she felt euphoric and unable to take the subject seriously, an experience that sounds similar to MDMA. Both drugs lower serotonin levels, though by different means.30, 67

I believe that the drug's various effects can be reduced to two primary effects, one physical and one mental: the relief of muscular tension and the dissolution of fear. People on Ecstasy feel able to move and to express themselves freely, so the drug provides a taste of living without the restraints we have become to regard as part of life. Users often compare the effect to memories of early childhood when they would look people in the eye, live for the moment and were free of inhibitions.

The ideas of Wilhelm Reich, a radical student of Freud who developed his own theories, may be relevant. Reich developed the theory that children in times of trauma brace themselves against pain by tensing their muscles, a reaction which becomes habitual, and which develops into what he called 'body armour'. As adults, people prevent themselves from being hurt through 'being cool': avoiding expression of emotions or revealing weaknesses.

Reich believed that muscular tensions go hand in hand with emotional tensions or neuroses, and the test for being free of the latter is the ability to move in an 'orgasmic' way with spontaneous undulations flowing smoothly from head to toe, a form of movement that often occurs spontaneously on MDMA. It could be that the drug temporarily removes both neuroses and the associated body armour.

Ecstasy is unlike most other drugs in that it increases awareness of touch and sound, an effect that has been observed in laboratory rats.185 The drug has also been described as allowing the life force, or Chi, to flow freely.29 Traumatic memories, suppressed for years because they are too painful to face, may emerge and be looked at without terror. Insights into what is really happening in life can also occur. Pain may be reduced30, 31, 4, especially if it is based on fear, such as the fear of death.

Spiritual effects

It is also claimed that MDMA has some spiritual effects. Recently Alexander Shulgin told the story of a Japanese poet who tried MDMA and said: "It has taken twenty years of studying Zen for me to reach this clarity, but I'm glad I did it my way". A Benedictine monk at a monastery in Big Sur, California, tried to see if MDMA could aid meditation, and concluded that the drug 'facilitated the search by providing a glimpse of the goal', but that it did not replace the hard work required.5 A healer claimed that she saw a client's aura brightened by MDMA27, and there are many reports of people becoming more spiritually aware.28, 26

The Lion Path136, 149 is a road to enlightenment using MDMA as a tool. It is based on the idea that throughout history there have been certain 'open' periods related to astrology when there has been the opportunity for spiritual growth. Such an opening exists now until 1988, and the most 'open' days for each individual are determined according to their own astrological chart. On these particular days spread over 5 years, followers meditated in isolation on MDMA. Officially, MDMA is no longer recommended although it is still used by some followers.

Many spiritual practices "may be greatly facilitated and the effects amplified including meditation, yoga, tai chi, guided imagery, psychosynthesis, shamanic journey work and rebirthing. This is best done on low doses or towards the end of a session.166

The effects of MDMA vary greatly according to the intention of the user and external stimulation during the trip. In my experience, minimum stimulation (such as isolation with ear plugs) in secure surroundings produces the most inward-looking experience, while the direction, such as whether emotional or spiritual, depends on one's intention.

Telepathy

Many people feel telepathic on E, or as one reader remarked, "Where does empathy end and telepathy begin?" But although there are some anecdotes142, there were no responses when I asked readers to test their telepathic abilities with friends in another room.

Effects at raves

When MDMA is experienced at raves, it lacks some of the subtle effects experienced in quiet surroundings, but has an extra quality not seen when the drug is taken in private.32 The combination of the drug with music and dancing together produces an exhilarating trancelike state, perhaps similar to that experienced in tribal rituals or religious ceremonies.33

Ecstasy is often called the 'love drug', a name which suggests another way of looking at its effects. MDMA opens the heart and allows love to flow.

This may extend to loving oneself, overcoming awkwardness and allowing oneself to feel good.

Unpleasant effects

MDMA does not suit everyone. The most extreme example I have come across was a few years ago, when a man I knew who suffered from severe stomach cramps attempted to use the drug for self-therapy. During the trip he experienced a wonderful release, allowing him to move freely and flowingly.

However, as the effects wore off the cramps returned with a vengeance. It was a frightening experience; the following night he vomited until he was exhausted and has never wanted to take the drug again.

Even people who normally enjoy Ecstasy can have very different experiences including hallucinations, though these are usually due to another drug (such as LSD) sold as Ecstasy.Appendix 2 But even with pure MDMA paranoia is sometimes experienced.140

Less extreme reactions are more common. A woman friend who took E at a party reported that Ecstasy made her feel unpleasantly out of control and gave her a nasty headache, even though the pill appeared identical to that enjoyed by her friends. She went home early and felt depressed for the next two days.

Although I have found that Ecstasy temporarily stops pain such as toothache, some people have reported headaches and nausea accentuated without any of the pleasant effects. I believe it depends on what you focus your attention.

Ecstasy can upset people's lives. There are many examples of young people squandering ridiculous amounts of money on E and only living for their next binge. One known personally to me is that of a 23-year-old art student who used to live for the weekends when she and her friends took Ecstasy, and spent the rest of the time in a state of depression. This lasted for about a year until eventually she was thrown out of college, which made her even more depressed. However, two years later she emerged again as her former vibrant self, and looking back saw that her problems had resulted as much from her parents' divorce as from taking Ecstasy through which, she says, she made good friends.

In 1991, a survey conducted in Sydney34 found that 80% of those who tried Ecstasy thought that it was fun to use while 7% did not (13% found it 'neutral'). Three-quarters of regular users in Manchester said they usually enjoyed Ecstasy and most said it was 'here to stay' in their lives, but 18% enjoyed it less than they used to.182 Another Australian survey among amphetamine users showed that Ecstasy was not particularly liked.193 Much of the effect depends on the setting - if you feel relaxed anyway you are almost certain to enjoy it; although many tense people use the drug to help them relax, not everyone can yield to its effects. Clients who have used MDMA in psychotherapy - in which fun is not the object - tend to enjoy their first experience but to get absorbed in their problems on subsequent MDMA sessions.chapter 9

Although most people find the drug liberating and enjoy letting go, others may feel uncomfortable to be without their normal defences. Even for the same individual, a wonderful feeling of relief in a warm supportive environment can be extremely unpleasant in other circumstances. Users may come to bitterly regret having revealed their insecurity or longings when under the influence of Ecstasy and some insights, such as realising that your partner never loved you or that your dreams are not attainable, can be extremely unpleasant. To remember a traumatic situation without support can be devastating. When someone is 'on the edge' but just managing to keep life together, any of these situations may push them over, resulting in a 'nervous breakdown'.

It is important to realise that bad effects are not due to the drug alone, but to a combination of the effects of the drug and the situation at the time. A guide who has introduced MDMA to many people over the past 18 years assures me that none of them has ever had a bad experience, even though some were difficult cases. He attributes this to him being able to give whatever support was needed.144

Side effects

These can be uncomfortable, but hardly any users find that side effects spoil the experience. Dry mouth and loss of appetite are almost universal, and various muscular reactions are common, as though some muscles resist the drug's demand to let go. These include holding the jaw tightly clenched, eyes flickering from side to side, twitches, nausea and cramp, especially as the drug first takes effect. Generally these soon pass. Side effects are more pronounced with increased use.

Another more common but less serious problem with MDMA is that many people resist the effect of the drug. This is uncomfortable, often manifesting in a headache and nausea.

A long-term side effect experienced by ravers is weight loss which, for some women, is a motive for using the drug.35 Weight reduction is presumably caused by the combination of exercise and loss of appetite. Some women find their menstruation upset since they started using Ecstasy, but is probably an indirect effect.200 Some women also complain of urinary tract infections, but these may be due to the effect of MDA which is often sold as Ecstasy.173

Some people are concerned that a long term side effect may be to alter personality. However, the only changes identified have been improvements.157, 194

After effects

People often feel exhausted after taking Ecstasy. This 'hangover' is hardly surprising considering that the mind, and usually the body, have been so much more active than normal, and is similar to that experienced by users of LSD and amphetamine.34

Hangovers can be reduced by avoiding other drugs such as alcohol and ampheta mine and getting a good night's sleep afterwards. The antidepressant Prozac (and presumably other SSRIs) reduces hangover and prevents toxicity184, although regular Prozac use may interfere with the experience.142 Vitamins may also help36, and so may drugs such as L-Tyrosine and L-Tryptophan.192 Other after effects are most commonly stiffness from exercise, though depression28, 37, 44 inability to sleep191 and paranoia37 sometimes occur, particularly among heavy users. Pain in the lower back may be due to dehydration of the kidneys.200

Medical effects

When MDMA is swallowed, it is digested in the stomach and enters the blood stream. From there, some of it reaches the brain, but any MDMA that passes through the kidneys is removed and ends up in the urine - two thirds is excreted unchanged while some 7% is 'metabolised' into MDA. Every 6 hours the amount remaining in the body is roughly halved, so that after 24 hours there will be only about 3% left.38, Chapter 9 Other psychoactive drugs are excreted in a similar way, and this enables them to be 'recycled': Siberian reindeer hunters who take fly agaric mushrooms to get high drink each other's urine in order to prolong the effect.39

There are various chemicals called a 'neurotransmitters' naturally present in the brain which alter our mood and activity level to suit our situation.

Serotonin and adrenaline are just two of many neurotransmitters that block or allow the transfer of information between brain cells. Just as adrenaline affects our activity, serotonin (or 5HT) affects our mood. The mechanism by which they work is extremely complicated and is not yet fully understood. All that is really known is that we have varying amounts of these chemicals in our brains, and that the amounts vary along with our emotional state.

MDMA causes a release of serotonin from particular brain cells, and this produces a change of mood. It also affects aspects of the body's control system such as blood pressure and pulse rate and, most importantly, body temperature. It is this that has resulted in a number of deaths at raves, which are discussed in Chapter 6.

Effects on animals

Some people have described to me the effects of Ecstasy on animals.

The first is from a laboratory researcher.141 He believes that they do not enjoy any psychoactive drugs but feel confused, and that this is more so with higher animals like monkeys. However, a man described how he took E with a friend on the beach along with two German Shepherd dogs who had half an E each! He was convinced that one dog, who tended to jump up clumsily and too roughly for comfort, remained as affectionate as ever but became more sensitive and gentle; while the other dog displayed unusual signs of jealousy.

Thirdly, I have heard of Ecstasy being used as a cure-all for wild animals.188 The theory is that many animals from birds to horses are nervous, and it is this tension that makes them ill or prevents them from getting well, especially when kept by humans.

Lastly, I have been told of race horse being doped with MDMA before racing, which, like ravers, is said to make them calm as well as energetic.

Combining Ecstasy with other drugs

Ecstasy is often taken with cannabis, alcohol, LSD ('candy-flip') or amphetamines at raves, and cannabis is widely smoked in the 'chill-out' period afterwards. Although drinking has had a comeback41, most users feel that alcohol reduces the effect of Ecstasy. Alcohol taxes the liver and kidneys, causing dehydration, so taking it in combination with Ecstasy is likely to result in worse after effects than taking Ecstasy alone.40, 60, 62 Similarly, when taken with amphetamine the toxicity is greater than when the drugs are taken separately.141

Many users in the north of England particularly like to take Ecstasy with speed (one E with half a gram of amphetamine)40, which adds excitement and prolongs the experience. Home users in all areas generally prefer pure MDMA. The view generally held among these groups is that speed (amphetamine) spoils Ecstasy's subtle empathic quality.

Some ravers take Ecstasy alongwith LSD ('candy-flip'), with the hallucinogenic qualities of LSD adding to the warmth of the Ecstasy. This combination also extends the experience, as LSD lasts for about twice as long as MDMA, and is often used outdoors at music festivals and in natural surroundings.

Home users often refer to MDMA as a 'psychedelic amplifier' or 'catalyst', enhancing the effect of psychedelics without changing their quality. This has been tested with LSD, 2CB, MEM, 2-CT-2 and may apply to all other psychedelics. The psychedelic is taken towards the end of the strongest part of the Ecstasy trip.144 Some people use E to ensure against bad trips: once the MDMA has established its usual positive effect, the course is set for the LSD trip. Others find that LSD loses its usual effect and simply amplifies the effect of the E.128

A popular combination among home users is MDMA with 2CB taken towards the end of an E trip. As the 2CB takes over from the MDMA, the experience is subtly changed towards a more intellectual viewpoint from which some people find it easier to assimilate any insights gained.31 For hedonists taking E with a lover, the 2CB provides the erotic component of love suppressed by the Ecstasy.128

Nitrous oxide ('laughing gas') is said to be quite enjoyable while on E and can help if you get stuck in a particular state of mind128.

Ketamine can also be used while on Ecstasy for self exploration31, and sometimes also at raves though I have not heard of good experiences.

Drugs with similar effects

When you buy 'Ecstasy', it may not be MDMA but MDEA or MDA. These are all 'psychedelic amphetamines' with fairly similar effects and the amounts of each sold are about the same. Connoisseurs invariably prefer MDMA because of its empathic quality or warmth, but many users (and some dealers) can't tell the difference. MDA lasts twice as long (8-12 hours) and has a rather more amphetamine-like effect without producing much in the way of feelings of closeness. MDEA (sometimes sold as 'Eve'), lasts a rather shorter time (3-5 hours) than MDMA (4-6 hours) and is nearer to MDMA in effect, but still lacks its communicative qualities.38

The effects of all these drugs wears off after a few successive days' use, a phenomenon known as tolerance. However, there is no 'cross tolerance' between MDA and MDMA. Someone who has taken so much MDMA that it has no more effect on them can still get off on MDA.12

Future drugs like Ecstasy

The conditions are right for a flood of new and interesting drugs coming onto the black market. There is increased demand from both explorers and hedonists combined with new techniques which will enable drugs to be made with the effects users want without unwanted side effects.

There is a considerable amount of research into new psychoactive drugs now being carried out both legally (as basic research and in the search for new medicines) and illicitly. To some extent it is now possible to design a drug to produce a desired effect, while new techniques and equipment have opened the way to creating whole new ranges of drugs which were previously too difficult to synthesise.141

In addition, new methods allow the effects of new drugs to be assayed safely and quickly, such as by implanting electrodes in the brains of living animals. Recently drugs with very specific effects have been produced, and hallucinogens that are even more potent than LSD.141 It has also been shown that the desired effects of Ecstasy can be separated from the toxic effects.176, 184 The way is now open - and the search is on (illicitly) - to produce something that has the empathic qualities of MDMA without toxicity. One approach is to find a more potent drug so that a smaller, and therefore less toxic, dose is needed.141

Future psychoactive drugs may well be tailored according to fashion. As people become bored with the current fashion and move towards a new way of behaviour (such as being more grounded, perhaps) drugs will be created to produce the desired mood.

Sex

Although the media portray Ecstasy as an aphrodisiac, sexual arousal is not an effect of taking MDMA. In fact the drug tends to inhibit erections in men (and male rats190). However, people who are already feeling in a sexy mood as the drug takes effect may become aroused.128 Many users never become sexually aroused on E and find the state quite incompatible.

However, for others it depends on their libido at the time and this in turn depends on who they are with and the surrounding atmosphere, so that a place with sexual vibes such as a club may induce sexual behaviour while this virtually never happens at raves.200 In general, there is a tendency away from sexual desire but the drug allows one to continue on that energy level165, although erections are inhibited and orgasms suppressed.44 Behaviour at raves during the first few years, at events where nearly everyone was on E, was very different to that at alcohol-based clubs, and seemed to follow from the lack of male sexual aggression. Hugging and even caressing strangers was acceptable on a sensual level without implying a sexual advance.41 Ravers would have a sense of belonging at any club or event where others were on E.

According to Sheila Henderson writing in 1992, a researcher studying the way young women use Ecstasy and author of papers entitled Women, sexuality and Ecstasy41 and Luvdup and DeElited42, "Sex is not one of the foremost pleasures offered by Ecstasy. . . Most men have the opposite to an erection: a shrinking penis". Women can even enjoy snogging at raves because it is 'safe' - not a prelude to having sex. They are less likely to have casual sex following a night raving than after going to an alcohol-based club. As one girl put it, "you don't go to a rave to cop". In fact, sexual safety is an attraction at raves in contrast with alcohol-based clubs which are seen as a cattle market. However, by 1994 Ecstasy was not the predominant drug used in most venues174 and this atmosphere only survived in a few circles such as travellers' parties.

Other sociologists have noted that sexual behaviour at raves is less than at other social activities33, and that, on Ecstasy, "thoughts about sex are not always matched by desire". Though some found sex enhanced by the drug, others were disappointed.37 However, some women said that the chill-out period after raving was "the ideal time for long, slow sex".41 This view is shared by the girlfriends of working class men in the north, where Ecstasy has the reputation of being good for sex on comedown.40 An American pamphlet claimed that: "Sexual experience only occurs when it is appropriate on a heart level for both of you. . . Know that whatever you choose to create will be a perfect and appropriate choice".43

The question whether Ecstasy use increases risk factors concerning sexual behaviour is being examined in depth by Andrew Thomson. His study is not due to be complete until 1996Appendix 5, but preliminary results show that over three quarters of those interviewed who regularly used Ecstasy in clubs had practised sex while under its influence, and that one in six of these said that the effect of Ecstasy made it less likely that they would practice safe sex.125

Two other studies have indicated that injecting polydrug users who take Ecstasy have more sex than those who don't; but that amphetamine users who took E were less at risk of catching HIV because they were more likely to use condoms and no more likely to have sex.155

A group of Swiss psychotherapists (see chapter 9), who have experience of some hundreds of people in group and individual sessions, tell me that they have never come across a participant becoming sexually aroused while on MDMA, although it does sometimes happen on LSD. They say that sexual longings are sometimes expressed, but not the immediate desire for sex. The Swiss therapists appear to take it for granted that MDMA suppresses sexual arousal, and that men cannot have erections while on the drug.

However, a survey of users in the San Francisco area conducted in 198544 found that only half of the men who responded said it was more difficult to have an erection on MDMA, though, of those who said they had had sex on the drug, two thirds said they had problems in achieving an orgasm. While the great majority of users of both sexes said that the drug had no effect on their sexual desires, some reported a desire for sexual activities "that implied they felt free of inhibitions, such as group sex". Most respondents said that MDMA had made no lasting difference to their sexual pattern, although some reported positive changes such as being more open and relaxed. All the women and nearly all of the men thought that MDMA helped them to become emotionally closer to others. A third thought that MDMA had helped to overcome inhibitions, typically that it had "cleared pelvic blocks". The survey also found there to be no increase in the initiation of sexual activity, but slightly more receptiveness to it. In their conclusion, the authors comment that MDMA is a curious drug in that it can increase emotional closeness and enhance sexual activity, yet it does not increase the desire to initiate sex.

Respondents to an Australian survey34 described the effects of Ecstasy as 'sensual' rather than 'sexual'. In contrast, an unpublished survey of users in London45 found that 89% reported sexual arousal and 67% more sexual activity on MDMA.

I believe the explanation for such contradictory reports is that the effect varies considerably according to the user's expectations. Surveys may also produce results which are biased towards those who are more potent on the drug (or said they were), while those who felt that the questionnaire might reveal them to be inadequate were under-represented. There may also be some suggestion involved: the author of the London survey told me that he had experienced a sexual advance from a woman on E, and that he would expect increased sexual activity from users of a drug that increased energy and reduced inhibition. Similarly, I surmise that the Swiss men who were treated with MDMA were suggestible to their therapists' belief that men cannot have erections on the drug. I also suspect that many people do not make a clear distinction between sensuality and sexuality.

Women become sexually aroused more often than men, but find orgasm suppressed. Couples who have had sex on E say that it is unusually nice even without orgasm; they feel more loving than passionate and unusually sensitive to each other. It seems that a universal effect of the drug is to remove male sexual aggression, or, as one woman put it, "to bring out the feminine qualities in men". People on Ecstasy become more sensual and less lustful.

This sensual-rather-than-sexual aspect of the drug gives rise to non-sexual orgies at some parties, referred to as 'feely-feely' or 'snake slithering'.165 People indulge in group sensual delights through caressing and slithering over one another, though I've only heard of this in Australia and California.

The suppressive effect of Ecstasy on sexual drive has been a strong influence on rave culture. On Ecstasy, small talk and flirting seem ridiculously hollow, and so this sort of behaviour has become taboo in rave culture. Women became truly liberated; able to let go and enjoy themselves without fear of being taken advantage of by aggressive men, and this allowed them to approach men who they don't know. Similarly, women who didn't feel threatened by men felt free to respond warmly. The atmosphere inspired confidence and independence so that girls didn't feel the need to be under the protection of a boyfriend, often going to the rave with a group of friends but freely mixing with other people.41 However, this atmosphere has diminished in circles where alcohol and other drugs have largely replaced Ecstasy. Even then, women are less bothered by men due to group pressure to accept their liberated behaviour.

Another social effect of Ecstasy is to break down barriers between homosexuals and heterosexuals. Women are free to hug one another without being thought of as lesbian, and gays are as likely to be hugged by women as men.42

5 Who takes Ecstasy?

How many people take Ecstasy?

No-one knows just how many people take Ecstasy, but there are some clues.

In 1993, British customs seized 554 kg, double the previous year's haul.20 That year E was in more plentiful supply than the year before, so the proportion seized was probably less than usual. At 90 mg each, 554 kg is enough for somewhat over 6 million doses. In spite of claims by customs that they intercept 10%, the true figure may be nearer 1%195, implying that several hundreds of millions of doses were imported, quite apart from domestic production. This is no hard evidence, but does suggest that there are several million British users. Seizures have increased each year.179 Another indication is the growth in rave attendances to over a million per week and the ever-widespread use of Ecstasy in clubs.159, 146, 175

The only British national survey on usage was conducted by Harris Opinion Polls for the BBC Reportage programme in January 1992. Interviewers asked questions about drug use to people on their way into clubs in the 11 largest cities in Britain. The answers of 693 people aged between 16 and 25 covering all social groups who were 'regular club goers' - i.e. said they attended at least once a month - were analysed. Overall 31% said they had taken Ecstasy regardless of social group. 33% said they had taken an illegal drug, but 67% said that their friends had done so.23

Andrew Thomson, a sociologist doing research among this age groupAppendix 5, believes that those who told the Harris interviewers that they did not take drugs but that their friends did so were probably lying (because the questions were asked in public), and that they actually took drugs themselves. This would explain the discrepancy with his own impression, and that of other observers, that the majority of this group use Ecstasy.

The total number of 16-25 year-olds in Britain is 7,444,300.47 Statistics to show how many of these are regular club goers are not available, but Andrew Thomson believes that the figure is about 90% among those he is studying. If that were the case, and 80% of the age group live within reach of cities, then the national figure would be 3.5 million, or 1.7 million if only those who openly admitted taking Ecstasy are included. Recently, it has been suggested that there are just as many users living in the country as in inner cities.145

A survey of school children across the whole of England found that 4.25% of 14 year-olds had tried Ecstasy.48 This comes to 24,000. Another (regional) survey found that 6% of 14-15 year-olds have taken Ecstasy.49 If applied nationally, that would come to 70,000.

Further statistics depend on guesswork. Ian Wardle of Lifeline, a Manchester organisation concerned with young people who use illicit drugs40, estimated in 1992 that a million Es were consumed every week in Britain. Other estimates are lower, for instance the number of people who have tried Ecstasy at raves has been put at 750,000.33 There are a considerable number of users outside the 16-25 age group who attend clubs, so the total number of people who have tried Ecstasy in Britain probably lies between one and five million. The fact that six million doses were seized without causing a shortage suggests the actual figure is at the higher end.

In contrast, the number of American users is small. A survey of a similar age group in 1991 found that only 0.2%, or one in 500, had used Ecstasy in the previous 30 days; while 0.9% had used E in the previous year.22 These figures imply that Ecstasy use was far less among young people in America than Britain that year, though that was before rave culture started in the States. Though there was a shortage of E in California in 1993, by 1994 it was plentiful again.165

As for frequency of use, a study of 89 Ecstasy users in London found that 46 had used the drug more than 20 times; 23 more than 40 times and 5 more than 100. About one third used it at least once a week, while a minority 'binged' on 10-20 over a weekend. Many took other drugs along with MDMA.45, 182

What kind of people take Ecstasy?

MDMA is used by a wider variety of people than other illicit drugs, and has been credited with bringing together types of people who would not mix previously. Besides ravers, users include Hollywood stars139, New Agers154, gays175 and psychotherapists. All over Europe and north America Ecstasy is found in city dance clubs, and in Britain it has spread out to people living in the country145.

Young people are the most receptive to E. Among British schoolchildren, Ecstasy is the drug most frequently encountered apart from cannabis, with girls trying it earlier than boys.181, 182, 201 But Ecstasy has spread to some surprising quarters. Peter McDermott, editor of The International Journal on Drug Policy, describes how it hit a group in Liverpool: "I went down to the local pub, and some of the regular four-pints-a-night drinkers were there - drinking orange juice and giggling: they had discovered Ecstasy."

Another older group of users are those who used to take LSD in the sixties and perhaps still smoke cannabis. An account is given below of how Ecstasy was picked up by such people in a particular rural community, but a similar trend has occurred all over the country. There are even some raves organised by and for this age group, although the majority at those I attended were in their twenties.

Arno Adelaars, a Dutchman who has written a book about Ecstasy17, says that extroverts and introverts use the drug differently. The extroverts use it for entertainment, to open up and relate to strangers at parties, while the introverts take it at home with a lover or a few close friends to provide intellectual insights. Arno, who is familiar with the English club scene, says that there is also a difference between the way E is taken in Holland and in England. In Holland no-one likes to lose control, especially in public, but in England people like to show that they are 'out of it'.

Trends among ravers

When raving was new to Britain, ravers described it as one big happy family and would feel at home at any event where people were using E. But over the years, and particularly from 1993, the scene has divided up into distinct subgroups - each with their own style of music and clothes, their own music and drugs of choice. At one extreme are some younger Northerners who wave white gloved hands and blow whistles, while at the other are the upwardly mobile professionals who have absorbed Ecstasy and rave-type parties into their lifestyle, dressing much as they would for an office party and starting the evening with a few drinks.146

In 1993, alcohol made a comeback in Britain174 and other drugs such as poppers were more popular in some circles, probably due to worsening reputation of drugs sold as E.172 But by 1994 the quality of Ecstasy improved and it became re-established as the dance drug of choice.197 Amphetamines have always been used along with E in the north40 and are now frequently used in London too. Pure MDMA is seldom used as the main drug, largely due to other drugs being sold as Ecstasy172, 173, but also out of choice.

Along with these diversifications in consumption of drugs, the atmosphere at events also varies widely and in general is less open-hearted. My impression is that the key rave experience, as described in Chapter 2, occurs much less often. The rave parties that still manage to create the atmosphere from the good old days are those organised by and for travellers.

Overall, it seems that, like all counter-cultures, raving has become mainstream but in a diluted form. Rather than being the exception, it is now normal to take E in a club, but the proportion of those on E is far smaller and many of them have also had a few drinks. Clubs need E available to provide a good atmosphere, so they encourage dealers on one hand while pretending to try to keep them out.175

A new trend is commercialisation of chill out parties. Formerly, ravers would invite others back to their homes for impromptu chill out parties.

This was very much part of the culture and still goes on, but now some clubs cater for the same needs of somewhere to go while coming down off E with comfort and ambient music. On Ibiza there is a club that opens daily at 6am for the purpose.

Own Survey

Having read the published reports of surveys concerning Ecstasy, I felt that none had asked the most important question: "Has Ecstasy changed your life, and if so, in what way?" During December 1992, I distributed a dozen 4-page trial questionnaires and, as a result of the response, reduced this to a 2-page questionnaire. During January and February 1993, I distributed 200 survey forms via various people with whom I was in contact through my research. 46 were returned, though some respondents skipped several questions.

The sexes were roughly equally represented (20 men to 18 women). Half of the respondents were under 25 and the majority of these were 20-23.

Respondents tended to be either heavy users who had taken the drug an average of 73 times, or light users averaging 5 experiences.

75% said they thought that taking Ecstasy had had an effect on their life.

The page of questions and answers on How your personality may have changed as a result of taking Ecstasy is given opposite. The most pronounced change was to enjoy dancing more. There was an increase in spirituality, being more in touch with the spiritual side of oneself and closer to nature.

Another pronounced change was unexpected: an increase in caring about other people. Seeing more friends, increased enthusiasm, increased happiness and self-esteem were also frequently reported. Negative effects were less pronounced, the most common being that Ecstasy had made ordinary life seem more boring. Also reported by some were more depression and illness.

A question concerning paranoia produced the most surprising result.

Although several people felt much more paranoid as a result of taking Ecstasy, others felt less paranoid. Four of those who felt much more paranoid were women who had taken only half a dose or less. All had taken the drug previously. Even more surprising was that none of these answered that Ecstasy had, overall, been bad for her: three answered "good" and one "neutral".

Many people added a few lines about the effect they felt Ecstasy had had on their life. Most implied that the drug had enhanced their social lives, and mention was frequently made of profound experiences varying from intimate to philosophical.

So as to throw light on the theory of 'inappropriate bonding' versus the theory that 'whatever you do on E will be right', I asked Have you ever fallen in love on Ecstasy, and if so how did it turn out? There were 7 responses. 2 said they were still in a relationship started on Ecstasy; 2 said they were already involved but became much more in love with their partners; one had a 3-day blissful romance that ended abruptly with a bump; one said she had made several wrong choices on Ecstasy and one described how both partners were embarrassed the next day about what they had said to each other.

The sample was too small and self-selected to draw conclusions from, but it does appear that many users experience changes well beyond the immediate effect of the drug. However, a major obstacle to drawing conclusions from such a survey is indicated by one comment, "I can't tell you what changes are due to Ecstasy, as my life has changed so much anyway". To overcome this would require comparison with an equivalent sample not taking Ecstasy.

I hope that this will encourage some further research on what I perceive as the most fascinating and important aspect of the widespread use of Ecstasy:

How does it affect people's lives?

Raves in Northern Ireland

There have been a number of anecdotes about Catholic and Protestant kids, brought up to hate one another, taking E together at raves and ending up hugging.150 Just possibly this breakthrough from hatred to affection may extend to relationships outside the rave, and could just spell the end of hostilities.

I have been told that the IRA used to keep drugs out of Ireland by kneecapping suspected dealers - a far more effective method than the law!

But in 1993, they dropped this policy with the result that Ireland enjoyed a freshness of new-found Ecstasy experience long since lost in England.

E hits a rural community

In 1990 Ecstasy arrived at the Pennine town of Garston Bridge, midway between Carlisle and Newcastle. This is one of those rural communities that was deserted by farmers in the fifties in favour of better paid jobs in the cities, leaving their old stone houses, barns and even schools to be sold at rock bottom prices to ex-city dwellers in the sixties and seventies - mostly ex-hippies in their late twenties settling down to start a family.

Typically these people got jobs or started their own businesses and lost interest in drugs, apart from hash, until Ecstasy arrived. Their children are now teenagers who, having been to school with the local farmers' children, mix more with the indigenous population than the parents do.

There is plenty of social life since people think nothing of driving 30 miles to a party, and the generations mix freely - at any party you can find all ages from 5 to 50.

Although country dwellers, these people kept up strong ties with their city backgrounds, mostly in London, so they were not far behind when raves became popular. At first these were mini-raves in their houses or larger raves of up to 500 people in barns or marquees, usually far enough away from other houses to avoid disturbing neighbours who might call the police.

Even though the harsh 'Tribal-techno' style of music was unpopular at first, a core group of 20 or so enthusiasts quickly developed, who would fix up a party every week or two where they would take E and dance all night. Daniel, one of the rave organisers and a long-standing member of the community, told me: "There's a great atmosphere, you could say euphoria even, the ultimate party. The raves provide a safe environment where you can be your true self and realise that you're OK. I always have a fabulous time in a non-egotistical way."

Between parties, people would meet more often than before and communicate more wholeheartedly. "Although we had known each other for so long, it took Ecstasy to break through the very British taboo about hugging one another," Daniel said. But the new closeness also caused crises in couples' relationships. "We became more open and truthful. If couples had stayed together through habit, then it came out". Life was taken more seriously and heartfelt: honest expression was valued more than easy, superficial encounters. "Some people went too far and let go of the framework of their lives. At one time there was a myth that everyone involved would lose their jobs," Daniel said. But people would support each other through crises and there was usually someone who understood the problem well enough to be of help.

Up till then, this community had been strictly non-religious. But Ecstasy brought about spiritual development in many of the individuals. "It brought me closer to God", claimed one woman, and "I began to see myself as the source of love" said another, while Daniel remarked that "Being able to transcend the ego leads to self knowledge".

When looking back over the early days of Ecstasy use, people in the community commonly said that the emotional agony of one member had been felt by everyone else, as if it were their own. The community became very intimate: people who had known each other as neighbours for 10 or twenty years felt suddenly bonded in a far deeper way through the weekend raves.

For most people the raves were a joyful celebration, but some people did experience paranoia and one man who took a lot of E and LSD smashed up his own house. Others took some fairly drastic decisions during this period: a long-term couple split up with the man giving away everything he owned to "free himself of material things" so as to be able to develop his "inner self". He was last heard of cleaning trains in Gothenburg. A single parent, a woman in her mid thirties, felt that she had glimpsed her true destiny and had to follow it. She left her two children with their grand parents, said goodbye and disappeared.

Daniel said that some new serious relationships had formed, but these were unlike the casual affairs that were the pattern before. "You can't seduce, cheat or lie on E," he explained. The great majority of couples did stay together and developed much closer bonds; even single people felt that their quality of life was improved. The few outsiders who attended became like old friends overnight - two men who had never met before spent the next week travelling together.

The first ravers were of the parents' generation, but they were later joined by their teenage children and the children's friends and, after a year or so, by some younger members of the indigenous community. As more people joined, the raves became less intense but instead began to be accepted by the wider community, though the original group still set the style. A series of raves were held in village halls until the police clamped down and one was stopped by a court order. Since then they have been held in farm buildings without being publicly advertised; tickets have been sold at cost price - #5 to friends through the grapevine.

At least three quarters of the people at these parties take Ecstasy and sometimes virtually everyone takes the drug. The most common dose is a single E, but a half E is common and a few people take several Es at a time. Many also smoke dope right through the night, but hardly anyone drinks alcohol or takes amphetamine. In fact most have stopped social drinking because, as Daniel put it, "Alcohol doesn't get you there, but E does". These people don't use Ecstasy outside parties. "It isn't just the drug, it's a package: Ecstasy, the company, the music, the lights, the dancing. It's a tribal sort of experience, a ritual that depends on all of these things combined," Daniel explained.

The police don't try to stop the parties but sometimes search people on their way in, so some ravers cautiously swallow their tablet just before they arrive. When on a couple of occasions people were found with cannabis, they were taken down to the police station, cautioned and returned to the party by police car. It seems that, in view of their limited resources, the police regard the new rave scene as something to be tolerated. There has been no shortage of good E via the old established connections for scoring dope - friends club together to send someone to the city who buys in bulk and covers his or her costs and own E consumption rather than making a profit.

The conversion of Garston Bridge to Ecstasy was seen as overwhelmingly positive by the people involved, but as destructive by observers in another community some miles away. There the drug was enthusiastically taken up by some while others saw it as shallow and negative, even dividing some couples. Those in favour would point to the new sense of caring between people, while the others pointed to the break up of long-standing relationships that they felt were imperative for the welfare of the children. Nevertheless, Ecstasy spread to this and other neighbouring communities, albeit in a less intense way: parties typically have a few people taking E while others drink or smoke hash, with some people doing a bit of all three. A man who does not take E described how the 'openness and honesty' seem paper-thin to him: "It's over the top, all this display of affection and free expression. It doesn't feel real to an observer and actually alienates people, especially if, like me, you happen to have been on the receiving end of some pretty hurtful remarks". This view is supported by an experienced doctor who believes that openness and honesty only apply to new users.161

Looking back, it was commonly felt that Ecstasy had caused the biggest upheaval in Garston Bridge since the arrival of the first freak settlers.

"I see it as middle-age crisis on a group level. We needed something to fill our lives as our children had done, and along came E," Daniel said.

Football Supporters

Mark Gilman, a researcher who works for Lifeline, a non-statutory drug agency in Manchester, is conducting a study of drug use among young football supporters. Mark is using ethnographic methods, which involve socialising with the football supporters, and he witnessed at first hand their conversion from drinking alcohol to taking Ecstasy. His own account is included below.

The derby football matches, in which two teams from the same city play each other, are notorious for generating violent incidents. The Manchester derby is no exception. There is a long tradition of encounters between Manchester United fans and supporters of Manchester City resulting in trouble.

Even when they are not playing each other there have been some fights when the two groups meet in the city centre. If United have been playing at home, the 'lads' will meet up in a city centre bar to drink Saturday night away. If City have been playing away, their 'lads' will also make their way back to the centre of Manchester for a drink. It often happens that, sometime in the course of the night, the two groups clash and trouble follows. This occurs even though some of the men come from the same areas and are known to each other during the week. Saturdays are a special time when normal rules of behaviour are suspended.

The first derby game of 1989, which took place at Manchester City's ground in the late summer, was eagerly awaited by both sets of supporters, because Manchester City had been out of the first division for some time.

Manchester United's lads met in a pub early on Saturday morning and proceeded to get 'steamed up' on alcohol in preparation for the events to follow. After several false alerts the United fans finally moved off from the pub at about 2.30 pm. By this time they numbered several hundred.

Standing on a bridge that the United fans pass over on their way to the City ground, I looked back at the approaching horde. Their demeanour and presence was similar to those pictures you see of American GI's in Vietnam:

they were moving at a semi-trot and psyching each other up for violence.

When they reached City's ground, the United fans infiltrated the City end and the game was held up as police moved in to sort things out. Several arrests followed. After the game, sporadic fights broke out on the road to the city centre and in and around city centre pubs. All in all, it was a particularly violent day in a long history of violent days.

The corresponding fixture took place on a Saturday in February 1990. During the day a similar sequence of events took place, but this time the violence intensified, culminating in a running battle between United and City fans, which went on late into the night. During the battle, several pubs were smashed up and one young man was very seriously injured. An even more violent day in a long history of violent days.

The following season the kick off to the first derby game was brought forward to 12 noon. Despite an early drinking start this seemed to cut down on the trouble. By the time of the second derby, United had qualified for the European Cup Winners' Cup Final to be played in Rotterdam and nobody wanted to miss that by being arrested at the derby game, so it passed off fairly peacefully. The timing of the season's games largely neutralised the supporters' inclination to violence.

The first derby game in the 1991/92 season fell on a Saturday, but by this time something quite remarkable had happened. Many of the hard-core lads from both United and City had spent most of the summer dancing the weekends away to the sounds of house music at raves fuelled by the drug Ecstasy.

They had done this together! They had got into a routine of meeting up at rave clubs and taking Ecstasy in groups comprising both United and City lads.

On the night of Friday November 15, 'derby eve', another traditional time for preliminary skirmishing, a group of United's lads were preparing for the game not with the traditional pub crawl followed by a visit to a beery night club but by attending a low key rave at a smallish club in a nearby town and taking Ecstasy. Having swallowed their tablets and gone into the club, the United lads grouped in a corner of the bar. There were about a dozen of them. As they sipped their drinks waiting to 'come up' on their Ecstasy tablets, they noticed a small group of City lads with whom they had crossed many a sword.

One young man who was very new to the Ecstasy/rave scene, but something of a veteran of derby match violence, said that a shiver went down his back at the thought of what he expected to happen. "I thought - Oh no! - I don't believe this! Here I am, I've just necked an E; I'm just about to have the time of my life and it's going to go off (there's going to be a fight) with City," he said. "I'd only had E a couple of times then and I just couldn't imagine fighting off it - no way! Anyhow, X (one of the City lads) comes over and the last time I saw him he wanted to kill me and everybody like me. I thought, 'Hello, here we go,' and he just stands at the bar at the side of me and says; 'Well who'd have thought that we would be stood side by side the night before a derby game and there's no trouble in any of us.

It's weird innit? It could never have happened before E'. Well I thought to myself, 'Thank Christ for that,' and I had a can of Red Stripe to get back into it. It wasn't a great night as nights on 'E' go, the DJ was shit and the club was only half full and most of them were bits of kids, but it was sound enough. The best part was when I went to the toilet to get a drink and cool down. I'm stood at the sink pouring water over my head from a pint glass and looking at the size of my eyes and up behind me comes X (the City lad) and he's buzzing his tits off (on Ecstasy) and he says; 'This is better mate. This is better!' And he was dead right it was better, much better. They even came back to this house where we go for a smoke (of hash) after the raves. I went home to bed about 5 am. and, as I lay there waiting to get to sleep, I couldn't stop thinking how right he was this could never have happened before E."

The next day the United fans met up around 9 am. as usual for the derby game. Obviously, some of them had had very little sleep. In fact some hadn't had any. They had just gone home for something to eat; a bath and a change of clothes. Although drinking alcohol was again prominent in the pre-match build up, it was challenged by, or combined with, taking hash and amphetamines.

As United's fans moved off, there were, as usual, several hundred of them.

But from the vantage point of the same bridge I had stood on two seasons earlier, I could hardly believe that this group was largely made up of those same young men who had looked like they were about to go to war. This time they looked more like they were going to Glastonbury festival! Despite the protestations of some of the beer monsters who tried to drum up enthusiasm for trouble, this was a loose passive grouping; a rag-taggle army of Ecstasy-taking hedonists. They were looking forward to the night's Ecstasy. The match went off with hardly any trouble and afterwards United and City's lads once again danced the night away on, and in, Ecstasy. Just as the City lad said, it could never have happened without E.

In early 1993 Mark told me that the latest trend for this group of people is back to alcohol and, for the first time, cocaine ("You can hear the chopping in the toilets"). He believes this is partly due to the poor quality Ecstasy on sale (much contains no MDMA) which has put many users off the drug, and also because of overuse resulting in less empathic experiences. "E's mellow, there's genuine communion taking place, but coke's a selfish drug and alcohol goes with violence." That good atmosphere has been lost, but so many people miss it and hope it will return one day.

In fact, the level of soccer hooliganism dropped to its lowest level for five years that year.50

6 The dangers of Ecstasy

The most likely danger from taking Ecstasy is consuming something else instead. In Manchester in the summer of 1993, all 13 tablets and capsules bought as Ecstasy turned out to be other drugs.172 Some people have taken "Ecstasy" several times have never actually had MDMA. Although the quality was said to be improving during 1993-4, you can never be sure what you are getting unless it is from a batch that you know is good. Even dealers often have no idea what they are selling, and may not even know that "Ecstasy" means MDMA and nothing else.175 See Chapter 12 under Is it really Ecstasy.

What follows relates to MDMA.

There are several distinct ways in which MDMA can be dangerous, and as this is a very important issue, I want to look at each in turn. These can be divided into immediate, short term and long term medical dangers and psychological dangers, giving four categories. There is also the question of addiction.12

Immediate medical dangers

There have been frequent stories in the press about people who have died from taking Ecstasy in Britain, and several cases are reported in the medical journals. By July 1992 The British Medical Journal was claiming "at least seven deaths and severe adverse reactions have followed its use as a dance drug." Dr. John Henry of the National Poisons Unit (attached to Guy's Hospital, London), who studied MDMA-related deaths in the period 1990 and 1991, found the cause to be heat stroke in every case. All the fatalities occurred at crowded parties and clubs where "sustained physical activity, high ambient temperature, inadequate fluid replacement can all reduce heat loss and the direct effect of the drug may upset the thermoregulatory mechanism."51 By March 1993, the National Poisons Unit listed 14 deaths among people in whom MDMA was detected; 13 showed symptoms of overheating and one of asthma.52 Fortunately, with widespread knowledge about the danger of overheating and how to avoid it, this cause of death has been nearly eliminated, while in America it is as yet unknown.161

In the United States, where the drug has been widespread for far longer, very few deaths have been reported and none of them are believed to be due to heatstroke. A study of five deaths associated with MDMA in the US showed that there were other probable primary causes of death in four of the cases, while the cause in the fifth case was not established. The report suggested that "people with cardiac disease may be predisposed to sudden death by taking MDMA."53 The implication is that, rather than being toxic in itself, the drug made the users more vulnerable to preexisting conditions such as a weak heart. No cases of death due to overheating have been reported in the US.

Some people have attempted to explain this discrepancy by suggesting that poisonous additives may be the cause of death in Britain. However, this is not born out by Dr. Henry's studies or by samples analysed for the police.54

Overheating

The most likely explanation is the way the drug is used: in Britain people often take Ecstasy while dancing for hours on end in very hot, humid raves without sufficient drinking water. The conditions at some raves could cause heatstroke even without a drug.55 It has been suggested that a few individuals are particularly vulnerable to heatstroke, possibly because they have a tendency to develop a high temperature56, though it is more likely that the conditions are to blame.170

Heatstroke is a well-known cause of death, but in other situations it only affects people who are pushing themselves to the limit16 or are unable to escape from the heat. What is peculiar about Ecstasy-related deaths is that the victims appear to make no real attempt to cool down. This has been explained by ravers being in a trancelike state, but experiments with rats and mice show that overheating may be a more direct effect of the drug.57 Researchers have examined the way rats respond to Ecstasy in very hot conditions. Without MDMA, the rats did their best to cool down by becoming less active and losing heat through their tails. But on MDMA they became more active and did not attempt to lose heat - as though they had lost the sense of being too hot - until they died of heatstroke. Similarly, rats in a cold environment made no attempt to keep warm when on MDMA. Experiments on mice show that MDMA is five times more toxic in crowded conditions than in isolation.10, 12 This may help to explain why ravers die of heat exhaustion.

So how does overheating kill someone? Our body temperature (like that of other mammals) has to be controlled very precisely for us to function, which is why we use a thermometer to indicate when we are ill. If we get too hot, above 42 degrees C (108 degrees F), our blood starts to form tiny clots that stick to the artery walls. This is not usually a problem in itself, but the process uses up the clotting agent in the blood, so that there is nothing to prevent bleeding. There are always tiny cuts and scratches inside the body and brain which are due to the body constantly replacing worn out tissue with new cells, and normally these leaks are blocked by the clotting of blood so that you don't even notice them. But above 42 degrees bleeding is unfettered, and this is made worse by high blood pressure due to the speedy effect of MDMA and exercise. People can bleed to death in this way, and if bleeding occurs in the brain it can cause a stroke. When someone is bleeding internally, blood may run out of their mouth or anus.30

There are other ways of dying through taking Ecstasy, but they are unlikely to happen to normal healthy people. On MDMA, we can be more active without feeling pain or exhaustion; our temperature, sweating, blood pressure and pulse increase without the normal warning signs of feeling discomfort or exhaustion. It is not surprising that there have been cases of people with weak hearts or other medical conditions have died on MDMA, although there is no known reason why the use of MDMA should particularly affect asthmatics.58 There is also a well-documented case in America of a healthy woman who took MDMA and nearly died for no apparent reason, implying that certain individuals may react in extreme ways.59 Research suggests that some one in 12 people may be particularly sensitive to the drug for genetic reasons.178

Other adverse effects that have been reported in the press - such as chest pain, confusion, memory loss and being unable to stand up - often originate from staff working in the casualty departments of hospitals. However, one doctor told me that he believes that drug users tend to say they've taken Ecstasy when they ask for medical help because they believe they will receive more sympathy, yet their symptoms often imply they have taken another drug.

In addition, a possible minor danger has been suggested, that MDMA use liberates 'oxygen free radicals'. These are normal in small quantities, and the body has a protective system for controlling their level, but large amounts may overwhelm the system and contribute to fatigue and 'mental dysfunction associated with sustained amphetamine abuse'. The problem can be solved by taking vitamins: 2-4 grams of vitamin C and 1,000 IU of vitamin E along with the drug, or treble these quantities to treat the effects afterwards.36

Medium term medical dangers

In 1982 there were several reports of people who had contracted hepatitis or jaundice (both diseases of the liver) after taking MDMA several times60; kidney damage has also been suggested.30 The reports are based on the opinions of doctors without investigation or research, so they should be taken as potential rather than as established dangers. It is not known whether the diseases were caused by consumption of alcohol or other drugs55, or whether the patients had weak kidneys or livers to start with.

None of the cases were fatal. Such damage is not found in animal studies, and there have been no such cases reported in the US. The explanation may be that such damage was caused by a contaminant in a bad batch rather than the drug itself127 , or that the kidneys were effected by dehydration.200 There are, however, worries that Ecstasy may be harmful when taken with alcohol62, 60 or amphetamine.141

Long term psychological effects

One of the worst fears about Ecstasy is that it may be causing permanent brain damage to users without them being aware of it. It has been suggested that the drug destroys nerve endings or synapses73, and that eventually users will suffer from depression and senile dementia - the loss of memory and confusion that affects some old people - but at a much earlier age.

These fears have not been established. The most damning evidence concluded from a trial is that heavy MDMA users probably had slightly worse short-term memories, but were not depressed nor did they show any other problems that might effect their lives.156 In another trial, the researchers discovered to their surprise that long term MDMA users scored better than non-users: they were "less impulsive, more harm-avoidant, and have decreased indirect hostility".157 (More on this trial below under brain damage.)

Some people argue that damage may not show until old age. Serotonin levels decline with age, so MDMA use would exaggerate this decline. This assumes that some negative aspects of old age are linked to lower serotonin, but there is no evidence to support this hypothesis, such as MDMA having an adverse effect on old people.

Long term brain damage

Evidence that MDMA causes brain damage is based on experiments with animals, mainly rats, although mice, dogs and apes have also been used.

After the animal has been given the drug, it is killed and its brain sliced into sections for examination. Because there are billions of brain cells and they are very small, damage may be difficult to see, so various indirect methods have been developed to indicate whether and where damage has occurred.

The method most commonly used, because it is easiest, is to check the level of serotonin (5HT) within the brain cells and nerves several weeks or months after MDMA is administered. This is done by cutting out a section of the brain, extracting the serotonin and measuring it. Many prescription drugs lower serotonin temporarily. However, if the serotonin level fails to return to normal, it is inferred that the cells have been damaged and have allowed serotonin to escape. When serotonin levels take a long time to return to normal, this was interpreted as meaning that the brain was damaged but gradually repaired itself.63

Many trials deduced that MDMA was toxic because large doses lowered rats' serotonin levels. Also, researchers gave monkeys MDMA and found that their serotonin level was never completely restored, so assumed the monkeys' brains were permanently damaged, and this led to concern that the brains of humans may also be damaged.63 The doses given were somewhat larger than normally used, but the effect of MDMA does vary according to the species64 and humans tend to be more sensitive than animals.

News of this brain damage to animals caused a scare and contributed to MDMA being classified among the most dangerous drugs, but over the years doubts have grown as to whether the results were valid because this observed physical damage was not matched by psychiatric damage. There has not been a single confirmed case in the scientific literature which conclusively links MDMA neurotoxicity with behavioural or functional consequences; there is no evidence of damage in psychological tests on MDMA users, and no damage has been observed by psychiatrists using the drug on patients.69, 70, 141

In 1993, a chance discovery showed that much of the evidence about MDMA causing brain damage was based on a false assumption. Dr. James O'Callaghan, while trying to establish a standard way of measuring neurotoxicity, needed some rats whose brains had damaged cells, so he gave them MDMA. But, to his surprise, their brain cells were not damaged unless he gave them really enormous doses (over 30 mg/kg, the equivalent of taking 20 Es), twice daily for a week! He then looked into the previous work which showed nerve endings to be damaged by quite moderate doses, and discovered that the results were flawed. Instead of actually observing the damage, which involves a laborious procedure called 'silver staining', the scientists had made an assumption which turned out to be wrong: that a change in the amount of serotonin in the brain indicates damage. This assumption was made on the grounds that serotonin exists within brain cells, and that a reduction would occur if the cells were damaged. "It's rather like a hose pipe full of water," explained a researcher, "the scientists found it contained less water, so they jumped to the conclusion that the pipe was leaking without actually finding the damage".71 Another research project showed that the toxicity of MDMA on rats depends on the type of cage they are kept in, casting further doubt on previous research.177

However, in 1994, the results of a 5-year research project on humans was published indicating permanent brain damage in people who consumed large, but not unusual, amounts of MDMA for several years.157 The methods used were again indirect and although unsupported, must be taken seriously. Apes were given various doses of MDMA and their spinal fluid was examined, then they were killed and their brains examined for damage. By this method the researchers found 'markers' for brain damage in spinal fluid. Assuming similarity between humans and apes, the spinal fluid of MDMA users indicated that their brain cells that produce serotonin had died back. In apes, most of these grew again, but did not produce as much serotonin. The researchers then looked for signs of damage to those with supposedly damaged brains through psychological tests, but to their surprise found that MDMA users actually did better than non-users! In the media this was either ignored or passed off as due to people with milder personalities gravitating towards MDMA in the first place.

Other researchers have criticised the conclusion that there was physical damage caused, saying that the assumption about spinal fluid indicating damage was not justified. Also, there is an alternative explanation: that the MDMA users had lower serotonin levels in the first place and that no damage was caused. In conclusion, although there is strong evidence that MDMA is physically neurotoxic143, any damage caused to the brain does not appear to affect its function negatively, the only evidence so far being that the change is beneficial.194

Other evidence that the damage to serotonin-producing brain cells is unlikely to harm the brain's function is that the drug fenfluramine, which causes similar damage to MDMA has been used as a prescription drug for many years without reports of harmful side effects.26, 64, 65, 66, 70, 137, 141, 154, 157

Quite apart from physical damage to brain cells, another cause of concern is that constantly lowered serotonin levels may eventually cause psychiatric problems such as depression. However, drugs of the SSRI (Selective Serotonin Reuptake Inhibitor) type such as Prozac (fluoxetine)47, 137, 148, now widely prescribed as mood elevators, also cause long term reduction in serotonin levels and are considered harmless.30, 67, 68, 137

This is not evidence that Ecstasy is safe; only that some (widely publicised) evidence against it is unreliable. My conclusion is that using a lot of MDMA for many years probably does damage brain cells, but without causing psychiatric problems and may actually have benefits. However, even if the effects appear beneficial, there is obviously a risk in making any permanent changes to one's brain, especially when the process is not fully understood.

Contaminants

Another danger is that what you bought as E is mixed with a poison of some kind, or an addictive drug like heroin. Although this is a possibility, it doesn't appear to happen. Dr. John Henry of the National Poisons Unit looks for poisons in the blood and urine of people who have died or are seriously ill after taking drugs, and says he has not come across any such cases.51 However, he has come across Paracetamol, Codeine, Amphetamine, MDA, MDEA, Ketamine, Tiletamine and LSD.152 Dr. Les King, who analyses suspected drugs seized by the police at the Aldermaston forensic laboratory has never come across (or even heard of) poisonous additives to Ecstasy, although he does not specifically test for them.54

In Holland, where the government has a far more liberal attitude, people are employed to buy drugs sold on the street in Amsterdam. They are analysed and the results are then made public. Once again, poisons and addictive drugs have not been found mixed with drugs sold as Ecstasy.21

So why do these rumours persist? Much of the Ecstasy sold is not MDMA172, 175 so that users get a different effect than they expected. Also, many users are unaware that even pure MDMA can have unpleasant effects in some situations. Most users just want to have a good time and don't believe they have any psychological problems, so it is more acceptable to explain unpleasant experiences as being due to poisons. They report a terrible headache "like rat poison"; the media report it as being rat poison and other users believe it.

Psychological dangers

In my opinion, there is a far greater risk of damaging the mind than of damaging the body through taking MDMA. While scientists argue about whether there is any evidence of physical damage, instances of mental damage are easy to find. Just as I have witnessed people whose lives appear to have been enriched by MDMA, there are others whose lives have got worse, if not actually been ruined as the tabloid papers would have it. Ecstasy has a profound effect on many people, and this is not always for the better.

People may be pushed into taking Ecstasy by peer group pressure, and be made to feel inferior if they do not enjoy it. For instance, some people will claim that Ecstasy can do nothing but to bring out your true personality by removing 'blocks' or defences. While this may be true in a sense, there are many perfectly sane people who do not feel liberated by taking MDMA, and, for whatever reason, they do not enjoy it.

There are also those who do enjoy the drug but suffer from the psychological effects. Very often this is from taking too much too often, resulting in paranoia and depression. Others simply find that everyday life is boring by comparison, and lose motivation.

It is difficult to identify these dangers without further research, as there are always other factors involved with psychological problems, for instance other drugs. The stories I have heard about people whose lives have been 'screwed up' by Ecstasy have always involved taking large amounts or taking other drugs as well. In addition, there are the stories of first time users who have 'flipped'; I don't know of any personally, but it seems likely that these were unstable personalities. More research is needed; the results could prevent mishaps in the future.

Addiction

A drug is considered addictive if physical withdrawal symptoms occur when a regular user stops taking it. MDMA is not addictive by this definition, and in fact has a built-in barrier against frequent regular use - it rapidly produces tolerance while providing more side effects.34 Whereas you can get drunk every night on alcohol, MDMA soon ceases to work. The pleasant effects become less and less, and after less than a week's daily use of MDMA they disappear completely while the amphetamine-like effects increase.37 It is then necessary to stop taking MDMA for several days before you feel good on it again, and to get the full effect may take several weeks. Frequent use is almost unknown in the States, where Ecstasy has been noted as unique among recreational drugs in that it is not taken repeatedly.69 However, many British users do, in fact, take MDMA every weekend and try to overcome tolerance by increased doses while putting up with the poor quality of the effects.

There are many regular users who rely on Ecstasy to make them feel good, and who feel depressed and lacking in motivation except while enjoying its effects. Others simply find that life is dull except when they are on it. I have even heard of a man who can only function normally when he is on Ecstasy.75

Most hard drug users do not like Ecstasy.76 However, the Drug Enforcement Administration in the US carried out experiments which they interpreted as indicating potential for abuse: they found that cocaine-addicted monkeys would 'reinforce themselves with MDMA'.12, 141

Overdosing

The effect of taking several Es at once is to produce an amphetamine-like effect - "a jittery, anxiety-provoking high".5 Some users take Ecstasy specifically to achieve this sort of effect, but they are said to be switching to amphetamines.13 It is likely that taking large and frequent doses is bad for you77, although one man is said to have taken 42 tablets yet only suffered a hangover51, and a personal account is included of a woman who says she survived taking 100 at once.Appendix 2 Ecstasy and amphetamine are more toxic when taken together.180

Although there is no specific evidence that overdoses cause permanent damage, there is certainly a high risk that they do.12, 63, 74 This may be reduced by taking fluoxetine (Prozac)147, 148, 176, even several hours afterwards and perhaps also by taking vitamins.36

For medical treatment see reference 180 (or ring the National Poisons Unit on +44 (0)71-955 5000)

Does Ecstasy use lead on to other drugs?

Ecstasy and opiates have little in common, hence junkies do not find that MDMA satisfies their needs.76 Social workers with a broad experience of drug users believe that it is unlikely that MDMA users will go on to addictive drugs because junkies are a separate social group.42 Rather than being regarded as romantic antiheroes, the typical Ecstasy user sees them as "old and smelly"78, and is strongly anti-heroin.79 However, MDMA has been referred as a 'gateway' drug to the hallucinogens135, and there is some evidence to this effect.26, 40 One user has suggested that 2CB forms a bridge for Ecstasy users to cross over into the world of psychedelics.138 Besides, Ecstasy users do generally take other drugs, especially amphetamine, LSD and cannabis.78

Risk of death

There are two ways of looking at the risk of death from taking a drug.

The first is to compare the total number of people who have died with the total number of doses taken. This gives you the risk of death per dose, such as one in a million.

The second is to compare the number of people who have died in a year with the number of people who consume the drug. This gives the risk of death per year as a result of taking the drug.

In both cases, two figures are needed: the number of people taking the drug and the number of deaths resulting. These are examined below.

How many deaths are due to Ecstasy?

Surprisingly, this is not easy to answer. The official British Home Office figures are so out of date as to be useless, although officials guess that the present total figure is somewhere between 10 and 20.80, 81

The National Poisons Unit put the present figure of known confirmed Ecstasy-related deaths at 14 for the period January 1988 to July 1992.52 These are fatal cases where MDMA was found in the victim's blood or urine, but it is not necessarily implied that MDMA was the cause of death. Their list is not comprehensive.

Newspaper reports up to March 1993 blame Ecstasy for the death of 17 to 22 people82, but these figures cannot be trusted. The main reason is that 'Ecstasy-related death' is often mistakenly taken as meaning that MDMA was the cause of death, rather than that the victim was known to have taken MDMA but the cause had not been established. Even the 'quality' newspapers and medical journals cannot be trusted (see chapter 7).

In the USA, an examination of the deaths of five people who had taken Ecstasy showed that other potentially lethal medical factors played a major part. Although MDMA was found in the victims' blood when they died and may have contributed to their death in some unknown or indirect way, in four cases there was an explanation for their death which was not related to taking MDMA.53 The fifth death may also have been due to other causes.26

An organisation called DAWN (Drug Abuse Warning Network, part of the National Institute of Drug Abuse) collects reports of illicit drug use from hospital casualty departments all over the United States.22 Whenever someone turns up at an emergency room and a drug is involved, either found on the person or in their blood or urine, or even if a patient comes in with a problem and mentions that it is drug-related, a report is sent to DAWN besides reports from postmortem examinations when drugs have been detected. These reports are analysed and figures are published for all drugs that are reported over 200 times in the past year. Although 138 drugs are listed, Ecstasy has never been included. DAWN publishes a separate list of drugs that have caused more than 10 deaths, but again Ecstasy is not included. The figures imply that there is no general medical cause for concern over MDMA use: though there are mishaps, these are rare. Indeed, there are well over a hundred other drugs that cause more problems. Even if the number of problems due to MDMA were increased in proportion to usage in Britain, there would still not be a significant number.

In conclusion, it seems likely that, apart from very rare incidents, the deaths in Britain as a consequence of taking MDMA is limited to those who died of heat stroke, of which 14 cases are known to date. The worst annual figure was that for 1991 with seven confirmed Ecstasy-related deaths known to The National Poisons Unit.52

The number of people in the UK who take Ecstasy has been discussed in Chapter 5. An educated guess is that the number lies between one and five million. How often users take the drug is also open to guesswork. A London survey showed that a third of users took Ecstasy at least once a week, while a minority binged on 10-20 over a weekend. This would imply that average usage among this sample was somewhere in the region of 25 a year, although this may not be typical.

Taking the worst figure of seven deaths in 1991 and assuming there were only 1 million users, the risk of dying from using Ecstasy would have been 7 in a million or 1 in 143,000 per year. If users take an average of 25 Es a year, then the risk of death on each occasion is 7 in 25 million or 1 in 3.6 million.

To put this into perspective, if you take five rides at a fun fair you run a risk of 1 in 3.2 million of being killed through an accident.83 Some sports are obviously dangerous, such as parachuting which kills 3 in 1000 participants per year. Even skiing in Switzerland is risky - 1 in 500,000 are killed.84 If you play soccer, every year you run a risk of 1 in 25,000 of being killed. But if you stay at home instead of going out you still aren't safe, since the risk of being killed through an accident at home is 1 in 26,000 a year!16

Many prescription drugs carry a high risk, including some you can buy over the counter without prescription. For example, over 200 people die from taking Paracetamol in Britain each year, more than ten times as many as die from MDMA.30, 162

Many people will argue that these figures are meaningless as they are based on guessed statistics. Suppose the figures distort the results ten times over, the risk of dying through taking Ecstasy is still smaller than taking part in a wide range of acceptable activities. It has been said that more people would die if alcoholic drinks replaced Ecstasy at raves.55 Moreover, if ravers and