The Lure of Ecstasy
The elixir best known for powering raves is an 80-year-old illegal drug. But it's showing up outside clubs too, and advocates claim it even has therapeutic benefits. Just how dangerous is it?
By JOHN CLOUD and ROMESH RATNESAR
It's an early-summer morning in the U.S. suburb of Cobb County, Georgia, and 18-year-old "Karen" and five friends have decided to go for it. They skip their first class and sneak into the woods near their upscale high school. One of them takes out six rolls — six ecstasy pills — and they each swallow one. Then back to school, flying on a drug they once used only on weekends. That night they will all go out and drop more ecstasy, rolling into the early hours of another school day. It's rare that anyone would take ecstasy so often — it's not physically addictive — but teenagers everywhere have begun experimenting with it. "The cliques are pretty big in my school," Karen says, "and every clique does it."
A continent away in Prague, Eva, 19, is sipping a Coke at Chateau, a downtown bar. She's getting ready to roll at a rave later that night on a boat on the Vlata River. "I couldn't dance all night without it," she says. "I would get tired soon." She does e a few times a month, taking pills in halves, sometimes keeping the high going with the local amphetamine pervitin. She had her first hit of ecstasy when she was 16. It still produces a sensation of euphoria that she can't quite get anywhere else. "It gives me this great pleasure. All my worries seem to go away. I don't think of what was or will be. I am just enjoying the present moment."
So we know that ecstasy is versatile. Actually, that's one of the first things we knew about it. Alexander Shulgin, 74, the biochemist who in 1978 published the first scientific article about the drug's effect on humans, noticed this panacea quality back then. The drug "could be all things to all people," he recalled later, a cure for one student's speech impediment and for one's bad lsd trip, and a way for Shulgin to have fun at cocktail parties without martinis.
The evolution of ecstasy, from an underground urban drug to an almost mundane feature of middle-class life in the U.S. and Europe, is a newer phenomenon. Ecstasy — or "e" — came out of European clubs in resort locales such as Ibiza in the '80s, and peaked in popularity in the early 1990s, when raves began to infiltrate the night life of Europe's capitals. In the U.S., ecstasy remained common only on the margins of society — in clubland, in gay America, in lower Manhattan. But in the past year or so, ecstasy has returned to the American heartland; and in Europe, it has gone positively mainstream, sampled casually by suburban teens and dot com professionals alike. Established drug-running rings, most of which have their origins in Europe, have taken over the trade. Production of the drug in laboratories in the Netherlands and Eastern Europe has continued to heat up. So has smuggling: in April, Italian officials in Trieste intercepted a cache of 330,000 pills — 60,000 more than they picked up in all of 1999. In May, authorities seized half a million pills at San Francisco's airport — the biggest American e bust ever. Each pill costs pennies to make but sells for between $20 and $40, so someone missed a big payday.
At the height of the ecstasy craze in Europe, more than 1 million doses of e were consumed in U.K. dance clubs every weekend. Since then, the drug's sexiness has worn off, but the drug itself remains pervasive. Around 5% of young adults in Europe say they have tried ecstasy. Use among teenagers varies: in Finland, fewer than 1% of 15- and 16-year-olds have used e, but in the Netherlands, Ireland and the U.K. that figure is close to 9%. While the numbers of habitual users are small, recreational rolling soars at this time of the year, when young Europeans hit the sweaty clubs in tourist meccas like Ibiza. A survey of British clubgoers in Ibiza last year found that only 2% of ecstasy users said they did the drug five or more times a week when they were at home; but 42% did e at least five times during their stay in Ibiza. Ecstasy use in the U.S. is growing: 8% of U.S. high school seniors say they have tried it at least once, up from 5.8% in 1997.
The drug's appeal has never been limited to ravers. Igor, a 28-year-old lawyer in Belgrade, has been using e for four years. "It's a happy pill," he says. "It is so unevil." Maik, a 27-year-old from Cologne, Germany, who formerly did e every week, says that "for a while it seemed to be just a core group who used it. But now it's becoming more mainstream." Today you can buy e for just $10 a pill — the most popular variety is the one shaped like the Euro coin — at the clubs in the Adriatic resort town of Rimini, Italy. On a recent Saturday night, Daniela, a 20-year-old university student from Bologna, celebrated the end of exams with beer and pizza, then bought some ecstasy on the street and headed to Cocoricò, a pyramid-shaped superdisco. Giorgio, 19, who drove in from Milan, was offered e at a video-game arcade in Rimini that afternoon. "But it cost too much there," he says. "Better to buy it here in the disco. In the dark it's safer." At house parties in Prague, "20 people will offer you drugs and 100 others will ask you if you have any for sale," says Jan, a 21-year-old clubgoer. Adds Tomas, 24, an economics student who does e a couple of times a month: "It just goes with the environment, the music, the lights."
Indeed, much of the ecstasy taking — and the law enforcement underway to end it — has been accompanied by breathlessness. At ecstasy.org, you can find bloated praise of the drug. "We sing, we laugh, we share/ And most of all, we care," gushes an awful poem on the site, which also includes testimonials from people who say ecstasy can treat schizophrenia and help you make "contact with dead relatives." Young German users have even invented a tongue-twisting term — Zusammengehörigskeitsgefühl — to describe the feeling of belonging the drug inspires.
Ecstasy is popular because it appears to have few negative consequences. But "these are not just benign, fun drugs," says Alan Leshner, director of the U.S.'s National Institute on Drug Abuse. "They carry serious short-term and long-term dangers." Those who fight the war on drugs overstate these dangers occasionally — and users usually understate them. But one reason ecstasy is so fascinating is that it appears to be a safer drug than heroin and cocaine, at least in the short run, and appears to have more potentially therapeutic benefits.
Even so, the U.S. Senate has introduced a new law under which someone caught selling about 100 hits of ecstasy could be charged as a drug trafficker; current law sets the threshold at about 300,000 pills. In Europe, authorities in Belgium and the Netherlands have cracked down on ecstasy factories, and in May the Italian government launched a $5 million "I don't roll" campaign on radio, TV and the Internet. But Europe's longer history with e has made some governments more tolerant of it. A report by the British Police Federation this year recommended a loosening of penalties for ecstasy possession. And last month Switzerland's highest court ruled that selling ecstasy was not a serious narcotics offense.
What's the appeal of ecstasy? As a user put it, it's "a six-hour orgasm." About half an hour after you swallow a hit of e, you begin to feel peaceful, empathetic and energetic. Pot relaxes but sometimes confuses; lsd stupefies; cocaine wires. Ecstasy has none of those immediate downsides. "Jack," 29, an Indiana native who has taken ecstasy about 40 times, said the only time he felt as good as he does on e was when he found out he had won a Rhodes scholarship. He enjoys feeling logorrheic: ecstasy users often talk endlessly, maybe about a silly song that's playing or maybe about a terrible burden on them. "Mark," 25, who works at an Internet company in London, says that during one ecstasy high, he started putting words on paper: "It was some of the best stuff I've ever written. The weird thing is, it's so good and it came out so quickly that if I were to write something of similar standard it would take double or triple the amount of time."
All this marveling should raise suspicions, however. It's probably not a good idea to try to duplicate the best moment of one's life 40 times, if only because it will cheapen the truly good times. And even as they help open the mind to new experiences, drugs also can distort the reality to which users ineluctably return. Is ecstasy snake oil? And how harmful is it?
This is what we know:
An ecstasy pill most probably won't kill you or cure you. It is also unlike pretty much every other illicit drug. Ecstasy pills are (or at least they are supposed to be) made of a compound called methylenedioxymethamphetamine, or MDMA. It's an old drug: Germany issued the patent for it in 1914 to the German company E. Merck. Contrary to ecstasy lore, and there's tons of it, Merck wasn't trying to develop a diet drug when it synthesized MDMA. Instead, its chemists simply thought it could be a promising intermediary substance that might be used to help develop more advanced therapeutic drugs. There's also no evidence that any living creature took it at the time — not Merck employees and certainly not Nazi soldiers, another common myth.
Yet MDMA all but disappeared until 1953. That's when the U.S. Army funded a secret University of Michigan animal study of eight drugs, including MDMA. The cold war was on, and for years its combatants had been researching scores of substances as potential weapons. The Michigan study found that none of the compounds under review was particularly toxic — which means there will be no war machines armed with ecstasy-filled bombs. It also means that although MDMA is more toxic than, say, the cactus-based psychedelic mescaline, it would take a big dose of e, something like 14 of today's purest pills ingested at once, to kill you.
It doesn't mean ecstasy is harmless. Broadly speaking, there are two dangers: first, a pill you assume to be MDMA could actually contain something else. Anecdotal evidence suggests that most serious short-term medical problems that arise from "ecstasy" are actually caused by pills adulterated with other, more harmful substances. Second, MDMA itself might do harm.
There's a long-standing debate about MDMA's dangers. The theory is that its perils spring from the same neurochemical reaction that causes its pleasures. After MDMA enters the bloodstream, it aims with laser-like precision at the brain cells that release serotonin, a chemical that is the body's primary regulator of mood. MDMA causes these cells to disgorge their contents and flood the brain with serotonin.
But forcibly catapulting serotonin levels could be risky. Of course, millions of people manipulate serotonin when they take Prozac. But ecstasy actually shoves serotonin from its storage sites, according to Dr. John Morgan, a professor of pharmacology at the City University of New York (cuny). Prozac just prevents the serotonin that's already been naturally secreted from being taken back up into brain cells.
Normally, serotonin levels are exquisitely maintained, which is crucial because the chemical helps manage not only mood but also body temperature. In fact, overheating is MDMA's worst short-term danger. Flushing the system with serotonin, particularly when users take several pills over the course of one night, can short-circuit the body's ability to control its temperature. Dancing in close quarters doesn't help, and because some novice users don't know to drink water, e users' temperatures can climb as high as 43°. At such extremes, the blood starts to coagulate. In the past two decades, dozens of users around the world have died this way.
There are long-term dangers too. By forcing serotonin out, MDMA resculpts the brain cells that release the chemical. The changes to these cells could be permanent. Johns Hopkins neurotoxicologist George Ricaurte has shown that serotonin levels are significantly lower in animals that have been given about the same amount of MDMA as you would find in just one ecstasy pill.
In the 1980s, Ricaurte helped record for the first time the effects of ecstasy on the human brain. Eventually he gave memory tests to people who said they had last used ecstasy two weeks before, and he compared their results with those of a control group of people who said they had never taken e. The ecstasy users fared worse on the tests. Computer images that give detailed snapshots of brain activity also showed that e users have fewer serotonin receptors than nonusers, even two weeks after their last exposure. Ricaurte thinks the damage may be irreversible.
But Ricaurte's work isn't conclusive. The major problem is that his research subjects had used all kinds of drugs, not just ecstasy. (And there was no way to tell that the ecstasy they had taken was pure MDMA.) And critics say even if MDMA does cause the changes to the brain he has documented, those changes may carry no functional consequences. "None of the subjects that Ricaurte studied had any evidence of brain or psychological dysfunction," says cuny's Morgan. "His findings may simply mean that we can do without serotonin and be O.K. We have a lot of unanswered questions."
Ricaurte told Time that "the vast majority of people who have experimented with MDMA appear normal, and there's no obvious indication that something is amiss." He says we may discover in 10 or 20 years that those appearances are horribly wrong, but others are more sanguine about MDMA's risks, given its benefits. For more than 15 years, Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies, has been the world's most enthusiastic proponent of therapeutic MDMA use. He believes that the compound has a special ability to help people make sense of themselves and the world, that taking MDMA can lead people to inner truths. He uses his organization to "study ways to take drugs to open the unconscious."
Doblin first tried MDMA in 1982, when it was still legal and when the phrase "open the unconscious" didn't sound quite so gooey. At that time, MDMA had a small following among avant-garde psychotherapists, who gave it to blindfolded patients in quiet offices and then asked them to discuss traumas. Many of the therapists had heard about MDMA from the published work of former Dow chemist Alexander Shulgin. According to Shulgin, another therapist to whom he gave the drug in turn named it Adam and introduced it to more than 4,000 people.
Among these patients were a few entrepreneurs, people who thought MDMA felt too good to be confined to a doctor's office. One who was based in Texas (and who has kept his identity a secret) hired a chemist, opened an MDMA lab and promptly renamed the drug ecstasy, a more marketable term than Adam or "empathy" (his first choice, since it better describes the effects). He began selling it to fashionable bars and clubs in Dallas, where bartenders sold it along with cocktails; patrons charged the $20 pills, plus $1.33 tax, on their American Express cards.
Manufacturers at the time flaunted the legality of the drug, promoting it as lacking the hallucinatory effects of lsd and the addictive properties of coke and heroin. But after governments in the U.S. and Europe outlawed ecstasy, pointing to the private labs and club culture as evidence of abuse, therapeutic use quickly stopped. But Doblin's group has funded important MDMA studies, including Ricaurte's early work on the drug. Sue Stevens, who took e in 1997 with her husband Shane — he has since died of kidney cancer — learned about the drug from a mutual friend of hers and Doblin's. She believes e enabled Shane find the right attitude to fight his illness, and she helps Doblin advocate limited legal use. Soon his association will partly fund the first approved study of MDMA in psychotherapy, involving 30 victims of rape in Spain diagnosed with posttraumatic stress disorder.
In the U.S., the Federal Government has approved only three studies. In 1995, Dr. Charles Grob, a ucla psychiatrist, who believes MDMA could be used as a pain reliever for end-stage cancer patients, concluded the drug is safe if used in controlled situations under careful monitoring. The body is much less likely to overheat in such a setting. Grob believes MDMA's changes to brain cells are accelerated and perhaps triggered entirely by overheating.
In 1998, emergency rooms participating in the Drug Abuse Warning Network reported receiving 1,135 mentions of ecstasy during admissions, compared with just 626 in 1997. In European hotspots, such as the stretch of discos between Rimini and Riccione, Italy, 20 people are rushed to hospitals each weekend because of excessive heat, alcohol and e. If ecstasy is so benign, what's happening to these people? The two most common short-term side effects of MDMA — both of which remain rare in the aggregate — are overheating and something harder to quantify, psychological trauma.
A few users have mentally broken down on ecstasy, unprepared for its powerful psychological effects. A schoolteacher in San Francisco who took ecstasy a year ago began to recall, in horrible detail, an episode of sexual abuse. She became severely depressed for three months and had to seek psychiatric treatment. Others have suffered physical trauma. Melanie, a 19-year-old from Lausanne, Switzerland, unknowingly consumed a drink spiked with ecstasy last summer at a club in Spain. She woke up in a hospital.
Ecstasy's aftermath can also include a depressive hangover, a down day that users sometimes call Terrible Tuesdays. "You know the black mood is chemical, related to the serotonin," says "Adrienne," 26, a fashion-company executive who has used ecstasy almost weekly for the past five years. "But the world still seems bleak." Some users, especially kids trying to avoid the pressures of growing up, begin to use ecstasy too often — every day in rare cases.
Another downside: because users feel empathetic, ecstasy can lower sexual inhibitions. Men generally cannot get erections when high on e, but they are often ferociously randy when its effects begin to fade. Dr. Robert Klitzman, a psychiatrist at Columbia University, has found that men in New York City who use ecstasy are 2.8 times more likely to have unprotected sex.
Still, the majority of people who end up in the E.R. after taking ecstasy are almost certainly not taking MDMA but something masquerading under its name. No one knows for sure what they're taking, since emergency rooms don't always test blood to confirm the drug identified by users. Organizations in France, the Netherlands and Austria stake out raves and test ecstasy pills for purity: they shave off a sliver of the tablet and drop a solution onto it; if it doesn't turn black quickly, it's not MDMA. But Nicole Maestracci, head of the French drug policy ministry, says that even MDMA pills may also contain harmful substances that can't be detected.
In the U.S., an organization called DanceSafe, which tests pills for anonymous users who send in samples from around the nation, found that 40% of those pills are fake. In Rimini, police claim that 80% of the ecstasy sold to clubkids is only good enough to cure a headache. The most common adulterants in such pills are aspirin, caffeine and other over-the-counters. (Contrary to lore, fake e virtually never contains heroin.) But the most insidious adulterant is dxm (dextromethorphan), a cheap cough suppressant that causes hallucinations in the 130-mg dose usually found in fake e (13 times the amount in a dose of Robitussin). Because dxm inhibits sweating, it easily causes heatstroke. Another dangerous adulterant is PMA (paramethoxyamphetamine), an illegal drug that in May killed two Chicago-area teenagers who took it thinking they were dropping e. PMA is a vastly more potent hallucinogenic and hyperthermic drug than MDMA.
As demand has grown, so has the incentive to manufacture fake e, especially for one-time raves full of teens who won't see the dealer again. Established dealers, by contrast, operate under the opposite incentive. A Miami dealer who goes by the name Top Dog told Time he obtains MDMA test kits from a connection on the police force. "If [the pills] are no good," he says, customers "won't want to buy from you anymore." It's business sense: Top Dog can earn $300,000 a year on e sales.
As writer Joshua Wolf Shenk has pointed out, we tend to have opposing views about drugs: they can kill or cure; the addiction will enslave you, or the new perceptions will free you. Aldous Huxley typified this duality with his two most famous books, Brave New World — about a people in thrall to a drug called soma — and The Doors of Perception — an autobiographical work in which Huxley begins to see the world in a brilliant new light after taking mescaline.
Ecstasy can occasionally enslave and occasionally offer transcendence. Usually, it does neither. For Adrienne, an American woman who has been a frequent user for the past five years, ecstasy is a key part of life. "E has done two things in my life," she says. "I had always been aloof or insecure or snobby, however you want to put it. And I took it and realized, you know what, we're all here; we're all dancing; we're not so different. I allowed myself to get closer to people. Everything was more positive. But my life also became, quickly, all about the next time I would do it ... There's no sense of freedom like it. You feel at ease with yourself and right with the world, and that's a feeling you want to duplicate — every single week."
— With reporting by Duska Anastasijevic/Belgrade, Helena Bachman/ Geneva, Paul Davies/Ibiza, Francesca Folda/Rimini, Greg Fulton/Atlanta, François Messier/Paris, Alice Park/New York, Jan Stojaspal/Prague and Steve Zwick/Cologne, with other bureaus
17, 2000 VOL. 156 NO. 3