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 NISID HAJARI
On a Tuesday night, the Manhattan nightclub in Phnom Penh describes a classic Southeast Asian den of iniquity. Hulking bodyguards loom over tables filled with wealthy Chinese merchants and the children of government officials. Stunning young prostitutes work the crowd, dancing lasciviously to deafening pop music. Their smiles are not entirely fake: according to one local dealer, these working girls are the most regular customers for the ecstasy he sells for between $20 and $30 a "roll," or pill. Sometimes their "boyfriends" pay; other times the girls get discounts on the drug, which they say loosens their inhibitions. "If you're not friendly and outgoing, you won't get customers," giggles 19-year-old Lim, reapplying lipstick in the crowded women's room. "I take these pills to make me happy."
So we know that ecstasy is versatile. Actually, that's one of the first things we knew about it. Alexander Shulgin, 75, 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 person's speech impediment and another's bad LSD trip, and a way for Shulgin to have fun at cocktail parties without martinis.
The ready availability of ecstasy, from Phnom Penh to Grand Rapids, is a newer phenomenon. In the U.S. and Europe, ecstasyor "e"enjoyed a spurt of mainstream use in the '80s. After being outlawed in the States in 1985, it remained common only on the margins of societyin clubland, in gay America, in lower Manhattanwhile emerging as an integral part of rave culture in Europe. But in the past year or so, ecstasy has achieved a worldwide prominence unmatched by nearly any other drug. In Hong Kong and Singapore, where overall rates of drug abuse have been declining, ecstasy use has been rising precipitously. In Japan, police and customs agents seized 68,000 ecstasy pills in the first nine months of this yearfour times the number confiscated in all of 1999. In June, Hong Kong police hauled in 320,000 tablets in one raid. On May 12, U.S. authorities seized half a million pills at San Francisco's airportthe biggest e bust ever. Each pill costs pennies to make but sells for between $20 and $40 in the States, so someone missed a big payday.
For the moment, ecstasy is still a niche drug, even in the U.S.: the number of Americans who take it once a month remains so smallless than 1% of the populationthat ecstasy use doesn't register in the government's drug survey. In most parts of Asia, heroin and amphetamines still dominate the lists of preferred drugs, and in many countriesincluding Vietnam, India and South Koreae has made few inroads into the local population. (The biggest bust in Goa, famous for its full-moon beach raves, netted only 17 pills earlier this year.) Much of the drug's popularity in the West is tied to a rise in rave culture, and while "raves"really just all-night dance parties, held for the most part in regular venues with tickets rather than in illicit locations as was once the practicehave begun to attract an audience in cities like Hong Kong, Tokyo and Kuala Lumpur, they remain a diversion for Asia's gilded urban youth.
That, however, is part of the drug's appeal in this part of the worldits associations with a global underground culture that's chic, only somewhat dangerous and only recently available. In the Loft, a Beijing club where old Cultural Revolution movies unspool on giant screens, pricey e tablets represent much more than status symbols. "As long as you have money, you can be so happy in just a couple of minutes," says 23-year-old Wang Aibing. "In today's world, you can buy anything. Before, our parents couldn't buy such happiness." In Thailand, which has been devastated by amphetamines known as yaa baa the way certain U.S. communities were destroyed by crack, yaa e projects an image as surely as Miu Miu clothes or Oakley sunglasses: "My friends and I would never take yaa baa," swears Yui, a 27-year-old photographer in Bangkok. "But yaa e fits right in with our whole lifestyle, the music, the fashions." Says a hip, 28-year-old stock trader in Karachi: "It's the best drug of this century."
Indeed, much of the ecstasy takingand the law enforcement under way to end ithas been accompanied by a breathlessness that sometimes misses the point. In censorious Malaysia, newspapers warn of ecstasy tablets mixed with ground glass and tell tales of young, "scantily clad" girls on e disappearing into vans in the wee hours of the morning. (In the Philippines, commentators gleefully retell the story of a schoolgirl, supposedly aroused by ecstasy, lying down invitingly in the middle of a school fair.) On the other side of the spectrum, at www.ecstasy.org, you can find equally 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 includes testimonials from folks who say ecstasy can treat schizophrenia and help you make "contact with dead relatives."
Ecstasy is popular because it appears to have few negative consequences. "It's like eating ice cream," says 17-year-old Qu Zheng, a Beijing native who counts a rave held on the Great Wall earlier this year as the best experience of her life. "It's only a little bit bad for you, and it makes you feel good. Why not enjoy it?" That nonchalance could be dangerously naive. "These are not just benign, fun drugs," says Alan Leshner, director of the U.S. National Institute on Drug Abuse. "They carry serious short-term and long-term dangers." But one reason ecstasy is so fascinating, and thus dangerous to antidrug crusaders, 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.
What's the appeal of ecstasy? As one 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 energeticnot edgy, just clear. Pot relaxes but sometimes confuses; LSD stupefies; cocaine wires. Ecstasy has none of those immediate downsides. "Jack," 29, an American living in Indiana who has taken ecstasy about 40 times, says the only time he felt as good as he does on e was when he found out he had won a prestigious scholarship. He enjoys feeling logorrheic: ecstasy users often talk endlessly, maybe about a silly song that's playing or maybe about a terrible burden they face. E allows the mind to wander, but not into hallucinations. Users retain control. Jack can allow his social defenses to crumble on ecstasy. Qu, high on e at a Beijing club called Banana, wantonly drapes herself over her embarrassed boyfriend. "We Chinese sometimes feel uncomfortable touching each other," she says, "but with ecstasy, you feel like you can hug everybody without being worried."
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 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 company Merck. Contrary to ecstasy lore, and there's a ton of it, Merck was not 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 timenot Merck employees and certainly not Nazi soldiers, another common myth. (They wouldn't have made very aggressive killers.)
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 substances as potential weapons. The Michigan study found that none of the compounds under review was particularly toxic. 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.
That 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. In Indonesia pills are cut with anything from flour to laxatives to insect repellent. In Malaysia officials claim tablets are mixed with rat poison.
Second, and more controversially, MDMA itself might do harm. There is a long-standing debate about MDMA's dangers, which will take much more research to resolve. The theory is that the drug's 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 has 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 from the normal 37C to as high as 43C. 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 one ecstasy pill.
Late last year, Ricaurte recorded for the first time the effects of ecstasy on the human brain. 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 in their brains than nonusers, even two weeks after their last exposure. On the strength of these studies as well as a large number of animal studies, Ricaurte has hypothesized that the damage is irreversible.
Ricaurte's work has received much attention, but it 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 that even if MDMA does cause the changes to the brain that Ricaurte 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 should not be dismissed, but they may simply mean that we have a whole lot of plasticitythat we can do without serotonin and be O.K."
Ricaurte tells Time that "the vast majority of people who have experimented with MDMA appear normal, and there's no obvious indication that something is amiss." Ricaurte 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, Boston psychotherapist 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.
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 Shulgin. According to Shulgin (who is often wrongly credited with discovering MDMA), 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, folks who thought MDMA felt too good to be confined to a doctor's office. One who was based in Texas 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. The U.S. Drug Enforcement Administration was caught by surprise by the new drug not long after it had been embarrassed by the spread of crack. The administration quickly used new discretionary powers to outlaw MDMA, pointing to the private labs and club use as evidence of abuse. DEA officials also cited rudimentary studies showing that ecstasy users had vomited and experienced blood-pressure fluctuations.
Most therapeutic use quickly stopped. But Doblin's group has funded important MDMA studies, including Ricaurte's first work on the drug. Sue Stevens, the woman who took it in 1997 with her husband Shanehe has since died of kidney cancerlearned about the drug from a mutual friend of hers and Doblin's. She believes e helped Shane find the right attitude to fight his illness, and she works with Doblin to advocate for limited legal use. Soon his association will help fund the first approved study of MDMA in psychotherapy, involving 30 victims of rape in Spain diagnosed with post-traumatic stress disorder.
The first time Koon-hung, a Hong Kong toy salesman, took ecstasy, he says he lost his memory for about two minutes. The first time Ferry, a 28-year-old computer programmer in Jakarta, tried the drug, his foot began to swell, his right hand went numb, he had trouble breathing and he ended up in the emergency room. If ecstasy is so benign, what's happening to people like them? The two most common short-term side effects of MDMAboth of which remain rare in the aggregateare overheating and something even harder to quantify, psychological trauma.
A few users have mentally broken down on ecstasy, unprepared for its powerful psychological effects. 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, an American 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 oftenevery 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 emergency room after taking ecstasy are almost certainly not taking MDMA but something masquerading under its name. The most common adulterants in such pills are aspirin, caffeine and other over-the-counters. (Contrary to lore, fake e almost 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 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 Worldabout a people in thrall to a drug called somaand 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, the Midwesterner, ecstasy is a key part of life. "E makes shirtless, disgusting men, a club with broken bathrooms, a deejay that plays crap and vomiting into a trash can the best night of your life," she says with a laugh. That is a versatile drug indeed.
With reporting by Hannah Beech/Beijing, Carole Buia/Miami, Greg Fulton/Atlanta, Meenakshi Ganguly/New Delhi, Ghulam Hasnain/Karachi, Robert Horn/Bangkok, Kay Johnson/Phnom Penh, Wendy Kan/Hong Kong, Stella Kim/Seoul, Donald Macintyre/Tokyo, Alice Park/New York, Mageswary Ramakrishnan/Kuala Lumpur, Elaine Shannon and Dick Thompson/Washington, Nelly Sindayen/Manila and Jason Tedjasukmana/Jakarta
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