NEWSWEEK: What is the history of the ecstasy? SMITH: MDMA has been around for a long time. It was part of the Haight-Ashbury drug culture, but it was not particularly popular. In 1968 we published an article that focused on a group of drugs called psychotomimetic amphetamines. [Psychotomimetic drugs are those whose effects are similar to naturally occurring psychosis]. The most popular one back then was called MDA [methylenedioxyamphetamine], or “the love drug.” Another, MDMA [3,4-Methylenedioxymethamphetamine] later came to be known as ecstasy. At the time we published articles on it, some people were using it in therapy. In the early ’80s, we held a conference on using MDMA as an adjunct to psychotherapy. There were some abuse problems that were similar to amphetamines, as you would expect, because MDMA’s toxicity is similar to amphetamine.
What does that mean? It’s dose-related. You can have similar toxicities as experienced with methamphetamine, or speed, including heart attacks, hypothermia, seizure or psychosis with auditory and visual hallucinations…The cardiac problems and the seizures tend to occur with lower dosages or episodic use, for instance, when the users are dancing.
How did the drug go mainstream? Also in the early ’80s, ecstasy moved out of the psychedelic/psychotherapy scene into the youth/drug/club-dance scene. That’s when it got the name ecstasy, which of course is the world’s greatest marketing campaign. It suggested that it made sex better and gave you insight while you were doing it. The kids really loved it. So it’s an old drug that has been given a new name and a new marketing [strategy]. And from there, it has just exploded…The Internet is filled with pro-drug information that suggest that MDMA is the greatest drug on the face of the earth, and that nobody has any problem with it whatsoever. That [Web marketing] is one of the things that is fueling its spread. I know that one of the fathers whose son died of an MDMA-induced heart attack got us to introduce counter information on the Net, which we did. That was a couple of years ago.
What is the difference between methamphetamine and ecstasy? It’s my understanding that methamphetamine has more addictive and less psychedelic properties. Ecstasy has the basic methamphetamine structure, but on the phenyl ring is another side chain which is where the enedioxy comes in. So methylenedioxymethamphetamine, or ecstasy, is basically a variation on methamphetamine. If you take a low dose of ecstasy, you’ll get the combination of psychedelic with some stimulant effects. But if you escalate the dose, it acts like a methamphetamine. You can have abuse, dependence and cardiac toxicity. And that leads to something ominous. Also, say you’re a kid in a rave club and you’ve got a whole bunch of methamphetamine, which costs about 50 cents a tablet. This is what really blows my mind…ecstasy tablets are selling for about $10 to $20 dollars a tablet.
Even more, I hear, in New York City. So what do you do? You take the methamphetamine and you punch it out and you sell it as ecstasy. It’s good business practice. We have a rave club task force who [goes into clubs and] gets samples. And we’re alarmed to find that an increasing number of the ecstasy tablets in the clubs are actually methamphetamine. The kids really can’t tell the difference–they are not the sophisticated psychedelic gourmets of the ’60s.
There were a few reports in the news last week of seizures of drugs. There was a big seizure of ecstasy tablets but there were also reports of a big seizure of pseudoephedrine, [a chemical that goes into making methamphetamine]. Pseudoephedrine can also serve as a precursor to ecstasy, although the synthesis is a bit more complicated. It would be a whole lot easier to just convert it to methamphetamine and sell it as ecstasy. In the news, it looked as though they were totally different phenomena, but they are not.
How old are most of the kids you see? Teens and young adults.
How are these drugs being used? One of the things we are seeing in the rave clubs and in the youth drug scene is the combining of drugs. The dominant drug trend is uppers and downers. Getting too wired is dose related and you can get that way on ecstasy. If you get too wired, you’re going to want to come down. The new upper-downer is ecstasy and GHB. GHB [Gamma HydroxyButyrate] is a depressant. We’ve seen people take many, many tablets of ecstasy and get very, very toxic, very paranoid and want to come down. So they’ll do GHB or alcohol or marijuana. But the best downer is heroin. We’ve seen ecstasy in combination with smokeable heroin … The dependence we see is part of a multiple-drug pattern. With ecstasy, we see a lot more adverse reactions than we do dependence cases. But ecstasy is not an innocent bystander any more than speed was an innocent bystander.
Just how damaging can ecstasy be? What we have seen in the poly-drug abuse pattern involving ecstasy or in single-dose abuse is what we call the post-hallucinogenic perceptual disorder … Users will say, “I went up and I can’t get down.” It wasn’t so much they had a bad trip but they’ll feel like they’re still on it days, even weeks or months later. They start getting depressed or panicky and think they have brain damage. This depression and cognitive impairment suggests impairment in the seratonin system … We get a lot of inquiries and referrals from various centers in dealing with issues like this. I think a great deal more research is needed … I was recently lecturing in Italy, and the use of ecstasy has just exploded across Italy. It’s a world-wide phenomenon.
You say the problem tends to be dose-related. I know part of the problem is not knowing whether the tablets you are getting are really ecstasy or some other drug. But what if someone takes just one small dose? Not every one that uses small doses has trouble. But for a kid, it’s like playing chemical Russian roulette. That’s the problem-kids get dancing in the clubs and they get really hot and dehydrated and they have cardiac problems or seizures. And then they may get compulsive with it because it is a stimulant, pushing the dosage up higher and developing dependence – just like methamphetamine.
Any idea how much of an increase in use there has been? We’ve seen an increase, but the data gathering system is not very good. The system in the United States is geared to hospitals and emergency rooms. There are a great deal more people out there than actually go into hospitals … You’ve heard about the organized-crime connections. It’s not the summer of love anymore. You know that big-time organized crime doesn’t get into it unless there is a big increase in market demand.
There was an article in The New York Times last week about a 23-year-old who was arrested in New Jersey for possessing a large amount of ecstasy. He ended up committing suicide. New Jersey recently upped the maximum sentence, making penalties comparable to those for selling heroin and cocaine. There were suggestions that this may have contributed to his suicide. My question: Do you think increasing the penalties for possession and distribution of the drug will help solve the problem? It looks like [officials] are working on a supply-reduction strategy through increasing penalties, which everybody says alone will not solve the problem … There’s quite a brilliant marketing campaign going on [with this drug]. I almost feel like the drug dealers and the tobacco company executives went to the same business school. They are marketing to youth and creating the impression that this is a perfectly safe drug, which is not true. We need to have a better-articulated demand reduction strategy and better support of a demand-reduction strategy. Of course, if the Mafia is in it, you need law-enforcement to go after them.
