I’ve been surprised by the recent comments in the news from Professor Jake Najman, claiming that it is safer for people to use ecstasy than alcohol.  Whilst I am fiercely biased towards not using drugs, this is one that I have tried to look at objectively.  I’ve done a bit of a search online and found a few websties that describe the actual effects of both alcohol and ecstasy.  Both are disturbing, but I’m not about to stop drinking socially or start taking illicit drugs.  I’ve pasted some good extracts from some of the articles and also included the urls for those who wish to investigate for themselves.  It is an interesting and complex issue, but I have concluded that the opinions of Jake Najman published in the press are dangerous and irresponsible.

For a long time I have been opposed to the idea of harm minimisation with drugs, but also alcohol, as the approaches just do not work.  My opinions regarding drugs are stronger for the simple fact that most drugs used in these discussions actually fundamentally alter the way the brain works in the immediate short term.  Whilst alcohol does affect the brain during consumption and extensive long-term used literally turns your brain to mush (as well as damaging the liver and other organs), it’s worst effects are not immediate.  It can also alter the brain structure of adolescents, which is one of the many reasons we restrict it’s sale and consumption to those over the age of 18.  The effects of drugs on the brain seem to be quite different. They don’t merely slow everything down the way alcohol does, but actually messes with the way that your brain sends and receives signals from your body.  Ecstasy is no different – as you’ll see below.  The other thing to bear in mind as well is that on first taking drugs your brain does change when it starts to use receptors that it has not done previously.  The effects of drugs, including ecstasy are unpredictable, and in some cases extreme.  It’s the extreme biological and social reactions of people on drugs that makes the case for criminalising them compelling.  Also there’s part of me that thinks that there is more going for more naturally occurring compounds rather than something chemical and artificial is more beneficial (kind of like the argument in favour of organic food).  The other consideration is that drugs can also have immediate damaging psychological effects, such as psychotic or schizophrenic episodes and almost always causes some form of mental illness in the long term.  Ecstasy is a “young” drug as well, coming into being in the late 80’s so the long term impact to people’s health and well being has not been determined.  In fact, when you read some of the studies the impact of short term effects after the drug is no longer used is also yet to be determined.

Whilst I say no one had their first schizophrenic attack from their first drink, but they can get it from their first joint, for this I say no one had their muscles melt away from their first drink, but they can get it from their first Ecstasy pill.  Again, whilst the impact can be unpredictable (people may not know about underlying medical and hereditary factors that put them at risk when they take drugs), the dramatic impact of what can go wrong when it does go wrong is enough of a deterrent to discourage its use.

The other thing to realise, is that we can not say what the effects of people using neurotoxic drugs in the way that alcohol is used, will be.  For a start, researchers can not study the impact of Ecstasy in the way that can for alcohol or even therapeutic drugs.  It is unethical to conduct such research and I’m pretty sure Professor Najman knows that.  Whilst some data can be gathered, it can not be accurate or reliable as most people who take drugs, do not take just one drug.  And also the social effects can’t be determined the way alcohol can because it’s only a small portion of the population who use drugs to start with.  So we can not have any reliable information on cause of death etc.

One reason why people in authority may want people to take Ecstasy over drinking alcohol is that the mood of the consumer is either elated or anxious and depressed, but not aggressive.  Essentially making them easier to deal with when it comes to policing.  However no reasonable person could see this as a reason to introduce a drug with extreme and immediate adverse effects into the population.  It is usually concluded that people who have their first psychotic episode from marijuana have an underlying predisposition to it, and I believe the same is for people who become aggressive when consuming alcohol.  Generally, it slows most people down.  And this is more of a case for encouraging people to exhibit moderation when consuming alcohol, not the introduction of drugs.  Alcohol more than any other drug points to the fact that our policy of “harm minimisation” is actually an abject failure and needs to be revisited.  It also points to the fact that moderation will not be shown if people are allowed ready access to other drugs.

I want to say finally, that reading the research, the short term effects of using a small amount of Ecstasy is much less than the long term effects of alcohol abuse.  However most people use alcohol in moderation, and not to the point where it causes their brains and livers to shut down and their family home to be repossessed.  In fact most people who drink do not become aggressive or depressed or dangerous.  Whilst it needs to be treated with caution, it is a cornerstone of social interaction in our society and generally provides more good than harm.  The same can not be said of any illicit drugs.

www.therightmix.gov.au/pdfs/EffectsOnBody.pdf (Alcohol)

http://www.alcoholandwork.adf.org.au/browse.asp?ContainerID=health_effects_alcohol

Generally speaking, Australian men tend to drink alcohol more often and more heavily than Australian women. Of course there are individual men who drink lightly or not at all and women who drink at harmful levels.

Based on recent surveys, it has been conservatively estimated that:

• 12 per cent of Australian males drink alcohol every day, compared to 5.8 per cent of females
• 31 per cent of males drink at least once a month at levels placing them at risk of short-term harm (such as injury) from drinking
• 10 per cent of males are at risk of long-term health problems due to their alcohol consumption
• males aged 20 to 25 years are the most likely group to have consumed alcohol at risky or high risk levels for short term harm in the last week.

It has been calculated that 4 per cent of male deaths are alcohol-related, with the main causes of such deaths being alcoholic liver cirrhosis, road injury, stroke, suicide and alcohol dependence.

Health effects for young people

Many young adults do not drink alcohol at risky levels. However, if you are a young adult (aged 18 to 25 years), you are in the age group that is most likely to experience alcohol-related harm.

Young adults have the highest alcohol consumption in Australia and are the age group at highest risk of alcohol-related injury including road trauma, violence, unwanted sexual activity, falls, overdose related to a low tolerance to alcohol, accidental death (including drowning), and suicide.

Young people tend to experience many of the immediate effects of alcohol more strongly than adults and there is evidence that the earlier that a young person starts to drink alcohol, the greater the risk of alcohol-related problems in later life.

The Australian Alcohol Guidelines (Guideline 9) recommends that young people, aged about 18-25 years:

• are especially urged not to drink beyond the low-risk levels
• should not drink at all for at least several hours before undertaking potentially hazardous activities (for example, driving, swimming, boating)
• should not mix alcohol with other mood altering drugs.

Effects on brain function

However, there is another danger associated with young people drinking that has not received very much attention and relates to the developmental problems caused by alcohol. As a result of the changes in brain function that occur during adolescence, alcohol affects adolescents differently from the way it affects adults. Heavy exposure to alcohol during early adolescence may have a negative effect on healthy brain development. This can have long-term health and social consequences. (Drug Info)

Possible health benefits of alcohol

Research shows that moderate amounts of alcohol can reduce the risk of developing some types of cardiovascular disease. Death rates from coronary heart disease have been shown to be lower among middle-aged males who consume small to moderate amounts of alcohol than among non-drinkers.  The effect of alcohol in protecting against heart disease has shown to be relevant only for people over about 40 years. There is no evidence to suggest that it is relevant for younger age groups.

The Australian Longitudinal Study on Women's Health has found that Australian women who drink in moderation have a higher level of education, exercise more often and have more acceptable weight than teetotalers.

http://www.mja.com.au/public/issues/feb3/parr/parr.html (Medical report on the Anna Wood Case)

The effects of MDMA are numerous and complex, and severe reactions are unpredictable.¹ There have been many reports of MDMA-associated deaths caused by fulminant hyperthermia, coagulopathy and rhabdomyolysis,¹ and clinical awareness of these problems seems high. However, many other complications of MDMA ingestion, such as hyponatraemia, may result in death or serious morbidity and have received less publicity. Instances of hyponatraemia after MDMA ingestion have been reported, with postulated causes that include ingestion of large quantities of water, the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and contamination of the MDMA with other chemicals.^4-9 Hyponatraemia raises a diagnostic dilemma, as its signs may be indistinguishable from those of MDMA intoxication. ¹⁰ There is evidence that morbidity associated with hyponatraemia is highest in children and women and is not related to either the magnitude or duration of the hyponatraemia.¹¹

To our knowledge, this is the first Australian report of a fatality associated with ecstasy in which hyponatraemia and cerebral oedema appeared to be the main pathological processes. However, dissecting out the various factors involved in the death is extremely difficult. The roles of MDMA, the dance party environment, water ingestion, hyponatraemia, cerebral oedema, hypoxia, hypotension and SIADH are intertwined. The dance party environment encourages heavy exercise in a hot environment, with the advice to drink plenty of water. In the presence of high salt losses, this may produce hyponatraemia. Water ingestion may become uncontrolled as the individual attempts to treat symptoms or as the MDMA impairs rational judgement or possibly stimulates compulsive repetitive behaviour.¹² Cerebral oedema as a result of hyponatraemia is well recognised and may result in tentorial herniation, respiratory arrest and cerebral hypoxia.¹¹ SIADH has also been implicated in ecstasy-associated hyponatraemia.⁹ Although the mechanism is unclear, animal research suggests that serotonin increases secretion of antidiuretic hormone.¹³

Given the many people who take ecstasy without apparent ill-effect, it has acquired a safe reputation. Among the many adverse reactions, we must now include life-threatening hyponatraemia, which may have the same symptoms and signs as MDMA intoxication. To avoid adverse reactions, individuals using MDMA at dance parties are often advised to rest, avoid overheating, wear loose clothing and drink plenty of cool drinks.¹⁴ However, there is no evidence that this prevents adverse reactions. Furthermore, because of the possibility of hyponatraemia, this advice should be modified to suggest ingesting only moderate amounts of liquids. The importance of seeking medical attention promptly for non-resolving symptoms should also be emphasised.

http://www.smh.com.au/articles/2003/04/04/1048962923800.html

An animal study by Dr George Ricaurte and colleagues at John Hopkins University in Maryland published in Science last Septemberfound ecstasy damages the brain and causes a condition similar to Parkinson's disease known as Parkinsonas.

Ricaurte and his wife, Una McCann, have researched the drug for almost 15 years using animals.

The results of their work, damning long-term ecstasy use, were widely criticised, partly because multiple doses in animals do not simulate human exposure.

In Sydney, McGregor is recognised as a leading researcher into the long-term effects of ecstasy use. Like Ricaurte, he experiments on rats, but he is keen to avoid the same sort of criticism levelled at Ricaurte.

"We are very careful in our rat studies to give doses that are comparable to what a human would use," he says.

The most far-reaching aspect of McGregor's research is the finding that lab rats given modest amounts of MDMA still show effects three to six months later.

One of the effects is increased anxiety, even after small doses of the drug. "We put them in a new environment and they seem less confident in exploring that environment," he says.

"In the same test of social behaviour, rats display less social interaction than control rats who have never had the drug. It is almost like the social circuit of the brain is overactivated in the short term by ecstasy, but in the long term may become damaged or burnt out."

McGregor also found that ecstasy has a similar effect on rats to humans. "The immediate social effects of ecstasy are not confined to humans. Rats cuddle up just as much as humans do after using it. Rats also get hot and run around a lot after they have been given the drug," he says.

Paul Dillon agrees that the drug is less predictable than people think and "affects different people in different ways".

He cited the recent example of a man who shared an ecstasy tablet with his girlfriend. His temperature became so high that he suffered what Dillon calls a "melt down" and "lost part of his calf muscle. She suffered no apparent negative effects".

He knows young women who, after taking the drug, "have had panic attacks and haven't been able to function properly", but says that a pre-existing condition may have been exacerbated.

"Sometimes ecstasy can do terrible things to people, but it depends on the individual," he says.

Ultimately, "there are no common consequences".

http://www.thegooddrugsguide.com/ecstasy/faq.htm

» Is ecstasy addictive?
Physically no, the body will not crave more, or become dependent with repeated use. There is a psychological danger, however, that users can start to like it too much and crave the emotional contentment that it provides. Craving the next party, mood swings and inability to concentrate on mundane tasks are common signs.

» Why doesn't it work anymore?
Many users feel Ecstasy isn't as strong as it used to be, though purity tests suggest the average MDMA content has changed little over the years. Users quickly build up a tolerance, requiring more E to reach the same highs. Also, the novelty and surprise qualities of a person's first few experiences are unlikely to be repeated, unless use is very infrequent (once or twice a year).

» How many people die from using ecstasy? Isn't it very risky?
The UK figures suggest seven ecstasy-related deaths per million users. This compares to 625 alcohol-related deaths per million drinkers. In fact, more people in the UK die from choking on peanuts than from taking ecstasy.

» I've heard E is "neurotoxic" - what does that mean?
'Neurotoxic' is applied to any substance which causes temporary or permanent changes in the brain. Animal tests have shown MDMA to be neurotoxic in large amounts. Nobody is sure at what level MDMA becomes neurotoxic in humans, but even moderate E use can cause memory-impairments. See our special report: Does Ecstasy Impair Memory (follow this link it has a good report).

http://www.druginfo.adf.org.au/downloads/Prevention_Research_Quarterly/PRQ_05Dec_Ecstasy_and_related_drugs.pdf

Different studies examining the negative effects on users have largely produced consistent findings. These include loss of appetite, jaw clenching, teeth grinding, nausea, muscle aches, stiffness, ataxia (impairment of motor control), blurred vision, increased sweating, increased heart rate, insomnia and fatigue. Most of these side effects subside within 24 hours (Davison & Parrott 1997; Greer & Tolbert 1986; Topp et al. 2002; Liechti & Vollenweider 2000 Fry & Miller 2002).

The predominant toxicity patterns that emerge from emergency rooms and death reports are fulminant hyperthermia convulsions, disseminated intravascular coagulation (DIC) (blood clotting in the blood vessels), rhabdomyolysis (dissolution of skeletal muscle) and acute renal (kidney) failure. In fulminant hyperthermia, the ecstasy user experiences high body temperature that leads to multiple organ failure, and in some cases death. In most cases, when the user’s body temperature rises above 42°C, the reaction is fatal (Cole & Sumnall 2003). There is also some evidence to suggest that hyperthermia caused by ecstasy intake may cause liver damage (Andreu, Mas & Brugura 1998; Jones & Simpson 1999).

Ecstasy intoxication has also been linked to hyponatremia, a condition to which young women appear to be more susceptible than men (Budisavljevic, Stewart, Sahn & Ploth 2003). The pathogenesis of MDMA-associated hyponatremia involves excessive water intake, and inappropriately elevated antidiuretic hormone (ADH) levels. Many ecstasy users participate in raves, dancing for hours, usually in large crowds and in hot temperatures. In order to combat dehydration, it was initially recommended to ravers that they be aware of water consumption (Finch, Sell & Arnold 1996).  Many ravers then drank water excessively, which in turn led to hypothermia and cerebral oedema (Box, Prescott & Freestone. 1997). Moreover, to strengthen the effects of the drug, many users also began to consume “energy drinks” containing vitamins and amino acids, which increase the potential toxicity (Maxwell 2005). Currently, ecstasy users in raves/clubs are advised to drink isotonic sport drinks and small amounts of water in conjunction with salty foods.

Most of the findings relating to the effects of ecstasy on the central nervous system focus on the serotonergic pathways. Laboratory studies have reported a decrease in the number of 5-HT sites in the brain (Reneman, Booij, Schmand, van den Brink et al. 2001; Semple, Ebmeier & Glabus 1999). However, these changes have been found to be temporary. Other studies have found lower levels of 5-HIAA in the CSF among ecstasy users, compared to those in control groups (for example, Grob 2000; McCann 1994). This may point toward some dysfunction in the serotonergic pathway among users. Overall, due to the ethical issues associated with the provision of ecstasy to users for scientific study, this line of research produces inconsistent results, and as such, long-term effects are not known.

Ecstasy users report a wide range of psychological effects, positive (as mentioned above) and negative, which include anxiety, depression, depersonalisation, confusion, perceptual side effects such as “flashbacks” and hallucinations, aggression and impulsivity, motivational deficits, panic attacks and paranoia (Montoya, Sorrentino, Lukas & Price 2002). Many of these psychological effects seem to be consistent with the cumulative evidence that ecstasy has toxic effects on serotonergic pathways in the brain (Morgan, Mofie, Fleetwood & Robinson 2002).

The most commonly reported symptoms are panic attacks/anxiety and toxic psychoses. Panic attacks usually tend to occur within the first hour of ecstasy consumption (Williamson, Gossop, Powis, Griffiths et al. 1997). According to McCann and Ricaurte (1991), individuals with genetic predisposition to panic attacks are more vulnerable to experiencing an attack while using ecstasy. In such cases, the risk is that ecstasy use may trigger panic disorder.

With regard to toxic psychoses, Gouzoulis, von Bardeleben, Rupp, Kovar et al. (1993) showed that ecstasy caused psychosis when given to a healthy volunteer. While other cases have been reported (self reports), it is known that these individuals also presented with premorbid psychological dysfunctions (Gamma et al. 2000). In another study, heavy ecstasy users indicated significantly higher scores on a psychological symptoms list, compared to nonusers.  These include obsessive-compulsive patterns, anxiety, psychosis, somatisation and loss of pleasure from sexual activity (Parrott 2001). Further findings suggest high levels of depression among users (MacInnes, Handley & Harding 2001; Verheyden, Maidment & Curran 2003). Gender differences were also identified, with women being more susceptible than men to “flashbacks”, hallucinations (Liechti & Vollenwieder 2001) and low mood following a weekend of ecstasy use (Verheyden et al. 2002; Maxwell 2005).