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Sunday, Nov 8, 2009
The trouble with relatively new drugs is that the real trials take place outside of the lab -- in the love puddles, at the raves, in the desert.
"We test medicine for many years -- but with drugs, people often test themselves," says Mark Gold, chief of the division of addiction medicine at the University of Florida McKnight Brain Institute. He keeps a huge poster detailing Ecstasy use, abuse, emergency room visits and deaths on the wall of his office. "The research is really, 'How many people have become addicted or ended up in emergency room?' It's all done on the fly."
We do know that according to the U.S. Substance Abuse and Mental Health Administration (SAMHSA) in 2001, the number of Ecstasy-related emergency room visits rose to 5,542, up from 4,511 in 2000 and 2,850 in 1999. To put that number in perspective, that's about 3,000 more E.R. visits related to Ecstasy than for LSD, and 88,000 less than for heroin. (There were 61,000 antidepressant-related trips to the E.R. in 2001, in case you were wondering.)
When I was in high school, I had heard of E, but certainly didn't know anyone who had taken it. That was the early '80s. Cut to 2002, when Monitoring the Future (MTF), an organization that tracks trends in teen drug use, found that the increase among 12th graders using Ecstasy was the largest jump of any drug in its 26-year history of tracking teen drug use (11.7 percent have tried E), though in the past year teen use has dropped a bit, to below 11 percent. SAMHSA reported 63 Ecstasy-specific fatalities in the year 2000, most due to heatstroke, and occasionally due to hyponatremia, which is death by drinking too much water. Overdosing on E, in the sense that we think of someone OD'ing on Oxycontin, coke or heroin, is extremely rare.
Victor, for one, has never ended up in the E.R., but he does think all this E has been bad on the brain. "I've suffered some permanent memory loss -- both long- and short-term. Yes, it has something to do with the fact that I am older. And yes, there's the fact that I have been doing recreational drugs for 17 years. But I feel like after I take E, my mind is worse."
"I think I was one of the few voices in the group in the early days who was suggesting that we exercise some moderation," says Sarah (not her real name), a 32-year-old who works in the natural foods business in Northern California. "I knew many people who complained of mild depression the week following a particularly indulgent weekend, and one person who went into it hardcore and basically battled depression on a big scale. Eventually, he wound up going on multiple and varied hardcore antidepressants, with very little success. I think the initial reaction of the group when I brought this stuff up was that I was harshing their mellow."
That attitude has changed. Now we're very curious: Does Ecstasy cause irrevocable brain damage? Will we get Parkinson's? Will we become depressed? Will our kids be fucked up? Empirically, there is an answer. We just don't know what it is yet.
In the short term, the $20 question is whether it's addictive. Here, the experts disagree. "The answer to this is a definite yes," says Dr. Cadet. "Ecstasy can influence the same feel-good systems that drugs like cocaine and speed stimulate."
Dr. Holland disagrees. "I don't believe a physiological addiction has been demonstrated," she says. "I work in the psych E.R. where I routinely treat people addicted to alcohol, cocaine or heroin -- and I have never seen a case of Ecstasy addiction. But I will say that people can become psychologically addicted to any activity, from surfing the Internet, to compulsively having sex, to using Ecstasy."
Experts always disagree; that's why they're experts. In the end all you can do is hear them out, add in your own experiences and those of people you know and make your best guess. Talk to anyone who does the drug regularly and there's a good bet you'll hear something like this: When I'm on it, I really want to stay on it. This can lead to compulsive -- and chemically pointless -- pill popping in order to stay high. Bottom line: It may or may not fall under what is considered a physical addiction, but many people still have a psychological jones for it. In the many conversations I had with my friends about Ecstasy for this story, I could almost feel their heart rates increase when recounting the great early E experiences. E remains exciting stuff -- even when it worries us.
Checking back with the four monkeys who survived Ricaurte's über-doses is one way to find out E's long-term downsides, if any. Of course, the doctor's subjects will still be overdosed monkeys, not humans. Checking back with my friends in another 15 years -- when many of us will be celebrating our 50th year on earth -- might be a more natural laboratory in which to observe the drug's long-term effects.
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Hawkeye from "M*A*S*H" liked to say: Nothing exceeds like excess.
The Buddhist philosopher Alan Watts famously wrote: When you get the message, hang up the phone.
For the past few years, my Ecstasy club has been teetering in between these two notions. We're beginning to realize that drugs are many things, but in the end they are just that: drugs.
What, after all these years, are we trying to cure? And how will we continue to do the work of self-medication as the E wears off, whether through total abandonment of the drug or tapering?
Ecstasy showed up at a time in our lives when our need for intimate human connections was bigger than our desire to be independent -- Rushkoff's post-caveman clan theory. Now, with most of us over 30, many closer to 40, we've got real jobs at real companies, and are in committed relationships with partners with whom we share real mortgages and may even raise real families. "When the order of business is no longer how to lose the self," says Rushkoff, "that's not the moment you take E."
