Ecstasy, Temperature, and Long-Term Effects

Ecstasy has become increasingly popular among young adults, especially within the young adult dance scene at parties known as “raves.” Ecstasy or 3,4-methylenedioxymethamphetamine, also known as MDMA, gives users a euphoric feeling, often making them feel closer to other people, thus giving it the name, the “love drug” (Ramcharan, Meenhorst, Otten, Koks, de Boer, Maes, and Beijnen, 1998). Patented in 1914 as an appetite suppressant, MDMA was banned in the 1980s (Henry, Jeffreys, and Dawling, 1992). Many users today assume that MDMA is relatively safe and only causes slight impairments to functioning; however, research shows that use of MDMA can have neurotoxic effects. Studies indicate that ambient temperatures can induce toxicity, and MDMA use can cause a decrease in 5-HT (one type of serotonin receptor) axons and axon terminals (Malberg and Lewis, 1998). When regeneration of 5-HT axons does occur, it is often abnormal (Green and Goodwin, 1996; Hatzidimitriou, McCann, and Ricaurte, 1999).

Kalat (2001) states that low serotonin release can cause an increase in aggressive behavior. Studies show that monkeys with low levels of serotonin turnover display an increase in aggressive behavior. This also may be true for humans with similar serotonin deficiencies: low serotonin has also been found in persons attempting suicide. However, it is not conclusive that low serotonin is responsible for aggression as it is for impulsiveness. Mice given the choice of a small but more frequent reward or a larger reward with a longer waiting period chose the small but frequent reward. Serotonin levels not only affect aggression and impulses but thermoregulation as well (Ramcharan, Meenhorst, Otten, Koks, de Boer, Maes, and Beijnen, 1998). In studies of tissue distribution in MDMA users, the brain and liver showed the highest levels of MDMA (Ramcharan, et al, 1998).

In a study of the effects of ambient temperature and neurotoxicity on MDMA, it was found that a change in the ambient temperature of as little as 2° Celsius (C) can cause neurotoxicity (Malberg and Lewis, 1998). In the study, rats were treated with either MDMA or saline. Ambient temperatures were controlled at 20°, 22°, 24°, 26°, 28°, or 30° C, core temperature was measured, and after two weeks, the rats were killed, and 5-HT and 5-hydroxyindole acetic acid levels were analyzed for toxicity (Malberg and Lewis, 1998). It was found that in rats that were treated with saline, the core temperature was not affected by the ambient temperature; however, in the MDMA treated rats, hypothermia was produced in ambient temperatures of 20° and 20° C, and hyperthermia was verified in the MDMA-treated rats in an ambient temperature of 28°-30° C (Malberg and Lewis, 1998).

No changes in neurotransmitter levels were found in the saline-treated rats that were in an ambient temperature of 24°-40° C; however in the MDMA treated rats, depletions of 5-HT and 5-HIAA levels occurred with 24° C being the “breaking point.” As the ambient temperature increased, the more depletion of serotonin receptors was found (Malberg and Lewis, 1998). It seems that MDMA causes neurotoxicity with increased ambient temperatures. Caution is needed since many users take MDMA at “rave” parties where the environment is very warm, and the users are often dancing, drinking alcohol, and not replacing lost fluids. Thus, one of the environments that MDMA use is most popular, raves, could also be one of the elements that increases the neurotoxicity of the drug.

In another study (Hatzidimitriou, McCann, and Ricaurte, 1999), monkeys were studied to find if 5-HT deficits continued after seven years of being treated with MDMA. Previous studies were done 18 months after MDMA had been administered. Monkeys were treated with either saline or MDMA and killed at either two weeks or seven years following administration of saline or MDMA. The monkeys treated with saline showed no significant changes in 5-HT axon density, thus ruling out axon degeneration caused by aging. In MDMA-treated monkeys, significant reductions of 5-HT axon densities occurred in many areas of the brain, including the cerebral cortex, hippocampal formation, striatum, amygdaloid complex, hypothalamus, thalamus, and raphe nuclei. Of those areas, all except the hypothalamus, thalamus, and raphe nuclei, showed significant loss in 5-HT axon density at two weeks, and when there was recovery after seven years, it was rarely full recovery and often the recovery was abnormal. After seven years, the hypothalamus had complete recovery to damaged 5-HT axons, most of the nuclei of the thalamus had complete recovery in the seven-year monkeys, and the raphe nuclei showed no loss of cell bodies or 5-HT axons at either two weeks or seven years in the MDMA-treated monkeys (Hatzidimitriou, McCann, and Ricaurte, 1999). Hatzidimitriou, et al., state that there could be several factors to explain the regeneration in some areas of the brain and not in others. One explanation is the proximity of the axons to the cell bodies, the myelination of the fibers, and the size of the lesion caused by MDMA. In the occipital lobe and the primary visual cortex, reduction occurred in fibers in layer IVC. Even after seven years, the layer was still unrecognizable as a distinctive layer. In the hippocampal formation, the subiculum showed the most decrease in 5-HT axons, with an 80 percent loss remaining even after seven years (Hatzidimitriou, McCann, and Ricaurte, 1999).

Boot, McGregor, and Hall (2000) state that the most long-term damage is done to the 5-HT axons of the cortex, hippocampus, and striatum. There is an argument in the studies aforementioned. One argument is that the laboratory animals have the MDMA injected, while many human users of MDMA take the drug orally. The injection of MDMA in monkeys is far more neurotoxic than oral ingestion in humans (Boot, McGregor, and Hall, 2000). Another argument is that low densities of 5-HT axons might be the cause of MDMA use. 

There have been links between low 5-HT concentrations and impulsiveness (Boot, McGregor, and Hall, 2000). Boot, McGregor, and Hall (2000) also state that heavy users of MDMA have EEG patterns similar to patterns of people who are aging or experiencing dementia.

Research shows that severe degeneration of parts of the brain can occur after a single dose of MDMA in rats (Green and Goodwin, 1996). Yet, there are cases of individuals who have survived massive overdoses of MDMA.

In one case, a 30-year old man, who was reported to have taken 50 tablets of MDMA in addition to alcohol and oxazepam, was admitted to the hospital comatose and convulsing. With the exception of an increase in the enzyme creatine phosphokinase (CPK), (probably convulsion induced), the subject had a complete recovery in two days (Ramcharan, et al, 1998). Although the literature does not state whether or not there was significant reduction in his 5-HT axons or axon terminals, perhaps the dosage was not as lethal as it could have been. The man took the dosage at home in a cool and relaxed atmosphere where the ambient temperature did not increase to the levels indicative of toxicity (Ramcharan, et al, 1998). The literature does not indicate if the individual was taking any prescription drugs in prescribed dosages. Studies (Malberg and Lewis, 1998) have shown that fluoxetine (Prozac) can prevent MDMA from entering 5-HT neurons. Although rats in the experiment still suffered from hyperthermia, there was no evidence of neurotoxicity with a fluoxetine pretreatment. Despite this individual’s survival of such high doses of MDMA, due to the neurotoxicity of MDMA, and its effects on 5-HT axons and axon receptors, there could also be long-term psychological problems due to impairment of serotonin processing, including depression, aggression, and impulsiveness. Studying the effects of MDMA in humans is difficult. MDMA cannot be administered to humans in a research situation, and the means of administration to animals is often different from that of humans, so frequently studies must be done on individuals and self-reports. Even when examined in a scientific situation, results may be inconsistent. If people obtain MDMA illegally, and it is not a natural-based drug, ingredients and the levels of the ingredients are likely inconsistent, thus making it difficult to determine exactly at what levels neurotoxicity occurs, and if perhaps other chemicals might be reacting with MDMA. In the mean time, more research needs to be done to determine the effects of MDMA on humans, and the effects selective serotonin reupkate inhibitors such as fluoxetine have on the decrease of the toxicity of MDMA.

References

Boot, B., McGregor, I., & Hall, W. (2000, May). MDMA (Ecstasy) neurotoxicity: assessing and communicating the risks. The Lancet [Online Serial], 355 (9217): 1818, Retrieved March 24, 2001 from the World Wide Web: http://web7.infotrac.galegroup.com/itw/I..._A62266508&dyn=105!ar_fmt?sw_aep=nu_ma

Green, R. &Goodwin, G. (1996, June). Ecstasy and neurodegeneration: ecstasy’s long term effects are potentially more damaging than its acute toxicity. British Medical Journal [Online serial], 312(7045):1493, Retrieved March 24, 2001 from the World Wide Web: http://web7.infotrac.galegroup.com/itw/I...0_A18456698&dyn=70!ar_fmt?sw_aep=nu_ma

Hatzidimitriou, G., McCann, U., & Ricaurte, G. (1999, June). Altered Serotonin Innervation Patterns in the Forebrain of Monkey Treated with (+/-)3,4-Methylenedioxymethamphetamine Seven Years Previously: Factors Influencing Abnormal Recovery. The Journal of Neuroscience [Online serial], 19(12):5096-5107, Retrieved March 24, 2001 from the World Wide Web: http://www.jneurosci.org/cgi/content/ful...d=QID_NOT_SET&stored_search=&FIRSTINDE>

Henry, J., Jeffreys, K., & Dawling, S. (1992, Aug). Toxicity and deaths from 3,4-methylenedioxymethamphetamine (“ecstasy”). The Lancet [Online serial], 340(8816): 384(4), Retrieved March 24, 2001 from the World Wide Web: http://web7.infotrac.galegroup.com/itw/I...0_A12554376&dyn=98!ar_fmt?sw_aep=nu_ma

Kalat, J. (2001). Biological Psychology (7^th ed.). Belmont: Wadsworth/Thompson Learning

Malberg, J & Seiden, L. (1998, July). Small Changes in Ambient Temperature Cause Large Changes in 3,4-Methylenedioxymethamphetamine (MDMA)=Induced Serotonin Neurotoxicity and Core Body Temperature in the Rat. The Journal of Neuroscience [Oneline serial], 18(13):5086-5094, Retrieved March 24, 2001 from the World Wide Web: http://www.jneurosci.org/cgi/content/ful...d=QID_NOT_SET&stored_search=&FIRSTINDE>

Ramcharan, S., Meenhorst, P.L., Otten, J.M.M.B., Koks, C.H.W., de Boer, D., Maes, R.A.A., & Beijnen, J.H. (1998, Dec.). Survival After Massive Ecstasy Overdose. Journal of Toxicology: Clinical Toxicology [Online serial], 36 (7): 727, Retrieved March 24, 2001 from the World Wide Web: http://web7.infotrac.galegroup.com/itw/i...0_A53499521&dyn=49!as_fmt?sw_aep=nu_ma

Kane's Room

"Boy, if you don't clean that room, I'm going to beat you. Do you understand me?" I try to sound stern, but I think I come across more as defeated. It is already 12 o'clock on a beautiful Sunday afternoon in late September, the kind of afternoon that begs you to come out and play. My five-year-old son, Kane, has been cleaning his room since Friday night, and the really frustrating part is that it isn't even that messy. It should take him all of twenty minutes—that is if he would just go in there and get busy, but he has his mama's ability to entertain himself. This is definitely history reenacted. As I say those words to him, I can hear my mother saying the same thing to me 27 years earlier as I lay on my bedroom floor marveling at the fibers of split-pea-soup-green carpet. I wonder how they twisted all those little hairs together, and how they got those tiny fibers to stick together without moving or falling off—oh, look over there—there’s a little spider. See how he bobs when he walks? I wonder why he does it. Is he doing spider push-ups? I stand up, mimicking the spider, and bounce like I am a little basketball and someone is dribbling me ever so slowly to the hoop. Is it a girl spider or a boy spider?

I am torn. How can I get upset with Kane when he is exactly like me? I understand him. He is me. When other parents see it as being difficult, I see it as the innocent, inquisitiveness of a five-year-old trying to find the answers to everything he sees and finding beauty and intricacy in all the things we take for granted as adults: the way the dust settles on the carpet behind the bed; the chip of paint, missing from the door frame, a chip so small you can't see it unless you are laying on the floor and looking at a 45 degree angle; and all the wonderful zoo animals formed by the texture on the walls when you just sort of stare off and let your eyes go lazy. But, nevertheless, I still need him to learn how to be responsible and clean up the messes he makes.

I walk back into the living room to finish cleaning the house, and decide to put another CD in the stereo. I look through my two hundred plus CDs and can't decide what I want to listen to. I take each one out and read the song lists, searching for a CD that will bring back memories of happy times and that will motivate me. And while I am doing this, I am contemplating my next course of action with Kane if he still hasn't made progress on his bedroom. Should I take his Batman toys away? Maybe I will tell him he will be grounded if he doesn't have it done by 2 o'clock. My mind wanders back and forth between my disciplinarian actions with Kane and the alphabetizing of my CDs. After all, if they are in alphabetical order, they will be easier to find next time.

Before I can go back in and check on Kane's progress, he comes running down the hall shouting in an elated voice, "Mom! Mom! Look! I drew you a picture. Do you want to see it?"

My first inclination is to tell him no, and to go back into his room and finish cleaning, but his grin is as big as a banana, and his eyes have excitement dancing in them as if he has just discovered buried treasure.

"Okay. You can show Mama the picture, but then you need to finish cleaning your room," I say this trying to sound somewhat authoritarian. Kane climbs up on my lap and begins to describe his work of art to me.

"Look, I drew a house. That's our house—that’s the window, that's the door, that's the door knock, (he will argue until he is red with frustration that it is a door knock and not a door knob), and that's the sidewalk. See, there are some birds--five birds because I am five. And that is a flower growing on the top of the roof. That's kinda silly, huh?" He giggles and grins even bigger when he tells me about the flower on the roof. And, I just look at him with amazement and wonder at how I have been blessed with such a wonderful child with such a sweet and beautiful spirit.

“That is the chimney, but I couldn't draw the bricks, so I drew squares. That is smoke, but it isn't real smoke. It's pretend smoke. Those are clouds, but they aren't rain clouds. They are white clouds. That is the grass, and that is the dirt. You have to have the dirt so the grass won't fall down. There is the sun, but I didn't make it yellow because I used a pen, and the pen was only blue, but the sun isn't really blue. Those are train tracks. Mama, I like trains. Do you like trains? And that is you. You are holding a flower because you like flowers. You love flowers, don't you, Mama? See, and you are smiling. You are smiling because you are happy. You are so happy because you have a flower. And that is me. I am doing my Winnie the Pooh puzzle and putting it away."

All I can do is look at his drawing with the same admiration as if I am looking at a Renoir painting. I look at Kane and I look at his masterpiece again. I feel my eyes becoming moist. "Honey, I love it. It is a beautiful picture. Thank you for drawing such a lovely picture for me. You did a great job, and you drew it with so much detail."

"Mom, what does that mean? What is dee-tail?" I explain detail to Kane and then ask him if he has finished cleaning his room.

"Oh, I forgot to clean my room, but I will, Mama. I'll do it right now." I think about it. I have lost almost two days with my beautiful, precious baby. I will have to go to work tomorrow, and I won’t have an opportunity like this again until next weekend. We have the rest of our lives to clean, but only a moment to enjoy the beauty of the world through his five-year-old eyes.

"Tell you what, baby. You go in there and get your shoes on while I look for a frame for this beautiful picture you drew."

"Do I still have to clean my room?"

"You still have to clean your room, but not right now. How about if we go to the park, and when we get home, I will help you clean your room?"

"ALL RIGHT! We're going to the park, Mom?"

"Yes, we are going to the park, and don't think you hornswaggled me, because you didn't." I laugh as I say that to him. I know he indeed hornswaggled me. He pulled a fast one on me whether he meant to or not. But, he also taught me a valuable lesson--the mess will always be there, but the innocence and the excitement he has when he sees the world around him will fade too fast. I may be his mother, but that doesn't give me the right to break his beautiful, inquisitive, and innocent little spirit.

"I love you, my son." Kane looks at me and smiles at me with a huge toothless smile.

"I love you too, Mama."

Tangelo Stallion

Lo, gallant stone, I

Tell a gal to sin on

A goon’s ill talent.

A gent, lain lost. Lo!

An agent ill, loots.

Alone, stalling to

Listen. Go on, a tall,

Tall elation song.

O! An angel’s ill tot,

No legs; all on a tit.

No little gals on a

Tangelo stallion.

All gents toil on a

Gale lost, lain not

Slain, not legal to

Tell it on a slogan.

On a little slogan,

I lost all on a gent,

Into legal talons

Not on a legal list.

In all, get lost on a

Tangelo stallion

To let all sing on a

Long-last elation.

I stall on tangelo

Tangelo stallion

Slain nag too. Tell

All—ten slain! Go to

Gloat, all in stone.

Align no stale lot.

Alone, sin got tall,

Along tall stone, I

Got all silent on a

Stone gal, ill to an

Angel, a tot son—ill!

Lo! All-stone giant

Still to no glean, a

Gallant oilstone,

All lit onstage, on

A signal to tell on.

Angel, it’s on all to

Align solo talent

Ain’t along to sell

A tall silent goon.

Alas, no telling, to

Let slang toil on a

Last legal notion—

Tell it on a slogan!

I, along tall stone,

Alone, angst I toll,

In all, get lost on a

Legal nation lost

To let all sing on a

Long-last elation.

In all, get lost on a

Tangelo stallion.

Alas, no ill gotten

Long salt elation

Lo! All nations get

A glint lost alone.

Piss-Shit Water

Feces floatin’

in a porcelain bowl

of beer-yellow urine,

“Git chur ass ov’r here!

Ya little chickenshit! I’ll give ya shit!”

Whiskey-tainted piss-shit water

Flushin’ away six-year-old tears,

stinkin’ in my nostrils

forcin’ me to fight,

encouragin’ me to lie,

wakin’ me from sleep,

scarin’ me into survival.

Pruno-tainted piss-shit water

remindin’ my cellie he’s my bitch

Feces floatin’

in a stainless steel bowl

of beer-yellow urine,

whiskey-tainted piss-shit water

still with me after thirty years.

To Virginia

I lost you once,

and I lost you twice, then

I lost you thrice

stolen in secrecy

a decade before

you would weep

your thief

dead

before discovery

unaware

you were gone

you were

resurrected

snatched away violently

weeks before

you were legal

thieves

abscond

into dark anonymity

your absence

denied

you were

resurrected

given

instantly

to the first bidder

the recipient

not fit for

your worth

your absence

acknowledged

your were

not resurrected

like the son

you were

sacrificed

for the sins

of the mother’s drunken father

of the two drunken men in the red truck

of the

hopeless

drunken

girl

I lost you once,

and I lost you twice, then

I lost you thrice.

The Liquor Store: a sestina

One night I stopped to buy some smokes. Into

the liquor store I walked. Many people

were inside, some in search of bad habits;

our vices bring most of us here. A woman

in front of me was buying smokes—two types;

she bought beer too. I looked over at her.

She was clean and well groomed. She reached in her

purse, took out her card, put her PIN into

the machine. Plastic has different types.

Some people have bank cards, and some people

credit. An EBT card this woman

used—welfare! To support her habits?

I felt my body tense up. My habits

aren’t paid by the government. I watched her

and felt a deep disgust for this woman.

I wanted to curse her. I delved into

my mind to ask why we allow people

to use aid to purchase things of these types.

I began to think of different types

of people. Each of us has our habits.

I don’t know all the obstacles people

face. Then I pondered the “what-ifs.” Was her

story one I could understand? “Try to

put yourself in the life of this woman.”

Did her man say, “Go to the store, woman,

and buy me some beer and smokes—get two types.”

Did he make a threat to beat her into

oblivion—again? Are his habits

supported by Her fear of him? Is her

life spent taking care of other people?

Her life intrigued me. She treated people

with respect. She was pleasant, this woman

who I wanted to curse. Now I saw her

differently—just one of many types

of people, all with various habits

and whose lives I will never get into.

In the store are people of many types,

and I found this woman may have habits,

but I can’t judge her or what she’s into.

Little Bird

I found a little bird with broken wings,

so emaciated from starvation.

There’s no voice for songs, just a sound that stings.

His scared, child-like eyes can’t see salvation.

Cold and trembling, sure that harm is to come,

his beak and talons are just as a hawk’s

Angry about what his life has become,

if I try to help, he scratches and squawks.

So, he lacks the skills of civilized cultures.

Some would say he’s just a barbarian.

He’s a dove, been raised by vultures,

and fed just bits of diseased carrion.

I see his chance for recovery’s slim,

so I put him back where once I found him.