Beware agony that follows the ecstasy

6th January 2006 at 00:00
After cannabis, ecstasy is the most commonly consumed illegal drug in Europe. Figures are hard to come by, but research suggests that up to one in 10 adolescents will take ecstasy at some point in their lives. It's also become a topic of political debate, with new Tory leader David Cameron saying that he would consider downgrading the drug from class A to class B.

Ecstasy or, to use the technical term, 3,4-methylenedioxymethamphetamine (MDMA), is a derivative of methamphetamine and was first manufactured in 1912 when it was patented in Germany as an appetite suppressant. The US military took an interest, but gave up when they realised that the drug's main effect is to arouse feelings of closeness and empathy with strangers. Although in the short term ecstasy enhances mood, perhaps by a mechanism not dissimilar to some antidepressants, and while there is typically no "hangover", there is an "offset" period in which mood worsens. This low mood, which persists for several days, is known as the "midweek blues".

Ecstasy can also kill. The most hazardous clinical symptom is hyperthermia: most deaths result from a persistent highly elevated body temperature which leads to the breakdown of skeletal muscle and organ failure. The drug's deadly reputation has been fuelled by the deaths of healthy young clubbers, yet the number of fatalities is tiny compared to the thousands of people who use the drug every weekend without suffering obvious physical harm.

Nevertheless, many young people regard it as an unsafe drug, unlike the widespread perception of cannabis.

This view is particularly pronounced in the UK; a survey in 1999 found that more than 90 per cent of 13 to 59-year-olds considered ecstasy "very" or "fairly harmful". In another survey, carried out in 2000, 58 to 75 per cent of schoolchildren and adolescents said they thought ecstasy was "always unsafe".

And yet kids still use it. When researchers at the Australian National University in Canberra surveyed young people on why they took ecstasy, around half reported enhanced mood, and 28 per cent said it improved their confidence. A paradox then. Many users know it's dangerous but use it nevertheless. But it's possible that many of these young people are suffering from problems which require a lot more than self-medication with ecstasy. Drug use is usually a symptom of a deeper underlying problem, and there is little point in the "just say no" approach.

Dr Raj Persaud is Gresham professor for public understanding of psychiatry, and director of the Centre for Public Engagement, King's College London.

His latest book is The Motivated Mind (Bantam Press). Email: rajpersaud@tes.co.uk

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