E for Ecstasy by Nicholas Saunders
Appendix 1: Reference Section

30 Visit to Dr. John Henry at the National Poisons Unit at Guy's Hospital, London, 11/12/92

The unit offers a 24-hour telephone enquiry service to doctors throughout the UK who are presented with symptoms that they cannot clearly identify. All telephone enquirers are asked to send blood and urine samples for testing, which is usually carried out using one of three types of chromatography. Most samples are taken from live patients, but some are taken during a post mortem. Some drugs are easier to detect through blood and urine samples than others. Cannabis "can be detected 5 weeks after a single reefer"; LSD is very hard to detect.

Recently, a large proportion of samples of Ecstasy sent in for testing have been found to contain MDEA instead of MDMA. Dr. Henry thinks MDEA is less toxic than MDMA because it produces less jaw clench.

Asked what advance symptoms people who have taken MDMA should look out for as signs of the onset of overheating, Dr. Henry said that excessive sweating, staggering, thirst and exhaustion were the main symptoms. He said that overheating was unlikely to occur if enough water was drunk. Dr. Henry said that he believes that MDMA stimulates opiods, a neurotransmitter that acts as an internal anaesthetic. Opiods go into action when people bruise themselves badly playing football. Dr. Henry compares dancing at a rave with running a marathon - it involves four hours of exhausting exercise.

Neurotransmitters such as 5HT and opiods can be stimulated either by chemicals such as MDMA or by feelings of excitement. Dr. Henry says that this could explain why people who go to raves without taking drugs pick up on the same mood: the environment may cause them to produce their own neurotransmitters and this affects their mood.

Asked about the dangers of Paracetamol relative to those of MDMA, Dr. Henry said that Paracetamol causes over 200 deaths a year, but is very safe in normal doses. Overdosing affects the liver, and can cause death at doses of between 15 and 200 tablets. He said that MDMA is broken down by the liver into MDA and metabolites, which are excreted by the kidneys into the urine.

I asked Dr. Henry what evidence there was of a link between liver damage and Ecstasy use, mentioning that liver damage associated with Ecstasy use has not been reported in the USA and suggesting that cases in Britain might be the result of parallel use of alcohol or other drugs. Dr. Henry said that he has no doubt that MDMA causes hepatitis because some patients have exhibited the symptoms of hepatitis after each of several ingestions of MDMA.

I also asked about kidney failure (or 'acute renal failure' as reported in the medical journals) associated with Ecstasy use. Dr. Henry said that he believes this is the result of muscular breakdown overloading the kidneys with myoglobin. Muscular breakdown can also be caused by intense bouts of physical exercise.

Dr. Henry explained the mechanism of heatstroke. Dissolute Intravascular Coagulation (DIC) - blood clotting in the arteries - occurs at 42-43 degrees C (c.108 degrees F) and tiny blood clots stick to the artery walls. This is harmless in itself, as the blood clots are too small to cause a blockage, but the process can use up all the clotting agent, with the result that the blood will pour out of any of the tiny haemorrhages which occur throughout the cardiovascular system as part of the normal process of breakdown and repair. Such internal bleeding can be fatal. Internal bleeding in the brain, combined with high, pulsating blood pressure can cause strokes.

Out of all the millions of brain cells only 10,000 hold the chemical serotonin which is affected by MDMA. Serotonin levels have a marked effect on mood and a statistically significant proportion of suicide victims have been found to have depleted serotonin. Antidepressants of the SSRI type such as Prozac (Fluoxetine) inhibit the re-uptake of serotonin.

I asked Dr. Sheila Dorling, a lab researcher at the National Poisons Unit, what had been found in samples of E besides MDMA and MDEA. She said some MDA had been found plus various available drugs such as paracetamol and codeine; other samples only contained amphetamine. None contained LSD. The poisons unit does not analyse many Ecstasy pills.