E for Ecstasy by Nicholas Saunders
Appendix 1: Reference Section

59 MDMA - The Dark Side of Ecstasy, by Gregory Hayner and Howard McKinney, from Journal of Psychoactive Drugs, Vol. 18/4 1986

This paper concerns toxic effects of MDMA on illicit users who attended the Haight Ashbury Free Medical Clinic in 1986.

The authors note that both the doses taken and user's reactions were variable. Analysis of samples showed doses ranging from 16 to 165 mg. Acute reactions were rare and were usually confined to sensitive people taking high doses, particularly when they repeated the dose within a short period. Overdoses had unpredictable results: some effects lasted up to 2 weeks. Psychosis, including paranoia and hallucinations, usually resulted from very high dosages.

The paper includes two case reports:

1. A heroin addict who was adequately sedated had hallucinations and paranoia and was violent after a large dose of MDMA.

2. A normal 33 year-old woman who worked for a publisher took a large dose - estimated at 50 to 100mg - with 4 friends. The trip was normal, with the woman still remembering it as the best time of her life. But one month later she took a normal dose from the same batch and within 20 minutes experienced feelings of dread and had visual hallucinations of the sky turning black and a devastated landscape spiralling in on her "like a ton of bricks". She lost consciousness and was taken to hospital where she had to be restrained for several hours. After 3 days she was regarded as normal, but stayed off work for a month. She was depressed, had bouts of crying and was not her normal self for 6 months. Laboratory analysis showed the batch of MDMA to be 95% pure and no other substances showed up in her body fluids.

The authors conclude that this unexplained case is disturbing, as the woman nearly died in conditions that are normally regarded as safe.