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[Appendix 4][Appendix 6]

E is for Ecstasy by Nicholas Saunders

Appendix 5: Research

Ongoing research projects into MDMA and/or its effects

An ethnographic study into the impact of Ecstasy on the drug taking habits of a group of young men in the Greater Manchester area, by Mark Gilman, a research officer with Lifeline, Manchester. Started October 1991; expected completion date October 1993. Lifeline, Globe House, Southall Street, Manchester M3 1LG. Tel: 061 834 7160.

Gilman is studying the behaviour of the young men, who include football supporters, by means of informal social meetings over the two-year period.40 See also chapter 5.

Beyond the Spectacle - The Matrix of Drugs and Computers, to be published by Routledge, 1993/4 by Dr. Sadie Plant, lecturer in cultural studies at Birmingham University. Department of Cultural Studies, School of Social Sciences, Birmingham University, Edgbaston, Birmingham B15 2TT. Tel: 021 515 3531

Plant says: "The argument developed in my book concerns the convergence of drugs and information technology, and it is in this context that I am looking at Ecstasy as the site of a migration beyond the spectacular, visual domain and into a new tactility 'behind the screens' of the reality studio (to pinch a line from Burroughs). I don't see drugs as the improvement of the human (or its values); what I am looking at is the extent to which the human being is being reprogrammed by the drugs and technologies it uses."

The use and misuse of Ecstasy (MDMA) in Scotland: a pilot study, by Kellie Anderson, research associate, at the University of Edinburgh. Kellie Anderson or Professor Martin Plant, Alcohol Research Group, Department of Psychiatry, University of Edinburgh, Morningside Park, Edinburgh EH0 5HF123

This paper is awaiting approval from the Scottish Office, which funded the pilot study, for release of its results. The aims of the study were: 1. To examine available evidence on use. 2. Review its implications. 3. To establish priorities for the future.

It looked at Ecstasy use among mature students in five Scottish cities.

Survey of alcohol use and deviance among 776 school children aged 14 to 15 years in the north west of England by Professor Howard Parker et al, Department of Social Policy and Social Work, Manchester University. Started October 1991, expected completion date October 1993. Manchester University, Dover Street, Manchester M13 9PL. Tel: 061 275 4762.

Funded by the Alcohol Education and Research Council. For preliminary findings see reference 49.

What are the relationships between alcohol use, drug taking, deviant behaviour and social background among young people in the 90s? To answer this question three studies are being conducted:

1. A three year longitudinal survey of a cohort of 776 14-15/16-17 year-olds.

2. Interviews with up to 100 18-25 year-olds on probation orders and their probation officers comparing problem drinkers with other clients.

3. Fieldwork in pubs and nightclubs involving interviews with up to 100 young drinkers and staff of clubs and pubs.

70% of the sample were 14; 30% 15 years. 54% boys; 88% white; 70% Christian; 84% had fathers in paid work and 68% had mothers in paid work.

Assessing psychiatric morbidity associated with taking Ecstasy, by Adam Winstock, at the Hammersmith Hospital, London. Tel: 081 743 2030 bleep 094

Winstock is starting a National Ecstasy Research Project involving thousands of respondents examining what effect Ecstasy has had on them.

The E'sy Sex Survey: risk factors and social contexts, by Andrew Thomson, research officer with Southend Community Care Services NHS Trust. Started June 1991; expected completion date June 1996.

Thomson is undertaking a five-year research analysing the risk factors of Ecstasy use. The study is being funded by the Southend Community Care Services NHS Trust.

The project, which Thomson claims is the largest piece of Ecstasy-related research in Europe, involves an assessment of the health needs of Ecstasy-users, and results are intended to provide information for harm reduction policies. 250 Ecstasy-users and 250 non-users between the ages of 16 and 21 are being studied by in-depth interview. Their sexual behaviour is being compared (with allowances made for other differences between the two groups) with a view to finding out whether Ecstasy-users are more likely to have unprotected sex and with more partners. For preliminary results, see reference 125.

A socio-psychiatric investigation of health and other consequences of MDMA-use in a chain-referred sample of Glasgow users, by Dr. Jason Ditton, Director, Criminology Research Unit, Glasgow University. Started Spring 1993; expected completion date Spring 1995. Sociology department, University of Glasgow, University Avenue, Glasgow G12 8QQ. Tel: 041 339 5413

Dr. Ditton has a grant of #150,000 from the Scottish Office. He aims to recruit about 225 people, including 25 light, 25 medium and 25 heavy users, who are "initiates", "mid-career-users" and "ex-users". (9 categories in all) for psychiatric trials. Subjects will be interviewed to determine the level of depression, anxiety, paranoia and craving they experience. Urine and hair samples will be taken to establish which drug(s) the subjects have taken. Urine samples have to be taken within 8 hours of ingestion of a drug, whereas samples of 6" long hair can reveal drug usage over the preceding 12 months. The tests cost about #45 each. A similar test on Lord Byron's hair confirmed that he took opium.

Dr. Ditton is dubious about the results of attitude surveys. He says that, when asked, people tend to report about half the usage revealed by urine tests and that hair analysis (which includes a complete history of drug use) doubles the figure again: people tend to underestimate their drug use fourfold. In a previous study of Ecstasy-buying habits among University students, he found that 15% of his sample had taken Ecstasy, making it second only to cannabis in popularity. By clubbing together to buy for friends, students risked the enormous penalties attached to supplying an illegal drug.

A study of the effects of MDMA on gene expression in brain cells, by Dr. Marcus Rattray, lecturer in biochemistry and Dr. JV Priestley, senior lecturer in biochemistry, both at the United Medical and Dental School at Guy's Hospital, London. Started September 1990, expected completion date December 1993. UMDS, Guy's Hospital, St Thomas's Street, London SE1 9RT. Tel: 071 955 4529

Drs. Rattray and Priestley's study takes findings in animal studies that MDMA is neurotoxic as a base line. But where previous studies have concentrated on examining whether MDMA causes damage to the nerve endings in the brain, theirs is looking at whether the drug harms the neuronal body of rats' brain cells and in particular the mechanism by which the manufacture of serotonin is triggered when a cell runs out of serotonin. Changes to the cell body affect the level of expression of some of its genes, and this is being measured in populations of neurons by a semi-quantified method called in situ hybridisation to determine whether Ecstasy is causing damage. The rats are given 4 or 8 very high doses of MDMA: 10 mg per kg of body weight, and their brain cells are examined 24 hours and 2 weeks afterwards. This procedure reveals temporary damage but is not a reliable indicator of permanent damage.

They are looking in particular at genes in the serotonin transporter, a protein present in the nerve endings of serotonin-manufacturing cells and in tryptophan hydroxylase, an enzyme mostly produced in serotonin-manufacturing cells.

"We're finding that if you have a population of cells that all make serotonin, some seem to be more affected than others - about five per cent of cells don't seem to recover. We're trying to find out what it is about the affected cells that makes them more sensitive," Dr. Rattray said. They have found that changes to the serotonin transporter after rats were dosed with MDMA coincide with the level of messenger RNA going well down, but that a sharp fall in the level of tryptophane hydroxylase, appears to be accompanied by the level of messenger RNA going up.

They are going on to examine the effects of single doses at a much lower levels, comparable to the doses taken by human users.

A descriptivestudy of psychological disorders among Ecstasy-users presenting at the Maudsley Hospital, London and A study of the effect of regular use of Ecstasy on human users' brain cells, by Dr. Philip McGuire, honorary senior registrar in psychiatry at the Maudsley Hospital. The descriptive study started in February 1990 and was completed in February 1993 and the second study began in February 1991 and the completion date is not known. Genetics Section, Institute of Psychiatry, Decrespigny Park, Denmark Hill, London SE5 8AF.

The descriptive study is based upon in-patients and out-patients at the Maudsley with a history of Ecstasy use. From 1990 to 1993, all psychiatrists at the Maudsley who discovered that a patient with a distinct psychological problem had taken a lot of Ecstasy, referred the patient to Dr. McGuire's research team to be interviewed.

"The patients were typically young people who took Ecstasy at the weekend, and usually were multiple drug users", Dr. McGuire said. 13 patients are described in detail. Of these, eight had psychotic syndromes; two had visual disorders such as hallucinations, distortions and palinopsia (in which after-images behind moving objects are prolonged); one had severe depression; one suffered from panic attacks and one experienced 'depersonalisation'.

The second study is examining the effect of Ecstasy on the bodies of brain cells in human subjects. Dr. McGuire advertised in Drug Link, a magazine for social workers, to find regular Ecstasy users who were mentally and physically fit to act as subjects in the research.

Prior research into the effects of Ecstasy on the brain has used animals [and involved dissection]. This study, in common with research on animals, uses long-term reductions in the level of the chemical serotonin in the brain cells as an indicator of brain damage. Serotonin is released by the brain cells when they are stimulated by a number of drugs, including Ecstasy. The release of serotonin in turns stimulates release of the hormone prolactin into the blood.

In this study, Ecstasy users are given the drug Fenfluramine, a widely-available slimming drug, which also stimulates the release of serotonin. Blood samples taken from the subjects are then tested for the presence of prolactin. If this is not present, it is inferred that serotonin has not been released and therefore levels of serotonin in the brain cells must be reduced, indicating brain damage.

No provisional results were available. But Dr. McGuire said: "If the results of our study are similar to those on monkeys, a lot of people are going to be brain damaged". [The assumption that a reduction in serotonin levels implies brain damage has been disputed.71]

A study of the effect of MDMA on activity levels and body temperature in rats, by Dick Dafters, lecturer in psychology at Glasgow University. Started January 1993; expected completion date autumn 1993. Psychology Department, University of Glasgow, University Avenue, Glasgow G12 8QQ. Tel: 041 339 8855 X4559

This study is funded through Glasgow University but Dafters has applied to the Scottish Office Home and Health Department for funding to conduct a parallel study examining MDMA's effect on body temperature and activity levels in humans. He also hopes to publish this second study in autumn 1993.

In the study on rats, both the animals' temperature and gross body movements are measured using remote biotelemetry; a technique in which readings are taken from a tiny transmitter cell that is implanted under the animals' skin. The rats are divided into two groups, one of which is injected with MDMA and one with a placebo, and measurements are taken on both.

Provisional findings from readings on temperature indicate big increases in rats' body temperature after they have been given MDMA under normal temperature conditions, but substantial decreases in the animals' body temperature when they are given the drug in a cold environment. Mr Dafters said there was also a clear increase in rats' activity level. He is going on to examine tolerance to MDMA in rats.

"I'm drivenby the human problems, such as does going into a 'chilling out' room reduce your temperature and how long does it take?" Dafters said. "I'm asking how do you examine [such problems] in an animal model in a way that's going to give useful information".

Because of ethical considerations, the planned study of the effects of MDMA on humans cannot be anything like as thorough as that on rats. But, given that mammals respond in very similar ways to stimulation by drugs, the hope is that, taken together, the two studies will provide a reasonably accurate measure of the effects of Ecstasy on human body temperature and activity levels. The study on humans will be specifically designed to identify differences of degree between the effect of the drug on rats and on humans It will be conducted at Glasgow clubs known to be frequented by regular Ecstasy users. Ravers will be invited to take part in a study of changes to people's body temperature and activity levels in a club environment, but not told that it is aimed specifically at Ecstasy users. To correlate the findings with drug use, those taking part will be asked, without revealing their names, to answer a questionnaire about their use of drugs and to give a urine sample. The urine sample will show whether or not a person has taken Ecstasy but not how much they have taken.

Mr Dafters expects to be able to provide informed guidance for authorities and agencies that are drawing up codes of conduct for clubs catering to ravers from his conclusions about the effects of ambient temperature on Ecstasy takers and about tolerance to MDMA.

A survey of the use of Ecstasy in Glasgow and surrounding areas, by Alex Meikle of Possil Drug Project, 101, Denmark St, Possilpark, Glasgow G22 5AU Meikle is gathering data on users expectations and experiences of Ecstasy; how much they take, and in combination with what other drugs; where they take it and what further help, advice and information they want about E and other rave drugs.

The aim is to build up a knowledge base for the use of workers in the field. Asked what problems users had with Ecstasy, Alex said they reported restlessness, paranoia and over-use affecting their performance at work - most users had jobs. Typical E use in Glasgow follows the "weekend binge pattern" - kids take up to 4 different drugs together (such as E, LSD, cannabis and amphetamine), often starting on Thursday night. Some problems are due to users taking Temazepam, a prescription drug sold on the black market for #1.50 to #3.00 after an Ecstasy trip in order to get a good night's sleep. Temazepam is a good sleeping pill in normal doses and 2-3 tablets can help E users come down and rest after an E trip, but it is often used in overdose, resulting in a "zombie-like" state. Alex says that users soon find Ecstasy has no more good effects and go off it, but try it again later. Most users have no grasp of the idea of tolerance to a drug.

[Appendix 4][Appendix 6]