One little pill.
It is about the size of an aspirin and comes in a range of colors, including baby blue, frog green, canary yellow and plain white.
It goes by numerous nicknames — Omega, Tweety and Mitsubishi — but is best known simply as X.
Ecstasy use among Americans has skyrocketed in recent years, highlighting an urgent need for more research into its effects and for new approaches to combat its growing use among young people.
Because the drug, called MDMA by scientists, is often found among a younger, party-going crowd, college towns such as Columbia are considered natural environments for ecstasy use to flourish.
While data on how prevalent ecstasy is in Columbia is limited, drug counselors say it should not be underestimated.
Kim Dude, director of MU’s Wellness Resource Center, said the center tries to educate students about the drug’s danger.
“It impairs learning and long-term memory, causing extreme damages to the brain,” Dude said.
Peer educators from the center’s Alcohol and Drug Abuse Prevention Team offer brochures on club drugs, stressing the effects of ecstasy on students’ most fundamental resources.
If students need special support, they are referred to therapists at McCambridge Center or at Phoenix House of Columbia.
Dude and MU police said the major problems on the MU campus are the use of alcohol and marijuana.
Susan Schopflin, director of the McCambridge Center, said that she can recall only two cases related to ecstasy where it was the patient’s drug of choice.
Most of her patients, Schopflin said, are struggling with heavier substances and are older.
“Ecstasy hides in the shade because nothing peculiar stands out,” she said. “Unfortunately, since a physical addiction doesn’t occur, the damages are not too evident until it’s too late.”
Schopflin said the lack of visible symptoms among ecstasy users is far different from methamphetamine users, whose physical appearance is clearly affected by their drug use.
Schopflin said many ecstasy users start taking the drug at an early age in clubs and underestimate its power. She said the difficulty in identifying ecstasy users makes it harder to reach out to people who may be experimenting with the drug.
“Columbia has a very large student population, but surprisingly there is no rehabilitation center targeted to our adolescents’ specific battles,” she said.
From 1998 to 2001, ecstasy use among teenagers nearly doubled, according to a survey conducted by University of Michigan. The survey also found that in 2001, more than 46 percent of 12th graders said it was “very easy” to obtain the drug.
According to the Web site of the Partnership For A Drug Free America, nationwide emergency room visits related to ecstasy increased from 421 in 1995 to 4,511 in 2000.
In Missouri, the U.S. Drug Enforcement Administration maintains that ecstasy is available at dance clubs and colleges and universities throughout the state. Between 2001 and 2003 ecstasy seizures in Missouri increased from 4 to 1,429 tablets, according to the DEA.
The difficulty in combating ecstasy use has been compounded by a turmoil among researchers about pinpointing just what the drug’s short- and long-term effects are on users.
Ecstasy works by altering the serotonin levels in a person’s brain. Serotonin is a chemical that regulates mood, sleeping and eating habits, thinking and behavior processes, sensitivity to pain and sexual behavior.
But how exactly damage to the serotonin system leads to behavioral and cognitive changes is not entirely clear. How the brain responds and compensates for changes in serotonin levels is also somewhat of a mystery.
In 2002, Dr. George Ricaurte, a neurologist at Johns Hopkins University, published an article in the journal Science describing the extreme effects of the drug.
Ricaurte is one of the most well-known ecstasy researchers. He has conducted research on the drug for 20 years and has received $10 million from the National Institute on Drug Abuse, more than any other researcher looking at club drugs.
Ricaurte’s $1.3 million study supported evidence that repeated use of ecstasy can lead to permanent brain damage and possibly to symptoms similar to Parkinson’s disease.
NIDA ended up using some of the results of Ricaurte’s study in an anti-club-drug campaign.
But last September, Ricaurte admitted fundamental faults in his findings on the long-term effects of the drug.
He claimed that vials had been mislabeled and that he had mistakenly tested methamphetamine and not MDMA in his study.
Others have since criticized the fact that, in his study, Ricaurte injected the drug — most users take the drug in pill form — and that the dosages used were much higher than those taken by the typical recreational user.
The NIDA has since pulled the ecstasy information section from its Web site in order to update it.
The Therapeutic use of MDMA
Twenty years ago, before ecstasy was classified as a “Standard 1” illegal street drug by the DEA, it was used by psychiatrists to create breakthroughs in therapy.
Since then, studies on its therapeutic use have been limited.
Rick Doblin, president of the Multidisciplinary Association for Psychedelic Studies in Florida, said the funding of research into illegal drugs has long been tied to politics.
“The history of research in the U.S. is a constant decision of criminalizing drug research over science,” he said. “Only after September 2003, with Ricaurte’s errors being so outrageous, have his findings been challenged.”
Doblin is particularly critical of an NIDA postcard featuring positron emission topography, or PET, scans that Ricaurte performed in 1988 in collaboration with his wife Una McCann.
The postcard compared a slice of serotonin-rich brain to a depleted one, claiming that the latter was “ your brain on ecstasy.”
Doblin said the image “was based on distorted evidence but was nevertheless used by NIDA for a $42-million anti-club- drug campaign.”
The campaign was pulled shortly before Ricaurte’s retraction, Doblin said.
Doblin and other researchers are now attempting to further the study of the possible therapeutic benefits of MDMA.
“For the first time after 20 years, a comprehensive research about both its positive and negative effects will be resumed,” he said.
Doblin said he has received approval by the U.S. Food and Drug Administration to research MDMA use for psychotherapy.
Doblin hopes to start researching the psychotherapeutic use of ecstasy on post-traumatic stress disorder within six months.
He also hopes to resume a Spanish study which is using ecstasy to help rape victims and an Israeli study which uses it to help victims of war and terrorism deal with their trauma.
Doblin said over 1,400 papers have been published on ecstasy research.
“A close look at the data shows that therapeutic use pose no risks, contrary to its recreational use,” he said.
Julie Holland, clinical assistant professor of psychiatry at New York University School of Medicine, participates in Doblin’s project and believes reliable information on ecstasy is key to reducing its harm.
According to Holland, since MDMA works on two brain chemicals, serotonin and dopamine, it can be compared to a combination of the effects of Prozac-type antidepressants and amphetamine.
She stressed that the research doesn’t justify the recreational use of ecstasy.
“I’m not standing for those people who take it every weekend, without knowing what they are getting and doing so in very dangerous conditions,” she said. “Patients will receive only one or two doses in a lifetime as a sufficient intake and will be monitored in the safest conditions.”
She added that recreational users put themselves in danger by taking the drug in overheated conditions, which can lead to stroke and brain damage. They may also drink too much water, causing over-hydration, she said.
Scientists face a number of difficulties when trying to determine exactly what ecstasy does to the brain when used for recreational purposes.
Dennis Miller, an assistant professor in MU’s psychological sciences department, pinpointed a specific problem that might come into play when testing ecstasy.
“Since MDMA is mostly manufactured in basements and clandestine laboratories, the percentage of the drug and the consequent potency of each pill can vary significantly,” he said. “Not only from batch to batch but also within the single tablet.”
Miller also said drug cookers play a significant role in what users end up taking.
“Frequently the percentage of MDMA is lower because it can be mixed with caffeine and other substances to spike its effects,” he said.
In this way, the dealers can save on the use of MDMA and pass off the product by mixing it with other substances, Miller said.
The varying potency of the drug is evident in the plethora of names it goes by. The Office of National Drug Policy lists nearly 160 different names for ecstasy on its Web site, including such slang terms as 007, Bermuda triangle, Candy flipping on a string, Care Bears and Blue Nile.
The Drug Help Web site says ecstasy can cause convulsions, irrational behavior and hallucinations. Users have also reported insomnia, anxiety, depression and lack of concentration.
Overdose effects vary from extremely high body temperatures and blood pressure to death. According to Drug Help, these short-term effects occur during use and can persist from one to 14 days after intake. The drug’s long-term effects are harder to predict.
Dude of the wellness center said the current debate among ecstasy researchers about the drug’s potential benefits and dangers has been played out before.
“This is a case of a typical process that all the drugs go through,” she said. “They are considered somehow effective in therapy but then in due course of time their real dangerous effects are assessed.”