The popular drug Ecstasy has hit the news in the UK amidst controversy over plans to downgrade its legal standing, and therefore the punishment the judicial system would meter out for involvement with it.
The drug, otherwise known as 3,4 methylenedioxymethamphetamine (MDMA), has recently become the number one illicit drug of abuse in many countries.
To take just one example, Susan Sherman and colleagues from the Department of Epidemiology at Johns Hopkins University Medical School in the USA, recently reported on research that found up to one third of school age children in Thailand had abused the drug. They contend this explains why it was the recent focus of that Government’s 2003 infamous crackdown or ‘‘war on drugs’’, notorious because it was widely regarded as excessively punitive, resulting in arrests and compulsory treatment of thousands of addicts.
This potent drug works by encouraging the release of the neurotransmitter dopamine in the brain – a chemical which is closely linked to a sense of reward, and is therefore responsible for carrying messages between nerve cells involved in Brain reward systems. This explains why it’s so difficult for abusers to let go of taking drugs like these – most other activities that life offers are not as rewarding because they don’t directly target the Brain’s reward systems in the way this kind of chemical does.
As a result of it’s action on dopamine the drug produces euphoria, augmented sexual arousal, a useful loss of appetite if you are trying to lose weight, elevated energy levels (so you can dance all night in a night club), and prolonged sexual performance. This latter effect explains why it significantly elevates HIV risk because there is good evidence that in the gay community, as in others, its use leads to more sex and in particular more unprotected sex.
Getting past all these apparent benefits are the lurking dangers, which tend to result from the long term consequences of its use, and which arise from depletion of dopamine in the brain. If you lose the brain chemical underpinning a sense of reward, it’s no surprise that life doesn’t appear generally very gratifying after this. Given brain dopamine activity is also the mechanism of action which is currently hypothesized underpins serious mental illnesses like schizophrenia, its no surprise to psychiatrists that ecstasy use results in paranoia, violence, depression and psychosis.
However it’s also the case that if thousands of young people are taking this drug, how come the Accident and Emergency Departments of Hospitals up and down the country are not overflowing with drug induced schizophrenia – or mental illnesses which resemble this?
This goes to the heart of the debate over risk; one key conundrum is understanding that risk does not lie in the drug, but instead arises out of an interaction between drug and user.
A good analogy would be to consider the risk of driving. In the hands of some careless, irresponsible, under-skilled drivers, a car is a lethal weapon from which they should be disarmed in order to protect themselves and the public. However if behind the wheel is a more average cautious person, a car is not as dangerous. The hazard partly lies in the car but also in a major sense in the person doing the driving. This interaction makes it difficult to for the debate about the dangers of drugs to be conducted sensibly. The media and politicians tend to reduce the argument to one of which drug is more dangerous than another, and, therefore, are sanctions rationally proportionate?
But if we can grasp that risk doesn’t lie purely within the substance being ingested, but in the context in which this happens, plus the person doing the taking, then the true complexity of the picture reveals the nonsense of trying to attribute levels of risk to a particular drug or activity.
Yet this is precisely what happened recently when one expert was criticized for comparing the level of risk involved in taking ecstasy with being not significantly greater than that of riding a horse.
But science is now coming to the aid of unraveling this mystery of why the drug varies in its danger depending on who takes it.
Thelma Schilt and colleagues at the Amsterdam Institute for Addiction Research based at the University of Amsterdam in the Netherlands are just about to publish research which shows that the negative effect on your memory of taking ecstasy is moderated by your genetic profile.
Their research published in the esteemed academic journal European Neuropsychopharmacology suggests that a key reason its been difficult for previous research to be conclusive about the brain damage caused by Ecstasy, is that its effect depends on whether you carry a particular gene or not, which influences the workings of a key enzyme that plays a crucial role in the way the body metabolises the drug. Enzymes are fundamental chemicals in the body which assist with practically all biochemical processes, and ensure they run fast enough to sustain life.
The enzyme known as Catechol-O-methyltransferase (COMT) is involved in the breakdown of Ecstasy once it’s in the body. If you metabolise Ecstasy fast, this means it will have less negative effects on your brain than if your body has a version of the enzyme which leads to slower decomposition.
Schilt and colleagues in their paper freely describe Ecstasy as a neurotoxin, which basically means they are convinced it causes brain damage. These neurotoxic effects have been studied extensively and there is now accumulating evidence that it also causes damage to the brain’s Serotonin system which is a neurotransmitter (another crucial chemical responsible for transmission of messages between nerve cells like dopamine) involved in intellectual functions like memory, decision-making and mood.
Schilt and colleagues found that how damaging the drug was on your brain functions, like memory, was crucially determined by your genetic profile in terms of what enzymes you were carrying that were involved in the breakdown of ecstasy.
What this research is leading to is a new view, which is not that a drug carries danger – more that the drug interacting with the wrong genetic profile in the taker leads to catastrophe.
In fact we kind of already knew this – some people can drink alcohol and not do so to excess – while for others it’s a physical and mental poison that they must learn not to touch if they want to survive.
The problem is as a society we find it difficult to think about drugs and risk because we are locked into a simplistic view that the danger lies in the drug, and we have failed to grasp that in fact the peril arises out of the drugs interaction with particular individuals.
Its not possible as yet to know who can take this drug safely, and given this means you are playing Russian Roulette with your brain whenever you experiment with substances like these, why take the risk?
The problem is that in legislating against a drug you are inevitably depriving many who could relatively safely try it, from the pleasant effects of its use, because another significant sector of the population can’t handle it.
Imagine having to give up your favourite tipple, which you have always enjoyed responsibly just because of the joy riders down the street who can’t hold their drink? This doesn’t seem fair.
Whatever the solution to this problem, its vital to improve the drugs debate by ceasing to refer to drugs as dangerous. The danger isn’t in the drug. It’s in the interaction between the user and their habit.
European Neuropsychopharmacology, Volume 19, Issue 2, February 2009, Pages 116-124 Thelma Schilt, Maarten W.J. Koeter, Maartje M.L. de Win, Janneke R. Zinkstok, Thérèse A. van Amelsvoort, Ben Schmand, Wim van den Brink
Journal of Adolescent Health, Volume 44, Issue 2, February 2009, Pages 169-175
Susan G. Sherman, Catherine G. Sutcliffe, Danielle German, Bangorn Sirirojn, Apinun Aramrattana, David D. Celentano
RAJ PERSAUD IS A CONSULTANT PSYCHIATRIST WORKING IN THE NHS AND IN PRIVATE PRACTICE