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The Agony Of Ecstasy

An EDM party at the Avalon in Hollywood. Photo by b@fly via Flickr.
EDM at the Avalon Hollywood. Photo by b@fly via Flickr.

“Ecstasy” is back in the news, although now it's being called “Molly.” A few young partiers have died at big “Electronic Dance Music” (EDM) festivals around the nation, even prompting cancellation of some such events. Many more have wound up in hospital emergency rooms for a visit, and countless others have just had some sort of “bad trip” experience but kept that relatively private.

A dozen years back, I co-chaired a national conference on “ecstasy” featuring leading researchers, doctors, drug educators, and a large contingent of those somehow involved in what was then still called “rave” culture — the huge party subculture focused on dancing all night — and sometimes for days — while high on some version of MDMA. In a sort of flashback to the LSD scenario of the 1960s, MDMA, which had first been developed in the early 1900s and then languished in obscurity until researchers started testing it on patients for various indications in the 1980s. Soon the news was out on how good real MDMA could make one feel — it has been likened to a month's dose of antidepressants in one pill, which is not so far from how it impacts brain chemistry in the short run — and Britain had it's own version of a “summer of love” in 1988 with huge outdoor raves fueled by MDMA instead of the LSD that helped spark San Francisco's version in the sixties. Raves spread worldwide, MDMA was hastily declared dangerous and illegal globally as well, and the parties went on, underground.

In Northern California the height of the rave scene came in the 1990s. For research purposes, I attended some of the “parties” ("rave” was already a passé term here, used only for the big commercialized events the true aficionados disdained). And even without the chosen drugs, some of them were indeed magical — a thousand people dancing on a remote beach under a full midnight moon (one of the best recurring events was simply called “Full Moon,” and at least one occurred near Point Arena) was a memorable experience. So was wandering through multiple floors of an abandoned downtown office building, visiting rooms with different deejays plying their trade and many people, many of them very attractive, danced with abandon. There was a lot of, well, groovy rhetoric attached to the scene, such as “PLUR” — Peace, Love Unity and Respect — but from what I saw, it often applied, with profiteering and exploitation not much in evidence. Fun while it lasted....

But in my day job, I was seeing some downsides. Multiple times, young folks would come to a clinic or other health setting and say things like “I'm strung out on “E” — been taking it for months now every night and can't stop.” There are problems with that self-diagnosis, as real MDMA is not physiologically addictive, and actually rapidly decreases in desired impact if used too intensely. Our brains cannot replace the neurotransmitters released fast enough. What was happening was “substitution” — other, cheaper drugs were being sold as “ecstasy” — usually some version of amphetamines, or “speed.” That stuff is very addictive. The math was fairly simple — speed is cheap on the street, but “extasy” sold at $10, $15, even $20 or more per dose then. An unscrupulous manufacturer/dealer could reap a 1000% profit with little work or backlash, as many young users hardly could tell the difference. But they'd be hooked, and doubly endangered, yet still deny that their PLUR-type dealer would do such a thing. But some of them certainly did.

The serous acute consequences were relatively rare but could be severe, even lethal. Heat exhaustion and dehydration from dancing too long and hard led to some deaths; some actually overdoses and severe “hyper metabolic” reactions — think of your car's throttle stuck to the floor — killed some partiers. Much drug education helped, with a controversial practice of providing non-judgmental counseling and actual testing of pills at parties undeniably helping in many cases, even as “just say no” drug warriors complained. Giant raves were even banned at some venues due to bad reactions to both the drugs themselves and those who sought to practice this type of “harm reduction.” The controversies continued through the 2000s but at a lower level than before.

Now we have “Molly” — supposedly pure MDMA, but rarely even approaching that, it seems. Same scenario as before — much adulteration is going on, and some “horrible deaths” — as one grieving parent reported — have occurred and many more lesser bad reactions. A new class of adulterants are called “bath salts” — chemically-similar substances known as synthetic cathinones, including methylone and mephedrone. — note the “meth"-type terminology. Like the speed used before, these are strong stimulants with potentially severe impact on both mind and body. Ironically, the “Molly” term emerged a decade ago in an attempt to “rebrand” ecstasy, which had garnered a bad rap due to impurity. The rise in deaths and other lesser problems, even as overall self-reported use of “MDMA” has declined overall, indicates the marketers have succeeded again. A report from New York where 143 street-bought lab tests of drugs sold as Molly showed that only 13% of the drugs had MDMA, while over 60% were bath salts. This is a similar result to such street surveys done in San Francisco in the late 1990s.

A million people reported using MDMA — or what they thought it was — nationwide in 2009. That declined a bit in more recent surveys, but the prevalence of bath salts seems to still be increasing rapidly. Again, unsurprisingly, profit is the driving factor. The bath salt ingredients can be purchased online, at one-tenth the cost of what would be needed to get real MDMA. But again, the street price is the same, and the users are the victims. Some more cautious users test the product using kits also bought online, but most take their chances. A federal bill has been introduced to ban some of the most prevalent synthetic drugs, including bath salts, but industrious drug dealers tend to stay ahead of such efforts, both chemically and legally, by “tweaking” the formulas used (and again, note the terminology's similarity to meth language). The drug testing/education harm reduction groups are still working, although still opposed in some quarters.

Ironically, real MDMA is finally getting some tentative official approval for research in patients with terminal diseases, PTSD, and a few other indications. Out on the street, though, the partying continues (and one old joke holds that the drugs are essential to such parties — “What did one raver say to the other when they ran out of drugs? — “Hey, this music really *does* suck!"). A medical expert on the topic has written that counter-indications to MDMA use should include “heart disease, high blood pressure, liver disease, seizure history, diabetes, hypoglycemia, glaucoma, or hyperthyroidism or any woman who was pregnant.” I'd add depression, and the spectre of longterm neurological damage resulting from heavy use has yet to resolved to most observers' satisfaction, but such cautions must be heightened when one does not know what's really in that pill or powder, and where the big money is just too tempting. Screening for those medical risks obviously does not occur at parties, or in street deals. Thus, as always: Let the Buyer Beware. And perhaps consider that any dealer who cons a naive buyer should be forced to ingest his own product. That might slow the scams down a bit.

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