|The man who took 40,000 ecstasy pills -
|The man who took 40,000 ecstasy pills
|The strange case of the man who took 40,000 ecstasy
pills in nine years
? Usage increased to 25 tablets a day at peak
? Memory problems and paranoia may be lasting
Doctors from London University have revealed details of what they believe is
the largest amount of ecstasy ever consumed by a single person. Consultants
from the addiction centre at St George's Medical School, London, have
published a case report of a British man estimated to have taken around
40,000 pills of MDMA, the active ingredient in ecstasy, over nine years. The
heaviest previous lifetime intake on record is 2,000 pills.
Though the man, who is now 37, stopped taking the drug seven years ago, he
still suffers from severe physical and mental health side-effects, including
extreme memory problems, paranoia, hallucinations and depression. He also
suffers from painful muscle rigidity around his neck and jaw which often
prevents him from opening his mouth. The doctors believe many of these
symptoms may be permanent.
The man, known as Mr A in the report in the scientific journal
Psychosomatics, started using ecstasy at 21. For the first two years his use
was an average of five pills per weekend. Gradually this escalated until he
was taking around three and a half pills a day. At the peak, the man was
taking an estimated 25 pills every day for four years. After several severe
collapses at parties, Mr A decided to stop taking ecstasy. For several
months, he still felt he was under the influence of the drug, despite being
His condition deteriorated and he began to experience recurrent tunnel
vision and other problems including hallucinations, paranoia and muscle
rigidity. "He came to us after deciding that he couldn't go on any more,"
said Dr Christos Kouimtsidis, the consultant psychiatrist at St George's
Medical School in Tooting who treated him for five months. "He was having
trouble functioning in everyday life."
The doctors discovered that the man was suffering from severe short-term
memory problems of a type usually only seen in lifetime alcoholics. But
evaluating the full extent of his condition was difficult as his
concentration and attention was so impaired he was unable to follow the
simple tasks involved in the test.
"This was an exceptional case. His long- term memory was fine but he could
not remember day to day things - the time, the day, what was in his
supermarket trolley," said Dr Kouimtsidis. "More worryingly, he did not seem
aware himself that he had these memory problems."
With no mental illness in his family and no prior psychiatric history, the
doctors concluded that his unique condition was direct result of his intense
"This is obviously an extreme case so we should not blow any observations
out of proportion," says Dr Kouimtsidis. "But if this is what is happening
to very heavy users, it might be an indication that daily use of ecstasy
over a long period of time can lead to irreversible memory problems and
other cognitive deficits."
For 10 years, MDMA has been suspected of causing these kinds of effects in
heavy users. It is thought to be due to its disruption of the regulation of
serotonin, a brain chemical believed to play a role in mood and memory. It
remains unclear whether these effects are the result of permanent neurotoxic
damage or just temporary reversible alterations in the brain.
A special two-part MDMA study in recent issues of the Journal of
Psychopharmacology (available online at sagepub), suggests long-term
side-effects may be temporary. The researchers from the University Of
Louisiana could find no significant relationship between depression and
recreational ecstasy use.
In the case of Mr A, a structural MRI brain scan failed to show any obvious
damage or atrophy in his brain. However, these results, says Dr Kouimtsidis,
are difficult to interpret. "A scan of this type is not sensitive enough,"
Such limitations in brain scanning technology, along with ethical and legal
barriers to giving MDMA to human test subjects, have limited direct
observation of the drug's effects in humans.
Instead, scientists have had to use recreational drug users as subjects in
their studies. Conclusions from this are often flawed because few, if any,
drugs users use ecstasy in isolation.
Mr A was also a heavy cannabis user, and when he was encouraged to decrease
his use, his paranoia and hallucinations disappeared and his anxiety abated.
But his memory and concentration problems remained, leading the doctors to
suspect that these may be permanent disabilities.
When he was admitted to a specialist brain injury unit and put on
anti-psychotic medication, he did start to show some improvement.
"Unfortunately, he discharged himself before we were able to complete the
assessment," says Dr Kouimtsidis. "We continued to support him. But he
started to use cannabis again and he dropped out. We tried to re-engage him
but we lost him about a year ago."
The Guardian made several attempts to find the man without success.
Effects of ecstasy
MDMA is one of the most intensely studied recreational drugs in history. But
despite thousands of research papers and studies, scientific evidence on the
side-effects remains inconclusive.
Death by overdose
Undoubtedly, large amounts of ecstasy can lead to over-heating which in
turn, in rare cases, can trigger fatal heat stroke. Many factors contribute:
number and strength of pills taken, environment, alcohol-consumption, body
weight - but women seem more at risk. The bulk of ecstasy-related deaths
around the world have been young women.
Panicking users, fearing they are overdosing, drink too much water and
provoke hyponaetraemia (water-poisoning). Leah Betts died after drinking 14
pints in just 90 minutes. The recommended amount of water to drink per hour
is one pint.
Much of the reports of toxic reactions are muddled with overdose or
water-poisoning deaths. There is no clear evidence that some people suffer
allergic reactions to ecstasy. However, around 10% of Western users do lack
a key liver enzyme CYP2D6 needed to break down MDMA. This may make them more
sensitive to the effects and more prone to accidental overdose.
Many weekend users report a mid-week mood dip. This is suspected to be
related MDMA's effect on serotonin, but hard evidence is lacking. In heavy
users, dips can turn to crashes and depression. However studies suggest this
effect reverses after a 2-3 month abstinence.
Users still claim "long lasting improvements in self-awareness, self-esteem,
openness and insight into personal problems", reports the study from the
University Of Louisiana. In the US, research continues into the use of MDMA-assisted
psychotherapy to treat Post Traumatic Stress Disorder.