Week 8 Reading: Chapter 2 (Is Ecstasy more Dangerous than Horse Riding)

Question 1

Basic Premise

Answer 1

Activities like horse riding are deemed acceptable by society and yet they present many of the same dangers if not more dangers than drug use.

Question 2

Comparing horse riding with Ecstasy

Answer 2

• Deaths = 10-50 deaths per year for ecstasy use -> Horse riding = 10 deaths per year + some fatal traffic accidents.
  
  • Harms of ecstasy use as laid out by the 2003 advisory council report on the misuse of drugs = 2,000 serious but non-fatal injuries from ecstasy each year (hospital admissions). -> Horse riding = 100 non-fatal traffic accidents, 5,700 serious accidents.
  • Addictiveness of ecstasy = 1,000 seek treatment every year, 1,000 others are also addicted. This does not really have an equivalent in the realm of horse riding.
  • Psychological damage = Ecstasy can cause mild cognitive impairment for heavy users, memory problems, occasionally people have visual hallucinations and panic attacks. There’s a weak link to depression. While for horse riding there is memory loss, personality change, early-onset Parkinson’s.
  • Loss of tangible relationships = rare cases for both ecstasy use and horse riding.
  • Injury to others = very little for ecstasy. For Horse riding road traffic accidents, occasional aggression between hunters and hunt saboteurs.
  • Crime = for Ecstasy not much apart from dealing and supply of drug itself. For house riding illegal hunts.
  • Economic costs = for both comes from treating injures on the UK national health service.
  • Total number of adverse events = 6,000/ year for both ecstasy use and horse riding.
  • Horse riding concluded to be more dangerous as with 60 million total tablets of ecstasy taken every year and the 6,000 figure it means ecstasy only causes acute harm every 10,000 episodes/ pill. For horse riding there was 2 million incidents per year so instance of harm occur every 350 episodes (horse riding is more dangerous).

Question 3

Equasy

Answer 3

• Equine addiction syndrome= made up for the purposes of an article that David Nutt wrote about comparing the harms of horse riding and ecstasy use.
  
  • Made the argument that the drugs debate tends to take place without reference to other causes of harm in society i.e. we disproportionately worry about drugs.
    David Nutt had to publicly apologise for this article.

Question 4

What is Ecstasy?

Answer 4

• Made illegal in 1977 (UK) because it was believed to be similar to LSD - although ecstasy very rarely produces hallucinations.
  
  • Was used in the US during the 60s to aid with psychotherapeutic sessions e.g. couples-counselling -> at this time was known as ‘empathy’.
  • In 1980 rebranded as ecstasy and started selling at dance clubs, became popular.
  • Serotonin and dopamine released in response to ecstasy and cause it’s euphoric effects.

Question 5

Does Ecstasy Kill?

Answer 5

• First deaths mainly from dehydration + hyperthermia. This is due to dancing for hours in poorly ventilated clubs with little water. Cool rooms and education surrounding this helped (most common for men)
  
  • BUT second wave of deaths due to people drinking too much water. Hyponatraemia -> plasma sodium level drops and becomes so low that the water is sucked into brain cells by osmosis -> brain swells -> can cause brain damage/ comas (water intoxication particularly common for women due to more release of ADH hormone which acts to keeps water in the blood).
  • Also some cases of liver failure, kidney failure and sudden cessation of heartbeat. Blood clotting (due to serotonin effects) ,heart attacks, brain haemorrhages. BUT reading a likens these reactions to being like allergies rare due to genetic and environmental interactions.

Question 6

What are other harms of Ecstasy?

Answer 6

• Shift has moved to the psychological harms
  
  • Studies in animals found neurodegeneration i.e. that ecstasy harms serotonin nerve cells but this was no replicated in humans.
  • Heavy users = degree of cognitive impairment + memory loss but mild and short term i.e. stops once use stops.
  • Hard to determine the cause of ecstasy alone (i.e. most people that use it use other drugs too i.e. polyusers) -> study on Mormon teenagers who used no others drugs + alcohol found that ecstasy use had no left on mental functioning.
  • No studies have found a clinically significant link between ecstasy use and depression (proposed due to ecstasy’s impact on the serotonin system).
  • Did find slightly higher ratings on depression inventory scales but that’s it.

Question 7

Ecstasy becomes a media crusade

Answer 7

• Brought into the UK after the summer of 1986 when thousands of clubbers used it in Ibiza and then brought it back.
  
  • Lots of impact -> essentially created rave culture as was wide spread in clubs and these clubs started to struggle due to gangs following people in to sell the drug and also a lack of buying alcohol (due to drug use instead).Club venues drove up there prices to stay afloat and so the party scene responded by making ‘free parties/ raves’ in open remote fields.
  • These free parties did pose a health risk in terms of their remoteness i.e. lack of emergencies services, gang affiliations (violence from sellers) and the mixing of drugs that occurred at them.
  • Response by the UK government was to ban “free parties” as part of the criminal justice and public order act of 1994.
  • There was youthful protests to this and backlash
  • Media started disproportionately reporting the harms of ecstasy e.g. out of 256 deaths from paracetamol the media reported only 1, but in the same period 26 of 28 deaths to due with ecstasy were reported (some of which might not have even be solely due to ecstasy - estimated at 1/3).
  • The media continually overreports the harms not focusing on potential benefits of ecstasy (marital therapy, couples counselling, PTSD, controlling Parkinson’s tremor etc.).
  • In UK class = determines penalties for possession and supply. And Schedule= determines how the drug is regulated for medicinal use. Ecstasy is in schedule 1 which presumes no useful medical uses and that it is one of the most harmful drugs.
  • Any attempts to change classes/ laws related to MDMA results in extreme media backlash. More successful changes have managed to occur in the US as opposed to the UK but the class systems still overestimate the harms of MDMA to an extreme degree.

Question 8

Ecstasy a Moral Issue

Answer 8

• Drugs but in their own category i.e. policies not determined based on actual harms. Overarching feeling that drugs are just bad and people who use them are just bad.
  
  • Moralistic debates have led to harms i.e. reversal of push to get clubs to provide cool rooms and water as this ‘promotes drug use’/ sends the wrong message.

Question 9

Why Measuring Drug Harms Frightens Politicians

Answer 9

• Complicated to measure drug harms -> what things do you take into consider? Deaths, injuries? How do you compare it other risks?
  • If only consider drug use a moral issue then the harms caused to users is not really a concern i.e. they did to themselves they deserve what they get mentality. This logic is flawed though when you do consider that horse riding accident victims for example also in some ways are responsible for their injuries because they got on the horse, cause a lot of costs to society and yet newspapers would never outwardly blame or say we should abandon them - this stigma and blaming mentality on exists for drugs.

Question 10

A Cautionary Tale: How the UN made the Harms of Ecstasy Much Worse

Answer 10

• UN banned precursor to MDMA safrole oil due to lack of progress in reduction of drug use
  
  • Chemists turned to other means and used aniseed oil which looks similar to safrole.
  • In reality the UN’s actions drove the production of a much more harmful drug than MDMA called PMA or PMMA.
  • This drug is absorbed more slowly from the stomach -> takes longer for hit and therefore if thought was MDMA might take another pill thinking the drug effect was too week.
  • PMA causes release of serotonin and then prevents its breakdown meaning it can reach toxic levels -> lead to serotonin syndrome with hyperthermia, seizures and death.
  • More deaths caused by PMA in period post introduction than any caused by MDMA
    Finally, chemists found another loophole synthesising safrole oil instead of extracting it from plants. This is a far cheaper process and so now tabs are more readily available and concentration upped (tabs greater than 150mg in strength are now common whereas in the early days used to be more like 40-50mg).

Question 11

Ecstasy and Post-Traumatic Stress Disorder

Answer 11

• In a 2010 trial that used MDMA (ecstasy) to treat people suffering from treatment-resistant PTSD it was extremely successful i.e. 83% success rate.
  
  • Further studies have backed this up.
  • But because it’s illegal PTSD sufferers aren’t allowed to use it -> may be some progress on this front though calls for moves to schedule 1 so that MDMA can be made more available for research and clinical treatment.