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Critics Take Issue With Antidrug Campaign
Pubdate: Mon, 30 Dec 2002
Source: Philadelphia Inquirer, The (PA)
Copyright: 2002 Philadelphia Newspapers Inc
Contact: http://www.philly.com/mld/inquirer/
Details: http://www.mapinc.org/media/340
Author: Benjamin Wallace-Wells
Bookmark: http://www.mapinc.org/mdma.htm (Ecstasy)
CRITICS TAKE ISSUE WITH ANTIDRUG CAMPAIGN
With stark pictures and dire warnings, the federal government's anti-ecstasy
campaign strikes exactly its intended tone: scientific fright.
In schools around the country, counselors are showing students sleek and
sharply contrasting images of the brains of habitual ecstasy users and
nonusers. The brain scans of nonusers show plenty of colorful activity. The
users' scans are full of ominous black blotches resembling holes.
"We tell them, 'Ecstasy eats your brain like a moth eats an old sweater,' "
said Susan Billy, who directs the Chester County student-assistance program,
a group of teachers who coach public school students on the dangers of drugs
and addiction.
It's a powerful message. But is it true?
There is increasing debate in scientific circles about the validity of the
research behind government claims about the dangers of ecstasy.
By overdramatizing its hazards, the critics say, antidrug campaigners may be
achieving the opposite of what they seek. Like the crusaders against alcohol
and marijuana before them, the anti-ecstasy forces may be persuading a
generation of already skeptical youths that adults are more interested in
scaring kids than informing them.
The government's campaign is based on research that is "seriously, seriously
flawed," says Charles Grob, a professor of psychiatry at UCLA and a leading
ecstasy researcher. (Ecstasy is the street name for
3,4-methylenedioxymethamphetamine or MDMA.)
A more honest approach, the critics argue, would be to cite the known
hazards without sensationalizing the unproven. The drug, they say, can cause
kidney damage, dehydration, high blood pressure, elevated heart rate, and
increases in body temperature that can, on rare occasions, be fatal. And,
though ecstasy is not physically addicting, it can create psychological
dependence.
Scientists also agree that research shows ecstasy as damaging to serotonin
neurons in rat brains.
But an honest campaign, critics note, would stop short of saying that
ecstasy causes long-term brain damage in humans.
The popularity of ecstasy has grown in the last decade, particularly among
young people who like the euphoric, trance-like high the drug produces.
According to the University of Michigan's 2002 Monitoring the Future study,
10.5 percent of American 12th graders reported having taken ecstasy at some
point, up from 6.9 percent in 1997. In the same period, the study reports,
marijuana use in the same group fell from 49.6 percent to 47.8 percent,
cocaine use 8.7 percent to 7.8 percent, and heroin use from 2.1 percent to
1.7 percent.
At the same time, emergency-room visits involving ecstasy increased 58
percent in the United States, according to the latest information provided
by the National Institute on Drug Abuse, a division of the National
Institutes of Health - from 2,850 visits in 1999 to 4,511 in 2000.
Ecstasy was present in the bodies of eight people who died in Philadelphia
in the first six months of 2001, according to the Philadelphia Department of
Health - the same number as died showing traces of ecstasy in all of 2000.
In 1999, there were eight MDMA-related deaths in Miami and five in
Minneapolis/St. Paul, according to NIDA.
Glen Hanson, NIDA's acting director, says he has heard the criticisms of his
anti-ecstasy policies but isn't ready to give up the vivid campaign.
A research pharmacologist, Hanson said he has studied the drug for 17 years,
and "when someone comes along and says the potential risk of the drug is
overstated, I know they're wrong."
Ecstasy is a synthesized drug with both hallucinogenic and stimulant
properties. It was patented by German scientists working for Merck in 1913
who wanted to use it as a diet pill.
In the early 1980s, recreational use of the drug began to grow; and in 1985,
after researchers testified that ecstasy caused brain damage in rats, it was
outlawed by the Drug Enforcement Administration. Even so, the drug grew in
popularity throughout the 1990s, particularly among white, suburban
teenagers and at intense, all-night dance parties called raves.
Police say the drug is now readily available for about $25 per dose. It
comes in pill or tablet form.
In rare cases, teens on ecstasy have died from hyperthermia, a rise in body
temperature. In those cases, the drug seems to inhibit the body's ability to
regulate its own temperature. Scientists say they cannot say how exactly the
drug causes hyperthermia.
However, the current policy debate stems not from these dangers but from an
intense scientific disagreement over what long-term use of ecstasy does to
the human brain.
The central figure in the debate is Johns Hopkins neurologist George
Ricaurte. NIDA's Positron Emission Tomography (PET) brain-scan images, which
use radioactive tracers to map the brain's chemistry, are taken directly
from a 1999 study Ricaurte published in Lancet, the British medical journal.
In that study, Ricaurte found that consistent, long-term use of ecstasy
damaged 50 percent to 80 percent of the neurons that secrete serotonin, a
brain chemical that helps regulate mood and sleep.
"There is significant brain damage," Ricaurte said, "and it happens after
recreational levels of use."
A subsequent study by Dutch researchers found that long-term, moderate use
of ecstasy caused damage of up to 20 percent of the neurons in women but no
significant damage in men.
A growing number of researchers say errors in the methodology and
presentation of Ricaurte's study mean that NIDA is overselling the damage
done by ecstasy.
"Neither they [NIDA] nor the researchers have answered the serious
methodological questions," said Grob, the UCLA research psychiatrist, "and
their data analysis is problematic. And the way they're relating it is of
concern because I'm not convinced there's much relation to the facts."
Ricaurte's paper, say Grob and other researchers, showed so much "scatter"
in both the user and control groups - that is, so much variability in
serotonin neuron counts - that it is not scientifically dependable.
"The scatter is so high that one can't draw any conclusion," said Steven
Kish, toxicology professor at the University of Toronto.
The diagrams NIDA publicizes, critics say, use examples from the far ends of
that scattered spectrum to make their point, comparing the brain of the most
serotonin-depleted ecstasy user to that of the most serotonin-robust
nonuser.
Some of the critics have also said that because Ricaurte measured his
subjects only two weeks after they took their last dose of ecstasy, and then
did no follow-up studies, he may have missed the body's natural recovery.
"This is the beauty of science," Ricaurte replies. "You publish your
studies, the critics publish their studies, and eventually it all comes out
in the wash."
Pointing to the acceptance of his article bythe peer-reviewed Lancet, he
says the variability in his data is statistically defensible.
"Four years later we can look back and say there was more variability in the
control and MDMA groups than perhaps we would have liked.
"[Yet] despite the variability, there is a significant difference between
the control and MDMA group. That fact speaks to the robustness of the
finding."
Ricaurte describes as misguided the criticisms that his experiments might
have missed the body's natural recovery period because "we're making no
claim that the damage is permanent."
Several drug-policy analysts have said that Ricaurte's research allows NIDA
to repeat earlier mistakes with drug prevention.
Drug education has traditionally been two-pronged, said Joel H. Brown,
professor of drug education at the University of Oklahoma: coaching on how
to say no to drugs and "some sort of graphic portrayal" of the consequences
of saying yes. Ricaurte's images, Brown says, have become that graphic
portrayal.
"It's safe to say," he adds, "that prevention science in this traditional
form is an unmitigated disaster. Kids are very well-informed about this
drug; and if you tell them something that's not true, [the danger is]
they'll know [that it's not], and they'll stop paying attention to any
further studies."
Hanson says he has a duty to try to keep the broader population off drugs.
"There is a very real risk here," he said, "and I think people need to be
aware of that risk."
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