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 bedridden.

Hallucinations

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 ecstasy use.

"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 study today in a special MDMA issue of the British Journal of
Psychopharmacology, 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," he said.

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.

Cannabis User

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 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.

Water-Poisoning

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.

Toxic Reactions

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.

Depression

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.

Positive Effects

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.