“AN OPEN LETTER TO THE ACMD ABOUT ECSTASY”
BY PROFESSOR ANDREW PARROTT
The Advisory Council on the Misuse of Drugs has been devoting time to reclassifying ecstasy downwards, even though not requested by government to do so.
Deirdre Boyd recalls parliament’s criticism of the ACMD here.
Read Professor Andrew Parrott’s expert view below.
"After conveying my concerns to the ACMD, its response leaves me with very serious concerns. Indeed, it leaves me even more concerned than I was before.
I cannot believe that I have spent the past 14 years undertaking numerous scientific studies into Ecstasy/MDMA in humans, then for the ACMD to propose downgrading MDMA without a full and very detailed consideration of the extensive scientific evidence on its damaging effects. My research has been published in numerous top quality journals, and can be accessed via my Swansea University webpage here.
The topics the committee are covering seem to be very limited. It also seems to be relying on meta-analyses – apparently, the ACMD organised that the HTA conduct a NICE-type metanalytical review of all the neurocognitive studies of MDMA. But meta-analysis is inherently limited as a procedure (see final section below). And it seems to be focusing on the longer-term effects of MDMA. This is only one aspect of the dangers of MDMA. Three areas need to be considered.
MDMA has very powerful effects in all users. Cardiac stimulation, faster breathing, gurning/jaw stimulation….etc. Most recently, we have demonstrated an average 800% increase in the stress hormone cortisol in recreational MDMA users at dance clubs (Parrott et al, 2008). Every acute ecstasy/MDMA user is in a state of strong
metabolic overstimulation. So all users typically display levels of the serotonin syndrome – see my 2002 paper. Car driving, attention and impulsiveness/riskiness are similarly impaired. Hence it is very dangerous in real-life situations – especially in a polydrug context. As a recent study of London hospitals shows, even children are being admitted for care after mixing ecstasy and alcohol.
DANGERS: POST-MDMA RECOVERY.
Low moods, anhedonia, fatigue, disrupted sleep, mid-week depression… It takes several days to recover from MDMA. In frequent users – eg, every weekend – this is a problem for the everyday health and occupational well-being of all ecstasy users (see Topp et al, 1999 for a more detailed coverage). The ACMD should be fully
aware of this – but is it? If it is not fully informed of these, why not?
Neurocognitive damage is just one element here, and probably not the most important. There are also frontal-executive deficits and development of impaired immunocompetence over time (Pacifici et al).
Reay et al (2006) demonstrated impaired social intelligence. There is increased oxidative stress and well-publicised psychiatric problems as well as harm to many other functions – see my 2006 review.
At the recent Swinburne MDMA conference which I organised, Una McCann from Johns Hopkins in the US reported on sleep apnea. This was significantly higher in young E users than controls; there is also significantly more sleep apnea in the more experienced lifetime E users. The thoracic medics involved in the study were not surprised – they knew about the serotonergic control components of breathing during sleep etc.
I could go on, but there is plenty more in my published papers. ACMD chair David Nutt and his committee should know all this. So why does it not act on all this empirical information?
The ACMD reply to my concerns seemed to suggest that there are few adverse effects of MDMA. Has it actually read the review articles I sent? It would seem not, according to Nutt’s article in The Lancet in which limited information led to a dubious ‘low harm’ score for MDMA compared with other drugs.
As the committee does not seem to have read my earlier email attaching pdfs of my reviews, as I requested – I reiterate that request here. I also request that they then email me with their understanding about the effects of MDMA on everyday health and wellbeing. Please also forward this email to them. They need to achieve
an in-depth understating about MDMA before they can come to any conclusions. It is inadequate to just sit around and listen to a few people speak one morning, then have a 'vote' on this important question – especially when the outcome seems predetermined, as it was the ACMD which instigated the downgrading in the first place.
The main area which the ACMD has acknowledged is the longer-term effects of regular usage. These are very complex and modulated by numerous co-factors. These I debated at considerable depth and length in my 2006 review, where I concluded that it is indeed damaging in various areas.
Note: When anyone undertakes statistical meta-analyses into the longer term effects of MDMA, all the subtle co-influences tend to be lost, so that only the lowest common denominator can emerge. So it is possible to subject the cannabis and cognition data to 'meta-analyses' and show that its effects are minimal. You can probably do the same with boxing and head injury. I am sure that any decent meta analysis will show that it is safe to be a soldier fighting in a war zone! If you include enough co-variables, and all good and poor studies, the error variance will always tend to dominate and the experimental effect will reduce in size.
This might help to explain to clinicians and policymakers why statistical 'meta-analyses' in the behavioural sciences typically conclude that the effect is there – but is generally weak. In every area of interest, you need to follow a far more intelligent, critical, and theory driven approach to reach a more accurate understanding.
MDMA is certainly a damaging psychoactive drug and it should not be downgraded.
Professor Andy C. Parrott
Department of Psychology
Swansea University, Wales, UK
Swansea SA2 8PP