On a high at weekend, but hitting a low during the week

Cormac O’Keeffe looks at the long-term risks of ecstasy use.

Finding a television story difficult to follow. Telling someone a joke you've already told them. Forgetting what you wanted to say in the middle of a sentence.

But these are not people in their 70s and 80s they are young people, in the their 20s and 30s who have taken ecstasy.

Recent research published in England indicates that ecstasy users were 23% more likely to suffer long-term memory problems than people who don't take illegal drugs.

While the damage done is related to the intensity and duration of use, even moderate users experience memory difficulties, University of Newcastle researchers said.

Dr Des Corrigan, chairman of the National Advisory Committee on Drugs (NACD), said the research had credibility due to the size of the survey sample and the fact that it tied in with the body of research evidence about ecstasy.

But Dr Corrigan, a long-time expert on the drug, cautioned against jumping to conclusions.

"There is going to be the normal loss of memory and learning ability as you get older, one way or the other, and whether ecstasy users are going to be worse off I don't if anyone can say for certain at this stage."

But he said the mounting research into the effects of ecstasy were in the main pointing to some degree of brain damage.

Much of the research has focused on the effects ecstasy has on nerve cells that produce serotonin. Serotonin is a chemical that influences mood, memory, aggression, appetite and sexual behaviour.

Since 1998, brain imaging techniques have indicated that MDMA (the ecstasy ingredient) damages these nerve cells, limiting the ability of the cells to produce serotonin in the future.

A number of research projects, including one published last year by London Metropolitan University, suggested that ecstasy users suffer higher levels of depression that those who have taken other illegal drugs.

A large survey of 519 users found that occasional users of ecstasy, while not clinically depressed, were susceptible to problems triggered by stress or emotional turbulence.

Dr Eamon Keenan is a clinical psychiatrist working at the Eastern Regional Health Authority. He's concerned that, with the focus on cocaine, ecstasy is being pushed to the back burner.

"The concern from people like myself is that ecstasy is becoming acceptable. Because we're getting such huge seizures it's obvious ecstasy is still being widely used."

He said: "I still see people suffering from depression from ecstasy use, both an immediate depression someone using a bit at the weekend and getting disphoric during the week or, more serious, people may develop long term depressive disorders."

He said these cases usually result from heavy use, but that some occasional users can also suffer severe reactions.

He said in most chronic cases the user had an already existing psychological problems, which was triggered after taking ecstasy.

But he said there were cases where the ecstasy had actually caused the psychiatric reaction.

Despite the huge seizures of ecstasy and the widespread, if fluctuating, use of the drug for more than 14 years, the treatment services don't reflect major problems associated with ecstasy.

An analysis of figures supplied by the Health Research Board (HRB) show:

People received treatment for ecstasy across all the health boards in 2000 (about 3% of all drug cases).

A total of 2,170 people have been treated for ecstasy-related problems between 1996 and 2000.

The number of people treated for ecstasy has increased by 32% between 1996 and 2000.

The increases have been greatest outside the eastern area where treatment for ecstasy has dropped.

Getting a handle on drug trends, availability and usage is very difficult, given the lack of reliable indicators in Ireland.

While the graph shows dramatic fluctuations in seizures, observers express caution into reading too much into them.

For example, in 2002, a relatively small number of tablets were seized. But these figures did not include a consignment of more than 590,000 tablets bound for Ireland but seized on the France-Dutch border.

The figure for 2003 includes the country's biggest ever seizure of 1.2 million tablets in Ashbourne, Co Meath. Gardaí often suggest that higher seizures are the result of better intelligence, and don't necessary reflect greater usage or availability. But the figures do tend to suggest a significant increase since 1998.

A survey of drug use, published by the NACD last October, found that 3.8% of 15-to-64-year-olds had taken ecstasy at some stage in their lives.

That translates to around 50,000 people, including more than 23,000 young adults.

But, when broken down to usage in the last year, the figure drops to 1% of the population, or around 14,530 people.

Breaking it down further to usage in the last month, the figure drops to 0.3% or just under 4,000 people.

It's difficult to marry these figures with the colossal ecstasy seizures we are seeing every few months. The two million-plus tablets seized last year would work out at around 160,000 tablets a month.

This would lead to the highly improbable conclusion that each of the 4,000 users would be taking about 40 tablets per month.

The NACD survey recorded lower drug usage figures than previous estimates for Ireland.

According to HRB figures, the NACD survey puts us third, rather than first, as in previous surveys, among 10 European countries for ecstasy use.

Prices are a good indication of availability. Prices of tablets are now between 5 and 10 compared to 13 three years ago, a price which had remained steady since the mid 1990s.

The indications are that availability and usage have increased in recent years. But, along with that, are growing signs that risks particularly long-term risks may also be on the up.