The researchers led by Dr. Liesbeth Reneman investigated the effects of dose, gender and long term abstention from MDMA use with respect to it's toxic effects. They looked at four groups of people, one group was moderate MDMA users who had taken not more that 50 pills all in all, one group were heavy users, one group were ex-users who had taken a minimum of 50 pills, and finally a control group who had never taken MDMA. The
users were recruited from (unspecified) clubs in Holland. The researchers took very comprehensive brain scans using a 'SPECT' technique after giving the subjects a radioactive marker that binds to the serotonin transporters. These are the devices that move the serotonin molecules out of storage in the axon to the synapse, where it
acts on the next neuron. Taking MDMA turns up the rate that these transporters move serotonin to Warp Speed, causing the massive release of serotonin which most of us are familiar with. Using this technique they are able to establish the 'health' of the serotonin system, not merely serotonin levels. The issue they were pursuing was the damage
MDMA use does to these serotonin transporters, since this as at the very heart of the issue of the (not completely understood) neurotoxicity of MDMA, which we are all very concerned about.

SPECT Brain Scans of the subjects

What they found was that "there was a gender difference in the susceptibility to MDMA use", since the results were different between the men and women groups. They also found that these changes were dose-related. Specifically, they showed that women who used a lot of MDMA had less brain serotonin transporters. Although a reduction was
seen in men, it was nowhere near as prominent as that seen in the women. Their data also revealed that moderate use of MDMA (which they set at less than 50 pills) did not lead to a significant reduction in those serotonin transporters. Lastly, they were also able to show that this decrease in serotonin transporters could be reversible in the female users, since the ex-heavy users showed almost normal levels.

This research indicates that heavy female MDMA users are more at risk than male users as far the decrease of their serotonin transporters goes. Little difference was detected in heavy male users. They also saw a return to almost normal in the group of female ex-users.

However, there is a number of points to consider when looking at these research results. The number of subjects is quite small (69 people all in). The research took place in The Netherlands, a country that has led the way in Harm Reduction, and they don't have they hangups about recreational drug use that a lot of countries have. Perhaps this might
mean that the places where people party are safer, users are perhaps aware of issues like body temperature, since it has been shown in animals that neurotoxicity is related to high body temperatures.

The research also did not consider body weight: generally women are of lower mass than men, and thus women generally get a higher concentration of MDMA in their bodies per pill than men. This could contribute to these results. Also, the researchers did not look at any neurofunctional issues, that is the functioning of the brain. We know from our RaveSafe survey that many users report long terms side effects such as personality changes, emotional instability, depression and mood swings amongst others. Even though this research indicates that the serotonin transport system "grows back", it might do so with differences, resulting in the above neurofunctional side effects.

Another important point is that this research does not really correspond with other research done (even if these are questionable). It leaves a number of puzzles for the research community to try and solve. With millions of people using MDMA every weekend, clinical research should be done as a matter of urgency. Some research in the regard is being done in Portugal, and possibly soon the USA where MDMA use is being tested for the treatment of Post Traumatic Stress Disorder (PTSD). Here they give subjects pure MDMA, all the circumstances known and all the effects observed with clinical precision.

Concluding, these results do not mean you should be dropping MDMA pills with wild abandon, thinking that it will all be OK down the life line. Much is still not known. Besides abstinence, the case for moderate use amongst users is stronger than ever before. Women should be very careful with dosage, and everyone should be keeping their cool!

6th December 2001

References:

Liesbeth Reneman, Jan Booij, Kora de Bruin, Johannes B Reitsma, Frederik A de Wolff, W Boudewijn Gunning, Gerard J den Heeten, Wim van den Brink "Effects of dose, sex, and long-term abstention from use on toxic effects of MDMA (ecstasy) on brain serotonin neurons" The Lancet, Volume 358, Number 9296. 1 December 2001

The complete paper can be found on the Lancet web site (www.lancet.com)

Many thanks to the members of the MAPS list for insight.