Reports of the prevalence of ecstasy use in Ireland vary widely, as does the medical opinion on its impact on health, writes Shane Hegarty
It is 15 years since the drug ecstasy arrived in Ireland and still it is surrounded by confusing information and hype. A recent UN report declared the Irish used more ecstasy and amphetamines than any other nation in Europe. Last week, those figures had been challenged by the National Advisory Committee on Drugs (NACD), which said we ranked mid-table. Last Wednesday, the the European Monitoring Centre for Drugs and Drug Addiction released further NACD research confirming that there was a decrease in numbers seeking treatment for ecstasy dependency in the late 1990s, followed by a rise again in 2000. The statistics alone were enough to make the head spin.
Meanwhile, every week thousands of Irish continue to take ecstasy and whatever risk might come with it. Costing between €3 and 10 each a pill, in most cases the drug is not even pure MDMA (its chemical term), but contains cheaper synthesised drugs. And a generation of clubbers who took the drug in the early 1990s, and who have left their wild nights behind them, seem to have emerged unscathed from the experience.
Studies of its medical effects are often contradictory. Some suggest that ecstasy can damage memory or result in prolonged psychotic episodes, that it could lead to abnormalities in unborn babies or that it could even be blamed for baldness. Others, however, believe it could be a valuable psychiatric tool. The drug was central to the 1990s club scene, and along with giving reserves of energy needed to dance all night, it fosters feelings of empathy and lowers inhibitions. These, some argue, had such a societal impact on young men at the time that it reduced Britain's football hooligan problems almost overnight.
In 2002, research from Johns Hopkins University School of Medicine in Baltimore suggested that a single pill could lead to Parkinson's disease in later life. After sparking widespread alarm within the media, the researchers recently admitted that they had mistakenly given the wrong drug to the laboratory monkeys. In the meantime, tests at the University of Manchester suggested that ecstasy might actually ease Parkinsonian tremors.
So what do we actually know about ecstasy? We know that the NACD figures - from a survey more comprehensive and recent than that quoted by the UN - say that 4.4 per cent of Irish people between the ages of 15 to 64 have taken it in their lifetime. Among the 15-34 age group that figure rises to 8.8 per cent, or more than one in every 11 people surveyed. It is most popular in Northern Ireland. In the South, more people have taken magic mushrooms than they have ecstasy.
"We're not that surprised," says Dr Hamish Sinclair of the NACD. "Those figures are actually lower than earlier studies, although we can't be sure if it's a true drop or as a result of different methodology. This though was done to a European standard, which at least makes it reliable when compared to other countries' statistics." On that basis, Ireland is fifth in Europe for ecstasy and amphetamine use. The United Kingdom tops the table.
We do not know how many tablets are taken each week. In the first three months of this year, however, the Garda seized €15 million worth of ecstasy, which suggests there is a lot of it swilling about the drugs scene. As with the widespread use of cannabis, it has often been argued that the criminalisation of the drug means that thousands of otherwise law-abiding citizens could be sent to jail for possessing even small amounts or buying and distributing for friends, as is common among ecstasy users. However, while there is no breakdown of prosecutions for dealing or possession , it would seem that the law has become relatively lenient when it comes to those possessing or dealing in small amounts of illegal drugs, including ecstasy. In 2002, only 22 of 363 summary drug offences minor enough to be dealt with in the district courts resulted in imprisonment.
We know, as the media has often pointed out, that ecstasy kills. As its users realise, however, it has a relatively low fatality rate, although definitive figures are elusive. "It is difficult to know how often it's been a cause of death, because the death itself often comes through heat exposure or cardiac failure," explains Dr Sinclair. "If someone takes an opiate drug such as heroin it's more clear-cut because they need direct treatment for that." Besides, Ireland doesn't have a special registry of suspicious deaths in which drugs are involved.
"If we did we would have more accurate figures," says Dr Sinclair
We know that it is not physically addictive, but that in a small number of cases it has led to psychological dependence. The most recent figures from the Drug Misuse Research Division of the Health Research Board, say that of the 2,000 people who sought treatment for problem drug use in the year 2000, just over a tenth of those reported ecstasy as the drug causing them the most problems.
Dr Brian Sweeney, consultant psychiatrist at the National Drug Treatment Centre, says that ecstasy does not take up a good deal of his work, as it tends to be used alongside other drugs, but that it is more likely to be found in cases admitted to psychiatric hospitals. "One of its less well-known side-effects is that it can lead to a prolonged psychosis, a schizophrenia-like syndrome, and that some recover from that and some don't. However, it's a chicken-and-egg situation in that it's not known whether ecstasy is the cause or that it's just triggering a latent illness. With shorter-term psychotic reactions that resolve themselves, and which can be as brief as 24 hours, we can presume they are a result of the ecstasy. When they don't resolve themselves, we can't be so sure."
Heavy users can be prone to mood disorders and memory disorders, he says, and there is preliminary evidence to suggest that women in their 20s might be especially vulnerable to prolonged depression, although he stresses that "the professional community is still out on this". That 5 per cent of the general population is already predisposed to depression further muddies the statistics.
Despite the belief among users that MDMA in its purest form is relatively safe, Dr Sweeney adds that it is often associated with sudden deaths and can also permanently lower levels of the body's mood-balancing chemical serotonin. "However, if we're providing balance, we can't pretend that for a lot of ecstasy users it doesn't appear safe. And while the long-term effects in heavy users would bother me, we have to acknowledge that it is relatively safe. Let's not over-hype this. It's about credibility and it's like the boy who cried wolf. The young are discerning and you must give them the correct information. Those who end up with psychological problems are a very small proportion of users."
The UN figures were greeted with scepticism by many at the coalface of addiction treatment, who believe that the use of the drug levelled off some years ago, although they say that it blossomed late in rural communities as it declined in the cities.
Club culture has also declined in recent years as pub culture has grown. While ecstasy remains prevalent, it no longer has the cultural resonance it once did.
"There's a change in fashion and music culture," says one veteran club promoter. "The club culture is old-hat to a degree, and ecstasy's not as new or fresh. It's not as trendy as it used to be, I suppose."
