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Although the number of
ER visits associated with 'ecstasy' is relatively low, the thought
of over five thousand users near
death's door being hauled in by ambulances is rather troubling. But...the
data doesn't mean what it seems to imply at first glance. Look at the
"marijuana" column near the bottom. For every case where
'ecstasy' was present, there were about twenty marijuana-related cases.
How can this be?
Marijuana is extremely safe; the vast majority of these people were
clearly not in medical danger. The explanation is that people on psychoactive
drugs often come to the ER because they think something might
be wrong; they get scared. With MDMA, a lot of 'got scared' stories appear
to be happening
as well. A study of ER admissions in the Netherlands found that, of the
patients there for some complaint related to 'ecstasy', most (89%) did
not require treatment beyond the initial visit/talk with a doctor.[1]
Most ER cases also involve alcohol. [2] (If you feel
something might be wrong, either with yourself or somebody else, do
not hesitate to seek medical attention. Maybe it's nothing serious,
but better to be safe than sorry.)
From this data, the total rate of ER
visits among 'ecstasy' users is approximately 1 in 600 users per year.
If we
assume that the experience of the Netherlands is comparable to that
of the US, we might assume a rate of actual emergency medical problems
associated
with 'ecstasy' use of approximately 1 in 6,000 users per year. Numbers
alone don't really tell the whole story, however: Where things get
interesting is not how many users encounter medical problems, but why
they do. The distribution of injuries and deaths is not random throughout
the user population; it is associated with specific risk factors and
behaviors.
(Read the rest of the Risks section for more information.)
The number
of ER visits rapidly increased from 1994-2001, declining in 2002 (apparently
due to reduced rates of use.) Most of this increase was simply due
to the greatly increased number of people
using
'ecstasy'.
However, the ER visits increased at a faster
rate than use, leading me to speculate that users are becoming more
likely to seek medical attention if they fear something is wrong, coupled
with
increases in use by younger and less competent/careful users.
Fatalities
Most of the people that show up in the
ER, even those in genuine medical danger, will make a full recovery.
Most...but
not all. In recent years in the US, the greatly increasing rate of
MDMA use has made deaths a somewhat regular occurrence. Listening to
the government
'drug experts' you might think users were dropping like flies. The
truth, as usual, is less grim than the drug warriors would have us believe:
Deaths involving MDMA (from districts reporting to SAMHSA):
| Year: |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001* |
| Reported Deaths: |
1 |
6 |
8 |
3 |
9 |
42 |
63 |
76 |
*Incomplete data; the actual total is probably closer
to 100.
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Graphically represented, the data spike of 1998-2000
is even more obvious. This increase is something of a mystery,
given that the overall rate of use seems to have only about doubled
between 1996 (8 deaths) and 2000 (63 deaths.) The increase in reports
does, however, better match the increases in Emergency Room visits.
My concern is that this trend was partly the result of MDMA's spread
from users who generally knew what they were doing to younger and
more
ignorant
users. The government failed in both respects; They were unable
to stop the growth of usage, and they refused to provide useful
drug education to young people. |
Some important things need to be said
about how this information is gathered. First, not all medical examiners
(coroners) report to SAMHSA, particularly in rural areas. As a result,
there have no doubt been some cases that have gone unreported. Also,
the basis of reporting a death as "associated with MDMA" is
not that it was caused by MDMA; rather that it was caused by drug use,
and one
of the drugs present was MDMA. This is a slippery distinction. For
instance, if a person takes MDMA and drinks at a party, then, hours
later, drives
drunk and is killed in an accident, the death would be reported as
MDMA-related. It's also possible that the increased number of 1999-2001
death reports
is simply the result of more comprehensive toxicology screening
finding
MDMA
in more people who died as a result of other drug use (such as alcohol
or amphetamines.) The 2001 data came with more information: A listing
of all the drugs involved in each case:
As expected, amphetamine
and methamphetamine made a showing. Somewhat surprising to me were
the high numbers of cases involving cocaine and opiates (heroin,
oxycodone, ect.) Out of a total of 76 deaths involving MDMA reported
in 2001,
only
9 involved only MDMA. It seems unlikely that cannabis
was a significant factor in deaths.
In a recent
study in the UK, of 81 deaths
where MDMA was present, only 6 died from simple MDMA toxicity. |
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The leading causes of actual MDMA-related
death are complications of "malignant hyperthermia/hyperpyrexia"...what
most people would call Heatstroke. Perhaps
the second most common cause of death (significantly less common than
heatstroke-related)
is Hyponatremia, sometimes called "water
intoxication." Even rarer causes of death are due to underlying
health problems (heart disease, etc.) being aggravated by MDMA's
stimulant effects
and a few 'misadventure' deaths (falls, etc.) Fatal cardiac arythmias
have been claimed, but seem to be unreported in the case studies.
Putting things in perspective:
The death rate for MDMA, assuming
that there really were about 60 deaths directly caused by MDMA in 2000,
would be roughly 2 in 100,000 users. The death rate from smoking, by
contrast,
is on the
order of 400 per 100,000 users. Even alcohol, America's official "it's
not really a drug" drug, nets about 50 deaths per 100,000 users
each year:[3]
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Equally important
in considering risks is that, while there is no safe way to be
a pack-a-day cigarette smoker, most of the people that died as
a result of their MDMA use
did something unwise to cause their demise. An informed MDMA
user is unlikely to be a hyponatremia death.
No responsible MDMA user is likely to be a 'driving under
the influence' or drug mixing death.
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Some people have objected to this comparison,
saying that one beer or one cigarette is not as dangerous as one pill
of MDMA. While that's true, my interest is (quite justifiably,
I think) the overall risk posed by the lifestyle, not by per-unit risks.
Yes, smoking a single cigarette is probably safer than taking
one ecstasy tablet, but that's not the way real world users behave.
The smokers don't stop at just one cigarette and the drinkers don't
stop
at just one beer. The statistics shown here mean exactly what they
say: Your odds as an MDMA user of being killed from your MDMA use are
a very
small fraction of your odds as a smoker or drinker of being killed
as a result of your
smoking or drinking.
Rates of Use of MDMA ('Ecstasy')
When it was first scheduled,
MDMA was something of niche drug. Tens of thousands had probably tried
it, but it hadn't made a big splash on the national drug scene. After
scheduling, MDMA began an almost geometric pattern of growth. Today,
on
the order of 10-12 million Americans have used MDMA at least once in
their life. If nothing else, the runaway growth of ecstasy use has
demonstrated the almost complete inability of law enforcement to actually
prevent
drug use by fighting the supply side; where there is a demand, the
supply will always find it.
The group we have the
most data on is young people (mainly high school students), thanks
to the
government funded Monitoring
the Future survey,
which studies eighth, tenth, and twelfth grade students (approximately
ages 14, 16 and 18) from across the US.
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As shown in this graph from
the MTF survey, use of MDMA by teenagers saw
extremely
strong growth in the late 90's, with use by high school seniors
more than doubling just from 1998 to 2000.
2002 to 2004 saw large declines
in reported last-month usage. The 2002 drop
is consistent with declines in MDMA-involved emergency room
visits for
2002. The curve appears to be bottoming out, however;
it is likely that usage is approaching a minimum and will
stabilize or even rebound.
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Perceived availability has a
correlation with usage rates, although this is likely
to be largely a trailing indicator (increasing usage causing
increases in perceived availability.)
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The trend had been for slowly
increasing acceptance of 'ecstasy' use by teenagers until 2002.
There is a modest but significant correlation between Disapproval
and usage levels.
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Fear-mongering anti-ecstasy
ad campaigns appear to have paid off.
In 2003 a new standard was set when the percentage of high school
seniors who thought trying ecstasy would be very dangerous exceeded
the percentage who though trying crack or methamphetamine would
be very dangerous. Although perceived risk slightly increased in
2004, the curve is clearly flattening; anti-MDMA propaganda seems
to be reaching the limits of its effectiveness. Given the
rather thorough discrediting of "it'll eat holes in your brain"
propaganda, even these gains may well be temporary. (See:
Neurotoxicity.)
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Other data from MTF:
• In
2001 at the 12th grade level, Hispanic students were slightly more
likely than white students (13.1% vs. 12.4%) to
have tried MDMA, while only a small number of black students (3.1%)
had tried the drug. (Perhaps surprisingly, rates of drug use by
black teenagers are much lower than for whites in almost all categories,
including crack cocaine. Why then are our prisons crammed with black
drug offenders?)
• Among
college-aged people (1-4 years past high school) the lifetime prevalence
of MDMA
use was
approximately
16%
(people attending
college were somewhat less likely to have tried it.)
• Males are somewhat
more likely to have used MDMA than females.
• Distribution
of use is fairly even among all regions of the US (except for the
south
which had significantly less use) and all parental educational
backgrounds (children of the least educated parents were less likely
to have
used.)
• Major cities
had ~60% more past-year use than small towns.
[1] Spruit IP "Ecstasy use and
policy responses in the Netherlands" Journal of Drug Issues, 1999;
29(3):653-678. Abstract
[2] Substance
Abuse and Mental Health Services Administration/DAWN Emergency Department
data.
[3] Death numbers are based on 'rough
justice': The US Centers for Disease Control reports over 100,000 alcohol
related deaths per year, with close to 200 million Americans using alcohol.
CDC also reports over 400,000 smoking related deaths per year out of
about
100 million smokers. The 'ecstasy related' drug deaths number is
based on an assumption of about 60 deaths (in all probability there were
only a handfull of purely 'ecstasy' deaths) out of a user population
of
about 3 million (based on the 2000 National Household Survey on Drug
Abuse Statistics, conducted by SAMHSA.)
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