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MDMA works by increasing the levels of certain of the brain's neurotransmitters: dopamine, norepinephrine and, particularly, serotonin. The last of these is important in many things -- in the body's regulation of mood and its sense of well-being, as well as in regulating anxiety, sleep, appetite and body temperature -- and E users end up with a massive amount of it in their brains. The problem, doctors say, is that MDMA functions almost like a laser-guided weapon that destroys what it hits: the nerve terminals, which are the parts of brain cells that release serotonin.

"Clearly, the amount of MDMA is important, but it's also important to recognize that even a single dose of MDMA may be enough to produce neuro injury," says Dr. George Ricaurte of Johns Hopkins University, lead author of the recent study. Besides the recent primate study, Ricaurte has done myriad other tests on human ecstasy users. "By contrast, if you consider the case of alcohol, it's only in long-term alcoholics where one senses changes in brain structure."

Ricaurte concedes that since his study was done not on E-using ravers but on primates, there is room for uncertainty about its effects on humans. He says the amount of the drug the researchers gave the monkeys was high. The point of the study was to find out whether the monkeys' bodies could repair E-induced brain damage once it was incurred. Twice a day for four days, Ricaurte and his researchers gave squirrel monkeys either ecstasy or salt water. Two weeks later, they killed part of the test sample and looked at their brains. McCann explains that for E to qualify as neurotoxic in their study, there had to be damage remaining after two weeks. There was.

Six or seven years later, the researchers killed the remaining monkeys and found that, although the serotonin neurons recovered in certain parts of the brain, there was still damage remaining elsewhere. The areas particularly affected were the neocortex, which is important for conscious thought, and the hippocampus, which is critical for long-term memory.

"Ecstasy is a great drug," says Dr. Bill Wilson. "It's just too bad it's so damn neurotoxic." Wilson is a professor of pharmacology at Duke University Medical Center and co-author of the 1998 book "Buzzed: The Straight Facts About the Most Used and Abused Drugs From Alcohol to Ecstasy." "Ecstasy falls into the category of 'extremely dangerous' because you can use other drugs like alcohol or cocaine 50 or 100 times and still recover from it with drug treatment," Wilson says. "But you can't recover that lost serotonin function in your brain -- there's nothing to do to recover that. It's gone forever."

Other scientists disagree. They dispute that MDMA is neurotoxic, and find flaws in both the test methods in animal tests and the studies that have involved humans. For the tests on humans, critics say there's no way to tell for sure that the subjects had been using pure MDMA. Ecstasy is often cut with other drugs, so it would be difficult to tell whether it was the actual X doing the damage or the other drugs in the mix.

"From a scientific standpoint, there is no evidence that it causes brain damage in humans," contends Dr. James P. O'Callaghan, head of the molecular neurotoxicology lab at the Centers for Disease Control and Prevention, who has studied MDMA's effects on the nervous system. "Because these drugs act by releasing serotonin, you have to have terminals there for the drug to act on. By definition, you can't be destroying the machinery if the drugs continue to work."

Next page | "If I get brain damage, I'll just take Prozac"