The strange case of the man who took 40,000 ecstasy pills in nine years

[enquirewithin]

Neurological and Psychopathological Sequelae Associated With a Lifetime Intake of 40,000 Ecstasy Tablets

Christos Kouimtsidis, Fabrizio Schifano, University of London, UK, Tim Sharp, Watford, UK, Lisa Ford, Justin Robinson, and Colm Magee, Slippers Hill, UK

….. Ecstasy consumption has spread since the late ‘80s, and the reduction in price observed over the last few years has possibly increased access to the drug. Clinicians are now meeting with a generation of patients who have been exposed to the drug for more than a decade.

Case Report

Mr. A, 37 years old, used ecstasy between the ages of 21 and 30. For the first 2 years, he took 5 tablets every weekend, escalating to an average daily use of 3.5 tablets for the next 3 years, and further escalation to an average of 25 tablets daily over the next 4 years. An estimate of lifetime consumption yielded a total intake of more than 40,000 tablets. …

Mr. A reported current cannabis consumption, together with a previous history of polydrug misuse (i.e., solvents, benzodiazepines, amphetamines, LSD, cocaine, heroin). After three episodes of "collapsing" at parties, Mr. A finally stopped his ecstasy use. For a few months, he felt as if he was still under the influence of ecstasy and suffered several episodes of "tunnel vision."

He eventually developed severe panic attacks, recurrent anxiety, depression, muscle rigidity (particularly at the neck and jaw levels), functional hallucinations, and paranoid ideation…. The Mini-Mental State Exam revealed disorientation to time, poor concentration, and short-term memory difficulties…. Although Mr. A was able to fully understand the instructions given, his concentration and attention were so impaired that he was unable to follow the sequence of the tasks required. A structural MRI brain scan revealed no focal cerebral lesions…There was no evidence to suggest atrophy. Mr. A was then prescribed olanzapine 10 mg and admitted to a brain-injury unit, where there was some improvement of his memory skills as a result of the use of compensatory strategies.

Comment

To our knowledge, this is the largest amount of ecstasy lifetime consumption ever described, the heaviest lifetime intake previously reported being around 2,000 tablets. Although much information is self-reported and might have been affected by Mr. A’s memory impairment, the history given was confirmed by notes from another service he attended just after having stopped ecstasy use.

All ecstasy misusers would develop a (mild-degree, in most cases) serotonin syndrome after acute drug intake, which is characterized by enhanced physical activity, hyperthermia and sweating, increased muscle rigidity, rhabdomyolysis, hyperreflexia, trismus, jaw-clenching, myoclonus, tremor, and nystagmus.

Mr. A gave consent to his history being reported to a medical journal.

-Psychosomatics 47:86-87, February 2006

[Alfa]

Care to edit that to make it easier to read?

[enquirewithin]

Persistent Psychosis After a Single Ingestion of ‘Ecstasy’

JANICE VAN KAMPEN, M.D.
MARK KATZ, M.D., FRCP(C)


There is a widely held belief that MDMA is a “safe” drug, but a growing body of literature has documented both medical and psychiatric adverse reactions to MDMA....In this paper, we describe an individual who developed prolonged psychosis after a single recreational use of MDMA.

Case Report

Ms. F., an 18-year-old female high school student was admitted to the internal medicine service of a university-affiliated teaching hospital for investigation of confusion and an altered level of consciousness. The previous night, she had smoked marijuana, drunk a small amount of tea containing psilocybin ("magic mushrooms"), and taken one tablet of ecstasy at an all-night party. The following day, Ms. F. returned to her parents' home in a confused and disoriented state. She was taken to the emergency department, where she displayed a fluctuating level of consciousness; disorientation to name, place, and time; marked loosening of associations; and bizarre, agitated, and sexually inappropriate behavior... A diagnosis of hallucinogenic (and possibly cannabis-induced) delirium was made....

At 6 weeks after discharge, however, her psychotic symptoms had still not resolved, [but]...By 3-month follow-up, the psychotic symptoms had not returned and Ms. F. had resumed her academic and extracurricular activities, with full return to her previous personality and level of functioning.

Discussion
Our patient developed a prolonged psychotic reaction to recreational use of MDMA that was treated successfully with olanzapine. Initially, she experienced an MDMA-induced intoxication delirium... Once the delirium had cleared, prominent psychotic symptoms emerged, including disorganized thought form, delusional ideation, and ideas of reference that lasted approximately 12 weeks. The diagnosis of MDMA-induced psychotic disorder seemed most appropriate...

[GDxCAT]

why is this considered an MDMA indusced psychosis (im talking about the female) as opposed to a mushroom delerium.

It just sounds like they are demonizind ecstasy.

They also fail to mention that if used responsibly these things would not be occuring.

[raven3davis]

And apparntely Mr A was using other drugs like solvents! To SWIMs knowledge solvents do some of the most damage out of any drugs, if you could even consider them a drug. 25 tablets a day is just flat out irresponsible and stupid. After a few days the xtc wouldnt even effect you. Taking 25 tablets of any kind of drug every day is not a good idea. SWIM also wondered why they blamed the delerium on the xtc. It would seem much more likely that her episode was caused by the shrooms or mayne just the combination of shrooms and x.

[Nature Boy]

This is some of the most ridiculous shit I've ever read in my life. The first case is obviously concerned with some moron who probably enjoys sniffing the amonia out of urinal cakes and dropping random pills found in old ladies' handbags in which he's so fucked up, all the analysis in the world won't figure out what made him mental. Sheer stupidity is the short but sweet answer.

The second case is even more idiotic. All the side-effects she displayed during her un-needed trip to the emergency ward suggest to me that she was simply still tripping on the shrooms whilst there and that all of her paranoia and fear could have easily been avoided by having a sitter, a decent setting for a trip, and a little bit of education on what to expect from mushrooms. To suggest that it was cannabis-induced delirium is laughable. The so-called 12 week delirium was more likely 12 weeks of having embarassing stories being spread about her which probably lead to a bit of depression. The article also fails to point out that she may not have even taken MDMA. A "tablet of ecstasy" could have contained anything and may never have contained any MDMA at all. Ecstasy is a very general term for "random dodgy pill which might contain MDMA". The sale of ecstasy tablets has destroyed the reputation of the wonderful drug that is MDMA.

Reputation Comments on this post:

fuckin' A, good analysis

[Nagognog2]

When Bongo was 13, an idiot accidently bayonetted him through his hand. The closest hospital was a Catholic hospital in Boston, Massachusetts.

Bongo had lost a very large amount of blood, and the attending physician in the ER took his blood pressure and pulse. The AP determined, due to low BP and pulse, that Bongo was high on Marijuana and called the police. It was not a possibility in the AP's eyes that a low BP and pulse could result from blood loss and shock. Bongo had not smoked any pot. But the police officer agreed that Bongo was a druggie as Bongo liked his hair long (still does). The policeman then grabbed Bongo's injured hand and pulled it, while uttering an ethnic insult due to Bongo's last name. Bongo's tendon, which was partially severed from the bayonette, snapped and went up his arm. Bongo's hand was never the same again due to the severed tendon.

It was written on the hospital diagnosis that Bongo was injured due to Marijuana-Induced Trauma.

Quack! Quack!

[Nature Boy]

Bongo was treated like shit frankly.

About the long hair, the law usually ignore people with long hair over here and tend to pick on shaven-headed types in white tracksuits i.e. "scobes". SWIM also keeps his hair long with the occasional homemade haircut.

[cupdetat]

I want to hear more about how Bongo got his hand stabbed with a bayonette.

[nanobrain]

now thats a duck of a tail!

[napoleon in rags]

Darwin, eat your heart out bitch.

[motorhead]

April 04, 2006
The Guardian (UK)
David McCandless

THE STRANGE CASE OF THE MAN WHO TOOK 40,000 ECSTASY PILLS IN NINE YEARS

- - Usage increased to 25 tablets a day at peak - Memory problems and paranoia may be lasting

Doctors from London University have revealed details of what they believe is the largest amount of ecstasy ever consumed by a single person. Consultants from the addiction centre at St George's Medical School, London, have published a case report of a British man estimated to have taken around 40,000 pills of MDMA, the active ingredient in ecstasy, over nine years. The heaviest previous lifetime intake on record is 2,000 pills.

Though the man, who is now 37, stopped taking the drug seven years ago, he still suffers from severe physical and mental health side-effects, including extreme memory problems, paranoia, hallucinations and depression. He also suffers from painful muscle rigidity around his neck and jaw which often prevents him from opening his mouth. The doctors believe many of these symptoms may be permanent.

The man, known as Mr A in the report in the scientific journal Psychosomatics, started using ecstasy at 21. For the first two years his use was an average of five pills per weekend. Gradually this escalated until he was taking around three and a half pills a day. At the peak, the man was taking an estimated 25 pills every day for four years. After several severe collapses at parties, Mr A decided to stop taking ecstasy. For several months, he still felt he was under the influence of the drug, despite being bedridden.

Hallucinations

His condition deteriorated and he began to experience recurrent tunnel vision and other problems including hallucinations, paranoia and muscle rigidity. "He came to us after deciding that he couldn't go on any more," said Dr Christos Kouimtsidis, the consultant psychiatrist at St George's Medical School in Tooting who treated him for five months. "He was having trouble functioning in everyday life."

The doctors discovered that the man was suffering from severe short-term memory problems of a type usually only seen in lifetime alcoholics. But evaluating the full extent of his condition was difficult as his concentration and attention was so impaired he was unable to follow the simple tasks involved in the test.

"This was an exceptional case. His long-term memory was fine but he could not remember day to day things - the time, the day, what was in his supermarket trolley," said Dr Kouimtsidis. "More worryingly, he did not seem aware himself that he had these memory problems."

With no mental illness in his family and no prior psychiatric history, the doctors concluded that his unique condition was direct result of his intense ecstasy use.

"This is obviously an extreme case so we should not blow any observations out of proportion," says Dr Kouimtsidis. "But if this is what is happening to very heavy users, it might be an indication that daily use of ecstasy over a long period of time can lead to irreversible memory problems and other cognitive deficits."

For 10 years, MDMA has been suspected of causing these kinds of effects in heavy users. It is thought to be due to its disruption of the regulation of serotonin, a brain chemical believed to play a role in mood and memory. It remains unclear whether these effects are the result of permanent neurotoxic damage or just temporary reversible alterations in the brain.

A study today in a special MDMA issue of the British Journal of Psychopharmacology, suggests long-term side-effects may be temporary. The researchers from the University Of Louisiana could find no significant relationship between depression and recreational ecstasy use.

In the case of Mr A, a structural MRI brain scan failed to show any obvious damage or atrophy in his brain. However, these results, says Dr Kouimtsidis, are difficult to interpret. "A scan of this type is not sensitive enough," he said.

Such limitations in brain scanning technology, along with ethical and legal barriers to giving MDMA to human test subjects, have limited direct observation of the drug's effects in humans.

Instead, scientists have had to use recreational drug users as subjects in their studies. Conclusions from this are often flawed because few, if any, drugs users use ecstasy in isolation.

Cannabis User

Mr A was also a heavy cannabis user, and when he was encouraged to decrease his use, his paranoia and hallucinations disappeared and his anxiety abated. But his memory and concentration problems remained, leading the doctors to suspect that these may be permanent disabilities.

When he was admitted to a specialist brain injury unit and put on anti-psychotic medication, he did start to show some improvement. "Unfortunately, he discharged himself before we were able to complete the assessment," says Dr Kouimtsidis. "We continued to support him. But he started to use cannabis again and he dropped out. We tried to re-engage him but we lost him about a year ago."

The Guardian made several attempts to find the man without success.

Effects Of Ecstasy

MDMA is one the most intensely studied recreational drugs in history. But despite thousands of research papers and studies, scientific evidence on the side-effects remains inconclusive.

Death By Overdose

Undoubtedly, large amounts of ecstasy can lead to over-heating which in turn, in rare cases, can trigger fatal heat stroke. Many factors contribute: number and strength of pills taken, environment, alcohol-consumption, body weight - but women seem more at risk. The bulk of ecstasy-related deaths around the world have been young women.

Water-Poisoning

Panicking users, fearing they are overdosing, drink too much water and provoke hyponaetraemia ( water-poisoning ). Leah Betts died after drinking 14 pints in just 90 minutes. The recommended amount of water to drink per hour is one pint.

Toxic Reactions

Much of the reports of toxic reactions are muddled with overdose or water-poisoning deaths. There is no clear evidence that some people suffer allergic reactions to ecstasy. However, around 10% of Western users do lack a key liver enzyme CYP2D6 needed to break down MDMA. This may make them more sensitive to the effects and more prone to accidental overdose.

Depression

Many weekend users report a mid-week mood dip. This is suspected to be related MDMA's effect on serotonin, but hard evidence is lacking. In heavy users, dips can turn to crashes and depression. However studies suggest this effect reverses after a 2-3 month abstinence.

Positive Effects

Users still claim "long lasting improvements in self-awareness, self-esteem, openness and insight into personal problems", reports the study from the University Of Louisiana. In the US, research continues into the use of MDMA-assisted psychotherapy to treat Post Traumatic Stress Disorder.

[Nagognog2]

If this is true, it certainly shows the safety of MDMA - and whatever else may have been in these pills. Imagine if he had taken 40,000 tylenols? 40,000 salt tablets...

However this character wins the same prize as the guy from the Guiness Book of World Records who ground up a bicycle, placed it into capsules, and swallowed them. In an attempt to make the record book. He did - as the world's stupidest person!

[MrJim]

Maybe this should be merged with this....

http://www.drugs-forum.com/forum/sho...846#post142846

[sg43]

Well I have to say thank you to that guy even though it was stupid to take that many but he has given lots of info for researchers to study.

[kemistudent]

weeeetard!

This person must have wanted to see what it was like being a oinion.

[anj0vis]

25 tabs a day... whoa, that is quite a hefty amount. It must be really cheap there also or he would have to be a king to support that habit.

[Euphorium]

In London it would not be particularly expensive. 25 pills a day would not exactly be breaking the bank, especially comapred to many opiate/cocaine/amphetamine/cannabis users I know.

All things considered, this guy seems to prove that MDMA is fairly safe. His daily doses were well above the no effect level established by US researchers, and he still only has moderate imparement. That's somewhat encouraging, anyway.



edit: Removed price reference, as per forum rules. Apologies to all for the oversight.

Reputation Comments on this post:

Prices not allowed

[enquirewithin]

Though the man, who is now 37, stopped taking the drug seven years ago, he still suffers from severe physical and mental health side-effects, including extreme memory problems, paranoia, hallucinations and depression. He also suffers from painful muscle rigidity around his neck and jaw which often prevents him from opening his mouth. The doctors believe many of these symptoms may be permanent.

Can you belive what you read in the papers? I don't think this is in the original report!

[acenicho]

That's somewhat encouraging, anyway.

Thats the first thing a friend of mine thought when reading the article. He does wish though, that the Mr. A stuck around for more tests. Such as liver and kidney's tests!

[motorhead]

UK: Column: Only Someone On Drugs Could Think 'Just Say No'
by Sam Leith, (08 Apr 2006) Daily Telegraph United Kingdom
There was a solid thump as the back of the hippie's head hit the wooden floor. The hippie was lying on his back, confused. His mouth was open and his eyes were staring glassily at nothing much in particular. A member of the venue's staff with a walkie-talkie crouched by him.

"Dude," said the man with the walkie-talkie. "Can you hear me? Hello, dude. Do you know where you are?" The hippie continued to stare at the ceiling, conscious, but not communicating. "Can we get a medic over here?" the man said into the walkie-talkie. He set about trying to raise the hippie's head, and pour water from a bottle into his mouth.

This was Tuesday night, a rock venue in Cambridge, where we were seeing Mogwai - a band that specialises in producing ear-bashingly loud yet melodic walls of guitar noise. They are the sort of band, the downed hippie had obviously decided, that might sound particularly nice on ecstasy. Cabbaged before the main act had even come on stage, he had to sit out the remainder of the gig on a low stool, sipping quietly from a bottle of water and staring benignly into the middle distance.

If you think he had problems, what of Mr A? Mr A is a 37-year-old who, we learnt this week, claims to have taken 40,000 ecstasy tablets over nine years, including 25 pills a day for four of them. Bloody hell. If we take this - admittedly questionable - data as read, that represents a twentyfold improvement on the previous documented record of 2,000 pills in a lifetime.

Mr A is unlikely to get it together to contact the Guinness Book of Records, however, because he is a gibbering wreck. His short-term memory is so bad, he can't go to the supermarket because he forgets what's in his trolley. He suffers hallucinations, depression, and muscle seizures so severe he sometimes can't open his mouth.

Unfortunately, the conclusion many will have drawn from the tale of Mr A is exactly the opposite of the one its shock-horror presentation hopes to lead us to. They won't think, wow, this drug must be really bad for you: the man's a gibbering wreck. Of course the man's a gibbering wreck: he was taking 25 doses a day of a drug with a powerful impact on the central nervous system. They will think, instead, wow: gibbering wreck or not, he is still alive. It suggests to the layman, in fact, that the toxicity of ecstasy is astonishingly low.

I am not a pharmacologist. But I'd guess if you drank 25 large espressos a day for four years, you would be a gibbering wreck. If you took 25 paracetamol tablets a day for four years, you would like as not be stone dead. The effects of taking 25 Imodium a day for four years do not even bear thinking about.

This is not to say that ecstasy is good for you. Just ask Mr A, if he can concentrate for long enough to give you a straight answer. There are indications that long-term use is associated with depression and memory problems. In the short term, it causes mood swings. Its use is also associated with very perilous behaviour, such as dancing maniacally until you overheat and collapse, or drinking so much water you poison your system. Nasty adulterants are present in most pills. It would be best if nobody took ecstasy.

How to stop them, though? Not the way we're currently going about it. The iron orthodoxy in public life is to treat all illegal drugs as if they were morally and pharmacologically identical. This is counterproductive nonsense. Talking about any illegal drugs calmly or even positively is regarded as "irresponsible", and suggestions of drug use are a cheap way for the press to seek a political scalp. Drugs are regarded as a blanket evil.

Perhaps this is a reasonable position to take for the public good. The trouble is, it's a position that will serve the public good only if the sizeable minority of people who use one or several of the wide spectrum of different drugs available believed it for a second. And they don't.

Every time a raver reads that "ecstasy kills", they will look about them at hundreds and thousands of their contemporaries, or even at Mr A, and they will think: "No, it doesn't." Every time the example of Leah Betts is wheeled out, they will consult their dim understanding of statistics and wonder what it means that the totemic instance of a death from a drug taken by the million, over nearly two decades, happened in 1995 - and was from water-poisoning, not directly from the drug itself.

Thousands of people continue to take ecstasy because it can produce feelings of great spiritual and somatic warmth and wellbeing. And they take it because they calculate, rightly, that it is very unlikely to kill them. If we want to stop them, we're going to have to do better than repeat, like South Park's Mr Mackey: "Drugs are bad, 'mkay?"

Reputation Comments on this post:

	Interesting read
	Fascinating article

[enquirewithin]

...because he is a gibbering wreck.

It curious to note how the original report from a scientific journal has been altered by the UK press.

[anj0vis]

Those articles are still better than what any major newspaper would publish here in northern europe.. articles here are on the level of that South Park's Mr. Mackey..

[wertfun]

edited by wertfun

Reputation Comments on this post:

Prices

[23smooches]

Originally Posted by GDxCAT

why is this considered an MDMA indusced psychosis (im talking about the female) as opposed to a mushroom delerium.

It just sounds like they are demonizind ecstasy.

They also fail to mention that if used responsibly these things would not be occuring.

In journalism, you pursue complete neutrality when writing stories. It doesnt necesarily seem like the reporter is demonizing anything, just reporting what happened when she took thes drugs. Her psychosis was caused by drug use. That is the bottom line, and that is what the reporter said. Just because you are a strong advocate of, or unable to live without drugs or whatever reason you have to be criticizing anyone who reports adverse affects of drugs, doesnt mean that they you can accuse someone of trying to mislead the public. Experts agree, this includes Shulgin and the late Hoffman, that MDMA and other psychoactives like LSD and Psilocybin and so on, are extremely useful, and beneficial tools and should not be demonized, but should definitely not be used for recreational purposes. And preoccupying ourself with altered states of consciousness is considered addiction, as is unhealthy preoccupation with anything.
peace
I also want to add that you are not a doctor, and you were not there to treat this girl, and study her, so you have no reason to claim that it was a psilocybin induced psychosis.

Reputation Comments on this post:

	Magnificent! Really, I haven't laughed so hard in a long time. Thank you. Ah to have the idealism of the young!
	good post
	Agreed. Good eye.