Introduction

On behalf of Director McCaffrey, I would like to thank the Caucus on International Narcotics Control for the opportunity to testify today about one of the most problematic drugs that has emerged in recent years that hails under the misnomer “Ecstasy.” It is anything but. To identify this illegal substance more accurately, I will refer to the drug as “MDMA”, which stands for its chemical structure 3-4 methylenedioxymethamphetamine.

Chairman Grassley, Senator Biden, and distinguished members of the Caucus, we appreciate your interest in all aspects of drug control policy. We especially appreciate your committed, bipartisan support of the National Drug Control Strategy’s number two goal: To increase the safety of America’s citizens by substantially reducing drug-related crime and violence. We welcome this opportunity to discuss MDMA and to urge you to continue supporting initiatives that are scientific and research-based to combat this problem.

At the outset, I would like to recognize our partners in our integrated federal approach. The United States Customs is our front-line defense to the illegal trafficking and distribution of illicit drugs into the country. The Department of Justice and the Drug Enforcement Administration, heroically pursue the increasing numbers of cases brought to their attention. The Department of State works to assure ever-increasing cooperation in the economic community. I would also like to thank Dr. Alan Leshner, Director of the National Institute on Drug Abuse, which plays a critical role in shaping and conducting research necessary for our understanding of the complexities of this drug and its effect on the brain. Dr. Leshner is, without question, one of the world’s leading authorities on drug abuse. Under his leadership, NIDA sponsors roughly 85 percent of the world’s research into drug addiction. We are all indebted to Dr. Alan Leshner for providing continued leadership in research leading to the design of effective drug prevention and treatment strategies. With the committee’s permission I would like to submit a statement from NIDA for the record.

Overview

MDMA is a synthetic, psychoactive drug. It has both amphetamine (stimulant-like) and hallucinogenic properties. MDMA is known by several street names, such as E, X, Adam and Essence, and Ecstasy. In a recent article on MDMA, Time magazine quoted a young woman who used MDMA for the past five years as saying, “E[cstasy] makes shirtless, disgusting men, a club with broken bathrooms, a deejay that plays crap, and vomiting into a trash can the best night of your life.” That’s just the tip of the iceberg. The ills of MDMA get much more grave and far-reaching.

The good news of the 1998 National Household Survey on Drug Abuse is that drug use among 12-17 year-olds decreased 13 percent from the previous year. The bad news is that drug use among 18 to 25-year-olds has been rising since 1994 and currently stands at 16 percent. We are now aware that this increase is largely due to drugs such as MDMA, which has gained popularity through “raves” and other activities, aggressively marketed to late teens and young adults. Between 1997 and 1998, emergency room mentions of MDMA nearly doubled from 637 to 1,142.

I. History of MDMA

MDMA was first discovered in the early 1900s as a chemical precursor in the synthesis of pharmaceuticals. Chemically, it is similar to the stimulant, amphetamine, and the hallucinogen, mescaline. At first, it was marketed as an over-the-counter drug and extolled by some therapists for facilitating the therapeutic process. It was originally thought to improve self-insight, promote positive change in attitudes and emotions, reduce anxiety and encourage close interpersonal relationships. But, it was never approved for these uses. Current research, which I will discuss later, reveals an alarming array of both short-term and long-term complications from its use.

The drug was largely ignored until the 1960’s, when it began to be used for non-medical purposes. It was banned in the United States in 1985, and today is a Schedule I substance--- an illegal drug with no medical purpose and high potential for abuse. Yet, the drug gained popularity with high school and college students throughout the 1980’s, despite numerous reports of its negative effects. Reducing the availability of MDMA has become one of the biggest challenges faced by the U.S. Drug Enforcement Administration today. Many young adults create it in makeshift labs. Chemical formulae, manufacturing instructions, and precursor availability information are all readily accessible on the Internet.

II. MDMA is Inexpensive and Easy to Use

MDMA is usually taken orally in tablet, capsule or powder form, but it can also be injected with a syringe. Orally, the effects begin within 20 – 40 minutes, initially producing rushes of exhilaration that can be accompanied by nausea. The substance peaks between 60 –90 minutes after taking it and generally lasts for 3-6 hours. Effects from the drug can linger up to 14 days.

MDMA is a “designer drug” or chemical variant of another substance. Its relatively low street price, between fifteen and forty dollars per pill, further adds to its appeal. Sometimes, sellers “cut” the drug with even cheaper substances, which makes the tablets even less expensive and more dangerous. Because of its popularity, many street chemists began designing compounds, which were sold as MDMA. Few, if any, of these compounds proved to be the real thing. People who think they are buying MDMA may be getting any number of different chemicals, including even more powerful and more dangerous psychedelics.

III. Use of MDMA is Increasing

One of the biggest factors fueling MDMA use among our children is increased supply. While supply interception and interdiction will be discussed fully by other panelists, the problem is beginning to bleed out of our large cities and reach the entire nation. It is particularly widespread among white adolescents in the northeastern states. Use of the drug is often associated with the underground “Rave” youth subculture, but in truth is a problem anywhere young people congregate. Drug marketers don’t target a place; they target kids - with New Age, Zen, self-awareness, Harmony with Nature and other philosophies to attract youth with a seemingly positive message.

The positive messages are clearly nothing more than a marketing ploy. Raves participants gain information on locations, dates, and times of raves by accessing Internet sites, handbills, and by word of mouth. Admission to a rave costs about $20, and organizers can gross $100,000 in one night. Rave attendees are usually upper/middle class white youths in their mid-teens to early twenties. Lifetime use of MDMA has more that doubled between 1989 (3.3%) and 1998 (7.2%) among students between the ages of 19 and 28. MDMA suppresses the need to eat, sleep, or drink and, consequently, allows users to stay awake all night. These qualities make it appealing for teenagers and young professionals. PMA (or, paramethoxyamphetamine) is similar to MDMA, and manufacturers make the cheaper PMA pills resemble MDMA, down to the size, shape, color and decoration. Since the pills induce a less intense high, users are apt to use more and more of the drug, increasing the chance of overdose. PMA is becoming widely available in the U.S. club scene and is implicated in a number of deaths among young club-goers around the country.

While 1.5 percent of the American young people aged 12 and older have ever used MDMA, use is highest among 18-25 year-olds. Many in this group have just graduated from college, and are starting their first jobs. They may feel invincible and generally downplay the possible negative effects of this drug. Others have been in the workforce for a while. They disregard the adverse effects of the drug in hopes that staying awake longer and working later will boost their careers. All are jeopardizing their health and employment prospects by use of this illegal drug. In fact, ONDCP has learned that many drug-testing laboratories are receiving employer requests to specifically screen for MDMA when testing for the presence of drugs of abuse.

Unfortunately use among school-aged children is also increasing. Past-year use of MDMA among tenth graders increased from 3.3 percent in 1998 to 4.4 percent in 1999. Lifetime use by twelfth-graders increased by 38 percent (5.8 % to 8 %); annual use increased 56 percent (from 3.6 % to 5.6 %); and current, or past month, use increased 67 percent (from 1.5 % to 2.5 %).

IV. Effects of MDMA are Dangerous and Persistent

The affects of MDMA on the body are similar to that of amphetamines (dilated pupils, dry mouth and throat, lower jaw tension, grinding of the teeth) accompanied by some of the qualities associated with psychedelics. Recent studies show that chronic MDMA users are experiencing cracked enamel, worn teeth, and jaw problems. Worse, MDMA can produce a significant increase in heart rate and blood pressure and a sense of alertness like that associated with amphetamine use. It is these stimulant effects of MDMA, which enable users to dance for extended periods, and may also lead to high blood pressure. These stimulant effects of the drug, combined with the hot, crowded conditions usually found at raves can lead to dehydration and overheating. MDMA-related fatalities at raves have been reported. Depth perception is so impaired that driving under the influence of MDMA is extremely dangerous as well.

MDMA is toxic to the human nervous system. Scientific studies, with both animal and human subjects, found that MDMA use produces long-lasting, perhaps permanent, damage to the neurons that release serotonin, and consequent memory loss. Because MDMA affects the serotonin system, which regulates mood as well as body temperature, use can result in a marked increase in body temperature (malignant hyperthermia) leading to muscle breakdown and kidney and cardiovascular system failure. The biggest short-term threat of MDMA is its ability to overload the heart, precipitating heart attacks or strokes, depending on the age of the user.

Moreover, MDMA use can result in mental confusion, anxiety and panic attacks, depression and paranoia. We now know that it leads to significant impairments in visual and verbal memory and may lead to impairments in other cognitive functions, such as the ability to reason or sustain attention. In a recent study, primates exposed to MDMA for four days experienced brain damage still present seven years later. Dr. Alan Leshner, Director of NIDA, explains, “[P]eople who take MDMA, even just a few times, will likely have long-term, perhaps permanent, problems with learning and memory.” An English study demonstrated preliminary proof that MDMA use during pregnancy causes serious birth defects. Attendees at raves may take MDMA – called the “hug drug” – in order to dance all night or “feel close” to their friends. Some users describe a release of their sexual and emotional inhibitions and an increase in feelings of understanding and acceptance. Many raves have large lounge areas where attendees can lay and hold each other and others have designated sex rooms. With one’s mood altered and reasoning faculties impaired, such experimentation often results in unprotected sex, sex with multiple partners, unwanted pregnancy, and sexually transmitted disease including hepatitis and HIV.

V. Combination Use Poses Additional Risks

Since alcohol diminishes the effects of MDMA, users tend to avoid mixing MDMA with alcohol. But, since MDMA suppresses the libido and impairs male sexual function, some men are beginning to use MDMA in combination with Viagra. This combination can lead to dangerously low blood pressure levels. And, since MDMA lowers sexual inhibitions, users often feel freer to take more and different drugs after taking MDMA. Eventually, users can become too disoriented to be aware of what they're taking. Mixing MDMA with opiates, for instance, increases toxicity. Increasingly, deaths are associated with the MDMA /opiate combination. Unlike earlier, single-drug subcultures, MDMA is marked by the taking of concoctions of various drugs, called “salads.” The majority of MDMA deaths are related to such “polyabuse.”

VI. The Federal Government Has Launched a Comprehensive Counter Campaign

Mr. Chairman, I am pleased to tell you that the various federal agencies have recognized the increasing danger of MDMA and have taken measures to counteract its appeal to, and effects on, our young people. As you know, ONDCP’s mission takes a holistic approach to countering the drug culture, including prevention, supply reduction, and treatment. But drugs are powerful and getting a user clear is arduous work --- for both the user and the caregiver. Many lives and millions of dollars each year are spent fighting to repair damage from drug use. Scientists largely agree that adult drug habits are set during adolescence. We urgently strive to give kids the information and support they need to stay drug-free.

The National Institute for Drug Abuse (NIDA) has launched a special “Club Drug Initiative” to combat the increasing use of club drugs. NIDA is partnering with the American Academy of Child and Adolescent Psychiatry (AACAP), Community Anti-Drug Coalitions of America (CADCA), Join Together, and National Families in Action to create this national research and education initiative. NIDA has placed 350,000 postcards with warnings in racks at clubs and record stores and will spend $54 million on MDMA research this year. This represents a 40% increase over 1999 spending.

ONDCP is equally concerned, and already engaged in combating this public health issue. It has been a part of our concern for some time now, and has been included in our strategies and annual reports. Through ONDCP’s National Youth Anti-Drug Media Campaign, specifically aimed at the 9-17 year old age group, there are several web sites that offer specific information on club drugs and MDMA. Our scientific guidance has cautioned that MDMA-specific messaging might (1) educate children about a drug they’re only vaguely aware of (8% of teenagers have tried MDMA) and (2) might weaken our successful age-specific effort against marijuana. As a result, we are focusing our anti-MDMA actions in interactive media. We include a number of areas featuring information on club drugs on our Freevibe.com site:

1. "Did You Know?" factoids for younger teens are featured on each page of www.freevibe.com and change each time the visitor clicks a page. Facts on MDMA, GHB and LSD/hallucinogens are among those items featured in the rotation.

2. The "Lowdown" (drug-specific) section of the site features information about MDMA, Ketamine, GHB, and hallucinogens.

3. Weekly polls on “Freevibe” periodically feature club drug questions.

4. “Freevibe” newsflashes periodically focus on club drugs. For example, next week’s newsflash features MDMA and includes the NIDA picture of MDMA's affect on the brain. It also links back to www.clubdrugs.org -- NIDA's Web resource for information on these drugs.

A recent National Council on Alcohol and Substance Abuse national survey showed that 82% of students aged 12-17 reported learning about the negative effects of drugs from their parents. And, the kids are listening to the messages: 42% of all teens that don’t use marijuana credit their parents’ influence over all other influences. Our adult-targeted site www.theantidrug.com provides extensive information on club drugs. A "Drug Information" pull-down list, which is accessible from all the pages on the site, allows site visitors to select either the generic category of "Club Drugs" or they can chose to read specifically about individual drugs. Each of these pages includes further links to related sources of information on web sites hosted by NIDA, Partnership for a Drug Free America, Substance Abuse and Mental Health Services Administration, and National Clearinghouse on Alcohol and Drug Information. In addition to the above, Fleishman-Hillard and our multicultural subcontractors are exploring the option of placing the drug-specific database on the in-language sites. Since their creation two years ago, our sites have been viewed more than 13 million times.

In a June 2000 report, the Annenberg School reported that --- for the first time in history --- the number of houses with children under 17 with Internet subscriptions surpassed the number of houses with children under 17 with newspaper subscriptions. What was a “new” medium just a few years ago is now a major venue to our children. ONDCP is developing still more Internet banner ads and radio ads specific to MDMA. This work will be carried out under consultation with our Behavioral Change Expert Panel and in conjunction with efforts by NIDA, SAMHSA, CSAT, DHHS, and other appropriate federal agencies. These new features will be launched within the next 90 days.

The increase of MDMA by the 18-25 years-old age group, and drug prevention research demonstrate that young adults need specialized prevention messages and delivery mechanisms. We will continue to coordinate the prevention effort of all federal agencies to ensure that accurate information is provided to this vulnerable age group.

VII. Conclusion

Mr. Chairman, I commend the caucus on its efforts to inform the American people of this difficult, and alarming, drug and thank you for the opportunity to speak about the facts of this very dangerous substance. While the drug has been attractively marketed and stealthily distributed, it has not escaped detection and counter efforts by numerous federal government agencies and their partners. We are determined to turn back the threat posed by MDMA and other designer drugs to the public health of our country and especially the still-developing minds and bodies of our youth.

Notes:
SAMHSA, 1997 DAWN Emergency Department Data
National Institute on Drug Abuse (NIDA), “Study Takes a Closer Look at Ecstasy Use,” April 1997.
DEA, “Operation Flashback” presentation, 1999.
NIDA, December 1996.
Ibid.
CESAR FAX December 13, 1999, Vol 8, Issue 50
http://www.jointogether.org, June 7, 2000.
http://www.nida.nih.gov/Infofax/ecstasy.html, June 7, 2000.
Drug Intelligence Brief, “MDMA-Ecstasy,” June 1999.
Monitoring the Future, 1999 Survey
NIDA, “Long-Term Brain Injury from Use of Ecstasy,” June 14, 1999.
http://www.erowid.org/chemicals/mdma/mdma_research.html, June 7, 2000.
New Scientist, “Press the Panic Button,” January 25, 1997.
James R. McDonough, Testimony before the Government Reform Committee, Subcommittee on Criminal Justice, Drug Policy and Human Resources, June 1, 2000.