‘Dance Safe’ in the San Francisco bay area is a harm reduction organisation serving the ‘raving’ night club community. We operate the North American laboratory pill analysis project where users anonymously send pills to a lab for qualitative analysis. We do on-site testing at local ‘raves’ and dance club events where ecstasy is used and we provide health and safety information. We have a website (harmreduction.net) where we have a lot of information on ecstasy and on neurotoxicity. One of the things we try to do is translate some of the technical, scientific data into language that the average user can understand and in such a way that it offers some kind of practical advice. One of the biggest questions of concern for users, next to contraindicated medications, is "What are the long-term effects of ecstasy?" Thus the significance of ecstasy neurotoxicity is quite high and people want to know about it.

Doctor George Ricaurte is from the department of neurology at John Hopkins University in the USA, Erik Fromberg is from the Trimbos Instituut in the Netherlands and Karl Jansen is a psychiatrist from South London and Maudsley NHS Trust St Thomas' Hospital in England. As well as being a medical doctor, Karl has a PhD in clinical pharmacology at the University of Oxford and has worked full time for 6 years on brain research as well as directly with drug addicts. The issue of ecstasy neurotoxicity is a hotly debated topic and many of George’s conclusions and to a lesser extent some of his methodology have been criticised by other researchers.

Three topics need to be addressed:-

1. What are the long term effects? Not the effects on brain anatomy per se but psychological and behavioural effects.

This is the question that most users who e-mail us want to know and it is the hardest question for us to answer, we do not know a lot.

2. What are the implications for primary prevention?

It has been suggested that the effects of MDMA neurotoxicity may rise many, many years down the line. It would be so devastating that harm reduction activists and policy makers may really want to say this is dangerous stuff, promote primary prevention and perhaps abstention.

3. What potentials exist for secondary prevention?

People are going to continue to use MDMA despite its potential neurotoxicity. What can harm reduction activists and policy makers do to minimise the risks and potential for long term behavioural or psychological consequences, if there are any, from the use of MDMA? One thing that comes to mind is the use of Prozac or fluoxetine as a preventative measure. It has been shown in some animal studies that the administration of Prozac prevents the neurotoxic damage in lab animals. Regulating the dose level and on-site analysis can also help so that users can know how much they are taking because neurotoxicity may be related directly to how much you take and how frequently. What kind of advice should we give to the user to avoid the potential effects? Core body temperature has also been implicated in neurotoxicity and poly-drug use.