Response to 48 Hours and MTV ecstasy specials
November 30, 2000

On November 30, 2000, 48 Hours (CBS) and MTV aired back-to-back shows on ecstasy. Fairly comprehensive and much less sensational than previous shows like 60 Minutes II and 20/20, these two prime time hours mark a turning point in mainstream media coverage of the drug. Effective public policy regarding the regulation of ecstasy and other illicit drugs can come about only in a climate of rationality and calm, open dialogue. By reducing hysteria and presenting multiple perspectives on the drug, those who use it and why, as well as the very real problems that can result from overuse and abuse, MTV and 48 Hours have done a great service.

One issue, however, must be clarified. The MTV program profiled a young woman who had been a frequent user of ecstasy and a number of other drugs. On the program, the woman's doctor displayed a brain scan which suggested that her brain was full of holes, implying that the "holes" resulted from ecstasy use. Below is a clarification of the meaning of the brain scan written by Rick Doblin, Ph.D. President of MAPS.

Commentary by Rick Doblin, Ph.D.:

"The recent MTV special on MDMA showed the results of a SPECT scan of a young woman, Lynn Smith, who had used a very large amount of MDMA. Lynn's doctors reported that her SPECT scan showed "holes in the brain" similar to what a scan would look like of an elderly woman who had had multiple small strokes.

The graphic image shown on the MTV special was a 3-D reconstruction of the SPECT image, which clearly showed dramatic and frightening holes throughout her brain. However, this image was in no way a visual representation of the structure of her brain The SPECT scan actually measured the variation in cerebral blood flow in Lynn's brain. The 3-D image was then created by assigning a different color to different amounts of blood flow. How the graphic image looks is a matter of threshold effect on the image processing.

One can take any normal brain SPECT and lower the threshold (lower areas of blood flow assigned a low or zero level of color) , and one will see "holes" on the 3-D image. Conversely, you can also take the same image and adjust (increase) the threshold to "remove the holes". These are not absolute blood flow measurements. The "holes" simply demonstrate relatively lower blood flow compared to the entire brain. One cannot make any statements about whether it's normal or abnormal unless absolute blood flow measurements are made, which requires more sophisticated scanning procedures than were conducted on Lynn Smith.

Dr. Linda Chang, Harbor-UCLA Medical Center, has conducted a scientifically rigorous, controlled SPECT study in 21 MDMA users compared to 21 controls. [Chang, L. et al, Effect of Ecstasy ( 3,4-methylenedioxymethamphetamine [MDMA]) on cerebral blood flow: a co-registered SPECT and MRI study. Psychiatry Research-Neuroimaging, Section 98 (2000) 15-28.]

The MDMA users in Dr. Chang's study averaged 211 exposures to MDMA, with a range of from 6-1500 exposures. The average amount of MDMA consumed was 13.1 grams. There were no significant differences in amount of cerebral blood flow between the MDMA users and the controls, either globally or in specific brain regions. Furthermore, none of the MDMA users showed any signs of stroke, as measured by MRI scans.

In Dr. Chang's study, 10 of the subjects were scanned again, after the administration of two doses of MDMA. Cerebral blood flow was reduced somewhat in some brain regions at two weeks after the last dose of MDMA. 2 subjects were scanned again after 10 weeks and were found to have elevated cerebral blood flow in some regions. Dr. Chang reported, "Our findings suggest that the initially decreased rCBF normalizes with time and may even increase above baseline at later time points."

In order to diagnose a stroke, or strokes, one can simply do an MRI and even lesions as small as 1-2 millimeter will be visible. MAPS has offered to pay for the costs of an MRI scan on Lynn. Even if there is evidence of stroke, which is highly unlikely, it would be possible to say whether this was from MDMA or from other drugs that Lynn had taken. Cocaine or methamphetamine both can cause strokes in some individuals.

No drug is completely safe and MDMA is no exception to this rule. However, the claim that MDMA causes "holes in the brain" is not backed up by scientific research. Such claims are irresponsible and serve to further reduce the credibility of anti-MDMA warnings. If MAPS arranges for Lynn to receive an MRI scan and/or another SPECT scan, MAPS will report accurately and honestly what the results show."

For MTV, use the email form on their website as well as sending email directly to them at newsdocs@mtvstaff.com. For 48 Hours, email them from their website.