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Neuroimaging Recent neuroimaging studies have provided some of the most compelling evidence of the long term neurotoxic effects of MDMA. In a PET study with the selective 5-HT transporter McN-5652, heavy MDMA users, who had remained abstinent for some time, showed decreased brain 5-HT transporter binding compared with controls and this decrease correlated with the extent of previous MDMA use (McCann et al 1998).

Single photon emission computed tomography (SPECT) has shown heavy MDMA users to exhibit a widespread reduction of cortical 5-HT transporter binding, with normal dopamine receptor binding (Semple et al 1999). SPECT has also shown regional upregulation of the 5-HT2a receptor in the occipital cortex of heavy MDMA users, possibly as a response to 5-HT depletion (Reneman et al 2000). Once again all three of these studies do not seem to have adequately controlled for other drug use. Due to the fact that there is fairly strong evidence for the neurotoxicity of some of the classic hallucinogenic drugs (Cooper, Bloom and Roth 1991) these studies should be regarded with a degree of caution.

It has been reported that heavy MDMA users exhibit a lower global brain volume and an increased percentage of CSF (Chang et al 2000). The neuroimaging evidence supports the theme, which has in my opinion been becoming more evident through each stage of investigation I have discussed. The evidence is not conclusive but is highly indicative that prolonged or high dose use of MDMA causes long term neurotoxicity, irregular use of low doses probably does not.

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