We Asked an Expert if One Pill Can Have Lasting Effects on the Brain

One evening, a friend and I were drinking at a bar in Paris when this random guy came and sat at our table. He didn't say much and he frowned a lot. His name was Alexandre and he was from Russia. Alexandre had apparently come from Siberia to Paris by foot when he was ten or 11. We didn't tell him his story sounded fake because he was terrifying. His leg moved up and down frantically and he constantly scratched his head. Every time one of us would address him, he would stare into our eyes for about ten seconds before uttering even one word. Then, in the middle of this semblance of a conversation—just after I asked him whether he felt all right—Alexandre announced that he had taken a pill ten years ago and had never "come down."

According to the French Drugs and Addictions Observatory (OFDT), the use of pills has been regressing for about a decade. Nevertheless, 2013 saw a 163 percent increase of the number of pills seized in France, as well as a 70 percent raise in the total weight of ecstasy seized—from 279 kg in 2012 to 474 kg in 2013. The situation in the UK is similar.

I called Dr. Daniel Bailly—a psychiatrist and professor at the Saint-Marguerite teaching hospital in Marseille—to ask whether what my new friend claimed happened to him could actually be true.

VICE: What exactly happens in our brains when we take ecstasy?
Dr. Daniel Bailly: Ecstasy destroys the serotonergic neurons. Serotonin is a neurotransmitter that plays a part in many functions like mood, impulsivity, sleep, and regulation. This drug also affects the dopaminergic pathways regulating motivation.

Ecstasy is a weird drug. It was used a lot in psychotherapy back in the days of Gordon Alles—the chemist and pharmacologist who invented amphetamines. This drug is supposed to improve our empathy. It's also a stimulant—it makes you feel euphoric. It gives us a sensation of well-being and the feeling that we are in communion or in harmony with our environment.

The other day I came across this guy who spoke incoherently and was generally acting strange. He said he had been high for ten years after taking one single ecstasy pill. But of course that is also an urban legend. In your opinion, is that even possible?
The problem here is causality. Is ecstasy alone capable of creating such troubles? The answer is very likely, no. But it could probably act as a precipitating factor. These kinds of effects depend a lot on the personality of the person or what he or she is going through before using ecstasy.

So it could happen to someone with a predisposition for mental instability?
Yes, that's it. At the end, the effects felt do not depend so much on the dose or the frequency of use, but you can become mentally unstable after one single dose of ecstasy. I've had patients who went completely insane after taking ecstasy only once.

But there are many unanswered questions concerning the nature of the factors acting on the effects. We think there could be some factors concerning genetic vulnerability and personality playing a part in the whole process.

Are we necessarily empathetic when ingesting a pill?
As with all drugs, it depends on the person taking it. Ecstasy could also have the opposite effect. It can make someone sad or depressed, but generally it's a drug sought for the fact that it stimulates feelings of euphoria and empathy. This is why it is often used by young people at parties.

I see. How do the long-term effects manifest?
Some users speak about long-term effects that take over months or even years to manifest. They can come with symptoms of depression, phenomena of depersonalization—or they can come in the shape of flashbacks or even hallucinations. That is not something happening only with ecstasy. We find it in different hallucinogens.

Do we know the factors predisposing someone to stay high?
No, because genetics are very complicated. The problem with every toxic substance is that you can only know your individual sensitivity by experimenting with the substance in question. The problem with ecstasy is that the experiment can become dramatic from the first use.

Once someone goes insane, is there a way back?
No.

To come back to my encounter with that stranger, is it really possible that he's been high for ten years?
Completely. But in order to know, we should have met him before. I cannot be sure about what was up with this man, but from what you told me, he sounds psychotic.

Do we have to worry about people taking ecstasy?
I personally think this substance is like arsenic. It is a highly toxic substance that comes with unpredictable effects. It's similar to Russian roulette. Many will say, "I took some and nothing happened." Sure. But if something does happen and you go crazy, then there could be no way back.

I'm not worried at all about the increase in cannabis consumption, but I think consuming ecstasy is really dangerous because it's a poison: It's neurotoxic—it destroys neurons. So any problem that comes with it could be long-term. As we age, our stock of neurons decreases. If you start with a stock that is already amputated because of a neurotoxic substance, at 40 or 50, you might encounter dementia problems.

If I told you, "I took some and nothing happened." What would you say?
Maybe next time you'll be totally fried.