Besides the logistical questions of where he found sufficient money for this or indeed any time to eat, the report that he felt like he was still on ecstasy for several months after he halted consumption doesn't ring true. MDMA's effect basically comes from causing the brain to dump its reserves of serotonin, dopamine and norepinephrine. These need replenishing, and almost every ecstasy user I've ever known reported 'hangover Tuesday' following consumption on a Saturday night (the ones that didn't tailored diet and vitamin intake to offset the effects).

The self-reports of someone with such measurable impairment, even consistent reports separated by a long period, are not a reliable metric. The physicians don't even tell us what his body weight is or was, which might yield some clue about base tolerance. What of his liver and kidneys, which should show some response to such an enormous metabolic load? And what of this estimate of 40,000 over the lifetime of his consumption? They talk of 'further escalation to an average of 25 tablets daily over the next 4 years,' (emphasis added) but the 40k total would require him to have sustained that 25/day intake over the same period. Whether this ambiguity is the result of skimpy reporting or a poor grasp of statistics I can't tell, but having reread the letter several times now I'm left with more questions than answers.

It's clear that Mr. A took an absurd quantity of drugs and is now severely impaired. But this report seems like a bid for notoriety rather than a contribution to clinical knowledge. It's like finding some tall tale of a giant catfish in the Journal of Aquatic Biology.

"uh yeah man, I took like 12 pills a day man, I'm so weird man..."

That said, if street e is as impure and subject to cutting as people say it is, then he was exposed to an enormous amount of other garbage as well.

One thing that struck me. Does e run on the same mechanisms as the SSRIs? This got a couple of mentions in the article, so you'd think there'd be an enormous number of people on SSRI's long-term to study.