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July 19, 2001

CONFERENCE. July 19, 2001. Claire Sterk’s . MDMA Brief Historical Overview. 1912 MDMA was synthesized (Merck) 1950s U.S. army studied as potential agent in psychological warfare 1970s MDMA used in psychotherapy – “penicillin for the soul”

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July 19, 2001

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  1. CONFERENCE July 19, 2001

  2. Claire Sterk’s

  3. MDMA Brief Historical Overview • 1912 MDMA was synthesized (Merck) • 1950s U.S. army studied as potential agent in psychological warfare • 1970s MDMA used in psychotherapy – “penicillin for the soul” • 1985 MDMA became illegal in the U.S.; 1988 in the Netherlands • 1990s… Still limited knowledge of prevalence of use, levels of risk and consequences

  4. PHYSIOLOGICAL Sensatory awareness Loss of appetite Nausea Muscle ache Tachycardia Hypothermia Cardiological complications Liver damage PSYCHOLOGICAL Euphoria Anxiety, depression, and panic attacks Depersonalization Paranoia Psychotic experiences Cognitive deficiencies, e.g., memory loss and decreased planning ability EFFECTS OF MDMA USE

  5. Settings of Use The settings at which MDMA is being used Are diversifying according to all presenters And these include: • Raves and concerts • Clubs and bars • House parties • At home with friends or other private settings The setting of use (e.g, crowd and high temperature at rave) needs to be explored when studying the negative outcomes of use . . . In addition, use patterns should be explored ( e.g., poly drug use and binge use). Problematic MDMA use tends to involve intense use within a few days (as opposed to daily, multiple use patterns common for other drugs)

  6. MDMAEcstasyXTCX E • The tablets/capsules have many forms, weights, colors, and names with little reliable identification of the active ingredients • XTC/MDMA may be. . . • MDMA (3,4 – methylendioxy-N-methamphetamine) • MDA (3,4 – methylendioxy-N-amphetamine) • MDE (3,4 – methylendioxy-N-ethylamphetamine) • MBDB, amphetamine, heroin, caffeine

  7. Jim Hall’s Key Slides

  8. Advances: evolution • The of abuse as a Public Health issue MDMA

  9. Mentions of MDMA (“esctasy”) in National Emergency Room Reports 1992-1999 Source: US Dept HHS: SAMHSA - OAS: DAWN

  10. "x" 78 % of MDMA ED Cases are Multi-drug Episodes Source: US Dept HHS: SAMHSA - OAS: DAWN

  11. CEWG Advance Report MDMA & Club Drugs • Consequences UP in 13 of 20 cities • More routine settings: home and school • More concomitant and sequential abuse

  12. Trish CaseMDMA Users (N=55)Selected other drugs used - last three months % Ketamine 69 Methamphetamine 56 Inhaled cocaine 55 Inhaled nitrites (poppers) 53 Viagra 38 GHB 24 Anabolic steroids 13 LSD 13 Mushrooms 7 Marijuana 76 Injected last three months 11 Enrolled in drug treatment program- ever 15

  13. MDMA Administration • Intranasal • Bumpers • Inhale “bumps” from the back of the hand • Other paraphernalia such as spoons, pen caps • Oral • Pills and capsules • Anal Insertion • “Booty bumping”

  14. “Ecstasy” may not be MDMA • These are some of the “Ecstasy” pills tested by the dancesafe organization (www.dancesafe.org) Methyl Salicylate, Caffeine 90% DXM MDMA MDA

  15. HIV Risks • 24 percent of current MDMA users in our study are HIV positive. • Unsafe sex reported but is almost always attributed to other drugs such as methamphetamine. • Unwanted sexual attention and sex has been reported in the context of MDMA use.

  16. Challenges - Prevention • Prevention messages regarding MDMA use have had little effect among MSM. • Other drugs such as GHB are seen as more dangerous, have become stigmatized, and use has reduced. • While MDMA is not perceived as a safe drug, it is seen as much safer than other drugs.

  17. Jean Schensul

  18. Effect of MDMA on cerebral blood flow: A co-registered SPECT and MRI study 2 Weeks Post MDMA Baseline Highest Dose Lowest Dose L. Chang Psychiat Res (2000) 98: 15)

  19. Factors associated with MDMA and other Club Drug Use (correlations sig. At .05 or better) • Involvement in selling drugs ever and now • Younger age of initiation of drug sales • Previous incarceration • More frequent incarceration • Being a gang member in the past and now • Carrying a gun in the past 30 days • Trying to hurt or kill yourself • Being a victim of violence (only X users) • Perpetrated violence (only other club drug users) • Having more sex partners in the past 30 days • Trading sex for money • Having more sexual encounters (only X users)

  20. Rat Hippocampus (2 wks after 20 mg/kg; 2X daily, 4 days) • Result: • long-term • loss of • 5HT fibers (O’Hearn et al. J. Neurosci. 8 [1989] 2788)

  21. 5-HT levels in monkey after MDMA (two 5 mg/kg daily for 4 days) • Result: • -long-term • loss of 5HT • fibers in • monkeys 2 weeks 7 years -some recovery (caudate nucleus) (Hatzidimitriou et al., J. Neurosci. 19 [1999] 5092)

  22. SUMMARY • Preclinical studies predictions about MDMA: • Moderate to high doses cause rapid and long-term regional 5HT loss with some localized recovery • Immediate increase in dopamine activity but little long-term impact on dopamine systems

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