Clinical and toxic effects of MDMA ("Ecstasy").

Substance abuse remains an area of acute concern and active investigation in behavioral health care and the neurosciences. Over the past decade, an alarming trend has been identified in the increased use of club drugs, a class of synthetic compounds that possess various stimulant or hallucinogenic properties. Club drugs, which include ketamine, methamphetamine, and 3,4-methylenedioxy-N-methylamphetamine (MDMA; better known as "Ecstasy"), are illicitly produced in labs and are quite popular among teenagers and young adults on college campuses and in bars, dance clubs, or all-night dance parties (rave or trances). Research conducted by the National Institute on Drug Abuse indicates that use of club drugs, particularly in conjunction with alcohol, can result in significant complications, including death. This is a concern, particularly in light of data indicating that the use of club drugs is increasing. This trend may be due in part to the erroneous and potentially lethal misperception that these drugs are safe and harmless. This article discusses the pharmacological and clinical effects of MDMA, as well as the nuerotoxicity of MDMA and its residual effects on mood and cognition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trends in ecstasy use in the United States from 1995 to 2001: Comparison with marijuana users and association with other drug use.

This study aims to estimate changes in the prevalence of ecstasy use over time, analyze the overlap of ecstasy use and other drug use, and compare other drug use in ecstasy versus marijuana users. The authors hypothesized that ecstasy users early in the "epidemic" would be polydrug users and that associations between ecstasy and other drug use would diminish as the prevalence of ecstasy use increased. Data were drawn from public use data files from the 1995, 1997, 1999, and 2001 National Household Survey on Drug Abuse. Ecstasy use increased in the U.S. population and the prevalence was greater in younger age groups. Ecstasy users were likely to use a variety of other drugs; however, association of ecstasy use with other drug use was strongest early in the "epidemic," diminishing as the number of new users increased. Later, more drug-naive adolescents and young adults began experimenting with ecstasy. These results can orient prevention strategies that target ecstasy users. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of the effect of EMLA and semicircular subcutaneous anaesthesia in the prevention of tourniquet pain during plexus block anaesthesia of the arm

The present study examined resting heart rate variability (HRV; an index of parasympathetic tone) and heart rate response to the Valsalva maneuver (Valsalva ratio; an index of overall autonomic responsiveness) in 12 repeat users of 3.4-methylenedioxymethamphetamine (MDMA, "Ecstasy"), and a matched comparison group of presumed nonusers. HRV and Valsalva ratio were smaller in users than in controls. Three out of 12 MDMA users but no controls had Valsalva ratios below 1.50, the cut-off for autonomic dysfunction. In several users, there was a total absence of post-Valsalva release bradycardia. All MDMA users were polydrug users. Parasympathetic cardiovascular tone appears impaired in repeat MDMA users, although the ubiquitous problems in such epidemiologic designs (including lack of testing before the first use of the drug and confounding with use of other drugs) preclude definitive causal interpretations.     

M.D.M.A. ("Ecstasy"); a case of possible drug-induced psychosis

3, 4, Methylenedioxymetamphetamine (M.D.M.A., Ecstasy) is a modified amphetamine with stimulant and hallucinogenic properties. Ecstasy has been increasingly abused in Dublin in recent years. It is commonly perceived by users as a safe drug. We report a case of prolonged psychosis following brief recreational use of Ecstasy.     

Positron emission tomographic evidence of toxic effect of MDMA ("Ecstasy") on brain serotonin neurons in human beings

BACKGROUND: (+/-)3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") is a popular recreational drug that selectively damages brain serotonin (5-HT) neurons in animals at doses that closely approach those used by humans. We investigated the status of brain 5-HT neurons in MDMA users. METHODS: We enrolled 14 previous users of MDMA who were currently abstaining from use and 15 controls who had never used MDMA. We used positron emission tomography (PET) with the radioligand carbon-11-labelled McN-5652, which selectively labels the 5-HT transporter. We analysed whether there were differences in 5-HT transporter binding between abstinent MDMA users and participants in the control group. Blood and urine samples were taken and tested to check for abstinence. FINDINGS: MDMA users showed decreased global and regional brain 5-HT transporter binding compared with controls. Decreases in 5-HT transporter binding positively correlated with the extent of previous MDMA use. INTERPRETATION: Quantitative PET studies with a ligand selective for 5-HT transporters can be used to assess the status of 5-HT neurons in the living human brain. We show direct evidence of a decrease in a structural component of brain 5-HT neurons in human MDMA users.     

Syllogistic Reasoning Performance in MDMA (Ecstasy) Users.

Previous research has demonstrated working memory and executive deficits in recreational users of MDMA (3,4-methylenedioxymethamphetamine; Ecstasy). In turn, both of these constructs have been implicated in syllogistic reasoning performance. Twenty-two MDMA users (mean age=21.36) and 26 MDMA nonuser controls (mean age=21.31) were tested on syllogisms of varying difficulty and on measures of working memory and executive functioning. MDMA users were significantly impaired in aspects of syllogistic reasoning, and the effect remained significant after the authors controlled for the use of other drugs. However, the MDMA-related variance was reduced to below statistical significance following control for group differences in working memory span. The results are consistent with the possibility that MDMA-related deficits in aspects of executive functioning result in impaired reasoning performance among MDMA users. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beliefs about the harmfulness of drug use in adults who use different drugs.

255 college students in different categories of drug use (abstainers, low alcohol users, high alcohol users, cigarette users, marijuana users, and cocaine users) rated the harmfulness of several factors of drug use, including type of drug (cigarettes, alcohol, marijuana, and cocaine), frequency of use (weekly vs daily), location of use (never at work vs sometimes at work), SES of the user (custodial worker vs CPA), and the pregnancy status of the user. Results show that Ss with greater drug experience had lowered concerns about harmfulness and more differentiated beliefs, not only for the drug or drugs that they were using but also for drugs that they were not using. Heavier use of alcohol was associated with lowered concern about the harmfulness of as-yet-untried drugs. Intervention may need to be aimed at changing systems of beliefs people have about drug use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanical alterations in smooth muscle from mice lacking desmin

The authors conducted formative research on the use of partner notification with HIV-infected drug users (i.e. those who use/abuse injectable drugs, crack or cocaine) in order to guide the development of an effective intervention for this population in New York City. Structured focus group and personal interviews were conducted with 25 in- and out-of-treatment drug users, 23 counsellors from a sexually transmitted disease (STD) clinic and a methadone maintenance treatment programme (MMTP), and nine experts in the field of HIV partner notification and/or substance abuse prevention and treatment. Results revealed factors associated with HIV-positive disclosure, the strengths and barriers of existing partner notification programmes and issues that should be considered in designing an effective intervention with HIV-infected drug users. Further research and planning activities are recommended before piloting and evaluating such a programme.     

Sexual and drug use behaviors among women crack users: implications for prevention

The literature suggests that important and contributing factors in the rise of HIV and AIDS among women are crack use and the exchange of sex for drugs or money. However, not all women who use crack report they are exchanging sex for drugs or money. Thus, women are at differential risk for HIV and AIDS. The purpose of this study is to compare and describe women crack users (n = 292) who reported exchanging sex for drugs and money with women crack users who did not report exchanging sex. Results indicated that both women crack users who exchanged sex (n = 162) and women crack users who did not exchange sex (n = 130) were likely to be African American, to be about the same age, to have had incomes below +500 during the previous month, to have had similar education and martial backgrounds, to have had unprotected sexual intercourse as often, to have had similar drug use patterns, and to have initiated drug use at similar ages. However, women who exchanged sex had more sexual partners, had unprotected oral sex more often, used drugs before and during sex more often, and had a higher rate of sexually transmitted diseases than women who did not exchange sex. In addition, women who exchanged sex were also twice as likely to be homeless, four times more likely to have been in treatment, and twice as likely to have been arrested and charged/booked two or more times in their lifetime than women who did not exchange sex.     

Non-medical drug use amongst non-student youth in India

In a survey of non-medical drug use by 266 non-students in the age range 10-24 years, tobacco, alcohol and cannabis were found to be the drugs more commonly used. Use was greater in males, older age groups, those with lower educational levels and those from urban areas. In comparison to students, among non-students use was practically limited to tobacco, alcohol and cannabis, the use was more regular and the age at onset lower. In a pilot trial of two additional strategies to identify drug users among non-student youth, namely cross-validation by fellow employees and verbal group administration of the questionnaire, the number of current users identified was very similar to that found by individual verbal administration, suggesting that these cheaper methods may be useful in some circumstances.     

Severe ketoacidosis complicated by 'ecstasy' ingestion and prolonged exercise

Ecstasy (3,4-methylenedioxymethamphetamine or MDMA) is used with increasing frequency as a recreational drug. Accumulated evidence over recent years indicates a growing demand for the drug with a corresponding increase in number of reports of adverse effects from its use. There are reported metabolic disturbances due to MDMA use. These, in addition to the prolonged exercise involved in dancing at 'raves' where MDMA may be used, may exacerbate ketoacidosis. We report two cases of ketoacidosis complicated by MDMA ingestion.     

Drugs and homicide by women

In this paper we use data derived from interviews with 215 female homicide offenders incarcerated or on parole in New York to examine their drug use prior to and at the time of the homicide, their victims' drug use, and their perceptions as to the drug-relatedness of the homicides. We found that about 7 out of 10 respondents had been regular users of some drug at some point in their lives prior to their incarceration, while over half had been addicted to a substance. Over one-third of the respondents who were present at the scene were "high" on a drug at the time, while about half of the victims of these homicides used drugs before the homicide. Almost two-thirds of the homicides committed by respondents who were present at the scene were perceived to be drug-related. Alcohol, crack, and powdered cocaine were the drugs most likely to be related to these homicides. The implications of our findings are discussed.     

Risk of human immunodeficiency virus infection among pregnant crack cocaine users in a rural community

OBJECTIVE: To investigate why women who use crack cocaine are at increased risk of human immunodeficiency virus (HIV) infection. METHODS: One thousand one hundred fifty-two (99.7%) of 1155 consecutive prenatal patients attending a rural public health clinic were interviewed about drug use and sexual practices and tested for HIV infection and other sexually transmitted diseases. RESULTS: Fifty-one (4.7%) of 1096 pregnant women reported ever using crack cocaine, but only five (10%) of the crack cocaine users had ever injected drugs. Eighteen (35%) of the crack users were HIV infected compared with 22 (2%) of the 1045 women who reported never using crack (odds ratio 25, 95% confidence interval 12-52; P < .001). Crack users were more likely to have had a known HIV-infected sex partner, exchanged sex for money or drugs, and tested positive for syphilis than were non-crack users (for each comparison, P < .001). Before using crack, 18% of crack users had exchanged sex for money or drugs and 8% had averaged three or more sex partners per month; in contrast, after beginning to use crack, 76% of crack users exchanged sex for money or drugs and 63% averaged three or more sex partners per month (for both comparisons, P < .001). Crack users who were not HIV infected were more likely to have almost always used condoms and/or had fewer than three sex partners per month than were HIV-infected crack users (P < .01). CONCLUSION: Women who reported using crack cocaine were at an increased risk of HIV infection because crack use was associated with a significant increase in unprotected sexual contact.     

A neuropsychological study of polydrug users

The long-term neuropsychological effects of persistent nonmedical drug use are still unknown. In this study, 22 young men, all extensive "polydrug" users, were examined while free from drugs for an average of 60 days by means of the Halstead-Reitan Neuropsychological Test Battery. Their performance was compared to that of age-education-sex-matched neurologically intact medical patients and a similarly matched group of neurologically impaired patients. Blind independent ratings of test protocols by two experienced clinicians judged 41% to 64% of the drug users, 11% to 26% of the medical patients, and 84% to 89% of the neurologic patients to be impaired. Interpretation of these results suggests that in some individuals, heavy "polydrug" use may be associated with neuropsychological dysfunction, which persists at least an average of two months beyond cessation of drug use.     

CD5 B cells and B-cell malignancies

Evidence from both animal, and human, studies suggests that repeated administration of 3,4-methylenedioxymethamphetamine (MDMA: "ecstasy") produces lasting decreases in serotonergic activity. Serotonin is believed to play a modulatory role in a variety of psychological processes, including learning and memory. There are recent reports that polydrug users, who have used ecstasy recreationally, exhibit selective impairments in memory. However, these studies did not compare ecstasy users with polydrug users who had not taken ecstasy, leaving open the possibility that the memory deficits may be associated with a history of use of other illicit drugs. The present study used the Rivermead Behavioural Memory test to investigate immediate and delayed recall in: 25 polydrug-users who had taken more than 20 tablets of ecstasy (MDMA group), 22 participants (polydrug controls) who had never taken ecstasy, but, otherwise has personal characteristics (e.g. age, gender, education, height, weight), and illicit drug use histories, that were generally not significantly different from those of the MDMA group, and 19 participants who had not used illicit drugs but who also had similar personal characteristics (non-drug controls). Participants in the MDMA group recalled significantly fewer ideas (approximately 75% of the number of ideas recalled by participants in either of the other two groups), in both immediate and delayed recall conditions. The two illicit drug-using groups did differ in their estimated IQ scores and their duration of use of LSD, but only the latter proved to be a statistically significant covariate, and the difference in recall performance between the MDMA and polydrug controls groups remained statistically significant when this variable was treated as a covariate. The present findings provide the first evidence that deficits in memory performance in recreational ecstasy users are primarily associated with past exposure to ecstasy, rather than with the other legal and illicit drugs consumed by these individuals, and are consistent with reduced serotonergic modulation of mnemonic function as a result of long-term neurotoxic effects of MDMA in humans.     

Dependent opioid users assessed for methadone treatment in Otago: patterns of drug use

AIMS: To provide detailed information about the types of drugs used and the patterns of drug use for injecting drug users presenting for methadone treatment. METHODS: A retrospective case note review was carried out for 126 consecutive clients who were assessed for methadone treatment in the Otago province over a 2 year period. Patterns of drug use in the three months prior to presentation were recorded. RESULTS: Over 60% of those presenting were using three or more opioid drugs, with the most common being homebake (63%), sustained release morphine sulphate tablets (62%), buprenorphine (52%), opium poppies (50%) and methadone (41%). Use of diacetylmorphine (heroin) was reported primarily by those returning from recent overseas travel. Most clients reported the regular use of multiple other of clients using benzodiazepines daily. Almost 80% of the group were regular tobacco smokers and 11% showed evidence of alcohol disorders (abuse or dependence). Low levels of use were reported for cocaine, amphetamines, and hallucinogens. CONCLUSION: These patterns of drug use have important implications for the planning of methadone treatment programmes.     

Use of calcium channel blockers and risk of suicide: ecological findings confirmed in population based cohort study

OBJECTIVE: To investigate possible associations between use of cardiovascular drugs and suicide. DESIGN: Cross sectional ecological study based on rates of use of eight cardiovascular drug groups by outpatients. A population based cohort study including users of drugs to control hypertension. SUBJECTS: The ecological study included 152 of Sweden's 284 municipalities. The cohort study included all inhabitants of one Swedish municipality who during 1988 or 1989 had purchased cardiovascular agents from pharmacies within the municipality. Six hundred and seventeen subjects (18.2%) were classified as users of calcium channel blockers and 2780 (81.8%) as non-users. MAIN OUTCOME MEASURES: Partial correlations (least squares method) between rates of use of cardiovascular drugs and age standardised mortality from suicide in Swedish municipalities. Hazard ratios for risk of suicide with adjustments for difference in age and sex in users of calcium channel blockers compared with users of other hypertensive drugs. RESULTS: Among the Swedish municipalities the use of each cardiovascular drug group except angiotensin converting enzyme inhibitors correlated significantly and positively with suicide rates. After adjustment for the use of other cardiovascular drug groups, as a substitute for the prevalence of cardiovascular morbidity, only the correlation with calcium channel blockers remained significant (r = 0.29, P < 0.001). In the cohort study, five users and four non-users of calcium channel blockers committed suicide during the follow up until the end of 1994. The absolute risk associated with use of calcium channel blockers was 1.1 suicides per 1000 person years. The relative risk, adjusted for differences in age and sex, among users versus non-users was 5.4 (95% confidence interval 1.4 to 20.5). CONCLUSIONS: Use of calcium channel blockers may increase the risk of suicide.