Ecstasy MDMA

Methylenedioxymetamfetamine (MDMA), commonly known by names such as ecstasy , XTC , E , or Love Drug , was synthesized in 1914 for use in chemical warfare, but has more recently become a popular drug of abuse among young people, especially at raves . It is relatively easy to obtain and is erroneously regarded as a safe drug. However, it has actions like those of amphetamine. 

Concern has been raised about the increasing use of ecstasy in Europe (3), particularly the UK and the Netherlands. The patterns and trends of substance use among college students have been evaluated over a 30-year period (4). Alcohol use remained stable, but illicit drug use peaked in 1978 and fell sharply over the next 20 years. Ecstasy was the exception its use rose from 4.1% in 1989 to 10% in 1999. Ecstasy was the second most frequently tried illicit drug after marijuana. 

Associated with increased physical activity and altered thermoregulation, ecstasy has been reported to cause unconsciousness, seizures, hyperthermia, tachycardia, hypotension, disseminated intravascular coagulation, and acute renal insufficiency, as well as death. 

The toxic effects of ecstasy have been reported in seven individuals who took it in a nightclub and developed varying degrees of toxicity (10). Three collapsed in or around the nightclub and arrived in an ambulance. Four came in themselves. 

No other drugs were detected in the serum samples from any of these patients. Detailed analyses of the tablets obtained from the patients showed ecstasy and no contaminants. The authors commented on the unpredictable nature of toxicity with ecstasy, especially when death can occur with one tablet in some cases, while others survive even after they have consumed large quantities. In this series there was no correlation between the amount of ecstasy taken and the resulting serum MDMA concentration in most patients. However, high serum concentrations correlated with the severity of symptoms, including death. The local news headlines prominently implied that poisoned ecstasy had led to death when in fact there was no contamination. The authors suggested that such headlines lead people to believe erroneously that ecstasy use is safe except when it is contaminated. 

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Methylenedioxymethamphetamine (MDMA ecstasy) is a synthetic analog of amphetamine that produces hallucinations, an elevation in mood, and a feeling of emotional closeness . This latter property has led to Ecstasy being referred to as the hug drag . The unique properties of Ecstasy as compared to the parent compound amphetamine are believed to be due to the more selective effects of Ecstasy in promoting transporter-mediated release of serotonin. The use of Ecstasy has become a part of the culture associated with rave style dance parties. 

National Institute on Drug Abuse Research Report Series MDMA (Ecstasy) Abuse. Rockville, MD, National Institute on Drug Abuse, 2004b. Available at http // www.drugabuse.gov/ResearchReports/MDMA/MDMA3. html. Accessed May 9, 2005. 

Ricaurte GA, McCann UD, Szabo Z, et al Toxicodynamics and long-term toxicity of the recreational drug 3,4-methylenedioxy-methamphetamine (MDMA, Ecstasy ). Toxicol Lett 112-113 143-146, 2000 Robinson TN, Killen JD, Taylor CB, et al Perspectives on adolescent substance use a defined population study. JAMA 258 2072-2076, 1987 Rubinstein JS Abuse of antiparkinson drugs feigning of extrapyramidal symptoms to obtain trihexyphenidyl. JAMA 239 2365, 1978 Rumack BH (ed) LSD, in Poisindex, Vol 54. Denver, CO, Micromedex, 1987 Rusyniak DE, Banks ML, Mills EM, et al Dantrolene use in 3,4-methylenedioxymethamphetamine ( ecstasy )-medicated hyperthermia (letter). Anesthesiology 10 263, 2004... 

Schreiber R, Brocco M, Audinot V, et al (l-(2,5-Dimethoxy-4 iodophenyl)-2-amino-propane)-induced head-twitches in the rat are mediated by 5-hydroxytryptamine (5-HT) 2A receptors modulation by novel 5-HT2A/2C antagonists, Dj antagonists and 5-HTagonists. J Pharmacol Exp Ther 273 101—112, 1995 Screaton GR, Singer M, Cairns HS, et al Hyperpyrexia and rhabdomyolysis after MDMA ( ecstasy ) abuse. Lancet 399 667—668, 1992... 

Allen RP, McCann UD, Ricaurte GA Persistent effects of +/- 3,4-methylene-dioxymethamphetamine (MDMA, ecstasy ) on human sleep. Sleep 16 560-564, 1993... 

Bolla KI, McCann UD, Ricaurte GA Memory impairment in abstinent MDMA ( ecstasy ) users. Neurology 51 1532—1537, 1998 Borgen L, Lane E, Lai A Xyrem (sodium oxybate) a study of dose proportionality in healthy human subjects. J Clin Pharmacol 40 1053, 2000 Borgen LA, Okerholm R, Morrison D, et al The influence of gender and food on the pharmacokinetics of sodium oxybate oral solution in healthy subjects. J Clin Pharmacol 43 59-65, 2003... 

Scrima L, Hartman PG, Johnson EH, et al The effects of gamma-hydroxybutyrate on the sleep of narcolepsy patients a double blind study. Sleep 13 479 90, 1990 Series F, Series 1, Cormier Y Effects of enhancing slow-wave sleep by gamma-hydroxybutyrate on obstructive sleep apnea. Am Rev Respir Dis 143 1378-1383, 1992 Shannon M Methylenedioxymethamphetamine (MDMA, ecstasy ). Pediatr Emerg Care 16 377-380, 2000... 

In other respects the storage of 5-HT resembles that of noradrenaline with its uptake by vesicles resting on energy-dependent, vesicular monoamine transporters (VMATs) (see Chapter 8). Functional disruption of this transporter, either through competitive inhibition (e.g. by methylenedioxymethamphetamine (MDMA, Ecstasy )) or dissipation... 

Semple, DM, Ebmeier KP, Glabus MF, O Carroll, RE and Johnstone, EC (1999) Reduced in vivo binding to the serotonin transporter in the cerebral cortex of MDMA ( ecstasy ) users. Br. J. Psychiatry 175 63-69. 

MAO has been inhibited. As a result, transmitter accumulates in the cytoplasm and is exported into the synapse via the membrane-bound transporter. The ensuing (impulse-independent) sympathetic arousal can be disastrous, culminating in a hypertensive crisis and stroke. Although this process is a pharmacological curiosity and certainly contributed to the demise of MAOIs, it is possibly overrated (Tyrer 1979) it has been estimated that the number of deaths associated with the use of the MAOI, tranylcypromine, amounts to only 1 per 14000 patient years. However, this sequence of events echoes exactly the acute actions of methylenedioxymethamphetamine (MDMA, Ecstasy ) and undoubtedly accounts for some of the deaths attributed to this drug. 

Glennon, R.A. Titeler, M. Lyon, R.A. and Yousif, M. MDMA ( Ecstasy ) Drug discrimination and brain binding properties. Abstr Soc Neurosci 12 919, 1986c. 

Hubner, C.B. Bird, M. Rassnick, S. and Kometsky, C. The threshold lowering effects of MDMA (ecstasy) on brain-stimulation reward. Psychopharmacology 95 49-51, 1988. 

Peroutka, S. Incidence of recreational use of 3,4-methylenedioxymetham-phetamine (MDMA, Ecstasy ) on an undergraduate campus. N Engl J Meri 317 1542-1543, 1987. 

Battaglia, G. Kuhar, M.J. and De Souza, EB. MDA and MDMA (ecstasy) interactions with brain serotonin receptors and uptake sites In vitro studies. Abstr Soc Neurosci 12 1234, 1986. 

Itzhak, Y., Achat-Mendes, C. Methamphetamine and MDMA (Ecstasy) neurotoxicity of mice and men. IUBMB Life. 56 249, 2004. 

Vollenweider, F.X., Gamma, A., Liechti, M., and Huber, T., Psychological and cardiovascular effects and short-term sequelae of MDMA ( ecstasy ) in MDMA-naive healthy volunteers, Neuropsychopharmacology 19(4), 241-251, 1998. 

Doblin, R., A clinical plan for MDMA (Ecstasy) in the treatment of posttraumatic stress disorder (PTSD) partnering with the FDA, J. Psychoactive Drugs 34(2), 185-94, 2002. 

Setola, V., Hufeisen, S.J., Grande-Alien, K.J., Vesely, I., Glennon, R.A., Blough, B., Rothman, R.B., and Roth, B.L., 3,4-Methylenedioxymethamphetamine (MDMA, Ecstasy ) induces fenfluraminelike proliferative actions on human cardiac valvular interstitial cells in vitro, Mol. Pharmacol. 63(6), 1223-1229, 2003. 

Lyles, J. and Cadet, J.L., Methylenedioxymethamphetamine (MDMA, Ecstasy) neurotoxicity cellular and molecular mechanisms, Brain Res. Brain Res. Rev. 42(2), 155-168, 2003. 

Schechter, M.D., Serotonergic-dopaminergic mediation of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy ), Pharmacol. Biochem. Behav. 31(4), 817-824, 1988. 

McGregor, I.S., Clemens, K.J., Van der Plasse, G., Li, K.M., Hunt, G.E., Chen, F., and Lawrence, A.J., Increased anxiety 3 months after brief exposure to MDMA ( Ecstasy ) in rats association with altered 5-HT transporter and receptor density, Neuropsychopharmacology 28(8), 1472-1484, 2003. 

MDMA (Ecstasy) No clinical uses, although it has been used for psychotherapy recreational use widespread acute hyperthermic problems midweek depression during neurochemical depletion long-term problems include neurotoxicity, memory/cognitive deficits and a range of psychiatric problems. 

Outline the long-term neuropsychological consequences of regular MDMA/ Ecstasy use in humans. 

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