CONFERENCE July 19 2001 Claire Sterk s

CONFERENCE July 19, 2001

Claire Sterk’s

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

EFFECTS OF MDMA USE 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

Settings of Use The settings at which MDMA is being used Are diversifying according to all presenters And these include: l l 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

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

Jim Hall’s Key Slides

Advances: The of abuse as a Public Health issue

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

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

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

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

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

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

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.

Challenges - 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.

Jean Schensul

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

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)

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

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

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