# Presentation: 079942

## CONFERENCE

**July 19, 2001**

**CONFERENCE**

## 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”
- 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

## 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:**
**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)**

## MDMA   Ecstasy   XTC   X   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**

## Jim Hall’s Key Slides 

## Advances:

**The                          of**
**abuse**
**as a ****Public Health**** issue **

**evolution **

- MDMA

## Mentions of MDMA (“esctasy”) in National Emergency Room Reports 1992-1999

- Source: US Dept HHS: SAMHSA - OAS: DAWN

## "x"

-   **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					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

## 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”

## “Ecstasy” may not be MDMA

- These are some of the “Ecstasy” pills tested by the dancesafe organization (www.dancesafe.org)

- 90% DXM

- Methyl Salicylate, Caffeine

- MDA

- MDMA

## 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

- 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 

## Baseline

- 2 Weeks Post
- MDMA

- L. Chang Psychiat Res (2000) 98: 15)

- Highest Dose

- Lowest Dose

- Effect of MDMA on cerebral blood flow: A co-registered
- SPECT and MRI study

**Notes:**
Axial MRI and 133 Xe-calibrated 99m Tc-HMPAO SPECT in MDMA users at baseline and after MDMA administration. The top row shows images from a male subject who received the highest dosage 4.75 mg / kg of MDMA and the bottom row shows images from a male subject who received the lowest MDMA dosage. Color scales denote range of CBF ml/100 g tissue per min .
Note decrease in global and rCBF only in the subject who received the larger dose of MDMA.

## 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; 2X daily, 4 days)

**Rat Hippocampus (2 wks after 20 mg/kg; 2X daily, 4 days)**

**(O’Hearn et al. J. Neurosci. 8 [1989] 2788)**

** ****Result:**
**   ****long-term**
**  ****loss of **
**  ****5HT fibers**

## (caudate nucleus)

**5-HT levels in monkey after MDMA (two 5 mg/kg daily for 4 days)**

**(Hatzidimitriou et al., J. Neurosci. 19 [1999] 5092)**

**2 weeks                 7 years**

** ****Result:**
**  ****-long-term**
**   ****loss of 5HT**
**   ****fibers in **
**   ****monkeys**

**  ****-some**
**   ****recovery**

## SUMMARY

_**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**