Ecstasy Use Among College Students


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  • MDMA is 3,4 methylenedioxymethamphetamine, a ring substituted derivative of phenethylamine, which is a close structural analog of amphetamine, methamphetamine and 3,4 methylenedioxyethylamphetamine (MDE: Eve). methylenedioxy (-O-CH2-O-) joining the 3,4 phenyl carbons to form a ring
  • During the 1970s there was an interest by some psychiatrists in using MDMA as a therapeutic agent because it was reported to reduce the inhibition of their patients to speak openly during therapy sessions.
  • CSA = Controlled Substances Act In the 1980s, MDMA got a new nickname, Ecstasy (also XTC and E), given to it by the newest group to experiment with it, our Nation’s youth. But at about the same time that MDMA first appeared as a so-called “party” or “club” drug at raves or all-night dance parties, evidence was emerging that this compound was not harmless, and indeed, could cause damaging effects on serotonergic neurons. In fact, in 1985 the U.S. Drug Enforcement Administration added MDMA to the Schedule I list of drugs with no accepted medical use.
  • 63% - either MDMA or 3,4 – methlyenedioxy-ethyl-amphetamine
  • PMA = paramethoxyamphetamine PMMA = paramethoxymethamphetamine Five hours after death, the body temperature was recorded at 104.
  • R – rectus (Latin for right) - S – sinister (Latin for left) Chiral is from the Greek kheir meaning “hand” Maximum number of stereoisomers is = to 2^n where n = number of chiral carbons MDA = methylenedioxyamphetamine … HHMA = 3,4-dihydroxymethamphetamine MDMA also induces a state characterized as "excessive talking" (loquacity), which was once believed to be helpful in psychotherapy. In the 1970s, MDMA was documented to produce permanent damage to serotonin pathways in the brains of rats and monkeys. Much like other amphetamines, MDMA causes these neurotransmitters to be released from their storage sites in neurons, increasing brain activity. Compared to the potent stimulant methamphetamine, MDMA triggers a larger increase in serotonin and a smaller increase in dopamine. Serotonin is a major neurotransmitter involved in regulating mood, sleep, pain, emotion, and appetite, as well as other behaviors. By releasing large amounts of serotonin, and also interfering with its synthesis, MDMA leads to a significant depletion of this important neurotransmitter. As a result, it takes the human brain a significant amount of time to rebuild the store of serotonin needed to perform important physiological and psychological functions.
  • This over-stimulation can selectively kill the neurons that normally release dopamine & serotonin Damage is not necessarily immediately apparent or noticeable as behavior
  • Serotonin (5-hydroxytryptamine, 5-HT) MDMA blocks 5-HT reuptake and induces 5-HT release and causes, to a lesser extent, DA and NE release.
  • High anti-diuretic levels stop kidneys from producing urine – can cause dangerously high water content in blood as kidneys improperly process water "Ataxia," which refers to coordination problems such as clumsy or awkward movements and unsteadiness, occurs in many different diseases and conditions. Friedreich's ataxia is an inherited disease that causes progressive damage to the nervous system resulting in symptoms ranging from muscle weakness and speech problems to heart disease. In Friedreich's ataxia, ataxia results from the degeneration of nerve tissue in the spinal cord and of nerves that control muscle movement in the arms and legs. The spinal cord becomes thinner and nerve cells lose some of their myelin sheath - the insular covering on all nerve cells that helps conduct nerve impulses. Nystagmus is an involuntary eye movement which usually results in some degree of visual loss. The degree and direction of eye movement, amount of visual loss and resulting impairment varies greatly from person to person. Role of MDMA in hyperthermia is not fully understood – might be the result of increased dopamine release through interactions with the dopamine D1 receptor
  • Malignant hyperthermia is a sharp increase in body temperature. Role of MDMA in hyperthermia is not fully understood – might be the result of increased dopamine release through interactions with the dopamine D1 receptor
  • Dose to cause these effects = 150 lb human taking 350 mg over 4 days
  • This slide shows brain PET scans of an individual who has never used MDMA (seen at the top of slide marked "control") and those of an individual who used MDMA for an extended period of time up until 3 weeks prior to the images being taken. Specifically, the PET scans show the brain's ability to transport a neurotransmitter called "serotonin" from the synapse back into the releasing neuron. Serotonin is fundamental to the brain's integration of information and emotion. Brighter colors in the PET scans indicate that more serotonin is being transported than do duller colors. As seen in the slide, the brain of the MDMA user shows duller colors compared to the control, indicating a decrease in the MDMA abuser's ability to remove serotonin from the synapse. Such findings are leading researchers to conclude that MDMA may increase the risk of long-term, perhaps permanent, problems with learning and memory.
  • From Department of Health and Human Services Monitoring the Future study for 2002
  • Older NY gay men may use ecstasy as part of a post-traumatic stress response to having lived through the death years of AIDS Youth may be rebelling
  • Ecstasy Use Among College Students

    1. 1. Ecstasy Brian Wells University of Florida October 8th, 2003
    2. 2. What is Ecstasy? <ul><li>Stimulant and mild hallucinogen </li></ul><ul><li>3,4 – metheylenedioxymethamphetamine (aka MDMA, Ecstasy, Hug Drug, Feel Good Drug, Adam, XTC, etc.) </li></ul>Source:
    3. 3. Types of Ecstasy
    4. 4. History of Ecstasy <ul><li>Discovered in Germany in 1913 and patented by Merck in 1914. </li></ul><ul><li>Myth that is was intended as an anorectic drug – never marketed due to side-effects </li></ul><ul><li>1950s - U.S. Army studied it as a potential chemical warfare agent that would temporarily disable enemy troops. </li></ul><ul><li>Found an interest among psychiatrists in 1970s </li></ul>
    5. 5. History of Ecstasy <ul><li>Early 1980s - MDMA got a new nickname, Ecstasy (also XTC, E, the Hug Drug, others) </li></ul><ul><li>Production of MDMA in clandestine laboratories, increasing use among adolescents prompted emergency scheduling of MDMA into C1 of the CSA in 1985. </li></ul>
    6. 6. The Ecstasy Problem <ul><li>MDMA has no approved use in the U.S. </li></ul><ul><li>Despite the Schedule 1 classification, MDMA continues to be used illegally. </li></ul><ul><li>MDMA is now being used increasingly in both urban and suburban populations </li></ul><ul><li>Many young people believe Ecstasy is safe and offers nothing more than a pleasant high </li></ul>Source: MDMA/Ecstasy Research: Advances, Challenges, Future Directions A Scientific Conference -
    7. 7. The Ecstasy Problem <ul><li>Most MDMA manufactured in Western Europe (Netherlands and Belgium => 80%) </li></ul><ul><li>Majority of MDMA produced in other countries is trafficked to US by Israeli and Russian organized crime </li></ul><ul><li>All major airports in Europe act as shipping points for MDMA destined for US </li></ul><ul><li>Major US Influx Gateways are Los Angeles, Miami, and New York </li></ul><ul><li>USCS seized 3.5M tablets in 1999 and 9.3M in 2000 </li></ul>Source: MDMA.
    8. 8. The Ecstasy Problem <ul><li>Is it really Ecstasy? </li></ul><ul><li>A November 2000 study appearing in JAMA found that: </li></ul><ul><ul><li>63% contained MDMA or analogue </li></ul></ul><ul><ul><li>29% contained identifiable drugs but no MDMA or analogue </li></ul></ul><ul><ul><li>Most common drug found (other than MDMA) was DXM – 21% </li></ul></ul><ul><ul><li>Other drugs found were caffeine, ephedrine, pseudoephedrine, and salicylates. </li></ul></ul><ul><ul><li>8% contained no identifiable drug. </li></ul></ul>Source: Jones, Reese T. et al. Chemical Analysis of Ecstasy Pills. JAMA, November 1, 2000; Vol 284, No. 17.
    9. 9. The Ecstasy Problem <ul><li>News story from Florida </li></ul><ul><ul><li>Pills being sold in central Florida were PMA and PMMA </li></ul></ul><ul><ul><li>PMA causes user to overheat, become confused, hallucinate, and finally collapse (body temperature as high as 108 degrees F). </li></ul></ul><ul><ul><li>Six people in Florida died from using counterfeit pills </li></ul></ul><ul><ul><li>PMA easier and cheaper to make </li></ul></ul><ul><ul><li>“ It’s like Russian roulette…If you get these PMA pills and take them, there is a chance you will die.” – Bruce Goldberger, forensic toxicologist at UF. </li></ul></ul>Source: Killer Club Drug.
    10. 10. The Ecstasy Problem
    11. 11. Ecstasy: Chemistry, Symptoms, and Other Fun Topics
    12. 12. How does it work? <ul><ul><li>Chemistry </li></ul></ul><ul><ul><ul><li>Structurally similar to amphetamine, methamphetamine, and mescaline </li></ul></ul></ul><ul><ul><ul><li>Two stereoisomers </li></ul></ul></ul><ul><ul><ul><li>Most activity associated with (S)-(+)-MDMA </li></ul></ul></ul>Source: Fallon, J.K. et al. Stereospecific Analysis and Enantiomeric Disposition of 3,4-Methlyenedioxymethamphetamine in Humans. Clinical Chemistry, 1999. 45, 1058 – 1069.
    13. 13. How does it work? <ul><li>Chemistry </li></ul><ul><ul><ul><li>Metabolism of MDMA results in formation of MDA by N-demethylation and HHMA (major) by O-demethylation </li></ul></ul></ul><ul><ul><ul><li>Metabolites generate free radicals (oxidative stress and membrane damage) </li></ul></ul></ul><ul><ul><ul><li>MDMA inhibits tryptophan hydroxylase (rate-limiting enzyme in the pathway of 5-HT synthesis) – irreversible reaction </li></ul></ul></ul>Source: Lyles, Johnalyn, et al. MDMA neurotoxicity: cellular and molecular mechanisms. Brain Research Reviews, 2003. 42, pg 155 – 168. Bogen, Inger L., et al. Short and long-term effects of MDMA (“ecstasy”) on synaptosomal and vesicular uptake of neurotransmitters in vitro and ex vivo. Neurochemistry International, 2003. 43, pg 393 – 400. Sprague, Jon E., et al. Hippocampal serotenergic damage induced by MDMA (ecstasy): effects on spatial learning. Physiology and Behavior, 2003. 79, pg 281 – 287.
    14. 14. How does it work? <ul><ul><li>MDMA increases the activity of three neurotransmitters </li></ul></ul><ul><ul><ul><li>Serotonin (5-HT) </li></ul></ul></ul><ul><ul><ul><li>Dopamine (DA) </li></ul></ul></ul><ul><ul><ul><li>Norepinepherine (NE) </li></ul></ul></ul><ul><ul><li>High affinity for 5-HT receptor </li></ul></ul><ul><ul><li>Binds with less affinity to DA and NE receptors </li></ul></ul>Source: Lyles, Johnalyn, et al. MDMA neurotoxicity: cellular and molecular mechanisms. Brain Research Reviews, 2003. 42, pg 155 – 168.
    15. 15. What are the symptoms associated with its use?
    16. 16. What are some of the symptoms associated with its use? <ul><li>Effects last 4 to 6 hours and include: </li></ul><ul><ul><li>Euphoria </li></ul></ul><ul><ul><li>Peaceful, emotional feelings </li></ul></ul><ul><ul><li>Feelings of increased closeness to others </li></ul></ul><ul><ul><li>Heightened sensory awareness </li></ul></ul>
    17. 17. What are the symptoms associated with its use? <ul><li>Physical </li></ul><ul><ul><li>Muscle tension </li></ul></ul><ul><ul><li>Involuntary teeth clenching </li></ul></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>Blurred Vision </li></ul></ul><ul><ul><li>Faintness </li></ul></ul><ul><ul><li>Chills or Sweating </li></ul></ul><ul><ul><li>Rash similar to acne with associated liver damage in some individuals </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Hyperthermia </li></ul></ul><ul><ul><li>Hyperexcitability </li></ul></ul><ul><ul><li>Tachycardia </li></ul></ul><ul><ul><li>Myocardia Ischemia </li></ul></ul><ul><ul><li>Elevated anti-diuretic hormone levels </li></ul></ul><ul><ul><li>Ataxia </li></ul></ul><ul><ul><li>Nystagmus </li></ul></ul><ul><ul><li>Cerebral hemorrhage </li></ul></ul>Source: Shannon M. Methylenedioxymethamphetamine. Pediatric Emerg Care 2000; 16:377-380
    18. 18. What are the symptoms associated with its use? <ul><li>Ecstasy is neurotoxic </li></ul><ul><li>High doses can cause malignant hyperthermia leading to </li></ul><ul><ul><li>muscle breakdown </li></ul></ul><ul><ul><li>kidney and cardiovascular system failure. </li></ul></ul>
    19. 19. What are the symptoms associated with its use? <ul><li>Psychological </li></ul><ul><ul><li>Euphoria and Closeness </li></ul></ul><ul><ul><li>Confusion </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Sleep Problems </li></ul></ul><ul><ul><li>Drug Cravings </li></ul></ul><ul><ul><li>Severe Anxiety </li></ul></ul><ul><ul><li>Paranoia </li></ul></ul><ul><li>Can be during or sometimes weeks after taking Ecstasy </li></ul>
    20. 20. What are the symptoms associated with its use? <ul><li>Tolerance </li></ul><ul><ul><li>Evidence from lab animal studies suggest tolerance with repeated use </li></ul></ul><ul><li>Not known as a physiologically addictive substance </li></ul>
    21. 21. What are the symptoms associated with its use?
    22. 22. PET Scan
    23. 23. Usage Trends
    24. 26. What about among College Students? <ul><li>Harvard College Alcohol study showed that </li></ul><ul><ul><li>1997 – 2.8% of college students used ecstasy </li></ul></ul><ul><ul><li>1999 – 4.7% used ecstasy </li></ul></ul><ul><ul><li>Increase of 68% in two years </li></ul></ul><ul><li>Factors more common is ecstasy users than other students </li></ul><ul><ul><li>Binge drinking </li></ul></ul><ul><ul><li>Increased number of sexual partners </li></ul></ul><ul><ul><li>Smoking </li></ul></ul><ul><ul><li>Rating arts and parties as more important than academic pursuits. </li></ul></ul>
    25. 27. What about among College Students?
    26. 29. What can we do about these Trends? <ul><li>Target specific audiences </li></ul><ul><ul><li>Each group of people is driven by unique motivations </li></ul></ul><ul><li>2001 article in JAMA – “Ecstasy Experts Want Realistic Messages” </li></ul><ul><ul><li>NIDA’s prevention campaign relies on “scare tactics” </li></ul></ul><ul><ul><li>Social science researchers say that “blunt prevention messages fail to reduce Ecstasy use” and advocate less extreme campaigns that users can identify with. </li></ul></ul>
    27. 30. What can we do about these Trends? <ul><li>Legislation </li></ul><ul><ul><li>Ecstasy Anti-Proliferation Act of 2000 </li></ul></ul><ul><ul><ul><li>Effective May 1, 2001 </li></ul></ul></ul><ul><ul><ul><li>Increased sentencing guidelines for ecstasy trafficking </li></ul></ul></ul><ul><ul><ul><li>Mainly targets upper-middle-level distributors </li></ul></ul></ul>Source: MDMA.
    28. 31. What can we do about these Trends? <ul><li>Legislation </li></ul><ul><ul><li>Ecstasy Awareness Act of 2003 </li></ul></ul><ul><ul><ul><li>HR 2962 of 108 th Congress (1 st Session) </li></ul></ul></ul><ul><ul><ul><li>Introduced by Rep. Pascrell, Rep. Terry, Rep. Pallone, Rep. Etheridge, and Rep. Capuano </li></ul></ul></ul><ul><ul><ul><li>Referred to Committee on Energy and Commerce, Committee on the Judiciary, and Subcommittee on Crime, Terrorism, and Homeland Security </li></ul></ul></ul><ul><ul><ul><li>Amends section 416 of CSA (21 U.S.C. 856) </li></ul></ul></ul><ul><ul><ul><li>`(c) Whoever profits monetarily from a rave or similar electronic dance event, knowing or having reason to know that the unlawful use or distribution of a controlled substance occurs at the rave or similar event, shall be fined not more than $500,000 or imprisoned not more than 20 years, or both. If the defendant is an organization, the fine imposable for the offense is not more than $2,000,000.'. </li></ul></ul></ul>Source: Library of Congress.
    29. 32. What can we do about these Trends? <ul><li>Legislation </li></ul><ul><ul><li>Reducing Americans' Vulnerability to Ecstasy Act of 2003 (RAVE Act) </li></ul></ul><ul><ul><ul><li>HR 718 of 108 th Congress (1 st Session) </li></ul></ul></ul><ul><ul><ul><li>Introduced by Rep. Coble and Rep. Smith (TX) </li></ul></ul></ul><ul><ul><ul><li>Companion bill to S. 226, the Illicit Drug Anti-Proliferation Act, introduced by Sen. Biden </li></ul></ul></ul><ul><ul><ul><li>Referred to the Subcommittee on Crime, Terrorism, and Homeland Security </li></ul></ul></ul><ul><ul><ul><li>Purpose is to prohibit an individual from knowingly opening, maintaining, managing, controlling, renting, leasing, making available for use, or profiting from any place for the purpose of manufacturing, distributing, or using any controlled substance, and for other purposes. </li></ul></ul></ul>
    30. 33. What can we do about these Trends? <ul><li>Legislation </li></ul><ul><ul><li>Communities Combating College Drinking and Drug Use Act </li></ul></ul><ul><ul><ul><li>S. 406 of 108 th Congress (1 st Session) </li></ul></ul></ul><ul><ul><ul><li>Introduced by Sen. Dewine and Sen. Lieberman </li></ul></ul></ul><ul><ul><ul><li>Referred to the Committee on Health, Education, Labor, and Pensions </li></ul></ul></ul><ul><ul><ul><li>The purpose of this Act is to encourage States, institutions of higher education, local communities, nonprofit groups, including community anti-drug or anti-alcohol coalitions, and other substance abuse groups within the State to enhance existing or, where none exist, to establish new statewide coalitions to reduce the usage of drugs and alcohol by college students both on campus and in the surrounding community at large. </li></ul></ul></ul>
    31. 34. Interesting Facts and Studies <ul><li>Mental Health Weekly had an article suggesting that prior Ritalin or Ecstasy use may increase sensitivity to cocaine. </li></ul><ul><ul><li>High doses of Ritalin were used </li></ul></ul><ul><li>An article in Neurotoxicology and Teratology showed that Ecstasy exposed rat pups had a 502% increase in the number of DA neuron fibers in the frontal cortex compared with control. </li></ul><ul><ul><li>Possible that Ecstasy may affect the fetus during pregnancy </li></ul></ul><ul><ul><li>Differences seen only in male pups but why? </li></ul></ul>
    32. 35. Questions?
    33. 36. Sources for Additional Information <ul><li>MDMA/Ecstasy Research: Advances, Challenges, Future Directions A Scientific Conference - </li></ul>