Transcript What do you know about ECSTASY?

Hallucinogens
•Where do they come from?
–Organic and synthesized origins
•History
–plants used in religious ceremonies and as part of indian rituals
–LSD discovered in 1938; Hoffman absorbed it
–became widely recognized and used in 1960s
–e.g., cultish subculture: T. Leary--turn on, tune in, drop out
–reemergence of LSD in rave subculture in 1990s
–uses of LSD in psychotherapy
Hallucinogens
Types
•1. Serotonergic hallucinogens
–chem similar to serotonin
•2. Methylated amphetamines
–chem similar to norepinephrine...alterations in mood without much
change in senses
•3. Anticholinergic - (Ach)
– found in plants: belladonna, mandrake, jimson weed
–trance or dream-like states
•4. Dissociative anesthetics
–can remain conscious in surgery; causes euphoria, numbness,
aggressive behavior, and tactile sense disturbances
Serotonergic Hallucinogens
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Lysergic acid diethylamide (LSD)
Psilocybin (mushrooms)
Dimethyltryptamine (DMT)
Mescaline
Harmaline, Harmine
Ergine, Isoergine
Lysergic Acid Amide
Ergot fungus
mushrooms
Virola trees
Peyote cactus
Ayahuasca vine
morning glory
morning glory
Methylated Amphetamines
• MDMA (Ecstacy; X)
• MDA (Love Drug)
synthetic
synthetic
Acetylcholinergic Hallucinogens
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Atropine
Scopolamine
Hyoscyamine
Ibogaine
belladonna plant
roots of mandrake, herbane
roots of mandrake, herbane
Iboga plant
Dissociative Anesthetic
Hallucinogens
• Phencyclidine (PCP, Angel Dust)
• Ketamine
synthetic
PCP-like drug
Hallucinogens
Effects Vary by
Type
NHSADA Hallucinogen Use % (2004)
Lifetime
Past yr
Past mo
Total
14.3
1.6
.4
12-17
4.6
3.0
.8
18-25
21.3
6.0
1.5
26 & older
14.4
0.6
.1
Male
17.7
2.2
.6
Female
11
1.1
.2
What do you know
about the drug
ECSTASY?
Methylenedioxymethamphetamine
• “MDMA” for short
• It is popularly called:
Ecstasy
X
Adam
Lover’s Speed
XTC
E
Clarity
(among other names)
Pharmacology & History
• MDMA is a synthetic norepinephrine-related
hallucinogenic drug
• Not to be confused with “Herbal ecstasy”
containing ephedrine and other herbs
• Reputed to be a safe “recreational” or
“therapeutic” drug in a dose of 1 to 2 mg.
• At least 68 deaths have been attributed to the use
of MDMA (mostly from symptoms resembling
heatstroke).
Pediatrics vol 100 (1997)
MDMA Appeal
MDMA has the stimulant qualities of amphetamines and
the hallucinogenic (psychedelic) qualities of mescaline
It’s effects last approximately 3-6 hours
History
• First synthesized in Germany in 1914
• First used in the 1970s in the U.S. as an adjunct to
psychotherapy
– to enhance empathy, introspection,
communication
– to induce positive mood states & feelings of
intimacy and tranquility
• At the same time animal studies showed it
produced permanent brain damage
• Popular with young people since the late 1980s
– often used at dance parties called “raves”
History
• In 1989 the Drug Enforcement Administration
placed MDMA on the Schedule I drug list
• Interestingly, the Multidisciplinary Association for
Psychedelic Study continues to lobby to legalize
MDMA for research
• Has undeserved reputation as being safe
Methods of Use
• Distributed in tablet form for oral ingestion
• In New York, 100 mg. tablet costs approx. $20
• Many “rave-goers” report experimenting with
“stacking” -– taking 3 or more tablets at once and/or
– mixing MDMA with herbal ecstasy, LSD, alcohol,
marijuana, and other drugs of abuse
Signs and Symptoms of
MDMA Intoxication:
Most Common Symptoms and Signs:
• Muscle tension and aches
• jaw clenching
• sweating
• fatigue
• difficulty concentrating & retaining newly learned material
• Confusion or delirium even weeks after drug use
Occasional Symptoms:
• Intense dysphoria (depression, anxiety)
Common Serious Adverse Effects
of MDMA
Serious Illness and Death have occurred from:
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Dehydration
Hyperthermia
Cardiac arrhythmia
Hypertensive crises
Disseminated intravascular coagulation (blood clot)
Acute renal failure
Hepatic toxicity (liver)
Your Brain on Ecstasy
• The brain scan on the right belongs to
an individual who used Ecstasy many
times, but had not used any drugs in
the last 3 weeks before the scan.
• The bright red spots on the left
“normal” brain scan are serotonin
receptor sites.
• Whereas, the dark spots at the top of
the right scan are serotonin receptor
sites which are not active
Prevalence
MONITORING THE FUTURE STUDY
Ecstasy Use by Students, 2000:
Grade:
8th
10th
12th
Ever Used
4.3% 7.3% 11.0%
Used in Past Year
3.1% 5.4% 8.2%
Used in Past Month
1.4% 2.6% 3.6%
Ecstasy tablets seized by the Drug Enforcement
Administration increased from 13,342 in 1996
to 949,257 in 2000
Prevalence
What are Raves?
• Clandestine dance parties
(location usually kept
quiet until 1-2 days before
event)
• Held at abandoned
warehouses…
• Advertised by flyers or
word of mouth
What are they like?
•Loud, repetitive, synthesized electronic music at 80-120
beats per minute mixed by disk jockeys
•Only laser lights illuminate
the darkened building
•Vigorous, all night dancing
Raves
• Rave attendees are usually high school and college
students (some junior high students)
• Because alcohol may not be served at some raves,
water and power drinks are served to help to replenish
fluid losses from vigorous dancing and MDMA use
• Carnival-like atmosphere with sales of:
– drug paraphernalia and drugs
– brightly-colored nitrous oxide filled balloons
– baby bottles and pacifiers (used to help
mediate adverse effects of jaw-clenching)
Raves
Raves
• PLUR Philosophy (Peace, love, unity, and respect)
plus the focus on drugs (ecstasy, LSD, GHB, speed &
pot) has earned ravers the name “techno-hippies”
• According to rave-goers, PLUR is what Raves are all
about.
Quote from a rave attendee:
“We have unconditionally-accepting ‘freaks are
us’ love.”
Raves
– “The rave scene is great as an accepting
environment, but it becomes problematic when
it’s intrinsically tied to drug use. It can set up a
pattern of lifelong drug use. Drug use can lead
to unsafe sex and HIV transmission.”
– “Anything goes at a rave, and that’s both its
strongest asset and its biggest flaw.”
– Caitlin Ryan, clinical social worker and co-author of Lesbian and
Gay Youth: Care and Counseling.
Screening & Emergency
Treatment of Acute Toxicity
• MDMA can be detected by drug screening for
amphetamines
• but test sensitivity is reduced by about 50%
• Treatment:
– Rapid Cooling
– Rehydration
– Monitoring electrolytes
– Monitoring organ function
Risk Factors of MDMA Usage
Adolescents who have aggregates of the following:
– Have close friends who use drugs
– Frequently attend raves
– Early use of nicotine
– Frequent use of marijuana
– May have interpersonal issues with parents
and authority figures
Diagnosis and Treatment
• The diagnosis is complicated by comorbidity
• Least intrusive method is outpatient after-school
drug treatment and education
• Most drug treatment programs recommend:
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abstinence from drugs and alcohol
severing ties with drug-using friends
Self-help groups
Unscheduled monitoring by urine toxicology tests