Transcript Ecstasy and Party Drugs

Ecstasy &
Party Drugs
Ecstasy & Party Drugs
Party Drugs: GP’s Role
• GPs will see increasing presentations related
to problems associated with ‘Party Drugs’
• Types of drugs available change regularly
• Increasing diversity of drugs used
• A range of drugs, variously called ‘Designer’
or ‘Party Drugs’ includes PMA, MDA, GHB
and Ecstasy
Ecstasy & Party Drugs
Case Study
Andy, a 28 year old engineer, was referred
to you by the local hospital Emergency Department
after he collapsed at a dance party. He was placed
under observation then discharged to your care, as
his GP.
You were not previously aware that Andy used
recreational drugs.
What would you include in your assessment?
How would you assist Andy to avoid
similar situations?
Ecstasy & Party Drugs
MDMA/Ecstasy:
3,4-methylenedioxymethamphetamine
• MDMA is generally classed as a stimulant with mild
hallucinogenic properties
• MDMA enhances extracellular concentrations of:
– serotonin
– dopamine
• All amphetamine-type substances share common
effects and problems related to their use.
Ecstasy & Party Drugs
How Ecstasy is Used
Forms
• tablets, capsules, powder, liquid
Routes of administration
• oral (crushed / snorted), smoked, anal (‘shelved’) or
inserted in vagina (‘shafted’), some IV use
Dose
• normally 75–150 mg in one good quality tablet
• usual dose is 1–2 tablets, although more may be
taken if desired effect not reached.
Ecstasy & Party Drugs
Who Uses Party Drugs?
• Young, usually mid-teens or early to mid-20s
• More common amongst young males
• Relatively well-educated, employed or studying
• Little contact with police, social authorities, or
treatment agencies
• Unlikely to be from socially deprived backgrounds
• Unlikely to have incarceration history.
Party Drugs = ecstasy + others; e.g. ketamine, GHB, ‘pills’
which may or may not have stimulant properties.
Ecstasy & Party Drugs
Patterns of Party Drug Use
In 2001, almost 1 million (6.1%) Australians >14 years had
ever used ecstasy/designer drugs. Typically:
• around 25% use weekly to fortnightly
• around 60% report ‘bingeing’ within last 6 months
• 52% reported ecstasy as their favourite drug
• polydrug use common (average 6–7 drugs used in
last 6 months)
• injection rare
• prevalence increased in recent years.
IDRS (2002); NHS (2001)
Ecstasy & Party Drugs
Party Drugs and Polydrug Use
Polydrug use is common. Combinations
include:
• other depressants (e.g. alcohol, cannabis,
benzodiazepines)
• other stimulants (e.g. speed, tobacco, cocaine)
• hallucinogens (e.g. LSD)
• other drugs (e.g. amyl nitrite, ketamine, GHB).
Ecstasy & Party Drugs
MDMA / Ecstasy:
3,4-methylenedioxymethamphetamine
Manipulation of molecular structures of
amphetamines results in the production of
other drugs such as the more potent PMA
(paramethoxymethamphetamine).
Ecstasy & Party Drugs
Ecstasy Stimulates Serotonin
serotonin cells
serotonin neurones
(yellow)
serotonin (red dots)
from axon terminals
Serotonin cells in a rat’s brain, stimulated by
ecstasy to release serotonin
Ecstasy & Party Drugs
The ‘Ecstasy Experience’
Plateau
• Feel good, happy,
relaxed, open, loving
• Heightened senses
• Energy, confident,
talkative
• Decreased urine output
• Increased thirst.
Coming up
• Tightening of muscles, esp. jaw
• dilated pupils, visual distortions
• Smooth or sudden
nausea or vomiting
• Strong pulse, incr. temp
• Confusion, panic.
0
4
Hours After Ingestion
Coming down
• Physical exhaustion, flat,
depressed, tired, anxious
irritable, paranoid
• Comedown more intense
if IDU / polydrug user
8
Ecstasy & Party Drugs
MDMA & Related Drugs:
Effects of Short-term, Low-High Dose
Low dose:
Desired effects
 enhancement of
emotions and
empathy, or
increased sociability
or closeness (hence
‘love drug’)
 feelings of euphoria
(‘peace’, ‘tranquility’,
‘joy’)
 increased
confidence
 mild alterations in
visual perception
 decreased fatigue
 increased alertness
Low dose:
Unwanted effects
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blurred vision
tachycardia/ hypertension
hypotension
depression/anxiety/ panic
attacks
muscle aches/stiffness
teeth grinding, jaw
clenching
raised body temperature
pupillary dilation
profuse diaphoresis
confusion
irritability
headache
High dose:
Unwanted effects
 distortion of
perception, thinking or
memory
 hallucinations,
paranoia, psychosis
 lasting anxiety or
depression
 ? long term
neurotoxicity
Ecstasy & Party Drugs
Problems Associated with
Short-term Use
Immediate (post-administration)
• Hyperthermia, dehydration, overhydration/hyponatraemia
• Safety issues
• Overdose.
Short term problems
• Finances, work or study
• Relationships
• Mood and mental health.
Ecstasy & Party Drugs
Long-term Use
• Increased negative or undesired effects
• Increased tolerance leading to increased
dosage
• Potential neurotoxicity.
Ecstasy & Party Drugs
Ecstasy Overdose
• Fluid retention / renal failure
• Agitation, confused mental state, disordered speech,
psychosis, hallucinations, convulsions, severe headache
• Tachycardia (resting heart rate >120 bpm)
• Hypertension / hypotension
• Hyperthermia (temp >38.6o C )
• Nausea or vomiting
• Excessive fluid consumption
• Muscle rigidity
• Death.
In the case of overdose
refer to the
Emergency Department
Ecstasy & Party Drugs
Ecstasy:
Treatment of Overdose or Complications
Hyperthermia
cool compresses, sponging, hypothermia
blankets, iced baths. Medical intervention may
include Dantroline (muscle relaxant)
Rhabdomyolysis
assess and monitor urine output, ensure
hydration. Indications of renal failure require
urgent medical attention ? haemodialysis
Hypertension
arrhythmias
reduce stimuli, encourage relaxation.
May require medication
Convulsions
usual seizure management, life support,
hospitalisation
Intensive Care may be required so do NOT delay referral.
Ecstasy & Party Drugs
Assessing Patients
Include:
• lifestyle issues in relation to use of ecstasy and
other party drugs
• polydrug use and implications
• use trigger questions about:
– patterns of use
– potential harms (including physical safety and
emotional health and wellbeing)
– contact with other drugs / drug users
– work or study performance
– quality of personal and social relationships.
Ecstasy & Party Drugs
GP Interventions: Ecstasy
Interventions include:
• brief interventions
• harm reduction
• assessment, screening and monitoring for
depression
• Emergency Department referral for overdose.
Treatment:
• psychosocial support and counselling
• unlikely that most people who use ecstasy will
require long-term interventions.
Ecstasy & Party Drugs
Harm Reduction Advice
GPs can advise patients to...
Plan:
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•
•
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eat first, don’t mix drugs, limit use
take breaks from dancing
maintain fluid and food intake
develop safety plans.
‘Come Down’ carefully:
• avoid using other drugs
• sleep it off
• plan ‘using’ and ‘recovery’ time
• understand the consequences associated
with using and coming down.
In general:
• undertake physical and emotional self-care.
Ecstasy & Party Drugs
Harm Reduction:
Contraindications for Ecstasy Use
Ecstasy is contraindicated if family history of:
• heart disorders, hypertension or cardiovascular disease
• mental health problems, or use of antidepressants such
as Prozac, Aropax, Zoloft, Aurorix, or MAOIs
• neurological / nervous system impairment
• kidney disease
• obesity managed with medication
• previous severe or unpleasant reaction to ecstasy.
Ecstasy & Party Drugs
Dependence on Ecstasy
• Low likelihood of physical dependence
• Tolerance tends to result in reduced
effects, reduced enjoyment, and
‘loss of the ecstasy magic’ as
lifetime use increases.
Ecstasy & Party Drugs
Ketamine and PCP
• Ketamine may be called Special K, kitkat,
Vitamin K, K, Ket
• PCP may be called angel dust, peace pill,
crystal, hog, horse tranquilliser)
• Produces a dissociative state
– detachment
– disorientation
– disordered thoughts
– loss of proprioception.
Ecstasy & Party Drugs
Ketamine and PCP
Recreational Use
• Both sold as pills, tablets, capsules or powder, and
snorted, swallowed, smoked or injected
• Some opioid-like effects (incl. respiratory depression)
• Onset of effect varies with route of administration
(30 sec (IV) to 10–20 mins (oral))
• Duration of action:
– ketamine 1–3 hours
– PCP 4–6 hours.
Ecstasy & Party Drugs
Ketamine and PCP
Medical Use
• Primarily used as a short acting anaesthetic in
surgical procedures
• Especially useful for children under 10 years, or older
people (over 60 years)
• Popularity:
– popularity grew in 1980s and 1990s
– widely perceived as a ‘date-rape
drug’ and ‘club drug’.
Ecstasy & Party Drugs
Ketamine and PCP Effects
Major Problems Are Rare
Short-term
Adverse
Long-term
• Euphoria
• Anxiety
• Dependence
• Hallucinations
• Agitation
• Flashbacks
• Pleasant
stimulation
• Paranoia
• Perceptual
distortions
• Numbness of
extremities.
• Stupor
• Amnesia
• Depression
• Hostile / violent
behaviour
Ecstasy & Party Drugs
Ketamine and PCP Overdose
• Ketamine:
– wider margin of safety
– respiratory depression possible, with
complete recovery
• PCP:
– acute hypertensive crisis
– convulsions, coma, death.
Ecstasy & Party Drugs
Ketamine and PCP Toxicity
Acute Toxicity – Low Dose
• Resembles alcohol intoxication
• Ataxia, slurred speech,
nystagmus, euphoria & numbness
in the extremities.
Acute Toxicity – High Dose
• Distorted sensory perception and
disorganised thought
• Drowsiness and apathy
• Hostile or bizarre behaviour
• Anaesthesia
Chronic Toxicity
• Chronic effects not well
researched - include personality
changes, difficulty with memory,
speech and thinking.
• Catatonic-like muscle rigidity and
convulsions
•  HR & BP
• Sweating and fever
• Myoclonus
• Respiratory depression and coma
•  Pupillary & corneal reflexes.
Ecstasy & Party Drugs
GHB:
Gammahydroxybutyrate or Sodium Oxybate
• ‘Fantasy’, ‘grievous bodily harm’ (GBH),
liquid ecstasy
• Laboratory manufactured. Also produced in the
brain through synthesis of GABA
• Developed as an anaesthetic, but withdrawn
• Sedative effects vary between individuals
• Affects some neurotransmitters.
Ecstasy & Party Drugs
GHB Recreational Use
• Like alcohol, used as a
recreational intoxicant
• Associated with dance music scene
• May assist with sleep
• Body builders may use GHB to increase
production of growth hormone.
Ecstasy & Party Drugs
How GHB is Used
Form
• colourless, odourless liquid (from powder mixed
with water). May be slightly salty or bitter to taste.
Dose
• usual dose is around 1–3 g powder;
approx. 1 g : 1 ml water (i.e. 5 g per teaspoon).
Concentration is widely variable.
Route
• oral, less often IV.
Onset
• 10–60 minutes.
Ecstasy & Party Drugs
GHB: Duration of Effect
Onset
10–20 minutes
Coming up
15–20 minutes
Plateau
45–90 minutes
Coming down 15–30 minutes
After effects
2–4 hours
Ecstasy & Party Drugs
GHB Effects (1)
Small dose (1–3 g)
Larger Dose (4–5 g)
• Decreased inhibitions
• Powerful sedative effects
• Increased libido
• Nausea and vomiting
• Euphoria similar to
ecstasy
• Stiffening of muscles
• Sedative effects
• Profound sedation
• Disorientation
• Memory loss (sedation) • Convulsions
• Synergistic effect when • Coma
combined with alcohol
(significantly increases • Respiratory collapse.
risk of overdose).
Ecstasy & Party Drugs
GHB: Overdose and Long-term Use
• Overdose risk if mixed with other CNS depressants:
– respiratory depression
– diaphoresis
– ‘eyes rolling’
– muscular spasms, convulsions
• Those hospitalised in Australia have made full recovery
• Potential for dependence, with symptoms similar to
alcohol
• Other long-term consequences unknown.
Ecstasy & Party Drugs
PMA:
Paramethoxyamphetamine
• Synthetic amphetamine, stimulant and hallucinogenic
properties, usually produced in clandestine laboratories
• Not MDMA, though sold as MDA, MDMA, speed.
Potency >6 times MDMA
• No known indications for its medical use.
Form
• White crystalline to yellow or amber, may be powder,
chunks, ‘gummy’ material, capsules, tablets, powders.
Route
• Sniffed, swallowed, IV.
Ecstasy & Party Drugs
PMA: Short-term Effects
CNS
• Behavioural (subjective)
• Hallucinations, delirium, convulsions, coma
• Restlessness, agitation, hyperactivity
• Muscle contractions, rigidity
• Hyperthermia, sweating.
Cardiovascular system
• Tachycardia, unknown effects on BP.
Gastrointestinal system
• Nausea and vomiting.
Ecstasy & Party Drugs
PMA: High Risk and
Long-term Effects
• High doses can be fatal
• PMA-related deaths have been confirmed
• Effects of long-term use are unknown:
• ? if long-term use leads to tolerance or
dependence
• specific patterns of use are unknown, as
PMA is often sold as MDMA, MDA or other
designer drugs.
Ecstasy & Party Drugs
LSD
Ecstasy
Ecstasy&&Party
PartyDrugs
Drugs
LSD: Pharmacology
• Street dose typically around 0.1–0.5 mg
• Multiple receptor actions (partial agonist
effects at 5-HT2 and D1 and D2 receptors)
• Onset of action between 30–60 minutes;
ppc of 2–4 hours
• Acute psychotic symptoms can occur as a
result of activation of serotonin receptors.
Ecstasy & Party Drugs
LSD Effects
Largely sympathomimetic:
Non-sympathomimetic:
• pupillary dilatation
• dizziness
• ↑ BP
• weakness
• tachycardia
• drowsiness
• hyper-reflexia
• paraesthesia
• tremor
• emotional lability.
• nausea
• piloerection
• muscular weakness
• ↑ temperature.
Ecstasy & Party Drugs
LSD: Chronic Effects
• Flashbacks (experienced by 15% of users)
• No evidence of long-term toxicity
• Some evidence for reduced capacity for
abstract thinking with repeated use
• Tolerance to subjective and behavioural effects
develops rapidly but not to autonomic effects
• Risk of dependence is low.
Ecstasy & Party Drugs
Psilocybin
• Psilocybin is found in psilocybe (and some other)
mushrooms. Concentration varies with mushroom
age and conditions of growth (i.e. light)
• 2–4 mushrooms produce relaxation and wellbeing;
20–30 produce a full LSD-like response
• Effects: 6–8 hours followed by drowsiness
• Acute toxic effects include agitation, panic,
psychosis and ataxia
• Chronic toxicity is not well documented.
Ecstasy & Party Drugs
Anticholinergics
• Datura stramonium contains hyoscine
• Effects: delirium, changes in cognition,
awareness and memory, delusions
• Low doses
– dry mouth, blurred vision, mydriasis,
urinary retention and tachycardia
• Higher doses
– hallucinogenic effects
• Toxicity resembles other hallucinogens.
Ecstasy & Party Drugs