View Full Version : Exctasy profile
A drug that has been around for a little while seems to be on the upswing in certain areas again.
Exctasy produces a euphoric feeling and sense of well being with exageration of infantile type pleasure and visual disturbances.
It causes an unusual primary excitation of the optic nerve. This is why users often carry cyalume sticks and like christmas lights, etc. Users are drawn to chhildhood toys, ie. Teddy bears, soft cuddlies.
It also causes a user to grind his teeth, thus users often carry pacifiers around their necks which they suck on to prevent grinding. Suckers are also popular.
Exctasy produces extreme pupillary dilation which often makes the pupil nearly as large as the iris.
Exctasy is the primary drug at Raves (impromtu gatherings of young folk for music and dance).
While overdosage of exctasy can produce death, the most extreme problem is serotonin depletion and destruction of serotonin production. Serotonin is an extremely important chemical in mood regulation. When depleted it leads to extreme depression and suicidal tendencies. Unfortunately, exctasy damages future production of serotonin and makes this state irreversible.
Parents - be aware! IF you child is exhibiting any of the above questions, you need to be asking a lot of questions and be prepared to intervene.
Medics - You are probably going to be seeing an upswing in the use of this stuff at least temporarily.
Jag
first I have neaver heard that it permanently damages future seratonin production - have a pointer to where I could find more info on this?
I have also never heard of a case where an overdose caused death. This is supposed to be a relatively safe drug.
I have been arround people on extacy and believe you are overstating the degree of pupilary dialation - but yes, they do dialate. Have never knowticed teeth grinding, oral fixations or stuffed animals. Yes, light sticks are VERY popular!
did hear some years ago that cronic use can cause hydrocephaly(sp?), but have been unable to confirm that. this may have been a local situation related to contamination of the drug w/ industrial chemicals used for manufacture. Anyone know?
most ER visits related to this drug are from bad formulations. Organizations like dancesafe were for a time offering free, anonymous, qualitative testing in order to prevent poisonings. Unfortunantly both the US and UK governments have cracked down on this practice.
other signs that someone might be involved with this scene are temporary or permanent hearing loss and a change in clothing choice as well as developing a liking for very loud techno music.
users have described the day after as "feeling like the dow chemical factory"...
tactile scences and certain other "desires" are also enhanced, or so I have been told by users, so additional medical complications may include unwanted pregnancies and STD's.
you're right about the seratonin...
Ann Emerg Med 1998 Sep;32(3 Pt 1):377-80
Death by "ecstasy": the serotonin syndrome?
Mueller PD, Korey WS
University of Florida, Gainesville, USA.
"Ecstasy" or 3,4-methylenedioxymethamphetamine (MDMA) is a popular
drug of abuse and is generally regarded as safe by
the lay public. There are an increasing number of reports of
MDMA-induced toxicity that exhibit features of the serotonin
syndrome. We report a case of severe hyperthermia, altered mental
status, and autonomic dysfunction after a single
recreational ingestion of MDMA.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
FASEB J 1997 Feb;11(2):141-6
The abused drug MDMA (Ecstasy) induces programmed death of human
serotonergic cells.
Simantov R, Tauber M
Department of Molecular Genetics, Weizmann Institute of Science,
Rehovot, Israel.
The widely abused amphetamine analog 3,4-methylenedioxymethamphetamine
(MDMA, also called "ecstasy") induces
hallucination and psychostimulation, as well as long-term
neuropsychiatric behaviors such as panic and psychosis. In rodents
and monkeys, MDMA is cytotoxic to serotonergic neurons, but this is
less clear with humans. Herein, MDMA was cytotoxic
to human serotonergic JAR cells; it altered the cell cycle, increased
G2/M phase arrest, and induced DNA fragmentation in a
cycloheximide-sensitive way. This apoptosis was not observed in
nonserotonergic human NMB cells. The stereospecific effect
of amphetamines in JAR cells, and the key role of NO and dopamine in
MDMA-induced apoptosis were determined. The
relevancy of MDMA-induced cell death to drug users is discussed.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Addiction 1994 May;89(5):539-51
3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy"):
pharmacology and toxicology in animals and humans.
Steele TD, McCann UD, Ricaurte GA
Department of Neurology, Johns Hopkins University School of Medicine,
Baltimore, MD.
(+/-)3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy"), a
ring-substituted amphetamine derivative first synthesized in
1914, has emerged as a popular recreational drug of abuse over the
last decade. Pharmacological studies indicate that MDMA
produces a mixture of central stimulant and psychedelic effects, many
of which appear to be mediated by brain monoamines,
particularly serotonin and dopamine. In addition to its pharmacologic
actions, MDMA has been found to possess toxic activity
toward brain serotonin neurones. Serotonergic neurotoxicity after MDMA
has been demonstrated in a variety of experimental
animals (including non-human primates). In monkeys, the neurotoxic
dose of MDMA closely approaches that used by humans.
While the possibility that MDMA is also neurotoxic in humans is under
investigation, other adverse effects of MDMA in
humans have been documented, including various systemic complications
and a number of untoward neuropsychiatric sequelae.
Notably, many of the adverse neuropsychiatric consequences noted after
MDMA involve behavioral domains putatively
influenced by brain serotonin (e.g., mood, cognition and anxiety).
Given the restricted status of MDMA use, retrospective
clinical observations from suspecting clinicians will probably
continue to be a primary source of information regarding MDMA's
effects in humans. As such, this article is intended to familiarize
the reader with the behavioral pharmacology and toxicology of
MDMA, with the hope that improved recognition of MDMA-related
syndromes will provide insight into the function of
serotonin in the human brain, in health as well as disease.
I got the info from one of the anesthesia and analgesia reviews at the hospital. I'll see if I can find it when I get back to work. It seems that the gist of the article referred to repeated use of the drug. A one time exposure probably wouldn't cause the damage referred to. We are starting to see a slight upswing in usage.
Jag
Tangent,
Ive seen 4 deaths in the last 5 years (large urban ED) from Ecstasy - 3 from hyperthermia and 1 from water intoxication. Its not a safe drug - safer than alcohol perhaps :) , but not a safe drug. As for the stuff about long term serotonin depletion in humans - nobody knows for sure - it hasnt been around for long enough - but the probablilities are high that there will be a large number of very depressed middle aged ex-dance clubbers.
cheers
Craig (who as luck would have it, has a subspeciality interest in toxicology)
Sorry, also ment to say the drug testing (at raves) is abit of waste of time - only ever confirmed the presence of MDMA - gave no indication as to concentration, the the presence or absence of other similar agents, different drugs or the bases the drug was made up in. IMO they offer a false sense of security, while providing no really useful information - I dont see they have a role. I have no moral objection to dance drugs - but let the buyer beware - there is no role for this sort of testing.
Craig
I'd call that 3 deaths by hypothermia and one by dehydration. That you went out without appropriate clothing happens all the time. People die here, during summer in the desert even!, due to hypothermia.
dehydration - the person didn't bring or was stupid enough not to drink enough water. happens any time you get enough people (heat) dancing (sweating).
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WHOA!: edit! - you said water intoxication, not dehydration... DANG! - that's hard to do! Don't you have to drink an incredible amount of water, like 30 liters in order to die from it??? Still sounds like it could have been DMX (see below)
btw: admin issue - one of the few things I don't like about this new board (old board had the same issue) is the inability to scroll down and refer to what you are replying to. Suppose you could open 2 windows, though that artificially increases the read count.
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in both cases, extacy may have been a contributing cause, but no worse that ETOH or just endorphins kicking in and having too good of a time...
by the same token, you want to talk about a REALLY dangerous drug? - SUGAR! get a kid hyped up on it, add a skate board or a bicycle and we're looking for major trauma! - we should defiantly ban sugar! OK - I'm being sarcastic, but it's to make a point.
OK - the extacy may have, and probably did contribute to the poor judgment that got these people in trouble. I don't see how you could possibly say it was the "cause" of their demise any more than you could list "candy bar" as the cause of death of a 12 year old that got into trouble on his bicycle.
As to testing - didn't know they did it at raves. The testing I was referring to was gas chromatography. hmm... looks like they are still in business - thought they had been shut down.
looks like they are involved w/ at rave testing too (now)...
http://www.dancesafe.org/documents/druginfo/labtesting.php
http://www.dancesafe.org/labtesting/
rather interesting site... and not exactly trying to promote extacy use either:
"These six pills are just a few that highlight the incredible danger of an unregulated, illicit ecstasy market."
hmmm... this might explain at least one of your deaths:
"Adulterant screening or "pill testing" is an important harm reduction service for Ecstasy users. Many tablets sold on the illicit market as "ecstasy" actually contain substances far more dangerous than MDMA (real ecstasy). In the Spring of this year, for example, three young people died in Chicago after ingesting tablets they thought contained ecstasy, but actually contained PMA, a powerful stimulant that is cheaper and easier to manufacture than ecstasy but far more dangerous. PMA has been responsible for six deaths in Australia and many more in Europe and England.
In the summer of 1999 we discovered that tablets containing high doses of DXM were causing the majority of medical emergencies in the Oakland rave community, as well in many other cities across the US. DXM is a legal cough suppressant that in high doses can prevent sweating. Our laboratory analysis program, along with our onsite pill testing program, allowed us to correlate most of these cases of heat stroke to DXM pills, and we were thus able to warn users about this increased risk."
are you sure it was MDMA?
And it looks like this is how they got around the testing ban:
"The United States DEA currently forbids quantitative anonymous testing. The lab is not allowed to test for the number of milligrams in each pill. They are only allowed to identify what ingredients are in the pill (but not how much). Pills with more than one active ingredient will have their ingredients listed in order of relative amount, with the dominant ingredient listed first.
All tests are performed using gas chromatography (GCMS). The laboratory is able to identify the presence of MDMA, MDA, MDE, MBDB, MDOH, PCP, amphetamine, methamphetamine, ketamine, 2-CB, DOB, 4-MTA, caffeine, ephedrine, dextromethorphan (DXM) and just about every other known drug."
Tangent - Hyperthermia (not hypo) - its an idiosynchratic reaction to the drug, not the dancing. The water intoxic is due to excessive fluid intake (and the threshold for it seems to be much less than in people who havent taken the drug. These were deaths directly related to the use of ecstasy
Local drug testing here (and in the UK), at raves, has not been spec, it has been colour change chemical tests identifying MDMA.
As I say, I dont care about use, but it is a dangerous drug.
I treat people who have taken a variety of these drugs every week. Please dont tell me Im imagining the problem. Ecstasy and its use has significant problems
cheers
Craig
agree that it has significant problems. this has been an interesting thread - it certainly has revised my opinion on how safe MDMA is. thanks!
btw: I think the "harm reduction" (testing) and educational programs about real dangers are great! If you tell kids DON'T and don't tell them why or give them a lot of obvious propiganda (like the DARE program does), it just makes them more querious and they don't believe you.
Hi, let me introduce myself, i am Roy and i am a techie that helps to run this forum/site. I have zero knowledge of medicine but i use XTC from time to time and felt the need to respond.
Too much of anything is bad for you, same goes for XTC (MDMA/MDA). Here in the Netherlands XTC usage is common, not so strange for the worlds biggest XTC exporting country. Any deaths relating to XTC were caused by dehydration or chemicals other then MDMA/MDA, like PMA. I know a lot of people that have been using it for years without any side effects, no depressions or other physical/psychological effects.
There is no physical addiction and i do not know anyone that is addicted psychologically.
The average XTC pill in the netherlands contains 75-100 mg of MDMA, taking 2 or more pills, depending on your weight and size, does make you grind your teeth and dialates the eyes. Stuffed animals i have never seen, but light sticks rule! (where does this info come from heh)
Drug testing is common and can be done with self tests which only identify a few chemicals and do not tell you the exact quantities. Detailed drug testing can be done at numerous drug testing centres found in every major city.
These are my experiences, as with any drug i think it is important that people learn how to deal with it instead of the government prohibiting it. Its here and it wont go away.
Roy
Roy,
As I said to Tangent, I have no problems with E or similar drugs. I also think risk minimisation with education is the way to go, and that banning it is a waste of everyones time. I also think that alcohol is a far more dangerous drug to the individual and to society. BUT I do find the constant theme that its the safest drug on the planet a little annoying. It is a relatively safe drug. But I dont think the number of deaths that have been clearly linked (ie. only MDMA on their tox screen) can be ignored. Talk to any ED doctor - we are seeing these people with relative frequency - as I say 4 in the last couple of years - the argument that its not the drug but the dancing is also rubbish - the hyperthermic reactions seen have also occured with no associated exercise - although Im sure the exercise contributes in many, and cerebral oedema attributed to water intoxication with only a two or three litres of water - MDMA is intimately involved.
As for long term serotonin depletion - no one knows for sure -but animal and post-mortum studies have shown significantly reduced serotonin levels in the brains of frequent users and animal models. We definitely know that serotonin is vital for mood and people who are depressed have low serotonin, and that serotonin falls naturally with age. So the very real concern is that natural decline with aging, combined with the depletion associated with using MDMA will result is early onset, severe depression in certain people. No one knows how big a problem this will be - but it is irresponsible to dismiss the risk.
The whole central nervous regulation of mood is very complex and serotonin plays a vital role - I feel very uncomfortable manipulating a system we dont fully understand with frequent use of drugs such as E.
As I say, Im certainly not blasting dance drugs here, Im very pro-choice, but much effort has gone into the smoke screen that E is a safe drug - and although safer that alcohol - it still causes many hospital admissions and the odd death.
Craig (who regularly provides medical cover at large raves)
Craig,
I agree with you. E is like any other drug and should be used with care if at all.
Some people are willing to take the risk and others are not.
Roy
I went back and checked the resource, as you would know it has left the department but I did manage to find out that it was from "neurology" not sure what issue,vol. etc.
I think the verdict is still out on MDMA and we will not see patterns emerge for a few years. I don't use any chemical enhancement other than my morning coffee. At my age my brains are scrambled enuf. I would be concerned if my daughter was using this stuff however and would try and dissuade her.
Jag
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