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21st Century Street Drugs: Ecstatic? NOT!
By Yick Moon Lee, M.D.
(presented at the CAMS 2005 Annual Scientific Meeting)
3,4-Methylenedioxymethamphetamine (MDMA), popularly known
as "Ecstasy" is an illicit drug of abuse that has undergone an explosive
expansion in use in the past decade. It is a "mood elevator" that produces a
relaxed, euphoric state and no hallucinations. MDMA is often used in clubs and
sold as a tablet with many different possible brand names encraved on it. A
standard oral dose of MDMA is between 80-150mg and the price ranged from $10 to
$250. Black market "Ecstasy" tablets often contain other drugs like ephedrine,
caffeine and dextromethorphan. Before it was made illegal in 1985, MDMA
"Penicillin for the soul" was used by psychiatrists as a therapeutic tool.
Once considered a "Safe" drug, on the contrary it has many acute and chronic
toxicities. Mild acute toxic effects include nausea, emesis, anxiety and
palpitations. Severe acute toxic effects include heart/liver/kidney failure,
hyperthermia, hyponatremia, hypoglycemia and bruxism. Chronically, it may
cause cognitive and memory impairments, neurodegenerative effects and severe
depression. An additional unique adverse effect associated with the use of
MDMA is SIADH and symptomatic hyponatremia. These chronic effects were based on
studies with animals e.g. rats and monkeys and their applications to human
beings remain controversial.
MDMA can affect the brain by increasing the activity of three neurotransmitters:
serotonin, dopamine and norepinephrine. Unlike other drugs of abuse, MDMA
causes greater serotonin release and we know serotonin is involved with
regulating mood and emotion. Depression may be due to serotonin depletion and
down regulation of its receptors. MDMA causes neurotoxicities in laboratory
animals, propably due to the break down of dopamine within serotonin axons
(Sprague, Everman and Nichols et. al. 1998). Prozac with its greater affinity
to bind onto the serotonin reuptake transporters appears to prevent
neurotoxicities.
In April 30, 2003, President Bush signed the RAVE ACT which is a federal law
making it a felony to organize an event or operate any type of space where
illicit drug activities would take place. Though the MDMA usage has decreased
in recent years its popularity is still on the rise among our young Americans.
Clearly, education and more research is needed to eradicate ECSTASY.
Dr. Lee is Director of Inpatient Unit, Beth Israel Medical Center
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