Ecstasy Use Among College Students

EcstasyEcstasy

Brian WellsBrian WellsUniversity of FloridaUniversity of FloridaOctober 8th, 2003October 8th, 2003

What is Ecstasy?What is Ecstasy?

Stimulant and mild hallucinogenStimulant and mild hallucinogen 3,4 – metheylenedioxymethamphetamine 3,4 – metheylenedioxymethamphetamine

(aka MDMA, Ecstasy, Hug Drug, Feel (aka MDMA, Ecstasy, Hug Drug, Feel Good Drug, Adam, XTC, etc.)Good Drug, Adam, XTC, etc.)

Source: http://www.usdoj.gov/dea/concern/mdma/mdma020700.htm

Types of EcstasyTypes of Ecstasy

History of EcstasyHistory of Ecstasy

Discovered in Germany in 1913 and Discovered in Germany in 1913 and patented by Merck in 1914.patented by Merck in 1914.

Myth that is was intended as an anorectic Myth that is was intended as an anorectic drug – never marketed due to side-effectsdrug – never marketed due to side-effects

1950s - U.S. Army studied it as a potential 1950s - U.S. Army studied it as a potential chemical warfare agent that would chemical warfare agent that would temporarily disable enemy troops.temporarily disable enemy troops.

Found an interest among psychiatrists in Found an interest among psychiatrists in 1970s1970s

History of EcstasyHistory of Ecstasy

Early 1980s - MDMA got a new Early 1980s - MDMA got a new nickname, Ecstasy (also XTC, E, the nickname, Ecstasy (also XTC, E, the Hug Drug, others)Hug Drug, others)

Production of MDMA in clandestine Production of MDMA in clandestine laboratories, increasing use among laboratories, increasing use among adolescents prompted emergency adolescents prompted emergency scheduling of MDMA into C1 of the scheduling of MDMA into C1 of the CSA in 1985.CSA in 1985.

The Ecstasy ProblemThe Ecstasy Problem

MDMA has no approved use in the U.S.MDMA has no approved use in the U.S. Despite the Schedule 1 classification, Despite the Schedule 1 classification,

MDMA continues to be used illegally.MDMA continues to be used illegally. MDMA is now being used increasingly MDMA is now being used increasingly

in both urban and suburban populationsin both urban and suburban populations Many young people believe Ecstasy is Many young people believe Ecstasy is

safe and offers nothing more than a safe and offers nothing more than a pleasant highpleasant high

Source: MDMA/Ecstasy Research: Advances, Challenges, Future Directions A Scientific Conference - http://www.drugabuse.gov/NIDA_Notes/NNVol16N5/Conference.html

The Ecstasy ProblemThe Ecstasy Problem Most MDMA manufactured in Western Europe Most MDMA manufactured in Western Europe

(Netherlands and Belgium => 80%)(Netherlands and Belgium => 80%) Majority of MDMA produced in other countries Majority of MDMA produced in other countries

is trafficked to US by Israeli and Russian is trafficked to US by Israeli and Russian organized crimeorganized crime

All major airports in Europe act as shipping All major airports in Europe act as shipping points for MDMA destined for USpoints for MDMA destined for US

Major US Influx Gateways are Los Angeles, Major US Influx Gateways are Los Angeles, Miami, and New YorkMiami, and New York

USCS seized 3.5M tablets in 1999 and 9.3M in USCS seized 3.5M tablets in 1999 and 9.3M in 20002000

Source: MDMA. http://www.whitehousedrugpolicy.gov/publications/factsht/mdma/


Is it really Ecstasy?Is it really Ecstasy? A November 2000 study appearing in JAMA A November 2000 study appearing in JAMA

found that:found that: 63% contained MDMA or analogue63% contained MDMA or analogue 29% contained identifiable drugs but no MDMA 29% contained identifiable drugs but no MDMA

or analogueor analogue Most common drug found (other than MDMA) Most common drug found (other than MDMA)

was DXM – 21%was DXM – 21% Other drugs found were caffeine, ephedrine, Other drugs found were caffeine, ephedrine,

pseudoephedrine, and salicylates. pseudoephedrine, and salicylates. 8% contained no identifiable drug.8% contained no identifiable drug.

Source: Jones, Reese T. et al. Chemical Analysis of Ecstasy Pills. JAMA, November 1, 2000; Vol 284, No. 17.


News story from FloridaNews story from Florida Pills being sold in central Florida were PMA and Pills being sold in central Florida were PMA and

PMMAPMMA PMA causes user to overheat, become confused, PMA causes user to overheat, become confused,

hallucinate, and finally collapse (body hallucinate, and finally collapse (body temperature as high as 108 degrees F).temperature as high as 108 degrees F).

Six people in Florida died from using Six people in Florida died from using counterfeit pillscounterfeit pills

PMA easier and cheaper to makePMA easier and cheaper to make ““It’s like Russian roulette…If you get these PMA It’s like Russian roulette…If you get these PMA

pills and take them, there is a chance you will pills and take them, there is a chance you will die.” – Bruce Goldberger, forensic toxicologist die.” – Bruce Goldberger, forensic toxicologist at UF.at UF.

Source: Killer Club Drug. http://abcnews.go.com/sections/us/DailyNews/ecstasy000929.html


Ecstasy: Chemistry, Ecstasy: Chemistry, Symptoms, and Other Fun Symptoms, and Other Fun

TopicsTopics

How does it work?How does it work?

ChemistryChemistry Structurally similar to amphetamine, Structurally similar to amphetamine,

methamphetamine, and mescalinemethamphetamine, and mescaline Two stereoisomersTwo stereoisomers Most activity associated with (S)-(+)-MDMAMost activity associated with (S)-(+)-MDMA

Source: Fallon, J.K. et al. Stereospecific Analysis and Enantiomeric Disposition of 3,4-Methlyenedioxymethamphetamine in Humans. Clinical Chemistry, 1999. 45, 1058 – 1069.


ChemistryChemistry Metabolism of MDMA results in formation Metabolism of MDMA results in formation

of MDA by N-demethylation and HHMA of MDA by N-demethylation and HHMA (major) by O-demethylation(major) by O-demethylation

Metabolites generate free radicals Metabolites generate free radicals (oxidative stress and membrane damage)(oxidative stress and membrane damage)

MDMA inhibits tryptophan hydroxylase MDMA inhibits tryptophan hydroxylase (rate-limiting enzyme in the pathway of 5-(rate-limiting enzyme in the pathway of 5-HT synthesis) – irreversible reactionHT synthesis) – irreversible reactionSource: 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.


MDMA increases the activity of three MDMA increases the activity of three neurotransmittersneurotransmitters Serotonin (5-HT)Serotonin (5-HT) Dopamine (DA)Dopamine (DA) Norepinepherine (NE)Norepinepherine (NE)

High affinity for 5-HT receptorHigh affinity for 5-HT receptor Binds with less affinity to DA and NE Binds with less affinity to DA and NE

receptorsreceptors

Source: Lyles, Johnalyn, et al. MDMA neurotoxicity: cellular and molecular mechanisms. Brain Research Reviews, 2003. 42, pg 155 – 168.

What are the symptoms What are the symptoms associated with its use?associated with its use?

What are some of the What are some of the symptoms associated with symptoms associated with

its use?its use? Effects last 4 to 6 hours and include:Effects last 4 to 6 hours and include:

EuphoriaEuphoria Peaceful, emotional feelingsPeaceful, emotional feelings Feelings of increased closeness to Feelings of increased closeness to

othersothers Heightened sensory awarenessHeightened sensory awareness


Physical Physical Muscle tensionMuscle tension Involuntary teeth Involuntary teeth

clenchingclenching NauseaNausea Blurred VisionBlurred Vision FaintnessFaintness Chills or SweatingChills or Sweating Rash similar to Rash similar to

acne with acne with associated liver associated liver damage in some damage in some individualsindividuals

HypertensionHypertension HyperthermiaHyperthermia HyperexcitabilityHyperexcitability TachycardiaTachycardia Myocardia IschemiaMyocardia Ischemia Elevated anti-diuretic Elevated anti-diuretic

hormone levelshormone levels AtaxiaAtaxia NystagmusNystagmus Cerebral hemorrhageCerebral hemorrhage

Source: Shannon M. Methylenedioxymethamphetamine. Pediatric Emerg Care 2000; 16:377-380


Ecstasy is neurotoxicEcstasy is neurotoxic High doses can cause malignant High doses can cause malignant

hyperthermia leading to hyperthermia leading to muscle breakdownmuscle breakdown kidney and cardiovascular system kidney and cardiovascular system

failure.failure.


PsychologicalPsychological Euphoria and ClosenessEuphoria and Closeness ConfusionConfusion DepressionDepression Sleep ProblemsSleep Problems Drug CravingsDrug Cravings Severe AnxietySevere Anxiety ParanoiaParanoia

Can be during or sometimes weeks after Can be during or sometimes weeks after taking Ecstasytaking Ecstasy


ToleranceTolerance Evidence from lab animal studies Evidence from lab animal studies

suggest tolerance with repeated usesuggest tolerance with repeated use Not known as a physiologically Not known as a physiologically

addictive substanceaddictive substance


PET ScanPET Scan

Usage TrendsUsage Trends

What about among College What about among College Students?Students?

Harvard College Alcohol study showed thatHarvard College Alcohol study showed that 1997 – 2.8% of college students used ecstasy1997 – 2.8% of college students used ecstasy 1999 – 4.7% used ecstasy1999 – 4.7% used ecstasy Increase of 68% in two yearsIncrease of 68% in two years

Factors more common is ecstasy users Factors more common is ecstasy users than other studentsthan other students Binge drinkingBinge drinking Increased number of sexual partnersIncreased number of sexual partners SmokingSmoking Rating arts and parties as more important than Rating arts and parties as more important than

academic pursuits. academic pursuits.

What about among College What about among College Students?Students?

What can we do about these What can we do about these Trends?Trends?

Target specific audiencesTarget specific audiences Each group of people is driven by unique Each group of people is driven by unique

motivationsmotivations 2001 article in JAMA – “Ecstasy Experts 2001 article in JAMA – “Ecstasy Experts

Want Realistic Messages”Want Realistic Messages” NIDA’s prevention campaign relies on NIDA’s prevention campaign relies on

“scare tactics”“scare tactics” Social science researchers say that “blunt Social science researchers say that “blunt

prevention messages fail to reduce Ecstasy prevention messages fail to reduce Ecstasy use” and advocate less extreme campaigns use” and advocate less extreme campaigns that users can identify with.that users can identify with.


LegislationLegislation Ecstasy Anti-Proliferation Act of 2000Ecstasy Anti-Proliferation Act of 2000

Effective May 1, 2001Effective May 1, 2001 Increased sentencing guidelines for ecstasy Increased sentencing guidelines for ecstasy

traffickingtrafficking Mainly targets upper-middle-level Mainly targets upper-middle-level

distributorsdistributors

Source: MDMA. http://www.whitehousedrugpolicy.gov/publications/factsht/mdma/


LegislationLegislation Ecstasy Awareness Act of 2003Ecstasy Awareness Act of 2003

HR 2962 of 108HR 2962 of 108thth Congress (1 Congress (1stst Session) Session) Introduced by Rep. Pascrell, Rep. Terry, Rep. Pallone, Introduced by Rep. Pascrell, Rep. Terry, Rep. Pallone,

Rep. Etheridge, and Rep. CapuanoRep. Etheridge, and Rep. Capuano Referred to Committee on Energy and Commerce, Referred to Committee on Energy and Commerce,

Committee on the Judiciary, and Subcommittee on Committee on the Judiciary, and Subcommittee on Crime, Terrorism, and Homeland Security Crime, Terrorism, and Homeland Security

Amends section 416 of CSA (21 U.S.C. 856) Amends section 416 of CSA (21 U.S.C. 856) `(c) Whoever profits monetarily from a rave or similar `(c) Whoever profits monetarily from a rave or similar

electronic dance event, knowing or having reason to electronic dance event, knowing or having reason to know that the unlawful use or distribution of a know that the unlawful use or distribution of a controlled substance occurs at the rave or similar controlled substance occurs at the rave or similar event, shall be fined not more than $500,000 or event, shall be fined not more than $500,000 or imprisoned not more than 20 years, or both. If the imprisoned not more than 20 years, or both. If the defendant is an organization, the fine imposable for defendant is an organization, the fine imposable for the offense is not more than $2,000,000.'.the offense is not more than $2,000,000.'.Source: Library of Congress. http://thomas.loc.gov


LegislationLegislation Reducing Americans' Vulnerability to Ecstasy Reducing Americans' Vulnerability to Ecstasy

Act of 2003 (RAVE Act)Act of 2003 (RAVE Act) HR 718 of 108HR 718 of 108thth Congress (1 Congress (1stst Session) Session) Introduced by Rep. Coble and Rep. Smith (TX)Introduced by Rep. Coble and Rep. Smith (TX) Companion bill to S. 226, the Illicit Drug Anti-Companion bill to S. 226, the Illicit Drug Anti-

Proliferation Act, introduced by Sen. BidenProliferation Act, introduced by Sen. Biden Referred to the Subcommittee on Crime, Terrorism, Referred to the Subcommittee on Crime, Terrorism,

and Homeland Security and Homeland Security Purpose is to prohibit an individual from knowingly Purpose is to prohibit an individual from knowingly

opening, maintaining, managing, controlling, renting, opening, maintaining, managing, controlling, renting, leasing, making available for use, or profiting from leasing, making available for use, or profiting from any place for the purpose of manufacturing, any place for the purpose of manufacturing, distributing, or using any controlled substance, and distributing, or using any controlled substance, and for other purposes. for other purposes.


LegislationLegislation Communities Combating College Drinking and Communities Combating College Drinking and

Drug Use Act Drug Use Act S. 406 of 108S. 406 of 108thth Congress (1 Congress (1stst Session) Session) Introduced by Sen. Dewine and Sen. LiebermanIntroduced by Sen. Dewine and Sen. Lieberman Referred to the Committee on Health, Education, Labor, Referred to the Committee on Health, Education, Labor,

and Pensions and Pensions The purpose of this Act is to encourage States, The purpose of this Act is to encourage States,

institutions of higher education, local communities, institutions of higher education, local communities, nonprofit groups, including community anti-drug or anti-nonprofit groups, including community anti-drug or anti-alcohol coalitions, and other substance abuse groups alcohol coalitions, and other substance abuse groups within the State to enhance existing or, where none within the State to enhance existing or, where none exist, to establish new statewide coalitions to reduce the exist, to establish new statewide coalitions to reduce the usage of drugs and alcohol by college students both on usage of drugs and alcohol by college students both on campus and in the surrounding community at large. campus and in the surrounding community at large.

Interesting Facts and Interesting Facts and StudiesStudies

Mental Health Weekly had an article Mental Health Weekly had an article suggesting that prior Ritalin or Ecstasy use may suggesting that prior Ritalin or Ecstasy use may increase sensitivity to cocaine.increase sensitivity to cocaine. High doses of Ritalin were usedHigh doses of Ritalin were used

An article in Neurotoxicology and Teratology An article in Neurotoxicology and Teratology showed that Ecstasy exposed rat pups had a showed that Ecstasy exposed rat pups had a 502% increase in the number of DA neuron 502% increase in the number of DA neuron fibers in the frontal cortex compared with fibers in the frontal cortex compared with control.control. Possible that Ecstasy may affect the fetus during Possible that Ecstasy may affect the fetus during

pregnancypregnancy Differences seen only in male pups but why?Differences seen only in male pups but why?

Questions?Questions?

Sources for Additional Sources for Additional InformationInformation

MDMA/Ecstasy Research: Advances, MDMA/Ecstasy Research: Advances, Challenges, Future DirectionsChallenges, Future DirectionsA Scientific Conference - A Scientific Conference - http://www.drugabuse.gov/Meetings/MDMA/MDMAExSummary.html