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CORK Bibliography: Ecstasy

74 citations. October 2007 to present

Prepared: September 2008

Alati R; Kinner SA; Hayatbakhsh MR; Al Mamun A; Najman JM; Williams GA. Pathways to ecstasy use in young adults: Anxiety depression or behavioural deviance? Drug and Alcohol Dependence 92(1/3): 108-115, 2008. (38 refs.)

Aims: To investigate pathways to ecstasy use disorders from pre-birth to early adulthood with particular attention to the relationship between early depressive and anxiety symptoms and later ecstasy use disorders. Design: Prospective, longitudinal, population-based study started in Brisbane, South East Queensland (Australia) in 1981. Participants were 2143 young adults, followed up from pre-birth to young adulthood. Measurements: Ecstasy use disorders were assessed with the composite international diagnostic interview (CIDI-Auto). Maternal socio-economic position and mental health status were assessed at baseline (antenatal visit); maternal substance use was measured at the 5-year follow-up, adolescents' behaviour at the 5- and 14-year follow-up and tobacco and alcohol use were assessed at the 14-year follow-up. Findings: Eight syndrome scales of childhood behaviour were examined. After adjustment for important confounders, delinquent and aggressive behaviour in early adolescence remained significantly associated with ecstasy use disorders in early adulthood. The associations became statistically non-significant when adolescent tobacco and alcohol use were included in the model [OR = 1.50 (95% CI = 0.75, 3.01) for delinquency and OR = 1.69 (95% CI = 0.92, 3.12) for aggression]. Formal mediation tests were statistically significant (p = 0.001 for delinquent behaviour and p = 0.05 for aggressive behaviour). Conclusions: Our findings suggest a pathway from early deviant behaviour to ecstasy use disorders, possibly mediated through licit drug experimentation in early adolescence.

Archer T. Ecstasy toxicity and the cooling factor. Emergency Medicine Journal 25(8): 534-534, 2008. (6 refs.)

Ben Abdallah A; Scheier LM; Inciardi JA; Copeland J; Cottler LB. A psycho-economic model of ecstasy consumption and related consequences: A multi-site study with community samples. (review). Substance Use & Misuse 42(11): 1651-1684, 2007. (101 refs.)

Becker and Murphy's (1988) theory of rational behavior suggests that economic factors play an influential role in the decision leading to drug consumption and possibly dependence. Psychological models, on the other hand, emphasize internal regulatory cues that motivate drug use and play a contributory role in dependence. Until now, the confluence of both economic and psychological models has not been tested empirically. The present study used latent-variable structural equation modeling (SEM) to examine the influence of both economic (social anomie, unit price, and time spent acquiring drugs) and psychological risk factors (motivation, depression, and sexual risk behaviors) on self-reported ecstasy use. Data were obtained from 612 recreational ecstasy users in the United States and Australia participating in a NIDA-funded epidemiological study examining trends in ecstasy use. The sample was mainly white (61%), male (58%), and young (mean age = 23 yrs [5.25]). All of the hypothesized latent constructs were statistically reliable and correlated in the expected direction. A saturated SEM indicated that monetary and opportunity cost, but not income, significantly predicted ecstasy use. Among the psychological measures, motivational cues were the strongest predictor of both use and dependence. Inclusion of gender, age, race, education, and site variables did not appreciably alter the final model parameters. The implications of incorporating the role of economic factors in shaping a more refined understanding of addiction are discussed. Suggestions for future research and study limitations are also noted.

Brand HS; Dun SN; Amerongen AVN. Ecstasy (MDMA) and oral health. British Dental Journal 204(2): 77-81, 2008. (46 refs.)

3,4-methylenedioxymethamphetamine (MDMA), more commonly known as 'ecstasy' or XTC, is frequently used by young adults in the major cities. Therefore, it is likely that dentists might be confronted with individuals who use ecstasy. This review describes systemic and oral effects of ecstasy. Life-threatening complications include hyperthermia, hyponatraemia and liver failure. In addition, psychotic episodes, depression, panic disorders and impulsive behaviour have been reported. Oral effects include xerostomia, bruxism, and an increased risk of developing dental erosion. Mucosal changes have also been reported. Recent use of ecstasy may interfere with dental treatment. Finally, the potential use of saliva for non-invasive detection of ecstasy is discussed.

Brown J; Edwards M; McKone E; Ward J. A long-term ecstasy-related change in visual perception. Psychopharmacology 193(3): 437-446, 2007. (53 refs.)

Rationale The present study provides the first evidence of the long-term consequences of ecstasy use on visual processes thought to reflect serotonergic functions in the occipital lobe. Methylenedioxymethamphetamine ("ecstasy") is known to cause lasting changes to the serotonin system in animals, and convergent evidence suggests that similar changes occur in human ecstasy users. Other research suggests that serotonin may be involved in lateral inhibition between orientation sensitive neurons in the occipital lobe, and that disruption to the serotonin system causes an increase in the magnitude of the tilt aftereffect illusion that is known depend on those neurons. Objectives The aim of the present study was to determine if ecstasy users have detectable changes in occipital lobe behavioural functioning, as revealed by the tilt aftereffect illusion. Materials and methods Thirty ecstasy users and 34 non-drug using controls were compared on the magnitude of the tilt aftereffect illusion following adaptation to stimuli oriented at 15 and 40 degrees from vertical. Results Ecstasy users who had not used amphetamines for 115 days or more had a larger average tilt aftereffect than non-drug using controls after adaptation to 40 degrees stimuli but not after adaptation to 15 degrees stimuli. Additionally, there was no difference between non-drug using controls and ecstasy users who had used amphetamines within the last 61 days at either adaptation angle. Conclusions: The results were consistent with the proposal that ecstasy-related damage to the serotonin system causes behavioural changes on tests of visual perception processes that are thought to reflect serotonergic functions in the occipital lobe.

Brown SD; Rhodes DJ; Pritchard BJ. A validated SPME-GC-MS method for simultaneous quantification of club drugs in human urine. Forensic Science International 171(2/3, special issue): 142-150, 2007. (29 refs.)

A solid-phase microextraction-gas chromatographic-mass spectrometric (SPME-GC-MS) method has been developed and validated for measuring four club drugs in human urine. These drugs include gamma-hydroxybutyrate (GHB), ketamine (KET), methamphetamine (MAMP), and methylenedioxyrnethamphetamine (MDMA). These drugs are referred to as 'club drugs' because of their prevalence at parties and raves. Deuterium labeled internal standards for each of the four drugs was included in the assay to aid in quantitation. The drugs were spiked into human urine and derivatized using pyridine and hexylchloroformate to make them suitable for GC-MS analysis. The SPME conditions of extraction time/temperature and desorption time/temperature were optimized to yield the highest peak area for each of the four drugs. The final SPME parameters included a 90 degrees C extraction for 20 min with a I min desorption in the GC injector at 225 degrees C using a splitless injection. All SPME work was done using a 100 mu m PDMS fiber by Supelco. The ratio of pyridine to hexylchloroformate for derivatization was also optimized. The GC separation was carried out on a VF-5ht column by Varian (30 m, 0.25 mm i.d., 0.10 mu m film thickness) using a temperature program of 150-270 degrees C at 10 degrees C/min. The instrument used was a ThermoFinnigan Trace GC-Polaris Q interfaced with a LEAP CombiPal autosampler. The data was collected by using extracted ion chromatograms of marker m/z values for each drug from the total ion chromatograms (TIC) (full scan mode). Calibration curves with R-2 > 0.99 were generated each day using the peak area ratios (peak area drug/peak area internal standard) versus concentration. The validated method resulted in intra-day and inter-day precision (% R. S.D.) of less than 15% and a % error of less than 15% for four concentrations in the range of 0.05-20 mu g/mL (MAMP) and 0.10-20 mu g/mL (GHB, KET, and MDMA). This method has the advantage of an easy sample preparation with acceptable accuracy and precision for the simultaneous quantification of these four drugs of abuse and shows no interference from the urine matrix.

Bruhn JG; El-Seedi HR; Stephanson N; Beck O; Shulgin AT. Ecstasy analogues found in cacti. Journal of Psychoactive Drugs 40(2): 219-222, 2008. (10 refs.)

Human interest in psychoactive phenethylamines is known from the use of mescaline-containing cacti and designer drugs such as Ecstasy. From the alkaloid composition of cacti we hypothesized that substances resembling Ecstasy might occur naturally. In this article we show that lophophine, homopiperonylamine and lobivine are new minor constituents of two cactus species, Lophophora williamsii (peyote) and Trichocereus pachanoi (San Pedro). This is the first report of putatively psychoactive phenethylamines besides mescaline in these cacti. A search for further biosynthetic analogues may provide new insights into the structure-activity relationships of mescaline. An intriguing question is whether the new natural compounds can be called "designer drugs."

Clatts MC; Giang LM; Goldsamt LA; Yi H. Male sex work and HIV risk among young heroin users in Hanoi, Vietnam. Sexual Health 4(4): 261-267, 2007. (25 refs.)

The present study describes complex drug and sexual risk in a group of male sex workers (n = 79) who were recruited in the context of a larger study of young heroin users in Hanoi, Vietnam (n = 1270). Male sex workers were significantly more likely than male non-sex workers to be migrants (P < 0.001) and to have unstable housing (P < 0.001), to have lifetime exposure to marijuana (P < 0.001), 3,4 methylenedioxymethamphetamine (MDMA, ecstasy) (P < 0.01), amphetamines (P < 0.05), cocaine (P < 0.01) and morphine (P < 0.001). Male sex workers are more likely to currently use MDMA (P < 0.05), amphetamines (P < 0.001), morphine (P < 0.05) and to 'smoke' as their most frequent mode of heroin administration (P < 0.01). Male sex workers are more likely to have both male and female concurrent sex partners (P < 0.001), to have a history of sexual victimisation (P < 0.001), to have had more than three different sex partners in the past 30 days (P < 0.001), and to have had partners who injected drugs before sex (P < 0.001) or who used drugs during sex (P < 0.01). In their last sexual encounter with a client partner, approximately one-third (31.1%) reported having had receptive anal sex. In nearly three-quarters of these exchanges (71.4%), no condom was used. Similarly, in their last sexual encounter with a client partner, 42.2% reported having had insertive anal sex and in nearly half (47.4%) of these encounters no condom was used. Consistent with recent data from elsewhere in the region, there is an urgent need for additional research on male sex work in South-east Asia in order to properly situate behavioural interventions for male sex workers in this region.

Cole JC; Goudie AJ; Field M; Loverseed AC; Charlton S; Sumnall HR. The effects of perceived quality on the behavioural economics of alcohol, amphetamine, cannabis, cocaine, and ecstasy purchases. Drug and Alcohol Dependence 94(1/3): 183-190, 2008. (32 refs.)

Previous research has indicated that non-dependent polydrug users are willing to pay more money to buy good quality drugs as their income increased. This study sought to examine whether altering the perceived quality of controlled drugs would affect drug purchases if the monetary price remained fixed. A random sample of 80 polydrug users were recruited. All participants were administered an anonymous questionnaire consisting of the Drug Abuse Screening Test for Adolescents (DAST-A), the Severity of Dependence Scale for cannabis (SDS), the,Alcohol Use Disorders Identification Test (AUDIT), the Hospital Anxiety and Depression Scale (HADS), and questions about their drug use. Participants then completed a simulation of controlled drug purchases where the price of alcohol, amphetamine, cannabis, cocaine, and ecstasy remained the same but their perceived quality changed (i.e. unit price increased as the perceived quality decreased). The demand for alcohol was quality inelastic and alcohol quality had no effects on the purchase of any other controlled drug. Demand for cannabis was quality elastic and alcohol substituted for cannabis as its unit price increased. Demand for cocaine was quality elastic and alcohol, cannabis, and ecstasy substituted for cocaine as its unit price increased. Demand for ecstasy was quality elastic and alcohol and cocaine both substituted for ecstasy as its unit price increased. These results suggest that perceived quality influences the demand for controlled drugs and that monitoring the perceived quality of controlled drugs may provide a warning of potential public health problems in the near future.

Concheiro M; Simoes SMD; Quintela O; de Castro A; Dias MJR; Cruz A; Lopez-Rivadulla M. Last LC-MS/MS method for the determination of amphetamine, methamphetamine, MDA, MDMA, MDEA, MBDB and PMA in urine. Forensic Science International 171(1): 44-51, 2007. (47 refs.)

A fast method was designed for the simultaneous determination of amphetamine (A), methamphetamine (MA), PMA, MDA, MDMA, MDEA and MBDB in urine. The drugs were analysed by LC (ESI)-MS/MS, after a simple liquid-liquid extraction in the presence of the deuterated analogues. Reverse phase separation on an Atlantis dC 18 Intelligent Speed column was achieved in less than 4 min under gradient conditions, and the total run time was 8 min. The method was fully validated, including linearity (1-1000 ng/mL for A, MDMA, MDEA and MBDB; 2-1000 ng/ mL for MDA and PMA; 1-200 ng/mL for MA; r(2) > 0.99 for all compounds), recovery (> 80%), within-day and between-day precision and accuracy (CV and MRE < 12.7% for intermediate level and ULOQ, and < 17.2% for LLOQ), limit of detection (0.2 ng/mL for MDMA, MDEA and MBDB; 0.5 ng/mL for A, MA and PMA; 1 ng/mL for MDA) and quantitation (1 ng/mL for A, MA, MDMA, MDEA and MBDB; 2 ng/mL for MDA and PMA) and relative ion intensities. No matrix effect was observed. The procedure proved to be sensitive, specific and rapid, and was applied to real forensic cases.

Deluca P; Schifano F; Psychonaut 2002 Research Group. Searching the internet for drug-related web sites: Analysis of online available information on ecstasy (MDMA). American Journal on Addictions 16(6): 479-483, 2007. (37 refs.)

Although the Internet is a growing source of information on MDMA/ecstasy, no studies so far have investigated the level and quality of ecstasy information available to the typical Web user. In the present study, 280 Web sites were identified and analyzed; 50.4% had an anti-drug approach, 16.2% a harm reduction approach, and 24.8% a pro-drug approach. MDMA pro-drug Web sites appeared significantly earlier in the search engines' results list than both anti-drug and harm reduction Web sites (F (3; 159) 3.288; p=.022). This study represents the first systematic analysis of information available online on ecstasy. Implications for further research are discussed.

Dew BJ; Elifson KW; Sterk CE. Treatment implications for young adult users of MDMA. Journal of Addictions & Offender Counseling 26(2): 84-98, 2006. (55 refs.)

Young adults' 3,4-methylenedyoxymethamphetamine (MDMA) use is a national public health concern. Although research on the epidemiology of MDMA use has increased, inquiry into intervention and treatment is needed. The authors examine results from an epidemiological investigation from a clinical perspective and provide suggestions for clinicians working with MDMA users.

Dresen S; Kempf J; Weinmann W. Prevalence of gamma-hydroxybutyrate (GHB) in serum samples of amphetamine, metamphetamine and ecstasy impaired drivers. Forensic Science International 173(2/3): 112-116, 2007. (19 refs.)

Two hundred and forty-seven serum samples which have been collected by police during roadside testing and have been found positive for amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA) and/or 3,4-methylenedioxyethamphetarnine (MDE) were analyzed for y-hydroxybutyrate (GHB). Serum samples were spiked with deuterated GHB as internal standard and acetonitrile was added to achieve dilution and protein precipitation. Samples were analyzed with a LC-MS/MS system operated in the multiple reaction monitoring mode (MRM) using a TurbolonSpray source. Chromatographic separation was achieved using a Synergi Polar RP column applying a gradient elution with a runtime of 15 min. To differentiate between endogenous and exogenously administered GHB a cut-off concentration of 10 mu g/mL was applied. Five samples exceeded this concentration and were found positive for GHB. These samples were only found positive for amphetamine but no other amphetamine derivatives were detected, while in three samples THC and in one sample cocaine, benzoylecgonine and ethanol were found.

Droogmans S; Cosyns B; D'haenen H; Creeten E; Weytjens C; Franken PR et al. Possible association between 3,4-methylenedioxymethamphetamine abuse and valvular heart disease. American Journal of Cardiology 100(9): 1442-1445, 2007. (12 refs.)

Valvular heart disease, inducing valvular regurgitation, has been described in users of drugs such as anorectic agents and ergot derivates. 3,4-Methylenedioxymethamphetamine (MDMA; "ecstasy") also leads in vitro to the proliferation of cardiac valvular interstitial cells by activation of the 5-hydroxytryptamine 2B receptor. The aim of this study was to determine the occurrence of valvulopathy in young adults taking MDMA. Twenty-nine subjects using or having used MDMA and 29 gender- and age-matched controls were blindly evaluated with echocardiography. Eight subjects (28%) who took MDMA had abnormal echocardiographic results using the United States Food and Drug Administration's criteria for appetite suppressant-induced valvular heart disease, compared with none in the control group (p = 0.0045). Six (21%) subjects had mitral regurgitation of 1/4 and 4 (14%) of >= 2/4, compared with none in the control group (p = 0.002). The mean mitral regurgitant area ratios (jet/atrium) were 12 +/- 9.8% and 5 +/- 1.3%, respectively (p = 0.007). Tricuspid regurgitation >= 2/4 was present in 13 MDMA users (45%) and absent in controls (p < 0.001). The mean tricuspid regurgitant area ratios were 19 +/- 9.5 % and 9 +/- 4.5 %, respectively (p <0.001). Four MDMA users (14%) had mild aortic regurgitation (p = 0.11). Valvular "strands" were present in 6 MDMA users (21%) and in none of the controls (p = 0.02). In conclusion, MDMA may lead to mild to moderate valvular heart disease and valvular strands.

Dumont GJH; Wezenberg E; Valkenberg MMGJ; De Jong CAJ; Buitelaar JK; Van Gerven JMA; Verkes RJ. Acute neuropsychological effects of MDMA and ethanol (co-)administration in healthy volunteers. Psychopharmacology 197(3): 465-474, 2008. (58 refs.)

Rationale In Western societies, a considerable percentage of young people expose themselves to 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"). Commonly, ecstasy is used in combination with other substances, in particular alcohol (ethanol). MDMA induces both arousing as well as hallucinogenic effects, whereas ethanol is a general central nervous system depressant. Objective The aim of the present study is to assess the acute effects of single and co-administration of MDMA and ethanol on executive, memory, psychomotor, visuomotor, visuospatial and attention function, as well as on subjective experience. Materials and methods We performed a four-way, double-blind, randomised, crossover, placebo-controlled study in 16 healthy volunteers (nine male, seven female) between the ages of 18-29. MDMA was given orally (100 mg) and blood alcohol concentration was maintained at 0.6C by an ethanol infusion regime. Results Co-administration of MDMA and ethanol was well tolerated and did not show greater impairment of performance compared to the single-drug conditions. Impaired memory function was consistently observed after all drug conditions, whereas impairment of psychomotor function and attention was less consistent across drug conditions. Conclusions Co-administration of MDMA and ethanol did not exacerbate the effects of either drug alone. Although the impairment of performance by all drug conditions was relatively moderate, all induced significant impairment of cognitive function.

Durdle H; Lundahl LH; Johanson CE; Tancer M. Major depression: The relative contribution of gender, MDMA, and cannabis use. Depression and Anxiety 25(3): 241-247, 2008. (31 refs.)

Previous research has suggested that 3,4-methylenedioxymethamphetamine (MDMA; ecstasy) users have elevated depressive symptomatology, although it is not clear whether this is due to MDMA or other drug use. This study aimed to investigate the contributions of MDMA and cannabis use to Major Depressive Disorder in MDAM users. A total of 226 MDMA users were studied. Participants (65% male) reported an average number of 35.8 uses of MDMA (SD = 45.6, range = 2-400). Participants were administered a Structured Clinical Interview for DSM-IV Twenty-six individuals (11.5%) met lifetime criteria for Major Depressive Disorder. High rates of lifetime Cannabis Abuse (30.1%) and Cannabis Dependence (12.4%) were reported. No association was found between number of uses of MDMA and Major Depressive Disorder. Those with lifetime major depression were found, however, to have higher rates of lifetime cannabis use disorder (adjusted OR = 2.40). A logistic regression indicated that lifetime cannabis use disorder, but not MDMA use, was significantly associated with lifetime Major Depressive Disorder. Stratified analyses suggested that for males, neither drug use variable was associated with major depression. For females, a lifetime cannabis use disorder (adjusted OR = 4.99), but not MDMA use, was associated with lifetime Major Depressive Disorder. Results of this study suggest that although MDMA use was not found to be significantly associated with major depression for either gender, a lifetime cannabis use disorder was significantly associated with lifetime major depression for female, but not male, users of MDMA.

Ebejer KA; Lloyd GR; Brereton RG; Carter JF; Sleeman R. Factors influencing the contamination of UK banknotes with drugs of abuse. Forensic Science International 171(2/3 special issue): 165-170, 2007. (19 refs.)

Bank of England banknotes sampled from different locations in the UK have been analysed for the presence of cocaine, diamorphine (DAM), Delta(9)-tetrahydrocannabinol (THC) and 3,4-methyleriedioxymethamphetamine (MDMA). A database of the contamination detected is routinely used as a benchmark against which the contamination detected on seized banknotes can be compared. Evidence presented at court details how banknotes seized from a suspect may differ from banknotes in general circulation in terms of their contamination with controlled drugs. A question arising from such evidence is whether seized banknotes could have become contaminated through being in circulation in drug "hot spots". In order to address this issue. a Plackett-Burman experimental design was used to investigate the influence of source location and other factors on banknote contamination with drugs of abuse. Banknotes were drawn from banks in eight regions throughout the UK. Each location could be described by a unique combination of the factors under investigation, namely whether the location was rural or urban, in the North or South of the UK, and whether it was a port of entry. The socioeconomic class and the proportion of drug offenders in the area and the denomination of the banknotes were also considered as potentially influential factors. Indices were calculated to describe the degree to which samples were contaminated with different drugs, and normal probability plots were used to identify the factors that could account for the contamination observed. Whilst some factors were more influential than others, it was shown that, at the 95% confidence level, none of the proposed factors were significant influences on the contamination. Cocaine contamination on banknotes has been shown to follow a log-normal distribution. It was, therefore, possible to calculate F- and t-statistics to compare the cocaine contamination on the entire sample set with that detected on a second sample set consisting of banknotes all drawn from a single bank branch. It was shown that both inter-bank samples and intra-bank samples had similar variance and similar contamination levels at the 95% confidence level. This suggests that there are no significant regional trends in the contamination of banknotes with drugs of abuse across the UK.

Eifinger F; Roth B; Kroner L; Rothschild MA. Severe Ecstasy poisoning in an 8-month-old infant. European Journal of Pediatrics 167(9): 1067-1070, 2008. (18 refs.)

We report on an 8-month-old male infant who accidentally ingested an Ecstasy tablet (3,4-methylenedioxymetamphetamine, MDMA). Here we discuss, according to the available literature, the treatment, complications, and pharmacokinetics of MDMA intoxication in a young infant. Serum MDMA level 2 hours after ingestion was with 785 ng center dot mL(-1) above the dose considered lethal for adults (> 500 ng center dot mL(-1)). After ingestion the patient showed life-threatening tachycardia of 210 beats min(-1), hyperthermia of 38.9 degrees C, seizures, and hypertension of 125/70 mmHg. Under supportive treatment (benzodiazepine, body cooling, rehydration therapy), 6 hours after admission, body temperature as well as the elevated blood pressure and heart beat had returned to normal values. Nine hours after ingestion the serum MDMA level was still 274 ng center dot mL(-1). The patient made a full clinical recovery and afterwards appeared to be a healthy boy. This case illustrates the need to consider the possibility of accidental Ecstasy ingestion in the differential diagnosis of a child suffering from convulsions with fever.

European Monitoring Centre for Drugs and Drug Addiction. The State of the Drugs Problem in Europe. Annual Report 2006. Luxembourg: European Monitoring Centre for Drugs and Drug Addiction, 2006. (50 refs.)

This is the 11th Annual Report on the drug use within the European Union. The background to the annual report are two new action plans recently enacted in the EU. One is measures to strengthen measures against drug trafficking. Another is the adoption of a drug strategy to be implemented between 2005-2012, with an emphasis on prevention, treatment, and harm reduction to reduce demand. Also, in contrast to the U.S. greater distinction is made between drug trade and drug use, with greater penalties for the former and a reduced emphasis on custodial emphasis for the latter. The report provides an overview of drug problems throughout the 25 EU member countries, Norway, Bulgaria, Romania and Turkey. The report begins with a highlight on new developments and trends. For example, drugs are probably cheaper now than ever before in Europe, based on a five-year trend analysis of the street prices of drugs such as cannabis, cocaine, heroin, amphetamines and ecstasy. Between 1999 and 2004, the rate of decline has been greatest for ecstasy (45% decline) and least for herbal cannabis (13% decline). The report has eight chapters. The first chapter outlines polices and laws. Chapter 2 provides an overview of the response to drug problems. Chapters 3 through 6 address specific drugs - cannabis, amphetamines (plus ecstasy and other psychotropics), cocaine, opiates. For each of these there is information on patterns of use, source of drugs, treatment demand, patterns of use and comparisons between countries, and production and trafficking, price and purity. Chapter 7 considers drug-related infectious disease and related mortality. The concluding chapter addresses issues related to monitoring drug use and creation of indicators, and challenges related to adequately describing polydrug use. Three aspects are selected for special attention - recreational drug use, European drug policies and gender differences in drug use. In respect to heroin, there is an increasing use of drug substitution therapy as well as a "graying" of heroin users and those involved in substitution therapy. There are 14 figures.

Farre M; Abanades S; Roset PN; Peiro AM; Torrens M; O'Mathuna B et al. Pharmacological interaction between 3,4-methylenedioxymethamphetamine (Ecstasy) and paroxetine: Pharmacological effects and pharmacokinetics. Journal of Pharmacology and Experimental Therapeutics 323(3): 954-962, 2007. (39 refs.)

3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") is increasingly used by young people for its euphoric and empathic effects. MDMA can be used in combination with other drugs such as selective serotonin reuptake inhibitors. A clinical trial was designed where subjects pretreated with paroxetine, one of the most potent inhibitors of both 5-hydroxytryptamine reuptake and CYP2D6 activity, were challenged with a single dose of MDMA. The aim of the study was to evaluate the pharmacodynamic and pharmacokinetic interaction between paroxetine and MDMA in humans. A randomized, double-blind, crossover, placebo-controlled trial was conducted in 12 healthy male subjects. Variables included physiological parameters, psychomotor performance, subjective effects, and pharmacokinetics. Subjects received 20 mg/day paroxetine (or placebo) orally for the 3 days before MDMA challenge (100 mg oral). MDMA alone produced the prototypical effects of the drug. Pretreatment with paroxetine was associated with marked decreases of both physiological and subjective effects of MDMA, despite a 30% increase in MDMA plasma concentrations. The decreases of 3-methoxy-4-hydroxymethamphetamine plasma concentrations suggest a metabolic interaction of paroxetine and MDMA. These data show that pretreatment with paroxetine significantly attenuates MDMA-related physiological and psychological effects. It seems that paroxetine could interact with MDMA at pharmacodynamic (serotonin transporter) and pharmacokinetic (CYP2D6 metabolism) levels. Marked decrease in the effects of MDMA could lead users to take higher doses of MDMA and to produce potential life-threatening toxic effects.

Feldman KW; Mazor S. Ecstasy ingestion causing heatstroke-like, multiorgan injury in a toddler. Pediatric Emergency Medicine 23(10): 725-726, 2007. (4 refs.)

3,4-Methylenedioxymethamphetamine (MDMA) ingestion can cause febrile status epilepticus in children but has not been reported to cause multiorgan dysfunction seen in young adults. We describe a toddler who was diagnosed at this stage of multiorgan injury. This drug, a synthetic amphetamine, has the "street" name of "ecstasy" and is commonly used by teenagers and young adults to augment the euphoric experience of "raves."

Giraudon I; Bello PY. Monitoring ecstasy content in France: Results from the National Surveillance System 1999-2004. Substance Use & Misuse 42(10): 1567-1578, 2007. (23 refs.)

The French National Identification System for Drugs and Other Substances (SINTES) is an original scheme gathering analytical information for synthetic drugs, both through police and customs' seizures in the entire country and collection of samples and questionnaires directly from the users by social field workers. Between July 1999 and June 2004, 9543 samples were included. Tablets (7004) were mainly containing MDMA (82%) and caffeine was the most frequent blended psychoactive substance. Mean MDMA dosage of tablets decreased from 1999 to 2003 and dosage for tablets bearing the same logo appeared to be highly variable. Notwithstanding the difficulties for data collection due to the illicit nature of these drugs, this surveillance and early warning system, which combines the cooperative efforts of law enforcement laboratories and social workers, provided relevant and timely information. It is accurate regarding the follow-up of trends in drugs' composition, and the identification of new or potentially dangerous substances, to the professionals, the public, and the European partners.

Graham AW; Schultz TK; Mayo-Smith MF; Ries RK; Wilford BB, eds. Principles of Addiction Medicine. Chevy Chase MD: American Society of Addiction Medicine, 2003. (Chapter refs.)

This volume is a comprehensive text on addictions. It is organized into 14 major sections, each of which has multiple chapters. There are over 200 contributors. The sections deal with the following themes: basic science and core concepts; pharmcology; diagnosis, assessment and early intervention; overview of addiction treatment; management of intoxication and withdrawal; pharmacologic interventions; behavioral interventions; 12-step programs and other recovery-oriented interventions; alcohol and drug problems in the workplace; medical disorders and complications of addiction; co-occurring addictive and psychiatric disorders; pain and addiction; and children and adolescents. There are also six appendices.

Guneysel O; Onur OE; Akoglu H; Denlzbasi A. Ecstasy-induced recurrent toxic hepatitis in a young adult. Current Therapeutic Research, Clinical and Experimental 69(3): 260-265, 2008. (16 refs.)

BACKGROUND: The drug 3,4-methylenedioxymethamphetamine (MDMA), otherwise known as "ecstasy," is a synthetic amphetamine that produces euphoria, increases sociability and energy, and is often used as a "weekend" recreational drug by young adults. CASE SUMMARY: A 23-year-old male (height, 184 cm; weight, 68 kg) presented to the emergency department of Marmara University Hospital, Istanbul, Turkey, with jaundice and nausea lasting for 6 days. The patient reported that he had been a chronic user of MDMA for 2 years. He also reported that I week before presenting, he had ingested twice (2 tablets) the usual amount (I tablet) of the drug at the same time. Blood tests were performed and hematologic findings were as follows: aspartate aminotransferase (AST), 1423 U/L (reference range, 10-37 U/L); alanine aminotransferase (ALT), 2748 U/L (10-40 U/L); alkaline phosphatase, 271 U/L (0-270 U/L); gamma-glutamyl transpeptidase, 124 U/L (7-49 U/L); total bilirubin, 13.23 mg/dL (0.2-1 mg/dL); direct bilirubin, 8.75 mg/dL (0-0.3 mg/dL); amylase, 80 U/L (0-220 U/L); prothrombin time, 21.2 sec; activated partial thromboplastin time, 37.3 sec; and international normalized ratio, 1.66. Liver enzymes and bilirubin levels were found to be extremely high (AST = 40x normal, ALT = 70x normal, and bilirubin = 13x normal). Viral, autoimmune, and metabolic causes were excluded. Serologic tests for hepatitis A, B, and C viruses, mononucleosis, cytomegalovirus, and HIV infection were all negative. A diagnosis of ecstasy-induced toxic hepatitis was made. The patient's medical history further revealed that the current incident was actually his second occurrence of jaundice and acute hepatitis associated with the ingestion of higher amounts (twice the usual amount of MDMA he ingested at the same time). Supportive therapy (IV saline and vital sign monitoring) was initiated and liver enzymes, bilirubin levels, and prothrombin times were monitored daily. All had returned to normal values in 2 weeks. CONCLUSIONS: MDMA, or the recreational drug ecstasy, might be responsible for acute hepatitis and/or acute liver failure, particularly in young people. Physicians might need to be alert to the possibility of ecstasy-induced liver damage occurring in younger patients, although the presence of other hepatotoxins and alternative diagnoses requires exclusion. The use of this drug should be investigated in young patients with severe hepatitis of unknown origin.

Hagan IG; Burney K. Radiology of recreational drug abuse. Radiographics 27(4): 919-U10, 2007. (75 refs.)

Recreational drug abuse is increasing throughout the world. Use of these drugs may result in a diverse array of acute and chronic complications involving almost any body organ, and imaging frequently plays a vital role in detection and characterization of such complications. The nature of the complications depends to a large extent on the drug used, the method of administration, and the impurities associated with the drug. Radiologically demonstrable sequelae may be seen after use of opiates, cocaine, amphetamines and their derivatives such as 3,4-methylenedioxymethamphetamine ("ecstasy"), marijuana, and inhaled volatile agents including amyl nitrite ("poppers") and industrial solvents such as toluene. Cardiovascular complications include myocardial infarction, cardiomyopathy, arterial dissection, false and mycotic aneurysms, venous thromboembolic disease, and septic thrombophlebitis. Respiratory complications may involve the upper airways, lung parenchyma, pulmonary vasculature, and pleural space. Neurologic complications are most commonly due to the cerebrovascular effects of illicit drugs. Musculoskeletal complications are dominated by soft-tissue, bone, and joint infections caused by intravenous drug use. Awareness of the imaging features of recreational drug abuse is important for the radiologist because the underlying cause may not be known at presentation and because complications affecting different body systems may coexist. Intravenous drug abuse in particular should be regarded as a multisystem disease with vascular and infective complications affecting many parts of the body, often synchronously. Discovery of one complication should prompt the radiologist to search for coexisting pathologic conditions, which may alter management.

Halkitis PN; Palamar JJ. Multivariate modeling of club drug use initiation among gay and bisexual men. Substance Use & Misuse 43(7): 871-879, 2008. (23 refs.)

This paper documents patterns and sequence of initiation of club drug use in a sample of 450 gay and bisexual men in New York City. Quantitative and qualitative baseline data from a yearlong longitudinal investigation conducted between 2001 and 2005 were analyzed. The study focused on the use of five club drugs - cocaine, GHB, ketamine, ecstasy, and methamphetamine - using self-reported indications of use for a period of 4 months prior to assessment. Patterns of club drug use among gay and bisexual demonstrated that poly-club-drug use is common, and that patterns of use can be differentiated along the lines of age, race/ethnicity, and sexual orientation, with those who are older, Black, and bisexual, reporting less club drug use. The majority of the men initiated use of the five club drugs as follows: (a) cocaine, (b) ecstasy, (c) ketamine, (d) methamphetamine, and (e) GHB. Variations in patterns were related to both age and level of poly-club-drug use. The sequencing and/or patterns of club drug use may be better explained by socialization processes in the gay community than by Gateway Theory, which has been traditionally used to explain patterns of drug use in the population. Future research should more closely examine the synergy of drug use combinations with an emphasis on measuring the extent to which the drugs are taken in synchronicity.

Hanson KL; Luciana M; Sullwold K. Reward-related decision-making deficits and elevated impulsivity among MDMA and other drug users. Drug and Alcohol Dependence 96(1-2): 99-110, 2008. (100 refs.)

Background: The recreational drug, 3,4-methylenedioxymethamphetamine (MDMA; 'Ecstasy'), is a synthetic amphetamine derivative and a serotonin neurotoxin. MDMA use is associated with cognitive dysfunction and impulsivity, but since polydrug abuse is common among users it is difficult to attribute these problems specifically to MDMA. Moreover, few studies have examined reward-related cognitive processes. Our aim was to examine reward-related decision-making and impulsivity among MDMA users while controlling for polydrug use via appropriate comparison groups. Methods: We examined decision-making [Iowa Gambling Task, IGT; Bechara, A., Damasio, A.R., Damasio, H., Anderson, S.W., 1994. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 50, 7-15], self-reported impulsivity (Multidimensional Personality Questionnaire-Brief Form [constraint subscale]; Barratt, Impulsiveness Scale; Zuckerman Sensation Seeking Scale), and drug use among 22 abstinent MDMA users, 30 other drug users, and 29 healthy non-drug controls. Results: MDMA and other drug users showed comparable patterns of decision-making and impulsivity. However, both drug groups demonstrated poorer IGT performance and elevated self-reported impulsivity relative to controls. Poorer decision-making was related to heavier drug use in the past year, heavier weekly alcohol use, and meeting lifetime substance use disorder (SUD) criteria for more drug classes. Elevated impulsivity was associated with heavier drug use, heavier weekly alcohol use, more lifetime SUDs, and higher self-reported depression levels. Conclusions: These findings contradict the idea that MDMA is specifically associated with deficient decision-making. Drug users, in general, may be at risk for decision-making deficits and elevated impulsivity. Such behaviors may represent trait factors that lead to the initiation of drug and alcohol use, and/or they may represent behavior patterns that are exacerbated by extensive use.

Iverson LL. Speed, Ecstasy, Ritalin: The Science of Amphetamines. Oxford, UK: Oxford University Press, 2007

Amphetamines have had a relatively short history. From their use in wartime, their abuse by the beat generation, up to the popularity of Ecstasy in the late 20th century, many have found amphetamines an enjoyable, though unpredictable, stimulant. More than that though, amphetamine-based treatments have been found to have beneficial effects for those suffering from attention deficit disorders, and are now widely prescribed in the US and elsewhere as a treatment for children and adults. What is the truth behind these medical claims? What are the real effects of stimulants like Ecstasy? This book explores the history and use of amphetamines, their pharmacology and effects on the brain, their medical use, use as a performance enhancer, and use in medical research on psychosis, and the associated harm. A chapter is devoted to ecstasy.

Jager G; de Win MM; Vervaeke HK; Schilt T; Kahn RS; van den Brink W et al. Incidental use of ecstasy: No evidence for harmful effects on cognitive brain function in a prospective fMRI study. Psychopharmacology 193(3): 403-414, 2007. (49 refs.)

Rationale: Heavy ecstasy use in humans has been associated with cognitive impairments and changes in cognitive brain function supposedly due to damage to the serotonin system. There is concern that even a single dose of 3,4-methylenedioxymethamphetamine may be neurotoxic, but very little is known about the consequences of a low dose of ecstasy for cognitive brain function. Objectives The objective of the study was to assess the effects of a low dose of ecstasy on human cognitive brain function using functional magnetic resonance imaging (fMRI). Materials and method We prospectively studied, as part of the NeXT (Netherlands XTC toxicity) study, sustained effects of a low dose of ecstasy on brain function in 25 subjects before and after their first episode of ecstasy use (mean 2.0 +/- 1.4 ecstasy pills, on average 11.1 +/- 12.9 weeks since last ecstasy use), compared to 24 persistent ecstasy-naive controls, also measured twice and matched with the novice users on age, gender, IQ, and cannabis use. Cognitive brain function was measured in the domains of working memory, selective attention, and associative memory using fMRI. Results No significant effects were found of a low dose of ecstasy on working memory, selective attention, or associative memory neither at the behavioral level nor at the neurophysiological level. Conclusions: This study yielded no firm evidence for sustained effects of a low dose of ecstasy on human cognitive brain function. The present findings are relevant for the development of prevention and harm reduction strategies. Furthermore, the study is relevant to the discussion concerning potential therapeutic use of ecstasy.

Jones AW; Holmgren A; Kugelberg FC. Driving under the influence of central stimulant amines: Age and gender differences in concentrations of amphetamine, methamphetamine, and ecstasy in blood. Journal of Studies on Alcohol and Drugs 69(2): 202-208, 2008. (34 refs.)

Objective: A zero-tolerance law for driving under the influence of drugs (DUID) was introduced in Sweden in 1999. This change in legislation has led to a 12-fold increase in the number of blood samples sent by the police for toxicological analysis. Here we report the age and gender of offenders, along with the concentrations of amphetamine, methamphetamine, and ecstasy (3,4-methylenedioxymethamphetamine) in blood samples analyzed since the institution of the new legislation. Method: A forensic toxicology database (TOXBASE) was used to identify cases of DUID in which central stimulant amines were verified in blood during a 5-year period (2000-2004). Results: Amphetamine was present in 15,898 of 26,556 cases of DUID (60%) either alone or together with other licit or illicit drugs. In 6,094 cases, amphetamine was the only psychoactive substance in blood at mean (median) and highest concentrations of 1.01 mg/L (0.80 mg/L) and 11.9 mg/L, respectively. The users of amphetamine were mainly men (85% vs 15% women; p < .001), and men tended to be a few years older than the women; the mean (SD) age for men was 37 (9.2) years and for women it was 35 (8.1) years (p < .001). In 644 cases, amphetamine and methamphetamine were present in blood samples at mean (median) concentrations of 0.85 mg/L (0.60 mg/L) and 0.34 mg/L (0.20 mg/L), respectively (p < .001). The mean (median) and highest concentrations of ecstasy in 493 DUID offenders were 0.23 mg/L (0.10 mg/L) and 3.5 mg/L, respectively The mean age of ecstasy users was 26 (7.2) years, which was about 10 years younger than those using amphetamine (p <001). Conclusions: The high prevalence of amphetamines in blood of apprehended drivers in Sweden verifies widespread use of these stimulants as recreational drugs. The findings from this study suggest that a zero-tolerance DUID law has not deterred offenders, which suggests that more attention should be given to the underlying substance-abuse problem instead of conventional penalties such as monetary fines and/or imprisonment.

Karlsen SN; Spigset O; Slordal L. The dark side of ecstasy: Neuropsychiatric symptoms after exposure to 3,4-methylenedioxymethamphetamine. (review). Basic Clinical Pharmacology & Toxicology 102(1): 15-24, 2008. (116 refs.)

3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) is a known neurotoxin in animals. This review discusses the history, pattern of use, pharmacology, acute and long-term effects of MDMA. Emphasis is given to the concern that MDMA may induce long-term cognitive and psychiatric effects. MDMA is an illegal substance, and investigations of the effects of exposure in human beings have limitations and weaknesses. There are numerous studies suggesting a correlation between MDMA exposure and psychopathology, and that the psychotropic effects may be long-lasting or permanent. However, it is not possible to conclude that there is a causal relationship between exposure and the increased psychopathology observed in MDMA users. Longitudinal studies are needed to assess whether MDMA causes persistent cognitive impairment and/or psychiatric symptoms in human beings.

Kelly BC. Club drug use and risk management among "bridge and tunnel" youth. Journal of Drug Issues 37(2): 425-443, 2007. (22 refs.)

Club drugs present a range of risks similar to the range of psychoactive effects resulting from the use of the substances in this classification. These drugs remain in wide use amongst those in rave and club subcultures. This paper explores a range of risk management practices used by youth who utilize club drugs within rave and club subcultures. Through the use of ethnographic methods during a two-year period of fieldwork, the author collected data on club drug use and risk taking among "Bridge and Tunnel" youth. The resulting paper provides a descriptive typology of a series of risk management practices and explores how these practices are strategically deployed in an effort to maximize enjoyment and minimize danger.

Kinner SA; Degenhardt L. Crystal methamphetamine smoking among regular ecstasy users in Australia: increases in use and associations with harm. Drug and Alcohol Review 27(3): 292-300, 2008. (43 refs.)

Introduction. This study examined (a) changes in crystal methamphetamine use among regular ecstasy users (REU) in Australia and (b) associations of crystal use and smoking with demographics, drug use and harm. Design and Methods. Cross-sectional surveys (2000-06) of REU in three Australian capital cities, and in 2006, 750 REU in all Australian capital cities. The interview included: demographics, drug use, risk behaviour, recent criminal activity and methamphetamine dependence using Severity of Dependence Scale. Results. There was little change in overall methamphetamine use, but a marked increase in crystal methamphetamine smoking. Among recent methamphetamine users in 2006 (n=606), crystal methamphetamine users (n=364) reported more frequent methamphetamine use and higher levels of dependence. Compared with those who had used only other forms of methamphetamine, recent crystal methamphetamine users were more likely to 'binge' on drugs for >= 48 hours, engage in crime and experience financial and legal problems related to drug use. Non-smoking crystal methamphetamine users (n=78) more often reported recent injecting and heroin use. Recent smokers were more likely to have: greater polydrug use, recently overdosed on a 'party drug', and accessed medical services for their drug use. Many of these associations were accounted for by their injecting and heavier methamphetamine use, rather than smoking per se. Conclusions. Crystal methamphetamine smoking among REU has increased markedly and is associated with significant harm. This appears related to smokers' heavier levels of methamphetamine use. Effective harm reduction strategies should be tailored to these specific risks.

Kolbrich EA; Goodwin RS; Gorelick DA; Hayes RJ; Stein EA; Huestis MA. Physiological and subjective responses to controlled oral 3,4-methylenedioxymethamphetamine administration. Journal of Clinical Psychopharmacology 28(4): 432-440, 2008. (38 refs.)

A randomized, within-subject, double-blind, inpatient study of the physiological and subjective effects of oral 3,4-methylenedioxymethamphetamine (MDMA) was conducted in human volunteers with previous MDMA experience. Placebo, low (1.0 mg/kg), and high (1.6 mg/kg) doses of oral MDMA were administered in a controlled inpatient setting at least 7 days apart to 6 African American (4 male, 2 female) and 2 white (both male) volunteers (mean [SE] age, 21.1 [0.8] years; weight, 77.2 [7.7] kg). 3,4-Methylenedioxymethamphetamine doses were 46 to 150 mg, in the range of typical recreational doses. Participants completed all sessions without clinically significant adverse events. 3,4-Methylenedioxymethamphetamine produced significant dose-dependent increases in heart rate (highest, 132 bpm), systolic (highest, 171 mm Hg) and diastolic (highest, 102 mm Hg) blood pressure, and subjective responses for energy level, closeness to others, mind racing, heightened senses, and high (evaluated by visual analog scales). Peak effects occurred 1 to 2 hours after dose, with no secondary peak. There were no significant effects on body temperature (measured at tympanic membrane), respiratory rate, or blood oxygen saturation (by pulse oximetry). Although most physiological and subjective parameters were significantly correlated with MDMA plasma concentrations, correlation coefficients were low and clinically insignificant, eliminating the ability to predict effects from single plasma concentrations. These findings suggest that oral MDMA in typical recreational doses produces short-term effects on cardiovascular function and subjective state but that temperature effects may result from interaction with environmental and subject factors.

Koper C; van den Boom C; Wiarda W; Schrader M; de Joode P; van der Peijl G et al. Elemental analysis of 3,4-methylenedioxymethamphetamine (MDMA): A tool to determine the synthesis method and trace links. Forensic Science International 171(2/3 special issue): 171-179, 2007. (22 refs.)

The elemental composition of 3,4-methylenedioxymethamphetamine (MDMA) powders and tablets was determined. The objective was the identification of the synthesis method and application of the elemental profile in comparative analysis. The developed analytical method comprised the digestion of a sample followed by quantitative analysis with inductive coupled plasma mass spectrometry (ICP-MS) and inductive coupled plasma atomic emission spectroscopy (ICP-AES). The sample collection consisted of a unique set of MDMA powders (57) from illicit production sites and MDMA tablets (97) taken from large seizures (over 500 tablets) in the Netherlands. The production method of MDMA could be determined for 89 of the 97 tablets. In 84 cases reductive amination using Pt as the catalyst was used, in four cases reductive amination using NaBH4 or a similar reducing agent was employed and one mixed sample (Pt and 13) was found. None of the MDMA tablets were assigned to the aluminium amalgam method. Using the elemental profile, 13 links were identified within the 97 MDMA tablets using cluster analysis based on Pearson correlations. Of these links 10 were corroborated by additional analyses.

Kung SW; Chan YC; Tse ML; Lau FL; Chiu WK. Accidentental ecstasy poisoning in a five-year-old boy. Hong Kong Journal of Emergency Medicine 15(2): 111-114, 2008. (16 refs.)

We report a 5-year-old child with fever and confusion after ingestion of a tablet of methylenedioxymethamphetamine (MDMA). He was treated successfully with supportive measures and titrated doses of benzodiazepine. In children with unexplained fever, sympathetic hyperactivity, confusion or convulsion, MDMA poisoning should be considered.

Laws KR; Kokkalis J. Ecstasy (MDMA) and memory function: A meta-analytic update. (review). Human Psychopharmacology: Clinical and Experimental 22(6): 381-388, 2007. (58 refs.)

A meta-analysis was conducted to examine the impact of recreational ecstasy use on short-term memory (STM), long-term memory (LTM), verbal and visual memory. We located 26 studies containing memory data for ecstasy and non-ecstasy users from which effect sizes could be derived. The analyses provided measures of STM and LTM in 6 10 and 439 ecstasy users and revealed moderate-to- large effect sizes (Cohen's d) of d = -0.63 and d = -0.87, respectively. The difference between STM versus LTM was non-significant. The effect size for verbal memory was large (d = - 1.00) and significantly larger than the small effect size for visual memory (d = -0.27). Indeed, our analyses indicate that visual memory may be affected more by concurrent cannabis use. Finally, we found that the total lifetime number of ecstasy tablets consumed did not significantly predict memory performance.

Mackesy-Amiti ME; Fendrich M; Johnson TR. Prevalence of recent illicit substance use and reporting bias among MSM and other urban males. Addictive Behaviors 33(8): 1055-1060, 2008. (12 refs.)

This paper explores whether elevated rates of self-reported substance use among MSM compared to other males may be an artifact of reporting bias. Past month prevalence rates of marijuana, cocaine, heroin, methamphetamine, Ecstasy. and Ketamine use were compared between a sample of men who have sex with men (MSM), and a general household sample of men, all residing in Chicago. We compared rates of self-reported use, and corrected rates based on the results of drug testing (urine and oral fluid tests). While MSM over 30 years old were significantly more likely than other men in this age group to report past month use of cocaine, test-corrected rates of use were equivalent. On the other hand, test-corrected estimates confirmed elevated rates of Ketamine and Ecstasy use in the MSM sample. Differential disclosure of substance use between MSM and other males may in some cases lead to distorted conclusions about differences in substance use between these groups. The use of biological testing in epidemiological studies of substance use can reduce the uncertainty of such comparisons.

Martinez D; Kim JH; Krystal J; Abi-Dargham A. Imaging the neurochemistry of alcohol and substance abuse. Neuroimaging Clinics of North America 17(4): 539-+, 2007. (97 refs.)

Animal models of abuse and dependence have long suggested that chronic drug and alcohol exposure is associated with marked changes in neurochemistry. The development of PET and SPECT imaging now allows investigation of the effects of addiction on the neurochemistry of the human brain. This article reviews the literature of radiochemical imaging in cocaine, alcohol, heroin, methamphetamine, MDMA, and ketamine abuse and dependence.

Martins SS; Storr CL; Alexandre PK; Chilcoat HD. Adolescent ecstasy and other drug use in the National Survey of Parents and Youth: The role of sensation-seeking, parental monitoring and peer's drug use. Addictive Behaviors 33(7): 919-933, 2008. (60 refs.)

The association between high sensation-seeking, close friends' drug use and low parental monitoring with ecstasy (MDMA) use in adolescence was examined in a sample of US household-dwelling adolescents aged 12 - 18 years (N=5049). We also tested whether associations were of stronger magnitude than associations between these correlates and marijuana or alcohol/tobacco use in adolescence. Data from Round 2 of the National Survey of Parents and Youth (NSPY) Restricted Use Files (RUF) was analyzed via Jackknife weighted multinomial logistic regression models. High sensation-seekers were more likely to be ecstasy, marijuana, and alcohol/tobacco users, respectively, as compared to low sensation-seekers. High sensation-seeking and close friends' drug use were more strongly associated with ecstasy as compared to marijuana and alcohol/tobacco use. Low parental monitoring was associated with marijuana use and alcohol/tobacco use and there was a trend for it to be associated with ecstasy use. Ecstasy use is strongly associated with peer drug use and more modestly associated with high sensation-seeking. School prevention programs should target high-sensation-seeking adolescents and also encourage them to affiliate with non-drug using peers.

Martins SS; Storr CL; Alexandre PK; Chilcoat HD. Do adolescent ecstasy users have different attitudes towards drugs when compared to marijuana users? Drug and Alcohol Dependence 94(1/3): 63-72, 2008. (61 refs.)

Background: Perceived risk and attitudes about the consequences of drug use, perceptions of others expectations and self-efficacy influence the intent to try drugs and continue drug use once use has started. We examine associations between adolescents' attitudes and beliefs towards ecstasy use; because most ecstasy users have a history of marijuana use, we estimate the association for three groups of adolescents: non-marijuana/ecstasy users, marijuana users (used marijuana at least once but never used ecstasy) and ecstasy users (used ecstasy at least once). Methods: Data from 5049 adolescents aged 12-18 years old who had complete weighted data information in Round 2 of the Restricted Use Files (RUF) of the National Survey of Parents and Youth (NSPY). Data were analyzed using jackknife weighted multinomial logistic regression models. Results: Adolescent marijuana and ecstasy users were more likely to approve of marijuana and ecstasy use as compared to non-drug using youth. Adolescent marijuana and ecstasy users were more likely to have close friends who approved of ecstasy as compared to non-drug using youth. The magnitudes of these two associations were stronger for ecstasy use than for marijuana use in the final adjusted model. Our final adjusted model shows that approval of marijuana and ecstasy use was more strongly associated with marijuana and ecstasy use in adolescence than perceived risk in using both drugs. Conclusion: Information about the risks and consequences of ecstasy use need to be presented to adolescents in order to attempt to reduce adolescents' approval of ecstasy use as well as ecstasy experimentation.

Medina KL; Shear PK. Anxiety, depression, and behavioral symptoms of executive dysfunction in ecstasy users: Contributions of polydrug use. Drug and Alcohol Dependence 87(2/3): 303-311, 2007. (70 refs.)

Background: Given ecstasy's (MDMA) potential serotonergic neurotoxicity, it is plausible that regular ecstasy users would have an elevated prevalence of behavioral executive dysfunction or mood symptoms. However, recent studies have found that the relationship between ecstasy use and psychological symptoms was no longer significant after controlling for marijuana use (e.g., Morgan et al., 2002). The goal of the present study was to examine the relationship between ecstasy exposure and self-reported executive functioning and psychological symptoms after controlling for gender, ethnicity, and other drug use. Methods: Data were collected from 65 men and women with a wide range of ecstasy use (including 17 marijuana-using controls). Participants were administered the Frontal Systems Behavioral Scale, State-Trait Anxiety Inventory for adults, and the Beck Depression Inventory-2nd edition. Results: Although 19-63% of the ecstasy users demonstrated clinically elevated psychological symptoms, frequency of ecstasy use did not predict the psychological symptoms. No gender differences or interactions were observed. Conclusions: These results revealed that, although ecstasy users demonstrate elevated levels of psychological symptoms and executive dysfunction, these symptoms are not statistically associated with their ecstasy consumption. Instead, other drug use (alcohol, marijuana, opioids, and inhalants) significantly predict psychological symptoms in this sample of polydrug users.

Mizia-Stec K; Gasior Z; Wojnicz R; Haberka M; Mielczarek M; Wierzbicki A et al. Severe dilated cardiomyopathy as a consequence of Ecstasy intake. Cardiovascular Pathology 17(4): 250-253, 2008. (12 refs.)

Dilated cardiomyopathy (DCM) is one of the most common causes of heart failure with a prevalence of 1:2500. There are several primary and secondary etiologic factors, including gene mutations, infection agents, particularly viruses, toxins, autoimmune, and systemic disorders, and pheochromocytoma, neuromuscular, metabolic, mitochondrial, and nutritional disorders. However, a precise diagnosis can be reached only in no more than 50% of all cases. Herein, we report a rare case of hepatic damage and severe DCM as a consequence of relatively popular socially used narcotic-Ecstasy (3,4-methylenedioxy-N-methylamphetamine [MDMA]).

Moeller FG; Steinberg JL; Lane SD; Buzby M; Swann AC; Hasan KM et al. Diffusion tensor Imaging in MDMA users and controls: Association with decision making. American Journal of Drug and Alcohol Abuse 33(6): 777-789, 2007. (31 refs.)

Diffusion Tensor Imaging (DTI) may provide information regarding effects of 3,4-methylenedioxymethamphetamine (MDMA) use on brain structure. Twelve MDMA users and 20 healthy controls underwent whole brain DTI data acquisition. Fractional anisotropy ( FA), mean diffusivity ( D-av), and longitudinal ( lambda(1)) and transverse ( lambda(T)) diffusivities were compared between MDMA users and controls in 6 regions of the corpus callosum. MDMA users also completed the Barratt Impulsiveness Scale (BIS), and a subset of subjects completed the Iowa Gambling Task (IGT). Results showed significantly smaller lambda(1) in the rostral body of the corpus callosum in MDMA users, with no differences between groups on lambda(T), FA, or D-av. MDMA users also had a significantly higher BIS nonplanning score and greater preference for disadvantageous choices on the IGT. There was a significant positive correlation between lambda(1) in the rostral body of the corpus callosum and advantageous choices on the IGT. Further research on the etiology of these findings is warranted.

Montgomery C; Fisk JE. Ecstasy-related deficits in the updating component of executive processes. Human Psychopharmacology: Clinical and Experimental 23(6): 495-511, 2008. (48 refs.)

Aims: Research shows that users of ecstasy (MDMA) exhibit deficits in executive processes. The updating component appears to be particularly susceptible. Less is known about the precise nature of such deficits. The present study sought to determine if ecstasy-related deficits in memory updating are related to serial position of items presented, or length of the list of items. Method Seventy-three ecstasy/polydrug users and seventy-three non-ecstasy users completed tasks of verbal and spatial memory running memory, recalling the most recent items, in lists of varying and unknown length. Participants were categorised according to letter and spatial span (four, five or six), producing six sub-samples for analysis. Results Ecstasy-polydrug users were impaired in four out of the six sub-sample analyses. Three of these were due to impaired recall of earlier serial positions. Conclusions: The results of the present study provide further support for updating deficits in ecstasy-polydrug users. The results are suggestive of a breakdown in the maintenance of information in working memory in terms of chunking; it appears that ecstasy/polydrug users are as able as non-ecstasy users to form memory 'chunks' from the items, but that such chunks are not retained as effectively.

Montgomery C; Fisk JE. Everyday memory deficits in ecstasy-polydrug users. Journal of Psychopharmacology 21(7): 709-717, 2007. (32 refs.)

Recent research suggests that not only does the use of recreational drugs impact on working memory functioning, but more 'everyday' aspects of memory (e.g. remembering to do something in the future) are also affected. Forty-three ecstasy-polydrug users and 51 non-ecstasy users were recruited from a university population. Each participant completed the Cognitive Failures Questionnaire (CFQ) and Everyday Memory Questionnaire (EMQ). Of these, 28 ecstasy-polydrug users and 35 non-ecstasy users completed the Prospective Memory Questionnaire (PMQ). In addition, an objective measure of cognitive failures (the CFQ-for-others) was completed by friends of participants. With the exception of the CFQ-for-others, in each regression equation, cannabis emerged as the only significant predictor of everyday and prospective memory deficits. Significant correlations were found between the different indicators of everyday memory and various measures of illicit drug use. Cannabis featured prominently in this respect. The present study provides further support for cannabis related deficits in aspects of everyday memory functioning. Ecstasy may also be associated with cognitive slips, but not to the same extent as cannabis.

Nelson DA; Nirmaier JL; Singh SJ; Tolbert MD; Bost KL. Ecstasy (3,4-methylenedioxymethamphetamine) limits murine gammaherpesvirus-68 induced monokine expression. Brain, Behavior and Immunity 22(6): 912-922, 2008. (49 refs.)

While Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) has been shown to modulate immune responses, no studies have addressed drug-induced alterations to viral infection. In this study, bone marrow-derived macrophages were exposed to MDMA, then infected with murine gammaherpesvirus-68, and the expression of monokines assessed. MDMA-induced reductions in virus-stimulated monokine mRNA expression were observed in a dose-dependent manner. In particular, IL-6 mRNA expression and secretion was significantly decreased in gammaherpesvirus-infected macrophages exposed to MDMA. Concentrations of MDMA capable of reducing monokine production did not induce significant cell death and allowed normal viral gene expression. These studies represent the first to demonstrate the ability of this drug of abuse to alter a viral-induced macrophage response.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Patterns of Hallucinogen Use and Initiation: 2004 and 2005. (July 5, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (6 refs.)

Combined data from SAMHSA's 2004 and 2005 National Surveys on Drug Use and Health indicate that an annual average of 943,000 persons aged 12 or older were recent initiates of hallucinogens (i.e., they had used hallucinogens for the first time in the 12 months before the survey). Of these recent hallucinogen initiates, 52.3% had used psilocybin mushrooms and 42.9% used Ecstasy in the past year. Recent female initiates were more likely than males tohave used Ecstasy (49.5%vs. 37.7%), while recent male initiates were more likely than female counterparts to have used psilocybin (61% vs. 41%)

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Use of Specific Hallucinogens: 2006. (February 14, 2008). Rockville MD: Substance Abuse and Mental Health Services Administration, 2008. (6 refs.)

Hallucinogens include lysergic acid diethylamide (LSD), phencyclidine (PCP), Ecstasy (MDMA), Salvia divinorum, ketamine, peyote, mescaline, and psilocybin (mushrooms). Specific questions on the following hallucinogens were first collected in SAMHSA's 2006 National Survey on Drug Use and Health: ketamine, dimethyltryptamine (DMT), alpha-methyltryptamine (AMT), 5-methoxy-diisopropyltryptamine (5-MeO-DIPT or "Foxy"), and Salvia divinorum. Based on SAMHSA's 2006 National Survey on Drug Use and Health of persons aged 12 or older, 23 million had used LSD, 6.6 million used PCP, 2.3 used ketamine, 1.8 million used Salvia divinorum and 0.7 million had used DMT, AMT, or Foxy at least once in their lifetime. Among youth aged 12 to 17, females were more likely than males to have used Ecstasy in the past year (1.4% vs. 1.0%). Among youth aged 12 to 17, males were more likely than females to have used Salvia divinorum in the past year (0.9% vs. 0.3%). In 2006, young adults aged 18 to 25 were more likely than youths aged 12 to 17 or adults aged 26 or older to be past year users of LSD, Ecstasy, and Salvia divinorum.

Public Domain

Parrott AC; Milani RM; Gouzoulis-Mayfrank E; Daumann J. Cannabis and ecstasy/MDMA (3,4-methylenedioxymethamphetamine): An analysis of their neuropsychobiological interactions in recreational users. (review). Journal of Neural Transmission 114(8): 959-968, 2007. (100 refs.)

The majority of recreational Ecstasy/MDMA users (90-98%) also take cannabis. This co-drug usage is often viewed as a methodological confound, which needs to be removed statistically. Here we take a rather different approach, and debate the potential complexities of their psychobiological interactions. The ring-substituted amphetamine derivate MDMA (3,4-methylendioxymethamphetmaine, or 'Ecstasy') is a powerful CNS stimulant, whereas cannabis is a relaxant. Their co-usage may reflect opposing effects in three psychobiological areas: arousal, body temperature, and oxidative stress. Firstly MDMA is alerting whereas cannabis is sedating. Secondly MDMA is hyperthermic whereas cannabis is hypothermic. Thirdly MDMA increases oxidative stress whereas cannabinoids are antioxidant. Hence cannabis may modulate the acute and sub-acute reactions to MDMA, reduce the acute hyperthermia induced by MDMA, and ameliorate the oxidative stress caused by MDMA. The limited empirical evidence on each topic will be critically examined. In terms of chronic effects each drug is functionally damaging, so that polydrug users generally display cumulative neurobiological impairments. However in certain aspects their neuropsychobiological effects may interactive rather than additive. In particular, the combined use of cannabis and MDMA may have rather different neuropsychobiological implications, than their separate usage. In order to investigate these potential complexities, future research will need better empirical data on the exact patterns of co-drug usage.

Peters GJY; Kok G; Abraham C. Social cognitive determinants of ecstasy use to target in evidence-based interventions: A meta-analytical review. Addiction 103(1): 109-118, 2008. (56 refs.)

Aims: The health hazards and prevalence of ecstasy use have been documented in two decades of research, but no review reporting on potentially modifiable antecedents of use is available. The aim of this study was to integrate systematically research identifying cognitive correlates of ecstasy use. Such research has the potential to identify targets for evidence-based interventions designed to discourage use. Methods The databases PsycINFO and MedLine were searched, inclusion criteria applied to resulting hits, and descendency and ancestry approaches applied to the selected publications. Reported associations between cognitive determinants, including intention to use and ecstasy use measures, were synthesized by calculating a weighted mean effect size, r. Results: The pattern of associations lent support both to the theory of planned behaviour (TPB) and the expectancy approach as descriptions of potentially useful determinants. Attitudes were associated most strongly with intention and use, followed by subjective norm and perceived behavioural control. Conclusions: Consideration of the strength of associations and the potential modifiability of identified cognitions suggests that evidence-based interventions to discourage ecstasy use should target negative expectancies, perceived behavioural control and anticipated regret, and consider tailoring perceived behavioural control elements.

Pisetsky EM; Chao YM; Dierker LC; May AM; Striegel-Moore RH. Disordered eating and substance use in high-school students: Results from the youth risk behavior surveillance system. International Journal of Eating Disorders 41(5): 464-470, 2008. (31 refs.)

Objective: To examine the association between disordered eating (fasting, diet product use, and vomiting or laxative use) and use of 10 substances (cigarettes, alcohol, marijuana, cocaine, inhalants, heroin, methamphetamines, ecstasy, steroids, and hallucinogens) in a nationally representative adolescent sample. Method: Participants were 13,917 U.S. high-school students participating in the 2005 Youth Risk Behavior Surveillance System. Results: Disordered eating was significantly associated with the use of each substance. Using effect size estimates that take base rates into consideration, for female students, associations between substance use and disordered eating were weak for all but three forms of substance use: current smoking, binge drinking, and inhalants. Among male students, strong (marijuana, steroids, and inhalants) or moderate effects (all other substances) were observed. Conclusion: Future research needs to focus on inhalant use and methamphetamine use in males. Increased medical attention should be directed toward adolescents who practice disordered eating behaviors because they are also at elevated risk for using cigarettes, alcohol, inhalants, methamphetamines, and steroids.

Rendell PG; Gray TJ; Henry JD; Tolan A. Prospective memory impairment in "ecstasy" (MDMA) users. Psychopharmacology 194(4): 497-504, 2007. (41 refs.)

Rationale: Considerable research indicates that "ecstasy" users perceive their memory for future intentions (prospective memory) to be impaired. However, only one empirical study to date has directly tested how this capacity is affected by ecstasy use, and this study provided relatively limited information regarding the extent, scope, or implications of problems experienced. Objectives: The present study assessed prospective performance on a laboratory measure of prospective memory that closely represents the types of prospective memory tasks that actually occur in everyday life and provides an opportunity to investigate the different sorts of prospective memory failures that occur (" Virtual Week"). Method: Ecstasy user group (27 current users and 34 nonusers) was between participants, and prospective memory task (regular, irregular, time- check) was within participants. A measure sensitive to specific aspects of psychopathology was also administered. Results: Ecstasy users were significantly impaired on Virtual Week, and these deficits were of a comparable magnitude irrespective of the specific prospective memory task demands. The pattern of results was unchanged after controlling for marijuana use, level of psychopathology, and sleep quality. Further, prospective memory was shown to be significantly impaired for both relatively infrequent and relatively frequent ecstasy users, although for the latter group the magnitude of this deficit was greater. Conclusions: Prospective memory performance is sensitive to regular and even moderate ecstasy use. Importantly, ecstasy users experience generalized difficulties with prospective memory, suggesting that these deficits are likely to have important implications for day- to- day functioning.

Sadeghian S; Darvish S; Shahbazi S; Mahmoodian M. Two ecstasy-induced myocardial Infarctions during a three month period in a young man. Archives of Iranian Medicine 10(3): 409-412, 2007. (14 refs.)

Ecstasy normally contains 3,4 methylenedioxymethamphetamine (MDMA) that increases the levels of serotonin, dopamine, and epinephrine in the central nervous system with consequent adverse effects on the cardiovascular system. Herein, we presented a case of ecstasy abuse which resulted in two episodes myocardial infarction during a three month period; the second episode led to death due to thrombus formation.

Sales P; Murphy S. San Francisco's freelancing ecstasy dealers: Towards a sociological understanding of drug markets. Journal of Drug Issues 37(4): 919-950, 2007. (59 refs.)

We present analyses based on selected findings from a NIDA-funded project entitled, "An Exploratory Study of Ecstasy Distribution" (2003-2006). We conducted in-depth interviews with 120 men and women in the San Francisco Bay area who had sold five or more doses five or more times in the six months prior to the interview. The research focused on the motivations and circumstances surrounding the decision to initiate sales, sales settings, the characteristics of both sellers and buyers and their relationships. It also focused on negotiated order and social identities. We describe the ways in which a sample of educated, housed, and employed Ecstasy dealers' attitudes and practices compared with more marginalized groups from other drug market studies. These findings suggest attention to social class, that is, the social characteristics of sellers and the availability of types of sales settings (public vs. private) is critical to developing a sociological understanding of drug markets.

Sauvageau A. Death from a possible anaphylactic reaction to ecstasy. Clinical Toxicology 46(2): 156-156, 2008. (4 refs.)

Ecstasy (3,4 methylenedioxymethamphetamine, or MDMA) is a recreational drug widely used among young people in discos or rave parties. MDMA is taken because it gives a feeling of euphoria, enhances energy and sociability, and heightens sensations and sexual arousal. However, several side effects have been described: headache, nausea, anorexia, xerostomia, insomnia, myalgia, trismus, and bruxism. More serious complications have also been reported, sometimes even leading to death: hyperthermia, disseminated intravascular coagulopathy, rhabdomyolysis, acute renal failure, liver failure, and water intoxication. We report the unusual case of a death due to an apparent allergic reaction following ecstasy ingestion.

Scherbaum N; Bonnet U; Schifano F; Birkemeyer W; Hufnagel A; Schmitz D et al. Low hospital admission rates following MDMA (Ecstasy) intake in Essen (Germany). (letter). American Journal on Addictions 16(5): 428-429, 2007. (7 refs.)

Sterk CE; Theall KP; Elifson KW. Getting into ecstasy: Comparing moderate and heavy young adult users. Journal of Psychoactive Drugs 39(2): 103-113, 2007. (50 refs.)

In this article, the authors examine factors associated with initial and present Ecstasy use among young adults. Face-to-face structured interviews were conducted in Atlanta, Georgia among 261 active Ecstasy users. The median age at which respondents first heard of Ecstasy was 16 years, whereas the median age of first Ecstasy use was 18 years. Initial Ecstasy use frequently involved polydrug use, including alcohol (50.4%). In terms of their current use, 47.5% of respondents were considered heavy Ecstasy users (using on 10 or more separate occasions in the last 90 days). White respondents, those who used more than one pill during their initial use, and those who used again within one month after their initial use were more likely to be current heavy Ecstasy users. Women, those who waited a longer time between initial and subsequent Ecstasy use, and those who considered themselves in the upper SES bracket were less likely to be current heavy Ecstasy users. A better understanding of initial and current Ecstasy use patterns, including polydrug use, is essential for effective prevention and intervention efforts.

Stone AL; O'Brien MS; De la Torre A; Anthony JC. Who is becoming hallucinogen dependent soon after hallucinogen use starts? Drug and Alcohol Dependence 87(2/3): 153-163, 2007. (18 refs.)

This study, based upon epidemiological survey data from the United States (U.S.) National Household Surveys on Drug Abuse (NHSDA) from 2000 to 2001, presents new estimates for the risk of developing a hallucinogen dependence syndrome within 24 months after first use of any hallucinogen (median elapsed time similar to 12 months). Subgroup variations in risk of becoming hallucinogen dependent also are explored. Estimates are derived from the NHSDA representative samples of non-institutionalized U.S. residents ages 12 and older (n = 114,241). A total of 2035 respondents had used hallucinogens for the first time within 24 months prior to assessment. An estimated 2-3% of these recent-onset hallucinogen users had become dependent on hallucinogens, according to the NHSDA DSM-IV computerized diagnostic algorithm. Controlling for sociodemographic and other drug use covariates, very early first use of hallucinogens (age 10-11 years) is associated with increased risk of hallucinogen dependence (p < 0.01). Excess risk of developing hallucinogen dependence was found in association with recent-onset use of mescaline; excess risk also was found for recent-onset users of ecstasy and of PCP. This study's evidence is consistent with prior evidence on a tangible but quite infrequent dependence syndrome soon after the start of hallucinogen use; it offers leads that can be confirmed or disconfirmed in future investigations.

Stull BW. Spontaneous pneumomediastinum following ecstasy ingestion and sexual intercourse. (editorial). Emergency Medicine Journal 25(2): 113-114, 2008. (4 refs.)

Ecstasy is an illegal drug that has become widely used among adolescents and young adults. It is used recreationally for its stimulant and sensory-altering properties. Serious adverse effects are well documented and include arrhythmias, hyperthermia, seizures and long-term neuropsychiatric effects. A handful of previous case reports have recognised a relationship between ecstasy use and spontaneous pneumomediastinum, but an underlying mechanism has been difficult to identify. This report describes a 21-year-old man who presented with chest pain and dysphagia 1 day after using ecstasy. He was subsequently found to have both mediastinal and retropharyngeal emphysema. It is suspected that the underlying aetiology of the findings in this case was sexual intercourse.

Summers SA; Glynne PA. Acute poisoning on the medical admissions unit. (editorial). Clinical Medicine 7(3): 277-279, 2007. (19 refs.)

Alcohol intoxication, deliberate medicinal overdoses and ingestion of (illegal) substances are common reasons for admission to emergency departments in the UK, particularly in inner city hospitals. This review discusses problems related to the ingestion of selected toxins. In terms of alcohol, attention here is directed to ethylene glycol, methanol and isopropyl alcohol - each of which can produce fatal intoxication through the ingestion of relatively small doses. The most common medicinal agents involved in overdose are paracetamol and salicylate. As for illicit recreational drugs, the problems of securing an accurate history are noted, along with the limitations of drug testing. The most prominent recreational agents are 3,4-methylenedioxymethamphetamine (MDMA or ecstasy); gamma-hydroxybutyrate (GHB or liquid ecstasy); flunitrazepam (Rohypnol); and ketamine (Ketalar). Each is described, including its presentation and management.

Sumnall HR; Beynon CM; Conchie SM; Riley SCE; Cole JC. An investigation of the subjective experiences of sex after alcohol or drug intoxication. Journal of Psychopharmacology 21(5): 525-537, 2007. (85 refs.)

Despite long-standing concern over the sexual health of the population there has been little work undertaken in the UK investigating sexual risk taking and sexual behaviours in the context of substance use. To investigate this further, 270 non-drug treatment seeking members of the public aged between 18 and 66 were administered a questionnaire containing the Alcohol Use Disorders Identification Test (AUDIT), the Drug Abuse Screening Test (DAST), the Severity of Dependence Scale (SDS), the Sexual Risks Scale and Attitudes toward condom use (SRSA), the Sexual Sensation Seeking Scale (SSSS); the Hospital Anxiety and Depression Scale (HADS), and questions pertaining to sexual episodes proximal to substance use. The population reported a varied history of substances and despite there not being self-awareness of problematic drug use, 39.4% reported above the cut-off mark of six on the DAST. An even greater percentage (57.8%) reported a score above eight on the AUDIT indicating hazardous or harmful drinking behaviour. The substance most often associated with sexual episodes was alcohol, followed by cannabis and ecstasy, and all were most frequently consumed in private houses. Sexual activity after drug use was most frequently circumstantial (i.e. the individual hadn't taken the substance for the specific purposes of sex), and was significantly associated with use of cannabis and ecstasy. The second most frequently reported association between drug use and sex was facilitation of a sexual encounter (i.e. to lower sexual inhibitions, increase self esteem and confidence), which was associated with use of alcohol, cannabis, cocaine and ecstasy. Although it was not possible to identify differences in subjective sexual changes after use of particular drugs, subjects reported that compared to sex after alcohol, sex on other drugs was more pleasurable and satisfying, with a greater perception of interpersonal contact with the partner and a greater willingness to sexually experiment. However, this latter change was not associated with changes in the type of sexual activity engaged in. Regression analysis revealed that the greatest subjective changes in sexual experiences were reported by younger participants who had ingested either ecstasy or cannabis prior to the sexual episode. These results are discussed in the context of sexual risk taking and suggest areas of intervention focus which may address substance use and sexual risk taking together.

Verdejo-Garcia A; Lawrence AJ; Clark L. Impulsivity as a vulnerability marker for substance-use disorders: Review of findings from high-risk research, problem gamblers and genetic association studies. (review). Neuroscience and Biobehavioral Reviews 32(4): 777-810, 2008. (351 refs.)

There is a longstanding association between substance-use disorders (SUDs) and the psychological construct of impulsivity. In the first section of this review, personality and neurocognitive data pertaining to impulsivity will be summarised in regular users of four classes of substance: stimulants, opiates, alcohol and 3,4-methylenedioxymethamphetamine (MDMA). Impulsivity in these groups may arise via two alternative mechanisms, which are not mutually exclusive. By one account, impulsivity may occur as a consequence of chronic exposure to substances causing harmful effects on the brain. By the alternative account, impulsivity pre-dates SUDs and is associated with the vulnerability to addiction. We will review the evidence that impulsivity is associated with addiction vulnerability by considering three lines of evidence: (i) studies of groups at high-risk for development of SUDs; (ii) studies of pathological gamblers, where the harmful consequences of the addiction on brain structure are minimised, and (iii) genetic association studies linking impulsivity to genetic risk factors for addiction. Within each of these three lines of enquiry, there is accumulating evidence that impulsivity is a pre-existing vulnerability marker for SUDs.

Verduin ML; Payne RA; McRae AL; Back SE; Simpson SA; Sarang RY et al. Assessment of club drug use in a treatment-seeking sample of individuals with marijuana dependence. American Journal on Addictions 16(6): 484-487, 2007. (13 refs.)

Club drug use is becoming increasingly popular in the United States and has been associated with chronic psychiatric symptoms and neuropsychological abnormalities. Patterns of club drug use and characteristics of club drug users are not homogeneous. Thus, treatment-seeking marijuana-dependent individuals may have a differential pattern of club drug use. Baseline assessments collected from 55 individuals participating in a pharmacological treatment study for marijuana dependence were examined. Individuals completed a 16-item self-report questionnaire assessing club drugs used, frequency and patterns of use, problems associated with use, and reasons for use. Subjects were primarily male (87.3%) and Caucasian (81.8%), with a mean age of 32.1 (+/- 9.1 years). As expected, a large number of individuals had used ecstasy (75%). However, LSD and methamphetamine use was also reported by many users (82.5% and 47.5% respectively), with many individuals reporting the use of more than one club drug. Notably, 31.6% of individuals reported tolerance to club drugs. These results emphasize the significant co-occurrence of club drug use in marijuana-dependent individuals. This appears to be the first study to report on club drug use in treatment-seeking marijuana-dependent individuals. Clinical implications and directions for future research are discussed.

Vervaeke HKE; Korf DJ; Benschop A; van den Brink W. How to find future ecstasy-users: Targeted and snowball sampling in an ethically sensitive context. Addictive Behaviors 32(8): 1705-1713, 2007. (21 refs.)

This article documents the design and the sampling procedures of a prospective longitudinal multidisciplinary study on the neurotoxicity of ecstasy (MDMA): the Netherlands XTC Toxicity Study (NeXT). Targeted and snowball sampling was used to recruit 188 respondents who were ecstasy-naive at baseline. All respondents completed baseline questionnaires and underwent medical and neuropsychological examinations. At the end of a 11- to 26- month follow-up period in which they completed four additional questionnaires, 160 respondents remained (85.1%). A total of 65 participants (40.6%) took ecstasy for the first time during the follow-up period. This paper discusses the ethical dilemmas inherent in a study of this type and the specific problems and solutions that emerged in the sampling. The sampling was tightly constrained by our need to locate respondents who were potential future ecstasy users while also meeting strict medical and technical criteria. The 'intention to use' criterion proved to be a clear-cut inclusion rule that was practical to apply in the fieldwork.

Wiley JL; Evans RL; Grainger DB; Nicholson KL. Age-dependent differences in sensitivity and sensitization to cannabinoids and 'club drugs' in male adolescent and adult rats. Addiction Biology 13(3-4): 277-286, 2008. (46 refs.)

Lifelong substance abuse is often initiated during adolescence; yet, most pre-clinical research in this area has been conducted in adult animals. Substantial evidence exists that the brain development that continues throughout adolescence may result in pharmacological responses that differ in a crucial manner from those of adults. The goal of this study was to evaluate age differences in motor activity following acute and repeated administration of drugs that are commonly abused by adolescents, including cocaine, Delta(9)-tetrahydrocannabinol (Delta(9)-THC), and the club drugs, ketamine and 3,4-methylenedioxymethamphetamine (MDMA). Adolescent and adult male rats were injected once daily with saline or with a dose of one of the test drugs for two 5-day dosing periods, separated by a 2-day drug holiday during which they remained in their home cages. Following each injection, rats were placed in a locomotor chamber for a 20-minute session. The potencies of cocaine, ketamine and MDMA for producing motor stimulation were less in male adolescents than in male adults. Furthermore, sensitization to the club drug, ketamine, developed after repeated dosing in adults, but not adolescents. In contrast, adolescents were initially more sensitive to the stimulatory effects of low doses of Delta(9)-THC than were adults, although rapid tolerance occurred. These results suggest that adolescents are less sensitive to the acute and repeated stimulant effects of some, but not all, of the drugs that are preferentially abused by this age group. This differential sensitivity may contribute to the different patterns of use that have been noted in adolescent versus adult drug abusers.

Winkelman MJ; Roberts TB, eds. Psychedelic Medicine: New Evidence for Hallucinogenic Substances as Treatments (two volumes). Westport CT: Praeger Perspectives, 2007. (Chapter refs.)

Psychedelic substances present in nature have been used by humans across hundreds of years to produce mind-altering changes in thought, mood, and perception -- changes otherwise only rarely experienced, be it in dreams, religious exaltation, or psychosis. U.S. scientists were studying the practical and therapeutic uses for hallucinogens, including LSD and mescaline, in the 1950s and 1960s. The government took steps to ban all human consumption of hallucinogens, by the 1970s, all human testing was stopped. Medical concerns were less the issue, than social issues and those who advocated free use of hallucinogens by all who desired. The FDA has again begun approving hallucinogenic research using human subjects. In these two volumes, researchers explain the testing and research underway to use - under the guidance of a trained provider - psychedelic substances for better physical and mental health, and their ability to treat disorders ranging from arthritis to post traumatic stress disorder. Spiritual uses are also addressed and the perceived benefits described. Medical and legal issues for therapeutic uses are also presented. The psychedelic drugs described include: LSD, ayahuasca, psilocybin, peyote, MDMA/ecstasy, marijuana. Volume I, deals with the medical use of psychedelic drugs and the social, clinical and legal perspectives. Volume II deals with the use of psychedelics in addiction medicine as well as their use in religious and mystical traditions. Appendices list a sample of sites where medical research with psychedelics is underway, and describe prominent advocates and organizations pushing to further this research.

Wu ZHL; Eschbach K; Grady JJ. Contextual influences on polydrug use among young, low-income women: Effects of neighborhood and personal networks. American Journal on Addictions 17(2): 135-144, 2008. (61 refs.)

This study assessed contextual risks for polydrug use in a triethnic sample (non-Hispanic white, African American, Hispanic) of young women with a low income. For the current analysis, a total of 712 young women aged 18 to 31 years who sought care in state-funded family planning clinics in southeast Texas from December 2001 to May 2003 participated in the survey. The main outcome of the study was the number of illicit drugs (including marijuana, MDMA [ecstasy], crack cocaine, and other hard drugs) used in the last 12 months. Of the 712 subjects, 198 (28%) reported using illicit drugs it? the past 12 months. Neighborhood socioeconomic status was significantly associated with drug use in a bivariate model. The proportion of women living in the most advantaged neighborhoods who reported drug use was more than twice that of women living in the most disadvantaged neighborhoods. However, the significance of neighborhood socioeconomic status was eliminated after controlling for ethnicity or for personal network characteristics in a multivariate ordinal logistic regression model. In contrast, in multivariate models, personal network indicators, such as a larger number of monthly contacts with friends (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.11, 1.56) and a target-number of friends who used illicit drugs (OR = 1.47, 95% CI = 1.33, 1.62) were associated with increased drug use. In addition, not being currently married (vs. being married) (OR = 2.73, 95% CI = 1.44, 5.16) was associated with a larger number of drugs used in the last 12 months. In conclusion, we found that neighborhood socioeconomic status was not directly associated with more drug use when controlling for ethnicity or for personal network characteristics. Personal networks may mediate the relationships between neighborhood and drug use. Strategies to reduce polydrug use should target personal networks where friends use illicit drugs.

Xavier CAC; Lobo PLD; Fonteles MMD; de Vasconcelos SMM; Viana GSD; de Sousa FCF. Ecstasy (MDMA): Pharmacological and toxic effects, mechanism of action and clinical management. [review (Portuguese)]. Revista de Psiquiatria Clinica 35(3): 96-103, 2008. (74 refs.)

Background: The consumption of the amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) by young people increased in the past years. Objectives: To conduct a literature review on the pharmacology of MDMA and particularly with respect to the putative mechanism of action implicated in the acute and long-term toxicity and neurotoxic effects. Methods: A literature review using the key words: 3,4-methylenedioxymethamphetamine, ecstasy, neurotoxicity, intoxication, abuse drugs was performed in the databases MEDLINE and LILACS. The search covered all articles published between 1985 and 2007. Results:Mere were still many unanswered questions regarding the pharmacology of ecstasy and the pathophysiology of its toxic effects. The fundamental mechanism of action is insufficient to explain all effects induced by the drug. The exact mechanism responsible for mediating the toxic effects of MDMA on 5-HT neurons remain to be elucidated. Discussion: There is limited information in published literature about the underlying pharmacology and mechanism of action that could account for the neurotoxic and other phathophysiological effect of MDMA.

Yacoubian GS; Peters RJ. An exploration of recent club drug use among rave attendees. Journal of Drug Education 37(2): 145-161, 2007. (80 refs.)

Raves are characterized by large numbers of youth dancing for long periods of time and by the use of "club drugs," such as 3, 4-methylenedioxymethamphetamine (MDMA or "ecstasy"). While a small body of research has explored the use of ecstasy and other club drugs (EOCD) among club rave attendees in the United States, we are aware of no studies that have investigated the relationship between EOCD use and high-risk sexual behaviors among members of this population. We explored the association between EOCD use and high-risk sexual behaviors among a sample of 283 club rave attendees interviewed during the spring and summer of 2005. Data were collected at 13 rave events in two different clubs along the Baltimore-Washington corridor between March 17 and September 3, 2005. Potential respondents were conveniently sampled and approached between 12 a.m. and 5 a.m. as they exited the clubs. Only 12% reported using ecstasy within the two days preceding the interview, findings considerably lower than our earlier studies of club rave attendees. Moreover, no significant relationship was discerned between recent MDMA use and high-risk sexual behavior. These findings suggest that the use of EOCD among rave attendees has diminished and that the allocation of significant resources to combat their proliferation, among this and other populations at risk for EOCD use, may be premature.

Yen CF; Cheng CP; Tsai JL; Hsu SY. Family, peer and individual factors related to methylenedioxymethamphetamine use in Taiwanese adolescents. Psychiatry and Clinical Neurosciences 61(5): 552-557, 2007. (34 refs.)

Examination of the correlates of methylenedioxymethamphetamine (MDMA) use is crucial for the development and implementation of effective prevention programs for adolescents. The aim of the present study was therefore to identify the family, peer and individual factors that were related to MDMA use in Taiwanese adolescents. Two hundred adolescents who used MDMA and 200 who did not use MDMA were recruited into the study. The family, peer and individual factors related to MDMA use were examined using chi(2) automatic interaction detection (CHAID) analysis. The results indicated that the adolescents who had more friends involved with substance use, disruptive family and attitude favoring MDMA use were more likely to use MDMA. Multiple factors of family, peer and individuals were related to MDMA use among Taiwanese adolescents. This knowledge may be helpful when designing and implementing preventive intervention programs.

Yen CF; Hsu SY; Cheng CP. Poly-substance use and its correlates in adolescent ecstasy users in Taiwan. Addictive Behaviors 32(10): 2286-2291, 2007. (10 refs.)

The aim of this study was to examine whether individual, family and peer factors can increase the risk of polysubstance use in Taiwanese adolescent ecstasy users. Two hundred adolescents with ecstasy use were recruited into this study. Their experience of using any other harmful substance in the preceding year and a variety of individual, family and peer characteristics were collected. The correlates of polysubstance use were examined using the two-step procedure of variable selection. The results indicated that 59 (29.5%) of the adolescent ecstasy users were polysubstance users. Ketamine, alcohol and areca quid were the three most prevalent substances used. Users who experienced dropping out of school, had poor mental health status and whose fathers had a low education level had an increased risk of polysubstance use. Clinicians should thoroughly screen adolescent ecstasy users who have the above factors as they are more likely to use other substances concomitantly.

Yen CF; Hsu SY. Symptoms of ecstasy dependence and correlation with psychopathology in Taiwanese adolescents. Journal of Nervous and Mental Disease 195(10): 866-869, 2007. (23 refs.)

This study aimed at examining the spectrum and frequency of symptoms of ecstasy dependence and their correlation with psychopathology by controlling polysubstance use in Taiwanese adolescents. Two hundred adolescents who had used ecstasy were recruited into this study. Symptoms of ecstasy dependence that had occurred in the preceding year were determined by an interview using the Kiddie epidemiologic version of the Schedule for Affective Disorders and Schizophrenia. The adolescents' psychopathology was examined using the Symptom Checklist-90-Revised Scale. The proportion of participants who had symptoms of ecstasy dependence was calculated. The association between the number of symptoms of ecstasy dependence and psychopathology was examined by using stepwise multiple regression analysis. The results indicated that "continuing ecstasy use despite knowledge of having a problem related to ecstasy use," "spending a great deal of time in activities related to ecstasy use or to recover from its effects," and "ecstasy use tolerance" were the 3 most prevalent symptoms of dependence, and "withdrawal" was the symptom least reported. Heavy ecstasy use led to more symptoms of ecstasy dependence than light use. Symptoms of ecstasy dependence independently increased the risk of severe psychopathology after controlling the effects of polysubstance use. The results of this study indicated that adolescents were aware of the adverse effects of ecstasy use and that repeated ecstasy use would result in dependence on it. Screening the dependence symptoms of adolescent ecstasy users may help clinicians more thoroughly understand their psychopathology.

Zakzanis KK; Campbell Z; Jovanovski D. The neuropsychology of ecstasy (MDMA) use: A quantitative review. (review). Human Psychopharmacology: Clinical and Experimental 22(7): 427-435, 2007. (71 refs.)

A growing number of empirical studies have found varying neuropsychological impairments associated with use of 3, 4-methylenedioxymetlianiphetamine (MDMA) use. We set out to determine to what extent neuropsychological abilities are impaired in MDMA users. To do so, meta-analytical methods were used to determine the magnitude of neuropsychological impairment in MDMA users across pre-specified cognitive domains. We found that cognitive impairment secondary to recreational drug use may result in what might be described as small-to-medium effects across all cognitive domains with learning and memory being most impaired. We also found that total lifetime ingestion of MDMA appears to be negatively associated with performance on tasks ranging from attention and concentration to learning and memory. Implications and limitations of these findings are discussed.