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CORK Bibliography: Ecstasy

97 citations. March 2011 to present

Prepared: September 2012

Abdon JG; Wallin E; Andreasson S. The "Clubs against Drugs" program in Stockholm, Sweden: Two cross-sectional surveys examining drug use among staff at licensed premises. Substance Abuse Treatment, Prevention and Policy 6: e-article 2, 2011. (38 refs.)

Background: The objective of this study is to examine self-reported drug use among staff at licensed premises, types of drugs used, attitudes towards drugs, and observed drug use among guests. Results are presented from two measurement points (in 2001 and 2007/08). This study was carried out within the framework of the "Clubs against Drugs" program, which is a community-based multi-component intervention targeting licensed premises in Stockholm, Sweden. Methods: Two cross-sectional surveys were conducted, the first in 2001 and the second in 2007/08. Staff at licensed premises attending server training were asked to participate in the anonymous survey. A survey was administered in a classroom setting and consisted of four sections: 1) demographics, 2) respondents' own drug use experience, 3) respondents' attitudes towards drug use, and 4) observed drug use among guests at licensed premises. Results: Data were collected from 446 staff in 2001 and 677 staff in 2007/08. The four most commonly used drugs among staff were cannabis, cocaine, amphetamine, and ecstasy. The highest rates of drug use were reported by staff in the two youngest age groups, i.e., those younger than 25 and those between the ages of 25 and 29. In 2007/08 staff reported significantly lower rates of drug use than staff in 2001. Last year drug use for the sample in 2007/08 was 19% compared to 27% for the 2001 sample. While drug-using staff compared to non drug-using staff reported more observations of drug use among guests, they were less inclined to intervene. Overall, staff reported restrictive attitudes towards drugs. Conclusions: The prevalence of life-time and last year drug use among staff at licensed premises is high compared to the general population in Sweden. Lower rates of self-reported drug use among staff were reported in 2007/08. The results of this study highlight that staff at licensed premises represent an important target population in club drug prevention programs.

Copyright 2011, BioMedical Central

Aitchison KJ; Tsapakis EM; Huezo-Diaz P; Kerwin RW; Forsling ML; Wolff K. Ecstasy (MDMA)-induced hyponatraemia is associated with genetic variants in CYP2D6 and COMT. Journal of Psychopharmacology 26(3, special issue): 408-418, 2012. (55 refs.)

We hypothesised that genetically determined poor metabolism of 3,4-methylene dioxymetamphetamine (MDMA) due either to the presence of CYP2D6 genotypes giving absent or low CYP2D6 enzyme activity, or a COMT genotype predicting low COMT enzyme activity would be associated with a greater degree of MDMA-induced reduction in plasma sodium and osmolality than other genotypes at these genes following consumption of 'ecstasy' tablets by clubbers. Of the 48 subjects who returned to the test site post-clubbing, 30 provided samples for measurement of vasopressin (AVP), plasma sodium, urea and plasma and urine osmolality. Genotyping was performed for functional variants in CYP2D6 (n = 29) and COMT (Val158Met, n = 30). In subjects with urinary MDMA detected post-clubbing, there was a significant association between change in plasma osmolality (p = 0.009) and in plasma sodium (p = 0.012) and CYP2D6 genotypic category. Individuals with the low-activity but readily inhibitable CYP2D6 extensive metaboliser/intermediate metaboliser (EM/IM) genotype showed greater reductions in these measures than all other CYP2D6 genotypic categories. COMT lowactivity genotypes (Met/Met and Val/Met) were also significantly associated with reductions in plasma osmolality (p = 0.028) and in plasma sodium (p = 0.003). On conservative Bonferroni correction for two independent genes, the CYP2D6 and COMT plasma sodium findings remain significant. The relatively high frequency of the low-activity CYP2D6 and COMT genotypes in the population warrants further attention, since consumption of free water following ingestion of MDMA in these individuals may trigger dilutational hyponatraemia and increased risk of syndrome of inappropriate antidiuretic hormone secretion.

Copyright 2012, Sage Publications

Arendt M; Munk-Jorgensen P; Sher L; Jensen SOW. Mortality among individuals with cannabis, cocaine, amphetamine, MDMA, and opioid use disorders: A nationwide follow-up study of Danish substance users in treatment. Drug and Alcohol Dependence 114(2-3): 134- 139, 2011. (74 refs.)

This is a register-based cohort study of 20,581 individuals in treatment for illicit substance use disorders in Denmark between 1996 and 2006. All in all, 1441 deaths were recorded during 111,445 person-years of follow-up. Standardized mortality ratios (SMRs) associated with different primary substance types were calculated and Cox-regression analyses were performed in order to establish hazard ratios (HR) associated with injection drug use and psychiatric comorbidity. SMRs for primary users of specific substances were: cannabis: 4.9 (95% confidence interval (Cl): 4.2-5.8), cocaine: 6.4 (Cl: 3.9-10.0), amphetamine: 6.0 (Cl: 4.2-8.3), heroin: 9.1 (Cl: 8.5-9.8), and other opioids 7.7 (Cl: 6.6-8.9). For MDMA ('ecstasy') the crude mortality rate was 1.7/1000 person-years (Cl: 0.4-7.0) and the SMR was not significantly elevated. Injection drug use was associated with significantly increased hazard ratios in users of opioids and cocaine/amphetamine. Overall, psychiatric comorbidity was not associated with increased mortality (HR: 1.1 [Cl: 0.9-1.2], p = .28), but an association was found specifically among cocaine/amphetamine users (HR: 3.6 [Cl: 2.1-6.4], p <.001).

Copyright 2011, Elsevier Science

Bosker WM; Kuypers KPC; Conen S; Kauert GF; Toennes SW; Skopp G et al. MDMA (ecstasy) effects on actual driving performance before and after sleep deprivation, as function of dose and concentration in blood and oral fluid. Psychopharmacology 222(3): 367-376, 2012. (30 refs.)

Experimental research has shown that 3,4-methylenedioxymethamphetamine (MDMA) can improve some psychomotor driving skills when administered during the day. In real life, however, MDMA is taken during the night, and driving may likely occur early in the morning after a night of "raving" and sleep loss. The present study assessed the effects of MDMA on road-tracking and car-following performance in on-the-road driving tests in normal traffic. Sixteen recreational MDMA users participated in a randomized double-blind placebo-controlled four-way cross-over design. They received single, evening doses of 0, 25, 50, and 100 mg MDMA on separate occasions. Actual driving tests were conducted in the evening when MDMA serum concentrations were maximal and in the morning after a night of sleep loss. The primary measure of driving, i.e., standard deviation of lateral position (SDLP, a measure of weaving) was significantly increased during driving tests in the morning in all treatment conditions, irrespective of MDMA dose and concentration. The increments in SDLP were of high clinical relevance and comparable to those observed for alcohol at blood alcohol concentrations > 0.8 mg/mL. These impairments were primarily caused by sleep loss. In general, MDMA did not affect driving performance nor did it change the impairing effects of sleep loss. It is concluded that MDMA cannot compensate for the impairing effects of sleep loss and that drivers who are under the influence of MDMA and sleep deprived are unfit to drive.

Copyright 2012, Springer

Bruno R; Matthews AJ; Dunn M; Alati R; Mcllwraith F; Hickey S et al. Emerging psychoactive substance use among regular ecstasy users in Australia. Drug and Alcohol Dependence 124(1-2): 19-25, 2012. (42 refs.)

Background: The past decade has seen the development of an array of emerging psychoactive substances (EPS), however, there is minimal information on the extent of their use outside Europe. This study aimed to determine the extent of use of EPS from stimulant (such as mephedrone) and psychedelic classes (such as 5-methoxy-dimethyltryptamine [5-MeO-DMT]) among an Australian sample of regular ecstasy users (REU). Further, to determine if consumers of these drugs represent a distinct subgroup of REU. Methods: Australian national cross-sectional surveys of 693 regular (at least monthly) ecstasy users conducted during 2010. Results: More than one quarter (28%) of REU had used an EPS in the past six months, most commonly from the stimulant class (20%, typically mephedrone, 17%) rather than the psychedelic class (13%). Demographics and risk behaviours of REU that used stimulant EPS were largely no different from non-EPS consuming REU. Those using psychedelic EPS were distinct, initiating ecstasy use earlier, more frequently using multiple substances (cannabis, inhalants, GHB, ketamine) and more commonly experiencing legal, psychological and social problems. Conclusions: Psychedelic EPS use appears largely restricted to a distinct subset of REU with high-level non-injecting polydrug use, but use appears generally limited. The demographic similarity of stimulant EPS consumers with 'mainstream' REU, in conjunction with positive responses to the psychoactive effects of these drugs and declining ecstasy purity, suggests strong potential for stimulant EPS to expand further into ecstasy markets. Such drugs may have a greater public health impact than ecstasy, and merit careful monitoring into the future.

Copyright 2012, Elsevier Science

Brunt TM; Koeter MW; Niesink RJM; van den Brink W. Linking the pharmacological content of ecstasy tablets to the subjective experiences of drug users. Psychopharmacology 220(4): 751-762, 2012. (76 refs.)

Most studies on the subjective effects of ecstasy are based on the assumption that the substance that was taken is 3,4-methylenedioxymethamphetamine (MDMA). However, many tablets sold as ecstasy contain other substances and MDMA in varying doses. So far, few attempts have been made to take this into account while assessing subjective effects. This study aims to link the pharmacological content of tablets sold as ecstasy to the subjective experiences reported by ecstasy users. Self-reported effects on ecstasy tablets were available from 5,786 drug users who handed in their tablets for chemical analysis at the Drug Information and Monitoring System (DIMS) in the Netherlands. Logistic regression was employed to link the pharmacological content of ecstasy tablets to the self-reported subjective effects and compare effects with MDMA to other substances present. MDMA showed a strong association with desirable subjective effects, unparalleled by any other psychoactive substance. However, the association of MDMA was dose-dependent, with higher doses (> 120 mg/tablet) likely to evoke more adverse effects. The novel psychostimulants mephedrone and p-fluoroamphetamine were considered relatively desirable, whereas meta-chlorophenylpiperazine (mCPP) and p-methoxymethamphetamine (PMMA) were strongly associated with adverse subjective effects. Also, 3,4-methylene-dioxyamphetamine (MDA) and benzylpiperazine (BZP) were not appreciated as replacement for MDMA. Linking the pharmacological content of ecstasy sold on the street to subjective experiences contributes to a better understanding of the wide range of subjective effects ascribed to ecstasy and provides a strong rationale for the prolonged endurance of MDMA as the key ingredient of the ecstasy market.

Copyright 2012, Springer

Brunt TM; Niesink RJM; van den Brink W. Impact of a transient instability of the ecstasy market on health concerns and drug use patterns in The Netherlands. International Journal of Drug Policy 23(2): 134-140, 2012. (46 refs.)

Background: A recent decline in MDMA-like substances in ecstasy tablets has been reported by a number of countries in the European Union. This study describes the instability of the ecstasy market in The Netherlands during 2008 and 2009, and investigates whether this had any impact on drug testing or patterns of drug use. Methods: The health concerns of drug users handing in drug samples at drug testing facilities was measured using intervention time-series analysis. In addition, these ecstasy users were asked about changes in their drug use. Results: Nationally, the unstable market situation for ecstasy has increased the number of users handing in ecstasy tablets for testing because of health concern. There was no change in the number of users handing in cocaine or gamma hydroxybutyrate (GHB). Respondents reported no major changes in their drug use resulting from the shortage of MDMA-like substances. Conclusions: These findings provide further insight in drug policy based on both harm reduction and use reduction. In the event of reduced ecstasy quality, ecstasy users in The Netherlands have increasingly used drug testing as a potential harm reduction tool, rather than changing their patterns of drug use. This might indicate that a transient reduction of drug quality does not serve as a good drug use reduction strategy for ecstasy users.

Copyright 2012, Elsevier Science

Burgess AP; Venables L; Jones H; Edwards R; Parrott AC. Event related potential (ERP) evidence for selective impairment of verbal recollection in abstinent recreational methylenedioxymethamphetamine ("Ecstasy")/polydrug users. Psychopharmacology 216(4): 545-556, 2011. (39 refs.)

Ecstasy is a recreational drug whose active ingredient, 3,4-methylenedioxymethamphetamine (MDMA), acts predominantly on the serotonergic system. Although MDMA is known to be neurotoxic in animals, the long-term effects of recreational Ecstasy use in humans remain controversial but one commonly reported consequence is mild cognitive impairment particularly affecting verbal episodic memory. Although event-related potentials (ERPs) have made significant contributions to our understanding of human memory processes, until now they have not been applied to study the long-term effects of Ecstasy. The aim of this study was to examine the effects of past Ecstasy use on recognition memory for both verbal and non-verbal stimuli using ERPs. We compared the ERPs of 15 Ecstasy/polydrug users with those of 14 cannabis users and 13 non-illicit drug users as controls. Despite equivalent memory performance, Ecstasy/polydrug users showed an attenuated late positivity over left parietal scalp sites, a component associated with the specific memory process of recollection. This effect was only found in the word recognition task which is consistent with evidence that left hemisphere cognitive functions are disproportionately affected by Ecstasy, probably because the serotonergic system is laterally asymmetrical. Experimentally, decreasing central serotonergic activity through acute tryptophan depletion also selectively impairs recollection, and this too suggests the importance of the serotonergic system. Overall, our results suggest that Ecstasy users, who also use a wide range of other drugs, show a durable abnormality in a specific ERP component thought to be associated with recollection.

Copyright 2011, Springer

Calafat A; Blay NT; Hughes K; Bellis M; Juan M; Duch M et al. Nightlife young risk behaviours in Mediterranean versus other European cities: are stereotypes true? European Journal of Public Health 21(3): 311-315, 2011. (25 refs.)

Background: Mediterranean lifestyle has long been hailed as protective against certain risk behaviours and diseases. Mediterranean drinking patterns of moderate alcohol consumption as part of daily life have often been assumed to protect young people from harmful alcohol consumption, in contrast to Northern European drinking patterns. Nightlife environments are strong related to alcohol and drugs use, and other health risk behaviours but few cross-national studies have been undertaken amongst young Europeans frequenting bars and nightclubs. This study aims to understand differences in nightlife risk-taking behaviours between young nightlife users from Mediterranean and non-Mediterranean cultures, including alcohol and illicit drug use, unprotected sex, violence and driving under the influence of alcohol. Methods: A total of 1363 regular nightlife users aged 16-35 years were surveyed in nine European cities by means of a self-reported questionnaire. Sample selection was done through respondent driven sampling techniques. Results: after controlling for demographic variables, no differences among the Mediterranean and non-Mediterranean samples were found in current alcohol, tobacco, cannabis, or cocaine use, neither in violent behaviours, but Northern people were more likely to get drunk [adjusted odds ratio (AOR) = 0.53], while Mediterranean were more likely to have unprotected sex (AOR = 2.01) and to drive drunken (AOR = 5.86). Conclusion: Our data suggest that stereotypes are partially confirmed, and that Mediterranean lifestyle is protective for some risk behaviours (drunkenness, ecstasy and amphetamines current use), but not for all of them. Further research in depth is needed in order to clarify the relations between cultural patterns, social norms and nightlife risk behaviours assumed by the young people.

Copyright 2011, Oxford University Press

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. The DAWN Report: Emergency Department Visits Involving Ecstasy. (March 24, 2011). Rockville MD: Substance Abuse and Mental Health Administration, 2011. (4 refs.)

The number of drug-related emergency department (ED) visits involving 3,4-methylenedioxymeth-amphetamine (MDMA), commonly known as "Ecstasy," increased significantly from 10,220 visits in 2004 to 17,865 visits in 2008, representing a 74.8%increase. Most ED visits involving Ecstasy in 2008 (69.3 percent) were made by patients aged 18 to 29. An estimated 77.8 percent of these ED visits involved Ecstasy in combination with alcohol or other drugs (including pharmaceuticals or illicit drugs); in fact, 31.3% involved one other drug, 15.0% involved two other drugs, 14.0 percent involved three other drugs, and 17.5 percent involved four or more other drugs. Ecstasy-related ED visits among patients aged 21 or older were more likely than those made by patients aged 20 or younger also to involve alcohol (50.1 vs. 20.4%) or cocaine (43.4 vs. 14.7%). Because it provides psychedelic and stimulant side effects, Ecstasy is associated with dynamic social environments, such as parties or raves, where there is loud music and dancing. Yet the benign nicknames and the lively social environments in which the drug often is used belie the serious health and mental consequences that can result from casual to heavy Ecstasy use. Aside from addiction, Ecstasy use can cause anxiety, agitation, recklessness, increased blood pressure, dehydration, heat stroke, muscle cramping, blurred vision, hyperthermia, heart failure, and kidney failure.2 The social and environmental contexts in which Ecstasy often is used-prolonged vigorous activity in warm environments, such as dancing at crowded parties-can amplify associated cardiovascular health risks.3 Because it also compromises metabolic functioning, Ecstasy taken in combination with other drugs may place users at increased risk for additional and life-threatening drug interactions.3

Public Domain

Chen TT; Yen CF. Sexual intercourse experience and engagement in unprotected sex in adolescent MDMA users in Taiwan. Substance Use & Misuse 46(4): 398-403, 2011. (27 refs.)

This study aimed to examine the multidimensional correlates of having sexual intercourse experience and engaging in unprotected sex among adolescent ecstasy (3,4-methylenedioxyamphetamine or MDMA) users in Taiwan. The rates of having sexual intercourse and engaging in unprotected sex in 200 adolescent ecstasy users were calculated. Individual, family, and peer correlates of sexual intercourse and engagement in unprotected sex were examined. The results found that 124 (62%%) had had sexual intercourse and 79 (39.5%%) had engaged in unprotected sex at least once. Adolescent ecstasy users who were female, had used ketamine, had parents with habitual alcoholic problems, and more actively interacted with their peers were more likely to have had sexual intercourse. Those who were higher in novelty seeking and more actively interacted with peers were more likely to have engaged in unprotected sex. Sexual intercourse and engaging in unprotected sex in adolescent ecstasy users were correlated to multidimensional factors; the findings could provide a basis for interventions of prevention and reduction of harm.

Copyright 2011, Informa Healthcare

Chu M; Gerostamoulos D; Beyer J; Rodda L; Boorman M; Drummer OH. The incidence of drugs of impairment in oral fluid from random roadside testing. Forensic Science International 215(1-3): 28-31, 2012. (31 refs.)

Oral fluid (OF) has become a popular specimen to test for presence of drugs, particularly in regards to road safety. In Victoria, OF specimens from drivers have been used to test for the presence of methylamphetamine (MA) and Delta(9)-tetrahydrocannabinol (THC) since 2003 and 3, 4-methylenedioxy-N-methylamphetamine (MDMA) since 2006. LC-MS/MS has been used to test the most recent 853 submitted OF specimens from Victoria Police for 31 drugs of abuse including those listed in the Australian Standard AS4760-2006. At least one proscribed drug was detected in 96% of drivers, of which MA was the most common (77%), followed by THC (42%), MDMA (17%) and the combination of all three (3.9%). Opioids were detected in 14% of drivers of which 4.8% were positive for 6-acetylmorphine and 3.3% for methadone. The incidence of the opioids tramadol (1.2%) and oxycodone (1.1%) were relatively low. Cocaine (8.0%) was as commonly detected as benzodiazepines (8.0%), and was almost always found in combination with MA (7.9%). Samples positive to benzodiazepines were largely due to diazepam (3.5%) and alprazolam (3.4%), with only 0.2% of drivers combining the two. Ketamine was also detected in 1.5% of cases. While the incidences of the proscribed drugs itself are concerning, it is clear that many drivers are also using other drugs capable of causing impairment.

Copyright 2012, Elsevier Science

Ciorciari J; Marotte A. Implications of MDMA use for prospective memory function and substance use patterns in an Australian sample: A web-based pilot study. Australian Journal of Psychology 63(3): 142-149, 2011. (30 refs.)

The use of amphetamine type stimulants, particularly MDMA, is a global concern. Little research has been conducted on the association between MDMA use and everyday memory function-prospective memory. Twenty-five MDMA users, 37 cannabis users, and 43 illicit substance-naive controls were assessed on their substance use history and reported prospective memory performance as measured by the Prospective Memory Questionnaire (PMQ) using a web-based survey. There were significant differences between MDMA users and controls and cannabis users and controls on long-term episodic subscale of the PMQ. However, given the high prevalence of cannabis co-use by MDMA users, it was not possible to determine if MDMA use alone is associated with prospective memory performance. The substance use patterns of the sample were evaluated. Alcohol was the most used substance followed by tobacco, cannabis, and MDMA. The incidence of polydrug use was high, with all illicit substance use reporting having used at least two substances in their lifetime. The present study supports previous research into prospective memory deficits associated with substance use, and provides a basis for future research, particularly for elucidation of prospective memory deficits specific to MDMA use and further evaluation of substance use patterns.

Copyright 2011, Wiley-Blackwell

Cohen BMZ; Butler R. BZP-party pills: A review of research on benzylpiperazine as a recreational drug. (review). International Journal of Drug Policy 22(2): 95- 101, 2011. (41 refs.)

Background: BZP-party pills are yet another 'designer drug' which mimics the stimulant qualities of amphetamines and MDMA/Ecstasy. As legal markets for the substance have developed in the last decade (especially amongst young people) so has public and governmental concern. Methods: This article provides a summary of the available international research on benzylpiperazine (BZP) and its popular use in the compound form known as 'party pills'. Through performing an analysis of the available medical and social scientific literature, the review outlines current knowledge on the compound, the prevalence of usage of BZP-party pills, as well as the associated harms, risks and rationales for use of the drug. Results: Despite moves towards legislative control of BZP-party pills, the evidence presented suggests limited social and health harms associated with the drug, although research on long term effects is a significant gap in the literature. It also remains inconclusive as to whether BZP-party pills act as a 'gateway' to illegal drugs or, conversely, play a role in harm reduction with illegal drug users turning to legal alternatives; there is some evidence for both positions. Conclusion: With increasing controls of BZP-party pills, and with the increasing numbers of 'legal highs' and new designer drugs on the market, we conclude that new legal alternatives will continue to surface to replace the drug in the future. Considering a harm reduction approach to drug taking, it is suggested that policy makers consider the creation of a legal holding category which restricts and regulates the market in legal highs whilst the social and health harms associated with each drug can be thoroughly investigated.

Copyright 2011, Elsevier Science

Cuyas E; Verdejo-Garcia A; Fagundo AB; Khymenets O; Rodriguez J; Cuenca A et al. The influence of genetic and environmental factors among MDMA users in cognitive performance. PLoS ONE 6(11): e27206, 2011. (56 refs.)

This study is aimed to clarify the association between MDMA cumulative use and cognitive dysfunction, and the potential role of candidate genetic polymorphisms in explaining individual differences in the cognitive effects of MDMA. Gene polymorphisms related to reduced serotonin function, poor competency of executive control and memory consolidation systems, and high enzymatic activity linked to bioactivation of MDMA to neurotoxic metabolites may contribute to explain variations in the cognitive impact of MDMA across regular users of this drug. Sixty ecstasy polydrug users, 110 cannabis users and 93 non-drug users were assessed using cognitive measures of Verbal Memory (California Verbal Learning Test, CVLT), Visual Memory (Rey-Osterrieth Complex Figure Test, ROCFT), Semantic Fluency, and Perceptual Attention (Symbol Digit Modalities Test, SDMT). Participants were also genotyped for polymorphisms within the 5HTT, 5HTR2A, COMT, CYP2D6, BDNF, and GRIN2B genes using polymerase chain reaction and TaqMan polymerase assays. Lifetime cumulative MDMA use was significantly associated with poorer performance on visuospatial memory and perceptual attention. Heavy MDMA users (> 100 tablets lifetime use) interacted with candidate gene polymorphisms in explaining individual differences in cognitive performance between MDMA users and controls. MDMA users carrying COMT val/val and SERT s/s had poorer performance than paired controls on visuospatial attention and memory, and MDMA users with CYP2D6 ultra-rapid metabolizers performed worse than controls on semantic fluency. Both MDMA lifetime use and gene-related individual differences influence cognitive dysfunction in ecstasy users.

Copyright 2011, Public Library of Science

den Hollander B; Schouw M; Groot P; Huisman H; Caan M; Barkhof F et al. Preliminary evidence of hippocampal damage in chronic users of ecstasy. Journal of Neurology, Neurosurgery and Psychiatry 83(1): 83-85, 2012. (13 refs.)

Various studies have shown that ecstasy (3,4-methylenedioxymethamphetamine) users display significant memory impairments, whereas their performance on other cognitive tests is generally normal. The hippocampus plays an essential role in short-term memory. There are, however, no structural human data on the effects of ecstasy on the hippocampus. The objective of this study was to investigate whether the hippocampal volume of chronic ecstasy users is reduced when compared with healthy polydrug-using controls, as an indicator of hippocampal damage. The hippocampus was manually outlined in volumetric MRI scans in 10 male ecstasy users (mean age 25.4 years) and seven healthy age- and gender-matched control subjects (21.3 years). Other than the use of ecstasy, there were no statistically significant differences between both groups in exposure to other drugs of abuse and alcohol. The ecstasy users were on average drug-free for more than 2 months and had used on average 281 tablets over the past six and a half years. The hippocampal volume in the ecstasy using group was on average 10.5% smaller than the hippocampal volume in the control group (p=0.032). These data provide preliminary evidence that ecstasy users may be prone to incurring hippocampal damage, in line with previous reports of acute hippocampal sclerosis and subsequent atrophy in chronic users of this drug.

Copyright 2012, BMJ Publishing

Dowse MS; Shaw S; Cridge C; Smerdon G. The use of drugs by UK recreational divers: Illicit drugs. Diving and Hyperbaric Medicine 41(1): 9-15, 2011. (24 refs.)

Aims: Anecdotal observations suggest the use of illicit drugs takes place amongst recreational divers but, to date, there has been little open debate within the diving community concerning possible prevalence. This study investigated the prevalence and type of illicit drugs used by recreational divers in the United Kingdom (UK). Methods: Anonymous questionnaires were circulated via UK dive clubs, dive schools, dive shows and conferences. Questions incorporated diver and diving demographics and general health, which included anxiety, depression and panic attacks, alcohol use, smoking and illicit drug use since learning to dive and closest time to a dive. Questions pertaining to over-the-counter and prescription drug use were also asked. Results: 479 divers responded (66% males and 34% females) in the age range 16 to 59 years. Of the respondents, 22% had used one or more illicit drug since learning to dive, reporting benzodiazepines, amphetamines, cocaine, ecstasy, LSD, cannabis, heroin, and 'magic mushrooms'. Illicit drugs had been used by 3.5% of respondents in the last 12 months, and 3% in the last month. Cannabis, cocaine and ecstasy use was reported within 6 hours of a dive. Logistic regression confirmed a relationship between illicit drug use and depression (P = 0.014), and also between illicit drug use and anxiety (P = 0.024). Conclusion: These data support anecdotal reports that recreational divers use a range of illicit drugs. The significant relationship between illicit drug use and depression and anxiety supports the literature in non-diving populations.

Copyright 2011, South Pacific Underwater Medical Society

Dunn M; Thomas JO. A risk profile of elite Australian athletes who use illicit drugs. Addictive Behaviors 37(1): 144-147, 2012. (25 refs.)

Much of the literature investigating the relationship between sports participation and substance use has focused upon student populations, with little focus being given to athletes who participate at elite levels. Identifying why some athletes may be at a greater risk for substance use can help in the design and implementation of prevention initiatives. Data for the current study was from 1684 self-complete surveys with elite Australian athletes. Eight percent (n = 134) of the sample reported the use of at least one of the six illicit drugs under investigation (ecstasy, cannabis, cocaine, meth/amphetamine, ketamine and GHB) in the past year. Having been offered or having had the opportunity to use illicit drugs in the past year, knowing other athletes who use drugs and identifying as a 'full-time athlete' were significant predictors of past-year illicit drug use, while having completed secondary education or a post-school qualification was associated with a lower likelihood of past-year illicit drug use. Athletes are part of a sportsnet that includes family, coaches, support staff and other athletes, and these relationships may encourage the use, supply and demand for drugs. The current findings suggest that relationships with some of those in the sportsnet may play an important role when understanding illicit drug use among elite athletes. As education appears to be associated with a lower likelihood of illicit drug use among this group, initiatives should encourage athletes to engage in off-field pursuits which may also help prepare them for life after sport.

Copyright 2012, Elsevier Science

Fakier N; Wild LG. Associations among sleep problems, learning difficulties and substance use in adolescence. Journal of Adolescence 34(4): 717-726, 2011. (68 refs.)

This study investigated the relationships among sleep problems, learning difficulties and substance use in adolescence. Previous research suggests that these variables share an association with executive functioning deficits, and are intertwined. The sample comprised 427 adolescents (M age = 16 years) attending remedial schools and 276 adolescents (M age = 15 years) attending a mainstream school in Cape Town, South Africa. Participants completed anonymous self-report questionnaires. Results indicated that adolescents without learning difficulties were more likely to use tobacco, methamphetamine and cannabis, whereas those with learning difficulties engaged in more inhalant use. Adolescents who had more sleep problems were more likely to use tobacco, alcohol, methamphetamine, cannabis, inhalants, cocaine, ecstasy and any other illegal drug. Adolescents with learning difficulties had more sleep problems than those without learning difficulties. However, sleep problems remained independently associated with tobacco, cannabis and inhalant use when learning difficulties were taken into account.

Copyright 2011, Foundation for Professionals in Services for Adolescents

Fernando T; Gilbert JD; Carroll CM; Byard RW. Ecstasy and suicide. Journal of Forensic Sciences 57(4): 1137-1139, 2012. (29 refs.)

Deaths due to the ring-derivative amphetamines are not common and are usually accidental involving dehydration and hyperthermia. Suicides from 3, 4-methylenedioxymethamphetamine (MDMA) and related ring-derivative amphetamines overdose are rare. A 15-year-old female who had a history of depression and previous suicide attempts was found dead with a suicide note. Toxicology demonstrated lethal serum concentrations of MDMA (9.3 mg/L), with 34 mg/kg of MDMA in the liver, 2.4 mg/L in the urine, and 530 mg/kg in the stomach. The cause of death was MDMA toxicity, the manner suicide. While MDMA may be detected in victims in other drug-related or traumatic deaths, it is only rarely used in isolation in suicide, with a predominance in the 21- to 25-year-old range. Despite the rarity of such events, the possibility of a nonaccidental manner of death should be considered when high levels of MDMA and associated amphetamines are found at autopsy.

Copyright 2012, Wiley-Blackwell

Fernandez-Calderon F; Lozano OM; Vidal C; Ortega JG; Vergara E; Gonzalez-Saiz F et al. Polysubstance use patterns in underground rave attenders: A cluster analysis. Journal of Drug Education 41(2): 183-202, 2011. (45 refs.)

Drug use in mainstream rave parties has been widely documented in a large number of studies. However, not much is known about drug use in underground raves. The purpose of this study is to find out the polysubstance use patterns at underground raves. Two hundred and fifty-two young people between the ages of 18 and 30 who went to underground raves were interviewed. They were given a questionnaire to collect information on drug use at raves. Ravers used a mean of 4.9 different drugs at the last rave they had been to. Over 75% of them used tobacco, alcohol, cannabis, and amphetamine, and over half also used powder ecstasy. Two differentiated use patterns were found: one pattern concentrated more on the use of stimulants and the other on the use of hallucinogens. Underground ravers have a "standard" sociodemographic profile. The use of drugs is much higher than equivalent age group. Higher drug use prevalence than in mainstream rave parties is also observed. Different patterns of use appear which will be necessary to consider in designing preventions and risk reduction strategies.

Copyright 2011, Baywood Publishing

Fisk JE; Murphy PN; Montgomery C; Hadjiefthyvoulou F. Modelling the adverse effects associated with ecstasy use. Addiction 106(4): 798-805, 2011. (41 refs.)

Aims: Ecstasy, the street name for 3,4-meththylenedioxymethamphetamine, has been associated with a range of psychiatric symptoms and impaired psychological health in both problem and recreational users. The purpose of the present paper is to determine how these impairments are related to the history of polydrug use, and the conditions under which individuals ingest ecstasy. Design: Associations between the variables of interest were investigated utilizing negative binomial regression. Setting: Liverpool and Preston in the North West of England. Participants: A convenience sample of 159 recreational ecstasy/polydrug users (80 males, 79 females). The sample was composed primarily of undergraduates. Measurements: The dependent variable was the number of reported ecstasy-related adverse effects. Independent variables included quantitative aspects of ecstasy and other drug use, and the various beliefs and behaviours associated with ecstasy use. Findings: The number of adverse effects was associated positively with life-time exposure to ecstasy and negatively with period of abstinence from the drug. Adverse effects were more common among those who consumed ecstasy and alcohol concurrently, but were unrelated to other aspects of polydrug use. They were unaffected by whether the user took precautions when using the drug, and only weakly related to prior beliefs concerning the effects of ecstasy. Conclusions: Greater life-time exposure to ecstasy and consuming the drug concurrently with alcohol increase the likelihood of experiencing adverse effects, including paranoia, poor general health, irritability, confusion and moodiness. Adverse effects decrease with the period of abstinence from the drug.

Copyright 2011, Society for the Study of Addiction to Alcohol and Other Drugs

Fogger SA. Update on ecstasy. Journal of Psychosocial Nursing and Mental Health Services 49(4): 16-18, 2011. (14 refs.)

After years of declining use in the United States, youth consumption of ecstasy has increased significantly. Although ecstasy (3, 4-methylenedioxymethamphetamine) is known to be a drug with detrimental effects, users view the drug as a safe and attractive social lubricant. To update and clarify misperceptions, this article reviews current evidence regarding ecstasy's side effects and risks and encourages honest discussion focusing on risk-reduction behaviors.

Copyright 2011, Slack INC

Fulceri F; Ferrucci M; Lenzi P; Soldani P; Paparelli ABA; Gesi M. MDMA (Ecstasy) enhances loud noise-induced morphofunctional alterations in heart and adrenal gland. (review). Microscopy Research and Technique 74(9): 874-887, 2011. (169 refs.)

Noise is an environmental stressor increasingly more present in modern life and, in particular, in a variety of recreational contexts. The aim of this work is to show the effects of noise on the myocardium and adrenal gland, through a careful review of the literature dealing with the peripheral effects of noise exposure in experimental and clinical studies. Noise induces adverse effects in human health, principally involving the cardiovascular and autonomic nervous systems, and the endocrine apparatus. Several factors in recreational environments potentially worsen the effects induced by loud noise. Among these, the intake of 3,4-methylenedioxymethamphetamine (MDMA) is frequently associated with noise exposure in recreational situations, because of its high compliance within social and relaxation settings. For this reason, MDMA is defined as a club drug-as its intake by young people often occurs in association with other factors, such as aggregation, high temperatures, and noise. It is known that self-administration of MDMA by humans causes severe toxicity. In particular, the myocardium is affected early after MDMA intake-resulting in tachycardia, hypertension, and arrhythmia. Furthermore, MDMA alters the activity of the adrenal glands by elevating catecholamines and corticosterone levels. This review shows that combining MDMA and loud noise exposure potentiates the effects that are produced by each single stimulant alone as seen in experimental animal models. The convergence of the effects of prolonged loud noise exposure and the consumption of MDMA on the same system might explain the sudden fatal events that happen in recreational situations.

Copyright 2011, Wiley-Blackwell

Galicia M; Nogue S; Miro O. Liquid ecstasy intoxication: Clinical features of 505 consecutive emergency department patients. Emergency Medicine Journal 28(6): 462- 466, 2011. (25 refs.)

Background: To describe the epidemiological profile and clinical manifestations of liquid ecstasy (GHB) poisonings. Methods All cases of GHB poisoning or overdose admitted to the Emergency Department (ED) of the Hospital Clinic (Barcelona) between 2000 and 2007 were recorded. Results: A total of 505 patients (mean age 24.7 years, 68% men) were included. Most patients were brought to the hospital by ambulance (98%), during the weekend (89%) and during the early morning (75%). Symptoms began in a public place in 97%. Reduced consciousness was the most important clinical manifestation: 72% of patients had a Glasgow Coma Score of <= 12. 76% of patients had consumed other drugs: ethanol (64%), amphetamines and derivates (30%), cocaine (28%), ketamine (11%), cannabis (9%) and others (5%). Treatment was required in 26% of cases and an antidote was administered in 35 cases with no response. There were no deaths. The combined GHB group had a longer time to complete recovery of consciousness (71 +/- 40 vs 59 +/- 40 min, p<0.001) and a higher percentage of patients with severely reduced consciousness at ED arrival (54% vs 37%, p=0.01), need for treatment (29% vs 16%, p<0.01) and need for mechanical ventilation (3% vs 0%, p<0.05) compared with the pure GHB group. Conclusions: GHB intoxication leading to reduced consciousness is a frequent reason for ED admission, above all in young people and in the early morning at the weekend. Symptoms are more severe in patients who have taken GHB in combination with other substances of abuse.

Copyright 2011, BMJ Publishing

George AM; Windsor TD; Rodgers B. Are ecstasy users biased toward endorsing somatic mental health symptoms? Results from a general community sample. Psychopharmacology 214(4): 901-909, 2011. (34 refs.)

Whether the reported poorer mental health of ecstasy users is due to a bias in endorsement of somatic symptoms has been postulated, but rarely examined. The purpose of this study is to investigate whether levels of ecstasy use were associated with differential probabilities of endorsing somatic mental health symptoms. Current ecstasy users aged 24-30 years (n = 316) were identified from a population-based Australian study. Measures included frequency of ecstasy, meth/amphetamine, and cannabis use and the Goldberg anxiety/depression symptom scales. Multiple indicator, multiple cause models demonstrated no bias towards endorsing somatic symptoms with higher ecstasy use, both with and without adjustment for gender, cannabis, and meth/amphetamine use. Other studies using alternate measures of mental health should adopt this approach to determine if there is a bias in the endorsement of somatic symptoms among ecstasy users.

Copyright 2011, Springer

Gorun G; Curca GC; Hostiuc S; Buda O. "Legal highs" in Romania: Historical and present facts. Romanian Journal of Legal Medicine 19(1): 73-76, 2011. (7 refs.)

In the modern history of our country, the subject of psychoactive substances was banned as being against the socialist-communist political ideology, and consequently the research and knowledge on the historical evolution of the use of plants and substances for medical, hedonistic and/or ritual purposes in our country was not given any encouragement. In this context of a diluted and outdated knowledge on the psychoactive substances which had been maintained for decades, the explosion of the drug addiction phenomenon encountered an idealistic perception ("it is a problem of the Western world", "we are just a transit country", etc.), which lead to a fast increase in the number of young people who tried to consume illegal drugs. The political/administrative organisations, the civil society, the NGOs and particularly the scientific experts in Romania had all a very slow and laggard response, which has lead to the current situation when drug addiction is finally recognized as a very serious issue. Particular features of the Romanian phenomenon surprisingly not due to the local tradition or spontaneous flora (as long as currently marketed products are imported) are presented in this publication, giving examples from the criminal investigation experience. An alarming issue which has been highlighted by our research points to the fact that "classical drugs", such as opioids, methadone, ketamine, MDMA, are likely to be used in Romania for "spicing up" the so-called "legal" marketed products. In the following, we shall trace the historical evolution of the use of plants and substances for medical, hedonistic and/or ritual purposes in our country. We shall also reflect on the related legislative and medical issues, and the suggested measures.

Copyright 2011, Romanian Legal Medical Society

Hadjiefthyvoulou F; Fisk JE; Montgomery C; Bridges N. Everyday and prospective memory deficits in ecstasy/polydrug users. Journal of Psychopharmacology 25(4): 453-464, 2011. (52 refs.)

The impact of ecstasy/polydrug use on real-world memory (i.e. everyday memory, cognitive failures and prospective memory [PM]) was investigated in a sample of 42 ecstasy/polydrug users and 31 non-ecstasy users. Laboratory-based PM tasks were administered along with self-reported measures of PM to test whether any ecstasy/polydrug-related impairment on the different aspects of PM was present. Self-reported measures of everyday memory and cognitive failures were also administered. Ecstasy/polydrug associated deficits were observed on both laboratory and self-reported measures of PM and everyday memory. The present study extends previous research by demonstrating that deficits in PM are real and cannot be simply attributed to self-misperceptions. The deficits observed reflect some general capacity underpinning both time-and event-based PM contexts and are not task specific. Among this group of ecstasy/polydrug users recreational use of cocaine was also prominently associated with PM deficits. Further research might explore the differential effects of individual illicit drugs on real-world memory.

Copyright 2011, Sage Publications

Hadjiefthyvoulou F; Fisk JE; Montgomery C; Bridges N. Prospective memory functioning among ecstasy/polydrug users: Evidence from the Cambridge Prospective Memory Test (CAMPROMPT). Psychopharmacology 215(4): 761- 774, 2011. (50 refs.)

Prospective memory (PM) deficits in recreational drug users have been documented in recent years. However, the assessment of prospective memory has largely been restricted to self-reported measures that fail to capture the distinction between event-based and time-based prospective memory. The aim of the present study is to address this limitation. Extending our previous research, we augmented the range laboratory measures of prospective memory by employing the CAMPROMPT test battery to investigate the impact of illicit drug use on prospective remembering in a sample of cannabis only, ecstasy/polydrug and non-users of illicit drugs, separating event and time-based prospective memory performance. We also administered measures of executive function and retrospective memory in order to establish whether ecstasy/polydrug deficits in prospective memory were mediated by group differences in these processes. Ecstasy/polydrug users performed significantly worse on both event and time-based prospective memory tasks in comparison to both cannabis only and non-user groups. Furthermore, it was found that across the whole sample, better retrospective memory and executive functioning was associated with superior prospective memory performance. Nevertheless, this association did not mediate the drug-related effects that were observed. Consistent with our previous study, recreational use of cocaine was linked to prospective memory deficits. prospective memorP deficits have again been found among ecstasy/polydrug users, which appear to be unrelated to group differences in executive function and retrospective memory. However, the possibility that these are attributable to cocaine use cannot be excluded.

Copyright 2011, Springer

Halpern P; Moskovich J; Avrahami B; Bentur Y; Soffer D; Peleg K. Morbidity associated with MDMA (ecstasy) abuse: A survey of emergency department admissions. Human & Experimental Toxicology 30(4): 259-266, 2011. (35 refs.)

Methods: We conducted a prospective, representative-sample nationwide study on morbidity related to 3,4, methylenedioxymethamphetamine (MDMA; 'ecstasy') as determined from admissions to 5 geographically representative emergency departments (EDs) and from data from the poison information center (PIC). MDMA-related ED admissions were analyzed over a 7-month period and the records of all PIC calls were reviewed. Results: There were 52 (age 15-44 years, 32 males) ecstasy-related ED admissions during the study period. Most (68%) admissions presented to the ED at night, 52% on weekends and 44% consumed the drug at clubs and parties. Forty-six percent of the patients took between 1/2 to 3 tablets and 29 patients (56%) had taken ecstasy before. Twenty-two subjects (42%) reported poly-drug use. Fifteen subjects (29%) required hospitalization, six of them (11%) to the intensive care unit. The most common manifestations were restlessness, agitation, disorientation, shaking, high blood pressure, headache and loss of consciousness. More serious complications were hyperthermia, hyponatremia, rhabdomyolysis, brain edema and coma. Conclusion: The image of ecstasy as a safe party drug is spurious. The results of this study confirm that the drug bears real danger of physical harm and of behavioral, psychological and psychiatric disturbances.

Copyright 2011, Sage Publications

Halpern JH; Sherwood AR; Hudson JI; Gruber S; Kozin D; Pope HG. Residual neurocognitive features of long-term ecstasy users with minimal exposure to other drugs. Addiction 106(4): 777-786, 2011. (63 refs.)

Aims: In field studies assessing cognitive function in illicit ecstasy users, there are several frequent confounding factors that might plausibly bias the findings toward an overestimate of ecstasy-induced neurocognitive toxicity. We designed an investigation seeking to minimize these possible sources of bias. Design: We compared illicit ecstasy users and non-users while (1) excluding individuals with significant life-time exposure to other illicit drugs or alcohol; (2) requiring that all participants be members of the 'rave' subculture; and (3) testing all participants with breath, urine and hair samples at the time of evaluation to exclude possible surreptitious substance use. We compared groups with adjustment for age, gender, race/ethnicity, family-of-origin variables and childhood history of conduct disorder and attention deficit hyperactivity disorder. We provide significance levels without correction for multiple comparisons. Setting: Field study. Participants: Fifty-two illicit ecstasy users and 59 non-users, aged 18-45 years. Measurements: Battery of 15 neuropsychological tests tapping a range of cognitive functions. Findings: We found little evidence of decreased cognitive performance in ecstasy users, save for poorer strategic self-regulation, possibly reflecting increased impulsivity. However, this finding might have reflected a pre-morbid attribute of ecstasy users, rather than a residual neurotoxic effect of the drug. Conclusions: In a study designed to minimize limitations found in many prior investigations, we failed to demonstrate marked residual cognitive effects in ecstasy users. This finding contrasts with many previous findings-including our own-and emphasizes the need for continued caution in interpreting field studies of cognitive function in illicit ecstasy users.

Copyright 2011, Society for the Study of Addiction to Alcohol and Other Drugs

Hayatbakhsh MR; Kingsbury AM; Flenady V; Gilshenan KS; Hutchinson DM; Najman JM. Illicit drug use before and during pregnancy at a tertiary maternity hospital 2000-2006. Drug and Alcohol Review 30(2): 181-187, 2011. (26 refs.)

Introduction and Aims. To study the prevalence of use of illicit drugs by women of reproductive age before and during pregnancy and the changes in rates of illicit drug use in pregnancy over recent years. Design and Methods. All pregnant women attending the public antenatal clinic over a 7 year period (2000-2006) were routinely interviewed about their use of illicit drugs by a midwife at the antenatal booking visit. Measurements. Records for 25 049 women, who self-reported previous and current use of cannabis, amphetamines, ecstasy and heroin, were included in the study. Results. Cannabis was the most common illicit drug used before and during pregnancy; 9.3% of women were engaged in regular use prior to pregnancy and 2.5% were users during pregnancy. A very low proportion of women reported use of amphetamines, ecstasy or heroin in pregnancy. There was an increase in ever regular use and any past use of cannabis, amphetamines and ecstasy over time. Conclusions. The prevalence of illicit drug use by young women prior to becoming pregnant is of concern. While pregnancy appears to be a strong motivator for women to cease substance use, there is a need to study whether women resume drug use after their baby is born.

Copyright 2011, Wiley-Blackwell

Hittner JB; Schachne ER. Meta-analysis of the association between ecstasy use and risky sexual behavior. Addictive Behaviors 37(7): 790-796, 2012. (53 refs.)

A random-effects meta-analysis was conducted to examine the association between ecstasy use and risky sexual behavior. Analysis of 17 studies revealed a small to moderate sized effect (mean weighted r = 0.211, 95% CI: 0.085-0.336). Random-effects homogeneity testing was non-significant, thus formal moderator analyses were not performed. Moreover, numerical and visual diagnostics suggested that publication bias was not a concern. It is hoped that the present meta-analytic findings and recommendations will encourage investigators to broaden their research methodologies and will stimulate new insights into the association between ecstasy use and risky sexual behavior.

Copyright 2012, Elsevier Science

Hoggett K; McCoubrie D; Fatovich DM. Ecstasy-induced acute coronary syndrome: Something to rave about. Emergency Medicine Australasia 24(3): 339-342, 2012. (10 refs.)

Ecstasy or 3,4-methylenedioxymethamphetamine is a commonly used illicit recreational drug, enjoying popularity for its stimulant effects. Although acute coronary syndrome is recognized after cocaine and methamphetamine use, association with Ecstasy use has rarely been reported. We report three cases of significantly delayed acute coronary syndrome and ST elevation myocardial infarction related to ingestion of Ecstasy.

Copyright 2012, Wiley-Blackwell

Hondebrink L; Meulenbelt J; van Kleef RGDM; van den Berg M; Westerink RHS. Modulation of human GABA(A) receptor function: A novel mode of action of drugs of abuse. Neurotoxicology 32(6): 823-827, 2011. (30 refs.)

Drugs of abuse are known to mainly affect the dopaminergic and serotonergic system, although behavioral studies indicated that the GABA-ergic system also plays a role. We therefore investigated the acute effects of several commonly used drugs of abuse (methamphetamine, amphetamine, 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA) and meta-chlorophenylpiperazine (mCPP)) on the function of the human alpha(1)beta(2)gamma(2) GABA(A) receptor (hGABA(A)-R), expressed in Xenopus oocytes, using the two-electrode voltage-clamp technique. Although none of the tested drugs acted as full agonist on the hGABA(A)-R, some drugs induced differential modulation of hGABA(A)-R function, depending on the degree of receptor occupancy. Methamphetamine did not affect the GABA-evoked current at high receptor occupancy, but induced a minor inhibition at low receptor occupancy. Its metabolite amphetamine slightly potentiated the GABA-evoked current. MDMA and its metabolite MDA both inhibited the current at low receptor occupancy. However, MDMA did not affect the current at high occupancy, whereas MDA induced a potentiation. mCPP induced a strong inhibition (max. similar to 80%) at low receptor occupancy, but similar to 25% potentiation at high receptor occupancy. Competitive binding to one of the GABA-binding sites could explain the drug-induced inhibitions observed at low receptor occupancy, whereas an additional interaction with a positive allosteric binding site may play a role in the observed potentiations at high receptor occupancy. This is the first study to identify direct modulation of hGABA(A)-Rs as a novel mode of action for several drugs of abuse. Consequently, hGABAA-Rs should be considered as target for psychiatric pharmaceuticals and in developing treatment for drug intoxications.

Copyright 2011, Elsevier Science

Huang YS; Tang TC; Lin CH; Yen CF. Effects of Motivational Enhancement Therapy on readiness to change MDMA and methamphetamine use behaviors in Taiwanese adolescents. Substance Use & Misuse 46(4): 411-416, 2011. (28 refs.)

The aim of this study was to examine the effect of brief modified motivational enhancement therapy (MET) on readiness to change patterns of methylenedioxymethamphetamine (MDMA) and methamphetamine (MAMP) use behaviors in adolescents. A total of 94 adolescents who used MDMA or MAMP were consecutively recruited from a juvenile abstinence center; 46 received a three-session MET intervention (intervention group), and 48 received educational materials only and no MET intervention (control group). Analysis of covariance was performed to examine the effect of motivational interviewing on the readiness of change scores on the University of Rhode Island Change Assessment and on the scores of its subscales. By using the pretreatment scores as covariates, the intervention group demonstrated higher posttreatment scores of readiness to change and of the contemplation subscale on the University of Rhode Island Change Assessment than the control group. The results of this study support the finding that brief modified MET is effective in promoting readiness to change MAMP and MDMA use behaviors in adolescents who receive short-term treatment programs.

Copyright 2011, Informa Healthcare

Hughes CE; Lancaster K; Spicer B. How do Australian news media depict illicit drug issues? An analysis of print media reporting across and between illicit drugs, 2003-2008. International Journal of Drug Policy 22(4): 285-291, 2011. (35 refs.)

Background: Media reporting on illicit issues has been frequently criticised for being sensationalised, biased and narrow. Yet, there have been few broad and systematic analyses of the nature of reporting. Using a large sample and methods commonly adopted in media communications analysis this paper sought to identify the dominant media portrayals used to denote illicit drugs in Australian newspapers and to compare and contrast portrayals across drug types. Methods: A retrospective content analysis of Australian print media was carried out over the period 2003-2008 from a sample comprised of 11 newspapers. Articles that contained one or more mention of five different drugs (or derivatives) were identified: cannabis, amphetamines, ecstasy, cocaine and heroin. A sub-sample of 4397 articles was selected for media content analysis (with 2045 selected for full content analysis) and a large number of text elements coded for each. Key elements included topic, explicit or implicit messages about the consequences of drugs/use and three value dimensions: overall tone, whether drugs were portrayed as a crisis issue and moral evaluations of drugs/use. Results: The dominant media portrayals depicted law enforcement or criminal justice action (55%), but most articles were reported in a neutral manner, in the absence of crisis framings. Portrayals differed between drugs, with some containing more narrow frames and more explicit moral evaluations than others. For example, heroin was disproportionately framed as a drug that will lead to legal problems. In contrast, ecstasy and cocaine were much more likely to emphasise health and social problems. Conclusion: Media reporting on illicit drugs is heavily distorted towards crime and deviance framings, but may be less overtly sensationalised, biased and narrowly framed than previously suggested. This is not to suggest there is no sensationalism or imbalance, but this appears more associated with particular drug types and episodes of heightened public concern.

Copyright 2011, Elsevier Science BV

Hungerbuehler I; Buecheli A; Schaub M. Drug checking: A prevention measure for a heterogeneous group with high consumption frequency and polydrug use. Evaluation of Zurich's Drug Checking services. Harm Reduction Journal 8: article 16, 2011. (9 refs.)

Background: The increasing party culture in Zurich presents new challenges, especially regarding the consumption of alcohol and so-called party drugs. Streetwork, the youth advisory service of the city of Zurich, has provided onsite and stationary Drug Checking facilities since 2001 and 2006, respectively. Drug Checking always involves filling out an anonymous questionnaire, which allows the collection of important information about a largely unknown group of users and their consumption patterns. Methods: The questionnaires assessed sociodemographic characteristics, consumption patterns, Drug Checking experiences, information behavior and social support. The collected data were statistically analyzed by the Research Institute for Public Health and Addiction (RIPHA). Results: The majority of Drug Checking service patrons were male and between 20 and 35 years old. These patrons reported high lifetime prevalences and high consumption frequencies of legal and illegal substances, and they often reported polydrug use. Aside from tobacco and alcohol, the most consumed drugs during typical party nights were ecstasy, amphetamines, cannabis and cocaine. Party drug consumers using Drug Checking services form a heterogeneous group with respect to sociodemographic characteristics and consumption patterns. Users of the onsite Drug Checking facilities were significantly younger, were less experienced with drug testing, and reported more polydrug use than users of the stationary Drug Checking service. Conclusions: Drug Checking combined with a consultation appears to be an important harm reduction and prevention measure that reaches a group of consumers with high consumption frequency and polydrug use. Because of the heterogeneity of the target group, different prevention measures must be offered and embedded in an overall local concept.

Copyright 2011, BioMed Central

Hysek CM; Simmler LD; Ineichen M; Grouzmann E; Hoener MC; Brenneisen R et al. The norepinephrine transporter inhibitor reboxetine reduces stimulant effects of MDMA ("Ecstasy") in humans. Clinical Pharmacology & Therapeutics 90(2): 246-255, 2011. (49 refs.)

This study assessed the pharmacodynamic and pharmacokinetic effects of the interaction between the selective norepinephrine (NE) transporter inhibitor reboxetine and 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") in 16 healthy subjects. The study used a double-blind, placebo-controlled crossover design. Reboxetine reduced the effects of MDMA including elevations in plasma levels of NE, increases in blood pressure and heart rate, subjective drug high, stimulation, and emotional excitation. These effects were evident despite an increase in the concentrations of MDMA and its active metabolite 3,4-methylenedioxyamphetamine (MDA) in plasma. The results demonstrate that transporter-mediated NE release has a critical role in the cardiovascular and stimulant-like effects of MDMA in humans.

Copyright 2011, Nature Publishing

Irvine RJ; Kostakis C; Felgate PD; Jaehne EJ; Chen C; White JM. Population drug use in Australia: A wastewater analysis. Forensic Science International 210(1-3): 69-73, 2011. (26 refs.)

Accurate information on drug use in communities is essential if health, social and economic harms associated with illicit drug use are to be addressed efficiently. In most countries population drug use is estimated indirectly via surveys, medical presentations and police and custom seizures. All of these methods have at least some problems due to bias, small samples and/or long time delays between collecting the information and analysing the results. Recently the direct quantification of drug residues in wastewater has shown promise as a means of monitoring drug use in defined geographical areas. In this study we measured 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine and benzoylecgonine in sewage inflows in metropolitan and regional areas of Australia and compared these data with published European data. Cocaine use was small compared to European cities (p < 0.001) but was compensated for by much greater consumption of methamphetamine (p < 0.001) and MDMA (p < 0.05). MDMA was more popular in regional areas (p < 0.05) whereas methamphetamine and cocaine were mainly consumed in the city (p < 0.05). Greater than 5-fold increases in MDMA use were detected on weekends (p < 0.001). This approach has the potential to improve our understanding of drug use in populations and should be further developed to improve prevention and treatment programs.

Copyright 2011, Elsevier Science

Kazanga I; Tameni S; Piccinotti A; Floris I; Zanchetti G; Polettini A. Prevalence of drug abuse among workers: Strengths and pitfalls of the recent Italian Workplace Drug Testing (WDT) legislation. Forensic Science International 215(1-3): 46-50, 2012. (22 refs.)

Background: In 2008 a Workplace Drug Testing (WDT) law became effective in Italy for workers involved in public/private transportation, oil/gas companies, and explosives/fireworks industry with the aim to ensure public safety for the community. Aims: To examine and elaborate WDT data collected on a large group of workers (over 43, 500) during March 2009-February 2010 in order to highlight pros and cons and to draw suggestions for policies in the field. Setting: Northern Italy. Methods: After <= 24 h notification, workers provided a urine sample screened for opiates, methadone, buprenorphine, cocaine, amphetamines, ecstasy, and cannabinoids (THC) by immunoassay. Positives were confirmed by GC-MS. Results: The positive rate was 2.0%, THC being most frequent drug (1.3%; cocaine, 0.4%; opioids, 0.3%). 6.9% of the positive workers tested positive for >= 2 classes (most often THC + cocaine). Gender ratio and mean age were significantly lower in positives (F/M = 0.007; 35.5 +/- 8.3 years) than negatives (0.016 and 40.7 + 9.5, respectively). No decline in rates of positives and an increase of diluted samples over time were observed. The highest rates of positives were detected when sampling was performed just before/after weekend and during morning hours. Possible correlation between job type and drugs used were observed (e.g. more cocaine positives among road vehicle-drivers than among lift truck-drivers). Declared use of medicine/illicit drugs during the preceding week showed that illicit drug use was likely not always detected in urine and that almost 4% workers declared use of medicine drugs possibly affecting performance. Conclusions: This survey enabled to evidence relevant pitfalls of the law and to define strategies to improve the outcomes of WDT policies.

Copyright 2012, Elsevier Science

Khajeamiri AR; Kobarfard F; Ahmadkhaniha R; Mostashari G. Profiling of ecstasy tablets seized in Iran. Iranian Journal of Pharmaceutical Research 10(2): 211-220, 2011. (9 refs.)

In this study 50 samples of ecstasy tablets seized in Iran during the period of 2007 through 2008 were examined and their physical characteristics (appearance, marking, scored/not scored, color, weight, diameter, thickness) were determined. In order to determine the chemical characteristics of these tablets, color tests (Marquis test, Simon's test, Chen's test and Gallic acid test), Thin Layer Chromatography (TLC), anion test, residual solvents, Gas Chromatography-Mass Spectrometry (GC-MS) and Liquid Chromatography-Mass Spectrometry (LC-MS) were carried out on the tablets. The range of tablets weight was 96-308 mg and the range of 3,4-methylenedioxymethamphetamine (MDMA) hydrochloride content in these tablets was 60180 mg. No good correlation was found between the tablets weight and their MDMA contents. All of the tablets containing MDMA had this compound in hydrochloride form. Ketamine, phenmetrazine and ephedrine (or pseudoephedrine) were found in some of the tablets along with MDMA. No MDMA was found in 10% of the tablets. Some of these tablets contained compounds such as caffeine or tramadol as their active ingredient.

Copyright 2011, Shaheed Beheshti University

Khan U; Nicell JA. Refined sewer epidemiology mass balances and their application to heroin, cocaine and ecstasy. Environment International 37(7): 1236-1252, 2011. (153 refs.)

The detection of illicit drugs in environmental matrices may be a cause for concern, both from the perspective of their potential environmental impacts and the fact that their presence in detectable concentrations would be an indicator of significant drug use. The primary goal behind recent studies on this subject has been to use measured influent concentrations of selected illicit drugs or their in vivo metabolites in the environment as a means of estimating the abuse level of these drugs and patterns of consumption. Thus-far, such calculations have hinged on the use of solitary excretion estimates from single studies of limited scope and/or studies of limited applicability. Therefore, the need exists to conduct a comprehensive meta-analysis of metabolic disposition studies to construct excretions profiles for the various illicit drugs and their in vivo metabolites. The constructed excretory profiles should not only provide mean excretion values but also indicate the expected variations in excreted fractions that arise due to differences not only in the metabolic capacity of users but also in the efficiencies of various routes of administration for a given illicit drug. Therefore, the primary goal of the research presented here was to refine sewer epidemiology extrapolation mass balances for various illicit drugs of interest by constructing their excretory profiles segregated by route-of-administration. After conducting such a study with a multi-national scope on illicit drugs including cocaine, heroin and ecstasy, the results obtained clearly indicate that extrapolation factors currently being used in literature for these drugs to enumerate prevalence of abuse required significant refinement to increase their reliability.

Copyright 2011, Elsevier Science

Kim J; Fan B; Liu XH; Kerner N; Wu P. Ecstasy use and suicidal behavior among adolescents: Findings from a national survey. Suicide and Life-Threatening Behavior 41(4): 435-444, 2011. (49 refs.)

The relationship between ecstasy use and suicidal behavior among adolescents in the United States was examined. Data from the adolescent subsample (ages 12-17, N = 19,301) of the 2000 National Household Survey on Drug Abuse were used in the analyses. Information on adolescent substance use, suicidal behaviors, and related sociodemographic, family, and individual factors was obtained in the survey. The rate of past year suicide attempt among adolescents with lifetime ecstasy use was almost double that of adolescents who had used other drugs only, and nine times that of adolescents with no history of illicit drug use. In multinomial logistic regression analyses controlling for related factors, the effect of ecstasy use remained significant. Adolescent ecstasy users may require enhanced suicide prevention and intervention efforts.

Copyright 2011, Wiley-Blackwell

Kinner SA; George J; Johnston J; Dunn M; Degenhardt L. Pills and pints: Risky drinking and alcohol-related harms among regular ecstasy users in Australia. Drug and Alcohol Review 31(3): 273-280, 2012. (43 refs.)

Introduction and Aims. A significant proportion of young Australians engage in risky alcohol consumption, and an increasing minority are regular ecstasy (3,4-methylenedioxymethamphetamine) users. Risky alcohol use, alone or in combination with ecstasy, is associated with a range of acute and chronic health risks. The aim of this study was to document the incidence and some health-related correlates of alcohol use, and concurrent alcohol and ecstasy use, among a large, national sample of regular ecstasy users (REU) in Australia. Design and Methods. National, cross-sectional surveys of REU in Australia 2003-2008. Among REU in 2008 (n = 678) usual alcohol use, psychological distress and health-related quality of life were measured using the Alcohol Use Disorders Identification Test, Kessler Psychological Distress Scale and Short Form-8 Survey respectively. Results. Among REU in 2008, 36% reported high-risk patterns of usual alcohol consumption, 62% reported usually consuming more than five standard drinks with ecstasy, and 24% reported currently experiencing high or very high levels of psychological distress. Controlling for age and education, high-risk drinking among REU was associated with higher levels of psychological distress and poorer health-related functioning; however, the associations between concurrent alcohol and ecstasy use, and health outcomes, were not significant (P > 0.05). Discussion and Conclusions. A large and increasing proportion of REU in Australia engage in high-risk patterns of alcohol consumption, including in combination with ecstasy. High-risk alcohol consumption among this group is associated with adverse health-related outcomes. Prevention and harm reduction interventions for REU should incorporate messages about the risks associated with alcohol use. There is an ongoing need for youth-specific, coordinated alcohol and other drug and mental health services.

Copyright 2012, Wiley-Blackwell

Kirkpatrick MG; Gunderson EW; Perez AY; Haney M; Foltin RW; Hart CL. A direct comparison of the behavioral and physiological effects of methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) in humans. Psychopharmacology 219(1): 109-122, 2012. (58 refs.)

Despite their chemical similarities, methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) produce differing neurochemical and behavioral responses in animals. In humans, individual studies of methamphetamine and MDMA indicate that the drugs engender overlapping and divergent effects; there are only limited data comparing the two drugs in the same individuals. This study examined the effects of methamphetamine and MDMA using a within-subject design. Eleven adult volunteers completed this 13-day residential laboratory study, which consisted of four 3-day blocks of sessions. On the first day of each block, participants received oral methamphetamine (20, 40 mg), MDMA (100 mg), or placebo. Drug plasma concentrations, cardiovascular, subjective, and cognitive/psychomotor performance effects were assessed before drug administration and after. Food intake and sleep were also assessed. On subsequent days of each block, placebo was administered and residual effects were assessed. Acutely, both drugs increased cardiovascular measures and "positive" subjective effects and decreased food intake. In addition, when asked to identify each drug, participants had difficulty distinguishing between the amphetamines. The drugs also produced divergent effects: methamphetamine improved performance and disrupted sleep, while MDMA increased "negative" subjective-effect ratings. Few residual drug effects were noted for either drug. It is possible that the differences observed could explain the differential public perception and abuse potential associated with these amphetamines. Alternatively, the route of administration by which the drugs are used recreationally might account for the many of the effects attributed to these drugs (i.e., MDMA is primarily used orally, whereas methamphetamine is used by routes associated with higher abuse potential).

Copyright 2012, Springer

Kuypers KPC; Wingen M; Heinecke A; Formisano E; Ramaekers JG. MDMA intoxication and verbal memory performance: A placebo-controlled pharmaco-MRI study. Journal of Psychopharmacology 25(8): 1053-1061, 2011. (35 refs.)

The aim of the present study was to identify the neural substrate underlying memory impairment due to a single dose of MDMA (3,4-methylenedioxymethamphetamine) by means of pharmaco-MRI. Based on previous behavioral results it was hypothesized that this deficit could be attributed to a specific influence of MDMA on encoding. Fourteen Ecstasy users participated in this double-blind, placebo-controlled, within-subject study with two treatment conditions: MDMA (75 mg) and placebo. Memory performance was tested by means of a word learning task including two words lists, one addressing reading processes (control task, CWL) and a second (experimental task, EWL) addressing encoding and reading processes. Behavioral data showed that under the influence of MDMA, EWL performance was worse than placebo. Imaging data showed that Encoding was situated mainly in (pre)frontal, temporal and parietal areas. MDMA by Encoding interaction was situated in three areas: the left middle frontal gyrus (BA10), the right fusiform gyrus (BA19), and the left cuneus (BA18). Behavioral and functional data only correlated in BA10. It appeared that EWL performance caused BOLD signal change in BA10 during placebo treatment but not during MDMA intoxication. It is concluded that MDMA influences middle frontal gyrus processes resulting in impoverished memory encoding.

Copyright 2011, Sage Publications

Lee JP; Battle RS; Soller B; Brandes N. Thizzin': Ecstasy use contexts and emergent social meanings. Addiction Research & Theory 19(6): 528-541, 2011. (113 refs.)

The drug "Ecstasy" has been most commonly associated with raves, or electronic music dance events, and attributed with sexual disinhibition. In an ethnographic investigation of drug use among second-generation Southeast Asian youth in Northern California conducted in 2003, respondents described little use of or interest in using Ecstasy; yet in a second study, Ecstasy was the fourth most commonly used substance. This article investigates the social contexts for this change in use patterns. Respondents were second-generation Southeast Asian youths and young adults between the ages of 15 and 26 who were currently or recently drug-involved. We compared qualitative data from the two studies and found emerging patterns of meaning and context related to the observed change in use patterns. Ecstasy use among co-resident African American youth within the context of the local "hyphy" hip-hop music subculture had influenced Southeast Asian youths' uptake of the drug, known as "thizz." Respondents referred to the effects of the drug as "thizzin'," described as energizing, disinhibiting, numbing, and emotion enhancing. Reported consequences of "thizzin'" included violence and aggression as well as fun, while sexual disinhibition was rarely mentioned. The meanings assigned to drugs, including the effects ascribed to them, may be relative to the social contexts within which users are exposed to and consume drugs. The findings indicate the susceptibility of youths to local trends in drug use, particularly associated with popular cultural movements and music. Second-generation youths may be particularly susceptible relative to the conditions of their immigration and processes of identity formation unique to them.

Copyright 2011, Informa Healthcare

Licht CL; Christoffersen M; Okholm M; Damgaard L; Fink-Jensen A; Knudsen GM et al. Simultaneous polysubstance use among Danish 3,4-methylenedioxymethamphetamine and hallucinogen users: Combination patterns and proposed biological bases. Human Psychopharmacology: Clinical and Experimental 27(4): 352-363, 2012. (58 refs.)

Objective To describe patterns of simultaneous polysubstance use (SPU) among Danish 3,4-methylenedioxymethamphetamine (MDMA) (Ecstasy) and hallucinogen users. Methods A cross-sectional survey of 98 active MDMA and/or hallucinogen users recruited through homepage advertisements, flyers, and word of mouth in Denmark. Lifetime and recent substance use and SPU at last recalled use was described by structured interviews. Hair samples from a subset of participants were analyzed for MDMA. Results The participants had used an average of 12.6 (95% confidence interval: 11.713.4) psychoactive substances during their lifetime. SPU was prevalent among MDMA, d-lysergic acid diethylamide (LSD), and psilocybin users, in particular with alcohol and cannabis. Among MDMA users, 69% had combined MDMA with amphetamines, 56% with hallucinogens, and 47% with cocaine. At last recalled use, MDMA was taken with 2.1 +/- 1.2 substances in 32 different combinations. The participants preferred specific drug combinations and named several, which in their experience enhanced or counteracted each other. Alcohol and cannabis were typically used before, during, and after MDMA, LSD, and psilocybin, whereas amphetamines were predominantly taken before these substances. When LSD was combined with MDMA, the majority took MDMA after LSD. Conclusions Simultaneous polysubstance use was common among Danish MDMA and hallucinogen users, and patterns of preferred substance combinations were evident.

Copyright 2012, Wiley-Blackwell

Lindsey WT; Stewart D; Childress D. Drug interactions between common illicit drugs and prescription therapies. American Journal of Drug and Alcohol Abuse 38(4): 334-343, 2012. (51 refs.)

Objective: The aim was to summarize the clinical literature on interactions between common illicit drugs and prescription therapies. Methods: Medline, Iowa Drug Information Service, International Pharmaceutical Abstracts, EBSCO Academic Search Premier, and Google Scholar were searched from date of origin of database to March 2011. Search terms were cocaine, marijuana, cannabis, methamphetamine, amphetamine, ecstasy, N-methyl-3,4-methylenedioxymethamphetamine, methylenedioxymethamphetamine, heroin, gamma-hydroxybutyrate, sodium oxybate, and combined with interactions, drug interactions, and drug-drug interactions. This review focuses on established clinical evidence. All applicable full-text English language articles and abstracts found were evaluated and included in the review as appropriate. Results: The interactions of illicit drugs with prescription therapies have the ability to potentiate or attenuate the effects of both the illicit agent and/or the prescription therapeutic agent, which can lead to toxic effects or a reduction in the prescription agent's therapeutic activity. Most texts and databases focus on theoretical or probable interactions due to the kinetic properties of the drugs and do not fully explore the pharmacodynamic and clinical implications of these interactions. Clinical trials with coadministration of illicit drugs and prescription drugs are discussed along with case reports that demonstrate a potential interaction between agents. The illicit drugs discussed are cocaine, marijuana, amphetamines, methylenedioxymethamphetamine, heroin, and sodium oxybate. Conclusion: Although the use of illicit drugs is widespread, there are little experimental or clinical data regarding the effects of these agents on common prescription therapies. Scientific Significance: Potential drug interactions between illicit drugs and prescription drugs are described and evaluated on the Drug Interaction Probability Scale by Horn and Hansten.

Copyright 2012, Informa Healthcare

Lyne JP; O'Donoghue B; Clancy M; O'Gara C. Comorbid psychiatric diagnoses among individuals presenting to an addiction treatment program for alcohol dependence. Substance Use & Misuse 46(4): 351-358, 2011. (31 refs.)

A retrospective patient record review was conducted to examine comorbid psychiatric diagnoses, and comorbid substance use, among 465 patients below 45 years of age, presenting to a national alcohol addiction treatment unit in Dublin, between 1995 and 2006. Rates were high for depressive disorder (25.3%%) particularly among females (35.4%%). Lifetime reported use of substances other than alcohol was 39.2%%, and further analysis showed significantly higher rates of deliberate self-harm among this group. Lifetime reported use of ecstasy was also significantly associated with depression in this alcohol-dependent population using logistic regression analysis. Implications and limitations of the findings are discussed.

Copyright 2011, Informa Healthcare

Lyvers M. Commentary on Halpern et al. (2011): Strengthening the case against functionally significant serotonergic neurotoxicity in human MDMA (ecstasy) users. (commentary). Addiction 106(4): 787-788, 2011. (18 refs.)

Macias MS; Furton KG. Availability of target odor compounds from seized ecstasy tablets for canine detection. Journal of Forensic Sciences 56(6): 1594-1600, 2011. (14 refs.)

The aim of this study was to compare seized samples of 3,4-methylenedioxy-N-methylamphetamine (MDMA) pills, used to train law enforcement detection canine teams, to determine what differences exist in the chemical makeup and headspace odor and their effect on detectability. MDMA solutions were analyzed by liquid chromatography-mass spectrometry. Analysis of these samples showed a wide variance of MDMA (8-25%). Headspace SPME-GC/MS analysis showed that several compounds such as 3,4-methylenedioxyphenylacetone and 1-(3,4-methylenedioxyphenyl)-2-propanol are common among these MDMA samples regardless of starting compound and synthesis procedure. However, differences, such as the level of the various methylenedioxy starting compounds, were shown to affect the overall outcome of canine detection, indicating the need for more than one MDMA training aid. Combinations of compounds such as the primary odor piperonal in conjunction with a secondary compound such as MDP-2-OH or isosafrole are recommended to maximize detection of different illicit MDMA samples.

Copyright 2011, Wiley-Blackwell

Martins SS; Carlson RG; Alexandre PK; Falck RS. Perceived risk associated with ecstasy use: A latent class analysis approach. Addictive Behaviors 36(5): 551-554, 2011. (23 refs.)

This study aims to define categories of perceived health problems among ecstasy users based on observed clustering of their perceptions of ecstasy-related health problems. Data from a community sample of ecstasy users (n = 402) aged 18 to 30, in Ohio, was used in this study. Data was analyzed via Latent Class Analysis (LCA) and Regression. This study identified five different subgroups of ecstasy users based on their perceptions of health problems they associated with their ecstasy use. Almost one third of the sample (28.9%) belonged to a class with "low level of perceived problems" (Class 4). About one fourth (25.6%) of the sample (Class 2), had high probabilities of "perceiving problems on sexual-related items", but generally low or moderate probabilities of perceiving problems in other areas. Roughly one-fifth of the sample (21.1%. Class 1) had moderate probabilities of perceiving ecstasy health-related problems in all areas. A small proportion of respondents (11.9%, Class 5) had high probabilities of reporting "perceived memory and cognitive problems", and of perceiving "ecstasy related-problems in all areas" (12.4%. Class 3). A large proportion of ecstasy users perceive either low or moderate risk associated with their ecstasy use. It is important to further investigate whether lower levels of risk perception are associated with persistence of ecstasy use.

Copyright 2011, Elsevier Science

McCann UD; Edwards RR; Smith MT; Kelley K; Wilson M; Sgambati F; Ricaurte G. Altered pain responses in abstinent (+/-)3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") users. Psychopharmacology 217(4): 475-484, 2011. (56 refs.)

Rationale: (+/-) 3,4-Methylenedioxymethamphetamine (MDMA) is a popular recreational drug that has potential to damage brain serotonin (5-HT) neurons in humans. Brain 5-HT neurons play a role in pain modulation, yet little is known about long-term effects of MDMA on pain function. Notably, MDMA users have been shown to have altered sleep, a phenomenon that can lead to altered pain modulation. Objectives: This study sought to assess pain processing in MDMA users using objective methods, and explore potential relationships between pain processing and sleep indices. Methods: Forty-two abstinent MDMA users and 43 age-matched controls participated in a 5-day inpatient study. Outcome measures included standardized measures of pain, sleep polysomnograms, and power spectral measures of the sleep EEG. When differences in psychophysiological measures of pain were found, the relationship between pain and sleep measures was explored. Results: MDMA users demonstrated lower pressure pain thresholds, increased cold pain ratings, increased pain ratings during testing of diffuse noxious inhibitory control, and decreased Stage 2 sleep. Numerous significant relationships between sleep and pain measures were identified, but differences in sleep between the two groups were not found to mediate altered pain perception in MDMA users. Conclusions Abstinent MDMA users have altered pain perception and sleep architecture. Although pain and sleep outcomes were related, differences in sleep architecture in MDMA users did not mediate altered pain responses. It remains to be determined whether alterations in pain perception in MDMA users are secondary to neurotoxicity of 5-HT-mediated pain pathways or alterations in other brain processes that modulate pain perception.

Copyright 2011, Springer

Milani HS; Abadi AR; Helmzadeh Z; Abachizadeh K. Prevalence of ecstasy use and predisposing factors among Iranian female high school students. Journal of the Pakistan Medical Association 61(6): 566- 571, 2011. (22 refs.)

Objectives: To determine prevalence of ecstasy use and its predisposing factors among Iranian high school female students in Tehran, capital of Iran. Methods: In this cross-sectional study, 2350 female students of 36 high schools from Tehran, were selected by multi-stage cluster sampling to determine prevalence of ecstasy use and its predisposing factors. SPSS- version 13 was employed to conduct analysis through chi-square, fisher's exact test and logistic regression methods. Results: The prevalence of ecstasy use was 2.3% (95 A,Cl: 1.7-2.9%). Party was the most prevalent place of first use (65%) and access was easy for most users (63%). In multivariate analysis, smoking (P-V=0.005), alcohol use (P-V=003), use of other substances (P-V < 0.001), being in relationship with boys (P-V=0.015), families without one or two parents (P-V=0.020), night spending at friends home without parents' permission (P.V=0.001) were associated with ecstasy use. Conclusion: Due to relation of ecstasy use with other substances, designed programmes should be comprehensive, with different strategies and collaboration of several sectors. The main strategies are to improve students' health literacy, family support, to limit supply and access, and to legislate appropriate regulatory laws.

Copyright 2011, Pakistan Medical Association

Mitrevski B; Veleska B; Engel E; Wynne P; Song SM; Marriott PJ. Chemical signature of ecstasy volatiles by comprehensive two-dimensional gas chromatography. Forensic Science International 209(1-3): 11-20, 2011. (42 refs.)

A method for ecstasy volatiles 'signature' analysis based on two-dimensional gas chromatography separation and time-of-flight mass spectrometry detection (GC x GC-TOFMS) is presented. Organic impurity volatiles were extracted by head space solid phase microextraction (HS-SPME). The final column phase choice of the four different column combinations tested was a low-polarity 5% phenyl polysilphenylene-siloxane coupled with a polyethylene glycol phase, which best displayed the complex impurity profile. Second dimension (D-2) retention time reproducibility was found to be about 1% RSD, and area reproducibility of SPME sampling was just over 5% RSD for compounds with S/N ratio of about 100. High similarity of TOFMS spectra of impurities was obtained against commercial MS libraries. 16 components from the two-dimensional profiles were selected for comparison of the 24 ecstasy tablets, most of which proved to be benzodioxole derived compounds. All tablets were correctly classified in eight groups according to their post-tabletting characteristics, when appropriate data pre-treatment was applied. Principal component analysis revealed clustering of samples according to the country of origin. Samples from Macedonia were elevated in N-formyl-MDMA and N-acetyl-MDMA while samples from Australia were elevated in 3,4-methylenedioxypropane and 3,4-methylenedioxyacetophenone. Furthermore, three components were found to be unique for one of the source countries. The additional separation of components on the 2D column, increased response due to modulation, high acquisition rate with full mass spectra using TOFMS detection, and MS deconvolution extend the possibility of detecting additional markers and route-specific components, especially of low abundant, polar components.

Copyright 2011, Elsevier Science

Mohamed WMY; Ben Hamida S; Cassel JC; de Vasconcelos AP; Jones BC. MDMA: Interactions with other psychoactive drugs. (review). Pharmacology, Biochemistry And Behavior 99(4): 759-774, 2011. (335 refs.)

3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) is one of the most widely abused illegal drugs. Some users self-report euphoria and an increased perception and feeling of closeness to others. When taken in warm environments. MDMA users may develop acute complications with potential fatal consequences. In rodents, MDMA increases locomotor activity and, depending on ambient temperature, may produce a dose-dependent, potentially lethal hyperthermia. Like most other recreational drugs, MDMA is frequently taken in combination with other substances including tobacco, EtOH, marijuana, amphetamines, cocaine and, caffeine. Although polydrug use is very common, the understanding of the effects of this multiple substance use, as well as the analysis of consequences of different drug-drug associations, received rather little attention. The purpose of this review is to summarize our current knowledge about the changes on MDMA-related behavior, pharmacology, and neurotoxicity associated with co-consumption of other drugs of abuse and psychoactive agents.

Copyright 2011, Elsevier Science

Moonzwe LS; Schensul JJ; Kostick KM. The role of MDMA (ecstasy) in coping with negative life situations among urban young adults. Journal of Psychoactive Drugs 43(3): 199-210, 2011. (77 refs.)

This article examines the role of Ecstasy (MDMA or 3, 4-methylenedioxymethamphetamine) as a drug used for self-medication and coping with both short- and long-term negative life situations. We show that urban youth who do not have a specific diagnosed mental illness are more likely than those who have been diagnosed and have received treatment to use Ecstasy to cope with both situational stress and lifetime trauma. Diagnosed and treated youth sometimes self-medicate with other drugs, but do not choose Ecstasy for mediation of their psychological stress. We discuss the implications of self-medication with Ecstasy for mental health services to urban youth experiencing mental health disparities, and for the continued testing and prescription of MDMA for therapeutic use in controlled clinical settings.

Copyright 2011, Haight-Asbury Publishing

Morefield KM; Keane M; Felgate P; White JM; Irvine RJ. Pill content, dose and resulting plasma concentrations of 3,4-methylendioxymethamphetamine (MDMA) in recreational 'ecstasy' users. Addiction 106(7): 1293-1300, 2011. (50 refs.)

Aims: To improve our understanding of the pharmacology of 'ecstasy' in recreational environments; in particular, to describe the composition of ecstasy pills, patterns of ecstasy use and the relationship between dose of 3,4-methylendioxymethamphetamine (MDMA) and resulting plasma concentrations. Design, setting and participants: A naturalistic observational study of 56 experienced 'ecstasy' users in recreational settings in Australia. Measurements: Drug use patterns (number of pills consumed, other drugs consumed). drug content of pills and resultant plasma concentrations of MDMA and related drugs were assessed by gas chromatography/mass spectrometry (GC/MS). Findings: Ecstasy pills generally contained MDMA, but this was often combined with other drugs such as 3,4-methylendioxyethylamphetamine (MDEA) and methamphetamine. The dose of MDMA per pill ranged from 0 to 245 mg and users consumed from one-half to five pills, with the total dose consumed ranging up to 280 mg. Plasma concentrations of MDMA increased with number of pills consumed and cumulative MDMA dose. Use of larger numbers of pills was associated with extended exposure to the drug. Conclusions: MDMA is the major active drug in ecstasy pills, but there is a high degree of variation in doses. Use of multiple pills over the course of one session is common and results in a sustained increase in MDMA plasma concentrations over a number of hours. This is likely to lead to a much greater exposure of the brain to MDMA than would be predicted from controlled single-dose pharmacokinetic studies.

Copyright 2011, Society for the Study of Addiction

Mugele J; Nanagas KA; Tormoehlen LM. Serotonin syndrome associated with MDPV use: A case report. Annals of Emergency Medicine 60(1): 100-102, 2012. (15 refs.)

Serotonin syndrome is associated with use of certain street drugs, including methamphetamine, cocaine, and ecstasy. We describe a case of a woman who developed clinical findings consistent with serotonin syndrome after insufflation of 3,4-methylenedioxypyrovalerone (MDPV), a synthetic amphetamine. MDPV belongs to a group of substances called phenylethylamines, which are beta-ketone analogs of other drugs of abuse, such as amphetamines and 3,4-methylenedioxymethamphetamine. She also received fentanyl initially during her hospitalization, which has also been associated with serotonin syndrome. In addition to benzodiazepines and supportive care, she was treated with cyproheptadine for 8 days, with slow resolution of her symptoms.

Copyright 2012, Elsevier Science

Murphy PN; Bruno R; Ryland I; Wareing M; Fisk JE; Montgomery C et al. The effects of ecstasy' (MDMA) on visuospatial memory performance: Findings from a systematic review with meta-analyses. (review). Human Psychopharmacology: Clinical and Experimental 27(2): 113-138, 2012. (91 refs.)

To review, with meta-analyses where appropriate, performance differences between ecstasy (3, 4-methylenedioxymethamphetamine) users and non-users on a wider range of visuospatial tasks than previously reviewed. Such tasks have been shown to draw upon working memory executive resources. Abstract databases were searched using the United Kingdom National Health Service Evidence Health Information Resource. Inclusion criteria were publication in English language peer-reviewed journals and the reporting of new findings regarding human ecstasy-users' performance on visuospatial tasks. Data extracted included specific task requirements to provide a basis for meta-analyses for categories of tasks with similar requirements. Fifty-two studies were identified for review, although not all were suitable for meta-analysis. Significant weighted mean effect sizes indicating poorer performance by ecstasy users compared with matched controls were found for tasks requiring recall of spatial stimulus elements, recognition of figures and production/reproduction of figures. There was no evidence of a linear relationship between estimated ecstasy consumption and effect sizes. Given the networked nature of processing for spatial and non-spatial visual information, future scanning and imaging studies should focus on brain activation differences between ecstasy users and non-users in the context of specific tasks to facilitate identification of loci of potentially compromised activity in users.

Copyright 2012, Wiley-Blackwell

Murray E; Bruno R; Brown J. Residual effects of ecstasy (3, 4-methylenedioxymethamphetamine) on low level visual processes. Human Psychopharmacology: Clinical and Experimental 27(2): 226-234, 2012. (60 refs.)

Ecstasy (3, 4-methylenedioxymethamphetamine) induces impaired functioning in the serotonergic system, including the occipital lobe. This study employed the tilt aftereffect paradigm to operationalise the function of orientation-selective neurons among ecstasy consumers and controls as a means of investigating the role of reduced serotonin on visual orientation processing. The magnitude of the tilt aftereffect reflects the extent of lateral inhibition between orientation-selective neurons and is elicited to both real contours, processed in visual cortex area V1, and illusory contours, processed in V2. The magnitude of tilt aftereffect to both contour types was examined among 19 ecstasy users (6 ecstasy only; 13 ecstasy-plus-cannabis users) and 23 matched controls (9 cannabis-only users; 14 drug-naive). Ecstasy users had a significantly greater tilt magnitude than non-users for real contours (Hedge's g?=?0.63) but not for illusory contours (g?=?0.20). These findings provide support for literature suggesting that residual effects of ecstasy (and reduced serotonin) impairs lateral inhibition between orientation-selective neurons in V1, which however suggests that ecstasy may not substantially affect this process in V2. Multiple studies have now demonstrated ecstasy-related deficits on basic visual functions, including orientation and motion processing. Such low-level effects may contribute to the impact of ecstasy use on neuropsychological tests of visuospatial function.

Copyright 2012, Wiley-Blackwell

Newton TF. A perhaps unexpected role of norepinephrine in actions of MDMA. (editorial). Clinical Pharmacology & Therapeutics 90(2): 215-216, 2011. (8 refs.)

In this issue, Hysek and colleagues present new data describing the impact of treatment with reboxetine on the effects produced by 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") in human volunteers. They demonstrate that several effects of MDMA are mediated by reboxetine's actions on norepinephrine (NE) transporters, an unexpected finding. Building on earlier work, their new data provide new insights into the pharmacodynamics of MDMA and other monoamine-releasing agents.

Copyright 2011, Nature Publishing

Nulsen C; Fox A; Hammond G. Electrophysiological indices of altered working memory processes in long-term ecstasy users. Human Psychopharmacology: Clinical and Experimental 26(7): 488-497, 2011. (41 refs.)

Objective: The aim of this study was to determine the effect of light long-term ecstasy consumption on verbal short-term and working memory and to identify the cognitive processes contributing to task performance. Method: Electroencephalogram was recorded while ecstasy users (N=11), polydrug users (N=13), and non-users (N=13) completed forward and backward serial recognition tasks designed to engage verbal short-term memory and verbal working memory, respectively. Results All three groups displayed significantly lower digit-backward span than digit-forward span with ecstasy users displaying the greatest difference. The parietally distributed P3b was significantly smaller in the digits backward task than in the digits forward task in non-ecstasy-using controls. Ecstasy users did not show the reduced P3b component in the backward task that was seen in both non-ecstasy-using control groups. Conclusions: Ecstasy users' performance was suppressed more by the concurrent processing demands of the working memory task than that of the non-ecstasy-using controls. Non-ecstasy-using controls showed differential event-related potential wave forms in the short-term and working memory tasks, and this pattern was not seen in the ecstasy users. This is consistent with a reduction in the cognitive resources allocated to processing in working memory in ecstasy users.

Copyright 2011, Wiley-Blackwell

Ogeil RP; Rajaratnam SMW; Phillips JG; Redman JR; Broadbear JH. Ecstasy use and self-reported disturbances in sleep. Human Psychopharmacology: Clinical and Experimental 26(7): 508-516, 2011. (40 refs.)

Objective: Ecstasy users report a number of complaints after its use including disturbed sleep. However, little is known regarding which attributes of ecstasy use are associated with sleep disturbances, which domains of sleep are affected or which factors may predict those ecstasy users likely to have poor sleep quality and/or excessive daytime sleepiness. Methods: This study examined questionnaire responses of social drug users (n = 395) to the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Results: A significant proportion of ecstasy users (69.5%) had Pittsburgh Sleep Quality Index scores above the threshold used to identify sleep disturbance. Although frequency of ecstasy use did not affect the degree of reported sleep disturbance, participants who used larger amounts of ecstasy had poorer sleep. In addition, participants who perceived harmful consequences arising from their ecstasy use or had experienced remorse following ecstasy use had poorer sleep. Clinically relevant levels of sleep disturbance were still evident after controlling for polydrug use. Risk factors for poor sleep quality were younger age, injury post-ecstasy use and having been told to cut down on ecstasy use. Conclusions: Many ecstasy users report poor sleep quality, which likely contributes to the negative effects reported following ecstasy use.

Copyright 2011, Wiley-Blackwell

Palamar JJ; Kiang MV; Halkitis PN. Development and psychometric evaluation of scales that assess stigma associated with illicit drug users. Substance Use & Misuse 46(12): 1457-1467, 2011. (36 refs.)

This study established validity evidence for scales that assess perceived public stigma and stigmatization of illicit drug use. These concepts were measured with respect to five commonly used drugs: marijuana, powder cocaine, ecstasy, and nonmedical use of opioids and amphetamine. Data were collected from a diverse sample of 1,048 emerging adults in New York City in 2009. Exploratory and confirmatory factor analyses suggested two distinct factors, which were inversely related to exposure to users and recent use of each drug. These measures demonstrated good criterion, construct, and incremental validity and effectiveness in analyzing predictors of use. Study limitations were discussed.

Copyright 2011, Informa Healthcare

Parrott AC. MDMA and temperature: A review of the thermal effects of 'Ecstasy' in humans. (review). Drug and Alcohol Dependence 121(1-2): 1-9, 2012. (66 refs.)

Aims: To review the thermal effects of MDMA in humans, and discuss the practical implications. Methods: The literature on Ecstasy/MDMA, body temperature, and subjective thermal self-ratings was reviewed, and explanatory models for the changes in thermal homeostasis were examined and debated. Results: In human placebo-controlled laboratory studies, the effects of MDMA were dose related. Low doses had little effect, moderate doses increased body temperature by around +0.4 degrees C, and higher doses caused a mean increase of +0.7 degrees C. With Ecstasy/MDMA using dance clubbers, the findings showed greater variation, due possibly to uncontrolled factors such as physical activity, ambient temperature, and overcrowding. Some real world studies found average body temperature increases of over +1.0 degrees C. Thermal homeostasis involves a balance between heat production and heat dissipation, and MDMA affects both aspects of this homeostatic equation. Cellular metabolic heat output is increased, and heat dissipation mechanisms are stressed, with the onset of sweating delayed. Subjective responses of 'feeling hot' or 'hot-cold flushes' are frequent, but can show individual variation. Some recreational users report that heat increases or reinstates the positive mood effects of Ecstasy/MDMA. The dangers of acute hyperthermia can include rare fatalities. It is unclear why moderate hyperthermia can occasionally progress to severe hyperpyrexia, although it may reflect a combination or cascade of events. In chronic terms, the bioenergefic stress model notes that the adverse psychobiological effects of MDMA are heightened by various co-stimulatory factors, including heat stress. Conclusions: MDMA increases core body temperature and thermal stress in humans.

Copyright 2012, Elsevier Science

Parrott AC. MDMA and 5-HT neurotoxicity: The empirical evidence for its adverse effects in humans - no need for translation. British Journal of Pharmacology 166(5): 1518-1520, 2012. (17 refs.)

In this issue of the BJP, Green et al. suggest that animal data could not be used to predict the adverse effects of 3,4-methylenedioxymethamphetamine (MDMA) in humans and that MDMA did not produce 5-HT neurotoxicity in the human brain. This proposal was, however, not accompanied by a review of the empirical evidence in humans. The neuroimaging data on 5-HT markers in abstinent recreational ecstasy/MDMA users are extensive and broadly consistent. Reduced levels of the 5-HT transporter (SERT) have been found by research groups worldwide using a variety of assessment measures. These SERT reductions occur across the higher brain regions and remain after controlling for potential confounds. There are also extensive empirical data for impairments in memory and higher cognition, with the neurocognitive deficits correlating with the extent of SERT loss. Hence, MDMA is clearly damaging to humans, with extensive empirical data for both structural and functional deficits. [Linked article: This article is a commentary on Green et al., pp. 1523-1536 of this issue. A rebuttal by Green et al. also appears in this issue, pp. 1521-1522.]

Copyright 2012, Wiley-Blackwell

Parrott AC; Gibbs A; Scholey AB; King R; Owens K; Swann P et al. MDMA and methamphetamine: Some paradoxical negative and positive mood changes in an acute dose laboratory study. Psychopharmacology 215(3): 527- 536, 2011. (58 refs.)

This study investigated the acute mood effects of oral MDMA, methamphetamine, and placebo in a double-blind laboratory study. Fifty-two healthy participants comprised abstinent recreational users of stimulant drugs, 27 female and 25 male, mean age 24.8 years. Three test sessions involved acute 100 mg oral 3.4-methylendioxymethamphetamine (MDMA), 0.42 mg/kg oral methamphetamine, and matching placebo. Drug administration was counterbalanced, testing was double-blind, and medical supervision was present throughout. Car-driving performance on a laboratory simulator was assessed after 3 and 24 h, with the findings being presented elsewhere. Positive and negative moods (PANAS self-ratings) were completed before drug administration, 3, 4.5, and 24 h later. Blood samples were taken to monitor drug plasma levels. Following MDMA, there were no significant increases in positive moods, whereas negative moods were significantly higher than under placebo. Methamphetamine led to significant increases in both positive and negative moods. The MDMA findings contrast with the elated moods, typically noted by dance clubbers on Ecstasy. However, they are consistent with some previous laboratory findings, since a wide array of positive and negative mood changes have been demonstrated. One possible explanatory factor was the neutral environmental situation, particularly if a primary action of MDMA is to intensify ongoing psychological states. Other explanatory factors, such as dosage, gender, post-drug timing, neurohormonal aspects, and social factors, are also discussed. In the laboratory, acute methamphetamine led to significantly higher positive moods. However, against expectations, MDMA did not generate a significant increase in positive moods.

Copyright 2011, Springer

Parrott AC; Murphy P; Scholey AB. Applied human psychopharmacology: The practical psychobiological consequences of some novel and ancient psychoactive drugs. (editorial). Human Psychopharmacology: Clinical and Experimental 27(2): 103-105, 2012. (37 refs.)

This special applied issue of Human Psychopharmacology is based on two symposia from the 27th International Congress of Applied Psychology (ICAP). This was held at the International Congress Centre, Melbourne, Australia, on July 2010. The first of our two symposia was entitled �Psychoactive drugs, psychobiological health and wellbeing�. Here, the presenters covered the effects of a range of drugs, including cannabis, alcohol, nicotine, cocaine, ginseng and others. The second symposium was entitled �Ecstasy-MDMA: psychological and health related implications�; hence, the articles on Ecstasy/MDMA and related recreational stimulant drugs.

Copyright 2012, Wiley-Blackwell

Preti A; Usai I; Pintus E; Sardu C; Petretto DR; Masala C. Left-handedness is statistically linked to lifetime experimentation with illicit drugs. Laterality 17(3): 318-339, 2012. (100 refs.)

Handedness has been linked to an enhanced risk of alcohol abuse, while less is known about other drugs. A convenience sample of 1004 male and female Italian participants (females = 58%) from the general community (18 to 65 years old: average age = 30; standard deviation = 10, median = 25) was asked about: handedness (preference in writing); lifetime use of alcohol, tobacco, and illicit drugs; levels of psychological distress, as measured by the General Health Questionnaire (GHQ); and levels of delusion proneness, as measured by the Peters et al. Delusions Inventory (PDI). Overall, 92 individuals (9.2%) were classified as left-handed, with no significant difference reported among genders. Lifetime use of illicit drugs, primarily cannabis, was reported by 20% of the sample. In a multiple logistic regression analysis, after taking into account sex, age, and caseness on GHQ and PDI, left-handed people in the sample were statistically more likely to report lifetime experimentation with heroin, ecstasy/amphetamine, and, marginally, hallucinogens, but not alcohol or tobacco. Different mechanisms might contribute to an explanation of greater lifetime experimentation with some illicit drugs among left-handed people as compared to right-handed people. However, replications with clinical samples are necessary before any definitive statements can be made.

Copyright 2012, Psychology Press

Rosenberg H; Bonar EE; Pavlick M; Jones LD; Hoffmann E; Murray S et al. Associations between university students' reported reasons for abstinence from illicit substances and type of drug. Journal of College Student Development 53(1): 91-105, 2012. (35 refs.)

We recruited 211 undergraduates to rate the degree to which each of 34 listed reasons for not taking drugs had influenced their abstinence from MDMA/ecstasy, cocaine, marijuana, and hallucinogens. Participants rated reasons such as personal and family medical histories, religion, and physiological consequences of drug use as having little or no impact on abstention from all four substances. Consistent with previous research and developmental theory, concerns about drug-induced impairment and drug use being contrary to one's self-image reportedly inhibited students' consumption of notably different types of illicit substances.

Copyright 2012, Johns Hopkins University Press

Sawyer-Kurian KM; Browne FA; Carney T; Petersen P; Wechsberg WM. Exploring the intersecting health risks of substance abuse, sexual risk, and violence for female South African teen dropouts. Journal of Psychology in Africa 21(1): 15- 25, 2011. (41 refs.)

The study sought to better understand the cultural contexts of the risks for adolescent females who have dropped out of school. Focus groups were conducted with 37 Black and Coloured females aged 13 to 17 in Cape Town, South Africa. Data were analysed using content analysis. Methamphetamine, cannabis, and alcohol were used by both, however, Black teens also used methaqualone and Coloured teens used heroin and ecstasy. Some teens traded sex for drugs and others did so at the request of their drug-addicted mothers. Teens revealed high rates of violence, including rape, and many myths and barriers about condom use, revealing risky sex behaviours. Conclusion: Cultural nuances between the two groups will help inform the adaptation of an HIV prevention intervention.

Copyright 2011, Elliott & Fitzpatrick Inc

Schwaninger AE; Meyer MR; Barnes AJ; Kolbrich-Spargo EA; Gorelick DA; Goodwin RS et al. Stereoselective urinary MDMA (ecstasy) and metabolites excretion kinetics following controlled MDMA administration to humans. Biochemical Pharmacology 83(1): 131-138, 2012. (36 refs.)

The R- and S-enantiomers of racemic 3,4-methylenedioxymethamphetamine (MDMA) exhibit different dose-concentration curves. In plasma, S-MDMA was eliminated at a higher rate, most likely due to stereoselective metabolism. Similar data were shown in various in vitro experiments. The aim of the present study was the in vivo investigation of stereoselective elimination of MDMA's phase I and phase II metabolites in human urine following controlled oral MDMA administration. Urine samples from 10 participants receiving 1.0 and 1.6 mg/kg MDMA separated by at least one week were analyzed blind by liquid chromatography-high resolution-mass spectrometry and gas chromatography-mass spectrometry after chiral derivatization with S-heptafluorobutyrylprolyl chloride. R/S ratios at C(max) were comparable after low and high doses with ratios >1 for MDMA, free DHMA, and HMMA sulfate, and with ratios <1 for MDA, free HMMA, DHMA sulfate and HMMA glucuronide. In the five days after the high MDMA dose, a median of 21% of all evaluated compounds were excreted as R-stereoisomers and 17% as S-stereoisomers. Significantly greater MDMA, DHMA, and HMMA sulfate R-enantiomers and HMMA and HMMA glucuronide S-stereoisomers were excreted. No significant differences were observed for MDA and DHMA sulfate stereoisomers. Changes in R/S ratios could be observed over time for all analytes, with steady increases in the first 48 h. R/S ratios could help to roughly estimate time of MDMA ingestion and therefore, improve interpretation of MDMA and metabolite urinary concentrations in clinical and forensic toxicology.

Copyright 2012, Elsevier Science

Singer LT; Moore DG; Fulton S; Goodwin J; Turner JJD; Min MO et al. Neurobehavioral outcomes of infants exposed to MDMA (Ecstasy) and other recreational drugs during pregnancy. Neurotoxicology and Teratology 34(3): 303-310, 2012. (55 refs.)

3,4-methylenedioxymethamphetamine (MDMA) or "Ecstasy" is one of the most widely used illicit recreational drugs among young adults. MDMA is an indirect monoaminergic agonist and reuptake inhibitor that primarily affects the serotonin system. Preclinical studies in animals have found prenatal exposure related to neonatal tremors and long-term learning and memory impairments. To date, there are no prospective studies of the sequelae of prenatal exposure to MDMA in humans, despite concerns about its potential for harmful effects to the fetus. The present study is the first to prospectively identify MDMA-using women during pregnancy and to document patterns and correlates of use with neonatal and early infancy outcomes of offspring. All mothers and infants were prospectively recruited through the Case Western Reserve University (CWRU) and University of East London (UEL) Drugs and Infancy Study (DAISY) that focused on recreational drug use in pregnant women. Women were interviewed about substance use prior to and during pregnancy and infants were seen at 1 and 4 months using standardized, normative assessments of neonatal behavior, and cognitive and motor development, including the NICU Network Neurobehavioral Scale (NNNS), the Bayley Mental and Motor Development Scales (MDI, PDI), and the Alberta Infant Motor Scales (AIMS). The sample was primarily middle class with some university education and in stable partner relationships. The majority of women recruited had taken a number of illicit drugs prior to or during pregnancy. Group differences between those polydrug using women who had specifically used MDMA during pregnancy (n = 28) and those who had not (n = 68) were assessed using chi-square and t-tests. MDMA and other drug effects were assessed through multiple regression analyses controlling for confounding variables. Women who used MDMA during pregnancy had fewer prior births and more negative sequelae associated with their drug use, including more health, work, and social problems. MDMA exposed infants differed in sex ratio (more male births) and had poorer motor quality and lower milestone attainment at 4 months, with a dose-response relationship to amount of MDMA exposure. These findings suggest risk to the developing infant related to MDMA exposure and warrant continued follow-up to determine whether early motor delays persist or resolve.

Copyright 2012, Elsevier Science

Singer EO; Schensul JJ. Negotiating ecstasy risk, reward, and control: A qualitative analysis of drug management patterns among ecstasy-using urban young adults. Substance Use & Misuse 46(13): 1675-1689, 2011. (37 refs.)

This paper is based on qualitative in-depth interviews conducted from 2008 to 2009 with 118 ethnically diverse Ecstasy users from the greater Hartford area, CT, USA. Participants were urban, primarily Black and Hispanic, aged 18 to 36, and had limited higher education compared with samples in previous Ecstasy research. Interviews focused on personal background, history of Ecstasy and other drug use, and recent sexual events. In this paper, we examine: participants' negotiation of perceived risks and benefits of Ecstasy use, behavioral strategies employed to minimize risks, and the relationship of risk-benefit analysis, motivation for use, frequency of use, and polydrug use to participants' sense of control over their Ecstasy use. We conclude with recommendations for intervention approaches and suggestions for future research.

Copyright 2011, Informa Healthcare

Smerdon MJ; Francis AJP. Reward sensitivity and outcome expectancies as predictors of ecstasy use in young adults. Addictive Behaviors 36(12): 1337-1340, 2011. (31 refs.)

Extending recent studies showing that sensitivity to reward and outcome expectancies are associated with problematic alcohol and cannabis use, we undertook to determine if similar relationships would hold for ecstasy. One hundred and twenty five males and females aged between 18 and 35 years were recruited from RMIT University and through snowball sampling. Participants completed a questionnaire package measuring frequency, amount and first age of ecstasy use, sensitivity to reward and punishment as well as outcome expectancies relating to ecstasy use. Frequency of ecstasy use was significantly related to reward sensitivity (p<.05) and positive outcome expectancies (p<.01). Regression analysis revealed significant prediction of ecstasy use by study variables, with expectations of increased confidence making the largest individual contribution. Multiple intervention points are suggested by the results of this study, within a largely cognitive-based framework.

Copyright 2011, Elsevier Science

Solomon TM; Halkitis PN; Moeller RW; Pappas MK. Levels of methamphetamine use and addiction among gay, bisexual, and other men who have sex with men. Addiction Research & Theory 20(1): 21-29, 2012. (54 refs.)

Methamphetamine (MA) and poly-drug use among gay, bisexual, and other men who have sex with men (MSM) may be linked to risky sexual behaviors and the subsequent transmission of the human immunodeficiency virus. The goal of this analysis was to examine, quantify, and describe lifetime use of MA as well as MA use in the past year in relation to other substances by means of a standardized diagnostic tool, and along key socio-demographic variables. Data for this analysis were gathered from the screening assessment of a larger cross-sectional study examining MA use and psychosocial states in a sample of 215 MSM in New York City. Based on criteria set forth by the Mini International Neuropsychiatric Inventory, clinical dependence to MA was shown in 78% of participants. Of this group, over 70% were codependent on other substances, including cocaine and Ecstasy. Further, 95% of Black MSM reported MA use in the past year, of which 97% were classified as dependent. These findings suggest that MA continues to be used at significant rates among MSM and often in conjunction with other substances, and is increasingly used and abused by ethnic and racial minority MSM. Findings suggest the need for programs to address multiple drug dependence and in relation to co-occurring health problems.

Copyright 2012, Informa Healthcare

Stough C; King R; Papafotiou K; Swann P; Ogden E; Wesnes K et al. The acute effects of 3,4-methylenedioxymethamphetamine and d-methamphetamine on human cognitive functioning. Psychopharmacology 220(4): 799-807, 2012. (43 refs.)

This study investigated the acute (3-h) and 24-h post-dose cognitive effects of oral 3,4-methylenedioxymethamphetamine (MDMA), d-methamphetamine, and placebo in a within-subject double-blind laboratory-based study in order to compare the effect of these two commonly used illicit drugs on a large number of recreational drug users. Sixty-one abstinent recreational users of illicit drugs comprised the participant sample, with 33 females and 28 males, mean age 25.45 years. The three testing sessions involved oral consumption of 100 mg MDMA, 0.42 mg/kg d-methamphetamine, or a matching placebo. The drug administration was counter-balanced, double-blind, and medically supervised. Cognitive performance was assessed during drug peak (3 h) and at 24 h post-dosing time-points. Blood samples were also taken to quantify the levels of drug present at the cognitive testing time-points. Blood concentrations of both methamphetamine and MDMA at drug peak samples were consistent with levels observed in previous studies. The major findings concern poorer performance in the MDMA condition at peak concentration for the trail-making measures and an index of working memory (trend level), and more accurate performance on a choice reaction task within the methamphetamine condition. Most of the differences in performance between the MDMA, methamphetamine, and placebo treatments diminished by the 24-h testing time-point, although some performance improvements subsisted for choice reaction time for the methamphetamine condition. Further research into the acute effects of amphetamine preparations is necessary to further quantify the acute disruption of aspects of human functioning crucial to complex activities such as attention, selective memory, and psychomotor performance.

Copyright 2012, Springer

Susnjara IM; Smoljanovic A; Gojanovic MD. Drug related deaths in the Split-Dalmatia County 1997-2007. Collegium Antropologicum 35(3): 823-828, 2011. (40 refs.)

Drug overdoses are a major cause of mortality for drug users and, in many countries, are the leading cause of death in this group. The aim of the present study is to explore the frequency of all drug related deaths in the Split-Dalmatia County in the period between 1997 and 2007 and to analyze some of the characteristics of these deaths to help target preventive policies. The data on drug related deaths were collected using records from the Department of Forensic Medicine, Clinical Hospital Centre Split, University of Split, School of Medicine. There were 190 drug related deaths in the observed period of 11 years. Statistically significant difference (p=0.004, chi(2)-test for trend) was found in the number of deaths in 1997 in comparison with the number of deaths in 2007. The majority of 105 (55%) the decedents were 25-34 years old, and 92.1% (175) of them were male. There was a 94% higher probability of mortality in the 25-34 years group (chi(2)=5.55, p=0.064). Average age of all dead people was 31.01 +/- 7.59 years (median 31.0 years; range 18-49). Almost three quarters of the decedents were single and more than three fifths hadn't been employed. The most common location of death was at home. Approximately, 80% were autopsied followed by full histological and toxicological analyses. Out of all examined cases, the majority of drug related deaths (93 or 60.8%) were attributed to heroin. Heroin was the sole cause of death in 35(22.9%) cases. Methadone was cause of death in 24 (15.7%) cases. 3.4-methylenedioxy-methamphetamine (MDMA) deaths were rare (3.3%). Cocaine deaths were also rare (1.3%). Three fifths (55.6%) of the cases involved includes multi-substance use. During the investigation there was an evident trend towards multi-substance abuse patterns. These data suggest that interventions to prevent drug related mortality should address the use of drugs such as heroin and alcohol in combination.

Copyright 2011, Collegium Antropologicum

Swift W; Coffey C; Degenhardt L; Carlin JB; Romaniuk H; Patton GC. Cannabis and progression to other substance use in young adults: Findings from a 13-year prospective population-based study. Journal of Epidemiology and Community Health 66(7): e26, 2012. (49 refs.)

Background: Adolescent cannabis use predicts the onset of later illicit drug use. In contrast, little is known about whether cannabis in young adulthood also predicts subsequent progression or cessation of licit or illicit drug use. Methods: 13-year longitudinal cohort study with recruitment in secondary school students in Victoria, Australia. There were six waves of adolescent data collection (mean age 14.9-17.4 years) followed by three in young adulthood (mean age 20.7, 24.1 and 29.0 years). Discrete-time proportional hazards models were used to assess predictive associations between cannabis use frequency (occasional (Copyright 2012, BMJ Publishing Group

Temple JR; Freeman DH. Dating violence and substance use among ethnically diverse adolescents. Journal of Interpersonal Violence 26(4): 701-718, 2011. (61 refs.)

Teen dating violence is a serious public health concern with numerous and long-lasting consequences. Although alcohol and drug use have been associated with dating violence, little is known about the role of specific substances, especially the use of club drugs and the nonmedical use of prescription drugs. Thus, the authors examined the association between dating violence victimization and the use of a variety of licit and illicit substances among 1,565 ethnically diverse and economically disadvantaged high school students in southeast Texas. Past year dating violence victimization was reported by 14.1% of boys and 11.3% of girls. Compared to their nonabused counterparts, youth who experienced dating violence were more likely to smoke cigarettes, drink alcohol, binge drink alcohol, sniff glue to get high, use marijuana, use ecstasy, use Vicodin, and use Xanax. However, with the exception of alcohol and cigarettes, all substances were reduced to nonsignificance in multivariate analyses. No differences were found in the rate of dating violence between African American, White, and Hispanic adolescents.

Copyright 2011, Sage Publications

Van Havere T; Vanderplasschen W; Lammertyn J; Broekaert E; Bellis M. Drug use and nightlife: More than just dance music. Substance Abuse Treatment, Prevention and Policy 6: e-article 18, 2011. (58 refs.)

Background: Research over the last decade has focused almost exclusively on the association between electronic music and MDMA (3,4-Methylenedioxymethamphetamine or "ecstasy") or other stimulant drug use in clubs. Less attention has been given to other nightlife venues and music preferences, such as rock music or southern/funky music. This study aims to examine a broader spectrum of nightlife, beyond dance music. It looks at whether certain factors influence the frequency of illegal drug and alcohol use: the frequency of going to certain nightlife venues in the previous month (such as, pubs, clubs or goa parties); listening to rock music, dance music or southern and funky music; or sampling venues (such as, clubs, dance events or rock festivals). The question of how these nightlife variables influence the use of popular drugs like alcohol, MDMA, cannabis, cocaine and amphetamines is addressed. Methods: The study sample consisted of 775 visitors of dance events, clubs and rock festivals in Belgium. Study participants answered a survey on patterns of going out, music preferences and drug use. Odds ratios were used to determine whether the odds of being an illegal substance user are higher for certain nightlife-related variables. Furthermore, five separate ordinal regression analyses were used to investigate drug use in relation to music preference, venues visited during the last month and sampling venue. Results: Respondents who used illegal drugs were 2.5 times more likely to report that they prefer dance music. Goa party visitors were nearly 5 times more likely to use illegal drugs. For those who reported visiting clubs, the odds of using illegal drugs were nearly 2 times higher. Having gone to a pub in the last month was associated with both more frequent alcohol use and more frequent illegal substance use. People who reported liking rock music and attendees of rock festivals used drugs less frequently. Conclusions: It was concluded that a more extended recreational environment, beyond dance clubs, is associated with frequent drug use. This stresses the importance of targeted prevention in various recreational venues tailored to the specific needs of the setting and its visitors.

Copyright 2011, BioMed Central

van Wel JHP; Kuypers KPC; Theunissen EL; Bosker WM; Bakker K; Ramaekers JG. Effects of acute MDMA intoxication on mood and impulsivity: Role of the 5-HT2 and 5-HT1 receptors. PLoS ONE 7(7): article e40187, 2012. (55 refs.)

MDMA induces positive mood and increases impulse control during intoxication, but only a few studies on the neuropharmacological mechanisms underlying these processes have been conducted. It was hypothesized that pretreatment with 5-HT1 and 5-HT2 receptor blockers would prevent MDMA effects on mood and impulsivity. Subjects (N = 17) participated in a double-blind, placebo controlled, within-subject design involving 6 experimental conditions consisting of pretreatment (T1) and treatment (T2). T1 preceded T2 by 30 minutes. T1-T2 combinations were: placebo-placebo, 20 mg pindolol-placebo, 50 mg ketanserin-placebo, placebo-75 mg MDMA, 20 mg pindolol-75 mg MDMA and 50 mg ketanserin-75 g MDMA. Subjects completed a Profile of Mood States (POMS) questionnaire and several impulsivity tasks (Stop signal task, Matching familiar figures task, Cue dependent reversal learning task) at 1.5 hrs post-treatment. MDMA alone increased both positive (vigor, arousal, friendliness, elation, positive mood) and negative affect (anxiety, confusion) as assessed by the POMS questionnaire. MDMA also increased stop reaction time in the Stop signal task and reaction time in the Matching familiar figures task. Pretreatment with ketanserin blocked MDMA effects on positive affect, but not negative affect. Ketanserin did not influence the effects of MDMA on impulsivity. Pindolol did not interact with MDMA on any of the measures. In conclusion, 5-HT2 receptors mediate positive moods induced by MDMA but not negative moods or impulsivity. 5-HT1 receptors do not appear to be involved in MDMA effects on mood and impulse control.

Copyright 2012, Public Library Science

Vanden Eede N; Montenij LJ; Touw DJ; Norris EM. Rhabdomyolysis in MDMA intoxication: A rapid and underestimated killer. "clean" ecstasy, a safe party drug? Journal of Emergency Medicine 42(6): 655-658, 2012. (15 refs.)

Background: Ecstasy is a popular drug among young adults. It is often thought to be safe. The dose of methylenedioxymethamphetamine (MDMA) in a tablet of Ecstasy varies greatly, and there is also a difference in individual response to a dose of MDMA. Objectives: To increase the awareness of potential mortality in MDMA use. Case Report: We report the case of a patient with a lethal intoxication after pure MDMA intoxication. The serum toxicology screening showed an elevated level of MDMA (1.5 mg/L) but no other amphetamines or other drugs. Conclusions: The cause of death was a rapidly evolving hyperkalemia due to rhabdomyolysis. There is still a need to educate the public about the dangers of this so-called "safe" party drug.

Copyright 2012, Elsevier Science

Veldstra JL; Brookhuis KA; de Waard D; Molmans BHW; Verstraete AG; Skopp G et al. Effects of alcohol (BAC 0.5 parts per thousand) and ecstasy (MDMA 100 mg) on simulated driving performance and traffic safety. Psychopharmacology 222(3): 377-390, 2012. (48 refs.)

An increasing number of fatal road-accidents have been reported in which ecstasy was found in the blood of drivers. Although, ecstasy is frequently found to have been used in combination with alcohol, studies on the acute effects of ecstasy co-administered with alcohol on driving performance are relatively rare. The present study was designed to establish the extent of driver impairment as a consequence of ecstasy or combined ecstasy and alcohol use as compared to driving under the influence of 0.3aEuro degrees, 0.5aEuro degrees and 0.8aEuro degrees alcohol. Furthermore, subjective performance was also assessed. Alcohol and ecstasy mainly influenced automated driving performance such as lateral and speed control. However, small to no effects of the substances were found on more complex driving behaviour. Overall, variance within the different driving measures was high especially when participants were treated with 3.4-methylenedioxy-methamphetamine (MDMA) and alcohol. Furthermore, equivalence testing showed that combined use may lead to impaired driving for some, but not all, drivers. Participants rated their own performance to be slightly worse than normal in both studies. Since driving was actually seriously deteriorated, this was a falsely positive assessment of their condition. The dissociation between subjective perceptions and objective performance decrements are important notions for traffic safety since this may affect a driver's judgement of whether or not it is safe to drive. For example, an intoxicated individual might decide to drive because the feelings of alertness caused by MDMA cloud the impairing effects of other drugs such as alcohol, thereby creating a potentially serious risk for traffic safety.

Copyright 2012, Springer

Walls NE; Bell S. Correlates of engaging in survival sex among homeless youth and young adults. Journal of Sex Research 48(5): 423-436, 2011. (81 refs.)

Using a sample of 1,625 homeless youth and young adults aged 10 to 25 from 28 different states in the United States, this study examines the correlates of having engaged in survival sex. Findings suggest that differences exist based on demographic variables (gender, age, race, and sexual orientation), lifetime drug use (inhalants, Valium (TM), crack cocaine, alcohol, Coricidin (TM), and morphine), recent drug use (alcohol, ecstasy, heroin, and methamphetamine), mental health variables (suicide attempts, familial history of substance use, and having been in substance abuse treatment), and health variables (sharing needles and having been tested for HIV). In addition to replicating previous findings, this study's findings suggest that African American youth; gay, lesbian, or bisexual youth; and youth who had been tested for HIV were significantly more likely to have engaged in survival sex than White, heterosexual youth, and youth who had not been tested for HIV, respectively. Implications for interventions with youth and suggestions for future research are discussed.

Copyright 2011, Taylor & Francis

Watson C; Wilkinson J. The intensive care management of common and uncommon drugs of misuse. (review). British Journal of Hospital Medicine 72(4): 211-218, 2011. (33 refs.)

With an ever-expanding field of illicit drugs available, doctors working in the acute specialties will inevitably be involved in the management of the serious and life-threatening side effects of drug misuse, as outlined in this article.

Copyright 2011, International Thomson Publishing Co.

Weinborn M; Woods SP; Nulsen C; Park K. Prospective memory deficits in Ecstasy users: Effects of longer ongoing task delay interval. Journal of Clinical and Experimental Neuropsychology 33(10): 1119-1128, 2011. (79 refs.)

Ecstasy use has been associated with neurotoxicity and neurocognitive impairment in a variety of domains, including prospective memory (ProM), which involves the delayed execution of a previously encoded intention in response to a specific cue. The present study adopted the multiprocess theory of ProM to evaluate the hypothesis that Ecstasy users would evidence differentially impaired ProM on longer versus shorter ongoing task delays. Ecstasy (n = 31) users, high-risk alcohol users (n = 21), and healthy nonusers (n = 31) completed the short (2-min) and long (15-min) delay ProM scales of the Memory for Intentions Screening Test. Results showed a significant group by ProM delay interaction, such that Ecstasy users performed comparably to the comparison groups on short-delay trials, but were impaired on long-delay ProM, particularly for time-based cues. Among the Ecstasy users, long-delay ProM was positively associated with risky decision making, but not with retrospective memory or other aspects of executive functions. These findings suggest that Ecstasy users may be particularly susceptible to deficits in strategic target monitoring and maintenance of cue-intention pairings over longer ProM delays. Findings are discussed in the context of their potential everyday functioning (e. g., academic, vocational) and treatment implications for Ecstasy users.

Copyright 2011, Taylor & Francis

Wetherell MA; Atherton K; Grainger J; Brosnan R; Scholey AB. The effects of multitasking on psychological stress reactivity in recreational users of cannabis and MDMA. Human Psychopharmacology: Clinical and Experimental 27(2): 167-176, 2012. (40 refs.)

Background: Cannabis and 3, 4-methylenedioxymethamphetamine (MDMA) use is associated with psychobiological and neurocognitive deficits. Assessments of the latter typically include tests of memory and everyday cognitive functioning. However, to date, little attention has been paid to effects of drug use on psychological stress reactivity. We report three studies examining the effects of recreational use of cannabis and MDMA on mood and psychological responses to multitasking using a cognitively demanding laboratory stressor that provides an analogue for everyday situations involving responses to multiple stimuli. Methods The effects of the multitasking framework on mood and perceived workload were assessed in cannabis (N=25), younger (N=18) and older (N=20) MDMA users and compared with non-target drug controls. Results: Compared with respective control groups, cannabis users became less alert and content, and both MDMA groups became less calm following acute stress. Unexpectedly, the stressor increased ratings of calm in cannabis users. Users also scored higher than their controls with respect to ratings of resources needed to complete the multitasking framework. Conclusions: These findings show, for the first time, that recreational use of cannabis and MDMA, beyond the period of intoxication, can negatively influence psychological responses to a multitasking stressor, and this may have implications for real-life situations which place high demands on cognitive resources.

Copyright 2012, Wiley-Blackwell

Whaley RB; Smith JM; Hayes-Smith R. Teenage drug and alcohol use: Comparing individual and contextual effects. Deviant Behavior 32(9): 818-845, 2011. (30 refs.)

While both macro- and micro-level studies have identified important correlates of substance use, multi-level models may explain more than each level alone. Drawing on extant research and Akers' (1998) Social Structure-Social Learning model, we offer hypotheses about the relationship between contextual-and individual-level explanatory variables and substance use. The sample included 85,000 students in 202 school districts. Hierarchical linear modeling revealed low socioeconomic status, percent rural, and racial composition directly affected use of some substances net individuals' characteristics. Further, the effects of gender, age, and class were substantially mediated by differential association and school bonds, which significantly influenced alcohol, marijuana, ecstasy, and methamphetamine use.

Copyright 2011, Taylor & Francis

Wilkins C; Sweetsur P; Griffiths R. Recent trends in pharmaceutical drug use among frequent injecting drug users, frequent methamphetamine users and frequent ecstasy users in New Zealand, 2006-2009. Drug and Alcohol Review 30(3): 255- 263, 2011. (22 refs.)

Aims. To examine the rates of pharmaceutical drug use, and level of prescription use and injection of pharmaceutical drugs, by frequent injecting drug users (IDU), frequent methamphetamine users and frequent ecstasy users in New Zealand for 2006-2009. Design: and method. The paper draws on findings from the 2006, 2007, 2008 and 2009 Illicit Drug Monitoring System (IDMS). The IDMS interviews three groups of frequent illegal drug users (i.e. IDU, methamphetamine users and ecstasy users) from the three main cities of New Zealand using purposive sampling and 'snowballing'. Results. Pharmaceutical morphine rather than heroin was the principal opioid used by the IDU. Few of the IDU or frequent methamphetamine users had prescriptions to use morphine. A lower proportion of the IDU had a prescription to use morphine in 2009 compared to 2008. The injection of methadone by IDU and methamphetamine users was common. A higher proportion of the IDU had injected methadone in 2009 compared to previous years. A higher proportion of the IDU had used oxycodone in 2009 compared to 2008 and prescription use of oxycodone by IDU was very low. All three groups of frequent drug users were involved in the extra-medical use of methylphenidate and benzodiazepines. Discussion and conclusion. Extra-medical use of pharmaceuticals occurred among all three groups of frequent illegal drug users to varying degrees. Differences between the three groups in the level and type of extra-medical pharmaceutical drug use suggest that different control strategies may be effective for each group.

Copyright 2011, Wiley-Blackwell

Wimmer K; Schneider S. Screening for illicit drugs on Euro banknotes by LC-MS/MS. Forensic Science International 206(1-3): 172-177, 2011. (22 refs.)

A method for the simultaneous quantification of illicit drugs on Euro banknotes, using an ultra-performance liquid chromatography tandem mass spectrometry, was developed and validated. The method included cocaine, benzoylecgonine, MDMA, MDEA, MDA, methamphetamine, diacetylmorphine, 6-MAM, morphine and Delta(9)-THC. Drug residues were monitored and quantified via positive ESI mode using multiple reaction monitoring. Banknotes were extracted with methanol by vigorous shaking. Recovery rates were in the range of 60-80%. Calibration was performed with spiked banknotes in the range of 10-100 ng/note (R-2 0.98-0.99). Intra-day analysis showed fair precision and accuracy (<= 15%). Matrix effects were in the range from 27% to 235%. 7-15 samples of each denomination were analyzed. The calculated median values per note were 106 ng cocaine, 43 ng benzoylecgonine, 41 ng heroin, 15.5 ng 6-MAM, 16.5 ng morphine, 9 ng MDMA and 7 ng methamphetamine. Delta(9)-THC was detected on 4 banknotes. MDEA and MDA were not detected on any note. A widespread background contamination for cocaine and opiates was demonstrated.

Copyright 2011, Elsevier Science

Wolff K; Tsapakis EM; Pariante CM; Kerwin RW; Forsling ML; Aitchison KJ. Pharmacogenetic studies of change in cortisol on ecstasy (MDMA) consumption. Journal of Psychopharmacology 26(3, special issue): 419-428, 2012. (60 refs.)

In this study we investigate the association of cytochrome P450 enzyme CYP2D6, catechol-O-methyl transferase (COMT, Val158Met) and serotonin transporter promoter (5-HTTLPR) genotypes on change in cortisol concentration following 3, 4-methylenedioxy-methamphetamine (MDMA, 'ecstasy') consumption. Forty-eight subjects (30 males, mean age 23 years), self-nominating regular clubbers provided 'in the field' pre- and post-clubbing biological samples and associated information. Of the 39 subjects who provided a post-clubbing urine sample, 21 were positive for MDMA. Plasma cortisol concentrations increased in subjects (n = 48) tested for cortisol, with changes being significantly greater in the MDMA-positive group (736.9 +/- 83.2 vs. 350.9 +/- 34.5 mmol/l, p = 0.001). We found a positive association between the low activity COMT genotype (Met/Met) and MDMA-induced change in cortisol and also between this and change in cortisol in the whole sample (p = 0.039, Bonferroni corrected). For CYP2D6, there was an association between genotype and change in cortisol, confined to subjects with MDMA-positive urine post-clubbing (p = 0.039, Bonferroni corrected). There was no association with 5-HTTLPR genotype. These associations suggest that chronic use of MDMA may lead to HPA axis dysregulation and that the magnitude of this may be moderated by genetic polymorphism, and warrant further investigation in a larger sample of those who consume the drug on a regular basis.

Copyright 2012, Sage Publications

Wood DM; Stribley V; Dargan PI; Davies S; Holt DW; Ramsey J. Variability in the 3,4-methylenedioxymethamphetamine content of 'ecstasy' tablets in the UK. Emergency Medicine Journal 28(9): 764-765, 2011. (9 refs.)

Background Toxicity, such as hyperpyrexia, associated with the use of 3,4-methylenedioxymethamphetamine (MDMA; 'ecstasy') appears to be related to serum MDMA concentrations. However, there does not appear to be a similar association with the number of tablets ingested, suggesting variation in the tablet content of MDMA. Although work has shown this variation in other areas of the world, no studies have reported on the variation of MDMA content in UK ecstasy tablets. Methods Ecstasy tablets seized from individuals attending nightclubs were analysed qualitatively to determine if they contained MDMA and quantitatively to determine the MDMA content per tablet. Results: The mean amount of MDMA hydrochloride in 101 seized ecstasy tablets was 58.7 +/- 22.9 mg per tablet, with a range of 20 mg to 131 mg per tablet. The majority (96.0%) of tablets contained less than 100 mg MDMA per tablet. There appeared to be a bimodal distribution of MDMA content at approximately 20-40 mg per tablet and 60-80 mg per tablet. Conclusion: There is variability in the MDMA content of ecstasy tablets in the UK. This variability could potentially put users at increased risk of acute harm due to inadvertent excess ingestion of MDMA, as they are unaware of the differences in the MDMA content. Repeat sampling and quantification of MDMA content of ecstasy tablets in the UK will allow better education of users about the potential harms associated with the variability in the MDMA content. In addition, it will provide information to allow the monitoring of changes in not only the MDMA content, but also other adulterants, in ecstasy tablets.

Copyright 2011, BMJ Publishing

Wu ZH; Grady JJ; Rosales S; Berenson AB. Ecstasy use and its correlates among young, low-income women. Substance Use & Misuse 46(4): 404-410, 2011. (43 refs.)

We examined the association of illicit drug use with stress and sexual behaviors among 407 women, aged 18-31, who attended family-planning clinics in southeast Texas between June 2002 and May 2003 (n = 407). Paired comparisons of each of three types of drug users (of ecstasy, marijuana only, and other illicit drugs except ecstasy) with nonusers were assessed by logistic regressions. After controlling for demographics, both ecstasy users and marijuana-only users had a higher score on the stress scale than nonusers. All drug users were at higher risk of more lifetime sexual partners than those who had never used drugs, while those who had used ecstasy were more than twice as likely to have had prior sexually transmitted infections as those who had never used drugs. This study demonstrates that young, low-income women who use ecstasy experience higher levels of stress than nonusers. Stress level is correlated with drug use and participation in risky sexual behaviors. If stress is associated with drug use and risky sexual behavior, interventions designed to reduce substance use and risky sexual behavior in these women may need to also address factors that lead to increased stress. The study's limitations were noted.

Copyright 2011, Informa Healthcare