Introduction
MDMA (3, 4-methylenedioxymethamphetamine) is commonly referred to as “ecstasy” or “molly”. In recent years, this substance has gained a lot of popularity; and has become the drug of choice for recreational purposes among the adolescents and the adults. Beneath the widespread popularity of the drug, there is a belief that it is a safe drug with no toxicity, but this is not the case. Individuals who take MDMA often report that it gives them a sense of euphoria, minimal or no inhibitions, or increased sensuality (Hahn, 2013). The drug has various psychoactive properties that can make an individual addictive to its use. The addiction/ abuse has led to an increase in number of hospital’s emergency department (ED) visits throughout the world (Hahn, 2013).
There are a lot of slang words for MDMA. One knows the most commonly used terms which are “ecstasy” and "molly", but you may also hear “E,” “XTC,” “X,” “hug,” “love drug" “beans,” “Adam,” “clarity,” and “lover's speed (Hahn, 2013).”
History
MDMA was patented in 1913 by the pharmaceutical company, Merck, to be only sold as a diet pill. Later, the company decided not to market it anymore. Somewhere in 1953, the US army experimented with it, but the person who was actually responsible for modern research of MDMA is one by the name Alexander Shuglin who was a biochemist; and also the first reported human to use MDMA. Shuglin was doing a legal research specializing in the phenethylamines family of drugs. He described several drugs in detail, one of which is MDMA; and he felt that this drug came closest to fulfilling his ambition of finding the perfect therapeutic drug (Saunders, 1993).
In the period between 1977 and 1985, many therapists researched and tested the drug for use in psychotherapy. In 1985, a group of people sued the US Drug Enforcement Agency (DEA) to try to prevent them from outlawing the drug by placing it on Schedule 1. This received massive media attention. At that time, the US Congress had passed a new law allowing the DEA to put an emergency ban on any drug that it thought might be a hazard to people. On July 1st 1985, this right was used for the first time to ban MDMA (Saunders, 1993). Matters reached the court and a hearing was held to decide what steps can be taken against the drug. One argument was that MDMA caused brain damage in rats, but the other side argument was that this might not be true for humans and that there was a proof of the beneficial use of MDMA as a drug treatment in psychotherapy, and many therapists have already used it. The court recommended that MDMA be placed on Schedule 3; however, the DEA decided to place MDMA permanently on Schedule 1 (Saunders, 1993).
Epidemiology
A survey in 1993 by National Institute on Drug Abuse (NIDA) reported 2% of all US college students admitting to take MDMA in the previous year (Hahn, 2013). A decade later, in 2004, according to the National Health Survey on Drug Use and Health, more than 11 million people in the US aged 12 and above reported using MDMA at least once in their life. According to this survey, mentions of MDMA in drug abuse-related cases in hospitals in US were 2221 for last two quarters of 2003. Majority of them were seen to be in the age group of 18 to 20 years (NIDA Research Report, 2006). On a brighter side however, the survey by NIDA also reported a decline in MDMA use among the middle school and high school students (NIDA Research Report, 2006).
The Drug Abuse Warning Network (DAWN) data has shown a steady increase in ED (emergency department) visits in US hospitals with a greater than 800% increase from 421 ED visits in 1995 to 4,026 in 2002 and another 167% increase in 2005 with 10,752 ED visits (Hahn, 2013). Another study at Stanford University reported that 39% of individuals had taken MDMA at least once in their lifetime. In another survey by Tulane University, more than 1200 students revealed that 24% of them had used MDMA at least once in their life time. Some describe MDMA as a drug having greatest growth potential among all the illicit drugs available today with tens of thousands of users being introduced to the drug scene every month, which is particularly evident at the place of rave parties. The major problem seems to be the misconception among the old the new users that MDMA is a safe and non-toxic drug (Hahn, 2013).
According to a recent study by Wu and colleagues on MDMA use among US adolescents from 1999 to 2008, there was an increasing trend of using MDMA among US adolescents from 1999 to 2002 followed by a decreasing trend from 2002 to 2005 and again a slight increase from 2005 to 2008. The study found that MDMA was more likely used by adolescent girls than by boys (Wu, 2010). The research also showed that these girls may be more vulnerable to developing symptoms of hallucinogen dependence. It also showed MDMA use to be more common among non-Hispanic whites than in other racial/ethnic groups (Wu, 2010).
Pharmacology
MDMA acts on the brain. It increases the activity of at least three neurotransmitters - dopamine, serotonin, and norepinephrine. These neurotransmitters are usually stored in the neurons. MDMA, once in the body, causes them to be released from their storage sites resulting in an increase in neurotransmitter activity. MDMA causes somewhat greater serotonin release, a neurotransmitter that plays a role in regulating sleep, pain, mood, appetite, and other behaviors. However, due to release of excess amount of serotonin, the brain becomes significantly depleted of this neurotransmitter that leads to negative behavioral after - effects that can last for several days after consumption of MDMA. Several pre-clinical trials have shown that MDMA can damage serotonin-containing neurons and the resulting damage can be long – lasting. This can be true in humans too, but measuring serotonin damage in humans is difficult (NIDA Research Report, 2006).
Manufacturing, marketing, and transport of MDMA
MDMA is man – made. It is not derived from plants like the way marijuana or tobacco is derived. Sometimes, other chemicals like caffeine or cocaine or dextromethorphan are added to MDMA tablets during its manufacturing. Therefore, the purity of MDMA tablet is always a question (NIDA for Teens, 2012).
MDMA is available in a tablet form or as a capsule, powder, or liquid; however, most commonly, it is available in a tablet form. The tablets are often engraved with various motif symbols or brands like animals (e.g., elephants), birds (e.g., doves) numbers, cartoon characters, or cars like Ferrari (Hahn, 2013).
According to National Drug Threat Assessment (2010), Asian drug trafficking organizations (DTOs) are responsible for reappearance in MDMA availability in the US since 2005. These groups manufacture large amounts of the drug in Canada and smuggle it in the US through the northern border. Thus, ready availability of the drug in US has enabled distributors to expand their customer base and include new users.
Dosage, expected effects, side effects, and potential for overdose
The tablet is usually swallowed; however, if it is available in some other form like powder or liquid, it may be smoked or snorted or injected. Following oral intake, its action lasts for 8 to 24 hours with a half-life of 12 to 34 hours. This can, however, depend upon the purity of the drug ingested (Hahn, 2013).
This drug has become a very popular drug mainly because the positive effect that a person wants is experienced within just an hour of taking one dose. The effects are feeling of emotional warmth, mental stimulation, decreased anxiety, and a sense of well-being. Many users have reported an enhanced sensory perception with the use of MDMA. It can give dancers a capacity to dance for extended periods. However, some users also report undesirable effects immediately upon consumption of the drug, like agitation, recklessness, and anxiety (NIDA Research Report, 2006). Some of the reported undesirable side effects of the drug that can last for up to one week are anxiety, restlessness, sadness, irritability, insomnia, anorexia, aggression, increased thirst, reduced interest in sex, and significant reduction in mental abilities. In the long term, it can produce a number of adverse health effects like chills, nausea, muscle cramping, blurred vision, hyperthermia, dehydration, hypertension, and even kidney or heart failure. Overdose of MDMA can lead to hypertension, fainting, loss of consciousness, seizures, and panic attacks (NIDA Research Report, 2006).
The stimulant property of MDMA coupled with the environment in which it is taken is often associated with vigorous physical activity for extended period of time. This can lead to a very significant adverse effect – hyperthermia – though this is rare (NIDA Research Report, 2006).
The drug is rapidly absorbed in the blood stream, but in the body, its metabolites interfere with body’s metabolism; therefore, over dosage of the drug can produce unexpectedly high levels of drug in the blood that could potentially worsen cardiovascular and other toxic effects of the drug (NIDA Research Report, 2006).
Addiction with MDMA
For some people, the drug can be addictive. Continued use of the drug despite the knowledge that it can cause physical or psychological harm and withdrawal effects, all lead to its addiction. Almost 60% of people in a survey on young adults and adolescents’ MDMA use have reported withdrawal symptoms like fatigue, anorexia, depression, and trouble in concentration (NIDA Research Report, 2006).
Treatment of MDMA abusers/ addictions
Currently, there are no pharmacological treatments for use in dependence on MDMA. Education is most the important tool to prevent MDMA abuse. Social networking is an important component of MDMA use; therefore, drug prevention programs or peer-led advocacy could be a good approach to reduce MDMA use among adults and adolescents. Schools and colleges should deliver appropriate messages about the ill effects of using the drug. The most effective treatment available as on today to fight drug abuse and addiction is adequate counseling and cognitive behavioral therapies that help modify a patient’s thinking and behavior, and to educate the user to learn to cope with life’s stresses (NIDA Research Report, 2006).
Sometimes, some popular antidepressants are used to provide similar enhancement of the serotonin system without the severe side effects and disruption of life caused by heavy MDMA use. In mild cases of MDMA abuse, serotonin-elevating supplements like 5-HTP are given to suppress drug cravings; however, this sort of treatment is just symptomatic and doesn’t address the underlying issue of why the consumers become abusers in the first place (Drug Enforcement Agency, n.d.). Addiction to MDMA is not a criminal offence; neither a law enforcement problem; nor a physical health problem, but it is usually psychological - a matter of people with psychological issues trying to treat themselves with the tools available to them (in the form of illegal and prohibited drugs which, in spite of all government efforts, are still often easier to get than common antidepressant prescriptions.) If the reason consumers are addicted to the drug is motivated by emotional problems, those issues need to be tackled first to prevent further abuse or a return to drug abuse (Drug Enforcement Agency, n.d.). It is; however, wrong to understand an occasional or controlled drug user as a drug addict. Treating most users of prohibited drugs as addicts is not justified; the vast majority of users are not addicts as such and neither need nor benefit from any treatment programs (Drug Enforcement Agency, n.d.).
Withdrawal symptom is one thing that MDMA abusers usually have to fear about. Professional drug addiction treatments usually offer medically-supervised detox that can ease or even totally eliminate the difficult withdrawal symptoms. Once detox is complete, recovering addicts are made to participate in intensive individual and group counseling sessions that get to the root causes of their addiction i.e., treating their emotional and psychological issues (Treatment Solutions, n.d.).
References
Addiction. (n.d.). The DEA.org. Retrieved from: http://thedea.org/addiction.html; Accessed: 08th Nov, 2013.
E for Ecstasy by Nicholas Saunders. (1993). Published by Nicholas Saunders, 14 Neal's Yard, London, WC2H 9DP, UK. ISBN: 0 9501628 8 4, 320p.
Ecstasy Addiction Treatment. (n.d.). Treatment Solutions. Retrieved from: http://www.treatmentsolutions.com/ecstasy-addiction-treatment/; Accessed: 08th Nov, 2013.
Hahn, In-Hei. (2013). MDMA Toxicity. Medscape. Retrieved from: http://emedicine.medscape.com/article/821572-overview; Accessed: 08th Nov, 2013.
MDMA (Ecstasy) Abuse – Research Report series. (2006). National Institute on Drug Abuse. Retrieved from: http://www.drugabuse.gov/sites/default/files/rrmdma_0.pdf; Accessed: 08th November, 2013.
MDMA (Ecstasy or Molly) Drug Facts. (2012). NIDA for Teens. Retrieved from: http://teens.drugabuse.gov/drug-facts/mdma-ecstasy-or-molly; Accessed: 8th Nov, 2013.
MDMA Availability. (2010). National Drug Threat Assessment. Us Department of Justice. Retrieved from: http://www.justice.gov/archive/ndic/pubs38/38661/mdma.htm; Accessed: 08th Nov, 2013.
Rosenbaum, M., Doblin, R. (1991). Why MDMA Should Not Have Been Made Illegal? Chapter 6: The Drug Legalization Debate, SAGE Publications, Studies in Crime, Law and Justice, 7. Retrieved from: http://www.psychedelic-library.org/rosenbaum.htm; Accessed: 8th Nov, 2013.
Wu, P., Liu, X., Pham, T. H., Jin, J., Fan, B., Jin, Z. (2010). Ecstasy Use among U.S. Adolescents from 1999 to 2008. Drug Alcohol Depend, 112 (1-2), 33–38
