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Ecstasy
Abuse and Control |
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Technical
Paper
Mr. Chairman, and Members of the Committee, thank
you for inviting me to participate in this important
and timely hearing on MDMA. I am pleased with the
Committee's interest in this topic and for providing
the National Institute on Drug Abuse (NIDA) this
opportunity to share what the scientific community
has come to learn about this illegal drug, commonly
referred to as "Ecstasy" or "E."
It is particularly timely, given that a little over
a week ago, NIDA sponsored the first major international
scientific conference on this topic on the NIH campus,
to discuss the latest findings and to have the world's
leading drug abuse researchers help identify future
research directions. There is now tremendous interest
in this topic. Over 500 people attended the event.
I would like to start out by providing you with
a brief overview of MDMA. 3,4- methylenedioxymethamphetamine,
which is commonly abbreviated and referred to as
MDMA or "Ecstacy," is an illegal drug
that has characteristics of both stimulants and
hallucinogens. While MDMA does not cause overt hallucinations,
many people have reported distorted time and perception
while under the influence of the drug. It causes
an amphetamine-like hyperactivity in people and
animals and like other stimulants, it appears to
have the ability to cause addiction. It increases
heart rate, blood pressure and can disable the body's
ability to regulate its own temperature. Because
of its stimulant properties, when it is used in
club or dance settings, it can enable users to dance
vigorously for extended periods, but can also lead
to severe rises in body temperature, what is referred
to as hyperthermia, as well as dehydration, hypertension,
and even heart or kidney failure in particularily
susceptible people. MDMA is a synthetic drug, meaning
it is manufactured, in this case illegally. It is
typically produced in capsule or tablet form and
is usually taken orally, although there are some
documented cases that it is being administered by
other routes, including injection and snorting.
MDMA's acute effects typically last from three to
six hours depending on the dosage, with the reported
average dose of MDMA being between one and two tablets,
with each containing approximately 60-120 mg of
MDMA. Importantly, in many situations Ecstasy tablets
contain not only MDMA, but a number of other drugs
or drug combinations that can be harmful as well.
MDMA appears to be well absorbed from the gastrointestinal
tract, and peak levels are reached in about an hour.
MDMA works in the brain by increasing the activity
levels of at least three neurotransmitters: serotonin,
dopamine, and norepinephrine. Much like the way
amphetamines work, MDMA causes these neurotransmitters
to be released from their storage sites in neurons
resulting in increased brain activity. Compared
to the very potent stimulant, methamphetamine, MDMA
causes greater serotonin release and somewhat lesser
dopamine release. Serotonin is the neurotransmitter
that plays an important role in regulation of mood,
sleep, pain, emotion, appetite and other behaviors.
By releasing large amounts of serotonin and also
interfering with its synthesis, MDMA causes the
brain to become significantly depleted of this important
neurotransmitter. As a result, it takes the human
brain time to rebuild its serotonin levels. For
people who take MDMA at moderate to high doses,
depletion of serotonin may be long-term. These persistent
deficits in serotonin are likely responsible for
many of the long-lasting behavioral effects that
the user experiences and what concerns us most about
this drug. MDMA is not a benign drug. In fact, all
of the studies conducted to date in both animals
and more recently in humans, confirm that club drugs,
particularly MDMA, are not harmless "fun party
drugs" as they are often portrayed. While users
of club drugs often take them simply for energy
to keep on dancing or partying, research shows these
drugs can have long-lasting negative effects on
the brain that can alter memory and other behaviors.
There is substantial evidence to show that MDMA
damages brain cells. Within the scientific community
we can not say with absolute certainty how and to
what extent the damage it can actually cause, but
there is across-the-board agreement that brain damage
does occur. We know that even one dose of MDMA (10
mg in rats) has the ability to decrease serotonin
levels for up to 2 weeks. Research in animals has
unequivocally shown that MDMA is neurotoxic, meaning
it literally damages brain cells. It is only recently
with the advent of new brain imaging technologies
that we are now beginning to see and understand
the potential neurotoxic effects of MDMA in humans.
Essentially there are two ways that researchers
are able to measure the effects of MDMA in humans.
One is by looking at neurofunctional measures, which
tell us how the brain is working. The other is to
look at neurocognitive measures, which demonstrates
the output of the brain, or how the brain is performing.
Using brain imaging and other state-of-the art equipment,
researchers are able to show us in intricate detail
how the brains of MDMA users differ from those that
have not used this drug. We know from imaging that
cerebral blood flow (CBF) is affected by MDMA use
(see FIGURE 1). We also have evidence from brain
images that MDMA abusers may have fewer serotonin
producing neuronal processes in the brain than non-users.
In fact this is such a powerful and true-to-life
example that we have developed an education campaign
around these brain images. Individuals are able
to literally see that the brain has changed from
MDMA use.
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other way researchers are determining the
effects of MDMA in humans is by looking at
neurocognitive measures, such as standardized
tests of mental abilities. A number of studies
have consistently shown that repeated MDMA
exposure is associated with significant impairments
in visual and verbal memory. |
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| Source:
Chang, L. et al., Psychiatry Research:
Neuroimaging, Section 98, pp. 15-28,
2000. |
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| In short,
there is now a large body of evidence that links
heavy and prolonged MDMA use to confusion, depression,
sleep problems, persistent elevation of anxiety,
aggressive and impulsive behavior and selective
impairment of some working memory and attention
processes. The harm that MDMA may potentially
cause is not limited to the user alone. Findings
released in May of this year in the Journal of
Neuroscience found the first evidence that prenatal
use of MDMA may cause memory loss and other impairments
in offspring. Rats that were exposed to MDMA during
stages of brain development (similar to brain
and central nervous system development time frames
in humans) were found to have memory and learning
deficiencies.
One encouraging thought to keep in mind as we
unravel the effects of this drug on the human
brain is not to underestimate the amazing capabilities
of the brain and its ability to compensate and
adjust to stressors. For example, there is some
new research emerging on other drugs of abuse,
such as methamphetamine, a drug structurally similar
to MDMA, that is showing that neuronal functions
and systems that have been damaged by chronic
drug use can recover. This is a positive and hopeful
note, though it is too soon to determine how functional
the brain cells actually are after recovery and
to determine if an individuals' cognitive deficits
resulting from the initial damage are completely
reversed. One of the more alarming facts about
this drug is that despite its known detrimental
consequences, there are increasing numbers of
students and young adults who continue to use
MDMA in increasingly higher doses. Several of
our Nation's top monitoring mechanisms, including
NIDA's long-standing national survey of drug use
among 8th, 10th and 12th graders, Monitoring the
Future (MTF), and our Community Epidemiology Work
Group (CEWG) are reporting that the use of club
drugs, particularly MDMA, is increasing in popularity
among high school and college students. There
are also clear indicators that MDMA and other
so called "Club Drugs" such as GHB,
Rohypnol, and methamphetamine, are no longer just
being used in "night clubs" and "rave
settings." Results from the 2000 MTF indicate
that the use of MDMA increased among students
in all three grades from 1999 to 2000. For 10th
and 12th graders, this is the second consecutive
year MDMA use has increased. But this year the
drug has also spread to 8th graders. Lifetime
use of MDMA among 8th graders increased from 2.7%
in 1999 to 4.3% in 2000. Among 12th graders, lifetime
use increased from 8.0% to 11.0% -- one-in-nine
seniors have tried ecstasy in their lifetime.
In addition to the overall increases in use, perceived
availability of MDMA increased among seniors from
40.1% to 51.4%. African Americans, however, show
considerably lower rates of MDMA use than do either
Whites or Hispanics (1.3 percent versus 7.6 percent
and 10.6 percent, respectively, for past year
use among seniors in 2000). Ethnographic data
from NIDA's Community Epidemiology Workgroup meeting
in June of this year showed that MDMA use is spreading
from raves and dance parties to high schools,
colleges, and other social settings frequented
by youth and young adults. Although, compared
to other drugs, the number of cases of MDMA use
remains relatively small, the group of epidemiologists,
public health officials, and researchers who monitor
emerging drug trends, found increases in MDMA
abuse in 13 of the 21 CEWG areas looked at and
easy availability in most other areas. Also it
is increasingly presenting itself in emergency
rooms across the country. According to SAMHSA's
Drug Abuse Warning Network, emergency room mentions
in the US increased significantly from 253 in
1994 to 4,511 in 2000. Although to many, MDMA
appears to be the new drug on the scene, it is
not. In fact, it is a problem that Europe has
been dealing with for quite a number of years.
European scientists who participated in our MDMA
meeting last week discussed the trends in their
own countries and discussed approaches they have
tried to curtail use and to develop treatments.
It is also not a new problem in the US. MDMA's
origins date back to the early 1900s when MDMA
was first synthesized, developed and patented
in Germany. The drug remained somewhat dormant
in the US until the 1970s when it began being
used by some psychotherapists who claimed that
it enhanced communication in patient sessions.
In was in the mid 1980s that we there were indications
that MDMA was being used at all night dance parties
or raves. For a variety of reasons, including
the fact that there was a growing body of scientific
evidence that MDMA was causing damaging effects
on serotonergic axons in animals, the US Drug
Enforcement Administration moved the drug to Schedule
1 status in 1985. Schedule 1 under the Controlled
Substance Act means there is no accepted medical
use for MDMA in the US. Despite MDMA's status
as a Schedule 1 drug, it continues to be used
illegally. To ensure that the public is well informed
about the harmful effects of this and other drugs,
NIDA has undertaken a number of extraordinary
steps to share the scientific findings about his
drug. For example, we teamed with "In the
Mix," this past Spring to develop a television
show on Ecstasy for their award-winning PBS series
for teens. The MDMA conference I mentioned earlier,
"The Advances, Challenges And Future Directions
Of MDMA/Ecstasy Research," is one other example
of the type of international leadership NIDA is
stewarding to combat this particular public health
problem. We have learned a lot about the short
and long-term consequences of this particular
drug. Yet, there are many scientific questions
that remain to be explored and answered. By bringing
together leading researchers to candidly discuss
their findings and the challenges they confronted,
we are all in a better position to advance the
science and make policy and other public health
decisions that are based on a strong research
base and not anecdotal evidence. We have and will
continue to develop publications on this topic
for different audiences. We will continue to make
all of these materials available on a specially-designed
website - http://www.clubdrugs.org/. As new findings
become available, we will be able to alert the
public immediately through this and other venues.
In closing, I would like to say there are at least
two things that the research community has concluded
about this drug. One is that MDMA is not a benign
drug. It is a harmful drug that can damage brain
cells. And secondly, like other areas of science,
there is much more to be learned about this drug.
Thank you again for your interest in this subject.
I will happy to answer any questions you might
have.
Source: Nida
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| http://www.drugabuse.gov/Testimony/7-30-01Testimony.html
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