The scheduling of MDMA: a pharmacist's perspective

Designer Drugs of Abuse

Designer drugs of abuse represent a major health risk to those who use them. The toxic effects of these agents are very dangerous when they are correctly identified, but they are especially dangerous because they are often misidentified by emergency room personnel. The three groups of designer drugs are the opiates, amphetamine derivatives and phencyclidine derivatives. Amphetamine derivatives such as MDMA and MDA can cause fatal sequelae including hyperthermia, hypertension, and seizures. No specific antidote exists for these agents. Therefore, their widespread use in certain areas is a major concern. The opiate derivatives M PPP, MPTP and the fentanyl analogues produce a wide range of toxic effects. These agents are much more potent than heroin, and are sometimes sold as heroin unknowingly to the user. The results have been catastrophic, with many fatalities. Arylhexylamines such as phencyclidine and ketamine are becoming more popular as agents of abuse. These drugs may result in fatal toxicity resulting from cardiac arrest, hypertensive emergency, or status epilepticus. Familiarity with the signs and symptoms of toxicity from the designer drugs will expedite the care of these patients.

An exploration of the history and controversies surrounding MDMA and MDA

In existence for nearly a century, 3,4-methylenedioxyamphetamine (MDA) and 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") have gained quite a reputation. Perceived by some as dangerous neurotoxins, and by others as potential psychotherapeutics, these compounds have become a center of controversy among academics and law enforcement officials, and in the process have gained extensive media exposure. The classification of these drugs as illicit, controlled substances in the United States has not prevented their use, and MDMA, or Ecstasy, is currently one of the most popular substances used recreationally in North America. The scheduling of MDMA and MDA has, however, led to the distribution of contaminated, or falsely represented, Ecstasy tablets, and prevented responsible research into the detrimental and therapeutic effects of these drugs. A look at the history of these compounds suggests that they have the potential to be used safely as psychotherapeutic tools, and that the legal status of MDMA and MDA may be worth reconsidering.

Psychedelic and entactogenic drugs in the treatment of depression

CNS deficiency of 5-hydroxytryptamine (serotonin) has been implicated as a biochemical basis in some forms of depression. Existing drug modalities for treating depression include some with serotonergic effects. Studies suggest that psychedelic drugs are also serotonergic. This may indicate a role for psychedelics in the treatment of depression. Such treatment has already been attempted using psychedelic drugs in both the indoleamine and phenylalkylamine categories. Encouraging results seem to recommend further research, with special emphasis on drugs in the phenylisopropylamine subgroup of phenylalkylamines that are only peripherally psychedelic. Certain of these, called entactogens or empathogens, cause substantially less distortion of normative consciousness than classic psychedelics, such as LSD or mescaline. They could therefore be more easily assimilated into existing psychotherapy approaches, where their function would be to enhance the normal psychotherapeutic process rather than serving a maintenance role as chemotherapeutic agents. Their usefulness in such an application would be mainly at the start of psychotherapy in order to (1) reduce the client's "fear response" that often inhibits ability to deal with repressed traumatic material; (2) facilitate the client's interpersonal communications with the therapist, spouse or significant others; and (3) accelerate formation of a therapeutic alliance between client and therapist.

Recreational MDMA use in Sydney: a profile of 'Ecstacy' users and their experiences with the drug

'Ecstasy' (3,4-methylenedioxymethamphetamine or MDMA) is a recreational drug that is gaining popularity world wide. There is a paucity of research regarding the ways in which Ecstasy is used and the nature of its effects. A 'snowball' peer network technique was used to recruit 100 users who completed anonymous questionnaires. The research revealed that Ecstasy is primarily used by infrequent recreational drug users for 'fun' at dance parties and social gatherings. The primary reported effects of Ecstasy were a 'positive mood state' and feelings of intimacy and closeness to others. The secondary effects of Ecstasy were the stimulant effects of energy and activation, and the psychedelic effects of insight and perceptual and sensual enhancement. Ecstasy was reported to share the properties of both amphetamines and hallucinogens in the nature of its side effects and residual effects which were no more severe than those of the latter two classes of drug. It appeared Ecstasy was not conductive to regular and frequent use, because tolerance was reported to develop to the positive effects of Ecstasy, while negative effects increased with use. Although few problems associated with the recreational use of Ecstasy have surfaced to date, animal research has shown it to be neurotoxic to serotonergic nerve terminals. Caution must be observed until further research can determine the level of hazard in humans.

MDMA as a discriminative stimulus: isomeric comparisons

Using a two-lever, food-motivated discrimination procedure, eight male rats were trained to discriminate 1.5 mg/kg of racemic 3,4-methylenedioxymethamphetamine (MDMA) from its vehicle, distilled water. Once trained, the rats demonstrated a dose-related decrease in discriminative performance after administration of lower doses of MDMA (ED50 = 0.27 mg/kg). Racemic MDMA-stimulus generalization occurred with both isomers of MDMA with the ED50 of the (+) isomer calculated as 0.50 mg/kg and for the (-) isomer being 1.07. Time-course data indicate that racemic MDMA has a peak effect from 20-60 min post-injection with a declining effect from 120-240 min. This time-course closely resembles that observed by subjective reports in human abusers and, together with previous data, would indicate that the discriminative paradigm would be useful in investigations as to the neurochemical effects of MDMA.