FACT SHEET WHAT IS MDMA? MDMA (3,4-methylenedioxymethamphetamine) is the N-methyl analog of MDA, and shares similarities to both mescaline, a hallucinogen, and amphetamines, a family of stimulants. Although often referred to itself as a hallucinogen, this association is somewhat erroneous. The effects of MDMA dramatically differ from those of LSD and other psychedelics, with a notable lack of the perceptual distortions usually associated with these substances. WHO IS USING MDMA? MDMA appears to be most often used in urban areas, particularly certain college towns (e.g. UC Berkeley, UCLA, UC Santa Barbara, and UC Santa Cruz). In the past, some psychotherapists have employed it, under carefully supervised conditions, for a wide variety of purposes, ranging from improving couple communication to dealing with rape trauma. Illicit use has been most commonly associated with college students, gays and "yuppies." HOW IS MDMA MOST COMMONLY USED? MDMA is most often ingested orally, although inhalation and injection have been infrequently reported. The usual dose ranges from 100 to 150 mg and costs between $10 and $20. Although analyzed samples have been fairly pure in the past, this may change due to increased popularity and newly illicit status. WHY ARE PEOPLE USING MDMA? iii iii UCLA Drug Abuse Research Group (M. Douglas Anlgin, PhD, Director) Many users of MDMA are probably attracted to the drug for the same reasons as some psychotherapists. They feel that MDMA has the ability to increase empathy and self-insight. Reportedly, the advantages of MDMA over traditional psychedelics are less distortion of sensory perception and fewer unpleasant emotional reactions. In addition, many individuals describe strong euphoric and/or sensual effects associated with MDMA. DESCRIBE A 'TYPICAL' MDMA EXPERIENCE Effects generally appear within 20-60 minutes, when the user often experiences a brief "rush" of energy, usually described as mild but euphoric. After this rush, the high levels off to a plateau which lasts 2-3 hours and is followed by a gradual "coming down" sensation, culminating in a feeling of fatigue. MDMA exerts amphetamine-like effects which include dilated pupils, dry mouth and throat, tension in the lower jaw, grinding of the teeth, and overall stimulation. These side effects are dose dependent and will vary depending on the health of the individual user. In addition, MDMA exerts a strong paradoxical effect of relaxation which often causes many users to be unaware of the stimulant side effects. Most users cite a dramatic drop in defense mechanisms and increased empathy towards others. Combined with the stimulant effect, this generally produces an increase in intimate communication. WHAT IS KNOWN ABOUT THE TOXICITY OF MDMA? iv iv UCLA Drug Abuse Research Group (M. Douglas Anlgin, PhD, Director) Unfortunately, very little. So far, MDMA has been associated with few overdoses or deaths. However, studies in rats have indicated that large intravenous doses of MDMA in rats are associated with suspected degeneration of serotonergic nerve terminals in certain areas of the brain. Also, there may be some suppression of the immune system. Further research is needed to determine the significance of this damage, and to what extent it may occur in humans. WHAT IS MDMA'S ABUSE POTENTIAL? The euphoric effects of MDMA, combined with its street reputation, would suggest a significant abuse potential. To date, however, there appear to be relatively few cases of what might be considered serious abuse of MDMA. Excessive use is probably self limiting in that the frequent use of MDMA almost invariably produces a strong dysphoric (unpleasant) reaction, that is only exacerbated with continued use. In addition, frequent use produces an almost total loss of the desired actions with a greater rapidity and intensity than with other more commonly abused substances. v v UCLA Drug Abuse Research Group (M. Douglas Anlgin, PhD, Director) 11/14/86 epd Rev. 12/31/86 epd Rev. 3/24/87 vi vi UCLA Drug Abuse Research Group (M. Douglas Anlgin, PhD, Director) EXECUTIVE SUMMARY The 1980's have witnessed the emergence and popularization of a rather unique psychoactive substance -- MDMA, (3,4- methylenedioxy-methamphetamine), also known as "Adam," "Ecstasy," or "XTC". Extensive media coverage recently highlighted what appears to be a dramatic increase in both therapeutic and recreational use. A controversy has since ensued providing very different perspectives on the substance. Some psychotherapists view MDMA as a therapeutic aid which, when combined with psychological treatment, has benefits that outweigh potential health consequences and see minimal harm associated with carefully monitored use. Some drug treatment counselors and drug enforcement officials, on the other hand, see it as a potentially dangerous substance possessing harmful actions, and increasingly being abused outside of therapeutic circumstances. Unfortunately, research has only just begun to address many of the questions and concerns that have arisen. Consequently, it can be anticipated that much of the following information will become dated as more formal studies are completed. Research examining patterns of MDMA use has been minimal. Most of the information available regarding street use of MDMA is based on anecdotal accounts given to the media, therapists and substance abuse professionals. Beck has conducted preliminary research over the last ten years interviewing hundreds of individuals in the San Francisco Bay Area and at the University of Oregon in Eugene. Zinberg (1976) has published the only v naturalistic study of 23 users of MDA. Greer (1983) administered MDMA to 29 subjects in a therapeutic setting. Downing (1985) studied the effects of a single exposure to MDMA among 21 individuals. Siegel (1985) and Seymour (1986) have ongoing studies at UCLA and the Haight Ashbury Free Clinic, respectively. Much of the information for this paper is based upon these studies, testimony at federal hearings, and personal communications. MDMA, which is essentially the successor to MDA, first appeared on the street in the early 1970's. Use remained very limited until the end of the decade. On July 1, 1985 the Drug Enforcement Administration (DEA) used its emergency scheduling power to temporarily place MDMA in Schedule I of the Controlled Substances Act. The DEA's actions were challenged by some therapists and researchers who argued that a Schedule I status would severely hinder research into what they regarded as MDMA's therapeutic potential. Based on testimony from federal hearings, the administrative law judge recommended that MDMA be placed in Schedule III -- a category for drugs with accepted medical use and only a low to moderate abuse potential. However, the DEA administrator rejected his recommendation and MDMA was permanently placed in Schedule I effective November 13, 1986. The scheduling process and ensuing reaction by therapists using the drug in their practices brought MDMA to national attention via mass media features which often sensationalized the reputed euphoric and therapeutic qualities of MDMA. The increase in vi publicity was accompanied by an escalation in street demand from an estimated 10,000 doses distributed in all of 1976 to 30,000 doses distributed per month in 1985 (Siegel, 1986). The DEA found evidence of use in a majority of states. MDMA appears to be most often used in urban areas, particularly certain college towns. Its use has been most commonly associated with college students, gays and "yuppies". The usual dose ranges from 100 to 150 mg. and costs between $10 and $20. MDMA is most often ingested orally, although inhalation and injection have also been infrequently reported. Drug effects generally appear within 20-60 minutes after ingestion, when the user often experiences a brief "rush" of energy, usually described as mild but euphoric. After this rush, the high levels off to a plateau which lasts 2-3 hours and is followed by a gradual "coming down" sensation, culminating in a feeling of fatigue. MDMA exerts amphetamine-like side effects on the body, including dilated pupils, dry mouth and throat, tension in the lower jaw, grinding of the teeth, and overall stimulation. These effects vary depending on dose. In addition, MDMA exerts a strong paradoxical effect of relaxation, which often causes many users to be unaware of the stimulant side effects. Most users cite a dramatic drop in defense mechanisms and increased empathy towards others. Combined with the stimulant effect, this generally produces an increase in intimate communication. Psychotherapeutic Effects vii It appears that well over one hundred psychiatrists and other therapists have employed MDMA as a therapeutic adjunct. At the federal hearings several psychiatrists praised MDMA's ability to increase both empathy and self-insight. They felt that a major advantage of MDMA over the traditional psychedelics was that it produced far less distortion of sensory perception and fewer unpleasant emotional reactions. Although some preliminary research suggested that MDMA has significant therapeutic potential, the notable absence of well-controlled, double-blind studies seriously limits any conclusions concerning the possible efficacy or risk associated with the use of MDMA in therapy. Health Risks Although some research has assessed toxic and lethal doses in animals, little is known about MDMA's potential toxicity for humans. A few deaths have been associated with the use of MDMA, but its role as a causative factor in each case remains uncertain. As of April, 1986 20 emergency room incidents for MDMA had been listed in the federal government's Drug Abuse Warning Network (DAWN). Ignorance of the substance undoubtedly contributes to underreporting. However, the number of mentions still appears to be rather low when compared with the suspected extent of use described by Siegel and the DEA. MDMA has been associated with relatively few overdoses or deaths. However, it's neurotoxic potential is cause for concern. Acute and chronic problems are most often associated with the repeated use of high dosages. Generally, the side effects of viii MDMA are similar to those of amphetamine. MDMA also appears to exert an adverse action on the immunological response of some individuals, particularly with heavy use. Long-term users often describe increasingly uncomfortable and prolonged "burn-out" periods, sometimes lasting two or more days. Many individuals have also reported an increased susceptibility to various ailments, particularly sore throats, colds, flus, and herpes outbreaks. It should be noted that these reactions appear to be rare in novice users and individuals in good physical and mental health. Based on the limited information available, researchers have identified the following medical conditions as possible contraindications to MDMA use: diabetes, diminished liver function, epilepsy, glaucoma, heart disease, hypertension, hypoglycemia, hyperthyroidism and pregnancy. Infrequent psychological problems have been associated with the use of MDMA. Rare episodes of hyperventilation have been noted, but this phase is transitory. In addition, problems occur for some individuals who, in attempts at self-therapy, run the risk of exacerbating their emotional problems with unsupervised episodes. Among individuals who have tried both MDMA and cocaine, Beck found that the majority usually express a strong preference for MDMA which would suggest a high abuse potential. However, in sharp contrast to cocaine, there appear to be relatively few cases of what might be considered serious abuse of MDMA. ix Excessive use is probably self limiting in that frequent use of MDMA always produces a strong dysphoric (unpleasant) reaction, that is only increased with continued use. In addition, frequent use produces an almost total loss of the desired actions with a greater rapidity and intensity than with other more commonly abused substances. Conclusion Media accounts and substance abuse professionals often dismiss MDMA as a short-term fad. However, the perceived therapeutic and/or euphoric effects combined with the ease with which MDMA is usually experienced can be expected to attract new users. The danger in this regard is the uncertain potential for abuse. In addition, there are potentially severe health risks associated with MDMA and probable contraindications. This is particularly true with repeated use of high dosages which may lead to acute or chronic medical and psychological problems. Unfortunately, our current knowledge regarding nearly every aspect of MDMA is extremely limited and based almost exclusively on anecdotal data. Research is obviously needed to better determine the potential risks of a substance which is rapidly establishing itself in our drug culture. 11/14/86 epd Rev. 12/31/86 epd, 9/15/87 jh x X-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-X Another file downloaded from: The NIRVANAnet(tm) Seven & the Temple of the Screaming Electron Taipan Enigma 510/935-5845 Burn This Flag Zardoz 408/363-9766 realitycheck Poindexter Fortran 510/527-1662 Lies Unlimited Mick Freen 801/278-2699 The New Dork Sublime Biffnix 415/864-DORK The Shrine Rif Raf 206/794-6674 Planet Mirth Simon Jester 510/786-6560 "Raw Data for Raw Nerves" X-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-X