CORK Bibliography: Ecstasy Serving Substance Abuse Professionals Since 1993 Last Update: 17.09.06 C O R K O N L I N E powerpoint presentations CORK database search resource materials bibliographies clinical tools user services newsletters about cork home CORK Bibliography: Ecstasy 126 citations. June 2005 to present Prepared: September 2006 Akhondzadeh S; Hampa AD. Topiramate prevents ecstasy consumption: A case report. Fundamental & Clinical Pharmacology 19(5): 601-602, 2005. (8 refs.) The last decade has witnessed a development in the phenomenon 'ecstasy'. Several substances, with more or less the same effects, are grouped together by the term ecstasy, the best-known one being 3,4-methylenedioxymethamphetamine (MDMA). The psychopathological consequences of MDMA in humans are relatively poorly understood. In addition, the treatment approach is complicated by the lack of documented studies. Topiramate is an antiepileptic drug that has a broad spectrum of antiseizure effects, which appear to be the result of several neurostabilizing pharmacological mechanisms including facilitation of GABAergic neurotransmission and inhibition of glutametergic activity at AMPA/kainate receptors. As both GABAergic and glutametergic neurons appear to be important modulators of the brain reward system, it was postulated that topiramate would be an effective treatment for reducing MDMA consumption through the attenuation of MDMA-induced euphoria. The case of an ecstasy consumer, who started to discontinue ecstasy under topiramate treatment is presented here. Antiepileptics/mood stabilizers with glutamate inhibition activity like topiramate may present a promising new approach for challenging the consequence of drug abuse. Copyright 2005, Blackwell Publishing Allaste AA. Nightlife in Liverpool and Tallinn. Nordic Studies on Alcohol and Drugs 22(English Supplement): 139-141, 2005. (10 refs.) This is one of three articles dealing with the nightlife and political response in different countries. The goal is to identify trends in drug use and drinking, the culture, history and policies of each city. There is also attention to the emergence of a youth culture which transcends municipalities and countries. Once a remote city at the edge of the Soviet Union, the Estonian capital is now central in the Europe's weekend club scene. Since the restoriaton of Estonian independence it has the reputation of a party town. In the second half of the 1990s it became known as part of the club scene and a favorite destination of tourists, 60% from Finland. Almost one third of Tallin's population is in the partying age group, 15-34. However due to costs, relatively few of the customers in the clubs are regular local people. Alcohol, always with a reputation of being inexpensive is the most visible subtance used. In addition to alcohol, both amphetamine and ecstasy are readily available, inexpensive and producted locally. They are increasingly part of the drug trade regionally. Amphetamine use is among the highest in Europe among adolescents. Efforts are underway to institute greater controls. No longer is alcohol on sale around the clock. Prices have risen since Estonia joined the EU. While the official drug policy gives priority to harm reduction for recreational users, in fact it does not have a high priority in practice. Copyright 2005, STAKES Allott K; Redman J. Patterns of use and harm reduction practices of ecstasy users in Australia. Drug and Alcohol Dependence 82(2): 168-176, 2006. (49 refs.) Harm reduction refers to the use of strategies to prevent or reduce harmful consequences associated with illicit drug use. There is a paucity of research concerning the harm reduction practices employed by ecstasy users. This study aimed to explore the prevalence, nature and factors associated with harm reduction practices employed by ecstasy users in Australia, with a specific focus on the practice of preloading and postloading-the use of pharmaceuticals and natural products prior and subsequent to ecstasy use. One hundred and sixteen Australian residents aged 18 years and over who had used ecstasy at least once in their lifetime were recruited via convenience sampling, 'snowballing' and via web-based advertisements and completed an anonymous questionnaire. Participants reported using a wide range of strategies for minimising ecstasy-associated harm. The most common strategies used for reducing negative side effects, 'comedown' or neurotoxicity were drinking water, limiting or reducing ecstasy use, taking breaks and taking vitamins or other natural substances. Forty percent of the sample had tested their ecstasy pills for the presence of MDMA. Forty-one percent and 47% of participants had engaged in pre- and postloading, respectively, with the most common pre- and postloading substances being multivitamins, 5-HTP, magnesium and fruit or fruit juice. Younger mean age and 'high' total occasions of ecstasy use was significantly associated with preloading, and 'high' total use and frequency of use was associated with postloading. The results indicate that ecstasy users are aware of the potential for harm associated with ecstasy use and attempt to minimise harm by actively employing strategies. By exploring the pattern of harm reduction practices among ecstasy users, this study has highlighted the need for further research into the efficacy and potential clinical drug interactions associated with such practices, as well as the need for investigation of how such practices may affect patterns of ecstasy use. Copyright 2006, Elsevier Science Banta-Green C; Goldbaum G; Kingston S; Golden M; Harruff R; Logan BK. Epidemiology of MDMA and associated club drugs in the Seattle area. Substance Use & Misuse 40(9-10): 1295-1315, 2005. (26 refs.) Club drug use, MDMA in particular, appeared as a growing problem in the Seattle area in the late 1990s. To understand more about the patterns of MDMA use and to evaluate the current state of MDMA use, multiple data sources were examined. The seven data sources utilized included local community-based club drug surveys collected in 2003 at raves, treatment agencies, and gay-oriented bars and sex clubs; school surveys (collected in 2002); mortality data (deaths between 2000 and 2002); data from the sexually transmitted disease clinic (October 2002 to October 2003);,focus groups (2003) with men who have sex with men; emergency department drug mentions (1995 to 2002); and drug treatment admissions (1999 to 2003). Taken together, these data indicate moderate levels of MDMA use and relatively low levels of mortality and acute morbidity. However, there are several areas of concern including possible mental health effects and high levels of suspected adulteration of MDMA. Some data point to a relationship between MDMA use and risky behaviors including unprotected sex. Implications for prevention, intervention, and treatment are discussed. Copyright 2005, Marcel Dekker, Inc Baylen CA; Rosenberg H. A review of the acute subjective effects of MDMA/ecstasy. (review). Addiction 101(7): 933-947, 2006. (53 refs.) Aim: Although several relatively recent reviews have summarized the neuropsychiatric effects associated with chronic ecstasy use, there is no published comprehensive review of studies on the acute subjective effects (ASEs) of MDMA/ecstasy. Design: The present study reviewed the prevalence, intensity and duration of ASEs collected from 24 studies that provided frequency data on the prevalence of self-reported ecstasy effects and/or provided data on the intensity of ecstasy effects. Findings: Although hundreds of ASEs have been reported following MDMA consumption, we identified a subset of effects reported repeatedly by meaningful proportions and large numbers of participants across multiple investigations, most of which were either emotional (e.g. anxiety, depression, closeness, fear, euphoria, calmness) or somatic (e.g. nausea/vomiting, bruxism, muscle aches/headache, sweating, numbness, body temperature changes, fatigue, dizziness, dry mouth, increased energy). Only one sexual ASE (sexual arousal/increased sensual awareness), one cognitive ASE (confused thought), one sensory-perceptual ASE (visual effects/changes in visual perception), one sleep-related ASE (sleeplessness) and one appetite-related ASE (decreased appetite) were reported across five or more investigations. Three factors-number of hours between ingestion and assessment, dose level, and gender-have been associated with the acute subjective experience of MDMA/ecstasy. Conclusions: This review provides useful information for clinicians and researchers who want to understand the desirable and undesirable ASEs that may motivate and restrain ecstasy use, for public health advocates who seek to reduce biomedical harms (e.g. fainting, dehydration, shortness of breath, bruxism) associated with recreational use of MDMA/ecstasy, and for educators who wish to design credible prevention messages that neither underestimate nor exaggerate users' experiences of this drug. Copyright 2006, Society for the Study of Addiction to Alcohol and Other Drugs Bedi G; Redman J. Self-reported ecstasy use: The impact of assessment method on dosage estimates in recreational users. Journal of Psychopharmacology 20(3): 432-436, 2006. (26 refs.) While research has associated recreational ecstasy use with negative outcomes, there remain a number of methodological limitations of human studies. The present study examined the impact of self-report methodology on lifetime ecstasy dosage figures using three estimation methods: a single question estimation, a context-based timeline method and a quantity-frequency method. We used a repeated measures design, testing 38 participants aged over 18 years who reported using ecstasy on ten or more occasions. Methodology was found to impact on estimations made, with the timeline method producing higher figures than the single question. While single question and timeline estimations were positively correlated, there was no relationship between either of these methods and the quantity-frequency method. The present findings are in keeping with indications in the alcohol and other drug literature that the use of contextual memory cues increases accuracy of recall as indicated by higher estimations, and that quantity-frequency methods may not adequately assess variability in Lifetime drug-use patterns. Copyright 2006, Sage Publications Bernhoft IM; Steentoft A; Johansen SS; Klitgaard NA; Larsen LB; Hansen LB. Drugs in injured drivers in Denmark. Forensic Science International 150(2-3): 181-189, 2005. (9 refs.) As part of the project Impaired Motorists, Methods of Roadside Testing and Assessment for Licensing (IMMORTAL) under the European Commission's Transport RTD Programme of the 5th Framework Programme [I.M. Bernhoft, Drugs in accidents involved drivers in Denmark, D-R4.3 of the project Impaired Motorists, Methods Of Roadside Testing and Assessment for Licensing (IMMORTAL), www.immortal.or.at, 2005], a study regarding drugs in accident-involved drivers was carried out in Denmark. The main objectives of this study were: (1) to collect and analyse samples from injured drivers for the presence of drugs; (2) to give an indication whether drugs may have contributed to traffic accidents; and (3) to get information on the drug-positive drivers and their drug use. This paper focuses on objective 1. Injured drivers who were treated in hospital were asked to give a saliva sample, a blood sample or both. The samples were screened for the following substances: opiates, amphetamines, methamphetamines, incl. MDMA (ecstasy), cannabinoids and metabolites, cocaine and metabolites and benzodiazepines. Screenings were carried out by means of Cozart Microplate EIA kit. Positive screenings were confirmation analysed by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography/tandem mass spectrometry (LC/MS/MS). In total, 26 out of 330 patients were confirmed positive for one or more of the six drug groups. However, three patients were excluded from the survey for various reasons. Of the remaining 23 drug-positive patients 15 were found positive for one drug group, and in five of these cases alcohol was present in a concentration over the legal limit in Denmark (0.05%). The other eight patients were found positive for two drug groups, and in four of these cases, alcohol was also present in a concentration over the legal limit. Alcohol was found both in combinations with medicinal drugs, with illegal drugs and with both. Based on the saliva or blood concentrations, we estimate that there is a strong suspicion of impairment in 9 out of 23 cases, and in another six cases it was likely that the drivers were impaired. Copyright 2005, Elsevier Ireland Breen C; Degenhardt L; Kinner S; Bruno R; Jenkinson R; Matthews A et al. Alcohol use and risk taking among regular ecstasy users. Substance Use & Misuse 41(8): 1095-1109, 2006. (36 refs.) We examine alcohol use in conjunction with ecstasy use and risk-taking behaviors among regular ecstasy users in every capital city in Australia. Data on drug use and risks were collected in 2004 from a national sample of 852 regular ecstasy users (persons who had used ecstasy at least monthly in the preceding 6 months). Users were grouped according to their typical alcohol use when using ecstasy: no use, consumption of between one and five standard drinks, and consumption of more than five drinks ("binge" alcohol use). The sample was young, well educated, and mainly working or studying. Approximately two thirds (65%) of the regular ecstasy users reported drinking alcohol when taking ecstasy. Of these, 69% reported usually consuming more than five standard drinks. Those who did not drink alcohol were more disadvantaged, with greater levels of unemployment, less education, higher rates of drug user treatment, and prison history. They were also more likely than those who drank alcohol when using ecstasy to be drug injectors and to be hepatitis C positive. Excluding alcohol, drug use patterns were similar between groups, although the no alcohol group used cannabis and methamphetamine more frequently. Binge drinkers were more likely to report having had three or more sexual partners in the past 6 months and were less likely to report having safe sex with casual partners while under the influence of drugs. Despite some evidence that the no alcohol group were more entrenched drug users, those who typically drank alcohol when taking ecstasy were as likely to report risks and problems associated with their drug use. It appears that regular ecstasy users who binge drink are placing themselves at increased sexual risk when under the influence of drugs. Safe sex messages should address the sexual risk associated with substance use and should be tailored to reducing alcohol consumption, particularly targeting "heavy" alcohol users. The study's limitations are noted. Copyright 2006, Marcel Dekker Britt GC; McCance-Katz EF. A brief overview of the clinical pharmacology of "club drugs". Substance Use & Misuse 40(9-10): 1189-1201, 2005. (56 refs.) Four different "club drugs" are reviewed: MDMA (methylenedioxymethamphetamine, "Ecstasy"), GHB (gamma-hydroxybutyrate), ketamine, and Rohypnol (R) (flunitrazepam). The neurobiology, clinical pharmacology, and treatment issues for each are discussed. Copyright 2005, Marcel Dekker, Inc Butters JE; Smart RG; Mann RE; Asbridge M. Illicit drug use, alcohol use and problem drinking among infrequent and frequent road ragers. Drug and Alcohol Dependence 80(2): 169-175, 2005. (32 refs.) The purpose of this paper is to investigate the relationships between illicit drug and alcohol use, problem drinking, and road rage. Particular attention is devoted to the association between these behaviors and frequent involvement in road rage activities. The data are taken from the 2002 Centre for Addiction and Mental Health (CAMH) Monitor, a representative telephone survey with a sample of 2421 adults aged 18 and older in Ontario. A cluster analysis was performed and analysis of variance procedures were used to test for group differences. The cluster analysis revealed five distinct groups involved in various types of road rage behavior. Frequent road ragers, accounting for 5.3% of the sample, were involved in the most severe forms of road rage behavior and were most likely (24%) to report problem drinking and past year cannabis (23.8%), cocaine (5.4%), and ecstasy (10%) use. These data indicate that illicit drug use and alcohol problems are significantly greater for those involved in the most serious forms of road rage behavior. Further work is needed to identify the mechanisms by which illicit drug use and problem drinking are linked to road rage. Copyright 2005, Elsevier Ireland Ltd. Carlson RG; Wang JC; Falck RS; Siegal HA. Drug use practices among MDMA/ecstasy users in Ohio: A latent class analysis. Drug and Alcohol Dependence 79(2): 167-179, 2005. (73 refs.) This study describes the drug use practices among 402 recent MDMA (3,4-methelyenedioxymethamphetamine) users recruited in Ohio using respondent-driven sampling. About 64% of the participants were men, 81.6% were white, and the mean age was 20.9 years. Latent class analysis was used to identify subgroups of MDMA users. Use of cocaine, opioids, amphetamines, tranquilizers, inhalants, marijuana, and hallucinogens during the previous 6 months, and days of "drunkenness" in the past 30, were used for classification. A three-class model was preferable and reflected "Limited range," "Moderate range," and "Wide range" drug use patterns. For example, the conditional probability of using opioids during the previous 6 months was .07 in Class 1,.59 in Class 2, and .88 in Class 3. Other substances followed similar patterns. Predictors of class membership were examined in a multinomial logit model in which the "Limited range" Class was treated as the reference group. Participants who were white, younger, and who reported more than 10 occasions of MDMA use were more likely to be in the "Wide range" drug use Class. Latent class analysis is a useful method to help describe and understand variability in polydrug use patterns. Copyright 2005, Elsevier Science Ltd. Chanteloup F; Lenton S. WA Trends in Ecstasy and Drug Related Markets 2004: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 220. Sydney: National Drug and Alcohol Research Centre, 2005. (15 refs.) This report deals with ecstasy and the related drug markets in West Australia. Following an executive summary there is a brief description of the characteristics of regular ecstasy users. Following are individual sections dealing with ecstasy, methamphetamine, cocaine, ketamine, gamma-hydroxybutyrate, LSD, with data on demographic characteristics of users, drug use history and current use patterns, as well as price, purity, perceived availability, and the perceived risks and benefits of use. Other drug use is also summarized -- alcohol, marijuana, nicotine, benzodiazepines, inhalants and other opioids. Sections are also devoted to associated risk activities including injecting risk behavior, sexual activity, tattooing and piercing, and driving risk behavior; and also health risks, with reports of overdose, symptoms of dependence, and help-seeking behavior. Criminal encounters are also described. Copyright 2005, National Drug and Alcohol Research Centre (Australia) Cheng JYK; Chan DTW; Mok VKK. An epidemiological study on alcohol/drugs related fatal traffic crash cases of deceased drivers in Hong Kong between 1996 and 2000. Forensic Science International 153(2-3): 196-201, 2005. (17 refs.) This study is designed to evaluate the correlation between fatal vehicle crashes (FVC) and consumption of alcohol and/or drugs among drivers. Between 1996 and 2000 in Hong Kong, a total of 197 FVC cases of deceased drivers were investigated. The blood and/or urine samples of the victims were examined for the presence of alcohol and drugs. The 197 cases were then classified into two groups: single-vehicle crashes (SVC) and multiple-vehicle crashes (MVC). Out of the 106 cases for the latter group, alcohol and/or drugs were detected in 22 cases (21%) while the remaining 84 cases (79%) were regarded as no significant finding. As for the 91 cases in SVC group, 51 cases (56%) were positive for alcohol and/or drugs. The findings indicate that a driver consuming alcohol and/or drugs has a higher risk of being involved in a FVC. The most frequently detected drugs for SVC group (11 cases) were: 46% central nervous system (CNS) stimulants (including designer drugs like MDMA); 36% cannabis; 18% benzodiazepines and 9% ketamine. The detected drug for the only case in the MVC group was a CNS stimulant. The number of cases with ketamine, methamphetamine and MDMA detected has increased in recent years as these party drugs have gained popularity in Hong Kong. Copyright 2005, Elsevier Ireland Ltd. Choi KH; Operario D; Gregorich SE; McFarland W; MacKellar D; Valleroy L. Substance use, substance choice, and unprotected anal intercourse among young Asian American and Pacific Islander men who have sex with men. AIDS Education and Prevention 17(5): 418-429, 2005. (32 refs.) Substance use has been shown to be an important factor associated with having unprotected anal intercourse (UAI) among Asian and Pacific Islander (API) men who have sex with men (MSM). However, little is known about which substances are used in conjunction with sexual activity and whether having UAI varies by substance choice in this population. From January 2000 to September 2001, we sampled API MSM aged 18-29 years from 30 gay-identified venues in San Francisco, California, and interviewed 496 API men face-to-face using a standardized questionnaire. Overall, 47% of the sample reported UAI in the past 6 months. During the same time period, 32% and 34% reported being "high" or "buzzed" on alcohol and drugs during sex, respectively. The most common drugs used in conjunction with sex were methylenedioxymethamphetamine ("ecstasy"; 19%), followed by marijuana (14%), inhalant nitrites ("poppers"; 11 %), and crystal methamphetamine ("crystal"; 10%). In a multivariate model, we observed associations between UAI and being high or buzzed on ecstasy (odds ratio [OR] = 2.62; 95% confidence interval [CI] = 1.37,5.02) and poppers during sex (OR = 3.29; 95% CI = 1.50, 7.25). However, being high or buzzed on alcohol, marijuana, gamma-hydroxybutyrate (GHB), and crystal methamphetamine during sex had no association with UAI. One third of sampled young API MSM used drugs or alcohol during sex. The co-occurrence of ecstasy and popper use and unprotected sex underscores the need to develop HIV prevention programs focusing on particular drugs. Copyright 2005, Guilford Publications Inc. Clatts MC; Goldsamt LA; Yi H. Club drug use among young men who have sex with men in NYC: A preliminary epidemiological profile. Substance Use & Misuse 40(9-10): 1317-1330, 2005. (21 refs.) This paper describes findings from a study of young men who have sex with men (YMSM) in New York City. Using a cross-sectional design and a community-based targeted sampling approach, a total of 569 YMSM were recruited during 2000 and 2001 for a structured survey interview. High rates of lifetime exposure to a variety of club drugs (including methamphetamine, ketamine, and MDMA) are observed in the overall sample. Among those who use club drugs on a chronic basis (N = 145), we found high rates of a prior suicide attempt (including high rates of multiple suicide attempts), high rates of lifetime exposure to multiple types of drugs, high rates of current poly drug use (including multiple types of club drugs), and high rates of current depressive symptoms. Chronic club drug users had a mean CES-D score of 8.5 and nearly two-thirds had a score of 7 or more. Although high rates of condom use are reported in some types of sexual exchanges, data show multiple types of sexual risk among chronic club drug users, including high rates of unprotected anal intercourse (UAI) with most frequent partners and comorbid drug use among both YMSM and their sexual partners. Copyright 2005, Marcel Dekker, Inc Cole JC; Michailidou K; Jerome L; Sumnall HR. The effects of stereotype threat on cognitive function in ecstasy users. Journal of Psychopharmacology 20(4): 518-525, 2006. (46 refs.) Stereotype threat occurs when individuals, believed to be intellectually inferior, perform badly on cognitive tests they perceive to confirm stereotypes about them. Due to the wide media coverage of studies purporting to show cognitive deficits in ecstasy users it is possible that they experience stereotype threat. This study tested ecstasy and non-ecstasy using polysubstance misusers on a variety of cognitive tests after they had been exposed to stereotype threat. This priming consisted of exposing them to information about the long-term effects of ecstasy which either stated that ecstasy caused memory toss or that it did not. Ecstasy users that had been primed that ecstasy did not cause cognitive deficits performed better than the other three groups on the delayed portion of the prose recall task from the Rivermead BehavioraliouraL Memory Test battery. There were no other statistically significant differences between any of the groups on any of the other cognitive tests used. This suggests that stereotype threat exists in ecstasy users and may be influencing their performance in experiments designed to identify cognitive deficits. In order to prevent this occurring in future studies, experimenters must be careful how they conduct their experiments and discuss their results with the media. Copyright 2006, Sage Publications Community Epidemiology Work Group, eds. Epidemiologic Trends in Drug Abuse. Volume I: Proceedings of the Community Epidemiology Work Group. June 2004. Bethesda MD: National Institute on Drug Abuse, 2005. (Chapter refs refs.) This volume provides the presentations by the 21 Community Epidemiology Work Groups, as well as the results of a special expert panel on presectip drug abuse. The first introductory section of the volume provides a bried description of the CEWG roles, functions, and attributes as well as the major data sources used. This is followed by a discussion of the key findings in respect to presectiption drug abuse, polysubstance abuse, cocaine/crack/heroin, methamphetamine, marijuana, club drugs (MDMA/ecstasy, GHB, ketamine), phencyclidine, and also infectious deseases related to drug abuse. The next section presents the discussion and presentation on trends in prescription drug aubse, with summaries on the general epidemiology, student use of prescription drugs, treatment admissions related to the use of narcotic painkillers, teen's use and abuse of benzodiazepines, the nonmenidal use of prescription drugs by college students, and finally prescriptiondrug abuse among ecstaasy users in Miami. The final section is an international paper on Mexico, and Copyright 2005, Project Cork Compton WM; Thomas YF; Conway KP; Colliver JD. Developments in the epidemiology of drug use and drug use disorders. American Journal of Psychiatry 162(8): 1494-1502, 2005. (74 refs.) The past 30 years of research on the epidemiology of drug use, drug use disorders, and related conditions, such as HIV, has provided major insight into these conditions. Drug use peaked in the late 1970s, decreased across the 1980s, increased in the 1990s, and has remained stable during the past few years. Within this broad pattern, specific epidemics of crack cocaine, amphetamines, club drugs (such as Ecstasy), heroin, and prescription opioids and associated epidemics of HIV and other infectious diseases have been identified and tracked. Besides major accomplishments in surveillance, the epidemiology of drug use and drug use disorders has traditionally focused on identifying risk factors at the individual (genetic factors, high-risk behaviors), family (child abuse), neighborhood (high availability of drugs), and societal (policies and laws) levels as domains of influence, not as components of interrelated processes. Research includes careful cross-sectional and longitudinal observational studies as well as clinical epidemiological experiments in which prevention interventions test specific etiological theories. Building on this background, the next challenges for the epidemiology of drug use and drug use disorders will be to link individual vulnerabilities with specific environmental factors by using multilevel methodological approaches. For example, what are the environmental factors that interact with individual vulnerabilities to produce drug addictions and drug consequences such as HIV? Research in genetic epidemiology has demonstrated the potential for studies of interactions of genetic and environmental factors. The field needs to focus on linking science with epidemiology to make progress in understanding these complex health conditions. Copyright 2005, American Psychiatric Association Copeland J; Dillon P; Gascoigne M. Ecstasy and the concomitant use of pharmaceuticals. Addictive Behaviors 31(2): 367-370, 2006. (4 refs.) Recent anecdotal evidence suggests that it is becoming increasingly popular among ecstasy users to attempt to negate certain side-effects or enhance the drug experience through the concomitant use of pharmaceutical drugs or supplements. This study was designed to explore the practice of deliberately using pharmaceuticals for any reason in association with ecstasy and related drug (ERD) use. A cross sectional survey was conducted with 216 adults who had used ecstasy at least once in the previous 6 months. Generally, this sample was young, well educated, and likely to be in some form of paid employment. Males were slightly overrepresented within the sample. About one quarter of the sample had deliberately taken a pharmaceutical substance for its putative effects on the euphoric effects of, or recovery from, ecstasy use. Those who reported using pharmaceuticals were significantly more likely to be male, had more 'apparent' years of use, and were more likely to have injected ERDs. As a result, there appears to be a need for harm reduction information for ecstasy users regarding the risks associated with the mixture of ERDs with pharmaceuticals and supplements. Particular attention should be paid to informing users of the potentially fatal serotonin syndrome that is likely to arise from combining serotonin enhancing substances, such as ecstasy or SSRI and MAOI groups of antidepressants. Copyright 2006, Elsevier Science Ltd Dafters RI. Chronic ecstasy (MDMA) use is associated with deficits in task-switching but not inhibition or memory updating executive functions. Drug and Alcohol Dependence 83(2): 181-184, 2006. (12 refs.) This study aimed to establish whether prior ecstasy (MDMA) use caused impairments in tasks which targeted specific executive functions and whether the magnitude of impairments were correlated with the level of drug use. Subjects who had used ecstasy and cannabis (N=33), subjects who had used cannabis but not ecstasy (N=17) and subjects who had used neither drug (N=18) were tested on a standard and modified form of the Stroop Colour-Word test to look for impairments in inhibition and in task-switching, respectively. A Keep Track Task was used to assess working memory updating ability. Ecstasy users, but neither of the other groups were significantly impaired (slower reaction times) on the task-switching version of the Stroop test (p <.05), but not on the standard version or on the Keep Track Task. Regression analysis showed a significant correlation between level of lifetime ecstasy use and magnitude of the switching-impairment. The findings are interpreted in line with recent theoretical views which regard executive function as composed of multiple independent cognitive components such as inhibition, switching and memory updating, only some of which may be affected by drug use or other factors. Copyright 2006, Elsevier Science Dafters RI. Impulsivity, inhibition and negative priming in ecstasy users. Addictive Behaviors 31(8): 1436-1441, 2006. (12 refs.) A modified Stroop color-word interference paradigm was used to investigate the effects of recreational ecstasy (MDMA) use on central executive inhibitory processes. Ecstasy users who also used cannabis were compared with non-users matched for cannabis consumption and with non-drug users on a Stroop task in which standard color-word interference trials were interspersed with trials in which the target color was the same as the distractor word on the immediately preceding trial. Ecstasy's effects on standard inhibition (conscious suppression of a prepotent response pattern-responsible for Stroop interference) could thus be contrasted with its effect on the short-term, unconscious, inhibitory process responsible for suppression of the preceding distractor word (negative priming). Neither drug group differed from the non-drug users in level of Stroop interference but ecstasy users showed reduced negative priming compared to the cannabis users and non-drug users. The loss of inhibition in the ecstasy users was not related to impulsivity assessed by two standard scales since these were similar in both drug-user groups and raised relative to the non-drug users. It is argued that previous failures to demonstrate loss of inhibition could be partly due to the fact that standard executive function tests, such as the Stroop, are unable to differentiate between sub-types of inhibition, only some of which may be affected by ecstasy use. Copyright 2006, Elsevier Science de Win MML; Jager G; Vervaeke HKE; Schilt T; Reneman L; Booij J et al. The Netherlands XTC Toxicity (NeXT) Study: Objectives and methods of a study investigating causality, course, and clinical relevance. (review). International Journal of Methods in Psychiatric Research 14(4): 167-185, 2005. (107 refs.) This paper describes the objectives and methods of The Netherlands XTC Toxicity (NeXT) study focussing on the causality, course, and clinical relevance of ecstasy neurotoxicity. Previous studies suggest that ecstasy (3,4 methylenedioxymethamphetamine, MDMA, XTC) is toxic toward brain serotonin axons, but most of these studies have serious methodological limitations. The current study is a combination of different approaches with three substudies: (1) a cross-sectional substudy among heavy ecstasy users and controls with variation in drug use, which will provide information about potential neurotoxic consequences of ecstasy in relation to other drugs; (2) a prospective cohort substudy in ecstasy-naive subjects with high risk for future ecstasy use, which will provide information on the causality and short-term course of ecstasy use and potential neurotoxicity, and (3) a retrospective cohort substudy in lifetime ecstasy users and matched controls of an existing epidemiological sample that will provide information on long-term course and outcome of ecstasy use in the general population. Neurotoxicity is studied using (a) different imaging techniques (beta-CIT SPECT, H-1-MR spectroscopy, diffusion tensor imaging, Perfusion weighted imaging and functional magnetic resonance imaging), and (b) neuropsychological and psychiatric assessments of memory, depression, and personality. The combined results will lead to conclusions that can be used in prevention messages, clinical decision making, and the development of an (inter)national ecstasy policy. Copyright 2005, Whurr Publishers Ltd Degenhardt L. Drug use and risk behaviour among regular ecstasy users: Does sexuality make a difference? Culture, Health & Sexuality 7(6): 599-614, 2005. (75 refs.) This study aimed to compare homo/bisexual men and women with their heterosexual counterparts who were regular ecstasy users, to consider whether patterns of drug use or risk differed across these groups. Respondents (n = 852 ecstasy users) were recruited via advertisements in entertainment street press, gay and lesbian newspapers, music and clothing stores and at university campuses. Inter-viewer contacts and 'snowball' sampling were also utilized. In total, 23% of females in the sample self-identified as lesbian or bisexual and 13% of males interviewed self-identified as homo/bisexual. Rates of use of 'newer' drugs on the dance scene-crystal methamphetamine and ketamine were higher among homo/bisexual men and women. Self-reported risk behaviours such as unprotected sex and needle sharing (among those who had injected drugs) did not differ according to sexuality. However, homo/bisexual men and women were significantly more likely than heterosexual men and women to report a greater number of sexual partners and higher rates of injecting drug use. These findings suggest that among a group of people who were selected because they were regularly involved in the party drug market, initiatives designed to reduce harms related to injecting and sex risk may be needed for a greater proportion of homo/bisexual males and females who are involved in the dance/ nightclub scene. Copyright 2005, Routledge Degenhardt L; Agaliotis M; White B; Stafford J. New South Walses Trends in Ecstasy and Related Drug Markets 2004: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 221. Sydney: National Drug and Alcohol Research Centre, 2005. (48 refs.) This report deals with ecstasy and the related drug markets in New South Wales. Following an executive summary there is a brief description of the characteristics of regular ecstasy users. Following are individual sections dealing with ecstasy, methamphetamine, cocaine, ketamine, gamma-hydroxybutyrate, LSD, with data on demographic characteristics of users, drug use history and current use patterns, as well as price, purity, perceived availability, and the perceived risks and benefits of use. Other drug use is also summarized -- alcohol, marijuana, nicotine, benzodiazepines, inhalants and other opioids. Sections are also devoted to associated risk activities including injecting risk behavior, sexual activity, tattooing and piercing, and driving risk behavior; and also health risks, with reports of overdose, symptoms of dependence, and help-seeking behavior. Criminal encounters are also described. Copyright 2005, National Drug and Alcohol Research Centre (Australia) Degenhardt L; Copeland J; Dillon P. Recent trends in the use of "club drugs": An Australian review. (review). Substance Use & Misuse 40(9-10): 1241-1256, 2005. (107 refs.) The use of "club drugs" such as MDMA, ketamine, and GHB appears to have increased in Western countries over the last 20 years, and Australia is no exception to that trend. While levels of use appear to be relatively low in the general population, among users of these drugs a number of adverse health and psychological problems, including dependence, have been reported. MDMA or ecstasy is the third most commonly used illicit drug in Australia, and relatively more information is available on its use in Australia than of drugs such as GHB or ketamine. Although there are no population level data available, levels of ketamine use in the general population appear to be lower than those of MDMA. In addition, the harms reported by recreational users are not excessive and the mortality rate is low. At the individual level, many of those who experiment find the effects aversive and do not persist. The harms that require-further investigation are the association between ketamine and unsafe sex and injecting behaviors, the neurotoxic effects, and use in situations where there is a heightened risk of accidental death when the user's cognition is grossly impaired. In contrast, while least is known of the epidemiology of GHB use, there is mounting evidence suggesting significant acute and long-term risks associated with the use of this drug. This suggests an urgent need for international research on the patterns of use, health, and psychosocial consequences of GHB use. In order to address public health issues associated with a range of club drug use, there is a need for research to identify the trends in population prevalence of these drugs. This could be most easily achieved by the inclusion of MDMA, ketamine, and GHB in household surveys that are currently collected routinely in a number of countries. Copyright 2005, Marcel Dekker, Inc Degenhardt L; Stafford J; Kinner S; Johnson J; Fry C; Bruno R et al. Reflections on a Two-year National Pilot study of the Party Drugs Initiative (PDI). NDARC Technical Report No. 236. Sydney: National Drug and Alcohol Research Centre, 2005. (0 refs.) The PDI is a national monitoring system for ecstasy and related drugs that is intended to serve as a strategic early warning system, identifying emerging trends of local and national interest in ecstasy and related drug (ERD) markets. The PDI was conducted across Australia for the first time in 2003; monitoring of these markets has been undertaken since 2000 in NSW, SA and Qld. The PDI is based on the IDRS methodology and consists of three components: 1. interviews with regular ecstasy users (REUs), considered a sentinel group of drug users who could comment on these drug markets; 2. interviews with key experts (KEs), professionals who have regular contact with REUs through their work; and 3. indicator data sources related to ERDs. The PDI monitors the price, purity, availability and patterns of use of ecstasy, methamphetamine, cocaine, ketamine, GHB and other related drugs. It also monitors harms related to these drug types. It is designed to be sensitive to trends, providing data in a timely manner, rather than describing issues in extensive detail. The results of the two-year national pilot PDI indicate that regular ecstasy users tend to be young, relatively well-educated, and likely to be employed or engaged in studies. Small proportions of participants in all years were currently in drug treatment or had previously been incarcerated. This is in strong contrast to the demographic profile of the regular injecting drug users (IDUs) accessed for the IDRS, who are typically older, unemployed, and with both drug treatment and incarceration histories. Details about the harms, patterns of use and the price, purity and availability of ecstasy and related drugs can be obtained from the national and jurisdictional reports in 2003. Copyright 2005, National Drug and Alcohol Research Centre (Australia) Diamond S; Bermudez R; Schensul J. What's the rap about ecstasy? Popular music lyrics and drug trends among American youth. Journal of Adolescent Research 21(3): 269-298, 2006. (77 refs.) Trends in ecstasy use in America during the past decade were reflected in mainstream, American rap-music lyrics between 1996 and 2003. Drawing on communication and cultural studies theory, this article provides a content analysis of 69 rap songs mentioning the club drug ecstasy. The songs are coded according to whether they contain positive mixed or ambiguous, or negative messages about using or dealing ecstasy. Through an interpretive lens, the authors identify specific themes, messages, and behaviors pertaining to ecstasy use in the music lyrics and explore how these lyrics relate to shifting drug trends and to issues of race, class. and gender in American society. Copyright 2006, Sage Publications Dziegielewski SF. Understanding Substance Addictions: Assessment and Intervention. Chicago: Lyceum Books, 2005. (Chapter refs.) This book, directed to social workers and human service professionals, is organized into three sections. Section I provides an overview for dealing with addictions and addresses assessment, treatment planning, and documentation. Section 2 is organized around different substances, with individual chapters directed to stimulants, amphetamines, cocaine, caffeine, alcohol, nicotine, opiates and prescription drugs (sedatives, hypnotics, and analgesics), ecstasy, and inhalants. Section 3 considers the presence of co-occurring psychiatric disorders and also polydrug use. There is also discussion on the use of multiaxial diagnostic schema. Each chapter includes a case example as a vehicle for examining treatment planning and best practices. Copyright 2006, Project Cork Dziegielewski SF; Bersch TA. LSD, ecstasy, and PCP. IN: Dziegielewski SF, ed. Understanding Substance Addictions: Assessment and Interventions. Chicago: Lyceum Books, 2005. pp. 208-224. (36 refs.) This chapter discusses the most common psychedelic substances -- LSD, ecstasy, and PCP, all of which are classified as Schedule I by the Food and Drug Administration, meaning they have no medical uses. For each drug there is discussion of the prevalence, associated problems, and best practices in respect to interventions. Copyright 2006, Project Cork Eiserman JM; Diamond S; Schensul JJ. "Rollin' on E": A qualitative analysis of ecstasy use among inner city adolescents and young adults. Journal of Ethnicity in Substance Abuse 4(2): 9-38, 2005. (42 refs.) Ecstasy use has spread beyond the rave and club scenes into other arenas of party culture, and from middle-class America to working-class and low-income neighborhoods of large cities. In order to explore ecstasy use among inner city adolescents and young adults, we conducted in-depth interviews with 23 poly-drug users who had used ecstasy, in Hartford, CT. Most users reported positive experiences while on the drug. Negative experiences were most often related to poly-drug mixing. However, heavy users (40+ times ever used) experienced negative aftereffects, which led them to decide to decrease or halt their use. Some participants discussed using ecstasy during sex, and irregular use of condoms. These findings point to the need for more in-depth research on MDMA use within inner city settings, with a particular focus on ethnic and cultural context, self-controlled drug use, poly-drug mixing, and sex risk behaviors. Copyright 2005, Haworth Press Falck RS; Wang J; Carlson RG; Siegal HA. Prevalence and correlates of current depressive symptomatology among a community sample of MDMA users in Ohio. Addictive Behaviors 31(1): 90-101, 2006. (52 refs.) Research suggests that MDMA can cause serotonin depletion as well as serotonergic neurodegradation that may result in depression among users of the drug. Several small-scale studies have used various editions of the Beck Depression Inventory (BDI) to quantify depressive symptomatology among MDMA users. This study represents the largest application of the BDI to date to explore symptoms of current depression among a community sample of young adult MDMA users (n = 402). Internal consistency testing of the BDI-II with this sample revealed Cronbach's A = .92. Results show a mean BDI-II score of 9.8, suggesting low levels of depressive symptomatology among study participants. Two-thirds of the sample had scores that placed them in the non-depressed/minimal depression category, while 4.7% had scores indicative of severe depression. Logistic regression analysis revealed that men were significantly less likely than women and people who used opioids were significantly more likely than non-users to have higher levels of depressive symptomatology. Higher lifetime occasions of MDMA use were marginally related to symptoms of serious depression. Copyright 2006, Elsevier Science Ltd. Fendrich M; Johnson T. Editors' introduction to this special issue on club drug epidemiology. (editorial). Substance Use & Misuse 40(9-10): 1179-1184, 2005. (6 refs.) Fernandez MI; Bowen GS; Varga LM; Collazo JB; Hernandez N; Perrino T et al. High rates of club drug use and risky sexual practices among Hispanic men who have sex with men in Miami, Florida. Substance Use & Misuse 40(9-10): 1347-1362, 2005. (36 refs.) This study measured use of club drugs among 262 Hispanic men who have sex with men (MSM) recruited at community venues in Miami-Dade County, Florida in 2001. More than 50% of men used club drugs, and 36% used them in the last 3 months. Lifetime and 3-month rates were: ecstasy (36% and 20%), cocaine (34% and 12%), amyl nitrates (28% and 9%), and crystal methamphetamine (20% and 15%). Thirty-six percent had used two or more drugs (polydrug use) in their lifetime and 20% reported polydrug use in the last 3 months. Club drug users had significantly more sex partners in the last 12 months than nonclub drug users. High rates (35%) of unprotected anal sex in the last 3 months were reported by both groups. Men who reported polydrug use in the last 3 months were significantly more likely than men who used a single club drug to have had sex under the influence of club drugs (83% vs. 57%; X-2 = 7.4, p = 0.006). At the multivariate level, a significant association between preference for use of English and lifetime club drug use emerged. Effective interventions to reduce club drug use and risky sex for Hispanic MSM are needed. Copyright 2005, Marcel Dekker, Inc Fingeret MC; Moeller FG; Stotts A. Gender differences among MDMA users on psychological and drug history variables. Addictive Disorders & Their Treatment 4(2): 43-48, 2005. (15 refs.) Objectives: This study examined gender differences among MDMA users and non-drug abusing controls on psychological and drug history variables. Methods: Participants were administered self-report and interview-administered measures of depression, anxiety, and impulsivity, as well as questionnaires to assess drug history. Results: Regardless of frequency and severity of use, MDMA users scored significantly higher on measures of depression, anxiety, and impulsivity compared with controls. However, there were no gender effects for these psychological variables. Within the MDMA sample, high rates of lifetime history with additional drugs were found. Men were more likely to be heavier and more frequent users of MDMA. Significant gender differences were also found for the lifetime history with PCP and inhalants among MDMA users. Conclusions: Given the limited amount of research published in this area, these findings promote a greater understanding of associated features and differential patterns of MDMA use. Copyright 2005, Lippincott, Williams & Wilkins Firth AY. Class A drug abuse: An ophthalmologist's problem? Eye 19(6): 609-610, 2005. (31 refs.) This editorial summarizes the eye problems associated with drug misuse. The ocular sequelae from illicit drug use are varied, affecting visual acuity, perception, ocular posture or motility, the globe itself or its adnexa. Cocaine has the highest number of ocular problems The hypathomimetic effects leads to acute angular closure glaucoma and vasoactive properties lead to spasms of vessels or haemorrhages. Use may also lead to cerebral vasculitis. Esotropia has been found with heroin withdrawal. Other conditions that can occur with heroin results from agents used to cut the heroin, such as quinine, or endophthalmitis from the fungus transmitted from lemon juice used to prepare the heroin for injection, contamination via air-borne fungus. Problems related to hallucinogens, while less common nonetheless have been reported. These include visual perception disorder, palinopsia, and flashbacks.[Note: Class A drugs are essentially comparable to drugs which are illicit in the US.] Copyright 2005, Project Cork Fischer J; Kinner S. Queensland Trends in Ecstasy and Related Drug Markets 2004: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 223. Sydney: National Drug and Alcohol Research Centre, 2005. (8 refs.) This report deals with ecstasy and the related drug markets in Queensland. Following an executive summary there is a brief description of the characteristics of regular ecstasy users. Following are individual sections dealing with ecstasy, methamphetamine, cocaine, ketamine, gamma-hydroxybutyrate, LSD, with data on demographic characteristics of users, drug use history and current use patterns, as well as price, purity, perceived availability, and the perceived risks and benefits of use. Other drug use is also summarized -- alcohol, marijuana, nicotine, benzodiazepines, inhalants and other opioids. Sections are also devoted to associated risk activities including injecting risk behavior, sexual activity, tattooing and piercing, and driving risk behavior; and also health risks, with reports of overdose, symptoms of dependence, and help-seeking behavior. Criminal encounters are also described. Copyright 2005, National Drug and Alcohol Research Centre (Australia) Fisk JE; Montgomery C; Wareing M; Murphy PN. Reasoning deficits in ecstasy (MDMA) polydrug users. Psychopharmacology 181(3): 550-559, 2005. (43 refs.) Rationale/objectives: Previous research has shown that ecstasy users are impaired in thinking and reasoning. The present study sought to explore the possibility that syllogistic reasoning errors in ecstasy users were due to an inability to construct a model of the premises due to working memory limitations. Methods: Twenty-nine ecstasy users and 25 nonecstasy user controls completed abstract syllogistic reasoning problems varying in difficulty. Pairs of premises were provided, and participants were required to generate conclusions that followed necessarily from them. Results: On the easier problems, both groups performed at well above chance although nonusers achieved significantly more correct responses. Consistent with existing research, on the more difficult problems, errors by nonusers were characterised by incorrect conclusions suggesting that while nonusers have the working memory capacity to construct a single model of the premises, this is not an exhaustive representation and usually results in an erroneous conclusion. On the other hand, for all problem types, ecstasy users, rather than produce incorrect responses, were more likely to fail to generate a conclusion. Conclusions: The present results are consistent with the possibility that ecstasy users with their reduced working memory capacity may experience difficulty in constructing even a single model of the premises. While this might be attributable to the effects of 3,4-methlylenedioxymethamphetamine neurotoxicity, many of the ecstasy users in the present study were polydrug users. Thus, the possibility that other drugs including cannabis and cocaine might contribute to the present results cannot be excluded. Copyright 2005, Springer Frances RJ; Miller SI; Mack AH, eds. Clinical Textbook of Addictive Disorders, 3rd edition. New York: Guilford Press, 2005. (Chapter refs.) This is the third edition of a major reference work in the field of addiction medicine, which was created by the founders of the American Academy of Addiction Psychiatry (AAAP) It is organized into five major sections, with a total of 28 chapters and 51 contributors. This volume provides historical background, diagnostic process and assessment, diagnostic tools, substance specific discussions of the major drug classes, covers the full range of treatment approaches and how these can be adapted to the needs and characteristics of special populations. It also discusses other "behavioral" addictions such as gambling disorders. Section I deals with the foundations of addiction medicine, the neurobiology of substance dependence and the historical and social context of psychoactive substance use disorders. Section II is directed to assessment, both psychological evaluation in adolescents and adults, and laboratory testing. Section III deals with major drug classes: alcohol, nicotine, opiates, marijuana, hallucinogens, and club drugs, cocaine and stimulants, and sedative/hypnotics and benzodiazepines. Section IV considers special populations and special issues: comorbidity, polysubstance abuse; women; the elderly; the workplace; HIV/AIDS; pain; pathological gambling and other "behavioral" disorders. The final section is directed to treatment: individual psychodynamic psychotherapy; cognitive therapy, group therapy; self-help; family-therapy; adolescent treatment; and treatment matching. Copyright 2005, Project Cork Freudenmann RW. "Ecstasy": The drug of the techno generation. Clinical aspects. (review). Nervenheilkunde 24(7): 557-+, 2005. (103 refs.) This paper provides an introduction to "Ecstasy", the most popular abused drug of the techno music generation. It focuses on information for clinical purposes. "Ecstasy" is the street name for the ring-substituted amphetamine derivate 3,4-methylene-dioxy-methamphetamine (MDMA). Today, the name "Ecstasy" is used as a group name for MDMA and its close chemical analogs MDA, MDEA and MBDB. Starting from their chemistry their molecular mechanism of action is described. Central nervous and somatic effects of "Ecstasy" including complications and therapeutic measures after intoxication are described. In addition, we illustrate the most important aspects of pharmacokinetic and interactions with other substances. We also explain typical patterns of substance use, new epidemiological trends and legal issues. Finally, possible long-term effects in humans resulting from severe "Ecstasy" use are discussed. Copyright 2005, Schattauer GMBH-Verlag Medizin Freudenmann RW; Oxler F; Bernschneider-Reif S. The origin of MDMA (ecstasy) revisited: The true story reconstructed from the original documents. Addiction 101(9): 1241-1245, 2006. (27 refs.) Background: Little is known about the origin of methylenedioxymethamphetamine (MDMA, ecstasy). The most commonly repeated statement in the medical literature is that MDMA was synthesized by the German pharmaceutical company Merck in 1912 in order to develop an appetite suppressor. Aim: To reconstruct the true story of the first known description of MDMA at Merck using the original documents. Methods: A systematic analysis of the original documents in Merck's historical archive in Darmstadt, Germany, was conducted (years 1900-60). Results: There were no indications for plans to develop an appetite suppressant at Merck between 1900 and 1960. Although MDMA was, in fact, first synthesized at Merck in 1912, it was not tested pharmacologically because it was only an unimportant precursor in a new synthesis for haemostatic substances. The new pathway was patented in order to evade an existing patent by a local competitor. MDMA was called 'Methylsafrylamin' in 1912. In 1927 and 1959, the pharmacological effects of MDMA were studied at Merck, but not in humans. Discussion: A systematic analysis of the original documents in the company's archive revealed that uncritical copy-paste procedures may have contributed to the famous myth that MDMA was patented as an appetite suppressor in 1912 Copyright 2006, Society for the Study of Addiction to Alcohol and Other Drugs Gamma A; Brandeis D; Brandeis R; Vollenweider FX. The P3 in 'ecstasy' polydrug users during response inhibition and execution. Journal of Psychopharmacology 19(5): 504-512, 2005. (52 refs.) Substance abuse and associated externalizing disorders are characterized by behavioural disinhibition and low impulse control, with reduced neural inhibition postulated to be the common underlying brain mechanism. The P3 component of event-related potentials (ERPs) is a widely used neurophysiological measure thought to reflect inhibitory brain processes, but as yet has not been assessed in ecstasy users. We recorded ERPs evoked by a Continuous Performance Test (CPT) in 16 current ecstasy polydrug users and 17 controls. The CPT included conditions where a prepared motor response had to be executed (Go) or inhibited (NoGo). Both controls and ecstasy users showed normal, robust patterns of P3 anteriorization and delay in the NoGo compared to the Go condition. Ecstasy users had tower P3 amplitudes at midline electrodes and a less anterior Location of NoGo P3 peaks. These effects became weaker after statistically controlling for age, educational level and lifetime cannabis use. White Lower P3 amplitudes are consistent with higher levels of neural disinhibition in ecstasy polydrug users, the normal switch pattern between response execution and inhibition, and the less anterior location of the NoGo P3, do not indicate disturbed inhibitory brain mechanisms. Copyright 2005, Sage Publications Ltd. Garcia-Algar O; Lopez N; Bonet M; Pellegrini M; Marchei E; Pichini S. 3,4-methylenedioxymethamphetamine (MDMA) intoxication in an infant chronically exposed to cocaine. Therapeutic Drug Monitoring 27(4): 409-411, 2005. (14 refs.) Accidental ingestion of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) was detected in an infant admitted at the Pediatric Emergency Department by drug testing in urine. Concentrations of MDMA and its principal metabolite 4-hydroxy-3-methoxymethamphetamine (HMMA) in the infant's hydrolyzed urine were 11.7 mg/L and 34.4 mg/L, respectively. Apparent febrile convulsions and cardiovascular side effects resolved within I day after treatment with benzodiazepmes. Chronic exposure to cocaine was evidenced by segmental hair analysis. Continuous maternal denial of the presence of any drug in the household made diagnosis of accidental ingestion of MDMA and chronic exposure to cocaine problematic. Periodic clinical and laboratory follow-ups were requested to check eventual long-term effects of exposure to illicit drugs and discontinuation of the child from exposure to dangerous environments. Copyright 2005, Lippencott-Raven Publishers Goldsamt LA; O'Brien J; Clatts MC; McGuire LS. The relationship between club drug use and other drug use: A survey of New York City middle school students. Substance Use & Misuse 40(9-10): 1539-1555, 2005. (36 refs.) In order to explore the relationship between use of club drugs (crystal methamphetamine, ecstasy, GHB, ketamine), and use of other drugs, survey data collected from 23,780 middle school students in New York City during 2002-2003 was examined. Results of HGLM analyses (a generalization of HLM to accommodate nonlinear outcomes), controlling for the effect of school, indicate that Black students are less likely than White students to use club drugs depending on the time frame of use. The use of alcohol and/or marijuana predict club drug use regardless of the timeframe of use, and lifetime cigarette use predicts lifetime club drug use. Recommendations for future research and prevention efforts are discussed. Copyright 2005, Marcel Dekker, Inc Goldstein LH; Mordish Y; Abu-Kishak I; Toledano M; Berkovitch M. Acute paralysis following recreational MDMA (Ecstasy) use. Clinical Toxicology 44(3): 339-341, 2006. (17 refs.) Methylenedioxymethamphetamine (MDMA), commonly known as Ecstasy, is a hallucinogenic compound structurally related to amphetamine. Ecstasy's severe neurological toxicity includes seizures, subarachnoidal hemorrhage, cerebral infarction, intracranial bleeding and cerebral venous thrombosis. We describe the first case of spinal cord damage presenting as acute quadriplegia and respiratory insufficiency in a healthy adolescent following Ecstasy recreational usage. Copyright 2006, Taylor & Francis Gouzoulis-Mayfrank E; Daumann J. Neurotoxicity of methylenedioxyamphetamines (MDMA; ecstasy) in humans: How strong is the evidence for persistent brain damage? (review). Addiction 101(3): 348-361, 2006. (158 refs.) The popular dance drug ecstasy (3,4-methylenedioxymethamphetamine: MDMA and some analogues) causes selective and persistent neurotoxic damage of central serotonergic neurones in laboratory animals. Serotonin plays a role in numerous functional systems in the central nervous system (CNS). Consequently, various abnormalities including psychiatric, vegetative, neuroendocrine and cognitive disorders could be expected in humans following MDMA-induced neurotoxic brain damage. In recent years, the question of ecstasy-induced neurotoxicity and possible functional sequelae has been addressed in several studies with drug users. The aim of this paper was to review this literature and weigh the strength of the evidence for persistent brain damage in ecstasy users. We used Medline to view all available publications on 'ecstasy' or 'MDMA'. All available studies dealing with ecstasy users entered this analysis. Despite large methodological problems the bulk of evidence suggests residual alterations of serotonergic transmission in MDMA users, although at least partial restitution may occur after long-term abstinence. However, functional sequelae may persist even after longer periods of abstinence. To date, the most consistent findings associate subtle cognitive, particularly memory, impairments with heavy ecstasy use. However, the evidence cannot be considered definite and the issues of possible pre-existing traits or the effects of polydrug use are not resolved. Questions about the neurotoxic effects of ecstasy on the brain remain highly topical in light of its popularity among young people. More longitudinal and prospective studies are clearly needed in order to obtain a better understanding of the possible long-term sequelae of ecstasy use in humans. Copyright 2006, Society for the Study of Addiction to Alcohol and Other Drugs Greydanus DE; Patel DR. The adolescent and substance abuse: Current concepts. Disease-a-Month 51(7): 392-431, 2005. (93 refs.) This review addresses alcohol and other drug use among adolescents. The article addresses its etiology, adolescent development and how this is affected by and influences substance use. It also addresses factors which may be risk factors including the presence of psychiatric illness, environmental stresses and the widespread availability and access to drugs. The symptoms and stages of drug use and abuse are described. Specific attention is directed to alcohol, marijuana, nicotine, cocaine, opiates, amphetamines, methamphetamines, ecstasy, ketamine, the inhalants, gamma-hydroxybutyrate, barbiturates, PCP, as well as agents used to enhance athletic performance, including the anabolic steroids. There is also discussion of management and approaches to treatment. There are twenty-nine accompanying tables. Copyright 2005, Mosby Inc. Guillot C. A clinical crossroads for MDMA. Journal of Psychoactive Drugs 37(4): 445-447, 2005. (19 refs.) Clinical studies of MDMA have been hindered by the fear of harming participants through MDMA-induced neurotoxicity. However, experimental animal studies and brain imaging studies of recreational Ecstasy users have not evidenced that a therapeutic dose of MDMA would be sufficient to cause long-term serotonergic deficits. Furthermore, the issue of potential neurotoxicity may not be as important as it first seems since certain chemicals have been shown to protect against MDMA-induced neurotoxicity. Although clinical studies conducted thus far have been promising, more research into the effects of MDMA administration in humans is needed before solid conclusions can be made in respect to the possibility of safely using MDMA as an adjunct to therapy. Finally, a clear distinction should be maintained between the recreational and clinical use of MDMA. Copyright 2005, Haight-Ashbury Publications Hall AP; Henry JA. Acute toxic effects of 'Ecstasy' (MDMA) and related compounds: overview of pathophysiology and clinical management. (review). British Journal of Anaesthesia 96(6): 678-685, 2006. (75 refs.) Since the late 1980s 'Ecstasy' (3,4-methylenedioxymethamphetamine, MDMA) has become established as a popular recreational drug in western Europe. The UK National Criminal Intelligence Service estimates that 0.5-2 million tablets are consumed weekly in Britain. It has been reported that 4.5% of young adults (15-34 yr) in the UK have used MDMA in the previous 12 months. Clinically important toxic effects have been reported, including fatalities. While the phenomenon of hyperpyrexia and multi-organ failure is now relatively well known, other serious effects have become apparent more recently. Patients with acute MDMA toxicity may present to doctors working in Anaesthesia, Intensive Care and Emergency Medicine. A broad knowledge of these pathologies and their treatment is necessary for anyone working in an acute medical speciality. An overview of MDMA pharmacology and acute toxicity will be given followed by a plan for clinical management. Copyright 2006, Oxford University Press Han E; Yang W; Lee J; Park Y; Kim E; Lim M et al. The prevalence of MDMA/MDA in both hair and urine in drug users. Forensic Science International 152(1): 73-77, 2005. (20 refs.) The prevalence and age distribution of 3,4-methylenedioxymethamphetamine (MDMA) and 3,4-methylenedioxyamphetamine (MDA) in hair samples by gas chromatography/mass spectrometry (GC/MS) were studied. The recoveries obtained from hair were 97% and 99% for MDMA and MDA, respectively. The inter- and intra-assay precision and accuracy were determined. Out of 791 hair samples, 44 (5.6%) contained MDMA and/or MDA. Out of these 44 subjects, urinalyses from 35 were negative for both MDMA and MDA, while only 9 were positive. We also evaluated concentrations of MDMA and MDA, and the metabolite-to-parent drug ratios. This study showed that the abuse of MDMA or MDA was found principally among young adults and male abusers. We found the epidemiology of ecstasy users in Korea between March 2002 and April 2003. Copyright 2005, Elsevier Scientific Publishers Ireland, Ltd. Hendrickson JC; Gerstein DR. Criminal involvement among young male ecstasy users. Substance Use & Misuse 40(9-10): 1557-1575, 2005. (44 refs.) Ecstasy (MDMA) use increased rapidly in the U.S. between about 1995 and 2001. Most research on the drug focused on its psychopharmacological and public health contexts. Previous research on drugs-crime linkages suggests that there may have been a concomitant rise in ecstasy-related crimes. We explore this dimension here using data from 7794 arrested men, age 16 to 25, in the 2001 Arrestee Drug Abuse Monitoring (ADAM) sample and 9764 male respondents of similar age in the 2001 National Household Survey on Drug Abuse (NHSDA). Our results using a variety of bivariate and regression methods indicate that ecstasy use is less prevalent among young male arrestees than young men in general and that ecstasy use among arrestees is positively associated with various measures of drug market participation but negatively related to violent and property offenses. We recommend further investigation of ecstasy use in drug-oriented data sets and longitudinal studies to evaluate the link between ecstasy use and overall drug marketing. Copyright 2005, Marcel Dekker, Inc Hopfer C; Mendelson B; Van Leeuwen JM; Kelly S; Hooks S. Club drug use among youths in treatment for substance abuse. American Journal on Addictions 15(1): 94-99, 2006. (16 refs.) We describe lifetime rates of club drug use among 782 youths in treatment for substance abuse. Rates (%) for youths under eighteen (N=486) were methylenedioxymethamphetamine ( MDMA), 32.3; gamma-hydroxybutyrate (GHB), 7.0; lysergic acid diethylamide ( LSD), 48.6; ketamine, 18.3; and methamphetamine, 30.2. For youths 18-32 (N=289) rates (%) were MDMA, 37.0; GHB, 13.1; LSD, 42.9; ketamine, 17.0; and methamphetamine, 31.5. Older youths reported significantly more use of GHB than younger youths (p <.01). Youths reported using club drugs frequently outside of rave settings. Club drug use is common among youths in treatment for substance abuse and has spread beyond the rave culture. Copyright 2006, American Academy of Psychiatrists in Alcoholism and Addictions Hsu YJ; Chiu JS; Lu KC; Chau T; Lin SH. Biochemical and etiological characteristics of acute hyponatremia in the emergency department. Journal of Emergency Medicine 29(4): 369-374, 2005. (29 refs.) Hyponatremia can be classified as acute or chronic depending on its duration, and treatment options are tailored to this classification. However, it is sometimes difficult to differentiate acute from chronic hyponatremia in the Emergency Department (ED). The objective of this study was to identify characteristics to help diagnose and manage acute hyponatremia in the ED. Patients with acute hyponatremia in the ED were enrolled from a retrospective 2-year chart review. Eleven patients (0.8%) were identified with acute hyponatremia out of a total of 1321 hyponatremic patients. There were nine women and two men. The mean age was 48.9 years. The mean sodium (Na+) level was 115 +/- 4 mmol/L. Accompanying biochemical abnormalities included hypouricemia and hypouremia with increased fractional excretions of uric acid (UA) and urea. The estimated amount of water intake ranged from 2.5 to 10 liters (mean, 5.1 +/- 2.3 liters) during the day before ED presentation. All patients were treated with hypertonic saline and furosemide at a correction rate of 1.6 +/- 0.5 mmol/L/h. No patients had neurological sequelae after treatment. The causes of acute hyponatremia included induction of abortion with oxytocin (n = 1), primary polydipsia on neuroleptic agents (n = 2), polyethylene glycol (PEG) preparation for colonoscopy (n = 1), diuretic therapy for hypertension (n = 4), ecstasy use (n = 1), and weight-reducing herbal teas (n = 2). We conclude that in the right clinical setting, high free water intake and low serum urea and UA favor acute hyponatremia. A detailed drug history may be helpful in the differential diagnosis of acute hyponatremia. Copyright 2005, Elsevier Science Ltd. Huizink AC; Ferdinand RF; van der Ende J; Verhulst FC. Symptoms of anxiety and depression in childhood and use of MDMA: Prospective, population based study. British Medical Journal 332(7545): 825-827, 2006. (36 refs.) Objective: To investigate whether using ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is preceded by symptoms of behavioural and emotional problems in childhood and early adolescence. Design Prospective, longitudinal, population based study. Setting: The Dutch province of Zuid-Holland. Participants A sample of 1580 individuals, followed up across a 14 year period, From childhood into adulthood. Main outcome measures: The first assessment took place in 1983 before MDMA appeared as a recreational drug in the Netherlands and included the child behaviour checklist to obtain standardised parent's reports of their children's behavioural and emotional problems. Use of the drug was assessed with the composite international diagnostic interview 14 years later. Results Eight syndrome scales of childhood behaviour were examined. Scores in the deviant range for the scales designated as anxious or depressed in in childhood were significantly related to use of MDMA in adolescents and adults, resulting in an increased risk (hazard ratio 2.22, 95% confidence interval 1.20 to 4.11, P=0.01). Conclusions: Individuals with childhood symptoms of anxiety and depression may have all increased tendency to use MDMA in adolescence or young adulthood. Its effects are supposed to include enhanced feelings of bonding with other people, euphoria, or relaxation. Especially individuals With Symptoms of anxiety or depression may be susceptible to these positive effects. Copyright 2006, BMJ Publishing Group Hunt G; Evans K; Wu E; Reyes A. Asian American youth, the dance scene, and club drugs. Journal of Drug Issues 35(4): 695-731, 2005. (51 refs.) The available research data on young Asian American drug use is relatively limited compared to the availability of research on other major ethnic groups. Today more published data have highlighted the extent to which drug use is significant and rising in Asian American communities. From our ongoing research on the social context of ecstasy and other club drug use in the San Francisco Bay Area, we analyze data from a total of 56 face-to-face interviews with young Asian American club and rave attendees. We explore the development of a distinctive Asian American experience, in order to understand the attraction of club drugs and the dance scene. We examine the specific social groupings in which they operate, the types of social events they attend, and the nature of their club drug use. We highlight some of the ways in which they construct and express their identities around these social groupings, in terms of ethnic and socio-cultural distinctions as well as other cultural commodities. Copyright 2005, Journal of Drug Issues, Inc. Johanson CE; Kilbey M; Gatchalian K; Tancer M. Discriminative stimulus effects of 3,4-methylenedioxymethamphetamine (MDMA) in humans trained to discriminate among d-amphetamine, meta-chlorophenylpiperazine and placebo. Drug and Alcohol Dependence 81(1): 27-36, 2006. (28 refs.) In animals, two-choice drug discrimination studies have demonstrated that the behavioral effects of 3,4-methylenedioxymethamphetamine (MDMA) are mediated by dopaminergic and serotonergic systems. In order to delineate the relative role of these systems, three-choice paradigms have been used in animals, with findings indicating a more prominent role for serotonin. Human studies assessing the subjective and physiological effects of MDMA have also indicated a mixed action. To parallel animal studies, the participants in the present study were trained to discriminate among a prototypic dopaminergic agonist, d-amphetamine, a prototypic serotonergic agonist, meta-chlorophenylpiperazine (mCPP) and placebo and then were tested with two doses of MDMA. In addition, subjective and physiological effects were measured. The results demonstrated that humans could be trained to discriminate among 20 mg d-amphetamine, 0.75 mg/kg mCPP and placebo. When tested with 1.0 and 1.5 mg/kg, half the participants reported MDMA to be like amphetamine and half like mCPP. There were no clear differences between these two groups in other dimensions, although there was an indication that the individuals who discriminated MDMA as d-amphetamine were more sensitive to the effects of all the drugs. The subjective effects of all three drugs overlapped, although the effects of MDMA appeared more amphetamine-like. Copyright 2006, Elsevier Science Ltd. Kalantar-Zadeh K; Nguyen MK; Chang R; Kurtz I. Fatal hyponatremia in a young woman after ecstasy ingestion. Nature Clinical Practice Nephrology 2(5): 283-288, 2006. (18 refs.) Background: A 20-year old, otherwise healthy, female college student presented in an unresponsive state with respiratory distress after ingesting ecstasy (3,4-methylenedioxymethamphetamine). She had initial plasma sodium concentration of 117 mmol/l. Investigations: Physical examination, blood chemistry panel, urinary osmolality and electrolytes, arterial blood gas, chest X-ray, and CT scan of the brain. Diagnosis: Hyponatremia associated with noncardiogenic pulmonary edema and cerebral edema. Management: Administration of a total of 6.81 of isotonic saline and 0.245l of 3% hypertonic saline with sporadic administration of intravenous furosemide. The patient died approximately 12 h after admission. Copyright 2006, Nature Publishing Group Kelly BC. Conceptions of risk in the lives of club drug-using youth. Substance Use & Misuse 40(9-10): 1443-1459, 2005. (33 refs.) This paper describes current patterns of club drug use and local conceptions of risk among New York City area youth. The data is drawn from a NIDA-funded ethnographic study of club drug initiation among "Bridge and Tunnel" youth. The paper entails an examination of the harmony and discontinuity between folk models of risk within this population and professional models of risk. The author explores how club drug-using youth conceive of risks related to club drug use, specifically ecstasy, and how such conceptions compare and contrast with current professional models of risk. These conceptions of risk are crucial to understand, as they form an it formal logic by which club drug practices are guided. Ultimately, the author examines how the relationship between folk models and professional models might inform health promotion efforts targeting youth. Copyright 2005, Marcel Dekker, Inc Kenyon SL; Ramsey JD; Lee T; Johnston A; Holt DW. Analysis for identification in amnesty bin samples from dance venues. Therapeutic Drug Monitoring 27(6): 793-798, 2005. (13 refs.) The analysis of unknown substances discarded in amnesty bins, first described by Ramsey et al, from a large central London club and 7 smaller clubs in Manchester, UK are described. The contents of the bins were collected between July 2003 and March 2004. Solid dosage formulations were identified using the TICTAC database, chemical tests, and GC-MS screening. Drugs that could not be readily identified were subjected to other analytical techniques. The goal was to document the current range of drugs available on the dance scene and compare the findings between the London club, which had been the subject of a previous survey, and Manchester clubs. More than 1000 tablets, capsules, and powder doses were discarded in the amnesty bins. Tablets containing only MDMA (ecstasy) were found to be >94% and >84% of the total in London and Manchester, respectively. Although the quantities of tablets and powders recovered were different between London and Manchester, the proportions of the drugs were remarkably similar. The most common drugs found in powders in London and Manchester respectively were cocaine (29%, 40%), amphetamine (25%, 26%), ketamine (19%, 20%), and MDMA (19%, 11%). Copyright 2005, Lippincott, Williams & Wilkins Kouimtsidis C; Schifano F; Sharp T; Ford L; Robinson J; Magee C. Neurological and psychopathological sequelae associated with a lifetime intake of 40,000 ecstasy tablets. (letter). Psychosomatics 47(1): 86-87, 2006. (7 refs.) Copyright Kranzler HR; Ciraulo DA, eds. Clinical Manual of Addiction Psychopharmacology. Washington DC: American Psychiatric Press, 2005. (chapter refs.) This volume deals with the pharmacology of addictive drugs and the medications used to treat substance use disorders. This edited volume has 24 contributors and is organized into 9 chapters. These cover all of the major classes of that are clinically important in the substance use field. These include the following: alcohol, opioids, sedative-hypnotics, cannabis, cocaine and psychostimulants, hallucinogens and phencyclidine, club drugs (gamma-hydroxybutyrate, ecstasy, and ketamine), inhalants, and tobacco. For each of thee chapters there is consideration of three central aspects of a major drug group: an overview of the clinical pharmacology of the abused substance, phenomenology or pharmacological treatment with the abstinence syndrome, and pharmacological treatment for relapse prevention. In addition there is also discussion of the psychosocial treatment combined with drug therapies for alcohol, cocaine, and opiates use disorders. The goal is to illustrate how patient characteristics, such as substance use disorder typology, severity, family history, and comorbid psychopathology, may interact with psychosocial and pharmacological treatment. For disorders in which no clear pharmacotherapy has proven effective (e.g., cocaine dependence), or for disorders in which no clear abstinence syndrome has been established (e.g., marijuana dependence), authors review the basic pharmacology of the drug and the phenomenology of withdrawal to enable clinicians to evaluate new clinical research in medications development for those disorders. Copyright 2005, American Psychiatric Association Kranzler HR; Ciraulo DA. Alcohol. IN: Kranzler HR; Ciraulo DA, eds. Clinical Manual of Addiction Psychopharmacology. Washington DC: American Psychiatric Press, 2005. pp. 1-54. (212 refs.) This chapter dealing with cannabis is one of 8 chapters dealing with a major psychoactive drug class. While marijuana use can be seen as normative, it is the most commonly illicit drug used, for the majority of persons there is neither abuse nor dependence. The presence of abuse or dependence with marijuana were questioned until recently. Based on treatment episode data, in 2000, marijuana use was the primary drug problem, and a secondary problem for an additional 22% of those admitted to public facilities. There is discussion of the prevalence based on a number of studies, as well as discussion of withdrawal. The chapter concludes with a brief discussion of social and pharmacological treatment. Copyright 2005, American Psychiatric Association Kurtz SP; Inciardi JA; Surratt HL; CottlerL. Prescription drug abuse among ecstasy users in Miami. Journal of Addictive Diseases 24(4): 1-16, 2005. (57 refs.) This study examines the nature, extent and consequences of prescription drug abuse among 143 ecstasy users in Miami. Participants were recruited through nightclub and college campus outreach, and through respondent referrals. Instrumentation included the Risk Behavior Assessment, Substance Abuse Module and Center for Epidemiological Studies Depression Scale. Median age was 23, 42% were female and 50% Hispanic. An arrest history was reported by 44%, and 33% reported prior drug/alcohol treatment. Prescription drug abuse was reported by 87%; alprazolam (57%), oxycodone (36%), hydrocodone (32%) and diazepam (30%) were cited most often. Prescription drug abusers were more likely to report polydrug use, drug treatment histories, risky drug use behaviors, and symptoms of depression. They also reported numerous physical, psychological and social consequences of prescription drug abuse. Additional studies among larger samples are needed to understand the processes of prescription drug access and the extent of integration in club drug using cultures. Copyright 2005, American Society of Addiction Medicine Laidler KAJ. The rise of club drugs in a heroin society: The case of Hong Kong. Substance Use & Misuse 40(9-10): 1257-1278, 2005. (36 refs.) Although the contemporary dance drug scene is a global phenomenon, with many countries and cultures reporting similar developments with ecstasy and other club drug use, the scene, in many respects, is a reflection and expression of local culture. This article examines the rise of the dance drug scene in a society long associated with opiate use. After briefly describing Hong Kong's drug history, this article describes the diversification of its drug market to include ecstasy and ketamine in the context of a distinctive dance setting. The paper examines the trends in club drug use, particularly with the emergence of the dance scene, motivations to use, types of users, and the problems they experience with club drugs. The paper discusses the reasons for the rise and popularity of club drugs in the context of other locally available drugs, in particular heroin. This discussion draws from three studies that tracked drug use trends from 1995 to 2002 through a variety of data sources, including official statistics, field observations, individual interviews with 20 law enforcement officials, 16 focus groups with outreach and drug treatment workers, teachers, and representatives from different communities, and in-depth interviews with 27 club drug users. Copyright 2005, Marcel Dekker, Inc Leuthold LA; Mandscheff JF; Fathi M; Giroud C; Augsburger M; Varesio E et al. Direct ambient analysis of pharmaceutical and ecstasy tablets. Chimia 60(4): 190-194, 2006. (30 refs.) Desorption electrospray ionization (DESI) is a new ionization technique recently introduced in analytical chemistry for the ambient analysis of surfaces by mass spectrometry. We present here new developments in this field, focusing on their use for the analysis of solid forms, as pharmaceutical tablets or illicit drug tablets. Results recently published by ourselves are discussed in the context of related publications. Copyright 2006, Swiss Chemical Society Levy KB; O'Grady KE; Wish ED; Arria AM. An in-depth qualitative examination of the ecstasy experience: Results of a focus group with ecstasy-using college students. Substance Use & Misuse 40(9-10): 1427-1441, 2005. (22 refs.) This study examined ecstasy use in 30 college students who participated in one of four 60-minute focus groups with other participants who also had a history of ecstasy use. Ten topics emerged in the sessions: 1) pill ingredients, 2) mechanism of MDMA effects, 3) reasons for initiating ecstasy use, 4) risky behaviors and ecstasy use, 5) sexual activity and ecstasy, 6) positive effects from ecstasy use, 7) negative effects related to ecstasy use, 8) ecstasy and polysubstance use, 9) perceived risks of ecstasy use, and 10) motivational factors related to quitting ecstasy use. Most participants had a basic understanding of the contents of ecstasy pills, and the effects that ecstasy has on the brain and bodily functions. Participants reported positive effects on mood, social pressure, curiosity, availability, boredom, desire for an altered state of mind, desire to escape, self-medication, desire to have fun, and the ease of use of ecstasy in comparison to other drugs as reasons for initiating ecstasy use. They were divided regarding whether ecstasy increased the likelihood of engaging in risky behaviors, including risky sexual behavior. Participants described their experiences of both the positive and negative effects (physical and psychological) that they attributed to their use of ecstasy. All participants were polysubstance users, consuming a number of other substances simultaneously and concurrently with ecstasy. The majority was unaware of specific types of problems ecstasy could potentially cause and discounted its potential harm. Participants varied in their motivation./or quitting ecstasy use, including negative personal experiences while using ecstasy, health concerns, and addiction/tolerance. Implications for prevention and intervention are discussed. Copyright 2005, Marcel Dekker, Inc Libiseller K; Pavlic M; Grubwieser P; Rabl W. Ecstasy: Deadly risk even outside rave parties. Forensic Science International 153(2-3): 227-230, 2005. (28 refs.) Fatalities due to 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") are rare in Austria, although the use of designer drugs has become quite common. This is the first published case of a fatal MDMA intoxication in Austria. A 19-year-old girl died after the consumption of ecstasy tablets in the apartment of a friend. Blood analysis gave a concentration of MDMA as 3.8 mg/L and traces of its metabolite MDA. Cannabinoids were found as well. This case shows that the consumption of MDMA, without physical stress, can lead to death. Copyright 2005, Elsevier Ireland Ltd. Liechti ME; Kunz I; Kupferschmidt H. Acute medical problems due to Ecstasy use: Case-series of emergency department visits. Swiss Medical Weekly 135(43-44): 652-657, 2005. (18 refs.) Study aim: To describe the clinical characteristics of Ecstasy (3,4-Methylenedioxymethamphetamine, MDMA) toxicity. Methods: Retrospective case-study of 52 self-reported Ecstasy intoxications presenting to our Emergency Department (ED) between January 2001 and December 2003. Results: Most patients ingested Ecstasy together with other substances, including alcohol (51.9%) or other illicit drugs (71.1%). Medical problems leading to ED presentation were collapse or loss of consciousness (36.5%), palpitations (19.2%), dizziness or weakness (15.4%), and anxiety (13.5%). When other drugs were used in combination with Ecstasy the clinical presentation significantly changed. Panic reactions were observed in 4 of 13 patients with cocaine co-use (30.7%), compared to 3 of 39 patients without cocaine use (7.7%). Deep coma was found in 11 of 16 patients with co-use of gamma-hydroxybutyrate (GHB) or opiates (68.8%) but in none of the 36 patients who took Ecstasy without these drugs. Most patients were monitored in the ED. Six patients (11.5%) were transferred to an intensive care unit. Medical complications were severe in five patients and included cardiac arrest, hyperthermia, rhabdomyolysis, disseminated intravascular coagulation, renal insufficiency and liver failure, seizures, and one fatal outcome. Conclusions. The clinical picture of Ecstasy related problems is complicated by multiple drug ingestion. Co-use of cocaine induces panic reactions. Co-use of GHB or opiates results in depressed levels of consciousness. Copyright 2005, Swiss Medical Publishers Lundqvist T. Cognitive consequences of cannabis use: Comparison with abuse of stimulants and heroin with regard to attention, memory and executive functions. Pharmacology, Biochemistry and Behavior 81(2): 319-330, 2005. (91 refs.) This review aims to compare cognitive consequence between cannabis, and stimulants and heroin with regards to attention, memory and executive functions. The available studies using brain imaging techniques and neuropsychological tests show that acutely, all drugs create a disharmony in the neuropsychological network, causing a decrease of activity in areas responsible for short-term memory and attention, with the possible exception of heroin. Cannabis induces loss of internal control and cognitive impairment, especially of attention and memory, for the duration of intoxication. Heavy cannabis use is associated with reduced function of the attentional/executive system, as exhibited by decreased mental flexibility, increased perserveration, and reduced learning, to shift and/or sustain attention. Recent investigations on amphetamine/methamphetamine have documented deficits in learning, delayed recall, processing speed, and working memory. MDMA users exhibit difficulties in coding information into long-term memory, display impaired verbal learning, are more easily distracted, and are less efficient at focusing attention on complex tasks. The degree of executive impairment increases with the severity of use, and the impairments are relatively lasting over time. Chronic cocaine users display impaired attention, learning, memory, reaction time and cognitive flexibility. Heroin addiction may have a negative effect on impulse control, and selective processing. Copyright 2005, Elsevier Science Ltd. Lyvers M. Recreational ecstasy use and the neurotoxic potential of MDMA: cCrrent status of the controversy and methodological issues. (review). Drug and Alcohol Review 25(3): 269-276, 2006. (84 refs.) The controversy over possible MDMA-induced serotonergic neurotoxicity in human recreational ecstasy users is examined critically in light of recent research findings. Although the designs of such studies have improved considerably since the 1990s, the evidence to date remains equivocal for a number of reasons, including ( 1) inconsistent findings on the existence and reversibility of persistent ecstasy-related serotonergic and cognitive deficits; ( 2) lack of clear association between changes in brain imaging measures and functional deficits attributed to MDMA-induced neurotoxicity; ( 3) the contribution of concomitant cannabis or other drug use to both brain imaging abnormalities and cognitive deficits; ( 4) methodological shortcomings such as failure to adequately match samples of ecstasy users and controls; ( 5) the questionable relevance of animal models of MDMA-induced neurotoxicity to typical human patterns of ecstasy use; and ( 6) the potential role of inherent pre-drug deficits in serotonergic systems, impulse control and executive cognitive function that may predispose to excessive use of drugs including ecstasy. Given the retrospective nature of nearly all studies of ecstasy users to date, the controversy over whether MDMA has ever caused neurotoxicity or cognitive deficit in human ecstasy users is likely to continue for some time without resolution. Copyright 2006, Taylor & Francis Martins SS; Mazzotti G; Chilcoat HD. Trends in ecstasy use in the United States from 1995 to 2001: Comparison with marijuana users and association with other drug use. Experimental and Clinical Psychopharmacology 13(3): 244-252, 2005. (35 refs.) This study aims to estimate changes in the prevalence of ecstasy use over time, analyze the overlap of ecstasy use and other drug use, and compare other drug use in ecstasy versus marijuana users. The authors hypothesized that ecstasy users early in the "epidemic" would be polydrug users and that associations between ecstasy and other drug use would diminish as the prevalence of ecstasy use increased. Data were drawn from public use data files from the 1995, 1997, 1999, and 2001 National Household Survey on Drug Abuse. Ecstasy use increased in the U.S. population and the prevalence was greater in younger age groups. Ecstasy users were likely to use a variety of other drugs; however, association of ecstasy use with other drug use was strongest early in the "epidemic," diminishing as the number of new users increased. Later, more drug-naive adolescents and young adults began experimenting with ecstasy. These results can orient prevention strategies that target ecstasy users. Copyright 2005, American Psychological Asssociation Matthews A; Bruno R. Tasmanian Trends in Ecstasy and Related Drug Markets 2004: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 225. Sydney: National Drug and Alcohol Research Centre, 2005. (22 refs.) This report deals with ecstasy and the related drug markets in Tasmania. Following an executive summary there is a brief description of the characteristics of regular ecstasy users. Following are individual sections dealing with ecstasy, methamphetamine, cocaine, ketamine, gamma-hydroxybutyrate, LSD, with data on demographic characteristics of users, drug use history and current use patterns, as well as price, purity, perceived availability, and the perceived risks and benefits of use. Other drug use is also summarized -- alcohol, marijuana, nicotine, benzodiazepines, inhalants and other opioids. Sections are also devoted to associated risk activities including injecting risk behavior, sexual activity, tattooing and piercing, and driving risk behavior; and also health risks, with reports of overdose, symptoms of dependence, and help-seeking behavior. Criminal encounters are also described. Copyright 2005, National Drug and Alcohol Research Centre (Australia) Maxwell JC. Party drugs: Properties, prevalence, patterns, and problems. (review). Substance Use & Misuse 40(9-10): 1203-1240, 2005. (172 refs.) This review summarizes the latest literature on "party" or "club" drugs, defined as MDMA, GHB, ketamine, and Rohypnol, as published from 2002 to early 2005. Club drugs have been categorized as being used at raves and dance parties. The literature shows that each drug has different properties, users, and settings. Each drug has different adverse effects and requires different acute care protocols. Although these drugs were identified early, scientific information about them, including the toxicological tests to identify them, is still evolving. Increasing numbers of studies on the short- and long-term effects of these drugs on humans are being published, but because of limitations on research using human subjects, they may not always be as rigorous as desired and can be cited by drug users to discredit findings of harm. The lack of research-based information on these drugs has led to the emergence of web sites that may or may not provide accurate data. Evaluated chemical dependency treatment protocols using the latest research for each of these different drugs are needed. Copyright 2005, Marcel Dekker, Inc Maxwell JC; Spence RT. Profiles of club drug users in treatment. Substance Use & Misuse 40(9-10): 1409-1426, 2005. (31 refs.) There is little in the literature about treatment of pet-sons with problems with "club" or "party" drugs. This paper looks at the characteristics of individuals admitted to treatment for primary, secondary, or tertiary problems with club drugs such as ecstasy, gamma-hydroxybutyrate (GHB), ketamine, flunitrazepam (Rohypnol), methamphetamine, and hallucinogens (e.g., LSD) in programs funded by the Texas Commission on Alcohol and Drug Abuse. Some 38,350 unduplicated records front 1988 through 2003 of persons admitted with problems with club drugs were compared against users of alcohol or other drugs. Club drug users were more impaired on five of six Addiction Severity Index (ASI) indices at admission and they were more likely to use multiple substances more often. They were more likely than users of alcohol or other drugs to complete treatment, but this varied by drug. At follow-up 90 days after discharge, club drug users continued to report more ASI problems. Profiles of these clients show that ecstasy use has spread beyond the club culture, as indicated by the changes in client demographics over time. GHB clients presented a mixed picture of severe problems at admission and good response to treatment. Hallucinogen clients were young and less likely to complete treatment, while Rohypnol users were on the Texas-Mexico border The methamphetamine epidemic has resulted in increased admissions, and the proportion of "Ice" smokers has increased. However, methamphetamine clients were less likely to complete treatment and their higher level of problems at admission and follow-up are of concern. Of special note are the indications of co-occurring problems and the need for both mental health and substance dependence treatment for some clients. Copyright 2005, Marcel Dekker, Inc McCambridge J; Mitcheson L; Winstock A; Hunt N. Five-year trends in patterns of drug use among people who use stimulants in dance contexts in the United Kingdom. Addiction 100(8): 1140-1149, 2005. (35 refs.) Aims To describe and evaluate trends in the use of stimulant drugs over a 5-year period using an under-studied data collection method. Design Repeated-measures cross-sectional survey. Setting and participants Annual magazine-based survey targeting people who use stimulant drugs in dance contexts. Measurements Life-time use prevalence (ever used), age of first use, current use prevalence (any use within the last month) and extent of use within the last month (number of days used) for a range of stimulant drugs. Additional measures of quantity of ecstasy used were also collected. Findings Trends in life-time and current prevalence over time have been detected and comparisons made between different stimulant drugs. Evidence is obtained of broad stability in patterns of stimulant use in respect of age of first use and frequency of use among ongoing users. Despite an apparent reduction in the current prevalence of ecstasy use, the proportion of heavy users (usually > 4 pills per session) has more than doubled between 1999 and 2003. Conclusions This purposively sampled population study has yielded time trend data broadly consistent with other indicators, where they exist, and also has demonstrable potential to identify new drug trends. Further comparisons of purposive samples and randomly formed samples are needed. Copyright 2005, Society for the Study of Addiction to Alcohol and Other Drugs McDowell D. Marijuana, hallucinogens, and club drugs. IN: Frances RJ; Miller SI; Mack AH, eds. Clinical Textbook of Addictive Disorders, 3rd edition. New York: Guilford Press, 2005. pp. 157-183. (121 refs.) This chapter provides summaries of marijuana, hallucinogens, and the "club drugs" -- ecstasy, ketamine, GHB. The history of use, the mechanisms of action are outlined, as well as their physiolgoical effects and treatment approaches. Copyright 2005, Project Cork McElrath K. MDMA and sexual behavior: Ecstasy users' perceptions about sexuality and sexual risk. Substance Use & Misuse 40(9-10): 1461-1477, 2005. (38 refs.) This study examines the relationship between MDMA (Ecstasy), sexual behavior, and sexual risk taking. The sample consisted of 98 current and former users of MDMA. Several strategies were utilized to recruit respondents and data were collected through in-depth interviews during 1997 and 1998. The majority of respondents had used MDMA during the 6-month period prior to the interview and a large percentage had consumed the drug on 100 occasions or more. Most respondents reported feelings of emotional closeness while consuming MDMA but without the desire for penetrative sex. Others, however, reported that MDMA increased sexual arousal and some respondents (in particular, gay and bisexual females) had used MDMA specifically for sexual enhancement. Sexual risk taking (e.g., having multiple partners, engaging in sex without a condom) was prevalent among respondents who did engage in sexual activity during MDMA episodes. Explanations for the findings are offered and implications for prevention/intervention are discussed. Copyright 2005, Marcel Dekker, Inc McNamara R; Kerans A; O'Neill B; Harkin A. Caffeine promotes hyperthermia and serotonergic loss following co-administration of the substituted amphetamines, MDMA ("Ecstasy") and MDA ("Love"). Neuropharmacology 50(1): 69-80, 2006. (35 refs.) The present study determined the effect of caffeine co-administration on the core body temperature response and long-term serotonin (5-HT) loss induced by methylenedioxymethamphetamine (MDMA; "Ecstasy") and its metabolite methylenedioxyamphetamine (MDA; "Love") to rats. In group-housed animals, caffeine (10 mg/kg) enhanced the acute toxicity of MDMA (15 mg/kg) and MDA (7.5 mg/kg), resulting in an exaggerated hyperthermic response (+2 degrees C for 5 h following MDMA and + 1.5 degrees C for 3 h following MDA) when compared to MDMA (+ 1 degrees C for 3 h) and MDA (+ 1 degrees C for 1 h) alone. Co-administration of caffeine with MDMA or MDA was also associated with increased lethality. To reduce the risk of lethality, doses of MDMA and MDA were reduced in further experiments and the animals were housed individually. To examine the effects of repeated administration, animals received MDMA (10 mg/kg) or MDA (5 mg/kg) with or without caffeine (10 mg/kg) twice daily for 4 consecutive days. MDMA and MDA alone induced hypothermia (fall of 1 to 2 degrees C) over the 4 treatment days. Co-administration of caffeine with MDMA or MDA resulted in hyperthermia (increase of up to 2.5 degrees C) following acute administration compared to animals treated with caffeine or MDMA/MDA alone. This hyperthermic response to caffeine and MDMA was not observed with repeated administration, unlike caffeine + MDA, where hyperthermia was obtained over the 4 day treatment period. In addition, 4 weeks after the last treatment, co-administration of caffeine with MDA (but not MDMA) induced a reduction in 5-HT and 5-hydroxyindole acetic acid (5-HIAA) concentrations in frontal cortex (to 61% and 58% of control, respectively), hippocampus (48% and 60%), striatum (79% and 64%) and amygdala (63% and 37%). However, when caffeine (10 mg/kg) and MDMA (2.5 mg/kg) were co-administered four times daily for 2 days to group-housed animals, both hyperthermia and hippocampal 5-HT loss were observed (reduced to 68% of control). Neither MDMA nor MDA alone induced a significant reduction in regional 5-HT or 5-HIAA concentrations following repeated administration. In conclusion, caffeine promotes the acute and long-term toxicity associated with MDMA and MDA. This is a serious drug interaction, which could have important acute and long-term health consequences for recreational drug users. Copyright 2006, Elsevier Science Ltd Medina KL; Shear PK; Corcoran K. Ecstasy (MDMA) exposure and neuropsychological functioning: A polydrug perspective. Journal of the International Neuropsychological Society 11(6): 753-765, 2005. (58 refs.) Ecstasy (MDMA) is a popular drug that can act as a selective serotonin neurotoxin in several species. The goal of the present study was to examine the relationship between ecstasy exposure and cognitive functioning after controlling for other drug use and demographic variables. Furthermore, we assessed whether gender was a moderator of the relationship between cognitive functioning and ecstasy use. Data were collected from 31 men and 34 women with a wide range of ecstasy use (17 marijuana users with no ecstasy use and 48 ecstasy users ranging from low to heavy use). Participants were interviewed and administered a battery of neuropsychological tests. The primary finding was that ecstasy exposure was significantly related to poorer verbal learning and memory ability in a dose-dependent manner, while no such relationship was observed between ecstasy exposure and executive functioning or attentional ability. Gender was found to significantly moderate the relationship between ecstasy consumption and design fluency. These results suggest primary memory dysfunction among abstinent recreational ecstasy users. This finding is consistent with reports of hippocampal vulnerability, particularly among heavy users. Copyright 2005, Cambridge University Press Michaud P; Berchtold A; Eannin A; Chossis I; Suris JC. Secular trends in legal and illegal substance use among 16-20-year-old adolescents in Switzerland. Swiss Medical Weekly 136(19-20): 318-326, 2006. (59 refs.) Background: Data targeting trends in legal and illegal substance use by adolescents are scarce. Using the data from two similar large national surveys run in 1993 and 2002, this paper assesses secular trends in rates of substance use among 16-20-year-old Swiss adolescents. Methods: Self-reported regular use of tobacco, alcohol misuse, regular cannabis use (>= 1 occasion over last 30 days) and lifetime use of psychoactive medication, LSD, ecstasy, cocaine and heroin were assessed through identical questions using an anonymous self-administered questionnaire. 9268 (1993) and 7428 (2002) high school students and apprentices were included in the analyses. Results: There is a higher proportion of regular smokers among apprentices than among students (p < 0.001). Between 1993 and 2002 the increase in regular tobacco consumption was significant among both female and male apprentices (p < 0.001) but not among students. Between 1993 and 2002 alcohol misuse significantly increased in all four groups (p <.001). It is more prevalent among males than among females (p < 0.001) and higher among apprentices than among students (p < 0.001). Regular use of cannabis has increased in the four groups (p < 0.0001). It is higher among males than among females (p < 0.001), while it is largely the same among students and apprentices. While the increase in ecstasy use is highly significant in all four groups (p < 0.001), the increase in LSD and cocaine use is significant among apprentices only (p < 0.001). Use of LSD, ecstasy and cocaine is more prevalent among males than among females (< 0.001) and higher among apprentices than among students (p < 0.001). Conclusion: The secular increase in psychoactive substance use among older Swiss adolescents calls for the implementation of effective strategies both from individual and public health viewpoints. Copyright 2006, Swiss Medical Publishers, Ltd Milani RM; Parrott AC; Schifano F; Turner JJD. Pattern of cannabis use in ecstasy polydrug users: Moderate cannabis use may compensate for self-rated aggression and somatic symptoms. Human Psychopharmacology: Clinical and Experimental 20(4): 249-261, 2005. (70 refs.) Cannabis is one of the most common 'co-drugs' for ecstasy users. The aim of the present study was to explore self-reported psychobiological problems in ecstasy polydrug users in relation to their pattern of cannabis use. Two hundred and eighty ecstasy polydrug users were allocated into five cannabis groups according to the frequency of their cannabis use. The control group comprised 121 alcohol-tobacco users. There were no significant group differences with regard to age, diagnosed family psychiatric history and level of self-rated stress experienced during 6 months prior to the study. The present study produced three main findings: (a) Ecstasy users with no concomitant use of cannabis displayed more self-rated aggression and somatic symptoms compared with ecstasy users who were smoking cannabis on a monthly or weekly basis. (b) Ecstasy users who reported heavy cannabis use in the past displayed higher paranoid symptoms compared with ecstasy weekly and daily cannabis users. (c) Former heavy cannabis users were the most likely to complain of a variety of ecstasy related long-term problems. In conclusion, moderate cannabis use may help to ameliorate or mask MDMA-induced aggressivity and somatic symptoms. However, this study confirms that heavy cannabis and ecstasy use is associated with several psychobiological problems, which may emerge after a period of abstinence from both drugs. Copyright 2005, John Wiley & Sons Ltd Montgomery C; Fisk JE; Newcombe R; Wareing M; Murphy PN. Syllogistic reasoning performance in MDMA (Ecstasy) users. Experimental and Clinical Psychopharmacology 13(2): 137-145, 2005. (47 refs.) Previous research has demonstrated working memory and executive deficits in recreational users of MDMA (3,4-methylenedioxymethamphetamine; Ecstasy). In turn, both of these constructs have been implicated in syllogistic reasoning performance. Twenty-two MDMA users (mean age = 21.36) and 26 MDMA nonuser controls (mean age = 21.31) were tested on syllogisms of varying difficulty and on measures of working memory and executive functioning. MDMA users were significantly impaired in aspects of syllogistic reasoning, and the effect remained significant after the authors controlled for the use of other drugs. However, the MDMA-related variance was reduced to below statistical significance following control for group differences in working memory span. The results are consistent with the possibility that MDMA-related deficits in aspects of executive functioning result in impaired reasoning performance among MDMA users. Copyright 2005, American Psychological Association Montgomery C; Fisk JE; Newcombe R. The nature of ecstasy-group related deficits in associative learning. Psychopharmacology 180(1): 141-149, 2005. (36 refs.) Rationale/objectives: Research has revealed associative learning deficits among users of ecstasy; the present study explored the component processes underlying these deficits. Methods: Thirty-five ecstasy users and 62 non-ecstasy users completed a computer-based, verbal paired-associates learning task. Participants attempted to learn eight sequentially presented word pairs. After all eight had been presented, the first member of each pair was displayed and participants attempted to recall the second. Eight trials were administered. Correct responses on each trial, forgetting at various levels of learning, perseveration errors and the rate at which the associations were learned (trials to completion) were all recorded. Results: MANOVA revealed that ecstasy users performed worse overall and subsequent ANOVAs showed that users performed significantly worse on virtually all measures. Regression analysis revealed that over half of the ecstasy-group related variance in trials to completion was attributable to group differences in initial learning and forgetting. In relation to forgetting, it appears that cannabis use may be an important determinant. In relation to rate of learning (trials to completion) and initial learning, both ecstasy and cannabis may be implicated. Conclusions: There appears to be abundant evidence of associative learning deficits among ecstasy users. However, it appears that a range of illicit drugs including cannabis and ecstasy may contribute to these deficits. Copyright 2005, Springer Morgan MJ; Impallomeni LC; Pirona A; Rogers RD. Elevated impulsivity and impaired decision-making in abstinent ecstasy (MDMA) users compared to polydrug and drug-naive controls. Neuropsychopharmacology 31(7): 1562-1573, 2006. (60 refs.) Ecstasy (MDMA; 3,4-methylenedioxymethamphetamine) has a well-recognized neurotoxic effect on central serotonergic (5-HT) systems in animals, and there is some evidence of persistent serotonergic dysregulation in human ecstasy users. Serotonin is believed to mediate impulsive behavior and effective decision-making. Thus, the aim of the present study was to investigate impulsive behavior and decision-making in abstinent regular ecstasy users. Three groups were compared: 'ecstasy users' (recreational ecstasy users who reported modest use of illicit drugs other than cannabis), 'polydrug controls' (ecstasy naive illicit drug users), and 'drug-naive controls'. All participants completed personal details and general drug history questionnaires, the National Adult Reading Test, Matching Familiar Figures Test (MFF20), a risky decision-making task (RDMT), and the Card Arranging Reward Responsivity Objective Test (CARROT). The groups did not differ on the CARROT measure of responsiveness to financial incentive; however, the ecstasy group displayed significantly elevated MFF20 impulsivity, and showed reduced discrimination between magnitudes of prospective gains and losses when making risky decisions, compared to the 'polydrug' and 'drug-naive' control groups. These findings may reflect a vulnerability of 5-HT systems in the orbital prefrontal cortex and interconnected corticolimbic circuitry to the cumulative neurotoxic effects of ecstasy and have clinical significance for regular ecstasy users. The combination of elevated impulsivity and impaired use of reinforcement cues in uncertain decision-making may comprise risk factors for continued drug abuse and everyday functioning. Copyright 2006, American College of Neuropsychopharmacology Nakashima K. High-performance liquid chromatographic analysis of drugs of abuse in biologic samples. (review). Journal of Health Science 51(3): 272-277, 2005. (33 refs.) Recently, drug abuse has become a serious social problem world wide. In Japan, methamphetamine (MP) is the most popular drug of abuse. In addition to MP, the use of 4,5-methylenedioxymethamphetamine (MDMA), called ecstacy, is rapidly increasing, especially among young people. The development of simple and convenient analytical methods for the analysis of these drugs of abuse is necessary for the prediction of and protection from human health risks. Many useful methods have been developed for qualification and quantification of drugs of abuse. Among these, gas chromatography with mass spectrometry (MS) and high-performance liquid chromatography with MS (HPLC-MS or LC-MS) or fluorescence (HPLC-FL) detection are widely used. As highly sensitive methods, precolumn or postcolumn derivatization methods are commonly utilized in HPLC. This review focuses on HPLC methods used for the practical analysis of drugs of abuse, mainly for amphetamine derivatives and MDMAs in biologic samples such as urine, blood, and hair. Copyright 2005, Pharmaceutical Society of Japan Newman J; Moon C. NT Trends in Ecstasy and Related Drug Markets 2004: Findings from the Party Drug Initiative (PDI). NDARC Technical Report No. 222. Sydney: National Drug and Alcohol Research Centre, 2005. (32 refs.) This report deals with ecstasy and the related drug markets in the Northern Territory. Following an executive summary there is a brief description of the characteristics of regular ecstasy users. Following are individual sections dealing with ecstasy, methamphetamine, cocaine, ketamine, gamma-hydroxybutyrate, LSD, with data on demographic characteristics of users, drug use history and current use patterns, as well as price, purity, perceived availability, and the perceived risks and benefits of use. Other drug use is also summarized -- alcohol, marijuana, nicotine, benzodiazepines, inhalants and other opioids. Sections are also devoted to associated risk activities including injecting risk behavior, sexual activity, tattooing and piercing, and driving risk behavior; and also health risks, with reports of overdose, symptoms of dependence, and help-seeking behavior. Criminal encounters are also described. Copyright 2005, National Drug and Alcohol Research Centre (Australia) Novoa RA; Ompad DC; Wu YF; Vlahov D; Galea S. Ecstasy use and its association with sexual behaviors among drug users in New York City. Journal of Community Health 30(5): 331-343, 2005. (34 refs.) In the past two decades, recreational use of ecstasy has become a growing concern in the United States, although most studies assessing ecstasy use have focused on white, middle-class adolescents who use ecstasy during raves and in clubs. We assessed the prevalence of recent ecstasy use among predominantly minority heroin, cocaine, and crack users in New York City and the association between ecstasy and sexual risk above and beyond that of the other drugs. Between 2002 and 2004, injection and non-injection heroin, crack and cocaine users (N = 534) completed a risk behavior questionnaire that included items on ecstasy use. Logistic regression was used to investigate the relation between current ecstasy use and sexual behaviors. Of 534 illicit drug users, 69.7% were aged 25 years or older, 65.2% were Hispanic, 27.9% Black and 77.4% male; 36.7% were injectors. 17.2% of respondents reported recent (last six months) ecstasy use. In a multivariable logistic regression model, current ecstasy use was associated both with initiating sex before age 14 (adjusted odds ratio (AOR) = 1.51) and having two or more partners in the past two months (AOR = 1.86) after adjusting for age at study entry, current cocaine and marijuana use and being an injection drug user. This study suggests that ecstasy use may be more prevalent among urban drug users. Ecstasy use in urban settings, beyond clubs and raves, should continue to be monitored. Copyright 2005, Kluwer Academic O'Malley P. Ecstasy for intimacy: Potentially fatal choices for adolescents and young adults. Update for the clinical nurse specialist. (editorial). Clinical Nurse Specialist 19(2): 63-64, 2005. (20 refs.) Ompad DC; Galea S; Fuller CM; Edwards V; Vlahov D. Ecstasy use among Hispanic and black substance users in New York City. Substance Use & Misuse 40(9-10): 1399-1407, 2005. (18 refs.) Surveillance data suggests that use of ecstasy in the U.S. is predominantly among white adolescent and young adults. To investigate ecstasy use among substance users in New York City we added questions to ongoing efforts to recruit heroin and cocaine users. Of 715 participants recruited, 58.3% were injection dug users (ID Us). The medial? age was 32 (range 17-64), 76.4% were male, 49.0% were currently homeless, 62.4% were Hispanic, 27.3% were black, and 34.5% were born outside the United States. Overall, 23.4% used ecstasy in their lifetime and 11.9% had used in the last-6 months. In multivariate logistic regression, correlates of lifetime ecstasy use included younger age, being born in the U.S., and current homelessness. We observed a significant interaction between injection drug use and race where, compared to black non-IDUs, Hispanic non-IDUs, and white IDUs were significantly more likely to have a history of lifetime ecstasy use while black ID Us were significantly less likely. These findings are limited to persons who use other drugs, but suggest that further investigation of ecstasy use in minority populations is warranted. Copyright 2005, Marcel Dekker, Inc Parsons JT; Halkitis PN; Bimbi DS. Club drug use among young adults frequenting dance clubs and other social venues in New York City. Journal of Child & Adolescent Substance Abuse 15(3): 1-14, 2006. (38 refs.) A convenience sample of young adults (ages 18-25) in New York City was recruited to complete anonymous surveys in social venues (either dance clubs or other social settings, such as coffee shops and university "hangouts") regarding their use of "club drugs" (e.g., MDMA/Ecstasy, GHB, ketamine, crystal methamphetamine, cocaine, and LSD). Participants indicated their frequency of use for each drug and whether or not they had used each drug for the first time in the past six months. A total of 566 surveys were collected and 38.9% of participants reported the use of at least one club drug. Overall, males were significantly more likely than females to report club drug use. There were some differences in club drug use based on sexual orientation, comparing heterosexually identified youth to gay/bisexually identified youth. There were no differences in use among those recruited at dance clubs compared with those recruited from other social venues. The use of club drugs is a growing problem among young adults, as evidenced by the number of participants reporting having tried club drugs for the first time in the past six months. Educational interventions, 'particularly those designed to reach young adults who are just initiating the use of club drugs, are needed. Copyright 2006, Haworth Press Inc. Patel MM; Belson MG; Longwater AB; Olson KR; Miller MA. Methylenedioxymethamphetamine (ecstasy)-related hyperthermia. Journal of Emergency Medicine 29(4): 451-454, 2005. (20 refs.) MDMA (or 3, 4 methylenedioxymethamphetamine) was first manufactured in the 1920s and found to have structural similarities to both mescaline and amphetamines. Used briefly by some therapists in the 1970s and early 1980s as an adjunct to psychotherapy, it is now primarily abused by teenagers and young adults as an illicit recreational drug known as "ecstasy." As its popularity has increased, so have the number of fatalities and adverse events related to its use. We report six patients suffering fatal or life-threatening hyperthermia after MDMA use. These cases illustrate that hyperthermia associated with MDMA use cannot be solely attributed to rave parties (high ambient temperatures, excessive dancing, dehydration, and overcrowded conditions), drug contaminants, or co-ingestants. A better understanding of the etiology of hyperthermia after MDMA use is needed so that appropriate harm-reduction measures can be developed and instituted. Copyright 2005, Elsevier Science Ltd. Patel MM; Belson MG; Wright D; Lu H; Heninger M; Miller MA. Methylenedioxymethamphetamine (ecstasy)-related myocardial hypertrophy: An autopsy study. Resuscitation 66(2): 197-202, 2005. (29 refs.) Background: Myocardial hypertrophy is a well-recognized complication of cocaine and methamphetamine abuse and is a strong, independent risk factor for sudden death, myocardial infarction, and congestive heart failure. We sought to determine if use of MDMA (methylenedioxyamphetamine or "ecstasy") is associated with myocardial hypertrophy at death. Methods and results: A matched, retrospective study using medical examiner (ME) death reports. Consecutive MDMA positive (+) and MDMA negative (-) deaths identified from MEs in 10 states and a local county, respectively. Five MDMA(-) cases were matched to each MDMA(+) case for age, sex, and ethnicity. MDMA(+) cases were confirmed using GC/MS and other drugs of abuse (e.g., cocaine and methamphetamine) were absent. Matched MDMA(-) cases were trauma fatalities with intact hearts and blood negative for all illicit stimulants. Cardiac weights were compared between the two groups. Twenty seven MDMA(+) deaths and 135 matched MDMA(-) deaths were enrolled. Mean age was 20 years (range 16-33 years); 44% were female. 70.4% were Caucasian, 14.8% African-American, 11.1% Asian, and 3.7% Hispanic. Mean heart weight of MDMA(+) fatalities was 315.7 and 277.2 g for MDMA(-) fatalities (Diff = 38.5 g; 95% CI = 18.3-8.7). Multivariate analysis revealed that MDMA(+) fatalities were more likely to have an enlarged heart (OR = 18.3; 95% CI = 3.6-1.6). Conclusion: The findings of this study suggest that MDMA users might also be at risk for myocardial hypertrophy and possible cardiac toxicity, similar to other stimulants. Copyright 2005, Elsevier Ireland Ltd. Pichini S; Poudevida S; Pujadas M; Menoyo E; Pacifici R; Farre M; de la Torre R. Assessment of chronic exposure to MDMA in a group of consumers by segmental hair analysis. Therapeutic Drug Monitoring 28(1): 106-109, 2006. (15 refs.) The suitability of segmental hair analysis of MDMA to monitor past chronic exposure to the drug was investigated in a follow-up study of ecstasy consumers. The purpose, among others, was to look for an objective biomarker of the history of drug consumption. Thirteen naturally colored hair samples were used to assess possible association between hair concentration of MDMA in 1 -, 5-, and 9-cm segments and self-reported use in the last 1, 6, and 12 months. Agreement between the self-reported data given by the subjects on their "ecstasy" use in the previous month and MDMA hair concentration was good (r(2) = 0.92) in all the examined subjects, with the exception of 2 individuals who declared a high consumption of the drug (12 tablets in the last month). When comparing the subjects' declaration of tablets consumed per month within the last 6 months, concordance with the hair MDMA values decreased and no correlation seemed to exist between the mean number of tablets consumed in the last 12 months and the concentration of MDMA in hair. However, when grouping subjects with a similar level of declared drug use (independently of whether in the previous month, last 6 months and last 12 months) and comparing the data with the mean MDMA concentrations found in the corresponding hair segments, an excellent level of agreement was found in groups of subjects consuming < 5 tablets of MDMA per month (r(2) = 0.93). Although the present findings were obtained from a small group of individuals and are intended as preliminary results, we can conclude that a cutoff of 0.5 ng MDMA per mg hair seems reasonable to assess drug consumption, unless the level of consumption was once per month in the last 12 months. Doubling the monthly consumption increases hair MDMA by around 1 ng/mg hair up to a level of 4 consumed tablets a month. It does not seem possible to draw definitive conclusions from higher concentrations in hair samples. Copyright 2006, Lippincott, Willams & Wilkins Poikolainen K. Ecstasy and the antecedents of illicit drug use: Anxiety and depression may be risk factors for using ecstasy. (editorial). British Medical Journal 332(7545): 803-804, 2006. (12 refs.) Quednow BB; Jessen F; Kuhn KU; Maier W; Daum I; Wagner M. Memory deficits in abstinent MDMA (ecstasy) users: Neuropsychological evidence of frontal dysfunction. Journal of Psychopharmacology 20(3): 373-384, 2006. (97 refs.) Chronic administration of the common club drug 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) is associated with Long-term depletion of serotonin (5-HT) and loss of 5-HT axons in the brains of rodents and non-human primates, and evidence suggests that recreational MDMA consumption may also affect the human serotonergic system. Moreover, it was consistently shown that abstinent MDMA users have memory deficits. Recently, it was supposed that these deficits are an expression of a temporal or rather hippocampal dysfunction caused by the serotonergic neurotoxicity of MDMA. The aim of this study is to examine the memory deficits of MDMA users neuropsychologically in order to evaluate the rote of different brain regions. Nineteen male abstinent MDMA users, 19 male abstinent cannabis users and 19 mate drug-naive control subjects were examined with a German version of the Rey Auditory Verbal Learning Test (RAVLT). MDMA users showed widespread and marked verbal memory deficits, compared to drug-naive controls as well as compared to cannabis users, whereas cannabis users did not differ from control subjects in their memory performance. MDMA users revealed impairments in learning, consolidation, recall and recognition. In addition, they also showed a worse recall consistency and strong retroactive interference whereby both measures were previously associated with frontal lobe function. There was a significant correlation between memory performance and the amount of MDMA taken. These results suggest that the memory deficits of MDMA users are not only the result of a temporal or hippocampal dysfunction, but also of a dysfunction of regions within the frontal cortex. Copyright 2006, Sage Publications Quinton MS; Yamamoto BK. Causes and consequences of methamphetamine and MDMA toxicity. AAPS Journal 8(2): e337-347, 2006. (100 refs.) Methamphetamine (METH) and its derivative 3,4-methylenedioxymethamphetamine (MDMA; ecstasy) are 2 substituted amphetamines with very high abuse liability in the United States. These amphetamine-like stimulants have been associated with loss of multiple markers for dopaminergic and serotonergic terminals in the brain. Among other causes, oxidative stress, excitotoxicity and mitochondrial dysfunction appear to play a major role in the neurotoxicity produced by the substituted amphetamines. The present review will focus on these events and how they interact and converge to produce the monoaminergic depletions that are typically observed after METH or MDMA administration. In addition, more recently identified consequences of METH or MDMA-induced oxidative stress, excitotoxicity, and mitochondrial dysfunction are described in relation to the classical markers of METH-induced damage to dopamine terminals. Copyright 2006, American Association of Pharmaceutical Scientists Reay JL; Hamilton C; Kennedy DO; Scholey AB. MDMA polydrug users show process-specific central executive impairments coupled with impaired social and emotional judgement processes. Journal of Psychopharmacology 20(3): 385-388, 2006. (18 refs.) In recent years working memory deficits have been reported in users of MDMA (3,4-methylenedioxymethamphetamine, ecstasy). The current study aimed to assess the impact of MDMA use on three separate central executive processes (set shifting, inhibition and memory updating) and also on 'prefrontal' mediated social and emotional judgement processes. Fifteen polydrug ecstasy users and 15 polydrug non-ecstasy user controls completed a general drug use questionnaire, the Brixton Spatial Anticipation task (set shifting), Backward Digit Span procedure (memory updating), Inhibition of Return (inhibition), an emotional intelligence scale, the Tromso Social Intelligence Scale and the Dysexecutive Questionnaire (DEX). Compared with MDMA-free polydrug controls, MDMA polydrug users showed impairments in set shifting and memory updating, and also in social and emotional judgement processes. The latter two deficits remained significant after controlling for other drug use. These data tend further support to the proposal that cognitive processes mediated by the prefrontal cortex may be impaired by recreational ecstasy use. Copyright 2006, Sage Publications Roiser JP; Cook LJ; Cooper JD; Rubinsztein DC; Sahakian BJ. Association of a functional polymorphism in the serotonin transporter gene with abnormal emotional processing in ecstasy users. American Journal of Psychiatry 162(3): 609-612, 2005. (21 refs.) Objective: The long-term effects of the use of 3,4-methylenedioxymethamphetamine (MDMA, or Ecstasy) in humans are controversial and unclear. The authors' goal was to assess the contribution of a functional polymorphism in the gene encoding serotonin transporter to changes in emotional processing following chronic Ecstasy use. Method: They investigated Beck Depression Inventory scores and performance on the Affective Go/No-Go test, a computerized neuropsychological test sensitive to emotional processing, in Ecstasy users and comparison subjects, stratifying the results by serotonin transporter genotype. Results: Ecstasy use was associated with higher Beck Depression Inventory score and abnormalities in the Affective Go/No-Go test in individuals with the ss and ls genotype but not those with the ll genotype. Conclusions: Ecstasy users carrying the s allele, but not comparison subjects carrying the s allele, showed abnormal emotional processing. On the basis of a comparison with acute tryptophan depletion, the authors hypothesize that chronic Ecstasy use may cause long-term changes to the serotonin system, and that Ecstasy users carrying the s allele may be at particular risk for emotional dysfunction. Copyright 2005, American Psychiatric Association Rosenthal RN; Solhkhah R. Club drugs. IN: Kranzler HR; Ciraulo DA, eds. Clinical Manual of Addiction Psychopharmacology. Washington DC: American Psychiatric Press, 2005. pp. 243-267. (208 refs.) This chapter deals with the club drugs, which do not represent a single drug class, but are drugs associated with the rave scene. There are sections devoted to GHB (gamma-hydroxybutyrate), ecstasy, and ketamine, a veterinary anesthetic with dissociative properties. For each of these there is discussion of the epidemiology of use, clinical presentation, basic and clinical pharmacology, toxicity, and treatment. Copyright 2006, Project Cork Ross JD; Herin DV; Frankel PS; Thomas ML; Cunningham KA. Chronic treatment with a serotonin(2) receptor (5-HT2R) agonist modulates the behavioral and cellular response to (+)-3,4-methylenedioxymethamphetamine [(+)-MDMA]. Drug and Alcohol Dependence 81(2): 117-127, 2006. (69 refs.) 3,4-Methylenedioxymethamphetatamine [MDMA; ecstasy] evokes a multifaceted subjective experience in human users which includes stimulation, feelings of well-being, mood elevation, empathy towards others as well as distortions in time. sensation and perception. Aspects of this unique psychopharmacology of MDMA are thought to be related to its potent actions to release serotonin (5-HT) and indirectly stimulate the 5-HT2A receptor (5-HT2AR). In the present studies, we examined the interrelationship between down-regulation of 5-HT2AR expression and the behaviorally stimulatory effects generated by acute administration of (+)-MDMA, the most potent enantiomer of (+/-)-MDMA. Male Sprague-Dawley rats were chronically treated with the preferential 5-HT2AR agonist 2,5-dimethoxy-4-iodoamphetamine (DOI) which has been shown to down-regulate expression of the 5-HT2AR, but not the closely related 5-HT2CR. While chronic DOI treatment did not alter the functional sensitivity of either the 5-HT2AR or 5-HT2CR, this regimen enhanced (+)-MDMA-evoked hyperactivity. Subsequent analysis of c-Fos and 5-HT2AR immunoreactivity in brain sections demonstrated that DOI treatment decreased the number of (+)-MDMA-induced c-Fos immunopositive nuclei and 5-HT2AR immunostaining in select cortical and striatal areas. These results indicate that chronic DOI exposure results in an enhanced behavioral response to (+)-MDMA and in a pattern of neuronal activation which resembles that seen in psychostimulant sensitization. These data also suggest that expression of the 5-HT2AR in the NAc and PFC may play a role in the sensitivity to the locomotor-stimulating effects of (+)-MDMA and in the processes of neural regulation upon repeated psychostimulant administration. Copyright 2006, Elsevier Science Salasuo M. The spread of ecstasy use and development of the ecstasy market in Finland. IN: Lalander P; Salasuo M, eds. Drugs and Youth Cultures: Global and Local Expressions. NAD monograph no. 46. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2005. pp. 64-84. (54 refs.) While ecstasy gained in popularity in the beginning of the 1990s in Western Europe, in Finland things moved more slowly. This article traces the spread of ecstasy use in Finland and explores its relationship to the youth culture in the 1990s, primarily in the Helsinki metropolitan area. It also looks at the expansion of the ecstasy market and its relationship to the illegal drug market. The markets are studied primarily in light of information received from users and data that are available for the police. Subcultures related to ecstasy use and the ecstasy market are usually dealt with separately from other drug markets. The image of ecstasy users on the basis of interview and survey studies is different from the image obtained from police sources. There is also consideration of the phenomenon of diffusion of the party culture. The rise of the Finnish ecstasy market in the late 1990s was very much influenced by the invasion of organized crime, mainly from Estonia. Copyright 2005, Nordic Council for Alcohol and Drug Research Schensul JJ; Diamond S; Disch W; Bermudez R; Eiserman J. When the drug of choice is a drug of confusion: embalming fluid use in inner city Hartford, CT. Journal of Ethnicity in Substance Abuse 4(2): 39-71, 2005. (63 refs.) Ecstasy is a drug commonly associated with all-night, or all-weekend electronic dance events known as raves. Upper- and middle-class clubs, gay bars and clubs, and party venues are other common public settings where ecstasy use occurs. During the mid to late 1990s its use was reported in locations as distant as Australia and New Zealand, England and Scotland, and North America. In the United States, use increased dramatically at the end of the millennium, and drug monitoring systems began to report its presence among urban youth. Using social influence, social marketing and diffusion theory, this paper outlines the micro-level processes through which ecstasy traveled from downtown clubs catering to suburban young adults through urban youth networks through distributors and users. The paper is based on participant observation, and in-depth interviews with dealers and users collected during the period of peak diffusion 1999-2001, and survey data collected from 401 poly-drug users between the ages of 16 and 24 and collected at two time points from 1999-2002. Copyright 2005, Haworth Press Schifano F; Deluca P; Agosti L; Martinotti G; Corkery JM. New trends in the cyber and street market of recreational drugs? The case of 2C-T-7 ('Blue Mystic'). Journal of Psychopharmacology 19(6): 675-679, 2005. (26 refs.) 2C-T-7 ('Blue Mystic'), an illicit compound which shows similarities with MDMA and other designer drugs, has been only occasionally identified in the EU, but discussion on the Internet between experimenters has recently grown significantly. We aimed at collecting together in a review the available information on 2C-T-7, both at the cyber and at the street market level. 2C-T-7 was first synthesized in 1986; its desired effects include both a sense of empathy and of well-being. Hallucinations, nausea, anxiety, panic attacks and paranoid ideation are anecdotally reported. According to the different European sources here approached, the availability of 2C-T-7 at street level seems to be currently very low, although one death related to a mono-intoxication with 2C-T-7 has been documented in the USA. With respect to information on 2C-T-7 available online, due to both redundancy and relevance issues the initial identified sample of 360 was reduced to 118 websites. In 14 (11.9%) websites, the detailed description of the 2C-T-7 synthesis was given. Harm Reduction websites appeared significantly earlier in the search engines results' list than anti drugs (p=0.006) websites. Five (4.2%) websites apparently offered 2C-T-7 for sale. The large body of knowledge available online seems to contrast with small numbers of seizures at street level; an exhaustive web mapping of drug-related issues may be of interest for the clinician. Projects aimed at designing more 'attractive' prevention websites should be planned and future studies should better assess the characteristics of those consumers who take advantage of the online information of hallucinogenic compounds. Copyright 2005, Sage Publications Schilder AJ; Lampinen TM; Miller ML; Hogg RS. Crystal methamphetamine and ecstasy differ in relation to unsafe sex among young gay men. Canadian Journal of Public Health 96(5): 340-343, 2005. (30 refs.) Objective: Poly-substance use in gay social ('club') settings is common. Recent studies suggest a link between 'club' drug use and sexual risk behaviours. In this qualitative study, we compare and contrast two 'club' drugs: crystal methamphetamine and ecstasy (MDMA). Methods: Life history interviews were conducted with 12 HIV seroconverters and 12 age-matched controls recruited from a prospective cohort study of young gay and bisexual men in Vancouver, British Columbia. Textual data concerning illicit substance use and unsafe sex were analyzed using NUDIST software. Results: Most men related a substantial knowledge of and experience with crystal and ecstasy. Both drugs had attributes that enhanced gay socialization and were used in the same venues. Crystal was used to remain awake and increase energy. Ecstasy was used to induce euphoria and group connectedness. However, unlike ecstasy, crystal was associated with a distinct pattern of sexual arousal that frequently included unprotected (sometimes group) sex, was more likely to be used regularly by HIV-positive men, and was reportedly highly addictive and problematic. Conclusion: Crystal and ecstasy are used in the same social venues but differ markedly in relation to sexual risk behaviour. Copyright 2005, Canadian Public Health Association Schreckenberger M. "Ecstasy"-induced neurotoxicity: The contribution of functional brain imaging. (editorial). European Journal of Nuclear Medicine and Molecular Imaging 33(2): 185-187, 2006. (17 refs.) Siliquini R; Morra A; Versino E; Renga G. Recreational drug consumers: Who seeks treatment? European Journal of Public Health 15(6): 580-586, 2005. (24 refs.) Background: Recreational drug consumption represents a complex issue, because of the lack of a shared definition, settings and patterns of consumptions, and poorness of evidence-based treatments. In spite of the great number of users, just few seek specific treatment, probably representing those at major risk of continuing and problematic use. The general objective of this study was to report the characteristics and main consumption patterns of recreational drug consumers treated in Regione Piemonte (Italy), in order to formulate hypotheses suitable for further research aimed at establishing more effective preventive intervention and treatment. Methods: All addiction treatment services in the region were required to fill in, for each user, a questionnaire reporting: contact of the user with the service, socio-demoghaphic data, drugs consumption and interventions/treatments. Results: Among 441 users, 70.3% were new users, 85.5% were males and the average age of consumption onset was 22 years. Psychiatric and traumatics events were present in 13.3% and in 17.9% of cases, respectively. The most frequent primary substances were cocaine (76.9%) and ecstasy (13.8%). Substances taken in association with primary drug are quoted in 75% of cases. Conclusions: The users that get in touch with services are those showing greater problems, representing, therefore, the main target for preventive public health interventions. Some interesting points can be noted: among patients treated, cocaine represents the main issue; females seem to be more sensitive to recreational drug effects; social class (education), settings and use habits are similar for recreational drugs users and heroin users. Copyright 2005, Oxford University Press Sim T; Jordan-Green L; Lee J; Wolfman J; Jahangiri A. Psychosocial correlates of recreational ecstasy use among college students. Journal of American College Health 54(1): 25-29, 2005. (21 refs.) College students' ecstasy (MDMA) use increased significantly in recent years, yet little is known about these students. In this study, the authors used the Center for Alcohol and Other Drug Studies (CORE) survey to compare 29 college students who had used ecstasy and other illicit drugs with 90 students who had used marijuana and no other illicit drugs. They noted differences in age, frequency of alcohol and marijuana use, average age of onset of marijuana use, frequency of negative consequences associated with substance use, perceptions of peer norms' drug use, perceived peer acceptance of substance use, and risk perception of substance use. When they entered polysubstance use as a covariate, many of these correlates became nonsignificant. The authors suggest that college ecstasy initiators may be a cohort of marijuana users who tend to engage in multiple risk-taking behaviors. This study serves as a preliminary effort to better understand college students who use ecstasy recreationally. Copyright 2005, Heldref Publications Simons JS; Gaher RM; Correia CDJ; Bush JA. Club drug use among college students. (rapid communication). Addictive Behaviors 30(8): 1619-1624, 2005. (16 refs.) This study examined prevalence and frequency of "club" drug use among college students (N = 831) and associations with marijuana and alcohol use, sensation seeking, and positive and negative affectivity. Eighteen percent (n = 146) of the sample had used club drugs at least once in their lifetime. Results of a logistic regression indicated that club drug use was positively associated with marijuana use, negative affectivity, and female gender. Among those who had tried club drugs in their lifetime, 42% reported no past year use and 22.6% reported using 7-12 times or more in the past year. Regression analysis examined associations between 12-month use frequency and the predictors among those who had tried club drugs. Results indicated that sensation seeking and marijuana use were positively associated with use frequency. Copyright 2005, Elsevier Ltd. Soellner R. Club drug use in Germany. Substance Use & Misuse 40(9-10): 1279-1293, 2005. (35 refs.) In this paper the epidemiology of club drug use in Germany, including the use of 3,4-methylendioxy-N-methaniphetamine (MDMA) known as 'ecstasy' and related substances such as speed, amphetamines, hallucinogens, and cannabis is described on the basis of five different surveys. Two of them are representative household surveys to monitor the licit and illicit drug use behavior of the German population. The third one is a longitudinal study aimed at exploring comorbidity and posited risk and protective factors in adolescents and young adults with specific emphasis on substance use-related disorders. Since ecstasy seemed to be associated with a new music culture of the '90s called "techno" two studies investigating the relationship of using ecstasy and related substances in the techno party scene are additionally presented. The question of the clinical impact of using ecstasy and related substances is raised in terms of substance use-related and mental disorders associated with the use of ecstasy. Finally, the motivation for using and stopping the use of ecstasy is addressed. It is shown that ecstasy has reached the second place (after cannabis) in illegal drug preferences of adolescents and young adults in Germany. Evidence is found that ecstasy use as well as ecstasy use related disorders such as "abuse" and "dependence" are of a transient, "youth-limited" nature. Copyright 2005, Marcel Dekker, Inc Song BJ; Castillo-Garsow M; Rios-Soto KR; Mejran M; Henso L; Castillo-Chavez C. Raves, clubs and ecstasy: the impact of peer pressure. Mathematical Biosciences and Engineering 3(1): 249-266, 2006. (20 refs.) Ecstasy has gained popularity among young adults who frequent raves and nightclubs. The Drug Enforcement Administration reported a 500 percent increase in the use of ecstasy between 1993 and 1998. The number of ecstasy users kept growing until 2002, years after a national public education initiative against ecstasy use was launched. In this study, a system of differential equations is used to model the peer-driven dynamics of ecstasy use. It is found that backward bifurcations describe situations when suffcient peer pressure can cause an epidemic of ecstasy use. Furthermore, factors that have the greatest influence on ecstasy use as predicted by the model are high-lighted. The effect of education is also explored, and the results of simulations are shown to illustrate some possible outcomes. Copyright 2006, American Institute of Mathematical Sciences Sterk CE; Theall KP; Elifson KW. Young adult ecstasy use patterns: Quantities and combinations. Journal of Drug Issues 36(1): 201-228, 2006. (51 refs.) The objectives of this paper are to describe ecstasy use patterns among young adult (18-25 years) users and to compare use patterns and self-reported effects according to the frequency (number of days used in the last 90 days) and intensity (typical number of pills taken per sitting) of ecstasy use. Computer-assisted structured interviews were conducted with 261 young adult active ecstasy users in Atlanta, Georgia. A typical dose of ecstasy intake was two pills, often followed by a booster dose. In addition, binging on ecstasy was reported. Ecstasy was mentioned as the primary drug of choice by one fifth of respondents. Poly-drug use dominated, and a substantial proportion of the respondents reported symptoms of ecstasy dependence. Differences in sociodemographic characteristics, poly-drug use, and reported effects of ecstasy use were found according to frequency and intensity of ecstasy use. Findings from this paper are important for the development of effective prevention efforts, including drug treatment and policy. Copyright 2006, Journal of Drug Issues Inc. Stoove M; Laslett MA; Barratt M. Victorian Trends in Ecstasy and Related Drug Markets: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 226. Sydney: National Drug and Alcohol Research Centre, 2005. (32 refs.) This report deals with ecstasy and the related drug markets in Victoria. Following an executive summary there is a brief description of the characteristics of regular ecstasy users. Following are individual sections dealing with ecstasy, methamphetamine, cocaine, ketamine, gamma-hydroxybutyrate, LSD, with data on demographic characteristics of users, drug use history and current use patterns, as well as price, purity, perceived availability, and the perceived risks and benefits of use. Other drug use is also summarized -- alcohol, marijuana, nicotine, benzodiazepines, inhalants and other opioids. Sections are also devoted to associated risk activities including injecting risk behavior, sexual activity, tattooing and piercing, and driving risk behavior; and also health risks, with reports of overdose, symptoms of dependence, and help-seeking behavior. Criminal encounters are also described. Copyright 2005, National Drug and Alcohol Research Centre (Australia) Tanner-Smith EE. Pharmacological content of tablets sold as ÒecstasyÓ: Results from an online testing service. Drug and Alcohol Dependence 83(3): 247-254, 2006. (42 refs.) Purpose: This study examined the pharmacological content of tablets sold as ecstasy, the variation of tablet content by geographic region, and change in tablet content between 1999 and 2005. Methods: The sample was comprised of tablets anonymously submitted for laboratory testing between 1999 and 2005 (n = 1214). Tablet height, width, geographic region, and year of submission were all used to predict the pharmacological content of the tablets. Results: Overall, 39% of the tablets were comprised of MDMA only, 46% only contained substances other than MDMA and 15% were mixtures of MDMA and other substances. Tablet height and width were inversely related to tablet purity. Ecstasy tablets from California and Florida had decreased likelihoods of containing non-MDMA substances. The purity of tablets decreased over time, which was largely a result of an increasing number of tablets comprised of MDMA along with other substances. Conclusions: Ecstasy users may be putting themselves at increased risk of substance-induced anxiety, mood, and psychotic disorders by unknowingly ingesting substances other than MDMA. To decrease detrimental health effects, prevention programs should emphasize the impurity of ecstasy tablets and focus on the health impacts of these substances, particularly for populations at high-risk of substance-induced disorders. Copyright 2006, Elsevier Science ter Bogt TFM; Engels RCME; Dubas JS. Party people: Personality and MDMA use of house party visitors. Addictive Behaviors 31(7): 1240-1244, 2006. (10 refs.) Personality characteristics have been linked to substance use, however research on the association between personality and MDMA use is scarce. This study examined differences on Big Five personality dimensions between a population sample of non-hard drug using Dutch adolescents and young adults (n = 265), and a sample of young people visiting house parties, including both MDMA- and non-MDMA-users (n = 541). Results showed that 71% of the party visitors indicated using MDMA. Group differences were found on conscientiousness, extraversion, agreeableness and neuroticism-emotional stability, but not on resourcefulness-openness to experience. Compared to the non-hard drug using National respondents, MDMA-using party visitors reported higher levels of extraversion and both MDMA and non-MDMA-using partygoers showed less conscientiousness. Non-MDMA-using partygoers reported less agreeableness and emotional stability than National Sample respondents. MDMA-users actually high on the drug at the moment of administration of the questionnaire did not differ from their non-high counterparts on any of the personality dimensions. Copyright 2006, Elsevier Science Ltd. Ter Bogt TFM; Engels RCME. "Partying" hard: Party style, motives for and effects of MDMA use at rave parties. Substance Use & Misuse 40(9-10): 1479-1502, 2005. (44 refs.) This study examines motives for and consequences of MDMA use at different types of dance parties in the Netherlands (2001 and 2002). Participants were 490 visitors of three different types of rave parties, "club/mellow:' "trance/mainstream," and "hardcore" (34% female, mean age 22.3 years, 76.5% MDMA users). Party goers are motivated primarily by the energetic and euphoric effects they expect from MDMA. Quantity of MDMA use is associated with hardcore and trance/mainstream party style, with the motives of euphoria, sexiness, self-insight, and sociability/flirtatiousness (negative), and with gender, educational level (negative), and MDMA use by friends. Women report more (acute) negative effects-depression, confusion, loss of control, suspiciousness, edginess, nausea, dizziness-than men; and in particular, women who are motivated to cope with their problems by using MDMA are at risk. Men's polydrug use and notably their motivation to conform to friends by using MDMA are associated with negative effects. Copyright 2005, Marcel Dekker, Inc Thomas Y; Lambert EY. Special issue on club drug epidemiology. Foreward. Substance Use & Misuse 40(9-10): 1185-1187, 2005. (0 refs.) Thomasius R; Petersen KU; Zapletalova P; Wartberg L; Zeichner D; Schmoldt A. Mental disorders in current and former heavy ecstasy (MDMA) users. Addiction 100(9): 1310-1319, 2005. (43 refs.) Background: Ecstasy use has often been found to be associated with psychopathology, yet this research has so far been based largely on subjective symptom ratings. Aims: To investigate whether ecstasy users suffered from long-term psychopathological consequences. Measurements: We compared the prevalence of Diagnostic and Statistical Manual version IV (DSM-IV) mental disorders in 30 current and 29 former ecstasy users, 29 polydrug and 30 drug-naive controls. Groups were approximately matched by age, gender and level of education. The current ecstasy users reported a life-time dose of an average of 821 and the former ecstasy users of 768 ecstasy tablets. Findings: Ecstasy users did not significantly differ from controls in the prevalence of mental disorders, except those related to substance use. Substance-induced affective, anxiety and cognitive disorders occurred more frequently among ecstasy users than polydrug controls. The life-time prevalence of ecstasy dependence amounted to 73% in the ecstasy user groups. More than half of the former ecstasy users and nearly half of the current ecstasy users met the criteria of substance-induced cognitive disorders at the time of testing. Logistic regression analyses showed the estimated life-time doses of ecstasy to be predictive of cognitive disorders, both current and life-time. Conclusions: The motivation for ecstasy use is not likely to be self-medication of pre-existing depressive or anxiety disorders as these did not occur more frequently in the ecstasy users than in control groups or in the general population. Cognitive disorders still present after over 5 months of ecstasy abstinence may well be functional consequences of serotonergic neurotoxicity of 3,4-methylenedioxymethamphetamine (MDMA). Copyright 2005, Society for the Study of Addiction to Alcohol and Other Drugs Tournier M; Molimard M; Abouelfath A; Cougnard A; Begaud B; Gbikpi-Benissan G et al. Prognostic impact of psychoactive substances use during hospitalization for intentional drug overdose. Acta Psychiatrica Scandinavica 112(2): 134-140, 2005. (33 refs.) To assess whether current use of psychoactive substance(s) is a prognostic factor during hospitalization for intentional drug overdose (IDO). Current intoxication with psychoactive substance(s) [cannabis, opiate, buprenorphine, amphetamine/ecstasy, cocaine, lysergic acid diethylamide (LSD)] was identified using toxicological urinalysis in 671 patients with IDO. An IDO was a priori defined as serious if associated with one of the following events: death, hospitalization in intensive care unit longer than 48 h, respiratory support, use of vasopressive drugs, cardiac massage or dialysis. Subjects positive for toxicological assays were twice as likely to present with serious IDO (OR = 1.9, 95% CI: 1.3-2.8, P = 0.001), independently from a large range of confounding factors. The risk of serious IDO was especially marked in subjects using LSD, buprenorphine or opiates. Systematic investigation of substance use could be important to adapt medical management of subjects with IDO in general hospital, but also in primary care and psychiatric settings. Copyright 2005, Munksgaard International Publishers, Ltd. Used with permission Uys JDK; Niesink RJM. Pharmacological aspects of the combined use of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) and gamma-hydroxybutyric acid (GHB): A review of the literature. Drug and Alcohol Review 24(4): 359-368, 2005. (124 refs.) Epidemiological studies show that the use of club drugs is on the rise. Furthermore, the last few decades have seen a rise in patterns of polydrug use. One of the combinations frequently used is ecstasy (MDMA) with gammahydroxybutyrate (GHB). For effective prevention it is important to be aware of this phenomenon and of the pharmacology of these drugs. The effects of the combination extend to different neurotransmitter systems, including serotonin, dopamine and noradrenaline. Studies investigating the effects of combinations of psychoactive substances are limited. In this review we describe the subjective effects of the MDMA/GHB combination. Furthermore, we review the individual actions of MDMA on serotonin, dopamine and noradrenaline systems. In addition, actions of GHB on these systems are discussed as a possible pharmacological basis for the interaction of both drugs. It is postulated that GHB attenuates the unpleasant or dysphoric effects of MDMA by its effect on the central dopaminergic system. Copyright 2005, Taylor & Francis Ltd. van Ours JC. Ecstasy and cocaine: Patterns of use among prime age individuals in Amsterdam. Addictive Behaviors 30(7): 1468-1473, 2005. (5 refs.) This paper uses information about prime age individuals living in Amsterdam to study the patterns of use of ecstasy and cocaine. The information was collected in surveys in 1994, 1997 and 2001. The analysis shows that the use of ecstasy and cocaine is mainly influenced by calendar year, family situation, and parental cannabis use. Individuals that are more likely to use cocaine are also more likely to use ecstasy. The entrance of ecstasy in the Amsterdam drugs market in the course of the 1990s did not reduce the use of cocaine. Copyright 2005, Elsevier Science Weekley J; Pointer S; Ali R. SA Trends in Ecstasy and Related Drug Markets 2004: Findings from the Party Drugs Initiative (PDI). NDARC Technical Report No. 224. Sydney: National Drug and Alcohol Research Centre, 2005. (32 refs.) This report deals with ecstasy and the related drug markets in South Australia. Following an executive summary there is a brief description of the characteristics of regular ecstasy users. Following are individual sections dealing with ecstasy, methamphetamine, cocaine, ketamine, gamma-hydroxybutyrate, LSD, with data on demographic characteristics of users, drug use history and current use patterns, as well as price, purity, perceived availability, and the perceived risks and benefits of use. Other drug use is also summarized -- alcohol, marijuana, nicotine, benzodiazepines, inhalants and other opioids. Sections are also devoted to associated risk activities including injecting risk behavior, sexual activity, tattooing and piercing, and driving risk behavior; and also health risks, with reports of overdose, symptoms of dependence, and help-seeking behavior. Criminal encounters are also described. Copyright 2005, National Drug and Alcohol Research Centre (Australia) White B; Day C; Degenhardt L; Kinner S; Fry C; Bruno R; Johnston J. Prevalence of injecting drug use and associated risk behavior among regular ecstasy users in Australia. Drug and Alcohol Dependence 83(3): 210-217, 2006. (42 refs.) Background: The aim of the study was to investigate the prevalence of injecting drug use and associated risk behaviour among a sentinel sample of ecstasy users. Methods: Cross-sectional surveys were conducted with regular ecstasy users as part of an annual monitoring study of ecstasy and related drug markets in all Australian capital cities. Results: Twenty-three percent of the sample reported having ever injected a drug and 15% reported injecting in the 6 months preceding interview. Independent predictors of lifetime injection were older age, unemployment and having ever been in prison. Completion of secondary school and identifying as heterosexual was associated with a lower likelihood of having ever injected. Participants who had recently injected typically did so infrequently; only 9% reported daily injecting. Methamphetamine was the most commonly injected drug. Prevalence of needle sharing was low (6%), although half (47%) reported sharing other injecting equipment in the preceding 6 months. Conclusions: Ecstasy users who report having injected a drug at some time appear to be demographically different to ecstasy users who have not injected although neither are they typical of other drug injectors. The current investigation suggests that ongoing monitoring of injecting among regular ecstasy users is warranted. Copyright 2006, Elsevier Science White B; Degenhardt L; Breen C; Bruno R; Newman J; Proudfoot P. Risk and benefit perceptions of party drug use. (rapid communication). Addictive Behaviors 31(1): 137-142, 2006. (19 refs.) A cross-sectional survey of 372 regular ecstasy users was conducted to examine the benefits and risks perceived to be associated with the use of party drugs. A wide range of benefits and risks were reported across six drug types with some considered drug-specific. Commonly perceived risks included physical and psychological harms that were consistent with current harm reduction messages. Harm reduction campaigns may need to acknowledge benefits of drug use to ensure health promotion messages are considered credible and acceptable to users. Copyright 2006, Elsevier Science Ltd. Williams P. Correlates of ecstasy use in middle age and beyond. Drug and Alcohol Review 24(1): 33-38, 2005. (18 refs.) This study examines the socio-demographic characteristics, prevalence of and attitudes to illicit drug use, and support for illicit drug policies among persons aged 45 years and older who have used ecstasy at least once. Data are from a pooled sample of respondents (n = 14 622) from the 1998 and 2001 National Drug Strategy Household Surveys. It is estimated that 80,000 persons (0.6%) in the age group have used ecstasy. In a multivariate logistic regression analysis, socio-demographic factors were not predictive of ecstasy use. Support for needle and syringe exchange programs (OR 8.5) and a heroin prescription trial (OR 8.1); approval of the regular use by adults of ecstasy (OR 7.8) and cocaine (OR 11.2); support for the legalisation of the personal use of amphetamines (OR 5.2); and histories of having used amphetamines (OR 7.2), cannabis (OR 6.1) and cocaine (OR 4.5) were risk factors for having used ecstasy. A targeted study looking at the prevalence and patterns of, and motivations for ecstasy use among persons aged 45 years and older is recommended. Copyright 2005, Australian Medical and Professional Society on Alcohol and Other Drugs Wu ZH; Holzer CE; Breitkopf CR; Grady JJ; Berenson AB. Patterns and perceptions of ecstasy use among young, low-income women. Addictive Behaviors 31(4): 676-685, 2006. (31 refs.) A significant number of young, low-income women experiment with ecstasy outside of club or rave settings. The current study examined patterns and risk factors of ecstasy use among this group of women. A cross-sectional survey was conducted among 696 women aged 18 to 31 who sought gynecological care from two university clinics in southeast Texas between December 1, 2001, and May 30, 2003. Fifteen percent of participants reported ever using ecstasy. Of those, over 90% used it at a friend's home. Compared with women who used only marijuana or other illicit drugs, ecstasy users were more likely to be white, use a larger number of other drugs, be willing to use drugs in the future, and have more friends who used drugs. Fewer ecstasy users strongly disapproved of adult drug use than users of other illicit drugs. Future interventional efforts should target young, low-income women to prevent future experimentation with illicit drugs. Copyright 2006, Elsevier Science, Ltd. Yacoubian GS Jr.; Peters RJ. Identifying the prevalence and correlates of ecstasy use among high school seniors surveyed through 2002 monitoring the future. Journal of Alcohol and Drug Education 49(1): 55-72, 2005. (31 refs.) Media reports have suggested that the use of 3, 4-methylenedioxymethamphetamine (MDMA or "ecstasy') is a significant problem across the United States. To date, however, available evidence has shown that the use of ecstasy has been concentrated among "rave" attendees, with mainstream youth remaining relatively immune from its proliferation. In the current study we build on the ecstasy literature by examining the drug-using behaviors of 2,258 high school seniors with data collected through the Monitoring the Future program in 2002. Prevalence estimates of ecstasy use are generated and associations between ecstasy use, demographic characteristics, and alcohol and other drug use are explored. Ten percent of the sample reported lifetime ecstasy use, 7% reported use within the past 12 months, and 3% reported use within the past 30 days. Compared to non-users, 12-month ecstasy users were significantly more likely than non-users to be white and to have used all other drugs of abuse during the 12 months preceding the interview. These results suggest that ecstasy-related prevention efforts should target the at-risk population of rave attendees rather than the mainstream population of high school students. Copyright 2005, American Alcohol and Drug Information Foundation Zimmermann P; Wittchen HE; Waszak F; Nocon A; Hofler M; Lieb R. Pathways into ecstasy use: The role of prior cannabis use and ecstasy availability. Drug and Alcohol Dependence 79(3): 331-341, 2005. (71 refs.) Aim: To explore the role of cannabis use for the availability of ecstasy as a potential pathway to subsequent first ecstasy use. Methods: Baseline and 4-year follow-up data from a prospective-longitudinal community study of originally 3021 adolescents and young adults aged 14-24 years at baseline were assessed using the standardized M-CIDI and DSM-IV criteria. Results: Baseline cannabis users reported at follow-up more frequent access to ecstasy than cannabis non-users. Higher cannabis use frequencies were associated with increased ecstasy availability reports. Logistic regression analyses revealed that cannabis use and availability of ecstasy at baseline are predictors for incident ecstasy use during the follow-up period. Testing simultaneously the impact of prior cannabis use and ecstasy availability including potential confounders, the association with cannabis use and later ecstasy use was confirmed (OR = 6.3; 95%CI = 3.6-10.9). However, the association with ecstasy availability was no longer significant (OR = 1.2; 95%CI = 0.3-3.9). Conclusions: Results suggest that cannabis use is a powerful risk factor for subsequent first onset of ecstasy use and this relation cannot be sufficiently explained by availability of ecstasy in the observation period. Copyright 2005, Elsevier Science