Presentation is loading. Please wait.

Presentation is loading. Please wait.

Ecstasy Harmless Love Drug or Dangerous Neurotoxin? Meg Benningfield, MD Vanderbilt University.

Similar presentations


Presentation on theme: "Ecstasy Harmless Love Drug or Dangerous Neurotoxin? Meg Benningfield, MD Vanderbilt University."— Presentation transcript:

1 Ecstasy Harmless Love Drug or Dangerous Neurotoxin? Meg Benningfield, MD Vanderbilt University

2 2© Alcohol Medical Scholars Program 2010

3 3 This Talk Will Review:  What ecstasy is  Who uses it  How it works  Course & treatment © Alcohol Medical Scholars Program 2010

4 4 Ecstasy = MDMA 3,4-methylenedioxymethamphetamine E X or XTC Adam Euphoria Love Doves Hug Drug Disco Biscuit Go © Alcohol Medical Scholars Program 2010

5 5 MDMA Serotonin (5-HT) Amphetamine Mescaline © Alcohol Medical Scholars Program 2010

6 6 Ecstasy MDMA content varies May also contain –Methamphetamine –Caffeine –Dextromethorphan –Ephedrine –Cocaine 6© Alcohol Medical Scholars Program 2010

7 7 History 1912 Synthesized by Merck 1950s Military investigated use 1970s Used in treatment, no data 1980s Fatalities reported 1985 DEA Schedule sSharp ↑ in use 2000s2 clinical trials for anxiety © Alcohol Medical Scholars Program 2010

8 8 This Talk Will Review: What ecstasy is  Who uses it  How it works  Course & treatment © Alcohol Medical Scholars Program 2010

9 9 Epidemiology Worldwide: 9 mil annually US: 2.1 mil past year Adolescents: 4.1% have tried > 60% “easy to obtain” © Alcohol Medical Scholars Program 2010

10 10 Typical Ecstasy User Age M=F College student Rave parties Poly-drug user © Alcohol Medical Scholars Program 2010

11 11 Typical Pattern of Use 1 to 4 tabs per use Weekends Dancing Drinking water © Alcohol Medical Scholars Program 2010

12 Poly Drug Use Alcohol Marijuana Tobacco Hallucinogens Amphetamines Cocaine Opioids Nitrous Oxide 12 90% use ≥ 1 other drug © Alcohol Medical Scholars Program 2010

13 13 Ecstasy Use & Risk Taking Impulsivity Sexual behavior –↑ number of partners –↓ condom use © Alcohol Medical Scholars Program 2010

14 14 This Talk Will Review: What ecstasy is Who uses it  How it works  Course & treatment © Alcohol Medical Scholars Program 2010

15 Photo credit: Tomás Munita for The New York Times February 14, Desired Effects Empathy Energy Euphoria © Alcohol Medical Scholars Program 2010

16 Common Undesired Effects ↑ BP ↑ HR ↑Temperature Tremor Nausea Jaw clenching Teeth grinding Hyponatremia 16 © Alcohol Medical Scholars Program 2010

17 17 Rare Severe Effects Severe hyperthermia Rhabdomyolysis Disseminated intravascular coagulation Multi-organ failure (liver, kidney, etc.) Seizure Intracranial bleed or cerebral infarction Death © Alcohol Medical Scholars Program 2010

18 18 Serotonin Syndrome Hyperactivity Confusion Agitation Hyperreflexia ↑ Temperature Tachycardia Shivering Myoclonus Ocular oscillations Tremor © Alcohol Medical Scholars Program 2010

19 19 Risk of serious consequences ↑ with ↑ temperature, ↑ activity © Alcohol Medical Scholars Program 2010

20 20 MDMA Alters Brain Chemistry Serotonin (5-HT) Trends in cognitive sciences 12(1):31-40 © Alcohol Medical Scholars Program 2010

21 21 How Neurons Communicate Neurotransmitters are: 1.Synthesized in cytoplasm 2.Released from vesicles 3.Bound to post-synaptic receptors 4.Recycled by transporters 5.Broken down by enzymes 6.Bound to pre-synaptic receptors © Alcohol Medical Scholars Program 2010

22 22 Effect of MDMA at the Synapse 5-HTT 5-HT MDMA 5-HTR 22© Alcohol Medical Scholars Program 2010

23 23 Effect of MDMA on the Synapse 1. MDMA enters presynaptic cell 5-HTT 5-HT MDMA 5-HTR © Alcohol Medical Scholars Program 2010

24 24 Effect of MDMA on the Synapse 2. Vesicle breakdown 5-HTT 5-HT MDMA 5-HTR © Alcohol Medical Scholars Program 2010

25 25 Effect of MDMA on the Synapse 3. Reversal of 5-HT transporter 5-HTT 5-HT MDMA 5-HTR 5-HTT 5-HT MDMA 5-HTR © Alcohol Medical Scholars Program 2010

26 26 Effect of MDMA on the Synapse 4. Inhibits 5-HT breakdown 5-HTT 5-HT MDMA 5-HTR x x 5-HTT 5-HT MDMA 5-HTR 5-HTT 5-HT MDMA 5-HTR x x © Alcohol Medical Scholars Program 2010

27 27 Effect of MDMA on the Synapse 5. Inhibits new 5-HT synthesis 5-HTT 5-HT MDMA 5-HTR x x 5-HTT 5-HT MDMA 5-HTR 5-HTT 5-HT MDMA 5-HTR x x x 27© Alcohol Medical Scholars Program 2010

28 28 Effect of MDMA on the Synapse 6. Binds 2A receptor 5-HTT 5-HT MDMA 5-HTR x x 5-HTT 5-HT MDMA 5-HTR 5-HTT 5-HT MDMA 5-HTR x x © Alcohol Medical Scholars Program 2010 x

29 29 Long Term Toxicity to 5-HT Neurons Normal After MDMA Ricaurte, et al. (1988) JAMA 260:51-55 © Alcohol Medical Scholars Program 2010

30 30 This Talk Will Review: What ecstasy is Who uses it How it works  Course & treatment © Alcohol Medical Scholars Program 2010

31 31 Emergency Room Visits 16,000 visits in x rate in % ≤ 26 years old M=F Other drugs © Alcohol Medical Scholars Program 2010

32 Case 1: Acute toxicity 24 year old F Confused Agitated Visual hallucinations HR: 150, BP: 90/50, R: 36, T: 41.6˚ C Labs –LFTs, CPK, creatinine: elevated © Alcohol Medical Scholars Program

33 33 Management of Acute Toxicity Charcoal if <1h since ingestion Monitor vital signs Labs: BUN, creatinine, lytes, LFTs, CPK, UDS ECG © Alcohol Medical Scholars Program 2010

34 Management of Acute Toxicity Hyperthermia: cooling blanket Agitation: diazepam (Valium) 5-30 mg Hyponatremia: fluid restrict Hypertensive crisis: labetolol (40-80 mg iv q10 min) Hypotension: fluids Admit to ICU © Alcohol Medical Scholars Program

35 Case 1: Treatment Intubated to support ventilation 2L IV fluids for hypotension Icepacks for hyperthermia Diazepam for agitation Hemodynamically stable after 8 hours Extubated at 23 hours Severe complications resolved over 7 d © Alcohol Medical Scholars Program

36 36 Heavy use may be linked to Depression, Anxiety, Paranoia © Alcohol Medical Scholars Program 2010

37 Drug Abuse & Drug Dependence 37© Alcohol Medical Scholars Program 2010

38 38 Drug Abuse Presence of ≥ 1 in 12 months Inability to fulfill obligations Use in physically hazardous situations Use despite legal consequences Use despite interpersonal problems Never met criteria for drug dependence © Alcohol Medical Scholars Program 2010

39 39 Drug Dependence Presence of ≥ 3 in 12 months Use of larger amounts over longer time Desire or attempts to cut down ↑ time spent to obtain, use, or recover Give up other important activities Ongoing use despite problems Tolerance Withdrawal © Alcohol Medical Scholars Program 2010

40 40 MDMA Serotonin (5-HT) Amphetamine Mescaline © Alcohol Medical Scholars Program 2010

41 41 Screening, Brief Intervention, & Referral to Treatment (SBIRT) Assess Advise Agree Assist Arrange © Alcohol Medical Scholars Program 2010

42 SBIRT is collaborative Goal = enhance motivation for change Feedbackpersonalized, tailored to context Responsibilitybelongs to patient Adviceabout HOW to change Menuoptions for change Empathymeeting patients where they are Self-efficacystrength based © Alcohol Medical Scholars Program

43 Case 2: Chronic complications 22 year old M presents to PCP: Episodic chest pain, trouble breathing Thinks he may be dying Not sleeping well Stopped going to class Missing days at work © Alcohol Medical Scholars Program

44 Case 2, continued Ecstasy every weekend x 6 mos Now using “nerve pills” daily to cope Pills helped, but now needs more Spends day in bed Wants prescription © Alcohol Medical Scholars Program

45 Case 2: Treatment Benzodiazepine dependence –Detoxification –Outpatient follow-up Anxiety, depression –Cognitive behavioral therapy © Alcohol Medical Scholars Program

46 46 This Talk Will Review: What ecstasy is Who uses it How it works Course & treatment © Alcohol Medical Scholars Program 2010


Download ppt "Ecstasy Harmless Love Drug or Dangerous Neurotoxin? Meg Benningfield, MD Vanderbilt University."

Similar presentations


Ads by Google