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Drugs and the dance music scene: A survey of current drug use patterns among a sample of dance music enthusiasts in the UK

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Abstract

This study explores the utility of a self-completion survey method to quickly and cheaply generate information on patterns and trends among regular "recreational" drug consumers. Data is reported here from 1151 subjects accessed through a dance music publication. In keeping with previous studies of drug use within the dance scene polysubstance use was the norm. Many of those reporting use of "ecstasy" were regularly using multiple tablets often consumed in combination with other substances thus exposing themselves to serious health risks, in particular the risk of dose related neurotoxic effects. Seventy percent were drinking alcohol at hazardous levels. Subjects' patterns of drug purchasing also put them at risk of severe criminal sanction. Data supported evidence that cocaine use had become increasing popular in the UK, but contrasted with some commentators' views that ecstasy use was in decline. The utility of this method and how the results should be interpreted is discussed, as are the data's implications for harm and risk reduction activities.

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... Nitrous oxide is a drug of abuse among young adults in parties and night clubs [1]. It can be inhaled in the form of canisters. ...
... She was diagnosed with nitrous oxide-induced B12 deficiency leading to myeloneuropathy. In 1 1 1 the context of convincing clinical and laboratory features, further imaging was not pursued. The patient was started on intramuscular cyanocobalamin 1000 ug daily for five days and discharged on oral B12 supplementation. ...
... Nitrous oxide misuse has gained popularity recently at parties and music festivals. The 2012 Global Drug Survey, an international online survey of drug use in young adults, reported that almost half of respondents had used nitrous oxide recreationally at some point, 10% within the preceding 12 months [1]. It is relatively cheap, available in night clubs in the form of whippets which can be inhaled for recreational purposes. ...
Article
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Nitrous oxide abuse is an uncommon cause of subacute combined degeneration of the spinal cord. This is a case of a 27-year-old female exotic dancer who presented with clinical and laboratory manifestations of subacute combined degeneration of the spinal cord secondary to nitrous oxide-induced B12 deficiency from chronic whippets consumption.
... The link between engagement with the nightlife scene and the use of alcohol and illicit substances has long been established (Calafat, Fernandez, Juan, & Becona, 2008; McCambridge, Mitcheson, Winstock, & Hunt, 2005;Measham, Aldridge, & Parker, 2001;Nordfjaern, Bretteville-Jensen, Edland-Gryt, & Gripenberg, 2016;Palamar, Acosta, & Cleland, 2019;Winstock, Griffiths, & Stewart, 2001). Studies investigating young adults' motivations to use licit and illicit drugs highlight that most do so to enhance their enjoyment when engaging with the nightlife scene. ...
... Furthermore, a number of drug users in the nightlife scene are thought to be polydrug users, potentially compounding the risks of negative health outcomes (Winstock et al., 2001). Polydrug use is defined as the use of two or more substances at the same time or use of one while under the influence of another (Barrett, Darredeau, & Pihl, 2006;Grov, Kelly, & Parsons, 2009), or the use of multiple substances over a given period of time, such as 12 months (Connor, Gullo, White, & Kelly, 2014;Martin, 2008). ...
... Morley, Lynskey, Moran, Borschmann, & Winstock, 2015). Given the association between polydrug use and nightlife engagement, particularly with the electronic dance music scene (Connor et al., 2014;Grov et al., 2009;Winstock et al., 2001), it seems this would be an ideal population in which to employ methods such as LCA to further our understanding of polydrug use. However, there is a paucity of such research in the European nightlife scene, a key gap in the literature which is discussed in detail in Chapter 3. ...
Conference Paper
The use of alcohol and illicit drugs has long been a feature in the nightlife scene. However, there is a current paucity of research on contemporary patterns of drug use in European nightlife populations. Furthermore, there have been considerable developments in the European drug market, potentially placing people at elevated risk of harm. In Chapter 1, I provide an overview of this key gap in the literature and introduce the ALAMA-Nightlife project, a multi-country collaboration designed to address this. In Chapter 2, I demonstrate that the internet can be successfully used to recruit a sample of young European adults engaging with the nightlife scene, by showing an online sample to be broadly representative in terms of drug use, nightlife engagement and demographics as an offline sample recruited at nightclubs and festivals. The cross-sectional profiles of drug use are examined in Chapter 3, with Latent Class Analysis revealing six distinct subgroups indicating substantial heterogeneity in drug use patterns. Furthermore, increasing levels of polydrug use were associated with higher scores on indices of problematic alcohol and drug use. In Chapter 4, I examined the relationship between harm reduction and polydrug use, and identified five discrete patterns of personal protective strategies that differed in levels of polydrug use. Extensive endorsement of harm reduction behaviours was also associated with more positive and fewer negative consequences following drug use. Longitudinal trajectories of drug use in the European nightlife scene are assessed in Chapter 5, with findings suggesting considerable stability over the course of 12 months. Amongst the small percentage whose use did change at follow-up, both an increase and decrease were associated with lower perceptions of risk, while increasing or decreasing the number of electronic dance music events attended was associated with a corresponding change in drug use. In Chapter 6, I summarise these findings, discuss their implications and how they address current gaps in the evidence while considering their limitations, and suggest areas for future research on drug use in the European nightlife scene.
... In particular, the simultaneous use of several drugs (simultaneous polysubstance use, SPU) during the course of a single drug use session is common among street drug users (Barrett et al., 2006; EMCDDA, 2009; Tossmann et al., 2001) and may increase drug consumption (Barrett et al., 2006), morbidity and mortality from substance use (EMCDDA, 2009; Schifano et al., 2003), as well as influence the development of drug tolerance in complex ways (Parrott, 2005). Often, particular substances are combined to enhance psychoactive effects or to relieve unwanted after effects (Boys et al., 2001; Winstock et al., 2001). Whereas distinct characteristics of SPU have been described for different groups of street drug users and for users of particular substances including 3,4-methylenedioxymethamphetamine (MDMA) (Barrett et al., 2005; Tossmann et al., 2001), few studies have examined the order of substance administration and the doses used during SPU. ...
... The majority of participants in our study reported combining MDMA and alcohol in an interspersed manner (i.e., alcohol before, during, and after MDMA), whereas previous studies have found alcohol to be ingested predominantly before MDMA and less frequently in an interspersed manner (Barrett et al., 2006; Barrett et al., 2005). However, alcohol intake post-MDMA use has also been described; polysubstance users from the UK reported using alcohol to " improve the effects " and " help ease after effects " of MDMA (Boys et al., 2001), which is in agreement with a large UK study where 60% of MDMA users used alcohol to assist " come-down " after MDMA (Winstock et al., 2001). In our sample, the second-most prevalent coadministered substance with MDMA was cannabis, which is in agreement with previous reports of widespread MDMA and cannabis co-use (Hammersley et al., 1999; Parrott et al., 2007; Topp et al., 1999; Tossmann et al., 2001; Winstock et al., 2001). ...
... However, alcohol intake post-MDMA use has also been described; polysubstance users from the UK reported using alcohol to " improve the effects " and " help ease after effects " of MDMA (Boys et al., 2001), which is in agreement with a large UK study where 60% of MDMA users used alcohol to assist " come-down " after MDMA (Winstock et al., 2001). In our sample, the second-most prevalent coadministered substance with MDMA was cannabis, which is in agreement with previous reports of widespread MDMA and cannabis co-use (Hammersley et al., 1999; Parrott et al., 2007; Topp et al., 1999; Tossmann et al., 2001; Winstock et al., 2001). The high prevalence of cannabis and MDMA co-use may reflect psychosocial factors, such as the association of use of each substance with common genetic and environmental risk factors, as well as functional causes (Parrott et al., 2007). ...
... Though serious health incidents have been reported, including fatal cases, their incidence is very low especially considering its widespread use (van Amsterdam et al. 2020). MDMA is usually consumed in dance clubs and raves, frequently in the context of polysubstance use, i.e., MDMA in combination mainly with alcohol (and cannabis) (Barrett et al. 2005;Breen et al. 2006;Degenhardt et al. 2009;Izco et al. 2007;Mohamed et al. 2011;Schifano 2004;Winstock et al. 2001), probably because alcohol is legal and easily accessible in most countries. Around 90% of all ecstasy users also consume alcohol with over 70% of them at hazardous levels (Morefield et al. 2011;Winstock et al. 2001). ...
... MDMA is usually consumed in dance clubs and raves, frequently in the context of polysubstance use, i.e., MDMA in combination mainly with alcohol (and cannabis) (Barrett et al. 2005;Breen et al. 2006;Degenhardt et al. 2009;Izco et al. 2007;Mohamed et al. 2011;Schifano 2004;Winstock et al. 2001), probably because alcohol is legal and easily accessible in most countries. Around 90% of all ecstasy users also consume alcohol with over 70% of them at hazardous levels (Morefield et al. 2011;Winstock et al. 2001). In Australia, 65% of regular ecstasy users reported concomitant use of alcohol and MDMA (Breen, et al. 2006) and 35% reported concomitant high-risk alcohol use (Kinner et al. 2012). ...
... Then we summarize what is generally known about regulation of body temperature and hydration ("Mechanisms Involved in the Increased Risk of MDMA and Concomitant Alcohol Use"). Finally, we describe the literature on the possible mechanisms involved in the combined effects of MDMA and alcohol on hyperthermia ("Regulation of body Temperature"), dehydration ("Effect of MDMA and/or Green et al. (2004); Parrott (2012); Schütte et al. (2013); Topp et al. (1999) Prolonged and vigorous dancing in hot settings during "rave" dance parties Dafters (1995); Docherty and Green (2010); Kiyatkin et al. (2014); Parrott et al. (2006); Suy et al. (1999); Winstock et al. (2001) Reduced fluid intake and dehydration Bouchama and Knochel (2002); Coris et al. (2004); Montain and Coyle (1992); Sawka (1992) Alcohol on Body Temperature"), and hyponatremia ("Effect of MDMA and/or Alcohol on Hydration"). Table 2 describes the results of the nine studies finally included (one human study and eight rodent studies). ...
Article
Full-text available
Although MDMA (ecstasy) is a relatively safe recreational drug and is currently considered for therapeutic use for the treatment of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), recreational MDMA use occasionally elicits hyperthermia and hyponatremia, sometimes with a fatal outcome. Specific risk factors for both adverse effects are profuse sweating while vigorously dancing under unfavorable conditions such as high ambient temperatures and insufficient fluid suppletion which result in dehydration. Concomitant use of MDMA and alcohol is highly prevalent, but adds to the existing risk, because alcohol facilitates the emergence of MDMA-induced adverse events, like hyperthermia, dehydration, and hyponatremia. Because of potential health-related consequences of concomitant use of MDMA and alcohol, it is important to identify the mechanisms of the interactions between alcohol and MDMA. This review summarizes the main drivers of MDMA-induced hyperthermia, dehydration, and hyponatremia and the role of concomitant alcohol use. It is shown that alcohol use has a profound negative impact by its interaction with most of these drivers, including poikilothermia, exposure to high ambient temperatures, heavy exercise (vigorous dancing), vasoconstriction, dehydration, and delayed initiation of sweating and diuresis. It is concluded that recreational and clinical MDMA-users should refrain from concomitant drinking of alcoholic beverages to reduce the risk for adverse health incidents when using MDMA.
... The GDS expert advisory group and academic network formulate questions each year to gather data on drug use prevalence and patterns, cost, associated risks and harms and a range of specialist subject areas. Current research methods and tools are developed from previous work conducted by GDS, which has proven to be successful in identifying emerging drugs of abuse and use trends and patterns (McCambridge et al., 2007;Winstock and Barratt, 2013a;Winstock et al., 2001Winstock et al., , 2011Winstock et al., , 2014 Launched in mid-November, GDS promotes participation in the survey through social media and in collaboration with our media partners, including Fairfax Media, MixMag and The Guardian. Our recruitment strategy resulted in almost 80,000 people from over 150 countries participating in the most recent survey conducted in 2013, from which the data for this paper were taken. ...
... The findings are reliant on the retrospective self-report of participants who answered questions set by the survey, and high levels of poly-drug use, confounding effects from other substances and recall bias are all significant issues. These limitations and others have been discussed more fully elsewhere (McCambridge and Winstock, 2007;Winstock and Barratt, 2013b;Winstock et al., 2001;. The group has previously demonstrated that self-report studies among early-adopting drug-using groups are a valid and effective method for describing the effect profile and use characteristics of novel psychoactive substances (Winstock et al., 2002;. ...
Article
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In recent years the recreational use of inhaled nitrous oxide gas (N2O) is becoming increasingly popular, yet little is known about the characteristics of its users or the effects they experience. This paper presents original research from the 2014 Global Drug Survey (GDS) (n=74,864). GDS runs the largest survey of recreational drug use in the world. The findings confirm N2O as a very common drug of use, in particular in the UK and US (38.6% and 29.4% lifetime prevalence). In the UK N2O was reported to be the eighth most commonly used substance. N2O was generally consumed via gas-filled balloons, at festivals and clubs where use of other substances was common. The vast majority of users use infrequently, and their use is not associated with significant harm. However, there appears to be a subpopulation of heavy users who may be using in a dependent pattern. Analysis of last year N2O users (n=4883), confirms that N2O is associated with hallucinations and confusion (which may be the desired effects) and persistent numbness and accidental injury (27.8%, 23.9%, 4.3% and 1.2% of last year users, respectively). Accidental injury is associated with the highest number of 'hits' per session, suggesting a dose-response relationship. The presence of significant harm is discussed in the light of public education on the risks of N2O use and harm-reduction strategies appropriate to N2O use. Further work needs to be completed to confirm the presence of persistent neurological symptoms in recreational users.
... Tossman et al. (2001) noted that dance-rave music enthusiasts had 'considerably greater experience with ecstasy use than the general population of a corresponding age.' In a British survey of several thousand university students, 13% reported that they had ever used Ecstasy (Webb et al., 1996), whereas in another UK survey of a thousand dancer clubbers and ravers, the equivalent usage figure was 96% (Winstock et al., 2001). At a large Dutch rave, 81% reported having ever taken Ecstasy, while 64% had used it the previous night (Wijngaart et al., 1999). ...
... Lifetime Ecstasy/MDMA usage is one important factor, with heavier drug users demonstrating more neuropsychobiological problems than novice or light users (Bolla et al., 1998;Semple et al., 1999;Topp et al., 1999;Parrott et al., 2000Parrott et al., , 2001Parrott et al., , 2002Fox et al., 2001;Verkes et al., 2001;Gouzoulis-Mayfrank et al., 2003; see Table 3 in Morgan, 2000). Furthermore while 'pure' Ecstasy/ MDMA users can display neurocognitive deficits (Halpern et al., 2004;Yip and Lee, 2005), most Ecstasy users are polydrug users (Curran, 2000;Boys et al., 2001;Riley et al., 2001;Winstock et al., 2001;Scholey et al., 2004). The concomitant use of cannabis, alcohol, amphetamine, nicotine, LSD, ketamine, or other drugs, will also influence psychobiological functioning (Curran, 2000;Gouzoulis-Mayfrank et al., 2000, 2003Rodgers, 2000;Schifano, 2000;Croft et al., 2001;Fox et al., 2001Fox et al., , 2002Parrott, 2001Parrott, , 2003Parrott, , 2006Parrott et al., 2001;Milani et al., 2002Milani et al., , 2005Ling et al., 2003;Rodgers et al., 2003;Heffernan et al., 2005;Gouzoulis-Mayfrank and Daumann, 2006). ...
... These outcomes have also served to extend discussion beyond notions of individual criminality and morality to encompass social, economic and welfare debates, challenging conventional thinking about concepts like harm, risk and social responsibility by considering social contexts of drug use to understand the relationship that individuals and environments have on drug-related harms [43]. It is important, however, to emphasise that drug use is dangerous and cannot be conceptualised as risk-free, nor is pill testing a 'silver bullet' , with some well-documented concerns [44]. Instead, this article argues that pill testing needs to be viewed through a lens of pragmatism, where for certain users in certain settings, it is about providing young people with information about drugs and their use so they can make more informed choices to limit the associated harms, as well as making important practical changes to the settings in which drugs are used. ...
... Data are similar for use of methamphetamines with 6.3% reporting lifetime use and 1.4% revealing recent use [19]. Although these figures are lower than other western nations [44,66], and demonstrate stable or declining rates of use, they reveal that more than 2.2 million Australians have used ecstasy, and more than 1.3 million have used methamphetamines in their lifetime. However, it is not the numeric value but the location and nature of use and associated harms that are of most concern. ...
Article
Full-text available
Background: Recent deaths of young Australian music festival attendees from 'party-drug' overdoses have sparked debate about the effectiveness of drug policies. Australia is widely lauded for its harm minimisation approach to drugs, and yet, over the last 30 years, it can be argued its policies have been fragmented, sometimes inconsistent and contradictory. The present article examines the root of this inconsistency, using it as a foundation to advocate for drug policy reform. In keeping with the goals of the National Drug Strategy to promote policy innovation, there is an opportunity to learn from international studies which have shown promising findings in the reduction of party-drug use and its harms through application of pill testing. Method: This paper evaluates Australia's National Drug Strategy and pill testing through a lens of pragmatism, to determine whether there is space for testing practices in contemporary policy. Specifically, the paper analyses current drug policy literature and research studies, examining a range of key drug use indicators, social and political debate and research evidence. Results: The need for policy reform, attitudinal and cultural shifts and development of stronger cross-sectoral partnerships is highlighted, to ensure a rational and logical approach that genuinely tackles drug policy-making and strategy from a broad public health perspective. Conclusions: Using a theoretical frame of pragmatism and drawing from national and international research evidence, this paper recommends the integration of pill testing into Australia's harm minimisation strategy.
... A wide variety of psychoactive drugs, typically referred to as club drugs (MDMA/Ecstasy, methamphetamine, cocaine, ketamine, GHB, Rohypnol, marijuana, LSD, and psilocybin), are not only used, but normalized in the EDM scene (Hunt et al., 2007;Malbon, 1999;Takahashi & Olaveson, 2003;Winstock, Griffiths, & Stewart, 2001). However, MDMA (3,4-Methylenedioxymethamphetamine), also known as Ecstasy, is recognized internationally as the quintessential drug of EDM culture. ...
... He used systematic in situ observations to understand club drug use in the British EDM scene, with the goal to inform public health initiatives on how to enforce harm reduction policies in EDM culture (Measham & Moore, 2006). His research prompted a major trend of studies that used EDM culture to explore the use and effects of club drugs (Baggott et al., 2000;Bellis, Hughes, & Lowey, 2002;Grov et al., 2009;Halpern et al., 2010;Hunt & Evans, 2003;Hunt et al., 2007;Hunt et al., 2009;Kavanaugh & Anderson, 2008;Kelly, 2007;Malbon, 1999;Miller, Furr-Holden, Voas, & Bright, 2005;Moore & Miles, 2004;Parks & Kennedy, 2004;Parrot, 2004;Perrone, 2006;Rushkoff, 2001;Sanders, 2005Sanders, , 2006Winstock et al., 2001;Yacoubian et al., 2004). ...
Article
Full-text available
Electronic dance music (EDM) events may function as a ritual space for psycho-spiritual exploration and personal development, often linked to the occurrence of non-ordinary states of consciousness in participants. This paper reviews the literature addressing the spiritual, religious, and transpersonal facets of participants’ experiences at EDM events, with an emphasis on the subsequent integration of these experiences into daily life. Several empirical studies conducted in the past two decades, of which the most recent was conducted by the first author of the present paper (Redfield, 2017, this issue), provides grounds to argue that EDM events can be vectors for enhancing personal and psychosocial wellbeing for their participants—a discussion that was omitted in previous studies that strictly emphasized either the dangers or the purely hedonistic nature of EDM participation. The paper concludes with suggestions for further research into the specific ways in which EDM events may benefit individual participants.
... Our design afforded us the ability to collect a large sample rapidly and on an unprecedented various ROAs. This methodology has advantages and disadvantages including those surrounding reliability and validity at a population-based level, as discussed elsewhere (30)(31)(32)(33). Online surveys are considered a credible vehicle for opportunistic research and are valuable where current data are scarce, as is the current case. ...
... This study had some limitations. First, we used a selfnominating convenient (drug-using) sample using an Internet survey that this may have some reliability and validity issues that include the limited ability to generalize to the countries included in our analysis (30)(31)(32)(33). Therefore, these estimates should be treated with caution until replicated; although our data on UK ROAs show consistency with a previous GDS sample of UK cannabis users (37). ...
... Our design afforded us the ability to collect a large sample rapidly and on an unprecedented various ROAs. This methodology has advantages and disadvantages including those surrounding reliability and validity at a population-based level, as discussed elsewhere (30)(31)(32)(33). Online surveys are considered a credible vehicle for opportunistic research and are valuable where current data are scarce, as is the current case. ...
... This study had some limitations. First, we used a selfnominating convenient (drug-using) sample using an Internet survey that this may have some reliability and validity issues that include the limited ability to generalize to the countries included in our analysis (30)(31)(32)(33). Therefore, these estimates should be treated with caution until replicated; although our data on UK ROAs show consistency with a previous GDS sample of UK cannabis users (37). ...
Article
Full-text available
Cannabis and tobacco are common drugs of abuse worldwide and are often used in combination through various routes of administration (ROAs). Here, we aimed to provide an overview of how cannabis and tobacco routes varied across countries and assess the impact of tobacco-based ROAs on motivation to use less cannabis, and less tobacco, in different models. A cross-sectional online survey (Global Drugs Survey 2014) was completed by 33,687 respondents (mean age = 27.9; % female = 25.9) who smoked cannabis at least once in the last 12 months. Most common ROA, frequency of cannabis/tobacco use, and questions about motivation to use less cannabis/ tobacco were recorded. Tobacco-based ROA were used by 65.6% of respondents. These were most common in Europe (77.2–90.9%) and Australasia (20.7–51.6%) and uncommon in the Americas (4.4–16.0%). Vaporizer use was most common in Canada (13.2%) and the United States (11.2%). Using a non-tobacco ROA was associated with a 10.7% increase in odds for " desire to use less " tobacco (OR: 1.107, 95% CI: 1.003, 1.221), 80.6% increase in odds for " like help to use less tobacco " (OR: 1.806, 95% CI: 1.556, 2.095), and a 103.9% increase in the odds for " planning to seek help to use less tobacco " (OR: 2.039, 95% CI: 1.638, 2.539), in comparison to using a tobacco-based ROA. Associations between ROA and intentions to use less cannabis were inconsistent. Results support considerable global variation in cannabis and tobacco ROA. Tobacco routes are common, especially " joints with tobacco, " especially in Europe, but not in the Americas. Non-tobacco-based routes are associated with increased motivation to change tobacco use. Interventions addressing tobacco and cannabis need to accommodate this finding and encourage non-tobacco routes.
... Table 1 displays the distribution frequencies of the demographic characteristics. The median number of EDM events visited during the past 12 months were 15 (interquartile range: [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The most common music styles played at the events were house and techno, followed by electro, hip-hop, RnB, trance, and disco (see , Supplementary Table S3). ...
... Compared with previous studies conducted in nightlife settings, the present study showed a similarly high prevalence of illicit drug use during the previous year as that among club goers in Norway (43%) [20] and among staff at licensed premises in Stockholm (47% among 18-to 24-year-olds) [56]. Furthermore, in line with previous studies, the most commonly used drugs were cannabis, followed by ecstasy, cocaine, and amphetamine [4,[11][12][13]15,17,20,[23][24][25][26][27]41]. Moreover, 11% of participants reported last-year use of ketamine. ...
Article
Full-text available
Illicit drug use is prevalent in the nightlife scene, especially at electronic dance music (EDM) events. The aim of the present study was to investigate illicit drug use patterns and consequences of drug use among frequent visitors of EDM events. Young adults (18–34 years old) who had visited at least six EDM events in Sweden during the past year participated in a web-based survey on drug use patterns and its consequences. Fifty-nine percent of participants had used illicit drugs during the past year, most often cannabis followed by ecstasy, cocaine, and amphetamine. Nightlife venues were identified as the main setting for the use of central stimulants, while cannabis was mostly used at home. Frequent alcohol and tobacco use was associated with illicit drug use. The most prevalent negative consequences of drug use were related to mental health, such as impairments in mood, sleep, and memory problems, but physical manifestations were also reported, such as palpitations and collapsing. These findings confirm that drug use is prevalent and associated with negative health effects among EDM nightlife attendees. The nightlife scene is a setting with promising potential to reach a high-risk target group with illicit drug use prevention interventions.
... 14,15 Furthermore, studies have shown the link between the music genre of festivals and drug use patterns. [16][17][18] Electronic music festivals in particular have been extensively linked with higher drug consumption and particularly increased use of amphetamine-type stimulants (ATS) such as 3,4-methylenedioxymethamphetamine (MDMA). 16,18 Law enforcement agencies (LEAs) are tasked with preventing illicit drugs from reaching the festival site by performing searches at the entrance. ...
... [16][17][18] Electronic music festivals in particular have been extensively linked with higher drug consumption and particularly increased use of amphetamine-type stimulants (ATS) such as 3,4-methylenedioxymethamphetamine (MDMA). 16,18 Law enforcement agencies (LEAs) are tasked with preventing illicit drugs from reaching the festival site by performing searches at the entrance. 19,20 When a suspicious sample is encountered, LEAs require a fast on-site indication of the presence of illicit substances to decide on further actions. ...
Article
Full-text available
Music festivals have emerged as an important setting for the consumption of illicit drugs, harming both consumers and soci-ety. Therefore, law enforcement present at these events requires straightforward, robust and...
... MDMA users usually take one to two tablets per occasion and generally use MDMA once per week or less because of rapid tolerance to its desirable effects (Topp et al., 1999;Morgan, 2000;Winstock et al., 2001;Riley et al., 2001;Scholey et al., 2004;Gouzoulis-Mayfrank and Daumann, 2006;Parrott et al., 2006;ter Bogt et al., 2006). Only about 9%-17% of MDMA users take an average of three or four tablets per occasion, and about 3%-10% of MDMA users take an average of more than four tablets per occasion (Scholey et al., 2004;Parrott et al., 2006;ter Bogt et al., 2006). ...
Article
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3,4-Methylenedioxymethamphetamine (MDMA) is a synthetic, psychoactive drug that is primarily used recreationally but also may have some therapeutic value. At low doses, MDMA produces feelings of relaxation, empathy, emotional closeness, and euphoria. Higher doses can produce unpleasant psychostimulantand hallucinogen-like adverse effects and therefore are usually not taken intentionally. There is considerable evidence that MDMA produces neurotoxicity and cognitive deficits at high doses; however, these findings may not generalize to typical recreational or therapeutic use of low-dose MDMA. Here, we systematically review 25 years of research on the cognitive effects of MDMA in animals, with a critical focus on dose. We found no evidence that doses of less than 3 mg/kg MDMA—the dose range that users typically take—produce cognitive deficits in animals. Doses of 3 mg/kg or greater, which were administered most often and frequently ranged from 5 to 20 times greater than an average dose, also did not produce cognitive deficits in a slight majority of experiments. Overall, the preclinical evidence of MDMA-induced cognitive deficits is weak and, if anything, may be the result of unrealistically high dosing. While factors associated with recreational use such as polydrug use, adulterants, hyperthermia, and hyponatremia can increase the potential for neurotoxicity, the short-term, infrequent, therapeutic use of ultra low-dose MDMA is unlikely to pose significant cognitive risks. Future studies must examine any adverse cognitive effects of MDMA using clinically relevant doses to reliably assess its potential as a psychotherapeutic.
... A recent analysis of a nationally representative study of high school seniors found that compared to non-attendees, rave attendees were much more likely to report use of each of the 18 drugs queried, with use of all drugs other than marijuana being at least twice as prevalent among attendees (Palamar et al., 2015a). Many studies targeting this population have also found high prevalence of use of various drugs (Kelly, Parsons, & Wells, 2006;Kipke et al., 2007;Mattison et al., 2001;McCambridge, Mitcheson, Winstock, & Hunt, 2005;Palamar, Acosta, Ompad, & Cleland, 2016a;Pantalone, Bimbi, Holder, Golub, & Parsons, 2010;Winstock, Griffiths, & Stewart, 2001). Alarmingly, poisonings and drug-related deaths are now common at EDM festivals (Centers for Disease Control and Prevention, 2010;Lund & Turris, 2015;Ridpath et al., 2014). ...
Article
Background: Electronic Dance Music (EDM) party attendees are often polysubstance users and are at high risk for use of new psychoactive substances (NPS). We sought to identify patterns of use of common illegal drugs among EDM party attendees, sociodemographic correlates, and use of NPS as a function of patterns of use of more common drugs to inform prevention and harm reduction. Method: Using time-space-sampling, 1045 individuals aged 18-40 were surveyed entering EDM parties in New York City. We queried past-year use of common illegal drugs and 98 NPS. We conducted latent class analysis to identify polysubstance use profiles of use of eight common drugs (i.e., ecstasy, ketamine, LSD, mushrooms, powder cocaine, marijuana, amphetamine, benzodiazepines). Relationships between drug classification membership and sociodemographics and use of drugs within six NPS categories were examined. Results: We identified four profiles of use of common drugs: non-polysubstance use (61.1%), extensive polysubstance use (19.2%), moderate polysubstance use/stimulants (12.8%), and moderate polysubstance use/psychedelics (6.7%). Those in the moderate/psychedelic group were at higher odds of using NPS with psychedelic-type effects (2C, tryptamines, and other "new" psychedelics; Ps<0.05). Extensive polysubstance users were at increased odds of reporting use of 2C drugs, synthetic cathinones ("bath salts"), tryptamines, other new (non-phenethylamine) psychedelics, new dissociatives, and synthetic cannabinoids (Ps<0.05). Conclusion: NPS preference is linked to the profile of use of common drugs among individuals in the EDM scene. Most participants were identified as non-polysubstance users, but findings may help inform preventive and harm reduction interventions among those at risk in this scene.
... Bingeing on MDMA was initially rare (Winstock, 1991) and intermittent single dosages formed the typical pattern of use (Davison and Parrott, 1997). However, later surveys identified a rise in MDMA bingeing (Winstock et al., 2001). In contrast, the considerable abuse liability of mephedrone has been widely described in the early literature (Brunt et al., 2011;Winstock et al., 2011b;Wood et al., 2010b). ...
Article
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Aims: The purpose of this study was to compare the effects of mephedrone and 3,4-methylenedioxy-methamphetamine (MDMA), as reported by young recreational polydrug users. Methods: 152 MDMA users and 81 mephedrone users were recruited through snowballing on social network sites. They completed a standard online questionnaire for either mephedrone or MDMA. The questions covered the average amount taken per session, the longest duration of usage in the last 12-months, subjective effects while on-drug, and recovery effects in the days afterwards. Results: Mephedrone users reported a significantly longer maximum session of use than MDMA users. Mephedrone users also reported a significantly greater average amount used per session. The majority of on-drug subjective ratings did not differ between drugs, with similar increases in entactogenic effects. Although mephedrone users did report significantly more frequent issues with sleeping, anger and anxiety. In relation to recovery, mephedrone users reported more frequent craving, nasal irritation, paranoia, and relationship difficulties. Mephedrone users also rated general recovery effects as more severe over the seven-day period following use, taking more days to feel normal. Conclusions: The acute effects of MDMA and mephedrone were broadly similar. However, the recovery period for mephedrone was more enduring, possibly due to the longer duration of acute session usage.
... But, the survey provides a mechanism to recruit large numbers of otherwise hard-to-reach groups across multiple countries (Barratt et al., 2017). The value of the data borne from the survey is broad with over 25 peer-reviewed publication published using GDS data since 2013 (see for example Barratt, Ferris, & Winstock, 2014;Barratt et al., 2017;Labhart, Ferris, Winstock, & Kuntsche, 2017;Morley, Lynskey, Moran, Borschmann, & Winstock, 2015;Winstock, Griffiths, & Stewart, 2001), including for cross-national comparisons of the nature and impacts of different alcohol policies (Labhart et al., 2017). ...
Article
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Background: Drug law enforcement subsumes the majority of drug policy expenditure across the globe. Fuelled by knowledge that much of this investment is ineffective or counter-productive there have been increasing calls for cross-national comparisons to identify where policing approaches differ and what types of approaches may be more effective. Yet, to date cross-national comparison of drug law enforcement has proven a methodologically hazardous affair. Using a new drug policing module added to the 2017 Global Drug Survey, this study seeks to provide the first cross-national comparison of the incidence, nature and intensity of illicit drug-related police encounters amongst people who use drugs. Methods: The Global Drug Survey was administered in late 2016. Across 26 countries including Australia, Germany, Italy, Mexico, Switzerland, the UK and the USA a total of 45,942 people who had recently used drugs completed the drug policing module. Key variables assessed included the incidence and frequency of drug-related police encounters in the last 12 months that involved: a) being stopped and searched; b) encountering a drug detection dog; c) being given a caution or warning; d) being charged and arrested; and e) paying a bribe. Multi-level models were used to control for pre-existing national differences in drug use prevalence and non-drug specific policing (including the total number of police personnel in each country). Results: Drug-related police encounters were most commonly reported in Italy and Scotland. Conversely, police encounters were most likely to lead to arrest in Norway, Finland and Sweden. The type and locations of encounters further differed across countries, with for example stop and search most reported in Greece and Colombia, and encounters with drug detection dogs most reported in Scotland, Italy, UK and Australia. Multi-level models showed that the incidence of reported policing encounters continued to differ significantly across countries after controlling for pre-existing national differences in drug use prevalence and policing, and that drug policing encounters were 4 to 14 times more common in some nations than others. Conclusion: The findings unearth significant cross-national differences in the incidence and nature of drug-related policing of people who use drugs. This suggests that there may be opportunities for countries to learn from each other about how and why they differ, and the potential benefits of switching to lower intensity modes of drug policing.
... Due to widespread consumption as well as acute and chronic toxic effects, MDMA is a matter of high concern. In addition to positive effects of MDMA on mood, alertness and energy [2], MDMA-induced impairments of cognitive functions have been shown in different human and animal studies. A wide range of cognitive functions have been reported to be damaged due to MDMA consumption in humans including selective attention, spatial memory, decision making [3][4][5], and verbal memory [6]. ...
Article
Debate continues about the effect of 3, 4-methylenedioxymethamphetamine (MDMA) on cognitive and mitochondrial function through the CNS. It has been shown that physical exercise has an important protective effect on cellular damage and death. Therefore, we investigated the effect of physical exercise on MDMA-induced impairments of spatial learning and memory as well as MDMA effects on brain mitochondrial function in rats. Male wistar rats underwent short-term (2 weeks) or long-term (4 weeks) treadmill exercise. After completion of exercise duration, acquisition and retention of spatial memory were evaluated by Morris water maze (MWM) test. Rats were intraperitoneally (I.P) injected with MDMA (5, 10, and 15mg/kg) 30min before the first training trial in 4 training days of MWM. Different parameters of brain mitochondrial function were measured including the level of ROS production, mitochondrial membrane potential (MMP), mitochondrial swelling, mitochondrial outermembrane damage, the amount of cytochrome c release from the mitochondria, and ADP/ATP ratio. MDMA damaged the spatial learning and memory in a dose-dependent manner. Brain mitochondria isolated from the rats treated with MDMA showed significant increase in ROS formation, collapse of MMP, mitochondrial swelling, and outer membrane damage, cytochrome c release from the mitochondria, and finally increased ADP/ATP ratio. This study also found that physical exercise significantly decreased the MDMA-induced impairments of spatial learning and memory and also mitochondrial dysfunction. The results indicated that MDMA-induced neurotoxicity leads to brain mitochondrial dysfunction and subsequent oxidative stress is followed by cognitive impairments. However, physical exercise could reduce these deleterious effects of MDMA through protective effects on brain mitochondrial function.
... Its popularity in United Kingdom as a recreational drug has grown dramatically among dance and rave scene attendees. A study with 1,151 subjects ascertained through a dance music publication reported that lifetime and recent ketamine use histories in this sample were 26%, and none of them ever injected ketamine (75). A school survey in northeast England found that 1% of 13-to 14-year olds and 2% of 15-to 16-year-olds students had tried ketamine (76). ...
Article
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Background: Ketamine is an anesthetic commonly used in low-income countries and has recently been shown to be effective for treatment-resistant depression. However, the illicit manufacturing, trafficking, and nonmedical use of ketamine are increasing globally, and its illicit use poses major public health challenges in many countries. Objectives: To review the nonmedical use of ketamine in selected countries and its regulatory control. Methods: We conducted a review of literature identified from searches of the China National Knowledge Infrastructure (CNKI) (1979-2016) and PubMed databases, supplemented by additional references identified by the authors. Special attention was given to the regulation of ketamine. Results: Illicit manufacturing, trafficking, and use of ketamine appear to have begun on a large scale in several Asian nations, and it has subsequently spread to other regions. Regulations governing availability of ketamine vary across countries, but there is a clear trend toward tighter regulations. Conclusions: As nonmedical use of ketamine and its harmful consequences have worsened globally, stricter controls are necessary. Appropriate regulation of ketamine is important for international efforts to control ketamine's cross-border trafficking and its nonmedical use.
... Since ecstasy users abuse a variety of other recreational drugs (Gouzoulis-Mayfrank & Daumann, 2006a, 2006bRogers et al., 2009) it is difficult to ascertain the actual causes of the deficits. For instance, ecstasy users are more likely than non-users to use cannabis, amphetamine, cocaine, LSD, psilocybin, opioids, ketamine, inhalants, and other drugs that may cause neurocognitive deficits (Fox, Parrott, & Turner, 2001;McCann et al., 2008;Morefield, Keane, Felgate, White, & Irvine, 2011;Roiser & Sahakian, 2004;Schilt et al., 2007;Thomasius et al., 2003;Winstock, Griffiths, & Stewart, 2001). One study of mothers who used ecstasy during pregnancy in addition to significantly more cocaine, LSD, psilocybin mushrooms, and marijuana than non-ecstasy users confidently attributed motor delays in their offspring to the mother's ecstasy use (Singer et al., 2016). ...
Article
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Numerous studies have suggested that MDMA can cause neurocognitive deficits. However, the available data can only suggest an association-rather than a causal relationship-between MDMA use and neurocognitive deficits. The reliability and robustness of this association was evaluated using Bradford Hill's criteria for determining causation in epidemiology research. Several limitations in the literature were found. Studies have recruited people who abuse ecstasy-an illicit drug that does not always contain MDMA. There is inherent risk in consuming impure or falsely identified substances; and using this as a source as for scientific opinion may introduce biases in our understanding the actuals risks associated with MDMA. Importantly, given that ecstasy research is predominately retrospective, baseline functioning cannot be established; which may be influenced by a variety of preexisting factors. Many studies introduce statistical errors by inconsistently dichotomizing and comparing light and heavy ecstasy users, making dose-response relationships inconclusive. When interpreting the ecstasy literature effect sizes are a more meaningful indicator of neurocognitive functioning rather than relying on p-values alone. Most meta-analyses have failed to find clinically relevant differences between ecstasy users and controls. There is also consistent evidence of publication bias in this field of research, which indicates that the literature is both biased and incomplete. Finally, suggestions for improving the ecstasy literature are provided.
... MDMA, commonly known as ecstasy, is a popular drug in social settings [7]. Following ingestion, large amounts of serotonin are released, causing elevated mood, empathy and emotional closeness [8] and producing effects such as sociability, amicability, and interpersonal closeness [9]- [14]. ...
... While recall bias could potentially affect the validity of some of the included predictors (e.g., frequency of cannabis use), we had restricted the correlation analyses to variables relating to past year behaviors (e.g., frequency of cannabis use in the last year) only, to minimize the risk of bias. Of note, data was collected using non-representative sampling, which has advantages and disadvantages, including those surrounding reliability and validity at a population-based level, as discussed elsewhere [77][78][79]. However, the anonymous web survey design employed here is particularly valuable for the collection of data on sensitive topics, including substance use, as such design can provide a sense of privacy that is missing in faceto-face interviews. ...
Article
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Cannabis, a widely used psychoactive substance, can trigger acute cannabis-associated psychotic symptoms (CAPS) in people who use cannabis (PWUC). To assess rates and correlates of CAPS requiring emergency medical treatment, we analyzed data from an international sample of PWUC (n = 233,475). We found that 0.47% (95%CI 0.42; 0.52) PWUC reported lifetime occurrence of CAPS, defined as the occurrence of hallucinations and/or paranoia requiring emergency medical treatment following the use of cannabis. A range of factors correlated with risk of CAPS in the last year: higher rates were observed in young individuals [risk ratio (RR) 2.66, compared to older PWUC] and those residing in Denmark (RR 3.01, compared to PWUC from other countries). Furthermore, risk was elevated in those using predominantly high-potency resin (RR 2.11, compared to PWUC using herbal cannabis), those mixing cannabis with tobacco (RR 2.15, compared to PWUC not mixing with tobacco) and those with a diagnosis of psychosis (RR 14.01), bipolar (RR 4.30), anxiety (RR 2.92) and depression (RR 2.68), compared to individuals without a mental health diagnosis. Taken together, acute self-limiting psychotic symptoms in the context of cannabis use may occur in about 1 in 200 PWUC’s lifetime. Some individuals could be particularly sensitive to the adverse psychological effects of cannabis, such as young individuals or those with pre-existing mental health vulnerabilities. In light of the movements towards legalization of recreational cannabis, more research should focus on the potential harms related to cannabis use, to educate PWUC and the public about risks related to its use.
... 3,4-methylenedioxymethamphetamine (MDMA) is a psychoactive drug that has been widely used as a recreational drug for its entactogenic (promoting feelings of empathy and relatedness), pro-social and euphoric effects (Cami et al., 2000;Harris et al., 2002;Winstock et al., 2001). It may elicit these effects through modulation of monoamine neurotransmitter systems (Green et al., 2003). ...
... Likewise, an equal percentage of people liked to combine alcohol with MDMA or ecstasy with alcohol, even though lifetime drug use of both drugs were also very different in the two countries. Not only does this highlight the need for a more nuanced version of the normalization thesis, which is quantified and differentiated cross nationally, but it also highlights the dynamic nature of normalization within countries over time: For example, our study suggests a trend in the interest among young club-and bar-goers in England toward mixing heavy alcohol use with cocaine in the NTE rather that alcohol and ecstasy use, which dominated previous studies of the dance and rave scene (Carlson, Wang, Falck, & Siegel, 2005;Tossmann et al., 2001;Winstock et al., 2001). ...
Article
Cross-national surveys of young adults’ simultaneous polydrug use (SPU) are rare, as measuring polydrug use requires multiple questions capturing the timing, sequence, and dosage of mixing drugs. This study proposes a new way of measuring SPU by examining how preferences for simultaneous polydrug use (PSPU) vary among club/bar-goers in two European countries, Denmark and England, typically cited as exemplars of the normalization of illegal drug use. The study considers the utility of the normalization thesis for understanding preferences for polydrug use in the European nighttime economy. An in situ survey of 1,298 young adults (18–35 years) conducted in 50 bars, pubs, and nightclubs in England and Denmark assessed sociodemographics, substance use patterns, and personal preference(s) for mixing alcohol and drug use. Multinomial regression analyses examined the relative risk of PSPU categories among those reporting drug use, according to sociodemographics, alcohol intake, frequency of intoxication, and smoking. Illicit drug use was more prevalent among young adults in England than Denmark. The difference was smallest for cannabis use: Lifetime cannabis use is 66% in England and 58% in Denmark. Lifetime cocaine use was 38% in England and 17% in Denmark. In England, young adults with drug experience preferred to mix alcohol with cocaine (65%). In Denmark, young adults with drug experience preferred to mix alcohol with cannabis (78%). In multinominal regression, Danish young adults’ educational level was associated with PSPU, whereas in England legal substance use was associated with PSPU. This study calls for a more differentiated understanding of normalization. Preferences for mixing alcohol and drug use varied significantly cross nationally (alcohol/cocaine, England; alcohol/cannabis, Denmark). Different factors are associated with PSPU in each country. In England, not Denmark, drinking behaviors appear to shape preferences for mixing alcohol with cocaine, suggesting caution should be taken when replicating harm reduction interventions.
... simultaneous use, concurrent use or the last 12 months) (Connor, Gullo, White, & Kelly, 2014). This pattern of drug use has been linked to more negative consequences when compared with single drug use (Morley, Lynskey, Moran, Borschmann, & Wisntock, 2015;Quek et al., 2013;Verdejo-García et al., 2010), and has been typically reported to occur among festival attendees (Fernández-Calderón, Díaz-Batanero, Barrat & Palamar, 2019;Hesse, Tutenges, & Schliewe, 2010;Palamar, Griffin-Tomas, & Ompad, 2015;Winstock, Griffiths, & Stewart, 2001). High rates of drug use have been documented among attendees at these recreational settings. ...
Article
Background: Although the relationship between personality traits and substance use is well documented, no studies have analyzed this relationship in a sample of polysubstance users who attend festivals. Moreover, few studies have explored how personality traits could contribute to the use of harm reduction strategies for minimizing drug-related harms. Objective: To determine the relationship between personality traits, poly-substance use and harm reduction strategies among polysubstance-using music festival attendees. Methods: A cross-sectional web-based survey was employed with 1226 participants (mean age = 26.8; females = 32.6%) who self-identified as polysubstance users (operationalized as multiple past-year drug use) and music festival attendees. The Substance Use Risk Profiles Scale was used to assess four personality traits. Information on the use of 15 substances and nine harm reduction strategies was collected. Results: Higher levels of impulsivity, sensation seeking and hopelessness were associated with both an increased likelihood of using different substances, and extensive polysubstance use. Increases in impulsivity scores were related to lower odds of frequently using the nine strategies explored. Conclusions: Our findings suggest that among polysubstance users, the probability of using drugs and harm reduction strategies is linked to personality traits, which could inform the design of interventions for reducing drug-related harms among this population.
... Recreational ecstasy (3,4-methylenedioxymethamphetamine; MDMA) use has been increasingly associated with long-term psychological changes including elevated levels of psychoticism, phobic-anxiety, obsessive-compulsive symptomatology, depression and generalized anxiety (Parrott et al., 2000;Dugherio et al., 2001;Parrott et al., 2001;Daumann et al., 2001;Morgan et al., 2002;Thomasius et al., 2003). In a UK survey of ecstasy users, 55% reported continuing to use ecstasy despite reporting problems (Winstock et al., 2001). In the same study 15% of ecstasy users fell into the problematic range, as defined by the Severity of Dependence Scale. ...
... In humans, the use of MDMA, the psychoactive component in ecstasy, occurs during late adolescence and young adulthood, and is associated with long-term changes including depression and social anxiety (Winstock et al., 2001) MDMA administration, in rats, also induces long-term behavioral changes including a pronounced decrease in social contact, as measured in a social interaction test. ...
Poster
MDMA (3, 4 methylenedioxymethamphetamine) is a popular club drug in adolescents and young adults that is typically taken in an intermittent binge pattern. It seems to be unique among psychostimulants in its profound subjectively pro-social effects in humans. In rodent models of MDMA use, acute exposure causes an increase in social contact, whereas repeated MDMA exposure leads to a long lasting decrease in social behavior. Oxytocin and vasopressin are peptides produced in the paraventricular (PVN) and supraoptic (SON) nuclei of the hypothalamus. Both substances are known to influence social behavior in many species and research suggests that serotonin, the principal neurotransmitter affected by MDMA, may regulate oxytocin neurotransmission. We tested the model that the effects of MDMA on social behavior are mediated by its action on these peptides by assessing the effect of repeated MDMA binge administration in male rats on oxytocin and vasopressin content in the PVN and SON. MDMA (0, 2.5, or 5 mg/kg SC) was administered 4 times per day over a 6-h period to periadolescent rats on postnatal day (PND) 35, 40, 45, 50, 55, and 60. Approximately 3 months after the last MDMA treatment (at a time in which decreased social behavior consequent to MDMA exposure is apparent), brains were harvested, cut, and stained for either oxytocin or vasopressin using immunohistochemistry. We found that MDMA induced a significant dose-dependent decrease in basal oxytocin content in the PVN, but not in the SON. We found no significant effect of MDMA treatment on vasopressin. Our results show that, in rats, repeated exposure to MDMA during the periadolescent period induces long term changes in oxytocin content but not vasopressin content. Furthermore, the effect of MDMA on oxytocin is specific to the PVN and therefore, may be limited to the central activity of oxytocin. These results are consistent with our working model that the effects of MDMA on social behavior are mediated by MDMA-induced changes in oxytocin.
... 3,4-methylenedioxymethamphetamine (MDMA) is a psychoactive drug that has been widely used as a recreational drug for its entactogenic (promoting feelings of empathy and relatedness), pro-social and euphoric effects (Cami et al., 2000;Harris et al., 2002;Winstock et al., 2001). It may elicit these effects through modulation of monoamine neurotransmitter systems (Green et al., 2003). ...
Article
Rationale Novel, evidence-based treatments are required for treatment-resistant post-traumatic stress disorder (PTSD). 3,4-Methylenedioxymethamphetamine (MDMA) has beneficially augmented psychotherapy in several small clinical trials. Objective To review the use of MDMA-assisted psychotherapy in treatment-resistant PTSD. Methods Systematic searches of four databases were conducted from inception to February 2020. A meta-analysis was performed on trials which were double-blinded, randomised, and compared MDMA-assisted psychotherapy to psychotherapy and placebo. The primary outcomes were the differences in Clinician Administered PTSD Scale (CAPS-IV) score and Beck’s Depression Inventory (BDI). Secondary outcome measures included neurocognitive and physical adverse effects, at the time, and within 7 days of intervention. Results Four randomised controlled trials (RCTs) met inclusion criteria. When compared to active placebo, intervention groups taking 75 mg (MD −46.90; 95% (confidence intervals) CI −8.78, −5.02), 125 mg (MD −20.98; 95% CI −34.35, −7.61) but not 100 mg (MD −12.90; 95% CI −36.09, 10.29) of MDMA with psychotherapy, had significant decreases in CAPS-IV scores, as did the inactive placebo arm (MD −33.20; 95% CI −40.53, −25.87). A significant decrease in BDI when compared to active placebo (MD −10.80; 95% CI −20.39, −1.21) was only observed at 75 mg. Compared to placebo, participants reported significantly more episodes of low mood, nausea and jaw-clenching during sessions and lack of appetite after 7 days. Conclusion These results demonstrate potential therapeutic benefit with minimal physical and neurocognitive risk for the use of MDMA-assisted psychotherapy in TR-PTSD, despite little effect on Beck’s Depression Inventory. Better powered RCTs are required to investigate further. International Prospective Register of Systematic Reviews CRD42019109132 available online at www.crd.york.ac.uk/prospero .
... Furthermore, MDMA is consumed either alone or in combination with other drugs, such as ethanol, cannabis, and cocaine, which also are known to induce immune function alterations. [7][8][9][10][11] Hence, such effects have to be combined with those elicited by MDMA. Thus, more pronounced and long-lasting immunological changes may result from the aforementioned MDMA consumption patterns with potentially enhanced susceptibility to infection and immune-related disorders. ...
... According to internet surveys answered by men who have sex with men (MSM) in Japan [4], 65.5% of respondents had used illegal drugs in their lifetime. As overseas research indicates, MSM and rave attenders are at an especially high risk of drug use [5][6][7], with this likely also being true in the Japanese context. ...
Article
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Background Consuming drugs in conjunction with sexual intercourse may shape the perceived interdependence of drug use and sexual intercourse (PIDS). Additionally, the severity of drug problems may have a significant impact on PIDS. However, this relationship remains unverified. Therefore, this study investigates whether the severity of drug problems is associated with PIDS among adult males in drug addiction rehabilitation centers (DARC) in Japan. Methods This study was a secondary analysis of the “DARC Follow-Up Study in Japan” conducted by the National Center of Neurology and Psychiatry in 2016, in which participants from 46 facilities completed a self-report questionnaire. A total of 440 males with drug dependence were included in the analysis. We analyzed participants’ demographic characteristics, history of sexually transmitted disease diagnoses, and responses to questions related to drug use (e.g., primary drug use and PIDS). Additionally, we measured the severity of drug problems using the Japanese version of the Drug Abuse Screening Test-20 (DAST-20). Results The median age of the participants was 42 years. The median DAST-20 score was 14.0, the primary drug was methamphetamine (61.4%) and new psychoactive substances (NPS: 13.6%). Multivariate analysis indicated that participants’ experiences with unprotected sexual intercourse (“mostly a non-condom user”: adjusted odds ratio (AOR) = 4.410), methamphetamine use (AOR = 3.220), new psychoactive substances use (AOR = 2.744), and the DAST-20 score (AOR = 1.093) were associated with PIDS. Conclusions This study indicated that the frequency of unprotected sexual intercourse under the influence of drugs, methamphetamine and NPS use were strongly associated with PIDS. The severity of drug problems was also significantly associated with PIDS. It is necessary to develop culturally appropriate treatment programs adapted to the needs of patients who experience strong PIDS.
... Polysubstance use likely reflects different motivations for and instrumentalizations of substance use (Müller and Schumann, 2011;Valente et al., 2020). These include, for example, curiosity, craving social connectedness (Ter Bogt and Engels, 2005), enhancing one's energy or ability to focus, calming and relaxing (LeClair et al., 2015), and enhancing or counteracting the (side) effects and withdrawal symptoms of other substances (Boys et al., 2001;Winstock et al., 2001;Licht et al., 2012). We assumed that some of these motivations may already be reflected in specific childhood precursors. ...
Article
Full-text available
Polysubstance use (i.e., simultaneous or sequential use of different psychoactive substances) is associated with increases in the risk of severe health problems and social impairments. The present study leverages community-representative, long-term longitudinal data from an urban cohort to assess: (a) the prevalence and continuation of polysubstance use between adolescence and early adulthood; (b) different patterns of polysubstance use (i.e., combinations of substances) in early adulthood; and (c) childhood risk factors for polysubstance use in early adulthood. At age 20 (n = 1,180), respondents provided comprehensive self-reported information on past-year substance use, including use of legal and illicit substances (e.g., cannabinoids, stimulants, and hallucinogens), and nonmedical use of prescription drugs (e.g., opioids, tranquilizers). In adolescence (ages 13–17), limited versions of this questionnaire were administered. In childhood (ages 7–11), potential risk factors, including individual-level factors (e.g., sensation-seeking, low self-control, aggression, and internalizing symptoms) and social-environmental factors (e.g., social stressors, exposure to others’ substance use), were assessed. We fitted latent class models to identify classes of participants with different substance use profiles in early adulthood. The results show that polysubstance use increased between early adolescence and early adulthood. The continuation of polysubstance use was common (stability between all adjacent assessments: odds ratio >7). At age 20, more than one-third of participants reported polysubstance use (involving illicit substances, nonmedical use of prescription drugs, and cannabidiol). Four latent classes with polysubstance use were identified: (1) broad spectrum of substances; (2) cannabis and club drugs; (3) cannabis and the nonmedical use of prescription drugs; and (4) different cannabinoids. Risk factors for any polysubstance use included childhood sensation-seeking and exposure to others’ substance use; some childhood risk factors were differentially associated with the four classes (e.g., low self-control in childhood was associated with an increased likelihood of being in the broad spectrum class). The classes also differed with regard to socio-demographic factors. This study revealed that polysubstance use is a widespread and multifaceted phenomenon that typically emerges during adolescence. To facilitate the design of tailored prevention mechanisms, the heterogeneity of polysubstance use and respective socio-demographic and developmental precursors need to be considered.
... 3,4-methylenedioxymethamphetamine (MDMA) is a psychoactive drug that has been widely used as a recreational drug for its entactogenic (promoting feelings of empathy and relatedness), pro-social and euphoric effects (Cami et al., 2000;Harris et al., 2002;Winstock et al., 2001). It may elicit these effects through modulation of monoamine neurotransmitter systems (Green et al., 2003). ...
Article
Introduction Novel, evidence-based treatments are required for treatment-resistant post-traumatic stress disorder (PTSD). 3,4-Methylenedioxymethamphetamine (MDMA) has beneficially augmented psychotherapy in several small clinical trials. Objectives To review the use of MDMA-assisted psychotherapy in treatment-resistant PTSD. Methods Systematic searches of four databases were conducted from inception to February 2020. A meta-analysis was performed on trials which were double-blinded, randomised, and compared MDMA-assisted psychotherapy to psychotherapy and placebo. The primary outcomes were the differences in Clinician Administered PTSD Scale (CAPS-IV) score and Beck’s Depression Inventory (BDI). Secondary outcome measures included neurocognitive and physical adverse effects, at the time, and within seven days of intervention. Results Four randomised controlled trials (RCTs) met inclusion criteria. When compared to active placebo, intervention groups taking 75mg (MD -46.90; 95% CI -58.78, -35.02), 125mg (MD -20.98; 95% CI -34.35, -7.61) but not 100mg (MD -12.90; 95% CI -36.09, 10.29) of MDMA with psychotherapy, had significant decreases in CAPS-IV scores, as did the inactive placebo arm (MD -33.20; 95% CI -40.53, -25.87). A significant decrease in BDI when compared to active placebo (MD -10.80; 95% CI -20.39, -1.21) was only observed at 75mg. Compared to placebo, participants reported significantly more episodes of low mood, nausea and jaw-clenching during sessions and lack of appetite after seven days. Conclusions These results demonstrate potential therapeutic benefit with minimal physical and neurocognitive risk for the use of MDMA-assisted psychotherapy in TR-PTSD, despite little effect on Beck’s Depression Inventory. Better powered RCTs are required to investigate further. Disclosure James Rucker has attended trial related meetings paid for by Compass Pathways Ltd.
... The prevalence of illicit drug use, especially MDMA and other stimulants, has increased over the last decade among the younger section of UK population (22) , with related studies showing that approximately 50% of these ages [16][17][18][19][20][21][22], have tried an illicit substance, concerns has been expressed about the increasing popularity of stimulant drugs (23) , and their association with certain youth sub cultures. Studies about drug use among young people reported a lifetime use of ecstasy between 60%-80% (24) In a study in Poland of acute poisoning in children, the results concluded that 8 children only (1.7%) were admitted because of the Ecstasy designer drug (25) . The present results are in contrast with epidemiological studies of drug offenders which, revealed that those in their thirties rank first in Ecstasy users, accounting for around 40% of the total followed by those in their forties at about 26%, those in the twenties at 16% and those under 20 years old at less than 0.3% in Korea (1) The religious prohibition of psychoactive substances has not, however, curtailed the widespread use of drugs among people in the Arab countries. ...
Article
Aim To examine the patterns, correlates and context of 'recent' (preceding 12 months) ecstasy use using data from a nationally representative sample of Australians interviewed in 2001. Design Data were analysed from the 2001 National Drug Strategy Household Survey, a multi-stage probability sample of Australians aged 14 years or older. The focus was on ecstasy use among 14-19-year-olds and 20-29-year-olds, as the prevalence of recent use is highest among these groups. Recent ecstasy users were compared to those who had not used in the preceding 12 months and those who had never tried ecstasy ('others') on a range of demographic and drug use variables. Comparisons were also drawn between the patterns and context of ecstasy use of the two groups of recent ecstasy users (users aged between 14-19 and 20-29 years). Findings In 2001, 6.1% of Australians aged 14 years or older reported lifetime ecstasy use, and 2.9% reported recent use. One in 10 (10.4%) of 20-29-year-olds and 5.0% of 14-19-year-olds had used ecstasy recently. Although there were few demographic differences between recent users and others, compared to those who had not recently used ecstasy, recent ecstasy users were more likely to have used a range of other drugs. Although recent ecstasy users of both age groups could be characterized as polydrug users, 20-29-year-old users were more likely to use other drugs concurrently with ecstasy. Conclusions Following cannabis and amphetamines, ecstasy is the third most widely used illicit drug in Australia. Other than a greater likelihood of having used other drugs, few demographic variables appear to distinguish recent ecstasy users from others. Australian users in their 205 use ecstasy within a context of greater polydrug use than those in their teens. Although most ecstasy users described a pattern of occasional use, minorities reported weekly use, and difficulties in reducing their use despite wishing to do so. There is a need to develop interventions to assist problematic ecstasy users to reduce their use should they wish to do so and to increase education about the potential risks of combining ecstasy with other drugs.
Article
Many recreational ecstasy/MDMA users display neuropsychobiological deficits, whereas others remain problem free. This review will investigate some of the drug and non-drug factors which influence the occurrence of these deficits, Acute and chronic MDMA usage are both important. Intensive use within a session is often associated with more problems. In term of lifetime usage, novice users generally remain unimpaired, whereas most heavy users report memory or other psychobiological problems which they attribute to ecstasy. These complaints are confirmed by objective deficits in working memory, attention, frontal-executive, and episodic memory tasks. Psychobiological deficits include disturbed sleep, sexual dysfunction, reduced immuno-competence, and increased oxidative stress. Further MDMA-retated factors which may contribute to these changes, include acute and chronic tolerance, and drug dependence. Around 90-95% of ecstasy/MDMA users also take cannabis, and this can independently contribute to the adverse neuropsychobiological profiles; although in some situations the acute co-use of these two drugs may be interactive rather than additive, since cannabis has relaxant and hypothermic properties. Alcohol, nicotine, amphetamine, and other drugs, can also affect the psychobiological profiles of ecstasy polydrug users in complex ways. Pure MDMA users are rare but they have been shown to display significant neurocognitive deficits. Psychiatric aspects are debated in the context of the diathesisstress model. Here the stressor of ecstasy polydrug drug use, interacts with various predisposition factors (genetic, neurochemical, personality), to determine the psychiatric outcome. Recreational MDMA is typically taken in hot and crowded dances/raves. Prolonged dancing, feeling hot, and raised body temperature, can also be associated with more psychobiological problems. This is consistent with the animal literature, where high ambient temperature and other metabolic stimulants boost the acute effects of MDMA, and cause greater serotonergic neurotoxicity. In conclusion, the neuropsychobiological effects of MDMA are modulated by a wide range of drug and non-drug factors. These multiple influences are integrated within a bioenergetic stress model, where factors which heighten acute metabolic distress lead to more neuropsychobiological problems.
Article
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 intoxikation 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.
Article
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Aims: Describes how the relative normalisation of recreational drug use in the UK has been productive of, and fused with, the relatively normalised and non-commercial social supply of recreational drugs. Methods: Semi-structured interviews with 60 social suppliers of recreational drugs in two studies (involving a student population n = 30 and general population sample n = 30). Respondents were recruited via purposive snowball sampling and local advertising. Findings: Both samples provided strong evidence of the normalised supply of recreational drugs in micro-sites of friendship and close social networks. Many social suppliers described “drift” into social supply and normalised use was suggested to be productive of supply relationships that both suppliers and consumers regard as something less than “real” dealing in order to reinforce their preconceptions of themselves as relatively non-deviant. Some evidence for a broader acceptance of social supply is also presented. Conclusions: The fairly recent context of relative normalisation of recreational drug use has coalesced with the social supply of recreational drugs in micro-sites of use and exchange whereby a range of “social” supply acts (sometimes even involving large amounts of drugs/money) have become accepted as something closer to gift-giving or friendship exchange dynamics within social networks rather than dealing proper. To some degree, there is increasing sensitivity to this within the criminal justice system.
Article
The “rave” phenomenon has been a major element in the resurgence of psychedelic drug use in Western society. Purportedly central to raves is the use of “club drugs” such as 3,4-methylenedioxymethamphetamine (MDMA or “Ecstasy”). To date, however, few studies have examined the prevalence of Ecstasy use and dependence symptoms among rave attendees in the United States. In the current study, self-report drug use information and oral fluid (OF) specimens were collected from a sample of adult “club rave” attendees along the Baltimore-Washington corridor between September and November 2002. Data collection was scheduled between 12 midnight and 5 a.m. Participation rates were high. Of the 192 rave attendees approached, 80% completed the interview. Of those who completed the interview, 82% provided an OF specimen. Twenty-four percent of the respondents with usable specimens (N=103) reported using Ecstasy within the two days preceding the interview, while 30% tested positive for MDMA by OF analysis. Sixteen percent responded affirmatively to at least one of the three dependence symptoms. Self-reported 12-month Ecstasy users were more likely than non-users to be white, and recent users were more likely to have used most other drugs of abuse during the 12 months preceding the interview.
Technical Report
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The potential role of the Internet in facilitating drugs trade first gained mass attention with the rise and fall of Silk Road; the first major online market place for illegal goods on the hidden web. After Silk Road was taken down by the FBI in October 2013, it was only a matter of weeks before copycats filled the void. Today, there are around 50 so-called cryptomarkets and vendor shops where anonymous sellers and buyers find each other to trade illegal drugs, new psychoactive substances, prescription drugs and other goods and services. But it is not just the obscure parts of the Internet where drugs are on offer. There are numerous web shops, easily found by search engines, which offer new psychoactive substances, often labelled as 'research chemicals'. The Netherlands occupies a crucial position in European illicit drug markets. Data from the European Monitoring Centre for Drugs and Drug Addiction suggested it is the main producer of MDMA, ecstasy and herbal cannabis and a key distribution hub for cannabis resin and cocaine. Whether the pivotal role of the Netherlands also extends online, has yet been unclear. The Netherlands Ministry of Security and Justice commissioned RAND Europe to provide a firmer evidence base to this phenomenon and, in particular, the role of the Netherlands. This report analyses the size and scope of Internet-facilitated drugs trade both on the so-called clear and hidden web, paying special attention to the Netherlands, and delineates potential avenues for law enforcement for detection and intervention. Key Findings Monthly revenues from drugs on cryptomarkets are in the double-digit million dollars Of all products and services on offer, this study found that 57 per cent of listings across the eight analysed cryptomarkets offered drugs. The results indicate that these cryptomarkets generated a total monthly revenue of $14.2m (€12.6m) in January 2016, $12.0m (€10.5m) when prescription drugs and alcohol and tobacco are excluded (lower-boundary estimate). An upper-boundary estimate for monthly drug revenues via visible listings on all cryptomarkets would be $25.0m (€22.1m) and $21.1m (€18.5m) when prescription drugs and alcohol and tobacco are excluded. Cannabis, stimulants and ecstasy were responsible for 70 per cent of all revenues on the analysed cryptomarkets. No information was identified on revenues on the clear net. The values are based on EUR/USD exchange rate of 1.14 as of April 2016. Cryptomarkets are not just an 'eBay for Drugs' Large 'wholesale' level transactions (those greater than $1,000) are important for cryptomarkets, generating nearly one quarter of overall revenue both in September 2013 and in January 2016. Based on these findings it is likely that many cryptomarket customers are drug dealers sourcing stock intended for offline distribution. Most revenues are generated by vendors who indicate they are operating from Anglo-Saxon countries or Western Europe Most vendors appeared to be operating from the United States (890), followed by the United Kingdom (338), and Germany (225). Vendors indicating they ship from the United States generated 36% per cent of all drug revenues within our sample. Other Anglo-Saxon (Canada and the United Kingdom) as well as Western European countries (the Netherlands, Germany, Spain, France) also generate substantial proportions of revenues. Revenues from vendors operating from the Netherlands are by far the largest on a per capita basis Revenues to vendors reporting to operate from the Netherlands on cryptomarkets accounted for 8 per cent of total drug revenues. On a per capita basis, revenues to vendors operating from the Netherlands were 2.4 times higher than those from the United Kingdom and 4.5 higher than those from the United States. Vendors and buyers on online markets seem to have similar characteristics Traditional investigation techniques applied in the drug chain, postal detection and interception, online detection and online disruption are potential law enforcement strategies in the detection and intervention of Internet-facilitated drugs trade. In addition, international cooperation and coordination (and the accompanying legal challenges), capacity and resources and (technical) capabilities could play a facilitating role in deploying the different strategies to tackle Internet-facilitated drugs trade. There are four broad categories of modes of detection and intervention Traditional investigation techniques applied in the drug chain, postal detection and interception, online detection and online disruption are potential law enforcement strategies in the detection and intervention of Internet-facilitated drugs trade. In addition, international cooperation and coordination (and the accompanying legal challenges), capacity and resources and (technical) capabilities could play a facilitating role in deploying the different strategies to tackle Internet-facilitated drugs trade.
Chapter
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Ketamine (2-(2-chlorophenyl)-2-(methylamino)-cyclohexanone) developed by Parke Davis laboratories in 1962 is a dissociative general anaesthetic derivative of phencyclidine (PCP) available by prescription in the USA since the 1970s for human and veterinary use. Recreational use of ketamine was initially reported amongst those with access to the drug, particularly medical professionals, in 1967 and slightly later in 1971 in North America, linked by some to returning Vietnam veterans who may have been exposed to the drug on the battlefield. Ketamine became increasingly popular in the 1970s and 1980s, particularly in the USA. A growing number of reports of recreational use also emerged in the UK. More recently it has become a mainstream ‘club drug’ alongside 3, 4-methylenedioxymethampthetamine (MDMA or ‘ecstasy’), cocaine, and gammahydroxybutyrate (GHB).
Article
Background: Designer drugs of the amphetamine, benzyl, phenyl piperazine, or pyrrolidinophenone type produce feelings of euphoria and energy and a desire to socialize, reason why they are known as "rave drugs" or "club drugs". Although consumers adduce that these are safe drugs, experimental studies using bio models and epidemiological studies in humans, indicate potential risks for users. Materials and Methods: The review article analyses quantitatively scientific literature from Science Direct and PUBMED data bases related to metabolism of these drugs and their implications in health. Results: Relevant information related to the objectives proposed in the present review was found and it can be classified in 2 sections as follows: metabolism of designer drugs and clinical implications of consumption of designer drugs. Conclusion: The metabolic pathways which involve P450 isoenzymes are responsible for hepatic degradation of designer drugs. There are potential risks for consumers such as serotonin syndrome, hepatotoxicity, neurotoxicity, and psychopathology.
Chapter
Ecstasy (methylenedioxymethamphetamine, MDMA) is a synthetic drug which is popular among clubbers who love it for its euphoric and energizing effects. These subjective effects are experienced approximately between one and four hours after intake. It is also shown that MDMA affects driving-related behavior, as measured by performance tasks and simulated driving, as well as actual driving as assessed by on-the-road driving tests. Under optimal conditions that are during daytime, moderate doses, and with no co-use of other substances MDMA exerts stimulating effects on reaction time performance, tracking and weaving. However, when MDMA is combined with alcohol or sleep deprivation, these stimulating effects are no longer observable. Combined use of MDMA with cannabis or alcohol is common among ecstasy users. In addition, they usually take the drug at night and drive in the morning after a night of partying and sleep loss. Experimental data have shown that the stimulating effects of MDMA are not of sufficient magnitude to compensate for the impairing effects of sleep loss. Moreover, subjective data have shown that ecstasy users are not able to accurately estimate their objective impairment when under the influence of MDMA. Their lack of judgment during intoxication can put them at risk when engaged in traffic. Epidemiological studies and case studies have also shown that MDMA at normal doses (75 mg) is able to impair driving performance which is characterized by reckless behavior such as speeding and jumping red traffic lights. In addition, in a number of fatalities, ecstasy was detected in the blood of the driver. In sum, MDMA can exert stimulating effects on some aspects of driving when given at low doses. However MDMA is likely to produce driving impairment in combination with other drugs or during a night of sleep loss as is often the case in regular ecstasy users.
Article
The ‘war on drugs’ has engendered significant recent debate, encompassing a variety of opinions, evidence and knowledge (though often polarised), from a wide range of sources. In Australia, much of this debate has focused on the harms and risks associated with illicit drugs. Often of concern has been young people's use of illicit drugs in nightclubs, which recent media and government reports suggest has increased and requires critical review given young people's relative lack of knowledge and their desire for risk-taking behaviour. While there have been many attempts to address this subject, the persistence of this practice questions the effectiveness of current ‘expert’ strategies and highlights the need for a more nuanced, bottom-up approach. This article draws from mixed-method research that examined young people's risk perceptions, leisure practices and, for some, use of methamphetamines in five key nightclubs in Adelaide, South Australia. The article provides a snapshot of the prevalence of methamphetamine use, evaluates current policy responses, and details key empirical findings, concluding that there is need for a more open and diverse policy dialogue.
Article
MDMA (3,4-methylendioxymethamphetamine), also known as Ecstasy, is a stimulant drug recreationally used by young adults usually in dance clubs and raves. Acute MDMA administration increases serotonin, dopamine and noradrenaline by reversing the action of the monoamine transporters. In this work, we review the studies carried out over the last 30 years on the neuropsychobiological effects of MDMA in humans and mice and summarise the current knowledge. The two species differ with respect to the neurochemical consequences of chronic MDMA, since it preferentially induces serotonergic dysfunction in humans and dopaminergic neurotoxicity in mice. However, MDMA alters brain structure and function and induces hormonal, psychomotor, neurocognitive, psychosocial and psychiatric outcomes in both species, as well as physically damaging and teratogen effects. Pharmacological and genetic studies in mice have increased our knowledge of the neurochemical substrate of the multiple effects of MDMA. Future work in this area may contribute to developing pharmacological treatments for MDMA-related disorders.
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At present, there are no reliable data to identify the number of patients who present for infertility investigations and who are current users of illicit drugs. Therefore, the full extent of this problem remains hidden. Estimates can be made on the basis of population use, although this lacks rigour. The use of illicit drugs can impact on infertility investigations, treatment, welfare of the child and parenting. Furthermore, it can result in serious legal sanctions, including imprisonment. There does not appear to be consistent practice across HFEA licenced clinics in either requiring: (i) the addicted patient to have a specified drug-free period before commencing investigations; or (ii) all patients to be routinely screened. As well as describing the extent of illicit drug use in the UK population, and therefore in those who present in clinic, this paper will discuss screening and encourages debate across clinics regarding a mandatory drug-free period and the development of an appropriate Standard Operating Procedure.
Technical Report
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Executive Summary MDMA is well established as a popular psychoactive substance across much of the Western world. Hundreds of thousands of people break the law to access its effects, which include increased energy, euphoria, and enhanced sociability. The categorisation of MDMA as a Class A drug in the UK and Schedule 1 drug internationally – categories reserved for drugs deemed to pose the highest risk to individuals and society – has never meaningfully disrupted its supply, nor its widespread use. MDMA is cheaper and purer than ever before and is available at the click of a mouse via darknet drug markets. For several years, MDMA-related adverse events and fatalities have been increasing in the UK, with some claiming that taking MDMA today is the riskiest it has ever been. Responses are polarised between those who assert that the risks of MDMA use necessitate mitigation through prohibition and increased law enforcement, and those who perceive prohibition to be exacerbating these risks by exposing users to an unregulated market of pills and powder of unknown strength and quality. Whichever view you take, current policy is not meeting its goal of reducing harms, and greater control of MDMA production, distribution, purchase, and consumption is needed in order to prevent MDMArelated emergencies. This report examines the acute, sub-acute, and chronic harms related to MDMA use in detail. We examine the production, distribution, purchase, and consumption of the drug; related risks and harms; and the impact prohibition has on these, as well as the potential impact of alternative policies. Crucially, our evidence shows that many harms associated with MDMA use arise from its unregulated status as an illegal drug, and that any risks inherent to MDMA could be more effectively mitigated within a legally regulated market. 10 MDMA: Roadmaps to Regulation Under prohibition, people purchase MDMA pills, crystal, and powder from an illegal market, with little certainty as to what these products contain. Given that illegal drugs are not subject to strict production standards, consumers are exposed to the risks of poisoning or accidental overdose as a result of contamination, adulteration, and unknown strength and purity. Naïve commentators demonise the drug and simply urge young people to ‘just say no’, whilst failing to account for those who say ‘yes’. In the meantime, preventable deaths continue to occur, and otherwise law-abiding people are punished for non-violent offences such as the possession or social supply of MDMA. Governments and the mainstream media persist in perpetuating the myth that the War on Drugs is winnable if it were fought harder, and those calling for drug policy reform – as we do here – are framed as ‘radicals’ who have little or no regard for the health and wellbeing of citizens. This characterisation could not be further from the truth. Those calling for careful reform to existing drug policy include the parents of young people whose lives have been lost or ruined by harms related to the prohibition of MDMA. We incorporate their voices in this report alongside those of academics and former police officers, highlighting the ‘broad church’ of those dedicated to fighting for reform. This includes scientists undertaking ground-breaking research into the therapeutic potential of MDMA, who work within a regulatory regime that makes such research exorbitantly expensive and time-consuming, because of the Schedule 1 status that MDMA holds in the UK. As we enter the fourth decade of MDMA’s widespread use, new thinking is needed on how to better control production and distribution, and on how to reduce the risks associated with its consumption. There is growing evidence to support reorienting drug policy away from an ideologically driven criminal justice-led model to one rooted in pragmatic health and harm reduction principles. This is reflected in the widespread reform of cannabis laws occurring in numerous jurisdictions around the world, and the growth of treatment 11 Executive Summary programmes for heroin users which include prescription heroin and supervised injecting rooms. These hard-fought policy changes acknowledge the failure of prohibition to meet its goals and produce a ‘drug-free world’. They are built on a robust and ever-growing evidence base which demonstrates how permitting or prescribing the use of legally regulated drugs improves health and safety outcomes for people who use drugs and their communities at a reduced cost to the state, whilst also providing wider employment and economic opportunities. This logic can be extended to the use of MDMA and other currently prohibited psychoactive substances. Roadmaps to Regulation: MDMA follows this pragmatic path and pursues policy aims which many of us share, such as improvements in public health promotion, targeted harm reduction, evidence-informed policy and practice, human rights, social justice, participatory democracy, and effective governmental expenditure. For the first time, we outline detailed recommendations for drug policy reform to better control the production, distribution, purchase, and consumption of MDMA products. Reform and the reduction in MDMArelated harms this will bring cannot happen overnight. The changes we outline here, which culminate in a strictly regulated legal market for MDMA, are to be phased in gradually and closely evaluated through independent policy research to ensure health and social outcomes are properly documented, with findings folded back into the ongoing reform process.
Article
Recreational nitrous oxide (N 2 O) is commonly used among young people partly due to its low cost and accessibility, and awareness of its potential adverse effects is poor in this group. One such adverse effect is degeneration of the spinal cord due to its disruption of DNA synthesis by inactivating cobalamin (B 12 ). A 19-year-old man presented to the emergency department with a 4-week history of worsening paraesthesia in his fingers and lower limbs, and weakness in the hands and lower limbs for 2 weeks. On examination, he had an ataxic gait, reduced power of grip strength and ankle movements, and impaired sensation in the lower limbs. An MRI brain and spine revealed myelopathy of the cervical and thoracic cord. On further questioning, he reported recreational N 2 O inhalation. His symptoms improved after stopping this and he was treated with supplementation of B vitamins. Education strategies regarding the risks of N 2 O misuse are indicated.
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Background Nightclubs and bars are recreational settings with extensive availability and consumption of alcohol and recreational drugs. Objectives This study aims to determine the proportion of nightclub patrons in Norway that tested positive for illicit drugs, moreover, we examined the correlation between positive test results and demographic and substance use characteristics. Methods Patrons were recruited outside nightclubs on Friday and Saturday nights between 10:00 pm and 04:00 am. Substance use was determined by breath testing and oral fluid testing for alcohol and drugs, respectively, using accurate and specific analytical methods. Questionnaires recorded demographic and substance use characteristics. Results Of the 1988 included nightclub patrons, 90% tested positive for alcohol, 14% for illicit drug use, and 3% for two or more illicit drugs. The proportion of patrons who tested positive for illicit drugs was highest in the early hours of the morning. Nine out of ten who tested positive for illicit drugs also consumed alcohol. Testing positive for one or more illicit drugs was most strongly correlated with being male and unemployed, using tobacco or other nicotine products, and early on-set illicit drug use; further the correlations were strongest among those who tested positive for two or more illicit drugs. Conclusions/Importance: Patrons who used illicit drugs before or during nightclub visits most often combined drug use with alcohol consumption. Substituting alcohol with cannabis or other drugs was not common in this cohort. The study results provide evidence to introduce harm-reduction prevention programs to address illicit drug and excessive alcohol consumption.
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EDITOR,—A Richard Green and Guy M Goodwin emphasise the potential long term neurotoxicity associated with the use of ecstasy (3,4-methylenedioxymethamphetamine).1 Small studies of clinical populations have already given a clue to the possible functional impact of this drug on the human nervous system by showing a wide range of psychopathology associated with its short term ingestion.2 3 They also point out that people who metabolise the drug quickly, although perhaps protected from acute toxicity (some of which will no doubt …
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Discusses recent research on the use of illicit drugs by youth in Britain. Current research on the prevalence of illicit drug use identifies an unprecedented rise in such use by increasingly diverse groups of youth of all socioeconomic backgrounds. Presenting 4 yrs of data from the University of Manchester northwest longitudinal study of English adolescent drug use, the paper looks at patterns of use of different drugs, differential experiences with these drugs, and characteristics of use arid non-use throughout the mid-teens. Along with this transformation in adolescent drug use has been a similar rise in the prevalence of drug use by young adults, which is located in the context of the dance party or 'rave' scene in Britain, linked to the 'dance revolution' and to a wider youth culture that reflects an acceptance of drug use both by users and non-users as a part of youth leisure. This has led the authors to identify a process of 'normalization' of recreational drug use among youth with resulting legal, education, employment, and health implications. Ss were 14-15 yrs olds at beginning of the study. Ss were studied for 4 yrs to be able to examine 2 distinct stages of drug use and the social context for such use: for adolescents aged 13-17 and for young adults aged 17-25. (PsycINFO Database Record (c) 2004 APA, all rights reserved)
Article
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To study the postmortem pathology associated with ring substituted amphetamine (amphetamine derivatives) misuse. The postmortem findings in deaths associated with the ring substituted amphetamines 3,4-methylenedioxymethyl-amphetamine (MDMA, ecstasy) and 3,4-methylenedioxyethylamphetamine (MDEA, eve) were studied in seven young white men aged between 20 and 25 years. Striking changes were identified in the liver, which varied from foci of individual cell necrosis to centrilobular necrosis. In one case there was massive hepatic necrosis. Changes consistent with catecholamine induced myocardial damage were seen in five cases. In the brain perivascular haemorrhagic and hypoxic changes were identified in four cases. Overall, the changes in four cases were the same as those reported in heart stroke, although only two cases had a documented history of hyperthermia. Of these four cases, all had changes in their liver, three had changes in their brains, and three in their heart. Of the other three cases, one man died of fulminant liver failure, one of water intoxication and one probably from a cardiac arrhythmia associated with myocardial fibrosis. These data suggest that there is more than one mechanism of damage in ring substituted amphetamine misuse, injury being caused by hyperthermia in some cases, but with ring substituted amphetamines also possibly having a toxic effect on the liver and other organs in the absence of hyperthermia.
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To report on the extent and nature of acute MDMA (ecstasy) related problems presenting to a large London hospital's accident and emergency (A&E) department. The computerised attendance records for all patients attending the A&E department over a 15 month period were retrospectively screened. Potential cases thus identified had their case notes systematically reviewed to confirm the history of MDMA use and to extract other relevant data. Forty eight consecutive MDMA related cases were identified. All were in the 15-30 year age group with the majority presenting in the early hours at weekends and having consumed the drug at a night club. The mean number of tablets consumed was two and almost 40% had taken MDMA before. Polydrug use was common with half of the sample having concurrently taken another illicit substance--most commonly other stimulants (amphetamines and cocaine). A wide range of adverse clinical features was found. The most common symptoms were vague and non-specific such as feeling strange or unwell, however many patients had collapsed or lost consciousness. The most common signs elicited were related to sympathetic overactivity, agitation/disturbed behaviour, and increased temperature. The more serious complications of delirium, seizures, and profound unconsciousness (coma) were commoner when MDMA was used in combination with other substances. For young adults presenting late at night at weekends and exhibiting symptoms of sympathetic overactivity, disturbed behaviour, and increased temperature ("Saturday night fever") the use of stimulant dance drugs especially MDMA should be suspected. As MDMA use does not appear to occur in isolation, the clinical picture is likely to be complicated by multiple rather than single drug ingestion. This poses increased diagnostic and management challenges for A&E staff who typically represent the front line response to dance drug related problems.
Article
Recent surveys in the UK indicate that approximately half of all young people aged 16-22 have used an illegal drug. Despite such observations, remarkably little research has been conducted in the UK about the motivating factors which shape the decisions that young people make to use drugs or alcohol. This paper reports on a qualitative study exploring the range of factors which young people reported to be influential over such decisions. Results are presented from in-depth interviews conducted with 50 16-21-year-olds. Analysis of the data revealed individual-level influences (the perceived functions of drug use (or specific purpose for using a particular substance), drug-related expectancies, physical/psychological state, commitments and boundaries) and social/contextual-level influences (environment, availability, finance, friends/peers and media) on decision-making. Of these, the perceived function for using a particular substance was identified as particularly influential. The findings are related to existing drug prevention approaches and opportunities for their further development are discussed.
Article
EDITOR,—A Richard Green and Guy M Goodwin rightly point out that the risk of long term consequences of neurodegeneration associated with the use of ecstasy (3,4-methylenedioxymethamphetamine) may be greater than the risk of death from acute toxicity.1 Having reviewed the compelling evidence linking ecstasy with neurotoxicity in animals, they omit what is perhaps the strongest indication of neurotoxicity in humans. A universal finding of descriptive studies of users of ecstasy is that the first ecstasy tablet is the best and that with subsequent use the desired effects decline and side effects increase.2 3 4 As ecstasy is pharmacologically active for only a few hours and even frequent users usually limit their use to weekends, neurotoxicity seems a more likely explanation than tolerance through neu-roadaptation. Even newsgroups on the Internet that promote the use of ecstasy are now debating not whether it causes serotoninergic nerve cell damage but whether the result is detrimental, inconsequential, or even beneficial, with general advice to users being that “less is more” and “more than one tablet once a month is an overdose.” In Britain, use of ecstasy is inextricably related to dance culture and “raves.” Perceiving a diminished effect as being due to poor quality, ecstasy “ravers” often “stack up,” taking ecstasy in higher doses and more frequently than reported elsewhere. Whereas only a fifth of the Stanford cohort2 and a third of the Sydney cohort3 had taken ecstasy on more than 10 occasions, over half of a sample in London had used it more than 20 times.5 Media campaigns focusing on deaths from use of ecstasy are worse than useless: they no more deter young people from taking ecstasy than reports of deaths in an avalanche stop me from taking skiing holidays. Exaggerated, sensationalist drug prevention campaigns are recognised as such by young people and decrease the chance of prudent advice being taken seriously. Reference1.↵Green AR, Goodwin GM.Ecstasy and neurodegeneration.BMJ 1996;312: 1493-4. (15 June.)
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The Severity of Dependence Scale (SDS) was devised to provide a short, easily administered scale which can be used to measure the degree of dependence experienced by users of different types of drugs. The SDS contains five items, all of which are explicitly concerned with psychological components of dependence. These items are specifically concerned with impaired control over drug taking and with preoccupation and anxieties about drug use. The SDS was given to five samples of drug users in London and Sydney. The samples comprised users of heroin and users of cocaine in London, and users of amphetamines and methadone maintenance patients in Sydney. The SDS satisfies a number of criteria which indicate its suitability as a measure of dependence. All SDS items load significantly with a single factor, and the total SDS score was extremely highly correlated with the single factor score. The SDS score is related to behavioural patterns of drug taking that are, in themselves, indicators of dependence, such as dose, frequency of use, duration of use, daily use and degree of contact with other drug users; it also shows criterion validity in that drug users who have sought treatment at specialist and non-specialist agencies for drug problems have higher SDS scores than non-treatment samples. The psychometric properties of the scale were good in all five samples, despite being applied to primary users of different classes of drug, wing different recruitment procedures in different cities in different countries.
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How often do we use the word “academic” to mean irrelevant or inconsequential to real life issues? Research from the academic community is often treated with the same reservations. Reports how the Department of Construction Management and Engineering at Reading University is linking up with commercial organizations in collaborative FM related research. Like other UK universities involved in FM, it is seeking to break down the academic-industrial divide. Despite having a strong reputation in the construction sector, Reading has often been accused of being ambivalent about its position in facilities management. Claims that some light may be shed on this confusion from this discussion.
Article
Aims. To investigate the patterns of drug use among a sample of people in the rave scene in Perth, Western Australia and test the hypothesis that those who were less experienced in their drug use had less drug-related knowledge. Design. Respondents were recruited through flyers in cafes, clothing and music stores and through snowballing. They were paid $20 for a 11/2 hour interview which comprised both qualitative and quantitative components. Setting. Respondents were interviewed in cafes or restaurants, private dwellings, agencies or other public spaces. Participants. Eighty-three people who had been to a rave in the prior 6 months. Their mean age was 18.9years (range 13-48) and 53% were male. Measurements. Brief history of drug use, HIV risk behaviour, knowledge of drug-related harm and side effects experienced from drugs. Findings. The group was unremarkable apart from their drug use. Ninety per cent of respondents had ever used LSD, 76% had used ecstasy and 69% had used amphetamines. Before, during or after the last rave attended 52% used cannabis and 35% had used each of amphetamines and LSD. Those who were less experienced in their drug use had less knowledge about drugs. Many respondents began using ‘dance drugs’ while they were still at school. Conclusions. Those with less drug-using experience may have less drug-related knowledge and may be at greater risk of harm. Strategies should be implemented which involve people in the scene, promoters, health workers and the authorities to reduce drug-related harm associated with raves and other dance events.
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This study explored patterns of ecstasy use and associated harm through the administration of a structured interview schedule to 329 ecstasy users, recruited from three Australian cities. A broad range of ecstasy users were interviewed, but on the whole, the sample was young, relatively well educated and most were employed or students. Patterns of use were varied, although extensive polydrug use was the norm. High rates of intravenous drug use were recorded, which may relate to an over-representation of chaotic intravenous polydrug users. Subjects had experienced an average of eight physical and four psychological side-effects, which they attributed to their ecstasy use in the preceding 6 months. Approximately 40% of the sample also reported financial, relationship and occupational problems. Young, female, polydrug users and those who binged on ecstasy for 48 h or more appeared most at risk of experiencing harm that they related to their ecstasy use. One-fifth of the sample had received treatment for an ecstasy-related problem, most often from a GP or natural therapist, and 7% were currently in treatment. One quarter wanted to reduce their use because of financial, relationship and psychological problems. A total of 15% wanted formal treatment for an ecstasy-related problem and 85% requested more information. These results have implications for the development of policies to respond to drug use among this population.
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In the 1980s, methylenedioxymethamphetamine (MDMA) appeared on the Dutch market. The popular use of MDMA and MDMA-analogs (commonly known as ecstasy) spread quickly in the second half of the 1980s, especially at large-scale dance events. After prohibition in 1988, the ecstasy market became "polluted," adding the extra risk factor to its use. The Dutch government showed concern, and the Health Department initiated a research program. The Utrecht University Addiction Research Institute (CVO) conducted a socio-epidemiological study into the nature and extent of, and the risks involved in, ecstasy use at dance events. More than one thousand respondents, ranging in age from 14-46 yrs, participated in the study. This article focuses on the methodology and results of the study. Applied methods included observations, written questionnaires, in-depth interviews, and urine sampling. (PsycINFO Database Record (c) 2004 APA, all rights reserved)
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Professors explore what gets lost and found in translations of great literary works.
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'Ecstasy' (3,4-methylenedioxymethamphetamine or MDMA) is a recreational drug that is gaining popularity world wide. There is a paucity of research regarding the ways in which Ecstasy is used and the nature of its effects. A 'snowball' peer network technique was used to recruit 100 users who completed anonymous questionnaires. The research revealed that Ecstasy is primarily used by infrequent recreational drug users for 'fun' at dance parties and social gatherings. The primary reported effects of Ecstasy were a 'positive mood state' and feelings of intimacy and closeness to others. The secondary effects of Ecstasy were the stimulant effects of energy and activation, and the psychedelic effects of insight and perceptual and sensual enhancement. Ecstasy was reported to share the properties of both amphetamines and hallucinogens in the nature of its side effects and residual effects which were no more severe than those of the latter two classes of drug. It appeared Ecstasy was not conducive to regular and frequent use, because tolerance was reported to develop to the positive effects of Ecstasy, while negative effects increased with use. Although few problems associated with the recreational use of Ecstasy have surfaced to date, animal research has shown it to be neurotoxic to serotonergic nerve terminals. Caution must be observed until further research can determine the level of hazard in humans.
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The role of dopamine in the serotonergic neurotoxicity of 3,4-methylenedioxymethamphetamine, p-chloroamphetamine, methamphetamine, N-ethyl-3,4-methylenedioxyamphetamine and fenfluramine was assessed by determining the long-term effect of their coadministration with the dopamine precursor, L-DOPA (L-2,4-dihydroxyphenylalanine). L-DOPA administration potentiated the regional deficits in brain concentrations of serotonin measured one week after a single high dose of 3,4-methylenedioxymethamphetamine, p-chloroamphetamine or methamphetamine but did not alter the neurochemical response to N-ethyl-3,4-methylenedioxyamphetamine nor to fenfluramine. Consistent with this, in vitro release studies found the latter two agents to be the weakest of the five at increasing [3H]dopamine efflux from preloaded rat striatal slices. As an estimate of in vivo release, the effect of each agent on striatal dopamine concentrations was determined. Only those agents showing a synergism with L-DOPA in the long-term studies also produced changes in striatal dopamine consistent with an increase in transmitter release and synthesis. These results provide additional support for the hypothesis that dopamine release plays a role in the neurotoxicity of methylenedioxymethamphetamine, p-chloroamphetamine and methamphetamine. The lack of effect of L-DOPA on the neurotoxicity of fenfluramine as well as the modest effects of fenfluramine on dopamine release indicate this drug may produce its long-term effects on the serotonergic system through a unique mechanism not involving dopamine.
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The serotonergic deficits resulting from methylenedioxymethamphetamine (MDMA)-induced neurotoxicity were prevented by the simultaneous administration of 5-hydroxytryptamine2 (5-HT2) receptor antagonists such as MDL 11,939 or ritanserin. This effect was not region specific as protection was observed in the cortex, hippocampus and striatum 1 week after the administration of a single dose of MDMA. MDL 11,939 also showed some efficacy at reducing the deficits in 5-HT concentrations and tryptophan hydroxylase activity produced by multiple administrations of MDMA. Protection against the neurotoxicity required the administration of MDL 11,939 within 1 hr of MDMA indicating 5-HT2 receptor activation was an early event in the process leading to terminal damage. Examination of the effect of the 5-HT2 receptor blockade on the early neurochemical alterations induced by MDMA revealed an inhibitory effect on MDMA-stimulated dopamine synthesis. Analysis of these data and the associated changes in dopamine metabolites indicates that 5-HT2 receptor antagonists block MDMA-induced neurotoxicity by interfering with the ability of the dopamine neuron to maintain its cytoplasmic pool of transmitter and thereby sustain carrier-mediated dopamine release.
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Similar to other amphetamine analogs 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy"), a currently popular illicit drug, has been characterized recently as a serotonergic neurotoxin due to its ability to cause long-lasting deficits in markers of central serotonergic function in animals. Because the serotonergic toxicity associated with the MDMA analog methamphetamine has been linked previously to endogenous dopamine and because MDMA, like methamphetamine, elicits pronounced dopamine release in vitro, we have examined the role of endogenous dopamine in both the immediate (3 hr) and longer-term (3 days) central serotonergic deficits induced by systemic MDMA administration to rats. Depletion of central dopamine content with alpha-methyl-p-tyrosine or reserpine, or selective destruction of nigrostriatal dopamine projections with bilateral 6-hydroxydopamine-induced substantia nigral lesions, partially blocked the immediate MDMA-induced reduction in rat striatal tryptophan hydroxylase (TPH) activity. In addition, the longer-term TPH deficits caused by a high single dose of MDMA were completely prevented by prior alpha-methyl-p-tyrosine or reserpine, and attenuated significantly by inhibition of dopamine uptake with the selective dopamine-uptake blocker GBR 12909. These results implicate endogenous drug-released dopamine as a partial mediator of the initial decrease in TPH activity caused by MDMA and as an important prerequisite to the development of long-term MDMA-induced neurotoxicity. Potential mechanisms of dopamine-mediated toxicity are discussed.
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The binding of cocaine (COC) and cocaethylene (CE) in human serum was studied by equilibrium dialysis. Scatchard analysis suggested a high-affinity binder (Ka, 2.56 x 10(4)L/mol; Bo, 7.38 x 10(-5) mol/L) and a low-affinity binder (Ka, 4.47 x 10(3)L/mol; Bo, 2.77 x 10(-4) mol/L) for COC. Two high-affinity binders (Ka, 5.21 x 10(4) L/mol; Bo, 2.54 x 10(-5) mol/L; and Ka, 4.32 x 10(4) L/mol; Bo, 2.43 x 10(-5) mol/L) were discernible for CE. For both compounds additional, very-low-affinity, high-capacity (nonspecific) binding was also seen. Supplementation of serum with specific proteins suggested that the high-affinity binding was due to alpha-1-acid glycoprotein, whereas the low-affinity binding was due to albumin, inasmuch as such supplementation increased the ratio of bound to free drug for both COC and CE.
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Cocaethylene (the ethyl ester of benzoylecgonine) is a product of the interaction between ethanol and cocaine. The results of preclinical studies and of a pilot clinical study have shown cocaethylene to produce pharmacologic effects similar to those of cocaine. However, no information is available concerning the potency and pharmacokinetics of cocaethylene in comparison to those of cocaine in humans. We report the results of a single-blind, crossover study in which six male, healthy, paid volunteers, who were moderate users of cocaine, were intravenously injected with the water soluble fumarate salt of cocaethylene (0.25 mg/kg cocaethylene base) or an equivalent dose of the water soluble hydrochloride salt of cocaine (0.25 mg/kg cocaine base). Each dose was dissolved in normal saline and injected over a 1-min interval. Test sessions were separated by a 1-week interval. The variables measured were: cocaine and cocaethylene plasma concentrations, subjective and cardiovascular effects. The results indicate, that in comparison to cocaine, cocaethylene had a significant smaller elimination rate constant (0.42 versus 0.67 l/h), had a longer elimination half-life (1.68 versus 1.07 h), and induced ratings of "high" and changes in heart rate that were of lower magnitude (65%, and 43%, respectively). During the period of time that pharmacologic effects were present the plasma concentrations of cocaine and cocaethylene were statistically indistinguishable. This finding supports the conclusion that in humans cocaethylene is less potent than cocaine.
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Ecstasy (3,4-methylenedioxymethamphetamine) is a popular recreational drug, a "designer drug", which has been developed from the basic structure in amphetamine. Ecstasy has now reached the illegal drug market in Denmark via the US, Great Britain and Sweden. The drug is related to a certain youth culture from which it is estimated that many drug abusers have been recruited. The desired effects of ecstasy, namely enhanced openness, awareness and empathy, have previously been used in various therapeutic connections. In later years the drug has led to abuse which, in connection with certain cultural behaviour patterns (for example in discotheques), can cause dangerous psychiatric as well as somatic effects. The undesirable psychiatric effects range from fear through depression to actual psychoses, and the somatic effects vary from symptoms of increased sympathetic activity to malignant hyperthermia, disseminated intravascular coagulation, rhabdomyolysis, renal failure, and lethal hepatotoxicity. The last mentioned symptoms occur in connection with prolonged physical activities such as exhausting dancing sessions. The article discusses the available treatments for conditions of abuse and stresses the need for prophylactic efforts in the form of information and awareness of the problem.
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(+/-)3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy"), a ring-substituted amphetamine derivative first synthesized in 1914, has emerged as a popular recreational drug of abuse over the last decade. Pharmacological studies indicate that MDMA produces a mixture of central stimulant and psychedelic effects, many of which appear to be mediated by brain monoamines, particularly serotonin and dopamine. In addition to its pharmacologic actions, MDMA has been found to possess toxic activity toward brain serotonin neurones. Serotonergic neurotoxicity after MDMA has been demonstrated in a variety of experimental animals (including non-human primates). In monkeys, the neurotoxic dose of MDMA closely approaches that used by humans. While the possibility that MDMA is also neurotoxic in humans is under investigation, other adverse effects of MDMA in humans have been documented, including various systemic complications and a number of untoward neuropsychiatric sequelae. Notably, many of the adverse neuropsychiatric consequences noted after MDMA involve behavioral domains putatively influenced by brain serotonin (e.g., mood, cognition and anxiety). Given the restricted status of MDMA use, retrospective clinical observations from suspecting clinicians will probably continue to be a primary source of information regarding MDMA's effects in humans. As such, this article is intended to familiarize the reader with the behavioral pharmacology and toxicology of MDMA, with the hope that improved recognition of MDMA-related syndromes will provide insight into the function of serotonin in the human brain, in health as well as disease.
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The methodological issues surrounding the use of a privileged access interviewer team to generate a network sample of drug users are examined. Traditionally network samples have tended to be used by qualitative researchers. Privileged access interviewing provides a mechanism for the application of a structured instrument to a network sampling model. In doing so some problematic issues in this area for structured methodology are overcome, reduced or standardized. The use of this method is appraised in terms of meeting the methodological requirements of the Drug Transitions study. The practical experiences of our group in using a privileged access interviewer team to interview more than 400 heroin users, many of whom were not in contact with treatment services, are discussed. This method is most appropriate for the quick collection of data, from diverse networks of drug users, by use of a structured instrument. Success is likely to be dependent on careful implementation. The ongoing monitoring of data quality is of particular importance, as is good management practice and the establishment of supportive and non exploitative relationships with the interviewer team.
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The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10-item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol-related problems. Questions were selected from a 150-item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
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Widespread use of drugs at the currently popular 'raves' has caused concern principally because of an increasing number of cases of serious toxicity and even death. The availability and use of drugs at raves, mainly in the Edinburgh area, have been investigated and self-reported use of drugs compared with results of urine screening. Use of Ecstasy and LSD have been confirmed and there is evidence to support the use of Khat. A new preparation, Herbal Ecstasy, is readily available at Edinburgh raves and appears to be widely used. All urines tested positive for one or more drugs or drug metabolites and in general analytical results correlated well with self-reported use of drugs.
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Methamphetamine and MDMA as well as similar substituted phenethylamines are toxic to DA and/or 5-HT neurons. The duration and magnitude of these effects are dose dependent and are accompanied by different degrees of recovery. MDMA-induced 5-HT damage persists for up to 52 weeks in the rat, and methamphetamine-induced DA damage persists for up to 3 years in the rhesus monkey. Several possible mechanisms of amphetamine-analog toxicity have been reviewed. The excitatory feed-forward loop theory is best supported by the literature. This theory, however, is very wide ranging and difficult to prove or disprove. The hydroxy radical and DA mediation theories are both well supported by the data reviewed. It should be noted that these two hypotheses are closely related to each other. The DA mediation theory is based on the requirement of an intact DA system for methamphetamine and MDMA neurotoxicity to occur. The hydroxy radical theory is also based on the presence of DA and 5-HT; in addition, it suggests the formation of toxic hydroxy radicals from DA or 5-HT as the specific mechanism for the amphetamine-analog neurotoxicity. The hydroxy radical theory also accounts for the fact that amphetamine-analog neurotoxicity is selectively toxic to the DA and/or 5-HT systems of the brain; that is, the toxin is formed either in the synapse or within the neurons that release DA and/or 5-HT as a result of amphetamine analog treatment. The toxic drug metabolite theory, while not exhaustively studied, has little support from the literature at present. Similarly, the NMDA receptor mediation theory, in its most straightforward form, also has little support from the literature. The protective effects of the NMDA receptor antagonist MK-801 may be a modulatory effect resulting from changes in temperature regulation, rather than a direct effect of antagonizing a link in the toxic mechanism itself. It should be noted that the effects of the protective agent plus amphetamine-analog combinations on body temperature, when thoroughly investigated, may serve to separate agents which protect through a cooling mechanism from agents that protect by interfering with the toxic process itself.
Article
Alcohol and illicit drug use are increasing among school children and young adults in the UK. Such increases have also been noted among university students and there is a need for a large survey across different universities and faculties. We report such a survey. Information about drinking, use of cannabis and other illicit drugs, other lifestyle variables, and subjective ratings of anxiety and depression was obtained by questionnaire in a cross-faculty sample of 3075 second-year university students (1610 men, 1447 women, 18 sex not stated) from ten UK universities. The questionnaire was personally administered during scheduled lecture hours and almost all the students participated. The sample reflected the interfaculty and sex distribution and the proportion of non-white students at UK universities. 11% of the students were non-drinkers. Among drinkers, 61% of the men and 48% of the women exceeded "sensible" limits of 14 units per week for women and 21 for men. Hazardous drinking (> or = 36 units per week for women, > or = 51 for men) was reported by 15% of the drinkers. Binge drinking was declared by 28% of drinkers. 60% of the men and 55% of the women reported having used cannabis once or twice and 20% of the sample reported regular cannabis use (weekly or more often). Experience with other illicit drugs was reported by 33% of the sample, most commonly LSD (lysergic acid diethylamide), amphetamines, Ecstasy (methylenedioxymethamphetamine), and amyl/butyl nitrate which had each been used by 13-18% of students. 34% of these had used several drugs. Drug use had started at school in 46% of the sample; 13% began after entering university. The overwhelming reason given for taking alcohol or drugs was pleasure. Subjective ratings of anxiety on the hospital anxiety depression scale were high, and sleep difficulties were common, but neither related to alcohol or drug use. There is a need for better education about alcohol, drugs, and general health in universities. Such education should include all faculties. It remains unclear whether university students' lifestyles are carried over into later life.
Article
Interviews were conducted with 135 participants in the Glasgow dance (rave) scene. Drug use in this group was varied and not merely restricted to drugs associated with dance events, such as MDMA (Ecstasy). The setting in which each drug was used varied greatly. Amphetamine, nitrites and Ecstasy were the drugs most commonly used at dance events. Pharmaceuticals were least likely to be used in such settings. However, some drugs, such as Temazepam, were sometimes used prior to or after attending rave events. It is suggested that dance drug users are polydrug users who use drugs in a setting specific fashion. As such it would be wrong to classify such users solely on the grounds of their very visible behaviour in the public arena (at dance events). Other forms of substance use engaged in by this group may have a greater potential for harm than that seen at raves. The implications of these findings are discussed.
Article
Ingestion of 3,4-methylene dioxymethamphetamine (MDMA), commonly known as "Ecstasy", can produce toxicity that is characterised by hyperthermia, coagulopathy, rhabdomyolysis and renal failure. We report a fatality associated with MDMA ingestion and briefly review the current literature on MDMA-induced hyperthermia.