MDMA (3,4 methyl-enedioxy-methamphetamine), is a pheyethylamine with structural similarities to both amphetamine and mescaline. It has been classified into a novel pharmacological class termed “enactogens because it has a characteristic psychoactive profile that distinguishes it from classic hallucinogens and stimulants. Acute psychological effects include euphoria, elevated self-confidence, and heightened sensory awareness. Individuals feel closer to other individuals and groups of people. Adverse effects include depersonalization, derealisation, and cognitive disturbances.
MDMA increases release and prevents reuptake of 5-hydorxytryptamine-seratonin, and to a lesser extent, dopamine. Seratonin regulates mood, anxiety, aggression, impulsiveness, sexual activity, appetite, sleep, pain, circadian rhythm, and body temperature. The role it plays in cognition is poorly understood.
Also called ecstasy, MDMA is central to “raves” – all night dancing at clubs associated with loud music and flashing lights. MDMA is becoming increasingly popular as a recreational drug. Adverse effects include loss of appetite, trismus or bruxism, muscle aches and stiffness, ataxia, sweating, tachycardia, hypertension and hyperthermia. Life threats include hyperthermia, seizures, DIC, rhabdomyolysis, acute renal failure, and liver failure. Death is usually due to severe hyperthermia. All night dancing, sustained physical activity, and fluid loss accentuate the potential for hyperthermia. Treatment of overdose is supportive, with emphasis on rapid cooling of life-threatening temperatures.
One of the questions regarding ecstasy use is if permanent impairment can occur as a result of seratonergic neurotoxicity. There is evidence that chronic heavy use is associated with sleep disorders, depressed mood, anxiety, impulsiveness, hostility, and memory and attention impairment.
The Questions of the Week regarding Holiday Hazards (2001) have been attached.
Question of the Week will also be taking a holiday. Discussion of Drugs of Abuse will continue on January 20, 2003. Have a good holiday.
As always, if there are any questions, call the MTPC.
I am interested in any questions that you would like answered in “Question of the Week.” Please e-mail me with any suggestions at donna.seger@Vanderbilt.edu
Donna Seger, M.D.
Medical Director, Middle Tennessee Poison Center