Education
Pharmacists are medication experts. Periodically, our pharmacists will post information on this page in response to some of the more frequent questions they are asked. Today's topic is:
The Agony of Ecstasy
The chemical commonly found in "ecstsay" tablets is 3-4 methylenedioxymethamphetamine (MDMA). It is also referred to as E, Adam, XTC, hug, beans, love drug, X, and others. MDMA has stimulant (amphetamine-like) and some hallucinogenic (LSD-like) properties. It was first synthesized in 1912 and used therapeutically for short period of time in the 1970s. It has been used illicitly since the early 1980s.
Unfortunately, as the market for this illict drug has grown, other chemicals are being used to "cut" ecstaty tablets. In fact only 1/3 of ecstasy tablets sold contain MDMA. Other illict drugs that have been substituted for MDMA in ecstacy tablets include 3,4-methylenedioxyethamphetamine (MDA, a longer-lasting stimulant also known as "Eve") and methylenedioxyethylamphetamine (MDEA, a shorter-lasting hallucinogen), ketamine (a hallucinogen), and more. Other tablets contain solvents, OTC drugs (e.g., caffeine and dextromethorphan) and other synthetic chemicals. There has also been some speculation that ecstasy tablets containing 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) instead of MDMA were the cause of early-onset Parkinson's disease in one unfortunate individual (NEJM 341:1400-1401).
MDMA is said to produce a sense of euphoria, relaxation, and enhanced self-awareness. It works by releasing serotonin from selected nerves in the brain and preventing its reuptake, thereby elevating mood. MDMA also releases dopamine and norepinephrine to a lesser extent (this is increased by some of the previously-mentioned additives). MDMA also produces a syndrome of altered mental status, elevated heart and breathing rate, profuse sweating, and elevated body temperature.
Complications from MDMA can include rhabdomyalysis (muscle degradation), kidney failure, heart attack, liver failure, stroke, severe dehydration, profound psychosis, nerve damage, and long-lasting depression or anixety. The symptoms of depression and anxiety can be long-lasting and the severity of the other complications can vary depending on patterns of use, the presence of additives, and the dose ingested. Unfortunatley, it is impossible to know how much MDMA (if any) is present in a given tablet and what additives are present.
These complications are made more likely with underlying medical conditions, such as seizures, asthma, malignant hyperthermia, and others. Drug interactions can also increase the severity and frequency of complications. Some examples of drug interactoins wit MDMA include (this list in not exhausitve):
Drugs that can decrease clearance of MDMA from the body via the liver:
- Antidepressants: (e.g, Paxil®, Zoloft®, Prozac®, Luvox®, Elavil®, Desyrel®, Effexor®)
- Antihistamines: (Benedryl®)
- Codeine: (e.g. Tylenol #1, #2, #3)
- Anti-HIV and anti-malarial medications
- Cough syrups: (Benelyn®, Hycodan®)
- Antidepressants: (e.g., Paxil®, Zoloft®, Prozac®, Luvox®, Elavil®, Desyrel®, Effexor® etc.)
- Especially: Manerix®, Nardil®, Parnate®
- Stimulants: (Ritalin®, Dexedrine®)
- Alcohol is a potent diuretic, therefore increasing the risk of dehydration
- Long-term use of antidepressants may actually blunt the “high” therefore leading to potential overdose (taking more pills to get the “high”)
- Confusion, Agitation, Coma
- Elevated heart rate and blood pressure
- Nausea
- Muscle jerks or rigidity, restlessness, tremor, poor coordination, or shivering
- Sweating
- Unreactive pupils
- Elevated respiratory rate
- Elevated body temperature
The message here is that you don't need a pill to have fun. Ask yourself if you would come into the pharmacy and take an unknown medication without first asking the pharmacist what was in it and if there were any side effects. Most people would want to know what they are putting in their bodies. The problem with ecsatsy is that you don't know exactly what chemicals are present in each pill and there are significant risks in not knowing. That's the agony of ecsatasy.