Ecstacy

Question 1

What class is ecstasy/MDMA in?

Answer 1

It is an amphetamine but also classed as a hallucinogen.

Question 2

How is ecstasy different from meth?

Answer 2

It has a methylenedioxy ring.

Question 3

What happens when you modify the aromatic ring of MDMA?

Answer 3

Tends to reduce the stimulatory effect, but produces more serotonergic effects. Mediates more through serotonin pathways, still dopamine a bit but not as much

Question 4

What is the MDMA precursor?

Answer 4

Sassafras. Safrole is an oil obtained from the distillation of the root bark on sassafras

Question 5

How is ecstasy usually administered?

Answer 5

Almost always in pill form, most feel that effect from 75-125 mg

Question 6

What are some psychological effects of MDMA?

Answer 6

Positive mood change. Tend you drop defence mechanism when taking it. 1 ecstasy tablet is equal to about 6 months in therapy. Increased empathy for others (entactogens), increased self esteem, overall stimulating effects

Question 7

What are the physiological effects of using MDMA?

Answer 7

Rise in BP and heart rate, hyperactivity, hyperthermia, jaw clenching, bruxism (grinding of teeth) due to excess serotonin release

Question 8

What is the mechanism of ecstasy/MDMA?

Answer 8

Essentially works the same way as amphetamines, but works through serotonin pathways: blocks and reverses serotonin transporters, and pre membrane leaks out serotonin in the synapse, partial inhibition of MAO and also dopamine and noradrenaline transporters. It affects the 5HT transporter, then NA transporter with higher doses.

Question 9

What happens when there are high serotonin levels?

Answer 9

May lead to the release of oxytocin (hormone related to empathy/or falling in love)

Question 10

What usually classifies it as a hallucinogen?

Answer 10

Due to its agonist effects at the serotonin 5HT 2A receptor due to the methylenedioxy

Question 11

What are the effects on dopamine and serotonin levels in the NA?

Answer 11

Dopamine: there is a moderate increase in dopamine of about 200-300% (nothing like cocaine or AMPH)
Serotonin: huge increase on serotonin levels of about 1400%
–> not as reinforcing as other stimulants, danger usually comes from acute harm

Question 12

Where does MDMA mainly get metabolized?

Answer 12

80% in the liver, and about 20% is excreted by urine unchanged

Question 13

How many metabolites are there in the metabolism of MDMA?

Answer 13

As many as 9 metabolites have been found to induce apoptosis in neurones

Question 14

True or False: ecstasy results in increased in transporter activity like cocaine.

Answer 14

False, it results in decrease in transporter activity like AMPH

Question 15

What is “Suicide Tuesday”

Answer 15

There a sudden depression period where there is a huge decrease in NT (b/c so much was used up over the weekend), the brain needs time to regenerate some of the NT so you feel down and depressed (rebound effect)

Question 16

Why has memory loss been linked to MDMA more so than other stimulants?

Answer 16

Due to NT depletion when taking the drug

Question 17

Explain serotonin syndrome:

Answer 17

Caused when you have abnormally high levels of serotonin. Increased heart rate and BP, muscle rigidity, severe perspiration, delirium, hyperthermia, rhapdopmyolysis (muscle breakdown that can lead to kidney failure)

Question 18

Why does hyperthermia occur when taking MDMA?

Answer 18

Usually in a warm environment, repetitive physical activity (raves), dopamine causes vasoconstriction in the periphery which prevents you from radiating heat, heat gets trapped in the core and body temp can increase to 43 degree (fatal)

Question 19

What is hyponatremia?

Answer 19

Its water intoxication, state of low sodium in the blood, sometimes excessive thirst is triggered by hyperthermia, drink lots of water in short amount of time, dilute sodium in your blood so water rushes into the cells (loose equilibrium), the cells expand in the body and causes the brain to swell. Also MDMA triggers excessive release of ADH which leads to water retention

Question 20

Is hyponatremia fatal?

Answer 20

It can be yes, causes cerebral edam (brain swelling from too much was absorption), vomiting, coma, and respiratory arrest from compression of the brain stem

Question 21

Does MDMA cause neuronal loss/death?

Answer 21

A study in monkeys showed profound neuronal loss when taking MDMA twice a day for 4 days. There was only some regeneration in after 7 years.
A study in humans showed 50% marked deficits in some areas, but hard to be sure that they only took MDMA and no other drugs

Question 22

What is produced when 5HT is metabolized by monoamine oxidase?

Answer 22

Hydrogen peroxide–> can form hydroxyl radicals (5-HIAL) that can damage proteins and lipids

Question 23

What kind of damage do hydroxyl radicals like 5-HIAL cause?

Answer 23

Damage to mitochondria that results in damage to nerve terminals and eventual cell death

Question 24

True or false, there is a clear relationship between dosage of MDMA and death

Answer 24

False, sudden illness and death can occur with even small doses, there is no clear relationship between dose and death. We have no way to predict who will be sensitive to the effects

Question 25

When taking ecstasy with other substances, like Viagra, is there more neuronal death than with taking it alone?

Answer 25

No, strangely there is actually some evidence that shows Viagra might be a neuroprotective with respect to MDMA induced neurotoxicity

Question 26

What is paramethoxyamphetamine?

Answer 26

PMA is similar to amphetamines but contains an oxy and a methyl group. Has a delayed reaction but more potent and toxic, MAO inhibitor that causes increased serotonin and dopamine

Question 27

What are some of the dangers of PMA?

Answer 27

Hypoglycemia, hyperkalemia and hyperthermia

Question 28

What is N-benzylpiperazine (BZP)?

Answer 28

“Legal/natural ecstasy”. Synthetic compound from family used in plastics, pesticides and resins. Can get it in liquid free base form or pills

Question 29

What behaviours do BZP users exhibit?

Answer 29

Similar to amphetamines, increased serotonin and dopamine levels