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MDMA Ecstasy - Rollin' Rollin' Rollin'

February 14, 2017

Brian Samuels - Medical Student1, Matthew Vasey MD2


1MD Candidate, University of South Florida Morsani College of Medicine, Class of 2018
2Department of Emergency Medicine, Tampa General Hospital | TeamHealth, an affiliate of University of South Florida Morsani College of Medicine

Disclosure: Opinions reflect neither employer nor affiliated institutions, soley those of the author(s).


Friends, music, drinks, and good vibes - these are the classic ingredients of a great night. For years this recipe has been tampered with in an attempt to turn a great night into an EPIC night. In the 70s it was popular to sprinkle in some Quaaludes. In the 80s and 90s is was popular to add a dash of cocaine. Today's delicacy includes a heap of 3,4-methylenedioxymethamphetamine (MDMA). MDMA goes by many names - Ecstasy, Molly, Rolls, Beans, Skittles, Space Rocks, Gulley Stones, etc. - and has become one of the most popular drugs amongst adolescents and young adults.

MDMA is a synthetic drug which comes in a variety of forms including powder and crystal, or in pressed pills which are usually mixed with other goodies such as caffeine and/or methamphetamine [1]. This drug was originally developed in 1914 to be used as an appetite suppressant; however, shortly after its formulation, users quickly discovered it did a little more than just that. MDMA is now most famous for its effects on mood and energy. Users endorse experiencing feelings of euphoria, wakefulness, intimacy, sexual arousal, and disinhibition [2]. It's no wonder this drug is also known for its addictive potential, which is why there are tight restrictions on its use.

So how do these magical stones work you may ask? Well MDMA works similarly to other amphetamines, as well as, mescaline; the active hallucinogen in Peyote which has been used in religious ceremonies by Native Americans for many years [2]. Before we go any further, I want to explain how your nervous system works. Each neuron stores "messages" in the form of neurotransmitters such as norepinephrine, dopamine, serotonin, etc. Neurons are able to communicate by releasing these neurotransmitters into the synaptic cleft, the space between neurons (fig. 1). Once in the synaptic cleft, these neurotransmitters land on neighboring neurons which have receptors for each neurotransmitter. Depending on what type, how many, and for how long these receptors are activated, the receiving neuron will react by either passing the same message along, sending a different message, or doing nothing at all. In order to make sure our neurons are not constantly firing, our body has mechanisms to clear the neurotransmitters from the synaptic cleft. These mechanisms include enzymes that metabolize the neurotransmitters, as well as different receptors that re-uptake the neurotransmitters and recycle them for later use [3]. Okay, now that you've got that, like other amphetamines MDMA increases the release and decreases the reuptake of a class of neurotransmitters known as the catecholamines, mainly norepinephrine and dopamine. Like mescaline, MDMA increases the firing of serotonergic receptors. Specifically, MDMA increases the release and decreases the reuptake of serotonin. So basically MDMA floods the nervous system with norepinephrine, dopamine, and serotonin leading the users to experience euphoria, intimacy, sexual arousal, disinhibition, and wakefulness (the wise men Kid Cudi and Jackie Cain once chanted "Rollin' Rollin' Rollin' we ain't slept in weeks") [2]. The overall experience has become known as "rolling face" (fig.2)



"Wow Molly sounds fun man! What's with the media giving it such a bad rep?" With a nickname like Ecstasy you would think it's all gravy… but things aren't always as good as they sound. The neurotransmitter norepinephrine is one on the main players in the "fight or flight" response. As a result of extremely high levels of norepinephrine, users are put at risk for life threatening increase in heart rate and blood pressure, as well as, hyperthermia. Users often attempt to avoid hyperthermia by remaining well hydrated, however this has the potential to lead to further life threatening issues such as hyponatremia, a fancy way of saying low blood sodium [2]. As a result of extremely high levels of serotonin, users are at risk of developing "serotonin syndrome". This is another potentially life threatening condition in which is characterized by fun things like severe cramping, seizures, hyperthermia, diarrhea, confusion, agitation and more [2]. As a result of the over release of dopamine, MDMA has to potential to be psychologically addicting (i.e. your brain will rerun memories of how great it is so that you go back for more) [2]. The molecule MDMA has also been shown to be toxic to the liver and damage to the liver is potentially fatal [2]. So basically MDMA has a bunch of "side effects" most of which can kill you.



"Okay well say I survive the night - I'll be back to 100 the next day right?" Well maybe, however, most users feel down, drained, and sometimes depressed following a good night of "rolling face". These feelings mainly revolve around serotonin. Serotonin is commonly known as the happy neurotransmitter. It plays a role in feeling well and content, which is why many antidepressants work by increasing serotonin. As a result of the over release of this neurotransmitter, and the over stimulation of the serotonin receptors, users become drained of this neurotransmitter and the receptors themselves become damaged. With long-term abstinence, studies have shown some return in the amount of serotonin as well as "recovery" of some of the damaged receptors; however, there is still debate as to whether there is ever a full return to normal levels [2]. This means there is a possibility that users are at risk of feeling "off" for years after stopping use.

"Oh man now you're making Molly sound like something out of Final Destination." Although this drug has the ability to kill you several different ways, it also has the potential for much good. There are areas of research looking into the use of MDMA to treat mental disorders such as depression and PTSD [4]. These studies are performed in a controlled environment with medical staff. So, when used correctly there is potential for benefit; however, the "correct" way of use is still unknown. So is a couple hours in heaven worth the risk of landing in hell? To each is his own, but like anything else be informed before you try. Happy New Year and party on my friends!

REFERENCES:

1. "Partnership For Drug-Free Kids." Partnership for Drug-Free Kids. N.p., 17 Aug. 2012. Web. 06 Jan. 2017.
2. Hoffman, Robert J . "MDMA (ecstasy) intoxication." MDMA (ecstasy) intoxication. UpToDate, 28 Apr. 2016. Web. 06 Jan. 2017.
3. Zoli, Michele, and Luigi F. Agnati. "Wiring and volume transmission in the central nervous system: the concept of closed and open synapses." Progress in neurobiology 49.4 (1996): 363-380.
4. Parrott, Andrew C. "The psychotherapeutic potential of MDMA (3, 4 methylenedioxymethamphetamine): an evidence-based review." Psychopharmacology 191.2 (2007)
5. Synapse. Digital image. N.p., n.d. Web. 10 Jan. 2017.
6. Hora 61. Digital image. Thump. N.p., n.d. Web. 10 Jan. 2017.





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