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(partae)

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By  Professor Andy Parrott  one of the world’s leading experts on MDMA, Andy Parrott, Professor of Human Psychopharmacology, School of Health Sciences, Swansea University. 

Comparing alcohol with MDMA.Alcohol is certainly a damaging drug, but to suggest that MDMA is less damaging than alcohol does not agree with the scientific evidence (Professor Nutt, 21st May). Comparing these two drugs is like comparing an F1 sports car to a basic family saloon. MDMA is an extremely powerful drug, which heats up the brain, causing a massive increase in neurochemical activity, dramatic changes in mood state, and it takes the brain several days to recover. Regular MDMA usage impairs memory, reduces problem-solving ability, reduces white cell blood count, increases susceptibility to infections, causes sleep problems, and enduring depression. In pregnant women MDMA impairs foetal development. We and other research groups worldwide have compared the psychobiological functioning of recreational Ecstasy/MDMA users with alcohol drinkers, and in numerous studies it is always the Ecstasy/MDMA users who are comparatively worse. The ‘family car’ may kill more people each year than the F1 speed machine, but to suggest that the latter would be safer for everyday driving is completely erroneous. MDMA kills many young people each year, and the death toll is currently rising. Yours etc . . .

In the next few paragraphs, I have provided more information on this topic. What is the basis for Professor Nutt claiming that MDMA is a safer drug than alcohol? This statement was based primarily on a survey he published in the Lancet (Nutt et al, 2007, vol 369; 1047). However this article contains some astounding errors. Indeed when I was first shown it, I contacted the Lancet stating that they needed to publish a detailed reply from me, since it was important to point out these errors. After some email exchanges with one of the Lancet editors, the journal decided not to publish my letter. However I presented some of my criticisms as a conference paper (Parrott, 2009. ‘How harmful is Ecstasy/MDMA: an empirical comparison using the Lancet scale for drug-related harm’. Journal of Psychopharmacology, vol 23, page 41). 

I have listed below my main criticisms:

  1. Nutt stated that ‘for drugs which have only recently become popular such as Ecstasy or MDMA, the longer term health consequences can only be estimated from animal toxicology at present’. This statement was grossly incorrect. Numerous articles (indeed several hundred) had been published before 2006 by various research groups worldwide, including many papers from my own group. These papers revealed a wide range of adverse health and related problems.
  2. One of the Nutt harm scales was ‘intensity of pleasure’, since it is well documented that the most powerful mood enhancers also cause the most problems. Nutt’s article gave heroin and cocaine the maximum scores of 3.0, while nicotine was rated at 2.3, whereas MDMA was given the surprisingly low rating of 1.6. This made MDMA one of the least pleasurable of all their drugs (16th lowest out of their 20 drugs). This low pleasure score for MDMA is simply incomprehensible. How can anyone with even a rudimentary knowledge of human psychopharmacology state that Ecstasy/MDMA is less pleasurable than a cigarette? Yet this low rating was apparently given by Nutt’s group of experts! Recreational Ecstasy/MDMA users would certainly be very surprised at this low rating. It should be noted that this very low ‘pleasure’ score contributed directly to MDMA’s low ‘harm’ score.
  3. Drug ‘injection potential’ was another scale, with heroin and cocaine again being given maximum scores of 3.0. In contrast MDMA was given a score of 0.0. This zero score was again bizarre, since MDMA is injected by some heavy users, and they suffer from the problems typically associated with drug injecting. This practice has been noted in various academic papers. Hence the injection score for MDMA should have been similar to that given for cocaine – namely 3.0. The zero score in Nutt et al may be difficult to comprehend, but again it was crucial for generating MDMA’s low overall harm score.
  4. In my commentary paper (Parrott, 2009, see above), I provided harm estimates based on the empirical literature, and MDMA rose from 18th to 5th in the list of most damaging drugs. Hence the position of 18th given by Nutt et al in their Lancet paper is extremely misleading – and has no basis in science.
  5. So what exactly are the problems caused by MDMA?
  6. In 2011 I was asked by the USA Deputy Attorney General to be an expert witness in a court case, which debated the issue of the most appropriate sentences for Ecstasy/MDMA drug traffickers. I was asked to write a comprehensive report, based on all the available scientific research. This was later expanded into a comprehensive review (Parrott, 2013, Neuroscience and Biobehavioral Reviews 37: 1466-1484). The following brief summaries are based on that review, and many of my more recent papers.
  7. MDMA is damaging when taken acutely, since it heats up the brain, impairs thermal control, increases neurotransmitter release, and generates extreme mood changes. It also leads to cognitive confusion, and a marked increase in neurohormonal activity. Death rates from acute abreactions are comparatively rare (around 60 per year in the UK), but have been increasing due probably to the increasing levels of MDMA in Ecstasy tablets (see reports by Professor Fabrizio Schifano for the UK, with similar increases reported within mainland Europe).
  8. MDMA is also damaging when taken repeatedly. It leads to alterations and/or deficits in brain activity which may be permanent, with reductions in memory ability, reductions in problem-solving skills, deficits in complex visual abilities, impairments in some psychomotor skills, various health impairments, increased levels of depression, increased levels of aggression, and other deficits. Young women should certainly avoid MDMA if there is any possibility of pregnancy – since it can lead to impairments in subsequent child development (Professor Lynn Singer, et al, Neurotoxicology and Teratology, vol 54, pages 22-28).
  9. I could go on describing more of the problems caused by MDMA – but will limit myself to one final point. MDMA has been medically tested for cancer therapy, since it can damage/kill human cells. The medical term for this is apoptosis, and it was first demonstrated in laboratory animals, but has subsequently been confirmed in human cells (the relevant medical papers were cited in Parrott, 2013, Human Psychopharmacology, vol 28, pages 289-307).
  10. In summary, alcohol is certainly a damaging drug, and when misused it causes massive problems to individual drinkers, their families, and wider society. However the majority of alcohol drinkers are able to use it safely over their lifetimes. In contrast, MDMA is a far more powerful and damaging drug. Current evidence suggest that its regular usage is not only damaging to many young users, but that this damage may endure for several years following drug cessation (Taurah et al, 2013, Psychopharmacology vol 231, pages 737-751).

    MDMA Madness
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Cardiac sequelae are the second most common cause of death (behind overdose) in patients who use methamphetamines (“meth”). Like cocaine use, use of methamphetamines can produce both acute and chronic cardiovascular disease. Acute intoxication with methamphetamines produces a hyperadrenergic state, not unlike having a pheochromocytoma. The hypertension and tachycardia that result can lead to myocardial ischemia and infarction, aortic dissection, malignant arrhythmias, Takotsubo’s (stressinduced) cardiomyopathy, and cardiac arrest. Chronic methamphetamine use can lead to hypertrophic cardiomyopathy (due to persistent severe hypertension) or dilated cardiomyopathy (due to the drug’s toxic effects on myocardium), and the clinical syndrome of heart failure. In addition, chronic meth use can also cause pulmonary arterial hypertension (PAH). Meth-associated PAH is a devastating disease, with five-year mortality rates above 50%.

Diagnosing and managing acute methamphetamine intoxication:

Patients who present with suspected acute methamphetamine intoxication should undergo a full physical exam, electrocardiogram, and basic lab work (including basic metabolic panel, blood counts, clotting times (prothrombin time and international normalized ratio), liver function tests, creatine phosphokinase (CPK), urinalysis, and urine and serum toxicology screens). Amphetamine intoxication or toxicity is ultimatelydiagnosed by confirming the presence of amphetamines in urine or serum. However, if patients present with signs and symptoms which raise concern for amphetamine intoxication—including hyperthermia, agitation, hypertension, and tachycardia—treatment should not be delayed while waiting for these test results to return.

If there is concern for myocardial ischemia or infarction (for example, if the patient complains of chest discomfort or shortness of breath or the ECG shows ischemic changes), then cardiac biomarkers should be checked as well (i.e. troponin I or T). Acute methamphetamine intoxication with secondary sequelae (i.e. agitation, hypertension, tachycardia) should be managed initially with sedatives (benzodiazepines and 2nd generation atypical antipsychotics).

Hyperthermia should be managed aggressively by controlling core body temperature with sedatives and, if necessary, with paralysis and intubation (but antipyretics should not be used).

Rhabdomyolysis is common, and a CPK level should always be checked in patients who are acutely intoxicated with meth. If the hypertension is refractory to treatment with an adequate trial of sedation, then nitrates and/or phentolamine should be used. Calcium channel blockers can also be used, and are effective agents for managing tachycardia that persists despite sedation. Beta-blockers should be avoided in the acute setting to avoid precipitating unopposed alpha-mediated vasoconstriction (via identical mechanisms to those described above). If beta blockers are necessary for chronic management of a different disease process (e.g. cardiomyopathy or coronary artery disease), then labetalol or carvedilol are the preferred agents due to their partial alphaantagonism. Myocardial infarction in the setting of methamphetamine intoxication should be managed per evidence-based guidelines for the management of heart attacks, and as described above (for cocaine). The one exception is that, if heart rate control is needed, calcium channel blockers, not beta blockers, should be used. Interestingly, monoclonal antibodies against methamphetamine have been developed and are currently in clinical trials.

Chest pain in the setting of acute methamphetamine intoxication should raise concern not only for myocardial infarction, but also for acute aortic dissection. Methamphetamine abuse is the second most common cause of acute fatal aortic dissection in the US, after hypertension. Unlike chest discomfort due to myocardial ischemia, which often starts as mild or moderate discomfort and worsens progressively over minutes-hours, chest discomfort due to aortic dissection is typically extreme from the outset.

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However, while many adult users opt for e-cigarettes to ease themselves out of their smoking habit, some researchers have raised concerns that teenagers may be using them as a gateway into this very habit. E-cigarette usage seems to be popular among many teenagers, despite the fact that the Food and Drug Administration (FDA) have banned the sale of such devices to people under 18.

Carcinogens threaten teenagers' health

In order to reach their conclusions, Dr. Rubinstein and team collected and analyzed urine samples from 104 adolescents, aged 16.4 years, on average. Of these, 67 were e-cigarette users, 17 used e-cigarettes as well as traditional ones, and 20 did not smoke or vape (the controls).

Their analysis revealed that the teenagers who vaped had a three times higher concentration of toxic compounds in their bodies than their non-vaping peers. In the case of teenagers who used both tobacco cigarettes and e-cigarettes, the concentration of toxic chemicals in the body was three times higher than in the case of adolescents who only vaped. "E-cigarettes," Dr. Rubinstein says, "are marketed to adults who are trying to reduce or quit smoking as a safer alternative to cigarettes. While they may be beneficial to adults as a form of harm reduction, kids should not be using them at all."

For complete article E-CANCER!!

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by Katharine Q. Seelye New York Times, January 21, 2018. 

EXTRACTS

Drug deaths draw the most notice, but more addicted people live than die. For them and their families, life can be a relentless cycle of worry, hope and chaos.

* * * * *

Even in the cheeriest moments, when Patrick was clean, everyone — including him — seemed to be bracing for the inevitable moment when he would turn back to drugs.

“We are your neighbors,” his mother, Sandy Griffin, said of the many families living with addiction, “and this is the B.S. going on in the house.”

* * * * *

. But the opioid scourge, here and elsewhere, has overwhelmed police and fire departments, hospitals, prosecutors, public defenders, courts, jails and the foster care system.

Most of all, though, it has upended families.

* * * * *

 “It’s a merry-go-round, and he can’t get off,” Sandy said of Patrick and his overdoses. “The first couple of times, I started thinking, ‘At least he’s not dead.’ I still think that. But he’s hurting. He’s sick. He needs to learn to live with the pain of being alive.”

* * * * *

Unlike some of the other parents, Sandy seemed battle hardened, like one who had been immersed in a war for a long time.

“I lost myself 10 years ago,” she told the group. “I couldn’t go to work, I couldn’t get out of bed.” She said she was consumed by codependency, in which “you are addicted to this human being to save them.”

She said she had realized that she had to save herself. 

* * * * *

For drug users and their loved ones, though, the worry never ends. No day can be ordinary. The threat of relapse is constant.

When Patrick recently texted Sandy, saying, “I love you,” her first thought was that he was about to kill himself. She frantically called him back. Patrick told her he was fine, he had just been thinking about her.

For a moment, Sandy caught her breath.

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25 December 2017 By Zawn Villines,  Reviewed by Alan Carter, PharmD

Any drug that alters a person's consciousness in a way that makes self-defense or sound decision-making difficult can be a date rape drug.

Most estimates suggest that at least 25 percent or 1 in 4 of American women have been sexually assaulted or raped. Someone the victim knows, sometimes with the assistance of a date rape drug, commits most rapes.

Knowing the most common date rape drugs, their side effects, and the signs of a perpetrator planning to use one can prevent victimization.

Fast facts on date rape drugs:

  • Many people worry about a perpetrator adding a date rape drug to an alcoholic drink.
  • The primary sign of being drugged is a sudden, unexplained change in consciousness.
  • A person who thinks they may have been drugged should seek safety first and foremost.

Types and their side effects

Alcohol and benzodiazepines are commonly used date rape drugs, as they may cause physical weakness and loss of consciousness.

Date rape drugs make a sexual assault, including rape easier in one or more ways, such as:

  • making a victim more compliant and less able to say no
  • weakening a victim so they are unable to resist or fight back
  • making a victim fully or partially unconscious
  • weakening a victim's inhibitions, so they consent to sexual activity they may otherwise decline

Any drug that changes a potential victim's state of mind, including some prescription drugs, street drugs such as heroin, and popular drugs such as marijuana, can be a date rape drug.

The most common date rape drugs are:

  • Alcohol
  • Benzodiazepines
  • Ketamine
  • GHB
  • Other date rape drugs

Any drug that changes a victim's consciousness can be used to facilitate date rape.

In some cases, the victim might even ingest the drug willingly. A person who uses heroin, for example, may be so intoxicated that they do not realize a perpetrator is attempting to rape them. People who use drugs should, therefore, avoid taking them around certain acquaintances or in settings that might facilitate date rape.

  1. Types
  2. Signs and symptoms
  3. What to do
  4. Protecting yourself
  5. Takeaway

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