5. MDMA, Ecstasy, and Molly: Power-Packed Russian Roulette. The Effects of 5 Everyday Drugs on the Brain & Body

In this blog we will look at timely topics on the brain. Learn along with a copy from our book series, Healing the Brain. Get your copy today. A Thousand Moms offers workshops to the general public. These workshops are presented in clear, non-complicated language. In New York, Vermont and Massachusetts, please call 518 322-0607 or write to athousandmoms@yahoo.com.

 

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3,4-methylenedioxy-methamphetamine (MDMA) 

is a synthetic drug that alters mood and perception (awareness of surrounding objects and conditions). It is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception.

MDMA was initially popular in the nightclub scene and at all-night dance parties ("raves"), but the drug now affects a broader range of people who more commonly call the drug Ecstasy or Molly.

How do people use MDMA?

People who use MDMA usually take it as a capsule or tablet, though some swallow it in liquid form or snort the powder. The popular nickname Molly (slang for "molecular") often refers to the supposedly "pure" crystalline powder form of MDMA, usually sold in capsules. However, people who purchase powder or capsules sold as Molly often actually get other drugs such as synthetic cathinones ("bath salts") instead (see "Added Risk of MDMA").

Some people take MDMA in combination with other drugs such as alcohol or marijuana.

How does MDMA affect the brain?

MDMA increases the activity of three brain chemicals:

• Dopamine—causes a surge in euphoria and increased energy/activity
• Norepinephrine—increases heart rate and blood pressure, which are particularly risky for people with heart and blood vessel problems
• Serotonin—affects mood, appetite, sleep, and other functions. It also triggers hormones that affect sexual arousal and trust. The release of large amounts of serotonin likely causes the emotional closeness, elevated mood, and empathy felt by those who use MDMA.

Other health effects include:

• nausea
• muscle cramping
• involuntary teeth clenching
• blurred vision
• chills
• sweating

Photo by ©Jochen Schoenfield/Shutterstock

MDMA's effects last about 3 to 6 hours, although many users take a second dose as the effects of the first dose begin to fade. Over the course of the week following moderate use of the drug, a person may experience:

• irritability
• impulsiveness and aggression
• depression
• sleep problems
• anxiety
• memory and attention problems
• decreased appetite
• decreased interest in and pleasure from sex

It's possible that some of these effects may be due to the combined use of MDMA with other drugs, especially marijuana.

What are other health effects of MDMA?

High doses of MDMA can affect the body’s ability to regulate temperature. This can lead to a spike in body temperature that can occasionally result in liver, kidney, or heart failure or even death.
In addition, because MDMA can promote trust and closeness, its use—especially combined with sildenafil (Viagra^®)—may encourage unsafe sexual behavior. This increases people's risk of contracting or transmitting HIV/AIDS or hepatitis.

Added Risk of MDMA

Adding to MDMA's risks is that pills, capsules, or powders sold as Ecstasy and supposedly "pure" Molly may contain other drugs instead of or in addition to MDMA. Much of the Molly seized by the police contains additives such as cocaine, ketamine, methamphetamine, over-the-counter cough medicine, or synthetic cathinones ("bath salts"). These substances may be extremely dangerous if the person does not know what he or she is taking. They may also be dangerous when combined with MDMA. People who purposely or unknowingly combine such a mixture with other substances, such as marijuana and alcohol, may be putting themselves at even higher risk for harmful health effects.

Source: NIDA.gov Drug Facts

 

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Praise for Healing the Brain

"A book that can help medical professionals as well as the general public, Mr. Balog has tackled a subject that is complex and he makes it quite approachable. It has added and enriched my own practice of medicine by making me more aware of issues not often discussed in medical circles."--Peter Paganussi, MD, Virginia

"Author David Balog has done an excellent job of creating a book for educators (or anyone working with youth) that explains the complicated workings of the brain in an easy to understand manner. Balog goes on to discuss various types of trauma and how the adolescent brain responds to trauma such as depression, stress, addiction, risk taking, PTSD, etc. LGBT/Q youth may experience trauma in ways majority youth often do not. The author shares important coping strategies....I highly recommend this book!"--Carol Dopp, M.Ed. 

"David Balog understands the strain of alienation, so he tackles this subject with compassion and concern. Mr. Balog draws on his knowledge of brain science to give readers insight into what happens to young people under tremendous stress, and he offers practical advice on how to help and cope."--Gary Cottle, author

"Provides comfort and learning to the reader. Flows easily from one topic to the next and knits tidbits of information together in a unifying mosaic. Easy to read. Difficult to put down." --Michael J. Colucciello, Jr., New York State Dept. of Mental Health researcher, retired.

"Well researched, fleshed out with relevant case histories, this book packs a lot of solid information into its 152 pages. Written in an engaging style for the layman, it covers a wide range of topics. One learns a great deal about the biology of stress, particularly the vulnerability of the brain in the pre-adult years. This book also provides a glossary of key brain science terms and a listing of organizations serving the LGBT /Q community and resources on the brain."--Gary Bordzuk, librarian

3. Opioids: From bathroom cabinet to epidemic. How everyday drugs affect our health.

What is prescription opioid misuse?

Also known as: Oxy, Percs, Happy Pills, Hillbilly Heroin, OC, or Vikes

Prescription opioids are medications that are chemically similar to endorphins – opioids that our body makes naturally to relieve pain – and also similar to the illegal drug heroin.  In nature, opioids are found in the seed pod of the opium poppy plant. Opioid medications can be natural (made from the plant), semi-synthetic (modified in a lab from the plant), and fully synthetic (completely made by people).

Prescription opioids usually come in pill form and are given to treat severe pain—for example, pain from dental surgery, serious sports injuries, or cancer. Opioids are also commonly prescribed to treat other kinds of pain that lasts a long time (chronic pain), but it is unclear if they are effective for long term pain.

For most people, when opioids are taken as prescribed by a medical professional for a short time, they are relatively safe and can reduce pain effectively. However, dependence and addiction are still potential risks when taking prescription opioids. Dependence means you feel withdrawal symptoms when not taking the drug. Continued use can can lead to addiction, where you continue to use despite negative consequences. These risks increase when these medications are misused. Prescription medications are some of the most commonly misused drugs by teens, after tobacco, alcohol, and marijuana.

Common opioids and their medical uses are listed below.

Opioid Types	Conditions They Treat
oxycodone (OxyContin, Percodan, Percocet) hydrocodone (Vicodin, Lortab, Lorcet) diphenoxylate (Lomotil) morphine (Kadian, Avinza, MS Contin) codeine fentanyl (Duragesic) propoxyphene (Darvon) hydromorphone (Dilaudid) meperidine (Demerol) methadone	severe pain, often after surgery acute (severe) pain some forms of chronic pain (severe) cough and diarrhea

Fentanyl has been in the news recently.  It is a powerful opioid prescribed for extreme pain that is 50 to 100 times more potent than morphine. It is extremely dangerous if misused, and is sometimes added to illicit drugs sold by drug dealers. Find out more about Fentanyl.

Types of opioids:

Type of Opioid	How Are They Derived	Examples
Natural opioids (sometimes called opiates)	nitrogen-containing base chemical compounds,  called alkaloids, that occur in plants such as the  opium poppy	morphine, codeine, thebaine
Semi-synthetic/man-made opioids	created in labs from natural opioids	hydromorphone, hydrocodone, and oxycodone (the  prescription drug OxyContin), heroin (which is made  from morphine)
Fully synthetic/man-made opioids	completely man-made	fentanyl, pethidine, levorphanol,  methadone, tramadol,  dextropropoxyphene

How Prescription Opioids Are Misused
People misuse prescription opioid medications by taking them in a way that is not intended, such as:

• Taking someone else’s prescription, even if it is for a legitimate medical purpose like relieving pain.
• Taking an opioid medication in a way other than prescribed—for instance, taking more than your prescribed dose or taking it more often, or crushing pills into powder to snort or inject the drug.
• Taking the opioid prescription to get high.
• Mixing them with alcohol or certain other drugs. Your pharmacist can tell you what other drugs are safe to use with prescription pain relievers.

Prescription opioids are chemically closely related to heroin, and their effects, especially when misused, can be very similar. Because heroin may be cheaper to get, people who have become addicted to prescription pain medications sometimes switch to using heroin. Nearly 80 percent of people addicted to heroin started first with prescription opioids. However, the transition to heroin use from prescription opioids is still rare; only about 4 percent of people who misuse prescription opioids use heroin. Even so, because millions of people are using prescription opioids, this adds up to hundreds of thousands of heroin users.

Source: The National Institute on Drug Abuse Blog Team. (). Prescription Pain Medications (Opioids). Retrieved from https://teens.drugabuse.gov/drug-facts/prescription-pain-medications-opioids on June 14, 2017.

Upcoming: Cocaine, Ecstasy.

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Praise for Healing the Brain

"A book that can help medical professionals as well as the general public, Mr. Balog has tackled a subject that is complex and he makes it quite approachable. It has added and enriched my own practice of medicine by making me more aware of issues not often discussed in medical circles."--Peter Paganussi, MD, Virginia

"Author David Balog has done an excellent job of creating a book for educators (or anyone working with youth) that explains the complicated workings of the brain in an easy to understand manner. Balog goes on to discuss various types of trauma and how the adolescent brain responds to trauma such as depression, stress, addiction, risk taking, PTSD, etc. LGBT/Q youth may experience trauma in ways majority youth often do not. The author shares important coping strategies....I highly recommend this book!"--Carol Dopp, M.Ed. 

"David Balog understands the strain of alienation, so he tackles this subject with compassion and concern. Mr. Balog draws on his knowledge of brain science to give readers insight into what happens to young people under tremendous stress, and he offers practical advice on how to help and cope."--Gary Cottle, author

"Provides comfort and learning to the reader. Flows easily from one topic to the next and knits tidbits of information together in a unifying mosaic. Easy to read. Difficult to put down." --Michael J. Colucciello, Jr., New York State Dept. of Mental Health researcher, retired.

"Well researched, fleshed out with relevant case histories, this book packs a lot of solid information into its 152 pages. Written in an engaging style for the layman, it covers a wide range of topics. One learns a great deal about the biology of stress, particularly the vulnerability of the brain in the pre-adult years. This book also provides a glossary of key brain science terms and a listing of organizations serving the LGBT /Q community and resources on the brain."--Gary Bordzuk, librarian

Opioids, Heroin and Public Health

In this blog we will look at timely topics on the brain. Learn along with a copy from our book series, Healing the Brain. Get your copy today. A Thousand Moms offers workshops to the general public. These workshops are presented in clear, non-complicated language. In New York, Vermont and Massachusetts, please call 518 322-0607 or write to athousandmoms@yahoo.com.

Source: The Dana Foundation

The Opioid Epidemic

“We’ve moved from an epidemic to a crisis” in opioid abuse in the United States, said Daniel Ciccarone, M.D., MPH, during a panel discussion at AAAS in Washington, DC, this week. Ciccarone, a doctor at University of California, San Francisco, who treats addicted people and does research, described a pattern of intertwined waves involving abuse of prescription pills, heroin, and synthetic opioids like fentanyl.

For example, while overdose deaths due to prescription pill use are spread relatively evenly across the country, “this is not true for heroin,” Ciccarone said. The Northeast has had troubles with opioid abuse for a generation, while in the Midwest, numbers have jumped just recently. And while older folks (50-64) are using pills in greater numbers, it’s younger people (20-35) driving heroin use.
“Heroin itself is becoming more and more dangerous,” he said, especially when it is laced with synthetic drugs like fentanyl and carfentanil (used to tranquilize elephants). People who stop breathing after using these stronger concoctions often don’t respond to emergency treatments like naloxone.


The latest epidemic came about in large part out of doctors’ good intentions, said Nora Volkow, M.D., director of the National Institute on Drug Abuse, part of NIH. Starting in the late 1990s, doctors increasingly prescribed opioids to young and old for acute (sudden onset) and chronic pain (pain that is regular and has lasted for months). They were responding to a call to better help people who were in severe pain, and they thought that while the patient was experiencing pain, they would not be likely to become addicted to the drug.

“The epidemic really started from our over-prescription,” said Volkow, a member of the Dana Alliance for Brain Initiatives. For example, in 2013, the number of total pills prescribed in this country was the equivalent of a 1 month supply for every adult in the US, she said. Over the past 15 years, “the whole United States appeared to become infected,” she said.

Opioids are very effective for acute pain. Volkow described her own experience taking them after she was in a car accident: “It was amazing, not just because the pain was gone but because of that great sense of well-being.” But many people grow more tolerant of the drug the longer they use it, and need ever-increasing doses to find relief. This can lead to over-use, and to people transitioning from pills to black-market drugs like heroin and fentanyl. “80 percent of new cases of heroin are actually emerging from individuals who became addicted to prescription opioids,” she said; because prescription drugs are expensive and difficult to get, while heroin has gotten cheaper, they make the switch. (The other 20 percent of new users are mainly younger people, who started directly with heroin as a recreational drug.)

This is dire news, but we have experienced waves of other deadly maladies and overcome them before. “When we had the HIV epidemic, when we had the Ebola epidemic, we addressed it using science,” Volkow said. “Scientific solutions can provide us means to control these problems, and it’s not any different for the opioid crisis”

For example, Karen Drexler, M.D., an addiction psychiatrist and program director for addictive disorders at the Veterans Healthcare Administration (VA), described the success of Dr. John Snow in solving a cholera epidemic in 1854 London. While others blamed bad air for the outbreak, Snow looked at this map showing where the sickened people lived, and asked what they had in common. It turned out they all obtained water from one local pump. Snow stopped the outbreak by taking the handle off the pump. People obtained their water from elsewhere, and stopped getting sick.

Map of opioid prescriptions and overdoses. Data source: National Vital Statistics, 2013 Source: State of Maryland

Looking at “our ‘map of London’ for the opioid epidemic,” Drexler said, it was clear that the most overdoses were where there were the most over-prescriptions. For opioids, “taking the handle off the pump” means reducing the number of prescriptions and changing prescription advice to use the lowest effective dose for the shortest amount of time so people have the least risk of becoming addicted. “Prevention is best,” she said.

The VA is applying a series of evidence-based actions to reduce prescriptions, including more-closely monitoring people who are taking opioids, advising doctors not to prescribe opioids for chronic pain, and suggesting alternative drugs and counseling.

Volkow described three areas NIH and others are working on: developing better, safer treatments for chronic pain; designing better strategies to help addicted people come off the drugs; and finding more direct opioid-blocking drug interventions like methadone, naloxone, and buprenorphine. The latter are proven to help, but “they are not being used. Less than 15 percent of people who would benefit from these are getting them,” she said, because of stigma, lack of doctor training, and lack of insurance reimbursement. In addition, “with science, of course we look for transformation,” she said, including looking for a potential vaccine against fentanyl.

Drexler described several current models of treatment that have evidence of success, including brief one-on-one counseling, which “is sufficient for many with opioid-use disorder,” she said. Other methods include the Massachusetts model of buprenorphine maintenance, Project Echo in New Mexico, and a method mirroring the alcohol care management model.

“I’m very hopeful that we’ll be able to disseminate these models out,” she said, perhaps by using marketing methods similar to those drug companies use. Still, “we need more help for newer, better treatments as well as how to implement the ones we have.”

“We need to treat this as a poisoning epidemic, not a drug epidemic,” Ciccarone said, including boosting programs that do “harm reduction,” caring for people who are engaging in risky behavior. “We tend to think of harm reduction as ‘aiding and abetting drug users,’ in the political sphere, but harm reduction saves lives,” it’s cost-effective, and it can bring people into treatment, he said. “Stop treating the drugs as sort of the special privilege of the criminal justice folks and the injured bodies as only public health.”