A Public Health Perspective on MDMA

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The Up Front Lecture Series
Miami, Florida
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Hurricane eRave, Club, and Party DrugsFall
2001 Update
Jim Hall Up Front Drug Information Center Miami,
Florida
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is many drugs!
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Rave and Club Drugs

• MDMA (ecstasy or e)
• LSD
• GHB, GBL, and 1,4BDL
• Rohypnol, Xanax, Clonopin
• Ketamine (Special K)
• Methamphetamine
• Heroin
• Alcohol

Uppers in Red
Downers in Blue
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ECSTASY (MDMA)

• XTC, X, Rollers, and now e
• Hallucinogenic stimulant.
• Desired Effects--Introspectiony distorti
• Adverse Effects--Severe thirst, heat exhaustion,
  long-term brain disorders, death
• Usually tablets or capsules, but reports of
  injection of X.
• PMA Flatliners4-MTA SuperX 33

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A Public Health Perspective on MDMA
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A Public Health Perspective on MDMA
3,4 Methylenedioxymethamphetamine
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II. Challenges and Opportunities
What we know
I. Advances
"e"
MDMA
ecstasy
Turn adversity to advantage
Research
III. Future Directions
Next, please.
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Advances

• The of
• abuse
• as a Public Health issue

evolution
MDMA
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ecstasy
X-T-C
ecstasy

• The
• of

evolution
MDMA
Acid
"x"
rolling
"e"
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ecstasy
"e"
X-T-C
ecstasy

• The
• of

evolution
MDMA
Acid
rolling
"x"
"e"
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Advances

• The of
• abuse
• as a Public Health issue

evolution
MDMA
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Journal Citations

• Golub, AL and Johnson, BD. Crack's Decline Some
  Surprises Across U.S. Cities. NIJ Research in
  Brief US DOJ Office of Justice Programs,
  National Institute of Justice.

www.usdoj.nij.gov
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Plateau
Decline
Expansion
Generic Epidemic Model
Ugachaka
of Users Problems
Incubation
Time
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The Ugachaka Phenomena

• Epidemic Outbreak
• Compulsive
• I cant stop...
• Youthful

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History of Cocaine
Escalating cocaine use among young adult users
of other illicit drugs in the late 1970s and
adolescents in the early 1980s led to the
national cocaine epidemic twenty years ago.
Quaaludes 714
Pot
Ugachaka
Purple Micro-dots
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Cocaine Initiates (1000s)
One and a Half Million
1982
1998
1976
1970
Source 1998 National Household Survey on Drug
Abuse
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History of Cocaine
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Advances Extended Incubation Period
X-T-C

• Before 1996 and
• Among distinct groups

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The Early Years Designed and Legal by
1980 From MDA to MDMA
MDMA
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...Blow your Mind...
The Early Years Europe The
Warehouse Parties Acid House Music
Acid
Acid
Blow your Mind...
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BUSTED - 1985 Therapy ? Or No Clinical
Trails ?
Schedule I
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Its Safe, Isnt it ?
ecstasy
Crack Summer 1986 Cocaine Repudiated on
campus Replaced by MDMA
ecstasy
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The Club Drugs GHB Ketamine Heroin LSD
X-T-C
Generation X
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The Club Drugs Alcohol alprazolam
(XanaX) flunitrazepam (Rohypnol) clonazepam
(Klonopin)
X-T-C
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X-T-C

• User Scenes
• European Techno-Dance
• Gay men Dance Circuit Parties
• The Club Chic
• Campus Clubs
• Raves

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X-T-C

• User Scenes
• Heterosexual bars and parties
• Adolescents
• Tourists
• Young Adult Professionals

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rolling
Mid 1990s Years of Deception
Rising Interest Fewer Pills More Fakes
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MDMA
The Expansion Phase
"e"
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Expansion Phase
MDMA
Its Supply Driven

• Fueled by dramatic increases in MDMA trafficking,
  and
• Its availability to younger populations

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MDMA on the Plane
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MDMA on the Plane
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MDMA on the Plane
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Journal Citations

• Joint Assessment of MDMA Trafficking Trends. US
  DOJ National Drug Intelligence Center

www.usdoj.ndic.gov
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Hurricane e
e
e
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Source US Customs Service
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More Pills,More Kids, More Problems!
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Disapproval
Source NIDA Monitoring The Future Study,
University of Michigan
Availability
ecstasy
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Teen MDMA Annual Use 1999 to 2000
Source NIDA Monitoring The Future Study,
University of Michigan
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Perceived Risk
Use
"e"
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Availability
MDMA Among USA Adolescents
Risk
Use
Disapproval
Source NIDA Monitoring The Future Study
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Mentions of MDMA (ecstasy) in National
Emergency Room Reports 1992-2000
Source US Dept HHS SAMHSA - OAS DAWN
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"x"
78 of MDMA ED Cases are Multi-drug
Episodes
Source US Dept HHS SAMHSA - OAS DAWN
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Advances MDMA Abuse Update

• National Institute on
• Drug Abuse
• Community Epidemiology
  
• Work Group.
• June 2001

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CEWG Advance Report
June 12-15, 2001
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CEWG Advance Report

• June 12-15, 2001

MDMA Club Drugs

• Consequences UP in 13 of 20 cities
• More routine settings home and school
• More concomitant and sequential abuse

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CEWG Advance Report

• June 12-15, 2001

Ecstasy Deaths

• MDMA Related-Deaths reported in
• Florida, Minnesota, and Michigan
• Most are multiple-drug cases

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CEWG Advance Report

• June 12-15, 2001

PolyDrugs

• Now the norm everywhere
• the five-way
• trail mix

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CEWG Advance Report

• June 12-15, 2001

Methamphetamine

• Consequences UP in 2000
• Rising in Mississippi Valley

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CEWG Advance Report

• June 12-15, 2001

Heroin

• Consequences UP in 15 of 20 cities
• More suburban, rural, and younger

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CEWG Advance Report

• June 12-15, 2001

Cocaine

• Continued Downward trends in consequences for 10
  of 20 cities
• Change abuse patterns

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Cocaines Changing Role
Now its Number 2
More and more, its a Secondary Drug
just a bump up .a little of this and more of
that
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Advances

• Comparison with previous
• stimulant epidemics

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Challenges and Opportunities

• Classic pattern of a drug epidemic emerging among
  Hidden Populations.

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Ethnography

• Definition the description of a
• phenomena in the language of
• the participants
• "Poetry of the Sciences"

EthnographyisHard Science

• "Rich Points
• Sample

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WindowPane
Sid
LSd
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x
ecstasy
X-T-C
ecstasy
MDMA
Acid
rolling
"e"
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triping
ecstasy
"e"
ecstasy

• The
• of

evolution
MDMA
Acid
trolling
"x"
"e"
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Challenges and Opportunities

• Introduced the need to identify and track
• Hidden Consequences

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Challenges and Opportunities

• Problems related to
• MDMA are observed in
• the abuse of
• multiple drugs

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Challenges and Opportunities
2CB (nexus)
X that aint X
4-MTA
PCP
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Challenges and Opportunities

• Global nature of MDMA trafficking makes it a
  multinational problem
• Mandating international research networks for its
  surveillance and prevention.

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Future Directions

• Technological advances and
• Changes of the post-communist age fueled
  worldwide spread of MDMA
• Foreshadowing how widespread future drug
  epidemics could be.

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Future Directions

• Technological
• advances

The Internet Drugs
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Future Directions

• Earlier detection,
• Sharing of research findings, and
• Faster responses to emerging epidemics
• All are now required for the modern drug abuse
  era.

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Future Directions Prevention Alert

• Expose and identify multiple determinants of MDMA
  abuse
• Convert those determinants to risk and protective
  factors for targeting its prevention.

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Future Directions

• Linking Supply-side intelligence with Demand-side
  epidemiology
• Provides Information for Action for both Criminal
  Justice and Public Health strategies.

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Executive Summary
Patterns and Trends
MDMA
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ecstasy
ecstasy
x
X-T-C

• The
• of

evolution
MDMA
Acid
rolling
"e"
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A Public Health Perspective on MDMA
"e"
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key determinants
MDMA Abuse

•   Dramatic increase in availability of MDMA
•   Spread to younger populations (lower cost /
  peer approval)
•   Increasingly used in more dangerous poly-drug
  abuse patterns
•   

•   Tolerance to MDMA effects leads to multiple
  dosing
•   Public perception that MDMA is a relatively
  safe drug
•   Now an everyday, anywhere drug. Not just for
  raves or clubs.