(MDMA): alerting users to the dangers

KEYWORDS IT WOULDSEEMthat there have always The inhibitory effect may last for up to eight existed those people, usually the young, who hours, in which time the brain is tolerant to Ecstasy,MDMA, young people, have sought out and pursued sources of subsequent doses. ravedrugs, misuse and excitement that go against Serotonin is involved with delicate mood ABSTRACT common social rules. But, while that group adjustments so its exhaustion in the ganglion has alwaysexisted, so have those who see it as creates the psychedelic changes experienced thInthie chsemicalpaper,maktheauthoroutfinee-up of the s their duty to control and eradicate the by the user. More specifically, the user recreationaldrugecandstasy, perceived problem. However, the .fact must experiences a strong desire to bond with describessignsandsymptomsof be faced that the efforts of the latter have others, with a breakdown insocial inhibitions intoxicationwhichareespeciallyrarely conquered the behaviours of the through which emotional feelings can be usefultA&o EnurseHes.describes former, freely expressed? For this reason ecstasy is theeffectofs thedrugontheusers, Over the last six years the popularity of often referred to as a 'love drug', but as libido andsuggestsadvicewhichshouldecstasy as a recreational drug has soared, (especially male capacity for erection, and begiventousersonadmission with an estimated 750 000 doses being orgasm in both sexes) is severely impaired by consumed each weekend? A&E depart- MDMA, it is more accurately termed a 'hug ments throughout the country are wimessing drug'. Users also have boundless AndrewCookBSc, ,RGN,is a an increase in the numbers of individuals allowing for hours of continuous dancing, seniorstaffnurseA, &E, falling foul of its more unpleasant effects.2 with the reportedly taking on new BromleyHospital,Kent Nurses have an ideal opportunity to break meaning, hence the connection with the away from the group that aims to control, 'rave' scene. eradicate and judge the issue, and move Ecstasy is produced in a wide variety of towards practice that holds out a supportive tablets and capsules, each containing, hand rather than pointing a judgemental between 100-200mgofMDMA finger, on the brand.Eachbrandis recognisable by both presentation and Chemicalmake-up 'brand-name', for example, 'love doves', As MDMA is a complicated and expensive 'white diamonds', 'burgers', 'banana splits' compound to produce, much of the ecstasy and so on. The user may refer exclusively to sold on the street is adulterated with its ecstasy by these names. Each brand can simpler and cheaper precursors, MDA and usually expect to enjoy a three- to six-month MDEA (see Box 1). While there are many period of popularity until a new and anecdotal stories suggesting the adulteration seemingly better brand is produced.l of ecstasy with other street drugs such as The dose is most commonly ingested amphetamines (speed) and LSD, analysis of orally, however, rectal administration is seized hoards of ecstasy do not bear these popular as this decreases absorption time. out. Cocktails ofMDMA, MDEA and MDA The effects begin within 20 minutes, peak- are the norm.l lngafteronehour.Anormalnightlyintakeis Ecstasy isnota'designerdrug'/Designer between a half to two tablets, in divided Box l. Chemicalproperties drugs are substances which mirror the doses, over an eight-hour period. However, Ecstasy,or MDMA, effects of illegal drugs, but are able to avoid total intakes in excess of 10 tablets are often (methylenedioxymethampheta- the law because of their altered chemical seen. Many users may also take other drugs mine)belongstoagroup of structure, making them perfectly legal tosell. to supplement their MDMA, such as speed, drugs known broadlyas MDMA was in fact first patented in 1913 by LSD and cocaine, but avoid alcohol as this is psychedelicamphetamines, the German company Merck and, although said to reduce the effects of the MDMA) which alter mood and it has been used with varying success, withouttheuserlosinginsight, initially as a slimming agent but more Physicalandemotionalproblems orexperiencinthge recently and extensivelyin psychotherapy,4it Physical problems arise as MDMA induces a hallucinogenicpropertiesof has never truly gained the confidence of pyrexia. When combined with the effects of dierugssuthylamchideasly(LSDserg)ic. acid medical practitioners. 4 frenzied dancing in a crowded environment, MDMA has twomajor MDMA works by inhibiting the reabsorp- an uncontrollable hyperpyrexia can result. precursors;MDA tion of the neurotransmitter serotonin This pyrexia can cause muscle protein (methylenedioxyamphetamine()5HT) after it has been released into the breakdown, rhabdomyolysis and so renal andMDEA interganglionic synapse, l There is a finite failure. More alarmingly, disseminated (methylenedioxyethamphetami-quanity of serotonin within the brain, and intravascular coagulation (DIC) has been ne).BothMOAandMDEAhave new reserves are produced slowly. With noted in a few cases which have proven fatal. isimilar physiologicaleffects,but MDMA blocking reabsorpdon, the ganglia However, dehydration and collapse are more producefewerpsychdelic soon become exhausted of reserves as the common and, as many users consume oniy changes_ serotonin is locked in the synaptic space, mineral water during the night, their electvJ- 32 NURSIT' ;TIMES _PRII_ !0 V )II'X. lF ql \'(_ lfi too_ DRUG MISUSE

-'--' Legally, ecstasy is a Class A drug under the Misuse Of Drugs Act 1971 (Modifica- tion Order 1977). It is therefore in the same league as heroin. As such, it carries a maximum penalty of seven years imprison- ment plus a fine for possession, and life imprisonment plus a fine for supply. In eight reality,morelenientsentencesare given, ntto typicallycautionsor communityservice, especially for first-time offenders. aood ;lion Therole of the nurse need Althoughlife-threateningproblemsareseen user inA&Edepartments,theyarestillrelatively with rare.Morecommonarepyrexiasandpal- dons pitations,whichin otherwisefit, young a be individuals,causeonlytemporaryproblems. ,syis Panicattacksaredizensodisturbingthatthe bido userneedslitfieconvincingnotto usethe and drugagain. dby However,temporary'inconveniences' 'hug such-as these can herald far greater problems :rgy iftheindividualdoesnotre-evaluatehisor ng,g herusage.Itis thereforevitalthatthenurse new graspstheopportunityto explorewith,and the informhimorherof,thefactsaboutecstasy It is estimated that 750 000 doses of ecstasy are consumed each weekend in the UK and the risks involved. y of _ Thismustbe doneina non-threatening ling Box2.Advice to giveto users lyres can become dangerously unbalanced, and non-judgemental environment if the ting Whiledrugmisuseshouldbe Cardiac arrhythmias and grand mai convul- individual is not to become alienated. Creat- tally discouraged, information on sions are usual, and cardiac arrest not lng an atmosphere of trust, honesty and and saferwaystotakedrugsshould unheard of. However, recent reports have confidentiality will allow the patient to be 'es', lbe offered,asit isfoolishto suggested that liver failure in 'otherwise fit open about usage, and perhaps become more IRs' assume that one episode inA&E individuals may be linked to prolonged use of receptive to the advice that the nurse wishes y to il wi, stopfuture usage. MDMAS to convey. can 5uchadviceshouldinclude Long-term psychiatric illness resulting Clearly, understanding what the drug is, nth these points: from ecstasy taking has not been clearly how it works and the culture in which it is and fluids_Rehydrati°n--Drinkbupltenty°fdemonstrated,throughoutthenighthowever,, unwanted psycho- taken, will allow for both greater nurse notsimplywaterF. ruitjuicesand logical changes are very common. Many confidence and respect and trust from the ted softdrinkscanhelpreplacelost users report hangover, lethargy and mild user. is electrolytes depression in the first three days following While endorsing or condoning the use of ne. · Rest--Sleeping beforetaking ingestion. 'Flash-backs', where the user is drugs tbr recreation should not be a part of &k- MOMAcanreducethechancesof momentarily taken back to a full-blown any nurse's advice, accepting the lhct that is unwanted psychological ecstasy experience several days alter initial some people will always choose to experi- ted problems, such as'bad-trips' ingestion, are also common. There are, ment is neither unprofessional nor defeatist 'er, ®Tolerance--Leaveatleastsix however, some more serious reports of (see Box 2). In the same way that satYr-sex ten /,ours between doses to allow the firstdoseto becomefreed temporary psychosis in users, which have campaigns have acknowledged that some lgs fromtheserotoninreceptors, required in-patient psychiatric care. t people will always be promiscuous, and ed, Thiswillalsoallowforthe Panic attacks or 'bad trips' are the typical therefore aim to make safer practices more sis physiologicalaffectstosubside, psychological disturbance seen acutely. The inviting than unsafe sex, it is possible that L1 thusavoidingdangerous, user will present in a highly distressed state, nurses being faced with individuals whose compoundingeffects often believing that death is imminent, pursuit for excitement goes wrong, can help ®Chillout--Takebreaksfrom These patients require a genre, reassuring to educate them about how to limit the s a thedancefioorduringthenight, approach in order to bring them out of this risks. Nt

of and relax quietly with friends, emotional crisis. REFI_RENCES nC, This will allow the body to In A&E users who are under the influence llt. recuperateand cool down. Most _Saunders, N. Ets for Ecstasy.London: 5aunders, 1993. :in nightdubsnowprovideseparate of ecstasy commonly appear aroused and 2preston,A. Pointingouttherisk. NursingTimes1992;88:13, iai /chill-out'rooms restless. They may seem euphoric, talkative 23Jon4. es, C. MDMA: The doubts surrounding ecstasy and the · Inform--Telling friends and will often seem highly tactile. Their responseoftheemergencynuAcrsecid,entandEmergency ed iexactlywhathasbeentakenand conversation can appear disinhibited, Nursing1993;1:193.

en iroughlywhen, can provide the expressing blatant emotional feelings Jo4Hurnalenry'J1992;'Ecstasy305andth: 1,ed5.ance°fdeath'BritishMedical al. hospital staff with valuable towards those caring for them, It is important Sjones, C., Dickinson, P. From ecstasy to agony. Nursing Times re informationshouldthe tOnote the .time of presentation, typically in 1992;ss:13,28. . 6Salt, P. Rave review. Nursing Times1993; 15: 39,36. :Iv individualbetakentoA&Eina the earn hours of Saturday and Sundav _lnstitutefortheStudyofDrugDependencDrugAbuse. e :,- : c_Fapsed state ,_orl-.i?_s. Briefing{4th Ed). London: iSDD, 1991.