Literature Review and Assessment Report on MDMA / Ecstasy National Drug Policy Population Health Directorate Ministry of Health Wellington July 2009 Geoff Noller Contents EXECUTIVE SUMMARY ....................................................................................................................3 1.0 SUBSTANCE IDENTIFICATION, MECHANISM OF ACTION AND PRODUCTION...........................................................................................................5 1.1 CURRENT CLASSIFICATION ...........................................................................................7 2.0 OVERVIEW AND ANALYSIS OF INTERNATIONAL LITERATURE ON MDMA/ECSTASY .....................................................................................................7 2.1 HISTORY .......................................................................................................................7 2.1.1 Early Therapeutic Use..................................................................................................8 2.2 PATTERNS OF USE AND ABUSE.......................................................................................9 2.3 SPECIFIC EFFECTS / PHYSICAL HARMS ........................................................................10 2.3.1 Acute Effects...............................................................................................................11 2.3.1.1 Positive subjective effects...................................................................................................11 2.3.1.2 Less-severe physiological effects........................................................................................11 2.3.1.3 Serious acute effects............................................................................................................12 2.3.2 Long-term consequences of use..................................................................................15 2.3.2.1 Neurotoxicity ......................................................................................................................15 2.3.2.2 Animal studies and general critique ....................................................................................16 2.3.2.3 Psychopathology and cognitive deficits ..............................................................................17 2.4 RISKS TO PUBLIC HEALTH............................................................................................20 2.4.1 Availability and harms relative to population base....................................................20 2.4.2 Fatal toxicity compared with other drugs ..................................................................22 2.4.3 Seizure and production data.......................................................................................23 2.4.4 Purity and pricing ......................................................................................................23 2.4.5 Pill testing ..................................................................................................................24 2.4.6 Skewed media reporting and portrayal of drug use ...................................................25 2.4.7 Societal harms............................................................................................................26 2.4.7.1 Social harms comparison of MDMA with other drugs........................................................26 2.4.7.2 Public order.........................................................................................................................27 2.4.7.3 Drug facilitated sexual assault (DFSA)...............................................................................27 2.4.7.4 MDMA / ecstasy and drug policy .......................................................................................28 2.5 THERAPEUTIC VALUE ..................................................................................................30 2.5.1 Contemporary therapeutic research...........................................................................30 2.6 POTENTIAL FOR DEATH ...............................................................................................32 2.7 ABILITY TO CAUSE PHYSICAL AND PSYCHOLOGICAL DEPENDENCE .............................32 2.8 INTERNATIONAL CLASSIFICATION ...............................................................................35 2.8.1 United Nations’ drug control conventions .................................................................35 2.8.2 Other countries’ classification of MDMA ..................................................................35 3.0 RELEVANT NEW ZEALAND QUALITATIVE AND QUANTITATIVE RESEARCH ON MDMA/ECSTASY .....................................................................36 3.1 RESEARCH EXAMINING PREVALENCE OF MDMA / ECSTASY IN NEW ZEALAND..........36 3.2 ECSTASY-RELATED HARM IN NEW ZEALAND ..............................................................41 3.2.1 Physical and psychological health .............................................................................41 3.2.1.1 Dependence.........................................................................................................................44 3.2.2 Youth, social deviance, criminality, enforcement and economics ..............................46 3.2.2.1 Education ............................................................................................................................46 3.2.2.2 Driving................................................................................................................................47 3.2.2.3 Criminality ..........................................................................................................................49 3.2.2.4 Enforcement........................................................................................................................52 3.2.2.5 Economics...........................................................................................................................53 3.2.3 Policy..........................................................................................................................53 3.3 DISCUSSION ................................................................................................................59 3.4 RECOMMENDATIONS...................................................................................................60 4.0 INFORMATION CONCERNING MDMA/ECSTASY RELEVANT TO THE MISUSE OF DRUGS ACT (1975) SECTION 4B(2) .............................................61 1 4.1 GENERAL ....................................................................................................................61 4.2 DETAILED CRITERIA ...................................................................................................62 4.2.1 Likelihood or evidence of abuse.................................................................................62 4.2.2 Specific effects............................................................................................................63 4.2.3 Risks to public health .................................................................................................65 4.2.4 Therapeutic value.......................................................................................................66 4.2.5 Potential for use to cause death .................................................................................66 4.2.6 Ability for creation of physical or psychological dependence....................................67 4.2.7 International classification and experience of MDMA/Ecstasy in other jurisdictions... ....................................................................................................................................68 4.2.8 Other issues that the Minister may see fit to consider................................................69 REFERENCES ....................................................................................................................................70 APPENDICES ....................................................................................................................................87 APPENDIX I EXPERTS AND OTHER STAKEHOLDERS CONTACTED FOR COMMENT ON THE LITERATURE REVIEW OF MDMA / ECSTASY ....................................................................................88 APPENDIX II PROF. DOUGLAS SELLMAN: A BRIEF OVERVIEW OF PROPOSED ENTHEOGENIC RESEARCH ...................................................................................................................90 APPENDIX III MR. JOHN HORWOOD: OVERVIEW OF MDMA / ECSTASY-RELATED RESEARCH BY THE CHRISTCHURCH HEALTH AND DEVELOPMENT LONGITUDINAL STUDY (CHDS)..........92 APPENDIX IV COMMENT BY DR PHIL DALGARNO, RESEARCH LECTURER, DEPARTMENT OF PSYCHOLOGY, GLASGOW CALEDONIAN UNIVERSITY .................................................94 APPENDIX V PILL TESTING PROTOCOLS AND NEW ZEALAND EXAMPLE FROM: WWW.PILLREPORTS.COM.............................................................................................96 APPENDIX VI A DISCUSSION DOCUMENT PROVIDED BY MATT BOWDEN, STARGATE INTERNATIONAL FOUNDER, BACKGROUNDING PILL TESTING. ................................................................98 2 Executive Summary This paper reviews the international and New Zealand literature on the evidence on the risk of harm associated with 3,4, methylenedioxymethamphetamine [MDMA], an amphetamine-type stimulant (ATS). The information presented addresses the criteria which the Expert Advisory Committee on Drugs [EACD]