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Drugs, Drink'n and Smok'n Part I

August 2001

This is a two-part series on drugs. This month I'm writing about ecstasy, crystal-meth and cannabis and their side effects. When you take meds of any kind or mix any of the drugs listed, you increase your chances of something going wrong. It's not just the drugs; it's also the people you're with, their motives and yours.


What Is Ecstasy or X or E?

Ecstasy, X or E are all names for MDMA, or 3,4-Methylenedioxymethamphetamine. It belongs to a family of drugs called "entactogens," which literally means "touching within." Other drugs in this category include MDA, MDE and MBDB. Before it became illegal in 1985, MDMA was used by psychiatrists as a therapeutic tool. Studies are currently underway in Spain and Israel assessing MDMA's effectiveness in the treatment of post traumatic stress disorder (PTSD). E is almost always swallowed as a tablet or capsule. A normal dose is around 100-125mg. Ecstasy tablets vary widely in strength, and often contain other drugs.


Effects

  • Ecstasy is a "mood elevator" that produces a relaxed, euphoric state. It does not produce hallucinations. It takes effect 20 to 40 minutes after taking a tablet, with little rushes of exhilaration, which can be accompanied by nausea. Sixty to ninety minutes after taking the drug, the user feels the peak effects. Ecstasy is not physically addictive, however, the drug can often take on great importance in people's lives, and become rather compulsive in its use. Taken frequently, ecstasy loses its special effect. Ecstasy releases the brain chemical serotonin, elevating mood and acting as a short-term antidepressant. Users may be unconsciously trying to self-medicate for depression. But there are more effective treatments for depression available by qualified physicians. If you're beginning treatment with an anti-depressant medication, ecstasy will interfere with its effectiveness. Frequent or high doses have been linked to neurotoxic damage in laboratory animals. It is still unknown whether such damage occurs in humans or, if it does, whether this has any long-term, negative consequences.

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  • Ecstasy is illegal. Much of what is sold as X underground actually contains other drugs, which can be even more dangerous than MDMA, like PMA, speed, DXM and PCP.

  • Mixing ecstasy with alcohol or other drugs increases the risk of adverse reactions.

  • There have been some deaths associated with ecstasy. Most of them have usually been the result of heat stroke as a result of dancing in hot clubs without replenishing lost fluids. Heat stroke can happen even if you have only taken one tablet. Warning signs of dehydration and possible heatstroke include failure to sweat, cramps in the legs, arms and back, giddiness, dizziness, headache, fatigue, vomiting, fainting, loss of consciousness, suddenly feeling really tired, irritable and confused.

If you are going to take ecstasy, drinking water is vital. You should drink about a pint of water every hour. Sip water slowly rather than drinking a lot all at once, as this can be dangerous. Eat something salty and drink juice or Gatorade. This will replenish electrolytes and prevent hyponaetremia (water toxicity). Take breaks, allow your body to cool down, wear loose-fitting clothes and don't wear a hat, which keeps the heat in.

If someone collapses on ecstasy, call 911 immediately! Get them to a cool place. Drench them with water (as cold as possible). Fan them. Once the person's temperature is down, wrap them in a blanket or give them dry clothes. Be careful that the person's temperature should not fall below 102 degrees or serious consequences could develop. When help comes tell them what drug the person took and that you think the person is suffering from heat stroke. Be sure to get this person to a hospital as soon as possible! Alcohol is absolutely useless and dangerous for someone on ecstasy. Alcohol will dehydrate even more!

Remember that water is an antidote to dehydration, not ecstasy. Watch Out for DXM! Sometimes ecstasy tablets do not contain real ecstasy. DXM is a cough suppressant that dries the lungs and is often found in fake ecstasy tablets, DXM is even more likely to cause heat stroke. If you take a pill and start losing motor control of your body, hallucinate, feel very "out of your body," or if your skin itches, you may have taken DXM. Don't combine different types of ecstasy, accidentally getting DXM is bad enough, but accidentally combining it with real ecstasy is even worse.


Contraindications (Medications and Health Conditions that Pose Considerable Risk)

  • A MAO inhibitor ("MAO" is pronounced like "cow") is a type of prescription antidepressant. Some of the more common ones include Nardil, Parnate and Marplan. These drugs are very dangerous to combine with ecstasy and can result in a potentially fatal condition known as "serotonin syndrome." A number of people have died after consuming ecstasy while also taking a prescription MAO inhibitor.

    If you're taking a MAO inhibitor you would probably know (MAO inhibitors are usually prescribed for depression that also has accompanying anxiety. MAO inhibitors are different from SSRIs. Serotonin reuptake inhibitors like Prozac, Paxil and Zoloft do not interact dangerously with ecstasy. However, ecstasy may interfere with the effectiveness of SSRI medications. Some drugs are metabolized (broken down) through the same liver enzyme as ecstasy, known as the CYP2D6 enzyme (pronounced "sip-two-dee-six"). If you take ecstasy along with drugs that are metabolized by the CYP2D6 enzyme, they will both be metabolized much slower, as the same enzymes struggle to break down two drugs at the same time. It's like taking a higher dose of both drugs, and can be dangerous, especially if the other drug has a low overdose threshold.

  • The protease inhibitor ritonavir, which is used in the treatment of HIV is also metabolized by the CYP2D6 enzyme. At least one person has died from taking ecstasy while on ritonavir.

  • Other drugs metabolized by CYP2D6 include codeine and other opiate derivatives, as well as DXM. Prozac is also metabolized by the CYP2D6 enzyme. Taking ecstasy while on Prozac will inhibit the breakdown of both Prozac and X. However, Prozac prevents ecstasy from working, and has been shown to prevent ecstasy neurotoxic effects as well.

  • 125mg of ecstasy increases a person's resting heart rate approximately thirty beats per minute. Ecstasy produces a significant increase in heart rate and blood pressure. This means that people with heart conditions are vulnerable to heart attacks or heart complications if they take ecstasy.

  • If you have hepatitis or other liver ailments you may be vulnerable to liver damage if you take ecstasy. Your liver filters toxins from your blood, contrary to rumors, there is no method of ingesting ecstasy that will "bypass" your liver.

  • People prone to seizures are likely to have them if they take ecstasy. Call 911 if someone falls unconscious or has a seizure.

  • Some diseases, like central core disease, make people more susceptible to heat stroke. MDMA raises the risk of malignant hyperthermia in people with central core disease.


What Is Speed, Crystal-Meth or Tina?

Speed, Crystal, or Tina (amphetamine or methamphetamine) as it may be referred to is a stimulant drug; it produces alertness, confidence and raises levels of energy and stamina. It can reduce appetite and lessens the desire and ability to sleep. Regular use of speed can produce a need to increase the dose to get the same effect. Speed can produce a powerful craving for more of the drug. Long-term use can result in serious mental and physical problems. Speed can be swallowed, snorted (bumped), smoked, booty bumped (anally) or injected. Snorting speed takes effect faster than swallowing but it can damage the nose. Anal use is similar to swallowing in that it takes effect slower but last longer than other ways of introduction in to the body, Smoking speed takes effect immediately and can more easily lead to addiction. Injecting is the riskiest method of using speed. Speed is illegal.


Effects

  • The dose reaches the brain almost immediately, increasing the possibility of overdose.

  • Impurities are introduced directly into the blood and can cause septicemia and infections.

  • Repeated injections damage the veins, leading to thrombosis and abscesses.

  • Sharing syringes can cause hepatitis and HIV, the virus that can cause AIDS.

  • The "comedown" off of speed can make you feel tired, lethargic and depressed. This may tempt users to take more, and can lead to dependency. Users become physically run down, leaving them susceptible to illnesses.

  • Speed users are at higher HIV and hepatitis risk through unsafe sex and needle sharing.

  • Although rare, speed can cause seizures, heart attacks, strokes, and death from overdose.

  • Extended use of can cause psychosis. A user may think that everyone's out to get them.

  • Mixing speed with other medications, especially stimulants, increases the risk of adverse reactions.


What Is Cannabis, Weed, Dope or Pot?

Cannabis, or marijuana, comes from a plant. The dried buds of the female plant contain the highest concentration of psychoactive compounds. These buds are usually what is sold and consumed as marijuana. Cannabis usually costs about $10-$20 a gram and is illegal. Cannabis is usually smoked, although it can be eaten. Joints are the most common method of smoking but a wide range of pipes, bongs, hookahs, and other devices are also used. Cannabis can be prepared in butter or cooked directly into foods for ingestion. Often people will cook with the leaves of the plant rather than the buds.


Effects

  • In small quantities, users find cannabis both relaxing and stimulating. The senses are enhanced, as well as the appetite.

  • In larger quantities (or with stronger strains) the effects may feel similar to LSD or mushrooms. Users may experience nausea, mild hallucinations, anxiety, or paranoia.

  • Cannabis causes an increase in heart rate, reddening of eyes, and dryness in the mouth.

  • Cannabis is used medicinally to treat the symptoms of cancer, glaucoma, HIV and AIDS.

  • Cannabis does not create dependence; users do not experience withdrawal symptoms.

  • Smoking anything, including cannabis, can damage the lungs, throat, and mouth.

  • Cannabis slows down reaction time and impairs driving.

  • Some people feel uncomfortable, nauseous, or paranoid after using cannabis.

Next month I will cover the effects of GHB, ketemine, cocaine, alcohol and crack. Until then, be safe and be healthy.

For further information on drugs and how they can effect you, if you are in Atlanta, visit the AIDS Survival Project Treatment Resource Center where free and confidential assistance is offered to everyone. You can also contact the Atlanta Harm Reduction Center at 404-526-9222 or if you need counseling contact, Positive Impact at 404-589--9040. If you'd like to talk to someone anonymously, you can always call an ASP Peer Counselor at 404-874-7926 to talk. Peer Counselors have many regional and national referrals available for you. Thanks to DanceSafe for providing the above drug information, visit them at www.dancesafe.org.



  
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This article was provided by AIDS Survival Project. It is a part of the publication Survival News.
 
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Ask Our Expert, David Fawcett, Ph.D., L.C.S.W., About Substance Use and HIV
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