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Changing Your Mind: Methamphetamine
and MDMA in the Brain
Bertha K. Madras, Ph.D.
Deputy Director, Demand Reduction
Office of National Drug Control Policy
This is part of a series of articles on how specific drugs affect the brain and body.
Overall, youth are using drugs at a much lower rate today than in 2001. Some of the largest reductions are in the use of the amphetamine-type stimulants methamphetamine and MDMA, which is also known as ecstasy. Despite these declines, 259,000 people in the United States aged 12 or older reported using methamphetamine in 2006 for the first time. The number reporting MDMA use for the first time increased 40 percent between 2005 and 2006. Moreover, nearly one-third of these new users were under age 18 when they started using MDMA. Equally troubling is the small but steady decline since 2004 in beliefs among 8th and 10th graders that MDMA is harmful. After years of increased perception of risk for MDMA use, today’s young people are not comprehending that MDMA is dangerous and potentially deadly.
Origins of Methamphetamine and MDMA
Methamphetamine was originally made from ephedrine, a substance obtained from the Chinese plant Ma Huang. It was believed to enhance alertness and energy levels and was used by soldiers and pilots in the Second World War, particularly by the Axis powers. After the war, large supplies of methamphetamine stockpiled by the Japanese military became available to the general public, giving rise to the drug’s global spread. It was banned in Japan in 1951. In the United States, it was classified as a Schedule II controlled substance in 1971. Although Schedule II drugs have an accepted medical use, they have a high potential for abuse, and may lead to severe psychological or physical dependence. This classification, the removal of injectable formulations of methamphetamine from the United States market, and a better appreciation for its high abuse potential led to a sharp reduction in abuse. A resurgence occurred in the 1980s. Today methamphetamine is considered a highly addictive drug of abuse that plagues regions of the country.
Scientists patented MDMA in 1912 as an intermediate chemical used in the synthesis of a drug intended to control bleeding from wounds. It was tested in the late 1920s to determine if it affected blood flow, but then subsequently faded from view until the 1970s, when a research scientist rediscovered the drug and used it for psychotherapy sessions. In the early 1980s, MDMA rose to prominence in trendy nightclubs, and then spread to rave clubs in major cities around the country and eventually mainstream society. In 1985, MDMA was classified as a Schedule I controlled substance. Schedule I drugs have no accepted medical use, no accepted safe use under medical supervision, and a high abuse potential.
Methamphetamine: Actions and Consequences
In small doses, methamphetamine is a powerful stimulant and increases wakefulness and physical activity. All forms of methamphetamine are dangerous, but smoking and injecting increase both the potential for becoming addicted and the risk of serious health effects because of how rapidly the drug enters the brain and the blood stream.
Methamphetamine affects many elements of brain activity, but it is best known for its effects on cells that produce special chemical messengers such as dopamine, norepinephrine, and serotonin that are passed from cell to cell to activate key brain areas. Dopamine, for example, promotes alertness, activity, increased awareness of new experiences, and pleasure and is involved in learning and memory. Methamphetamine causes dopamine to flood the reward areas of the brain. This can result in depletion of dopamine and a “crash” phase, which can trigger more drug use to regain the methamphetamine sensation and relieve the “crash.”
A single dose and long-term use can both have serious consequences. Methamphetamine abuse can result in rapid or irregular heart rates and increased blood pressure.1 Repeated use of methamphetamine can cause paranoia, hallucinations, and delusion and lead to compromised brain function, including memory, information processing, motor skills, and language abilities.2 Methamphetamine also can cause heart attacks and stroke.3 Indeed, people under age 45 have nearly a four-times-greater risk of heart damage if they use methamphetamine.4 Stroke-producing damage to small blood vessels in the brain adds to the risk of compromised brain function. In some cases, chronic abusers experience changes in the structure and function of brain areas associated with memory, emotion, depression, and anxiety.5 Overdoses can cause erratic surges in body temperature, leading to convulsions and even death.
Fortunately, methamphetamine abuse among young people is rare. Less than one percent of 12th graders reported using the drug in the past 30 days. However, any methamphetamine use is dangerous during adolescence because the brain is still growing during this period. Drug use during this critical developmental time may lead to long-term changes in the brain’s structure and function, resulting in impairments that might last a lifetime. In addition to the potential for brain damage, a recent survey of adults admitted to a hospital trauma center showed that methamphetamine abusers were more likely to have an injury or a violent injury, to attempt suicide, and to die from their injuries than people who did not test positive for methamphetamine.6
| How Methamphetamine Affects Motor Skills and Memory |
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Figure 1 shows methamphetamine-induced changes in brain nerve cells that produce dopamine. The loss of red color in the methamphetamine abuser’s brain reflects the loss of a chemical found in nerve endings, the dopamine transporter. As indicated in figure 2, the greater the loss of this chemical, the greater the motor and memory deficits. Adapted from Volkow et al; Am J Psychiatry. 158(3):377–82, 2001. PMID: 11229977. |
MDMA: Actions and Consequences
Like methamphetamine, MDMA affects nerve cells that produce dopamine, norepinephrine, and serotonin. Serotonin, which is stored and released by specialized nerve cells, is critical for sleep, mood, and experiences of pleasure. MDMA enters these nerve cells, releases a deluge of serotonin, and remains inside the cells for an extended period of time, eventually depleting the serotonin. A single dose or long-term use can create pleasant feelings and an ease with social attachments. It also suppresses the need to eat, drink, or sleep. MDMA can induce jaw clenching, increased anxiety, and detachment from self. It compromises cognitive performance, attention, and decisionmaking7 and can lead to elevated body temperature, dehydration, and even death.
The effects of MDMA do not wear off immediately, and in fact several days after its use, users report lethargy, irritability, depression, anxiety, and insomnia.8 Repeated use of MDMA is associated with sleep, mood, and anxiety disturbances; increased impulsiveness; memory deficits; and attention problems,9 which may last for 2 years after stopping use.10
MDMA also is associated with long-term psychiatric effects, including depression, agitation, anxiety, psychotic symptoms, impulsive behaviors, sleep disturbances, panic attacks, and social phobias.11 Long-term effects of MDMA are not limited to brain function, as MDMA use is also associated with brain, heart, and liver toxicities. A major concern for early MDMA use is whether depletion of brain serotonin may give rise to mood disorders over a lifetime.
Combining Methamphetamine and MDMA
More than 55 percent of the MDMA samples seized in 2006 in the United States tested positive for methamphetamine. Both drugs are dangerous but become even more so when mixed. Laboratory studies in animals indicate that methamphetamine/MDMA combinations damage both dopamine and serotonin systems, and that their effects on brain chemistry and behavior are greater than the effects of either drug alone.12
Just a few years ago, much of the MDMA consumed in the United States was produced in Europe. Collaborations between the United States and European governments, as well as improved law enforcement operations and mass media efforts, effectively dismantled the European-United States MDMA trade. Unfortunately, United States and Canadian intelligence reports indicate that Canadian-based drug trafficking organizations are attempting to fill the supply void and have drastically increased their MDMA production and trafficking. In 2003, 568,220 dosage units of MDMA were seized in the ten Northern border States; 5,485,619 dosage units were seized in 2006.
Prevention Efforts
Federal law enforcement officers are working with their Canadian counterparts to put greater pressure on Canadian MDMA producers through increased intelligence sharing and coordinated enforcement operations. Canadian officials are focusing their efforts on the importation of precursor chemicals used in drug production. At the same time, John Walters, Director of National Drug Control Policy for the United States, is urging public health officials around the Nation to reinvigorate their prevention efforts, to enhance educational outreach to youth, parents, school systems, emergency departments, medical examiners, poison control centers, and law enforcement agencies regarding the hazards of MDMA and methamphetamine, to shore up treatment systems to look for and address the unique and well known challenges of meth addiction. “We cannot allow our young people to once again be victimized by the rave culture, ‘designer’ drugs, or the myth that drug use is safe,” said Director Walters in a January 2008 press release on methamphetamine-laced MDMA. “Just as we must teach new generations of children to read, we must continue to educate new generations of young people on the harms of drug use.”
When schools implement random drug testing programs, they are not only providing students with a reason to say “no” to drugs. They are also helping to increase student awareness, underscoring the seriousness of the drug threat and the urgent need to combat it. Given the addiction potential and serious health consequences associated with methamphetamine and MDMA, such awareness is essential to maintaining the encouraging declines in use among middle- and high-school students and to helping them make healthy and safe decisions about future drug use.
Citations
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