This news appeared in headlines throughout the world, as it represents an important – yet somewhat unorthodox – advance in PTSD treatment.
However, the media have largely been referring to Ecstasy – the street name for this drug – as the treatment in this trial, rather than MDMA (3,4-methylenedioxymethamphetamine). This can lead to misunderstanding, as recreational Ecstasy use is a highly stigmatized behavior. Using this terminology may further misconceptions about the study drug and its uses.
While Ecstasy is in fact a common street name for MDMA, what we call Ecstasy has changed dramatically since it became a prevalent recreational drug. Ecstasy now has a very different meaning – socially and pharmacologically.
Ecstasy tablets.
Drug Enforcement Agency Media Library
It is understandable why the media have referred to this drug as Ecstasy rather than MDMA. Not only has much of the public at least heard of Ecstasy (and would not recognize MDMA), but this also increases shock value and readership.
But referring to a therapeutic drug by its street name (such as Ecstasy) is misleading – especially since MDMA is known to be among the most popular illicit drugs used at nightclubs and dance festivals. This leads some to assume that street drugs are being promoted and provided to patients, perhaps in a reckless manner.
About 80-85 percent of high school seniors and young adults disapprove of someone even trying Ecstasy once or twice. But stigmatizing attitudes tend to be much harsher than mere disapproval.
I investigated stigma toward Ecstasy users, and among young adults (age 18-25) who reported no lifetime use of the drug, many reported strong negative feelings toward those who use Ecstasy.
“Ecstasy” is in fact often used to refer to MDMA, but a lot of Ecstasy in the U.S. often contains little to no MDMA. While many assume the term Ecstasy means or at least implies MDMA, others believe (or know) that Ecstasy tends to be an adulterated drug when purchased “on the street.”
When Ecstasy boomed in popularity in the early 1980s, it tended to consist of pure MDMA, or sometimes its chemical sister MDA (3,4-methylenedioxyamphetamine). But after MDMA became illegal in the U.S. in 1985, purity began to decrease.
Throughout the 1990s and 2000s, drugs such as cocaine, ketamine and methamphetamine were common adulterants in Ecstasy.
As a party drug, many people didn’t know or even care that ecstasy was supposed to be MDMA, but others specifically sought pure MDMA, rather than adulterated products. Demand grew. While pills said to be pure MDMA were certainly marketed and sold throughout the 1990s, more expensive Ecstasy in powder form (sold in capsules) slowly grew in demand. Within a few years this exploded into what we know now as “Molly.”
Molly is commonly marketed as being pure MDMA. But in recent years we have found that Molly is often the furthest thing from pure MDMA. Synthetic cathinones, also known as “bath salts,” appear to be the most common adulterants or outright replacements.
Deaths related to Ecstasy use appear to have increased in recent years, but many of these deaths appear to have been largely dependent on environmental conditions. MDMA can raise blood pressure and interfere with regulation of body temperature, which can certainly make it dangerous, especially in large doses and to those with preexisting conditions.
Hours of dancing and high heat can contribute to risks. In this photo: people at a Spring Break Europe party in Rovinj in 2012.
Antonio Bronic/Reuters
But what we often fail to consider is that Ecstasy-related deaths have tended to occur after hours of dancing – often in very hot conditions (such as crowded nightclubs or at festivals in 85 degree Fahrenheit or higher temperature), without adequate rest or proper hydration, or both.
Would these deaths have occurred without Ecstasy? Probably not. But most of these outcomes were very much dependent on extreme environmental conditions.
Many deaths in the U.S. related to Ecstasy or Molly use have also involved co-use of drugs such as alcohol, or unintentional use of “bath salts” or other adulterants, or a combination. In Europe, however, deaths have been increasing due to use of very high-potency pills (over 200 mg).
Extreme environmental conditions, adulterants, use of high-potency Ecstasy products, and ignorance about drug effects are all potential recipes for disaster when Ecstasy is used, especially when harm reduction techniques are not applied.
Is it really appropriate, then, to compare the therapeutic use of MDMA in this study to individuals using illegal, adulterated, or high-potency ecstasy, and dancing for hours in the heat?
The researchers are using pure MDMA, and in low doses. The drug is also used under medical supervision in a safe office, and patients receive medical clearance before entering the trial.
MDMA is by no means a new drug, but misconceptions have continued for decades. MDMA was discovered over a century ago, and the drug’s effects have been researched and documented for decades.
Knowledge about the drug’s potential therapeutic value is nothing new, either. We have known this since the 1970s, but have largely lacked the formal research supporting its efficacy. The drug was administered by thousands of therapists in the early 1980s before it hit the nightclub scene and was made illegal in 1985. Many therapists and advocates fought to keep MDMA legal when it was banned, and some of these fighters – primarily Rick Doblin and the Multidisciplinary Association for Psychedelic Studies (MAPS), have continued to fight for decades, to gain approval for clinical trials of MDMA to be conducted.
It’s easy to view MDMA as just a dangerous party drug, but it was used for therapeutic purposes way before it exploded into nightlife. All our lives we’ve been taught illicit drugs are bad, but so few of us know the history of these drugs prior to their criminalization. We also tend to focus on the negative publicized effects, and many individuals still believe misinformation such that MDMA use puts holes in the brain, drains spinal fluid, or causes Parkinson’s disease.
Amphetamine can be drugs of abuse, but can also treat ADHD under the name Adderall.
Patrick Mallahan III via Wikimedia Commons, CC BY-SA
We also often forget to consider that these same stigmatized drugs may also have important medical value. For example, amphetamine has been a drug of abuse since the 1930s, but it is efficacious in treating ADHD under the trade name Adderall. And despite increasing abuse of opioids in the U.S., these pills are still highly efficacious in treating pain. Like opioids and amphetamine, MDMA appears to have its place in medicine.
As drugs like MDMA and psilocybin move back into the spotlight as having therapeutic value, we must understand that while we may see various drugs as having “bad” uses, this doesn’t mean they are “bad” substances. Some of these drugs appear to be very useful in medical or therapeutic contexts.
Joseph Palamar, Assistant Professor of Population Health, New York University Langone Medical Center
Joseph Palamar, New York University Langone Medical Center
This article was originally published on The Conversation. Read the original article.
Our research team has spent the past two decades examining the chemical composition of the longest-lived animal that doesn’t live in a colony known to science – the ocean quahog clam – to find out how the climate of the North Atlantic ocean has changed in relation to the atmosphere.
This quahog can live for more than 500 years – and, as it does, it lays down growth rings in its shell. As with trees, the growth rings are at wider increments when conditions are more favourable and narrower when less so. By comparing these shell rings we were able to date each of them and find out what the temperature and salinity (or density) of the seawater was at the time of its growth. Any clams that lived at the same time had the same pattern of lines on their shells. So by comparing many of them together, we managed to extend the record backwards beyond the lifespan of just one individual, to around 1,000 years.
Using this information, we have discovered how the ocean environment that these clams live in has changed. And we now have the first precisely dated, annually resolved, record of North Atlantic ocean variability covering the entire last millennium, allowing scientists to examine the timing of past changes in the marine environment relative to those in the atmosphere.
Perhaps one of the most profound aspects of our research is the finding that human-driven climate change, resulting in an overall warming of surface air temperatures, has led to a reversal in the long-term natural coupling of the marine and atmospheric climate systems.
Evidence from the shells shows that over the modern industrial period (AD 1800-2000) changes in marine climate lagged behind the atmosphere. Surface air temperatures responded much faster to human-induced climate changes than the North Atlantic did. Though we cannot speculate on what this will mean for the future, this new information will play an important role in reducing uncertainty in predictions of future climate variability.
Though the shells of quahogs typically only grow up to 13cm in length, this finding from the study of the chemistry in their rings is astounding. Until now, there has been no direct evidence that variability in the North Atlantic during the past 1,000 years drove changes in the atmospheric climate, or if the oceans were merely responding to changes in the atmosphere. Our understanding of ocean variability timing in the North Atlantic, and the mechanisms behind it, were relatively poorly known until this study – and direct observations were limited to the 20th century.
Looking further back in time, the oxygen isotopes record developed from the clam shells shows marked changes in the climate over the past 1,000 or so years. During the last millennium, volcanic eruptions, the power of the sun (solar irradiance) and human industrial activity all played a significant role in driving the conditions in the North Atlantic.
Growth lines on the shell of an ocean quahog. The black line represents 0.3mm.
Author provided
In addition, our research found that the North Atlantic probably played an important role in the switch from the relatively warm conditions of the medieval climate anomaly (from about AD 1000 to 1400) into the cooler conditions of the “Little Ice Age” from about AD 1450 to 1850).
The most intriguing result from this period came from comparing the clam shell rings with ice cores and tree rings. While the shells allowed us to uncover marine variability, the ice and tree trunks have previously shown scientists what the atmospheric surface air temperature was like during different time periods in the northern hemisphere and Greenland.
By comparing the shells with ice and trees, we found that over the pre-industrial portion of the last millennium (between the years 1000 and 1800) changes in marine climate preceded changes in northern hemisphere surface air temperatures.
Between 1000 and 1800, changes in the North Atlantic – brought about by solar irradiance, gases being expelled into the atmosphere from volcanoes and changes in air circulation – were fed back into the atmosphere. This influenced the temperature of the atmosphere then, and means that the North Atlantic ocean was playing an active role in influencing atmospheric air temperatures.
This continues to play a pivotal role in future climate variability, albeit now with a backdrop of long-term warming driven by greenhouse gases.
This clam may indeed be small fry, but what we have learned about the ocean climate from quahog clam shells has drastically changed our view of the world’s atmosphere.
David Reynolds, Research associate, Cardiff University; Ian Hall, Head of School of Earth & Ocean Sciences and Research Professor, Cardiff University, and James Scourse, Professor of Marine Geology and Director of the Climate Change Consortium of Wales, Bangor University
David Reynolds, Cardiff University; Ian Hall, Cardiff University, and James Scourse, Bangor University
This article was originally published on The Conversation. Read the original article.
