Methylenedioxymethamphetamine (MDMA), also better known as ECSTASY, is one of the most popular "club drugs" available today. These drugs are sometimes referred to as entactogens. "Entactogens" is a term that has been coined to describe the class of drugs that increases a person's "warm and friendly feelings" for others. Ecstasy or MDMA is an amphetamine derivative, as can be seen by the amphetamine group at the end of the chemical name. Its chemical structure is related to both amphetamine and mescaline. Over the years, more than 1000 chemical variations of ecstasy have been produced.28
According to Robson, the Merck pharmaceutical company takes credit for first synthesizing this drug in about 1912 and obtained the patent rights for it in 1914. At that time it was suggested that it could be used as a weight control drug. However, it was not commercially marketed but did get a restart in the 1950s when the United States Army was testing it for use in psychological warfare. Recreational use started in the late 1960s, and in the 1970s it was used by some psychologists to aid in different types of therapy. In psychotherapy, it was suggested that it allowed people to communicate more effectively.28
Ecstasy utilizes the serotonin and dopamine neurotransmitters to create a stimulatory effect in the central nervous system. By stimulating a "flood of serotonin" within the brain, a person feels friendly to everyone he or she comes in contact with during the time period the drug is in effect. When researchers gave ecstasy to animals, it resulted in an increased temperature, heart rate, salivation and actually caused convulsions in high doses. Because it is an illegal drug and cannot be prescribed, it is not used in human research any longer. The use of ecstasy and resulting emergency room visits isncreased dramatically over the period from 1994 to 1999. In 1994 there were about 250 reported emergency room visits compared with an estimated 2850 cases of ecstasy overdose in 1999.3 In reviewing the most recent United State government drug abuse report,32 it appears that ecstasy use declined among high school students over the years 2000–2002. High school seniors who reported using ecstasy at some time in their life dropped from 11% in 2000 to 10.5% in 2002. This is not a significant reduction in the number of high school seniors taking ecstasy but a decline in the total number of students trying this drug.
Implications On Activity
Some of the social drugs can have dramatic and even life-threatening consequences on athletes. Because the athlete increases his or her heart rate through exercise, drugs such as cocaine or methamphetaminecan cause the heart rate to increase to a point of cardiac overload and result in the untimely death of the athlete. Some of the other social drugs, such as marijuana, are used by athletes on a more frequent basis for performance enhancement through increased relaxation. There are many other ways to increase relaxation in the athlete without use of illegal substances.
This drug is an illegal substance with many adverse effects. The main effect that people who take this drug are trying to achieve is the sudden exhilaration that comes anywhere from 20 to 90 minutes after oral consumption of the tablet. The feeling of exhilaration that the person experiences can last from 3 to 5 hours depending on the metabolism rate of the individual. It is also reported that the first experience using ecstasy is the most rewarding for the person, with subsequent experiences being less positive.29 It should also be remembered that this drug is typically taken in combination with one or multiple other party drugs such as alcohol, tobacco, marijuana, amphetamines, cocaine, etc. Some of the reported effects of ecstasy include being more friendly with others, and less aggressive and less defensive in interpersonal interactions. People report that they can overcome many of the stresses that are involved in everyday life including obsessive behavior and impulsiveness. It is claimed by many users that speech is enhanced and the perception of time is diminished when using Ecstasy. Adverse effects occurring during the original 3 to 5 hours include nausea and vomiting.
What to Tell the Athlete
At the high school and college level, there is a higher incidence of athletes "experimenting" with drug use because social pressure from peers. The athlete needs to be continually reminded of the detrimental effect of social drugs. Some tips for the ATC when educating the athlete about these drugs.
Social drugs like alcohol and tobacco are readily available. However, the athlete should be cautioned to not use these substances for acceptance by peers, to prove their independence or for some other superficial reason.
Alcohol is an easy drug to abuse, and alcoholism can be initiated at a young age.
Marijuana has a high level of social acceptance, but it also has a number of adverse effects the athlete must be aware of when using this drug.
Cocaine and club drugs are also easily obtained, and the chance of adverse effects and even death are very high with the use of these drugs.
Many times, athletes are the most respected and their behavior is an example to many other nonathlete students.
Abstaining from the use of social drugs will show the people around the athlete the real "strength" of the athlete.
Interestingly, the reported effects of ecstasy use can last up to a week in some individuals. Some report that for 1 week, they have an increased ability to interact with others and experience a decrease in fear, aggression, obsessive behavior, and anxiety. The adverse effects some experience for the week are a decrease in sleep and/or appetite, fatigue, depression, libido, restlessness, and a decreased ability to perform mental and physical tasks.12
This drug can have both acute and chronic toxic effects in the athlete.11 Memory loss and decreased mental functioning is a neurotoxic effect that results from use of even a single dose of ecstasy. Memory loss can include recognition and long-term memory.15,20 Mental functioning that has been documented to be impaired by Ecstasy use includes both immediate and delayed word recall. Other more obvious acute signs and symptoms include nausea, vomiting, dehydration, fainting, clumsiness, uncoordinated movements, increased body temperature, generalized "hangover" liver damage, and kidney failure,
Scenarios from the Field
A very good high school football quarterback was highly recruited to a number of Division I universities. He made his final decision and started fall football the summer after high school graduation at his newly selected university. The university, like all Division I universities, had a random drug testing procedure. This athlete was randomly drug tested his freshman year and tested positive for alcohol and marijuana. The university policy was to put any positive drug tested athletes into counseling and allow them to proceed with their education. The counseling sessions were initiated for this player, but he again tested positive for alcohol and marijuana in his sophomore year. He was removed from the team for 1 year and was again asked to attend drug counseling to determine if he could be helped with his problem. The third year he came back to play football but once again tested positive and was released from the football program as an athlete.
In this scenario the university had a quite liberal testing and counseling policy that allowed the player to continue his relationship with the team during the time he was in drug counseling. There are many universities that do not have a liberal counseling program and when a player tests positive the second time he or she are removed from the athletic department and sometimes the university. Not only do these athletes loose their athletic scholarship but, in some cases, the ability to finish their college education at that university.
Athletes could be willing to try ecstasy with their friends on a weekend, during a vacation period, or at some other time for any one of a number of reasons. As the athletic trainer, you should be able to explain the adverse effects the athlete may encounter days or even weeks after taking this drug. Encourage athletes to avoid the use of this drug because it could result in long-term disability or even death.
Gammahydroxybutyrate (GHB) is growing in popularity as a drug that creates a sense of euphoria or a feeling similar to alcohol intoxication in people. Some bodybuilders also use GHB to help them get into the deepest phase of the sleep cycle and remain in that stage for a longer time period.30 It is suggested that the deepest sleep cycles are associated with increased natural release of human growth hormone which will provide a greater muscle growth potential.33
GHB was originally developed as an anesthetic, but the effectiveness to limit or stop pain was never fully developed in this drug. It was determined that it could be of assistance in helping one to sleep. Later it was discovered that it had euphoric properties possibly emanating from its effect on the neurotransmitters in the central nervous system. GHB is rapidly absorbed in the mouth and begins to produce its effects within an hour after ingestion. It can be purchased in tablet or powder form at natural food stores in some states within the United States or on the internet at multiple sites in tablet, powder and solution forms. States such as California, Hawaii, Nevada, Texas, Georgia, Florida, Rhode Island and others have banned the sale of this drug completely. The probability of other states, if not all states, outlawing this drug in the future is great.
As with any of the social drugs, GHB is usually taken in combination with alcohol or other drugs because occurrence of use is frequently found in nightclubs, bars, and parties. The combined effects of GHB with other drugs can cause nausea, vomiting, muscle weakness, extreme fatigue, respiratory depression, and sometimes coma. The window between a nontoxic and toxic dose is small, and even a little too much GHB can cause an adverse reaction. Athletes should be cautioned from using GHB even to assist them with getting to sleep or other nonthreatening uses. The total effects produced by this drug have not been documented, and there are too many questions still not answered regarding this drug.
Web Resource Box
A lecture on cocaine from the U. of Pennsylvania is located at: www.uphs.upenn.edu/~recovery/pros/cocaine.html
For a good overview of the street drug nomenclature with pictures go to www.sayno.com/stimulant.html
Another site with good information for the high school or college athlete is:
www.pamf.org/teen/index2.cfm (Palo Alto Medical Foundation, excellent source of information for teens about the effects of many different types of drugs)
www.nida.nih.gov/infofax.html (government web site that is updated regularly and provides information regarding the different socially used and street drugs.)
www.cdc.gov/nccdphp/dash/yrbs/index.htm is a web site that you can get reports of youth behavior on health-related risks, not just drug abuse on a bi-annual basis starting with 1990.
www.cdc.gov/tobacco is a web site that provides a regular report of the effects of tobacco on the health of people who use tobacco regularly. Also located on this web site is assistance in smoking cessation programs, sports initiatives, celebrities against smoking, and other educational information. Different pages on this web site give a state by state breakdown of tobacco use by youth, adults, related deaths, etc.
www.quitnet.com is a web site that offers assistance to people trying to quit smoking. This website is interactive and includes counseling and other options to help people quit smoking for good.
www.rwjf.org is a web site offering information and assistance on healthy lifestyles including alcohol and tobacco use. This organization also provides grants and other options for people with ideas about programs to promote a healthy lifestyle.
Class Discussion Topics
Why do some athletes use marijuana before competition when the central nervous system needs to be highly active?
What are some techniques (chemical–behavioral) people use for smoking cessation programs today?
What are some of the reasons teenagers start using alcohol, tobacco, marijuana and other drugs?
What is the role of the athletic trainer working in a non-traditional setting in assisting the athlete overcome a drug problem?
High school is a time when many teens will be more susceptible to experimental drug use.
Many drug abusers are not aware that there are acute negative adverse effects associated with drug abuse.
There are signs that indicate current use and personality and behavior indicators that can be interpreted as possible future drug abuse.
The NCAA has been tracking drug abuse among athletes since the mid 1980's and has implemented programs to reduce drug use among collegiate athletes.
Alcohol has a depressing effect on the central nervous system, which is the opposite effect the athlete is expecting.
There are numerous chronic effects of alcohol on the body.
Tobacco is a complex drug with many chemicals inhaled by the smoker.
Smoking and the nicotine in the cigarette smoke has been shown to decrease motivation in people.
There are numerous smoking cessation programs, which include behavioral and pharmacological interventions.
Some athletes will smoke marijuana with the intent that this will relax them before a competition.
Cocaine can be used as a local anesthetic by a physician but is also abused by athletes to produce an amphetamine like high.
Ecstasy is an amphetamine derivative and is abused for the effects of increasing energy and friendliness.
The effects of ecstasy can begin within 20 minutes of ingestion and last for up to 5 hours.
Ecstasy use can result in long-term memory loss.
GHB is used by body-builders to enhance sleep time with the idea that increased growth hormone is released during this sleep period.
It should be remembered that drug abusers very often combine many different drugs (alcohol, tobacco, marijuana, cocaine, ecstasy, etc.) when they are out with a group or partying.