Understanding the effects of MDMA

I have been studying the effects of MDMA on the body and brain for a presentation that I will be undertaking to advise students to avoid taking the substance. Below is some information that I have found out.

An estimated two million drugs are smuggled into the US every day and one third of university students say that they have tried MDMA. It is very common in party scenes due to it being perceived in pop culture as not harmful, fun and trendy whilst costing only around £10 per pill of which the effects will last all night. MDMA has the street name “Mandy” in the UK and “Molly” in the US, which makes it sound sweet and appealing. However, the substance is currently a ‘schedule one’ substance in the USA which means it is very unsafe and a has a high potential for abuse.

MDMA is known as the pure form of ecstasy and is the short name of the molecule Methylenedioxy-N-Methylamphetamine whilst ecstasy contains both MDMA and other additives, for example caffeine or amphetamine. However it is important to remember that illicit drugs are hardly ever ‘pure’ due to drugs trafficking being an underground market where you do not ever know exactly what you are buying.

The drug is most commonly taken by oral ingestion but can also be inhaled up the nose and passes into the blood through capillaries.

Short term effects of MDMA include the increased release of two neurotransmitters; Serotonin and Dopamine. Neurotransmitters are chemicals in the body which relay a message from neurones to cells to control memory, emotion and reflexes. Between them, serotonin and dopamine control many things including appetite, memory, learning, mood, movement and sleep. As MDMA is a party drug, I focussed mainly on the neurotransmitters’ effects on mood, movement and sleep which are key to a good night out in a club or at a party.

Mood is lifted significantly when the drug is taken so that you become more empathetic and sociable whilst movement and therefore ability to dance to the beat is made easier by the drug. You do not get any motivation to sleep so you feel like you can party all night.

Furthermore, the hormone adrenaline is released through the blood from the adrenal glands (near the kidneys) which causes the eyes to dilate, the heart to beat and the jaw to clench which is commonly known as “gurning”.

These releases of neurotransmitters and hormones are common in every person who takes MDMA but there is also a potential for less common, more worrying incidents to happen as a cause of MDMA including seizures and potentially death. Seizures are caused when the water concentration in the blood gets too high so the brain crushes against the skull and spinal column.

Whilst death from MDMA use is extremely rare it is random who reacts this badly to it so my theory is to assume that you are in that tiny proportion of people who will react to it, so stop yourself taking the risk.

Some longer-term effects of taking MDMA are liver damage, higher risk pregnancy and brain damage. Liver damage is caused by the muscles working harder producing more heat, due to the release of adrenaline. When body temperature reaches 40 degrees centigrade, enzymes stop working, bind in cells and stop organs working so the enzymes to destroy toxic ecstasy or MDMA are destroyed themselves so MDMA is readily available to kill liver tissue. Higher risk pregnancy is due to the fact that you are more likely to have a premature birth if you take the drug and brain damage is caused by brain cells releasing serotonin being destroyed.

The come down from taking MDMA typically takes 3-8 hours and has bad effects in itself. The body’s receptors get tired of breaking down serotonin so begin to uptake more. This means that eventually more is broken down than usual so the person experiences feelings of negative mood, depression, irritation and/or tiredness due to the fact that there is less serotonin available to make you feel good about normal events. Marijuana is often used during the come down of many MDMA users as marijuana calms the body. However, this drug does cause anxiety so has negative effects by itself.

Even though in the majority of cases of people taking this illicit party drug there are negative outcomes, with some regulation there is the potential to safely use the drug as an anti-depressant for helping to cope with post-traumatic stress disorder or as relationship therapy. This is due to its nature of helping people to accept emotions, decrease stress, lower communication barriers and decrease negativity.

Emily Buchanan

 

 

 

Book Summary: Extreme Survival – Dr Kenneth Kamler

This book follows a doctor’s experience of injury and illness in extreme environments including; jungle, high seas, desert, underwater, high altitude and outer space. I really enjoyed reading this book as it is made up of advanced scientific knowledge about the limits of the human body whilst following a simple story line which meant it was an enjoyable and relatively easy read. The structure of the book is that every chapter is a new environment that the doctor has visited and attempted to help people.

The predominant underlying theme in Extreme Survival is that the mind is far more important in survival than we realise as humans concentrate too hard on worrying and rely too much on doctors and medicine when in discomfort. Often we forget about evolution and how we have adapted as a species to become something strong and something that can easily, with some thought, survive in any environment with some planning and positive thinking.

Whilst I learned about many interesting diseases and cures while reading this book, I know that this science can be taught throughout school and university. The doctor’s calm reactions in extremely difficult situations, his ability to think clearly under extreme pressure and his growth as a person, constantly learning to deal with new situations even when fully qualified, interested me the most. This growth in knowledge was seen through the doctor’s ability to link together conditions from two or more environments in his noting of the key similarities and differences due to difference in surrounding environment.

Furthermore, throughout this book it can be seen that the role of the doctor does not change around the world – you are a qualified doctor here in wealthy English hospitals and a qualified doctor in the Amazon rainforest, where there is very little medical equipment.  The illnesses to be cured are very different due to differences in the environment (eg. different ecosystems, living conditions, traditions, access to medicine) but the working of the human body remains the same wherever you go. The role of a doctor in the eyes of a patient never changes from professional, highly respected, kind and helpful, as highlighted by the physical application of red paint onto the face of the doctor in the Amazon rainforest to distinguish between the doctor and his patient, as in England doctors often wear a white coat or a stethoscope.

Being a doctor is not just paid work but a role of society and way of life – shown by the fact that the doctor is not paid to go to any of these places (he pays for the medication by fundraising at home) yet continues to risk his life in order to save many people that he does not know previous to joining them on explorations. Even when the doctor runs out of medication, people come to him to seek a cure, showing that doctors are expected to magically cure people in any situation. This is a common misconception in the medical world today.

Whilst I cannot write down everything I have learned from this book (as I would have to write a whole novel myself!), I am keen to spark some interest and encourage you to read it so I have attached my notes that I made. I hope that you find them interesting too.

Emily Buchanan

 

Extreme Survival – Dr Kenneth Kamler

Jungle

  • Open cut artery, malaria, snake venom, polio
  • herbal medicine
  • Patient/doctor differentiation key by red face paint (not white coat)

High seas

  • Starvation
  • Dehydration
  • Oedema

Desert

  • Thermoregulation – 2.3° disruption, 28° optimum outside temp, 43° ‘fries’ brain
  • Dehydration – 3% change in amount of water is dehydration, body allows up to 5% to allow not drinking all time, water v salt so tea/coffee/salty food
  • Overheating – liver does not detoxify blood, stomach & intestine stop digesting, muscles spasm, hypothalamus stops controlling water/salt so salt leaks into cells causing swelling and bursting
    • Proteins – tertiary structure unfolds until 41° when chaperone binds to protein to prevent deformation (cold, starve, sleep deprivation, isolation, fear, emotions)
    • Mirage – less dense bottom layer of air is heated and this density bends incoming light which is parallel
    • Endurance training ensures a strong heart, ease of transfer of glycogen to glucose to reduce heat build up, ensure a larger proportion of ‘slow twitch’ muscles which contract slowly to conserve energy, ‘cool down’ to continue air flow, genes activated to control metabolic rate that is resistant to heat
  • Melanin in black people’s skin which fends off UV rays, therefore protects from sunburn and skin cancer (however: dark colours retain heat) BALANCE

Underwater

  • Pressure increase (compression of lungs), weight of water
  • Caisson’s disease – gas forced into tissues by carbonation, blood circulates deep into organ so tissues/organs downstream starve causing an inflammatory response and blood clots
  • Concentrated 02 turns toxic so irritates nerves so divers inhale heliox which causes difficulty in communication and is very cold
  • [Deeper than 244m under sea level causes high pressure nervous syndrome when Helium is absorbed. Potential for future use of Hydrogen or robots.]
  • An adaptation needed: 3D proteins need to unfold and produce energy whilst remaining at a constant volume under increasing pressure
  • Gag reflex – stops solid/liquid entering trachea and lungs in conscious individuals

High Altitude

  • No heat, decreased air pressure, decreased o2
  • Potential for heatstroke if overdressed, blisters etc
  • High altitude sickness – blood vessels dilute and an increased fluid amount causes increased pressure in the brain and on the skull due to o2 –        Less than 50% o2 affects thinking whilst if less than 40% close to death

–       Dehydration – hypothalamus releases erythropoietin into the bone marrow where increase in red blood cell production is stimulated so that increased o2 is transported

  • Decreased pressure causes

–       2,3 diphosphoglycerate production is increased which weakens the link between oxygen and haemoglobin link so that less pressure is needed to transport o2

–       number of capillaries is increased

–       size of mitochondria is increased so that more o2 is burned & enzymes controlling burning of o2 are modified to be more efficient

  • Myglobin stores o2 in muscles
  • A 0.6°C drop in temperature causes a decrease in metabolic rate by 5%, a slowing of all chemical reactions, sluggish thinking, slowing of transmission of electrical impulses so body is numb/uncoordinated/apathetic
  • [At body temperature 27°C heartbeat becomes irregular, at 21° the heart stops]
  • Pulmonary oedema – due to cough/over exertion so lungs have to work harder, all blood vessels constrict so there is nowhere for blood to go, alveoli burst and release liquid into the air sacs so you die by drowning (Vasodilator containing Nitrous Oxide)
  • Toothache/Flatus – decrease in outside pressure causes an increase in volume in the tooth/intestine
  • ‘Hunter Reflex’ – wet feet feel warm even in sub-zero temperatures due to vasodilation if the foot is not removed then eventually only vasoconstriction as foot freezes
  • Cerebral Oedema – swelling impedes blood flow

–       cerebrospinal fluid (between brain and skull) enters spinal cord area where it acts as a barrier between vessels and cells so less o2 diffuses and the fluid enters cells causing them to swell

–       cerebellum (motor functions) area is swollen too so there is loss of balance and coordination

–       medulla (base) causes hallucinations and death due to confusion between limbic system and hypothalamus

–       [dexamethasone decreases tissue inflammation]

  • Heart attack – if too many RBCs are in blood making blood thick
  • Heat is mainly found in armpits (arm – brachial artery), groin (leg – femoral artery) and neck (head – carotid artery) [Nifedipine dilates blood vessels]
  • Blindness – UV rays enter the eye so the cornea goes opaque
  • Radial Keratotomy modifies the shape of the lens so that glasses do not need to be worn

Space

  • Increased gravity causes blood movement to legs and lower body, flattened wind pipe and air sacs break decreasing o2 transport, otolith and semi-circular canals make disorientation
  • Melatonin released when dark outside so makes you sleepy
  • Lithium Hydroxide intakes CO2 to balance air in rocket
  • Cold – fluid spreads in sinuses
  • Tall – fluid between vertebrae in spine separates out
  • Immune system weakens
  • Muscles weaken (including heart)
  • Calcium in bones decreases causing kidney stones
  • Stress causes cortisol to be released in the saliva
  • Thalamus sends danger signal to amygdala (for defense) which stimulates nerves joint together in brain stem to alter heart rate, blood pressure and rate of respiration

Words to research: altruism, IV bags, ICU

Brain

Amygdala – outside threats monitored (fear)

Parietal lobes – orientation to time and space, navigation eg. Manoeuvres necessary to sit in a chair

[Left – to be aware of borders of body are (not well developed as an infant); Right – assess space around body]

Frontal cortex – processing centre, awareness of self, controls attention/ alertness/concentration

Hippocampus – meters incoming signals and shuts down circuits when overloaded, recycle neurotransmitters to keep nerves firing

 

Work Experience with an ANP

I was lucky enough to ‘shadow’ an Advanced Nurse Practitioner for the last few days who was extremely keen to help me learn about applications for medical school, practical skills for becoming a doctor and how to professionally interact with patients from all walks of life.

When on the road to home visits we discussed the structure of the NHS and I was able to gain first-hand experience of the interaction between nurses, GPs and care workers by listening to discussions on the phone of the best options for the current and future situations of patients. This particularly helped me in understanding the role of doctor as a leader and coordinator of the healthcare team, as the nurse always checked in with the GP to ensure everything was recorded (medicinal and social information), and highlighted to me the extreme importance of team work for a successful healthcare system.

The practical skills that I was taught and used on many patients were; taking blood pressure and pulse, locating a pulse, applying a nebuliser, determining concentration of oxygen in the blood, listening to the chest through a stethoscope, interpreting tested urine samples and taking temperatures. Whilst I understand that it is not what you ‘do’ that interests med schools (it is ‘what you learn from what you do’), by practicing these basic observational skills I was able to distinguish the different ways the advanced nurse treated each patient. It helped me appreciate the exceptional quality of healthcare we have in this country due to every patient being treated individually and of equal importance (eg. any race, any age, if able bodied or disabled, both genders).  An example of this extra care taken that I noted was when I was asked to remove my surgical gloves when taking a blind woman’s blood pressure due to the fact that the difference in texture between glove and hand may have caused confusion and discomfort. This taught me that the patient and their concerns must always come first, and that early patient contact is essential to learn to deal with the large variety of different cases that we, as doctors, will come across.

I learned how to deliver bad news to a patient when the ANP made me tell a very reluctant lady that she must go to hospital. I spoke in an empathetic but firm manner, ensuring that she understood exactly why the admittance was necessary. After delivering the news I offered to help her change clothes and pack her bag so that she felt clean and ready to go to hospital when the ambulance arrived. I learned that doctors and nurses usually do not have time to offer to help with these things which made me feel sad. The ANP praised me for the way I handled the situation.

I will always remember the ANP’s professionalism in remaining calm and driven, even in difficult situations. He demonstrated many attributes that stand for great healthcare and that must be expressed by all healthcare professionals. This included being empathetic as opposed to sympathetic, self-aware in letting patients explain their problems and resilient through continuing to visit more patients, even after visiting a patient whose condition had significantly deteriorated.

 

Emily Buchanan