Sample Nursing Paper on MDMA ( 3, 4-methylenedioxymethamphetamine)

Introduction

The prevalence of drug abuse in society has been on a steady rise. This is a persistent public health issue which has been complicated further by the availability of synthetic recreational drugs. These drugs which are often referred to as “research chemicals” or “legal highs,” are artificial substitutes to traditional drugs of abuse.  Most of these synthetic drugs are taken for recreational purposes and they collectively fall in a class of drugs called “new psychoactive substances” (NPS) (Baumann, 2016).

. At present, 3, 4-methylenedioxymethamphetamine (MDMA), is one of the illegal synthetic drugs abused in the United States (U.S.). MDMA is one of the most abused drugs in the U.S., with its users numbering to millions across the country. This drug has several pseudo names as it is also known among its users as X, Molly, and ecstasy. At first, party revelers were the primary users of this drug, but over time its use has spread to different settings. The effects of consuming MDMA include stimulation, time distortion, and sensory perceptions (Meyer, 2013).

The effects of MDMA start setting in after 45 minutes of consumption and can last for 3 hours, with their peak being between 15 and 30 minutes. Moreover, this drug causes hangovers that last for up to two days. Typically, each tablet of ecstasy contains between 50 and 150 milligrams of MDMA, and users usually take between one and two pills with subsequent doses aimed at boosting the dwindling effects of the drug (Abadinsky, 2018). The users’ inclination to continue with the dosage to maintain the effects of MDMA heightens the risk of exposure to its side effects from the combined dosages (Meyer, 2013).

Most people take this drug in either its tablet or capsule form, which is sometimes called ecstasy. However, many ecstasy tablets contain more than just MDMA but a concoction of different drugs with varying concentrations with adverse effects on the human body (Abadinsky, 2018). Some of the drugs contained in ecstasy include caffeine, cocaine, phencyclidine (PCP), heroin, and anesthetic ketamine. In some cases, it may contain extromethorphan which is an over-the-counter cough suppressant.

The crystalline form of MDMA commonly goes by the name molly among users, and it is sold in the market either in capsule or powder forms. Similar to ecstasy, the composition of molly is often not 100% MDMA but contains varying concentrations of other contaminants, including stimulants such as methylone and ethylone (Passie & Benzenhöfer, 2016). The presence of varying impurities in molly exposes users to health risks from ingesting harmful substances unknowingly.

MDMA is synthetic, and its popularity has been rising since the 1980s prompting researchers to investigate the adverse effects associated with its continued use. These research initiatives revealed that MDMA has the propensity of increasing blood pressure, heart rate, and body temperature as well as causing damage to the kidneys, which in most cases results in a fatality (Abadinsky, 2018). Also, the continued consumption of this drug leads to memory and learning problems and an overall deficiency in the user’s cognitive abilities.

At, present, there is no conclusive evidence that classifies MDMA as an addictive drug despite the potential dangers that it exposes users to. However, MDMA has an effect on the brain’s neurotransmitter, just like the case with other addictive drugs. When one takes MDMA in the form of pills, the effects sets in within the first 45 minutes (Abadinsky, 2018). Under normal circumstances, it takes approximately half an hour for its effects to peak, and it can last up to three hours. MDMA’s adverse effects usually last for 24 hours. Recreational consumers typically take either one to two pills, first with concentrations of MDMA ranging between 50 and 150 milligrams (Abadinsky, 2018). To boost its effects, they take subsequent doses when the effects decline. Most importantly, the subsequent dosage of MDMA among users exposes them to increased risk owing to the combined dosages.

Despite the lack of evidence on MDMA being addictive, this drug has various side effects that may be life-threatening. The symptoms related to the use of this drug include panic attacks, hypertension, seizures, faintness, and loss of consciousness (Bora, Yılmaz & Bora, 2016).  The side effects of MDMA are associated with its stimulating properties and conditions under which the drug is consumed. For instance, when an individual exposed to vigorous physical activity consumes the drug, it interferes with the .ability of the human body to regulate its temperature precipitating into hyperthermia. The onset of unchecked hyperthermia is potentially fatal as it causes electrolyte imbalance, which is a precursor to kidney failure. Besides, swelling of the brain, dehydration, and reduced heart pumping efficiency are other effects of MDMA (Bora et al. 2016). Besides the adverse effects of MDMA resulting from its use under extreme physical exertion, lack of appetite, depersonalization, jaw clenching, nausea, sweating, headaches, illogical thoughts, and restless legs are some of the other adverse health effects of MDMA (Abadinsky, 2018).

Despite the side effects and potential fatalities that might result from the abuse of MDMA, research studies have pointed at some therapeutic attributes that may be derived from this drug. For instance, the combination of this drug with psychotherapy has an effectiveness of approximately 67% in treating patients with post-traumatic stress disorders (Yazar-Klosinski & Mithoefer, 2017). Besides, MDMA possesses anxiolytic properties that produce prosocial and empathetic feelings to counter anxiety problems in patients (Yazar-Klosinski & Mithoefer, 2017). Lastly, MDMA is also appropriate for the treatment of alcohol addiction in conjunction with apt psychotherapy regimes.

The presence of other drugs in MDMA tablets, crystals, or molecules causes some of the disturbances experienced by the users of this drug. Additionally, research studies have established links between continuous uses of MDMA with certain high-risk behaviors. For instance, risky sexual behavior among the users of MDMA is much higher than the case with individuals who abuse alcohol.  According to Garin, Zurita, Velasco, Feliu, Gutierrez,  Masip & Mangues (2017),  the frequent use of recreational drugs MDMA inclusive, has been shown to interfere with desired outcomes for HIV patients. The potential adverse effects emanate from the interaction of these drugs with the antiretrovirals prescribed for these patients (Garin et al. 2017).  According to Evers,Van Liere, Hoebe & Dukers-Muijrers (2019), MDMA is one of the drugs involved in chemsex in the Netherlands. Additionally, there is close link in the usage of MDMA and other drugs such as cocaine, crystal meth, and ketamine among Men who have sex with men (MSM). According to research, almost all MSM who used MDMA as a chemsex drug in the Netherlands, were also involved in the consumption of at least one of the forenamed chemsex drugs (Evers, et al. 2019).

The History of MDMA

The origins of MDMA can be traced back to Germany. This drug was first developed synthetically by a German pharmaceutical company named Merck back in 1912 and was formerly known as Methylsafrylaminc (Abadinsky, 2018). Initially, this drug was intended for medicinal purposes in the synthesis of bleeding control medication. This purpose contradicts the widely held perceptions that this drug was developed to control appetite. Upon its discovery and initial trails, MDMA was patented by Merck in 1914, who labeled it as having potential pharmaceutical value. However, further developments of this drug would take place decades later.

MDMA also claims some historical contribution to the Cold War as both the CIA and the U.S. Army experimented with its use alongside other hallucinogenic drugs for suitability in chemical warfare. These experiments took place in the 1950s under the code name MK-Ultra and were aimed at applying MDMA as an agent for mind control (Passie & Benzenhöfer, 2018). However, the experimental use of this drug was carried out on non-human subjects, and the results remain relevant to this day as a basis for MDMA toxicological studies.

Despite not having received formal approval in the U.S., this drug commanded a substantial following in the 1970s and 1980s. It was widely believed by psychiatrists to enhance patient communication and insights into their problems. The psychiatric use of this drug is attributed to its wide availability in the streets. The U.S. Drug Enforcement Agency (DEA) banned the use of MDMA in 1985 and listed it in schedule 1 of drugs. Drugs in schedule 1 are defined as those not accepted for medicinal use and with a high propensity of being abused (Meyer, 2013). In the U.S., the use of MDMA has close links with electronic dance music events and the rave culture embedded in society. The venues for these events, which are mostly clandestine, provide an apt environment for alcohol and drug abuse.

In the 1980s, raves became popular in Europe and the U.S. concurrent with the increased street availability and use of MDMA, leading to this drug being a mainstay in these raves. Besides, the prevalence in MDMA use during these events is associated with the perceived spiritual aspects that revelers related to the sense of acceptance and harmony that its intake provides (Passie & Benzenhöfer, 2016). The spread of MDMA usage became popular in the U.S. among white professionals leading to its acquisition of the name “yuppie drug” (Abadinsky, 2018). The usage of this drug was also initially prevalent among individuals who were part of what was known as the New Age spiritual movement (Abadinsky, 2018). However, with time, MDMA consumption has transcended over the ethnic boundaries and is now commonly use among African American community and university students in the U.S.

The manufacturing of MDMA utilizes several chemicals toxic to humans, such as mercury, ammonium chloride, and formaldehyde. There are six necessary steps in its manufacturing process, which start with the extraction of safrole, which is a phenylpropene through the distillation of oil from the sassafras plant. Research evidence shows that safrole having a carcinogenic effect on animals. The second step in the manufacture of MDMA is the production of methylamine hydrochloride by reacting formaldehyde and ammonium chloride. The next step involves the creation of MDP2P through the Wacker process, which is then followed by its distillation to acquire pure MDP2P (Evans, Costrino, do Lago, Garcia,  Roux & Blanes, 2016). After the acquisition of MDP2P in its pure form, it is then reacted with Aluminium amalgam to produce MDMA oil which then crystallizes when combined with isopropyl alcohol and hydrochloric acid. As described above, the MDMA production process involves the use of hazardous chemical elements and intricate procedures that may have adverse effects on humans if not properly executed and handled. . It is therefore important for individuals to refrain from engaging in its production.

References

Abadinsky, H. (2017). Drug use and abuse: A comprehensive introduction (9th Edition). San Francisco, CA: Cengage Learning

Baumann M. H. (2016). The Changing Face of Recreational Drug Use. Cerebrum : the Dana forum on brain science2016, cer-01-16.

Bernschneider-Reif, S., Öxler, F., & Freudenmann, R. W. (2006). The origin of MDMA (‘ecstasy’)–separating the facts from the myth. Die Pharmazie-An International Journal of Pharmaceutical Sciences61(11), 966-972. Retrieved from https://pdfs.semanticscholar.org/d0db/5ee342bd20cf96614ccc575d7b7d575e0d9a.pdf

Bora, F., Yılmaz, F., & Bora, T. (2016). Ecstasy (MDMA) and its effects on kidneys and their treatment: a review. Iranian journal of basic medical sciences, 19(11), 1151–1158.

Evans, E., Costrino, C., do Lago, C. L., Garcia, C. D., Roux, C., & Blanes, L. (2016). Determination of inorganic ion profiles of illicit drugs by capillary electrophoresis. Journal of forensic sciences, 61(6), 1610-1614.

Evers, Y. J., Van Liere, G. A., Hoebe, C. J., & Dukers-Muijrers, N. H. (2019). Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: A cross-sectional study in the Netherlands. PloS one, 14(5).

Garin, N.,   Zurita, B., Velasco,  C.,  Feliu, A., Gutierrez,  M., Masip,  M., & Mangues,  M. (2017). Prevalence and clinical impact of recreational drug consumption in people living with HIV on treatment: a cross-sectional study. BMJ, 18;7(1) doi: 10.1136/bmjopen-2016-014105.