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July 25, 2000
Presented by Alan I. Leshner, Director, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services

Statement for the Record

Mr. Chairman and distinguished members of the Caucus, thank you for allowing the National Institute on Drug Abuse (NIDA) to submit a formal statement for the record for this important and very timely hearing. As the world's largest supporter of research on the health aspects of drug abuse and addiction, I would like to share with you today what NIDA-supported research is beginning to tell us about club drugs, particularly 3,4-methylenedioxymethamphetamine (MDMA).

Although ecstasy, or the more scientific term, methylenedioxymethamphetamine (MDMA), is only now just beginning to rear its ugly head in the popular media, it is not a new drug. In fact, its origin dates back to the early 1900s when MDMA was synthesized, developed and patented in Germany by the pharmaceutical company Merck. It does not appear that MDMA was developed with any specific purpose in mind, but came about as a by-product in the more routine drug development process. The drug remained somewhat dormant until the 1970s when it began being used by some psychotherapists who claimed that it enhanced communication in patient sessions. In the mid 1980s, MDMA emerged as a so-called "party" or "club" drug at raves or all night dance parties by some young adult populations. ("Club drugs" is a collective term used for the drugs that are often associated with raves and dance parties. Other drugs, grouped under this vague term are Gamma-hydroxybutyrate (GHB), Rohypnol, ketamine, LSD, and methamphetamine. )

For a variety of reasons, including the fact that there was a growing body of scientific evidence that MDMA was causing damaging effects on serotonergic axons in animals, the U.S. Drug Enforcement Administration moved the drug to Schedule I status in 1985. Schedule I under the Controlled Substance Act means there is no accepted medical use for MDMA in the U.S.

Despite MDMA's status as a Schedule I drug, it continues to be used illegally. In fact, some of our Nation's top monitoring mechanisms, including NIDA's Monitoring the Future Survey and our Community Epidemiology Work Group (CEWG) are reporting that the use of club drugs, particularly MDMA, is on the rise. Unlike the current encouraging trend for other illicit drugs where we are seeing a stabilization or a decrease in drugs such as cocaine and heroin, just last week (June 13-16, 2000) researchers and public health officials from the 20 major U.S. metropolitan areas and the state of Texas that comprise the CEWG, reported that the use of MDMA is spreading beyond the more traditional rave setting. It is being used increasingly in both urban and suburban populations and is reportedly being combined with other drugs, such as LSD where it has been termed "rolling and trolling." Some cities, such as Boston, Minneapolis, St. Louis, Miami and Detroit, are reporting sharp increases in MDMA use among adolescents and young adults.

These more localized trends are being detected at the national level as well. NIDA's long-standing national survey of drug use among 8th, 10th and 12th graders found that illicit drug use, including the use of marijuana, generally has declined or stayed level in all categories: lifetime, past year and past month use. Among the few statistically significant changes reported were increases in the use of MDMA among 10th and 12th graders. Past year use of MDMA increased from 3.3 percent in 1998 to 4.4 percent in 1999 among tenth graders. Twelfth graders increased in all three categories. Lifetime use increased from 5.8 percent in 1998 to 8.0 percent in 1999. Past year use rose from 3.6 percent in 1998 to 5.6 percent in 1999. There also appears to be an increase in the number of twelfth graders who are reporting that ecstasy is "fairly easy" or even "very easy" to get.

What is most disturbing about these trends is the fact that MDMA is not a benign drug. In fact, all of the studies conducted to date in both animals and more recently in humans, confirm that club drugs, particularly MDMA, are not harmless "fun party drugs." While users of club drugs may think they're taking them simply for energy to keep on dancing or partying, research shows these drugs can have long-lasting negative effects on the brain that can alter memory function and motor skills.

Animal research has confirmed that MDMA shares the properties of both the hallucinogenic (LSD-like) and stimulant (amphetamine-like) drugs. Structurally, MDMA is similar to the stimulant methamphetamine and the hallucinogen mescaline. MDMA is typically taken orally, usually in capsule or tablet form, and its effects last three to six hours depending on the dosage, although confusion, depression, sleep problems, anxiety and paranoia have been reported to occur even weeks after the drug is taken. MDMA is also available in a powder and is sometimes snorted and occasionally smoked, but rarely injected.

MDMA can produce increases in heart rate, blood pressure and body temperature. And because its stimulant properties enable users to dance for extended periods, it can also lead to dehydration, hypertension, and heart or kidney failure. MDMA use can lead to long-lasting damage to serotonin-containing brain cells. In fact, through the use of modern imaging techniques, we now have direct evidence in humans to support the voluminous animal literature showing a decrease in a structural component of serotonergic or brain 5-HT neurons in human MDMA users. The attached figure depicts this reduction.

PET scans of normal brain and brain effected by MDMA. Shows much lower serotonin binding in lower brain sectionsFigure 1 shows the images of two human brains. Through the use of positron emission tomography (PET), we can actually see that the brain images on top belongs to an individual who has never used MDMA. The bottom images show the brain of an individual who had used MDMA heavily for an extended period, but was abstinent from drugs for at least three weeks prior to the study. Clearly the brain of the MDMA user on the bottom has been significantly altered. The specific parameter being measured is the brain's ability to bind the chemical neurotransmitter serotonin. Serotonin is critical to normal experiences of mood, emotion, pain, and a wide variety of other behaviors. On the figure, brighter colors reflect greater serotonin transporter binding; dull colors mean less binding capacity. This figure shows a decrease in the MDMA user's ability to remove this important neurotransmitter from the intercellular space, thereby amplifying its effects within the brain. This decrease lasts at least three weeks after the individual has stopped using MDMA.

We are now beginning to see signs that MDMA has the ability to impair one's cognitive abilities as well. Several findings, including those recently reported in the Journal of Neurology, Neurosurgery, and Psychiatry, found that when MDMA users who also occasionally used marijuana were given a battery of performance tests. They fared significantly worse on some components when compared to either marijuana users or non-drug users. Participants were tested for attention, memory and learning, frontal lobe function and general intelligence. In general, MDMA users, had poorer performance results in three general intelligence tests, they also required more repetitions to learn a word than both the marijuana and the non-drug users, and when compared to the non-drug users had poorer short-term memory performance. The researchers concluded that MDMA use over a period of months or a few years may cause long-term impairment of cognitive performance even when MDMA is taken in relatively small doses.

The bottom line on club drugs, particularly MDMA, is that given our current knowledge about these drugs, they appear to be extremely risky for anyone's health. MDMA has been shown to be neurotoxic, to cause long-lasting, or even permanent damage to the neurons that release serotonin and to have the ability to impair an individual's memory and cognitive performance. The citizens of this Nation deserve to know what the science is revealing about these drugs.

Toward this end, NIDA has initiated a Club Drug Research Initiative. We will be increasing our support for research on club drugs by 40 percent and are seeking to support studies that help us to better understand the populations that are using these drugs and to develop effective prevention and treatment approaches for these populations. We have also initiated a series of public information activities to disseminate science-based information about the consequences of club drugs. To ensure that we are reaching the communities most in need of this information, we have joined with community partners (American Academy of Child and Adolescent Psychiatry, Community Anti-Drug Coalitions of America, Join Together, and National Families in Action) to intensify our education and dissemination efforts. We issued a Community Drug Alert Bulletin on Club Drugs that has been mailed to almost half a million physicians, treatment providers, nurses and clinicians across the country. Also, NIDA set up a fax-on-demand service, called "NIDA Infofax," which provides fact sheets on drugs of abuse that can be faxed, mailed, or read over the phone in English or Spanish to the requestor. Since this system debuted in December 1997, we have distributed more than 250,000 fact sheets. Our "go-cards," or colorful postcard-like advertisements encouraging people to contact NIDA for research-based information have also been extremely popular, particularly with young adults. We have also made all of these materials available on our website. As new findings become available, we will be able to alert the public immediately through this and other venues.

We will continue to use our resources to combat this disturbing drug trend. NIDA's research portfolio has already produced important new treatment and prevention strategies for many drugs of abuse, and we are confident that science will continue to pay dividends to society for ways to combat this drug use trend as well.

Thank you again for allowing us to submit this statement and for your commitment to reducing the harmful effects that drugs can have on the citizens of this Nation. We will be happy to answer any questions on this statement that members want to submit for the record.