Club Drugs and Their Treatment

The reader is directed to several excellent and extensive reviews of the particular subject of MDMA and neurotoxicity (McCann et al., 2000; Montoya et al., 2002; Verkes et al., 2001).

The treatment of MDMA abuse may be divided into the treatment of acute reactions to the drug and the treatment of those who abuse the drug chronically.

Urgent treatments. Fatalities from Ecstasy use and overdose, although rare, do occur. Because polydrug use is the norm at many of the venues where Ecstasy is popular (Lee et al., 2003), it is sometimes difficult to ascertain the contribution of MDMA versus other substances. Fatalities can be caused by hyperpyrexia, rhabdomyolysis, intravascular coagulopathy, hepatic necrosis, cardiac arrhythmias and cerebrovascular accidents, as well as by a variety of behaviors associated with confusion and impaired judgment (Kalant, 2001).

Ecstasy has many chemical similarities to amphetamine drug detection products and may indicate a positive presence of amphetamine after use. Intoxication or overdose of MDMA may be suspected in any individual with alterations of sensorium, hyperthermia, muscle rigidity and/or fever. Because the drug is used in specific settings and by specific subgroups, the level of suspicion should be proportional to the user and the circumstance involved. In addition, the clinician should have a high degree of suspicion that the patient may have taken multiple drugs. Drugs that may have been substituted for Ecstasy tablets, such as ephedrine(Drug information on ephedrine), Ma-Huang (herbal Ecstasy; Ephedra sinica) and caffeine(Drug information on caffeine), should be considered.

Ecstasy overdose would most likely involve the ingestion of multiple doses and would also most likely occur in an environment that induced dehydration. Overdose or toxic reaction to MDMA is a diagnosis by exclusion. Supportive measures, such as effective hydration using intravenous fluids and lowering the temperature of the patient with cooling blankets or an ice bath, are often necessary. Standard gastric lavage should be employed (Ajaelo et al., 1998; Schwartz and Miller, 1997). Physical restraint may be necessary for agitated patients but should be used sparingly. Benzodiazepines are the preferred choice of sedating agent (Shannon, 2000). Hypertension often resolves with sedation. If it persists, nitroprusside (Nitropress) or a calcium-channel blocker is preferred over a β-blocker, which may worsen vasospasm and hypertension (Holland, 2001).

Nonurgent treatment. Ingestion of MDMA may be associated with a number of adverse psychiatric symptoms, notably anxiety, panic and depression. These symptoms usually subside in a matter of hours or days. Support and reassurance are often all that is needed. If the symptoms are of a more serious nature, brief pharmacotherapy to alleviate symptoms is recommended.

Although classical physiological dependence on MDMA does not occur, some individuals use the drug compulsively. For these people, the standard array of treatments, based on a thorough assessment of internal and external resources, should be employed. Clinicians are cautioned against adopting a knee-jerk negative attitude. People, in particular the young, use drugs for valid reasons, often because the drugs temporarily make them feel better. Automatic negativity may inadvertently preclude the initiation of a therapeutic alliance.

Ketamine is usually taken as a gray powder that is inhaled through the nose. The results are dose dependent and cause a feeling of altered reality and a feeling of being removed from one's body.