Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

8. Marijuana, Hallucinogens, and Club Drugs 167Extensive cognitive studies in individuals using MDMA, though rife withmethodological problems, show a consistent pattern of cognitive dysfunctionseen in the frontal cortex and the hippocampus. This phenomenon is consistentwith that found in animals exposed to MDMA (Fox, Parrott, & Turner,2001; Montoya et al., 2002). Psychiatric problems, such as depression, anxiety,panic, increased impulsiveness, and sleep disturbances, are significantly higherin MDMA users, even when users are abstinent and the last use is remote. In asymposium (“Is MDMA a Human Neurotoxin?”), Turner and Parrott (2000)concluded: “Novel studies . . . confirmed and extended the range of cognitive,behavioral, EEG, and neurological deficits, displayed by drug-free Ecstasy users.Moreover, these deficits often remained when other illicit drug use was statisticallycontrolled. In conclusion: If MDMA neurotoxicity in humans is a myth,then it is a myth with a heavy serotonergic component.” A recent study byRicaurte, Yuan, Hatzidiitrious, Cord, and McCann (2002) implicated MDMAas causal of dopaminergic neurotoxicity as well. The involvement of the dopaminesystem has important implications in terms of increased vulnerability to avariety of motor and cognitive functions. Some of the more dramatic results ofthe work of Ricaurte have recently been thrown into doubt and are controversial,but the basic results of his and others’ work are still considered consistent.This is a general chapter dealing with all aspects of club drugs and MDMA. Thereader is directed to several excellent and extensive reviews of the particularsubject of MDMA and neurotoxicity (McCann et al., 2000; Montoya et al.,2002; Verkes et al., 2001).TreatmentThe treatment of MDMA abuse may be divided into the treatment of acute reactionsto the drug and the treatment of those who abuse the drug chronically.Urgent TreatmentsFatalities from Ecstasy use and overdose, although rare, do occur. Becausepolydrug use is the norm in many of the venues where Ecstasy is popular (Lee &McDowell, 2003), it is sometimes difficult to ascertain the contribution ofMDMA versus those other substances. Fatalities can be caused by hyperpyrexia,rhabdomyolysis, intravascular coagulopathy, hepatic necrosis, cardiac arrhythmias,cerebrovascular accidents, as well as by a variety of behaviors associatedwith confusion and impaired judgment (Khalant, 2001).Ecstasy has many chemical similarities to amphetamine, and drug detectionproducts may indicate a positive presence of amphetamine after use.MDMA intoxication or overdose may be suspected in any individual with alterationsof sensorium, hyperthermia, muscle rigidity, and/or fever. Because the