My thoughts on Drugs Live:The ecstasy trial

Firstly, let us not be naïve about motives. Channel 4 funded this clinical trial and so whether a necessary evil or good publicity it was going happen. The question therefore is ‘Is the programme biased, one way or another?’ But also will it glamorize drug use, after all on the surface it is a Channel 4 programme based on ‘celebrities’ and the like taking a Class A drug.

I for one did not find the programme to be biased, as much as the Daily Fail and its readers would like you to believe. It was not Channel 4’s fault the ‘anti experts’ were unable to effectively put their points across. And it probably didn’t help that most of the published work they referenced was based on recreational users, where the dosage is not controlled and the drug could have been cut with all manner of substances. We know today that a lot of ecstasy pills contain no MDMA but actually contain drugs like PMMA or BZP. It didn’t glamourize drug taking. People take MDMA because of the euphoric effects, the lovey feelings, the closeness it brings. How can you show an unbiased programme without showing the reasons why people take it, to miss this out would surely be a lie?

And then to the point of the clinical trial, because lets not forget this is the reason for all of this! (And the funding is the reason for the programme). For most drugs that fall under the Misuse of Drugs Act 1971 there is a body of work behind the therapeutic uses of them. A good example of this is heroin/diamorphine. Heroin is semi-synthetic, produced from the opium poppy and has a long history of therapeutic uses before its inclusion in the Act; heroin was sold as a cough medicine.  Can you imagine if we didn’t have narcotic painkillers because of the number of people abusing heroin and research only showing the negative connotations of its use?

Unfortunately with MDMA its use and abuse meant it quickly became controlled and has since kept its stigma as a Class A party drug. There is no actual empirical evidence on how it may help with disorders such as PTSD or depression, and for all we know it might not. Though from the fMRI results there shows promise.

Many drugs are prescribed which are dangerous, which is why those patients prescribed it are subject to therapeutic drug monitoring (TDM) programs. MDMA may turn out to be a candidate for that. Who knows? No one yet! The programme showed an ex-SAS officer and a priest take MDMA, both with very different reactions. The dose of 83mg was enough to bring about lost memories of a traumatic experience for the priest who had suffered PTSD, showing potential (alongside the therapy sessions from the states). Then there is the ex-SAS soldier, maybe the dose was too high, maybe it wasn’t high enough, or maybe it would not be the right therapy for him. The point is, everyone is different, what drug works for one person may not work for the next. What dose works for one person, may not work for the next. And then there is defining a therapeutic range, should one be necessary. For example clozapine is prescribed for patients with treatment resistant schizophrenia, because other medications have failed. Originally it was banned because of its toxicity but it was too effective to ignore so a TDM program is in place for those who are prescribed it. A therapeutic plasma concentration is known, and doses can range dramatically from a daily starting dose of 12.5mg all the way up to doses of 1.5g.

The fact of the matter is we don’t know enough, if we really know anything of substance at all. There are too many maybes and maynots and this trial aims to change that. Lets not forget it will be published and peer-reviewed, and I look forward to seeing what results it yields.

What’s in your pill?

Two people are in hospital after taking what has been described as ‘potentially lethal’ ecstasy at Fabric nightclub last weekend. This lethal batch is thought to be making its way around London.

These cases follow the deaths of five people in Scotland. Their deaths are thought to be attributed to a ‘lethal’ batch of ecstasy and led to calls for festival goers to beware at last months T in the Park Festival.

But what is so different about these batches?

Methylenedioxymethamphetamine or MDMA is the chemical name for ecstasy. Pills taken recreationally are not 100% pure, they will have been cut with numerous other chemicals and sold as powder or pressed into pills. The pills are generally coloured or are stamped, which many attribute to a specific pill. The problem is, is that this is not always correct.

It has been found that in fact over the years the amount of MDMA in an ‘ecstasy’ pill has decreased and largely been replaced with ‘legal highs’. Mephedrone being one of the most popular replacements before its classification last year.

So why is this happening now?
Levels of MDMA are beginning to increase again, with the levels found in the Scottish batches reported to be up to 6 times stronger than expected. These increases mean users may think they are taking their ‘usual’ amount but are actually taking a lot more.

Batches found in other parts of the UK have been found to contain PMMA (paramethoxymethamphetamine) instead of MDMA. PMMA is not as strong as MDMA, leading users to take more in order to get the high but increasing their chance of overdose.

Currently one of the London clubbers is still in a critical condition.

“Ubertan is fine…. it’s herbal.”

Concern today over the use of a herbal nasal spray which gives you a tan, apparently by ‘heightening’ the body’s melanin levels. The problem is this product has not been tested by the MHRA, is not licensed in the UK and animal studies have found numerous potential side effects.

It is purported to contain Forskolin, however MHRA have discovered it contains Melanotan II. Melanotan II is also unlicensed and has many known side effects.

It is not currently illegal to use Ubertan, though you are putting yourself in danger, but under the Medicines Act, 1968 it is illegal to sell it.

But apparently it’s herbal so thats ok……….

Many people have this misconception that herbal medications are fine but this is far from true.
The best example is prehaps St. John’s Wort, a widely available over the counter herbal medication used for depression. Many people know that it can stop the contraceptive pill from working but do they know why? And what other medications it can affect?

St. John’s Wort is an inducer of the CYP3A4 and CYP2C9 enzymes and P-glycoprotein. These all play an important role in the absorption and metabolism of many drugs, thus St. John’s Wort decreases their bioavailability and efficacy.

And don’t forget about grapefruit!!!