Sentidos y vivencias relacionados con el uso recreativo de MDMA (Éxtasis)

Se presentan a continuación los resultados de un estudio exploratorio y descriptivo centrado en el análisis de los sentidos y vivencias asociados a experiencias de consumo de MDMA (3,4-metilendioximetanfetamina, Éxtasis) en usuarios jóvenes de esta sustancia que habitaban la ciudad de Montevideo en el período 2017-2019. Se desarrolló un muestreo no probabilístico en cadena que permitió la realización de 13 entrevistas a personas con edades comprendidas entre los 20 y 32 años. Los resultados de este trabajo confirman las motivaciones de consumo ya identificadas en otros estudios tales como la búsqueda de un estado de euforia y desinhibición así como de descarga energética y felicidad compartida. Sin embargo también se observó un particular interés en la posibilidad de comunicación sincera al igual que una marcada confianza en lograr experiencias poco riesgosas que propicien efectos duraderos en los vínculos generados por el consumo compartido. Estos indicios pueden ser de interés para el diseño de estrategias clínicas que incluyan a esta sustancia como fármaco coadyuvante de la experiencia terapéutica.

Below are presented the results of an exploratory and descriptive study focused on analyzing the senses and experiences associated with MDMA (3,4-methylenedioxymethamphetamine, Ecstasy) consumption experiences in young users of this substance living in the city of Montevideo in the period 2017-2019. A non-probabilistic chain sampling was developed that allowed for the realization of 13 interviews with people between the ages of 20 and 32. The results of this work confirm the consumption motivations already identified in other studies, such as the search for a state of euphoria and disinhibition, as well as energetic discharge and shared happiness. However, a particular interest was also observed in the possibility of sincere communication, as well as a marked confidence in achieving low-risk experiences that foster lasting effects on the relationships generated by shared consumption. These findings may be of interest for the design of clinical strategies that include this substance as an adjunct drug for therapeutic experiences.

A seguir estão apresentados os resultados de um estudo exploratório e descritivo centrado na análise dos sentidos e experiências associados ao consumo de MDMA (3,4-metilenodioximetanfetamina, Ecstasy) em usuários jovens desta substância que residiam na cidade de Montevideo no período de 2017 a 2019. Foi realizado um amostragem não probabilística em cadeia que permitiu a realização de 13 entrevistas com pessoas entre 20 e 32 anos de idade. Os resultados deste trabalho confirmam as motivações de consumo já identificadas em outros estudos, tais como a busca por um estado de euforia e desinibição, bem como a descarga energética e a felicidade compartilhada. No entanto, também foi observado um interesse particular na possibilidade de comunicação sincera, bem como uma confiança marcante em alcançar experiências de baixo risco que propiciem efeitos duradouros nos vínculos gerados pelo consumo compartilhado. Esses indícios podem ser de interesse para o desenvolvimento de estratégias clínicas que incluam esta substância como um fármaco coadjuvante da experiência terapêutica.

Study the effect of 3,4-Methylenedioxy methamphetamine on cytochrome P450 2E1 activity

Abstract Evaluating the effects of ecstasy on CYP2E1 activity is of great concern, mainly due to growing trends in abuse and co-administration of MDMA with ethanol and the dominant role of this isoenzyme on ethanol metabolism. This study aimed to evaluate the effects of MDMA on CYP2E1 activity. A total of 24 male rats were selected and divided into three groups. The first and second groups consisted of 12 rats and were employed to optimize the perfusion method, and the third group was employed for studying the alteration of CYP2E1 activity after liver exposure to MDMA (300 and 600 ng/ml). The amount of chlorzoxazone and 6-hydroxy chlorzoxazone in a sample obtained from liver perfusion before and after exposure to a buffer containing MDMA was determined by HPLC-FL. The enzymatic activity of rat CYP2E1 decreased after liver perfusion with a buffer containing 600 ng/ml of MDMA. However, no significant changes were observed in chlorzoxazone and 6-hydroxy chlorzoxazone concentration in perfusate before and after liver perfusion with a buffer containing 300 ng/ml of MDMA. Our findings suggest that the activity of CYP2E1 in rats might decrease only after administration of MDMA at a lethal dose. However, further animal and human studies are needed to confirm our assumption.

Uso de club drugs entre estudantes de graduação: prevalência, características associadas e a influência dos pares / Club drugs use among undergraduate students: prevalence, associated characteristics and peer influence

OBJETIVO: Medir a prevalência do uso na vida, no último ano e no último mês de duas club drugs ­ o ecstasy e o LSD ­, bem como as características associadas ao uso dessas substâncias, no último mês, entre estudantes de graduação de uma universidade no Sul do Brasil. MÉTODOS: Trata-se de um estudo transversal conduzido no ano de 2015 com amostragem aleatória sistemática por conglomerados. Participaram 1.423 estudantes de graduação. Foi utilizado um modelo de análise multivariável em três níveis hierárquicos por meio da regressão de Poisson com ajuste robusto da variância. RESULTADOS: As prevalências de uso na vida, no último ano e no último mês de club drugs foram de 12,7%, 7,8% e 3,8%, respectivamente. Indivíduos do sexo masculino, com orientação sexual homossexual ou bissexual, mais jovens, que moravam com seus pares, solteiros, e que relataram uso no último mês de tabaco e maconha apresentaram maior probabilidade de ter feito uso no último mês de alguma club drug. Entretanto, a variável mais fortemente associada a esse desfecho foi ter algum amigo que já fez uso de alguma droga ilícita na vida (RP = 19,54). CONCLUSÕES: O ambiente universitário parece ser um terreno fértil para a difusão do uso de club drugs. O fortalecimento de uma rede de apoio institucional da universidade, capaz de propor atividades de prevenção, bem como de identificar, acolher e encaminhar casos em que haja abuso e dependência dessas substâncias, pode ser uma estratégia importante para lidar com essa problemática.

OBJECTIVE: To measure the prevalence of lifetime, last-year, and last-month use of two club drugs ­ ecstasy and LSD ­, as well as the characteristics associated with the last-month use of these substances among undergraduate students at a university in southern Brazil. METHODS: This was a cross-sectional study conducted in 2015 with a clustered systematic sampling strategy. Overall, 1,423 undergraduate students participated. A three-level hierarchical multivariate analysis model was used through Poisson regression with robust adjustment of variance. RESULTS: Prevalence of lifetime, last-year, and lastmonth use of club drugs were 12.7%, 7.8% and 3.8%, respectively. Male participants, with homosexual or bisexual sexual orientation, younger, who lived with their peers, who were single, and who reported last-month use of tobacco and marijuana had higher probability of last-month use club drugs. However, the variable most strongly associated with this outcome was having a friend with lifetime use of illicit drugs (PR = 19.54). CONCLUSIONS: University environment seems to be a fertile ground for the spread of the use of club drugs. The strengthening of the university's institutional assistance network, capable of proposing prevention activities, as well as identifying, supporting and referring cases where there is abuse and dependence on these substances can be an important strategy to deal with this problem.

Análise clínica, terapêutica e dos parâmetros tomográficos de pacientes portadores de ceratocone atendidos na Fundação Hilton Rocha / Clinical analysis therapy and tomographic parameters of patients diagnosed with keratoconus attended at Fundação Hilton Rocha

Resumo Objetivo: Analisar dados clínicos, terapêuticos e parâmetros tomográficos dos pacientes portadores de ceratocone atendidos na Fundação Hilton Rocha. Métodos: É um estudo retrospectivo com amostra aleatória de 150 pacientes submetidos a tomografia de córnea e segmento anterior (Pentacam - Oculus, Wetzlar, Alemanha) na Fundação Hilton Rocha no ano de 2015. Os pacientes foram classificados como portadores ou suspeitos de ceratocone através dos parâmetros: paquimetria, elevação central anterior e posterior, Ambrosio Relational Thinnest (ART), valor de D e ceratometria. Após a seleção foi realizada análise dos prontuários, coletados dados clínicos e terapêuticos dos pacientes. Os dados foram colocados em tabela e analisados. Resultados: Dos pacientes classificados como portadores de ceratocone, 23% tinham 6 parâmetros alterados, e 10% foram classificados com apenas 1 parâmetro alterado. O índice ART foi o que mais se alterou (83%) nos pacientes portadores de ceratocone. Na análise dos dados clínicos e terapêuticos, 76,8% dos pacientes apresentaram acuidade visual melhor ou igual a 20/60, e 19% mencionaram apresentar atopia e, 90% dos pacientes utilizavam como tratamento apenas lentes corretoras (óculos e lente de contato). Conclusão: A utilização de índices tomográficos para o diagnóstico do ceratocone têm aumentado a sensibilidade e a especificidade na triagem de pacientes portadores desta ectasia, possibilitando o diagnóstico de maneira mais precoce e consequentemente maior sucesso terapêutico.

Abstract Objective: Analyze clinical data, therapy and tomographic parameters of patients attended at Fundação Hilton Rocha. Methods: This essay is a retrospective study based on a random sample of 150 patients submitted to cornea tomography and previous segment (Pentacam - Oculus, Wetzlar, Germany) at Fundação Hilton Rocha in the year 2015. The patients were classified as carriers or suspects of keratoconus through the following parameters: pachymetry, anterior and posterior central elevation, Ambrosio Relational Thinnest (ART), value of D and keratometry. After the selection an analysis of the medical records was done, followed by harvest of clinical and therapeutical data of the patients. The data was put on table and then analyzed. Results: From the numbers of the patients diagnosed with carriers of keratoconus, 23% had 6 altered parameters, and 10% were classified with only 1 altered parameter. The ART index was the one that suffered the largest change (83%) on the keratoconus carriers. After analysis of clinical and therapeutical data, 76.8% of patients showed better or more of 20/60 degree of visual acuity, and 19% mentioned signs of atopy, 90% of the patients were using only corrective lenses as treatment (glasses and contact lenses). Conclusion: The use of tomographic indexes for the diagnosis of keratoconus has been increasing the sensibility and specificity of the triage of carriers of this ecstasy, allowing an earlier and better diagnosis of this medical condition.

Bruxismo secundario al consumo recreacional de éxtasis: revisión de la literatura / Secondary bruxism after recreational ecstasy consumption: a review

El Metilendioximetanfetamina (MDMA) o éxtasis, es una droga sintética que fue accidentalmente aislada en 1914, sin encontrarse en ella una utilidad médica. La OMS la considera una droga psicotrópica y es ilegal en diversos países, incluyendo a Chile. De acuerdo al Estudio Global de Drogas Sintéticas, el consumo de éxtasis ha aumentado considerablemente en Latinoamérica entre el 2008 y 2014, estudios en Chile la muestran con una "nueva droga" cuyo consumo está aumentando en personas de 19­25 años de edad. El concepto de bruxismo en odontología ha cambiado con el paso del tiempo. Actualmente se reconoce su naturaleza multifactorial, en dónde los factores centrales (patofisiología) juegan un rol principal. Diversos autores han reportado bruxismo como un efecto secundario al consumo recreacional de éxtasis, con frecuencias que van entre el 50 a 89%. Esto puede explicarse debido al efecto de desbalance a nivel de las vías serotoninérgicas y/o domaminérgicas que produce el MDMA, tal como parece ocurrir en el bruxismo. Debido a que la Oficina de las Naciones Unidas contra la Droga y el Delito (UNODOC) advierte del aumento progresivo y significativo del consumo de éxtasis en la población joven chilena, es importante conocer las implicancias orales con la finalidad de lograr un mejor manejo odontológico, siendo necesarios mayores estudios para determinar la real asociación entre el consumo de éxtasis recreacional y bruxismo secundario.

Methylenedioxymethamphetamine (MDMA) or Ecstasy is a synthetic drug accidentally isolated in 1914, finding in it no specific medical use. The WHO considers it as a psychotropic drug and it is illegal in several countries, including Chile. According to the Global Synthetic Drugs Assessment, the use of ecstasy has increased steadily in Latin-America between the years 2008 and 2012, and studies in Chile show ecstasy as a "new drug", with an increased consumption in the 19-25 year-old age group. The concept of bruxism in dentistry has changed over time, moving to a multifactorial etiology where central factors, such as pathophysiology have a major role. Several authors report bruxism as a side effect of ecstasy consumption, at a rate of between 50 and 89%. This can be explained by the fact that MDMA acts centrally inducing imbalance at the level of serotonergic and/or dopaminergic pathways, as it occurs in bruxism. Since the United Nations Office on Drugs and Crime warns of a significant and progressive increase in the consumption of recreational ecstasy in young Chilean adult population, it is important to know there are oral implications in order to have better dental management, and further studies are necessary in order to determine an actual association between ecstasy consumption and secondary bruxism.

Association of ecstasy seizure rates with district Human Development Index in the municipality of São Paulo, Brazil, from 2000 to 2007

This study aimed to analyze whether ecstasy consumption is associated with the socioeconomic status in the Municipality of São Paulo, Brazil, from 2000 to 2007. We used an official, reliable and unbiased source supplied by the Department of Narcotics of the State of São Paulo (Denarc) database and the Human Development Index of the districts (HDId) where the seizures occurred. A Spearman correlation test between the average number of ecstasy seizures per million of inhabitants with the HDId was used. There were 190 seizures (totaling 47,934 tablets) spread out in 53 of the 96 districts and 51.6% were concentrated in only 8 districts. The higher rates of ecstasy seizures were directly associated with districts with high HDId that confirmed the association of ecstasy consumption with the socioeconomic status. Itaim-Bibi, Jardim Paulista and Moema were the top three districts with the highest HDId. In these districts, the number of tablets per seizure ranged from as few units to thousands, revealing that not only consumption but also traffic coexist at the same place. Districts with many nightclubs can also influence the incidence of seizures. This knowledge can be useful to help the police from other Brazilian cities to combat ecstasy trafficking.

Este estudo teve como objetivo analisar se o consumo de ecstasy está associado com o nível socioeconômico no Município de São Paulo, Brasil, de 2000 a 2007. Nós usamos uma fonte oficial, confiável e imparcial fornecida pelo banco de dados do Departamento de Narcóticos do Estado de São Paulo (Denarc) e o Índice de Desenvolvimento Humano dos distritos (IDHd), onde as apreensões ocorreram. O teste de correlação de Spearman entre o número médio de apreensões de ecstasy por milhão de habitantes e o IDHd foi utilizado. Houve 190 apreensões (totalizando 47.934 comprimidos) distribuídas em 53 dos 96 distritos e 51,6% concentraram-se em apenas 8 distritos. As maiores taxas de apreensão de ecstasy foram diretamente associadas com distritos com alto IDHd, o que confirmou a associação do consumo de ecstasy com o nível socioeconômico. Itaim Bibi, Jardim Paulista e Moema, distritos como os maiores IDHd, foram os três primeiros colocados. Nesses distritos, o número de comprimidos por apreensão variou de poucas unidades a milhares, revelando que não somente o consumo como também o tráfico coexiste no mesmo local. Distritos com muitas casas noturnas também podem influenciar a incidência de apreensão. Esse conhecimento pode ser útil no auxílio à polícia de outras cidades brasileiras no combate ao tráfico de ecstasy.

Implicaciones mttabólicas y clínicas de algunas drogas de diseño / Metabolic and ciinical implications of some designe ddrugs

Antecedentes: Las drogas de diseño del tipo anfetamina, o de benzil y fenil piperazina, o del tipo pirrolidinfenona, producen sentimientos de euforia, energía y deseos de socializar, por eso son conocidas como rave drugs o drogas de club. A pesar de que los consumidores aducen que son drogas seguras, estudios experimentales en biomodelos y de tipo epidemiológico en humanos, indican riesgos potenciales para quien las usa. Materiales y Métodos: El presente artículo de revisión analiza, cualitativamente, la literatura científica disponible en las bases de datos Science Direct y PUBMED, relacionada con el metabolismo de estas drogas recreacionales y sus implicaciones en salud. Resultados: Se obtuvo información pertinente relacionada con los objetivos propuestos, por lo cual puede clasificarse en 2 secciones a saber: metabolismo de las drogas de diseño e implicaciones clínicas de su consumo. Conclusión: Las vías metabólicas que involucran isoenzimas P450 son responsables de la degradación hepática de las drogas de diseño. Existen riesgos potenciales para quien las consume, entre los que se encuentran el síndrome de serotonina, hepatotoxicidad, neurotoxicidad y psicopatología.

Background: Designer drugs of the amphetamine, benzyl, phenyl piperazine, or pyrrolidinophenone type produce feelings of euphoria and energy and a desire to socialize, reason why they are known as "rave drugs" or "club drugs". Although consumers adduce that these are safe drugs, experimental studies using bio models and epidemiological studies in humans, indicate potential risks for users. Materials and Methods: The review article analyses quantitatively scientific literature from Science Direct and PUBMED data bases related to metabolism of these drugs and their implications in health. Results: Relevant information related to the objectives proposed in the present review was found and it can be classified in 2 sections as follows: metabolism of designer drugs and clinical implications of consumption of designer drugs. Conclusion: The metabolic pathways which involve P450 isoenzymes are responsible for hepatic degradation of designer drugs. There are potential risks for consumers such as serotonin syndrome, hepatotoxicity, neurotoxicity, and psychopathology.

Club drugs: review of the ‘rave’ with a note of concern for the Indian scenario.

'Club drugs’ which include Ecstasy, gamma-hydroxybutyrate (GHB), ketamine, and Rohypnol (flunitrazepam) have become popular with participants in ‘raves’, because they are perceived to enhance energy, endurance, sociability and sexual arousal. These drugs vary in their pharmacologic properties, physiological and psychological effects, and potential consequences. The use of club drugs by young people has increased in the last decade, and continue to get modified and evolve, making them very difficult to monitor. Further, these drugs are not picked up by routine drugs screening procedures, thereby making these popular with the criminals. India, which is in a phase of social transition, also faces this rising menace. Despite the nature and extent of this problem, this area has been under-researched. Data from India are sparse barring a few newspaper and police reports. Keeping abreast of current trends in club drug use prepares the clinician to recognize the clinical effects of club drug use, to manage club drug related emergencies, and to generate social awareness.

Differential behavioral outcomes of 3,4-methylenedioxymethamphetamine (MDMA-ecstasy) in anxiety-like responses in mice

Anxiolytic and anxiogenic-like behavioral outcomes have been reported for methylenedioxymethamphetamine (MDMA or ecstasy) in rodents. In the present experiment, we attempted to identify behavioral, hormonal and neurochemical outcomes of MDMA treatment to clarify its effects on anxiety-related responses in 2-month-old Balb/c male mice (25-35 g; N = 7-10 mice/group). The behavioral tests used were open field, elevated plus maze, hole board, and defensive behavior against predator odor. Moreover, we also determined striatal dopamine and dopamine turnover, and serum corticosterone levels. MDMA was injected ip at 0.2, 1.0, 5.0, 8.0, 10, or 20 mg/kg. MDMA at 10 mg/kg induced the following significant (P < 0.05) effects: a) a dose-dependent increase in the distance traveled and in the time spent moving in the open field; b) decreased exploratory activity in the hole board as measured by number of head dips and time spent in head dipping; c) increased number of open arm entries and increased time spent in open arm exploration in the elevated plus maze; d) increased time spent away from an aversive stimulus and decreased number of risk assessments in an aversive odor chamber; e) increased serum corticosterone levels, and f) increased striatal dopamine level and turnover. Taken together, these data suggest an anxiogenic-like effect of acute MDMA treatment, despite the fact that behavioral anxiety expression was impaired in some of the behavioral tests used as a consequence of the motor stimulating effects of MDMA.

Uso y abuso de drogas durante el embarazo / Illicit drug use and abuse during pregnancy

El consumo y dependencia de sustancias, es un serio problema social con alta morbilidad materno-fetal. El aumento de la oferta y el contexto social favorecedor, permitió que la difusión del consumo sustancias tóxicas ilícitas, conlleve una incidencia creciente en gestantes consumidoras de sustancias y aumento de recién nacidos afectados por las prácticas tóxicas de sus madres. La evaluación del riesgo cuando la gestación es expuesta a las drogas es difícil, los resultados pueden estar sesgados por el consumo concomitante de otros tóxicos o por factores sicológicos y socio-sanitarios desfavorables. Aunque tampoco se definió un patrón específico de anomalías congénitas, se considera que el abuso de drogas, en general, comporta mayor riego de desenlace anómalo del embarazo, por un incremento del riesgo de malformaciones congénitas, debido a la probable teratogenicidad de algunas sustancias o de la morbilidad perinatal afectando el crecimiento fetal o el normal desarrollo del embarazo. También existen posibles repercusiones a largo plazo en la capacidad de aprendizaje y comportamiento de los niños expuestos intraútero, aunque no demostró efectivamente. Por lo tanto, todo embarazo en el que se detecto un hábito tóxico se debe considerar de mayor riesgo, tomando las medidas oportunas para lograr que las pacientes se alejen de éstas prácticas, apoyadas por un equipo multidisciplinario, idealmente antes del inicio del embarazo, lo que implica la adopción de medidas profilácticas de información y concienciación de las mujeres en edad fértil y de apoyo durante el embarazo y la lactancia para el abandono de la dependencia

Illicit drug use and dependence is a serious social problem with high maternal and fetal morbidity. Supply increase and propitious social context allowed that the diffusion of the use of illicit toxic substances entails a growing incidence in pregnant women who use illicit drugs and an increase of newborns affected by the practices of their mothers. Risk evaluation is difficult when gestation is exposed to illicit drugs because the results could be biased by the concomitant consumption of others toxic substances or by psychological and socio-sanitary unfavorable factors. Though a specific pattern of congenital anomalies has not been defined, in general it is considered that drug abuse has an increased risk of anomalous outcomes in pregnancies. This risk is caused by an increase in the risk of congenital malformations due to the probable teratogenicity of some substances or the perinatal morbility affecting the fetal growth or normal pregnancy development. Although it has not been demonstrated effectively, there are also possible long-term repercussions in the learning capacity and behavior of the children exposed intra uterus. In conclusion, all pregnancies exposed to illicit drugs must be considered high risk pregnancies and measures should be taken so that the patients avoid these practices supported by a multidisciplinary team. Ideally, this team should start working before pregnancy implying the adoption of preventive measures such as information and public awareness of women in fertile age and support during pregnancy and maternal lactation

Análises físicas e químicas de comprimidos de ecstasy apreendidos no município de São Paulo / Physical and chemical analyses of ecstasy tablets seized in São Paulo city

Drug profiling, isto é, a caracterização de amostras de drogas apreendidas no sentido de estabelecer conexões entre apreensões realizadas em diferentes épocas e/ou locais a uma origem comum de produção clandestina, tem sido um objetivo dos órgãos governamentais responsáveis pela prevenção/repressão. Especificamente tratando-se de comprimidos de ecstasy, o conhecimento de suas propriedades físicas e químicas é de relevante importância para discriminar a apreensão de diferentes lotes. Nesse contexto, o presente trabalho propõe uma nova abordagem para estabelecer conexões entre apreensões de comprimidos de ecstasy, por meio da calorimetria exploratória diferencial (DSC), termogravimetria (TG) e difratometria de raios-X (DRX). Também foi realizada a caracterização física de todos os comprimidos (logotipo, coloração, massa, diâmetro e espessura), bem como a identificação/quantificação dos constituintes ativos por cromatografia em fase gasosa acoplada à espectrometria de massas (GC-MS) e o perfil de dissolução in vitro. Além disso, foi desenvolvido um método empregando a extração líquido-líquido para o isolamento da 3,4-metilenodioximetanfetamina (MDMA) dos comprimidos de ecstasy, que posteriormente foi cristalizada para cloridrato de MDMA (MDMA.HCl). Foram analisados dezessete diferentes lotes de comprimidos de ecstasy de diversos logotipos e colorações apreendidos no município de São Paulo, Brasil. Apenas um lote apresentou como única substância ativa a clorofenilpiperazina (CPP). Os outros continham apenas MDMA e o conteúdo de MDMA variou de 29 a 115-mg/comprimido. Os valores de massa dos comprimidos variaram de 143 a 341-mg, a espessura de 3,2 a 5,8-mm e o diâmetro de 7,0 a 9,5-mm. A comparação das curvas obtidas, tanto por calorimetria exploratória diferencial (DSC) como pelos difratogramas de raios-X (DRX), permitiu discriminar aqueles com perfis semelhantes, importante para identificar a origem de produção. O baixo grau de cristalinidade do MDMA.HCl de alguns comprimidos de ecstasy não impediu a caracterização por DSC e DRX. Esses resultados podem ser úteis para a aplicação no trabalho de inteligência forense

Drug profiling or the characterization of seized drug samples to link seizures made at different times and/or locations to their common clandestine origin, has long been a goal of law enforcement agencies. Considering the trafficking of ecstasy tablets, the knowledge of chemical and physical properties is of utmost importance to discriminate between different seizures. In this context this study proposed a new approach to establish links among seizures of ecstasy tablets by using differential scanning calorimetry (DSC), thermogravimetry (TG) and X-ray diffraction (XRD). Besides this characterization, physical appearance (logotype, color, weight, diameter and thickness), identification/quantification of active constituents by gas chromatography/ mass spectrometry (GC/MS) and in vitro drug dissolution assays were performed too. A method employing liquid-liquid extraction was also developed for the isolation of 3,4-methylenedioxymethamphetamine (MDMA) from ecstasy tablets and afterwards MDMA was crystallized to MDMA hydrochloride (MDMA.HCl). Seventeen different lots of various logotypes and colors of confiscated ecstasy tablets from seizures in São Paulo city, Brazil, were analyzed. Chlorophenylpiperazine (CPP) was found only as an active ingredient in one batch. The others tablets contained only MDMA and the content of MDMA varied from 29 to 115-mg/tablet. The weight values of tablets varied from 143 to 341-mg, the thickness from 3,2 to 5,8-mm and the diameter from 7,0 to 9,5-mm. DSC/TG curves and X-ray difratograms of the ecstasy tablets allowed distinguishing those with similar profile, for both techniques, which is important to identify the source of production. The low degree of MDMA.HCl crystallinity of some ecstasy tablets didnt prevent DSC and XRD characterization. These results can be useful for forensic intelligence work application

Êxtase (MDMA): efeitos farmacológicos e tóxicos, mecanismo de ação e abordagem clínica / Ecstasy (MDMA): pharmacological and toxic effects, mechanism of action and clinical management

CONTEXTO: O 3,4-metilenodioximetanfetamina (MDMA, êxtase) é um derivado da anfetamina, cujo consumo por jovens tem aumentado. OBJETIVOS: Conduzir uma revisão de literatura sobre os aspectos farmacológicos e fisiopatológicos do MDMA, incluindo o mecanismo de ação que possa explicar os efeitos neurotóxicos e a toxicidade aguda e a longo prazo. MÉTODOS: Revisão da literatura usando as palavras-chave: 3,4-methylenedioxymethamphetamine, ecstasy, neurotoxicity, intoxication, drug abuse, por intermédio do MEDLINE e LILACS. A busca incluiu todos os artigos publicados no período entre 1985 e 2007. RESULTADOS: Ainda existem muitas questões sem respostas sobre a farmacologia do êxtase e a fisiopatologia dos efeitos tóxicos dessa substância. A simples descrição do mecanismo de ação é insuficiente para explicar todos os efeitos induzidos pelo êxtase. O mecanismo exato responsável por mediar os efeitos tóxicos do MDMA sobre os neurônios da serotonina precisa ser elucidado. CONCLUSÕES: Existem poucas informações na literatura sobre a farmacologia e o mecanismo de ação do MDMA que possam explicar os efeitos neurotóxicos e outros efeitos fisiopatológicos. São necessários mais estudos para que o profissional de saúde possa obter informações e conhecimentos a fim de combater os efeitos terríveis do êxtase na população jovem vulnerável.

BACKGROUND: The consumption of the amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) by young people increased in the past years. OBJECTIVES: To conduct a literature review on the pharmacology of MDMA and particularly with respect to the putative mechanism of action implicated in the acute and long-term toxicity and neurotoxic effects. METHODS: A literature review using the key words: 3,4-methylenedioxymethamphetamine, ecstasy, neurotoxicity, intoxication, abuse drugs was performed in the databases MEDLINE and LILACS. The search covered all articles published between 1985 and 2007. RESULTS: There were still many unanswered questions regarding the pharmacology of ecstasy and the pathophysiology of its toxic effects. The fundamental mechanism of action is insufficient to explain all effects induced by the drug. The exact mechanism responsible for mediating the toxic effects of MDMA on 5-HT neurons remain to be elucidated. DISCUSSION: There is limited information in published literature about the underlying pharmacology and mechanism of action that could account for the neurotoxic and other phathophysiological effect of MDMA.

Uso y abuso de drogas durante el embarazo: [revisión] / Illicit drug use and abuse during pregnancy: [review]

El consumo y dependencia de sustancias, es un serio problema social con alta morbilidad materno-fetal. El aumento de la oferta y el contexto social favorecedor, permitió que la difusión del consumo sustancias tóxicas ilícitas, conlleve una incidencia creciente en gestantes consumidoras de sustancias y aumento de recién nacidos afectados por las prácticas tóxicas de sus madres. La evaluación del riesgo cuando la gestación es expuesta a las drogas es difícil, los resultados pueden estar sesgados por el consumo concomitante de otros tóxicos o por factores sociológicos y socio-sanitarios desfavorables. Aunque tampoco se definió un patrón específico de anomalías congénitas, se considera que el abuso de drogas, en general, comporta mayor riego de desenlace anómalo del embarazo, por un incremento del riesgo de malformaciones congénitas, debido a la probable teratogenicidad de algunas sustancias o de la morbilidad perinatal afectando el crecimiento fetal o el normal desarrollo del embarazo. También existen posibles repercusiones a largo plazo en la capacidad de aprendizaje y comportamiento delos niños expuestos intraútero, aunque no demostró efectivamente. Por lo tanto, todo embarazo en el que se detecto un hábito tóxico se debe considerar de mayor riesgo, tomando las medidas oportunas para lograr que las pacientes se alejen de éstas prácticas, apoyadas por un equipo multidisciplinario, idealmente antes del inicio del embarazo, lo que implica la adopción de medidas profilácticas de información y concienciación de las mujeres en edad fértil y de apoyo durante el embarazo y la lactancia para el abandono de la dependencia.

Illicit drug use and dependence is a serious social problem with high maternal and fetal morbidity. Supply increase and propitious social context allowed that the diffusion of theuse of illicit toxic substances entails a growing incidence in pregnant women who use illicit drugs and an increase of newborns affected by the practices of their mothers. Risk evaluation is difficult when gestation is exposed to illicit drugs because the results could be biased by the concomitant consumption of others toxic substances or by psychological and socio-sanitary unfavorable factors. Though a specific pattern of congenital anomalies has not been defined, in general it is considered that drug abuse has an increased risk ofanomalous outcomes in pregnancies. This risk is caused by an increase in the risk of congenital malformations due to the probable teratogenicity of some substances or the perinatal morbility affecting the fetal growth or normal pregnancy development. Although it has not been demonstrated effectively, there are also possible long-term repercussions in the learning capacity and behavior of the children exposed intra uterus. In conclusion, all pregnancies exposed to illicit drugs must be considered high risk pregnancies and measures should be taken so that the patients avoid these practices supported by a multidisciplinary team. Ideally, this team should start working before pregnancy implying the adoption of preventive measures such as information and public awareness of women in fertile age and support during pregnancy and maternal lactation.

Desenvolvimento e validação de um método cromatográfico em fase gasosa para análise da 3,4-metilenodioximetanfetamina (ecstasy) e outros derivados anfetamínicos em comprimidos / Development and validation of a gas chromatography method for determination of ecstasy and amphetamines derivatives in tablets

O uso abusivo das anfetaminas e seus derivados vêm aumentando dramaticamente nos últimos anos em diversas regiões do mundo, notando-se especial utilização do Ecstasy. A análise de amostras da droga apreendidas nas ruas evidenciou, além da presença de MDMA (3,4-metilenodioximetanfetamina), componente principal da droga, outras feniletilaminas, como a MDA (3,4-metilenodioxanfetamina) e MDEA (metilenodioximetiletilanfetamina) este último também conhecido como a droga Eve, ainda pouco difundida no Brasil. O objetivo do presente trabalho foi desenvolver e validar um método analítico confiável, prático e acessível aos laboratórios de toxicologia, de médio e pequeno porte, no Brasil e em países em desenvolvimento, para identificação separada do MDMA, MDA e MDEA. A cromatografia em fase gasosa utilizando-se coluna capilar e detector de ionização de chama foi a técnica escolhida. O método analítico apresentou para os três analitos de interesse, faixa ampla de linearidade (1,0 a 500,0 μg/mL); limites de quantificação de 1,0 μg/mL e coeficientes de variação intra e interensaio inferiores a 9,5 por cento. Os limites de detecção estabelecidos foram 0,7 μg/mL, 0,8 μg/mL e 0,6 μg/mL, respectivamente para o MDMA, MDA e MDEA. O método foi seletivo na presença de epinefrina, cocaína, anfetamina, ácido acetilsalisílico, metanfetamina, ácido dietilbarbitúrico, p-aminobenzoil dietilbarbitúrico, paracetamol e cafeína.

The abusive use of the amphetamine derivative ecsyasy in the world come increasing in the last years. Many tablets samples kept on the streets shown the presence not only of the MDMA- 3,4-methylenedioxymethamphetamine, the main drug component but also of the MDA - 3,4- methylenedioxyamphetamine and MDEA - 3,4-methylenedioxymethylethylamphetamine. The present study sought to develop and validate an analytical method for determination of MDMA, MDA and MDEA in tablets to be accessible for the most small or medium laboratories of toxicology of the development countries as Brazil. It was chosen for development and validation a gas chromatography method with flame ionization detection. The analytic validation results for MDMA, MDA and MDEA were linearity range of 1.0 to 500.0 μg/mL, intra and interassay coefficient of variation lower than 9.5 percent and quantification limit of 1.0 μg/mL. The detection limits were 0.7 μg/mL, 0.8 μg/mL and 0.6 μg/mL respectively to MDMA, MDA and MDEA. The method showed a good seletivity as the epinephrine, cocaine, amphetamine, methamphetamine, acethyl salicilic acid, diethyl barbituric acid, p-aminobenzoyl diethyl barbituric, paracetamol and caffeine presences did not interfere with the measurement of the three analytes.

Erotismo e religião: um diálogo instigante / Erotism and Religion: an instigative dialogue / Erotismo e religión: un diálogo instigador

A partir de uma experiência pessoal, de profundo impacto emocional, evocada pela escultura Êxtase de Santa Teresa, de Gian Lorenzo Bernini, desenvolvo algumas idéias sobre as relações entre erotismo e experiência religiosa. Destaco a íntima conexão entre erotismo e religião na arte do período barroco, bem como a escassez de textos psicanalíticos enfocando essa relação. Teço algumas considerações sobre a relação entre psicanálise, religião e erotismo, a partir das idéias de Freud.

For a personal experience of profound emotional impact evoked frm Gian Lorenzo Bernini’s Saint Thereza Ecstasy some ideas about the relationship between erotism and religion have been developed. The intimate connection between erotism and religion in the art during the baroque period, as well as, the lack of psychoanalytic texts showing that relationship, is emphasized. Some ideas about the relationship between psychoanalysis, religion and erotism are discussed.

Partiendo de una experiencia personal, de profundo impacto emocional, evocada por Lo éxtasis de Santa Teresa de Gian Lorenzo Bernini, desenvuelvo algunas ideas sobre las relaciones entre erotismo e experiencia. religiosa. Destaco la profunda conexión entre erotismo e religión en la arte del período barroco, bien como la escasez de textos psicoanalíticos enfocando tal relación. Desenvuelvo algunas consideraciones acerca de la relación entre psicoanálisis, religión e erotismo, a partir de las ideas de Freud.

Ecstasy – is very dangerous

Ecstasy has been registered in 1914 as an anti-tired medicament for military use. From the year 1980, Ecstasy becomes an excitant using in amusing with the name of “shaking drug”, “Rabid drug”. After consumption, users become cheery, infatuated, vigilant, untiring, loosing of the feel of hunger, fond of groping for and embracing, drinking alcohol and beer, dancing in all night. In the state of passionately fond the user can kill and rape. After a stage of exciting, the user can get severe and long weakening, get psychologic disturbance, get acute hepatitis. The harmfulness of ecstasy can be continuously listed