In Malaysia, the recent increasing trend in the use of Ecstasy has been so alarming, particularly amongst young adults from well-to-do backgrounds and also teenagers. This unhealthy phenomenon has caught the attention of our whole nation and demanded urgent efforts from the relevant authorities, as well as non-government organisations to combat this social ill.

In Sabah, intravenous drug abuse has always been less prevalent than West Malaysia. However, with regards to amphetamines, we are no exception on this side of the South China Sea. During the first eight months this year, the National Narcotic Agency Sabah Branch reported that a total of 760 cases involving the use of Ecstasy pills in the state. Our Capital Kota Kinabalu recorded 422 cases, more than 50% of the total, followed by Tawau (105) and Lahad Datu (41). Apart from Ecstasy, Sabah also faces a significant problem from street methamphetamine, popularly known as Syabu, which are apparently cheaper and hence popular amongst the poorer sector of the community, including the illegal immigrants.

It is urgent that we, the medical profession, participate actively in the ongoing anti-drug campaign. Hence, it is timely for us to learn about these drugs.

Amphetamine abuse is by no means a new kid on the block. In USA and Western Europe, it has emerged since the 1980s, teenagers and young adults who enjoy all-night dance parties known as "raves" are encountering more than just music. Its use escalated in the 90's. Dangerous substances known collectively as "club drugs"- including Ecstasy, GHB, and Rohypnol, ketamine, LSD- are gaining popularity.

Although users may think these substances are harmless, research has shown that club drugs can produce a range of effects, including hallucinations, paranoia, amnesia, and, in some cases, death. When used with alcohol, these drugs can be even more harmful, can dangerously boost the effects of both substances. Also, there are great differences among individuals in how they react to these substances and no one can predict how he or she will react. Fatal reactions in first time users have been reported. And studies suggest club drugs found in party settings are often adulterated or impure and thus even more dangerous.

Because some club drugs are colourless, tasteless, and odourless, they are easy for people to slip into drinks. Some of these drugs have been associated with sexual assaults, and for that reason they are referred to as "date rape drugs."

Today, I shall limit the discussion to Ecstasy (MDMA) and Syabu (Methamphetamine).

Ecstasy - MDMA (3,4-methylenedioxymethamphetamine)

Street names: In chinese lingo, "yau tou wan," or "yau tiu yen," which means "head-shaking pill." Also "XTC," "clarity," "essence," "Adam."

Its origin dates back to the early 1900s when MDMA was synthesized, developed and patented in Germany by the pharmaceutical company Merck. It was not developed with any specific purpose in mind, but came about as a by-product in routine drug development process. The drug remained 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 drugs".

Most often in tablet form and usually ingested orally. Also available as a powder and sometimes snorted and smoked but rarely injected.

Chemical structure similar to methamphetamine and mescaline and can produce both stimulant and psychedelic effects. It stimulates the release of serotonin from brain, producing a "high" that lasts from several minutes to an hour. It damages brain serotonin neurons. Serotonin is thought to play a role in regulating mood, memory, sleep, and appetite. Recent research indicates heavy MDMA use causes persistent memory problems in humans.

MDMA users may encounter problems similar to those of amphetamine and cocaine users, including addiction.

The drug's effects vary with the individual taking it, the dose and purity, and the environment in which it is taken. MDMA can produce stimulant effects such as an enhanced sense of pleasure and self-confidence and increased energy. Its psychedelic effects include feelings of peacefulness, acceptance, and empathy. Users claim they experience feelings of closeness with others and a desire to touch them.

Psychological effects can include confusion, depression, sleep problems, anxiety, and paranoia during, and sometimes weeks after, taking the drug.

Physical effects can include muscle tension, involuntary teeth-clenching, nausea, blurred vision, faintness, and chills or sweating. Tachycardia and hypertension are special risk for people with circulatory or heart disease.

MDMA-related fatalities at raves have been reported. The stimulant effects of the drug, which enable the user to dance for extended periods, combined with the hot, crowded conditions usually found at raves can lead to dehydration, hyperthermia, and heart or kidney failure. Ecstasy has also caused acute liver failure.

Syabu - Methamphetamine

Street name: In local, perhaps Filipino lingo, "Syabu"; In chinese lingo, "bing du," which means "ice poison" Also "Speed," "Ice," "Chalk," "Meth" "crystal," "crank," and "glass."

Often made in clandestine home laboratories, from inexpensive ingredients including over-counter medicines. These factors combine to make it a drug with high potential for widespread abuse.

It is a powerfully addictive stimulant. The drug was developed early in this century from its parent drug, amphetamine, and was used originally in nasal decongestants and bronchial inhalers. Its chemical structure is similar to amphetamine, but has more pronounced effects on the central nervous system. In the 1980's, "ice," a smokable form came into use. Ice is smoked in a glass pipe like crack cocaine. The smoke is odorless, leaves a residue that can be resmoked, and produces effects that may continue for 12 hours or more.

It is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol. It comes in many forms and can be smoked, snorted, ingested, or injected. The drug alters moods in different ways, depending on how it is taken.

Immediately after smoking the drug or injecting it intravenously, the user experiences an intense rush or "flash" that lasts only a few minutes and is described as extremely pleasurable. Snorting or oral ingestion produces euphoria -- a high but not an intense rush. Snorting produces effects within 3 to 5 minutes, and oral ingestion produces effects within 15 to 20 minutes.

It is often used in a "binge and crash" pattern. Because tolerance occurs within minutes - meaning that the pleasurable effects disappear even before the drug concentration in the blood falls significantly - users try to maintain the high by binging on the drug. In some cases, abusers forego food and sleep while indulging in a form of binging known as a "run," injecting as much as a gram of the drug every 2-3 hours over several days until the user runs out of the drug or is too disorganized to continue. Chronic abuse can lead to psychotic behavior, characterized by intense paranoia, visual and auditory hallucinations, and out-of-control rages that can be coupled with extremely violent behavior.

Its effects can last 6 to 8 hours. After the initial "rush," causes increased activity, decreased appetite, and a general sense of well-being. There is typically a state of high agitation that in some individuals can lead to violent behavior. There are a few accepted medical reasons for its use, such as the treatment of narcolepsy.

It has toxic effects. In animals, a single high dose of the drug has been shown to damage nerve terminals in the dopamine-containing regions of the brain. High doses can elevate body temperature to dangerous, sometimes lethal, levels, as well as cause convulsions.

Long-term abuse results in many damaging effects, including addiction. Addiction is a chronic, relapsing disease, characterized by compulsive drug-seeking and drug use which is accompanied by functional and molecular changes in the brain. Chronic abusers exhibit symptoms that include violent behavior, anxiety, confusion, and insomnia. They also display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects creeping on the skin, called "formication"). The paranoia can result in homicidal as well as suicidal thoughts.

Tolerance for methamphetamine can develop. In an effort to intensify the desired effects, users may take higher doses of the drug, take it more frequently, or change their method of drug intake.

Although there are no physical manifestations of a withdrawal syndrome when methamphetamine is stopped, there are symptoms that include depression, anxiety, fatigue, paranoia, aggression, and an intense craving for the drug.

Concern has arisen over its toxic effects on the brain. Researchers have reported that as much as 50 percent of the dopamine-producing cells in the brain can be damaged after prolonged exposure to relatively low levels of methamphetamine. Researchers also have found that serotonin-containing nerve cells may be damaged even more extensively.

It can cause a variety of cardiovascular problems. These include tachycardia, arrhythmias, hypertension, and stroke. Hyperthermia and convulsions occur with overdoses, and if not treated immediately, can result in death.

Chronic abuse who inject the drug, can result in thrombophlebitis, skin abscesses, and endocarditis. Heavy users also show progressive social and occupational deterioration. Psychotic symptoms can sometimes persist for months or years after use has ceased.

Acute lead poisoning is another potential risk for methamphetamine abusers. A common method of illegal methamphetamine production uses lead acetate as a reagent. Production errors may result in contamination with lead. There have been documented cases of acute lead poisoning in intravenous abusers.

Fetal exposure also is a significant problem in the United States. At present, research indicates abuse during pregnancy may result in prenatal complications, increased rates of premature delivery, and altered neonatal behavioral patterns, such as abnormal reflexes and extreme irritability. Abuse during pregnancy may be linked also to congenital deformities.

Increased HIV and hepatitis B and C transmissions are likely consequences of increased methamphetamine abuse, particularly in individuals who inject the drug and share injection equipment. Infection with HIV and other infectious diseases is spread among injection drug users primarily through the reuse of contaminated syringes, needles, or other paraphernalia by more than one person. Research also indicates that methamphetamine and related stimulants can increase the libido in users, in contrast to opiates which actually decrease the libido. However, long-term methamphetamine use may be associated with decreased sexual functioning, at least in men. Additionally, methamphetamine seems to be associated with rougher sex, which may lead to bleeding and abrasions. The combination of injection and sexual risks may result in HIV becoming a greater problem among methamphetamine abusers than among opiate and other drug abusers, something that already seems to be occurring in USA.

The most effective treatments for methamphetamine addiction are cognitive behavioral interventions. These approaches help modify the patient's thinking, expectancies, and behaviors and to increase skills in coping with various life stressors. Based on experience in USA, recovery support groups also appear to be effective adjuncts to behavioral interventions that can lead to long-term drug-free recovery.

There are currently no particular pharmacological treatments for dependence on amphetamine or amphetamine-like drugs. The current pharmacological approach is borrowed from experience with treatment of cocaine dependence. Unfortunately, this approach has not met with much success since no single agent has proven efficacious in controlled clinical studies. Antidepressant medications are helpful in combating the depressive symptoms frequently seen in methamphetamine users who recently have become abstinent.

As for methamphetamine overdose, hyperthermia and convulsions are common and often fatal complications of such overdoses, emergency room treatment focuses on the immediate physical symptoms. Overdose patients are cooled off in ice baths, and anticonvulsant drugs may be administered also.

Acute intoxication can often be handled by observation in a safe, quiet environment. In cases of extreme excitement or panic, treatment with antianxiety agents such as benzodiazepines has been helpful, and in cases of psychoses, short-term use of neuroleptics has proven successful.

We are now beginning to see signs that Ecstasy 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 is that given our current knowledge about these drugs, they appear to be extremely risky for anyone's health.

Both MDMA (Ecstasy) and methamphetamine (Syabu) are neurotoxic, potentially lethal, addictive, can cause long-lasting, even permanent damage to the brain and impairment of memory and cognitive performance. The citizens of our nation deserve to know what the science is revealing about these drugs.

The end…