Elaboración y validación de un cuestionario para detección del riesgo de reacciones adversas graves por empleo de drogas psicodélicas en terapia / Development and validation of a questionnaire to detect the risk of serious adverse reactions due to the use of psychedelic drug in therapy

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The use of psychedelic drugs for the treatment of some mental disorders is increasing. However, their use is associated to certain risks, being the most important the exacerbation of mental disorders, mainly psychosis or bipolar disorder. While both 3,4-methylenedioxymethamphetamine (MDMA) and psilocybin are on the Phase-III of the process of drug commercialization, there are not enough screening strategies in order to ensure the safety of patients who will receive those treatments. This article presents the development and validation of a test that assesses the risk of developing psychotic or bipolar disorders using two samples of 156 and 510 participants. The Graded Response Model from Item Response Theory was used. The final version of the test, composed by 30 items, shows very satisfactory psychometric indices, allowing its use as a screening tool in experimental or clinical settings

Serotonin syndrome unmasking thyrotoxicosis.

A 26-year-old cachectic man presented with an altered mental status. He was agitated, tremulous, hyperthermic and diaphoretic with largely dilated pupils. Collateral history revealed acute ingestion of 3,4-methylenedioxymethamphetamine on a background of chronic drug abuse. His condition deteriorated requiring sedation and intubation with transfer to the intensive care unit. A diagnosis of serotonin syndrome was made, based on his findings in keeping with the Hunter criteria, and he was treated with supportive management during a resultant and briefly sustained delirium. With gradual resolution of his agitated state, further questioning and blood work a concurrent, and potentially contributory, thyrotoxicosis was revealed. The patient was commenced on treatment for this with urgent outpatient follow-up with both a local otolaryngologist and endocrinologist for consideration of further treatment.

Doping control adverse results prevalence worldwide for 13 consecutive years / Prevalencia de resultados adversos en los controles de dopaje a nivel mundial durante 13 años consecutivos

The presence of adverse results in doping controls is always bad news for the sport, as it reflects the moral and ethical absence of a clean competition. Its prevalence and evolution is important to know and have criteria on the relevance of this event. Method: The results of doping controls from 2003 to 2015 at the global level, offered by the World Anti-Doping Agency on its website, have been revised. Results: The presence of adverse results of the year 2015 as last reference, reached 0.83% in Olympic sports and 2.04% in the non-Olympic ones. It remains a similar level during the last 7 years, tending to decline in the Olympics and increase in the non-Olympics. The groups of predominant substances are, in order, anabolic steroids 50.3%, stimulants 15.4% and maskers 12.5%, being the rest diverse and variable. It should be noted that many treatments with therapeutic authorisation, i.e., beta agonists (3-4%), glucocorticosteroids (6-8%) or central nervous system (3-5%), are shown as adverse results, but are therefore not doping positive and in their case punishable. Similarly, the high number of anabolic positives is the result of fraud, but also the presence of repeated samples in the follow-up study of some athletes. Conclusion: The data serve as a reference to have a more accurate criterion in reference to this field of sport (AU)

La presencia de resultados adversos en los controles de dopaje son siempre una noticia nefasta para el deporte, pues refleja la ausencia moral y ética de una competición limpia. Su prevalencia y evolución es importante para conocer y disponer de criterio sobre la relevancia de este suceso. Método: Se han revisado los resultados de los controles de dopaje del 2003 al 2015 a nivel mundial, ofrecidos por la Agencia Mundial Antidopaje en su web. Se ofrecen, además, los resultados por deportes del 2015. Resultados: La presencia de resultados adversos, tomando de referencia ese año, alcanza un 0,83% de las muestras estudiadas en los deportes olímpicos y un 2,04% en los no olímpicos. Se mantiene un nivel similar en los últimos 7 años, tendiendo a disminuir en los deportes olímpicos y aumentar en los no olímpicos. Los grupos de sustancias predominantes son, por orden, anabolizantes (50,3%), estimulantes (15,4%) y enmascarantes (12,5%), siendo el resto diverso y variable. En el total de resultados debe tenerse en cuenta que muchos tratamientos con autorización terapéutica, por ejemplo para beta-agonistas (3-4%), glucocorticoides (6-8%) o del sistema nervioso central (3-5%), se muestran como resultados adversos, pero no son por tanto dopaje positivo ni en su caso sancionables. De igual manera, el elevado número de positivos en anabolizantes son fruto del fraude pero también de la presencia de muestras repetidas en los seguimientos de estudio de algunos deportistas. Conclusión: Los datos sirven de referencia para disponer de un criterio más certero en referencia a este ámbito del deporte (AU)

A Case of a Spontaneous Self-resolving Retrobulbar Hemorrhage Following 3,4-Methylenedioxy-methamphetamine Use.

This case report discusses the case of a 23-year-old male patient who experienced retrobulbar pain, diplopia, proptosis, and mild lower eyelid bruising after consuming 3,4-methylenedioxy-methamphetamine. The symptoms settled over 10 days and vision returned to normal without intervention. The authors discuss the differential diagnosis relevant to the presenting complaints and propose several mechanisms linking 3,4-methylenedioxy-methamphetamine use to spontaneous nontraumatic intraorbital hematoma.

Effects of stress and MDMA on hippocampal gene expression.

MDMA (3,4-methylenedioxymethamphetamine) is a substituted amphetamine and popular drug of abuse. Its mood-enhancing short-term effects may prompt its consumption under stress. Clinical studies indicate that MDMA treatment may mitigate the symptoms of stress disorders such as posttraumatic stress syndrome (PTSD). On the other hand, repeated administration of MDMA results in persistent deficits in markers of serotonergic (5-HT) nerve terminals that have been viewed as indicative of 5-HT neurotoxicity. Exposure to chronic stress has been shown to augment MDMA-induced 5-HT neurotoxicity. Here, we examine the transcriptional responses in the hippocampus to MDMA treatment of control rats and rats exposed to chronic stress. MDMA altered the expression of genes that regulate unfolded protein binding, protein folding, calmodulin-dependent protein kinase activity, and neuropeptide signaling. In stressed rats, the gene expression profile in response to MDMA was altered to affect sensory processing and responses to tissue damage in nerve sheaths. Subsequent treatment with MDMA also markedly altered the genetic responses to stress such that the stress-induced downregulation of genes related to the circadian rhythm was reversed. The data support the view that MDMA-induced transcriptional responses accompany the persistent effects of this drug on neuronal structure/function. In addition, MDMA treatment alters the stress-induced transcriptional signature.

Estudio morfométrico de las organelas del hepatocito tras la administración de drogas de abuso / Morphometric analysis of the liver cell after administration of different abuse drugs

Se han descrito, diferentes alteraciones producidas por el consumo de las drogas de abuso a nivel de distintos órganos siendo uno de los más relevantes, por las funciones por el desarrolladas, el hígado. Cuantificar estas alteraciones es el objetivo principal marcado en el trabajo. MATERIAL Y MÉTODOS: se realiza un trabajo experimental en el ratón albino con el fin de valorar desde el punto de vista morfométrico las posibles alteraciones que tres drogas de abuso como son la cocaína, el extasis y la heroína , producen a nivel del hígado desde el punto de vista ultraestructural. Se realiza la intoxicación de los animales y se realiza un estudio del hígado, después del procesamiento de las piezas bajo microscopía electrónica de transmisión y valoración morfométrica de las organelas intracelulares. RESULTADOS: el estudio mostró una disminución de la densidad y área mitocondrial con abalonamiento de estas organelas. Incremento del número de lisosomas y de su tamaño también con engrosamiento de las mismas. Diminución muy significativa del retículo endoplásmico y número de ribosomas. También se muestran disminuidas las rosetas de glúcógeno, pero incrementado el tamaño y número de vacuolas grasas. Alteraciones que se muestran en todos los animales intoxicados con las drogas siendo mas relevantes las del grupo de heroína. DISCUSIÓN. Los resultados muestran una grave alteración de las organelas intracelulares hepáticas tanto en el número como en las estructura de las mismas, siendo indicativo de sufrimiento celular y mal funcionamiento del complejo ultraestructural del hepatocito. Estas alteraciones son más relevantes en el grupo intoxicado con heroína y menos en el de extasis y cocaína. Se puede considerar que aunque a las dosis tratadas a los animales no exista una gran destrucción intracelular, si que hay una alteración a nivel de organelas y sobre todo las relacionadas con el aparato energético de la célula o de producción proteica como mitocondrias o ribosomas, apareciendo o incrementándose las de lisis celular como son los lisosomas (AU)

Have been described, various changes caused by the consumption of drugs of abuse at the level of different organs is one of the most relevant, by the developed functions, the liver. Quantifying these changes is the main goal scored at work. MATERIAL AND METHODS: we performed an experimental study in the albino mouse in order to evaluate from the standpoint of possible alterations morphometric three drugs of abuse such as cocaine, ecstasy and heroin, produced in the liver from the ultrastructural view. Poisoning takes animal and a study is made of the liver, after processing of the parts under transmission electron microscopy, and morphometric evaluation of the intracellular organelles. RESULTS: the study showed a decrease in mitochondrial density and area of these organelles ballooning. Increase in number of lysosomes and their size also thickening them. Significant diminution of the endoplasmic reticulum and number of ribosomes. Also shown glycogen rosettes decreased but increased the size and number of fat vacuoles. Alterations shown in all animalsintoxicated with drugs being the most relevant group of heroin. DISCUSSION. The results show a severe disruption of the intracellular organelles liver both the number and the structure thereof, being indicative of cell suffering and malfunctioning complex ultrastructural hepatocyte. These changes are most relevant in the group intoxicated with heroin and less on that of ecstasy and cocaine. Can be considered that although the dose treated animals there is a large intracellular destruction if there is a disturbance at the level of organelles and especially those related to energy device or cell protein production as mitochondria or ribosome, appearing or increasing the cell lysis such as lysosomes (AU)

Estudio morfométrico del hepatocito tras la administración de drogas de abuso / Morphometric evaluation of liver cell after adminstration of abuse drugs

Las drogas ocasionan diferentes alteraciones a nivel de los diversos órganos y aparatos del cuerpo humano. Por sus mecanismos de acción, la mayoría de las drogas tienen una especial implicación a nivel del hígado, considerando su papel metabólico a nivel del organismos. En el presente estudio de base experimental, realizado en el ratón se ha evaluado las posibles acciones de tres drogas de abuso como son la cocaína, el éxtasis y la heroína a nivel del hepatocito. Se han valorado aspectos celulares y del núcleo. Los resultados muestran escasa alteraciones constatadas mediante morfometría a nivel del hepatocito y se centran fundamentalmente a nivel de elementos vasculares del espacio porta con alteraciones a nivel de la pared de los vasos y elementos estructurales de esta formación estructural. Los resultados cuantificados no se pueden considerar muy relevantes y los que han presentado alteraciones pueden en parte interpretarse de acuerdo a la relación con la droga suministrada y de acuerdo a otras alteraciones descritas en la bibliografía (AU)

Drugs cause different alterations in the various organs and systems of the human body. For their mechanisms of action, most drugs are particularly liver involvement level, considering its metabolic role at the level of organisms. In the present study experimental basis, conducted in mice was evaluated three possible actions of drugs of abuse such as cocaine, ecstasy and heroin hepatocyte level. We evaluated the nucleus and cellular aspects. The results show little alterations which are established by morphometry hepatocyte level and focus mainly vascular level space holder elements with alterations in the vessel wall and structural elements of the structural formation. The quantified results can not be considered very important and those who submitted alterations may in part be interpreted according to the relationship with the drug tested and according to other conditions described in the literatura (AU)

Studio ultraetructural de los efectos de las drogas de adicción a nivel del hígado. Estudio experimental / Ultraestructural study of the effects on the liver of the abuse drugs. Experimental study

Los consumidores de drogas de adicción suelen desarrollar alteraciones hepáticas con lesiones a nivel histopatológico. El propósito del presente trabajo es evaluar a nivel ultraestructural, la acción de diferentes drogas de abuso en el hígado del ratón. La lesión hepática, es inducida en el estudio por dosis repetitivas durante 21 días de diferentes drogas como la cocaína, el éxtasis y la heroína en cada grupo de estudio. Se ha realizado un estudio ultraestructural, tras el procesado de las muestras hepáticas tratadas por las diferentes drogas administradas a los animales integrados en los diferentes grupos de estudio. En los resultados se muestran a nivel de las diferentes estructuras y organelas intracelulares los cambios inducidos por la administración de las diferentes drogas. Se intenta correlacionar las alteraciones ultraestructurales con las repercusiones desde el punto de vista fisiopatológico y sus consecuencias clínicas en el humano (AU)

Drugs abusers are frequently found to have abnormal liver function tests and hepatic histology. The aim of the present work was to analyse, at the ultrastructural level, the action of drugs abuse in the liver mice. Liver injury was induced by a repetitive dose of cocaine, ecstasy and heroin in male albino Swiss mice during 21 days. There has been an ultrastructural study, after processing of the liver samples treated by different drugs given to animals integrated into different groups. The results are shown different level of intracellular organelle structures and changes induced by the administration of different drugs. It attempts to correlate ultrastructural changes with repercussions from the physiological point of view and its clinical consequences in humans (AU)

Determination of piperphentonamine and metabolites M1 and M6 in human plasma and urine by LC/MS/MS and its application in a pharmacokinetics study in Chinese healthy volunteers.

Piperphentonamine hydrochloride (PPTA) is a new calcium sensitizer. A liquid chromatography-tandem mass spectrometry (LC/MS/MS) method for determination of piperphentonamine and its metabolites M1 and M6 was developed for the first time and applied to a pharmacokinetics study. Protein precipitation was used for pre-treatment of plasma samples, and solid phase extraction method was used for pre-treatment of urine samples. The chromatographic separation was achieved on a C(18) column using gradient elution in this study: A: 1% acetic acid aqueous solution, and B: acetonitrile. The whole analysis lasted for 10.5min and the gradient flow rate was 0.25mL/min constantly. The detection was performed of a triple quadrupole tandem mass spectrometer by multiple reaction monitoring (MRM) mode via a positive electrospray ionization source. The results were that the m/z ratios of monitored precursor ions and product ions of PPTA, M1 and M6 were 354.0→191.8, 356.0→148.7 and 358.0→148.7, respectively. From the standard curve, the concentration ranges of both PPTA and M1 in blood and urine samples were 0.1-500ng/mL and 0.1-200ng/mL, respectively; the concentration ranges of M6 in blood sample and urine sample were 0.2-500ng/mL and 0.2-200ng/mL, respectively; and the correlation coefficient of standard curve was r>0.99. A total of 31 healthy Chinese subjects participated in the pharmacokinetic study of single bolus intravenous injection of piperphentonamine hydrochloride. They were divided into three dosage groups and given 0.2, 0.4 and 0.6mg/kg of PPTA. After drug administration, concentrations of PPTA, M1 and M6 in human plasma and urine samples were determined to evaluation the pharmacokinetic characteristics of PPTA and its metabolites M1 and M6.

A mechanistic insight into 3,4-methylenedioxymethamphetamine ("ecstasy")-mediated hepatotoxicity.

3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") is a popular drug of abuse among young people with stimulant and hallucinogenic properties. The drug is generally thought to be safe among consumers due to its low-mortality rates. However, MDMA-adverse effects can occur and the risks are not clearly associated to a specific pattern since the consumption quantity seems not to be correlated with the initiation and severity of the injury. MDMA-mediated adverse health effects have been widely studied and can be evoked by multiple factors such as hyperthermia, polydrug abuse (drug-drug interactions), the altered release of neurotransmitters, impairment of mitochondrial function and apoptosis, metabolism and immune responses. Another adverse effect often associated with MDMA is liver toxicity, yet the mechanism of MDMA-induced liver toxicity is not completely understood. A critical starting point appears to be the hepatic metabolism of MDMA by phase I and II enzymes, leading to reactive metabolites. Elucidating the mechanism of hepatic injury mediated by MDMA is of high toxicological and clinical relevance. In this review, an overview of the literature and the latest findings with respect to the mechanism of MDMA-mediated liver toxicity is described.

Acute liver failure following recreational use of psychotropic "head shop" compounds.

The recreational use of the so-called "legal-highs" has been in both the medical and political arena over the last year as a result of the appearance of "head shops" in many towns in Ireland. These shops specialized in selling new psychotropic compounds that circumvented established drug legislation. Little is known about the potentially harmful effects of these substances but case reports suggest a plethora of harmful psychological and physical effects. Our case describes for the first time acute liver failure associated with the ingestion of two of these amphetamine type compounds.

Morbidity involving the hallucinogenic designer amines MDA and 2C-I.

A case is presented of a 39-year-old woman who suffered severe debilitation because of a hemorrhagic stroke in the context of substance abuse. The patient presented to the emergency room with rapidly diminishing mental status, hypertension, and vasoconstriction; her friends provided a history of ingestion of cocaine, 3,4-methylenedioxymethamphetamine (MDMA), and 2C-I, a novel designer amine. A multi-targeted LC-MS/MS method for sympathomimetic amines and related drugs in urine detected and quantified 2C-I and MDA, while ruling out MDMA. The cause of the stroke was determined to be an underlying cerebrovascular abnormality called Moyamoya, secondary to substance abuse. In clinical laboratories, gas chromatography-mass spectrometry or liquid chromatography-tandem mass spectrometry (LC-MS/MS) confirmation of a positive amphetamine immunoassay is usually directed only towards amphetamine, methamphetamine, MDMA and MDA. This report demonstrates the utility of testing for a wider menu of compounds using LC-MS/MS in order to better characterize the prevalence and toxicities of novel amines such as 2C-I.

Review article: amphetamines and related drugs of abuse.

Acute amphetamine toxicity is a relatively common clinical scenario facing the Australasian emergency medicine physician. Rates of use in Australasia are amongst the highest in the world. Clinical effects are a consequence of peripheral and central adrenergic stimulation producing a sympathomimetic toxidrome and a spectrum of central nervous system effects. Assessment aims to detect the myriad of possible complications related to acute amphetamine exposure and to institute interventions to limit associated morbidity and mortality. Meticulous supportive care aided by judicial use of benzodiazepines forms the cornerstone of management. Beta blockers are contraindicated in managing cardiovascular complications. Agitation and hyperthermia must be treated aggressively. Discharge of non-admitted patients from the emergency department should only occur once physiological parameters and mental state have returned to normal. All patients should receive education regarding the dangers of amphetamine use.

The effect of long-term repeated exposure to 3,4-methylenedioxymethamphetamine on cardiovascular and thermoregulatory changes.

RATIONALE: 3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") disrupts thermoregulation in rats and can lead to life-threatening hyperthermia in humans. MDMA administration can also lead to long-term neurotoxicity in animals and possibly humans. OBJECTIVES: The purpose of the current study was to extend previous results on the acute effects of MDMA on behavioral thermoregulation to a repeated dosing regime, simulating regular weekend use of ecstasy, on measures of thermoregulation and heart rate (HR). MATERIALS AND METHODS: Sprague-Dawley rats with telemetry implants were administered 40 micromol/kg MDMA on three consecutive days each week for 1 or 6 weeks before being confined to an elevated ambient temperature (TA) (HOT; 30+/-1 degrees C) or an area at room temperature (ROOM; 21.5+/-1.5 degrees C) for 30 min. After the final drug administration, rats were placed in a thermal gradient for 4 h to allow behavioral thermoregulation. RESULTS: HOT rats showed higher core temperature (TC), HR, and locomotor activity than ROOM rats during confinement to a set TA (P<0.001). HR responses to MDMA over 6 weeks at both TAs progressively decreased with repeated dosing (P<0.05). TC was significantly higher in both 6-week groups compared to the 1-week groups (P<0.05) at the end of time in the gradient. Cortical concentrations of dihydroxyphenylacetic acid (DOPAC; P<0.05) and 5-hydroxyindole acetic acid (5-HIAA; P<0.001) decreased significantly irrespective of TA, while concentrations of dopamine and 5-HT did not change. CONCLUSION: Long-term treatment with MDMA resulted in apparent tolerance to the effects of the drug on HR, dysregulation of TC in thermal gradient, and depletion of cortical DOPAC and 5-HIAA.

Neumomediastino y enfisema cervical tras consumo de “éxtasis” (3, 4 metilendioximetanfetamina) / Pneumomediastinum and cervical emphysema after “ecstasy” (3, 4 methylenedioxymetamphetamine) consumption

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Ecstasy (MDMA, MDA, MDEA, MBDB) consumption, seizures, related offences, prices, dosage levels and deaths in the UK (1994-2003).

In the last decade, a global trend of escalating ecstasy (MDMA, MDA, MDEA, MBDB) use was observed. Mentions on medical death certificates, last year's ecstasy use, number of drug offenders, seizures, prices and dosage levels figures were used for this descriptive and correlational study. Figures (1994-2003) were taken from the UK General Mortality Registers, from the Home Office Statistical Bulletins, from the British Crime Survey and from those reported to both the National Crime Intelligence and Forensic Science Services. A total of 394 ecstasy deaths mentions were here identified from the UK; in 42% of cases ecstasy was the sole drug mentioned. Overall, number of fatalities showed a year-per-year increase and positively correlated with: prevalence of last year's use (p < 0.01); number of offenders (p < 0.01) and number of seizures (p < 0.01) but negatively correlated with ecstasy price (p < 0.05). Price negatively correlated with: prevalence of last year's use (p < 0.001) and number of seizures (p < 0.01); but positively correlated with average MDMA dosage per tablet (p < 0.01). MDA, MDEA and MBDB accounted for a significant proportion of tablets only up to 1997, but not afterwards. Increasing production with a concomitant decrease in ecstasy price may have facilitated an increase in consumption levels and this, in turn, may have determined an increase in number of ecstasy deaths mentions. Only medical death certificates and not coroners' reports at the end of their inquests were here analysed; no data were available in respect of other drugs use and toxicology results.

¿Son reversibles los efectos neurotóxicos de las drogas de síntesis? / Are reversible the neurotoxic effects of synthetic drugs?

La investigación preclínica sobre las drogas de síntesis realizada en animales de laboratorio nos indica que las acciones neurotóxicas pueden ser de dos tipos: a corto y reversibles y a largo plazo e irreversibles. En efecto su consumo se traduce enseguida en un aumento de las concentraciones extracelulares de serotonina y dopamina que parece conllevar una subida de la temperatura corporal, pero este efecto es reversible en un tiempo medio de 6 horas. Sin embargo, una segunda acción aparece entre un día y una semana más tarde, con consecuencias neurotóxicas que afectan sobre todo al sistema serotoninérgico y a las terminaciones finas de las fibras nerviosas de serotonina que proceden de los núcleos del rafe dorsal, puede que sea por un incremento en la oxidación de ciertos procesos celulares en esas neuronas. La suspensión de la administración de esas neuronas. La suspensión de la administración de esas drogas hace que, a lo largo plazo, haya un nuevo crecimiento de las dañadas terminaciones finas, pero un patrón de reinervación distinto al que originalmente había. Es probable que en humanos ocurra un proceso parecido, puesto que esto ocurren en primates no humanos. Tampoco conocemos las consecuencias psicológicas a largo plazo del daño neurotóxico que causan las drogas de síntesis en humanos, incluida, en su caso, una posible reinervación de las terminaciones serotoninérgicas, si se abandona durante un tiempo considerable el consumo. Pero es sabido que la serotonina es un neurotransmisor implicado en numerosos procesos cognitivos y emocionales y puede que sean la causa de las disfunciones psicológicas mantenidas que muestran los que han consumido drogas de síntesis

It is clear from animal studies that substituted amphetamine derivatives have two sort of effects: immediate and reversible, and prolonged and reversible. The immediate effect of substituted amphetamine intake is an increment to extracellular levels of serotonin and dopamine that return to normality in about 6 h. And may produce an augmentation of corporal temperature. However, this reversible effect is followed by other long lasting that usually occurs in the period between 24 h and one week. Inthis case, damage in serotonergic neurons appears, involving reuptake proteins and fine axon terminals, that are persistently lost. The mechanisms that might cause these neurotoxic effects are unknown, but it seems that an increment in cellular oxidative systms may have a role. Animal studies have also shown that an enduring cessation of amphetamine derivatives intake results in a progressive serotonergic re-inervation, but with a pattern that is different from the previously established during the normal development. Although we don´t know if such re-inervation process may develop in human beings, is tempting to speculate that it will occur given that it happens in non-human primates. The behavioural consequences of serotoninergic system damage and the hypothetical re-inervation process in humans are also unknown. However, they might be related to several behavioural malfunctions such as anxiety, depression or memory impairments that former amphetamine derivatives users exhibits in the span of their lives

¿Qué quieren saber los usuarios de éxtasis?: estudio de una lista de correo de Internet / What do ecstasy users want to know? Study based on an internet mailing list

Objetivo: Obtener información acerca de las creencias, actitudes y opiniones que los usuarios de éxtasis (3,4-metilendioximetanfetamina o MDMA) tienen sobre esta droga. Material y métodos: Entre el 7 de Agosto y el 6 de Diciembre de 2003 se revisaron los 15.117 mensajes de correo electrónico enviados a una lista de correo de Internet en castellano sobre reducción de riesgos en el consumo de drogas. Se clasificaron y analizaron 681 preguntas relacionadas con el éxtasis y la salud. Resultados y conclusiones: Los mensajes con preguntas sobre las diferentes presentaciones de la MDMA constituyeron la categoría más frecuente (n=171; 25.11%). Además se encontró una gran cantidad y variedad de preguntas en relación con distintos aspectos como combinaciones con fármacos (n=162; 23.9%), efectos adversos (n=98; 14.39%), combinaciones con drogas (n=69; 10.13%) o toxicidad (n=61; 8.96%) entre otros. Algunos de los resultados obtenidos son congruentes con los de estudios previos. La repetición de determinadas cuestiones que no han sido descritas previamente en la literatura científica (posología, fármacos con efecto neuroprotector, efectos de pastillas concretas…) sugiere que foros como el estudiado pueden constituir una importante fuente de información sobre el patrón de consumo de nuevas drogas así como una herramienta preventiva complementaria

Objective: To obtain information on beliefs, attitudes and opinions that ecstasy (3,4-3,4-methylenedioxymethamphetam ine or MDMA) users have about this drug. Material and methods: 15,117 e-mails sent to a Spanish Internet mailing list dealing with risk reduction in drug use were checked between 6 August and 7 December 2003. 681 questions related to ecstasy and health were classified and analyzed. Results and conclusions: e-mails containing questions about the different presentation of MDMA were the most commonly found (n=171; 25.11%). In addition, there was a large number and variety of questions related to other aspects such as its combination with prescription drugs (n=162; 23.9%), adverse effects (n=98; 14.39%), combination with illegal drugs (n=69;10.13%) or toxicity (n=61; 8.96%). Some of the results that were obtained are consistent with those from previous studies. The repetition of specific questions, not previously described in scientific bibliography (dosage, neuroprotective drugs, effects of specific pills …), suggests that mailing lists like the one reviewed here can become an important source of information about drug use habits, as well as a complementary preventive tool