March 31-April 2, 2000
Visegrád, Hungary
Executive Summary
During the March 31 to April 2, 2000, scientific meeting in Visegrád, Hungary, 45 drug abuse researchers from 9 Eastern European nations, the United Nations International Drug Control Programme (UNDCP), and the United States exchanged information about the growing abuse of methamphetamine and MDMA (Ecstasy) by young people and the potential for research cooperation in this area. The United States - Eastern Europe Regional Meeting on Methamphetamine and Ecstasy Research was cosponsored by NIDA and the Hungarian Ministry of Youth and Sports, with scientific organizing assistance from Semmelweis University, Budapest, and the Biological Research Centre of the Hungarian Academy of Sciences, Szeged. Meeting participants discussed scientific data about these drugs, sharing knowledge about how the drugs act on the brain, how the drugs produce their behavioral effects, and strategies for prevention and treatment.
Deputy State Secretary Ákos Topolánszky, Hungarian Ministry of Youth and Sports; Dr. Gyula Telegdy, President, Hungarian Academy of Sciences Medical Section; and NIDA Director Dr. Alan I. Leshner spoke at the welcoming session. The meeting was planned by an international organizing committee cochaired by Dr. Anna Borsodi, Hungarian Academy of Sciences; Dr. Tibor Wenger, Semmelweis University; and Dr. M. Patricia Needle, International Program Director, NIDA Office of Science Policy and Communications. In addition to Drs. Leshner and Needle, the U.S. delegation included Dr. Marianna K. Baum, University of Miami; Dr. Patricia Case, Harvard University; Dr. Richard Rawson, University of California, Los Angeles; Dr. George A. Ricaurte, The Johns Hopkins University; and Dr. Claire Sterk, Emory University.
Opening the scientific sessions, Rector Péter Sótonyi, Semmelweis University, called the scientific meeting a very important means of exchanging information about the social, medical, and legal consequences of drug abuse. Dr. Leshner updated participants on the December 1999 decision to substantially increase NIDA support for research into methamphetamine, MDMA (Ecstasy), and related drugs, focusing on the mechanisms of action, consequences of abuse, and development of effective prevention programs and treatment medications. Dr. Kálmán Szendrey, formerly of UNDCP and now with the University of Szeged, Hungary, used UNDCP data to report on international developments in methamphetamine abuse, focusing on the drug's rapidly changing chemical composition and geographic distribution. Dr. Needle and Dr. Alexandra Sulcová, Masaryk University, cochaired the session.
Dr. Borsodi; Dr. Telegdy; Dr. Philip Lazarov, Bulgarian National Centre for Addictions; and Dr. Piotr Popik, Polish Academy of Sciences, chaired scientific sessions on the pharmacology of stimulants. Dr. Susanna Fürst, Semmelweis University, described the actions of amphetamine and related psychomotor stimulants that release monoamines from nerve terminals in the brain, particularly the noradrenaline and dopamine neurotransmitters. Dr. Sulcová presented studies of intravenous self-administration of methamphetamine by rats that indicate that both the serotonergic (5-HT) and cannabinoid receptor systems appear to play a role in the mechanism of action of methamphetamine. Dr. Sulcová also reported on studies that employed chemiluminescence to measure metabolic activation of leukocyte phagocytic activity in mice treated with saline, methamphetamine, fluoxetine, or a combination of methamphetamine and fluoxetine. Dr. Malgorzata Filip, Polish Academy of Sciences, described research that indicated 5-HT1B receptors are not involved in the locomotor, sensitization, and discriminative stimulus effects of cocaine in rats, but that pharmacological stimulation of these receptors counteracts the overall effects of cocaine. Dr. Julia Timár, Semmelweis University, presented the results of an investigation of short- and long-term behavioral consequences of methamphetamine- or MDMA (Ecstasy)-induced neurotoxicity. Dr. Popik discussed studies suggesting that the metabotropic group II glutamate receptors were involved in the development of antinociceptive morphine tolerance. Dr. Ryszard Przewlocki, Polish Academy of Sciences, described studies of the regulation of the PDYN and PENK gene expression in the nucleus accumbens as well as the opioid peptide and CRF gene expression in the central nucleus of the amygdala that suggest amphetamine and cocaine have different effects on the biosynthesis of opioid peptides in the mesolimibic system and amygdala, and that the changes they induce may play some role in the mechanism of addiction to psychostimulants.
Patterns and trends of methamphetamine and MDMA (Ecstasy) abuse in Eastern Europe and the United States were the topics for sessions chaired by Dr. Baum; Dr. Vlastimil Mayer, Slovakian National Programme on HIV/AIDS Prevention; Dr. Radu Vrasti, Romanian Psychiatric Hospital; and Dr. Rawson. Dr. Sterk presented information on U.S. trends in methamphetamine and MDMA (Ecstasy) abuse. She also discussed how data from national household surveys; school surveys; and law enforcement, drug treatment sites, and emergency rooms can be combined with targeted, cross-sectional, longitudinal, and enthnographic studies. Dr. Ladislav Csémy, Prague Psychiatric Centre, compared adolescent use patterns for methamphetamine and heroin, which he said imply that more attention should be devoted to prevention programs targeting adolescents and that treatment programs should be adapted to the needs of methamphetamine users. Dr. Zsolt Demetrovics, Eötvös Loránd University, stressed the importance of structural and dynamic family characteristics in explaining the onset and maintenance of addiction. Dr. Alojz Nociar, Slovakian Ministry for Drug Dependencies and Control, presented data demonstrating the marked increase of illicit drug abuse between 1994 and 1998 in the Slovak Republic, including the increased abuse of methamphetamine and MDMA (Ecstasy). Dr. Nociar compared responses from 1995 and 1999 school surveys to identify the following trends: drug use is increasing, particularly marijuana use; by 1999, drug use had spread to all areas of Slovakia; and MDMA (Ecstasy) and LSD use is increasing, as is consumption of alcohol and tobacco. Dr. Lubomir Okruhlica, Institute for Drug Dependencies, reported that based on treatment demand, Slovakia is not yet facing a crisis in methamphetamine use, but that lifetime prevalence of methamphetamine use and polydrug use is increasing. Dr. Vlastimil Mayer, Slovakian National Reference Center for HIV/AIDS Prevention, cited estimates that 75 percent of injection drug abusers in Bratislava share needles and engage in unsafe sexual practices, predicting that an epidemic of HIV infection is imminent among Slovakian drug users. Dr. Case discussed U.S. trends in methamphetamine and MDMA (Ecstasy) use, especially among men who have sex with men. She reported that methamphetamine use is associated with high-risk sexual behavior and high rates of HIV. Researchers do not know if MDMA (Ecstasy) use is a factor in high-risk sexual behaviors or increased HIV incidence. Dr. Case reported that because the drug use patterns are increasing so rapidly, researchers and surveillance systems often fail to include appropriate questions or classify drugs in different ways. Dr. Andrej Kastelic, Slovenian Center for Treatment of Drug Addiction, discussed attitudes toward methamphetamine and MDMA (Ecstasy) use and described prevention and treatment activities. Dr. József Fürész, Hungarian Defense Forces Health Protection Institute, reported on an armed forces drug screening system that provides surveillance data, decreases general drug use, better identifies those soldiers who might benefit from interventions, and has decreased abuse of methamphetamine and methadone.
Dr. Wenger and Dr. Matej Sande, University of Llubljana, Slovenia, chaired sessions on the neuropharmacology of methamphetamine and MDMA (Ecstasy). Dr. Ricaurte reported that those amphetamine derivatives, such as methamphetamine and MDMA (Ecstasy), which have high abuse liability for humans, produce particularly long-lasting and high neurotoxic activity in the brain, and that even a single dose of MDMA (Ecstasy) carries the risk of producing serotonin neuron cell injury in humans. Dr. Ricaurte also discussed advances in positron emission tomography (PET) that permit researchers to assess the status of brain dopamine and serotonin neurons in living humans. He called for additional research on the functional consequences of neuronal injury in the brain, and the mechanisms by which amphetamine derivatives damage brain cells.
Treatment options and the consequences of abuse were the topics of a session chaired by Dr. Ricaurte. Dr. Rawson reported on science-based methamphetamine treatment protocols funded by NIDA and developed jointly by researchers at the University of California and treatment providers at six Los Angeles-area clinics. He described treatment manuals which provide session-by-session guidelines for a 6-month outpatient treatment plan that includes cognitive behavioral therapy, education, positive reinforcement, classical conditioning, and family involvement. The manuals are available through the NIDA Web page, www.drugabuse.gov or www.nida.nih.gov. Dr. Miran Pustoslemsek, a Slovenian psychiatrist, described the diagnosis and treatment for a patient with acute MDMA (Ecstasy)-induced psychosis. Dr. Sándor Funk, Nyírö Gyula Hospital, Budapest, reported that most Hungarian methamphetamine or MDMA (Ecstasy) abusers seek treatment only as a result of legal mandates, family interventions, or drug-related medical emergencies. Dr. Baum reported that methamphetamine and MDMA (Ecstasy) are associated with high-risk injection and sexual behaviors that increase the risk for HIV infection and hepatitis. Toxicity and fatality are associated with drug-related cardiac arrhythmia and hypothermia.
Dr. Needle addressed funding mechanisms and professional development opportunities available to support the development of international collaborative research on drug abuse. Dr. Baum discussed the AIDS International Training and Research Program that is administered through the Fogarty International Center.
This program book is also available in pdf format for download [2.8 Mb].
