(Documents V and VIII)

4.1 Individual health risks

(a) Acute effects: The major acute neuropharmacological effects of MBDB in the rat are an
increase in serotonin release in the brain and the inhibition of serotonin and noradrenaline reuptake.
These effects compare well with those of MDMA, although the latter is more potent as
a re-uptake inhibitor and releaser. MBDB may also slightly increase dopamine release and
inhibit dopamine re-uptake, but with a far weaker potency than MDMA. This is important, as
dopamine release has been implicated in the serotonin neurotoxicity caused by MDMA and in
the reinforcing qualities of substances such as cocaine and amphetamine.

A study using PET scanning techniques in heavy long-term ecstasy users has shown a
decrease in a structural component of brain 5-HT neurones.

The few toxicological data available suggest that MBDB may cause serotonergic deficits and
neurotoxicity, although the potency of MBDB to cause this effect is smaller than that of MDMA.
Severe acute reactions in man as have been reported for MDMA have not been reported for
MBDB.

(b) Dependence: Based on animal studies the dependence potential of MBDB appears to be
small, probably even smaller than that of MDMA.

(c) Psychological effects: There are little data on the neuropsychological effects of MBDB in
man. Neuropsychological findings for MDMA have been described, but these are not
necessarily identical for MBDB. Concern has been expressed in one Member State about
compulsive patterns of use of ecstasy which have been reported in some studies of heavy
consumers. The main subjective effects of MBDB in man are a pleasant state of introspection,
with greatly facilitated interpersonal communication and a pronounced sense of empathy and
compassion between subjects. In this respect, MBDB again resembles MDMA. However,
there are also differences. MBDB has a slower and more gentle onset of action than MDMA,
produces less euphoria and has less stimulant properties. The class of substances to which
MBDB belongs has been named ‘entactogens’.

4.2 Public health risks

(a) Availability and quality: The availability and quality of MBDB across the EU is also hard to
assess precisely. Based on the analysis of seizures, only a small proportion of tablets (pills)
sold as ecstasy contain MBDB (typically around 1–2%, though this varies over time and
between countries, ranging from almost zero to about 5%). In some cases MBDB is the only
active ingredient, although on available data it appears more commonly to be combined with
other substances (notably 2C-B or MDMA, sometimes LSD or other analogues of MDMA). On
the basis of limited information, the typical dose of MBDB is reported to be about 100–130mg,
although higher (200mg) and lower amounts are reported.

(b) Knowledge and perception of MBDB among users: There are very limited data on
knowledge and perceptions of MBDB. It appears that consumers of ecstasy are often aware
that what is sold as ecstasy sometimes contains other substances, but rarely know what
those substances are. Apart from the studies of Nichols et al. (1986) and Shulgin and Shulgin
(1991) there are anecdotal reports from some EU countries of users who were aware that
they had taken MBDB. These reports are not entirely consistent and may be based on atypical
users, but they generally suggest that MBDB is experienced as having lower stimulant effects
as well as lacking the alteration in sensory perceptions associated with MDMA. The
predominant impression from these reports is that users prefer MDMA to MBDB, although a
few reports reflect more positive reactions to MBDB. It is difficult to interpret these latter
reports because the content of the tablets is uncertain, and the characteristics of the users
and the effects they were seeking were not reported.

(c) Prevalence and patterns of use: It can be assumed that the patterns of use of MBDB are
almost always the same as for MDMA and that the prevalence of (inadvertent) use depends
on the extent to which MBDB is present in tablets sold as ecstasy on the market. There
appear to be individuals who have consciously used MBDB, but it is probable that these are
atypical consumers with a particular interest in, and a sophisticated knowledge of, synthetic
drugs. It is also possible that there are local groups of ecstasy users where MBDB has on
occasion appeared on the market as MBDB. Since users of MDMA, especially more regular
users, are also very likely to consume other drugs (cannabis, alcohol, amphetamines, etc.),
MBDB appears to be a very small element in a much wider phenomenon.

(d) Characteristics and behaviours of users: Consumers of MBDB do not differ from users of
dance drugs in general. Given the current marginal position of MBDB in the overall pattern of
synthetic drug use, it is unlikely that there are any important risk factors or vulnerable groups
associated with MBDB in particular.

(e) Indicators of health consequences: There are no reports of emergencies or treatment
requests involving MBDB. It is possible that accidents or other episodes involving MBDB, if
they occur, are overlooked. However MBDB together with other drugs has been reported in
one fatal road traffic accident. It is possible that the lower stimulant effect of MBDB, and the
introspective state of mind that it has been reported to induce, might mean that the risk of
excessive dancing is reduced. At present no evidence is available on long-term health
consequences and possible public health costs.

(f) Context of use: Risks and risk factors linked to the circumstances and rituals of
consumption of MDMA include excessive dancing in hot and crowded settings; accidents that
may result from sleep deprivation or perhaps direct impairment of driving skills; and also
combined use with other drugs (especially alcohol, but also amphetamines, cannabis, LSD
and cocaine). It is likely that these apply to MBDB, although to a lesser extent than MDMA.

Because of the scarcity of information on MBDB, the meeting welcomed the integration of
bio-medical and socio-economic aspects of drug abuse research in the EC 5th Framework
Programme for research and technological development, and hoped that support would be
granted to research projects sharing the common objective of developing a coherent and
consistent data package on the individual, public health and social consequences of the use
of synthetic drugs.