ECSTASY: HISTORY, USE, EFFECTS AND HOW IT WORKS

ECSTASY

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ecstasy tablets
Ecstasy (or simply "E") is the street name for a euphoric stimulant with mild hallucinogenic effects called MDMA (the abbreviation for 3,4-methylenedioxy-methamphetamine). A hybrid of amphetamines and the hallucinogen mescaline, and sometimes called the love drug, it makes people feel good and positive. Some have suggested that of it was given to all the world leaders there would be no war.

MDMA is a synthetic drug and a member of the phenethylamine family of chemicals that may act as stimulants, hallucinogens, and/or entactogens. It alters mood and perception (awareness of surrounding objects and conditions). It is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception. Even though ecstasy is sometimes described as a hallucinogen it usually doesn’t cause people to see things that are not there. Rather users say it enhances and distorts sensory perception and time. It works by flooding the brain with serotonin, a feel-good chemical that helps regulate memory, sleep, libido, appetite and temperature. Ecstasy is taken mostly in the form of pills that come in a variety of colors but are usually white, beige or yellow. Doses per pill vary from 50 milligrams to 300 milligrams. Bootleg pills are very common. They often contain caffeine, amphetamines or ephedrine but not MDMA.

In a study by a team led by Prof. David Nutt of Britain’s Bristol University published in the British medical journal Lancet, alcohol and tobacco were ranked as worse than cannabis and ecstasy using a ranking system that took into consideration physical harms caused by a substance, the potential for addiction and cost to society from its use. Drug guru Sasha Shulgin told the Independent: "There is nothing addictive about psychedelics unless you are one of those people who is going to get addicted to anything." Ecstasy users claim that bad rap that ecstasy receives is propaganda. "E's not a killer drug. It kills fewer people than peanuts," one 19-year-old girl told Newsweek. "it's like you're in a secret club and nobody understands."

Websites and Resources: U.S. Drug Enforcement Administration (DEA) justice.gov/dea/concern ; Vaults of Erowid erowid.org ; United Nations Office of Drugs and Crime (UNODC) unodc.org ; Wikipedia article on illegal drug trade Wikipedia ; Frank’s A-to-Z on Drugs talktofrank.com ; Streetdrugs.org streetdrugs.org ; Illegal Drugs, country by country listing, CIA cia.gov/library/publications/the-world-factbook

Books: “Buzzed” by Cynthia Kuhn Ph.D. Scott Swartzwelder, Ph.D., Wilkie Wilson Ph.D. of the Duke University Medical Center (Norton, 2003); “Consuming Habits: Drugs in Anthropology and History” by Goodman, Sharratt and Lovejoy; “Drug War Heresies: Learning from Other Vices, Times and Places” by Robert MacCoun and Peter Reuter (Cambridge University Press).

History of Ecstasy

MDMA (Ecstasy) was first developed by German pharmaceutical company in 1912as a step in the process of making another drug. Originally known as “Methylsafrylaminc,” it was intended as a parent compound to synthesize medications that control bleeding, not to control appetite as is often incorrectly cited.Merck took out a patent on the drug in 1914 as a "promising intermediary substance that was hoped could be used to make advanced drugs."

During its first 60 years of existence there was no evidence of anybody or even an animal ever using it. In the 1940s, it was marketed as a treatment for Parkinson’s disease but didn’t attract attention. In 1953, the drug appeared in an animal study at the University of Michigan, funded by the U.S. Army, as part of an investigation on the use of drugs as weapons. A similar drug, MDA, was popular in the 1960s.

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MDMA structural formula
Ecstasy was first used in the late 1970s by a small group of avant-garde psychotherapists, who described it as a tool for therapy and a kind of miracle feel-good drug that made patients open up about their feelings. The drug gained a small following among psychiatrists in the late 1970s and early 1980s, despite the fact that the drug had not undergone formal clinical trials nor received approval from the U.S. Food and Drug Administration (FDA) for use in humans. Some psychiatrists believed that it enhanced communication in patient sessions and allowed patients to achieve insights about their problems.It was also during this time that MDMA started becoming more widely available on the street.

Initially, like LSD in the early 1960s, ecstasy was not illegal. Marriage counselors prescribed it to troubled couples to get them to open up and have positive feelings about one another (hence the nickname the "hug drug") and yuppies bought it and other "designer drugs" at trendy clubs in New York, Los Angeles and San Francisco. Ecstasy was made illegal in 1985 by the U.S. Drug Enforcement Administration (DEA) after it was found that it damaged the brains of laboratory animals. In 1985, the DEA declared an emergency ban on MDMA, placing it on the list of Schedule I drugs, defined as substances with no currently accepted medical use and a high potential for abuse. MDMA has remained a Schedule I substance since then, with the exception of a brief period of time between 1987 and 1988.

Ecstasy made its way to Britain where it was embraced by the Rave and House Music scene that evolved in the mid-1980s. The drug was a popular in the nightclub scene and at all-night dance parties ("raves"). During the late 1980s and 1990s it expanded beyond the fringes into the mass popular culture. By the early 2000, the use of ecstasy was growing faster in the United States than any other drug. The drug now affects a broader range of people and is becoming increasingly popular in Asia.

Sasha Shulgin and Ecstasy

The San Francisco-based chemist Alexander Sasha Shulgin, a former employee at Dow, is credited with popularizing the MDMA. In 1978 he published the first scientific papers recommending its use in therapy and later said it had a panacea quality that "could be all things to all people." [Source: The Independent]

In the late 1970s Shuglin gave MDMA to a therapist friend who called it Adam and introduced it to more than 4,000 people. One of these people hired a chemist in Texas and opened an MDMA lab. He coined the name “Ecstasy” and began selling the drug at bars and clubs in Dallas, where people charged the $20 pills with their American Express cards.

Later Shuglin gave instructions on how to make the drug in a book called “Phenethylamines I Have Known and Loved” . Cowritten with his wife Anne, the book contained recipes for 300 mind-altering drugs. It sold 21,000 copies and made Shulgin an enemy and of the U.S. Drug Enforcement Administration. A few years later Shulgin published a sequel called “Tryptamines I Have Known and Loved” . In this book he described how to make STP, currently sold on the streets as “tripstacy”

In the early 2000s, well into 70s, Shulgin was still experimenting with new psychoactive drugs, often on himself and his wife and their friends. The Independent described one experiments he did with a drug extracted from a Mexican cactus that left him so full of fear he was afraid to move and left his wife afraid she was going to be killed by a contemptuous moon. Of the 12 friends who took the drug, six felt a pleasant high and six became violently ill.

Ecstasy, Raves and Clubs

In spite of posted signs at many techno clubs that warn about the danger of ecstasy, many of the patrons are high on the drug. Glow sticks stimulate the dilated pupils of ecstasy users. Pacifiers relieve the teeth grinding associated with the drug. Ecstasy use is so widespread some clubs have in house doctors.

Club owners like ecstasy because it suppresses aggression and sexual desire and everybody is nice to one another and happy. They much prefer the atmosphere of an ecstasy party to an alcohol-fueled bash.

Raves and House Parties — kinds of anarchist entertainment often held in abandoned warehouses that guests found their way to following enigmatic maps — emerged in the 1980s and were closely linked to ecstasy and other drugs. Electric kool-aid was sold by the glass, ecstasy was widely available and every danced to thumping bass driven psychedelic disco house music.

Describing a central London psychedelic techno club called the Fridge, Katharine Chubbock wrote in Newsweek: "A man is strung up amid flashing lights, gyrating wildly in a leather harness above pulsing throngs of dancers. Rave music grinds at an impossible beat, but pale-faced girls, each with an ounce of eyeliner, keep perfect time." Music critic David Wells of Time out told AFP: Instead of taking 10 pints of lager and going to the match, football fans take ecstasy and all love each other...'E' us, of all the success stories, one of the biggest."

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MDMA molecule
Mid Nineties Generation Ecstasy Expressions:
Kicking (wonderful)
Large it (have a good time)
Easy, Star (relax, friend)
Lallies (legs)
Vada (to look, ex. "Vada the llalies on her.")

Mental (bizarre, out of control)
Mashed up (intoxicated)
Chalice (cannabis joint)
Dibble (brush with cops)
Renton (very short haircut, from the character Renton in the film "Trainspotting")
Kickoff merchant (aggressive, even violent individual)
Sorted (arranged, "It's sorted man.") [Source: Newsweek]

How Ecstasy Works

MDMA increases the activity of three brain chemicals: 1) Dopamine, which produces increased energy and activity and acts in the reward system to reinforce behaviors; 2) Norepinephrine, which increases heart rate and blood pressure, which are particularly risky for people with heart and blood vessel problems; and 3) Serotonin, a chemical that regulates mood and body temperature and is believed to be associated with feelings of well being, emotional stability, bliss, empathy and enhanced cognitive powers. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]

Like other amphetamines, MDMA enhances release of these neurotransmitters and/or blocks their reuptake, resulting in increased neurotransmitter levels within the synaptic cleft (the space between the neurons at a synapse). MDMA causes greater release of serotonin and norepinephrine than of dopamine. MDMA’s effects on norepinephrine contribute to the cognitive impairment, emotional excitation, and euphoria that accompanies MDMA use.

Ecstasy affects neurotransmitters like dopamine as is the case with amphetamines. It mainly affects nerve cells in the brain that produce serotonin, which affects mood, appetite, sleep, and other functions. It also triggers hormones that affect sexual arousal and trust. Serotonin helps transmit electrical signals from one neuron to another. Serotonin neurons originate in the raphe nuclei, near the base of the brain, and extend into the brain through threadlike extensions known axons. The release of large amounts of serotonin likely causes the emotional closeness, elevated mood, and empathy felt by those who use MDMA.

Ecstasy and Serotonin

Serotonin is a neurotransmitter that plays an important role in the regulation of mood, sleep, pain, appetite, and other behaviors. Serotonin is usually stored at the end of the axons which can be as much as a foot long. Under normal circumstances, serotonin is released when an electrical signal travels from the cell body at the base of the axon through the axon to vesicles where the serotonin is stored. When discharged serotonin is released into synapses (gaps between neurons), where some is absorbed by adjacent neurons and the rest is broken down by enzymes. This release of serotonin is believed to cause feelings of well-being.

Ecstasy causes nerve cells to release all their serotonin at once, often without electrical impulses. The chemical floods the synapses, overwhelming serotonin receptors. Ecstasy also prevents serotonin from being broken down by enzymes. Prozac also manipulates serotonin but instead of releasing it in a massive flood it prevents serotonin that has already been released from being broken down.

The excess release of serotonin by MDMA likely causes the mood-elevating effects people experience. However, by releasing large amounts of serotonin, MDMA causes the brain to become significantly depleted of this important neurotransmitter, contributing to the negative psychological aftereffects that people may experience for several days after taking MDMA. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, September 2017]

Research in rodents and primates has shown that moderate to high doses of MDMA, given twice daily for four days, damages nerve cells that contain serotonin. MDMA-exposed primates showed reduced numbers of serotonergic neurons seven years later, indicating that some of MDMA’s effect on the brain can be long lasting. MDMA has additional effects on the serotonin system. For example, 1 to 2 weeks following binge-dosing with MDMA (three or four low doses in one day), rats showed decreased expression of the serotonin transporter, a protein that allows cells to take up and recycle released serotonin. The rats also showed changes in the expression of genes that regulate tryptophan hydroxylase, an enzyme involved in serotonin synthesis.

Low serotonin is associated with poor memory and depressed mood, thus these findings are consistent with studies in humans that have shown that some people who use MDMA regularly experience confusion, depression, anxiety, paranoia,and impairment of memory and attention processes.79 In addition, studies have found that the extent of MDMA use in humans correlates with a decrease in serotonin metabolites and other markers of serotonin function and the degree of memory impairment.



Phenethylamines

Phenethylamines refer to a class of substances with documented psychoactive and stimulant effects and include amphetamine, methamphetamine and MDMA.The phenethylamines also include ring substituted substances such as the ‘2C series’, ring substituted amphetamines such as the ‘D series’ (e.g.DOI, DOC), benzodifurans (e.g. Bromo-Dragonfly, 2C-B-Fly) and others (e.g. p-methoxymethamphetamine (PMMA)). A number of studies have reported the synthesis of some phenethylamines and amphetamine substitutes. In the 1980s and 1990s, Shulgin, reported the synthesis of numerous new psychoactive compounds.This included the ‘D series’ (e.g. DOC, DOI) and the ‘2C series’ (e.g. 2C-T-7, 2C-T-2) of phenethylamines. [Source: UNODC]

Simple variations on the mescaline molecule (a natural phenylethylamine) led to the synthesis of powerful hallucinogenic substances, e.g. 4-bromo-2,5-dimethoxyphenethylamine (2C-B), synthesized by Shulgin in 1974. The ‘2C’ series differs from the ‘D’ series only by a slight modification in the chemical structure, and their psychoactive effects have been reported to be dose dependant, ranging from mere stimulant effect at lower doses, with hallucinogenic and entactogenic effects at higher doses.

Over two decades later, a new generation of phenethylamines was researched by Professor David Nichols and his research team at Purdue University in the United States. The team found the potency of synthetic analogues of mescaline such as 2C-B and DOB, to exceed that of many naturally occurring hallucinogens. Several substances were synthesized, including a wide range of benzodifuranyl substances, later known as the ‘FLY’.Benzodifurans, such as ‘FLY’ (tetrahydrobenzodifuranyl) and ‘Dragonfly’ (benzodifuranyl aminoalkanes) are potent hallucinogens. Bromo-Dragonfly is the most common and potent substance in this sub-group.

Other phenethylamines such as PMMA, first synthesized in 1938, are also sold in the drug market as a substitute for ‘ecstasy’. PMMA, in combination with PMA (a substance listed in Schedule I of the 1971 United Nations Convention on Psychotropic Substances), has been frequently found in tablets that carry a similar logo to ‘ecstasy’. Whereas some phenethylamines such as 2C-B, brolamphetamine (DOB), STP/DOM, MDE, 4-MTA, are listed in Schedules I and II of the 1971 Convention, most of the new substances such as the 2C series, the D-Series and ‘others’ such as PMMA are not under international control. Some phenethylamine derivatives are controlled in some countries.

Street names for some phenethylamines include ‘Europa’ for 2C-E; ‘4-FMP’, ‘para-fluoroamphetamine’, ‘RDJ’ for 4-FA; and ‘4-MMA’, ‘Methyl-MA’ for PMMA. Phenethylamines are usually available in form of pills, but FLY compounds are commonly sold in powder form, while oral doses (on a slip of blotter paper) are usually available for ‘D substances’. Ingestion is the most common route of administration of phenethylamines.

Ecstasy Users

According to the National Survey on Drug Use and Health, more than 18 million people in the United States have tried MDMA at least once in their lifetime. Today, there are estimated to be 20 million “ecstasy” users globally. Global Seizures in 2019 were 16 tons, an increase of 38 percent from 2018. [Source: United Nations Office on Drugs and Crime (UNODC); U.S. National Institute on Drug Abuse (NIDA)]

According to the UNODC: Reflecting the level of uncertainty in the estimates of “ecstasy” use in some subregions, in 2019 it was estimated that between 0.2 percent and 0.7 percent (best estimate: 0.4 percent) of the global population aged 15–64, or between 9 million and 35 million (best estimate: 20 million) people, had used “ecstasy” in the past year. Past-year prevalence of “ecstasy” use is higher than the global average in the subregion of Australia and New Zealand (2.8 percent), North America (0.9 percent) and Western and Central Europe (0.9 percent). The extent of “ecstasy” use in the other subregions, where data are available and prevalence can be estimated, is lower than the global average. [Source: United Nations Office on Drugs and Crime (UNODC), World Drug Report 2021]

In North America (including Mexico), it is estimated that in 2019, 0.9 percent of the population aged 15–64, or 2.9 million people, had used “ecstasy” in the past year. In the United States, “ecstasy” use has remained stable since 2015 (data prior to 2015 are not comparable for the purpose of trend analysis due to methodological changes); in 2019, 0.9 percent of the population aged 12 and older, or 2.5 million people, were estimated to have used “ecstasy” in the past year. The annual prevalence of “ecstasy” use was estimated to be the highest among young adults aged 18–25, who accounted for over 1 million past-year users (3.2 percent of that age group). In Canada, by contrast, “ecstasy” use increased over the period 2015–2017, with 271,000 people aged 15 and older (0.9 percent) estimated to be past-year “ecstasy” users in 2017.

In the U.S., among people aged 12 or older in 2020, 0.9 percent (or about 2.6 million people) reported using MDMA (Ecstasy) in the past 12 months. In 2021, an estimated 0.6 percent of 8th graders, 0.7 percent of 10th graders, and 1.1 percent of 12th graders reported using MDMA in the past 12 months. [Source: 2020 National Survey on Drug Use and Health, 2021 Monitoring the Future Survey]

MDMA first gained popularity among adolescents and young adults in the nightclub scene and at dance parties known as raves. However, the profile of the typical person who uses MDMA has been changing. Beginning in 1999, community-level data from NIDA's Community Epidemiology Work Group began to report that use of MDMA had spread among populations outside the nightclub scene. [Source: National Institute on Drug Abuse (NIDA), National Institutes of Health, U.S. Department of Health and Human Services, September 2017]

MDMA is predominantly used by males between the ages of 18 and 25.43,50 Most use typically begins at 21 years of age.51 NIDA-funded research shows that sexual orientation also influences MDMA usage rates. For example, gay or bisexual men and women are more likely than their heterosexual counterparts to have used MDMA within the last 30 days and to report harm associated with MDMA use.

Ecstasy Use

When MDMA is taken in tablet or capsule form, a person begins feeling the effects 45 minutes later, on average. These effects peak 15 to 30 minutes after they are first felt and last an average of 3 hours, though side effects could be experienced up to days later.17,28 People typically take one to two tablets on each occasion, with each tablet generally containing between 50 and 150 milligrams of MDMA. People often take a second dose of the drug as the effects of the first dose begin to fade, increasing the risk of adverse side effects as doses combine. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, September 2017]

People who use MDMA usually take it as a capsule or tablet, though some swallow it in liquid form or snort the powder. The popular nickname Molly (slang for "molecular") often refers to the supposedly "pure" crystalline powder form of MDMA, usually sold in capsules. However, people who purchase powder or capsules sold as Molly often actually get other drugs such as synthetic cathinones ("bath salts") instead (see "Added Risk of MDMA").[Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]

Ecstasy is regarded as a going out drug while heroin is considered a staying in drug. Users generally take ecstasy in pill form and begin feeling empathetic, peaceful and energetic but clear after about a half hour. As the drug takes effect the effects become stronger and users are apt to begin engaging in long conversations with strangers, revealing their inner most feelings, or dancing with great enthusiasm. Users at clubs sometimes form "cuddle puddles," large groups consisting of individuals who cuddle, hug, touch and massage one another. One 23-year-old woman told Time, "Feathers, toys, lotions, anything. A guy touching your skin with a cold drink. It's delicious."

MDMA's effects last about three to six hours. Recreational use of MDMA is often characterized by repeated drug taking over a number of days (binges), followed by periods of no drug taking. In one animal study, this pattern of use produced irregular heartbeat (arrhythmia) and heart damage. In the week following use of the drug, many people report depression, impaired attention and memory, anxiety, aggression, and irritability.

Effects of Ecstasy

Most phenethylamines act as either central nervous system stimulants, or as hallucinogens. Stimulants mediate the actions of dopamine, norepinephrine and/or serotonin, mimicking the effects of traditional drugs such as cocaine, amphetamine, methamphetamine, and ecstasy. Classic hallucinogens (psychedelics) mediate specific serotonin-receptor activities and produce hallucinations. Substances in these group mimic the effects of traditional drugs such as 2C-B, LSD and DMT but may also possess residual stimulant activity.[Source: UNODC]

Ecstasy accelerates the heartbeat, increases blood pressure, causes dehydration, dizziness, overheating and teeth-grinding and jaw-clenching. Health effects of ecstasy may include nausea, muscle cramping, involuntary teeth clenching, blurred vision, lack of appetite, mild detachment from oneself (depersonalization), illogical or disorganized thoughts, nausea, hot flashes, headaches, electrolyte (sodium) imbalances, faintness panic attacks, muscle or joint stiffness, restless legs, chills and sweating. High doses of MDMA can affect the body’s ability to regulate temperature. This can lead to a spike in body temperature that can occasionally result in liver, kidney, or heart failure or even death. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]

In the hours after taking the drug, MDMA produces significant reductions in perceiving and predicting motion — for example, the ability to judge whether a driver is in danger of colliding with another car. This emphasizes the potential dangers of performing complex or skilled activities, such as driving a car, while under the influence of this drug. Men reportedly can't get erections while using ecstasy but they become very horny when the effects wear off.

Over the course of the week following moderate use of the drug, a person may experience: 1) irritability; 2) impulsiveness and aggression; 3) depression; 4) sleep problems; 5) anxiety; 6) memory and attention problems; 7) decreased appetite; 8) decreased interest in and pleasure from sex. In addition, because MDMA can promote trust and closeness, its use — especially combined with sildenafil (Viagra) — may encourage unsafe sexual behavior. This increases people's risk of contracting or transmitting HIV/AIDS or hepatitis.

Positive Effects of Ecstasy

Ecstasy induces intense euphoria, emotional closeness, mild hallucinations and the ability to dance all night non-stop. Effects include an enhanced sense of well-being, increased extroversion, emotional warmth, empathy toward others, and a willingness to discuss emotionally-charged memories. In addition, people report enhanced sensory perception. MDMA usually doesn't cause bad trips that are sometimes associated with LSD or produce the agitated, wired feeling associated with amphetamines. People generally don't become violent while on Ecstasy and the drug is not considered addictive like cocaine or heroin.

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ecstasy tablets

On the website ecstasy.org, one ecstasy user wrote, "We sing, we laugh, we share, and most of all we care." Another user told Time, it's "six-hour orgasm." Anne Shulgin, wife of Sasha Shulgin, had used the drug for 17 years as of the early 2000s. She told the Independent, "It dissolves paranoia. One for the great fears that everyone has is that the essential self is a terrible thing. This is a basic unconscious fear. MDMA dissolves that fear and replaces it with a tremendously peaceful acceptance, not just of yourself but of other people, too."

People who do ecstasy often describe great feelings of empathy. One friend told me, "it's not a sexual drug...you simply feel like you love everybody." In the book “Buzzed” , a first time use said, “The drug takes away all your neuroses. It takes away your fear response. You feel open, clear, loving. I can’t imagine anyone being angry, under the influence or feeling selfish, or mean, or even defensive. You have insights into yourself, real insights, that stay with you after the experience is over. It doesn’t show you anything that isn’t already there. It’s not a trip. You don’t lose touch with the world. You could pick up the phone, call your mother and she’d never know.”

One young woman told Time, "E makes shirtless, disgusting men, a club with broken bathrooms, a deejay that plays crap, and vomiting into a trash can the best night of your life...I had always been aloof, insecure or snobby, however you want to put it. And when I took it and realized, you know that, we're all here; we're all dancing; we're not so different. I allowed myself to get close to people. Everything was positive. But my life became, quickly, all about the next time I would do it...You feel at ease with yourself and right with the world, and that's a feeling you want to duplicate-every single week.”

Describing the appeal of ecstasy, a 19-year-old techno club patron told Newsweek, "Not only is it an all time high, it’s the perfection of the universe. You don't feel cold; you don't feel pain. Everything is beautiful and you can dance all night." Another user told the Face: "I did my first E at Cream [a nightclub] and it was brilliant...I was flying...I'll do two maybe three a night. I go most weeks...I know there's a comedown from E, you feel well battered the next day like, but I never feel weepy like some do."

Theraputic Use of Ecstasy

MDMA was first used in the 1970s as an aid in psychotherapy (mental disorder treatment using "talk therapy"). The drug did not have the support of clinical trials (studies using humans) or approval from the U.S. Food and Drug Administration (FDA). In 1985, The U.S. Drug Enforcement Administration (DEA) labeled MDMA as an illegal drug with no recognized medicinal use. However, some researchers remain interested in its value in psychotherapy when given to patients under carefully controlled conditions. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]

The evidence on MDMA’s therapeutic effects is limited thus far, although research is ongoing in this area. Proponents of MDMA-assisted therapy recommend that it only be used for reactive disorders such as post-traumatic stress disorder because it can worsen some psychiatric conditions. In the early 1990s, the FDA approved the first human trial exploring whether MDMA could help relieve pain in terminally ill patients, as well as serve as an adjunct to psychotherapy. Results from this study have not been published; however, these early studies helped establish safety parameters for administering MDMA to human participants in controlled, clinical settings. Clinical trials are ongoing to explore whether MDMA has therapeutic potential in the treatment of post-traumatic stress disorder and anxiety in autistic adults and patients with a terminal illness such as cancer. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, September 2017]

MDMA is currently in clinical trials as a possible treatment aid for post-traumatic stress disorder (PTSD); for anxiety in terminally ill patients; and for social anxiety in autistic adults. Recently, the FDA gave MDMA-assisted psychotherapy for PTSD a Breakthrough Therapy designation. In Spain, ecstasy is being tested as a possible therapy for people with post-traumatic stress disorder and anxiety. The Multidisciplinary Association of Psychedelic Drugs is an advocate of the therapeutic uses of ecstasy.

Some researchers have reported very promising results. “Sometimes with a therapeutic, you look at the data and think, ‘It slightly moved the needle,’” Jennifer Mitchell, a neurologist at the Weill Institute for Neurosciences at the University of California, San Francisco, who worked on the recently finished MDMA trial, told Nature. “Then you see MDMA and you’re like, ‘Never mind that.’ It’s a very different effect size.” [Source: Paul Tullis, Nature, January 27 2021]

Paul Tullis wrote in Nature: Approvals still have a long way to go. Towards the end of 2020, Multidisciplinary Association for Psychedelic Studies (MAPS) reported in a news release that there are statistically significant differences in the response between the control and placebo groups in its MDMA trial. But the company won’t say more about the results until it releases the full data some time this year. It is also recruiting for a second phase III study using MDMA therapy for people with moderate-to-severe PTSD, which it aims to complete before the end of the year.

Robert Malenka, a psychiatrist and neuroscientist at Stanford University in California who has studied MDMA’s effects on rodents, says he thinks that some psychedelic drugs will eventually earn approval as treatments for certain conditions. “They have potential to be — I want to use the right analogy — a part of our toolset for treating patients,” he says. But he warns against overzealousness, particularly a brand of evangelism he’s seen among some of the underground purveyors of psychedelic-assisted psychotherapy. “I don’t think they’re going to be miracle cures,” he says. He argues that the hypotheses for how the drugs might be working in the brain still need further research, and that investigating compounds that provide the same benefits without the hallucinatory effects could prove worthwhile in the long run. Others point out that SSRIs work for many individuals without clinicians fully understanding their mechanism.

Negative Side of Ecstasy

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Ecstasy capsules
Ecstasy accelerates the heartbeat, increases blood pressure and causes dehydration. It can stress the heart, increasing heart rate and blood pressure, and can damage the kidneys. Animal studies show that MDMA may also damage specific neurons in the brain, but research on MDMA’s effects on the human brain is not conclusive at this time. However, a number of studies show that long-term, heavy MDMA use is associated with cognitive deficits, including problems with learning and memory. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]

Responding to the notion that ecstasy has religious qualities, a drug counselor told Newsweek, "The idea that ecstasy is some great religious sacrament, some amazing panacea, is bullshit. It's one thing to give it to an 80-year-old Buddhist monk to contemplate Zen. It's another thing if you're going home to a semi-burnt-out flat and your life is a shithole of poverty and degradation."

Once MDMA is metabolized, or broken down in the body, its byproducts interfere with the body's ability to metabolize MDMA. As a result, additional doses of MDMA can produce unexpectedly high blood levels, which could worsen the toxic effects of this drug.

There have been reports of brain damage, depression, psychosis and memory loss linked to long-term use of ecstasy but research is not conclusive. Ecstasy users describe Terrible Tuesdays, a sort of post-use depression that effects users one or two days after they use the drug. The depression is believed to be caused by using up too much serotonin while on ecstasy. Research by Valerie Curran of University College London indicates that many Ecstasy users do suffer from a midweek depression after using the drug on the weekends. In some cases the depression has lasted for months and users have needed to seek psychological help.

Various studies have found that MDMA use is associated with risky sexual behaviors. For example, both males and females who use MDMA are more likely than alcohol-drinking controls to engage in risky sexual behaviors (e.g., without a condom). MDMA use within the past six months is associated with initiating sex before age 14 and having two or more partners in the past two months.In addition, people who use heavily report more sexual risk taking than those who use less often. People who use heavily are also more likely to have been tested for HIV, though they believe they are at low risk for contracting the disease. Homosexuals and bisexuals who use MDMA, both male and female, reported more sexual partners and more injection drug use — but did not have higher rates of unprotected sex and needle sharing — compared to heterosexuals who use MDMA.[Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, September 2017]

Ecstasy and Other Drugs

Adding to MDMA's risks is that pills, capsules, or powders sold as Ecstasy and supposedly "pure" Molly may contain other drugs instead of or in addition to MDMA. Much of the Molly seized by the police contains additives such as cocaine, ketamine, methamphetamine, over-the-counter cough medicine, or synthetic cathinones ("bath salts"). These substances may be extremely dangerous if the person does not know what he or she is taking. They may also be dangerous when combined with MDMA. People who purposely or unknowingly combine such a mixture with other substances, such as caffeine, amphetamines, amphetamine-like mephedrone, cannabis or alcohol, may increase the risk of adverse health effects associated with MDMA. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, September 2017]

Chemical analyses of drugs sold as ecstasy seized by the U.S. Drug Enforcement Administration (DEA) have shown that they often contain no MDMA at all. Epidemiologists from Washington state and Florida reported in 2013 that substances being sold as Molly were actually methylone, a synthetic stimulant commonly found in “bath salts.” In 2015, ethylone, a synthetic stimulant similar to methylone but with some differences in binding within the brain, replaced methylone as the main substance marketed as Molly. This underscores that people who take Molly often do not know what they are ingesting, and the substances sold as Molly may pose serious health risks.

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ecstasy tablets
Many users are harmed by substances which are used to cut ecstasy — heroin, strychnine, ketamine (a stimulate popular in the U.S.), aspirin, dog-worm pills and aquarium cleanser. Another club drug, "Liquid X," which causes similar sensations as Ecstasy but is chemically unrelated, easily causes coma and death. DMX (detraomethorphna), a cheap cough medicine that can cause hallucinations, is sometimes passed off as Ecstasy. It inhibits sweating and can easily cause heatstroke. Studies have shown that 20 percent of Ecstasy pills contain something else. Dancesafe, an organization founded by one of the founders of Microsoft, tests Ecstasy pills for other substances.

Phenethylamines included in the ‘D series’ are described to be longer lasting, more potent and reportedly more liable to induce vasoconstriction than other members of the phenethylamine family. Reported adverse effects associated with the use of the ‘D series’ derivatives include agitation, tachycardia, mydriasis, hallucinations, severe limb ischemia, seizures, liver and renal failure.Bromo-Dragonfly has also been associated with a number of deaths in Scandinavia.[10]A case of acute psychosis after ingestion of 2C-T-4 was reported in Japan.[11] Three fatal cases associated with the use of 2C-T-7 have been identified, two of which involved poly-drug use. [Source: UNODC]

PMA, PMMA and 4-methylthioamfetamine have been more often associated with incidental deaths than other phenethylamines. PMA and PMMA are known to have a particularly high toxicity but there is no data available on fatalities associated with their use. Clinical observations have reported severe hyperthermia following the use of these substances.[13] Studies in animals have suggested that some metabolites may be exposed to increased toxicity from 4-MTA.

Serious Dangers from Ecstasy

Serious impacts that can occur while someone is taking ecstasy can include Loss of consciousness, seizures, kidney failure and swelling of the brain. MDMA can cause a dangerous increase in body temperature that can be fatal in some environments. Most ecstasy-related emergency room admissions are for dehydration and overheating. Taking several pills over the course of night can inhibit the body's ability to regulate its own temperature. E users with a body temperature of 110̊F have been recorded. Frequent users avoid the problem by drinking a lots of water when they do the drug, especially if they are doing a lot of dancing in a hot nightclub.

Because of its stimulant properties and the situations in which it is often taken, MDMA is associated with vigorous physical activity for extended periods in warm environments. This can lead to one of the most significant, although rare, acute adverse effects — a marked rise in body temperature (hyperthermia). Research in rats shows that even moderate doses of MDMA interfere with the body’s ability to regulate temperature, potentially leading to deadly consequences in warm environments.

Many of the more serious problems attributed to ecstasy — liver failure, seizures, brain bleeding, heart palpitations, rises in blood pressures, and even death — may be caused by ecstasy look-alikes rather than ecstasy itself. Many of the look-alikes conation paramethoxyamphetamine (PMA), which raises the body temperature to dangerous levels.

Perhaps ecstasy's biggest problem is its reputation for being relatively harmless. One emergency room doctor told The Independent, "We still don't know how ecstasy affects the brain, if there'll be a whole generation of depressives." One psychologist who predicts a wave depression and suicide among ecstasy users told Newsweek, "We're in the middle off a huge natural experiment. the price will be paid in human lives.”

Deaths from Ecstasy

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ecstasy tablet
While fatal overdoses on MDMA are rare, they can potentially be life threatening — with symptoms including high blood pressure (hypertension), faintness, panic attacks, and in severe cases, a loss of consciousness and seizures.

Acute deaths caused solely by ecstasy use are very rare. In the Netherlands there are about 100 deaths a year from heroin but only one or two from cocaine and one from ecstasy. In Britain in the 1980s when around 1 to 2 million people were taking ecstasy at least once a week there were only two deaths attributed to the drug. Between 1990 and 1995, fifty-three people officially died from ecstasy (the youngest was 16 and the oldest was 24). One British girl, Leah Betts, collapsed after taking a hit of Ecstasy on her 18th birthday and went into a coma and later died. The figure of 53 was derived from press clippings.

In 2006, a 13-year-old girl girl from Rigaud, west of Montreal, Canada, died after taking ecstasy during sleepover. CBC News reported: “Police say the girl and a friend were at a sleepover when they started talking about taking ecstasy. They say the two curious teens called a 16-year-old friend and went over to his place to get the drug. The boy's parents weren't home at the time. When the girls returned to the sleepover, the 13-year-old became very ill. "One of them really felt like nauseous and not well and so the mother was advised. The mother saw the state of the child and she called 911," Mackels said. [Source: CBC News, February 7, 2006]

An ambulance carried her to a local hospital, where she was stabilized before being transferred to Montreal Children's Hospital. Police said it's not clear why only one of the girls became sick and died, given that both took equal amounts of the powerful drug. "For children that want to experiment with drugs, it's always a bad idea, especially if it's in a powder or a pill, because you don't know what was put in there by whom and when it was done, and the concentration of whatever you're taking."

Most problems with ecstasy are related to overheating, hypothermia or mixing ecstasy with other drugs. Among those who have died are hard-core partiers who died from dehydration and heatstroke. Some users die after their body temperature rises so high their blood starts to coagulate, bringing on cardiac arrest.

Treatment of hyperthermia requires prompt medical attention, as it can rapidly lead to muscle breakdown or an electrolyte (sodium) imbalance, which can in turn produce kidney failure or fatal swelling of the brain, especially in women. MDMA use in combination with vigorous exercise causes dehydration, leading some people to drink large amounts of liquids. However, this could increase the risk of electrolyte imbalance or brain swelling because MDMA causes the body to retain water. One modest dose of MDMA can also reduce the pumping efficiency of the heart in people who use regularly,65 which is of particular concern during periods of increased physical activity.

Deaths of Four People in Two Months in Vancouver Area Linked to Ecstasy

In early January 2012, Vancouver police said a 22-year-old woman died after taking ecstasy at a house party. She was the fourth death linked to the drug in the Vancouver area in two months. Police Constable Lindsey Houghton said there is an "inherent risk and potential peril" of ingesting the drug, cautioning that there is no quality control in illegal drug manufacturing. "This isn't made in a sterile pharmaceutical lab. This is made in garage, or bathtub or on someone's stove." [Source: ctvbc.ca, January 9, 2012]

Ctvbc reported: “Investigators say the latest victim appears to have taken the party drug recreationally with several friends who did not suffer similar reactions, despite taking the same dosage. "They took the exact same amount: one pill," Houghton said. The incident follows similar tragedies that claimed the lives of 20-year-old Tyler Miller on November 27, 17-year-old Cheryl McCormack on Dec. 20 and an unnamed Burnaby resident who ingested ecstasy on New Year's Eve.

“Abbotsford police say that McCormack appears to have been taking the party drug for weight loss purposes, while Miller used it recreationally with friends. A 24-year-old Abbotsford resident was also rushed to hospital in critical condition on New Year's Eve after taking ecstasy with friends, who say she may have taken more of the drug than they had. Const. Ian MacDonald said he was last updated on the young woman's condition and remained "fighting for life" and had yet to regain consciousness.

Several public warnings about the drug have been issued in recent weeks, but Houghton said people continue to put themselves at risk. To mitigate the chances of further tragedy, police are now urging users to pay attention to warning signs. "If there is even the slightest hint of discomfort in your body or you react, phone 911 immediately. Don't wait, don't lie down and hope you'll get better," Houghton said. "Delaying could cost your life."

Long Term Negative Effects of Ecstasy

Among the potential longer term health effects of ecstasy (including those observed days or weeks post-MDMA use) are:; 1) Arrythmia (irregular heart beat) and heart damage; 2) Irritability; 3) Depression; 4) Impulsivity; 5) Impaired attention and memory; 6) Anxiety; 7) Aggression; 8) Sleep disturbances; 9) Concentration difficulties; 10) Lack of appetite; 11) Heart disease; and 12 ) Decreased cognitive function. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, September 2017]

Effects of regular MDMA use include sleep disturbances, lack of appetite, concentration difficulties, depression, heart disease, and impulsivity. In addition, heavy MDMA use over a two-year period of time is associated with decreased cognitive function. Some of these disturbances may not be directly attributable to MDMA, but may be related to some of the other drugs often used in combination with MDMA, such as cocaine, alcohol, or cannabis, or to adulterants commonly found in MDMA tablets. More research is needed to understand the specific effects of regular MDMA use. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, September 2017]

Is Ecstasy Addictive?

Research hasn’t definitively answered whether MDMA is addictive, although it affects many of the same neurotransmitter systems in the brain that are targeted by other addictive drugs. Experiments have shown that animals will self-administer MDMA — an important indicator of a drug’s addictive potential — although the degree of self-administration is less than some other addictive drugs, such as cocaine. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, September 2017]

Data from both humans and animals suggest that regular MDMA use produces adaptations in the serotonin and dopamine systems that are associated with substance use disorder and related behaviors, such as increased impulsivity.Few studies have attempted to assess MDMA addiction or dependency among people with a history of use in the general population. Studies that have been conducted have shown widely varying results, likely because of the different population samples and different types of measures used. Some people who use MDMA do report symptoms of addiction, including continued use despite negative physical or psychological consequences, tolerance, withdrawal,and craving.

The most effective current treatments for patients with an MDMA use disorder are cognitive behavioral interventions that are designed to help modify the patient's thinking, expectancies, and behaviors, and to increase skills in coping with life's stressors. Recovery support groups may be effective in combination with behavioral interventions to support long-term recovery. Although there are currently a number of medication targets that show promise in animal models and in some eary clinical trials, there are currently no FDA-approved medications to treat MDMA use disorder.

Studies on the Dangers of Ecstasy

There is pretty good evidence that ecstasy cause permanent brain damage. Long term studies with rodents and monkeys have indicated that ecstasy damages serotonin neurons. A study with squirrel monkeys and baboons has indicated that ecstasy damages dopamine-producing neurons in the brain, which in turn may hasten the onset of Parkinson’s disease. Animal studies however do not necessarily translate to the same result in humans. In the primate studies, 20 percent of the baboons were killed by the drug. One in five human users haven’t dropped dead from it.

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ecstasy tablet
A lot research has focused on the impact of ecstasy on the serotonin system. Does the system recover? If so, how long does it take? Is there any long term damage? Can that be reversed? Studies conducted by George Ricaurte at John Hopkins University indicated that people who took ecstasy more than 200 times over a five year period had damaged cells which release serotine. Loss of serotonin can cause psychological problems. The studies also showed "the vast majority of people who have experiment with MDMA appear perfectly normal.”

Ecstasy seems to use up the supply of serotonin so that their isn't any left when users stop using the drug, which at least partly explains the Terrible Tuesday phenomena. Some studies have shown that frequent ecstasy users are often depressed for a long time after they stop using the drug. An Italian study suggests that chronic use may cause DNA mutation.

The flood of serotonin may cause damage to the ends of the axons. Some studies show the nerve endings die off. Other show they grow back, although abnormally. The axons may also be altered so they no longer reach the part of the brain they were intended to reach. Dr. Michael Morgan, a psychologist at the University of Sussex, found that former ecstasy users who had not used the drug for more than two years suffered from memory loss similar to that suffered by people in the early stages of dementia. Studies of people on ecstasy show they perform about 10 percent to 15 percent worse on memory tests than people given a placebo but the impairment vanishes after six hours. There is little evidence that the damage persists.

Positron emission tomography (PET) brain imaging studies of people who have stopped using MDMA have shown decreases in brain activity at rest in prefrontal, parietal, and mediotemporal cortices as well as in the amygdala, cingulate, and hippocampus. These are brain regions involved in learning, memory, and emotion formation and processing. PET imaging also showed that one low dose of MDMA increased cerebral blood in the ventromedial frontal and occipital cortex and inferior temporal lobe and cerebellum. It decreased cerebral blood flow in the motor and somatosensory cortex, amygdala, cingulate cortex, insula, and thalamus. These are brain regions involved in emotion formation and processing, behavioral learning, and sensory and motor function. Few imaging studies have explored the effects of moderate MDMA use on the human brain, and results that do exist are inconsistent due to methodological differences across studies. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, September 2017]

More studies are needed to determine whether the observed changes in brain activity in people who use MDMA are caused by MDMA, other drug use, or other common risk factors that predispose people to use MDMA. Additionally, most studies in people do not have behavioral measures from before MDMA use started, making it difficult to rule out pre-existing differences or common underlying risk factors across groups that are separate from MDMA use. Factors such as gender, dosage, frequency and intensity of use, age at which use began, and the use of other drugs, as well as genetic and environmental factors all may play a role in some of the cognitive deficits associated with MDMA use and should be taken into consideration when studying the effects of MDMA in humans.

Studies with ecstasy are tainted by the fact that ecstasy users usually use other drugs and it is difficult to say which drugs causes a certain problem. One British man, for example, who took ecstasy 40,000 times over nine years was studied by doctors who found his memory loss was so severe he had trouble determining where he was and what time of the day it was. Still the doctors couldn’t point their finger at ecstasy because he also took a lot of LSD, cannabis, heroin, amphetamines, solvents and cocaine.

Image Source: DEA (Drug Enforcement Administration); Wikimedia Commons

Text Sources: 1) “Buzzed, the Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstasy” by Cynthia Kuhn, Ph.D., Scott Swartzwelder Ph.D., Wilkie Wilson Ph.D., Duke University Medical Center (W.W. Norton, New York, 2003); 2) National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services; 3) United Nations Office on Drugs and Crime (UNODC) and 4) National Geographic, New York Times, Washington Post, Los Angeles Times, Wikipedia, The Independent, Times of London, The New Yorker, Time, Newsweek, Reuters, Associated Press, AFP, , Lonely Planet Guides, and various books and other publications.

Last updated April 2022


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