Susan Merle Gordon, director of research at the Caron Foundation,
provides this description of the popular club drug and its effects.
Ecstasy is a commonly used name for the chemical substance methylene-dioxymethamphetamine, which is abbreviated as MDMA. Ecstasy is comprised of chemical variations of amphetamine or methamphetamine (stimulants) and a hallucinogen, such as mescaline. In addition to MDMA or the related compounds MDEA and MDA, drugs sold on the street as Ecstasy also contain other psychoactive or mind-altering drugs, like caffeine, ephedrine, selegiline and ketamine . Numerous illegal laboratories produce MDMA and use a wide variety of drug combinations, some of which are more lethal than others.
MDMA is produced in tablet or capsule form and is usually taken orally, although there are documented cases of intravenous use . MDMAs acute effects last from three to eight hours  and its short-lasting effects include feelings of euphoria, enhanced mental and emotional clarity, sensations of lightness and floating and other hallucinations. Users of MDMA also have suppressed appetite, thirst or need to sleep. Sometimes users who are attending two- to three-day parties suffer from severe dehydration or exhaustion .
Other unpleasant and/or dangerous acute effects include feelings of depersonalization, elevated anxiety, muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, chills and sweating, hypertension, tremors, seizures and increased body temperature. It is very possible to overdose on MDMA; these overdoses may produce fatality by heart failure or extreme heat stroke .
Increase in MDMA Abuse
MDMA is relatively inexpensive and easily accessible, especially in the northeastern part of the U.S. and western Europe. Most MDMA found in the U.S. has been manufactured abroad and smuggled into the country. It is estimated that more than two million tablets of MDMA are smuggled into the U.S. each week .
Abuse of MDMA has significantly increased, by 500 percent, from 1993 to 1999. In 1993 only 196 tablets of MDMA were submitted to the Drug Enforcement Agency (DEA) laboratories; in 1998, 143,600 tablets were confiscated and submitted to the DEA. Likewise, in 1993 only 79 cases of MDMA overdose were reported by hospital emergency rooms; in 1999, however, emergency rooms reported 2,850 MDMA cases .
MDMA often is used by adolescents and young adults at dance clubs, all-night dance parties (raves) and rock concerts. Use by young people sharply increased in 1999 from prior years of decline. Approximately one in 20 10th- and 12th-grade students reported they had used MDMA at least one time in 1999. MDMA appears to be easily available to young people, especially in the northeastern U.S. The proportion of high school seniors who think that MDMA is easy to obtain doubled from 1991 to 1997 .
Negative Consequences of MDMA Abuse
It is believed that many of the negative consequences of MDMA are a the result of the destruction of serotonin-producing neurons in the brain . Serotonin is a brain chemical that plays an important role in regulating mood, aggressive behavior, sexual activity, sleep, and pain sensitivity. Some research also has linked a decrease in serotonin activity to cognitive problems, such as memory processes .
Research studies on nonhuman primates have found decreases in serotinin activity for as long as seven years following MDMA exposure . Some scientists think that humans may be more susceptible to brain damage than are other primates. Cumulative doses of MDMA that are taken by moderate users over a prolonged time period may have similar negative consequences to the high experimental doses given within short time periods to nonhuman primates.
Other naturalistic research studies that assess the psychological and cognitive functioning of people who abuse MDMA also find long-lasting impairments. A recent review of the major research studies on MDMA concluded that there is a body of evidence that links heavy and prolonged MDMA use to confusion, depression, sleep problems, severe anxiety, and aggressive and impulsive behavior .
Because many regular users of MDMA also use marijuana, a recent research study compared people who use both marijuana and MDMA with people who use only marijuana and to people who use neither drug. The study found that MDMA users performed worse than the other two groups on complex cognitive tasks of attention, memory, learning and general intelligence. People who heavily used MDMA and marijuana had lower levels of cognitive performance than lighter users . Other research has confirmed that moderate to heavy use of MDMA is linked to impairments in memory .
Although MDMA generally is not considered to be an addictive substance, recent reports in the scientific literature suggest that some people may become dependent on or addicted to the drug. Most people who use MDMA restrict their use to weekends because frequent use quickly reduces the positive effects as tolerance to the drug develops . Tolerance is a major symptom of drug dependence. Withdrawal symptoms are also among the necessary criteria for dependence. Another important symptom of drug dependence is difficulty in controlling or abstaining from drug use despite negative social, psychological or physical consequences.
A case study of three young, male, heavy and prolonged MDMA users identified these symptoms of dependence. All three realized that their daily functioning had become impaired as a result of MDMA; they each unsuccessfully attempted to abstain from the drug; and during detoxification, they experienced fatigue, low mood, anxiety and sleep disturbances as withdrawal symptoms. The authors concluded that each of the three cases met criteria for MDMA dependence .
MDMA is marketed by street drug dealers as a "safe," nonaddictive recreational drug that enhances a persons enjoyment and ability to interact with others. Nothing could be further from the truth. Even occasional light users of MDMA risk overdose and premature death. Moderate to heavy users risk addiction, as well as long-term impairments in psychological and cognitive functioning. All users of MDMA at least temporarily lose their ability to relate to and enjoy being with other people without the influence of a mind-altering, dangerous substance.