Ecstasy

[Chy]

The so-called "club drug" MDMA continues to be used by millions of Americans across the country despite growing evidence of its potential harmful effects. 3,4-Methylenedioxymethamphetamine (MDMA, or "Ecstasy") has gained a deceptive reputation as a "safe" drug among its users. This illegal drug, which has both stimulant and psychedelic properties, is often taken for the feelings of well-being, stimulation, as well as the distortions in time and sensory perceptions that it produces. MDMA first became popular in the "rave" and all-night party scene, but its use has now spread to a wide range of settings and demographic subgroups. According to the 2002 National Survey on Drug Use and Health, more than 10 million people have tried MDMA at least once.
Myths abound about both the acute effects and long-term consequences of this drug, often called "Ecstasy" or "X". Indeed, one reason for the rapid rise in the drug's popularity is that many young people believe that MDMA is a new safe drug. But MDMA is not new to the scientific community, with many laboratories beginning their investigations of this drug in the 1980s, and the picture emerging from their efforts is of a drug that is far from benign. For example, MDMA can cause a dangerous increase in body temperature that can lead to cardiovascular failure. MDMA can also increase heart rate, blood pressure, and heart wall stress. Animal studies show that MDMA can damage specific neurons in the brain. In humans, the research is not conclusive at this time; however, a number of studies show that long-term heavy MDMA users suffer cognitive deficits, including problems with memory.
NIDA-supported research is developing a clearer picture of the potential dangers of MDMA, and this Research Report summarizes the latest findings. We hope that this compilation of scientific information will inform readers and help the public recognize the risks of MDMA use.
Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse
All materials appearing in the Research Reports Series are in the public domain and may be reproduced without permission from NIDA. Citation of the source is appreciated.
To obtain printed copies of this report, please call or write the National Clearinghouse on Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20852, 1-800-729-6686. NIDA Research Report - MDMA Abuse (Ecstasy): Printed April 2004. This page has been accessed 198720 times since 4/1/04.



Who is abusing MDMA?

MDMA first gained popularity among adolescents and young adults in the nightclub scene or weekend-long dance parties known as raves. However, recently the profile of the typical MDMA user has been changing. Community-level data from NIDA's Community Epidemiology Workgroup (CEWG), reported in June 2003, indicate that use of MDMA has spread beyond the rave and nightclub scene to a variety of urban, suburban and rural areas throughout the country, including greater use on college campuses. For example, reports from Chicago suggest that Ecstasy, or drugs sold as Ecstasy, are widely available among high school and college students.
Use of this drug has also increased among different ethnic groups. For example, reports from Texas indicate use spreading beyond predominantly White youth to a broader range of ethnic groups. In Chicago, where a single MDMA pill can be purchased for about $12 to $15, the drug continues to be predominantly used by White youth, but there are increasing reports of its use by African American adults in their twenties and thirties. Also indicators in New York suggest that both the distribution and use of club drugs are becoming more common in non-White communities.
MDMA has also become a more popular drug among urban gay males. Reports have shown that some gay and bisexual men take MDMA and other club-drugs in myriad venues. This is concerning given that the use of club drugs has been linked to high-risk sexual behaviors that may lead to HIV or other sexually transmitted diseases. Many gay males in big cities report using MDMA as part of a multiple-drug experience that includes marijuana, cocaine, methamphetamine, ketamine, and other legal and illegal substances.


What are the effects
of MDMA?

MDMA has become a popular drug, in part because of the positive effects that a person experiences within an hour or so after taking a single dose. Those effects include feelings of mental stimulation, emotional warmth, empathy toward others, a general sense of well being, and decreased anxiety. In addition, users report enhanced sensory perception as a hallmark of the MDMA experience. Because of the drug's stimulant properties, when used in club or dance settings MDMA can also enable users to dance for extended periods. However, there are some users who report undesirable effects immediately, including anxiety, agitation, and recklessness.
As noted, MDMA is not a benign drug. MDMA can produce a variety of adverse health effects, including nausea, chills, sweating, involuntary teeth clenching, muscle cramping, and blurred vision. MDMA overdose can also occur - the symptoms can include high blood pressure, faintness, panic attacks, and in severe cases, a loss of consciousness, and seizures.
Because of its stimulant properties and the environment in which it is often taken, MDMA is associated with vigorous physical activity for extended periods. This can lead to one of the most significant, although rare, acute adverse effects -- a marked rise in body temperature (hyperthermia). Treatment of hyperthermia requires prompt medical attention, as it can rapidly lead to muscle breakdown, which can in turn result in kidney failure. In addition, dehydration, hypertension, and heart failure may occur in susceptible individuals. MDMA can also reduce the pumping efficiency of the heart, of particular concern during periods of increased physical activity, thereby further complicating these problems.
MDMA is rapidly absorbed into the human blood stream, but once in the body MDMA interferes with the body's ability to metabolize, or break down, the drug. As a result, additional doses of MDMA can produce unexpectedly high blood levels, which could worsen the cardiovascular and other toxic effects of this drug. MDMA also interferes with the metabolism of other drugs, including some of the adulterants that may be found in MDMA tablets.
In the hours after taking the drug, MDMA produces significant reductions in mental abilities. These changes, particularly those affecting memory, can last for up to a week, and possibly longer in regular users. The fact that MDMA markedly impairs information processing emphasizes the potential dangers of performing complex or even skilled activities, such as driving a car, while under the influence of this drug.
Over the course of the week following moderate use of the drug, many MDMA users report feeling a range of emotions, including anxiety, restlessness, irritability, and sadness that in some individuals can be as severe as true clinical depression. Similarly, elevated anxiety, impulsiveness, and aggression, as well as sleep disturbances, lack of appetite and reduced interest in and pleasure from sex have been observed in regular MDMA users. 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 or marijuana, or to potential adulterants found in MDMA tablets.

Is MDMA Addictive?

For some people, MDMA can be addictive. A survey of young adult and adolescent MDMA users found that 43 percent of those who reported ecstasy use met the accepted diagnostic criteria for dependence, as evidenced by continued use despite knowledge of physical or psychological harm, withdrawal effects, and tolerance (or diminished response), and 34 percent met the criteria for drug abuse. Almost 60 percent of people who use MDMA report withdrawal symptoms, including fatigue, loss of appetite, depressed feelings, and trouble concentrating.
MDMA affects many of the same neurotransmitters systems in the brain that are targeted by other addictive drugs. Experiments have shown that animals prefer MDMA, much like they do cocaine, over other pleasurable stimuli, another hallmark of most addictive drugs.


What do we know
about preventing
MDMA abuse?

Because social context and networks seem to be an important component of MDMA use, the use of peer led advocacy and drug prevention programs may be a promising approach to reduce MDMA use among adolescents and young adults. High schools and colleges can serve as important venues for delivering messages about the effects of MDMA use. Providing accurate scientific information regarding the effects of MDMA is important if we hope to reduce the damaging effects of this drug. Education is one of the most important tools for use in preventing MDMA abuse.


Are there effective
treatments for
MDMA abuse?

There are no specific treatments for MDMA abuse. The most effective treatments for drug abuse and addiction 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. Drug abuse recovery support groups may be effective in combination with behavioral interventions to support long-term, drug-free recovery. There are currently no pharmacological treatments for dependence on MDMA. Antidepressant medications might be helpful in combating the depressive symptoms frequently seen in MDMA users who have recently become abstinent.


Where can I get
more scientific
information about MDMA?

Fact sheets on MDMA, other illicit drugs, and related topics can be accessed through www.drugabuse.gov.

Resource: NIDA