Ecstasy (MDMA) (3,4-methylenedioxymethamphetamine) is a synthetic, psychoactive drug that is chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. Ectasy produces feelings of increased energy, euphoria, emotional warmth, and distortions in time, perception, and tactile experiences.
How Is Ecstasy Abused?
Ecstasy is taken orally, usually as a capsule or tablet. It was initially popular among Caucasian adolescents and young adults in the nightclub scene or at weekend-long dance parties known as raves. More recently, the profile of the typical Ecstasy user has changed, with the drug now affecting a broader range of ethnic groups. Ecstasy is also popular among urban gay males—some report using Ecstasy as part of a multiple-drug experience that includes marijuana, cocaine, methamphetamine, ketamine, sildenafil (Viagra), and other legal and illegal substances.
How Does Ecstasy Affect the Brain?
Ecstasy exerts its primary effects in the brain on neurons that use the chemical (or neurotransmitter) serotonin to communicate with other neurons. The serotonin system plays an important role in regulating mood, aggression, sexual activity, sleep, and sensitivity to pain. Ecstasy binds to the serotonin transporter, which is responsible for removing serotonin from the synapse (or space between adjacent neurons) to terminate the signal between neurons; thus Ecstasy increases and prolongs the serotonin signal. Ecstasy also enters the serotonergic neurons via the transporter (because Ecstasy resembles serotonin in chemical structure) where it causes excessive release of serotonin from the neurons. Ecstasy has similar effects on another neurotransmitter—norepinephrine, which can cause increases in heart rate and blood pressure. Ecstasy also releases dopamine, but to a much lesser extent.
Ecstasy can produce confusion, depression, sleep problems, drug craving, and severe anxiety. These problems can occur soon after taking the drug or, sometimes, even days or weeks after taking Ecstasy. In addition, chronic users of Ecstasy perform more poorly than nonusers on certain types of cognitive or memory tasks, although some of these effects may be due to the use of other drugs in combination with Ecstasy. Research in animals indicates that Ecstasy can be harmful to the brain—one study in nonhuman primates showed that exposure to Ecstasy for only 4 days caused damage to serotonin nerve terminals that was still evident 6 to 7 years later.1 Although similar neurotoxicity has not been shown definitively in humans, the wealth of animal research indicating Ecstasy’s damaging properties strongly suggests that Ecstasy is not a safe drug for human consumption.
Addictive Potential of Ecstasy
For some people, Ecstasy can be addictive.2 A survey of young adult and adolescent Ecstasy 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).3 These results are consistent with those from similar studies in other countries that suggest a high rate of Ecstasy dependence among users.4 Ecstasy abstinence-associated withdrawal symptoms include fatigue, loss of appetite, depressed feelings, and trouble concentrating.2
What Other Adverse Effects Does Ecstasy Have on Health?
Ecstasy can also be dangerous to overall health and, on rare occasions, lethal. Ecstasy can have many of the same physical effects as other stimulants, such as cocaine and amphetamines. These include increases in heart rate and blood pressure—which present risks of particular concern for people with circulatory problems or heart disease—and other symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating.
In high doses, Ecstasy can interfere with the body’s ability to regulate temperature. On rare but unpredictable occasions, this can lead to a sharp increase in body temperature (hyperthermia), which can result in liver, kidney, cardiovascular system failure, or death. Ecstasy can interfere with its own metabolism (breakdown within the body); therefore, potentially harmful levels can be reached by repeated Ecstasy administration within short periods of time. Other drugs that are chemically similar to Ecstasy, such as MDA (methylenedioxyamphetamine, the parent drug of MDMA) and PMA (paramethoxyamphetamine, associated with fatalities in the United States and Australia),5 are sometimes sold as ecstasy. These drugs can be neurotoxic or create additional health risks to the user. Furthermore, ecstasy tablets may contain other substances, such as ephedrine (a stimulant); dextromethorphan (DXM, a cough suppressant); ketamine (an anesthetic used mostly by veterinarians); caffeine; cocaine; and methamphetamine. Although the combination of Ecstasy with one or more of these drugs may be inherently dangerous, users who also combine these with additional substances such as marijuana and alcohol may be putting themselves at even higher risk for adverse health effects.
What Treatment Options for Ecstasy Addiction Exist?
There are no specific treatments for Ecstasy abuse and addiction. The most effective treatments for drug abuse and addiction in general are cognitive-behavioral interventions that are designed to help modify the patient’s thinking, expectancies, and behaviors related to their drug use and to increase skills in coping with life stressors. Drug abuse recovery support groups may also be effective in combination with behavioral interventions to support long-term, drug-free recovery. There are currently no pharmacological treatments for addiction to Ecstasy .
How Widespread Is Ecstasy Abuse?
National Survey on Drug Use and Health (NSDUH)***
In 2009, an estimated 760,000 people (0.3 percent of the population) in the United States aged 12 or older used MDMA in the month prior to being surveyed. Lifetime use increased significantly among individuals aged 12 years or older, from 4.3 percent (10.2 million) in 2002 to 5.7 percent (14.2 million) in 2009; however, past-year use of ecstasy decreased from 1.3 percent to 1.1 percent during the same period. Approximately 1.1 million Americans used ecstasy for the first time in 2009, which is a significant increase from the 894,000 first-time users reported in 2008.
*** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans aged 12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of Health and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone from NIDA at 877–643–2644.
1 Ricaurte GA and McCann UD. Experimental studies on 3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”) and its potential to damage brain serotonin neurons. Neurotox Res 3(1):85–99, 2001.
2 Stone AL, Storr CL, and Anthony JC. Evidence for a hallucinogen dependence syndrome developing soon after onset of hallucinogen use during adolescence. Int J Methods Psychiatr Res 15:116–130, 2006.
3 Cottler LB, Womack SB, Compton WM, Ben-Abdallah A. Ecstasy abuse and dependence among adolescents and young adults: Applicability and reliability of DSM-IV criteria. Human Psychopharmacol 16:599–606, 2001.
4 Leung KS, Cottler LB. Ecstasy and other club drugs: A review of recent epidemiological studies. Curr Opin Psychiatry 21:234–241, 2008.
5 Kraner JC, McCoy DJ, Evans MA, Evans LE, Sweeney BJ. Fatalities caused by the MDMA-related drug paramethoxyamphetamine (PMA). J Anal Toxicol 25(7):645–648, 2001.