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NationalInstituteonDrugAbuse(NIDA)
MDMA(Ecstasy)Abuse
LastUpdatedMarch2006
https://www.drugabuse.gov
1
TableofContents
MDMA(Ecstasy)Abuse
LetterfromtheDirector
WhatisMDMA?
ABriefHistoryofMDMA
WhatisthescopeofMDMAabuseintheU.S.?
WhoisabusingMDMA?
WhataretheeffectsofMDMA?
WhatdoesMDMAdotothebrain?
IsMDMAAddictive?
WhatdoweknowaboutpreventingMDMAabuse?
ArethereeffectivetreatmentsforMDMAabuse?
WherecanIgetmorescientificinformationaboutMDMA?
Glossary
References
2
LetterfromtheDirector
Theso-called"clubdrug"MDMAcontinuestobeusedbymillionsofAmericans
acrossthecountry,despiteevidenceofitspotentialharmfuleffects.3,4methylenedioxymethamphetamine(MDMA,orecstasy)hasgainedadeceptive
reputationasa"safe"drugamongitsusers.Thisillegaldrug,whichhasboth
stimulantandpsychedelicproperties,isoftentakenforthefeelingsofwellbeing,stimulation,andthedistortionsintimeandsensoryperceptionsthatit
produces.MDMAfirstbecamepopularinthe"rave"andall-nightpartyscene,
butitsusehasnowspreadtoawiderangeofsettingsanddemographic
subgroups.Accordingtothe2004NationalSurveyonDrugUseandHealth,
morethan11millionpeoplehavetriedMDMAatleastonce.
Mythsaboundaboutboththeacuteeffectsandlong-termconsequencesofthis
drug,oftencalledecstasyor"X".Indeed,onereasonfortherapidriseinthe
drug’spopularityisthatmanyyoungpeoplebelievethatMDMAisanewsafe
drug.ButMDMAisnotnewtothescientificcommunity,asmanylaboratories
beganinvestigatingthisdruginthe1980s,andthepictureemergingfromtheir
effortsisofadrugthatisfarfrombenign.Forexample,MDMAcancausea
dangerousincreaseinbodytemperaturethatcanleadtokidneyfailure.MDMA
canalsoincreaseheartrate,bloodpressure,andheartwallstress.Animal
studiesshowthatMDMAcandamagespecificneuronsinthebrain.Inhumans,
theresearchisnotconclusiveatthistime;however,anumberofstudiesshow
thatlong-term,heavyMDMAuserssuffercognitivedeficits,includingproblems
withmemory.
NIDA-supportedresearchisdevelopingaclearerpictureofthepotential
dangersofMDMA,andthisResearchReportsummarizesthelatestfindings.
Wehopethatthiscompilationofscientificinformationwillinformreadersand
helpthepublicrecognizetherisksofMDMAuse.
NoraD.Volkow,M.D.
Director
NationalInstituteonDrugAbuse
3
WhatisMDMA?
MDMAisanillegaldrugthatactsasbothastimulantandpsychedelic,
producinganenergizingeffect,aswellasdistortionsintimeandperceptionand
enhancedenjoymentfromtactileexperiences.1,2Typically,MDMA(anacronym
foritschemicalname3,4-methylenedioxymethamphetamine)istakenorally,
usuallyinatabletorcapsule,anditseffectslastapproximately3to6hours.The
averagereporteddoseisonetotwotablets,witheachtablettypicallycontaining
between60and120milligramsofMDMA.1Itisnotuncommonforuserstotake
aseconddoseofthedrugastheeffectsofthefirstdosebegintofade.
MDMAcanaffectthebrainbyalteringtheactivityofchemicalmessengers,or
neuro-transmitters,whichenablenervecellsinthebraintocommunicatewith
oneanother.ResearchinanimalshasshownthatMDMAinmoderatetohigh
dosescanbetoxictonervecellsthatcontainserotoninandcancauselonglastingdamagetothem.1,3Furthermore,MDMAraisesbodytemperature.On
rarebutlargelyunpredictableoccasions,thishasledtoseveremedical
consequences,includingdeath.3,4Also,MDMAcausesthereleaseofanother
neurotransmitter,norepinephrine,whichislikelythecauseoftheincreasein
heartrateandbloodpressurethatoftenaccompaniesMDMAuse.5,6
4
AlthoughMDMAisknownuniversallyamongusersasecstasy,researchers
havedeterminedthatmanyecstasytabletscontainnotonlyMDMAbutalsoa
numberofotherdrugsordrugcombinationsthatcanbeharmfulaswell.
AdulterantsfoundinMDMAtabletspurchasedonthestreetinclude
methamphetamine,caffeine,theover-the-countercoughsuppressant
dextromethorphan,thedietdrugephedrine,andcocaine.7,8Also,aswithmany
otherdrugsofabuse,MDMAisrarelyusedalone.Itisnotuncommonforusers
tomixMDMAwithothersubstances,suchasalcoholandmarijuana.
5
ABriefHistoryofMDMA
MDMAwasdevelopedinGermanyintheearly1900sasaparentcompoundto
beusedtosynthesizeotherpharmaceuticals.Duringthe1970s,intheUnited
States,somepsychiatristsbeganusingMDMAasapsychotherapeutictool,
despitethefactthatthedrughadneverundergoneformalclinicaltrialsnor
receivedapprovalfromtheU.S.FoodandDrugAdministration(FDA)forusein
humans.Infact,itwasonlyinlate2000thattheFDAapprovedthefirstsmall
clinicaltrialforMDMAthatwilldetermineifthedrugcanbeusedsafelywith2
sessionsofongoingpsychotherapyundercarefullymonitoredconditionsto
treatpost-traumaticstressdisorder.Nevertheless,thedruggainedasmall
followingamongpsychiatristsinthelate1970sandearly1980s,withsome
evencallingit"penicillinforthesoul"becauseitwasperceivedtoenhance
communicationinpatientsessionsandreportedlyalloweduserstoachieve
insightsabouttheirproblems.ItwasalsoduringthistimethatMDMAfirststarted
becomingavailableonthestreet.In1985,theU.S.DrugEnforcement
Administration(DEA)bannedthedrug,placingitonitslistofScheduleIdrugs,
correspondingtothosesubstanceswithnoproventherapeuticvalue.2
6
SerotoninPresentinCerebralCortexNeuronsLong-termeffectsinmonkeys.Theleft
panelisbraintissuefromanormalmonkey.Themiddleandrightpanelsillustratethe
lossofserotonin-containingnerveendingsfollowingMDMAexposure.
7
WhatisthescopeofMDMAabusein
theU.S.?
ItisdifficulttodeterminetheexactscopeofthisproblembecauseMDMAis
oftenusedincombinationwithothersubstances,anddoesnotappearinsome
traditionaldatasources,suchastreatmentadmissionrates.
Morethan11millionpersonsaged12orolderreportedusingecstasyatleast
onceintheirlifetimes,accordingtothe2004NationalSurveyonDrugUseand
Health.Thenumberofcurrent(useinpastmonth)usersin2004wasestimated
tobe450,000.9
MonitoringtheFutureSurvey*-TrendsinMDMA
Prevalance,2002-2004
Note:Thesedataarefromthe2005MonitoringtheFuturesurvey,fundedbythe
NationalInstituteonDrugAbuse,NationalInstitutesofHealth,DHHS,andconducted
annuallybytheUniversityofMichigan'sInstituteforSocialResearch."Annual"refers
touseatleastonceduringtheyearprecedinganindividual'sresponsetothesurvey.
"30-day"referstouseatleastonceduringthe30daysprecedinganindividual's
responsetothesurvey.
TheDrugAbuseWarningNetwork,maintainedbytheSubstanceAbuseand
MentalHealthServicesAdministration,reportedthatmentionsofMDMAindrug
8
abuse-relatedcasesinhospitalemergencydepartmentswere2,221forthe
thirdandfourthquartersof2003.Themajorityofpatientswhocameto
emergencydepartmentsmentioningMDMAasafactorintheiradmissions
duringthattimewereaged18–20.10
TrendsinPerceivedHarmfulnessofMDMAUse
Thereis,however,someencouragingnewsfromNIDA’sMonitoringtheFuture
(MTF)survey,anannualsurveyusedtotrackdrugabusetrendsamong
adolescentsinmiddleandhighschoolsacrossthecountry.Between2001and
2005,annualecstasyusedecreasedby52percentin8th-graders,58percent
in10th-graders,and67percentin12th-graders.RatesoflifetimeMDMAuse
decreasedsignificantlyfrom2004to2005among12thgraders.
In2005,8th-gradersreportedasignificantdecreaseinperceivedharmfulness
inusingMDMAoccasionally.TheMTFdataalsoshowthatMDMAuseextends
acrossmanydemographicsubgroups.Among12th-gradersin2005,for
example,3.9percentofWhites,3.0percentofHispanicstudents,and1.4
percentofAfrican-AmericansreportedusingMDMAintheyearpriortothe
9
11
survey.11
10
WhoisabusingMDMA?
MDMAfirstgainedpopularityamongadolescentsandyoungadultsinthe
nightclubsceneorweekendlongdancepartiesknownasraves.However,the
profileofthetypicalMDMAuserhasbeenchanging.Community-leveldatafrom
NIDA'sCommunityEpidemiologyWorkGroup(CEWG),continuedtoreportthat
useofMDMAhasspreadamongpopulationsoutsidethenightclubscene.
ReportsalsoindicatethatuseisspreadingbeyondpredominantlyWhiteyouth
toabroaderrangeofethnicgroups.InChicago,thedrugcontinuestobe
predominantlyusedbyWhiteyouth,butthereareincreasingreportsofitsuse
byAfrican-Americanadultsintheirtwentiesandthirties.Also,indicatorsinNew
Yorksuggestthatboththedistributionanduseofclubdrugsarebecoming
morecommoninnon-Whitecommunities.12
11
WhataretheeffectsofMDMA?
MDMAhasbecomeapopulardrug,inpartbecauseofthepositiveeffectsthata
personmayexperiencewithinanhourorsoaftertakingasingledose.Those
effectsincludefeelingsofmentalstimulation,emotionalwarmth,empathy
towardothers,ageneralsenseofwellbeing,anddecreasedanxiety.In
addition,usersreportenhancedsensoryperceptionasahallmarkoftheMDMA
experience.1,2
EffectsofMDMA
ReportedUndesirableEffectsEffects(upto1weekpostMMDA,orlonger):
Anxiety
Restlessness
Irritability
Sadness
Impulsiveness
Aggression
SleepDisturbances
Lackofappetite
Thirst
Reducedinterestinandpleasurefromsex
Significantreductionsinmentalabilities
PotentialAdverseHealthEffects:
Nausea
12
Chills
Sweating
Involuntaryjawclenchingandteethgrinding
Musclecramping
Blurredvision
Markedriseinbodytemperature(hyperthermia)
Dehydration
HighBloodPressure
Heartfailure
Kidneyfailure
Arrythmia
SymptomsofMDMAOverdose:
HighBloodPressure
Faintness
Panicattacks
Lossofconsciousness
Seizures
Asnoted,MDMAisnotabenigndrug.MDMAcanproduceavarietyofadverse
healtheffects,includingnausea,chills,sweating,involuntaryteethclenching,
musclecramping,andblurredvision.2MDMAoverdosecanalsooccur—the
symptomscanincludehighbloodpressure,faintness,panicattacks,andin
severecases,alossofconsciousnessandseizures.1
Becauseofitsstimulantpropertiesandtheenvironmentsinwhichitisoften
13
taken,MDMAisassociatedwithvigorousphysicalactivityforextended
periods.2Thiscanleadtooneofthemostsignificant,althoughrare,acute
adverseeffects—amarkedriseinbodytemperature(hyperthermia).3,4
Treatmentofhyperthermiarequirespromptmedicalattention,asitcanrapidly
leadtomusclebreakdown,whichcaninturnresultinkidneyfailure.Inaddition,
dehydration,hypertension,andheartfailuremayoccurinsusceptible
individuals.MDMAcanalsoreducethepumpingefficiencyoftheheart,6of
particularconcernduringperiodsofincreasedphysicalactivity,further
complicatingtheseproblems.
MDMAisrapidlyabsorbedintothehumanbloodstream,butonceinthebody,
MDMAmetabolitesinterferewiththebody'sabilitytometabolize,orbreakdown,
thedrug.8Asaresult,additionaldosesofMDMAcanproduceunexpectedly
highbloodlevels,whichcouldworsenthecardiovascularandothertoxiceffects
ofthisdrug.MDMAalsointerfereswiththemetabolismofotherdrugs,including
someoftheadulterantsthatmaybefoundinMDMAtablets.
Inthehoursaftertakingthedrug,MDMAproducessignificantreductionsin
mentalabilities.Thesechanges,particularlythoseaffectingmemory,canlastfor
uptoaweek,andpossiblylongerinregularusers.ThefactthatMDMA
markedlyimpairsinformationprocessingemphasizesthepotentialdangersof
performingcomplexorskilledactivities,suchasdrivingacar,whileunderthe
influenceofthisdrug 2,13.
TheNeurobiologyofEcstasy(MDMA)
14
MDMAaltersbrainchemistrybybindingtoserotonintransporters.
Overthecourseofaweekfollowingmoderateuseofthedrug,manyMDMA
usersreportfeelingarangeofemotions,includinganxiety,restlessness,
irritability,andsadnessthatinsomeindividualscanbeassevereastrue
clinicaldepression.14Similarly,elevatedanxiety,impulsiveness,and
aggression,aswellassleepdisturbances,lackofappetite,andreduced
interestinandpleasurefromsexhavebeenobservedinregularMDMA
users.15,16Someofthesedisturbancesmaynotbedirectlyattributableto
MDMA,butmayberelatedtosomeoftheotherdrugsoftenusedincombination
withMDMA,suchascocaineormarijuana,ortoadulterantscommonlyfoundin
MDMAtablets.
15
WhatdoesMDMAdotothebrain?
MDMAaffectsthebrainbyincreasingtheactivityofatleastthree
neurotransmitters(thechemicalmessengersofbraincells):serotonin,
dopamine,andnorepinephrine.5Likeotheramphetamines,MDMAcauses
theseneurotransmitterstobereleasedfromtheirstoragesitesinneurons,
resultinginincreasedneurotransmitteractivity.Comparedtotheverypotent
stimulant,methamphetamine,MDMAcausesgreaterserotoninreleaseand
somewhatlesserdopaminerelease.17Serotoninisaneurotransmitterthatplays
animportantroleintheregulationofmood,sleep,pain,appetite,andother
behaviors.TheexcessreleaseofserotoninbyMDMAlikelycausesthemood
elevatingeffectsexperiencedbyMDMAusers.However,byreleasinglarge
amountsofserotonin,MDMAcausesthebraintobecomesignificantlydepleted
ofthisimportantneurotransmitter,contributingtothenegativebehavioral
aftereffectsthatusersoftenexperienceforseveraldaysaftertakingMDMA.18
NumerousstudiesinanimalshavedemonstratedthatMDMAcandamage
serotonin-containingneurons;1,3someofthesestudieshaveshownthese
effectstobelonglasting.Thissuggeststhatsuchdamagemayoccurinhumans
aswell;however,measuringserotonindamageinhumansismoredifficult.
StudieshaveshownthatsomeheavyMDMAusersexperiencelonglasting
confusion,depression,andselectiveimpairmentofworkingmemoryand
attentionprocesses.19,20,21,22,23Suchmemoryimpairmentshavebeen
associatedwithadecreaseinserotoninmetabolitesorothermarkersof
serotoninfunction.ImagingstudiesinMDMAusers19,21,24haveshownchanges
inbrainactivityinregionsinvolvedincognition,emotion,andmotor
function.25,26,27However,improvedimagingtechnologiesandmoreresearch
areneededtoconfirmthesefindingsandtoelucidatetheexactnatureofthe
effectsofMDMAonthehumanbrain.
Itisalsoimportanttokeepinmindthatmanyusersofecstasymayunknowingly
betakingotherdrugsthataresoldasecstasy,and/ortheymayintentionallyuse
otherdrugs,suchasmarijuana,whichcouldcontributetothesebehavioral
effects.Additionally,moststudiesinpeopledonothavebehavioralmeasures
frombeforetheusersbegantakingdrugs,makingitdifficulttoruleoutpreexistingconditions.20,28,29Factorssuchasgender,dosage,frequencyand
16
intensityofuse,ageatwhichusebegan,theuseofotherdrugs,aswellas
geneticandenvironmentalfactorsallmayplayaroleinsomeofthecognitive
deficitsthatresultfromMDMAuseandshouldbetakenintoconsiderationwhen
studyingtheeffectsofMDMAinhumans.
GiventhatmostMDMAusersareyoungandintheirreproductiveyears,itis
possiblethatsomefemaleusersmaybepregnantwhentheytakeMDMA,either
inadvertentlyorintentionallybecauseofthemisperceptionthatitisasafedrug.
ThepotentialadverseeffectsofMDMAonthedevelopingfetusareofgreat
concern.Behavioralstudiesinanimalshavefoundsignificantadverseeffects
ontestsoflearningandmemoryfromexposuretoMDMAduringa
developmentalperiodequivalenttothethirdtrimesterinhumans.30However,
theeffectsofMDMAonanimalsearlierindevelopmentareunclear;31,32
therefore,moreresearchisneededtodeterminewhattheeffectsofMDMAare
onthedevelopinghumannervoussystem.
LifeThreateningEffects
17
IsMDMAAddictive?
MDMAaffectsmanyofthesameneurotransmittersystemsinthebrainthatare
targetedbyotheraddictivedrugs.Experimentshaveshownthatanimalswill
selfadministerMDMA—animportantindicatorofadrug’sdependencypotential
—althoughthedegreeofself-administrationislessthansomeotherdrugsof
abusesuchascocaine.34
FewstudieshaveattemptedtoassessMDMAdependencyamongusersinthe
generalpopulation,andthosethathavebeenconductedhaveshownwidely
varyingresults,likelybecauseofthedifferentpopulationsamplesanddifferent
typesofmeasuresused.WedoknowthatsomeMDMAusersreportsymptoms
including:continuedusedespiteknowledgeofphysicalorpsychologicalharm;
tolerance(ordiminishedresponse);andwithdrawaleffects,suchasfatigue,
lossofappetite,depressedfeelings,andtroubleconcentrating.
18
Whatdoweknowaboutpreventing
MDMAabuse?
Becausesocialcontextandnetworksseemtobeanimportantcomponentof
MDMAuse,theuseofpeer-ledadvocacyanddrugpreventionprogramsmay
beapromisingapproachtoreduceMDMAuseamongadolescentsandyoung
adults.Highschoolsandcollegescanserveasimportantvenuesfordelivering
messagesabouttheeffectsofMDMAuse.Providingaccuratescientific
informationregardingtheeffectsofMDMAisimportantifwehopetoreducethe
damagingeffectsofthisdrug.Educationisoneofthemostimportanttoolsfor
useinpreventingMDMAabuse.
19
Arethereeffectivetreatmentsfor
MDMAabuse?
TherearenospecifictreatmentsforMDMAabuse.Themosteffectivetreatments
fordrugabuseandaddictionarecognitivebehavioralinterventionsthatare
designedtohelpmodifythepatient'sthinking,expectancies,andbehaviors,
andtoincreaseskillsincopingwithlife'sstressors.Drugabuserecovery
supportgroupsmaybeeffectiveincombinationwithbehavioralinterventionsto
supportlong-term,drug-freerecovery.Therearecurrentlynopharmacological
treatmentsfordependenceonMDMA.
20
WherecanIgetmorescientific
informationaboutMDMA?
TolearnmoreaboutMDMAandotherdrugsofabuse,gotoourDrugSummary
pages.
21
Glossary
Addiction:Achronic,relapsingdiseasecharacterizedbycompulsivedrug
seekinganduse.
Adulterant:Asubstance,eitherabiologicallyactivematerialsuchasanother
drugoraninertmaterial,addedtoadrugwhenitisformedintoatabletor
capsule.
Cardiovascularsystem:Theheartandbloodvessels.
Dopamine:Aneurotransmitterpresentinregionsofthebrainthatregulate
movement,emotion,motivation,andthefeelingofpleasure.
Ecstasy:CommonstreetnameforMDMA.
Gastrointestinalsystem:Thestomachandintestines.
Hyperthermia:Apotentiallydangerousriseinbodytemperature.
MDMA:Commonchemicalnamefor3,4-methlyenedioxymethamphetamine.
Neurotransmitter:Achemicalthatactsasamessengertocarrysignalsor
informationfromonenervecelltoanother.
Norepinephrine:Aneurotransmitterpresentinregionsofthebrainthataffect
heartrateandbloodpressure.
Serotonin:Aneurotransmitterusedinwidespreadpartsofthebrain,whichis
involvedinsleep,movementandemotions
Tolerance:Adecreaseintheeffectofadrugthatoccurswithrepeated
22
administration.
23
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