This section contains information on: MDMA ingestion, Effects of MDMA on the brain, Short-term effects and Long-term effects of MDMA abuse.

MDMA (3,4-Methylenedioxymethamphetamine) is the collective name for a group of hallucinogens, which has amphetamine as the basic chemical structure. The slang label “ecstasy” originally referred to MDMA, but has gradually come to refer to several substances, including MDA, MDEA, and MMDA among others. All the substances are white powder which is usually mixed with inert substances such as chalk to form tablets, or filled in capsules. MDMA is an illegal drug that acts as both a stimulant and hallucinogen, producing an energizing effect, as well as distortions in time and perception and enhanced enjoyment from tactile experiences.

MDMA has a reputation as a “safe” drug, but research indicates that there are significant risks (both physical and neurological) associated with MDMA abuse. Abuse can increase heart rate, blood pressure, and heart wall stress. In rare cases MDMA can cause a dangerous increase in body temperature that can lead to cardiovascular failure. According to the National Institute on Drug Abuse (NIDA) in the USA , 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.

Additional risks associated with MDMA abuse include the presence of other drugs in the tablets, such as methamphetamine, caffeine, the diet drug ephedrine, and cocaine, which can increase the risks associated with MDMA abuse. Furthermore, drug abusers often take MDMA in combination with other drugs, such as marijuana and LSD, further increasing potential medical complications.

Almost 60 percent of people who abuse 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.

MDMA ingestion
Ecstasy is usually sold as tablets of various shapes and colors with different imprints, or logos. It can also be found in the form of capsules. The predominant form of ingestion is swallowing. The average reported dose is one or two tablets, with each tablet containing between 75-160 milligrams of MDMA. The euphoria comes within 30 minutes and reaches its maximum after 90 minutes, and remains for about three hours. It is not uncommon for users to take a second dose of the drug as the effects of the first dose begin to fade.

MDMA tablets recently seized in China . Courtesy National Narcotics Control Commission (NNCC), China

Effects of MDMA on the brain
MDMA exerts its primary effects in the brain by increasing the activity of neurons that use the chemicals serotonin, dopamine and norepinephrine to communicate with other neurons. Compared to methamphetamine, MDMA causes greater serotonin release and somewhat lesser dopamine release. The serotonin system plays an important role in regulating mood, aggression, sexual activity, sleep, and sensitivity to pain. The excess release of serotonin by MDMA likely causes the mood elevating effects experienced by MDMA users. However, by releasing large amounts of serotonin, MDMA causes the brain to become significantly depleted of this important neurotransmitter, contributing to the negative behavioral aftereffects that users often experience for several days after taking MDMA.

Research in animals links MDMA exposure to long-term damage to neurons that are involved in mood, thinking, and judgment. A study in nonhuman primates showed that exposure to MDMA for only 4 days caused damage to serotonin nerve terminals that was evident 6 to 7 years later. While similar neurotoxicity has not been definitively shown in humans, the wealth of animal research indicating MDMA's damaging properties suggests that MDMA is not a safe drug for human consumption.

Further, MDMA can interfere with the body's ability to control its temperature, which has on rare occasions led to severe medical consequences, including death. Also, MDMA causes the release of another neurotransmitter, norepinehrine, which is likely what causes the increase in heart rate and blood pressure that often accompanies MDMA use.

It is also important to keep in mind that many users of Ecstasy may unknowingly be taking other drugs that are sold as Ecstasy, and/or they may intentionally use other drugs, such as marijuana, which could contribute to these behavioral effects.

Short-term effects of MDMA abuse
The physical effects of usual doses of MDMA usually begin with a light sickness feeling and thirst, jaw clenching, teeth grinding, rapid eye movements, sweating, or nausea. Others report feelings of profound physical relaxation. After 30 minutes the euphoria occurs. Typical sought-after psychological effects include feeling "at peace" or experiencing a generalized "happy" feeling, and emotional closeness to oneself and others. MDMA can significantly enhance and distort the senses of touch, vision (contours of things and persons fade and are colored), taste, and smell. But for others, or even the same person at different times, the hallucinations can be scary and produce feelings of anxiety. Under moderate doses the user seldom loses complete control of the situation.

At higher doses, MDMA can produce physical effects resembling amphetamine, including fast or pounding heartbeat, sweating, dizziness, restlessness. 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, typically associated with “raves”. 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 abusers are particularly vulnerable to overdose due to poor judgment caused by the drug combined with a desire to extend the sought-after effects. In addition, MDMA interferes chemically with its breakdown within the body, further increasing the possibility of overdose.

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 other drugs contained in the MDMA tablet itself, such as methamphetamine.

Long-term effects of MDMA abuse
For some people, MDMA can be addictive. According to NIDA, 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.

The potential adverse effects of MDMA on the developing fetus are of great concern. Behavioral studies in animals have found that fetal exposure to MDMA can have significant adverse effects on learning and memory.

There was also rising concern that ecstasy for many young people was the gateway to other hallucinogens like LSD and other drugs like cannabis and heroin to chill out after ecstasy use.

References:
UNODC Regional Centre Project AD/RAS/97/C5/THA "The Enhancement of Drug Law Enforcement Computer-based Training in East Asia ", Drug Identification DVD.

U.S Department of Health and Human Services - National Institute on Drug Abuse: Research Report Series. MDMA (Ecstasy) Abuse, 2004.