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MDMA (Ecstasy)

MDMA (3,4 methylenedioxymethamphet-

amine) † is a synthetic, psychoactive drug

that is chemically similar to the stimulant

methamphetamine and the hallucinogen

mescaline. It produces an energizing

effect as well as feelings of euphoria,

emotional warmth, and distortions in time

perception and tactile experiences.

(or space between adjacent neurons)

when the signal between neurons needs

to be terminated. MDMA also causes

excessive release of serotonin and has

similar but less potent effects on neurons

that contain dopamine and norepineph-

rine. The serotonin system plays an

important role in regulating mood,

aggression, sexual activity, sleep, and

sensitivity to pain.

How is MDMA Abused?

MDMA is taken orally as a capsule or

tablet. It was initially popular among

white adolescents and young adults in

the nightclub scene or at weekend-long

dance parties known as raves. However,

the profile of the typical MDMA user has

changed, and the drug now affects a

broader range of ethnic groups. MDMA

is also popular among urban gay

males—some report using MDMA as

part of a multiple-drug experience that

includes marijuana, cocaine, metham-

phetamine, ketamine, and other legal

and illegal substances.

MDMA can produce confusion, depres-

sion, sleep problems, drug craving, and

severe anxiety. These problems can

occur soon after taking the drug or,

sometimes, even days or weeks after tak-

ing MDMA. In addition, chronic users of

MDMA 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 MDMA.

Research in animals indicates that

MDMA can be harmful to the brain—

one study in nonhuman primates showed

that exposure to MDMA for only 4 days

caused damage to serotonin nerve termi-

nals 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

MDMA’s damaging properties strongly

suggests that MDMA is not a safe drug

for human consumption. This is currently

an area of active research.

How does MDMA Affect

the Brain?

MDMA exerts its primary effects in the

brain on neurons that use the chemical

serotonin to communicate with other

neurons. MDMA binds to the serotonin

transporter, which is responsible for

removing serotonin from the synapse

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Addictive Potential

For some people, MDMA can be addic-

tive. 2 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 contin-

ued use despite knowledge of physical

or psychological harm, withdrawal

effects, and tolerance (or diminished

response). 3 These results are consistent

with those of similar studies in other

countries that also suggest a high rate

of MDMA dependence among users. 4

MDMA abstinence-associated withdrawal

symptoms include fatigue, loss of

appetite, depressed feelings, and

trouble concentrating. 2

sions, this can lead to a sharp increase

in body temperature (hyperthermia),

which can result in liver, kidney, and

cardiovascular system failure, and

death. MDMA can interfere with its

own metabolism (breakdown within

the body); therefore, potentially harmful

levels can be reached by repeated

MDMA administration within short

periods of time.

Other drugs that are chemically similar

to MDMA, such as MDA (methylene-

dioxyamphetamine, the parent drug of

MDMA) and PMA (paramethoxyamphet-

amine, associated with fatalities in the

United States and Australia), 5 are some-

times also sold as ecstasy. These drugs

can be neurotoxic or create additional

health risks to the user. Furthermore,

ecstasy tablets may be adulterated with

other substances, such as ephedrine

(a stimulant); dextromethorphan (DXM,

a cough suppressant); ketamine (an

anesthetic used mostly by veterinarians);

caffeine; cocaine; and methampheta-

mine. Although the combination of

MDMA with one or more of these drugs

may be inherently dangerous, users

might also combine these with other sub-

stances such as marijuana and alcohol,

putting themselves at even higher risk.

What Other Adverse

Effects does MDMA

Have on Health?

MDMA can also be dangerous to over-

all health and, on rare occasions, lethal.

MDMA 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 circu-

latory problems or heart disease; and

other symptoms such as muscle tension,

involuntary teeth clenching, nausea,

blurred vision, faintness, and chills

or sweating.

What Treatment

Options Exist?

There are no specific treatments for

MDMA abuse and addiction. The most

effective treatments for drug abuse and

addiction in general are cognitive-

In high doses, MDMA can interfere with

the body’s ability to regulate tempera-

ture. On rare but unpredictable occa-

August 2008

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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 com-

bination with behavioral interventions to

support long-term, drug-free recovery.

There are currently no pharmacological

treatments for addiction to MDMA.

For the third year in a row, the younger

students surveyed reported a slightly

weaker attitude about the risks associated

with MDMA use. The proportion of 8th-

graders who perceived risk of harm from

using MDMA “occasionally” decreased

significantly, from 52.0 percent in 2006

to 48.6 percent in 2007; this proportion

also fell significantly among 10th-

graders, from 71.3 percent in 2006 to

68.2 percent in 2007. Perceived risk of

MDMA use remained unchanged for

12th-graders from 2006 to 2007.

How Widespread is

MDMA Abuse?

Monitoring the Future (MTF)

Survey ††

Between 2005 and 2007, past-year

abuse of MDMA increased among 12th-

graders, from 3.0 percent to 4.5 per-

cent; and between 2004 and 2007,

past-year abuse of MDMA increased

among 10th-graders, from 2.4 percent

to 3.5 percent.

National Survey on Drug Use

and Health (NSDUH) ††††

In 2006, an estimated 528,000 people

(0.2 percent of the population) in the

United States age 12 or older used

MDMA in the month prior to being sur-

veyed. Lifetime use increased among

individuals aged 12 years or older, from

4.3 percent in 2002 to 5.0 percent in

2006; however, past-year use of ecstasy

decreased from 1.3 percent to 0.9 per-

cent during the same 5-year period.

Approximately 860,000 Americans

used ecstasy for the first time in 2006,

which is a significant increase from the

615,000 first-time users reported in

2005. Most (70.1 percent) of these new

users were 18 or older; and among

past-year initiates aged 12 to 49, the

average age at initiation in 2006 was

20.6 years.

MDMA Use by Students

2007 Monitoring the Future Survey

8th Grade 10th Grade 12th Grade

Lifetime †††

2.3%

5.2%

6.5%

Past Year

1.5

3.5

4.5

Past Month 0.6

1.2

1.6

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† For more information, please visit www.clubdrugs.org and www.teens.drugabuse.gov .

For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit

www.whitehousedrugpolicy.gov/streetterms/default.asp .

†† These data are from the 2006 Monitoring the Future survey, funded by the National Institute on Drug Abuse,

National Institutes of Health, Department of Health and Human Services, and conducted annually by the University

of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes

since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at

www.drugabuse.gov .

††† “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during

the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days

preceding an individual’s response to the survey.

†††† NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age

12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest sur-

vey are available at www.samhsa.gov and from NIDA at 877-643-2644.

References

1 Ricaurte GA, 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, 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 para-

methoxyamphetamine (PMA). J Anal Toxicol 25(7):645–648, 2001.

National Institutes of Health – U.S. Department of Health and Human Services

This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.

August 2008

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