Ecstasy (MDMA)

E, XTC, X, MDMA, Love Doves

• Ecstasy is an illegal 'recreational' drug containing mainly MDMA (3,4-Methylenedioxy-N-Methylamphetamine).
• It is a Class A drug which means it is against the law to use it or supply it, and it cannot be prescribed by doctors.¹
• Other substances - some more dangerous than others - have been found contaminating tablets, including the amphetamine variants MDEA (Methyl Diethanolamine) and MDA (methlenedioxiamphetamine), lysergic acid diethylamide (LSD), ketamine, caffeine, and aspirin.²
• The appearance varies considerably from brown, white or pink tablets to yellow, clear, red and black or red and yellow capsules.
• Logos, pictures or designs are found on some preparations.
• Crystalline MDMA is also starting to appear.³

• Ecstasy was first made by two German chemists in 1912 and patented in 1914 in case some medical use could be found for it.
• The American military experimented with it in the 1950s and it was later employed by Swiss and American psychiatrists.
• As with other amphetamine-related drugs, it was already banned by the time it arrived in the UK in the 1980s, but its use nevertheless became widespread due to its stimulant and mood-altering properties. It was particularly associated with the House music and warehouse rave culture scene.

• A Home Office survey suggests a peak in ecstasy use in 2001, after which it has remained stable.
• 2% of people surveyed between the ages of 16-59 admitted to using it (614,000 in 2003), and it is the commonest used drug after cannabis among 16-24 year olds.
• There is considerable geographic variation, the highest use being in affluent urban areas.
• The street price of ecstasy has come down in recent years, no doubt contributing to its increased popularity.

• Ecstasy has stimulant and mild hallucinogenic properties and its effects have been described as taking a mixture of amphetamine and LSD.
• Onset takes between 20-60 minutes or longer, and the effects can last for several hours.
• Many users have reported an initial 'rushing' feeling, followed by a feeling of energy, lack of aggression, empathy with others, a greater appreciation of music, and increased sexual and sensual experience. It is this combination of effects plus the drug's ability to fight tiredness that have led to its popularity on the club and dance scene.

• Immediate adverse psychological effects are more likely if the user is already anxious or takes a high dose.
• Symptoms include anxiety, panic, confusion, and unpleasant distortion of the senses. These effects can last for days or even weeks.
• Organic symptoms include tightening of the jaw, nausea, sweating, loss of appetite and dry throat and mouth.³
• Objective physiological signs include dilation of the pupils, hypertension, and tachycardia.³
• The immediate post-drug period is often characterised by extreme tiredness, and users may require a long period of sleep, which may last several days (the 'comedown').
• Regular use can lead to sleep disturbance, anorexia, depression or anxiety.
• Physical dependence is not known, but psychological dependence can occur.³
• A considerable body of evidence is building to suggest that ecstasy has neurotoxic properties. This has certainly been demonstrated in animal studies up to primate level. Research suggests that consistent high dose use leads to loss of presynaptic neurones, affecting the regulation of impulsivity, and impairing decision making.⁶
• Ecstasy causes release of the neurotransmitter serotonin and inhibition of its re-uptake. This can in itself lead to serotonin syndrome, It is more likely to do so if taken with other drugs that increase serotonin levels. These include some antidepressants (serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, tricyclic antidepressants, mono-amine oxidase inhibitors), tramadol, certain opioids (including dextromethorpan and pethidine), other drugs of abuse (cocaine, amphetamines and LSD).
• Impairment of long- and short-term memory may also be a feature or prolonged use.^7,8
• Crystalline MDMA is thought to be the cause of several drug-induced seizures and overdoses, due to its high purity (95-100%).

Ecstasy Deaths

• The prevention of ecstasy abuse needs to be taken in the context of wider campaigns to reduce the use of illegal substances in the community, since crime prevention statistics confirm that if the supply of one drug is restricted, abusers simply switch to another drug.³ Initiatives such as the Drug Education and Prevention Service (DEPIS - see contact details below) have been set up to provide drug education and prevention in school and community settings.
• Testing kits designed to test that ecstasy pills are free from other contaminants are used in some clubs in Holland but have been criticised by the UK government as they appear to condone drug use. However, they have been marketed by a company in this country.¹³
• 'Safer dancing' campaigns are encouraging clubs to provide 'chill out' areas, ensure there is a plentiful supply of water and arranged for staff to have first aid training. However, the message still needs to get across that water should be sipped slowly (no more than a pint an hour) and not drunk quickly in large quantities.