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What is MDMA?
MDMA is an illegal drug that acts as both a stimulant and psychedelic, producing an energizing effect, as well as distortions in time and perception and enhanced enjoyment from tactile experiences.1,2 Typically, MDMA (an acronym for its chemical name 3,4-methylenedioxymethamphetamine) is taken orally, usually in a tablet or capsule, and its effects last approximately 3 to 6 hours. The average reported dose is one to two tablets, with each tablet typically containing between 60 and 120 milligrams of MDMA.1 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 can affect the brain by altering the activity of chemical messengers, or neurotransmitters, which enable nerve cells in the brain to communicate with one another. Research in animals has shown that MDMA in moderate to high doses can be toxic to nerve cells that contain serotonin and can cause long-lasting damage to them.1,3 Furthermore, MDMA raises body temperature. On rare but largely unpredictable occasions, this has led to severe medical consequences, including death.3,4 Also, MDMA causes the release of another neurotransmitter, norepinephrine, which is likely the cause of the increase in heart rate and blood pressure that often accompanies MDMA use.5,6
Although MDMA is known universally among users as ecstasy, researchers have determined that many ecstasy tablets contain not only MDMA but also a number of other drugs or drug combinations that can be harmful as well. Adulterants found in MDMA tablets purchased on the street include methamphetamine, caffeine, the over-the-counter cough suppressant dextromethorphan, the diet drug ephedrine, and cocaine.7,8 Also, as with many other drugs of abuse, MDMA is rarely used alone. It is not uncommon for users to mix MDMA with other substances, such as alcohol and marijuana.
A Brief History
of MDMA
MDMA was developed in Germany in the early 1900s as a parent compound to be used to synthesize other pharmaceuticals. During the 1970s, in the United States, some psychiatrists began using MDMA as a psychotherapeutic tool, despite the fact that the drug had never undergone formal clinical trials nor received approval from the U.S. Food and Drug Administration (FDA) for use in humans. In fact, it was only in late 2000 that the FDA approved the first small clinical trial for MDMA that will determine if the drug can be used safely with 2 sessions of ongoing psychotherapy under carefully monitored conditions to treat post-traumatic stress disorder. Nevertheless, the drug gained a small following among psychiatrists in the late 1970s and early 1980s, with some even calling it "penicillin for the soul" because it was perceived to enhance communication in patient sessions and reportedly allowed users to achieve insights about their problems. It was also during this time that MDMA first started becoming available on the street. In 1985, the U.S. Drug Enforcement Administration (DEA) banned the drug, placing it on its list of Schedule I drugs, corresponding to those substances with no proven therapeutic value.2
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What is the scope
of MDMA abuse in
the U.S.?
It is difficult to determine the exact scope of this problem because MDMA is often used in combination with other substances, and does not appear in some traditional data sources, such as treatment admission rates.
More than 11 million persons aged 12 or older reported using ecstasy at least once in their lifetimes, according to the 2004 National Survey on Drug Use and Health. The number of current (use in past month) users in 2004 was estimated to be 450,000.9
The Drug Abuse Warning Network, maintained by the Substance Abuse and Mental Health Services Administration, reported that mentions of MDMA in drug abuse-related cases in hospital emergency departments were 2,221 for the third and fourth quarters of 2003. The majority of patients who came to emergency departments mentioning MDMA as a factor in their admissions during that time were aged 18–20.10
There is, however, some encouraging news from NIDA’s Monitoring the Future (MTF) survey, an annual survey used to track drug abuse trends among adolescents in middle and high schools across the country. Between 2001 and 2005, annual ecstasy use decreased by 52 percent in 8th-graders, 58 percent in 10th-graders, and 67 percent in 12th-graders. Rates of lifetime MDMA use decreased significantly from 2004 to 2005 among 12th graders.
In 2005, 8th-graders reported a significant decrease in perceived harmfulness in using MDMA occasionally. The MTF data also show that MDMA use extends across many demographic subgroups. Among 12th-graders in 2005, for example, 3.9 percent of Whites, 3.0 percent of Hispanic students, and 1.4 percent of African-Americans reported using MDMA in the year prior to the survey.11
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