Pregnancy Category None

Uses. MDMA was discovered and patented in Europe as World War I began, intended to make soldiers feel less hungry. In civilian usage the drug was supposed to help people lose weight, but other effects portended the product's commercial failure, and it never went on the market. Those other effects attracted attention in the 1960s and 1970s among therapists and recreational drug users alike.

MDMA intensifies sensory sensations (taste, touch, etc.), alters old understandings of what people observe, and allows people to feel distant from themselves. Some users experience self-insights and closer emotional attachment to other persons. Generally the drug does not appear to act as an aphrodisiac, but users report enhanced sexual experiences while under the influence. In therapeutic doses, which may be lighter than those taken by recreational abusers, effects occur without hallucinations and without causing apparent mental cloudiness while intoxicated. Before being banned by the U.S. Drug Enforcement Administration (DEA), doses were given to encourage patients to participate more freely in psychotherapy discussions—a usefulness that still found advocates in the 1990s—and to facilitate understandings among patients, understandings that helped reduce their problems. Underground knowledge of psychiatric usage persists despite an absolute legal prohibition against using the compound: Medical literature reports someone illegally taking the drug for self-medication of posttraumatic stress disorder.

In the history of abused drugs, psychological benefits claimed by proponents have often been deflated by scientific investigation. MDMA is no exception. Psychological tests have compared polydrug users who have or have not taken MDMA and also persons who have abstained from any illicit drug. These tests find no difference among these groups in anger, anxiety, or mood. Whatever feelings of peacefulness that recreational MDMA users experience while intoxicated, those results do not seem to persist afterward. Indeed, experimenters who gave these tests found the MDMA group to have more psychological trouble than the nondrug group. In such findings a key question is whether the drug caused psychic problems or whether problems caused the drug use. Staff members at a Spanish hospital's psychiatric service reviewed a substantial amount of medical literature about MDMA users and observed that the case reports did not sustain a conclusion that MDMA was the primary cause of users' psychiatric problems.

One significant exception exists in findings about MDMA's limited value in promoting personal insight and healthy integration with the world. That exception comes with persons using the drug for spiritual purposes rather than recreationally. Here the all-important influence of set and setting are demonstrated. Spiritual users tune in to certain kinds of psychic effect promoted by the drug and apparently are able to focus their attention so intensely that they can disregard and be unaffected by psychological effects that trouble recreational abusers. This situation appears to demonstrate a principle familiar to historians of drug use, who find that a substance can be beneficial in a particular cultural context and yet have catastrophic consequences when used by someone who disregards that context. Any spiritual purpose for which MDMA may be used will, of course, have no impact on the drug's physical actions, although persons who seldom use it may be spared various hazards documented by scientists.

MDMA is legally classified as a hallucinogen, but it is pharmacologically classified as an entactogen—a type of drug with both stimulant and hallucinogenic qualities. MDMA is recreationally used more for its hallucinogenic actions than for stimulant actions. It is an analog to MDA and related to MDEA, amphetamine, methamphetamine, and mescaline. MDMA is described as mellower than MDA, and some users experience MDMA as less potent than mescaline. MDMA can alter perceptions of time and space and induce feelings of peacefulness. Users typically understand that MDMA hallucinations (such as floating in midair or seeing geometrical designs) are unreal; users normally do not undergo a temporary psychosis in which the sensations are misper-ceived as objective reality.

After recreational use became publicized, MDMA was made a Schedule I controlled substance. Despite that ban, during the 1990s MDMA was popular at high-energy all-night rave dance parties, not only for psychic actions but for enabling people to go without sleep, food, and drink while physically exerting themselves. A person using MDMA in that way will likely feel complete exhaustion when the drug experience ends. The compound reduces pain and promotes talkativeness, factors that might be appealing at raves.

The Drug Abuse Warning Network (DAWN) tracks "mentions" of illicit drugs in hospital emergency room cases. A "mention" means that examination of a patient showed traces of a drug, not that the drug caused injury. DAWN thereby helps track a drug's popularity. In 1993 MDMA had 196 DAWN mentions; in 1998 the total was 143,600. As the twenty-first century began, the DEA reported 750,000 doses being consumed each week in just the New Jersey and New York City areas.

Drawbacks. Scientific literature portrays MDMA as a drug of extremes, producing pleasures and afflictions that either enrapture or kill users. Compared to many other drugs, much more is known about MDMA's hazards simply because so many persons have used it and received medical aid when things went badly. The volume of medical emergencies, however, is more than just a statistical phenomenon caused by sheer numbers of users. Some drugs used even more widely do not generate nearly as many medical complaints. MDMA really is more dangerous than many other substances.

One problem in evaluating MDMA dangers, a problem openly acknowledged by some scientists, is the challenge of confirming that a sick person indeed ingested MDMA a month ago rather than a fake substitute. All sorts of substances can produce effects similar to those of MDMA, which is why illicit dealers can so easily sell fake merchandise. Nonetheless, researchers investigating drug actions can often enough verify that MDMA is the actual substance. The following information reflects the scientific consensus about MDMA.

It has the physical and mental actions typical of amphetamine. A group of persons who at one time or another used amphetamine, LSD, and MDMA said they felt most pepped-up with amphetamine, least so with LSD, but had the greatest euphoria and contentedness with MDMA. Another group comparing amphetamine and MDMA reported MDMA to have fewer drawbacks. The DEA considers the drug less addictive than cocaine or heroin.

The substance degrades thinking processes. In tests of alertness, memory, learning, and intelligence a group of marijuana users performed as well as nonusers of marijuana, while a group that had used both marijuana and MDMA did worse. MDMA causes persistent and even permanent organic changes in the brain. Grand mal brain seizures have been attributed to the substance. Brain damage observed in MDMA users is consistent and is related to how much drug has been used (size of dose and frequency with which the drug is taken). Psychological tests verify that persons with such damage have trouble remembering things that are seen and heard, although the brain damage has not been proven to cause the memory difficulty. Whatever the precise cause, in memory tests polydrug users who have taken MDMA do worse than those who have never taken the compound. Evidence exists that MDMA re duces attention span and interferes with reasoning. The drug produces brain injury suspected of increasing someone's impulsiveness. In tests comparing polydrug users who have used MDMA with those who have not, MDMA users show increased impulsiveness correlating with how much they have used the drug. Interviews comparing polydrug users find the MDMA group more prone to paranoia, to physical complaints lacking any apparent bodily cause, to nervousness and unfriendliness, to phobias, and to obsessing on various things. Panic disorder with agoraphobia (fear of open spaces) can occur.

MDMA has various influences on blood. The drug is suspected of causing anemia. Under the influence of MDMA, blood components may block vessels, having the effect of tiny clots that can cause internal bleeding, evidenced by purple spots on the skin. Blood clots in the brain and death of cerebral tissue have been credited to MDMA. Autopsies have shown massive blood clotting throughout organs, accompanied by skeletal muscle deterioration.

Many other hazards exist. MDMA increases body temperature, sometimes enough to mimic heat stroke, and animal experiments indicate that temperatures in surroundings or inside the body can affect the amount of brain damage caused by MDMA. The drug boosts pulse rate. Initially a dose increases blood pressure (sometimes enough to burst vessels in the brain), but later, as the effects of a dose proceed, blood pressure falls below the user's original reading (a decline that can promote fainting). MDMA can create heart malfunction, kidney failure, and liver disease. Liver cirrhosis and failure can result—sometimes treatable, sometimes fatal. Cramps and muscle tics have been observed, even including one case where Parkinson's disease developed. Cases are reported of MDMA causing pneumomediastinum, an ailment involving severe breathing difficulty. The drug promotes nausea. Hazy eyesight and a case of temporary double vision caused by MDMA have been reported. Jaw clenching and grinding after taking the drug result in excessive tooth wear; one study of teeth in MDMA users found enamel completely worn away from some areas, an affliction seen far less often in people who did not use the drug. MDMA can cause skin rash and pimples.

Gender difference in drug effect is possible. One survey of case reports noted that men tended to use more MDMA than women did, and an experiment found that at any given dose the drug seemed to harm verbal memory more in men than in women. Another experiment showed male users having more change in two measures of brain chemistry function than females did. An experiment with rats showed males maintaining higher blood levels of the drug than females did, while females experienced more increase in body temperature than male rats did.

Abuse factors. In a survey of 100 American university students, two thirds said that desirable actions declined and undesirable ones increased as MDMA use continued; similar results came from a survey of 100 users in Australia, and scientists studying the drug concur with those survey findings. As with other potent stimulants, abusers are known to use MDMA in binges, taking one dose after another before the previous ones wear off. Heavy MDMA users have scored low in measures of harm avoidance, and MDMA use correlates with unprotected male homosexual conduct. Such findings raise the question of cause and effect: Does MDMA promote reckless behavior, or are self-destructive users simply indifferent about all sorts of life hazards, of which MDMA is only one?

Flashbacks are reported, with case reports mentioning time lengths ranging from less than one minute to two hours.

Drug interactions. Taking MDMA together with the drug saquinavir (used against human immunodeficiency virus [HIV] in AIDS [acquired immunodeficiency syndrome]) may be dangerous; usage with the HIV/AIDS drug ritonavir can be fatal. Untoward reaction with the antidepressant fluoxetine (Prozac) is suspected, and reaction with the antidepressant phenelzine sulfate (a monoamine oxidase inhibitor—MAOI) can produce excessive blood pressure, heavy sweating, muscle tics, and rigidity. Such perils are quite possible with any other MAOI. Keeping in mind the need to be cautious about extrapolating animal experiments to humans, we can note that taking MDMA with LSD (candyflipping) produces a multiplier effect intensifying MDMA actions in rats. Chloral hydrate permits some MDMA action in rats while reducing subsequent organic brain change. Also in rats MDMA boosts pain relief provided by morphine. In male rats the malaria and heart drug quinidine can increase MDMA's tendency to raise body temperature. Alcohol allegedly reduces some effects sought by MDMA users, but that belief has not received general scientific sanction. Scientists have confirmed that alcohol increases MDMA's reduction of immune system function, which may increase risk of infections. Physicians treating MDMA overdose find that water can worsen dangerous effects, and these doctors have concluded that people should not drink much liquid of any sort while using the drug (hard advice for sweaty and overheated dancers).

Cancer. Not enough scientific information to report.

Pregnancy. Scientists who studied what happened with 49 women who used MDMA while pregnant were unable to reach any conclusions about influence on fetal development. The researchers did conclude that the women's lifestyles routinely included assorted factors perilous to achieving healthy offspring—tobacco smoking, consuming alcohol to excess, unwanted pregnancy. A study of 136 women who used MDMA while pregnant noted an incidence of birth defects much higher than normal (15.4% versus normal 2% or 3%), but the usual confounding factors, such as polydrug abuse and unwanted pregnancy, hindered conclusions about effect on fetal development. Rat experiments confirm maternal brain damage but have not found brain damage in offspring even though their behavior differs in some respects from rats whose mothers receive no MDMA during pregnancy. An experiment with chickens found no MDMA effect on measured aspects of embryo development.

Additional information. "Benzedrine," "biphetamine," "dexedrine," "iboga" (ibogaine), and "khat" are nicknames for MDMA, but none of those substances is MDMA.

Additional scientific information may be found in:

Downing, Joseph. "The Psychological and Physiological Effects of MDMA on Normal Volunteers." Journal of Psychoactive Drugs 18 (1986): 335-39.

Gouzoulis-Mayfrank, E., et al. "Impaired Cognitive Performance in Drug Free Users of Recreational Ecstasy (MDMA)." Journal of Neurology, Neurosurgery, and Psychiatry 68 (2000): 719-25.

Greer, G., and R. Tolbert. "Subjective Reports of the Effects of MDMA in a Clinical Setting." Journal of Psychoactive Drugs 18 (1986): 319-27.

McGuire, P. "Long Term Psychiatric and Cognitive Effects of MDMA Use." Toxicology Letters 112-13 (2000): 153-56.

Rochester, J.A., and J.T. Kirchner. "Ecstasy (3,4-Methylenedioxymethamphetamine): History, Neurochemistry, and Toxicology." Journal of the American Board of Family Practice 12 (1999): 137-42.

Shulgin, A.T. "The Background and Chemistry of MDMA." Journal of Psychoactive Drugs 18 (1986): 291-304.

Vollenweider, F.X., et al. "Psychological and Cardiovascular Effects and Short-term Sequelae of MDMA ("Ecstasy") in MDMA-Naive Healthy Volunteers." Neuropsychopharmacology 19 (1998): 241-51.

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