MDMA (Ecstasy)

MDMA is a synthetic, psychoactive drug with both stimulant (amphetamine-like) and hallucinogenic (LSD-like) properties. Street names for MDMA include Ecstasy, Adam, XTC, hug, beans, and love drug. Its chemical structure (3-4 methylenedioxymethamphetamine, "MDMA") is similar to methamphetamine, methylenedioxyamphetamine (MDA), and mescaline - other synthetic drugs known to cause brain damage.

MDMA also is neurotoxic. In addition, in high doses it can cause a sharp increase in body temperature (malignant hyperthermia) leading to muscle breakdown and kidney and cardiovascular system failure.

Health Hazards

Brain imaging research in humans indicates that MDMA causes injury to the brain, affecting neurons that use the chemical serotonin to communicate with other neurons. The serotonin system plays a direct role in regulating mood, aggression, sexual activity, sleep, and sensitivity to pain. Many of the risks users face with MDMA use are similar to those found with the use of cocaine and amphetamines:

• Psychological difficulties, including confusion, depression, sleep problems, drug craving, severe anxiety, and paranoia - during and sometimes weeks after taking MDMA.
  
  
• Physical symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, rapid eye movement, faintness, and chills or sweating.
  
  
• Increases in heart rate and blood pressure, a special risk for people with circulatory or heart disease.
  
  
• Also, there is evidence that people who develop a rash that looks like acne after using MDMA may be risking severe side effects, including liver damage, if they continue to use the drug.
  
  

Research links MDMA use to long-term damage to those parts of the brain critical to thought and memory. One study, in primates, showed that exposure to MDMA for 4 days caused brain damage that was evident 6 to 7 years later.

MDA, the parent drug of MDMA, is an amphetamine-like drug that has also been abused and is similar in chemical structure to MDMA. Research shows that MDA also destroys serotonin-producing neurons in the brain.

MDMA also is related in its structure and effects to methamphetamine, which has been shown to cause degeneration of neurons containing the neurotransmitter dopamine. Damage to these neurons is the underlying cause of the motor disturbances seen in Parkinson's disease. Symptoms of this disease begin with lack of coordination and tremors and can eventually result in a form of paralysis.

Extent of Use

Community Epidemiology Work Group (CEWG)*

In many of the 21 metropolitan areas monitored by CEWG members, MDMA, once used primarily at dance clubs, raves, and college scenes, is now being used in a number of other social settings.

It is the most prominent stimulant used in Chicago; it is sold in many singles bars in Denver; it is used by a wide variety of age groups and in a number of recreational settings in Atlanta; it has become the drug of choice among white middle class young adults in Washington, D.C. In Miami in 1999, there were eight MDMA-related deaths, and five in Minneapolis/St. Paul. In Boston during the first three quarters of 2000, MDMA was the most frequently mentioned drug in telephone calls to the Poison Control Center. MDMA is usually taken orally in pill form, but snorting has been reported in Atlanta and Chicago, as has injecting in Atlanta, and anal suppository use in Chicago.

Ecstasy content varies widely, and it frequently consists of substances entirely different from MDMA, ranging from caffeine to dextromethorphan.

Emergency room data indicate that MDMA is increasingly used by marijuana users, with reports of MDMA in combination with marijuana increasing from 8 in 1990 to 796 in 1999.*

Ecstasy tablets seized by the Drug Enforcement Administration increased from 13,342 in 1996 to 949,257 in 2000.

National Household Survey on Drug Abuse (NHSDA)***

Each year, NHSDA reports on the nature and extent of drug use among the American household population age 12 and older. The 1998 survey is the latest for data relating to MDMA use. It found that an estimated 1.5 percent (3.4 million) of Americans had used MDMA at least once during their lifetime. By age group, the heaviest use (5 percent or 1.4 million people) was reported for those between 18 and 25 years old.

Monitoring the Future Study (MTF)****

From 1999 to 2000, the use of MDMA increased among all three grade levels measured in this study - 8th, 10th, and 12th. For 10th and 12th graders, this is the second consecutive year MDMA use has increased. Past year use of MDMA increased among 8th graders from 1.7 percent in 1999 to 3.1 percent in 2000; from 4.4 percent to 5.4 percent among 10th graders; and from 5.6 percent to 8.2 percent among 12th graders. Also among 12th graders, the perceived availability of MDMA rose from 40.1 percent in 1999 to 51.4 percent in 2000.

African American students showed considerably lower rates of Ecstasy use than white or Hispanic students in the 2000 MTF. For example, past year use among African American 12th graders was 1.3 percent, compared to 7.6 percent for white 12th graders and 10.6 percent for Hispanic 12th graders.

"Ever used" refers to use at least once during a respondent's lifetime. "Past year" refers to an individual's drug use at least once during the year preceding their response to the survey. "Past month" refers to an individual's drug use at least once during the month preceding their response to the survey.

* CEWG is a NIDA-sponsored network of researchers from 21 major U.S. metropolitan areas and selected foreign countries who meet semiannually to discuss the current epidemiology of drug abuse. CEWG's most recent report is Epidemiologic Trends in Drug Abuse, Advance Report, December 2000.

** The 1999 Drug Abuse Warning Network (DAWN) emergency room (ED) data are from a national probability survey of 21 hospitals nationwide. The survey captures data on ED episodes that are related to the use of illegal drugs or the nonmedical use of legal drugs. The DAWN survey is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). Copies of the latest survey are available from the National Clearinghouse for Alcohol and Drug Information at 1-800-729-6686, or at http://www.samhsa.gov/.

*** The National Household Survey on Drug Abuse (NHSDA) is an annual survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). Copies of the latest survey (1999) are available from the National Clearinghouse for Alcohol and Drug Information at 1-800-729-6686, or at http://www.samhsa.gov/.

*** The Monitoring the Future (MTF) survey is funded by National Institute on Drug Abuse, National Institutes of Health, and is conducted 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. For the latest, year 2000 study, 45,173 students were surveyed from a representative sample of 435 public and private schools nationwide; the student response rate was 86%. For the latest survey results, please visit the NIDA website at http://www.drugabuse.gov/

1 U.D. McCann, et al. The Lancet, Vol. 352:1433. October 31, 1998.

2 G. Hatzidimitriou, et al. J. Neuroscience. 1999 19:5096-5107.