Effects of Ecstasy Pills and MDMA
Effects Classification: Euphoric Empathogen; Stimulant; Phenethylamine
Common Names: MDMA, Ecstasy; Extacy Pills, E; X; XTC; Rolls; Beans; Adam, Tabs
Chemical Name: 3,4-methylenedioxymethamphetamine
Description: MDMA is one of the most popular recreational psychoactives, most commonly sold in the form of “ecstasy” tablets. It is known for its empathogenic, euphoric, and stimulant effects, and has also been used in psychotherapy.
What is Ecstacy?
MDMA, or ‘Ecstasy Pills’ are a ‘psychedelic amphetamine’ that has gained popularity over the past 20 years because of its ability to produce strong feelings of comfort, empathy, and connection to others. It most frequently comes in tablet form, although it is also found in capsules or as powder. It is most frequently used orally and rarely snorted. MDMA use is closely tied to the underground rave (and dance club) scene throughout the world, but has also been widely used by therapists as an adjunct to psychotherapy.
Because MDMA is so popular and because it goes well with dance parties, the demand for it usually exceeds supply–especially at any given location on any given night. This creates an opening for unscrupulous individuals to sell virtually anything as ‘ecstasy’. While ‘ecstasy’ is the popular name for MDMA, the functional definition of ecstasy is any pill represented as MDMA on the street. Ecstasy pills are notoriously unreliable in content, more so than most other street drugs, and commonly contain either caffeine, ephedrine, amphetamines, MDA, MDE, DXM, or–in rare cases–DOB, and don’t necessarily contain MDMA or any psychoactive. This problem has led to the development of simple MDMA testing kits that may help give the user a general sense of the content of a pill.
The primary effects attributable to MDMA consumption are predictable and fairly consistent amongst users. Generally, users report feeling effects within 30–60 minutes of consumption, hitting a peak at approximately 1–1.5 hours, reaching a plateau that lasts about 2–3 hours, followed by a comedown of a few hours which may be accompanied by fatigue and minor effects.
The most common effects reported by users include:
- A general and subjective alteration in consciousness
- A strong sense of inner peace and self-acceptance
- Diminished aggression, hostility, and jealousy
- Diminished fear, anxiety, and insecurity
- Extreme mood lift with accompanying euphoria
- Feelings of empathy, compassion, and forgiveness towards others
- Feelings of intimacy and even love for others
- Improved self-confidence
- The ability to discuss normally anxiety-provoking topics with marked ease
- An intensification of all of the bodily senses (sound, touch, smell, vision, hearing)
- Substantial enhancement of the appreciation for quality of music
- Mild psychedelia, consisting of mental imagery and auditory and visual distortions
- Stimulation, arousal, and hyperactivity (e.g., many users get an “uncontrollable urge to dance” while under the influence)
- Increased energy and endurance
- Increased alertness, awareness, and wakefulness
- Increased desire, drive, and motivation
- Analgesia or decreased pain sensitivity
Ecstasy Side effects
In January 2001, an overview of the subjective side effects of MDMA was published by Liechti, Gamma, and Vollenweider in the journal Psychopharmacology. Their paper was based on clinical research conducted over several years involving 74 healthy volunteers.
The researchers found that there were a number of common side effects and that many of the effects seemed to occur in different amounts based on gender. The top side effects reported were difficulty concentrating, jaw clenching, grinding of the teeth during sleep, lack of appetite, and dry mouth/thirst (all occurring in more than 50% of the 74 volunteers).
Liechti, et al. also measured some of the test subjects for blood pressure, heart rate, and body temperature against a placebo control. No statistically significant changes were seen.
Effects reported by some users once the acute effects of MDMA have worn off include:
- Anxiety and paranoia
- Impaired attention, focus, and concentration, as well as drive and motivation (due to depleted serotonin levels)
- Residual feelings of empathy, emotional sensitivity, and a sense of closeness to others (afterglow)
- Dizziness, lightheadedness, or vertigo
- Loss of appetite
- Gastrointestinal disturbances, such as diarrhea or constipation
- Aches and pains, usually from excessive physical activity (e.g., dancing)
- Jaw soreness, from trismus or bruxism
When they occur, these after subacute effects are typically reported to last up to 3 to 7 days, with the exception of depression, which in some cases has become chronic.
Extasy Health Risks
While the short-term adverse effects and contraindications of MDMA are fairly well known, there is significant debate within the scientific and medical communities regarding possible long-term physical and psychological effects of MDMA.
Short-term health concerns
Short-term physical health risks of MDMA consumption include hyperthermia, and hyponatremia. Continuous activity without sufficient rest or rehydration may cause body temperature to rise to dangerous levels, and loss of fluid via excessive perspiration puts the body at further risk as the stimulatory and euphoric qualities of the drug may render the user oblivious to their energy expenditure for quite some time. Diuretics such as alcohol may exacerbate these risks further. Although one study argues that MDMA itself causes fluid retention and increased body temperature, while alcohol is a diuretic and lowers the body temperature. Therefore, it is possible that a small amount of alcohol may help counteract a few of the adverse effects of MDMA.
Long-term effects on serotonin and dopamine
MDMA causes a reduction in the concentration of serotonin transporters (SERTs) in the brain. The rate at which the brain recovers from serotonergic changes is unclear. One study demonstrated lasting serotonergic changes in animals occurring due to MDMA exposure. Other studies have suggested that the brain may recover from serotonergic damage.
Some studies show that MDMA may be neurotoxic in humans. Other studies, however, suggest that any potential brain damage may be at least partially reversible following prolonged abstinence from MDMA. However, other studies suggest that SERT-depletion arises from long-term MDMA use due to receptor down-regulation, rather than true neurotoxicity. Depression and deficits in memory have been shown to occur more frequently in long-term MDMA users. However, some recent studies have suggested that MDMA use may not be associated with chronic depression.
p>One study on MDMA toxicity, by George A. Ricaurte of Johns Hopkins School of Medicine, which claimed that a single recreational dose of MDMA could cause Parkinson’s Disease in later life due to severe dopaminergic stress, was actually retracted by Ricaurte himself after he discovered his lab had administered not MDMA but methamphetamine, which is known to cause dopaminergic changes similar to the serotonergic changes caused by MDMA. Ricaurte blamed this mistake on a labeling error by the chemical supply company that sold the material to his lab, but the supply company responded that there was no evidence of a labeling error on their end. Most studies have found that levels of the dopamine transporter (or other markers of dopamine function) in MDMA users deserve further study or are normal.
Several studies have indicated a possible mechanism for neurotoxicity in a metabolite of MDMA, through the reaction of Alpha-Methyldopamine, a principle metabolite, and Glutathione, the major antioxidant in the human body. One possible product of this reaction, 2,5-bis-(glutathion-S-yl)-alpha-methyldopamine, has been demonstrated to produce the same toxic effects observed in MDMA, while MDMA, and alpha-methyldopamine themselves have been shown to be non-neurotoxic. It is however, impossible to avoid the metabolism of MDMA in the body, and the production of this toxic metabolite. Some studies have demonstrated possible ways to minimize the production of this particular metabolite, though evidence at this point is sparse at best.
Purity and dosage of “ecstasy”
Another concern associated with MDMA use is toxicity from chemicals other than MDMA in ecstasy tablets. Due to its near-universal illegality, the purity of a substance sold as ecstasy is unknown to the typical user. The MDMA content of tablets varies widely between regions and different brands of pills and fluctuates somewhat each year. Pills may contain other active substances meant to stimulate in a way similar to MDMA, such as amphetamine, methamphetamine, ephedrine, or caffeine, all of which may be comparatively cheap to produce and can help to boost overall profits. In some cases, tablets sold as ecstasy pills do not even contain any MDMA. Instead they may contain an assortment of presumably undesirable drugs and substances, such as paracetamol, ibuprofen, talcum powder, etc.
There have been a number of deaths attributed to PMA, a potent and highly neurotoxic hallucinogenic amphetamine, being sold as ecstasy pills. PMA is unique in its ability to quickly elevate body temperature and heart rate at relatively low doses, especially in comparison to MDMA. Hence, a user who believes he is consuming two 120 mg pills of MDMA could actually be consuming a dose of PMA that is potentially lethal, depending on the purity of the pill. Not only does PMA cause the release of serotonin, but also acts as a monoamine oxidase inhibitor, MAOI. When combined with an MDMA or an MDMA-like substance, serotonin syndrome can result. Combining MAO inhibitors with certain legal prescription and over the counter medications can also lead to (potentially fatal) serotonin syndrome.
MDMA was first synthesized in 1912 by Merck chemist Anton Köllisch. At the time, Merck was interested in developing substances that stopped abnormal bleeding. Merck wanted to evade an existing patent, held by Bayer, for one such compound: hydrastinine. At the behest of his superiors Walther Beckh and Otto Wolfes, Köllisch developed a preparation of a hydrastinine analogue, methylhydrastinine. MDMA was an intermediate compound in the synthesis of methylhydrastinine, and Merck was not interested in its properties at the time. On 24 December 1912 Merck filed two patent applications that described the synthesis of MDMA and its subsequent conversion to methylhydrastinine.
Over the following 65 years, MDMA was largely forgotten. Merck records indicate that its researchers returned to the compound sporadically. In 1927, Max Oberlin studied the pharmacology of MDMA and observed that its effects on blood sugar and smooth muscles were similar to ephedrine’s. Researchers at Merck conducted experiments with MDMA in 1952 and 1959. In 1953 and 1954, the United States Army commissioned a study of toxicity and behavioral effects in animals of injected mescaline and several analogues, including MDMA. These originally classified investigations were declassified and published in 1973. The first scientific paper on MDMA appeared in 1958 in Yakugaku Zasshi, the Journal of the Pharmaceutical Society of Japan. In this paper, Yutaka Kasuya described the synthesis of MDMA, a part of his research on antispasmodics.
MDMA was being used recreationally in the United States by 1970. In the mid-1970s, Alexander Shulgin, then at University of California, Berkeley, heard from his students about unusual effects of MDMA; among others, the drug had helped one of them to overcome his stutter. Intrigued, Shulgin synthesized MDMA and tried it himself in 1976. Two years later, he and David Nichols published the first report on the drug’s psychotropic effect in humans. They described “altered state of consciousness with emotional and sensual overtones” that can be compared “to marijuana, and to psilocybin devoid of the hallucinatory component”.
Shulgin took to occasionally using MDMA for relaxation, referring to it as “my low-calorie martini”, and giving the drug to his friends, researchers, and other people whom he thought could benefit from it. One such person was psychotherapist Leo Zeff, who had been known to use psychedelics in his practice. Zeff was so impressed with the effects of MDMA that he came out of his semi-retirement to proselytize for it. Over the following years, Zeff traveled around the U.S. and occasionally to Europe, training other psychotherapists in the use of MDMA. Among underground psychotherapists, MDMA developed a reputation for enhancing communication during clinical sessions, reducing patients’ psychological defenses, and increasing capacity for therapeutic introspection.
In the early 1980s in the U.S., MDMA rose to prominence as “Adam” in trendy nightclubs and gay dance clubs in the Dallas area. From there, use spread to raves in major cities around the country, and then to mainstream society. The drug was first proposed for scheduling by the Drug Enforcement Administration (DEA) in July 1984 and was classified as a Schedule I controlled substance in the U.S. on 31 May 1985.
In the late 1980s MDMA, known by that time as “ecstasy”, began to be widely used in the UK and other parts of Europe, becoming an integral element of rave culture and other psychedelic-influenced music scenes. Spreading along with rave culture, illicit MDMA use became increasingly widespread among young adults in universities and later in high schools. MDMA became one of the four most widely used illicit drugs in the U.S., along with cocaine, heroin, and cannabis. According to some estimates as of 2004, only marijuana attracts more first time users in the U.S.
After MDMA was criminalized, most medical use stopped, although some therapists continued to prescribe the drug illegally. Later Charles Grob initiated an ascending-dose safety study in healthy volunteers. Subsequent legally-approved MDMA studies in humans have taken place in the U.S. in Detroit (Wayne State University), Chicago (University of Chicago), San Francisco (UCSF and California Pacific Medical Center), Baltimore (NIDA–NIH Intramural Program), and South Carolina, as well as in Switzerland (University Hospital of Psychiatry, Zürich), the Netherlands (Maastricht University), and Spain (Universitat Autònoma de Barcelona).
In 2010 the BBC reported that use of MDMA had decreased in the UK in previous years. This is thought to be due to increased seizures and decreased production of the precursor chemicals used to manufacture MDMA. The availability of legal alternatives to MDMA such as mephedrone is also thought to have contributed to its decrease in popularity.