MDMA (Methylenedioxymethamphetamine), commonly referred to as ecstasy, was manufactured as a potential pharmaceutical early last century. It had some limited use in the 1970s as a therapeutic aid in trauma treatment and in relationship counselling, and more recent studies using MDMA for trauma have shown some promise.
Structurally, MDMA is similar to the stimulant methamphetamine and to the hallucinogen mescaline, and so has both stimulant and mildly hallucinogenic effects.
Most problems with recreational MDMA are acute. Dependence and other long-term problems are quite rare. Less than 1% of all drug treatment presentations are for ongoing problems with MDMA, such as dependence.
Most fatalities from taking ecstasy are a result of a combination of factors, not just the drug itself.
Most of these conditions don’t result in death if they are treated early, but because of the stigma associated with using illicit drugs, sometimes people don’t seek help early enough. Any unusual or unwanted symptoms experienced while taking ecstasy should be treated as soon as they appear.
Contaminants and polydrug use
Most people are under the impression drugs are illegal because they are dangerous, but a drug’s legal status isn’t necessarily related to relative danger. In fact, drugs are much more dangerous because they are unregulated, manufactured by backyard chemists in clandestine laboratories.
Unlike alcohol, which is a highly regulated drug, there’s no way to tell how potent illicit drugs are or what’s in them, unless you test them.
In Australia, what is sold as ecstasy may contain a lot of MDMA or very little. Pills can contain other more dangerous drugs that mimic the effects of MDMA, and benign substances, such as lactose, as filler agents.
A recent report on findings from Australia’s first official pill testing trial at the Groovin’ the Moo music festival last year, found nearly half the pills tested were of low purity. Some 84% of people who had their pills tested thought they had bought MDMA but only 51% actually contained any MDMA.
Some of the more dangerous contaminants found in pills include PMA (paramethoxyamphetamine), which is more toxic at lower doses than ecstasy; N-Ethylpentylone, a cathinone which is a lot more potent than MDMA making it easier to take too much; and NBOMes (N-methoxybenzyl), which is more toxic at lower doses than other hallucinogenic drugs and can cause heart attack, renal failure, and stroke.
Pills have also been detected in UK and NZ with up to three doses of MDMA in a single pill.
Although it’s possible to take too much MDMA and experience severe toxic effects, as with other illicit drugs, most ecstasy-related deaths involve multiple drugs.
Sometimes these drug mixes are unexpected and sometimes people take multiple drugs deliberately. It’s safer for people using ecstasy to limit use of other drugs, including alcohol, to avoid risk of adverse effects.
Heatstroke or hyperthermia (dangerously high body temperature) is one of the most common issues among people taking MDMA.
MDMA increases body temperature and sweating, and using it is often accompanied by physical activity (such as dancing) in a hot environment (such as a crowded venue or in the summer heat), exacerbating fluid loss. If you don’t have enough fluids your body can’t cool itself properly.
The effect of ecstasy can be exacerbated by consuming alcohol. Alcohol is a diuretic, so it makes you urinate more and increases dehydration. Dehydration increases risk of heatstroke.
People using MDMA can get really thirsty. Some is probably the direct effect of MDMA, some because they’re hot, and some from dehydration.
But if you have too much water the ratio of salts and water in the body becomes unbalanced – basically the level of salt in your body gets too low and your cells start swelling with water. The technical name is hyponatraemia.
MDMA is an anti-diuretic, so it makes you retain water, which can increase risk of water intoxication.
People may feel nausea with vomiting, confusion, severe fatigue, muscle weakness and cramps.
People taking ecstasy need to stay hydrated but only replace what is lost through sweating – around 500ml per hour if active and around 250ml an hour when inactive.
The main action of MDMA in the brain is an increase in serotonin, which among other things is responsible for regulating pro-social behaviour, empathy and optimism. This is why people who have taken MDMA feel connection with and positivity towards others.