Ecstasy or MDMA (methylenedioxymethamphetamine) is a popular “club drug” with stimulant and hallucinogenic effects. It produces feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception.

Ecstasy was first used in the 1970s as an aid in psychotherapy (mental disorder treatment using “talk therapy). The drug didn’t have the support of clinical trials or approval from the US Food and Drug Administration. In 1985, the US Drug Enforcement Administration labeled MDMA as an illegal drug with no recognized medicinal use. 

Some researchers remain interested in the value of the drug in psychotherapy when it is given in controlled conditions. Recently, a team of researchers has moved into the phase III trials for Ecstasy to be used as treatment of Post-Traumatic Stress Disorder or PTSD and expects approval from the Food and Drug Administration (FDA) by 2021. It is also in clinical trials as a possible treatment for anxiety in terminally ill patients and for social anxiety in autistic adults.

Prescription Name and Overview

Currently, Ecstasy (MDMA) is a schedule 1 narcotic according to the Drug Enforcement Administration (DEA). Abuse rate is scheduled from 1-5, with 1 having the highest abuse rate, and 5 having the lowest rate. A schedule 1 narcotic means it has the highest potential for abuse and the biggest potential to create severe psychological and/or physical dependence.

Since Ecstasy or MDMA is still a schedule 1 narcotic, this means it is considered to have “no currently accepted medical use” and has a “high potential for abuse”. 

Generic Name and Overview

3,4-methylenedioxymethamphetamine (MDMA) is a synthetic drug that alters one’s awareness of surrounding objects and conditions. It alters mood and is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception.

OTC  Name and Overview

Manufacturer

Ecstasy was originally developed by Merck Pharmaceutical company in 1912 and was originally known as MDMA (methylenedioxymethamphetamine). It was first used as a psychotherapy drug. 

In the 1980s, the name “Ecstasy” began the general name for dealers selling the drugs with similar effects. However, the drugs that were sold this time may in fact have very little or no MDMA at all. 

Labeled Indications

As of 2017, Ecstasy or MDMA has no accepted medical indications. An indication means there is a valid reason for the drug to use a certain test, medication, or procedure. 

However, before Ecstasy was banned, it was used by the US Army in 1953 in psychological warfare tests and in the 1960s was used as a psychotherapy medication to “lower inhibitions”.

Active Ingredients

Methylenedioxymethamphetamine is the active ingredient of Ecstasy. 

What Is It Used For?

How Does it Work?

People who use this drug usually take it orally though some swallow it in liquid form or snort the powder. Most of the packaging of this drug present it as colorful tablets with cute logos. 

The National Institute on Drug Abuse states that Ecstasy (MDMA) increases the activity of three brain chemicals: 

• Dopamine- produces increased energy/activity and acts in the reward system to reinforce behaviors
• Norepinephrine- increases heart rate and blood pressure, which are particularly risky for people with heart and blood vessel problems
• Serotonin- affects mood, appetite, sleep, and other functions. It also triggers hormones that affect sexual arousal and trust. The release of large amounts of serotonin likely causes the emotional closeness, elevated mood, and empathy felt by those who use it. 

What are the Approved Uses?

There are no approved uses for this drug. However some researchers have recently moved into the 3rd phase of testing the drug for post-traumatic stress disorder, anxiety, depression, and long-term alcohol addiction. This team of researchers say they expect approval from the Food and Drug Administration for the drug by 2021.

Production Anecdotes / History

In 1912, a German pharmaceutical company first created MDMA for the purpose of making an appetite suppressant. By the end of 1970, it was rediscovered by a small team of therapists in the United States for use in marriage counselling and psychotherapy. In the late 1980s up to early 1990s, Ecstasy became popular as a recreational drug and abuse of the drug became popular in the United States. When 1988 came, it was categorized as a Schedule I drug, and became illegal. 

Ecstasy soon became produced illegally and became popular at large dance parties with electronic music and blinking lights–raves, and was largely abused there. Soon, it became the popular illicit drug at house parties, college dorms, and other places where people gather for fun. 

Precautions

Today, what is called “Ecstasy” may contain an assortment of substances that may include LSD, cocaine, heroine, amphetamine and methamphetamine, rat poison, caffeine, dog deworming substances, and other unknown ingredients. And while MDMA itself can produce harmful effects, no one can exactly pinpoint the extent of the damages the wide mixture of dangerous substances the modern-day Ecstasy may produce. Despite the cute logos and packaging of the pills, these unknown mixtures are actually what makes Ecstasy particularly dangerous; a user may never know what he/she is actually taking. This danger is worsened when a user doubles the dose seeking a previous high, without considering that the pill that he/she is now taking may contain an entirely different mixture of drugs from the previous one. 

Long-Term Use Considerations

Continuing studies are still being made regarding the precise mental and physical outcomes of Ecstasy. There is no exact way to know how Ecstasy would affect a person given the varied ingredients it comes with today, but listed below are comprehensive effects that a person should consider before taking this drug:

• Psychological Difficulties- excessive intake of the drug can deplete the ability of the mind to produce serotonin. Since Ecstasy pushes neurotransmitters into overdrive, several instances of consumption may start to wear down the neurotransmitter systems in the brain. 

Irregularities in serotonin production may lead to what doctors call the Serotonin Syndrome. This manifests through insomnia, mood swings, depression, and lack of appetite. Suicide can be a result of withdrawal symptom of Ecstasy. 

• Physical Weakness- when a person stops taking the drug, the body will experience fatigue and weakness. Muscle cramps, increase in heart rate, increase in blood pressure, and teeth grinding ay occur. 
• Liver Problems- Ecstasy users develop a peculiar acne on the face which is linked to liver damage. These manifestations outside the body point to damage to the liver. 
• Drug Impurity- drug dealers use fillers to increase the size of a batch of drugs they sell. Without chemical inspection, it is hard to trace the exact ingredients that are mixed into the drug. As a result, these impurities in the drug causes users to take in harmful substances under the guise of Ecstasy. These unknown additives may include meth, ketamine, caffeine, heroin, and MDA. 

Drug Interactions

Drug interactions happen when a substance that you are taking changes or disrupts a drug’s intended function. Interactions may be harmful to you, increase your risk for serious side effects, or inhibit a drug from functioning properly. Always consult a doctor if you are going to start a medication with a new drug. 

Can Interact with the Following

Today’s Ecstasy pills have varied unknown ingredients that may include cocaine ketamine, methamphetamine, over-the-counter cough medicine, synthetic cathinones (bath salts), floor cleaner, rat poison, etc.These substances may be extremely dangerous if the person does not know what he/she is taking. This may be more dangerous when combined purposely or unknowingly with marijuana, alcohol, and other substances. Mixing this drug with other substances may cause overdose or death.

Can’t Interact with the Following

Since there are no approved uses of the drug, taking the drug by itself is dangerous. Mixing this with other substances may increase the harmful risks of this drug.

When To Stop Taking

Since this drug has no legal use and is a banned substance, it is recommended to stop taking the drug immediately. 

Long-Term Side Effects

Long-term effects of Ecstasy (MDMA) include:

• Long-lasting Confusion
• Depression
• Problems with attention, memory, and sleep
• Drug craving 
• Increased anxiety
• Impulsiveness
• Less interest in sex
• Paranoia
• Possible depletion of serotonin and memory
• Death 

Ecstasy-related deaths were largely due to dehydration and heat exhaustion as a result of dancing in hot clubs without replenishment of lost body fluids. These two causes are the biggest dangers when a person is under the influence of Ecstasy. 

FDA Warnings (History Of)

Ecstasy is illegal in most countries. And since it has no approved uses, it is banned by the Drug Enforcement Administration. 

FDA has not acknowledged it as a drug nor has approved it in clinical trials so far. However, this changed in 2017, when the FDA has acknowledged MDMA a breakthrough therapy for PTSD, stating that the drug shows promise in treating the disorder. It is still in the 3rd phase of clinical trials, and FDA will decide about it’s status soon. 

Other Common Side Effects

• Dehydration
• Hyperthermia
• Bruxism (Grinding and clenching of teeth)
• Increased wakefulness (insomnia)
• Increased perspiration and sweating
• Increased heart rate and blood pressure
• Increased psychomotor activity
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Erectile dysfunction
• Visual and auditory hallucinations (rare)
• Mydriasis
• Trismus
• Loss of appetite
• Tiredness or lethargy
• Anxiety or paranoia
• Depression
• Irritability
• Impulsiveness
• Restlessness
• Memory Impairment
• Anhedonia
• Lowered Inhibition
• Enhanced sensory perception

Lawsuits

As an illegal drug, suppliers and manufacturers of these drugs make sure that the drugs cannot be traced back to them. Most of the lawsuits involving Ecstasy focus on the establishments or festival promoters where the overdose or emergency situations happen. 

In 2015, an overdose happened during the Electric Daisy Carnival in Las Vegas which was promoted by Insomniac and Live Nation. While the festival was in full swing, Nicholas Tom, a teenager, overdosed on Ecstasy. He was frantically stretchered out of the crowd but died in a medical tent during the event. Nicholas Tom’s father sued the festival promoters, alleging that the staff was untrained and water was not available in sufficient quantities to handle the emergency. This lawsuit for wrongful death and negligence is still ongoing. 

Other Ecstasy-related lawsuits have also been filed against other establishments, alleging that the deaths of the victims could have been prevented if only there are trained and prepared medical staff on hand.

Tracy Everhart

Tracy Everhart is the Editor for Drug Law Journal. A highly-trained and certified medical professional, Tracy is also an accomplished medical writer. After spending years on the front lines of the medical profession, Tracy now devotes her expertise and skills to researching and reporting on new drugs and devices that enter the market, as well as their side-effects and the real-life stories involved. Prior to joining Drug Law Journal, Tracy wrote for benchmark online healthcare resources focused on families and, in particular, women’s health issues. Tracy holds post-graduate degrees from both the American College of Healthcare Sciences and the Yale School of Nursing. She is also a graduate of both Hampshire College, where she studied microbiology and the University of South Carolina school of nursing.