According to the book Ecstasy: The Clinical, Pharmacological and Neurotoxicological Effects of the Drug MDMA, ecstasy (MDMA: 3, 4-methylenedioxy-methamphetamine) is a drug that has the properties of both amphetamines (stimulant drugs/medications) and mescaline (psychedelic or hallucinogenic drugs). MDMA was originally used as a therapy aid for individuals in the treatment of psychological disorders. There are currently clinical trials investigating its use for the treatment of disorders like post-traumatic stress disorder.
One of the side effects of its use is that it produces euphoria and results in individuals being very open and social. Due to its tendency to make people feel sociable and “more in tune” with others, it became a popular drug on the nightclub scene used by young adults and adolescents.
Some of the more common street names for MDMA are ecstasy, X, E, XTC,Molly,Rolls.
- Ecstasy and Molly are different forms of MDMA. Manufacturers and users consider Molly to be a more pure form of MDMA, but this may not be true (see below regarding chemical analysis of varies types of MDMA).
- Molly most often is used as a powder, whereas ecstasy is taken a pill form. Both ecstasy and Molly contain MDMA in some form.
- A number of different research studies have analyzed various forms of MDMA and found that other substances are often in the pills or powder, such as amphetamines, cocaine, PCP, caffeine, and a number of other drugs. The concentration of MDMA in different forms of the drug and from different street manufacturers/suppliers varies considerably.
- Despite current research trials investigating MDMA’s utility as a therapeutic aid for post-traumatic stress disorder and other psychological disorders, the Drug Enforcement Administration has classified MDMA as a Schedule I drug. This means it has no known therapeutic value and a high potential for the development of addiction and abuse, and its use is potentially dangerous in humans.
- MDMA use results in the release of the neurotransmitters serotonin, dopamine, and norepinephrine, leading to a rush of energy and also resulting in hallucinogenic effects. When people take significant amounts of MDMA, this also leads to a number of potentially dangerous side effects.
- Chronic use of MDMA may alter various neurobiological pathways.
- MDMA use produces increased energy, feelings of empathy towards others, emotional warmth, and sensory distortions. After someone uses ecstasy, it is also not uncommon for them to experience a severe “crash” that consists of depression and emotional withdrawal 1-2 days later due to depletion of the aforementioned neurotransmitters.
Potential Effects of MDMA Use
Based on the research link above and many other different studies, there are a number of different side effects that occur with MDMA use. These can be divided into short-term effects and long-term effects. Short-term effects are outlined below.
- A major concern regarding MDMA use is that the drug is often taken in crowded venues, such as nightclubs. One potentially dangerous side effect from taking MDMA is hyperthermia, which is a rapid increase in body temperature. Taking large amounts of MDMA in a crowded, enclosed area, where the temperature is already going to rise, may result in a number of potential health issues due to overheating, dehydration, and related issues.
- In addition, the side effects of MDMA use include hyperactivity, clenching or grinding the teeth, blurred vision, nausea, muscle cramps, and excessive sweating.
- The “crash” that occurs several hours after one has used MDMA can lead to issues with depression, anxiety, insomnia, restlessness, and immediate issues with cognition that can result in the potential to make poor decisions or be involved in accidents (e.g., issues with attention and memory).
Over the long-term, there is evidence for some serious potential side effects.
- The massive release of neural transmitters when a person takes the drug results in a compensatory situation where there is a large depletion of available neurotransmitters following drug use. This results in the potential for alterations in neurobiology and neurochemistry that can result in some serious emotional and cognitive long-term issues.
- Other potential physical effects as a result of chronic use of MDMA include high blood pressure and other cardiovascular problems, such as arrhythmia (irregular heartbeat), the potential to develop renal issues (e.g., kidney failure), and potential liver damage.
The research is mixed on whether or not chronic use of MDMA produces physical dependence (having both the syndromes of tolerance and withdrawal). However, there is less controversy regarding the notion that MDMA is a potential drug of abuse and its chronic use/abuse can result in a substance use disorder. There is certainly the potential for chronic use of MDMA to produce a number of emotional, psychological, and behavioral symptoms that would indicate the presence of a substance use disorder. Individuals who appear to be most vulnerable to developing a substance use disorder as a result of MDMA abuse are between 16 and 24 years old.
Some of the signs an individual might be abusing MDMA include the following:
- The individual appears to have a sudden rush of energy and even appears to be hyperactive. This behavior is most often observed in social situations, such as in clubs, at parties, etc.
- In conjunction with the above symptoms, an individual suddenly appears to be able to dance for extremely long periods of time.
- The person also becomes uncharacteristically friendly and talkative, and displays unusual amounts of physical affection, such as hugging, kissing, etc.
- The person sweats excessively and overheats easily, but may complain of chills.
- The person stays awake for uncharacteristically long periods of time.
- The individual has dilated pupils and may display sensitivities to light and sound.
- In the morning, the person is uncharacteristically quiet, seems depressed, and becomes withdrawn.
- These patterns of extreme energy and being extremely social, followed by periods of withdrawal, apathy, depression, isolation, and irritability occur in conjunction with the individual going to nightclubs, parties, or other social gatherings. In the evening, they are extremely energetic and social, and the following day, they are withdrawn and seemingly depressed or down.
Treatment Options for the Abuse of Ecstasy
Ecstasy is a drug that is most often used in the context of socializing, especially with adolescents and younger adults. Because of the demographics of individuals who primarily use MDMA, a solid prevention program may be the most promising treatment approach. This would involve the use of high schools and universities to deliver the message regarding the facts about the dangers of ecstasy use. Peer-led advocacy groups and programs are likely the most effective means of delivery regarding prevention programs.
Certain drugs of abuse, such as alcohol, narcotic pain medications, and so forth, have well-developed and very structured approaches to treatment that are tailored for the specific factors associated with recovery from abuse of these types of drugs. There is no specific tailored approach for the treatment of MDMA abuse. Instead, the general blueprint regarding substance use disorder treatment would be the most efficient approach. This approach includes:
- The potential for initial inpatient or residential treatment: Even though the evidence regarding the potential of MDMA to produce physical dependence is mixed, there still may be rather severe emotional issues associated with discontinuation of the drug (e.g., the crash associated with MDMA use). An inpatient medically assisted detox program may be appropriate for some individuals as a result. Moreover, initial inpatient treatment can isolate individuals who have potentially toxic environmental issues that leave them vulnerable for relapse and give them a solid foundation in recovery.
- Medically assisted treatment: This care should be available throughout the recovery process to address specific issues that different individuals may have. These may include both psychological and medical issues.
- A formalized therapy or counseling component: This may consist of individual therapy, group therapy, or combination of both.
- Social support: This may come in the form of family therapy, 12-Step group participation, or other social support group participation.
- Aftercare: Long-term participation in some type of an aftercare program will help clients to avoid potential relapse in the future.