MDMA is a stimulant and part of the amphetamine class of drugs. It is most commonly used in pill form, and known by its street name -‘ecstasy’. Pure MDMA however is a white crystal, and is sometimes used in this form. It is produced synthetically and first rose to prominence as a recreational drug in the 1980s in North America and Europe, when it became heavily associated with the club culture.
MDMA, or 3,4 Methylenedioxmephamphetamine, produces its ‘euphoric’ effects by acting on important neurotransmitters in the brain, namely seratonin, norepinephrine and dopamine. This process can later lead to prolonged bouts of lethargy and low mood. In frequent users there is growing evidence that MDMA may permanently affect mood, memory and cognitive function.
The history of MDMA dates back to 1912, when it was developed by German pharmaceutical company Merck as an ingredient used in the manufacture of a drug intended to suppress bleeding. At this point though no pharmacological testing took place.
MDMA’s transition to psychoactive recreational drug is widely accepted to have begun in the 1970s, when controversial American chemist Alexandra Shulgin and others tested and popularised the drug. At this time it was also used by some psychiatrists for therapeutic purposes.
Its use, amongst mainly young users, continued to grow throughout the 1980s and ‘90s. In the UK it became one of the most frequently used illegal drugs, with estimates ranging between 500,000 to two million ecstasy tablets consumed every week at peak levels.
Many reports suggest that the use of MDMA has declined in the UK recently, owing to reduced availability of the chemicals needed to manufacture the drug, and the rising popularity of alternatives such as mephedrone. In other parts of the world such as China, South East Asia and Australia, a 2010 report by the United Nations Office on Drugs and Crime found that use of MDMA is increasing.
MDMA is illegal in most countries under Schedule I one of the UN Convention on pyschotropic substances. It has been a Class A drug in the UK since 1977, and a controlled substance in the US since 1985.
Ecstasy tablets containing MDMA are often known simply as 'E' or 'X', but individual tablets have a wide variety of names and often carry logos. Street names include Disco Biscuits, Smarties and Scooby Snacks.
Many specific names for the tablets are region specific, relating to particular batches of the drug produced in illegal labs. These often mimic popular brand names such as Mitsubishi, MTV, Apple Macs and so on. Others are named after the picture on the tablet, hence the moniker Smileys, Smurfs, Blue Dragons etc.
Many of these tablets do not contain pure MDMA, and may be cut with everything from caffeine to ketamine. Some may contain no MDMA at all, instead using methamphetamine or another substance as the active ingredient. This dangerous ambiguity over their content adds to the risk factor of taking ecstasy.
In addition to ecstasy tablets, MDMA is sometimes sold in its pure crystalline form, and is usually eaten but is sometimes rubbed into the gums, or crushed and inhaled through the nose. Generic names for MDMA include Adam, Molly and Madman.
MDMA can have a profound negative effect on the user’s mood for days afterwards. An average dose will rapidly deplete the stores of serotonin in the brain, and these can take a week or more to replenish. During this time, particularly in the first day after taking MDMA, users report feeling depressed – what is often referred to as a ‘comedown’.
In frequent users, the body may constantly suffer from a drought of serotonin as a result of prolonged exposure to the effects, and this can lead to more serious depression.
Seratonin syndrome or poisoning may occur during use as a result of excessive free-flowing serotonin in the brain. This may be particularly prevalent when MDMA is mixed with another illegal or prescription drug that acts upon the serotonin system, triggering a range of symptoms from agitation and hallucinations to death in extreme cases.
The presence of other unknown drugs within many ecstasy tablets can lead to a high risk of suffering from serotonin syndrome, and is also a major risk in its own right.
MDMA use also carries a risk of accidental overdose, as some users will take additional doses of the drug before it is fully in effect, in anticipation of the ‘high’.
People with pre-existing health conditions, including heart and blood pressure problems or epilepsy, can also suffer serious complications from taking MDMA.
Because of its use in hot energetic environments such as clubs, MDMA users may also be at risk from severe dehydration. Conversely because MDMA affects the body’s urinary system, water intoxication can be a risk, and has led to death in a number of cases.
MDMA is a man-made drug, and is synthesised principally from safrole oil, a natural product of the sassafras plant of North America and a number of other plants. Safrole and its derivatives also have some legitimate uses, including the manufacture of some pesticides and perfumes.
In addition to safrole, MDMA production requires a variety of other chemical precursors including isosafrole, piperonal and a substance known as PMK. These chemicals can also be synthesised from safrole oil.
Suitable laboratory equipment and a high level of knowledge and skills in chemistry are also required to manufacture MDMA. Many of the needed chemical precursors for producing MDMA are themselves controlled substances under international law.
The needed raw ingredients for MDMA are smuggled in large quantities around the world from their sources of origin to the underground labs that will use them to synthesise crystalline MDMA powder. In some cases this powder will be sold on to other illegal manufacturers who will simply press it into tablets, often lacing it with a variety of other chemicals. These tablets are then bought by dealers, who will in turn sell it on the street as ‘E’.
Thus, MDMA production is not constrained to any particular country, group of countries or regions, but is spread throughout the world via the underground distribution of the ingredients required for its synthesis, and the setting up of secret drug labs.
Synthesis of the drug occurs in illegal laboratories around the world. In a 2008 report on laboratory seizures by the United Nations Office on Drugs (UNODC) and Crime, illegal laboratories producing MDMA were reported in Canada, the US, Belgium, Germany, Holland, China, India and Australia.
In recent years, following a crackdown on the raw chemicals used to manufacture MDMA, production has declined or even halted in many western countries. However this has led to the illegal drug manufacturers using other similar or unrelated drugs to make ecstasy tablets, which are then sold to unsuspecting users who believe they are buying MDMA. Such ‘substitute’ drugs include MDA and PMA.
A 2011 report by the UNODC into the international drug problem found that seizures of MDMA-producing laboratories in Western Europe declined rapidly from the turn of the millennium, from almost 50 in 2000 to just 1 in 2009. Comparatively other regions, such as South America and South East Asia and Australasia, reported that production and laboratory seizures increased over the same period, indicating a major geographic shift in the production of ecstasy.
These underground laboratories are often set up close to areas of high demand, in or close to major cities with thriving club cultures. But ecstasy tablets are also trafficked overseas from their point of origin, often great distances.
In the past, the main trafficking routes for MDMA in tablet and powder form has been from illegal labs in Western European countries to other countries in the region, and to other areas of the world as far-flung as Russia, South Africa, Egypt, Argentina, US and Canada. Sources of the drug from these latter two are also known to traffick MDMA in North America and to other regions.
A person’s moods are perhaps the most visible sign of MDMA abuse, though they may be hard to distinguish from ordinary mood swings and conditions such as depression.
When under the influence of the drug, the user will most likely appear euphoric - extremely happy, more than normally empathetic with strangers and their environment. Their outlook on life may seem at odds with their normal everyday personality, and they may appear to be much more ‘in the moment’, with little regard for future concerns.
But MDMA is not a drug that can be or is taken on a daily basis, and is instead a ‘party drug’, generally used on weekends or special occasions. This is because it rapidly depletes reserves of serotonin in the brain, which must then be replenished. When there is a lack of serotonin available in the body, the drug will have little or no effect.
The ‘high’ experienced by MDMA users when under the influence of the drug is generally followed by a ‘comedown’ effect, as in many cases the brain will have access to less serotonin than it did before the tablet or crystals were taken. This will manifest itself in low mood, fatigue, and even varying degrees of depression. This low period may last anything from a day to a week, and in chronic users may become particularly noticeable.
Unusual or disrupted sleep patterns, in conjunction with other symptoms and behaviour, may be a sign of MDMA abuse. Memory and cognitive ability may also be impeded.
Unlike some other drug addictions, there are no pharmaceutical treatments available for MDMA abuse. There are, however, cognitive and psychological therapies that can help the user to break the cycle that leads to abuse of the drug.
For many frequent users of MDMA, the drug creates within them a psychological dependency in which they are constantly seeking to recapture the euphoric ‘high’ and exhilaration that it gives them. Thus treatment is very much focused on the patient’s mindset and helping them to confront the role that MDMA has in their lives, and to find ways of coping with life without the drug.
MDMA can form an addictive cycle in the individual, because of the oscillations between highs and lows during regular use. Because taking an ecstasy tablet or using MDMA crystals is generally followed by a period of euphoria, the user comes to associate this artificial sense of intense wellbeing with the drug. This psychological conditioning often discounts the fact that the corresponding low moods following use are also a product of the drug.
This psychological reward-based addiction to the drug is the primary cause of abuse, and so it is also at the heart of treatment.
Cognitive Behavioural Therapy (CBT) is one approach to treatment that may be used. This focuses on the reasons why the individual feels compelled to take MDMA, explores alternative behaviours available to them, and helps them to enact these. If there are underlying psychological factors that lead them to depend on MDMA to make them feel good, these may also be addressed by CBT and other talking therapies.
Counselling in private sessions or as part of a group may form an important part of treatment. Hypnosis which aims to change the MDMA-seeking behaviour and thoughts of the individual may also be an effective form of treatment.
Treatment for MDMA addiction can take place as an outpatient, attending regular counselling sessions and help groups. But a treatment programme may also be undertaken as an inpatient in a drug rehabilitation centre.
In-house rehab programmes enable users to detox in controlled conditions, before beginning a comprehensive programme intended to break their dependency on the drug and teach them alternative ways of living without it. Fortunately, MDMA does not lead to severe withdrawal symptoms, such as those experienced during detox from alcohol or narcotics, but the patient may go through a period of depression and agitation after cessation.
Treatment in this way can help to ensure successful recovery from the addiction, and prevent further relapses.
What is important is that, whatever form the treatment takes, it is adapted to the needs of the individual. In the same way that each individual has their own reasons for taking the drug, the methods with which they break free of its influence will vary too.
In some cases, MDMA use may be part of a larger drug-related lifestyle involving other substances, and a successful treatment programme will seek to uncover and treat these related addictions as well.
The patient will also be assessed for any long-term damage done by the drug, and if there is any corrective treatment that may be given this may be administered.