MDMA is a stimulant drug, part of the amphetamine group. Better known by its street name, ecstasy, it often comes in pill form. It is also sometimes used in its pure, white crystal form. This synthetically produced substance became widely used as a recreational drug in the 1980s in North America and Europe, mainly in nightclubs.
MDMA, or 3,4 methylene-dioxy-N-methylamphetamine, produces its “euphoric” effects by acting on the brain’s main neurotransmitters: serotonin, norepinephrine and dopamine. This process can later lead to prolonged periods of lethargy and depression. In regular users, there is now evidence that MDMA can permanently affect mood, memory and cognitive function.
The history of the drug dates back to 1912, when it was developed by a German pharmaceutical company, Merck, as an ingredient in a drug to stop bleeding. However, at that time, no pharmacological trials were conducted.
It is generally accepted that MDMA became a psychoactive recreational drug in the 1970s, when the controversial American chemist Alexander Shulgin and others of his ilk tested and popularized the drug. It was already being used by some psychiatrists for therapeutic purposes.
Its use, especially among young people, continued to increase throughout the 1980s and 1990s. In the United Kingdom, it has become one of the most popular illegal drugs, with an estimated 500,000 to 2 million ecstasy tablets consumed each week during peak periods.
Numerous reports show that MDMA use has recently declined in the UK, due to the reduced availability of the chemicals needed to make the drug and the growing popularity of its alternatives, such as mephedrone. In other parts of the world, such as China, Southeast Asia and Australia, a 2010 report by the United Nations Office on Drugs and Crime (UNODC) indicates that MDMA use is increasing.
MDMA is illegal in most countries under Schedule I of the United Nations Convention on Psychotropic Substances. It has been considered a Class A drug in the United Kingdom since 1977 and a controlled substance in the United States since 1985.
Ecstasy tablets containing MDMA are often abbreviated as “E” or “X” but individual tablets have different names and often have logos. Street names include “disco cookies”, “Smarties” or “scoopy snacks”.
Many of the names given to the tablets are specific to each region and are linked to the batches manufactured in the clandestine laboratories. They often parody popular brand names such as Mitsubishi, MTV, Apple, Mac, etc. Others take the name of the illustration on the tablet: smileys, Smurfs, Blue Dragons, etc.
Many of these tablets do not contain pure MDMA and can be cut with any substance, from caffeine to ketamine. Some do not contain MDMA at all, but methamphetamine or another substance as the active ingredient. These ambiguous contents add to the risk of taking ecstasy.
In addition to ecstasy tablets, MDMA is sometimes sold in its pure crystalline form. It is then ingested, or even rubbed on the gums or crushed and inhaled through the nose. Generic names for MDMA include Adam, Molly and Madman.
MDMA can have a particularly negative effect on users’ moods several days later. An average dose quickly depletes the brain’s serotonin stores, which can take a week or more to replenish. During this period, especially the day after taking the drug, users feel depressed. This is often referred to as the “crash”.
In regular users, the body may suffer from a permanent lack of serotonin due to prolonged exposure to the effects, which can lead to deeper depression.
Serotonin syndrome, or serotonin poisoning, can occur during use because of excess free serotonin in the brain. This frequently occurs when MDMA is mixed with another illegal or prescription drug that acts on the serotonin system, triggering a series of symptoms ranging from agitation to hallucinations and even death in extreme cases.
The presence of other unknown drugs in many ecstasy tablets puts users at major risk for serotonin syndrome, but is also a risk in itself.
MDMA use also poses a risk of accidental overdose, as some users take additional doses before the drug has fully kicked in and made them “high.
In addition, taking MDMA can lead to serious complications in people with existing health problems, including heart or blood pressure problems or epilepsy.
Because of its consumption in very hot and energetic environments, such as nightclubs, users can also expose themselves to severe dehydration. Conversely, because MDMA affects the urinary system, there is a risk of water intoxication, which has already resulted in a number of deaths.
MDMA is a man-made drug. It is mainly synthesized from safrole oil, a natural product derived from the North American plant called sassafras and several other plants. Safrole and its derivatives also have legitimate uses, including the manufacture of certain pesticides and perfumes.
In addition to safrole, MDMA production requires several other precursor chemicals, including isosafrole, heliotropin and a substance called PMK. These chemicals can also be synthesized from safrole oil.
On the other hand, the manufacture of MDMA requires appropriate laboratory equipment and significant chemical knowledge and skills. Many of the precursor chemicals required are themselves regulated by international law.
The raw ingredients required to manufacture MDMA are trafficked internationally in large quantities from their original source to clandestine laboratories, which use them to synthesize crystalline MDMA powder. In some cases, this powder is sold to other illegal manufacturers, who simply press it into tablets, often mixing it with various chemicals. These tablets are then purchased by traffickers, who sell them on the street under the name “E”.
MDMA production is therefore not limited to any one country, group of countries or region. It takes place all over the world, through the clandestine distribution of the ingredients necessary for its synthesis and the installation of secret laboratories.
The synthesis of the drug takes place in illegal laboratories all over the world. According to a report on laboratory dismantling published by the UNODC in 2008, clandestine laboratories have been discovered in Canada, the United States, Belgium, Germany, Holland, China, India and Australia.
In recent years, as a result of a stricter crackdown on the raw chemicals used to make MDMA, production has declined or even ceased in many Western countries. However, this has prompted illegal manufacturers to use other drugs (similar or not) to make ecstasy tablets, which are then sold to unsuspecting users who believe they are buying MDMA. These “substitutes” include MDA and PMA.
According to a 2011 UNODC report on the world drug problem, MDMA production lab dismantlements have declined rapidly in Western Europe since Y2K, from nearly 50 in 2000 to just 1 in 2009. In comparison, other regions such as South America, Southeast Asia, and Australasia have seen an increase in production and dismantlements over the same period, indicating a major geographic shift in ecstasy production.
These clandestine labs are often located near areas of high demand, in or around major cities where the nightlife scene is thriving. But ecstasy tablets are also exported far from their point of origin.
In the past, the main trafficking routes for MDMA tablets and powder were from illegal laboratories in Western European countries to other countries in the region or to other parts of the world as far away as Russia, South Africa, Egypt, Argentina, the United States and Canada. In the latter two countries, suppliers are also known to supply North America and other regions.
FACTS AND STATISTICS
MDMA is a synthetic stimulant.
It is illegal in most countries under national and international law.
In its raw form, it is a whitish crystal, which is usually pressed into tablets and mixed with other substances.
MDMA goes by many names, including ecstasy, E, X, Molly and Adam. The tablets have different names and are often decorated with a logo.
MDMA is usually taken in pill form, but it can also be ingested or inhaled in its crystalline form.
It gets the user “high” by stimulating the release of serotonin (one of the mood chemicals) in the synapses between brain cells. This serotonin then binds to the corresponding receptors on the adjoining cells and provides the temporary feeling of euphoria and happiness described by users.
Some of the adverse effects experienced include: anxiety, paranoia, mental confusion, psychosis and nausea.
The high from MDMA is usually followed by a “crash” period triggered by a decrease in serotonin in the brain. A feeling of depression may persist for several days after use, while regular users may be at a higher risk of depression.
The effects of a single ecstasy pill vary in duration and intensity depending on the amount of pure MDMA it contains and the other substances added. On average, the effects can last between 3 and 6 hours, but this depends on the individual and the amount taken.
MDMA is mostly taken by well-to-do young people in nightclubs, raves and similar places.
MDMA can be very addictive psychologically.
As of 2009, the United Nations estimates of the number of ecstasy users in each region of the world are as follows
Africa: 390,000 to 1900,000 (0.1 to 0.3% of 15-64 year olds)
North America: 320,000 (1.1%)
South America: 50,000 to 50,000 (0.2%)
Central America: 20,000 to 30,000 (0.1%)
Asia: 230,000 to 17,330,000 (0.1 to 0.6%)
Europe: 380,000 to 39,200,000 (0.7%)
Oceania: 850,000 to 90,000 (3.6 to 4%)
For a total of 110,850,000 to 280,000,000 users worldwide (0.2 to 0.6% of 15-64 year olds). As MDMA use is illegal, these are of course only estimates.
In 2008, a British crime survey found that 1.5% of 16-59 year olds had used ecstasy in the past year, a sharp drop from 2% in 2003.
The same study found that 3.9% of Britons aged 16-24 had used ecstasy in 2008.
Approximately 0.3% of the U.S. population (750,000 people) aged 12 years or older admitted to using ecstasy in 2009.
In the United States, MDMA use is particularly high in Los Angeles County, where the number of people admitting that it was their drug of choice when they entered a detoxification center increased by 650% between 2005 and 2009.
Between 2003 and 2007, the United Kingdom recorded 69 deaths due to ecstasy.
In the United States, the average price of an ecstasy tablet is $10-15 (€7-11) per unit, making it one of the most affordable “club drugs.
In the United States, 5542 emergency room admissions in 2001 were related to MDMA use.
Between 1994 and 2001, the number of annual deaths due to this drug increased from 1 to 76 in the United States.
SIGNS OF ADDICTION
The individual’s moods are perhaps the most visible sign of MDMA abuse, although it can be difficult to distinguish between ordinary mood swings and a pathology such as depression.
Under the influence of the drug, the user will most likely appear euphoric, extremely happy and more empathetic than normal towards strangers and their environment. His or her outlook on life may seem different from his or her usual personality, and he or she may appear to be living more “in the moment,” without much concern for future worries.
But MDMA is not a drug that can be taken or is actually taken on a daily basis. It is more of a “party drug”; consumed on weekends or special occasions. It quickly depletes the brain’s serotonin reserves, which must then be replenished. When the organism lacks serotonin, the drug gets few effects (if any).
The “high” experienced by MDMA users while on the drug is usually followed by a “crash” effect, as the brain often has less serotonin than before taking the pill or crystals. This manifests itself as low mood, fatigue and even depression of varying degrees. This period of gloom can last from one day to one week and can be particularly noticeable in regular users.
Sleep disorders associated with other symptoms and behaviours can be a sign of MDMA abuse. Finally, memory and cognitive functions may be impaired.
Unlike other drug addictions, there is no pharmaceutical treatment for MDMA abuse. However, cognitive and psychological therapies can help the user to end the addiction.
For many regular users, MDMA is psychologically addictive, with the user constantly seeking the euphoria and exhilaration that the drug provides. Treatment is therefore particularly focused on the patient’s state of mind and aims to help them become aware of MDMA’s place in their lives and find a way to cope with life without the drug.
MDMA can create a cycle of addiction in the individual, due to the alternating highs and lows generated by regular use. Because a period of euphoria usually follows the taking of an ecstasy pill or MDMA crystals, the user comes to associate this artificial feeling of intense well-being with the drug. This psychological conditioning often causes the user to forget that the depression that follows the use is also generated by the drug.
This reward-based psychological addiction is the primary cause of abuse and is also the focus of treatment.
Cognitive behavioral therapy (CBT) is one of the possible treatment methods. It focuses on why the individual feels compelled to use MDMA, examines the alternative behaviors that are available to him or her, and helps him or her to practice them. If there are underlying psychological factors that lead the individual to depend on MDMA to feel good, CBT and other talk therapies may address this as well.
Private or group counseling sessions can be an important part of treatment. Hypnosis, which aims to change the individual’s drug-seeking behavior and thoughts, can also be effective.
Treatment for MDMA addiction can be done on an outpatient basis, by attending regular counseling sessions and support groups. However, the treatment program can also involve a stay in a detox center.
These inpatient programs allow users to detox under controlled conditions, before beginning a comprehensive program designed to end the drug addiction and teach them how to live without it. Fortunately, MDMA does not cause significant withdrawal symptoms like alcohol or narcotics, but the patient may experience depression and agitation after withdrawal.
These in-house treatments help to ensure that the patient is cured and does not relapse.
The most important thing is that the treatment, in whatever form, is tailored to the individual’s needs. Just as each person uses drugs for different reasons, the methods of recovery vary.
In some cases, MDMA use is part of a larger addiction involving other substances. The treatment program will need to identify these other addictions and address them as well.
Finally, the long-term damage caused by the drug to the patient will be assessed and remedial treatment will be administered as appropriate.