Ecstasy: How Safe Is It?

MDMA (3,4-methylenedioxy-methamphetamine) or “Ecstasy” is a psychoactive drug with many unique effects. Adolescents and young adults use it for its euphoriant, energy, sensual arousal, and bonding effects. It is an amphetamine-like stimulant (heightened activity, alertness, heart rate, blood pressure), a hallucinogenic (distorts sensory, time perception, enhances tactile sensations), and an “ectactogen” (enhances emotional warmth and empathy toward others).

Although considered a party drug and used at “raves,” the use of ecstasy has expanded to college campuses and other venues. In 2013, use of ecstasy in grades 10 and 12 was higher than that of cocaine, reflecting a diminishing perception of its harmful effects.

Use Patterns

MDMA is usually swallowed in pill form (50 to 150 mg capsule or tablet) and, rarely, by crushing the pills and insufflating (snorting) or injecting the powder. Tolerance to the effects of ecstasy can develop over time, compelling users swallow 2 to 6 tablets at once or stagger use of several tablets in a short period of time. Within 45 minutes of consumption, the effects appear and then wane in 3 to 6 hours. Ecstasy tablets may not be pure, and can be adulterated by contaminants, fillers, and other drugs (e.g., cocaine, amphetamines, cathinones) that are harmful and are an added risk.

Immediate Effects and Long-Term Consequences

Ecstasy is not a benign drug; the list of potential short and long-term adverse consequences is growing. In 2011, there were 22,498 Emergency Department mentions related to ecstasy. High doses of ecstasy can interfere with body temperature regulation, leading to dangerously sharp rises in temperature, especially if combined with use in a hot room, with hours of dancing, and insufficient hydration. This rare, unpredictable rise in body temperature can lead to liver, kidney, cardiovascular failure and severe muscle damage. Ecstasy can also produce tremors, involuntary teeth clenching, muscle cramps, increased heart rate, blood pressure, and blurred vision. Alarming psychological effects in susceptible individuals report confusion, anxiety, depression, and paranoia, which can persist for weeks.

Ecstasy use can cause significant psychological damage, as a function of use patterns: the accumulated amount used (lifetime number of doses used), the frequency of use (times per day/week/month/year), the intensity of use (number of pills/session), and the environment (temperature, water supply, physical activity).

Immediately after consumption, ecstasy enters the brain and lodges in brain areas with high populations of nerve cells that produce serotonin, norepinephrine and dopamine. Serotonin is a critical target of the drug: it is a chemical message (neurotransmitter) implicated in modulating a wide range of brain functions—mood, depression, appetite, memory, sleep, and release of hormones involved in stress, love, trust, sexual arousal, socialization. During normal brain function, serotonin is released at nerve endings and activates a variety of targets (serotonin receptors) in the brain. After completing this task, serotonin is transported back into nerve endings and stored for future release. As an “imposter of serotonin,” ecstasy is transported into nerve cells and stored in serotonin storage vessels. Ecstasy interferes with serotonin transport and storage, causing an unnatural, massive release and accumulation of serotonin. Serotonin receptors become flooded with these signals, accounting for the immediate psychological effects of ecstasy.

But by this very action, ecstasy depletes serotonin in the brain, accounting for the “hangover” effect of ecstasy—depression, sleep problems, drug craving, and anxiety, cognitive impairment—that can last days or weeks after the last dose has cleared. With cumulative use, the human brain gradually adapts to, and in some cases undergoes significant change and damage. Chronic use of ecstasy can produce a loss of serotonin nerve endings in former abusers. Seven brain imaging studies performed in various countries, have shown a loss of serotonin nerve ending in heavy users, long after the last dose. Even six doses reportedly affect brain structure.

What is the functional significance of these observable changes? A number of studies demonstrate that ecstasy use increases the risk of long-term problems with memory, attention, sleep, depression, and learning.

The prevalence of addiction among adult users is lower than for other drugs (~ 5 to 6%). As with other drugs, the risks for an ecstasy use disorder (addiction) is greater among adolescents. In 12- to 17-year-olds, prevalence of addiction exceeds 20% and is double the prevalence of cocaine addiction in this same age range.

Overall, because ecstasy it is a neurotoxin that can affect, subtly or robustly, higher brain function, its use is considered an unsafe practice. Some researchers are interested in exploring whether ecstasy can ameliorate post-traumatic stress disorder or other medical indications. The therapeutic potential of ecstasy for chronic medical conditions needs to be weighed against mounting evidence of its neurotoxic effects and whether these are permanent or reversible.