What Kind of Drug Is It?
MDMA, best known as ecstasy, is a drug usually taken in pill form, often in social settings such as parties, clubs, or raves. (A rave is a wild overnight dance party that typically involves huge crowds of people, loud techno music, and illegal drug use.) By 2004, however, ecstasy use had spread beyond the party scene. According to the Office of National Drug Control Policy of the Executive Office of the President: "[R]esearch indicates that the use of MDMA is moving to settings other than nightclubs, such as private homes, high schools, college dorms, and shopping malls."
The illegal substance produces a variety of effects on behavior and basic metabolism (bodily function). Some of these effects are temporarily pleasant. The user may feel happy, more in tune with others, and more energetic. Other effects are not so welcome. These include clenched jaws, dehydration, and dangerous fever.
Although some drugs have a long history of use and abuse, ecstasy is a relatively new arrival on the illegal drug scene. The earliest studies in people and animals do indicate that ecstasy has a lasting effect on its users in terms of depression, memory loss, and impulsive behavior. Depression is a mood disorder that causes people to have feelings of hopelessness, loss of pleasure, self-blame, and sometimes suicidal thoughts.
Official Drug Name: 3, 4-methylenedioxymethamphetamine (METH-uhleen-die-OCK-sy-meth-am-FETT-uhmeen); almost always referred to by shortened names MDMA or ecstasy
Also Known As: ADAM, booty juice, disco biscuits, E, essence, hug drug, rave, roll, Scooby snacks, X, XTC
Drug Classifications: Schedule I, stimulant with hallucinogenic properties
Ecstasy was named a Schedule I substance by the U.S. government in 1985. Basically, that means that scientists have not found any safe medical use for the drug. Its production, sale, and consumption are illegal, and this affects the quality of each individual pill. Ecstasy is a synthetic drug, meaning that it is made in a laboratory—it does not occur in nature. It is created from chemicals. These laboratories operate in secret, with no official medical or government agency regulating or checking on the quality, dosage, or even the composition of the pills. Sold on the street, the ecstasy pills might also contain such substances as caffeine, dextromethorphan (deks-troh-meth-ORR-fan), or a dangerous hallucinogen called PMA. (Entries for caffeine, dextromethorphan, and PMA are also available in this encyclopedia.)
Ecstasy behaves differently than other controlled substances. Some scientists call it an "entactogen" (ent-AK-tuh-jenn), meaning that it enhances feelings of kindness, well-being, and empathy or understanding. Others call it a stimulant—a substance that increases the activity of a living organism or one of its parts. In the body, ecstasy works like a combination of amphetamines and hallucinogens. Like amphetamines, it stimulates users, making them more likely to dance for long periods and interact with others in a most outgoing way. Like hallucinogens, ecstasy heightens sensations, particularly those having to do with happiness and intimacy.
In his book Illegal Drugs: A Complete Guide to Their History, Chemistry, Use and Abuse, Paul M. Gahlinger quoted a frequent ecstasy user who said: "E makes shirtless, disgusting men, a club with broken bathrooms, a deejay that plays crap, and vomiting into a trash can the best night of your life."
Ecstasy use increased every year between 1990 and 2001. With that increase came a better understanding of the drug's pitfalls and how it affected human beings over time. Current statistics indicate that ecstasy use is declining as those experimenting with it have become aware of its dangers. Deaths among ecstasy users have been reported in the United States, Australia, Canada, and the United Kingdom.
Ecstasy, or MDMA, was first created in 1910 by German scientists studying amphetamines. Merck, a German pharmaceutical company, took out a patent on the chemical in 1914. Some sources say the company thought MDMA might be useful to suppress appetite. Whether it was studied for this purpose or not, it showed little usefulness and was nearly forgotten for half a century.
The drug resurfaced in the 1950s during the Cold War (1945–1991), an era that saw extreme tension between the United States and the former Soviet Union as the two competed for world dominance. Throughout the 1950s, scientists in the United States studied a number of amphetamines and hallucinogens for use in chemical warfare. MDMA, then known as EA-1475, was one of the drugs tested by the U.S. Army Office of Strategic Services (a precursor to the Central Intelligence Agency, or CIA). Since the army was searching for drugs that would produce psychotic or violent behavior, MDMA proved useless. Again it drifted into disuse.
The compound surfaced again in the laboratory of American chemist Dr. Alexander T. "Sasha" Shulgin (1925– ) in the 1960s. Shulgin, according to the London-based Guardian Unlimited news service, has tested and synthesized some 200 psychoactive substances during his lifetime. Reporter Dan Glaister noted: "Shulgin seems destined to be remembered for one small episode in 1965 when, tipped off by a student about an interesting but forgotten compound, he synthesised MDMA." Shulgin created his own batch of MDMA and experimented on himself and others in his inner circle of friends and colleagues who were willing to try unknown drugs. His belief, after using MDMA, was that it might have some value as a drug for mental disorders. He especially thought that MDMA might help people to "open up" about troubling events in their lives that they did not want to discuss otherwise.
In the 1960s and 1970s, MDMA was not an illegal substance, but it also was not being manufactured by any drug company. Some chemists made small batches that were used by psychiatrists,
especially in California. At first the medical community in California was excited about the drug that seemed to heighten feelings of closeness and connectedness in patients. But as the drug drifted into recreational use, animal testing indicated that it destroyed brain cells. The doctors backed away, but the drug had found a following among college students. In those days it was commonly known as ADAM, a scrambling of MDMA.
Ecstasy's Popularity Soars
The identity of the person who first called the drug "ecstasy" has been lost to history. However, it is commonly believed that a drug pusher coined the term. Various sources note that MDMA was once called "empathy," which described the drug's effects on some users. But the name was later changed to "ecstasy" to make it sound more appealing. The word ecstasy comes from the Greek word ekstasis, meaning to be outside of oneself or outside of one's body. The name caught on as the drug became ever more popular on college campuses.
Gahlinger estimates that in 1976, private laboratories produced about 10,000 doses per month. By 1985, that number had risen to 50,000 doses per month. And then demand simply skyrocketed. Time magazine reported that in December of 1999, drug agents seized 1.2 million tablets of ecstasy in a single bust in Los Angeles. U.S. customs agents confiscated 9.3 million tablets in 2000, a small fraction of the total sold and consumed that year. In April 2005, as reported by ABC News Online, "Australian … authorities found 5 million ecstasy tablets, with a street value of more than $250 million, in a shipment of tiles." That was the biggest single bust of ecstasy on record as of that date.
Ecstasy Found at Raves:
The popularity of ecstasy coincided with a new type of all-night dance party called a "rave." Beginning in 1987 on the Spanish island of Ibiza, British vacationers staged all-night parties, complete with loud, beat-driven dance music in crowded conditions. Raves spread first to the United Kingdom and then to the United States. By the mid-1990s they were widespread, particularly in big cities. The use of "club drugs" to enhance the enjoyment of the party experience was already established in America, where certain discos catered to cocaine and amphetamine users. Ecstasy fit the rave scene better than cocaine, however. Under its influence, otherwise shy or cautious people became wild dancers, open and friendly to strangers, and able to stay awake all night.
By the time raves became established in the United States, ecstasy had already been added to the Schedule I list of controlled substances by the U.S. Food and Drug Administration (FDA). Ecstasy's placement on the list in 1985 was under an "emergency" clause. As animal testing continued, even the psychiatrists who had used it for patient therapy began to agree that the drug was unsafe. When illegal ecstasy became the drug of choice at raves, the government's position was strengthened. Emergency room visits sparked by bad reactions to ecstasy spiked from 253 in 1994 to 5,542 in 2001, according to the Drug Abuse Warning Network (DAWN) report. In 2002, ecstasy-related ER visits dropped to 4,026. In 2000, the Christian Science Monitor reported 72 deaths related to ecstasy in the state of Florida alone.
What Is It Made Of?
Ecstasy's long, complicated scientific name refers to the various parts of its molecule. A particular group of atoms, in a specific arrangement, make up the ecstasy molecule. The drug begins with an N-methyl group of carbon and hydrogen atoms, attached to a nitrogen-containing compound. A methylene bridge attaches more carbon, with "dioxy," or two oxygen atoms as part of the bridge. The molecule becomes more complex with attachments of benzene, propane, another chain of carbon and hydrogen atoms, and an amino group. Drawn out on a blackboard, the molecule looks like an answer on an advanced chemistry test. In its pure form, ecstasy is a white powder. If the powder is light brown in color, it is impure.
The MDMA molecule does not occur in any living organism. It must be created in a laboratory by a process known as "synthesis." The process of creating ecstasy is fairly simple for chemists, and it is inexpensive to make. Pills that are manufactured for pennies apiece can sell in the illegal drug market for $15 to $40 per dose. A vast underground network of laboratories, most of them in Europe, supply a cunning army of smugglers who bring the pills to the United Kingdom and the United States.
Pills bought on the street might not contain pure ecstasy, however. Dosages vary widely. So do the ingredients in the illegal pills. Some might contain caffeine or dextromethorphan, others might have powerful hallucinogens. Occasionally the pills have nothing in them at all but sugar or aspirin. The old phrase "buyer beware" applies to any illegal drug purchased on the street.
Is It Really Ecstasy?
Since it is illegal, an ecstasy pill is not regulated for purity. Authorities have found pills being sold as ecstasy that have contained:
- 4-bromo-2, 5-dimethoxyamphetamine (2C-B), a hallucinogen
- caffeine, a stimulant
- dextromethorphan, an active ingredient in cough syrup
- lysergic acid diethylamide (LSD), a hallucinogen
- paramethoxyamphetamine (PMA), a hallucinogen
- pseudoephedrine, an antihistamine (a drug that blocks the creation of "histamines," chemicals released in allergy attacks)
The dosage levels of ecstasy also vary from pill to pill. In March 2005, a healthy 24-year-old man in Glastonbury, United Kingdom, died of an ecstasy overdose. The local coroner blamed the death on "rogue tablets" containing high doses of the drug.
How Is It Taken?
At least part of ecstasy's popularity is based on how easy it is to take. It is sold primarily in pill form. Users swallow the small pills with water or alcohol. Some users have been known to crush ecstasy and snort it. The average dose per pill is 50 milligrams, but the dosages can range up to 300 milligrams.
Sometimes ecstasy is taken deliberately with other controlled substances. A combination of ecstasy and LSD is called a "candy flip." The DAWN report indicates that ecstasy users who are admitted to hospital emergency rooms sometimes also test positive for marijuana, hallucinogens, or stimulants such as cocaine.
Ecstasy pills come in various colors and designs. According to the White House Office of National Drug Control Policy's Pulse Check: Trends in Drug Abuse from November 2002: "In order to market their product, 'cooks' [drug makers] in many areas produce ecstasy pills in a variety of colors and shapes, with numerous logos, labels, and stamps. Corporate names, fashion designers, and cartoon characters are often featured, with constant changes in some
cities as different fads come and go." Popular designs include the letter "e," hearts, shamrocks, animals, smiley faces, car logos, the Nike symbol, Pokemon characters, Batman, Superman, Popeye, Mickey Mouse, Buddha, and the Statue of Liberty. Patterns and colors often vary by region of the country.
Are There Any Medical Reasons for Taking This Substance?
The FDA puts all prescription medications through thorough tests to make sure the substances are safe, that they work on the condition for which they are prescribed, and that they have no long-term negative side effects. The scientific research done on ecstasy to date indicates that it does cause brain damage, memory loss, and long-lasting mood disorders. Currently ecstasy cannot be prescribed by doctors, and it is not produced by legitimate pharmaceutical companies.
That being said, the FDA has approved small studies of ecstasy use. One involves people suffering from post-traumatic stress disorder (PTSD), which is a mental illness that can occur after one experiences or witnesses life-threatening events, such as serious accidents, violent assaults, or terrorist attacks. Symptoms of PTSD include reliving the experience through nightmares and flashbacks, having problems sleeping, and feeling detached from reality. Those who suffer from PTSD tend to repress memories of the dangerous incident that provoked the disease. It is thought that ecstasy might help patients relive the trauma to reduce anxiety about it. The study of ecstasy for use in PTSD patients was in preliminary stages in 2005.
The FDA has also approved a trial study of ecstasy use in terminally ill cancer patients who have been given only a short time to live. In this case, it is thought that the drug will ease the patient's anxiety about death, while also increasing the patient's ability to talk openly with grieving family members. This study highlights the dangers of casual ecstasy use at parties. Since those being given ecstasy in the study are going to die within weeks or months, the worries of long-term brain damage do not exist.
Ecstasy was created in the early 1900s, but it is one of the newer drugs of abuse in the United States. Here is a brief look at ecstasy's history.
1910 German scientists first synthesize MDMA while studying amphetamines. The Merck company patents the drug in 1914.
1965 Alexander T. "Sasha" Shulgin (1925—) synthesizes MDMA and experiments with it himself. Shulgin feels the drug could have uses in the mental health field.
1985 Faced with growing recreational use and tests indicating that the drug causes brain damage in animals, the U.S. government adds ecstasy to the Schedule I list of controlled substances.
2000 U.S. customs agents seize 9.3 million doses of ecstasy from smugglers and dealers.
2004 Monitoring the Future researchers note a decline in ecstasy use among eighth, tenth, and twelfth graders in the United States.
2005 Australian authorities seize approximately 5 million ecstasy tablets in the biggest MDMA drug bust to that date.
Neither of these studies have resulted in the classification of ecstasy as a drug with medical benefits.
By the mid-1980s, when it was declared illegal, ecstasy had already found users among college students. However, the drug found its most visible place in the rave and club scene of the 1990s. Even though it is illegal, ecstasy use increased dramatically among partygoers and rave attendees. Taking a small pill seems far less extreme than snorting, smoking, or injecting a drug, so many young people thought ecstasy was not dangerous. Peer pressure added to the drug's popularity. In a crowded club, friends could easily persuade other friends to try it.
With increased ecstasy use came increased information on how the drug behaves, its side effects, and its dangers. This information seems to have filtered into the population of ecstasy users—and those who might consider using it. According to the 2004 Monitoring the Future (MTF) study, ecstasy use peaked among eighth, tenth, and twelfth graders around the year 2000 and has since sharply declined for all of those age groups. The 2003 National Survey on Drug Use and Health (NSDUH) likewise reported a decrease in repeat use between 2002 and 2003, as well as a decrease in the number of first-time users, from 1.8 million in 2002 to 1.1 million in 2003. Young people also reported that the drug became harder to find than it was in the past. M. J. Ellenhorn, in Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning, wrote: "Desirable effects begin to change with each successive dose: freshmen love it, sophomores like it, juniors are ambivalent, and seniors are afraid of it."
Whatever the cause, from legal crackdowns on raves to word of mouth, ecstasy use began to decline in 2003.
Effects on the Body
Medical doctors say that ecstasy increases the levels of several neurotransmitters in the brain. Neurotransmitters are substances that help spread nerve impulses from one nerve cell to another. Specifically, ecstasy increases serotonin, which regulates mood and blood vessel behavior; dopamine, which regulates movement and mood; and norepinephrine, which regulates blood pressure.
Government Steps In
The Ecstasy Prevention Act of 2001, Senate Bill S1208 IS, offered government grants to communities that put a high priority on curbing the sale of ecstasy at clubs and raves. The bill also provided $7 million in federal funding for a national media campaign on the dangers of ecstasy and other club drugs. The same bill instituted a drug test for ecstasy use among government employees.
The neurotransmitters flood the brain's synapses, which are junctions between two nerve cells where signals pass, and are not taken in again by the brain's nerve terminals. An excess of serotonin in the brain affects emotions and perception. An excess of dopamine alters muscle movements and the ability to feel pleasure and pain.
Basically, the ecstasy user's brain chemistry is altered. About twenty minutes after ingestion, ecstasy causes a "rush" that leads to a high, lasting about three to six hours. During that high, a user often experiences high levels of happiness, contentment, affection for friends and strangers, self-confidence, and increased energy. The drug lowers inhibitions and encourages people to act on their impulses. Its use has been linked to casual sexual encounters.
In a club or rave setting, an ecstasy user might dance nonstop for hours, "feeling" the music with a heightened sense of awareness. However, repeated incidents have shown that crowded clubs prove a bad setting for ecstasy use. The drug's side effects can be intensified by heat, exercise, and dehydration.
Ecstasy affects many functions of the body beyond mere emotion. It causes uncomfortable clenching of the jaw, muscle tension, nausea and vomiting, excessive sweating, tremors, chills, and blurred vision. In certain people it can lead to death through elevated body temperature, heart attack, stroke, or seizure. Some ecstasy deaths have occurred when users drank too much water, leading to fatal swelling of the brain. A condition called rhabdomyolysis has also been linked to ecstasy use. Medical literature also warns that ecstasy use can lead to kidney failure through alteration of the salt level in the bloodstream.
The most difficult side effects of ecstasy use begin as the drug wears off. These effects can last for weeks or months. In his book, Gahlinger observed: "Coming down off a weekend rave, the aftermath of MDMA can feel like a bad hangover that some users refer to as the Terrible Tuesdays." The user feels stressed, anxious, tired, and depressed. Ecstasy differs from other drugs in that users do not get relief from their hangovers from taking another dose of the substance. Sometimes the extra dose of ecstasy makes the bad symptoms worse. Even in those who get some rebound relief from another dose, ecstasy users build up a tolerance level. After awhile, the desired high does not come, no matter how much ecstasy the user takes.
Gahlinger noted: "Monkeys show abnormal patterns of serotoninproducing neurons up to seven years after treatment with MDMA. In people who have taken MDMA 20 times or more, analysis of the spinal fluid shows a depletion of serotonin metabolites, indicating a long-term disruption in normal brain functioning." Ecstasy abuse has been linked to long-term depression, panic attacks, impulsive behavior, and memory loss—all symptoms of a serotonin imbalance in the brain. Studies show that ecstasy is neurotoxic in animals. In other words, it can damage their brains.
About one in twelve people lack an enzyme called cytochrome P450-246 that metabolizes ecstasy. One dose of the drug can be fatal to this group of users.
Reactions with Other Drugs or Substances
Sometimes people intend to mix ecstasy with other drugs or alcohol. Sometimes the "ecstasy" pill actually contains other substances. Either way, ecstasy does not react well with any drug or with alcohol. Taking ecstasy while drinking alcohol can greatly increase the possibility of fever and dehydration. Combining ecstasy with hallucinogens such as ketamine, LSD, or 2C-B can magnify the level of hallucinations. Mixingecstasy with stimulants such as cocaine or methamphetamine can increase blood pressure and heart rate.
Certain prescription drugs known as monoamine oxidase inhibitors (MAOIs) should never be combined with MDMA. The reaction between the two substances can be fatal. MAOIs are prescribed for depression and for the symptoms of acquired immunodeficiency syndrome (AIDS).
Some other drugs prescribed for depression and anxiety may actually block the brain's reaction to ecstasy. This group of drugs is called selective serotonin reuptake inhibitors, or SSRIs, and includes Prozac, Zoloft, and Paxil.
People suffering from anxiety, depression, phobias, or other mental disorders should avoid taking ecstasy at all. Even one dose can cause mental problems to become worse, or to last longer, or to be resistant to treatment.
Ecstasy and Mental Health
Late in 2004, the Food and Drug Administration approved two pilot studies of ecstasy for use in the mental health field. In one study, terminally ill cancer patients were given ecstasy in hopes that the drug would ease their anxiety as they faced death. In another, the drug was given to victims of posttraumatic stress disorder (PTSD), a condition brought on in response to a frightening or life-threatening event. The government did not fund either of these studies. They were paid for by a private, nonprofit foundation called the Multidisciplinary Association for Psychedelic Studies.
Treatment for Habitual Users
While not physically addictive, ecstasy is dangerous because repeated use—even weeks or months apart—can damage neurons in the brain. Today's habitual users are tomorrow's research subjects, because scientists do not know how repeat use of ecstasy will affect brain function as people age. Animal studies show that brain damage after heavy MDMA use may last a lifetime. Effects on humans are highly debated. Some research indicates long-term memory problems.
Anyone wishing to quit an ecstasy habit should consult a doctor or psychiatrist. The emotional and mental problems brought on by ecstasy may be eased by prescription medication. Users are advised to talk about the reasons why they began using illegal drugs—and stay away from situations where such drugs might be available. The nonprofit organization Narcotics Anonymous (NA) has chapters in most towns and cities where drug abusers can share experiences and help each other to stay straight. NA also operates a telephone hotline and can give referrals to doctors and hospitals where drug abusers can receive attention.
Ecstasy use can lead to death through several paths. An overdose can occur from a pill containing too much of the drug. In this case, the user collapses, becomes unconscious, and stops breathing. Cases have been reported of heart attack due to ecstasy overdose.
Sweating and hyperthermia or overheating brought on by ecstasy use in crowded settings, combined with exercise such as dancing, can lead to death in two ways. In the first case, the user simply dies of organ damage, similar to a heat stroke. In the second case, the user drinks so much water that the body falls into a condition called hyponatremia, literally, water poisoning. Drinking too much water too quickly flushes important sodium from the body and causes the brain to swell. A sixteen-year-old girl in Boulder, Colorado, died of this condition in 2001 after taking ecstasy at a party.
The rebound "low" after taking ecstasy has been linked to suicidal depression. A teenager named Dayna Moore is quoted on the Monitoring the Future Web site on the pitfalls of ecstasy rebound: "When I came down, I fell into a deep, dark hole. It was a depression I couldn't stand." Anyone with a history of mental problems would be more likely to experience this difficulty.
Ecstasy might not always kill, but it does damage the brain—sometimes after even one use. Repeat users face a host of rebound symptoms, including panic attacks, phobias, depression, loss of appetite, and memory problems.
Ecstasy is a Schedule I substance, carrying the highest degree of illegality for possession and distribution. It is illegal in the United States, Canada, and the United Kingdom, and it cannot be obtained by prescription. Anyone caught with ecstasy can face stiff fines, possible
prison time, and other penalties. These penalties vary from state to state and can differ depending on the amount of the substance seized.
In 2003 the federal government passed the Reducing Americans' Vulnerability to Ecstasy bill. It is a law that places a great deal of responsibility on organizers of raves or large get-togethers. The bill makes these club owners or promoters responsible if ecstasy is found at their events. Prior to the passage of this bill, some clubs had purity testing facilities on their premises so that ecstasy users could be sure their pills had no other ingredients. In this regard, the bill further increases the dangers of ecstasy use because it is now illegal to run purity tests in clubs.
Given the scientifically proven dangers of ecstasy use, it is unlikely that the substance will be removed from Schedule I status, except perhaps for the use of hospice patients who are about to die. As of late 2004 and early 2005, there was some renewed interest in using MDMA to treat the mentally ill. However, studies need to be conducted to determine how this could best be achieved.
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