NIDA InfoFacts: MDMA (Ecstasy)

Health Hazards

For some people, MDMA can be addictive. A survey of young adult and adolescent MDMA users found that 43 percent of those who reported ecstasy use met the accepted diagnostic criteria for dependence, as evidenced by continued use despite knowledge of physical or psychological harm, withdrawal effects, and tolerance (or diminished response), and 34 percent met the criteria for drug abuse. Almost 60 percent of people who use MDMA report withdrawal symptoms, including fatigue, loss of appetite, depressed feelings, and trouble concentrating.

Cognitive Effects
Chronic users of MDMA perform more poorly than nonusers on certain types of cognitive or memory tasks. Some of these effects may be due to the use of other drugs in combination with MDMA, among other factors.

Physical Effects
In high doses, MDMA can interfere with the body’s ability to regulate temperature. On rare but unpredictable occasions, this can lead to a sharp increase in body temperature (hyperthermia), resulting in liver, kidney, and cardiovascular system failure, and death.

Because MDMA can interfere with its own metabolism (breakdown within the body), potentially harmful levels can be reached by repeated drug use within short intervals.

Users of MDMA face many of the same risks as users of other stimulants such as cocaine and amphetamines. These include increases in heart rate and blood pressure, a special risk for people with circulatory problems or heart disease, and other symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating.

Psychological Effects
These can include confusion, depression, sleep problems, drug craving, and severe anxiety. These problems can occur during and sometimes days or weeks after taking MDMA.

Neurotoxicity
Research in animals links MDMA exposure to long-term damage to neurons that are involved in mood, thinking, and judgment. A study in nonhuman primates showed that exposure to MDMA for only 4 days caused damage to serotonin nerve terminals that was evident 6 to 7 years later. While similar neurotoxicity has not been definitively shown in humans, the wealth of animal research indicating MDMA's damaging properties suggests that MDMA is not a safe drug for human consumption.

Hidden Risk: Drug Purity
Other drugs chemically similar to MDMA, such as MDA (methylenedioxyamphetamine, the parent drug of MDMA) and PMA (paramethoxyamphetamine, associated with fatalities in the U.S. and Australia) are sometimes sold as ecstasy. These drugs can be neurotoxic or create additional health risks to the user. Also, ecstasy tablets may contain other substances in addition to MDMA, such as ephedrine (a stimulant); dextromethorphan (DXM, a cough suppressant that has PCP-like effects at high doses); ketamine (an anesthetic used mostly by veterinarians that also has PCP-like effects); caffeine; cocaine; and methamphetamine. While the combination of MDMA with one or more of these drugs may be inherently dangerous, users might also combine them with substances such as marijuana and alcohol, putting themselves at further physical risk.

Extent of Use

National Survey on Drug Use and Health (NSDUH)*
In 2004, an estimated 450,000 people in the U.S. age 12 and older used MDMA in the past 30 days. Ecstasy use dropped significantly among persons 18 to 25—from 14.8 percent in 2003 to 13.8 percent in 2004 for lifetime use, and from 3.7 percent to 3.1 percent for past year use. Other 2004 NSDUH results show significant reductions in lifetime and past year use among 18- to 20-year-olds, reductions in past month use for 14- or 15-year-olds, and past year and past month reductions in use among females.

Community Epidemiology Work Group (CEWG)**
In many of the areas monitored by CEWG members, MDMA, once used primarily at dance clubs, raves, and college scenes, is being used in a number of other social settings. In addition, some members reported increased use of MDMA among African-American and Hispanic populations.

Monitoring the Future (MTF) Survey ***
Lifetime**** use dropped significantly among 12th-graders in 2005, from 7.5 percent in 2004 to 5.4 percent. The perceived risk in occasional MDMA use declined significantly among 8th-graders in 2005, and perceived availability decreased among 12th-graders.

Lifetime Prevalence of MDMA Use by Students
Monitoring the Future Survey, 2003–2005

For more information, please visit www.ClubDrugs.org and www.Teens.drugabuse.gov.

* NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at www.samhsa.gov and from the National Clearinghouse for Alcohol and Drug Information at 800-729-6686

** CEWG is a NIDA-sponsored network of researchers from 21 major U.S. metropolitan areas and selected foreign countries who meet semiannually to discuss the current epidemiology of drug abuse. CEWG’s most recent reports are available at www.drugabuse.gov/about/organization/cewg/pubs.html

*** These data are from the 2005 Monitoring the Future Survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov.

**** "Lifetime" refers to use at least once during a respondent's lifetime. "Annual" refers to use at least once during the year preceding an individual's response to the survey. "30-day" refers to use at least once during the 30 days preceding an individual's response to the survey.