Ecstasy

Methylenedioxymethamphetamine, or MDMA (though most commonly known as ecstasy, E, thizz, X, XTC, or when in its pure, unadulterated form, molly), is a common psychoactive amphetamine with entactogenic, psychedelic, and stimulant effects on the brain. It is classified as serotonergic; it primarily works by releasing enormous amounts of the neurotransmitter serotonin.

MDMA is considered a very unique drug in that it can procure feelings of not only intense euphoria, but overwhelming love and empathy for all walks of life. These effects were thought to have therapeutic value in certain people, mainly those suffering from depression. Before it was outlawed and regulated under the federal government, the drug was used as an augmentation of psychotherapy, typically couples therapy and the treatment of anxiety disorders. Currently, clinical trials are being conducted as to the benefits of use if taken by someone suffering from post-traumatic stress disorder.

MDMA is one of the most widely used recreational drugs, aside from cannabis, and is generally associated with younger people at clubs and raves. Many forms of music have cropped up at raves and dance parties to excite and stimulate the user of MDMA.

History
MDMA was first synthesized in 1912 by Merck chemist Anton Köllisch. At the time, Merck was interested in developing substances that stopped abnormal bleeding. Merck wanted to evade an existing patent, held by Bayer, for one such compound - hydrastinine. At the behest of his superiors Walther Beckh and Otto Wolfes, Köllisch developed a preparation of a hydrastinine analogue, methylhydrastinine. MDMA was an intermediate compound in the synthesis of methylhydrastinine, and Merck was not interested in its properties at the time. On December 24, 1912 Merck filed two patent applications that described the synthesis of MDMA and its subsequent conversion to methylhydrastinine.

Over the following 65 years, MDMA was largely forgotten. Merck records indicate that its researchers returned to the compound sporadically. In 1927, Max Oberlin studied the pharmacology of MDMA and observed that its effects on blood sugar and smooth muscles were similar to ephedrine's, but that, in contrast, MDMA did not appear to produce pupil dilation. Researchers at Merck conducted experiments with MDMA in 1952 and 1959. In 1953 and 1954, the United States Army commissioned a study of toxicity and behavioral effects in animals of injected mescaline and several analogues, including MDMA. These originally classified investigations were declassified and published in 1973. The first scientific paper on MDMA appeared in 1958 in Yakugaku Zasshi, the Journal of the Pharmaceutical Society of Japan. In this paper, Yutaka Kasuya described the synthesis of MDMA, a part of his research on antispasmodics.

MDMA first appeared as a street drug in the early 1970s after its counterculture analogue, MDA, became criminalized in the United States in 1970. In the mid-1970s, Alexander Shulgin, then at University of California, heard from his students about unusual effects of MDMA; among others, the drug had helped one of them to overcome his stutter. Intrigued, Shulgin synthesized MDMA and tried it himself in 1976. Two years later, he and David Nichols published the first report on the drug's psychotropic effect in humans. They described "altered state of consciousness with emotional and sensual overtones" that can be compared "to marijuana, to psilocybin devoid of the hallucinatory component".

Shulgin took to occasionally using MDMA for relaxation, referring to it as "my low-calorie martini", and giving the drug to his friends, researchers, and other people whom he thought could benefit from it. One such person was psychotherapist Leo Zeff, who had been known to use psychedelics in his practice. Zeff was so impressed with the action of MDMA that he came out of his semi-retirement to proselytize for it. Over the following years, Zeff traveled around the U.S. and occasionally to Europe training other psychotherapists in the use of MDMA. Among underground psychotherapists, MDMA developed a reputation for enhancing communication during clinical sessions, reducing patients' psychological defenses, and increasing capacity for therapeutic introspection.

Due to the wording of the United Kingdom's existing Misuse of Drugs Act of 1971, MDMA was automatically classified in the U.K. as a Class A drug in 1977.

In the early 1980s in the U.S., MDMA rose to prominence as "Adam" in trendy nightclubs and gay dance clubs in the Dallas area. From there, use spread to raves in major cities around the country, and then to mainstream society. The drug was first proposed for scheduling by the Drug Enforcement Administration (DEA) in July 1984 and was classified as a Schedule I controlled substance in the U.S. on May 31, 1985.

In the late 1980s MDMA, as "ecstasy", began to be widely used in the U.K. and other parts of Europe, becoming an integral element of rave culture and other psychedelic- and dance-floor-influenced music scenes, such as Madchester and Acid House. Spreading along with rave culture, illicit MDMA use became increasingly widespread among young adults in universities and later in high schools. MDMA became one of the four most widely used illicit drugs in the U.S., along with cocaine, heroin, and marijuana. According to some estimates as of 2004, only marijuana attracts more first time users in the U.S..

After MDMA was criminalized, most medical use stopped, although some therapists continued to prescribe the drug illegally. Later Charles Grob initiated an ascending-dose safety study in healthy volunteers. Subsequent legally-approved MDMA studies in humans have taken place in the U.S. in Detroit (Wayne State University), Chicago (University of Chicago), San Francisco (UCSF and California Pacific Medical Center), Baltimore (NIDA-NIH Intramural Program), and South Carolina, as well as in Switzerland (University Hospital of Psychiatry, Zürich), the Netherlands (Maastricht University), and Spain (Universitat Autònoma de Barcelona).

Terminology
When used therapeutically in the late 1970s and early to mid-1980s, MDMA was given the names "Adam" and "empathy." It was not until the raver scene that it became "ecstasy". This was often abbreviated to E, X, or XTC. MDMA in its absolute pure, uncut, unadulterated crystalline powder form is what users commonly call "molly." MDMA has become known as dozens of colloquial terms such as "thizz", "clarity", "essence", "magic", "transcendence", "love", "hug drug", "lover's speed", "euphoria", "love drug", "cloud nine", and many more. Being under the influence of MDMA is commonly given the term "rolling". The name arose in reference to the involuntary rapid eye movements experience by those who are under the influence.

Therapeutics
There have long been suggestions that MDMA might be useful in psychotherapy, facilitating self-examination with reduced fear. Indeed, some therapists, including Leo Zeff, Claudio Naranjo, George Greer, Joseph Downing, and Philip Wolfson, used MDMA in their practices until it was made illegal. George Greer synthesized MDMA in the lab of Alexander Shulgin and administered it to about eighty of his clients over the course of the remaining years preceding MDMA's Schedule I placement in 1985. In a published summary of the effects, the authors reported patients felt improved in various, mild psychiatric disorders and other personal benefits, especially improved intimate communication with their significant others. In a subsequent publication on the treatment method, the authors reported that one patient with severe pain from terminal cancer experienced lasting pain relief and improved quality of life. However, few of the results in this early MDMA psychotherapy were measured using methods considered reliable or convincing in scientific practice. For example, the questionnaires used might not have been sensitive to negative changes and it is not known to what extent similar patients might improve from chance or from psychotherapy.

The therapeutic potential of MDMA is currently being tested in several ongoing studies, some sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). Studies in the U.S., Switzerland, and Israel are evaluating the efficacy of MDMA-assisted psychotherapy for treating those diagnosed with post-traumatic stress disorder or anxiety related to cancer. In interviews, patients and researchers from the South Carolina PTSD pilot study report tendencies for some participants to have reduced disease severity after MDMA psychotherapy. MAPS reported statistically significant results.

Recreational Uses
MDMA and the rave scene started around the late 1980s and early 1990s. People consume ecstasy for its euphoria and happiness-enhancing effects. Most users feel reawakened, refreshed, and lively from an experience with ecstasy, while others thinks of its effects as mild compared to even cannabis use.

Price
In the United Kingdom, and most other European countries, the cost of a single ecstasy tablet is approximately €3 to €9. In the United States however, the price is as much as ten to twenty dollars a pill. Despite this, buying in huge quantities will bring about prices in the two to ten dollar range.

Legal Alternatives
A huge number of ecstasy tablets, especially in the United Kingdom, contain large portions or are solely comprised of meta-Chlorophenylpiperazine (mCPP). The effects of mCPP are crudely related to that of MDMA, however the downfalls of legal alternatives are far graver than that of ecstasy usage. mCPP is known to cause migraines, nausea, insomnia, etc. "Legal highs" offer a colossal profit for the dealers considering they can be purchased fairly cheaply online and sold at a much greater price than paid for. And because of their leagl status, being caught poses a far lower risk of prosecution. Benzylpiperazine (BZP), which is another legal substance that mimics ecstasy's effects, has a greater risk of possession and sale.

Poly Drug Use
Poly drug use refers to the combination of two or more psychoactive drugs to achieve a whole new effect. MDMA is a drug known for it's conjunction with other psychedelic substances. When ecstasy is taken with LSD, the term is known as "candy-flipping." When it is taken in combination with psilocybin mushrooms, it is refered to as "hippie-flipping." If either of those choices are combined with cocaine, they become "candy-flipping on a string" as well as "hippie-flipping on a string." "Kitty-flipping" is used to describe the use of MDMA and ketamine. Many people ingest mentholated products while on MDMA for their cooling sensation with ecstasy's primary effects.

Dosage And Duration
The average threshold dosage of pure MDMA commonly consumed is anywhere between sixty and 150 milligrams. Strong to overwhelming doses range from 150 to above two hundred, which can be harming or even fatal considering different people can react differently to the same dose. A person that takes one hundred milligrams may feel barely anything, while another person has one hundred milligrams and feels everything. Always start with a low dosage, especially on a first time experience.

Ecstasy is known for producing a huge, sudden rush or euphoria. The drug's onset is anywhere from twenty to ninety minutes and the come up (the infamous rush) can be five to twenty minutes depending on dose and individual. After the rush, the plateau lasts from three to five hours, with effects gradually diminishing thereafter.

Purity
MDMA is considered to be one of the most adulterated drugs on the street. Dealers and manufacturers of ecstasy easily cut tablets with a variety of other substances. These may include methamphetamine, amphetamine, ephedrine, cocaine, caffeine, etc. In actuality, some MDMA pills may not even contain any traces of ecstasy. Instead they may be solely manufactered from ibuprofen, piperizines, or even PMA. The latter is one of the most toxic hallucinogenics ever made and a number of deaths have been attributed to it. The reasons for adulterating MDMA range from the inexpensive prices or merely to side-step any legal issues if caught.

Beneficial Effects
These are some of the most common beneficial factors of ecstasy as reported by most users.


 * A strong idea of peace and self-acceptance
 * Decreased agitation, anxiety, aggression, hostility, jealousy, fear, and insecurity
 * Extreme mood lift accompanied by mild to severe euphoria
 * Feelings of empathy, compassion, forgiveness, acceptance, intimacy, and even love towards other individuals
 * Insight, introsepective thoughts, and mental clarity
 * Self-confidence without arrogance
 * The ability to discuss anger-provoking concepts with newfound ease
 * Intensification of tactile, auditory, and optical senses
 * Substantial appreciation of music
 * Mild psychedelia
 * Stimulation and arousal
 * Increased energy, alertness, endurance, awareness, wakefullness, desire, and motivation
 * Hypersexuality
 * Analgesia

Side Effects
Ecstasy can affect the body very physically and emotionally, and sometimes these sypmtoms are undesireable. The most common adverse side effects reported by users are as follows:

Psychological

 * Paradoxial anxiety
 * Restlessness
 * Decrease in attention and concentration
 * Mild memory impairment

Physiological

 * Dizziness, lightheadedness, and vertigo
 * Involuntary and rapid eye movements
 * Pupil dilation
 * Dryness of the mouth
 * Nausea and emesis
 * Gastrointesitinal disturbances
 * Headache
 * Jaw-clenching or teeth-grinding
 * Muscle tremors
 * Urinary retention
 * Sexual dysfunction
 * Decreased appetite
 * Insomnia
 * Increased heart rate, body temperature, blood pressure, and perspiration
 * Water-electrolyte imbalance

Rebound or Withdrawal
Once the effect's of ecstasy are completely over, withdrawal sypmtoms from not being under the influence may occur. Below are most of the withdrawal or rebounding sypmtoms.

Psychological

 * Depression or even suicidal thoughts
 * Irritability and aggression
 * Strong fatigue
 * Agitation or restlessness
 * Impaired concentration and motivation
 * Memory impaiment
 * Residual feelings of empathy, emotional sensitivity, affection, and closeness to others (afterglow, as opposed to hangover)

Physiological

 * Dizziness, lightheadedness, or vertigo
 * Gastrointestinal disturbances
 * Headaches or migraines
 * Insomnia
 * Panic attacks

Overdose
Overdosing on MDMA can be fatal. Certain syndromes and diseases such as serotonin syndrome (the release of more serotonin than the body can tolerate), stimulant psychosis (a form of psychosis brought on by stimulants such as methamphetamine or amphetamine derivatives), or hypertensive crisises (condition in which blood pressure is dangerously and life-threateningly high) can occur if ecstasy is abused with a high enough dosage. Symptoms of overdose are included below.

Psychological

 * Disorientation and confusion
 * Anxiety and/or panic attacks
 * Hypervigilance (increased htreat detection
 * Hypo- or full-blown mania
 * Derealization and depersonalization
 * Hallucinations
 * Disorganized throughts
 * Retrograde or anterograde amnesia
 * Delirium or insanity

Physiological

 * Severe muscle spasms
 * Overresponsive and overreactive reflexes
 * Rapid breathing and shortness of breath
 * Abnormal beating of the heart
 * Severe chest pain
 * Abnormal electrical activity of the heart
 * Ciculatory and cardiac arrest
 * Destruction of blood vessels
 * Cardiotoxicity
 * Hemorrhaging and/or stroke
 * Severe hyperthermia to the point of potential organ failure

Miscellaneous

 * Fainting or loss of consciousness
 * Seizures
 * Organ failure
 * Severe neurotoxicity
 * Comatose and/or death

Chronic Use
Currently, there is reportedly strong evidence of damaging neurotoxicity caused by the use of MDMA in studies performed on certain rodents and non-human primates. It is believed that the neurotoxicity primarily affects the serotonergic terminals and pathways in the human brain. Some studies state increased rates of depression and anxiety, even after abstaining from the drug. In additional studies, MDMA use could potentially lead to long-term memory and cognitive impairment. Ecstasy has been occasionally linked with liver damage, excessive wearing of teeth, and (though very rarely) Hallucinogen Persisting Perception Disorder (HPPD) in which one constantly sees optical distortions. A myriad of determining factors, such as total lifetime MDMA use, the duration of abstinence between uses, the environment of use, mental health quality, various lifestyle choices, and predisposition to certain mental illnesses may contribute to certain health consequences.

Health Concerns
While the short-term adverse effects and contraindications of MDMA are fairly well known, there is significant debate within the scientific and medical communities regarding possible long-term physical and psychological effects of MDMA.

Short-Term Health Risks
Short-term physical health risks of MDMA consumption include hyperthermia and hyponatremia. Continuous activity without sufficient rest or rehydration may cause body temperature to rise to dangerous levels, and loss of fluid via excessive perspiration puts the body at further risk as the stimulatory and euphoric qualities of the drug may render the user oblivious to their energy expenditure for quite some time. Diuretics such as alcohol may exacerbate these risks further.

Long-Term Health Risks
MDMA causes a reduction in the concentration of serotonin transporters (SERTs) in the brain. The rate at which the brain recovers from serotonergic changes is unclear. A number of studies have demonstrated lasting serotonergic changes occurring due to MDMA exposure. Other studies have suggested that the brain may recover from serotonergic damage.

Some studies show that MDMA may be neurotoxic in humans. Other studies, however, suggest that any potential brain damage may be at least partially reversible following prolonged abstinence from MDMA. However, other studies suggest that SERT-depletion arises from long-term MDMA use due to receptor down-regulation, rather than true neurotoxicity. Depression and deficits in memory have been shown to occur more frequently in long-term MDMA users. However, some recent studies have suggested that MDMA use may not be associated with chronic depression.

One study on MDMA toxicity, by George A. Ricaurte of Johns Hopkins School of Medicine, which claimed that a single recreational dose of MDMA could cause Parkinson's Disease in later life due to severe dopaminergic stress, was actually retracted by Ricaurte himself after he discovered his lab had administered not MDMA but methamphetamine, which is known to cause dopaminergic changes similar to the serotonergic changes caused by MDMA. Ricaurte blamed this mistake on the chemical supply company that sold the material to his lab. Most studies have found that levels of the dopamine transporter (or other markers of dopamine function) in MDMA users deserve further study or are normal.

Legality
United States—Schedule I of the Controlled Substances Act

United Kingdom—Class A

User Stories
"I guess it kind of feels like everything loves you and you love everything. The world seems unique and fresh, like you are seeing it for one of the very first times. All you want to do is be with the people you care about most. I felt the need to empathize with everyone and everything. I was awe-inspring, really."—Anonymous

"I didn't really feel all that spectacular to be honest. It just felt like a moderate weed high but just in my legs. I felt a little happier but that was about it. The only cool thing about it was that everything seemed a little more vibrant."—Zachary Torrent

"Snorting it makes the effects at least ten times as intense. The first time I tried E, I took a WHOLE pill, barely anything; I was a little bit happier but that was it. Later that month I was recommended to snort it and that it would be much better, so I snorted a quarter of a pill and it was much more intense than swallowing an entire pill. It lasted only like two hours, but it made me feel much more happy and empathetic."—Anonymous