Actions

Ecstasy

Also known as

XTC, superman, rolexs, pink superman, pills, mitsubishi's, mdma, mandy, E, dolphins, crystal, cowies, brownies

Classification

Stimulant, psychedelic, hallucinogen

Overview

Ecstasy (also known by its chemical name, MDMA) is often seen as the original designer drug because of its high profile links to dance music culture in the late 80's and early 90's. Clubbers took ecstasy to feel energised, happy, to stay awake and to dance for hours. The effects take about half an hour to kick in and tend to last between 3 to 6 hours, followed by a gradual comedown [1].

The main effects and risks of ecstasy include -

  • An energy buzz that makes people feel alert, alive, in tune with their surroundings, and with sounds and colours often experienced as more intense.
  • Users often develop temporary feelings of love and affection for the people they're with and for the strangers around them.
  • Short-term risks of ecstasy can include feeling anxious or getting panic attacks, and developing confused episodes, paranoia or even psychosis.
  • Some people have been known to take another 'E' when they haven't yet felt the expected 'high' of their first 'E'. The danger then is that both Es kick in at once and you've got a double dose of effects to deal with [1].

A big problem with ecstasy is that it's rarely pure. Sometimes, there is no MDMA at all. Sometimes, it contains other drugs, like PMA, which can be fatal. Regardless of what it looks like and what it is called, you can't be sure what's in a pill or a powder and you can't predict how you'll react [1].

Ecstasy is the popular name for MDMA but informally ecstasy usually refers to the pill form and MDMA, usually a higher strength, refers to powder form. Ecstasy speeds up the body's reactions and functions in many different ways [2].

What does it look like?

White or off-white powder or as crystals soluble in water [3].

Pure ecstasy is a powder made of white crystals, known to chemists as MDMA. Ecstasy is usually sold on the street as tablets, although it's getting more common to see it sold as powder and called by its chemical name, MDMA, or 'crystal'.

Ecstasy pills come in all sorts of colours and some of them have designs or logos stamped into them. This can result in some ecstasy pills getting 'nicknames', for example some pills were called Mitsubishi's because they were stamped with a Mitsubishi logo.

Some dealers pass off new man-made drugs like _PMA_ and 4-MTA and 'legal highs' as E's.

Their effects can be very different or they may take longer to kick in with a risk of the user 'double-dosing' to get the buzz they're looking for (risking double the side-effects) [1].

Ecstasy is sold in a white, yellow, or brown tablet or capsule. It is also available in powder form. Some users crunch it up and snort it. It may be stamped with an image, which gives it a candy-like appearance [4].

Ecstasy tablets may be any colour, and are generally embossed with a logo or design such as a butterfly, heart, lightning bolt, star, clover, or Zodiac sign. Ecstasy can be found in powder or in capsules [5].

MDMA is mainly distributed in tablet form. MDMA tablets are sold with logos, creating brand names for users to seek out. The colourful pills are often hidden among colourful sweets. MDMA is also distributed in capsules, powder, and liquid forms [6].

Pure MDMA comes as a white crystalline powder. However, due to the number of different labs and different processes that produce MDMA, appearance is very varied and the product sold in the UK is as likely to be tan/amber coloured. MDMA powder is compressed in to tablets, which may come in a wide variety of colours and shapes, and with a wide range of logos.

Imprinted tablets often end up being refrred to by the logo on them, so people would refer to Doves, Smiley, Mitsubishis and so on. This sort of branding, initially designed to gain a 'brand' a market share is no guide to quality. Once a brand is established as being 'better quality', other producers copy the design, but may not copy the content. MDMA is also supplied as a powder, typically in bags small bags. Capsules are less common now but did come in a range of colours [7].

Street price

Ecstasy was initially a relatively expensive drug in the UK, selling for between £10 - £20 per tablet. Cost (and quality) dropped massively, with tablets selling for £1 - £2 or less.

MDMA powder, considered to be a better quality product has been more expensive, selling at between £30 - £50/gm. However with concern that MDMA powder is being adulterated with other white powder stimulants, the price of MDMA powder has dropped in some areas.Over the past few years there has been a re-emergence of stronger, higher-price pills, selling at around £10 a pill [7].

When ecstasy first hit the dance scene, a pill typically cost £25. Today, prices have fallen to as low as £5, depending on the quantity of pills bought and their quality [8].

Why take it?

Sought after effects

  • sense of euphoria,
  • feelings of empathy or emotional understanding in and between individuals [2],
  • exhilaration,
  • energy [9].

Undesired effects

  • raised blood pressure,
  • raised body temperature,
  • 'comedown' (usually depressed and tired feeling) as effects wear off [2].
  • sweating,
  • nausea,
  • vomiting,
  • nystagmus,
  • dehydration,
  • confusion,
  • anxiety [9].

What are the different forms of MDMA?

MDMA can be found in a number of forms -

  • pills are the most common form in which MDMA is sold, and are commonly referred to as ecstasy. They often contain other substances or adulterants such as MDA, MDEA, amphetamine, methamphetamine, caffeine, 2C-B or ketamine. Care should be taken when ingesting unknown pills.
  • powder, also called Molly, is commonly a white to yellow substance which can be put into gel capsules, or administered sublingual, buccal or via insufflation.
  • crystals can be dissolved, crushed, and snorted or put into gel capsules or edible paper to swallow whole [10].

How long do its effects last?

Onset of effects

- oral - 20 - 60 minutes [10], 20 - 70 minutes [11].

Peak

- oral - 90 - 150 minutes [10], 120 - 180 minutes [11].

Offset

- oral - 1 - 2 hours [10].

Duration of effects

- oral - 3 - 5 hours [10], [11].

After-effects

- oral - 12 - 48 hours [10], 2 - 24 hours [11]. - all ROA's - 1 - 72 hours [11].

Pharmacology

MDMA acts on a range of neurotransmitter systems in the brain; serotonin, noradrenaline and dopamine. It acts by inhibiting their re-uptake. Components of a neuron work to remove a neurotransmitter once they have been used by the neuron, and MDMA reduces their function, so causes an increase in the levels of these neurotransmitters. The combined impact on such a variety of systems cause the various effects, and lead us to consider it somewhere in between a stimulant and psychedelic. Its stimulant properties are from the noradrenaline and dopamine systems, where the serotonin system leads to the psychedelic, slightly out-of-body and emphathogenic feelings that are experienced with this drug [2].

MDMA acts as a releasing agent of the neurotransmitters known as serotonin, dopamine and noradrenaline [12] which are the neurotransmitters in charge of pleasure, motivation and focus. This is done by inhibiting the reuptake and reabsorption of the neurotransmitters after they have performed their function of transmitting a neural impulse, essentially allowing them to accumulate and be reused in a manner which causes physically stimulating and euphoric effects [13].

It has also been noted that MDMA, even at lower doses, stimulates the release of oxytocin and prolactin, two hormones that have a role in the feeling of trust and love [14].

MDMA increases levels of serotonin, dopamine and nor-adrenalin. Use results in increased release of stored chemicals and inhibits their reuptake. MDMA is also probably a serotonin agonist (mimic). Compared to a drug like amphetamine, MDMA has less dopaminergic action and more serotoninergic action, so is less rewarding and possibly therefore less habituating [7].

Half-life

8 - 9 hours [15].

Lethal dosage

The exact toxic dosage is unknown, but considered to be far greater than its effective dose [10].

Mode of use

Ecstasy pills are usually swallowed - although some people do crush them up and smoke or snort them.

A recent study has suggested that some ecstasy pills may be marketed as being stronger than others, and that increased strength may be reflected in a higher price.

MDMA powder can be 'dabbed' onto the gums or snorted.

People have been known to take another E when they haven't initially felt the expected 'high' from the first one, this is called 'double dosing'. The danger then is that both Es kick in and you've a double dose of effects (and risks!) to deal with [1].

Usually orally, but can be smoked. Injection is unpopular because of the shortened duration of action. This is the stereotypical dance drug [9].

MDMA tablets are usually swallowed. MDMA powder is often snorted, or wrapped in a cigarette paper and swallowed. Pills and powders have also been used rectally. Injecting is rare [7].

Signs of usage

  • significantly dilated pupils,
  • increased perspiration,
  • clenching and grinding of the jaws,
  • jerky, erratic movements,
  • tactility,
  • altered perceptions [7],
  • impulsivity,
  • inability to pay attention,
  • cognitive, perception and mental changes,
  • loss of memory,
  • uncoordinated,
  • distortion of perception, thinking, and memory,
  • disorientation to time and place,
  • slow reactions,
  • excitability,
  • anxiety [16].

Effects

Ecstasy makes users feel energised, alert and alive - and on its own, it's not a drug that makes people violent [1].

It can also have other effects -

  • Ecstasy makes people feel 'in tune' with their surroundings, and can make music and colours more intense.
  • Users often have temporary feelings of love and affection for the people they're with and for the strangers around them.
  • Short-term effects of use can include anxiety, panic attacks, confused episodes, paranoia and even psychosis.
  • Lots of people feel really chatty on E., (although these chats don't always make sense to people who aren't on an E!).
  • Physical side-effects can include dilated pupils, a tingling feeling, tightening of the jaw muscles, raised body temperature and the heart beating faster [1].

Short-term effects

  • faintness,
  • chills,
  • sweating,
  • muscle tension,
  • impaired judgment,
  • depression,
  • blurred vision,
  • sleep problems,
  • false sense of affection,
  • nausea,
  • severe anxiety,
  • drug craving,
  • involuntary teeth clenching,
  • confusion,
  • paranoia [17].
  • diminish inhibitions,
  • improve mood to a state of euphoria,
  • strengthen feelings of connectedness,
  • increase pleasure from physical touch,
  • heighten sexuality and sexual arousal,
  • increase alertness,
  • enhance energy,
  • make the user lose track of time [18].

Long-term effects

Prolonged use causes -

  • long-lasting brain damage and perhaps permanent damage to the brain,
  • impaired judgment,
  • impaired thinking ability [17],
  • confusion,
  • depression,
  • sleep problems,
  • drug craving,
  • severe anxiety,
  • paranoia,
  • possible depletion of serotonin and memory,
  • death [19].

Physical effects

  • muscle tension,
  • tremors,
  • involuntary teeth clenching,
  • muscle cramps,
  • nausea,
  • faintness,
  • chills,
  • sweating,
  • blurred vision [6],
  • physical euphoria,
  • pupil dilation,
  • spontaneous tactile sensations,
  • bodily control enhancement,
  • stamina enhancement,
  • stimulation,
  • tactile enhancement,
  • appetite suppression,
  • pain relief,
  • perception of decreased weight,
  • brain zaps,
  • dehydration,
  • difficulty urinating,
  • increased blood pressure,
  • increased heart rate,
  • increased perspiration,
  • teeth grinding,
  • temporary erectile dysfunction [10].

Cognitive effects

  • confusion,
  • anxiety,
  • depression,
  • paranoia,
  • sleep problems,
  • drug craving [6],
  • cognitive euphoria,
  • compulsive redosing,
  • irritability,
  • mindfulness,
  • time distortion,
  • creativity enhancement,
  • dream potentiation,
  • empathy, love, and sociability enhancement,
  • focus enhancement,
  • immersion enhancement,
  • increased libido,
  • increased music appreciation,
  • motivation enhancement,
  • stamina enhancement,
  • thought acceleration,
  • wakefulness,
  • anxiety suppression,
  • cognitive fatigue,
  • dream suppression,
  • motivation suppression,
  • thought deceleration,
  • existential self-realisation,
  • unity and interconnectedness [10].

Visual effects

  • colour enhancement,
  • pattern recognition enhancement,
  • symmetrical texture repetition,
  • tracers,
  • double vision,
  • vibrating vision,
  • autonomous entities,
  • external hallucinations,
  • internal hallucinations,
  • peripheral information misinterpretation,
  • perspective alterations,
  • scenarios and plots,
  • settings, sceneries, and landscapes [10].

Auditory effects

  • auditory distortion,
  • auditory enhancement,
  • auditory hallucinations [10].

Positive effects

  • mild to extreme mood lift,
  • euphoria,
  • increased willingness to communicate,
  • increase in energy (stimulation),
  • ego softening,
  • decreased fear, anxiety, and insecurities,
  • feelings of comfort, belonging, and closeness to others,
  • feelings of love and empathy,
  • forgiveness of self and others,
  • a sense of inner peace and acceptance of self, others, and the world,
  • increased awareness of senses (taste, smell, touch, hearing, vision),
  • life-changing spiritual experiences,
  • analgesia, anti-nocioception, decreased pain perception [11].

Neutral effects

  • decreased appetite,
  • visual distortion,
  • nystagmus,
  • mild visual hallucinations (uncommon),
  • moderately increased heart rate and blood pressure (increases with dose),
  • restlessness,
  • nervousness,
  • shivering,
  • change in body temperature regulation,
  • upwellings of unexpected emotion,
  • emotional lability,
  • drug craving [11].

Negative effects

Negative side-effects increase with higher doses and frequent use.

  • inappropriate and/or unintended emotional bonding,
  • anxiety or paranoia (less common than opposite),
  • agitation (less common than opposite),
  • tendency to say things you might feel uncomfortable about later,
  • mild to extreme trisma, tongue and cheek chewing, and bruxia,
  • short-term memory scramble or loss & confusion,
  • short periods of swooning, or disconnection from the external world, usually at very high doses or during brief blasts of intense rushing while coming up,
  • muscle tension (common),
  • insomnia, inability to fall asleep when physically tired,
  • erectile disfunction and difficulty reaching orgasm,
  • increase in body temperature, hyperthermia, dehydration (drink water),
  • hyponatremia (don't drink too much water),
  • nausea and vomiting,
  • headaches, dizziness, loss of balance, and vertigo,
  • sadness on coming down, sense of loss or immediate nostalgia,
  • post-trip crash - unpleasantly harsh comedown from the peak effect,
  • hangover the next day, lasting days to weeks,
  • possible strong urge to repeat the experience, though not physically addictive,
  • possible psychological crisis requiring hospitalization (psychotic episodes, severe panic attacks, etc) (rare),
  • possible liver toxicity (rare),
  • neurotoxicity,
  • small risk of death; approximately 2 per 100,000 new users have extreme negative reactions resulting in death (very rare) [11].

Side-effects

  • jaw clenching,
  • teeth grinding,
  • restlessness,
  • insomnia,
  • irritability,
  • anxiety,
  • sweating,
  • impulsiveness,
  • nausea,
  • thirst,
  • increased heart rate [20].

Coming down

  • restless sleep,
  • exhaustion,
  • anxiety,
  • irritability,
  • depression,
  • difficulty concentrating [21], [22], [23], [24].

Overdose

  • high blood pressure,
  • faintness,
  • panic attacks,
  • loss of consciousness,
  • seizures,
  • high body temperature [5].

Risks

Taking ecstasy involves some risks [1]. Here's what it could do to you -

  • There's no way of telling what's in ecstasy until you've swallowed it. There may be negative side-effects from other drugs and ingredients added to the E.
  • The comedown from ecstasy can make people feel lethargic and depressed.
  • Evidence suggests long-term users can suffer memory problems and may develop depression and anxiety.
  • Using Ecstasy has been linked to liver, kidney and heart problems. Some users report getting colds and sore throats more often, which may be partly caused by staying awake for 24 hours, which can itself affect your immune system.
  • Anyone with a heart condition, blood pressure problems, epilepsy or asthma can have a very dangerous reaction to the drug.
  • There have been many deaths involving Ecstasy. Between 1996 and 2014 in England & Wales there were 670 deaths in which ecstasy/MDMA was recorded on the death certificate.
  • Ecstasy affects the body's temperature control. Dancing for long periods in a hot atmosphere, like a club, increases the chances of overheating and dehydration. Users should take regular breaks from the dance floor to cool down and watch out for any mates who are on it - they mightn't realise they're in danger of overheating or getting dehydrated.
  • However, drinking too much can also be dangerous. Ecstasy can cause the body to release a hormone which stops it making urine. Drink too quickly and it affects your body's salt balance, which can be as deadly as not drinking enough water. Users should sip no more than a pint of water or non-alcoholic drink every hour [1].

The use of any drug carries a risk of harm. This risks associated with using ecstasy are increased when -

  • Large amounts are taken, for example a whole pill at once.
  • It's used with alcohol or other drugs including prescribed or over-the-counter medications.
  • Ecstasy is taken when there's no one around such as a good friend who can help if things start going wrong or in an emergency.
  • Too much water is drunk (more than 600ml per hour) due to dancing or doing other activities vigorously or for too long. It's possible to 'drown' the brain by drinking too much water. It's also possible to overheat from doing these activities so drinking water is important.
  • Driving, swimming, operating machinery or being involved with other risky activities while under the influence of ecstasy or 'coming down' from it, which can take several days [25], [24].

Warning signs suggestive of a serious life and death event include -

  • excessive thirst and profuse sweating,
  • muscle cramping,
  • shaking chills,
  • little to no urine output,
  • blurred vision,
  • fainting,
  • seizure [20].

If not treated as an emergency, any of the above potential complications can lead to death [20].

The unwanted signs of ecstasy include -

  • higher heart rate,
  • increase blood pressure,
  • muscle tension,
  • tightness in mouth and jaw,
  • feeling faint,
  • hot or cold flushes,
  • organ complications due to increased body temperature [18].

Risk of negative effects increases because -

  • people using ecstasy commonly take multiple doses in one session,
  • with uncontrolled drug manufacturing, it is impossible to tell how much of the drug one is consuming,
  • frequently, there are other drugs mixed into the tablets,
  • ecstasy can stimulate physical activity, which can lead to dehydration [18].

Short-term

  • heatstroke,
  • collapse,
  • coma [9].

Long-term

  • psychological disturbance,
  • depression,
  • liver damage,
  • kidney damage [9].

There is growing evidence of damage to nerve endings in the brain but the effects of this on behaviour and the long term consequences for users is still unknown [9].

Purity

A big problem with Ecstasy pills is that they're rarely pure. They can be cut with amphetamines (like speed), caffeine and other substances with some similar effects - because it's cheaper to produce and can increase the dealer's profits.

When Ecstasy has been cut with an alternative stimulant that is slower to kick in than MDMA, some users have then topped-up with another dose prematurely; and then they find they suffer side-effects because they've then overdosed [1].

Tablets contain, on average, 60 - 70 mg (base equivalent) of MDMA either as the hydrochloride salt or, less commonly, as the phosphate salt. Loose powders may range from crushed tablets (typically 30% - 40% purity) to almost pure MDMA. The free base constitutes 84% of the hydrochloride salt. Apart from the active drug, tablets contain a bulking agent such as lactose and smaller quantities of binders. In 2011, average values of 43 (Denmark) to 113 mg (Turkey) MDMA per tablet were reported across Europe.

During the last few years, there has been a change in the content of illicit drug tablets in Europe, from a situation where most tablets analysed contained MDMA or another ecstasy-like substance (MDEA, MDA) as the only psychoactive substance, to one where the contents are more diverse, and MDMA-like substances less present. This shift was most pronounced in 2009, when only three countries reported that MDMA-like substances accounted for a large proportion of the tablets analysed. More recently, there is evidence of a return to MDMA in tablets. In 2011, the number of countries reporting a predominance of tablets containing MDMA-like substances increased to eleven [3].

Today, a high percentage of pills contain other drugs; some pills marketed as ecstasy may not even contain any MDMA. These adulterants can include other club drugs such as MDA, PMA, Ketamine, PCP, and DXM, while some pills are cut with ephedrine, pseudoephedrine, and even caffeine and over-the-counter medications. It is believed that the contents of a pill can be identified based on its logo or colour (e.g. red pills are believed to contain mescaline, brown pills assumed to contain heroin, etc.), but a pill's colour and logo say nothing about its ingredients, as pill manufacturers often add food colouring to dye the tablets [26], [19].

The quality of all drugs is variable and nowhere is this more true than with MDMA. Users were always at risk of buying low quality tablets. However, as cost dropped, so did quality and some pills sold contain little or no MDMA.

Some will contain other psychoactive substances, there is a chance that any old tablet finds its way onto the streets - headache tablets, other medications, veterinary supplies, old capsules filled with any white powder. There are plenty of tales of things like 'worming tablets' being sold - partly based on the reality that tablets containing piperazines (an E-like stimulant) were originally used as cattle worming tablets.

Even if the tablet or capsule contains a genuine illegal, psychoactive drug, it may not be MDMA. As the drugs market becomes swamped with newer psychoactive compounds, so products sold as 'Ecstasy' could contain other drugs. These could be an MDMA-related compound, such as MDEA or MDA.

Recently, tablets have been found to contain the chemical PMA or PMAA. Although in the same general family as MDMA, PMA is considerably more dangerous, with a slow onset, high risk of overdosing and a significant impact on body temperature. It has caused a number of fatalities in recent years.

Other tablets have been found to contain emergent drugs like mephedrone, ketamine, butylone, amphetamine and a host of other compounds.

It should be stressed that tablets containing pure MDMA can still be risky. Some tablets contain very high doses of MDMA, and so fatalities could be due to strong tablets as much as contaminated ones.

For a long time, people who were wary of the pill market would seek out MDMA powder as being better quality. While there is still undoubtedly good quality MDMA powder on the market, there is also a lot of highly contaminated MDMA, bulked out with other white-powder drugs [7].

Quality control

The UK doesn't currently have any routine MDMA testing processes in place in club settings. In lieu of such a harm-reduction intervention, there are a number of DIY alternatives.

The old website Pill Report has become increasingly reliable as an international database of pill-feedback. It is primarily user-generated and includes bulletins from agencies where relevant. It is international so people should ensure that they are looking at recent, local reports to ensure that they are relevant.

Testing kits are available, and while they are able to identify the presence of MDMA they cannot reliably indicate the presence of potentially dangerous contaminants.

MDMA can have a distinctive vanilla-esque smell and very bitter taste. However both the smell and taste can be faked [7].

Is ecstasy getting stronger?

There have been many reports in the media that ecstasy is getting stronger. [study from the European Monitoring Centre on Drugs and Drug Addiction] (EMCDDA) from April 2016 looked at this issue. They state that in the 1990's and 2000's the average MDMA content of tablets was somewhere between 50 - 80 mg, as reported by drug checking services and forensic institutes. Currently, however, the averages are closer to 125 mg MDMA per tablet, while there are also 'super pills' found on the market in some European countries with a reported range of 270 - 340 mg. There are reports of large variations in the dosage in similar looking tablets [8].

Addiction

It's possible to build up tolerance to ecstasy, which means people need to take more of the drug to get the same buzz.

You may also develop a psychological dependence (a strong desire to keep on using despite the long-term risks, such as damaging relationships or losing your job) [1].

MDMA is generally considered to have a low potential for addiction, especially when compared to drugs such as alcohol, tobacco or heroin. Although users may report a strong desire to take the drug, they are generally able to stop use if they feel that it is negatively affecting their lives. However, in some cases people have found it difficult to control their use [27].

Dangerous interactions

Although many drugs are safe on their own, they can become dangerous and even life-threatening when combined with other substances. The list below contains some common potentially dangerous combinations, but may not include all of them. Certain combinations may be safe in low doses of each but still increase the potential risk of death. Independent research should always be done to ensure that a combination of two or more substances is safe before consumption [10].

  • 25x-NBOMe - Both the NBOMe series and this compound induce powerful stimulation and their interaction may cause severe side-effects. These can include thought loops, seizures, increased blood pressure, vasoconstriction, increased heart rate, and heart failure (in extreme cases).
  • alcohol - It is dangerous to combine alcohol, a depressant, with stimulants due to the risk of excessive intoxication. Stimulants decrease the sedative effect of alcohol which is the main factor most people consider when determining their level of intoxication. Once the stimulant wears off, the effects of alcohol will be significantly increased, leading to intensified disinhibition as well as respiratory depression. If combined, one should strictly limit themselves to only drinking a certain amount of alcohol per hour.
  • DXM - This combination may cause increased heart rate and panic attacks.
  • MXE - Increased heart rate and blood pressure may occur.
  • tramadol - This combination can increase the risk of seizures.
  • MAOIs - This combination may increase the amount of neurotransmitters such as dopamine to dangerous or even fatal levels. Examples include syrian rue, banisteriopsis caapi, 2C-T-2, 2C-T-7, αMT, and some antidepressants [28].
  • stimulants - The neurotoxic effects of MDMA may be increased when combined with other stimulants.
  • cocaine - This combination may increase strain on the heart [10].

Dangerous

  • αMT,
  • DXM,
  • Tramadol - Tramadol and stimulants both increase the risk of seizures,
  • MAOIs - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises [11].

Unsafe

  • PCP - This combination can easily lead to hypermanic states [11].

Caution

  • DOx - The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.
  • NBOMes,
  • 2C-T-x,
  • 5-MeO-xxT - Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care
  • MXE - There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.
  • Cocaine - Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.
  • Caffeine - Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA
  • Alcohol - Both MDMA and alcohol cause dehydration. Approach this combination with caution, moderation and sufficient hydration. More than a small amount of alcohol will dull the euphoria of MDMA
  • GHB/GBL - Large amounts of GHB/GBL may overwhelm the effects of MDMA on the comedown [11].

Withdrawal

Symptoms

Much of the psychological symptoms of ecstasy withdrawal have to do with serotonin levels being depleted. Over time, your brain can restore its depleted levels of serotonin, but it certainly does not happen overnight. Just know that it may take an extended period of time before you are able to consider yourself fully recovered from the effects of MDMA. Below is a list of the psychological and physical symptoms that you may experience when withdrawing from Ecstasy or 'Molly' [29].

  • Anxiety - It is common to feel fearful and high levels of anxiety when quitting Ecstasy. As your brain restores its serotonin levels, your anxiety should eventually subside. This may last for quite some time though depending on your usage.
  • Confusion - Mental confusion and cognitive impairment is a common symptom of withdrawal.
  • Cravings - Many people have intense cravings for Ecstasy when they've stopped. The drug makes many people feel so good that they cannot think of living life without it.
  • depersonalisation - You may feel unlike your real self - this is because your brain chemicals are out of homeostasis.
  • Depression - One of the most difficult symptoms for people to deal with when withdrawing from Ecstasy is depression. Depression is a common symptom and is a result of abnormally low levels of serotonin.
  • Delusions - Certain people may experience delusions or 'false beliefs' about reality. You may think that someone is out to get you - in similar manner to someone would with schizophrenia.
  • Fatigue - You may feel both mentally and physically fatigued upon stopping Ecstasy. The lethargy may be overwhelming initially and you may find yourself sleeping or tired on a consistent basis.
  • Hallucinations - Some people actually hallucinate when coming off of Ecstasy. Hallucinations could be both auditory and visual. You may see things and/or hear voices. Although these aren't necessarily typical symptoms, they have been documented.
  • Insomnia - Inability to fall asleep at night is another common symptom that could be a result of your withdrawal.
  • Irritability - If you find yourself becoming increasingly irritable, just know that this is a common symptom of withdrawal.
  • Loss of appetite - Another symptom is loss of appetite - you may not feel like eating for awhile. Do your best to eat what you can and consume healthy foods.
  • Mood swings - It is pretty common for people withdrawing from any drug to experience mood swings. With Ecstasy, mood swings are particularly common due to the fact that the drug throws your brain's serotonin and dopamine levels out of homeostasis.
  • Memory loss - Experiencing temporary memory loss is another symptom that some people report. Eventually your memory functioning should return to normal.
  • Muscle rigidity - Some people experience muscle rigidity and/or stiffness - almost like they are constantly flexed. In order to reduce this rigidity and possible soreness, give it time.
  • Panic attacks - Any drug that affects the serotonin system could result in the user experiencing panic attacks when trying to withdraw.
  • Paranoia - In long-term frequent users, many develop paranoid thinking. This is because the drug itself affects serotonin and dopamine. Although it releases more serotonin than dopamine, the decreased amount of dopamine stores could result in paranoid thinking.
  • Poor concentration - Due to your brain trying to readjust, you may notice lapses in your ability to concentrate. Withdrawal symptoms from MDMA are similar to that of amphetamines.
  • Psychosis - Some people experience psychosis or psychotic-like symptoms when coming off of this drug [29].
  • Aches and pains,
  • Exhaustion,
  • Restless sleep,
  • Agitation [24].

Duration of withdrawal

Like the symptoms of ecstasy withdrawal, the duration of the process is different for everyone. Symptoms usually peak within a few days of quitting the drug and last about a week. Severe psychological symptoms, like depression and cravings, may persist for several weeks to several months [30].

Ecstasy withdrawal timeline

  • Days 1 - 13 - Withdrawal symptoms begin within a few days of quitting ecstasy. Anxiety, irritability, insomnia, an inability to concentrate, paranoia and depression may present quickly and intensely. Users may also lose their appetite and feel physically and mentally tired.
  • Days 4 - 10 - Most withdrawal symptoms last about a week and will lessen in severity toward the end of that time. Depression, cravings and problems with sleeping, concentration and memory may persist.
  • Days 11+ - Over the next few weeks, depression can be severe as the user's brain chemistry continues to readjust. The user may still struggle with cravings, insomnia, and concentration and memory problems. These symptoms will eventually fade, but it can take weeks or even months for some users to be completely free of the effects of withdrawal [30].

Drug testing

Determining exactly how long ecstasy is detectable in the body depends on many variables, including which kind of drug test is being used. Ecstasy - also known as Adam, STP, XTC - can be detected for a shorter time with some tests, but can be 'visible' for up to three months in other tests.

The timetable for detecting ecstasy in the system is also dependent upon each individual's metabolism, body mass, age, hydration level, physical activity, health conditions and other factors, making it almost impossible to determine an exact time ecstasy will show up on a drug test [15].

The following is an estimated range of times, or detection windows, during which ecstasy can be detected by various testing methods -

How long does ecstasy show up in urine?

Ecstasy is detectable in a urine test for 2 - 5 days [15].

How long does ecstasy stay in the blood?

A blood test will detect Ecstasy for up to 24 hours [15].

How long will ecstasy show up in a saliva test?

A saliva test will detect Ecstasy from 1 - 5 days [15].

How long does ecstasy remain in hair?

Ecstasy, like many other drugs, can be detected with a hair follicle drug test for up to 90 days [15].

Legality

  • Ecstasy is a Class A drug and is illegal to have, give away or sell.
  • Possession can get you up to seven years in jail.
  • Supplying someone else, including your friends, can get you life and an unlimited fine [1].

What if you're caught?

If the Police catch you with ecstasy, they'll always take some action. This could include a formal caution, arrest and prosecution [1].

  • A conviction for a drug-related offence could have a serious impact. It can stop you visiting certain countries - for example the United States - and limit the types of jobs you can apply for [1].

Did you know?

  • Like drinking and driving, driving when under the influence of drugs is illegal - in fact you can still be unfit to drive the day after using ecstasy, especially if you've been up all night dancing. You can get a heavy fine, be disqualified from driving or even go to prison.
  • Allowing other people to supply drugs in your house or any other premises is illegal. If the police catch people supplying illegal drugs in a club they can potentially prosecute the landlord, club owner or any person concerned in the management of the premises [1].

Mixing with other drugs

Although many drugs are safe on their own, they can become dangerous and even life-threatening when combined with other substances. The list below contains some common potentially dangerous combinations, but may not include all of them. Certain combinations may be safe in low doses of each but still increase the potential risk of death. Independent research should always be done to ensure that a combination of two or more substances is safe before consumption [31].

  • 25x-NBOMe - Both the NBOMe series and this compound induce powerful stimulation and their interaction may cause severe side-effects. These can include thought-loops, seizures, increased blood pressure, vasoconstriction, increased heart rate, and heart failure (in extreme cases),
  • Alcohol - It is dangerous to combine alcohol, a depressant, with stimulants due to the risk of excessive intoxication. Stimulants decrease the sedative effect of alcohol which is the main factor most people consider when determining their level of intoxication. Once the stimulant wears off, the effects of alcohol will be significantly increased, leading to intensified disinhibition as well as respiratory depression. If combined, one should strictly limit themselves to only drinking a certain amount of alcohol per hour,
  • DXM - This combination may cause increased heart rate and panic attacks,
  • MXE - Increased heart rate and blood pressure may occur,
  • Tramadol - This combination can increase the risk of seizures,
  • MAOIs - This combination may increase the amount of neurotransmitters such as dopamine to dangerous or even fatal levels. Examples include syrian rue, banisteriopsis caapi, 2C-T-2, 2C-T-7, αMT, and some antidepressants.
  • Stimulants - The neurotoxic effects of MDMA may be increased when combined with other stimulants,
  • Cocaine - This combination may increase strain on the heart [31].
  • Ecstasy + alcohol - increased risk of dehydration and consequently drinking too much water [32].
  • Ecstasy + ice or speed - increased risk of anxiety and reduced brain functioning due to dopamine depletion. Enormous strain on the heart and other parts of the body, which can lead to stroke [33].
  • Ecstasy + antidepressants - Drowsiness, clumsiness, restlessness and feeling drunk and dizzy [34].

Harm reduction

About 10 Ecstasy-related deaths have been reported in the UK each year for the past several years. Although the number of deaths is relatively low compared to drugs such as heroin or alcohol, there is still cause for concern.

The following may help to reduce the risks associated with ecstasy use -

  • You should avoid using ecstasy if you have high blood pressure, heart disease, epilepsy (or family history of epilepsy), diabetes or liver problems. You should also avoid using it if you have had psychiatric problems like depression or anxiety. The combination of ecstasy and flashing lights in clubs can make some people more susceptible to seizures. Take advice if you are unsure [2]. These conditions and ecstasy/MDMA mean that you can be at increased risk of bad reactions to ecstasy, so it is best avoided [8].
  • Taking ecstasy and dancing in hot clubs can cause dehydration and overheating. Non-alcoholic drinks such as water or isotonic drinks help to prevent this. However, it can be dangerous to drink too much fluid. It is therefore advisable to sip one pint of non-alcoholic liquid (not more) per hour. Regular rests from dancing will also reduce the risks of dehydration and overheating [2]. Relax somewhere cool and sip water or another non-alcoholic drink slowly (one pint an hour). Do not drink too much as this can also be dangerous. Drinking too much or too quickly affects your body's salt balance [8].
  • People using ecstasy in clubs or at dance events should ensure that they will be looked after in the event of an emergency. It is advisable to go to events that adhere to a safer dancing code of conduct, including adequate ventilation, rest areas, freely available water and staff who are trained to deal with emergencies.
  • Regular users sometimes report that they develop a tolerance to MDMA and need to take higher doses to experience the same effects. This will increase the risks.
  • Comedowns can last 3 - 4 days and can leave users feeling very low and irritable [2].
  • There is no way to know what is in an ecstasy pill unless you can get it tested. Information from testing centres suggest that ecstasy is getting stronger so the advice is to start low and go slow - e.g. begin by taking a quarter of a pill and wait an hour or two to see the effects. This advice is reiterated in the CrushDabWait campaign, where users are encouraged to crush their pill, dab in a wet finger, swallow and wait to see how strong the effects are.
  • If possible get the tablets tested. Testing facilities are becoming increasingly available at festivals and clubs.
  • As with all drugs it is best not to use ecstasy alone but to be with friends you trust and who preferably know some first aid.
  • Always seek medical attention if you are worried about your or a friend's reaction to ecstasy [8].

Before

Research local warnings about pills; look here - http://www.pillreports.net

  • ensure that you are in good physical and mental health before use; use for people with pre-existing health problems is especially risky,
  • use should not take place on top of other substances (including alcohol) and can be especially risky on top of some anti-depressants,
  • use should take place in an environment where you feel safe, with a sober person, who you trust, and who will seek help if you need it [7].

Test the drug

Dealers can mix other chemicals, from caffeine to methamphetamine, into MDMA and ecstasy. We recommend that you always test your pills using a [testing kit]. Depending on the country you're in, there are places where you can [samples of your pills] to be tested. Another recommended source is [Reports], where you can search for an ecstasy pill by its stamp and appearance. However, this is not a foolproof way to making sure that your pills are safe.

Accidental deaths have occurred due to ingesting compounds such as [in a pill that was thought to be MDMA]. We know some people cannot be bothered to test, but it is becoming increasingly important to do this in order to stay safe [35].

Dose

As you cannot be sure about the strength or quality of what you are taking, use ¼ to ½ a tablet to start with, or 1/10th gram or less of powder. Allow up to two hours for the drug to work. Even if nothing happens after two hours, don't use any more; the drug may be having an undetectable effect of which you are unaware.

If you like the effects and want to use more, use a smaller second dose, and don't keep redosing all evening [7].

During

  • keep cool - take time out from dancing in club settings and get in to a cool environment to lose heat; remove scarves or hats to help cool down,
  • use cool water on face and neck to help cool down,
  • stay hydrated - sipping around a pint of water per hour. Don't use caffeinated energy drinks as they can increase heart problems and dehydration,
  • the safest option would be to drink sports rehydration drinks as they will help replace lost minerals along with fluids,
  • don't panic if you can't pee - it doesn't mean you are dehydrated: MDMA affects kidney function and reduces urine output,
  • don't drink too much water as this can be dangerous,
  • MDMA can make users feel sexually aroused; ensure you are around friends who you trust and ensure you have condoms with you in case things go further,
  • jaw clenching can damage teeth - use gum to help protect you from grinding [7].

Take a break from dancing

MDMA can change your body temperature regulation, while dancing increases your body temperature. These combined can lead to heat stroke, so take a break from dancing from time to time to cool down [35].

Avoid re-dosing

A common mistake which can lead to a bad experience (or even to hospitalisation) is taking another dose of MDMA because the first one did not have an effect. This leads to 'coming up' twice as hard, which is very dangerous. MDMA takes a long time to digest and absorb, so be patient, and wait for it to kick in [35].

Emergencies and overdosing

  • How to know if someone took an overdose -
    • vomiting,
    • headaches,
    • dizziness,
    • serotonin syndrome - increased heart rate, shivering, twitching, over-responsive reflexes, extremely high temperatures [35].

Do not hesitate to call a paramedic if you feel any of these symptoms. You will not get into trouble [35].

After

The MDMA hangover, or comedown, varies from person to person and is dependent on the amount taken. The effects can also last from 1 up to 14 days after use [35].

The after-effects include -

  • fuzzy memory,
  • decrease in attention or difficulty concentrating,
  • some people feel happier in general and more focused,
  • mild to strong depression [35].

Some people experience a 'loss of magic' after using MDMA after a couple of uses, meaning the drug doesn't feel as good as the first few times. However, this does not happen to all people. If MDMA is taken on successive days or weeks, then the negative and comedown effects are worsened [35].

Lots of people report a serious dip in mood after using MDMA - the dreaded 'mid-week blues'. At this point people may have low levels of serotonin which can leave the person feeling sad, weepy, depressed and experiencing poor quality sleep.

The temptation is for people to escape this low mood through use of other drugs (like cannabis or tranquillisers) or use of stimulants to lift mood. Use of any drugs is liable to worsen mental wellbeing.

Healthy diet, including bananas, dairy, poultry, nuts and pulses can help the brain's levels of serotonin get back to normal. Some people advocate the use of supplements such as 5-HTP. Natural sleep and moderate exercise can help.

If low mood persists, seek help.

Have a good long break (three or more weeks minimum) before use of more MDMA. Allow yourself to fully recover [7].

Additional harm reduction advice

Drink plenty of water before and after, and we also recommend taking vitamin supplements. Here is [[1]] [35].

Guide to supplementing vitamins with MDMA -

6 hours before
  • 200mg (2 pills, normally) Magnesium Glycinate,
  • A glass of grapefruit juice [35].
1 - 3 hours before
  • 100mg Na-R-ALA (when buying, make sure it is Na-R-ALA, not R-ALA),
  • 200mg Magnesium Glycinate,
  • 1000mg Vitamin-C (e.g. 1x Emergen-C packet),
  • 100mg Grape Seed Extract,
  • A Glass of grapefruit juice,
  • 500mg ALCAR,
  • 400mg EGCG,
  • 100mg CoQ10 [35].
30 mins before
  • 1x Tums/Rolaids (unlike the other supplements listed here, this is not for harm reduction. Instead, it increases stomach alkalinity which prolongs the roll) [35].
2 hours after dosing
  • 100mg Na-R-ALA,
  • 200mg Magnesium Glycinate,
  • 1000mg Vitamin-C,
  • 100mg Grape Seed Extract [35].
4 hours after dosing
  • 100mg Na-R-ALA [35].
That night
  • 5--10mg Melatonin [35].
The following 3 - 7 nights
  • 100mg 5-HTP,
  • 400mg EGCG [35].

History

MDMA was 'rediscovered' by Dr Alexander Shulgin who, although in official retirement, was the sole holder of the licence given by the Government of the United States to develop compounds that may have health and commercial benefits. Shulgin spent a lot of time working on the phenethylamine group of drugs of which MDMA (first synthesised by Merck just before the First World War) belongs to. It was used as a tool in psychotherapy, and its rediscovery pushed it back into that field again. It was found that the drug had disinhibiting qualities that promoted feelings of 'empathy' and 'openness' which helped couples in dysfunctional relationships. As it gained popularity amongst students as a 'party' drug in the US, the name 'E' (short for 'ecstasy', although it may originally have been intended to stand for 'empathy', which could be considered more logical) became associated with it.

Ecstasy became very closely associated, and its use and popularity magnified with the dance rave culture in the late 1980's. This continued for around a decade, after which a great decrease in purity was seen along with a move away from the dance scene and perhaps associated with the ageing 80's 'clubber' generation. However, the last few years have seen another big explosion of Ecstasy use. This time round, we are seeing MDMA powder becoming more popular, probably due to the very low quality of pills found, and MDMA powder entering the market as a 'cleaner', purer, more real form [2].

In 1912, a German pharmaceutical company first synthesized MDMA in an attempt to create an appetite suppressant. In the late 1970's, it was rediscovered by a small group of U.S. therapists hoping to utilise it in psychotherapy and marriage counselling. MDMA became illegal in 1988 and was categorised as a Schedule I drug. Recreational, illicit use of the drug started becoming popular in the United States in the late 1980's and early 1990's. Ecstasy soon became popular at 'raves' - large dance parties with throbbing electronic music and pulsating lights. Currently, however, raves are not the only setting where ecstasy is used; abuse at house parties, college dorms, and various other places has become more widespread [19].

MDMA was originally synthesised in 1912 by the chemist Anton Köllisch as a potential medicine to stop abnormal bleeding. Over the following 65 years, MDMA was widely forgotten about with the first reports of it being used recreationally going back to 1970 [36]. Chemist Alexander Shulgin is credited with popularising the use of MDMA in psychotherapy in the late 1970's [37]. It was finally scheduled as a controlled substance in 1985 when its use began to propagate out to mainstream society and rave culture [38].

Researchers are investigating whether a few low doses of MDMA may assist in treating severe, treatment-resistant post traumatic stress disorder (PTSD) [39], [40]. More research is needed to determine if its usefulness outweighs the risk of harm [39], [40].

Emergencies

Panic attacks

If you feel or someone you are looking after start getting panicky (heart racing, breathing getting very fast, feeling very anxious) the following might help -

  • Sit down with your back against something solid (wall, fence),
  • Bring knees up and have head between knees,
  • Take deep regular breaths in through the nose and breath out through the mouth,
  • If you are helping a person who is panicking, provide reassurance, by talking calmly and ensuring that they aren't being hassled by lots of people,
  • If the symptoms get worse or there are persisting chest pains seek medical help urgently [7].

Convulsions

MDMA and related compounds can cause convulsions. If you are with someone having a convulsion -

  • Don't try to restrain them or put anything in their mouth,
  • Do move furniture or other hazards out of the way so the person won't hit them,
  • Do place a pillow, cushion or folded jacket under the person's head cushion it,
  • Always send someone to get help [7].

Overheating

MDMA-type drugs can cause a dangerous increase in body temperature. This can be fatal [7]. Signs of overheating aren't always easy to spot but can include -

  • Feeling very hot,
  • Stopping sweating,
  • Cramps in legs and arms,
  • Headaches,
  • Feeling anxious or panicky [7].

Dealing with overheating

  • It's a medical emergency: dial 999 or get on-site medics to help,
  • Keep the person cool,
  • Get them in to fresh air. (At a festival this includes taking them out of sleeping bag or tent),
  • Remove any heavy outer clothes,
  • Spray them with cool water,
  • If they are shaking or convulsing don't restrain them as this will make them hotter,
  • Don't try and make them drink anything at this stage - it could make things worse,
  • Tell the emergency services the person may have taken an MDMA-type drug [7].

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 Ecstasy, 2016, http://www.talktofrank.com/drug/ecstasy
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Ecstasy/MDMA, 2017, http://www.release.org.uk/drugs/ecstasy-mdma/
  3. 3.0 3.1 Methylenedioxymethamphetamine (MDMA or 'Ecstasy') drug profile, 2015, http://www.emcdda.europa.eu/publications/drug-profiles/mdma
  4. What Is Ecstasy?, 2017, http://www.thegooddrugsguide.com/ecstasy/index.htm
  5. 5.0 5.1 Ecstasy (MDMA), 2017, http://www.castlecraig.co.uk/resources/drugs/types-drugs/ecstasy
  6. 6.0 6.1 6.2 DEA, Drugs of Abuse, 2015, Drug Enforcement Administration, https://www.dea.gov
  7. 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 7.12 7.13 7.14 7.15 Ecstasy (MDMA), 2017, http://www.kfx.org.uk/drug_facts/drug_facts_ecstasy.php
  8. 8.0 8.1 8.2 8.3 8.4 Ecstasy, 2016, http://www.drugwise.org.uk/ecstasy/
  9. 9.0 9.1 9.2 9.3 9.4 9.5 Ecstasy, 2014, http://www.dan247.org.uk/Drug_Ecstasy.asp
  10. 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 10.11 10.12 MDMA, 2017, https://psychonautwiki.org/wiki/MDMA
  11. 11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 11.10 MDMA, 2017, https://wiki.tripsit.me/wiki/MDMA
  12. Fitzgerald, J. L. and Reid, J. J., Effects of methylenedioxymethamphetamine on the release of monoamines from rat brain slices, European Journal of Pharmacology, 1990, 191, 2, 217-220, http://10.1016/0014-2999(90)94150-V, http://www.sciencedirect.com/science/article/pii/001429999094150V
  13. Fleckenstein, A. E. and Volz, T. J. and Riddle, E. L. and Gibb, J. W. and Hanson, G. R., New Insights into the Mechanism of Action of Amphetamines, Annual Review of Pharmacology and Toxicology, 2007, 47, 681-698, http://10.1146/annurev.pharmtox.47.120505.105140, http://www.annualreviews.org/doi/abs/10.1146/annurev.pharmtox.47.120505.105140
  14. Passie, T., Healing with Entactogens: Therapist and Patient Perspectives on MDMA-Assisted Group Psychotherapy, 2012, Multidisciplinary Association for Psychedelic Studies, isbn 978-0979862274, https://www.amazon.com/Healing-Entactogens-Perspectives-MDMA-Assisted-Psychotherapy/dp/0979862272
  15. 15.0 15.1 15.2 15.3 15.4 15.5 How Long Does Ecstasy Stay in Your System?, 2016, https://www.verywell.com/how-long-does-ecstasy-stay-in-your-system-80255
  16. MDMA (methylenedioxymethamphetamine, Ecstasy): Uses, Symptoms, Signs and Addiction Treatment, 2017, http://addictionlibrary.org/illicit/mdma.html
  17. 17.0 17.1 Ecstasy, 2016, http://www.drugfreeworld.org/drugfacts/drugs/ecstasy.html
  18. 18.0 18.1 18.2 Patterson, E., Ecstasy Abuse, 2016, http://drugabuse.com/library/ecstasy-abuse/
  19. 19.0 19.1 19.2 Ecstasy, 2013, http://www.cesar.umd.edu/cesar/drugs/ecstasy.asp
  20. 20.0 20.1 20.2 Davis, K., MDMA (Ecstasy): Facts, Effects and Hazards, 2015, http://www.medicalnewstoday.com/articles/297064.php
  21. Campbell, A., The Australian illicit drug guide, 2000, Black Inc., Melbourne
  22. Brands, B. and Sproule, B. and Marshman, J., Drugs & drug abuse, 1998, 3rd edition, Addiction Research Foundation, Ontario, Canada
  23. Upfal, J., The Australian Drug Guide, 2006, Black Inc., Melbourne
  24. 24.0 24.1 24.2 Ecstasy, 2016, http://www.druginfo.adf.org.au/drug-facts/ecstasy
  25. Goren, N., Prevention Research Quarterly, 2005, http://www.druginfo.adf.org.au/attachments/353_ResearchbookletDec05.pdf
  26. MDMA (Ecstasy/Molly), 2016, https://www.drugabuse.gov/publications/drugfacts/mdma-ecstasymolly
  27. MDMA, 2017, http://www.drugscience.org.uk/drugs/stimulants/mdma/
  28. Gillman, P. K., Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity, British Journal of Anaesthesia, 2005, 95, 4, 434-441, https://doi.org/10.1093/bja/aei210, https://academic.oup.com/bja/article/95/4/434/302715/Monoamine-oxidase-inhibitors-opioid-analgesics-and
  29. 29.0 29.1 MDMA (Ecstasy, Molly) Drug Withdrawal Symptoms: What You May Experience, 2014, http://mentalhealthdaily.com/2014/03/19/mdma-ecstasy-molly-drug-withdrawal-symptoms-what-you-may-experience/
  30. 30.0 30.1 Smith, K., Ecstasy Withdrawal and Detox, 2016, https://www.addictioncenter.com/drugs/ecstasy/withdrawal-detox/
  31. 31.0 31.1 MDMA, 2016, https://psychonautwiki.org/wiki/MDMA
  32. Hernandez-Lopez, C. and Farre, M. and Roset, P. and Menoyo, E. and Pizarro, N. and Ortuno, J. and de la Torre, R., 3,4-Methylenedioxymethamphetamine (ecstasy) and alcohol interactions in humans: Psychomotor performance, subjective effects, and pharmacokinetics, Journal of Pharmacology and Experimental Therapeutics, 2002, 300, 1, 236-244, https://www.ncbi.nlm.nih.gov/pubmed/11752122
  33. Australian Government Department of Health & Ageing, National Amphetamine-Type Stimulant Strategy, 2007, http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/98CFCAEC1A10BE00CA2574C5000C2641/File/mono69.pdf
  34. Copeland, J. and Dillon, P. and Gascoigne, M., Ecstasy And The Concomitant Use Of Pharmaceuticals, National Drug and Alcohol Research Centre, 2004, 201, http://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/TR.201.pdf
  35. 35.00 35.01 35.02 35.03 35.04 35.05 35.06 35.07 35.08 35.09 35.10 35.11 35.12 35.13 35.14 35.15 MDMA, 2016, http://www.drugsand.me/mdma/
  36. Bernschneider-Reif, S. and Öxler, F. and Freudenmann, R. W., The origin of MDMA ('Ecstasy') - separating the facts from the myth, Die Pharmazie - An International Journal of Pharmaceutical Sciences, 2006, 61, 11, 966-972, http://www.ingentaconnect.com/content/govi/pharmaz/2006/00000061/00000011/art00015
  37. Shulgin, A. and Shulgin, A., PiHKAL: A Chemical Love Story, 1991, 1, Transform Press
  38. Adam, D., Pharmaceutical company unravels drug's chequered past, 2006, http://www.mdma.net/merck/history-ecstasy.html
  39. 39.0 39.1 Meyer, J. S., 3,4-methylenedioxymethamphetamine (MDMA): current perspectives, Substance Abuse and Rehabilitation, 2013, 4, 83-99, https://doi.org/10.2147/SAR.S37258, https://www.dovepress.com/34-methylenedioxymethamphetamine-mdma-current-perspectives-peer-reviewed-article-SAR
  40. 40.0 40.1 Parrott, A. C., The potential dangers of using MDMA for psychotherapy, Journal of Psychoactive Drugs, 2014, 46, 1, 37-43, http://10.1080/02791072.2014.873690, https://www.ncbi.nlm.nih.gov/pubmed/24830184