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FACT SHEET
WHAT IS MDMA?
MDMA (3,4-methylenedioxymethamphetamine) is the N-methyl
analog of MDA, and shares similarities to both mescaline, a
hallucinogen, and amphetamines, a family of stimulants. Although
often referred to itself as a hallucinogen, this association is
somewhat erroneous. The effects of MDMA dramatically differ from
those of LSD and other psychedelics, with a notable lack of the
perceptual distortions usually associated with these substances.
WHO IS USING MDMA?
MDMA appears to be most often used in urban areas,
particularly certain college towns (e.g. UC Berkeley, UCLA, UC
Santa Barbara, and UC Santa Cruz). In the past, some
psychotherapists have employed it, under carefully supervised
conditions, for a wide variety of purposes, ranging from
improving couple communication to dealing with rape trauma.
Illicit use has been most commonly associated with college
students, gays and "yuppies."
HOW IS MDMA MOST COMMONLY USED?
MDMA is most often ingested orally, although inhalation and
injection have been infrequently reported. The usual dose ranges
from 100 to 150 mg and costs between $10 and $20. Although
analyzed samples have been fairly pure in the past, this may
change due to increased popularity and newly illicit status.
WHY ARE PEOPLE USING MDMA?
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UCLA Drug Abuse Research Group (M. Douglas Anlgin, PhD, Director)
Many users of MDMA are probably attracted to the drug for
the same reasons as some psychotherapists. They feel that MDMA
has the ability to increase empathy and self-insight.
Reportedly, the advantages of MDMA over traditional psychedelics
are less distortion of sensory perception and fewer unpleasant
emotional reactions. In addition, many individuals describe
strong euphoric and/or sensual effects associated with MDMA.
DESCRIBE A 'TYPICAL' MDMA EXPERIENCE
Effects generally appear within 20-60 minutes, when the user
often experiences a brief "rush" of energy, usually described as
mild but euphoric. After this rush, the high levels off to a
plateau which lasts 2-3 hours and is followed by a gradual
"coming down" sensation, culminating in a feeling of fatigue.
MDMA exerts amphetamine-like effects which include dilated
pupils, dry mouth and throat, tension in the lower jaw, grinding
of the teeth, and overall stimulation. These side effects are
dose dependent and will vary depending on the health of the
individual user. In addition, MDMA exerts a strong paradoxical
effect of relaxation which often causes many users to be unaware
of the stimulant side effects. Most users cite a dramatic drop
in defense mechanisms and increased empathy towards others.
Combined with the stimulant effect, this generally produces an
increase in intimate communication.
WHAT IS KNOWN ABOUT THE TOXICITY OF MDMA?
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iv
UCLA Drug Abuse Research Group (M. Douglas Anlgin, PhD, Director)
Unfortunately, very little. So far, MDMA has been
associated with few overdoses or deaths. However, studies in
rats have indicated that large intravenous doses of MDMA in rats
are associated with suspected degeneration of serotonergic nerve
terminals in certain areas of the brain. Also, there may be some
suppression of the immune system. Further research is needed to
determine the significance of this damage, and to what extent it
may occur in humans.
WHAT IS MDMA'S ABUSE POTENTIAL?
The euphoric effects of MDMA, combined with its street
reputation, would suggest a significant abuse potential. To
date, however, there appear to be relatively few cases of what
might be considered serious abuse of MDMA. Excessive use is
probably self limiting in that the frequent use of MDMA almost
invariably produces a strong dysphoric (unpleasant) reaction,
that is only exacerbated with continued use. In addition,
frequent use produces an almost total loss of the desired actions
with a greater rapidity and intensity than with other more
commonly abused substances.
v
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UCLA Drug Abuse Research Group (M. Douglas Anlgin, PhD, Director)
11/14/86 epd
Rev. 12/31/86 epd
Rev. 3/24/87
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UCLA Drug Abuse Research Group (M. Douglas Anlgin, PhD, Director)
EXECUTIVE SUMMARY
The 1980's have witnessed the emergence and popularization
of a rather unique psychoactive substance -- MDMA, (3,4-
methylenedioxy-methamphetamine), also known as "Adam," "Ecstasy,"
or "XTC". Extensive media coverage recently highlighted what
appears to be a dramatic increase in both therapeutic and
recreational use. A controversy has since ensued providing very
different perspectives on the substance. Some psychotherapists
view MDMA as a therapeutic aid which, when combined with
psychological treatment, has benefits that outweigh potential
health consequences and see minimal harm associated with
carefully monitored use. Some drug treatment counselors and drug
enforcement officials, on the other hand, see it as a potentially
dangerous substance possessing harmful actions, and increasingly
being abused outside of therapeutic circumstances.
Unfortunately, research has only just begun to address many of
the questions and concerns that have arisen. Consequently, it
can be anticipated that much of the following information will
become dated as more formal studies are completed.
Research examining patterns of MDMA use has been minimal.
Most of the information available regarding street use of MDMA is
based on anecdotal accounts given to the media, therapists and
substance abuse professionals. Beck has conducted preliminary
research over the last ten years interviewing hundreds of
individuals in the San Francisco Bay Area and at the University
of Oregon in Eugene. Zinberg (1976) has published the only
v
naturalistic study of 23 users of MDA. Greer (1983) administered
MDMA to 29 subjects in a therapeutic setting. Downing (1985)
studied the effects of a single exposure to MDMA among 21
individuals. Siegel (1985) and Seymour (1986) have ongoing
studies at UCLA and the Haight Ashbury Free Clinic, respectively.
Much of the information for this paper is based upon these
studies, testimony at federal hearings, and personal
communications.
MDMA, which is essentially the successor to MDA, first
appeared on the street in the early 1970's. Use remained very
limited until the end of the decade. On July 1, 1985 the Drug
Enforcement Administration (DEA) used its emergency scheduling
power to temporarily place MDMA in Schedule I of the Controlled
Substances Act. The DEA's actions were challenged by some
therapists and researchers who argued that a Schedule I status
would severely hinder research into what they regarded as MDMA's
therapeutic potential. Based on testimony from federal hearings,
the administrative law judge recommended that MDMA be placed in
Schedule III -- a category for drugs with accepted medical use
and only a low to moderate abuse potential. However, the DEA
administrator rejected his recommendation and MDMA was
permanently placed in Schedule I effective November 13, 1986.
The scheduling process and ensuing reaction by therapists using
the drug in their practices brought MDMA to national attention
via mass media features which often sensationalized the reputed
euphoric and therapeutic qualities of MDMA. The increase in
vi
publicity was accompanied by an escalation in street demand from
an estimated 10,000 doses distributed in all of 1976 to 30,000
doses distributed per month in 1985 (Siegel, 1986). The DEA
found evidence of use in a majority of states.
MDMA appears to be most often used in urban areas,
particularly certain college towns. Its use has been most
commonly associated with college students, gays and "yuppies".
The usual dose ranges from 100 to 150 mg. and costs between $10
and $20. MDMA is most often ingested orally, although inhalation
and injection have also been infrequently reported. Drug effects
generally appear within 20-60 minutes after ingestion, when the
user often experiences a brief "rush" of energy, usually
described as mild but euphoric. After this rush, the high levels
off to a plateau which lasts 2-3 hours and is followed by a
gradual "coming down" sensation, culminating in a feeling of
fatigue.
MDMA exerts amphetamine-like side effects on the body,
including dilated pupils, dry mouth and throat, tension in the
lower jaw, grinding of the teeth, and overall stimulation. These
effects vary depending on dose. In addition, MDMA exerts a
strong paradoxical effect of relaxation, which often causes many
users to be unaware of the stimulant side effects. Most users
cite a dramatic drop in defense mechanisms and increased empathy
towards others. Combined with the stimulant effect, this
generally produces an increase in intimate communication.
Psychotherapeutic Effects
vii
It appears that well over one hundred psychiatrists and
other therapists have employed MDMA as a therapeutic adjunct. At
the federal hearings several psychiatrists praised MDMA's ability
to increase both empathy and self-insight. They felt that a
major advantage of MDMA over the traditional psychedelics was
that it produced far less distortion of sensory perception and
fewer unpleasant emotional reactions. Although some preliminary
research suggested that MDMA has significant therapeutic
potential, the notable absence of well-controlled, double-blind
studies seriously limits any conclusions concerning the possible
efficacy or risk associated with the use of MDMA in therapy.
Health Risks
Although some research has assessed toxic and lethal doses
in animals, little is known about MDMA's potential toxicity for
humans. A few deaths have been associated with the use of MDMA,
but its role as a causative factor in each case remains
uncertain. As of April, 1986 20 emergency room incidents for
MDMA had been listed in the federal government's Drug Abuse
Warning Network (DAWN). Ignorance of the substance undoubtedly
contributes to underreporting. However, the number of mentions
still appears to be rather low when compared with the suspected
extent of use described by Siegel and the DEA.
MDMA has been associated with relatively few overdoses or
deaths. However, it's neurotoxic potential is cause for concern.
Acute and chronic problems are most often associated with the
repeated use of high dosages. Generally, the side effects of
viii
MDMA are similar to those of amphetamine. MDMA also appears to
exert an adverse action on the immunological response of some
individuals, particularly with heavy use. Long-term users often
describe increasingly uncomfortable and prolonged "burn-out"
periods, sometimes lasting two or more days. Many individuals
have also reported an increased susceptibility to various
ailments, particularly sore throats, colds, flus, and herpes
outbreaks. It should be noted that these reactions appear to be
rare in novice users and individuals in good physical and mental
health.
Based on the limited information available, researchers have
identified the following medical conditions as possible
contraindications to MDMA use: diabetes, diminished liver
function, epilepsy, glaucoma, heart disease, hypertension,
hypoglycemia, hyperthyroidism and pregnancy.
Infrequent psychological problems have been associated with
the use of MDMA. Rare episodes of hyperventilation have been
noted, but this phase is transitory. In addition, problems occur
for some individuals who, in attempts at self-therapy, run the
risk of exacerbating their emotional problems with unsupervised
episodes.
Among individuals who have tried both MDMA and cocaine, Beck
found that the majority usually express a strong preference for
MDMA which would suggest a high abuse potential. However, in
sharp contrast to cocaine, there appear to be relatively few
cases of what might be considered serious abuse of MDMA.
ix
Excessive use is probably self limiting in that frequent use of
MDMA always produces a strong dysphoric (unpleasant) reaction,
that is only increased with continued use. In addition, frequent
use produces an almost total loss of the desired actions with a
greater rapidity and intensity than with other more commonly
abused substances.
Conclusion
Media accounts and substance abuse professionals often
dismiss MDMA as a short-term fad. However, the perceived
therapeutic and/or euphoric effects combined with the ease with
which MDMA is usually experienced can be expected to attract new
users. The danger in this regard is the uncertain potential for
abuse. In addition, there are potentially severe health risks
associated with MDMA and probable contraindications. This is
particularly true with repeated use of high dosages which may
lead to acute or chronic medical and psychological problems.
Unfortunately, our current knowledge regarding nearly every
aspect of MDMA is extremely limited and based almost exclusively
on anecdotal data. Research is obviously needed to better
determine the potential risks of a substance which is rapidly
establishing itself in our drug culture.
11/14/86 epd
Rev. 12/31/86 epd, 9/15/87 jh
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