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As of 2015, the National Institute on Drug Abuse (NIDA) reports that nearly 7 percent of American adults have used MDMA (3,4-methylenedioxymethamphetamine) at some point in their lifetime. MDMA is an illegal synthetic drug often made in clandestine laboratories and typically sold as colorful tablets called ecstasy at parties, clubs, and raves. It may also be marketed in liquid, powder, and in capsule form. It is also known as Adam, XTC, lover’s speed, clarity, hug drug, beans, Eve, E, or X, or in a supposedly pure form called Molly.
Young adults between the ages of 18 and 25 abuse ecstasy at the highest rates, NIDA publishes. MDMA works as both a hallucinogenic drug and a stimulant drug, which means that it increases energy, activity, and alertness levels while also distorting time and sensory perceptions and inducing a sense of emotional warmth and closeness. The Drug Enforcement Administration (DEA) warns that MDMA, or ecstasy, has no accepted medicinal use within the United States and therefore considers the drug to be dangerous, and illegal, to use.
The effects of ecstasy start working within about 20-30 minutes of taking MDMA orally, and the National Highway Transportation Safety Association (NHTSA) reports that the bulk of them last about an hour while residual side effects may continue for 2-3 hours. Ecstasy is often taken in conjunction with other drugs or alcohol, which can increase the duration and impact of the drug. Called “candy-flipping,” MDMA is commonly combined with the hallucinogenic drug LSD (lysergic acid diethylamide) to prolong the “trip,” for example. It may also be abused by “stacking,” which is taking several tablets at once, or by “piggy-backing,” which is when doses are taken back to back. These methods of abuse can intensify and extend the drug’s effects but also increase the potential risks.
Ecstasy interferes with three major naturally occurring chemicals in the brain: dopamine, serotonin, and norepinephrine. Dopamine intensifies gratification and energy levels. Norepinephrine raises blood pressure, heart rate, and body temperature. Serotonin impacts appetite, sleep functions, mood, emotional closeness, feelings of empathy, trust, and sexual excitement.
Ecstasy distorts a person’s sense of time as well as their senses in general and impairs rational thought and decision-making processes. Increased sensitivity to light and touch, increased sociability, and amplified empathy are common indicators of ecstasy use. A person taking ecstasy often feels emotionally close to those around them and may engage in sexual activities at an increased rate. They will also appear happy, euphoric, energetic, have less of an appetite, and be wide awake. Individuals are more likely to participate in activities that may be potentially risky and engage in behaviors and actions that are out of character when under the influence of ecstasy.
Not all ecstasy trips are the same; sometimes, they can be more negative than positive, causing a person to become anxious and paranoid and experience auditory and visual hallucinations and/or panic attacks. After ecstasy wears off, a person is liable to feel exhausted, irritable, fatigued, depressed, or aggressive. They may have trouble sleeping, concentrating, and thinking straight, and suffer from muscle tension, apathy, anxiety, a lowered interest in sex, and impulsivity, which can last up to a week after taking the drug.
Additional health effects of ecstasy abuse include teeth clenching, dilated pupils, blurred vision, nausea, muscle cramps, sweating, dehydration, chills, irregular heart rate, impaired motor skills and coordination, mental confusion and difficulties concentrating, and tremors or convulsions.
Abusing ecstasy can impair a person’s ability to make rational decisions as well, and individuals are more likely to then put themselves into situations or engage in behaviors that can be potentially hazardous. Unsafe sexual practices are common, for example, which can put a person at risk for contracting a sexually transmitted or infectious disease, such as hepatitis and HIV/AIDS, NIDA warns.
Over 20,000 people received emergency department (ED) services due to an adverse reaction to MDMA abuse in 2011, the Drug Abuse Warning Network(DAWN) reports. MDMA interferes with how the body controls its temperature, which can cause it to spike dangerously high, leading to heart, kidney, or liver failure, which can be potentially fatal.
An ecstasy overdose can occur when too much MDMA enters the bloodstream; the body cannot break it down and levels become toxic. NIDA reports that panic attacks, high blood pressure, faintness, seizures, hyperthermia, and a loss of consciousness can occur during an MDMA overdose. Prompt medical attention is required in order to attempt to reverse the side effects of an MDMA overdose and minimize the possible medical consequences. Without swift professional intervention, an overdose on ecstasy can be fatal.
When ecstasy is combined with alcohol or other drugs, the risks and potential side effects increase and may be more difficult to treat. There is also the added danger of not knowing exactly what is in the drug that is being taken. Ecstasy is an illegal drug made in illicit laboratories, and it may be “cut” with other products or have potentially toxic additives or adulterants in it. An individual may never know exactly what is in the drug they are taking, and this can raise its potential risks.
When ecstasy is taken often, a person can build up tolerance to the drug and need to take more of it for it to keep working the same way. There is some evidence that regular use of MDMA can also lead to physical dependence, as the drug does damage and interfere with the brain’s serotonin production. Reported MDMA withdrawal symptoms include:
There is much debate as to whether or not ecstasy is an addictive drug. NIDA reports that people may develop drug tolerance and withdrawal symptoms as a result of ecstasy use. They may also lose their ability to control how often and how much of the drug they take and keep using the drug even though they know it will have numerous negative consequences. All these are signs of addiction.
Ecstasy interacts with the reward system in the brain, and it may take some time for the naturally occurring chemical messengers and brain circuitry to return to normal. During this period, emotions and withdrawal symptoms may be regulated and managed through a complete addiction treatment program that may include a period of detox and then be followed with behavioral therapies, counseling, support groups, and relapse prevention programs.
Detox for Ecstasy abuse is typically mostly supportive in nature, as there are no explicit medications designed and approved to treat MDMA addiction. That being said, pharmacological tools can be helpful for certain symptoms of withdrawal as needed. Fluids can be administered, and nutrition and sleep patterns can be balanced through healthy meals and structured sleep schedules. Detox may last a few days to a week, and a treatment program can then attend to the behavioral and emotional ramifications of drug abuse and addiction.
Both outpatient and inpatient addiction treatment programs can be beneficial for managing ecstasy abuse and addiction. An inpatient program is more structured and may be able to offer a wider range of treatment options and amenities, especially if a person also suffers from co-occurring mental health or medical issues. Treatment needs are determined though an evaluation prior to admission that can help treatment providers design an individual care plan that will enhance recovery.
Treatment plans often include group, family, and individual counseling and therapy sessions, educational and life skills workshops, tools for relapse prevention, participation in a 12-step or peer support group, and holistic measures, such as massage therapy, yoga, mindfulness meditation, and fitness training. Each treatment plan will be specifically suited to the person in need to facilitate long-term recovery.