MDMA chemical structureEcstasy commonly appears in a tablet form, usually imprinted with a monogram.The title screen to Peter Jennings - Ecstasy Rising
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MDMA

MDMA (3,4-methylenedioxymethamphetamine), most commonly known today by the street name ecstasy, is a synthetic entactogen of the phenethylamine family whose primary effect is to stimulate the secretion of and inhibit the re-uptake of large amounts of serotonin as well as dopamine and noradrenaline in the brain, causing a general sense of openness, empathy, energy, euphoria, and well-being. more...

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Tactile sensations are enhanced for some users, making general physical contact with others more pleasurable; but, contrary to popular mythology it generally does not have aphrodisiac effects. Its ability to facilitate self-examination with reduced fear has proven useful in some therapeutic settings, leading to its 2001 approval by the United States FDA for testing in patients with post-traumatic stress disorder.

Acute dehydration is a risk among users who are highly physically active and forget to drink water, as the drug may mask one's normal sense of exhaustion and thirst. Also the opposite, "water intoxication" resulting in acute hyponatremia has been reported. By far the biggest danger comes from the fact that other, more dangerous chemicals (such as PMA, or methamphetamine) are either added to ecstasy tablets, or more often simply sold as ecstasy. Long-term effects in humans are largely unknown and the subject of much controversy —particularly with regard to the risks of severe long-term depression as a result of a reduction in the natural production of serotonin.

MDMA is also known by many other street names, including Adam, Beans, Biscuits, Candy, E, Eccies, Googs, Jack and Jills, MaDMAn, Mollies, Pills, Rolls, Scoobies, Smarties, Tabs, Thizz, Vitamin E, Vitamin X, X, XTC, Yaotou (in East Asia), and Yokes.

History

A patent for MDMA was originally filed on Christmas eve 1912 by the German pharmaceutical company Merck, and granted two years later (to the day). At the time, MDMA was not known to be a drug in its own right; rather, it was patented as an intermediate chemical used in the synthesis of a styptic (a drug intended to control bleeding from wounds.) Over half a century would pass before the first known ingestion of MDMA by humans.

Contrary to many rumours, the drug was never used as an appetite suppressant or as a stimulant for armed forces during wartime. (This was in fact methamphetamine.) The U.S. Army did, however, do lethal dose studies of it and several other compounds in the mid-1950's. It was given the name EA-1475, with the EA standing for Edgewood Arsenal. The results of these studies were not declassified until 1969. MDMA was first brought to public attention through Dr. Alexander Shulgin in the 1960s who recommended it for use in certain therapy sessions, naming the drug 'window' (he discovered it while searching for compounds that might have a similar psychoactive effect as other compounds contained in nutmeg). It was widely used therapeutically by US psychotherapists because of its empathogenic effects until its criminalization in the late 1980s. The drug was hailed as a miracle by therapists and counselors who claimed couples could have six months worth of progress in one use of the drug, and soldiers returning from the Vietnam war could overcome their PTSD sometimes more effectively than talk or group therapy. A small number of therapists continue to use it in their practices today. (See below for 2001 FDA approval and DEA licensing for use in patients with post-traumatic stress disorder.)

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Sex, Drugs & Techno Music: Why the rap against Ecstasy has a familiar ring to it
From Reason, 1/1/02 by Jacob Sullum

LAST SPRING, THE Chicago City Council decided "to crack down on wild rave parties that lure youngsters into environments loaded with dangerous club drugs, underage drinking and sometimes predatory sexual behavior," as the Chicago Tribune put it. The newspaper described raves as "one-night-only parties...often held in warehouses or secret locations where people pay to dance, do drugs, play loud music, and engage in random sex acts." Taking a dim view of such goings-on, the city council passed an ordinance threatening to jail building owners or managers who allowed raves to be held on their property. Mayor Richard Daley took the occasion to "lash out at the people who produce the huge rogue dance parties where Ecstasy and other designer drugs are widely used." In Daley's view, rave promoters were deliberately seducing the innocent. "They are after all of our children," he warned. "Parents should be outraged by this."

The reaction against raves reflects familiar anxieties about what the kids are up to, especially when it comes to As the chemical symbol of raves, MDMA-a.K.a. Ecstasy--has come to represent sexual abandon and, partly through association with other "club drugs," sexual assault. These are not the only fears raised by MDMA. The drug, whose full name is methylenedioxymethamphetamine, has also been accused of causing brain damage and of leading people astray with ersatz feelings of empathy and euphoria (concerns discussed later in this article). But the sexual angle is interesting because it has little to do with the drug's actual properties, a situation for which there is considerable precedent in the history of reputed aphrodisiacs.

A relative of both amphetamine and mescaline, MDMA is often described as a stimulant with psychedelic qualities. But its effects are primarily emotional, without the perceptual changes caused by LSD. Although MDMA was first synthesized by the German drug company Merck in 1912, it did not gain a following until the 1970s, when the psychonautical chemist Alexander Shulgin, a Dow researcher turned independent consultant, tried some at the suggestion of a graduate student he was helping a friend supervise. "It was not a psychedelic in the visual or interpretive sense;' he later wrote, "but the lightness and warmth of the psychedelic was present and quite remarkable." MDMA created a "window," he decided. "It enabled me to see out, and to see my own insides, without distortions or reservations."

After observing some striking examples of people who claimed to have overcome serious personal problems (including a severe stutter and oppressive guilt) with the help of MDMA, Shulgin introduced the drug to a psychologist he knew who had already used psychedelics as an aid to therapy. "Adam;' the pseudonym that Shulgin gave him (also a nickname for the drug), was on the verge of retiring, but was so impressed by MDMA's effects that he decided to continue working. He shared his techniques with other psychologists and psychiatrists, and under his influence thousands of people reportedly used the drug to enhance communication and self-insight. "It seemed to dissolve fear for a few hours," says a psychiatrist who tried MDMA in the early '80s. "I thought it would have been very useful for working with people with trauma disorders." Shulgin concedes that there was "a hint of snake-oil" in MDMA's reputed versatility, but he himself considered it "an incredible tool." He quotes one psychiatrist as saying, "MDMA is penicillin for the soul, and you don't give up penicillin, once you've seen what it can do."

Shulgin did not see MDMA exclusively as a psychotherapeutic tool. He also referred to it as "my low-calorie martini," a way of loosening up and relating more easily to others at social gatherings. This aspect of the drug came to the fore in the '80s, when MDMA became popular among nightclubbers in Texas, where it was marketed as a party drug under the name Ecstasy. The open recreational use of Ecstasy at clubs in Dallas and Austin brought down the wrath of the Drug Enforcement Administration, which decided to put MDMA in the same legal category as heroin. Researchers who emphasized the drug's psychotherapeutic potential opposed the ban. "We had no idea psychiatrists were using it," a DEA pharmacologist told Newsweek in 1985. Nor did they care: Despite an administrative law judge's recommendation that doctors be allowed to prescribe the drug, the ban on MDMA took effect the following year.

Thus MDMA followed the same pattern as LSD, moving from discreet psychotherapeutic use to the sort of conspicuous consumption that was bound to provoke a government reaction. Like LSD, it became illegal because too many people started to enjoy it. Although the DEA probably would have sought to ban any newly popular intoxicant, the name change certainly didn't help. In Ecstasy: The MDMA Story, Bruce Eisner quotes a distributor who claimed to have originated the name Ecstasy. He said he picked it "because it would sell better than calling it 'Empathy.' 'Empathy' would be more appropriate, but how many people know what it means?" In its traditional sense, ecstasy has a spiritual connotation, but in common usage it simply means intense pleasure--often the kind associated with sex. As David Smith, director of the Haight-Ashbury Free Clinic, observed, the name "suggested that it made sex better." Some marketers have been more explicit: A 1999 article in the Journal of Toxicology (headlined "SEX on the Streets of C incinnati") reported an analysis of "unknown tablets imprinted with 'SEX'" that turned out to contain MDMA.

Hyperbolic comments by some users have reinforced Ecstasy's sexual connotations. "One enthusiast described the feeling as a six-hour orgasm!" exclaimed the author of a 2000 op-ed piece in Malaysia's New Straits Times, picking up a phrase quoted in Time a couple of months before. A column in The Toronto Sun, meanwhile, stated matter-offactly that MDMA "can even make you feel like a six-hour orgasm." If simply taking MDMA makes you feel that way, readers might reasonably conclude, MDMA-enhanced sex must be indescribably good.

Another reason MDMA came to be associated with sex is its reputation as a "hug drug" that breaks down emotional barriers and brings out feelings of affection. The warmth and candor of people who've taken MDMA may be interpreted as flirtatiousness. More generally, MDMA is said to remove fear, which is one reason psychotherapists have found it so useful. The same effect could also be described as a loss of inhibitions, often a precursor to sexual liaisons. Finally, users report enhanced pleasure from physical sensations, especially the sense of touch. They often trade hugs, caresses, and back rubs.

Yet the consensus among users seems to be that MDMA's effects are more sensual than sexual. According to a therapist quoted by Jerome Beck and Marsha Rosenbaum in their book Pursuit of Ecstasy, "MDMA and sex do not go very well together. For most people, MDMA turns off the ability to function as a lover, to put it indelicately. It's called the love drug because it opens up the capacity to feel loving and affectionate and trusting." At the same time, however, it makes the "focusing of the body and the psychic energy necessary to achieve orgasm...very difficult. And most men find it Impossible....So it is a love drug but not a sex drug for most people."

Although this distinction is widely reported by users, press coverage has tended to perpetuate the connection between MDMA and sex. In 1985 Newsweek said the drug "is considered an aphrodisiac," while Maclean's played up one user's claim of "very good sexual possibilities." Life also cited "the drug's reputation for good sex," even while noting that it "blocks male ejaculation." More recently, a 2000 story about MDMA in Time began by describing "a classic Southeast Asian den of iniquity" where prostitutes used Ecstasy so they could be "friendly and outgoing." It warned that "because users feel empathetic, ecstasy can lower sexual inhibitions. Men generally cannot get erections when high on e, but they are often ferociously randy when its effects begin to fade." The story cited a correlation between MDMA use and "unprotected sex." A cautionary article in Cosmopolitan began with the account of "a 28-year-old lawyer from Los Angeles" who brought home a man with whom she felt "deeply connected" under the influen ce of MDMA. "We would have had sex, but he couldn't get an erection," she reported. "The next day, I was horrified that I had let a guy I couldn't even stand into my bed!"

Rape Drugs

MDMA has been linked not just to regrettable sexual encounters but to rapes in which drugs are used as weapons. The connection is usually made indirectly, by way of other drugs whose effects are quite different but which are also popular at raves and dance clubs. In particular, the depressants GHB and Rohypnol have acquired reputations as "date rape drugs," used to incapacitate victims to whom they are given surreptitiously. Needless to say, this is not the main use for these substances, which people generally take on purpose because they like their effects. It's not clear exactly how often rapists use GHB or Rohypnol, but such cases are surely much rarer than the hysterical reaction from the press and Congress (which passed a Date Rape Drug Prohibition Act last year) would lead one to believe. The public has nonetheless come to view these intoxicants primarily as instruments of assault, an impression that has affected the image of other "club drugs," especially MDMA.

Grouping MDMA with GHB and Rohypnol, a 2000 Knight Ridder story warned that the dangers of "club drugs" include "vulnerability to sexual assault." Similarly, the Chicago Tribune cited Ecstasy as the most popular "club drug" before referring to "women who suspect they were raped after they used or were slipped a club drug." In a Columbus Dispatch op-ed piece, pediatrician Peter D. Rogers further obscured the distinction between MDMA and the so-called rape drugs by saying that "Ectasy...comes in three forms;' including "GHB, also called liquid Ecstasy," and "Herbal Ecstasy, also known as ma huang or ephedra" (a legal stimulant), as well as "MDMA, or chemical Ecstasy." He asserted, without citing a source, that "so-called Ecstasy"--it's not clear which one he meant--"has been implicated nationally in the sexual assaults of approximately 5,000 teen-age and young adult women." Rogers described a 16-year-old patient who "took Ecstasy and was raped twice. She told me that she remembers the rapes but, high on the dr ug, was powerless to stop them. She couldn't even scream, let alone fight back." If Rogers, identified as a member of the American Academy of Pediatrics' Committee on Substance Abuse, had trouble keeping the "club drugs" straight, it's not surprising that the general public saw little difference between giving a date MDMA and slipping her a mickey.

As the alleged connections between MDMA and sex illustrate, the concept of an aphrodisiac is complex and ambiguous. A drug could be considered an aphrodisiac because it reduces resistance, because it increases interest, because it improves ability, or because it enhances enjoyment. A particular drug could be effective for one or two of these purposes but useless (or worse) for the others. Shakespeare observed that alcohol "provokes the desire, but it takes away the performance." Something similar seems to be true of MDMA, except that the desire is more emotional than sexual, a sense of closeness that may find expression in sex that is apt to be aborted because of difficulty in getting an erection or reaching orgasm. Also like alcohol, MDMA is blamed for causing people to act against their considered judgment. The concern is not just that people might have casual sex but that they might regret it afterward.

Surely this concern is not entirely misplaced. As the old saw has it, "Candy is dandy, but liquor is quicker." When drinking precedes sex, there may be a fine line between seducing someone and taking advantage, between lowering inhibitions and impairing judgment. But the possibility of crossing that line does not mean that alcohol is nothing but a trick employed by cads. Nor does the possibility of using alcohol to render someone incapable of resistance condemn it as a tool of rapists.

The closest thing we have to a genuine aphrodisiac--increasing interest, ability, and enjoyment--is Viagra, the avowed purpose of which is to enable people to have more and better sex. Instead of being deplored as an aid to hedonism, it is widely praised for increasing the net sum of human happiness. Instead of being sold on the sly in dark nightclubs, it's pitched on television by a former Senate majority leader. The difference seems to be that Viagra is viewed as a legitimate medicine, approved by the government and prescribed by doctors.

But as Joann Ellison Rodgers, author of Drugs and Sexual Behavior, observes, "there is great unease with the idea of encouraging sexual prowess....At the very least, drugs in the service of sex do seem to subvert or at least trivialize important aspects of sexual experiences, such as love, romance, commitment, trust and health." If we've managed to accept Viagra and (to a lesser extent) alcohol as aphrodisiacs, it may be only because we've projected their darker possibilities onto other substances, of which the "club drugs" are just the latest examples.

Signal of Misunderstanding

The current worries about raves in some ways resemble the fears once symbolized by the opium den. The country's first anti-opium laws, passed by Western states in the late 19th century, were motivated largely by hostility toward the low-cost Chinese laborers who competed for work with native whites. Supporters of such legislation, together with a sensationalist press, popularized the image of the sinister Chinaman who lured white women into his opium den, turning them into concubines, prostitutes, or sex slaves. Although users generally find that opiates dampen their sex drive, "it was commonly reported that opium smoking aroused sexual desire," writes historian David Court-wright, "and that some shameless smokers persuaded 'innocent girls to smoke in order to excite their passions and effect their ruin.'" San Francisco authorities lamented that the police "have found white women and Chinamen side by side under the effects of this drug--a humiliating sight to anyone who has anything left of manhood." In 1910 Hamilton Wright, a U.S. diplomat who was a key player in the passage of federal anti-drug legislation, told Congress that "one of the most unfortunate phases of the habit of smoking opium in this country" was "the large number of women who [had] become involved and were living as common-law wives or cohabiting with Chinese in the Chinatowns of our various cities."

Fears of miscegenation also played a role in popular outrage about cocaine, which was said to make blacks uppity and prone to violence against whites, especially sexual assault. In 1910 Christopher Koch, a member of the Pennsylvania Pharmacy Board who pushed for a federal ban on cocaine, informed Congress that "the colored people seem to have a weakness for it....They would just as leave rape a woman as anything else, and a great many of the southern rape cases have been traced to cocaine." Describing cocaine's effect on "hitherto inoffensive, law abiding negroes" in the Medical Record, Edward Huntington Williams warned that "sexual desires are increased and perverted."

Marijuana, another drug that was believed to cause violence, was also linked to sex crimes and, like opium, seduction. Under marijuana's influence, according to a widely cited 1932 report in The Journal of Criminal Law and Criminology, "sexual desires are stimulated and may lead to unnatural acts, such as indecent exposure and rape." The authors quoted an informant who "reported several instances of which he claimed to have positive knowledge, where boys had induced girls to use the weed for the purpose of seducing them." The federal Bureau of Narcotics, which collected anecdotes about marijuana's baneful effects to support a national ban on the drug, cited "colored students at the Univ. of Minn. partying with female students (white) smoking [marijuana] and getting their sympathy with stories of racial persecution. Result pregnancy." The bureau also described a case in which "two Negroes took a girl fourteen years old and kept her for two days in a hut under the influence of marijuana. Upon recovery she was found to be suffering from syphilis."

Drug-related horror stories nowadays are rarely so explicitly racist. A notable and surprising exception appears in the 2000 film Traffic, which is critical of the war on drugs but nevertheless represents the utter degradation of an uppermiddle-class white teenager who gets hooked on crack by showing her having sex with a black man. Whether related to race or not, parental anxieties about sexual activity among teenagers have not gone away, and drugs are a convenient scapegoat when kids seem to be growing up too fast.

The link between drugs and sex was reinforced by the free-love ethos of the '6os counterculture that embraced marijuana and LSD. In the public mind, pot smoking, acid dropping, and promiscuous sex were all part of the same lifestyle; a chaste hippie chick was a contradiction in terms. When Timothy Leary extolled LSD's sex-enhancing qualities in a 1966 interview with Playboy, he fueled the fears of parents who worried that their daughters would be seduced into a decadent world of sex, drugs, and rock 'n' roll. The Charles Manson case added a sinister twist to this scenario, raising the possibility of losing one's daughter to an evil cult leader who uses LSD to brainwash his followers, in much the same way as Chinese men were once imagined to enthrall formerly respectable white girls with opium.

The alarm about the sexual repercussions of "club drugs," then, has to be understood in the context of warnings about other alleged aphrodisiacs, often identified with particular groups perceived as inferior, threatening, or both. The fear of uncontrolled sexual impulses, of the chaos that would result if we let our basic instincts run wild, is projected onto these groups and, by extension, their intoxicants. In the case of "club drugs," adolescents are both victims and perpetrators. Parents fear for their children, but they also fear them. When Mayor Daley warned that "they are after all of our children," he may have been imagining predators in the mold of Fu Manchu or Charles Manson. But the reality is that raves--which grew out of the British "acid house" movement, itself reminiscent of the psychedelic dance scene that emerged in San Francisco during the late '60s--are overwhelmingly a youth phenomenon.

The experience of moving all night to a throbbing beat amid flickering light has been likened to tribal dancing around a fire. But for most people over 30, the appeal of dancing for hours on end to the fast, repetitive rhythm of techno music is hard to fathom. "The sensationalist reaction that greets every mention of the word Ecstasy in this country is part of a wider, almost unconscious fear of young people," writes Jonathan Keane in the British New Statesman, and the observation applies equally to the United States. For "middle-aged and middle-class opinion leaders...E is a symbol of a youth culture they don't understand."

This is not to say that no one ever felt horny after taking MDMA. Individual reactions to drugs are highly variable, and one could probably find anecdotes suggesting aphrodisiac properties for almost any psychoactive substance. And it is no doubt true that some MDMA users, like the woman quoted in Cosmo, have paired up with sexual partners they found less attractive the morning after. But once MDMA is stripped of its symbolism, these issues are no different from those raised by alcohol. In fact, since MDMA users tend to be more lucid than drinkers, the chances that they will do something regrettable are probably lower.

I Love You Guys

Another alcohol-related hazard, one that seems to be more characteristic of MDMA than the risk of casual sex or rape, is the possibility of inappropriate emotional intimacy. The maudlin drunk who proclaims his affection for everyone and reveals secrets he might later wish he had kept is a widely recognized character, either comical or pathetic depending upon one's point of view. Given MDMA's reputation as a "love drug," it's natural to wonder whether it fosters the same sort of embarrassing behavior.

Tom Cowan, a systems analyst in his 30s, has used MDMA a few times, and he doesn't think it revealed any deep emotional truths. (All names of drug users in this story are pseudonyms.) "For me," he says, "it was almost too much of a fake....It was too artificial for me....I felt warm. I felt loved. All of those sensations came upon me....I had all these feelings, but I knew that deep down I didn't feel that, so at the same time there was that inner struggle as far as just letting loose and just being....That was difficult because of the fakeness about it for me." More typically, MDMA users perceive the warm feelings as real, both at the time and in retrospect. Some emphasize an enhanced connection to friends, while others report a feeling of benevolence toward people in general.

"I was very alert but very relaxed at the same time," says Alison Witt, a software engineer in her 20s. "I didn't love everybody....It's a very social drug, and you do feel connected to other people, but I think it's more because it creates a sense of relaxation and pleasure with people you're familiar with." Walter Stevenson, a neuroscientist in his late 20s, gives a similar account: "I felt really happy to have my friends around me. I just enjoyed sitting there and spending time with them, not necessarily talking about anything, but not to the degree that I felt particularly attracted or warm to people I didn't know. I was very friendly and open to meeting people, but there wasn't anything inappropriate about the feeling."

Adam Newman, an Internet specialist in his 20s, believes his MDMA use has helped improve his social life. "It kind of catapulted me past a bunch of shyness and other mental and emotional blocks," he says. Even when he wasn't using MDMA, "I felt a lot better than I had in social interactions before." Bruce Rogers, a horticulturist in his 40s, says one thing he likes about MDMA is that "you can find something good in somebody that you dislike." He thinks "it would make the world a better place if everybody did it just once."

That's the kind of assertion, reminiscent of claims about LSD's earthshaking potential, that tends to elicit skeptical smiles. But the important point is that many MDMA users believe the drug has lasting psychological benefits, even when it's taken in a recreational context-the sort of thing you don't often hear about alcohol.

Not surprisingly, people who use MDMA in clubs and at raves emphasize its sensual and stimulant properties, the way it enhances music and dancing. But they also talk about a sense of connectedness, especially at raves. Jasmine Menendez, a public relations director in her early 20s who has used MDMA both at raves and with small groups of friends, says it provides "a great body high. I lose all sense of inhibition and my full potential is released....It allows me to get closer to people and to myself."

Too Much Fun

Euphoria is a commonly reported effect of MDMA, which raises the usual concerns about the lure of artificial pleasure. "It was an incredible feeling of being tremendously happy where I was and being content in a basic way," Stevenson recalls of the first time he felt MDMA's effects. He used it several more times after that, but it never became a regular habit.

Menendez, on the other hand, found MDMA "easy to become addicted to" because "you see the full potential in yourself and others; you feel like you won the lottery." She began chasing that feeling one weekend after another, often taking several pills in one night. "Doing e as much as I did affected my relationship with my mother," she says. "I would come home cracked out from a night of partying and sleep the whole day. She couldn't invite anyone over because I was always sleeping. She said that my party habits were out of control. We fought constantly. I would also go to work high from the party' if I had to work weekends. The comedown was horrible because I wanted to sleep and instead I had to be running around doing errands."

Menendez decided to cut back on her MDMA consumption, and recently she has been using it only on special occasions. "I think I've outgrown it finally," she says. "I used e to do some serious soul searching and to come out of my shell, learning all I could about who I really am. I'm grateful that I had the experiences that I did and wouldn't change it for the world. But now, being 23, I'm ready to embrace mental clarity fully. Ecstasy is definitely a constructive tool and if used correctly can benefit the user. It changed my life for the better, and because of what I learned about myself, I'm ready to start a new life without it."

Sustained heavy use of MDMA is rare, partly because it's impractical. MDMA works mainly by stimulating the release of the neurotransmitter serotonin. Taking it depletes the brain's supply, which may not return to normal levels for a week or more. Some users report a hangover period of melancholy and woolly-headedness that can last a few days. As frequency of use increases,

MDMA's euphoric and empathetic effects diminish and its unpleasant side effects, including jitteriness and hangovers, intensify. Like LSD, it has a self-limiting quality, which is reflected in patterns of use. In a 2000 survey, 8.2 percent of high school seniors reported trying MDMA in the previous year. Less than half of them (3.6 percent) had used it in the previous month, and virtually none reported "daily" use (defined as use on 20 or more occasions in the previous 30 days). To parents, of course, any use of MDMA is alarming, and the share of seniors who said they'd ever tried the drug nearly doubled between 1996 and 2000, when it reached II percent.

Parental fears have been stoked by reports of sudden fatalities among MDMA users. Given the millions of doses consumed each year, such cases are remarkably rare: The Drug Abuse Warning Network counted nine MDMA-related deaths in 1998. The most common cause of death is dehydration and overheating. MDMA impairs body temperature regulation and accelerates fluid loss, which can be especially dangerous for people dancing vigorously in crowded, poorly ventilated spaces for hours at a time. The solution to this problem, well known to experienced ravers, is pretty straightforward: avoid clubs and parties where conditions are stifling, take frequent rests, abstain from alcohol (which compounds dehydration), and drink plenty of water. MDMA also interacts dangerously with some prescription drugs (including monoamine oxidase inhibitors, a class of antidepressants), and it raises heart rate and blood pressure, of special concern for people with cardiovascular conditions.

Another hazard is a product of the black market created by prohibition: Tablets or capsules sold as Ecstasy may in fact contain other, possibly more dangerous drugs. In tests by private U.S. laboratories, more than one-third of "Ecstasy" pills turned out to be bogus. (The samples were not necessarily representative, and the results may be on the high side, since the drugs were submitted voluntarily for testing, perhaps by buyers who had reason to be suspicious.) Most of the MDMA substitutes, which included caffeine, ephedrine, and aspirin, were relatively harmless, but one of them, the cough suppressant dextromethorphan (DXM), has disturbing psychoactive effects in high doses, impedes the metabolism of MDMA, and blocks perspiration, raising the risk of overheating. Another drug that has been passed off as MDMA is paramethoxyamphetamine (PMA), which is potentially lethal in doses over 50 milligrams, especially when combined with other drugs. In 2000 the DEA reported 10 deaths tied to PMA. Wary Ecstasy users ca n buy test kits or have pills analyzed by organizations such as DanceSafe, which sets up booths at raves and nightclubs.

Nervous Breakdown

Generally speaking, a careful user can avoid the short-term dangers of MDMA. Of more concern is the possibility of long-term brain damage. In animal studies, high or repeated doses of MDMA cause degeneration of serotonin nerve receptors, and some of the changes appear to be permanent. The relevance of these studies to human use of MDMA is unclear because we don't know whether the same changes occur in people or, if they do, at what doses and with what practical consequences. Studies of human users, which often have serious methodological shortcomings, so far have been inconclusive.

Still, the possibility of lasting damage to memory should not be lightly dismissed. There's enough reason for concern that MDMA should no longer be treated as casually as "a low-calorie martini." If the fears of neurotoxicity prove to be well founded and a safe dose cannot be estimated with any confidence, a prudent person would need a good reason--probably better than a fun night out--to take the risk. On the other hand, the animal research suggests that it may be possible to avoid neural damage by preventing hyperthermia or by taking certain drugs (for example, Prozac) in conjunction with MDMA. In that case, such precautions would be a requirement of responsible use.

However the debate about MDMA'S long-term effects turns out, we should be wary of claims that it (or any drug) makes people "engage in random sex acts." Like the idea that certain intoxicants make people lazy, crazy, or violent, it vastly oversimplifies a complex interaction between the drug, the user, and the context. As MDMA's versatility demonstrates, the same drug can be different things to different people. Michael Buchanan, a retired professor in his early 70s, has used MDMA several times with one or two other people. "It's just wonderful," he says, "to bring closeness, intimacy--not erotic intimacy at all, but a kind of spiritual intimacy, a loving relationship, an openness to dialogue that nothing else can quite match." When I mention MDMA use at raves, he says, "I don't understand how the kids can use it that way."

Senior Editor Jacob Sullum is writing a book about the morality of drug use.

COPYRIGHT 2002 Reason Foundation
COPYRIGHT 2002 Gale Group

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