Ecstasy

Synonyms: E, MDMA

What is ecstasy?¹

Ecstasy is an illegal 'recreational' drug. It remains a Class A drug which means it is against the law to use it or supply it and it cannot be prescribed by doctors.²

Ecstasy comes in pill and powder forms or, very occasionally, as crystals. Pure ecstasy takes the form of a white powder. It is known as MDMA (3,4 Methylenedioxymethamphetamine).

Ecstasy pills are usually taken orally or they may be crushed up into a powder and snorted. Powder can also be wrapped in cigarette paper and swallowed (“Bombing”).

Other substances - some more dangerous than others - have been found contaminating tablets, including the amphetamine variants methyl diethanolamine (MDEA) and methylenedioxyamphetamine (MDA), lysergic acid diethylamide (LSD), ketamine, caffeine and aspirin.³

Prevalence⁴

For the year ending June 2022, the prevalence of ecstasy use was at its lowest level since data were first collected.

0.7% of adults aged 16 to 59 years and 1.1% of adults aged 16 to 24 years had reporting taking ecstasy in the previous year (a 47% decrease for those aged 16 to 59 years and a 72% decrease for those aged 16 to 24 years compared with the year ending March 2020).

The Office of National Statistics report suggested that the decreased prevalence may have been a result of the coronavirus (COVID-19) pandemic and government restrictions on social contact.

Pharmacological effects¹

Ecstasy is a stimulant drug which also has mild hallucinogenic effects. The effects of taking a moderate dose start after 20-60 minutes (longer if on a full stomach) and can last for up to several hours.

Physical effects include pupil dilation, jaw tightening and an increase in body temperature, blood pressure and heart rate. There is often a loss of appetite, and there may be a period of nausea.

Many users experience an initial rushing feeling followed by a combination of feeling energetic but calm. Loss of anger, empathy with other people and an enhanced sense of communication are common. There may also be a heightened sense of their surroundings, greater appreciation of music and increased sexual and sensual experience.

Adverse effects and risks¹

Bad experiences can occur, and may include feeling anxious and panicky, confusion and unpleasant distortion of the senses, which may last for days, even weeks. This is more likely if users take high doses or are already feeling anxious.

The disorientating effects of ecstasy increases the risk of accidents. A number of ecstasy-related deaths have been connected with non-stop dancing in hot, crowded clubs leading to overheating and dehydration. Taking a break from dancing, cooling down and sipping water regularly and slowly (one pint over an hour) can help prevent this from happening.

After taking ecstasy users may feel very tired and low and need a long period of sleep to recover. This may last up to three or four days and is known as a comedown.

Regular ecstasy use may lead to sleep problems, lack of energy, dietary problems and feeling depressed or anxious. Increased susceptibility to colds, flu and sore throat may follow. Although physical dependence is not a problem, psychological dependence on the feelings of euphoria and calmness and the whole scene around ecstasy use can develop.

Short term mood changes include the ‘mid-week hangover’ following weekend use, and impairments in short term memory function. There have been indications of liver damage in some ecstasy users, but it is unclear whether this is a more immediate consequence of heatstroke, or due to toxicity over the longer term.

The functional consequences of neurotoxicity (cognitive, behavioural and emotional changes in users), and their severity, especially in the longer term, are not clear. There is no agreement that there is any irreversible ‘brain damage’ that will impact the user in years to come.

Ecstasy deaths⁵

The number of deaths involving MDMA registered in 2018 across the UK was the highest on record. There were 8 deaths registered in England and Wales in 2010 (the lowest on record), but in 2018 there were 92 MDMA-related deaths. In Scotland, in 2010 there were no reported deaths involving MDMA, and 35 registered in 2018. In Northern Ireland the number of MDMA related deaths was 11 in 2018, also the highest number on record.

Prevention

• The prevention of ecstasy abuse needs to be taken in the context of wider campaigns to reduce the use of illegal substances in the community, since crime prevention statistics confirm that, if the supply of one drug is restricted, abusers simply switch to another drug.¹ Local drug education and prevention initiatives have been set up with Government funding to provide services in school and community settings.

• Testing kits designed to test that ecstasy pills are free from other contaminants are used in some clubs in Holland but have been criticised by the UK government as they appear to condone drug use. However, they are available via the internet.¹

• 'Safer dancing' campaigns are encouraging clubs to provide 'chill out' areas, ensure there is a plentiful supply of water and arrange for staff to have first aid training. However, the message still needs to get across that water should be sipped slowly (no more than a pint an hour) and not drunk quickly in large quantities.