Using Science to Counter the Spread of Ecstasy Abuse

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NIDA Director, Alan I. Leshner

At a time when the abuse of most illicit drugs has leveled off or declined slightly among the Nation's youth, one drug has soared in popularity. It is known by many names, among them "MDMA," "ecstasy," "X," or simply "E." (See "MDMA/Ecstasy-A Drug With Complex Consequences") MDMA (3,4-methylenedioxymethamphetamine) is the only drug whose use has increased significantly among the Nation's 10th- and 12th-graders during each of the last 2 years. Last year it extended its reach to younger adolescents as use increased among eighth-graders. Recent epidemiologic data indicate that MDMA abuse also is spreading beyond its base of youthful users who attend dance clubs or all-night parties called "raves." Increasingly, Americans of all ages, social classes, and sexual orientations are using the drug in diverse social settings throughout the country.

In 1999, NIDA mounted its Club Drug Initiative to respond to recent increases in the abuse of MDMA and other drugs, such as gamma-hydroxybutyrate (GHB), Rohypnol, ketamine, and methamphetamine. The ongoing initiative seeks to increase awareness of the dangers of these drugs among teens, young adults, parents, and communities. NIDA is supporting a broad range of animal and human studies on MDMA and other club drugs. The goal of those studies is to provide scientific information about the nature and extent of club drug abuse, the biological and behavioral effects of the drugs, and the personal and public health consequences of their abuse.

We already have amassed a considerable of scientific knowledge about the dangers of MDMA.

Some of the early fruits of NIDA's club drug research, along with the findings of international experts who have been studying MDMA for years, were featured at NIDA's scientific conference, "MDMA/Ecstasy Research: Advances, Challenges, Future Directions," at the National Institutes of Health in Bethesda, Maryland, in July. The conference highlighted the advances research has made in understanding MDMA and addressing the many questions we still must answer to develop prevention and treatment approaches to stem the abuse of this drug. (See "NIDA Conference Highlights Scientific Findings on MDMA/Ecstasy.")

Research clearly shows a pervasive perception among users that MDMA is a "fun" drug with minimal risks. We know that people are more likely to use a drug if they think they have nothing to lose by doing so. Thus, the myth that ecstasy is a benign drug that exacts virtually no price for its euphoric effects may at least in part be driving the widespread increases in the drug's abuse. This dangerous misperception challenges the drug abuse research, treatment, and prevention community to identify the true costs of using ecstasy and convey this information in ways that will effectively reduce abuse.

We already have amassed a considerable of scientific knowledge about the dangers of MDMA. This drug can produce significant increases in heart rate and blood pressure that can last for several hours. MDMA abusers commonly take multiple tablets within brief time periods, often along with other commonly abused substances, such as alcohol, and while dancing for extended periods in hot and crowded conditions. These factors can dangerously increase MDMA's toxicity and lead to dehydration, hyperthermia, seizures, and heart or kidney failure. In fact, we have seen a nearly 18-fold increase in MDMA-related emergency room incidents from 1994 to 2000 reported by the Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network.

Research presented at the conference suggests some users dismiss the potential medical consequences because they do not often witness them. A pilot ethnographic study by researchers at Wright State University School of Medicine in Dayton, Ohio, indicates that ecstasy users in Central Ohio see a disjunction between media messages about the dangers of MDMA use and what people in their social networks tell them about their experiences with the drug. As a result, they feel they can use MDMA casually with few problems beyond a possible increase in anxiety, depression, and restlessness that some users experience a day or two after using the drug.

MDMA users may not think that transient mood disturbances are too high a price to pay for MDMA's euphoric effects. However, those symptoms provide a warning that potentially serious underlying brain damage is occurring. Increasingly, studies show that regular MDMA use causes long-lasting damage to brain cells that contain a critical neurotransmitter, serotonin, which helps regulate mood, pain, appetite, and sleep.

NIDA also is supporting prevention research to develop effective approaches that can address the entire spectrum of MDMA users.

Studies have associated MDMA use with loss of the serotonin-synthesizing enzyme tryptophan hydroxylase, depletions in serotonin content in tissue, and decreases in the structural component of serotonin neurons that enables the cells to convey signals. We do not yet know if the alterations are permanent, but we do know that they can persist for many years in animals and may be equally long-lasting in people. The consequences of such damage may include memory impairments, disrupted sleep cycles, mood disorders such as depression, and persistent anxiety, particularly among moderate to heavy MDMA users.As ongoing research provides more information about MDMA, NIDA is using all means of dissemination to keep the Nation up to date. This past spring, we teamed with the award-winning PBS series for teens, "In the Mix," to develop a television show on ecstasy. "Ecstasy" first aired last April and is regularly rebroadcast in all major markets of the country on more than 90 PBS stations with an audience of more than 1 million viewers.

In the last 2 years, our ongoing Club Drug Initiative has mailed a Community Drug Alert Bulletin on MDMA and other club drugs to nearly half a million physicians, treatment providers, nurses, and other clinicians; made English and Spanish fact sheets on MDMA available through our fax-on-demand service, NIDA Infofax; and distributed colorful postcards showing a brain scan of dramatic changes that linger in the brain's serotonin system weeks after MDMA is used. The cards are popular with young people and encourage them to contact NIDA for facts about MDMA. NIDA also is supporting prevention research to develop effective approaches that can address the entire spectrum of MDMA users. Our research recognizes the need for prevention interventions aimed at different groups of MDMA users, such as men who have sex with men, ethnically diverse urban youths, and predominantly white heterosexual users in the Midwest. (See "The Many Faces of MDMA Use Challenge Drug Abuse Prevention.")

We have learned a lot about MDMA, the people who abuse it, and the short- and long-term consequences of such abuse. These answers - and those still to come from ongoing NIDA-supported research - will provide a solid foundation for the public policy, prevention, and treatment responses that will enable us to stem the abuse of MDMA and reduce its potentially devastating health consequences.