Ecstasy (3,4 methylededioxymethamphemtamine [MDMA]) is an illegal synthetic amphetamine used as a stimulant and hallucinogen. People aged 18-34 are the majority of ecstasy users and many in my practice ask me about it. As I say about most substance use, know what the upsides and downsides are. What is it going to make you feel like in the acute phase? What will it make you feel like afterwards? Here are the things you need to know about ecstasy use and you decide: good or bad?
How will I feel?
For the first 4 hours you will feel mental and physical euphoria, a sense of general well-being and contentedness, decreased negative emotion and decreased stress, anxiety and fear. You will feel increased sociability and simple colors and sounds are enhanced as are tactile sensations (touching, hugging, and sex for example all feel more pleasant).
Sounds great right? What next. In the days following ecstasy use people experience lowered mood or even depression (comedown) after the effects have worn off, increased anxiety, stress, and other negative emotions.
The first time: Who uses ecstasy?
In a large national survey on adolescents in the United States initiation of ecstasy use is predicted by an adolescent's early initiation of smoking, drinking, or marijuana use. Parent drug use is a significant predictor of child initiation of ecstasy use, while living with both parents and close parental monitoring was protective against it. At the individual level, sensation seeking tendencies and close associations with deviant peers were also predictive of ecstasy use.
A melting pot of sorts
Ecstasy use goes along with other drug use. In the same national study of current ecstasy users, 44% used >3 other classes of illicit drugs in the past year, compared to 1.6% of non-ecstasy drug users. This is the problem with studying long term effects of ecstasy in that it very often co-occurs with other drug use. You can also start to see what a mess this can become, right?
"Hug drug" and unprotected sex
In my practice I have treated many patients for STDs from this scenario. The short term effects of ecstasy frequently lead users to engage in sex and when they do, according to surveys done in the U.S., only 35% of people reported using condoms during sex while on ecstasy.
This issue is close to my heart as my hospital saw the brunt of the action on Jan 1st 2010 when Los Angeles County had eighteen ecstasy-related emergency department visits and one death, all linked to a New Year's Eve event attended by approximately 45,000 people. All were aged 16-34 years, and nine were female.
In addition to using ecstasy, 10 of the 18 had used alcohol, and five had used other drugs. Raves present a perfect storm for hyperthermia and hyponatremia which are two of the acute problems with ecstasy use. Ecstasy works in different ways to alter sodium and water balance that can lead to seizures and death. Ecstasy increases thirst and users at raves are encouraged to drink lots of water to prevent rhabdomyolysis (muscle breakdown which can cause kidney failure) and hyperthermia. However, drinking lots of water lowers your blood sodium, leading to hyponatremia (low blood sodium) and potentially death.
The agony of ecstasy/ecstasy and the mind
The evidence is pretty clear here but there are two things to know: the more you use the worse off you are, and if you use ecstasy along with other drugs these issues are compounded.
A large body of literature has established that ecstasy use is associated with impaired short-term memory function and that this impairment is related to total lifetime ecstasy consumption. Ecstasy use reduces cognition by reducing levels of dopamine and serotonin in the central nervous system resulting in cognition impairment, particularly in complex cognitive skills, as well as causing disorders such as mood changes, hallucinations, altered perception and memory loss. Enough said.
Ecstasy and sleep
Ecstasy users view themselves as being more evening types and having poorer sleep quality than marijuana users and those not using any drugs. Ecstasy users were also more likely to have missed a night's sleep and this may reflect ecstasy-related serotonergic dysfunction resulting in problems with shifting circadian rhythms.
In two National Surveys on academic achievement, ecstasy users were compared with marijuana use (without ecstasy use), alcohol/tobacco use (without other drug use) and non-drug use in adolescence. It shouldn’t be of much surprise that ecstasy, marijuana, and alcohol/tobacco use were associated with moderate and low academic achievement in both surveys. Moreover, ecstasy was more strongly associated with low academic achievement than alcohol/tobacco and marijuana.
So there you have it.