MDMA is a Class A substance which was outlawed under the Misuse of Drugs Act in 1977. The Advisory Council on the Misuse of Drugs (ACMD) collected a body of evidence confirming the ‘undoubted harms’ of MDMA drug use in high doses. This article reviews evidence on the consumption of MDMA to understand the wider health effects of substance misuse.

MDMA is an acronym for methylenedioxy-methylamphetamine. This stimulant drug can come in crystal form and in a range of colors, but they are usually white or brownish depending on the purity. Crystals are crushed then snorted or made into a ‘bomb’ (crushed MDMA put into a rolling paper) that the user swallows. MDMA powder can be compressed into pills known as ‘ecstasy’; the strength of ecstasy pills can vary depending on MDMA purity and adulterants.

The 2015-2016 Crime Survey for England and Wales (CSEW) indicated the largest proportion of people who took MDMA in 2015 were aged 16-24, representing around 279,000 people who mostly are irregular users. According to the 2016 Global Drug Survey, many people who take MDMA do so ‘no more than 10x times per year.’

In the 1980s scientists wanted to gain a more profound understanding of the effects of MDMA. In San Francisco, 21 healthy volunteers were recruited to take this stimulant (Downing, 1986:335) and test the effects. In the experiment, participants ingested between 75 -150 mg of MDMA and they all reported positive perceptual effects,feelings of intimacy and a sense of “togetherness”. These conclusions were derived from MDMA’s ability to enhance feelings of empathy.

During the experiment, all participants reported noticeable negative side effects: 80%had a tightened jaw; 60% reported headaches; 20% had eyelid twitches (Downing,1986:337). In another clinical study, one female during an MDMA session reported negative side-effects: ‘nausea, a small amount of vomiting, jaw tension. urinary urgency, blurred vision, sweating, brief short-term memory loss, and brief distortion in depth perception with a brief hallucination,’(Greer & Tolbert, 1986: 321).

MDMA is a stimulant which activates three neurotransmitters to cause a chemical surge of the ‘happy’ hormones: serotonin, dopamine and epinephrine. MDMA changes the electrical function of the brain by speeding up these chemical messages so people can experience a sense of euphoria which drives pleasure-seeking behaviour. A ‘trip’ can last between 4 to 8 hours depending on the quantity taken. Once no more MDMA is taken then the person will experience the ‘come-down’ as serotonin reserves are depleted so altering the person’s mood.

Serotonin (5-HT) plays a role in almost every psycho-social and biological process as it is responsible for regulating mood, heart rate, sleep and appetite. The regulation of serotonin in the hippocampus (the area of the brain that controls emotion, learning and memory) is vital to the human experience of ‘pleasure’ so any disturbance can be the cause of impulsive action, mental health issues or addiction. MDMA and serotonin have an interconnected relationship that can impact upon both physical and mental health.

Academic researchers Prof. Valerie Curran & Ross. A. Travill (1971) titled their paper ‘Week-end ‘high’ followed by mid-week low’ to describe how people’s mood can fluctuate a few days after MDMA is ingested. The prolonged side effect of feeling depressed is caused by the body trying to replenish the ‘happy hormone’ serotonin. Over a prolonged period regular MDMA users might find they have less efficient mental skills because low serotonin levels can result in memory lapse (Parott & J.Lasky 1998: 263).

In the early 2000s, the scientific community continued to build a body of evidence around drug-taking and depression as rates of ecstasy use remained consistently high at that time. Jonathan P. Roiser and Barbara J. Sahakian (2004) paper, ‘Relationship between ecstasy and depression:a study controlling poly-drug use,’ compared a poly-drug group (people who take multiple substances) with an MDMA-using group to examine a possible link between MDMA and depression. Evidence suggested people who used illegal drugs,regardless of the substance type, score similar results on the Beck Depression Inventory (BDI), meaning that any form of substance misuse can cause anxiety and depression, especially if a person is genetically susceptible.

The popularity of MDMA has caused an increase in the number of people who suffer from a heart condition named Cardiac Valvulopathy. This disease stops the heart valves operating effectively so blood is leaked back into the heart chamber. In a scientific study by Droogman et al (2007)on a group of MDMA users, 28% of participants were diagnosed with Valvulopathy. The severity of the condition varied according to the extent of the individual’s drug-taking. Those in the study who were harmed the most consumed between 3-6 ecstasy pills per weekend over a 6-year period. The implication is that long-term use of significant amounts of MDMA can have long-lasting injurious effects on the body.

Relatively little is known about the exact cause of sudden death in individuals who have taken MDMA. In cases where MDMA users go into cardiac arrest, there is often an undiagnosed health problem that is a result of cardiomyopathy (disease of the heart muscle), hypertension (high blood pressure) or viral myocarditis (an infection that affects the muscles electrical system). Whether a person is a first-time MDMA user or an experienced drug-taker, there is always the risk of collapse or death.

Serotonin and dopamine both effect the regulation of body temperature, a process which is disrupted by consumption of MDMA and can lead to hyperpyrexia, when the body's temperature rises to potentially fatal levels (42 degrees Cellcius or 106.7 degrees Fahrenheit). If a person’s body temperature surges to these levels, then small blood clots form and organ failure is not unusual. In a 2006 article by the British Journal of Anesthesia, doctors reported: ‘The height and duration of hyperpyrexia are indicators of the risk of mortality. There are few survivors if the peak core temperature exceeds 42C, though the highest recorded value in a survivor reached 42.9C’ (Hall & Henry, 2006: 680).