MDMA and ecstasy

Where the substance comes from

MDMA is entirely synthetic, made from chemical precursors in clandestine laboratories concentrated in north-west Europe. Crystal is now the commonest form, ahead of tablets. Tablets are pressed with logos and colours that act as a brand and guarantee nothing: two tablets bearing the same logo can hold anything from 20 to over 250 milligrams, and some contain no MDMA at all but a synthetic cathinone or PMMA, which is far more toxic.

A little history

MDMA was synthesised in 1912 by Anton Köllisch at Merck in Darmstadt, as a mere intermediate in the manufacture of a drug against bleeding; patented in 1914, it was never marketed and slept in the archives. The American army tested it on animals in the 1950s. It was the chemist Alexander Shulgin who resynthesised it in 1976, described its effects on himself and introduced it to Californian psychotherapists, who used it discreetly for a decade.

Its move to the street took place in Texas in the early 1980s under the name "ecstasy"; the United States banned it as an emergency measure in 1985, despite the therapists' protests. In Europe it became the drug of rave culture and electronic music — Ibiza in 1987, Britain's "second summer of love" in 1988 — then of free parties and clubs; the death of Leah Betts in 1995 fixed the image of its danger in Britain.

Since the 2010s MDMA has been coming back through the door of research: the phase 3 trials run by the MAPS organisation on post-traumatic stress disorder gave promising results, Australia authorised its prescription by psychiatrists in 2023, but the American drug agency refused approval in 2024, judging the data insufficient. On the street, pills have become far stronger than twenty years ago.

The forms it takes

• Tablets, coloured and logo-stamped, swallowed.
• Crystal or powder, swallowed wrapped in a cigarette paper, dissolved in a drink, sometimes snorted.
• Hand-filled capsules, whose actual content is unknown.

What the user is looking for

A very characteristic emotional opening: empathy, a wish to talk and touch, social awkwardness gone, heightened response to music and light. The effect builds over thirty to sixty minutes and lasts three to five hours. It is that affective dimension rather than the stimulation that gives MDMA its particular place — and makes it deceptive, because the attachment felt is a pharmacological effect.

Immediate unwanted effects

• Clenched jaw, teeth grinding, very dilated pupils, nausea, tremor.
• Heatstroke: MDMA raises body temperature and removes the sense of fatigue. Dancing for hours in a hot room without a break leads to hyperthermia that can pass 40 °C and destroy muscle and kidneys. That is the mechanism behind most deaths.
• Hyponatraemia: conversely, drinking litres of water to “avoid dehydration” dilutes blood sodium and causes cerebral oedema. The risk is higher in women. The useful rule is around half a litre per hour of exertion, and drinks containing salt and sugar rather than plain water.
• Hypertensive crisis, arrhythmia, seizures, more rarely acute hepatitis.

Medium and long-term risks

The come-down is the most constant feature: two to four days of low mood, irritability and anxiety while serotonin stores rebuild. Using more often prevents that rebuilding; beyond monthly use, users unanimously describe that “the magic does not come back”, with persistent depression and sleep and memory problems. The available work points to damage to serotonergic terminals with heavy repeated exposure. Regular use adds dental wear from bruxism and a risk to the heart valves.

Combinations are dangerous: with serotonergic antidepressants, serotonin syndrome; with monoamine oxidase inhibitors, a risk to life; with cocaine or amphetamines, cumulative cardiac load.

How to spot use

Chewing gum in quantity, lollipops, a clenched jaw and night-time grinding, huge pupils, coming home at dawn, then two or three days of very low mood and withdrawal recurring after the same weekends. Urine detection: two to four days.

Why the effect is stronger in adolescents

At the same dose in a lighter body, the concentration reached is higher in an adolescent than in an adult. More importantly, the reward circuit matures well before the prefrontal cortex that is supposed to restrain it: the pull to repeat is stronger and the brake weaker, which markedly shortens the gap between first use and problem use. Use established before eighteen multiplies the risk of adult dependence whatever the substance — including legal ones such as the caffeine in energy drinks, alcohol or nicotine.