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A Rough Guide To Ecstasy
Reproduced with permission from 'the book of E', available from

The chemical name for ecstasy is 3, 4 methylenedioxymethylamphetamine. Which is a right royal bastard to type as well as read. Thankfully, it's generally known in scientific and medical circles as MDMA. Many users simply call it E. During the early days of the drug in the US, it was also often called X or XTC.

MDMA belongs to a family of drugs known as phenethylamines. Chemically speaking, it's closely related to another phenethylamine, MDA (3, 4-methylenedioxyamphetamine), and to mescaline. MDMA is also described as an hallucinogenic stimulant, or a psychedelic amphetamine. This a bit misleading, though, as there are very few reports of pure MDMA causing the sort of hallucinations prompted by, say, LSD (d-lysergic acid diethylamide, better known as acid).

It's worth noting early on that what is sold as ecstasy is not always MDMA. Occasionally it's MDA, a more classically psychedelic substance which leads to a longer and stronger high than the user anticipated. More commonly it's a third phenethylamine, MDEA (3,4-methylenedioxyethylamphetamine, also known as MDE), the effects of which generally only last a couple of hours.

Other ecstasy pills may contain a huge range of substances, including ketamine and added amphetamine (speed), while some have no illegal drug content whatsoever. There have been persistent rumours of pills containing heroin, but there's absolutely no evidence to suggest this is anything more than one of the many myths surrounding MDMA. For a start, it would make no economic sense. Nevertheless, the fact that MDMA can be cut with anything from LSD to caffeine means users can never be sure of what they're getting.


The pure form of MDMA is a white crystalline powder. Although it's increasingly sold as powder in a plastic bag, it's traditionally and more widely available as either a pressed tablet, often branded with a symbol of some sort, or a capsule. The active oral dose of the drug is at least 75mgs, with most pills containing 80-120mgs.

The exact nature and strength of the effects doesn't just depend on the dose, though. The body weight, tolerance levels, and general physical health and mental state of the user all have parts to play. So do the circumstances under which MDMA is taken. While it's best known as a dance drug and the most popular place to take it is at a club or a rave, some people pop pills at home. Without moving the furniture back, either.

MDMA acts on a brain chemical called serotonin (5-hydroxytryptamine, also known as 5-HT), a neurotransmitter which transfers messages across the synapses (or gaps) between adjacent neurons (nerve cells). Serotonin is thought to play an important part in shaping mood, thought processes, sleeping patterns, eating patterns, reaction to external stimuli and control of motor activity.

Many medical experts believe that low levels are associated with depression. The chemical is produced by one neuron and released into the synapses, transmitting information to another neuron before being absorbed back into the first in a process known as reuptake. MDMA causes a flood of both serotonin and dopamine (another important neurotransmitter) into the synapses and also disrupts the serotonin neurons' reuptake process.


An MDMA pill takes effect after 30 to 45 minutes, starting with little rushes of exhilaration. These are sometimes accompanied by feelings of nausea and disorientation. Some users also find their stomach starts churning. Others experience a mild panic, especially if they're unfamiliar with the drug. Such negative effects don't usually persist for long, though. The peak effects of MDMA are felt 60 to 90 minutes after ingestion and last for two to four hours, followed by a gradual comedown.

MDMA enhances physical sensations. The sense of touch is heightened, food may smell and taste different to normal, and many people say that music sounds better. There's more awareness of the moment and more contentment with whatever that moment might be.

People feel positive about both themselves and the wider world around them (a state known as entactogenesis from the Latin word meaning 'to touch within'). Inhibitions are loosened, egos are softened and people experience a close emotional bond with others (empathogenesis). Everyday social defences are weakened and communicating with strangers is no longer taboo.

Hence all that 'unity' and 'one love' stuff. In short, MDMA produces an overall sense of well-being, a feeling of happiness edging on euphoria. No wonder E culture hoisted the smiley symbol up its flagpole. The drug doesn't create happiness, though. It doesn't create anything. It merely unlocks feelings which are already present but held in check on a day-to-day basis. While the effect of MDMA on serotonin levels means these are generally positive, this isn't universally so and a few people encounter sadness. There is, however, a consensus among users that, whatever the exact shape of the experience, it is usually controllable.


The sense of well-being generally associated with MDMA can last for days, weeks and even months after taking the drug. For some people, it seems to help them to deal with enduring problems in their lives, such as understanding their sexuality, calming their aggression or coping with a childhood trauma.

For others, it simply makes them feel better about themselves. In other words, it helps them come to terms with who they are, with many accounts of vastly improved personal relationships as a result.

Other effects of MDMA are less pleasant. For a start, the drug can cause a loss of body temperature regulation, leading to a rise in body temperature or a perhaps fall. Or first one and then the other. There are changes in blood pressure and heart rate, too, usually upwards.

Users may also find they have a dry mouth, blurred vision, wiggling eyes and the chills. Involuntary muscular activity and muscular tension sometimes occurs, resulting in twitches and cramps. The lower face muscles are especially prone to this, causing jaw clenching and teeth grinding. This 'gurning' effect has long been a joke in clubland. Gurners don't realise they've morphed into gargoyles, though, because MDMA also has what is known as a paradoxical relaxation effect, which means that users are unaware of what is happening to their bodies. This paradoxical relaxation effect also makes physical activity seem easier, with minor pains and fatigue not noticed.


Many people feel tired or depressed in the days immediately after taking MDMA. A lot of clubbers put the tiredness down to several hours of ballistic behaviour on the dancefloor, but fatigue is also a common after-effect for those who take pills at home. People who suffer post-MDMA depression generally find that it peaks three or four days after they have taken the drug. This has led to a midweek blues syndrome within the weekend-focussed club community. In a few cases, depression becomes a long-term problem, sometimes of a severe nature.

The blues are by no means all that users have to worry about. According to some research, the involuntary jaw clenching may cause damage to back teeth. More seriously, there have been numerous cases of MDMA-induced hepatitis and, more seriously still, liver failure. Those who repeatedly take the drug may also suffer from a range of post-MDMA psychological problems - paranoia, anxiety, panic attacks, insomnia and nightmares, to name just a few.

In addition, there's the question of whether MDMA causes long-term neurological (brain) damage. At the time of writing, the latest research into the neurotoxicity of the drug suggests that it decreases the density of serotonin neurons in the brain. Moreover, it seems that the extent of this decrease is linked to the extent of MDMA use.

But while some medical scientists believe that this is proof of brain damage, others are not so sure. It is also presently unclear whether or not the effect on serotonin neurons is permanent. And how, in terms of functionality, the effect might be exhibited in users. Having fiercely debated MDMA neurotoxicity for a number of years, the medical world looks set to continue to do so well into the 21st Century.


What is certain is that taking MDMA can prove fatal. A few people are particularly chemically sensitive to the drug and just one dose may be enough to kill them. Some of those who have suffered liver failure have required liver transplants, but the transplants have not always been successful.

Other fatalities associated with MDMA have been due to an overdose, the signs of which include vomiting, dizziness, head pains and strong muscle cramps. The most common cause of MDMA-related death, however, is due to the drug inducing a rise in body temperature to the point of hyperthermia (overheating).

The potential danger of hyperthermia is all the greater for clubbers. Part of the drug's appeal to clubbers is that the paradoxical relaxation effect, the unawareness ingredient, allows them to dance for a long time without feeling tired. But in doing so they are pushing their body temperatures up further.

The loss of body fluids through sweating and the often crowded, perhaps airless environment are factors, too. The result can be extreme heatstroke. To add another possible problem to the pile, the paradoxical relaxation effect also means that most of those in danger of overheating don't even realise it.

In the same way that their legs don't seem to feel tired, they're oblivious to the normal warning signs that their temperature is soaring and their pulse is racing.


Some of those who have died of MDMA-induced hyperthermia have registered body temperatures as high as 43 degrees C (almost 110 degrees F). Normal body temperature is 37 degrees C (98.6 degrees F). As the body starts to overheat, small clots form in the bloodstream, leading to a condition called Disseminated Intravascular Coagulation (DIC).

The clots cause a depletion of the blood's essential coagulation agent, which is normally used to stem internal bleeding from the hundreds of tiny cuts constantly present in body and brain tissue due to damage caused in the day-to-day running of the body. A depletion of coagulation agent can be extremely dangerous. If bleeding occurs in the brain, for example, it can lead to a stroke. It's also possible to bleed to death. What's more, this whole process can occur in just a few hours.

Clubbers taking MDMA should replace body fluids lost through dehydration by drinking plenty of water. One pint every hour or so is a common guide, but it's better to sip small amounts regularly rather than gulp down a huge volume in one go.

Be aware that you don't need to drink so much if you're not dancing and that drinking an excessive amount can lead to acute water intoxication, which can itself be fatal. Water is not an antidote to MDMA, it just helps combat dehydration and overheating, and a large intake can produce an imbalance in body fluids, including a dilution of the salt in the blood. Salt holds water in the blood system and, with a reduced level, water is lost into the surrounding body tissue.

The tissue then swells. The brain is unable to swell, though, because of the skull. In some cases, the result is a dangerous compression of the brain. With this in mind, isotonic sports drinks are also recommended as they help to replace lost body salts. Alcohol, however, is best avoided because it can cause further dehydration.


Other advice is to take regular breaks away from the dancefloor (every 30 minutes, say) and wear light, loose clothes. Even if you own the funkiest woolly hat in history, it's perhaps best to stuff it in your pocket - you give out more heat at the extremities of the body. Keep in contact with your friends and tell them if you start feeling unwell or even just uneasy. And don't mix MDMA with other drugs. A fair few of the deaths associated with MDMA have involved another substance.

New users should also consider taking half rather than a whole pill. Almost all doctors would advise anybody with heart, liver, kidney or blood circulation problems to stay away from MDMA. The same goes for those suffering from hypertension, epilepsy, asthma, diabetes or glaucoma, anybody who is prone to panic attacks and anybody with a history of mental illness.

Taking MDMA while on certain anti-depressants can also be dangerous. This is especially so of anti-depressants which are MAOIs (monoamine oxidase inhibitors), as the combination invites the risk of fatal hypertensive crisis. Combining MDMA and anti-AIDS drugs which are protease inhibitors is another potentially deadly mix. Popping a pill isn't a very clever idea if you're pregnant, either. Anybody not wanting to break the law should also stay away from MDMA.

The manufacturing, trafficking and possession of the drug are outlawed pretty much worldwide. It is a Class A substance in the UK and Schedule I in the US, these categories being the most restrictive in their respective countries. In the UK, the maximum sentence for possession of a Class A substance is seven years in prison and an unlimited fine. The maximum sentence for trafficking is life in prison and an unlimited fine.


Other Class A drugs include heroin, acid, cocaine and speed which has been prepared for injection. MDMA is not addictive in the same way as, say, heroin. There are no heroin-type physical withdrawal symptoms. There have, however, been cases of users becoming dependent on the drug.

But while it's perhaps only human nature that people often want to relive the good times they've had on MDMA by taking it again, frequent use results in a significant decrease in the loved-up 'ecstasy feeling' and an increase in the amphetamine-like effects. This is probably why most people who take MDMA say their first experiences were more enjoyable than later ones. It may also be why some users complain about the purity of ecstasy even during those times when police analyses indicate that a lot of unadulterated MDMA pills are in circulation.

The reason for the drug becoming less effective with continued use isn't clear. Some suggest it could be psychological, it could be that the novelty simply wears off. Others say it's physical, it's because of changes to the neurons in the brain caused by use of MDMA itself.

One theory is that it's a result of some kind of unconscious self-defence mechanism acting to curb excessive use by depriving the drug of its more attractive features.


The lack of certain knowledge in so many areas is further complicated by the endless misconceptions surrounding MDMA. The one about it being a designer drug, for instance. A common misunderstanding is that this means it's chic and expensive. Another is that designer drugs are modelled to produce a particular set of effects - yet this could be said of any synthetic or part-synthetic drug.

The original American definition of the term was a drug which has undergone molecular modifications to change its status from illegal to legal while retaining the psychoactive properties of the original compound. A chemical remix, if you like. Under this definition, then, no illegal drug can be considered as a designer drug. The confusion over the term in Britain is perhaps understandable given that the very practice of 'drug design' has long been effectively prohibited under UK law, which bans whole families of drugs rather than dealing with them one at a time.

There are countless myths about MDMA, too, including that it is an aphrodisiac. The earliest media reports on the drug said this was why ecstasy was popular with young people. But the bond felt with others is more fraternal than sexual, more of a warm glow than a raging fire.

Although MDMA makes people more sociable and the enhancement of touch, taste and smell can give the sex act a few fresh twists, there's nothing to suggest users get their bells rung louder or more often than others. The reverse may actually be true, as a proportion of men experience erection problems with the drug - as much as 40 per cent according to some sources.

Some men also find the size of their penis is sometimes reduced when on MDMA. Shrivelled willies are common among male speed freaks, so this effect could just be down to amphetamine-heavy tablets.

© 2000 Omnibus Press.

"the book of E - all about ecstasy" is written by Push and Mireille Silcott and published by

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Special note:
This site is all about harm reduction. We realise that some people will take drugs no matter what advice they are given, so we have reproduced this guide for information purposes only. It is not medical advice. If you are being coerced into taking drugs, or are in any doubt about taking a substance, our advice is to always refuse.

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