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How it works:

MDMA affects the brain by increasing the activity of at least three neurotransmitters (the chemical messengers of brain cells): serotonin, dopamine, and norepinephrine. Like other amphetamines, MDMA causes these neurotransmitters to be released from their storage sites in neurons, resulting in increased neurotransmitter activity. Compared to the very potent stimulant, methamphetamine, MDMA causes greater serotonin release and somewhat lesser dopamine release. Serotonin is a neurotransmitter that plays an important role in the regulation of mood, sleep, pain, appetite, and other behaviors. The excess release of serotonin by MDMA likely causes the mood elevating effects experienced by MDMA users. However, by releasing large amounts of serotonin, MDMA causes the brain to become significantly depleted of this important neurotransmitter, contributing to the negative behavioral aftereffects that users often experience for several days after taking MDMA.

Numerous studies in animals have demonstrated that MDMA can damage serotonin-containing neurons; some of these studies have shown these effects to be long lasting. This suggests that such damage may occur in humans as well; however, measuring serotonin damage in humans is more difficult. Studies have shown that some heavy MDMA users experience longlasting confusion, depression, and selective impairment of working memory and attention processes. Such memory impairments have been associated with a decrease in serotonin metabolites or other markers of serotonin function. Imaging studies in MDMA users have shown changes in brain activity in regions involved in cognition, emotion, and motor function. However, improved imaging technologies and more research are needed to confirm these findings and to elucidate the exact nature of the effects of MDMA on the human brain.

It is also important to keep in mind that many users of ecstasy may unknowingly be taking other drugs that are sold as ecstasy, and/or they may intentionally use other drugs, such as marijuana, which could contribute to these behavioral effects. Additionally, most studies in people do not have behavioral measures from before the users began taking drugs, making it difficult to rule out pre-existing conditions. Factors such as gender, dosage, frequency and intensity of use, age at which use began, the use of other drugs, as well as genetic and environmental factors all may play a role in some of the cognitive deficits that result from MDMA use and should be taken into consideration when studying the effects of MDMA in humans.

Given that most MDMA users are young and in their reproductive years, it is possible that some female users may be pregnant when they take MDMA, either inadvertently or intentionally because of the misperception that it is a safe drug. The potential adverse effects of MDMA on the developing fetus are of great concern. Behavioral studies in animals have found significant adverse effects on tests of learning and memory from exposure to MDMA during a developmental period equivalent to the third trimester in humans. However, the effects of MDMA on animals earlier in development are unclear; therefore, more research is needed to determine what the effects of MDMA are on the developing human nervous system.

Ecstasy is usually taken in pill form and swallowed and it can also be injected. Some users have been known to crush and snort the resulting powder. Others insert the pill into the anus where it is absorbed. This process is known as “shafting,” or "booty bumping."


Health Effects:

MDMA can produce a variety of adverse health effects, including nausea, chills, sweating, involuntary teeth clenching, muscle cramping, and blurred vision. MDMA overdose can also occur—the symptoms can include high blood pressure, faintness, panic attacks, and in severe cases, a loss of consciousness and seizures.

Because of its stimulant properties and the environments in which it is often taken, MDMA is associated with vigorous physical activity for extended periods. This can lead to one of the most significant, although rare, acute adverse effects—a marked rise in body temperature (hyperthermia). Treatment of hyperthermia requires prompt medical attention, as it can rapidly lead to muscle breakdown, which can in turn result in kidney failure. In addition, dehydration, hypertension, and heart failure may occur in susceptible individuals. MDMA can also reduce the pumping efficiency of the heart, of particular concern during periods of increased physical activity, further complicating these problems.

MDMA is rapidly absorbed into the human bloodstream, but once in the body, MDMA metabolites interfere with the body's ability to metabolize, or break down, the drug. As a result, additional doses of MDMA can produce unexpectedly high blood levels, which could worsen the cardiovascular and other toxic effects of this drug. MDMA also interferes with the metabolism of other drugs, including some of the adulterants that may be found in MDMA tablets.

In the hours after taking the drug, MDMA produces significant reductions in mental abilities. These changes, particularly those affecting memory, can last for up to a week, and possibly longer in regular users. The fact that MDMA markedly impairs information processing emphasizes the potential dangers of performing complex or skilled activities, such as driving a car, while under the influence of this drug.

Research in animals links MDMA exposure to long-term damage to neurons that are involved in mood, thinking, and judgment. A study in nonhuman primates showed that exposure to MDMA for only 4 days caused damage to serotonin nerve terminals that was evident 6 to 7 years later. While similar neurotoxicity has not been definitively shown in humans, the wealth of animal research indicating MDMA's damaging properties suggests that MDMA is not a safe drug for human consumption.


Extent of Use:

In 1998, 3.6 percent of 12th-graders, 3.3 percent of 10th-graders, and 1.8 percent of 8th-graders reported they had used MDMA in the past year, according to the NIDA-funded Monitoring the Future survey (MTF), which is conducted by the University of Michigan's Institute for Social Research. MTF's followup of a group of graduates from each surveyed high school class indicates that the number of college students who had used MDMA during the past year rose from 0.9 percent in 1991 to 2.4 percent in 1997. Among young adults, annual MDMA use rose from 0.8 percent to 2.1 percent during the same period. According to the 2005 Monitoring the Future survey, 3.0% of 12th graders, 2.6% of 10th graders, and 1.7% of 8th graders had used Ecstasy in the past year.
NIDA Infofacts: High School and Youth Trends.

In 2005, an estimated 502,000 people in the U.S. age 12 or older used MDMA in the past month. While lifetime use increased among those 12 or older from 2002 to 2005, there were significant declines in lifetime use from 2004 to 2005 among those 12 to 17 and 14 or 15. Other 2005 NSDUH results show significant increases in past month use among females and declines in past year use among those 12 or older. Approximately 615,000 Americans used ecstasy for the first time in 2005. The majority of these new users were 18 or older (65.9 percent). Among past year initiates aged 12 to 49, the average age at initiation of Ecstasy in 2005 was 20.7 years. Past year use of MDMA was reported by 1.4 percent of 8th-graders, 2.8 percent of 10th-graders, and 4.1 percent of 12th-graders in 2006. Although these figures represent significant reductions in use since the peak year in 2001, trends in use have remained relatively stable over the past 3 years among these grade cohorts. Results from the current survey represent the second year in a row showing a weakening of attitudes among the youngest of students regarding MDMA. The proportion of 8th-graders reporting perceived risk of harm from using MDMA once or twice decreased significantly, from 40 percent in 2005 to 32.8 percent in 2006, and perceived harm from using it occasionally dropped from 60.8 percent to 52.0 percent. Disapproval of use also decreased significantly among 8th-graders for both trying MDMA once or twice and for taking it occasionally. More than 11 million persons aged 12 or older reported using ecstasy at least once in their lifetimes, according to the 2004 National Survey on Drug Use and Health.
Students Monitoring the Future Survey

Where it comes from:

The ecstasy drug market in the United States is supplied and controlled by Western European-based drug traffickers. In recent years, Israeli Organized Crime syndicates, some composed of Russian émigrés associated with Russian Organized Crime syndicates, have forged relationships with the Western European traffickers and gained control over a significant share of the European market. Moreover, the Israeli syndicates remain the primary source to the U.S. distribution groups. The increasing involvement of organized crime syndicates signifies the "professionalization" of the MDMA market. These organizations have proven to be capable of producing and smuggling significant quantities of MDMA from source countries in Europe to the United States. DEA reporting indicates their distribution networks are expanding from coast to coast, enabling a relatively few organizations to dominate MDMA markets nationwide.

MDMA is clandestinely manufactured in Western Europe, primarily in the Netherlands and Belgium. It is estimated that 90% of MDMA distributed worldwide is produced in these countries. MDMA production is a relatively sophisticated chemical process making it difficult for inexperienced individuals to produce MDMA successfully. However, there are several manufacturing processes for MDMA and a multitude of "recipes" that are posted on the Internet. Most of the MDMA laboratories are capable of producing 20-30 kilograms on a daily basis, although law enforcement authorities have seized some labs with the capability of producing 100 kilograms per day.

Normally, the MDMA is manufactured by Dutch chemists and transported and distributed by various factions of Israeli Organized Crime groups. These groups recruit and utilize Americans, Israeli and western European nationals as couriers. These couriers can smuggle anywhere from 10,000 to 20,000 tablets (2.5-5 kilograms) on their person and up to 50,000 tablets (10 kilograms) in specially designed luggage. In addition to the use of couriers, these organizations use the parcel mail, DHL, UPS, and U.S. Postal Service. Due to the size of the MDMA tablet, concealment is much easier than other traditional drugs smuggled in kilogram-size packages (cocaine, heroin and marijuana).

What brings these Drug Trafficking Organizations together is the enormous profit realized in these ventures along with the fact that MDMA is not produced in the United States. Although estimates vary, the cost of producing an MDMA tablet can run between $.50 - $1.00. The wholesale, or first level price for MDMA tablets have ranged from $1.00-$2.00 per tablet, contingent on the volume purchased. This potential four-fold profit provides huge incentives for the laboratory owner or chemist. Furthermore, manufacturing laboratories can realize these profits without coming into contact with anyone except the first level transportation or distribution representatives. Once the MDMA reaches the United States, a domestic cell distributor will charge $6-$8 per tablet. The retailer then turns around and distributes it for $25-$40 per pill. Clearly, there is a tremendous profit realized in each function in MDMA trafficking from the producer or clandestine laboratory operator to the transporter to the wholesaler to the retailer, then on to the consumer.



Ecstasy is an illegal, controlled substance. Possession of a controlled substance often results in incarceration. According to 2000 government statistics, drug possession sentences account for approximately thirteen percent of all state criminal convictions. Of these state ordered drug possession sentences, approximately 33 percent of offenders received prison time, 31 percent received jail time, and 36 percent received probation time. Drug possession sentences can be different depending on whether they are ordered by the federal or state courts. The average incarceration for federal drug possession sentences is 81 months, and the average incarceration for state drug possession sentences is about twenty months.

Some jurisdictions have mandatory minimums for drug possession sentences. This means that a pre-determined punishment will be ordered in drug possession sentences for possession of certain quantities of certain drugs. These laws give a judge little discretion when determining drug possession sentences and do not take into account a defendant’s background, character, role in the crime, and threat to society. In recent years drug courts have been established throughout the United States to provide non-violent drug offenders with drug treatment programs. Successful completion of these programs can result in reduced or dismissed drug possession sentences. They are also proving to be more effective and less costly than incarceration options.

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