MDMA is one of the most intensely studied recreational drugs in history. But despite thousands of research papers and studies, scientific evidence on the side-effects remains inconclusive.

Death by overdose

Undoubtedly, large amounts of ecstasy can lead to over-heating which in turn, in rare cases, can trigger fatal heat stroke. Many factors contribute: number and strength of pills taken, environment, alcohol-consumption, body weight - but women seem more at risk. The bulk of ecstasy-related deaths around the world have been young women.

Water-poisoning

Panicking users, fearing they are overdosing, drink too much water and provoke hyponaetraemia (water-poisoning). Leah Betts died after drinking 14 pints in just 90 minutes. The recommended amount of water to drink per hour is one pint.

Toxic reactions

Much of the reports of toxic reactions are muddled with overdose or water-poisoning deaths. There is no clear evidence that some people suffer allergic reactions to ecstasy. However, around 10% of Western users do lack a key liver enzyme CYP2D6 needed to break down MDMA. This may make them more sensitive to the effects and more prone to accidental overdose.

Depression

Many weekend users report a mid-week mood dip. This is suspected to be related MDMA's effect on serotonin, but hard evidence is lacking. In heavy users, dips can turn to crashes and depression. However studies suggest this effect reverses after a 2-3 month abstinence.

Positive effects

Users still claim "long lasting improvements in self-awareness, self-esteem, openness and insight into personal problems", reports the study from the University Of Louisiana. In the US, research continues into the use of MDMA-assisted psychotherapy to treat Post Traumatic Stress Disorder.

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