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MDMA / Ecstasy

MDMA commonly known as Ecstasy (3,4-methylenedioxymethamphetamine).

Ecstasy is considered unusual for its tendency to produce a sense of intimacy with others and diminished feelings of fear and anxiety.   These effects have led some to suggest it might have therapeutic benefits to some individuals. Before it was made a controlled substance, Ecstasy, marketed as Empathy, was used to aid psychotherapy, often couples therapy, and to help treat clinical depression, the results of which are poorly documented.

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Ecstasy is commonly associated with the rave culture and its related genres of music.

MDMA was first synthesized in 1912 by Merck chemist Anton Köllisch. At the time, Merck was interested in developing substances that stopped abnormal bleeding.

Over the following 65 years MDMA was largely forgotten.

Ecstasy first appeared as a street drug in the early 1970s after its counterculture analogue, MDA, became criminalized in the United States in 1970. In the mid-1970s, Alexander Shulgin, then at University of California, heard from his students about unusual effects of MDMA. Two years later, he and David Nichols published the first report on the drug’s psychotropic effect in humans. They described "altered state of consciousness with emotional and sensual overtones" that can be compared "to marijuana, to psilocybin devoid of the hallucinatory component".

Shulgin had taken to using MDMA occasionally, for relaxation, referring to it as "my low-calorie martini" and giving the drug to his friends, researchers and other people who he had thought could benefit from it.

Due to the wording of the United Kingdom's existing Misuse of Drugs Act of 1971, MDMA was automatically classified as a Class A drug in 1977.

In the early 1980s in the United States, MDMA rose to prominence as "Adam" in trendy nightclubs and gay dance clubs in the Dallas area. From there, use spread to rave clubs in major cities around the country, and then to mainstream society. The drug was classified as a Schedule I controlled substance in the United States from May 31, 1985.

In the late 1980s MDMA as "ecstasy" began to be widely used in the United Kingdom and other parts of Europe, becoming an integral element of rave culture and other psychedelic / dancefloor-influenced music scenes, such as Madchester and Acid House. Spreading along with rave culture, illicit MDMA use became increasingly widespread among young adults in universities and later in high schools. Ecstasy became one of the four most widely used illicit drugs in the United States, along with cocaine, heroin and marijuana.

The primary effects attributable to MDMA consumption are predictable and fairly consistent amongst users. Generally, users report feeling effects within 30–60 minutes of consumption, reaching a plateau that lasts about 4–6 hours, followed by a "comedown" period of a few hours which may be accompanied by fatigue and minor effects lasting for anywhere from a few hours to a few days.

The most common subjective effects reported by users include:

- Euphoria
- Decreased hostility and insecurity
- Increased feelings of intimacy with others
- Feelings of empathy towards others
- Ability to discuss anxiety-provoking topics with markedly increased ease
- A strong sense of inner peace and self-acceptance
- Feelings of insightfulness and mental clarity
- Intensification of sensory experience
- Decreased appetite
- Short-term memory lapses

The most common physical side effects reported by users include:

- Urinary retention
- Abnormal pupil dilation
- Increased physical energy
- Increased heart rate and blood pressure
- Increased mean body temperature
- Lockjaw
- Involuntary teeth grinding
- Gurning
- Rapid, uncontrollable eye movements

MDMA causes a reduction in the concentration of serotonin transporters (SERTs) in the brain. The rate at which the brain recovers from serotonergic changes is unclear.

Another concern associated with MDMA use is toxicity from chemicals other than MDMA in ecstasy tablets. Due to its near-universal illegality, the purity of a substance sold as ecstasy is unknown to the typical user.  Pills may contain other active substances meant to stimulate in a way similar to MDMA, such as amphetamine, methamphetamine, ephedrine, or caffeine, all of which may be comparatively cheap to produce and can help to boost profit overall. In some cases, tablets sold as ecstasy do not even contain any MDMA.

The chief executive of the UK Medical Research Council stated that MDMA is "on the bottom of the scale of harm," and was rated to be of lesser concern than alcohol, tobacco, and cannabis, as well as several classes of prescription medications, when examining the harmfulness of twenty popular recreational drugs. The UK study placed great weight on the risk for acute physical harm, the propensity for physical and psychological dependency on the drug, and the negative familial and societal impacts of the drug. Based on these factors, the study placed MDMA at number 18 in the list.

David Nutt, chairman of the UK Advisory Council on the Misuse of Drugs, stated in the Journal of Psychopharmacology in January 2009 that ecstasy use compared favourably with horse riding in terms of risk, leading to around 50 deaths a year compared to about 100 from horse riding.

Most people who die while under the influence of Ecstasy have also consumed significant quantities of at least one other drug. The risk of MDMA-induced death overall is minimal.

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