Methylenedioxymethamphetamine (MDMA)a.k.a. Ecstasy

Abstract As these words are written, the chemical we will call MDMA is a Schedule I drug. This means that MDMA (a) has no currently accepted medical use, (b) no currently accepted safety even under medical supervision, and (c) has a high potential for abuse. On the other hand, there are those who see great therapeutic potential in MDMA, and the Food and Drug Administration (FDA) has designated MDMA- assisted psychotherapy as a breakthrough therapy. We can foresee the day when it will be available by prescription. There is no doubt as to the chemical identity of MDMA, and much is known of its pharmacological effects in humans and in animals. The recreational drug commonly known as Ecstasy is more complicated. As is true for any illegal drug used by millions of people, demand for the drug has been met by persons not noted for their high ethical or manufacturing standards. Simply stated, short of chemical analysis, one can never be sure what street-bought Ecstasy is. For example, investigators at Vanderbilt University determined the contents of 1,214 tablets sold as Ecstasy. Only 39% contained only MDMA, while fully 46% were “substances other than MDMA.” Mixtures of MDMA and other drugs comprised the remaining 15%. On the other hand, sometimes in some places over the past several decades, nearly pure MDMA has been available on the illicit market. Nonetheless, a buyer of Ecstasy may ingest, rather than MDMA, drugs such as ketamine, gamma-hydroxybutyrate (GHB), cathinone, ephedrine, caffeine, or any one of the so-called designer drugs, many of which are amphetamine derivatives. A consequence of this pharmacological chaos is that many of the hazards associated with the use of Ecstasy have been uncritically attributed to MDMA. This fact has been a boon for those who would continue the Schedule I status of MDMA and a bane for those who would explore its therapeutic potential. However, in contrast with recreational use where purity of the drug is uncertain, MDMA in clinical trials is FDA approved and of known composition.