MDMA or 3,4-methylenedioxyemethamphetamine, otherwise known as ecstasy (or the "love drug," Adam, Eve, X, E, XTC), is both a hallucinogen and a stimulant. It induces a state of euphoria and increased self-awareness (Milroy 1999). It was first synthesized as an appetite suppressant in 1914 but its euphoric and energizing qualities made it a popular street drug since the 1980s with a particular high prevalence of use in college campuses or "rave" (very large dance parties in abandoned warehouses) clubs (Greydanus and Patel 2003, Shulgin 1986, Boot 2000). It is readily absorbed through the gastrointestinal tract, is swallowed, used rectally, smoked/snorted, or injected. Its effects on mood are mediated by actions on dopamine and serotonin pathways, as well as on noradrenergic pathways. The drug has been found to have detrimental effects on serotonergic neurons in the CNS. As a result, memory and cognitive dysfunction as well as behavioral problems are common side effects. The most commonly seen reaction to toxic ingestion of MDMA is a syndrome of altered mental status, tachycardia, tachypnea, profuse sweating, and hyperthermia, which closely resembles that of acute amphetamine overdose (amphetamine is chemically similar to MDMA). Some of the more rare but serious side effects include malignant hyperthermia, rhabdomyolysis, kidney failure, heart failure, disseminated intravascular coagulation (DIC), fulminant liver failure, strokes, seizures, and death (Reneman et al. 2000, Rittoo and Rittoo 1992, Fiege 2003, Brauer 1997). The hallucinogenic and stimulant effects of the drug can last 3-6 h but can last up to several days. When taken in pregnancy, the risk of congenital effects, such as cardiac anomalies, cleft lip and palate, biliary atresia, fetal IUGR, IUFD, and cerebral hemorrhage, is increased (Eriksson et al. 2000).
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