fact sheet - ecstasy use in South Africa
Prepared by:
Alcohol and Drug Abuse Research Group, Medical Research Council

What is Ecstasy?

• The principal active ingredient in Ecstasy is MDMA (3,4 methylenedioxymethamphetamine).
• MDMA has a chemical structure similar to the central nervous system (CNS) stimulant methamphetamine and the hallucinogen mescaline and can produce both stimulant and psychedelic effects.
• The psychedelic effects of MDMA are milder than those produced by hallucinogens such as LSD.
• MDMA is most often found in tablet form although it is sometimes found in powder and capsule form.

Modes of administration

• MDMA is usually administered orally.
• Less frequently, MDMA is administered intranasally (snorted), inhaled (smoked), or inserted anally.
• MDMA is rarely used intravenously.

Short-term effects

• MDMA stimulates the release of the neurotransmitters serotonin and dopamine, resulting in a "high" that can last between four to six hours.
• An MDMA "high" is characterised by CNS stimulant effects (such as an enhanced sense of pleasure, increased self-confidence, and increased energy) and psychedelic effects (that include feelings of peacefulness, acceptance, and empathy).
• This "high" occurs 30 to 90 minutes after ingestion.
• The stimulant effects of MDMA lead to transient side-effects that include an increased heart rate, raised blood pressure, nausea, dry mouth, decreased appetite, jaw clenching, grinding of teeth, muscle aches, gait disturbance, and insomnia.
• Transient hallucinatory side-effects may include perceptual and visual distortions, alterations in consciousness with sensual and emotional overtones, and altered speech.
• Large doses of MDMA can lead to hyperthermia, dehydration, urinary retention, seizures, strokes, heart attacks, cardiac arrthymias, paranoia, and hallucinations.
• Although rare, cases of MDMA toxicity leading to death have been reported. MDMA toxicity is generally caused by changes in thermo-regulatory processes characterised by hyperthermia, seizures, acute renal and hepatic failure, and disseminated intravascular coagulation disorder. Less frequently, death may occur due to hypnoatramia (a complication of heat exhaution). In such cases, depleted sodium levels may lead to the formation of brain oedemas that could damage the brain stem and result in loss of consciousness and death.

Long-term effects

• The long-term effects of MDMA are difficult to identify as Ecstasy tablets are often adulterated with a range of psychoactive substances.
• Although physical dependence on MDMA does not seem to develop, physical dependence on the other substances contained in Ecstasy tablets (e.g. amphetamines) may occur.
• With chronic use, tolerance for the effects of MDMA develop and psychological dependence on MDMA may develop (characterised by deterioration in social and occupational functioning, craving and tolerance).
• Adverse psychological consequences of regular MDMA use include major depression, anxiety and panic disorders, paranoid ideation, increased impulsiveness, and sleep disorders. MDMA use may precipitate the onset of psychosis in predisposed individuals.
• MDMA has a neurotoxic effect on the serotonin neurons which are thought to play a role in regulating mood, aggression, sleep, appetite, and cognition.
• Regular use of MDMA may lead to persistent memory deficits, especially in working memory.

Global use of ecstasy

• Worldwide, an estimated 4.5 million people use Ecstasy. In some countries Ecstasy is the second most widely abused illicit substance after cannabis (e.g. the Netherlands).
• Although Ecstasy markets are still concentrated in Western Europe, North America and Australia, they are expanding to Asia and Africa. This is in keeping with the globalisation of youth culture.¹

For current statistics visit our SACENDU site.