What is MDMA?

Answer

The first synthesis of MDMA was by Köllisch in 1912 at a German pharmaceutical company, Merck and Company, with the German patent 274350. At the time of patent application, no use was specified for MDMA and it was called "methylsafrylamin" in the annual report. MDMA was discovered while in the pursuit of hemostatic substances, not appetite suppressants. The erroneous association is due to MDA, 3,4-methylenedioxyamphetamine, a close analogue studied for its antidepressive and appetite suppressant effects developed in 1949-1957 by Smith, Kline, and French.

In 1927, Max Oberlin at Merck noticed the chemical similarity between MDMA and ephetonine-like and adrenalin-like substances. He conducted the first pharmacologic testing and noted that MDMA did not have pure sympathetic effects because it was devoid of the local effects on the eye. In 1978, Shulgin and colleagues reported human study results concerning the pharmacokinetic and psychotropic effects of MDMA.

Before MDMA became a Schedule I drug, some therapists used MDMA as an experimental therapeutic aid in marriage counseling and psychoanalysis due to its enactogenic effects, the ability to “touch within” and for increasing self-awareness. More recently, MDMA has shown efficacy in the treatment of posttraumatic stress disorder.^[1]

Inevitably, as public awareness grew, some members of the public began to use MDMA for recreational purposes, and its use began to increase on the streets. Recreational MDMA use began insidiously among middle class professionals and was confined to small groups. However, as the potential for huge profits appeared, MDMA soon spread to a younger crowd and became prevalent in bars, clubs, and college campuses across the country. During the early 1980s, this subculture of house music and house parties was found in major cities throughout the United States; at the same time, MDMA use spread throughout Europe in hideaways such as Ibiza, Spain, and the famed underground club scene in London.

In 1985, published reports stated that MDMA and its demethylated metabolite 3,4-methylenedioxyamphetamine (MDA) had long-term neurotoxic effects in laboratory animals. As a result of the study and concern over MDMA's increasing recreational use, the Drug Enforcement Agency placed MDMA in the Schedule I category of the Controlled Substance Act, hence declaring the drug illegal. Despite its illegal status as of 1986, the use of MDMA has continued to increase and rose dramatically with the arrival of the "rave" phenomenon.

Raves occur in dance halls and clubs. Typically, young adults ingest tablets of MDMA and dance all night to electronic music and laser lights. People gather by the thousands and dance for many hours in hot crowded venues or clubs; they may present to the ED, usually complaining of symptoms of dehydration and hyperthermia.^[2]While most improve with supportive treatment alone, the patient should be evaluated for signs of hyperthermia, dehydration, hyponatremia, seizures, hypertensive crises, cardiac dysrhythmias, and possible signs of serotonin syndrome.

MDMA use has increased dramatically, becoming a global phenomenon. The misconception that MDMA is a safe drug continues to be a major problem. Many of the myths concern the fact that it was once legal as a psychotherapeutic adjunct and that it has few adverse effects. The medical community's awareness of MDMA has increased, and conclusive evidence indicates that significant morbidity and mortality are associated with its use. Physicians must be able to recognize these symptoms and to treat and educate patients accordingly.

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In-Hei Hahn, MD, FACEP, FACMT Attending Physician, Department of Emergency Medicine, NYU Langone-Cobble Hill

In-Hei Hahn, MD, FACEP, FACMT is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, Wilderness Medical Society

Disclosure: Nothing to disclose.

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Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John G Benitez, MD, MPH Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Undersea and Hyperbaric Medical Society, Wilderness Medical Society, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

Peter MC DeBlieux, MD Professor of Clinical Medicine and Pediatrics, Section of Pulmonary and Critical Care Medicine, Program Director, Department of Emergency Medicine, Louisiana State University School of Medicine in New Orleans

Peter MC DeBlieux, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Radiological Society of North America, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

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Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author David Yew, MD, to the original writing and development of this article.

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