MDMA is almost exclusively available in pill form. Often the pills are stamped with clever images. The usual single dose is 100-150 mg. The onset of effect begins about 20-40 minutes after ingestion and is experienced with immediacy. Often this "rush" is accompanied by nausea and an urgent need to defecate (disco dump).
The plateau stage of drug effects lasts 3-4 hours. The principal desired effect, according to most users, is a profound feeling of relatedness to the rest of the world. Most users experience this feeling as a powerful connection to those around them, as well as to the universe (Leister, Grob, Bravo, & Walsh, 1992). Although the desire for sex can increase, the ability to achieve arousal and orgasm is greatly diminished in both men and women (Buffum & Moser, 1986). MDMA has thus been termed a sensual, not a sexual, drug. The prescription drug sildenafil (Viagra) may be taken in order to counteract this effect, and may be sold along with MDMA (Weir, 2000); the successor medications involving sexual enhancement can be expected to be used in this manner. The array of physical effects and behaviors produced by MDMA is remarkably similar across mammalian species (Green et al., 1995) and includes mild psychomotor restlessness, bruxism, trismus, anorexia, diaphoresis, hot flashes, tremor, and piloerection (Peroutka, Newman, & Harris, 1998).
Aftereffects associated with MDMA are common and can be pronounced. People using MDMA once, or on multiple occasions, may experience any number of symptoms, including lethargy, anorexia, decreased motivation, sleepiness, depression, and fatigue. Combining MDMA with PMA has been associated with a number of serious adverse events and deaths (Ling, Marchant, Buckley, Prior, & Irvine, 2001). Another acute adverse event, hyponatremia, followed by seizure and coma, appears be a result of the law of unintended consequences. The "harm reduction" admonition of advising MDMA users to adopt the strategy of ingesting copious amounts of water prior to and while taking MDMA appears, in some instances, to have backfired and has caused these severe physiological adverse events (Ajaelo, Koenig, & Snoey, 1998; Holmes, Banerjee, & Alexander, 1999).
Severe, immediate effects appear to be rare, but they do occur: altered mental status, convulsions, hypo- or hyperthermia, severe changes in blood pressure, tachycardia, coagulopathy, acute renal failure, hepatotoxicity, rhabdo-myolysis, and death have all occurred (Demirkiran, Jankovic, & Dean, 1996; Khalant, 2001). There are numerous case reports of a single dose of MDMA precipitating severe psychiatric illness. MDMA probably induces a range of depressive symptoms and anxiety in some individuals; for that reason, people with affective illness should be specifically cautioned about the dangers of using MDMA (Cohen, 1998; McCann, Ridenour, Shaham, & Ricaurte, 1994; McDowell, 1998).
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