"MDMA produces a state of excitement and disinhibition and accentuates physical sensation, empathy, and feelings of interpersonal closeness. Toxic effects are similar to those of the other amphetamines but are less common, perhaps because use is more likely to be intermittent. However, even with casual use, significant problems such as hyperthermia and centrally mediated hyponatremia may occur. The effects of intermittent, occasional use are uncertain. Rarely, fulminant hepatic failure occurs.

"Chronic, repeated use may cause problems similar to those of amphetamines, including dependence. Some users develop paranoid psychosis. Cognitive decline may also occur with repeated, frequent use."

"MDMA is not a new drug. It was first synthesized by the German pharmaceutical firm Merck in 1912. Human experimentation, however, has been traced back to the early 1970s (Eisner, 1989; Shulgin, 1990)."

"Preceding MDMA on the street and in the laboratory was its chemical cousin, MDA (3,4 methylenedioxyamphetamine) ... It quickly gained a reputation for producing sensual, easily managed euphoria ..."

"Few studies had been conducted to evaluate MDA's therapeutic potential before the government imposed legal restrictions and halted human research with LSD and other 'psychedelics' (Grinspoon and Balakar, 1979). Each of these investigations reported favorable outcomes, with subjects describing facilitation of self-insight, heightened empathy, and other positive qualities associated with the MDA experience."

"Beginning in 1976, a small number of therapists on both coasts began to utilize MDMA for similar purposes. They found 'Adam' (the therapists' nickname for MDMA) to be even more beneficial than MDA as a therapeutic adjunct, particularly in facilitating communication, acceptance, and fear reduction."

In 2004, the Drug Enforcement Administration gave permission for the first US trial of MDMA for use in treating trauma:

"Capping a 17-year effort by a small but committed group of activists, the federal Drug Enforcement Administration has agreed to let a South Carolina physician treat 12 trauma victims with the illegal street drug ecstasy in what will be the first U.S.-approved study of the recreational drug's therapeutic potential.

The DEA's move marks a historic turn for a drug that has long been both venerated and vilified."

(2002) "The DAWN metropolitan area profiles include information on 'club drugs' as a group, combining all mentions of methylenedioxymethamphetamine (MDMA or Ecstasy), Ketamine, gamma hydroxy butyrate (GHB) and its precursor gamma butyrolactone (GBL), and flunitrazepam (Rohypnol). As in prior years, these substances accounted for very few deaths in any of the DAWN metropolitan areas. Seven metropolitan areas reported no deaths involving these drugs, and only 7 metropolitan areas reported more than 5 mentions of club drugs. The areas with the highest numbers in 2002 were New York (19 mentions), Miami (9), Chicago (7), New Orleans (7), Philadelphia (9), Boston (6), and San Diego (6). Club drugs were rarely reported alone."

"Deaths associated with club drugs other than methamphetamine are quite rare in DAWN data.

"• Cumulatively, 2,601 deaths associated with methamphetamine abuse, 46 deaths associated with Ketamine, and 27 with MDMA were reported by participating medical examiners over the 5-year period from 1994 to 1998.

"• There were no notable increases in deaths involving club drugs from 1994 to 1998."

Some assertions about the negative health affects of MDMA use are exaggerated, and researchers have been forced to retract their more extreme claims. Dr. George Ricuarte wrote the journal Science on Sept. 12, 2003:

"We write to retract our report 'Severe dopaminergic neurotoxicity in primates after a common recreational dose regimen of MDMA ('ecstasy')' (1), following our recent discovery that the drug used to treat all but one animal in that report came from a bottle that contained methamphetamine instead of the intended drug, MDMA. Notably, methamphetamine would be expected to produce the same pattern of combined dopaminergic/serotonergic neurotoxicity (2) as that seen in the animals reported in our paper (1)."

"The main finding of the current longitudinal study is that continued use of MDMA is associated with different aspects of memory decline. For example, the ability to recall a short passage of prose being read aloud immediately and after a delay was found to decline significantly. This decline suggests impairment in retrospective memory, given that performance on the three RBMT prospective tests—1) remembering to ask the experimenter to telephone for a taxi; 2) remembering to deliver a message; and 3) remembering to ask for the return of a personal belonging—did not decline with continued MDMA use. Moreover, no changes in test scores were observed in terms of orientation for time and place and knowing the date.

"This investigation also indicates that vocabulary and the ability to recall first and second names may be adversely affected by the frequency of MDMA use, and that the ability to immediately recall a route may be related to the duration of MDMA use."

"In summary, our data suggest that ecstasy use over a period of months or a few years may cause long term impairment of cognitive performance even when ecstasy is taken in typical recreational and not necessarily very high doses."

"Pill testing interventions are important measures to enter into contact with hard-to-reach populations and to raise their interest in preventive and harm reduction messages."

In an evaluation of on-site pill testing, a European Monitoring Centre for Drugs and Drug Addiction scientific report concluded that:

"• Despite the lack of empirical data - for health systems in general and information and prevention projects in particular - it is crucial to know about new substances and consumption trends, otherwise there is a high risk of loosing credibility with well-informed users of psychoactive substances. Pill-testing projects can be an important source of information on new substances and consumption trends as they are in closest possible contact with the relevant scenes, more so than other organisations within the prevention system. They have, furthermore, an insight into most substances that are actually being consumed, and know who and where, in which manner, and why these substances are being consumed.

"• Pill-testing interventions have to be part of a global strategy for prevention and harm reduction in recreational settings.

"• By using the information from on-site pill-testing interventions, a national warning system could deepen its data pool in terms of social contexts: who are the people consuming these substances, how, where and why are they consuming these substances in this and that particular way and which information can be passed on to potential consumers in a meaningful and successful manner?

"• Due to the lack and difficulties of evaluation, on one hand there is still no strict scientific proof for the protective impact of on-site pill testing interventions, but on the other hand there is also no scientific evidence to conclude that such interventions would rather promote drug use or might be used by dealers for marketing purposes. Bringing together pieces of evidence is however often a first step for deciding on new intervention models."