Ecstasy pills in recreational settings often contain MDMA, but many also include other drugs like MDEA and methamphetamine. The amount of MDMA per pill varies widely, from 0 to 245 mg. Users typically consume between half a pill and five pills in a session, with total MDMA doses reaching up to 280 mg. Plasma concentrations of MDMA rise with the number of pills consumed and the cumulative dose. Taking multiple pills over several hours leads to sustained high MDMA levels in the blood, exposing the brain to the drug for longer than single-dose studies would suggest.
An international wastewater surveillance program analyzed influent samples from up to 47 sites in 16 countries between 2019 and 2022, detecting 18 new psychoactive substances (NPS) across at least one site. Synthetic cathinones were the most common class, followed by phenethylamines and designer benzodiazepines. Two ketamine analogues, the plant-based NPS mitragynine, and methiopropamine were also quantified. Use varied by region: mitragynine mass loads were highest in US sites, eutylone increased in New Zealand, and 3-methylmethcathinone rose in several European countries. The ketamine analogue 2F-deschloroketamine emerged recently and was quantified in sites including one in China, where it is considered a drug of most concern. Some NPS initially detected in specific regions spread to additional sites over time, demonstrating that wastewater surveillance can reveal temporal and spatial trends in NPS use.
Abstinent ecstasy users show abnormally large tremor during movement compared to non-drug users, while resting tremor remains unaffected. The study measured tremor with an accelerometer in abstinent ecstasy users (n=9), users of amphetamine-like drugs (n=7), cannabis users (n=12), and non-drug users (n=23). During finger movement, tremor amplitude was significantly greater in ecstasy users (frequency range 3.9-13.3 Hz) but not in cannabis or amphetamine users. Peak tremor frequency did not differ between groups. The finding suggests chronic ecstasy use may produce lasting motor effects, though further research is needed to determine if this increases risk of movement disorders.