Most MDMA users report feelings of emotional closeness without a desire for penetrative sex, but some, especially gay and bisexual females, use the drug specifically for sexual enhancement. Among those who do have sex during MDMA episodes, sexual risk taking—such as having multiple partners and not using condoms—is common. The study is based on in-depth interviews with 98 current and former MDMA users conducted in 1997 and 1998. Most had used MDMA in the prior six months, and many had used it 100 times or more.
Most Ecstasy users report positive effects, but nearly all experience at least one adverse psychological outcome. Negative experiences rarely deterred the 98 current or former users interviewed from using the drug again. Those negative outcomes almost always involved an interaction between two or more factors, nearly always including set or setting. Users' expectations of the drug's effects were related to the brand or label of Ecstasy consumed, even though the same brand can contain varying amounts of MDMA and other adulterants. The role of individual disposition in producing negative experiences remains unclear and may interact with user set or friends' set.