The ecstasy market in the Netherlands became unstable in 2009, with more than a 50% drop in tablets containing MDMA. A new substance, mephedrone, partially replaced MDMA in tablets sold as ecstasy, at doses between 96 and 155 mg. Based on reports from 70 regular ecstasy users, mephedrone produced enjoyable effects similar to other amphetamine-type stimulants, including MDMA, but unlike MDMA it induced strong cravings in most users. If the unstable market continues, mephedrone may substantially substitute for MDMA, raising health concerns.
Club drug use, particularly the combination of ecstasy (MDMA) and gammahydroxybutyrate (GHB), is increasing. This review describes the subjective effects of the MDMA/GHB combination and reviews the individual actions of MDMA on serotonin, dopamine, and noradrenaline systems, as well as GHB's actions on these systems. It is postulated that GHB attenuates the unpleasant or dysphoric effects of MDMA by its effect on the central dopaminergic system. Studies investigating combinations of psychoactive substances are limited, and awareness of this phenomenon and the pharmacology of these drugs is important for effective prevention.