MDMA (Ecstasy) is a synthetic amphetamine analogue used recreationally for its mood-enhancing effects, and its use is increasing among young people in Western countries. Unlike traditional drugs of abuse, MDMA dependence and dose escalation are relatively uncommon. However, MDMA is neurotoxic, damaging serotonergic neurons and impairing memory and mood. There are few effective treatments for acute intoxication or the long-term consequences of use. The literature indicates MDMA has a wide range of adverse effects.
Mental healthcare providers discussing esketamine (Spravato) online between 2019 and 2022 most frequently cited billing and reimbursement problems (65.1% of posts), billing codes (48.9%), staffing (18.3%), and pharmacy or drug procurement issues (16.7%) as implementation challenges. Sentiment about reimbursement was mostly negative (72.3%), and most posts comparing esketamine to ketamine favored using ketamine (86.7%). The findings suggest that under-reimbursement, billing difficulties, and logistical barriers may be hindering the adoption of esketamine for treatment-resistant depression.