MDMA (ecstasy, Molly) is a synthetic stimulant and hallucinogen commonly used at electronic dance music parties, especially by young people in Hong Kong and globally. While recreational use is widespread, serious illness and death can occur, linked to serotonin toxicity. Cyproheptadine, an antihistamine with serotonin-blocking properties, is reported as an effective treatment for moderate serotonin syndrome. This chapter reviews the life-threatening risks of MDMA use, the serotonin syndrome associated with it at EDM events, diagnosis and management, and the benefits of cyproheptadine as an antidote.
Public health efforts must balance preventing illicit drug use with ensuring access to medicines that have abuse potential. Drug interactions for drugs of abuse, unlike those for medicines, are largely underexplored and not part of clinical routine. MDMA (ecstasy, molly) exemplifies this: it is a popular recreational psychostimulant and is being evaluated for treating post-traumatic stress disorder. Understanding inter- and intraindividual factors, modulation factors, and potential interactions is crucial to assess intoxication risk for both recreational users and patients in future MDMA-assisted therapy.