Pill content, dose and resulting plasma concentrations of 3,4‐methylendioxymethamphetamine (MDMA) in recreational ‘ecstasy’ users

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.

Study at a glance

Abstract

ABSTRACT Aims To improve our understanding of the pharmacology of ‘ecstasy’ in recreational environments; in particular, to describe the composition of ecstasy pills, patterns of ecstasy use and the relationship between dose of 3,4‐methylendioxymethamphetamine (MDMA) and resulting plasma concentrations. Design, setting and participants A naturalistic observational study of 56 experienced ‘ecstasy’ users in recreational settings in Australia. Measurements Drug use patterns (number of pills consumed, other drugs consumed). drug content of pills and resultant plasma concentrations of MDMA and related drugs were assessed by gas chromatography/mass spectrometry (GC/MS). Findings Ecstasy pills generally contained MDMA, but this was often combined with other drugs such as 3,4‐methylendioxyethylamphetamine (MDEA) and methamphetamine. The dose of MDMA per pill ranged from 0 to 245 mg and users consumed from one‐half to five pills, with the total dose consumed ranging up to 280 mg. Plasma concentrations of MDMA increased with number of pills consumed and cumulative MDMA dose. Use of larger numbers of pills was associated with extended exposure to the drug. Conclusions MDMA is the major active drug in ecstasy pills, but there is a high degree of variation in doses. Use of multiple pills over the course of one session is common and results in a sustained increase in MDMA plasma concentrations over a number of hours. This is likely to lead to a much greater exposure of the brain to MDMA than would be predicted from controlled single‐dose pharmacokinetic studies.