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Ecstasy Consumption Patterns

Dosage (consumption) and purity

The amount of MDMA and/or related compounds in ecstasy tablets is extremely variable, if indeed there is any contained at all. Independent research[i] has shown the tablets purchased may contain less than 1mg to 12mg. The Drugs Intelligence Lab[ii] have indicated that the average MDMA content in tablets fell from 100mg in 1991 to 87mg in 1992. Saunders[iii] after studying analyses of a number of different ¬Ecstasy’ tablets, has indicated that the doses of MDMA & MDEA in tablets containing the drug range from 64mg to 196mg, with most falling in the range 100-130mg.

There are a number of studies, scientific, medical and sociological, which suggest that the effective dose of MDMA is between 75mg and 100mg[iv]. Women, in general, require less to achieve the same effect. By this token, one tablet should be sufficient to produce the desired psychotropic effect in a naive user. However, if the user takes tablets of low purity, or containing other substances entirely[v] [vi]ingestion of several tablets may not produce any discernible effect.

There is strong evidence of development of an acute tolerance to the drug, as with LSD, where repeated administrations have successively diminishing psychotropic effects. Animal studies have indicated decreased serotonin production, warning of long-term neurotoxicity[vii], and consequent tolerance over the longer term. It is suggested that each person has 10 good trips"[viii] before tolerance develops. This reduces the likelihood of prolonged daily use, although prolonged binges" may occur over a weekend with increasing doses used on successive occasions.

Doses claimed to represent up to 42 tablets have been reported as causing no detectable long-term effects, although much smaller doses have proven fatal. Risk factors include any person with a tendency to high fever during childhood or adolescence. The risk of toxic symptoms is not confined to the novice user, as a successful experience in one instance can be followed by a toxic episode using the same or even a lower dose.

Most deaths attributed to the drug have occurred at raves", and have been due to severe overheating. The hot humid atmosphere and high energy activity of a rave must be one of the most dangerous places to take a drug which can cause such increases in body temperature[ix]. High temperatures (over 43oC) have been reported as causing minute blood clots to form, depleting the blood of clotting factors, and paradoxically leading to internal haemorrhaging. Some advice given to users to drink lots of water may have led to recent tragedies outside the hot ¬rave’ environment, where the thirst induced by the drug has led to death via cerebral oedema, or swelling of the brain and internal organs.

The highest levels of use over a single day are reported in the USA by Beck et al[x] where respondents referred to friends" who used 900mg in one sitting, plus a college student who claimed to have used 1.25g (equivalent to 10-15 tablets) over a 24 hour period. A further long-term user would binge" on a total of 1.5g (13-18 tablets) over 24 hours. Both would binge over an evening or weekend. The effective limit on bingeing would appear to be 2-3 days, after which a prolonged period of recuperation would be required.

In the UK, ISDD[xi] report weekend dosages of up to 20 tablets, and some instances of chronic daily use of the drug over a 3 to 4 week period. The popular singer[xii] who claimed in an interview to use 12 tablets per night would certainly fall among the minority of heavier tolerant users, and would probably have suffered neurotoxic damage as a consequence, and cause, of high levels of ecstasy use.

Mixmag[xiii], in their 1999 survey of 1151 regular clubbers, found average number of tablets taken per session was 2.82, with half having used 5 or more tablets, one sixth having taken 10 or more, and 5% taking 15 or more. A quarter of respondents reported using at least 4 tablets a night on a regular basis, a pattern described by Winstock as ¬heavy chronic binge use’. A further Mixmag survey[xiv] found 5.7% of respondents take between 9 and 22 pills at one session, with over 40% taking four or more tablets.

Ecstasy consumption/purchase data from IDMU 'Regular Users' surveys

Our 1994 survey[xv] found that 14% of the drug users questioned used ecstasy on a more or less weekly basis, with 3 percent doing so more frequently. Occasional or experimental use was the norm. Over 50% of respondents had never used the drug. Regular users spent an average £88 per month on the drug, equivalent to 5-11 tablets per month.

Our 1997 survey considered the quantities purchased per occasion, and frequency of ecstasy purchase. Ecstasy was most commonly purchased in units of one to five tablets, with a small minority of individuals buying ten or more tablets at a time. The average price per deal was £28.08, equivalent to 3 tablets. Most users would purchase monthly, fortnightly or weekly.

Fig 1.  Ecstasy purchase behaviour (1997/98)

Regular ecstasy users (weekly or more often) in our 1997/8 surveys would spend an average £41.33 per month (4-5 tabs) with a 95% upper confidence limit of £147 per month (15-20 tabs). Regulars would buy £37 worth per occasion (up to 5 tabs), with a 95% upper confidence limit of £175 (20-30 tabs).

Data from our 2001-5 surveys (total sample 9929, 3568 regular ecstasy users), suggest that only around 1 in 10 regular ecstasy users consume the drug on a daily basis (206 used during the week, with 2276 respondents using at weekends). The average number of tablets taken per day (daily users only) was 3.63, the average at weekends (all users) being 2.92 tabs per day.

Fig 2  Distribution of Daily Ecstasy Usage (2001-5)

There were no significant differences in the probability of supplying tablets between experimental, occasional and regular users, in each case an average of 80-90% of tablets were consumed by the purchaser, representing 100% for the vast majority of users.

Successive ¬Mixmag’ surveys have found that regular clubbers rarely purchase single tablets at one time. In their 1999, 2000 and 2001[xvi] surveys, they found the average numbers of tablets bought on each occasion for personal use were 8.16 , 8.92 and 12.0 tablets respectively, suggesting falls in prices to result in an increase in the average quantity purchased per occasion.

Although less than 10% of regular ecstasy users used the drug during the week 24% of weekday users reported using 5 or more tablets per day during the week, 58% used two or more tablets. At weekends, 37% of users reported taking 3 or more tablets, 17% took 5 or more tablets, 4% took 10 or more. Overall 1% took 20 or more tablets per night, although among weekday users this proportion rose to 4%.

Table 1  Ecstasy Usage (2001-5 IDMU surveys)

No of



Weekly Total




Cum %



Cum %



Cum %





















1 < 3










3 < 5










5 < 10










10 < 15










15 < 20























Av 3.63



Av 2.92



Av 3.45

Effects of ecstasy

The main physiological action is to increase the release of serotonin (5-hydroxy tryptamine) and dopamine in the brain, changing the mood of the user by altering the processing of information[xvii]. The half-life of ecstasy (MDMA) in blood is around 6 hours. In general the effects are similar to, but more pronounced than, those of Prozac or similar antidepressants which block reuptake of serotonin thus raising the levels. It could be said that they achieve the same effects by ecstasy ¬turning on the taps’, and Prozac ¬putting in the plug’.

Physiological effects are similar to other stimulants  increased alertness and physical energy, raised body temperature (in many cases dangerously so), and dehydration. Liver and kidney damage has been reported. Most deaths have occurred due to overheating (heat stroke).

The main short-term psychological effects are reported by Leister & Grob[xviii] as altered time perception (90%), increased ability to interact with or be open with others (85%), decreased defensiveness (80%), decreased fear (65%), decreased sense of separation or alienation (60%), changes in visual perception (55%), increased awareness of emotions (50%), decreased aggression (50%), speech changes (45%), awareness of unconscious memories (40%), decreased obsessiveness (40% and cognitive changes (40%)." Medium-term changes (up to a week) included decreased sleep (40%), decreased appetite (30%), increased sensitivity to emotions (25%), decreased ability or desire to perform mental or physical tasks (20%), increased ability to interact with or be open with others (20%), and decreased defensiveness (20%)." Longer-term effects (more than one week) included improved social-interpersonal functioning (50%), changes in religious orientation or practice (46%), changed values or life priorities (45%), improved occupational functioning (40%), increased ability to interact with or be open with others (35%), decreased defensiveness (30%), changes in ego boundaries (30%), decreased desire to use alcohol (25% )and decreased fear (20%)" Other researchers have identified problems with memory and judgement[xix], or increased sensitivity to touch and sound[xx].

Short-term side effects include dry mouth, clenching or grinding of teeth, reduced appetite, weight loss, nystagmus, twitches, nausea and cramp. Adverse effects on mood are attributed by Saunders to the increased vulnerability of users when under the influence, due to increased openness and reduced defensiveness, such that insights may bring unbearable truths, and candid disclosures may be regretted[xxi]. Adverse psychological effects include sleep disturbance[xxii], depression and paranoia[xxiii], and exhaustion after use[xxiv]. Tolerance to the effects of ecstasy develops rapidly, such that the extreme euphoric effects tend to be limited to the first few occasions of use, and users may take increasing quantities in attempting to achieve a desired level of intoxication. Regular users can experience medium term depression[xxv] when not under the influence, which tends to reinforce ecstasy-seeking behaviour.

Evidence of damage to serotonergic neurons[xxvi], and lower serotonin levels among users and laboratory animals, provides a physiological model predicting long-term depressive illness in many chronic users. The neuronal damage also explains why tolerance occurs, as no matter how much stimulation they receive, the fewer remaining neurons can only secrete a limited amount of serotonin.


Most recreational users would use one to three tablets per occasion, regular clubbers would typically use three to eight ecstasy tablets per occasion[xxvii][xxviii]. However, there is a substantial minority of ecstasy users who can consume 9-20 tablets over a 24-48 hour period[xxix][xxx].

© IDMU Ltd 2006

[i]           Lifeline Project. What’s in a name Gay Times September 1994.

[ii]           King LA, Clarke K & Orpet AJ (1993) The Drug Content of Powders and Other Illicit Preparations. Aldermaston: Drugs Intelligence Laboratory Technical note 780.

[iii]          Saunders N [1995] op cit.

[iv]          Wills S. (1993) Amphetamines & Hallucinogens. Pharmaceutical Journal 250(6744) pp871-874

[v]           Lifeline Project (1995) Ecstasy and Eve. (leaflet)

[vi]          Nasmyth P (1986) The Agony & The Ecstasy. The Face no 78. October 1986.

[vii]          Kosten TR & Prich LH. (1992) Commentary: Phenomenology & sequelae of methylendioxymethamphetamine use. Journal of Nervous and Mental Disease. 180(6) pp353-354

[viii]         Beck J, Barlow D, McDonnell D, Morgan PA, Rosenbaum M, & Watson L (1989). Exploring Ecstasy: a description of MDMA users. Report to NIDA. San Francisco: Institute for Scientific Analysis.

[ix]                Wills S. (1993) op cit.

[x]           Beck J, Barlow D, McDonnell D, Morgan PA, Rosenbaum M, & Watson L (1989). Exploring Ecstasy: a description of MDMA users. Report to NIDA. San Francisco: Institute for Scientific Analysis.

[xi]          Ashton M (1992) The Emerging Ecstasy Problem - Ch. in Ashton (Ed) 1992 - The Ecstasy Papers. London: ISDD publications..

[xii]          Brian Harvey - East 17 singer, covered widely in press & television Dec. 1996

[xiii]         Winstock A & Howe R (2000). Mixmag Drugs Survey - Mixmag 105 (Feb 2000), pp62-78.

[xiv]         Winstock A. pp Mixmag (2001) The Mixmag Drugs Survey 2000. Mixmag 117 (Feb 2001) pp 54-79

[xv]          Atha MJ, Blanchard S & Newcombe RD (1996) op cit.

[xvi]         Mixmag (2002) The Mixmag Drug Survey 2001 (Hunt, Winstock et al), Mixmag 129 (Feb 2002) pp84-109

[xvii]         Saunders N (1997) Ecstasy Reconsidered ISBN 0 9539965 0 6

[xviii]        Leister M & Grob C (1992) Phenomenology and sequelae of MDMA use. J Nerv Med Dis 180(6)

[xix]         Downing J (1986) The psychological and physiological effects of MDMA on normal volunteers. J Psychoactive Drugs 18(4)

[xx]          Kehne et al (1992) Effects of MDMA on acoustic & tactile startle reflexes in rats. J Pharm Exp Ther 1/92

[xxi]         Saunders N (1997) Ecstasy Reconsidered ISBN 0 9539965 0 6

[xxii]         Allen et al (1993) Effects of MDMA on sleep. Sleep 9/93

[xxiii]        O’Dwyer T (1992) The phenomenology of ecstasy use. St Thomas Hosp, Morpeth (Leeds Addiction Unit).

[xxiv]        Beck G & Rosenbaum M (1994) The pursuit of Ecstasy - the MDMA experience. State University of New York Press

[xxv]         Greer G & Tolbert R (1986) Subjective reports of the effects of MDMA in a clinical setting. J Psychoactive Drugs 18(4)

[xxvi]        Ricaute G (1994) Serotonin neurotoxicity after MDMA a controlled study in humans. Neuropsychopharmacology 1994

[xxvii]        Saunders N (1995) Ecstasy & the dance culture

[xxviii]       Winstock A. pp Mixmag (2001) The Mixmag Drugs Survey 2000. Mixmag 117 (Feb 2001) pp 54-79

[xxix]        Newcombe RD (1991) Raving and Dance Drugs. Liverpool: 3-D Research Bureau. Also cited in The Independent 28-12-91

[xxx]         Beck J, Barlow D, McDonnell D, Morgan PA, Rosenbaum M, & Watson L (1989). Exploring Ecstasy: a description of MDMA users. Report to NIDA. San Francisco: Institute for Scientific Analysis.

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