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Schwartz RH, Miller NS. 
“MDMA (ecstasy) and the rave: a review”. 
Pediatrics. 1997 Oct;100(4):705-8.
The drug 3,4 methylenedioxymethamphetamine (MDMA), also known as 'ecstasy', is a 'designer' drug that is becoming popular with American adolescents at dance halls known as 'raves' and on college campuses. An analogue of amphetamine, MDMA shares properties with both amphetamine and hallucinogenic drugs. Now available in many US cities, MDMA has an undeserved reputation for safety and a long duration of action. The drug appeals to young people, who believe that enhances empathy and closeness to others. Common short-term adverse effects of MDMA include sweating, tachycardia, fatigue, and muscle spasms, including jaw-clenching. Serious adverse effects from MDMA include serious or fatal heat injury, fluid and electrolyte depletion, and central nervous morbid-system, cardiac, muscular, renal, and hepatic dysfunction. MDMA has been implicated in at least 53 deaths in the United Kingdom and at least five more deaths in the United States, mainly attributable to profound disturbances in thermoregulation (heat-stroke). MDMA is a selective serotonergic neurotoxin. 'Herbal ecstasy' containing ephedrine (Herba ephedrae) and other herbs, can be purchased by mail. Several toxicology screening tests for the amphetamine class of drugs of abuse can detect MDMA, but at about 50% reduced sensitivity. Treatment of acute toxic reactions includes rapid cooling and rehydration, monitoring electrolytes, and organ dysfunction. Because current national and state surveys show a significant increase in use of this drug, physicians in primary care, emergency medicine, critical care medicine, and addiction medicine can be expected to manage an occasional patient with acute MDMA toxicity.
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