- Updated 4 February 2019.
Ecstasy began to emerge on the youth party scene in the 1980s, initially in isolated pockets of youth subculture . It was previously investigated for medicinal purposes, predominantly in treating anxiety and PTSD  and its early use was largely clinical, amongst a closely connected group of psychiatrists and psychotherapists on the US west coast . Despite efforts to keep the drug largely under wraps and maintain its legal status, MDMA’s popularity grew immeasurably, to the point where it was impossible to hide . The catalyst for its publicity as a non-medical drug can be traced to an article published in 1984 in the San Francisco Chronicle, titled “The Yuppie Psychedelic” . The name “ecstasy” was coined as part of a marketing strategy by an LA-based distributor, and it quickly gained popularity throughout the US, particularly in Texas, where it was openly sold in bars and nightspots . In the UK, the government banned MDMA pre-emptively in the late 1970s, however it became wildly popular in the UK club and rave scene throughout the 1980s and 1990s, with use widespread despite its illegal status. . Australian police first seized MDMA in Sydney in the mid-1980s, leading to the National Drugs and Poisons Committee recommending it be prohibited nationwide . However, its use here increased during the 1990s, from 1% in 1990 to 3% by 1995 . Since then, ecstasy has increasingly been used by those within the 20-29 age demographic , with around one-fifth of this demographic having experimented at least once with ecstasy .
It is important to establish the difference between MDMA and the drug marketed as “ecstasy”. MDMA is the chemical compound that produces the well-documented psychoactive effects in those who consume it. MDMA was initially viewed as a potential treatment for anxiety and trauma, due to its ability to create feelings of empathy and trust amongst users . Ecstasy, on the other hand, is the street name for pills or capsules marketed as containing MDMA, but may contain a number of different substances as well as MDMA - or may not contain MDMA at all . When manufacturing ecstasy, certain other chemicals may be added that mimic the effects of MDMA. This could be something as harmless as caffeine, or as dangerous as PMA, a compound more toxic than MDMA and linked to several fatalities worldwide .
Initial research suggested that the ease with which the body becomes tolerant to ecstasy led users to consume it infrequently, thus maximising the positive effects . These early studies concluded that ecstasy was a relatively benign drug as usage was oral and intermittent, with mild, short-term side effects. However, as ecstasy usage increased, so did the ways and contexts in which it was used, leading to increased risk associated with its use. In a controlled, clinical context, pure MDMA carries a low risk when consumed, with some even describing it as “safe” . MDMA interferes with blood pressure and body temperature, and when manufactured with other adulterants or in unregulated potency as “ecstasy”, it can be dangerous .
In the United States, initial non-medical use of ecstasy was localised to nightspots, particularly in Texas . However, use quickly increased, especially amongst young people. In 1991, the lifetime use of MDMA amongst young adults between the ages of 19 and 28 in the United States was 3.2% and by 2001 it has increased rapidly to 13% .
Between 1995 and 2007 ecstasy use in Australia had been steadily increasing, but saw a gradual decline for the first time in 2007 , and fell from 3% in 2010 to 2.5% in 2013 . In 2010, the majority of Australians using ecstasy reported their use as once every few months or less . However, as of 2013 it remains the second most commonly used drug in a person’s lifetime, behind cannabis . According to the 2013 National Drug Strategy Household Survey, 2.1 million (10.9%) Australians aged 14 or older had used the drug at least once. The decrease reported between 2010 and 2013 was only significant amongst females and the 30-39 age demographic. There is also evidence suggesting small minorities of ecstasy users are increasingly consuming emerging psychoactive substances .
As previously mentioned, ecstasy use is highest amongst the 20-29 age group, and lowest amongst those aged 40-49 . Use has remained stable or increased across all age groups except those aged 14-19 . One study found significant gender-related differences in patterns of use. Whilst males reported taking larger amounts of ecstasy at any one time, they were not more frequent users when compared with females . Ecstasy remains a fairly easy drug to obtain, however between 2008 and 2011 an increasing amount of users (6% to 20%) reported that it was becoming more difficult to find , which may have an impact on usage patterns in the future.