In the UK, ecstasy (often known as 'E' or 'X') is an illegal class A drug. Dealing carries a maximum life prison sentence and unlimited fine, and possession up to seven years in prison and a hefty fine.

Ecstasy has both stimulant and hallucinogenic properties. Its active ingredient is a synthetic drug called MDMA. Originally used in psychotherapy, from the late 1970s it started to be used on the club scene due to its ability to reduce inhibitions, give an energy boost, induce relaxation, and give intense pleasure by releasing the neurotransmitter serotonin.

The drug is sold in tablet form, and less frequently as a powder. After about 30 to 45 minutes the drug gives an intense ‘high’, which may last for several hours. Because the body becomes tolerant of the drug, people may end up taking larger quantities to induce similar feelings of euphoria.

Because ecstasy is illegal there have been no proper clinical trials looking at the risks of using the drug for people with HIV. The effects of ecstasy on the immune system and on HIV disease progression are therefore uncertain.

In 1996, a man who had recently started taking a combination of anti-HIV drugs, including the protease inhibitor ritonavir, died after taking two and a half ecstasy tablets. An autopsy found that there was an unusually high amount of ecstasy in his blood, which may be partly explained by an interaction between the drug and ritonavir. The man was taking the full dose of ritonavir, not the smaller dose that is now used to boost other protease inhibitors. Full-dose ritonavir boosts the amount of ecstasy in the blood stream by between 200 and 300%, because the body uses the same process to break down both ritonavir and ecstasy.

Because other protease inhibitors (and NNRTIs and many other drugs) are metabolised using a similar process, there is a risk that ecstasy could interact dangerously with them, and there have been hospitalisations due to adverse reactions to ecstasy amongst people taking protease inhibitors.

If you’ve started a new treatment combination recently, the first four weeks, when your body gets used to the new drugs, are likely to be the riskiest time for interactions. Some doctors suggest that after this period, if you choose to take ecstasy, it may be safer to begin with a quarter or half a tablet first. This information has not been researched scientifically.

As with all recreational drugs, it is difficult to know what the ecstasy tablet you are using really contains. The doses found in street drugs are not controlled, and the ecstasy pill you buy might contain much larger quantities of the drug. Ecstasy may have been ‘cut’ with other substances or with other drugs.

In the short-term, ecstasy can cause dehydration, headache, chills, eye twitching, jaw clenching, blurred vision, nausea and vomiting, and like many drugs taken to get ‘high’, is commonly followed by a low period or ‘come-down’.

People can have an allergic reaction to the drug, which can be fatal (though deaths related to ecstasy are very rare relative to the extent of its consumption). The drug has also been associated with heart and lung problems, dramatic increases in body temperature, kidney failure, and liver damage. The potential liver toxicities of ecstasy and other recreational drugs are of particular concern to people with HIV as liver damage can make you very ill in its own right, and stop the body from processing anti-HIV drugs properly.

Long-term use has been linked to poor mental health, depression, psychotic episodes and memory problems.

If you are using ecstasy or planning to do so, then think about discussing this with your doctor or another member of your healthcare team. Most are quite happy to discuss drug use and can provide helpful information on minimising risks.

As with all recreational drugs it is wise to consider how use could impact on adherence to your HIV treatment or other areas of your health or life.

NAM reminds readers that ecstasy use is illegal in the UK, and in many other countries. This factsheet has been produced with UK law in mind. Readers in other countries should be aware that the legal status of ecstasy may differ from that described in this factsheet.