Most MDMA-related hospital emergency cases involved males, confirming trends in prevalence and patterns of use. Half of the centres reported no MDMA-related admissions to the intensive care unit. Türkiye is an outlier, with MDMA identified in almost 1 in 5 drug-induced deaths (46 out of 246 in 2022). A minority of these fatalities (13-25 %) were due to MDMA toxicity alone, with multiple drug toxicity being more prevalen

Surrey Young People’s Substance Use Service
Since most users take this drug only occasionally, dependence is not very prominent. Although some users become dependent, very few cases of MDMA-specific dependence have been reported in the literature. That said, with repeated use, it becomes difficult, if not impossible for users to experience the same effects they did when they first started. The significant buy mdma increase in serotonin and dopamine during MDMA use can result in users seeking these feelings repeatedly, leading to habitual use and eventually, dependency. The addiction risk ties back to its effects on neurotransmitters. They can lead to extended wakefulness and increased physical activity, which can strain the user’s cardiovascular system and overall physical health.

MDMA use can lead to dangerous levels of hyperthermia and dehydration – often exacerbated by the environments in which it is commonly consumed, such as crowded nightclubs or music festivals. While the population of Brussels is larger than that of Stockholm, the amount of MDMA consumed is almost 30 % higher in Stockholm. Estimates based on wastewater data for MDMA were noted to be more than double the amount estimated by the demand-based estimate. In a study commissioned for this analysis, wastewater estimates were found to give different results, either higher or lower, than demand-based estimates, depending on the drug concerned.

The effect appeared to have been short-lived, and by the end of 2020 the price returned to pre-pandemic values (NPNL, buy mdma 2022). Some of the price disparity may be attributed to local factors, including distance to the producing centres (Netherlands and Belgium), but statistical artefacts (e.g. small sample sizes) may also be a factor. Individual factors and sex affect this dose, with women considered to be more susceptible to the 5-HT-releasing effects of MDMA (Liechti et al., 2001). This is consistent with law enforcement information that suggests the MDMA market in Europe is supplied by the same pool of producers, mostly based in the Netherlands and Belgium. It should be noted that this trend was observed across several countries in Europe.

General / Short-Term Effects
Demographic insights obtained from drug-related emergencies are in general agreement with other data buy mdma sources (see Section Prevalence and patterns of use). The median percentage of drug-related presentations involving MDMA was 4.7 % across the reporting hospitals in 2022, and 2.8 % for presentations involving MDMA as the sole drug reported. For example, in Germany, MDMA was mentioned in 1 in 25 fatal overdoses in 2022, with most of the cases involving multiple drug

As so often, enforcement interventions have failed to prevent rising use, or prevent supply in the longer term, instead only serving to temporarily displace using behaviours and mutate the market in ways that increased health harm


In a study commissioned for this analysis, wastewater estimates were found to give different results, either higher or lower, than demand-based estimates, depending on the drug concerned. In these cases, the missing information was replaced with the mean, computed on the remaining countries. In calculating the amounts used, it was assumed that the maximum realistic amount to use in a day was five tablets; those reporting higher values were excluded. The amount of MDMA used annually by these two different user buy mdma groups was estimated using data from the EWSD.
Wastewater-based methods
(1) The European Web Survey on Drugs (EWSD) is a voluntary, anonymous survey run by the EUDA and its partners targeting directly people who use drugs who are 18 years old or older, and are living in one of the participating countries. When using wastewater data to estimate MDMA markets, the use of MDMA is based on the excreted parent drug, rather than on an excreted metabolite (which is the case for some other drugs, such as cocaine and heroin). While a slight decrease in price was observed in 2022 for ecstasy tablets, this may not be statistically significant or sustained in the coming years. In fact, it could be argued that MDMA in the form of ecstasy tablets became cheaper between 2012 and 2019 as tablets containing larger quantities of MDMA became increasingly available on the market (see Section The trend of large tablets containing more MDMA may be reversing).
Increased ener


From 2004 to 2009, the proportion of seized European ecstasy tablets that contained MDMA as the only scheduled substance dropped substantially. When availability of MDMA is high, ecstasy tablets tend to contain MDMA as the main or only psychoactive ingredient, with the opposite occurring when there are shortages. An equal percentage of respondents reported delivery through regular mail or post, and picking the drugs up from a location without any personal contact (7 %). More than three quarters of EWSD respondents (77 %) reported meeting their dealer outside as the usual method for receiving drugs, followed by home delivery (17 %). Web-based surveys, such as the EWSD, can provide a helpful insight, although the results cannot be generalised to the population as a whole, or indeed to all people who use drugs.
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