MDMA is well established as a popular psychoactive substance across much of
the Western world. Hundreds of thousands of people break the law to access its
effects, which include increased energy, euphoria, and enhanced sociability. The
categorisation of MDMA as a Class A drug in the UK and Schedule 1 drug
internationally – categories reserved for drugs deemed to pose the highest risk
to individuals and society – has never meaningfully disrupted its supply, nor its
widespread use. MDMA is cheaper and purer than ever before and is available
at the click of a mouse via darknet drug markets.
For several years, MDMA-related adverse events and fatalities have been
increasing in the UK, with some claiming that taking MDMA today is the
riskiest it has ever been. Responses are polarised between those who assert
that the risks of MDMA use necessitate mitigation through prohibition and
increased law enforcement, and those who perceive prohibition to be exacerbating
these risks by exposing users to an unregulated market of pills and powder of
unknown strength and quality. Whichever view you take, current policy is not
meeting its goal of reducing harms, and greater control of MDMA production,
distribution, purchase, and consumption is needed in order to prevent MDMArelated emergencies.
This report examines the acute, sub-acute, and chronic harms related to
MDMA use in detail. We examine the production, distribution, purchase, and
consumption of the drug; related risks and harms; and the impact prohibition
has on these, as well as the potential impact of alternative policies. Crucially,
our evidence shows that many harms associated with MDMA use arise
from its unregulated status as an illegal drug, and that any risks inherent to
MDMA could be more effectively mitigated within a legally regulated market.
MDMA: Roadmaps to Regulation
Under prohibition, people purchase MDMA pills, crystal, and powder
from an illegal market, with little certainty as to what these products contain.
Given that illegal drugs are not subject to strict production standards,
consumers are exposed to the risks of poisoning or accidental overdose as a
result of contamination, adulteration, and unknown strength and purity. Naïve
commentators demonise the drug and simply urge young people to ‘just say no’,
whilst failing to account for those who say ‘yes’. In the meantime, preventable
deaths continue to occur, and otherwise law-abiding people are punished
for non-violent offences such as the possession or social supply of MDMA.
Governments and the mainstream media persist in perpetuating the myth that
the War on Drugs is winnable if it were fought harder, and those calling for
drug policy reform – as we do here – are framed as ‘radicals’ who have little or
no regard for the health and wellbeing of citizens.
This characterisation could not be further from the truth. Those calling for
careful reform to existing drug policy include the parents of young people whose
lives have been lost or ruined by harms related to the prohibition of MDMA. We
incorporate their voices in this report alongside those of academics and former
police officers, highlighting the ‘broad church’ of those dedicated to fighting for
reform. This includes scientists undertaking ground-breaking research into the
therapeutic potential of MDMA, who work within a regulatory regime that
makes such research exorbitantly expensive and time-consuming, because of
the Schedule 1 status that MDMA holds in the UK.
As we enter the fourth decade of MDMA’s widespread use, new thinking
is needed on how to better control production and distribution, and on how
to reduce the risks associated with its consumption. There is growing evidence
to support reorienting drug policy away from an ideologically driven criminal
justice-led model to one rooted in pragmatic health and harm reduction
principles. This is reflected in the widespread reform of cannabis laws occurring
in numerous jurisdictions around the world, and the growth of treatment
programmes for heroin users which include prescription heroin and supervised
injecting rooms. These hard-fought policy changes acknowledge the failure of
prohibition to meet its goals and produce a ‘drug-free world’. They are built on
a robust and ever-growing evidence base which demonstrates how permitting
or prescribing the use of legally regulated drugs improves health and safety
outcomes for people who use drugs and their communities at a reduced cost to
the state, whilst also providing wider employment and economic opportunities.
This logic can be extended to the use of MDMA and other currently prohibited
Roadmaps to Regulation: MDMA follows this pragmatic path and pursues
policy aims which many of us share, such as improvements in public health
promotion, targeted harm reduction, evidence-informed policy and practice,
human rights, social justice, participatory democracy, and effective governmental
expenditure. For the first time, we outline detailed recommendations for drug
policy reform to better control the production, distribution, purchase, and
consumption of MDMA products. Reform and the reduction in MDMArelated harms this will bring cannot happen overnight. The changes we outline
here, which culminate in a strictly regulated legal market for MDMA, are to be
phased in gradually and closely evaluated through independent policy research
to ensure health and social outcomes are properly documented, with findings
folded back into the ongoing reform process.