While the majority of ecstasy users take small doses infrequently, a proportion use more frequently (monthly to weekly) and/or use larger amounts. There may also be a trend of increasing use by injection rather than orally (Topp et al., 1999). This study found it was young, female, polydrug users and those who binged on ecstasy (ie. administered high doses to maintain intoxication over a period of hours to days) who were most likely to report physical, psychological, financial, relationship and occupational problems which they attributed, at least in part, to their ecstasy use. Those who inject ecstasy are also likely to be at increased risk of harm arising from the more rapid onset of effects and higher peak levels in the blood following injection, thereby increasing the effect on the cardiovascular system and the liver and the possibility of physical trauma from loss of control during the 'rush' (Hunt, Jones & Shelley, 1993). Those who inject ecstasy are also at risk of vein damage and blood borne viruses due to their injecting behaviour. These groups of ecstasy users therefore may be appropriate targets for preventive interventions.

In the absence of research into specific interventions for ecstasy users, the closest approximation is interventions for users of other psychostimulant drugs, ie., cocaine and amphetamines. It is cocaine dependence that has been the subject of most research in this area. While cocaine and amphetamines are related to MDMA, it should be noted that there are substantial differences in the context and patterns of use, as well as pharmacology. Furthermore, it is now generally accepted that cocaine and amphetamine users can exhibit a dependence syndrome, while the existence of ecstasy dependence remains questionable (Topp, Hall & Hando, 1997).

Considerable research effort has been directed towards the identification of effective pharmacotherapies for cocaine users. To date these efforts have been largely unsuccessful and even if an effective pharmacotherapy were found, any transfer to the treatment of ecstasy users is questionable because of the differing pharmacology of the drugs — cocaine acts primarily through the dopamine system (Rawson, 1999) whereas MDMA acts through the serotonin system. Hence pharmacotherapies for ecstasy users should be innovative and specific to the action of MDMA. If taken concurrently with MDMA, SSRIs have been shown to block the usual subjective effects of MDMA (Stein & Rink, 1999). However, administration of SSRIs (e.g. fluoxetine, citalopram) subsequent to MDMA may potentiate the effects of the released serotonin, worsening any adverse effects (Green, Cross & Goodwin, 1995) and limiting their value as a treatment agent.