The use of ecstasy in São Paulo has had a recreational pattern quite similar to those described in previous studies. The assessment of the use of ecstasy as positive also agrees with the findings of the literature.

The present study was aimed at identifying patterns of Ecstasy (methylenedioxymethamphetamine-MDMA) use in the city of São Paulo. Ecstasy users were recruited through the snowball technique. Using the same technique, a non-user control group was recruited among individuals that had never tried the drug but shared with users a similar life style. Users (N = 52) and non-users (N = 52) were interviewed in order to obtain data on socio-demographic characteristics and use of psychoactive drugs. In addition, levels of anxiety, depression and impulsiveness were assessed through Spielberger's IDATE Trace Inventory, Beck's Depression Inventory and Barrat Impulsiveness Scale. Both users and non-users revealed similar socio-demographic characteristics: most subjects were middle class young heterosexual single men and women who had a college degree. Multiple drug use was more frequent among users than among non-users. Other features that were significantly more accentuated among users than among non-users were the presence of tattoos and piercings, the frequency of attending raves and the preference for electronic music. Beck Inventory results pointed to significantly lower depression scores among users. No differences were observed between groups regarding anxiety and impulsiveness scores. Although the use of Ecstasy in São Paulo is restricted to a young middle or high social class, their vanguard lifestyle tends to influence youngsters of other social extractions, so that the use of the drug may soon become widespread and thus a legitimate public health concern.

This review focuses on 3,4-methylenedioxymethamphetamine, an illegal drug known as "ecstasy." Ecstasy was introduced in Brazil in 1994. Data are lacking on the epidemiology and usage pattern of the drug in Brazil. However, there is evidence that until now the use of ecstasy has been limited to middle-class or upper-middle-class youth, so that most people, including health care professionals, are unfamiliar with the drug. However, ecstasy may be becoming more popular in Brazil, following a pattern seen in North America and Europe. Possible contributing to the drug's popularity is the fact that ecstasy is sold as a pill and is thus extremely easy to use. Ecstasy has a reputation for not being physically dangerous; however, there are many reports of adverse reactions associated with the drug. In addition, it is known that not all pills sold as ecstasy actually contain methylenedioxymethamphetamine. Since there is no quality control for the pills' contents, users never know exactly what they are taking. Thus, although users may perceive the effects of the drug as mostly positive, ecstasy is potentially dangerous. Primary and secondary interventions are needed to prevent the use of ecstasy and the occurrence of adverse reactions. To be effective, these measures must take into consideration the characteristics of the user population and the usage patterns. It is also essential to prepare health professionals for emergency medical interventions in cases of intoxication and complications resulting from the use of ecstasy.

The aim of this study was to gather information about ecstasy users in Brazil, particularly on issues related to risks associated to the use of the drug, so as to offer a basis to prevention projects. A total of 1,140 Brazilian ecstasy users answered an online questionnaire from August 2004 to February 2005. Participants were predominantly young single heterosexual well-educated males from upper economical classes. A categorical regression with optimal scaling (CATREG) was performed to identify the risks associated with ecstasy use. "Pills taken in life" had a significant correlation with every investigated risk, particularly ecstasy dependence, unsafe sex, and polydrug use. "Gender," "sexual orientation," and "socioeconomic class" were not predictive of risk behavior. The Internet proved to be a useful tool for data collection. Given the recent increase in ecstasy availability in Brazil, a first prevention campaign directed toward the drug is urgent. At least in a preliminary Brazilian intervention, the campaign must be conducted at night leisure places, mainly frequented by youngsters from upper socioeconomic classes. The results do not call for information material with specific targets, such as gender or sexual orientation. The study's limitations have been noted.

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