MDMA is a synthetic drug with both psychedelic and stimulant effects. Its psychological effects include confusion, depression, anxiety, sleeplessness, drug craving, and paranoia. Adverse physical effects include muscle tension, involuntary teeth clenching, nausea, blurred vision, feeling faint, tremors, rapid eye movement, and seating or chills. Because of MDMA's ability to increase heart rate and blood pressure, an extra risk is involved with MDMA ingestion for people with circulatory problems or heart disease. Rave party participants who ingest MDMA are at risk for dehydration, hyperthermia, and heart or kidney failure. In 1988 MDMA became a Schedule I substance under the Controlled Substances Act. The number of new MDMA users has increased since 1993, when there were 168,000 initiates. By 2001, the number of MDMA users reached 1.8 million. MDMA is most often manufactured clandestinely in Eastern Europe, primarily in Belgium and the Netherlands. In recent years, some initiatives have been launched to curb the use of MDMA and other club drugs. In 1999, the National Institute on Drug Abuse (NIDA) and its partners began a national research and education effort to combat the increased use of club drugs. NIDA increased funding for club drug research and mounted a multimedia public education strategy to alert teens, young adults, parents, educators, and others to the dangers of using MDMA and other club drugs. Other prevention and enforcement efforts have been undertaken by the Partnership for a Drug-Free America and the Drug Enforcement Administration (DEA). The DEA's Operation X-Out is a multifaceted, year-long initiative begun in 2002 that focuses on identifying and dismantling organizations that produce and distribute MDMA and other club drugs. 2 tables and 26 references