This review focuses on the acute and adverse effects of substances identified as "club drugs" by the authors, and was apparently written for an audience of health care professionals. The accuracy and strength of writing vary a great deal across sections, and it appears that the authors did not rely on original research for the majority of their examination of MDMA / ecstasy. Instead, they relied on information presented on Internet sites (e.g. National Institute on Drug Abuse [NIDA], or DanceSafe). Emergency care and, to a lesser degree, coverage of ecstasy user demographics, are the strong points of this paper, whereas the overall treatment of history, acute effects and adverse effects contains many inaccuracies and unsupported statements. The usual errors concerning the history of MDMA are repeated, and no mention is made of early non-medical use. Ecstasy pill adulterants and contents of "fake pills" are listed together, with no attempt to indicate whether a listed substance was more likely to be used as an adulterant (e.g. caffeine, methamphetamine) or falsely sold as MDMA (e.g. dextromethorphan). Acute effects are fairly accurately reported, but the authors did not refer to any clinical trials of MDMA, despite awareness of at least one such study (Lester et al. 2000), cited later in the text. When addressing the issue of potential neurotoxicity, the authors refer to studies in rodents and non-human primates without referring to any of the studies comparing brain or neurocognitive function in ecstasy users and non-users. Emergency room visits and common adverse effects are acknowledged as mostly minor, and the authors describe the most common severe adverse effects. While hyponatremia is noted as a severe adverse effect, no information or advice is provided on treating this condition. However, the authors' advice for treatment of various ecstasy-related adverse effects appears to be mostly sound, with a strong emphasis on using supportive care unless more aggressive treatments are absolutely necessary. This paper cannot serve as a primary source of information about MDMA or ecstasy, particularly considering the authors' failure to describe or refer to original research findings. However, it might be suitable as a reference providing information and recommendations for the treatment of ecstasy-related emergency room visits.