A college student shows signs of severe agitation and paranoia after attending a rave. What substance has he most likely ingested?

The symptoms of severe agitation and paranoia following attendance at a rave are most consistent with the use of Methylenedioxyamphetamine, commonly known by its street name MDMA or ecstasy. This substance is frequently associated with rave culture and is known to induce feelings of euphoria, increased energy, and social connectedness. However, it can also lead to adverse psychological effects, including anxiety, agitation, and paranoia, particularly if taken in high doses or in certain environmental settings.

MDMA can affect neurotransmitter systems in the brain, particularly those involving serotonin, which plays a significant role in mood regulation. In some individuals, especially when combined with other stimulants or in overstimulating environments like raves, MDMA use can lead to overwhelming feelings of anxiety and paranoia, manifesting as agitation.

In contrast, while Cannabis can cause anxiety and panic in some users, it typically does not produce the level of agitation and paranoia described. Ketamine is known for its dissociative properties and is not typically associated with the type of severe agitation noted here. Diacetylmorphine, or heroin, is an opioid that generally leads to sedation and euphoria rather than agitation and paranoia. Therefore, the symptoms presented align closely with Methylenedioxy