MDMA (Ecstasy)

What is MDMA Exactly?

MDMA, short for methylenedioxy-methamphetamine, is a synthetic or manufactured drug that changes how we feel and perceive things around us. It’s similar to both stimulants and hallucinogens. It makes us feel more energetic, happy, and warm inside. It also changes how we see and experience time passing.

In the U.S., almost 7 in 100 people aged 12 years and above reported using ‘Ecstasy’ recreationally (substances purported to contain MDMA) at least once in their lives.^[1]

How does MDMA affect people?

MDMA makes people feel more empathetic, kind, and connected to others. It also increases feelings of self-acceptance. Its effects last for 3 to 6 hours.

Recreationally, the MDMA experience is called “rolling.” Very intense rolls can make someone feel “floored,” where they want to remain sitting or lying down for several hours.^[2]

The substance boosts the activity of three chemicals in the brain:

• Dopamine, which produces increased energy and activity. Dopamine is also the reward system that reinforces behaviors.
• Norepinephrine, which increases the heart rate and blood pressure. For this reason, MDMA carries particular risks for people with heart and blood vessel problems.
• Serotonin, which affects mood, appetite, sleep, and other functions. It also triggers hormones that affect sexual arousal and trust. The release of large amounts of serotonin likely causes the emotional closeness, elevated mood, and empathy felt by those who use MDMA.

Apart from the boost in chemical messengers, MDMA’s primary therapeutic effect may come from its seeming ability to reopen what neuroscientists refer to as a “critical period.” This is a period during childhood when the brain has the ability to make new memories and store them. Evidence from a mice study indicated that MDMA may return the adult brain to this earlier and more receptive state^[3]. Physical effects also might include:

• • • nausea
    • higher tactile sensation
    • difficulty urinating
    • muscle cramping
    • involuntary teeth clenching
    • blurred vision
    • chills
    • sweating ^[4]

What does it look like?

MDMA often comes in the form of a capsule or a tablet. Some people might also drink it in liquid form or sniff it as a powder. When it’s in capsules or tablets, it can have different colors and sizes, and sometimes there’s a picture, symbol, or logo on them, such as Playboy bunnies, Nike swoosh, CK.

Besides being known as Ecstasy or Molly, MDMA goes by other names like Adam, Beans, Clarity, Disco Biscuit, E, Eve, Pepa, Go, Hug Drug, Lover’s Speed, Peace, STP, X, and XTC.^[5]

Why is there growing interest in MDMA?

MDMA has been around for over a century. It was first created and patented by the German pharmaceutical company Merck in 1912. It was rediscovered or re-synthesized in 1976 when it was found to have a big influence on human emotions without affecting the senses. So, people who took it didn’t suddenly see things differently or lose touch with reality.

After being used in therapy, it started being used recreationally, especially at dance parties. By 1985, the Drug Enforcement Administration classified it as a Schedule I drug. This puts it in the same category as substances with no approved medical use and a high risk for misuse. This legal classification put a halt to exploring its potential, even though it had been used in therapy before.

More recently, studies showed some promising outcomes in MDMA-assisted psychotherapy for people dealing with long-term conditions, especially those with PTSD.

Is it legal or illegal?

At the moment, MDMA is considered illegal by federal law. However, in 2017, the Food and Drug Administration (FDA) gave MDMA-assisted therapy for PTSD a special status called Breakthrough Therapy. This meant that even though the substance is generally illegal, the FDA allowed it to be used in special research trials due to its potential as a treatment.

However, in August 2024, the FDA turned down an application for MDMA to be used as a treatment for PTSD. Following the recommendation of independent experts, the FDA stated that there was not enough evidence to allow MDMA to be used as a treatment for PTSD. The FDA decision doesn’t necessarily mean that MDMA doesn’t work for PTSD but that the studies couldn’t prove it because of how they were done. The pharmaceutical company that filed the application said it would appeal the agency’s decision.^[6]

No state has fully legalized MDMA, but one state, Oregon, has decriminalized it. This means that if someone has MDMA, they won’t face legal troubles. Other states, like California and Washington, are thinking about decriminalizing it too.

In Missouri, they’re working on a law that would let a patient facing a terminal condition the “right to try” any controlled substance as treatment, including MDMA.^[7]

In 2023, Australia became the first country to allow MDMA to be prescribed as a medication by doctors.^[8]

What is MDMA said to be good for?

The research on MDMA-assisted therapy has focused chiefly on treating PTSD, but it’s showing potential for other problems too. Results often become noticeable pretty quickly, even after just a few sessions. However, trials had a small number of participants, who were mainly young, non-Hispanic white individuals. So, whether more diverse populations can benefit is unclear.

PTSD (Post-traumatic Stress Disorder): This mental health issue affects about 13 million people in the U.S., especially war veterans. Therapies and medications are available for this disorder, but about half of the people still have problems after trying them.

Unlike regular medications, MDMA doesn’t just cover up PTSD symptoms. Instead, when combined with therapy, it appears to help the brain process painful memories and support self-healing.

In a recent advanced-stage study, 88% of participants with severe PTSD saw a significant reduction in symptoms after their third session with MDMA. And just two months later, 67% of them didn’t even meet the criteria for PTSD anymore.^[9]

Similar positive findings have been seen in other trials. A study found that for about 41 months on average, people were still experiencing the benefits of the therapy.^[10] Another research found that 67% of individuals dealing with moderate to severe PTSD still didn’t have symptoms of the disorder after at least 12 months from their sessions with MDMA.^[11]

In a different study, individuals who had severe PTSD along with strong and lasting pain saw substantial improvements after joining in on MDMA-assisted therapy.^[12]

In 2022, an evaluation of a dozen studies of MDMA-assisted psychotherapy among adults with moderate or severe PTSD concluded that the use of MDMA may be beneficial. MDMA was paired with counseling led by 2 mental health professionals. The evaluation concluded that the trials improved the severity of PTSD symptoms. Some participants reported no symptoms, ranging from 1 month to 18 weeks. The participants had shown no improvement with previous trials of medication or therapy.^[13]

Social Anxiety in Autistic Adults: This is when people on the autism spectrum feel very scared in social situations. The trials involving them showed major improvements in their anxiety levels. Even six months after the trials, the positive changes stuck around. This was a big deal because there is no approved medicine for this issue.^[14]

Anxiety Related to Life-Threatening Illness: In a test, those who got MDMA had more anxiety reduction compared to those who got a fake pill (placebo). Both groups had the same kind of therapy, but the MDMA group had better results.^[15]

Alcohol Use Disorder: People who had issues with alcohol and went through detox were able to cut down on their drinking after just two sessions with MDMA and therapy. It seems like MDMA could help people deal with their alcohol cravings after detox.^[16]

Eating Disorders: Studies are going on to find out if MDMA, along with therapy, could help with eating disorders like anorexia and binge eating. Another study showed that MDMA and therapy significantly reduced eating disorder symptoms in people with severe PTSD.^[17]

What are the risks?

In studies with patients, only a few had mild to moderate negative reactions after taking MDMA, although these were gone after a week. The reactions included feelings like anxiety, sadness, irritability, and panic attacks. During the MDMA sessions, some folks felt dizzy, tired, got headaches, had a tight jaw, lost their appetite, or felt sick.

When used recreationally, it’s unclear whether MDMA can make people addicted. Some people report withdrawal symptoms, like feeling really tired, not wanting to eat, feeling down, or having trouble focusing.

MDMA can also affect the body’s ability to control temperature, especially when used in large quantities. This might cause a dangerous spike in body temperature, which could lead to problems with the liver, kidneys, heart, or even death.

Also, because MDMA can make people feel close and trusting, they might take risks, particularly when used with drugs for erectile dysfunction like Viagra. This can lead to unsafe sexual behavior, raising the chance of getting or spreading HIV/AIDS or hepatitis.

Another worry is that pills, capsules, or powders sold as ecstasy or molly might not actually have MDMA. They could have other drugs, like cocaine, ketamine, stuff from cough medicine and fentanyl.^[18][19] These can be very dangerous if someone doesn’t know what they’re taking. For that reason, it is always a good idea to use fentanyl test strips to confirm that a batch of MDMA does not contain the substance. You can learn more about how to use and where to get fentanyl test strips here and about the dangers of counterfeit pills here.

Using MDMA with other substances adds even more risk:

• • With over-the-counter or prescribed medications can be unpredictable and unsafe.
  • With alcohol can lead to dehydration or to drinking too much water, which can also be harmful.
  • With meth or cocaine can worsen anxiety and mess with the brain’s dopamine system. This strains the heart and body, which might cause a stroke.
  • With antidepressants might make a person feel tired, clumsy, restless, drunk, or dizzy. ^[20]

In 2020, there were over 3,000 visits to the emergency room in the U.S. because of problems related to MDMA, according to the Substance Abuse and Mental Health Services Administration.^[21]

What if my child is using MDMA?

If you’re worried about your child using MDMA, there are some signs to watch out for. You might notice they have more energy than usual, clench their teeth involuntarily, or have a dangerously high body temperature. They may also experience withdrawal symptoms.

Remember, you’re not alone in this. If you need help or support, you can reach out to our helpline specialists for free and confidential assistance.

Reducing the risks of using MDMA

As a parent, you might want your loved one to stop using drugs completely. But sometimes, they might not be ready for that change. In the meantime, it’s important to make sure they’re as safe as possible. If you know they’re using MDMA, here are some strategies they can consider to stay safe:

• • MDMA can make the body dehydrated and overheated, especially when people are dancing at festivals or parties. Encourage your loved one to take breaks to cool down and drink about a bottle of water every hour (around 8 to 16 ounces).
  • While staying hydrated is important, drinking too much water can also be dangerous and cause brain swelling.
  • They can also take practical steps to be safe:
    • • • Suggest that they start with a small dose and wait a couple of hours before taking more.
        • Tell them to avoid taking high doses, which can lead to a very intense experience.
        • Mixing MDMA with alcohol or other drugs can be risky, so it’s best to avoid that.
        • If they’re taking any other medications, they should check for interactions.
        • It’s a good idea for them to let a friend know what they’ve taken so they can get help if needed.
        • Taking MDMA or any substance with trusted friends in a safe environment can lower the risk of a bad experience.
        • Lastly, using MDMA too often can lead to building a tolerance, which means needing more of the substance for the same effect. ^[22]
  • Also, some people experience sadness, irritability, or emotional exhaustion in the days after taking MDMA, known as “blues”. To counter that, some supplements, including vitamin C, may offer a protective effect. ^[23]

Considering trying MDMA?

If you or your loved one are thinking about trying MDMA, you might want to look into clinical trials. There’s a leading research center called the Multidisciplinary Association for Psychedelic Studies (MAPS) that conducts these studies. You can find more information on their website.

You can also search for clinical trials involving MDMA in the United States and around the world using this search engine from the National Institutes of Health.