MDMA, most commonly known as ecstasy, is a synthetic drug that acts as a stimulant and a hallucinogen.  Often considered a “party drug,” MDMA produces an energizing effect, distortions in time and perception, increased sense of well-being, and heightened sensory experiences. MDMA is a Schedule I drug under the Controlled Substances Act, which means it has a high potential for abuse with no currently accepted medical use in treatment in the United States. (1)

MDMA was first developed by a German pharmaceutical company in 1912 and was intended as a compound to synthesize medications that control bleeding. (2) The increased use of ecstasy as a recreational drug began in the 1980s in the United States as part of the rave scene. While still popular among young people at nightclubs, parties, and festivals, MDMA is now more widely used. (3)  

Most of the MDMA confiscated in the U.S. is produced illegally in Canadian labs and smuggled across the U.S. border, though a portion is also manufactured in the Netherlands and in the U.S.

What is MDMA?

Image: MDMA pill

Street Names

Adam, Beans, Clarity, Disco Biscuit, E, Ecstasy, Eve, Go, Hug Drug, Lover’s Speed, MDMA, Peace, STP, X, and XTC (1)

MDMA is a Schedule I drug under the Controlled Substances Act, which means it has a high potential for abuse with no currently accepted medical use in treatment in the United States. (1)

How is MDMA used?

Ecstasy is often used to refer to MDMA in the tablet or capsule form, which is the most common way people take the drug. The colorful pills are usually swallowed, though can also be crushed and snorted and are sometimes smoked. Individuals often will take MDMA by “stacking,” which involves taking multiple tablets at once, or by “piggy-backing” — taking multiple tablets over the course of a short period of time. Polysubstance use with MDMA, or taking multiple substances together, is common with Marijuana, alcohol, and LSD frequently used simultaneously. Molly—slang for “molecular”—refers to the crystalline powder form of MDMA, usually sold as powder or in capsules. (2)

Image: MDMA pills

Studies show that many ecstasy tablets contain other drugs that can be harmful including methamphetamine, ketamine, ephedrine, heroin, cocaine, and PCP. (1, 2)

Studies show that many ecstasy tablets contain other drugs that can be harmful including methamphetamine, ketamine, ephedrine, heroin, cocaine, and PCP. (1, 2) 

According to the U.S. Drug Enforcement Administration, substances sold as “Molly” may not contain any MDMA, but instead are made up of other harmful chemicals like those found in “bath salts,” powerful and dangerous stimulants. Individuals need to understand that the substances they are taking may not be what they think and pose dangerous health risks.

Risks

Image: MDMA pills

Individuals need to understand that the substances they are taking may not be what they think and pose dangerous health risks.

Short-term effects and risks

  • Euphoria

  • Heightened senses

  • Fixation on sights/sounds

  • Feeling energized and confident

  • Nausea 

  • Chills or sweating

  • Dilated pupils

  • Increased heart rate and blood pressure

  • Reduced appetite

  • Muscle tension and teeth-grinding

  • Fatigue and insomnia

  • Short-term memory loss

  • Seizures (at higher doses)

Because MDMA is a stimulant and is often taken in warm environments where individuals have increased physical activity, such as dancing at a nightclub, dehydration and overheating can pose serious risks. (2, 5)

Effects of MDMA

Like most drugs, the effects of MDMA depend on many factors:

  • A person’s size, weight, and health

  • Whether a person has built up a tolerance to the drug

  • The amount taken

  • If other substances are also taken

  • The strength of the drug (4)

The effects of MDMA are usually felt within 45 minutes of the first dose. Typically, the major effects last for about 3-6 hours, depending on the dose. It takes about 14 days after use of MDMA for depleted levels of serotonin to return to normal. (5)

Long-Term Effects

While most effects of MDMA will diminish after 4-6 hours, some may last for weeks.

  • Anxiety and paranoia

  • Depression

  • Sleep abnormalities

  • Tremors

  • Withdrawal symptoms: cravings, aches/pains, exhaustion, agitation

  • Stress on the heart, increasing blood pressure and heart rate

  • Cognitive deficits – problems with learning and memory 

  • Damage to the serotonin system – reducing a person’s ability to feel pleasure

  • Psychosis (1, 2, 5)

Mixing MDMA with other drugs is dangerous and can pose serious and unpredictable health risks and knowing how an individual will respond to using multiple substances simultaneously is difficult.

Mixing MDMA with other drugs is dangerous and can pose serious and unpredictable health risks and knowing how an individual will respond to using multiple substances simultaneously is difficult.

Overdose

At high doses, MDMA can be toxic and even lethal as the body temperature drastically increases (hyperthermia) and the body becomes dehydrated. This can lead to liver, kidney, and cardiovascular failure. (1, 2)

Possible signs of overdose:

  • Abnormal heart rate and rhythm

  • Body temperature dysregulation

  • Hyperthermia – overheating of the body, particularly if you’ve been engaging in intense physical activity in hot settings, such as dance parties or concerts

  • Hyperthermia-related rhabdomyolysis (muscle breakdown) and kidney injury

  • Seizures (6)

In the case of an overdose 

  1. Call 911.

  2. Prevent injury – If the person is having a seizure, gently hold the back of their head, but do not restrain their arms and legs.

  3. Stay with the individual until emergency responders arrive.

Be prepared to provide information about what substances the individual has taken.

At high doses, MDMA can be toxic and even lethal as the body temperature drastically increases (hyperthermia) and the body becomes dehydrated. This can lead to liver, kidney, and cardiovascular failure. (1, 2)

Treatment and Prevention

Harm Reduction

  • Try a smaller dose first and wait 2 hours before taking more

  • Avoid taking high doses

  • Avoid mixing with other substances, including alcohol and prescription drugs

  • Take regular breaks to cool down and drink 8-16 oz of water per hour

  • Let a friend know what you’ve taken so they can help if you’re unwell

  • Avoid taking MDMA too frequently (4)

If you need treatment for substance use or misuse, call 916-874.9754.

(1)  Department of Justice & Drug Enforcement Agency. (2020, April). Ecstasy/MDMA Drug Fact Sheet. https://www.dea.gov/sites/default/files/2020-06/Ecstasy-MDMA-2020_0.pdf

(2) National Institute of Health & National Institute on Drug Abuse. (2017, September). MDMA (Ecstasy) Abuse Research Report.

(3)  Centre for Addiction and Mental Health. (2023). Ecstasy. Mental Illness and Addiction Index. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/ecstasy

(4)  Alcohol and Drug Foundation. (2023, August 24). Drug Facts: Ecstasy. https://adf.org.au/drug-facts/mdma/

(5) UC Davis Student Health and Counseling Services. (2019, June 17). Ecstasy (MDMA). https://shcs.ucdavis.edu/health-topic/ecstasy-mdma

(6) Martens, T. (2023, May 17). Ecstasy Overdose: Signs, Symptoms & Treatment for MDMA Overdose. American Addiction Centers