3,4-Methylenedioxymethamphetamine (MDMA),[note 1] commonly known as ecstasy (E), is a psychoactive drug primarily used as a recreational drug. The desired effects include altered sensations and increased energy, empathy, and pleasure. When taken by mouth, effects begin after 30–45 minutes and last 3–6 hours.
Adverse effects include addiction, memory problems, paranoia, difficulty sleeping, teeth grinding, blurred vision, sweating, and a rapid heartbeat. Deaths have been reported due to increased body temperature and dehydration. Following use people often feel depressed and tired. MDMA acts primarily by increasing the activity of the neurotransmitters serotonin, dopamine, and noradrenaline in parts of the brain. It belongs to the substituted amphetamine classes of drugs and has stimulant and hallucinogenic effects.
MDMA is illegal in most countries and, as of 2018, has no approved medical uses. Limited exceptions are sometimes made for research. Researchers are investigating whether MDMA may assist in treating severe, treatment-resistant posttraumatic stress disorder (PTSD) with phase 3 clinical trials to look at effectiveness and safety expected to begin in 2018. In 2017 the FDA granted MDMA a breakthrough therapy designation[note 2] for PTSD, meaning if studies show promise, a review for potential medical use could occur more quickly.
MDMA was first made in 1912. It was used to improve psychotherapy beginning in the 1970s and became popular as a street drug in the 1980s. MDMA is commonly associated with dance parties, raves, and electronic dance music. It is often sold mixed with other substances such as ephedrine, amphetamine, and methamphetamine. In 2016, about 21 million people between the ages of 15 and 64 used ecstasy (0.3% of the world population). This was broadly similar to the percentage of people who use cocaine or amphetamines, but fewer than for cannabis or opioids. In the United States, as of 2017, about 7% of people have used MDMA at some point in their life and 0.9% have used in the last year.
Effects
In general, MDMA users report feeling the onset of subjective effects within 30–60 minutes of MDMA consumption and reaching the peak effect at 75–120 minutes, which then plateaus for about 3.5 hours. The desired short-term psychoactive effects of MDMA have been reported to include:
Euphoria – a sense of general well-being and happiness
Increased self-confidence, sociability and feelings of communication being easy or simple
Entactogenic effects – increased empathy or feelings of closeness with others and oneself
Relaxation and reduced anxiety
Increased emotionality
A sense of inner peace
Mild hallucination
Enhanced sensation, perception, or sexuality
Altered sense of time
The experience elicited by MDMA depends on the dose, setting, and user. The variability of the induced altered state by MDMA is lower compared to other psychedelics. For example, MDMA used at parties is associated with high motor activity, reduced the sense of self-identity as well as poor awareness of the background surroundings.
Sometimes MDMA is labeled as an "empathogenic" drug, because of its empathy-producing effects. Results of different studies show its effects of powerful empathy with others. When testing the MDMA for medium and high dosage ranges it showed an increase on hedonic as well as arousal continuum. The effect of MDMA increasing sociability is consistent, however, effects on empathy have been more mixed.
Use
Recreational
MDMA is often considered the drug of choice within the rave culture and is also used at clubs, festivals, and house parties. In the rave environment, the sensory effects from the music and lighting are often highly synergistic with the drug. The psychedelic amphetamine quality of MDMA offers multiple reasons for its appeal to users in the rave setting. Some users enjoy the feeling of mass communion from the inhibition-reducing effects of the drug, while others use it as party fuel because of the drug's stimulatory effects. MDMA is used less frequently than other stimulants, typically less than once per week.
MDMA is sometimes taken in conjunction with other psychoactive drugs such as LSD, psilocybin mushrooms, and ketamine, an act called "candy-flipping".
Medical
See also: MDMA Research
As of 2017, MDMA has no accepted medical indications. Before it was widely banned, it saw limited use in therapy. A small number of therapists continue to use MDMA in therapy despite its illegal status.
Other
Small doses of MDMA are used as an entheogen to enhance prayer or meditation by some religious practitioners. MDMA has been used as an adjunct to New Age spiritual practices.
Forms
MDMA has become widely known as ecstasy (shortened "E", "X", or "XTC"), usually referring to its tablet form, although this term may also include the presence of possible adulterants or dilutants. The UK term "mandy" and the US term "molly" colloquially refer to MDMA in a crystalline powder form that is thought to be free of adulterants. MDMA is also sold in the form of the hydrochloride salt, either as loose crystals or in gelcaps.
In part due to the global supply shortage of sassafras oil, substances that are sold as molly frequently contain no MDMA and instead contain methylone, methylone, MDPV, mephedrone, or any other of the group of compounds commonly known as bath salts. Powdered MDMA ranges from pure MDMA to crushed tablets with 30–40% purity.
MDMA tablets typically have low purity due to bulking agents that are added to dilute the drug and increase profits (e.g., lactose) and binding agents. Tablets sold as ecstasy sometimes contain 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxyethylamphetamine (MDEA), other amphetamine derivatives, caffeine, opiates, or painkillers.
Some tablets contain little or no MDMA. The proportion of seized ecstasy tablets with MDMA-like impurities has varied annually and by country. The average content of MDMA in a preparation is 70 to 120 mg with the purity has increased since the 1990s. MDMA is usually consumed by mouth. It is also sometimes snorted.
Overdose
MDMA overdose symptoms vary widely due to the involvement of multiple organ systems. Some of the more overt overdose symptoms are listed in the table below. The number of instances of fatal MDMA intoxication is low relative to its usage rates. In most fatalities, MDMA was not the only drug involved. Acute toxicity is mainly caused by serotonin syndrome and sympathomimetic effects.
MDMA's toxicity in overdose may be exacerbated by caffeine, with which it is frequently cut (mixed with to increase volume). A scheme for management of acute MDMA toxicity has been published focusing on the treatment of hyperthermia, hyponatremia, serotonin syndrome, and multiple organ failure.
Interactions
A number of drug interactions can occur between MDMA and other drugs, including serotonergic drugs. MDMA also interacts with drugs which inhibit CYP450 enzymes, like ritonavir (Norvir), particularly CYP2D6 inhibitors. Concurrent use of MDMA high dosages with another serotonergic drug can result in a life-threatening condition called serotonin syndrome. Severe overdose resulting in death has also been reported in people who took MDMA in combination with certain monoamine oxidase inhibitors, such as phenelzine (Nardil), tranylcypromine (Parnate), or moclobemide (Aurorix, Manerix).
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