3,4-Methylenedioxymethamphetamine (MDMA), commonly known as ecstasy (E) or molly, is a psychoactive drug primarily used for recreational purposes. The desired effects include altered sensations, increased energy, empathy, as well as pleasure. When taken by mouth, effects begin in 30 to 45 minutes and last 3 to 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 neurotransmitter’s 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 for PTSD, meaning that if studies show promise, a review for potential medical use could occur more quickly.
MDMA was first developed in 1912 by Merck. It was used to enhance 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 may be 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 lower than for cannabis or opioids. In the United States, as of 2017, about 7% of people have used MDMA at some point in their lives and 0.9% have used it in the last year
In general, MDMA users report feeling the onset of subjective effects within 30 to 60 minutes of oral consumption and reaching a peak effect at 75 to 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 perception of facilitated communication
- Entactogenic effects—increased empathy or feelings of closeness with others and oneself
- Dilated pupils
- Relaxation and reduced anxiety
- Increased emotionality
- A sense of inner peace
- Mild hallucination
- Enhanced sensation, perception, or sexuality
- Altered sense of time
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 of music and lighting are often highly synergistic with the drug. The psychedelic amphetamine quality of MDMA offers multiple appealing aspects 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 often 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”.
As of 2017, MDMA has no accepted medical indications. Before it was widely banned, it saw limited use in psychotherapy. A few psychotherapists continue to use MDMA in therapy despite the drug’s legal status.