3,4-methylenedioxymethamphetamine (MDMA) continues to be used by millions of Americans across the country. This illegal drug is often taken for the feelings of well-being, stimulation, and distortions in time and sensory perceptions that it produces.1,2 MDMA first became popular in the all-night party scene (e.g., “raves”),3 but its use has now spread to a wide range of settings. According to the National Survey on Drug Use and Health, more than 18 million people in the United States have tried MDMA at least once in their lifetime.4

MDMA is a synthetic drug that became popular in the 1980s,5 leading researchers to begin investigating its effects. Their efforts identified a number of potentially serious negative side effects. For example, MDMA can cause a dangerous increase in body temperature that can be fatal in some environments.6

MDMA can also stress the heart, increasing heart rate7 and blood pressure,8 and can damage the kidneys.9 Animal studies show that MDMA may also damage specific neurons in the brain,10–12 but research on MDMA’s effects on the human brain is not conclusive at this time.13However, a number of studies show that long-term, heavy MDMA use is associated with cognitive deficits, including problems with learning and memory.14

  • MDMA is a synthetic drug that acts as a stimulant and hallucinogen.15–17 It produces an energizing effect, distortions in time and perception, and enhanced enjoyment from sensory experiences. It has also been described as an entactogen—a drug that can increase self-awareness and empathy.

Ecstasy is often used to refer to MDMA in the tablet or capsule form, which is the most common way people take the drug.17,19 Researchers have determined that many ecstasy tablets contain not only MDMA at different concentrations, but also a number of other drugs or drug combinations that can be harmful. Adulterants found in ecstasy tablets purchased on the street have included methamphetamine, the anesthetic ketamine, caffeine, the diet drug ephedrine,20 the over-the-counter cough suppressant dextromethorphan,21,22 heroin, phencyclidine (PCP), and cocaine.22

Molly—slang for “molecular”—refers to the crystalline powder form of MDMA, usually sold as powder or in capsules. Some people mistakenly believe that Molly does not contain contaminants often found in ecstasy. In fact, chemical analyses of drugs sold as Molly and seized by the U.S. Drug Enforcement Administration (DEA) have shown that they often contain other types of drugs and may not contain any MDMA.23 For example, epidemiologists from Washington state and Florida reported in 2013 that substances being sold as Molly were actually methylone, a synthetic stimulant commonly found in “bath salts.”24 In 2015, ethylone, a synthetic stimulant similar to methylone but with some differences in binding within the brain,25 replaced methylone as the main substance marketed as Molly.26 This underscores that people who take Molly often do not know what they are ingesting, and the substances sold as Molly may pose serious health risks.

When MDMA is taken in tablet or capsule form, a person begins feeling the effects 45 minutes later, on average. These effects peak 15 to 30 minutes after they are first felt and last an average of 3 hours,27 though side effects could be experienced up to days later.17,28 People typically take one to two tablets on each occasion,17,29,30 with each tablet generally containing between 50 and 150 milligrams of MDMA.31 People often take a second dose of the drug as the effects of the first dose begin to fade,32 increasing the risk of adverse side effects as doses combine.

MDMA seized in the United States is primarily synthesized in Canada and, to a lesser extent, the Netherlands. There are a small number of illegal MDMA labs operating in the United States.19

MDMA was developed by a German pharmaceutical company in 1912. Originally known as “Methylsafrylaminc,” it was intended as a parent compound to synthesize medications that control bleeding, not to control appetite as is often incorrectly cited.33,34

MDMA gained a small following among psychiatrists in the late 1970s and early 1980s, despite the fact that the drug had not undergone formal clinical trials nor received approval from the U.S. Food and Drug Administration (FDA) for use in humans. Some psychiatrists believed that it enhanced communication in patient sessions and allowed patients to achieve insights about their problems.35 It was also during this time that MDMA started becoming more widely available on the street.5,36

In 1985, the DEA declared an emergency ban on MDMA, placing it on the list of Schedule I drugs, defined as substances with no currently accepted medical use and a high potential for abuse. MDMA has remained a Schedule I substance since then, with the exception of a brief period of time between 1987 and 1988.37,38

Does MDMA Have Therapeutic Value?

The evidence on MDMA’s therapeutic effects is limited thus far,39although research is ongoing in this area. Proponents of MDMA-assisted therapy recommend that it only be used for reactive disorders such as post-traumatic stress disorder because it can worsen some psychiatric conditions.40

In the early 1990s, the FDA approved the first human trial exploring whether MDMA could help relieve pain in terminally ill patients, as well as serve as an adjunct to psychotherapy.41 Results from this study have not been published; however, these early studies helped establish safety parameters for administering MDMA to human participants in controlled, clinical settings.42 Clinical trials are ongoing to explore whether MDMA has therapeutic potential in the treatment of post-traumatic stress disorder and anxiety in autistic adults and patients with a terminal illness such as cancer.

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