MDMA / 'Ecstasy'
What is MDMA (ecstasy)?
MDMA (ecstasy) is a drug that produces feelings of euphoria and empathy along with energising effects similar to amphetamine.
MDMA was first made by the Merck pharmaceutical company in 1912, but its history as a recreational drug really began when pharmacologist Alexander Shulgin made some and tested it on himself in 1976. Some psychotherapists started using it to assist therapy, and it began gaining popularity and notoriety as the recreational drug ‘ecstasy’.
What are the different forms of MDMA (ecstasy)?
MDMA is often taken in pill form (‘ecstasy’ pills). In the last decade however, there has been a shift towards MDMA being sold as a powder, which often looks like crushed up, off-white, brownish or yellowish crystals. MDMA powder can be swallowed, dissolved into a drink or snorted.
Pills or powders sold as ‘ecstasy’ or MDMA cannot be relied on to contain any MDMA. Often pills or powders have other drugs and fillers mixed in, such as the drug PMA. This can make things much riskier. The designs on ecstasy pills are not a good guide to their safety and reliability as pills with a 'good reputation' can have their designs copied.
The quantity of MDMA in pills and powders varies all the way from 0% (e.g. pills made of plaster of Paris) to close to 100%, so you can't guide your dose reliably by the amount of powder or number of pills. This means that users can accidentally take more than intended. A single pill can contain enough MDMA to make some people feel overwhelmed, and on occasion pills and capsules have appeared which have contained quite dangerous amounts in one unit. Someone accustomed to taking several weak pills can overdose if the purity increases.
The popularity of MDMA powder is in part a reaction to the suspicion people have of pills. However, PMMA and other potentially harmful substances have been found in both pills and powder. Neither type can be relied upon to be unadulterated, or to contain a fixed dose.
How does MDMA (ecstasy) work as a drug in the body and brain?
MDMA (ecstasy) is a stimulant (it is structurally similar to amphetamine) that can give feelings of energy and exhilaration. Unlike typical stimulants though, it also produces distinct social and emotional effects, and alters perception. Because of this some scientists have proposed that it should be classed as an 'entactogen'. Compared to other stimulants, MDMA is particularly powerful in releasing a brain chemical called serotonin. This seems to affect many systems in the brain, usually boosting mood, and sometimes producing slightly psychedelic ('trippy') changes in perception. MDMA also has the effect of increasing levels of the hormones oxytocin and vasopressin, which may be involved in making users feel emotionally connected. All these enjoyable effects of MDMA are potential sources of risk too. The effects of excess serotonin or vasopressin, or too much stimulation are among the reasons that MDMA occasionally causes harm and death.
What are the effects of MDMA (ecstasy)?
How soon the effects of MDMA are felt depends on the method in which it is taken. Swallowing an ‘ecstasy’ pill or MDMA ‘bomb’ (MDMA powder wrapped in a cigarette paper) may result in a time lag of 20 minutes to an hour before the effects really kick in. Effects peak around 2 hours after a pill is swallowed. If a pill is in fact mostly or all another drug like PMMA (which can cause fatalities in moderate to large doses), effects may take longer to come on, so taking more to boost the effects without waiting is risky. Snorting MDMA crystal/powder allows for much quicker absorption into the bloodstream and so the effects are felt much sooner but do not last as long.
The effects of MDMA when swallowed last several hours. Although everyone reacts differently, the typical effects reported following a dose of MDMA can be described as follows:
•Increased energy, alertness and wakefulness.
•Higher body temperature, heart rate and blood pressure (especially when dancing)
•Lower aggression and anxiety (though anxiety can sometimes increase in some people).
•Lifted mood or euphoria.
•Increased empathy and sense of intimacy with others.
•Perceptual changes: heightened sense of colour; blurred vision.
•Muscle clenching, especially the jaw.
Anecdotally, it seems that taking very high doses of MDMA may only increase the energising speed like effects of MDMA, not the euphoric or emotional effects. Unpleasant effects, like anxiety, feeling unbearably hot, over-stimulated, confused or anxious are more likely the more you take.
Very rarely, heart attacks, strokes, and other medical emergencies can be brought on by MDMA, especially in people with pre-existing health problems, or who take it in big amounts and mix it with other drugs.
MDMA makes people feel thirsty and users can get dangerously hot if dancing non-stop. Some users have collapsed and even died from overheating and dehydration. In attempting to counter these problems a few people have also died from drinking too much water. MDMA affects the body’s ability to urinate out excess water, so too much water can cause the blood to become overly diluted, which can cause death (hyponatraemia). A much more common downside to MDMA is that its effects can be overwhelming, which can cause some people to become panicky.
Following MDMA use, there can be a comedown period which may last several days. In this period users may experience the following:
•Loss of appetite.
Does MDMA (ecstasy) have any medical uses?
Currently, MDMA has no medical uses.
A small initial study with individuals with Post Traumatic Stress Disorder (PTSD) has indicated that MDMA has potential uses in facilitating and supporting psychotherapy. One idea is that MDMA makes it easier for them to confront memories that they find hard to think about without severe emotional responses.
At present, MDMA cannot legally be used in psychotherapy and clearly much more research is needed to explore MDMA’s potential values and drawbacks as a therapeutic aid.
MDMA is not itself the treatment, but it is proposed that it enables therapy to be possible or more effective. Attempts to self-treat with MDMA could do more harm than good in the absence of a professional therapist trained in MDMA psychotherapy.
What are the risks of using MDMA (ecstasy)? Can they be avoided or reduced?
Some people taking MDMA have died following severe overheating and other medical emergencies. Deaths following the use of MDMA usually involve high doses and/or the simultaneous use of other substances. MDMA overdoses and drug combinations can also cause serotonin syndrome, which can be fatal. MDMA-associated deaths may alternatively involve overcompensation of the risk of dehydration by drinking much too much water, which coupled with the fact that MDMA may stop a person from urinating, causing fatally low concentrations of salt.
Many people feel depressed in the days after taking MDMA.
Are there health conditions that make MDMA (ecstasy) more dangerous?
Yes. MDMA increases heart rate, body temperature and blood pressure which puts strain on the heart. If someone has health problems like a heart condition or high blood pressure, they will be at higher risk from the drug. Similarly, if someone's kidneys or liver are not at full health, the risks of using MDMA could be higher.
Take your fitness and general health into consideration. Being unfit will mean that your body will be under greater pressure from MDMA.
Mixing MDMA (ecstasy) with other drugs
Drugs that act on the brain will interact in ways we do not yet know, potentially leading to unpredicatble problems. Many MDMA-related deaths happen when it is mixed with other drugs. Problematically, some pills or powders themselves may be made of a mixture of drugs. Alcohol can contribute to dehydrating when mixed with MDMA, and can dull the effects of stimulants, which combined with the poor judgement that alcohol causes, could lead to someone taking a more dangerous amount of MDMA.
Additionally, if someone is taking certain medications such as antidepressants or even herbal supplements that affect serotonin, there is an increased risk that taking MDMA (even several days afterwards) could cause too much serotonin to collect in the brain (serotonin syndrome) which is potentially fatal.
Serotonin syndrome can also be caused by MDMA mixed with other stimulant drugs.
How addictive is MDMA (ecstasy)?
MDMA is generally considered to have a low potential for addiction, especially when compared to drugs such as alcohol, tobacco or heroin. Although users may report a strong desire to take the drug, they are generally able to stop use if they feel that it is negatively affecting their lives. However, in some cases people have found it difficult to control their use.
What are the long-term effects of MDMA on health and wellbeing?
A very relevant thing that stands out in the science concerning MDMA, is that studies using people with a history light and occasional use of MDMA are far less likely to show mental deficits compared to studies where people have a history of binging on large amounts of MDMA or regular MDMA use. Whether or not deficits are caused by lack of sleep or use of other drugs, it is still the case that partying too hard may affect your mental abilities.
There is scientific controversy over the long term harmful effects of MDMA. Although, studies with MDMA users have found impairments in memory and impulsivity, there are other factors which may contribute to this, such as use of other drugs and lack of sleep. Controlling for such things, one particular study found no significant connection between MDMA use and performance on cognitive tests, although this study has received some criticism.
It is also possible that something like impulsivity could make someone more likely to take MDMA, rather than being caused by MDMA use (summarised in this article). A similar confusion is found with the link between MDMA and depression. Some studies have suggested that MDMA can contribute to depression, though some have found that those with depression may be more likely to later take MDMA.
Whether such effects would last for a very long time is also debatable. There is strong evidence from brain imaging studies suggesting that most changes in the brain areas affected by MDMA (serotonergic system) are not long term.
For most people, it is hard to know what to think when considering the possible long term harms of MDMA. One thing that you need to consider, is that a statistically significant effect on memory in a study, may reflect a very subtle (but possibly significant) effect on everyday life. Effects being subtle however, may also mean that effects on mental abilities caused by MDMA could go unnoticed. It is therefore very difficult to know if MDMA would affect you, or whether such effects would be a problem. Additionally, although the long term effects of MDMA may be less risky than something like tobacco, there is no way to know if what is bought illegally is actually MDMA.
There is also anecdotal evidence that after multiple uses of MDMA, the 'magic goes' and users no longer find the drug as enjoyable (although this is not reported by all).
MDMA (ecstasy) harm reduction advice?
How much are you taking?
Higher doses are more likely to cause immediate or lasting harm, as well as unpleasant after-effects. Higher doses are also more likely to cause unpleasantly overwhelming experiences especially in people using the drug for the first time. Some people may feel the effects of MDMA more strongly than others or simply dislike the effects of the drug. If you do decide to take a pill or some powder you should always first take a smaller dose then wait at least two hours before deciding if you really want to take more. If you don’t wait, you could end up taking a very high dose. You should note that some pills may be strong enough for one to be too much, so some people take part of a pill.
Do you know what you are actually taking?
It is common for substances that are meant to be MDMA to be another drug or mixed with different substances. This is a problem because other drugs sold as MDMA may differ in terms of the strength of effects or the amount of time they take to kick in. It is also possible that a pill or powder will contain a very different drug such as ketamine. In this case the effects will be very different from what you expect. What you are sold may also contain non-mind altering substances that could be harmful.
Are you drinking too much or too little water or overheating?
If you are dancing on MDMA, especially in a crowded place, you are likely to get hot and dehydrated. To avoid overheating and dehydration many people taking MDMA drink plenty of water. However, MDMA also can stop you from urinating as much and could affect your perception of how hydrated you are. This means you could end up drinking too much water, which when taken to an extreme is dangerous.
It is therefore a good idea to drink moderate amounts of water and maybe have some salty snacks if you think you have drunk too much. Isotonic sports drinks are helpful for reducing the risks from drinking too much or too little water. It is also a good idea to avoid other things that can make you dehydrated, such as alcohol.
MDMA (ecstasy) myths and misunderstandings
Does MDMA put holes in your brain?
MDMA does not put holes in your brain. This myth comes from messages broadcast by anti-drug campaigns in the late 1990s/early 2000s.
Is MDMA (ecstasy) powder purer than ecstasy pills?
Like most illegal drugs, the purity of MDMA changes all the time, so forms that might once have been more reliable cannot be guaranteed to remain so. It is quite easy for drug dealers to mix MDMA powder with any substance that looks like it, so taking MDMA powder does not necessarily mean you are not unknowingly taking other substances mixed with the drug.
Does MDMA (ecstasy) drain your spinal fluid?
No. This myth probably comes from experiments where researchers measured breakdown products of serotonin in the spinal fluid of animals who had taken MDMA. MDMA does not damage your spine.
Does MDMA (ecstasy) cause Parkinson's disease?
MDMA does not cause Parkinsons. This myth may come from an experiment where researchers accidentally gave methamphetamine (crystal meth) to laboratory monkeys instead of MDMA. There is a horribly toxic chemical with a four-letter acronym, MPTP, which does cause parkinsonism. It has appeared as an unwanted impurity in a heroin-like (opiate) drug called MPPP, causing the people who took the contaminated drug to 'freeze up' by destroying dopamine neurons in the brain, just as Parkinson's disease does. Neither MPTP or MPPP have any relation to MDMA.