MDMA (Ecstasy)
MDMA, commonly known as ecstasy, mandy or molly, is a drug of the stimulant class but which also can have mild hallucinogenic properties. MDMA’s common effects include euphoria, increased energy and a vastly heightened sense of empathy.
If you are an MDMA user, please read our PMA harm reduction guide to make sure you are staying safe.
MDMA is commonly sold as powder, crystals or pills. MDMA powder is simply crushed MDMA crystals. Powder can either be snorted or swallowed, and pills and crystals are swallowed.
There are always associated dangers of consuming MDMA in any form, or indeed consuming any illegal substance. The fact illicit drugs are not regulated means there’s no guarantee you’ll get the drug you think you’re getting, or how much of the actual drug itself you’ll get. You also won’t know how much else of the substance are adulterants or other potentially dangerous compounds.
The ecstasy pills you pick up at a rave may contain only small amounts of MDMA, a huge amount or none at all. Some pills have been found to contain 0% MDMA (like pills made of plaster of Paris) and some have been found to contain close to 100% MDMA content. This lack of standardisation in the amount of the drug in pills poses significant danger to users’ health. MDMA is active in relatively small amounts and has the potential to be life-threatening at high doses, making pills particularly dangerous as you cannot test how much of the substance is in the pill and you could be consuming far more of the drug than is safe.
Pills may contain other stimulants like caffeine, or worse still, have other dangerous compounds in them. One of these particularly dangerous compounds is PMA – a drug similar in structure to MDMA but with far less of the positive effects and far more negative effects at lower doses. PMA has caused a number of deaths since ecstasy rose in popularity in the underground drug scene, and sometimes ecstasy pills contain PMA instead of MDMA. If you are an MDMA user read our PMA harm reduction guide to make sure you are staying safe.
When MDMA is swallowed effects are typically felt anywhere between 20-60 minutes after ingestion and last anywhere between 3-6 hours. It is important not to re-dose if you consume some of the drug and find you don’t feel any effects, even if 2-3 hours pass. Everyone has different levels of tolerance and some anecdotal evidence has suggested it can take upto 3 hours for the effects of MDMA to be felt by some people.
The other important reason not to re-dose if none or very mild effects are felt is that you may have consumed something which you thought was MDMA but isn’t, or the drug was mixed with other drugs. It is very important to test any drug first before consuming it using a reagent test to ensure you stay safe. More detail on this below in heading 5; Before taking MDMA: What are the dangers and can they be avoided?
MDMA spikes the activation level of a natural chemical in the brain called serotonin. The drug does this by grabbing hold of serotonin-transporting proteins and forcing them to flood the brain’s circuits with its existing supply of serotonin. It’s thought to do this at a particular receptor which deals with many functions, among them being imagination, stress-coping, mood and personality.
MDMA’s hijacking of the brain’s serotonin system is thought to be where the drug’s main effects of vastly heightened empathy and euphoria come from. MDMA also spikes adrenaline and dopamine activation in the brain, but in smaller amounts than serotonin. Higher adrenaline levels are responsible for the energetic effects of the drug through increased heart-rate and blood pressure, and higher dopamine levels are thought to be responsible for other pleasurable feelings.
MDMA is also theorised to increase levels of vasopressin and oxytocin; hormones which also have many functions in the body.
Vasopressin helps regulates urination and an increase of it in the body translates to a person being less able to urinate. Oxytocin is the chemical most closely associated with love and emotional bonding, and its increase (along with the higher levels of serotonin) make a user feel much more bonded to anyone they interact with while under the influence of MDMA.
MDMA can have many different effects. These vary in type, strength and intensity person-to-person, but typically include the following.
Empathy & Emotional Openness
A vastly heightened sense of empathy and emotional connection with others. Perhaps the principle effect of the drug which most users report feeling. A direct consequence of the heightened levels of serotonin and possibly oxytocin in the brain.
Euphoria & Lifted Mood
Heightened or intense happiness and drastically lifted mood. An all-encompassing sense of well-being is often associated with the experience (as long as correct dosage and harm-reduction practices are followed).
Lowered Aggression
An almost distinct inability to feel anger or aggression, mediated through MDMA’s release of serotonin. Lowered anxiety can also be an associated effect, although some users report higher anxiety (but this tends to be on higher doses).
Increased Energy Levels
Heightened energy, alertness and wakefulness. A consequence of MDMA’s adrenaline release. High doses can turn energetic feelings into restlessness and over-stimulation.
Body temperature changes
Feelings of hot and cold when coming up and often feeling warm or hot in the body during the experience. A consequence of the fact MDMA affects cells in the part of the brain which deals with the body’s internal temperature control. Important to ensure you don’t get too hot – more on this in heading 6 below; When you’ve taken MDMA: What are the dangers and can they be avoided?
Raised Heart rate and blood pressure
A rise in both heart-rate and blood pressure. The rise can be sharp and is directly dependent on the dose taken – higher doses lead to higher increases in both. A consequence of the fact MDMA spikes adrenaline levels whilst also increasing serotonin levels at a receptor which increases vasoconstriction (tightening of blood vessels).
Difficulty Urinating
Users report urinating less whilst on the drug and generally having far less need to urinate, even if they’ve consumed more fluid. A result of the MDMA’s increase of vasopressin levels in the body. Ensure you do not over or under hydrate during the MDMA experience. More on this in heading 6 below; When you’ve taken MDMA: What are the dangers and can they be avoided?
Increased thirst levels
Users can feel thirstier than normal whilst under the influence – a result of the fact MDMA affects the body’s internal balance system (homeostasis). Coupled with the fact urination becomes more difficult, users must ensure they do not consume too much fluid or risk over-hydrated their bodies.
Suppression of appetite
Commonly reported – an almost complete loss of appetite or desire to consume any food.
Muscle clenching
Clenching muscles without realising, particularly the jaw muscles. Thought to be a consequence of adrenaline release. Users should be mindful of how much they jaw-clench, as this can be painful after the drug has worn off.
Perceptual changes
Heightened perception of colour, increased appreciation of music or sounds, blurred vision, mild colour hallucinations in some users.
Anecdotal evidence suggests higher doses of MDMA only increase the energising effects of the drug, not the emotional or euphoric effects. Unpleasant sensations like feeling overly hot, anxious, over-stimulated or confused are more likely to occur on higher doses and are far more likely to overshadow the positive effects users’ feel.
MDMA has significant associated dangers of organs overheating, heart or blood pressure problems, users’ consuming too much fluid and severe mood issues following the experience. More on these in headings 6 and 7, below.
We’ve touched upon points of harm reduction above, and the main points of staying safe before taking MDMA are; ensuring what you have is actually MDMA and ensuring the dosage is correct.
Ensuring what you have is actually MDMA
If you are consuming MDMA in any form — be they pills, powder or crystals — it is essential to test the substance with a reagent test before consuming any of it.
Reagent tests are legal chemicals which offer an easy colour-based test for drugs. Simply and carefully drop a couple of drops of the reagent chemical onto a small amount of what you think is MDMA. If you have powder simply separate some out; if you have crystals, chip a tiny amount off; if you have pills, scrape some off with a knife. The substance will change colour when it reacts with the reagent chemical and you can cross-reference the colour change with the reagent colour chart that comes with the test (or you can search it on the internet). If the colour change corresponds to the correct drug on the chart, you know the substance you have is actually MDMA (in this example). Reagent tests can pick up the presence of dangerous chemicals like PMA/PMMA. This is an easy and inexpensive way to ensure the drug you have is actually what you think it is, and to make sure you aren’t taking something which could kill you. It is essential to test any and all substances before taking them.
Ensuring the dosage is correct
MDMA is active at the milligram level, and a difference of 200-300mg (merely 20-30% of a gram) could mean the difference between a good experience or a trip to the hospital, or death. If you have powder or crystals it is impossible to measure correct dosage just by eye – dosages in this form must always be measured out using an appropriate milligram scale.If you have pills it is almost impossible to know how much dosage is in each pill. In this case, after testing the pill with a reagent test, start with a small amount (a quarter to a half of a pill) as there is no standardisation of dosages across pills. Some pills have been found to contain 0% MDMA and some close to 100%.
Higher dosages often mean an increase of negative effects like overheating, overstimulation and agitation while bringing no more of the positive effects like euphoria or empathy, whilst increasing chances of negative impacts on the body and a bad comedown.
Overheating
A considerable risk when consuming MDMA is the danger of overheating. MDMA affects the part of the brain that deals with our body’s internal temperature control (the hypothalamus), and it makes it difficult for our brains to regulate our body temperatures. The drug’s tendency to push the body’s temperature higher than the optimum level of 37C is directly dose-dependent, and users will tend to get hotter the more MDMA the consume. On the milder end of the spectrum this can lead to sweating or feeling uncomfortably warm, and on the dangerous end it can lead to organs overheating, posing a serious risk of severe illness or death. Cases have been recorded of users dying from organ failure from overheating as a direct result of consuming too much MDMA.How to minimise your risk of overheating
First of all, test your MDMA with a reagent test to ensure it isn’t another, more dangerous substance. Secondly, ensure you can measure the dosage correctly with a scale. Do not eyeball or estimate the measurement of a dose; doing so significantly increases your risk of taking too much or overdosing. If you have pills, consume a small amount (a quarter to a half), for there is no way to measure the MDMA content of a pill. The risks of overheating rise sharply when a user is in a hot environment like a sweaty rave or underground nightclub, especially if they’re doing aerobic activity like dancing (for this also raises the body’s temperature). To stay safe as safe as possible, ensure dosage is not too high and to take rests to cool off in a cooler environment.Drinking too much fluid
As a result of MDMA’s effect on the hypothalamus the body has difficulty regulating how thirsty and hungry it is. Hunger is often not felt at all on an MDMA trip but thirst tends to become stronger. Coupled with the fact the drug constricts blood vessels and releases a hormone which makes urinating much more difficult, there is a risk of overhydration – drinking too much fluid. Overhydration may not sound like a serious problem but it can lead to dilution of blood, which can seriously affect the function of organs. If an MDMA user is dancing in a hot and sweaty environment, not only are risks of overheating higher but risk of overhydration is higher as well, as we tend to consume more fluid with more exercise and the more we sweat.How to minimise your risk of overhydration
To minimise risk make sure you or anyone else do not take too high of a dose, especially if you are likely to partake in aerobic activity (e.g. dancing) in a hot environment. Be mindful of how much fluid a user is consuming. Everyone has different levels of ideal fluid/water intake, but as a general rule of thumb, one pint of (NON-alcoholic) fluid per 2-3 hours is around what a human would normally consume. Dehydration is also a risk, so users should ensure they drink roughly the correct amount of fluid.High blood pressure/Heart rate
MDMA has two effects on the body’s heart and blood pressure systems. Firstly, adrenaline released by the drug pushes heart rate higher than normal, and secondly MDMA constricts blood vessels through release of serotonin. The constricting of vessels raises blood pressure, but the fact the heart pumps faster than normal means blood pressure raises even further.How to stay safe
People with any heart or blood pressure problems should steer clear of MDMA, and any drugs in the stimulant class generally (e.g. cocaine, amphetamines). Drugs like these pose a serious risk of dangerously high blood pressure, heart attack or heart failure. MDMA’s raised blood pressure and heart-rate effects are dose-dependent (the higher the dose the higher the rise in both), and so correct dosage must be ensured to maximise safety. Aerobic activity during an MDMA experience will also raise heart rate, and so users and others around them should be mindful of how much activity they are engaging in.After an MDMA experience many users report feeling fatigue, anxiety or low mood in the days or sometimes 1-4 weeks to come. At the more extreme end users can experience impaired concentration, insomnia, loss of appetite and even depression.
These effects are commonly associated with lower levels of serotonin in the brain after an MDMA trip. MDMA uses the brain’s existing supply of serotonin to bring about its effects, and once the MDMA has worn off the brain breaks down the serotonin hijacked by the drug. This natural supply of serotonin are one of the things our brains use to regulate our mood, sleep and other things.
Serotonin is a slowly-produced chemical in the brain, and it can take around 1-4 weeks for our brains to replenish their own natural serotonin supply, depending on how much is lost, and therefore this is how long a comedown could last.
The potential severity of a comedown is directly dependent on the dosage taken. Higher dosages use more of the brain’s serotonin supply and therefore the brain has less serotonin afterward to regulate its normal functions (like mood and sleep). Bearing in mind higher doses of MDMA tend to bring more negative effects than positive ones, it is important for a user not to take too large of a dose, or otherwise potentially suffer for weeks after they take the drug.
It can also be beneficial to try to engage in experience-enriching activities during the trip which take advantage of the positive effects offered by the substance. For example, MDMA makes users feel highly empathetic and emotionally-connective during the trip, so activities centred around human connection like deep conversations or cuddling can enrich the experience without needing more of the drug. Since these activities naturally release positive chemicals in our brains anyway (like serotonin and oxytocin, whether you’re sober or not), they naturally increase the high of the drug without the user having to take any more of the drug itself. The same can be said of listening to music or engaging in other activities which the user might enjoy, as long as there is not too much aerobic activity, like dancing, taking place (especially in a hot environment).
The only way to ensure there is no comedown is not to consume MDMA at all, but if a person wishes to minimise their potential comedown from the drug, it is important to first of all ensure the drug you have is actually MDMA (tested with a reagent test), make sure the dose is moderate and not too high, and engage in activities which are naturally positive.
Currently MDMA is an illegal substance across the world – a class A drug in the UK and a schedule 1 substance in the US, meaning it is seen as having no therapeutic or medicinal value, but new and recent studies are challenging this notion.
Studies by David Nutt and Imperial College London have shown MDMA-assisted therapy to have significant potential in treating post-traumatic stress disorder (PTSD) and alcoholism. Various other studies seem to back-up MDMA’s potential for treating PTSD and also its positive use in psychiatry.
MDMA has also been shown to have vastly positive results in couples therapy, with some couples claiming partaking in MDMA-assisted therapy significantly helped them in their relationship and even as individuals.
The reasons for these benefits likely lie in MDMA’s empathy and euphoria effects. Due to the serotonin activation in the brain it seems difficult for users to feel anger, stress or negative emotions while on the drug. This seems to allow people to look at negative situations or past traumas with less anxiety or anger, and instead with empathy and understanding.
At present, MDMA cannot legally be used in psychotherapy but more and more studies are being done which test both MDMA’s positives and drawbacks. The drug itself is not the treatment but rather enables therapy to be 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.
Anyone with heart, blood pressure, liver or kidney issues should steer clear of MDMA, along with anyone on any medication which affects serotonin or adrenaline levels (like antidepressants such as SSRIs, SNRIs and MAOIs).
Anyone with existing heart problems or high blood pressure issues is at far increased risk from using MDMA. MDMA raises heart rate (through release of adrenaline) and increases blood pressure (through activation of serotonin). The effects of raised heart rate through tightened blood vessels raises heart rate even further. Consuming MDMA can be potentially quite dangerous if you have these issues.
MDMA could cause problems for those with existing liver issues (as the drug is processed through the liver) and the drug is shown to negatively affect liver-health with repeated use. Those with kidney issues should also avoid the drug because of its effect on the body’s diuretic system.
For those who suffer from depression; MDMA affects the same chemicals in the brain as many anti-depressant medications, so those who are taking or have recently taken these medications (like SSRIs, SNRIs or MAOIs) should avoid MDMA as drug-drug interactions in the brain can be unpredictable and potentially very dangerous. In addition, anyone with serotonin syndrome or who is known to be sensitive to serotonin should not take MDMA.
General fitness should also be taken into account; those with a low levels of fitness may be under greater pressure from the effects of MDMA on the body, and so should avoid the drug or start with smaller doses.
Drug-drug interactions can often be unpredictable and/or dangerous, especially when it comes to unregulated substances, so it is highly advisable not to mix MDMA with any other illicit drugs. If mixed, the substances may interact in strange or unforeseen ways which could be seriously threatening to health or life (many MDMA related deaths have taken place when mixed with other drugs). Alcohol can contribute to dehydrating the body when mixed with MDMA and also dull the drug’s effects, as MDMA is a stimulant and alcohol a depressant. Being under the influence of alcohol or other drugs before taking MDMA can also impair judgement, which could lead to overdosing.
MDMA affects serotonin, adrenaline and dopamine in the brain and body, and therefore it is highly advisable not to consume MDMA if you are on any medication which affects or interacts with these chemicals. SSRI’s (selective serotonin reuptake inhibitors), for example, are common antidepressant medications, as are SNRI’s (selective norepinephrine reuptake inhibitors) and MAOI’s (mono amine oxidase inhibitors). Steer clear of MDMA if you or anyone else is taking these forms of medication or anything else which interacts with the chemicals that MDMA affects (such as herbal supplements which could affect serotonin, like 5HTP).
Do not consume MDMA if you are on any heart or blood pressure medication (or have any heart problems), as MDMA raises both, and interactions with these medications can be unpredictable and dangerous.
MDMA is considered to have low potential for addiction, especially when compared to alcohol, nicotine or heroin, but that does not mean it cannot be addictive at all.
MDMA is unlikely addictive from a chemical standpoint. Chemical addiction occurs when a person continually takes a substance which affects the supply of a particular chemical in their brain, to the point the brain adjusts its own supply in response to the drug-taking. After this point the person must continue taking the drug in order to bring that particular chemical’s supply back to normal levels, hence they must keep drug-taking just to feel normal.
MDMA uses the brain’s existing serotonin supply to bring about its effects and the serotonin used is broken down after the drug wears off. The brain requires a certain level of serotonin to regulate normal functions like mood and sleep, and struggles if the supply is too low. MDMA reduces that natural supply and continued use of the drug reduces it further. The brain cannot replenish its own supply quick enough for chemical addiction to form, since continued and excessive MDMA-use quickly depletes natural serotonin supply.
Whereas MDMA has low potential for being chemically addictive, it has the possibility to be psychologically addictive. The feelings of euphoria, happiness and empathy commonly associated with the experience can make a person want to take MDMA again and again. However, taking the substance more often than once in 2-3 months can have severe implications on brain health and its ability to regulate mood, sleep, concentration and stress-coping abilities. Repeated and long term use has been shown to deteriorate brain health in general.
Taking MDMA too much can build a tolerance and with repeated/often use the substance can ‘lose its magic’. Using it too much will diminish the effects to the point you won’t feel anything anymore from taking MDMA, and instead have vastly negative implications on the health of the brain and the body. Anything more frequent than once in 2-3 months would be considered as too often.
MDMA studies show people with a history of light and occasional use of the drug are far less likely to show mental deficits, compared with studies where people have a history of binging on large amounts of MDMA or regular MDMA use.
There is scientific controversy over the long-term harmful effects of MDMA. Some studies have found links to MDMA use and impairments in memory and impulsivity, but there may be other factors which contribute to this like use of other drugs or 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 impulsive personality-types could make someone more likely to take MDMA, rather than being caused by drug use. 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 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. It is safest not to take the drug at all, but the above evidence suggests infrequent and mild use may not cause long term detrimental effects in the long term, while at the same time suggesting frequent and heavy use can lead to both psychological and physical negative changes.
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.
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