Medically reviewed on May 18, 2014 by L. Anderson, PharmD.
Common or street names: Ecstasy, E, Adam, XTC, Clarity, Essence, Hug Drug, Love Drug, Molly
What is MDMA?
MDMA (3-4 methylenedioxymethamphetamine) is a synthetic, psychoactive drug with a chemical structure similar to the stimulant methamphetamine and the hallucinogen mescaline. Ecstasy is an illegal drug that acts as both a stimulant and psychedelic, producing an energizing effect, as well as distortions in time and perception and enhanced enjoyment from tactile experiences. It is known commonly as Ecstasy.
Ecstasy exerts its primary effects in the brain on neurons that use the chemical serotonin to communicate with other neurons. The serotonin system plays an important role in regulating mood, aggression, sexual activity, sleep, and sensitivity to pain.
MDMA was first synthesized by a German company in 1912, possibly to be used as an appetite suppressant. MDMA has been available as a street drug since the 1980s. Its use escalated in the 1990s among college students and young adults. It is most often distributed at late-night parties called "raves", nightclubs, and rock concerts. As the rave and club scene expanded to metropolitan and suburban areas across the country, MDMA use and distribution increased as well. MDMA is frequently used in combination with other drugs. However, it is rarely consumed with alcohol, as alcohol is believed to diminish its effects.
Effects of MDMA Use
MDMA stimulates the release of the neurotransmitter serotonin from brain neurons, producing a high that lasts from several minutes to an hour. The drug's rewarding effects vary with the individual taking it, the dose and purity, and the environment in which it is taken. MDMA can produce stimulant effects such as an enhanced sense of pleasure and self-confidence and increased energy. Its psychedelic effects include feelings of peacefulness, acceptance, and empathy.
MDMA users may encounter problems similar to those experienced by amphetamine and cocaine users, including addiction. MDMA damages brain serotonin neurons. Serotonin is thought to play a role in regulating mood, memory, sleep, and appetite. Research indicates heavy MDMA may cause persistent memory problems in humans; however, a 2011 study has reported limited cognitive decline in users of MDMA.1
Psychological effects can include confusion, depression, sleep problems, anxiety, and paranoia, sometimes lasting for weeks after taking the drug. Physical effects can include muscle tension, involuntary teeth-clenching, nausea, blurred vision, faintness, and chills or sweating. Increases in heart rate and blood pressure are a special risk for people with circulatory or heart disease.
Also, there is evidence that people who develop a rash that looks like acne after using MDMA may be risking severe side effects, including liver damage, if they continue to use the drug. Almost 60 percent of people who use Ecstasy report withdrawal symptoms, including fatigue, loss of appetite, depressed feelings, and trouble concentrating.
MDMA-related fatalities at raves have been reported. The stimulant effects of the drug, which enable the user to dance for extended periods, combined with the hot, crowded conditions usually found at raves can lead to dehydration, hyperthermia (dangerous increase in body temperature), and heart or kidney failure.
Other drugs chemically similar to Ecstasy, such as MDA (methylenedioxyamphetamine, the parent drug of Ecstasy) and PMA (paramethoxyamphetamine, associated with fatalities in the U.S. and Australia) are sometimes sold as Ecstasy. These drugs can be neurotoxic or create additional health risks to the user.
Additionally, the illicit sale of Ecstasy makes it prone to being “cut” with other illicit and potentially toxic or deadly chemicals. Ecstasy tablets may contain other substances in addition to MDMA, such as ephedrine (a stimulant); dextromethorphan (a cough suppressant that has PCP-like effects at high doses); ketamine (an anesthetic used mostly by veterinarians that also has PCP-like effects); caffeine; cocaine; and methamphetamine. While the combination of Ecstasy with one or more of these drugs may be inherently dangerous, users might also combine them with substances such as marijuana and alcohol, putting themselves at further physical risk.
Methods of Use
MDMA is most often available in tablet form and is usually ingested orally. Ecstasy traffickers consistently use brand names and logos as marketing tools and to distinguish their product from that of competitors. The logos are produced to coincide with holidays or special events. Among the more popular logos are butterflies, lightning bolts, and four-leaf clovers. It is also available as a powder and is sometimes snorted and occasionally smoked but rarely injected.
Extent of MDMA Use
The National Institute on Drug Abuse (NIDA) funds the Monitoring the Future survey (MTF), which is conducted by the University of Michigan's Institute for Social Research. In 2010, 4.6 percent of 12th-graders, 4.7 percent of 10th-graders, and 2.4 percent of 8th-graders reported they had used MDMA in the past year. In 2000, 8.2 percent of 12th-graders, 5.4 percent of 10th-graders and 3.1 percent of 8th-graders reported they had used MDMA. African American students showed considerably lower rates of Ecstasy use than white or Hispanic students in the 2010 MTF survey.
The NIDA-sponsored Community Epidemiology Work Group (CEWG), a network of researchers from 21 major U.S. metropolitan areas, also has reported increased MDMA use by young adults and adolescents in many areas of the country. MDMA, once used primarily at dance clubs, raves, and college scenes, is now being used in a number of other social settings. It is the most prominent stimulant used in many major metropolitan areas. In Miami in 1999, there were eight MDMA-related deaths, and five in Minneapolis/St. Paul. In Boston during the first three quarters of 2000, MDMA was the most frequently mentioned drug in telephone calls to the Poison Control Center. Ecstasy content varies widely, and it frequently consists of substances entirely different from MDMA, ranging from caffeine to dextromethorphan. Ecstasy tablets seized by the Drug Enforcement Administration increased from 13,342 in 1996 to 949,257 in 2000.
In 2010, the Substance Abuse and Mental Health Services Administration published the Results from the 2010 National Survey on Drug Use and Health. Among persons aged 12 to 49, the average age at first use for MDMA was 19.4 years. In 2010, an estimated 695,000 Americans aged 12 or older were current (past month) MDMA drug users, meaning they had used an Ecstasy-type drug during the month prior to the survey interview. The 2010 current use estimate is similar to that from 2009. The rate of current MDMA use among youths aged 12 to 17 declined to 0.3 percent in years 2004 through 2007, but increased to 0.5 percent in 2009 and 2010. To put overall MDMA use in perspective, in 2010 the illicit drug category with the largest number of current users among persons aged 12 or older was marijuana use (2.4 million), followed by abuse of pain relievers (2 million), tranquilizers (1.2 million), Ecstasy (0.9 million), inhalants (0.8 million), and cocaine and stimulants (0.6 million each).2
- Bath Salts
- Devil's Breath
- Gray Death
- PCP (Phencyclidine)
- Psilocybin (Magic Mushrooms)
- Speed (methamphetamine)
- Synthetic Marijuana (Spice or K2)
- TCP (Tenocyclidine)
- U-47700 (Pink)
1. Halpern, J. H., Sherwood, A. R., Hudson, J. I., et al. Residual neurocognitive features of long-term ecstasy users with minimal exposure to other drugs. Addiction 2011;106: 777-86.
2. Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.