MDMA, or 3,4-methylenedioxymethamphetamine, is a synthetic drug that acts as both a stimulant and hallucinogen. Ecstasy, often referred to as E or XTC, usually relates to tablets containing the active ingredient MDMA. MDMA is also available in powder form, commonly known as Molly. The combination of stimulants and hallucinogens, relatively inexpensive street value and easy accessibility mean ecstasy is a popular party and club drug.

Ecstasy is illegal, having been classified as a Schedule I drug in 1985. In 2016, the SAMHSA (Substance Abuse and Mental Health Administration Services) National Survey on Drug Use and Health found that 7.4% of adults in the US had tried ecstasy at least once in their lifetime. Of these people, around 2 in 100,000 will die as a result of their use of MDMA. While this figure is relatively low compared to other drugs, it is significant enough that users should be aware of the risks associated with ecstasy and its short and long-term side effects.

Why Do People Take Ecstasy?

The active ingredient MDMA gives users a sense of euphoria, increases energy levels, lowers inhibitions, enhances sensory perception, and provides feelings of warmth and empathy towards others. The effects of ecstasy can begin within 45 minutes of taking the drug and last up to 6 hours.

Ecstasy became popular at nightclubs and raves in the 1980s and 1990s, with the majority of users being young adults. Available in brightly colored tablets with cartoon images and many light-hearted street names, including Happy Pills, Disco Biscuits, Love Drugs, Skittles, Sweets, and Candy, it is easy to underestimate the risks associated with the use of MDMA. Many users take ecstasy for the first time in a social environment or group setting where other people are also using the drug.

How Does MDMA Affect the Brain?

MDMA causes a release of three neurotransmitters, serotonin, norepinephrine, and dopamine. This affects the user in the following ways:

Serotonin: The sudden increase in serotonin after taking ecstasy enhances a person’s mood and is responsible for the euphoria that they experience. It triggers sexual arousal and the feelings of trust and closeness that are associated with the use of ecstasy.
Dopamine: An increase in dopamine causes a person to have more energy and triggers the feeling of a particular behavior being pleasurable and rewarding. This instant feeling of gratification encourages the user to retake the drug.
Norepinephrine: This neurotransmitter increases the heart rate and blood pressure and can lead to heart complications and risks associated with cardiovascular health.

Are There Any Medical Benefits to MDMA?

The Multidisciplinary Association for Psychedelic Studies (MAPS) is carrying out studies into the therapeutic use of MDMA. The FDA (Food and Drug Administration) has recently expanded access to clinics across ten states to trial the use of MDMA for the treatment of post-traumatic stress disorder (PTSD). Supervised by medical professionals, patients undertake orientation sessions followed by three controlled dosing sessions of MDMA. Results are positive, with some patients showing full recovery from PTSD. Other conditions that may also benefit from medically controlled use of MDMA are anxiety, depression, and alcohol addiction.

Regardless of whether full approval is given for the medical use of MDMA, users need to remember that it will only be legal under the supervision of medical professionals and in limited doses. MDMA is a hazardous substance and one that should not be taken outside a controlled medical environment.

Who Takes Ecstasy?

In 2020, the National Survey on Drug Use and Health reported that about 2.6 million people in the US had used MDMA (Ecstasy) within the last 12 months. Although the demographic of users ranges significantly, use is prevalent among adolescents. The 2021 Monitoring the Future Survey found that MDMA use in the past 12 months was reported by 0.6% of 8th graders, 0.7% of 10th graders, and 1.1% of 12th graders.

Ecstasy use among adolescents is of particular concern as the Drug Abuse Warning Network (DAWN) stated that the estimated number of emergency department visits involving ecstasy in patients younger than 21 increased by 128% from 2005 to 2011.

What Are the Risks of Taking Ecstasy?

While the risk of death from MDMA is lower than with some other drugs, many short and long-term effects and withdrawal symptoms still exist. The DEA (Drug Enforcement Administration) fact sheet on MDMA states that ecstasy users experience many of the same effects and face many of the same risks as users of other stimulants such as cocaine and amphetamines. One of the most significant risks associated with MDMA is that it is often mixed with other substances without the users’ knowledge. Sometimes it is cut with relatively harmless substances such as caffeine or baking soda, but dealers also combine it with other illicit drugs. This practice dramatically increases the risk of severe health implications and accidental overdose. One study found that only 39% of the ecstasy tablets tested consisted solely of MDMA and a greater number (46%) contained no MDMA at all and 15% of the tablets contained a combination of MDMA and other substances such as Ketamine.

Short-term Health Effects of MDMA

Immediately after taking MDMA or within the next few hours or days, unpleasant physical and psychological side effects and withdrawal symptoms can occur:

Physical effects can include muscle cramps, tremors, nausea, sweating, chills, blurred vision, sleep problems, and involuntary teeth clenching. The release of norepinephrine in the brain can also cause high blood pressure and a raised heart rate, leading to increased body temperature.
Psychological effects can cause users to experience short-term mental health issues, including unwanted hallucinations, anxiety, depression, and paranoia. These experiences can lead to panic attacks, and, in some rare cases, ecstasy use may even lead to suicide or attempted suicide.

When ecstasy is taken in a hot environment such as a nightclub and alongside alcohol, a diuretic, there is a risk of dehydration and heatstroke due to water loss in the body. Conversely, MDMA users who try to combat dehydration or experience extreme thirst as a side effect of the drug can suffer water intoxication by drinking too much water in a short time.

Long-term Health Impacts of Ecstasy Use

Studies have found that the regular use of MDMA can be associated with chronic psychiatric symptoms that persist after drug use cessation.

An area of particular concern is the effect on the brain’s level of serotonin. One study found that the serotonin level was depleted by 50% to 80% in the brain of a chronic user of MDMA. A reduction in serotonin can lead to mental health concerns such as depression, anxiety, and emotional instability. These effects can continue for many years after the last use of ecstasy.

Behavioral Risks of Using MDMA

As a stimulant and hallucinogen, ecstasy can cause users to act erratically and make impulsive decisions. Examples of potentially risky behaviors include:

Reduced inhibitions: This can lead to impaired decision-making, impulsivity, and involvement in situations that someone may usually avoid.
Legal trouble: MDMA is an illegal drug, and association with those who deal in the substance can result in trouble with the police. Some users may also resort to crime to fund their habit.
Risky sexual behavior: One study found that risky sexual behavior was prevalent during MDMA episodes. Lowered inhibitions and increased sexual arousal can lead to risk-taking, such as engaging in unprotected sexual activity with multiple partners.
Mixing substances: Users often mix MDMA with other drugs. “Candy flipping” is the practice of combining MDMA with LSD. Mixing drugs, including alcohol, with ecstasy increases the chance of cardiovascular issues, mental health problems, and overdose. MDMA toxicity alone can be fatal, but multiple drug toxicity remains more prevalent.

Is It Possible To Become Addicted to Ecstasy?

Addiction can be physical or psychological. As ecstasy is a hallucinogen, it has a more significant effect on the mind than on the body. It, therefore, is more likely to lead to a psychological addiction than a physical one. The National Institute on Drug Abuse (NIDA) states that research has shown that ecstasy has drug abuse potential, although to a lesser degree than drugs such as cocaine.

Psychological dependency on a substance is often linked to dopamine release in the brain. The user’s desire to replicate the sense of reward that ecstasy provides can lead them to repeatedly take more of the substance to achieve the same effect. As they develop a tolerance to MDMA, users can seek out more potent drugs to achieve the same effect. Substance use addiction can result from the ongoing pattern of ecstasy use and reward and its role as a gateway to other more addictive drugs.

7 Signs That You or a Loved One Have an Ecstasy Addiction

Often it can be difficult to know whether your drug use constitutes an addiction or that someone else is addicted. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) rates Substance Use Disorders, including ecstasy addiction, on a scale from mild to severe and outlines 11 signs of addiction. Some of the signs that you can look out for are:

Seeking out opportunities to take ecstasy: A person may change their social habits, friendship groups, and daily routine to accommodate opportunities to take drugs.
Reduced performance at school, work, or home: Priorities shift when someone has a drug dependency, and they may struggle to focus on activities that do not involve taking ecstasy.
Problems in relationships – Those with drug addiction often distance themselves from the people that are closest to them as they fear being judged. They may also become secretive and lie about their whereabouts.
Suffering from withdrawal symptoms: Sometimes, a noticeable change can occur in someone abusing ecstasy. They may develop mood swings, depression, insomnia, and fatigue, which means they regularly oversleep or seem unusually lethargic.
Inability to have fun without MDMA: One of the most common comments made by those who use ecstasy is that it becomes impossible to enjoy themselves socially without it. Finding that you or a loved one cannot attend a social occasion without factoring in opportunities to take ecstasy is a clear sign that there may be an addiction.
Financial difficulties: Using any substance regularly can become expensive. If someone is spending more than they can afford, borrowing, or even stealing money to fund their habit, this is another sign that dependency has set in.
MDMA has harmful effects, but use continues: When ecstasy abuse has a detrimental impact on someone’s life, but they continue to use it anyway, this is a sign that the cravings are intense and that they have an addiction.

What To Do if You Need Help With MDMA Addiction

Professional advice is available for anyone concerned about ecstasy addiction. Seeking help can give you the information and tools needed to address the situation for yourself or a loved one. There are many resources available, examples of which are:

SAMHSA’s National Helpline is available daily and offers bi-lingual (English and Spanish) advice and support on all aspects of addiction. Call: 1-800-662-HELP (1-800-662-4357).
The Rehab.com helpline is a trusted resource that provides those in need with help, advice, and available treatment options. It is free and confidential. Call now at (833) 386-0206.
Your doctor is a good source of information and available resources. You can find treatment options and a support network close to home by speaking to someone locally.
Narcotics Anonymous and other support groups are available across the US. People often benefit from the understanding and support that comes with meeting those in a similar situation.

What To Expect From Ecstasy Addiction Treatment

Successful ecstasy addiction treatment is tailored to a patient’s personal situation and needs. MDMA is often used alongside other drugs and alcohol, and therefore co-dependency on more than one substance is a factor that must be taken into account during treatment. Addiction treatment often starts with detox from the drug and continues with inpatient or outpatient treatment options. As ecstasy impacts the brain and the addiction is often psychological, many users find behavioral therapies beneficial, including Cognitive Behavioral Therapy (CBT), Contingency Management (CM), and Motivational Interviewing (MI).

When seeking out addiction treatment, it is always worth asking about the experience of the treatment center and its staff in assisting people with addiction to MDMA. The professionals at the treatment center will have expertise in guiding those with ecstasy addiction to address the root cause of their addiction and find ways to avoid taking the substance in the future. Finding a center with a good track record can help you find the right treatment program for your individual needs and your long-term well-being.

Ecstasy addiction can have far-reaching consequences on your life and the lives of those around you, but the help you need to overcome it is readily and easily available. By seeking advice and treatment options, you will be making the first step towards embarking on a treatment program that will assist you with putting your addiction aside and moving forward with the rest of your life.

Ecstasy Addiction: Understanding MDMA Abuse