MDMA

Once considered the quintessential party drug, MDMA (also known as “ecstasy,” “X,” or “molly”) is now experiencing a surge of interest in a completely different area: psychedelic-assisted psychotherapy. 

MDMA, which is short for 3,4-methylenedioxy-methamphetamine, is a synthetic psychedelic drug that enhances both physical and emotional sensations, often producing euphoria as well as a heightened sense of pleasure and even empathy. Originally developed by the German pharmaceutical company Merck in 1912, it was used as a therapy enhancement in the 1970s, helping to treat depression and to encourage emotional closeness in couples therapy. It became a popular club drug starting in the 1980s, commonly found at raves, music festivals, and dance parties due to its ability both to enhance the experience of ambient lights and music and to lower social inhibitions. However, its increased popularity as a street drug eventually led to it being added to the list of illegal drugs in the U.S. in 1985, and worldwide in 1986. 

What is it like to take MDMA? How long does MDMA last?

MDMA is usually taken orally, and comes in two different forms: pills (which are typically known as “ecstasy”) and a powder or crystal form (which is called “molly” and is often stirred into a drink, though it is sometimes snorted). It takes 30 to 60 minutes for its effects to show up. As MDMA is a type of amphetamine, it acts as a stimulant, altering a user’s sensory perceptions. Effects of MDMA vary by dose, but can include:

• Enhanced visual effects, such as heightened color perception or mild hallucinations
• Increased auditory and tactile sensation
• Increased alertness, energy, and physical stamina
• A heady sense of euphoria
• An increase in empathy
• A sense of calm and reduced anxiety
• Enhanced self-confidence
• Prosocial effects including increased closeness to others and a greater ability/desire to communicate and socialize

The effects of MDMA typically last for 3 to 8 hours. Common short-term side effects include dilated pupils, increased blood pressure and heart rate, dry mouth, sweating, jaw clenching, tooth grinding, and insomnia, among others. There are also possible comedown effects such as irritability, depression, fatigue, lockjaw, and loss of appetite, which can last for up to a week after taking MDMA. 

What does MDMA do to your brain?

Like other amphetamines, MDMA increases the activity of certain neurotransmitters, including dopamine, serotonin, and norepinephrine. Unlike other amphetamines, it is more effective on serotonin than either dopamine or norepinephrine, which explains its enhancement of a user’s emotional state. Several studies have shown that MDMA also promotes the release of oxytocin, which may partially explain its prosocial effects, though research is inconclusive.

Is MDMA illegal?

While MDMA is currently under review by the FDA for approval to be used for therapy in certain conditions, it is still a Schedule 1 drug in the U.S., meaning it is illegal to possess, manufacture, or distribute without a license. According to Natalie Ginsberg, director of policy and advocacy at the Multidisciplinary Association for Psychedelic Studies (MAPS), “MDMA is the psychedelic substance that people are arrested for most in the U.S.” It also hasn’t been widely decriminalized, so with the exception of the state of Oregon, getting caught with MDMA can still lead to stiff criminal penalties both in the U.S. and internationally. 

Can you microdose MDMA?

Unlike other psychedelics such as LSD and psilocybin, MDMA is not a popular psychedelic for microdosing, and it has not been given much thought by researchers as a possible option. Anecdotal reports by users offer mixed results, with many saying that the possible comedown effects were not worth the potential benefits. Also, given the relative unpredictability regarding the potency and purity of MDMA purchased on the street, it’s somewhat unreliable and more risky than other drugs to microdose.

Can MDMA be used for therapy? What conditions does it treat?

MDMA has shown particularly good results in the treatment of PTSD, causing the FDA to grant it a “Breakthrough Therapy” status in 2017. It is currently in Phase III clinical trials for use as an aid in PTSD therapy and may be approved for use as early as 2023. Other treatment situations where MDMA may be useful include social anxiety, eating disorders, trauma therapy (including therapy for racial trauma), alcohol addiction, and as an aid in couples therapy, since it enhances emotional response and bonding.

Is MDMA safe? What are its long-term effects?

Like other psychedelic drugs such as psilocybin or LSD, MDMA itself (when taken at recommended doses) is fairly safe and rarely fatal. However, MDMA sold on the street is often cut with other drugs such as fentanyl or MDMA analogs, which can result in serious side effects or even death. Some users have also required medical attention after taking MDMA pills that were more potent than expected. Outside of a clinical setting, it’s important to test any MDMA before taking it, even if it’s from a trusted supplier. 

MDMA can prove fatal when combined with other drugs and substances, including alcohol and MAOI or SSRI medications, among others. It can also exacerbate pre-existing medical conditions like a heart condition or high blood pressure. The most common serious conditions experienced after taking MDMA are heatstroke (often from too much dancing), water toxicity after ingesting too much water, and serotonin syndrome, which is a common result of combining MDMA with antidepressants.

Long-term, chronic use of MDMA has been shown to cause memory impairment, insomnia, increased depression, and concentration issues, as well as increasing the potential for heart attack, stroke, and heart disease. Some of the damage from chronic use can possibly be reversed after long-term abstinence from the drug. While light or moderate users do not show the same issues, nor do those who have used MDMA in a therapeutic setting, research is ongoing, and users should exercise caution and extreme moderation. 

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