The drug MDMA (3,4-methylenedioxymethamphetamine) or ecstasy is classified both as a hallucinogen and a stimulant substance that is primarily used for recreational purposes.1
Other Names: MDMA, Adam, Beans, Candy, Dancing Shoes, Disco Biscuits, E, E-Bomb, Eggs, Eve, Love Drug, Malcolm, Molly, Scooby Snacks, Smarties, Uppers, Vitamin E, X, XTC
Ecstasy is an amphetamine derivative, and its effect is similar to methamphetamine (a stimulant) and mescaline (a hallucinogen). This substance affects the body by enhancing the release of the neurotransmitters serotonin, norepinephrine, and dopamine (to a lesser extent), as well as blocking their reuptake.2 Serotonin is believed to act as a mood stabilizer, while norepinephrine doubles as a stress hormone. Dopamine, on the other hand, plays a role in how people feel pleasure.
The release of serotonin, in particular—triggered by the use of ecstasy—can lead to mood-elevating effects. Once this initial effect has waned, however, the user will feel the aftermath of serotonin depletion, and this can leave them with negative psychological effects for days or even weeks.2
Ecstasy is listed as a Schedule I drug under the federal drug scheduling system, which means it has a high potential for abuse.3
Why Ecstasy Is Abused
While ecstasy or MDMA is being investigated as a possible therapeutic substance for the management or treatment of post-traumatic stress disorder (PTSD), anxiety, depression, and alcohol addiction, it is still listed as a Schedule I drug, which means there is currently no accepted medical use for it in the United States.3, 4, 5
Ecstasy primarily affects brain cells that use the neurotransmitter serotonin to send and receive signals from and to one another. Because serotonin regulates mood, sexual activity, sleep, and sensitivity to pain, ecstasy may cause sensations like the following:3
- Increased sensitivity to touch
- Increased energy
- Sensual and sexual arousal
- The need to be touched
- The need to be stimulated
The possibility of experiencing such pleasurable sensations is the reason why ecstasy is popular as a party drug.
How Ecstasy Is Abused
Ecstasy or MDMA is most commonly consumed in pill or tablet form, though the drug is also available in capsule, powder, or liquid forms. While it is often taken by itself, ecstasy is also sometimes consumed with alcohol, marijuana, or LSD to enhance its effects. Among the common ways people abuse ecstasy are by:3
- Swallowing the drug in its pill, capsule, powder, or liquid form
- Reducing the drug to powder and inhaling (snorting) it
- Occasionally, by smoking or injecting the drug
There are also users who take 3 tablets or more at once (called “stacking”) and also those who take a succession of tablets over a short period of time (referred to as “piggy-backing”).3
How Ecstasy Interacts with Other Substances
Ecstasy or MDMA is an illicit substance, and as such, there are no suppliers or establishments that can ascertain the safety and purity of the items that are sold as ecstasy. Often, pills and powders being marketed as ecstasy contain fillers and a mix of other drugs that include amphetamine, ketamine, or synthetic cathinones.6
Ecstasy has no known negative interactions with food items, and there are very few resources that focus on clinically significant interactions between ecstasy and other drugs.7 However, there are recent studies on drug safety that look into how concomitant use of other drugs affect the mortality rate of ecstasy users. A report published in the scientific journal Nature indicates an increase in the odds of reported risk of death when MDMA is used in combination with the following substances and drug classes:8
- Amphetamines and stimulants
- MDMA metabolites or analogs
- Muscle relaxants
The said report proposes that these negative interactions happen because the combinations of these drugs enhance neurotransmission inhibition or increase the synaptic concentrations of monoamine neurotransmitters. But as these drugs can be quite dangerous on their own in high doses, it’s a challenge to determine exactly how concomitant use with MDMA increases the risk of death for each drug combination.
In addition, the following antidepressants and dopamine antagonists demonstrate greater odds of death when combined or used with MDMA:8
The Immediate Effects of Ecstasy Abuse
How ecstasy or MDMA affects a person can vary depending on several factors, such as the user’s age and body weight, the dose of the drug and frequency of use, preexisting mental or physical health conditions, and substances that are used concurrently with the drug. More often than not, though, a person who has taken ecstasy can experience the following desired and undesired effects within 3 to 6 hours of taking the drug:2, 9
- Empathy toward others
- Enhanced sensory perception
- Increased extroversion
- Electrolyte imbalance
- High blood pressure
- Hot flashes
- Hyperthermia or increase in body temperature
- Illogical or disorganized thoughts
- Involuntary jaw clenching and teeth grinding
- Kidney failure
- Lack of appetite
- Loss of consciousness
- Muscle or joint stiffness
- Panic attacks
- Restless legs
- Swelling of the brain
The negative behavioral aftereffects of these disruptions can last for many hours or several days after taking MDMA. “Suicide Tuesday,” for example, is a colloquial term that refers to a 24- to 48-hour period characterized by anorexia, lethargy, and dysphoria that many users experience after binging on MDMA and other substances over the weekend.
The Long-Term Effects of Ecstasy
There are studies that focus on how long-term use of ecstasy or MDMA can lead to serotonin toxicity, as the massive release of the neurotransmitter causes chemical damage to the cells that release it. The damage to the serotonin system, in turn, is being looked at as the cause of the following conditions among long-term MDMA users:9
- Decreased cognitive function
- Greater impulsivity and lack of self-control
- Impairment of visual and verbal memory
- Repeated panic attacks even after months of abstinence
- Recurrent paranoia, hallucinations, and psychotic episodes
- Severe depression
In addition, people who use ecstasy can also experience the following long-term effects days or weeks after their last dose of the drug:2
- Heart disease
- Sleep disturbances
As the use of the drug can promote trust and closeness, its use may also encourage people to engage in unsafe sexual behavior, increasing their risk of acquiring diseases such as HIV/AIDS or hepatitis.
Signs That a Person Has Overdosed on Ecstasy
Overdosing on ecstasy can be fatal, and dehydration and hyperthermia often play a significant role in these cases.10
People who have overdosed on MDMA exhibit the following symptoms and require immediate medical attention:3, 9
- A sharp increase in body temperature: This can be characterized by profuse sweating and lead to sodium imbalance, which can cause kidney failure or fatal swelling of the brain
- Hypertension and rapid heartbeat: These can increase the risk of ruptured blood vessels, internal hemorrhage, and heart failure
- Panic attacks
- Losing consciousness
It should be noted that people who suffer from the consequences of ecstasy use may go through depression, and those who are under the influence of the drug may engage in risky behaviors that increase the likelihood of their involvement in vehicular accidents.10
Symptoms of Ecstasy Addiction
Studies and clinical perspectives vary on how addictive ecstasy is, or if it is even addictive at all. While there are many users who claim to have been addicted to the drug, research on the subject is still lacking, and unfortunately, not as extensive as with many other illicit substances. Some studies indicate that while ecstasy is addictive, it is less so as compared to other drugs. However, that doesn’t mean that addiction to ecstasy is something that should be taken lightly.11
Medical professionals diagnose substance use disorders by checking a patient’s symptoms against the criteria described by the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). For ecstasy addiction, these include the following:12
- Using higher doses of ecstasy for longer than originally intended to produce the desired effects
- Having the urge to stop using ecstasy but not being able to do so
- Spending inordinate amounts of time to obtain or use ecstasy or recover from using it
- Craving for ecstasy
- Inability to manage responsibilities due to ecstasy use
- Continued use of ecstasy despite its negative consequences on one’s relationships
- Continued use of ecstasy even when it puts the person in danger
- Continued use of ecstasy even if it worsens psychological or physical problems
- Developing a tolerance to ecstasy or needing higher and higher doses to achieve the desired effects
- Developing withdrawal symptoms, which, when it comes to ecstasy, are usually not physical in nature.13
It’s important to note that addiction to a substance is not one and the same as being dependent on it. Addiction refers to the chronic and compulsive use of a drug despite its harmful effects. In comparison, dependence on a drug means that the body has adapted to the use of the substance, so much so that the person has developed a tolerance to the drug and that ceasing to use it abruptly can cause withdrawal symptoms. Often, physical dependence accompanies addiction.14
Symptoms of Ecstasy Withdrawal
There are a few studies that focus on ecstasy addiction or dependence, and these have had varying results. Some published literature indicate that significant physical symptoms are not characteristic of ecstasy withdrawal.13
More research needs to be done to determine the addictive potential of MDMA once and for all. What’s clear, however, is that using the substance affects the brain in the same way that other addictive substances do.11 As such, quitting MDMA can give rise to unpleasant symptoms, as the body often has a difficult time adjusting to the absence of the substance. This adjustment period can last anywhere from a week up to a month, and during this time, a person may experience the following symptoms of ecstasy withdrawal:6
- Anxiety and depression
- Aches and pains
- Cravings for the drug
- Restless sleep
- Trouble concentrating
Undergoing a detoxification program enables a person who has been taking ecstasy or MDMA to safely eliminate the drug from their system. This process is supervised by medical personnel who can offer interventions that are designed to address or reduce the discomfort brought about by the withdrawal symptoms. A person who is going through the detoxification program may be slowly weaned off the drug, and they may be provided with IV fluids, nutritional supplements, and symptomatic medications that will enable them to maintain their health and comfort during this challenging period.
Rehabilitation and Treatment of Ecstasy Addiction
As of now, there are no specific treatments for ecstasy or MDMA addiction, nor are there any medications that can treat an addiction to it. Instead, cognitive-behavioral interventions are recommended for those looking to kick the habit and to get clean. These programs are designed to change the way a patient thinks, as well as their behaviors and expectancies, so that they can develop better coping skills when dealing with stressors and triggers.14 To manage symptoms of depression often seen in former MDMA users, healthcare professionals may prescribe antidepressant medication.
Patients in the process of recovery typically have 2 options when it comes to their treatment programs: inpatient and outpatient care. These have their own sets of advantages.
- Inpatient ecstasy addiction treatment: Patients who are at risk of non-compliance to treatment protocols and those who have more severe symptoms are often recommended to undergo inpatient rehabilitation treatment. This program requires the patient to live in the rehabilitation facility and remain under the supervision of medical professionals who can provide them with the care and support they need throughout the treatment process. At the same time, living in a rehabilitation facility enables the patient to avoid triggers that may be present in their home or community.
- Outpatient ecstasy addiction treatment: Patients who have mild symptoms often go through outpatient treatment programs that grant them more freedom to resume their daily activities. They can continue living at home, but they have to attend regular treatment sessions at the facility that handles their rehabilitation.
Attending support group meetings for those in drug abuse recovery can also be helpful, especially when supplemented by the aforementioned behavioral interventions. Interacting with others who share the same experiences can be vital to keeping a former user accountable while supporting long-term freedom from drug use.
Call Now to Get the Treatment You Need
Dealing with an addiction problem can be one of the toughest challenges you’ll ever experience in your life. With the right kind of support, though, it can be overcome. If you or someone you know is addicted to ecstasy, you can find the help you need right now by getting in touch with a recovery support advisor from Better Addiction Care.
Call 1-800-429-7690 so we can provide you with personal assistance in verifying your insurance status or finding financing options for your treatment just in case you don’t currently have insurance coverage. We can also connect you with local treatment facilities that can provide you with a program that maximizes your chance of completing your journey to recovery.
The Origin and History of Ecstasy
First synthesized in 1913 by the German pharmaceutical company Merck & Co., 3,4-methylenedioxymethamphetamine was briefly marketed as a slimming aid before being produced as an appetite suppressant for German soldiers.15
In the early 1960s, biochemist Alexander Shulgin rediscovered MDMA by extracting the oils of mace and nutmeg. Soon after, scientists discovered its mood-altering properties and people began using it for its recreational and therapeutic qualities. By this time, psychotherapists had feared that MDMA would become a “street drug,” much like how LSD had become. They attempted to curtail the spread of information regarding MDMA and decided they had to wait until enough research was done before making the substance public. Meanwhile, MDMA advocates began restricting its prescription to medically supervised sessions and actively campaigned for its medical legitimacy.
In the late 1970s, MDMA rose to popularity as an effective pharmacotherapy during counseling sessions. Psychotherapists recognized that MDMA’s quick and positive effects on self-esteem, mood, and empathy were greatly beneficial in overcoming emotional boundaries. These same qualities made MDMA appealing as a recreational drug. The earliest illicit production and use of MDMA date back to the 1970s. MDMA was found to have a powerful synergistic relationship with up-tempo and electronic dance music. By the early 1980s, MDMA was becoming increasingly popular among club-goers across the country and eventually replaced cocaine as the drug of choice in the club scene.
- National Institute on Drug Abuse. (2017). What Is MDMA?. MDMA (Ecstasy) Abuse Research Report.
- National Institute on Drug Abuse. (2017). What Are MDMA’s Effects on the Brain?. MDMA (Ecstasy) Abuse Research Report.
- U.S. Drug Enforcement Administration. (2020). Drugs of Abuse, A DEA Resource Guide (2020 Edition).
- Mithoefer, M.C. et al. (2018). 3,4-Methylenedioxymethamphetamine (MDMA)-Assisted Psychotherapy for Post-Traumatic Stress Disorder in Military Veterans, Firefighters, and Police Officers: A Randomised, Double-Blind, Dose-Response, Phase 2 Clinical Trial. The Lancet Psychiatry.
- Wolfson, P.E. et. al. (2020). MDMA-Assisted Psychotherapy for Treatment of Anxiety and Other Psychological Distress Related to Life-Threatening Illnesses: A Randomized Pilot Study. Scientific Reports. Nature.
- Australian Alcohol and Drug Foundation. (2021). MDMA.
- Papaseit, E. et al. (2020). MDMA Interactions with Pharmaceuticals and Drugs of Abuse.
- Cohen, I. et al. (2021). Concomitant Drugs Associated with Increased Mortality for MDMA Users Reported in a Drug Safety Surveillance Database. Scientific Reports. Nature.
- Kalant, H. (2001). The Pharmacology and Toxicology of “Ecstasy” (MDMA) and Related Drugs. Canadian Medical Association Journal.
- National Institute on Drug Abuse. (2017). MDMA (Ecstasy) Abuse Research Report: What Are the Effects of MDMA?. MDMA (Ecstasy) Abuse Research Report.
- National Institute on Drug Abuse. (2017). Is MMDA Addictive?. MDMA (Ecstasy) Abuse Research Report.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
- Meyer, J.S. (2013). 3,4-methylenedioxymethamphetamine (MDMA): Current Perspectives. Substance Abuse and Rehabilitation.
- National Institute on Drug Abuse. (2017). Is There a Difference Between Physical Dependence and Addiction?. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
- Jenkins, J. P. (2020). Ecstasy. Encyclopedia Britannica.