3,4-methylenedioxy-methamphetamine (MDMA) is a synthetic drug that alters mood and perception (awareness of surrounding objects and conditions). It is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception. It is in the drug class of Entactogens and is often called an "empathogen," referring to its ability to create feelings of warmth and empathy towards others. Common terms for MDMA include X, XTC, ecstasy, and "Molly." MDMA was initially popular in the nightclub scene and at all-night dance parties ("raves") but is now found in many communities.
MDMA is typically used in the form of pills or capsules. It may also be swallowed in liquid form or snorted (powder). The term "Molly" is slang for "molecular" or a pure, crystallized powder form of MDMA. Pill composition can range from 50 mg to 300 mg. MDMA is absorbed through the intestinal tract and drug typically reaches peak levels within the bloodstream in about an hour. The effects can last anywhere from three to six hours, depending on the dosage.
MDMA primarily works by increasing dopamine, norepinephrine, and serotonin levels in the brain. Increased dopamine results in the typical euphoric response and increased psychological energy/activity. Increases in norepinephrine cause physiological changes such as an increase in heart rate and blood pressure, which can be risk factors for users suffering from pre-existing heart and blood vessel problems. Research suggests that MDMA works primarily on serotonin levels, which might explain reactions such as emotional closeness and empathy while intoxicated, and the subsequent depressive symptoms that can result once the drug has been metabolized and serotonin levels drop.
MDMA can lead to unpleasant and even dangerous effects when used in large doses (3 to 4 times greater than the amount of a usual single dose of 80 mg). Unintended effects include teeth clenching, muscle cramping, nausea, chills, and blurred vision. High doses of MDMA can also lead to a large increase in body temperature. This, combined with dehydration, has been a leading cause of death of MDMA users. The Drug Abuse Warning Network (DAWN) reported 8,621 emergency room admissions for MDMA use in 2004.
Sometimes, pills, capsules, or powders sold or distributed as "ecstasy" or "Molly" actually contain other drugs. Other drugs that are often "cut with" MDMA include methamphetamine, dextromethorphan, ephedrine, pseudoephedrine, ketamine, and other hallucinogens. Users run the risk of hitting the threshold of toxicity and negative health consequences much more quickly if they are using MDMA cut with these other substances. In fact, a 2006 survey of results from DanceSafe (an organization that tests ecstasy pills at events) found that about 40% of the pills submitted for testing were entirely MDMA, a little over half contained at least some MDMA, and about half continued no MDMA at all. It is important to note that this survey contained more "fake pills" due to user suspicion that pills were fake and were sent in for testing.
Research results vary on whether MDMA is addictive. Research on animals shows that they will self-administer the drug, but to a lesser degree than other addictive substances such as cocaine or methamphetamine. Some users have reported withdrawal symptoms including depression (possibly due to serotonin depletion), loss of appetite, fatigue, and trouble with attention and concentration.
Kuhn, C., Swartzwelder, S., & Wilson, W. (2008) Buzzed: The Straight Facts about the Most Used and Abused Drugs from Alcohol to Ecstasy.