MDMA is a common psychoactive recreational drug. It is often referred to as Molly or Ecstasy (E), and to a lesser extent, Mandy or Adam.
Last Update: August 4, 2020
MDMA (3,4-methylenedioxymethamphetamine), more commonly known by its street name, molly or ecstasy, causes stimulant and hallucinogenic effects. This synthetic drug was originally used to treat psychological problems. Although there is ongoing research on the viable use of this psychoactive drug, this is no longer used medically.
A ubiquitous substance in music festivals, raves, and nightclubs, MDMA usually takes the form of a tablet or a capsule. Traditionally, molly refers to the purer form of MDMA while ecstasy refers to a form of MDMA that’s mixed with other substances such as methamphetamine, ketamine, cocaine, caffeine, heroin, LSD (lysergic acid diethylamide), and PCP (Phencyclidine), which exacerbates the effects of MDMA.
The use of this substance produces an extraordinary burst of energy, a general feeling of emotional wellness, distortion of time perception, as well as sensory contortion. These effects are largely due to MDMA’s effects on these three key neurotransmitters in the brain:
Serotonin – This neurotransmitter is often referred to as the happy chemical since it produces a sense of happiness and well-being. It also plays a role in regulating other body functions like the internal body clock, cognition, emotion, appetite, bowel movement, and the body’s sleep cycle. People who take MDMA will experience a spike in serotonin, which causes them to feel euphoric, loving, empathetic, and highly sociable. Chronic use of MDMA would eventually lead to the depletion of serotonin in the brain.
Norepinephrine – This hormone also serves as a neurotransmitter. Its main function is to prime the body for action, particularly during dangerous or stressful situations. MDMA causes an increase in this hormone which triggers the release of glucose from the body’s energy stores, surge of blood flow to the muscles, as well as an increase of heart rate and blood pressure. People will feel energized, alert, and focused.
Dopamine – This hormone and neurotransmitter plays a key role in the body’s natural reward system and influences the way people think, plan, and find pleasure. An increase of this chemical in the brain will cause immense pleasure. The downside is that the prolonged increase of this chemical will also raise the threshold to get the same kind of pleasure. Eventually, users will have to take more of the substance to achieve the same level of high.
As with any drugs, MDMA has both short- and long-term effects on the body. People who take MDMA will feel its hallucinogenic and stimulant effects for 3-6 hours, which commences 30-45 minutes after taking the drug. MDMA can stay in the body for up to two hours and urine drug tests can detect traces of the substance for up to four days after last use. After flooding the brain with neurotransmitters, users will eventually experience a “crash” once MDMA leaves their system. This involves emotional withdrawal and feelings of depression due to the depletion of neurotransmitters.
When the euphoric feeling wanes, users usually take a second dose to prolong its effects. Once the effect of the drug fades, users may experience some of the following side effects:
Studies on animals have shown that repeated use of MDMA has an adverse long-term effect on the brain. Rodents exhibit damage to the nerve cells that contain serotonin after being administered twice a day with moderate to high dosage of MDMA for four days. Primates also exhibit the same damage even after 7 years from last use, indicating the long-lasting effects of the drug.
In humans, studies using PET (positron emission tomography) brain imaging have shown that people who have used MDMA exhibit lower activity in the regions of the brain that are involved in emotion, memory, and learning. There’s also decreased blood flow to the regions in the brain that control motor and sensory functions, behavioral learning, and processing of emotion.
In addition, chronic use of MDMA may lead to kidney and liver damage, as well as cardiovascular problems like hypertension, irregular heartbeat, and increased risk of heart attack or stroke.
Women who use MDMA during pregnancy may experience anorexia and elevated body temperature, which could be detrimental to the baby’s development. One study has shown that exposure to MDMA during pregnancy can lead to a delay in the child’s motor development up to two years of age. In addition, this substance may also cause premature birth and an increased risk of the baby developing cardiovascular issues or other disabilities.
One of the dangers of using ecstasy or molly is that aside from MDMA, these could also contain other unknown chemicals that could potentially harm the user as well as the developing fetus.
Aside from the use of other substances in combination with MDMA, these factors could contribute to the physiological effects observed in MDMA users:
Using MDMA does not automatically translate into addiction. There’s no conclusive research that shows just how addictive MDMA and its variants are. However, according to the National Institute on Drug Abuse (NIDA), MDMA affects the same part of the brain as other addictive substances. Additionally, studies on animals show that this drug could lead to addiction. But animals seem to seek MDMA less often than they do other addictive substances.
A survey found that as many as 43% of adolescent and young adult users of MDMA are drug dependent and as many as 34% of the respondents met the criteria for drug abuse. Here are tell-tale signs of MDMA addiction:
It should be noted that withdrawal can range from being unpleasant to downright deadly for the user. The intensity would largely depend on the length and frequency of drug use.
According to a survey done by the National Survey on Drug Use and Health in 2014, 17 million people, aged 12 years and up, have used MDMA at least once in their life. Nearly 7% of those surveyed, across different age groups (ages 12 years and up), have used ecstasy at least once in their life. Close to 1% of the same respondents have used ecstasy within the past year and 0.2% have used the drug within the past month. Young adults (ages 18-25) make up a large percentage of ecstasy users, with 12% of respondents reporting to having used the drug at least once in their life.
An analysis done on Monitoring the Future Survey (MTF) data on high school students shows that male students living in the city, with a weekly income, and reporting lifetime use of cigarettes, alcohol, and other illicit substances have greater odds of using MDMA.
In 2011, approximately 22,498 hospital emergency visits were MDMA-related. Almost 70% of these were male. The majority of these cases are due to negative interactions with other drugs especially with SSRI (selective serotonin reuptake inhibitor). SSRIs are antidepressant medications that can cause severe serotonin syndrome when taken in combination with ecstasy. While MDMA-related fatality is relatively low at 50 deaths per year on average, this can be due to the fact that deaths are not routinely reported as caused exclusively by ecstasy or molly.
Since MDMA addiction is most prevalent in adolescents and young adults, an inpatient program would be best to isolate him from bad influences that could impede his journey to recovery. An inpatient program is also very helpful for overcoming the initial “crash” that usually happens to people who regularly abuse MDMA due to the available medically-assisted detox program that can help patients safely cope with the symptoms. Withdrawal symptoms may include:
NIDA highly recommends cognitive behavioral therapy (CBT), a form of psychotherapy that helps people identify, understand, and modify destructive behaviors that may be due to their deep-seated personal issues. This therapy is instrumental in changing patients’ thinking and expectations, equipping them with the skills necessary to cope with life’s challenges.
In addition, engaging in a recovery support group and group therapy sessions with family members in attendance may also boost success in recovery.
Currently, there is no FDA-approved medication to treat MDMA use disorder, although some promising ones are under clinical trials. However, some medications may be used to help manage the symptoms. Also, since MDMA is rarely used alone, it’s important that other co-occurring disorders due to other substances are assessed and treated.
Generally, the “crash” may commence 12 hours after the last dose of MDMA, and withdrawal symptoms may peak after a few days and persist for weeks and even months. The duration would depend on several factors like the dose, length of time, and frequency of drug use. Other mitigating factors include gender, age, genetics, family history of drug use, levels of stress, and lack of family support. Co-occurring mental health and medical disorders may also influence the duration and intensity of the symptoms which can affect the detox program’s timeline.
Proper nutrition plays an important role in recovery. Most long-term MDMA users suffer from anorexia or loss of appetite leading to deficits in much-needed nutrients, which can help the body heal and recover. To correct this, a professionally-designed nutrition program is key to help hasten the patient’s recovery.
While detox is the initial step to recovery, the patient will have to undergo further a comprehensive treatment program that will provide them with all the tools they need to make better decisions and continue their journey to recovery and avoid relapse.