MDMA — known as ecstasy or molly — is an illicit synthetic drug with both stimulant and hallucinogenic properties. It’s sold in tablet, powder, crystal, or liquid form.
The stimulating effects of a single dose tend to go away within six hours, but people can experience aftereffects for a few days or longer. MDMA can harm the body’s ability to regulate temperature, which can lead to serious health problems. Taking multiple doses of pure MDMA at once, or combining it with alcohol or other illegal or prescription drugs, makes it even less safe.
While there is not yet a consensus as to whether MDMA is addictive, using it may have negative consequences. A licensed medical professional can diagnose and help you recover from issues related to MDMA use. Recovery may involve cognitive behavioral therapy, attending group counseling, and finding safe alternative activities.
MDMA — also known as ecstasy or molly — is a psychostimulant drug with effects similar to both stimulants and hallucinogens. Often considered a party drug, MDMA is one of the most widely used psychostimulants in the world.
MDMA is not considered safe for recreational use. When taken alone or combined with alcohol or other substances, it can cause serious health problems and may lead to dependence.
Recovery from MDMA use disorder is possible.
MDMA, which is short for 3,4-methylenedioxy-methamphetamine, is a drug that is chemically similar to both stimulants and hallucinogens. MDMA can make people feel euphoria, increased alertness, emotional warmth, and sexual closeness. It can also distort people’s senses and generate unpleasant effects.
MDMA is sold on the street in colorful pills — often stamped with logos or shaped into amusing patterns. These tablets are swallowed or are crushed and snorted. MDMA is also distributed in powder, crystal, or liquid forms. Doses of MDMA are usually between 50 and 150 milligrams. Effects start after about 30 minutes and last up to six hours.
The molly or ecstasy sold on the street is rarely pure MDMA — and may even contain little or no MDMA. Illegally sold products might be tainted with dangerous or poisonous chemicals such as cocaine, methamphetamine, fentanyl, ketamine, or “bath salts” (synthetic cathinones, which are stimulant drugs related to the khat plant).
Taking MDMA can cause health problems and lead to dependence — especially if you take MDMA frequently, in higher doses, or with alcohol or other drugs. Even a regular dose of pure MDMA can harm the body’s ability to regulate temperature, which can cause organ failure and other serious problems.
More health problems tend to occur in people who take high doses of MDMA, which some experts say is anything above 150 milligrams. These problems may include elevations in blood pressure and body temperature. Taking multiple doses of pure MDMA at once, or combining it with alcohol or other illegal or prescription drugs, makes it even less safe. Microdosing — taking a smaller dose, around 20–40 milligrams — can also produce negative side effects, particularly when the microdose is repeated within a short time frame.
What are the differences between MDMA, molly, and ecstasy?
MDMA is short for 3,4-methylenedioxy-methamphetamine. Ecstasy and molly are common slang terms for the substance.
People sometimes think of molly as pure MDMA, but experts warn that illicit molly and ecstasy — whether in pill, powder, crystal, or liquid form — are often laced with other drugs, including fentanyl. Laced MDMA products can be more addictive and have more dangerous effects.
Experts trace the creation of MDMA to the early 1900s, when it was manufactured for use as a medicinal compound. Starting in the 1970s, it was briefly explored for use in psychiatry. Around the same time, people began taking MDMA recreationally. Now its use is widespread in the United States and around the globe. People often use MDMA to boost their energy and mood while attending clubs, concerts, and all-night dance parties (“raves”).
MDMA is not legal in the United States. However, MDMA is among several drugs being studied for their therapeutic properties for mental health conditions.
Can MDMA treat PTSD and other health conditions?
MDMA is being explored as a treatment for certain medical conditions, such as post-traumatic stress disorder (PTSD) and depression. Researchers are studying how drugs with psychedelic properties, including MDMA, can be used to treat mental health conditions.
Limited research shows that controlled doses of pure MDMA could help treat symptoms of PTSD, depression, and other mental health conditions; the social symptoms of autism spectrum disorder; and anxiety in patients with a terminal illness. In 2017, early proof of MDMA’s potential as a PTSD treatment led the U.S. Food and Drug Administration to grant it “breakthrough therapy” status, a designation that can speed drug development.
However, studies of MDMA’s therapeutic possibilities — and lasting physical effects — are limited due to its classification as a controlled substance. MDMA is still not considered safe for recreational use or approved for medical use.
MDMA primarily stimulates three brain chemicals (known as neurotransmitters):
Some research indicates that MDMA can damage brain cells, memory, and the ability to learn and feel pleasure. MDMA use can trigger depression, anxiety, and — in rare cases — psychosis. Experts have called for more studies on MDMA’s lasting effects on the brain.
A “normal” oral dose of pure MDMA — usually between 50 and 150 milligrams — can take effect within 30 minutes. The stimulating effects of a single dose tend to peak at 1 1/2 to two hours and go away within four hours, but aftereffects may last for a few days or longer.
People taking a “normal” dose of pure MDMA report feeling more positive and sociable, less aggressive, more emotionally in tune with other people, and more alert.
Those who use MDMA can also have nausea, sweats, or muscle cramps and can clench their teeth. Some people experience other negative effects for up to a week after taking MDMA; these include anxiety, irritability, sleep issues, and lower pleasure from and desire for sex.
People with MDMA-induced euphoria who dance or exert themselves in hot or confined areas, such as at a rave, club, or dance party, are at risk of experiencing heatstroke. Hyperthermia, a dangerous spike in body temperature, is one of the most common and serious side effects of MDMA use. Elevations in blood pressure can also occur. People may try to lessen these effects by taking time to cool off and drink fluids — ideally juice or drinks with electrolytes. However, dehydrated MDMA users who quench their thirst with too much water could experience a drop in blood sodium. This condition, called hyponatremia, can cause cramping, vomiting, and, in serious cases, brain damage.
In addition to harming the body’s ability to regulate temperature, MDMA can cause other adverse effects, and the risk of these effects increases at higher doses. At very high doses, MDMA can stress the heart, damage other organs, and, in rare cases, lead to death. And taking MDMA with alcohol or other drugs can lead to poisoning and death.
Pure MDMA is not considered as addictive as other illicit drugs such as cocaine, but some people can develop a dependence on the drug and have withdrawal symptoms when they stop using it. Withdrawal symptoms include fatigue, depression, impaired concentration, and loss of appetite.
Can you overdose on MDMA?
Using pure MDMA rarely leads to fatal overdoses. But the illicit form of the drug is not always “pure”: MDMA products are often laced with other dangerous chemicals, including fentanyl. MDMA poisoning more often occurs when the drug is taken with large amounts of alcohol or with other drugs, combinations that increase its toxicity and risk to health.
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CloseTo safety stop use of MDMA, seek out a licensed medical professional who can help you develop a treatment plan.
Therapy: Your provider may refer you to a cognitive behavioral therapist, who can help you avoid resuming use of MDMA. Your provider may also suggest group therapy, a 12-step or other support group, or a residential treatment program.
Medication: There is not yet an approved medicine to treat dependence on MDMA.
Holistic recovery: Other ways to promote your recovery could involve complementary and alternative activities such as acupuncture, meditation, spiritual or religious practices, yoga, and art or music therapy. Learn more about pathways to recovery.
Content reviewed by Jasleen Salwan, M.D., MPH, FASAM, August 2023.
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