MDMA

3,4-Methyl​enedioxy​methamphetamine (MDMA), commonly known as ecstasy (E) or molly, is a primarily used for purposes., increased , , as well as . When taken by mouth, effects begin in 30 to 45 minutes and last 3 to 6 hours.

Adverse effects include , , , , , , and a . Following use people often feel and . , and in parts of the brain. It belongs to the and has and effects.

MDMA is illegal in most countries and, as of 2018, has no approved . Limited exceptions are sometimes made for research. (PTSD) with to look at effectiveness and safety expected to begin in 2018. granted MDMA a designation for PTSD, meaning that if studies show promise, a review for potential medical use could occur more quickly.[23]

MDMA was first developed in 1912 by . beginning in the 1970s and became popular as a street drug in the 1980s. MDMA is commonly associated with , , and . with other substances such as , , and . This was broadly similar to the percentage of people who use or , but lower than for or .

In general, MDMA users report feeling the onset of subjective effects within 30 to 60 minutes of oral consumption and reaching peak effect at 75 to 120 minutes, which then plateaus for about 3.5 hours.[28] The desired short-term psychoactive effects of MDMA have been reported to include:

The experience elicited by MDMA depends on the dose, setting, and user.[31]

MDMA has been described as an "empathogenic" drug because of its empathy-producing effects. Results of several studies show the effects of increased empathy with others. have been more mixed.[36]

Recreational

MDMA is often considered the drug of choice within the culture and is also used at clubs, festivals, and . with the drug. The psychedelic quality of MDMA offers multiple appealing aspects to users in the rave setting. Some users enjoy the feeling of mass communion from the inhibition-reducing effects of the drug, while others use it as party fuel because of the drug's stimulatory effects.

MDMA is sometimes taken in conjunction with other psychoactive drugs such as , , and , an act called "candy-flipping".[39]

Medical

As of 2017, MDMA has no accepted . A few psychotherapists continue to use MDMA in therapy despite the drug's legal status.

Other

Small doses of MDMA are used by some religious practitioners as an to enhance prayer or meditation. spiritual practices.[46]

Forms

MDMA has become widely known as ecstasy (shortened "E", "X", or "XTC"), usually referring to its tablet form, although this term may also include the presence of possible or diluents. The UK term "mandy" and the US term "molly" colloquially refer to MDMA in a crystalline powder form that is thought to be free of adulterants..

Partly due to the global supply shortage of —a problem largely assuaged by use of improved or alternative modern methods of synthesis—the purity of substances sold as molly have been found to vary widely. Some of these substances contain , , , , or any other of the group of compounds commonly known as , in addition to, or in place of, MDMA. Powdered MDMA ranges from pure MDMA to crushed tablets with 30–40% purity. Tablets sold as ecstasy sometimes contain (MDA), (MDEA), other amphetamine derivatives, caffeine, opiates, or painkillers. The proportion of seized ecstasy tablets with MDMA-like impurities has varied annually and by country.

MDMA is usually consumed by mouth. It is also sometimes .[14]

Ecstasy tablets which may contain MDMA

A salt of MDMA (typically white) with impurities, resulting in a tan discoloration

Crushed MDMA (1 gram) crystals

Short-term

Acute adverse effects are usually the result of high or multiple doses, although single dose toxicity can occur in susceptible individuals. and . Cases of life-threatening or fatal (excessively low sodium concentration in the blood) have developed in MDMA users attempting to prevent dehydration by consuming excessive amounts of water without replenishing .[51]

The immediate adverse effects of MDMA use can include:

Other adverse effects that may occur or persist for up to a week following cessation of moderate MDMA use include:

• [13]


• Loss of appetite[53]


• Insomnia[53]


• Tiredness or lethargy

As of 2015, the long-term effects of MDMA on human brain structure and function have not been fully determined. There is no evidence of structural or functional changes in MDMA users with only a moderate (<50 doses used and <100 tablets consumed) lifetime exposure. Nonetheless, MDMA in moderate use may still be . Long-term exposure to MDMA in humans has been shown to produce marked in , , , and serotonergic . Neurotoxic damage to serotonergic axon terminals has been shown to persist for more than two years. Adverse changes to brain and also occur in humans using low doses of MDMA. Reduced density in certain brain structures has also been noted in human MDMA users. Global reductions in gray matter volume, thinning of the parietal and orbitofrontal cortices, and decreased hippocampal activity have been observed in long term users. reduction.[61]

Impairments in multiple aspects of cognition, including attention, learning, memory, visual processing, and sleep have been found in regular MDMA users. The magnitude of these impairments is correlated with lifetime MDMA usage Several forms of memory are impaired by chronic ecstasy use; however, the effects for memory impairments in ecstasy users are generally small overall.

Serotonin depletion following MDMA use can cause depression in subsequent days. In some cases, depressive symptoms persist for longer periods. Depression is one of the main reasons for cessation of use.[3]

At high doses, MDMA induces a that, through several mechanisms, increases the permeability of the , thereby making the brain more susceptible to environmental toxins and .[] In addition, MDMA has effects in the and pro-inflammatory effects in the .[68]

During pregnancy

MDMA is a moderately (i.e., it is toxic to the fetus). exposure to MDMA is associated with a - and [72]

Reinforcement disorders

Approximately 60% of MDMA users experience symptoms when they stop taking MDMA. to some of the desired and adverse effects of MDMA is expected to occur with consistent MDMA use.

MDMA has been shown to induce in the ., the mechanisms by which it induces ΔFosB in the nucleus accumbens are analogous to other dopaminergic psychostimulants. Therefore, chronic use of MDMA at high doses can result in and that occur as a consequence of ΔFosB overexpression in the nucleus accumbens.

One study found approximately 15% of chronic MDMA users met the diagnostic criteria for .

There are currently no medications to treat MDMA addiction.[79]

Harm assessment

A 2007 UK study ranked MDMA 18th in harmfulness out of 20 recreational drugs. Rankings for each drug were based on the risk for acute physical harm, the propensity for physical and psychological dependency on the drug, and the negative familial and societal impacts of the drug. The authors did not evaluate or rate the negative impact of ecstasy on the cognitive health of ecstasy users (e.g. impaired memory and concentration).[69]

MDMA overdose symptoms vary widely due to the involvement of multiple organ systems. Some of the more overt overdose symptoms are listed in the table below. The number of instances of fatal MDMA intoxication is low relative to its usage rates. In most fatalities, MDMA was not the only drug involved. Acute toxicity is mainly caused by and effects. A scheme for management of acute MDMA toxicity has been published focusing on treatment of hyperthermia, hyponatraemia, serotonin syndrome, and multiple organ failure.[81]

A number of can occur between MDMA and other drugs, including drugs. MDMA also interacts with drugs which inhibit enzymes, like (Norvir), particularly inhibitors.. Severe overdose resulting in death has also been reported in people who took MDMA in combination with certain , such as (Nardil), (Parnate), or (Aurorix, Manerix).[88]