If you feel like ecstasy use is affecting your life or the life of a loved one, call our ecstasy helpline. We are here to discuss anything you may be struggling with. Our helpline is staffed 24 hours a day by friendly and knowledgeable advisors. Give us a call today and start your recovery process.

Substance Overview: Ecstasy

$20 to $30 per tablet
Annual deaths
Side effects
Hallucinations, psychosis, tremors, increase in body temperature
Also known as
Molly, E, XTC

History of MDMA/Ecstasy

MDMA (also called ecstasy) is an illegal drug that is used recreationally for its mood- and perception-altering effects. MDMA is short for methylenedioxymethamphetamine, a synthetic drug that was first patented in 1912 by a German pharmaceutical company. It is unclear what the drug was initially intended to treat, because it was never made commercially available. But the recreational use of MDMA began in the 1980s.

MDMA and ecstasy are often used interchangeably. MDMA is the primary ingredient in ecstasy, but other stimulants, amphetamines, or hallucinogenic drugs are commonly also added to ecstasy to create “rolls”. The most common street name for MDMA is Molly. Street names for ecstasy include X, XTC, X pills, E, double stacks, rolls, Holy Rollers, skittles, and candy.

By 1985, the recreational use of ecstasy had increased dramatically, leading the U.S. Drug Enforcement Administration (DEA) to schedule it as an illegal drug. MDMA was known mainly as a “club drug” because of its popularity in clubs, concerts, and “rave” parties. Over time, the drug has come to be used more widely, including in private homes and on college campuses. [1] [2]

While ecstasy has addictive properties, it is relatively uncommon for people to seek addiction treatment for this drug alone. Ecstasy addiction is much more common among poly-drug users. 

Interestingly, MDMA may soon no longer be a completely illegal drug. There is a a late-stage clinical trial underway through UC San Francisco to test the efficacy and safety of MDMA, in conjunction with psychotherapy, to treat people with severe-to-moderate PTSD. Early results from this the multi-site trial have found that in people suffering from moderate or severe PTSD, taking MDMA, along with psychotherapy sessions, increases the chances of recovery from trauma by twofold compared to placebo. These findings could mean that the illegal so-called party drug MDMA may become a powerful new tool in treating PTSD. [3] In July 2023, Australia became the first country in the world to make MDMA a prescription medicine.

MDMA/Ecstasy Effects

MDMA is typically ingested in pill or capsule form, but it is also occasionally available in powder form to be snorted. Some users take MDMA by “stacking” (taking three or more tablets together) or by “piggy-backing” (taking multiple tablets in quick succession to intensify the effects). It takes about 15 minutes for the effects of MDMA to become apparent. The drug reaches peak concentration in the blood after about 2 hours. The effects of MDMA last 3–6 hours and they can be intensified by combining it with other substances such as marijuana, alcohol, or stimulants. MDMA is eliminated from the body mainly by the liver. It takes the body up to 40 hours to clear ecstasy completely from the system. 

Once ingested, the drug causes feelings of euphoria, increased sensitivity to stimuli, intensified sensations, increased energy, and feelings of being close and emotionally connected with others. 

Because of its unique effect on emotions, MDMA is sometimes labelled as an empathogen, or a drug that increases emotional empathy. MDMA is also widely believed to increase sexual desire and pleasure and is commonly used to intensify sexual experiences.

MDMA produces these effects by increasing the availability of three neurotransmitters (natural chemicals) in the brain: dopamine, serotonin, and norepinephrine. These brain chemicals are closely linked to the regulation of pleasure, rewards, emotions, and wakefulness. Therefore, increased levels of these chemicals lead to the intense effects that MDMA typically causes in users.

The release of serotonin (5-HT) explains the mood-enhancing effects of ecstasy, while the release of norepinephrine increases energy. [4] Ecstasy and MDMA also increase dopamine levels, a chemical that regulates the brain’s reward system and reinforces drug-seeking behaviors. [5] Ecstasy’s primary effects, however, are on serotonin.

Serotonin, also called the happy chemical, has a wide range of functions in the body, including regulation of mood, appetite, sleep, and feelings of happiness and wellbeing. The massive boost in serotonin activity caused by MDMA generates feelings of intense pleasure, emotional wellbeing, and elevated mood. 

MDMA causes the brain to release large amounts of these brain chemicals. Once the levels of these chemicals come back to normal, there is a “crash” that is typically experienced the following day, as a result of the chemicals being depleted. An ecstasy crash can cause symptoms such as depression, paranoia, irritability, fatigue, headaches, and inability to focus, with the symptoms persisting for several days after drug use.

The depletion of brain chemicals following ecstasy use and the resulting crash may explain why ecstasy addiction is fairly uncommon. Regular use of the drug results in tolerance, whereby the drug becomes less effective over time. Also, the debilitating nature of the crash deters many users from regular use.

Unfortunately, it is fairly common for drugs being sold as MDMA or ecstasy to be adulterated with other substances, creating additional dangers for users. There is an increase in the number of inexperienced recreational ecstasy takers in the US. Combined with the stricter drug policies in the country, this makes it more challenging for drug manufacturer’s to import the right chemicals to make real MDMA. Restrictions also make it harder for venues and drug user advocacy groups to implement drug testing and other harm reduction measures.

The lack of an easily available test to verify the authenticity and purity of MDMA increases the likelihood of a drug user ingesting potentially toxic substances and suffering severe adverse effects, including a fatal overdose. On chemical testing of MDMA seized by law enforcement agencies in the US, common adulterants identified have included bath salts, over-the-counter cough medicines, cocaine, ketamine, PMA, and amphetamines. [6] Additionally, there are reports that purity of molly or ecstasy sold in the United States is dangerously poor compared to Europe. Testing has shown that anywhere from 30 to 60% of what is sold as MDMA in the US is not MDMA. DrugsData, a public drug testing program, found 111 different substances in over 500 ecstasy samples tested. [7]

ecstasy use

MDMA/Ecstasy Availability in the United States

Since the early 2000s, Asian drug-trafficking organizations have increased the availability of MDMA in the United States. The drug is produced in large quantities in Canada and smuggled across the northern border. [8] A second, albeit smaller, route is along the southwest border through commercial air transport.

State and local law enforcement agencies reported increased availability of MDMA in their areas between 2005 and 2009. Between 2005 and 2008, the National Forensic Laboratory Information System reported a 76% increase in MDMA drug evidence submissions (samples submitted to laboratories for analysis). Data shows that MDMA seizures along the US–Canada border increased by 156% and peaked in 2008. Although seizures declined in 2009, they remained higher than 2007 levels. Most seizures occur at ports of entry, but seizures between ports of entry also increased as smugglers developed new routes and methods of bringing ecstasy into the United States.

More recently, in 2022, MDMA was among the top 25 most frequently identified drugs submitted to laboratories, with over 3,000 samples submitted to the National Forensic Laboratory Information System (NFLIS). [9]

MDMA is also commonly sold on the dark web, a hidden part of the internet that people use for a range of illegal activities. It is shipped to users with disguised “stealth” packaging techniques. This was earlier considered a relatively safer method of obtaining the drug because the dark web tended to be a source of purer MDMA with lower legal risks, but this is no longer the case.

In recent years, there have been increased instances of interception of illicit drugs sold on the dark web and a number of high-profile drug busts by law enforcement agencies, including the infamous 2013 bust of the Silk Road marketplace. This has caused instability in the dark web markets, affecting a reliable source of MDMA that buyers once depended on to ensure they were purchasing authentic and pure drugs.

What Does MDMA/Ecstasy Look Like?

In its original form, MDMA is a crystalline powder substance. On the street, MDMA is typically sold as a single-dose tablet, pill, or capsule, which is swallowed by mouth. Ecstasy tablets are very professional looking and are available in a range of colors and shapes. It is common for the tablets to be imprinted with a logo, such as a smiley face, cartoon character, butterfly, or commercial logo like Nike. Some of these different designs have come to represent specific formulations of MDMA.

The typical dose in a single MDMA tablet for recreational use is 50 mg to 150 mg, but this can vary by up to 70-fold in different batches. [10] Besides the tablet form, it is also available in powder form. People will sometimes snort ecstasy powder or dissolve it in liquid and swallow it. 

Who Uses MDMA/Ecstasy?

Ecstasy first became popular with mostly White people at all-night rave parties, concerts, and music festivals, where people would use 1–2 tablets to postpone fatigue and dance energetically for hours. The drug was also commonly used by celebrities, including rappers, rockstars, and other musicians, increasing its appeal to young people who were easily influenced by pop culture.

For the most part, ecstasy remains popular as a club drug. It is used at late-night dance parties attended mostly by young people between the ages of 18 and 29 years old. One survey in New York City revealed that 70% of club-going young adults in this age group reported lifetime illicit drug use and 22% reported recent use of a club drug. Ecstasy was the main club drug used, followed by cocaine, LSD, ketamine, crystal meth, and GHB. [11] This is despite the fact that the average cost of ecstasy is $20–$30 per pill, making it more expensive than many other illicit drugs.

MDMA/Ecstasy Addiction and Abuse Statistics

  • In 2022, approximately 22 million people (7.8% of the population above 12 years of age) reported using ecstasy at least once in their lifetime. In addition, 0.7% reported past-year use and 0.1% reported past-month use of ecstasy. [12]
  • According to the 2022 Monitoring the Future Survey, 0.6% of 8th graders, 0.7% of 10th graders, and 1.4% of 12th graders reported past-year use of ecstasy. [13]
  • Since the early 2000s, MDMA use has spread among populations outside the nightclub scene. Ecstasy use is highest among males between the ages of 18 and 25 years. Use typically starts at around age 21. 
  • Sexual orientation also influences MDMA use. Gay or bisexual men and women are more likely to report past-month use of MDMA compared to their heterosexual counterparts and to suffer more harm from MDMA use
  • In 2020, there were over 3,200 MDMA-related emergency room visits. [14]
  • Data on MDMA-related deaths is unfortunately lacking. Deaths related to MDMA alone do occur, but they are far rarer than those related to other illegal drugs, such as opioids or cocaine. There is no reliable data on MDMA overdose deaths because many deaths are labelled ‘drug-involved’ and are due to multiple drugs in the system, making it difficult to ascertain the lethal effects of MDMA.

Recognizing Ecstasy Addiction

While ecstasy addiction is relatively uncommon, it does sometimes occur, especially as a component of a larger drug problem. Drugs affect each individual differently, and the signs and symptoms of MDMA addiction can vary from person to person. What’s more, many MDMA users are good at concealing their addiction and deny it when confronted.

Like all drugs, MDMA causes distinct changes in the way a person thinks, feels, and behaves. While each person’s response to the drug may be slightly different, some general signs of MDMA addiction include:

  • Dramatic peaks and crashes in energy
  • Disrupted or irregular sleeping and eating patterns
  • Changes in routine, including neglecting responsibilities
  • Inability to get up and function after a night out
  • Dramatic mood swings, including sadness, euphoria, and irritability
  • Becoming defensive or evasive when confronted or asked about drug use
  • Irresponsible spending patterns or an unexplained money problems
  • Increased sensitivity to touch, taste, smell, or sound
  • Impulsiveness or reckless decision-making
  • Teeth-clenching or tense muscles
  • Change in social circles, associating with new people
  • Lack of follow-through or response at attempts to contact
  • Noticeable change in weight or physical appearance
  • Finding unidentified pills, powders, or other suspicious substances

If you or someone you care about is abusing a drug like MDMA, it is important to seek professional help. With treatment, many people struggling with drug abuse and addiction can make a full recovery.

MDMA/Ecstasy and Poly-Drug Use

There is a very high chance of people who use ecstasy also using other intoxicating substances. Such individuals are called poly-drug users. They are at a significantly increased risk of health complications, overdose, and death from drug abuse.

A study published in the Journal of American College Health showed that 9% of university students had used MDMA in their lifetime. More interestingly, however, 98% of ecstasy users had also used marijuana. Ecstasy users were found to be up to three times more likely to have used inhalants, LSD, cocaine, and heroin in the past year compared to marijuana users. [15]

MDMA/Ecstasy Overdose

In addition to a range of negative health effects, it is possible to overdose and die from MDMA (ecstasy) use. MDMA affects the body’s ability to regulate temperature, especially in hot environments and when a person is exerting, such as at a concert or dance party. Therefore, although rare, ecstasy use can lead to hyperthermia (a sharp rise in body temperature), causing liver, kidney, and heart failure, and even death.

A significant number of MDMA toxicity reports mention jaundice, indicating liver damage. The explanations for this finding may be an allergic reaction to contaminants in MDMA or the result of high body temperature. However, the most common explanation for liver damage in MDMA toxicity is that the drug is metabolized (broken down) in the liver. Many people spontaneously recover from ecstasy toxicity over a period of weeks to months. However, long-term ecstasy users can experience repeated attacks of hepatitis (liver inflammation). Some studies have suggested that ecstasy is the second-most common cause of liver injury in people under the age of 25.

Besides the liver, ecstasy also has toxic effects on the cardiovascular system. The noradrenaline released by ecstasy intake can cause serious adverse effects such as high blood pressure, fast heartbeat, and disturbances in cardiac rhythm. The increased workload on the heart can result in heart failure and potentially even death.

Additional Dangers of Ecstasy Addiction

In addition to the serious health effects of MDMA abuse, ecstasy users are at risk of injury, illness, and death from accidents. There have been reports of deaths due to depression caused by an ecstasy crash that was severe enough to cause suicide. There have also been reported deaths due to bizarre risky behaviors and motor vehicle or pedestrian accidents under the influence of ecstasy.

Treatment Options for Ecstasy Addiction

There are no specific medications that can be used to treat ecstasy addiction. MDMA abuse and addiction are usually treated with behavioral therapies and other standard addiction treatment modalities. Seeking professional treatment for ecstasy abuse is critical. As mentioned, ecstasy use can lead to a variety of serious and potentially fatal health effects. The majority of MDMA users are adolescents and young adults. Parents, guardians, and physicians should therefore be especially alert to the signs of ecstasy addiction in this population. If you or someone you know is struggling with ecstasy abuse and addiction, you are encouraged to speak to a trusted adult, family member, friend, or healthcare provider to get help.

How to Find the Right Ecstasy Recovery Program

If you have been abusing ecstasy, seeking treatment is an important step in regaining control of your life. The best way to ensure a positive recovery journey is to find an ecstasy rehabilitation facility that meets your specific needs. Every drug user is different and the treatment plan should reflect this. In other words, facilities that take a cookie-cutter approach to addiction recovery are not as helpful as those that work with you to develop an individualized treatment plan.

The first thing to decide is whether you would benefit from a residential or outpatient recovery facility. Residential (inpatient) addiction treatment involves living at a treatment center for a defined time period, typically ranging between 30 and 90 days. A residential rehab facility provides a controlled environment that greatly benefits many recovering addicts, making it easier for them to concentrate on treatment, without the presence of drugs or triggers. Other treatment options include outpatient rehabilitation, individual counseling, group counseling, and support groups like Narcotics Anonymous.

If you decide to attend a residential program, there may be multiple treatment programs in your area. Some common program options include:

  • Hospital-based programs, which are usually located on a single floor or wing of the hospital building
  • Mental health facilities that also treat chemical dependencies
  • Standalone recovery centers that specialize in treating addictions to one or more drugs

Selecting a program can be overwhelming, especially if you are in the midst of a personal crisis. Speaking with someone about your desire for recovery is important. An honest conversation can be the important first step to accessing proper treatment. If you need help in selecting an ecstasy rehab program nearby, please call our ecstasy helpline today.

Questions to Ask About Each Program

When you call our ecstasy hotline, don’t be afraid to ask any questions that are on your mind, including comparing potential rehabilitation programs near you. To help you zero in on the best ecstasy rehab program, some questions that you may want to ask include:

  • What type of counseling options are provided?
  • Does the program have 24-hour medical staff to deal with withdrawal issues?
  • Are medications used as part of the treatment process?
  • Will the facility allow family to visit or be involved in treatment?
  • Will the staff include me in treatment planning?
  • What types of aftercare does the facility support or advocate?
  • Does the facility accept my insurance?
  • What types of financial arrangements or assistance are available to help cover patients’ out-of-pocket expenses?

Sources for Recovery Information

Education about drug abuse and addiction is an important aspect of staying sober. Therefore, finding sources of information and resources in your area is an excellent first step. Entering a drug recovery program can be a frightening and overwhelming experience, especially before you have had a chance to explore your options. Some places that might help include:

  • Addiction support groups like Narcotics Anonymous or SMART recovery
  • Your primary care physician, who may be able to provide treatment referral options
  • A licensed addiction counselor
  • Addiction treatment facilities (outpatient and inpatient)
  • Ecstasy helpline phone numbers

Whether you are an occasional ecstasy user or someone who cannot go a single day without drugs, help is at hand. As you may be aware, consuming illegal drugs such as ecstasy can have a terrible impact on almost every aspect of your life. Take the first step toward a more positive, fulfilling life by calling our ecstasy hotline today.

Last updated: March 14, 2024

Hailey Shafir, M.Ed., LCMHCS, LCAS, CCS

Hailey Shafir is a licensed addiction specialist and mental health counselor. She graduated from North Carolina State University with a master of education in clinical mental health counseling in 2012, and has developed deep expertise in the areas of mental health, behavioral addictions and substance abuse. She is passionate about using this knowledge to raise awareness, provide clear and accurate information, and to improve the quality of treatment for these disorders.

Hailey is an LCMHCS (license number: S9539) under the North Carolina Board of Mental Health Counselors, and an LCAS (ID: LCAS-21333) and CSS (ID: CCS-20721) under the North Carolina Addictions Specialist Professional Practice Board.


1 The United States Department of Justice. MDMA (Ecstasy) Fast Facts. Available online. Accessed on March 14, 2024.
2, 4 Hum Psychopharmacol. 2001;16(8):557-577. doi:10.1002/hup.351.  Parrott AC. Human psychopharmacology of Ecstasy (MDMA): a review of 15 years of empirical research. Available online. Accessed on March 14, 2024.
3 Nature Medicine. MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Available online. Accessed on March 14, 2024.
5 Addiction. 2006;101(9):1241-1245. doi:10.1111/j.1360-0443.2006.01511.x Freudenmann RW, Oxler F, Bernschneider-Reif S. The origin of MDMA (ecstasy) revisited: the true story reconstructed from the original documents. Available online. Accessed on March 14, 2024.
6 National Institute on Drug Abuse. MDMA (Ecstasy/Molly) Drug Facts. Available online. Accessed on March 14, 2024.
7 DrugsData. Anonymous Drug Analysis Program. Available online. Accessed on March 14, 2024.
8 The United States Department of Justice. Drug Availability Within the United States. MDMA Availability. Available online. Accessed on March 14, 2024.
9 National Forensic Laboratory Information System. 2022 Annual Report. Available online. Accessed on March 14, 2024.
10 CMAJ. 2001;165(7):917-928. Kalant H. The pharmacology and toxicology of “ecstasy” (MDMA) and related drugs. Available online. Accessed on March 14, 2024.
11 JURH 83, 884 (2006). https://doi.org/10.1007/s11524-006-9057-2 Kelly, B.C., Parsons, J.T. & Wells, B.E. Prevalence and Predictors of Club Drug Use among Club-Going Young Adults in New York City. Available online. Accessed on March 14, 2024.
12 The Substance Abuse and Mental Health Services Administration. Results from the 2022 National Survey on Drug Use and Health: Summary of National Findings. Available online. Accessed on March 14, 2024.
13 National Institute on Drug Use. What is the scope of MDMA use in the United States? Available online. Accessed on March 14. 2024.
14 SAMHSA. Treatment Episode Data Set 2020. Available online. Accessed on March 14, 2022.
15 J Am Coll Health. 2006;55(2):99-104. doi:10.3200/JACH.55.2.99-104 Wish ED, Fitzelle DB, O’Grady KE, Hsu MH, Arria AM. Evidence for significant polydrug use among ecstasy-using college students. Available online. Accessed on March 14, 2024.