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Substance Overview: Ecstasy

Legality

Illegal

Cost

$20 to $30 per tablet

Annual deaths

50

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 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 as it was never made commercially available, but it began to be recreationally abused in the 1980’s.

By 1985, when Ecstasy was scheduled as an illegal drug by the DEA, its recreational use had increased dramatically. 1While ecstasy has addictive properties, it is relatively uncommon for a person to seek treatment for ecstasy addiction alone, and is much more common among poly drug users. MDMA was once known mainly as a “club drug” because of its popular use in clubs, concerts and “rave” parties. Today, the drug is used more broadly, including in private homes and college campuses. 2

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

MDMA/Ecstasy Effects

MDMA is usually ingested in pill or capsule form but is occasionally available in powder form where it can be snorted. It takes about 15 minutes for the effects to become apparent. The drug reaches peak concentration in the blood after about 2 hours. It is removed from the body mainly by the liver. However, it can take up to 40 hours for Ecstasy to be cleared completely from the body.

Once ingested, the drug causes feelings of euphoria, increased sensitivity to touch, intensified senses, increased energy, and feelings of being close and emotionally connected with others. The effects of MDMA last 3-6 hours, and can be intensified with other drugs like marijuana, alcohol, or stimulants.

Because of its unique effect on emotions, MDMA is sometimes labeled 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 works by causing an increase in three chemicals in the brain: dopamine, serotonin and norepinephrine. These brain chemicals are closely related to pleasure, emotions, and feelings of wakefulness, helping to explain the effects MDMA has on users.

The release of serotonin (5-HT) helps to explain the mood-enhancing effects of ecstasy, while the release of norepinephrine increases feelings of energy. 3Ecstasy and MDMA also increase the levels of dopamine which acts on the brain’s reward system and reinforces drug-seeking behaviors.4 Ecstasy’s primary effects, however, are on the chemical serotonin.

Serotonin, which is also called the happy chemical, has a wide range of functions in the body, including 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. 

Because MDMA causes the brain to release large amounts of these brain chemicals, there is a crash that is commonly experienced the following day which is the result of these chemicals being depleted. The ecstasy crash can include depression, paranoia, irritability, fatigue, headaches, and unable to focus and these symptoms can persist for several days after use.

The depletion of brain chemicals following ecstasy use and the resulting crash may help to explain why ecstasy addiction is fairly uncommon. It is likely that regular use of the drug would result in a tolerance build-up or the drug becoming completely ineffective. Also, the debilitating nature of the crash could deter users from regular use.

 Unfortunately, it is fairly common that drugs being sold as MDMA or ecstasy have been adulterated with other substances, creating additional dangers to users. The inability to test and verify the authenticity and drug purity of MDMA makes it more likely that a person will ingest a potentially toxic substance which could lead to adverse effects or even overdose. In chemical testing of MDMA seized by the police, common adulterants included bath salts, over-the-counter cough medicines, cocaine, ketamine, PMA and amphetamines. 5

MDMA/Ecstasy Availability in the United States

Since 2005, Asian drug trafficking organizations have led to an increase in MDMA availability in the United States. The drug is produced in large quantities in Canada and smuggled across the Northern border. 6A 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 U.S.-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 have been increasing as smugglers develop new routes and methods of bringing Ecstasy into the United States.

MDMA is also commonly purchased on the dark web, a hidden portion of the internet that many use for a range of illegal activities. MDMA is sold on dark web sites and shipped to users using disguised “stealth” packaging techniques. While this was once a safer method of obtaining the drug because drugs on the dark web tended to be more pure and legal risks were low, this is no longer the case.

In recent years, there have been increased instances of legal interception of illicit drugs sold on the dark web and a number of high profile drug busts, including the infamous 2013 bust of the Silk Road marketplace. This has caused instability in dark web markets, decreasing the reliability buyers once depended on to ensure they were purchasing authentic and pure drugs.

What does MDMA/Ecstasy Look Like?

MDMA is usually 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.  7 Besides the tablet form, people who use Ecstasy sometimes snort it in powder form or swallow it in liquid form. In its original form, MDMA is a crystalline powder substance.

Who Uses MDMA/Ecstasy?

Ecstasy first became popular with mostly Caucasian users at all-night rave parties, concerts, and music festivals, where people used 1-2 tablets to postpone fatigue and dance energetically for hours. The drug is also commonly used by celebrities, including rappers and other music performers, increasing its appeal to young people influenced by pop culture.

For the most part, Ecstasy remains popular as a club drug. It is used at nighttime dance parties attended by young people between 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 club drug. 8 The average cost of the drug ranges between $20-30 per pill, making it more expensive than many other illicit drugs.

MDMA/Ecstasy Addiction and Abuse Statistics

  • In 2013, more than 750,000 people in the United States initiated the use of Ecstasy (used it for the first time). However, this number was lower than in 2009 when 1.1 million had tried MDMA for the first time. Nearly 70% of recent Ecstasy initiates in 2013 were aged 18 or older at the time of first Ecstasy use. 9
  • According to a 2014 national drug use survey, more than 17 million people in the U.S. reported MDMA use at least once in their lifetimes. This was a significant increase from 11 million a decade ago.
  • The NSDUH survey also found that 660,000 people reported past-month use of Ecstasy, compared to 450,000 in 2004.
  • More than 10% of seniors in high school report trying MDMA on at least one occasion. More than 2% report using Ecstasy within the past 30 days.
  • In 2016, a survey of adolescent drug use found that 2.7% of 12th graders and 1.8% of 10th graders had past-year use of MDMA.
  • Ecstasy use is higher among males and those living in cities. Teenagers who receive a weekly income or have a history of using other illicit substances also tend to have higher MDMA use.
  • In 2011, there were nearly 22,500 drug-related emergency department visits that mentioned MDMA (Ecstasy was involved in about 1.8% of all drug-related ED visits).The majority of patients were between 18 and 20 years old.

Harmful Health Effects of MDMA/Ecstasy

People use Ecstasy to experience intense elation, energy, wakefulness, sexual arousal, and postponement of sleepiness and fatigue. However, in addition to these desired effects, the drug can have serious adverse effects, which can sometimes prove fatal. Long-term or more regular use heightens the risk of these adverse effects. Some of the harmful effects of Ecstasy include: 10

Psychological Effects

  • Confusion and impaired judgment
  • Anxiety and depression
  • Paranoia
  • Hallucinations
  • Agitation
  • Bizarre or reckless behavior
  • Panic attacks
  • Delirium
  • Psychosis
  • Mood swings, irritability
  • Fatigue and trouble focusing

Physical Symptoms

  • Trouble sleeping
  • Increase in body temperature
  • Muscle tension and cramping
  • Involuntary clenching of teeth
  • Tremors
  • Blurred vision
  • Dry mouth
  • Headache
  • Nausea
  • Rapid eye movements
  • Restless leg movements
  • Sweating
  • Chills

People with heart disease or circulation problems are at a particularly high risk of health complications from Ecstasy because it can increase blood pressure, heart rate, and workload on the heart.

It is worth noting that people who abuse MDMA can experience hyperthermia (very high body temperature) and dehydration, leading to kidney and heart failure. The risk is especially high when the drug is used in a hot place with exertion, such as dancing for hours at a crowded party.

Deaths

Each year there are around 50 deaths involving Ecstasy, and around 10 cases where it is the only drug to blame for the event. The cause of death is almost always either hyperthermia (too high temperature) or hyponatremia (low sodium levels). The latter can be caused by drinking too much water.  11

Long-Term MDMA/Ecstasy Use

Long term MDMA use can result in undesirable adverse effects like irritability, aggression, impulsiveness, sleep problems, anxiety, depression, memory problems, decreased appetite, and decreased interest in sex.

MDMA promotes feelings of emotional closeness. When it is used, especially in combination with the erectile dysfunction drug Viagra (sildenafil), Ecstasy can lead to unsafe sexual encounters. This puts Ecstasy users at risk of contracting infections like HIV/AIDS and hepatitis.

Occasionally, something called serotonin syndrome can occur, which can prove fatal. In the days following Ecstasy use, 4 out of 5 users report rebound lethargy and depression during the “crash”. This is due to a depletion (falling levels) of serotonin in the brain. Regular users may escalate the dose to avoid these effects.

Repeated doses of Ecstasy are neurotoxic and can cause permanent damage in the brain. Regular Ecstasy users may, therefore, experience problems with learning and memory, difficulty with higher cognition, changes in sleep and appetite, and loss of interest in sex. The destruction of brain cells can be permanent and may last well after heavy recreational use of Ecstasy has stopped. 12

Is MDMA Addictive?

There are varying theories about the addictive potential of MDMA (Ecstasy). Experiments in animals indicate that subjects will self-administer the drug. This is an important indicator in the laboratory of a drug’s potential for abuse. It is also worth noting that MDMA targets the same brain chemistry as other drugs deemed highly addictive. But it is widely regarded that Ecstasy is less addictive than some other Schedule I drugs like cocaine.

Studies show that the continued use of Ecstasy, despite physical and psychological problems, occurs in more than 85% of users.13 Other studies have shown that more than 40% of Ecstasy users meet the criteria for dependence and more than 30% meet the criteria for abuse. 14

Ecstasy is considered addictive because nearly 70% of users experience unpleasant withdrawal symptoms when they stop using the drug after regular use.15 Withdrawal symptoms typically start about 12 hours after the last dose and are intense for the first few days. Some of the withdrawal symptoms of Ecstasy include:

  • Fatigue
  • Depression
  • Appetite loss
  • Problems with concentrating

On the other hand, studies have also shown that many Ecstasy users do not report high levels of craving for the drug. 15 Ecstasy users may not experience intense cravings when the drug contains additives and users do not always know precisely what “Ecstasy” contains when they take it. Therefore, any craving they experience could the result of mixed drugs. In other words, some additives like amphetamines are more addictive than Ecstasy, and cravings for the adulterant may be stronger than cravings for MDMA.

Recognizing Ecstasy Addiction

While ecstasy addiction is relatively uncommon, it sometimes occurs, especially as a component of a larger drug problem. Drugs affect everyone differently and the signs and symptoms of addiction can vary from person to person. What’s more, users are often good at concealing addiction and will deny it when confronted.

Like all drugs, MDMA causes distinct changes in the way a person thinks, feels and behaves. While each person may be slightly different in how they are affected by a drug, some general signs of addiction include:

  • Dramatic peaks and crashes in energy
  • Disrupted or irregular sleep or eating patterns
  • Changes or neglect of normal routines and activities
  • 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 drugs
  • Irresponsible spending patterns or an unexplained inability to pay bills
  • Increased response 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 to contact attempts
  • Noticeable change in weight or physical appearance
  • Finding unidentified pills, powders or other suspicious substances

If you or someone you care about is abusing drugs 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

People who use Ecstasy have a very high chance of regularly using other intoxicating substances. Such individuals, called polydrug users, are at 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 use inhalants, LSD, cocaine, and heroin in the past year compared to marijuana users. 16

MDMA/Ecstasy Overdose

It is possible to overdose and die from MDMA (Ecstasy) use. MDMA affects the body’s ability to regulate temperature, especially in hot environments where a person is exerting, such as a concert or dance party. Therefore, in rare instances, Ecstasy use can lead to hyperthermia (a sharp rise in body temperature), causing liver, kidney, and heart failure, even death.

A high percentage of MDMA toxicity reports mention jaundice, indicating liver damage.18 The explanations for this finding include 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 several 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 of 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 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 Ecstasy 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. Ecstasy can lead to a variety of serious and potentially fatal health effects. The majority of users are adolescents and young adults. Parents, guardians, and physicians should be especially alert to the signs of Ecstasy addiction in this population group. 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?

Seeking treatment is an important step in taking control of your life. The best way to ensure a more positive recovery process is to find an ecstasy rehabilitation facility that meets your specific needs. Not every case is the same, so facilities that take a cookie-cutter approach to addiction recovery are not as helpful as those that work with you to develop an individual treatment plan.

First, decide whether you would benefit from a residential or outpatient recovery facility. This involves living at a treatment center for a defined time period, often between 30 and 90 days. A residential facility provides a controlled environment that may benefit some individuals, making it easier to concentrate on treatment, because drugs and triggers are not present. 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 choices in your area. Some common program options include:

  • Hospital-based programs, which are usually located on a single floor or in a wing of the 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 lead to proper treatment. If you need help selecting a rehab program, please call our ecstasy helpline today.

Questions to Ask About Each Program

Don’t be afraid to ask questions about potential rehabilitation programs. Some questions that you may want to ask include:

  • What type of counseling options is 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 you in treatment planning?
  • What types of aftercare do the facility support or advocate?
  • Does the facility accept your 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 a key tool in staying sober, so finding sources of information in your area is a good first step. Entering a drug recovery program can be a frightening experience, especially before you explore your options. Education about drug abuse and addiction is a key tool in staying sober, so finding sources of information in your area is a good first step. Some places to turn to 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 user or someone who cannot go a single day without drugs, handling and consuming illegal substances can have a negative impact on almost every area of your life. Make the first step toward a more positive life by calling our ecstasy hotline today.

Last updated: September 14, 2020

About the author

Hailey Shafir
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.

References

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  2. The United States Department of Justice. MDMA (Ecstasy) Fast Facts. No date. Available online. https://www.justice.gov/archive/ndic/pubs3/3494/3494p.pdf
  3. Parrott AC. Human psychopharmacology of Ecstasy (MDMA): a review of 15 years of empirical research. Hum Psychopharmacol. 2001;16(8):557-577. doi:10.1002/hup.351.
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  5. National Institute on Drug Abuse. MDMA (Ecstasy/Molly) Drug Facts. No date. Available online. https://www.drugabuse.gov/publications/drugfacts/mdma-ecstasymolly 
  6. The United States Department of Justice. Drug Availability Within the United States. MDMA Availability. No date. Available online. https://www.justice.gov/archive/ndic/pubs38/38661/mdma.htm
  7. Kalant H. The pharmacology and toxicology of “ecstasy” (MDMA) and related drugs. CMAJ. 2001;165(7):917-928.
  8. 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. JURH 83, 884 (2006). https://doi.org/10.1007/s11524-006-9057-2
  9. The Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. No date. Available online. https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf
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  13. Cottler LB, Leung KS, Abdallah AB. Test-re-test reliability of DSM-IV adopted criteria for 3,4-methylenedioxymethamphetamine (MDMA) abuse and dependence: a cross-national study. Addiction. 2009;104(10):1679-1690. doi:10.1111/j.1360-0443.2009.02649.x
  14. Cottler LB, Womack SB, Compton WM, Ben-Abdallah A. Ecstasy abuse and dependence among adolescents and young adults: applicability and reliability of DSM-IV criteria. Hum Psychopharmacol. 2001;16(8):599-606. doi:10.1002/hup.343
  15. Davis AK, Rosenberg H. The prevalence, intensity, and assessment of craving for MDMA/ecstasy in recreational users. J Psychoactive Drugs. 2014;46(2):154-161. doi:10.1080/02791072.2014.901586.
  16. Wish ED, Fitzelle DB, O’Grady KE, Hsu MH, Arria AM. Evidence for significant polydrug use among ecstasy-using college students. J Am Coll Health. 2006;55(2):99-104. doi:10.3200/JACH.55.2.99-104