3,4-Methylenedioxymethamphetamine (MDMA) is a common recreational drug. It is also known as Molly or Ecstasy, and to a lesser extent, Mandy or Adam. MDMA is also beginning Phase 3 trials with the US FDA for the treatment of PTSD.
“MDMA’s risk profile is low enough to justify further explorations in clinical trial settings. However, this only applies to carefully designed research contexts with screened adult subjects, and does not apply to any other use of MDMA.
What is MDMA?
MDMA is a drug that can make people feel euphoric and empathetic. Molly is the street name for powder or crystal MDMA, often sold in capsules. Ecstasy is the street name for pill form of MDMA.
Molly vs Ecstasy vs MDMA
MDMA is the official chemical name for the pure chemical compound – in an ideal world, Molly would be 100% pure MDMA. Molly is a street name for MDMA in powder form, often contained in clear capsules. “Molly” doesn’t mean pure. Ecstasy is a street name for MDMA in pill/tablet form.
Caution: Drugs sold as MDMA, Molly or Ecstasy are often impure. 87% of “Molly” analyzed by the DEA between 2009 and 2013 contained 0% MDMA, instead mostly containing bath salts.
Quick MDMA Info
|Safety in research||Yes, safe in research|
|Street names||Molly, Ecstasy, X, Mandy|
|Risks||1. Fake MDMA 2. Overheating 3. Drinking too much water|
|Desirable effects (~3-7 hours)||Eurphoria, feelings of authenticity, empathy for others|
|Side effects (~3-7 hours)||Dry mouth, anxiety, thirst|
|Medical use||PTSD treatment combined with therapy|
Is MDMA safe?
Pure MDMA has been proven sufficiently safe for human consumption when taken a limited number of times in moderate doses. MDMA seems to be about as safe as skydiving, and a regulated environment would likely make MDMA safer. Regulation could reduce the risk of fake MDMA. MDMA appears to be safer than most other illegal drugs, though all drugs can be harmful under specific circumstances. MDMA is safer if you follow harm reduction guidelines.
Nonhuman animal studies have shown MDMA (structurally similar to some classical hallucinogens, but with a substantially different pharmacological mechanism of action) to have neurotoxic effects at high doses, although MDMA has been judged to be safe for human administration in the context of several therapeutic and basic human research studies.
What are the effects of MDMA?
Side effects during use (perhaps ~7 hours)
MDMA has the following side effects:
- Dry mouth
- Difficulty concentrating
- Feeling cold
- Impaired balance/gait
- Heavy legs
- Jaw clenching/tight jaw
- Lack of apppetite
- Restless legs
Long-term side effects
Doses around 1.5-1.7 mg/kg MDMA (roughly 100 to 125 mg MDMA) are unlikely to cause long-lasting serotonin changes. Studies by MAPS have looked for changes in mental abilities after people participated in their studies, with some participants receiving 125 mg followed by 62.5 mg, and have not found any changes.
Short-term desirable effects, lasting for 3-4 h
- Everything is perfect – with you and with the world
- Euphoria (extreme happiness)
- Empathy + increased ability to connect with others
- A feeling that you are more able to be yourself / be authentic
Long-term desirable effects
- Anecdotal reports that MDMA is effective in dealing with past trauma (and scientific support of MDMA helping PTSD in clinical settings)
- Increased bonds with friends
- A strengthened or enhanced romantic relationship.
For more info on how MDMA (Molly/Ecstasy) makes you feel, see this page.
What is the Difference Between MDMA, Ecstasy, and Molly?
If you or someone you know abuses MDMA, ecstasy, or Molly, you may be wondering about the differences between these substances. For example, you might be curious about whether one is potentially safer or purer, but you may also just want to know more about each drug.
Many people think MDMA, ecstasy, and Molly are entirely different drugs, ecstasy being the more dangerous; however, much of the MDMA sold on the streets—often “branded” as Molly—is anything but pure and could contain just as many harmful adulterants as ecstasy.
MDMA is the primary psychoactive chemical constituent of ecstasy, just as tetrahydrocannabinol (THC) is the main component of marijuana. It is a common misconception that Molly is pure MDMA, but that isn’t the case; both Molly and ecstasy are commonly cut with several dangerous additives.
MDMA is the acronym used to refer to the chemical, 3,4-methylenedioxy-methamphetamine, a man-made substance that is somewhat unique because it has both stimulant and hallucinogenic properties. MDMA is chemically similar to other amphetamines, but one main difference is that it contains the methylenedioxy group (-O-CH2-O-), making part of the molecule also similar in structure to the hallucinogen, mescaline. As its name implies, MDMA is a derivative of methamphetamine, also known as speed, crystal, or meth.
MDMA is the primary psychoactive substance found in ecstasy; however, some ecstasy tablets sold on the street may not actually contain any MDMA at all. Instead, they may contain compounds such as methylenedioxyethylamphetamine (MDEA Drug), methylenedioxyamphetamine (MDA Drug), paramethoxyamphetamine (PMA) or any number of additional substances.
What is Molly? Molly is the nickname for what many people think is “pure” MDMA found on the street. This form of MDMA most commonly appears in powder or capsule form. It is a common misconception that MDMA is a safer and purer alternative to ecstasy.
MDMA is a Schedule I substance, meaning that it has a high abuse potential and no accepted medical use. Since MDMA is illegal, it is unregulated on the street, so you can never be sure what drug you are actually taking. On the other hand, ecstasy is usually found in pill form and is generally considered to be less purethan MDMA or Molly, as people who use ecstasy often know that ecstasy is cut with other substances.
Regardless of what dealers or friends may claim, ecstasy, Molly, and MDMA are no different in the sense that they are cut with different drugs or additives and can have dangerous and, in some cases, deadly effects.
To have a rewarding time on MDMA, you need to have good quality MDMA. The only way to maximize your chance of getting the real thing is to know & trust your supplier. Note that MDMA is not known for causing strong visual distortions. If you take some “MDMA” and notice that a predominant effect is trippy visuals, what you got was probably not pure MDMA, or MDMA at all.
Note on Using MDMA Many Times:
Most users of MDMA who have taken the drug many times report that after some number of sessions, varying by person from a few to a few dozen, the desirable effects of the drug are no longer as pronounced. Said one, “it loses its magic.” Another person who used MDMA perhaps a dozen times (separated by weeks to months) noted the dropoff, waited three years (!), tried an ordinary dose of high-quality MDMA again, and found that the annoyance of the physical side effects outweighed the greatly diminished positive effects. He has sadly given up the drug. Others who have had fifty or more MDMA sessions still find them to be worthwhile on balance.
This MDMA effect dropoff might be explained by a psychological mechanism: loss of novelty. (On the other hand, people who have experienced MDMA effect dropoff generally report that there is not a similar dropoff in the effects of other psychedelics with which they are equally or more experienced, e.g. LSD and DMT.) Or the dropoff might be caused by lasting neurophysiological or neurological “changes” to the brain from exposure to MDMA, the prior state of the changed structures being necessary for ecstatic MDMA experiences. It is an as-yet-unanswered question whether such changes, if they happen, are best regarded as harmful, neutral, or beneficial.
If you choose to use MDMA, the lesson here may be to spend your first few sessions wisely and cherish them. Later sessions may never seem as ecstatic.
Why Do People Use MDMA, Molly, & Ecstasy?
People abuse ecstasy and Molly to experience particular desirable effects, which include:
- Feelings of closeness.
- Increased empathy.
- Increased sociability.
- Reduced inhibitions.
- Increased sexual desire/feelings.
In the past, young adults most commonly took ecstasy or Molly in clubs or at raves or parties, but nowadays its usage has expanded to college campuses and essentially any setting where people want to experience its effects.
While many people think taking ecstasy or Molly is fun, abusing these drugs can actually have serious consequences on your physical and mental health. Safely detoxing and recovering from MDMA, ecstasy, or Molly is best done with professional medical help.
What Are Molly and Ecstasy Cut With?
Both ecstasy and Molly are dangerous drugs that tend to be cut with other substances, such as:
- Over-the-counter cough medicine.
- Synthetic cathinones, also known as bath salts.
Bath salts, or synthetic cathinones, belong to a dangerous group of substances sometimes labeled as “new psychoactive substances.” They are risky because they are unregulated and not much is known about their exact effects on the brain.
Researchers do know that many common synthetic cathinones are chemically similar to drugs like MDMA, cocaine, and methamphetamine. Bath salts can produce both pleasurable and harmful effects, such as:
- Increased feelings of friendliness.
- Increased sex drive.
- Panic attacks.
- Extreme agitation and violent behavior.
- Raised blood pressure.
- Chest pain.
- Increased heart rate.
In the worst case scenario, bath salts can cause death, especially when snorted or injected. People who take Molly are often unknowingly taking bath salts. One report indicated that 4 out of 10 nightclub or festival attendees tested positive for bath salts without knowing that they had taken this substance. The report also indicated that half of the tests came back positive for MDMA, and half came back positive for bath salts, with butylone and methylone being the most common “bath salt” substances found in molly/ecstasy. Further evidence for the impurity of supposed MDMA comes from another study, which indicated that MDMA was only present in 60% of 529 ecstasy/MDMA samples tested from 2010-2015.
Taking a drug that is unregulated can be very hazardous because you essentially have no idea what substance you are really taking. Ecstasy can contain many different compounds that increase the risks of very serious health effects and death.
Signs & Symptoms of an Ecstasy or Molly Overdose
If you or someone you know uses ecstasy or Molly, it is crucial to educate yourself on the signs and symptoms of overdose so that you can seek appropriate medical attention if necessary. Overdoses are rare, but in some cases are associated with life-threatening complications. Some of the common signs of Molly/ecstasy overdose include:
- Hyperthermia, which can lead to kidney failure and the breakdown of muscle tissue.
- Irregular heart beat.
- High blood pressure.
- Brain hemorrhage or aneurysm.
- Panic attacks.
- Loss of consciousness.
If you suspect that you or someone else is experiencing an overdose, call 911 right away. Do not leave the person alone. If they are unconscious, you’ll first want to place them on their side and ensure that the airway is clear by tilting the head back and lifting their chin. Remain calm and provide as much information as you can to emergency medical personnel when they arrive, including the amount of drugs taken, if known, when the drugs were taken, and any other substances ingested.
Safety and Neurotoxicity Discussion
Behavioral Safety Concerns
As noted, a primary psychological effect of MDMA is to make the user feel “safe”, at peace with the world, pleasantly reconciled to things as they are, and things however they will be. This can remarkably diminish one’s ability to make sound judgements during the session. Examples:
- It becomes easy to want to prolong the MDMA state by taking more and more of the drug (or of other drugs), beyond what you would judge wise or worthwhile when not under its influence.
- It becomes easier to have unsafe sex. You may “forget,” judge that the risk of infection is very small, or feel that infection wouldn’t be such a terrible thing after all. If you think you might have sex while on MDMA, it may help you and your partner to stay safe if you lay out safer sex supplies before dosing in a place you’ll be sure to see them later, and agree beforehand that you’ll use them if the occasion arises.
Another danger stems from MDMA’s lessening of the awareness of pain (whether through chemical analgesia, or through psychological analgesia). Combined with the extra energy the drug gives, it becomes easy to sustain bruises, blisters, or other bodily damage from extensive dancing, hiking, climbing, etc., without noticing it until after the damage is done.
Under MDMA, it may seem “right” to make immediate changes in relationships (increasing or decreasing commitment) of all kinds. The fresh points of view appreciated during an MDMA session are one of the drug’s most prized benefits, but it is probably unwise to actually make lasting relationship changes until you have a chance to see how you feel about them after the drug and its afterglow wear off.
One claimed effect of MDMA use is lowered brain serotonin levels. One study (Peroutka) found no evidence for this, but at least two others (Ricaurte) have found significantly reduced serotonin metabolite levels, the more recent study showing a 30% average difference between the control group of non-MDMA users and the experimental group consisting of people who had used MDMA about 75 times each, on average. (Note though, that some of these studies used psychiatric patients or “polydrug abusers” – not representative user samples.)
What does this mean for users? Anecdotal evidence from years of legal and illegal use suggests that this is not of much concern for most people. Some folks, however, report periods of depression after using MDMA, on rare occasion severe depression. Considering that a primary action of many antidepressant drugs (MAOIs, SSRIs) is to increase brain serotonin levels, a connection between MDMA use and subsequent depression is not unbelievable. Psychological factors – sadness at returning to an ordinary state of consciousness after ecstasy – may also account for feeling down for a while. In any event, most users report the opposite: feelings of well-being or gentle euphoria in the days following an MDMA session. To get a better understanding of why the serotonin system may be critical to normalcy for some individuals and less so for others, see Listening to Prozac by Peter D. Kramer (Viking 1993). The entire book is worthwhile, but note pages 134-136 especially.
There is solid experimental evidence that MDMA, administered in large doses and/or repeatedly, causes partial loss of serotonergic neurons in laboratory animals. Uncertain is whether this loss is permanent, reversible, or important. One study found in the rat nearly 100% recovery within a year. In another study (Ricaurte), non-human primates were dosed with MDMA and their brains were examined for morphological changes. Ricaurte found that there was no effect after 2.5 mg/kg oral doses given every two weeks, for a total of eight doses. But after a single oral dose of 5 mg/kg, he observed a 20% reduction in serotonin and its metabolite 5-HIAA, only in the thalamus & hypothalamus. There appeared to be some regrowth over time, not necessarily complete, and also some “collateral sprouting” – growth of other types of neurons in the reduced serotonin areas.
Note that in all of the animal studies, even when there are quite large serotonin system reductions (up to 90% in high MDMA dose rat studies), no behavioral deficits are observed.
It is also uncertain how these studies would extrapolate to humans – the human brain may well be more or less sensitive, or sensitive in different areas, compared with other animals. In any case, what is known is that there are no reported cases that link behavior changes in humans with MDMA-induced serotonin system changes or neuronal loss. And, the long-term human behavior changes that are noted (in studies and from anecdotal case reports) are generally regarded as positive – lowered impulsiveness and hostility, improved social/interpersonal functioning, changes in religious/spiritual orientation or practice, etc.
One of the reasons so little is known about the lasting effects of MDMA on the human brain is that no subjects (to date) have recorded their drug use history, then volunteered their brains for post-mortem study. If you would like to consider doing this, you can get donor information at 1-800-UM-BRAIN.
Studies with live human subjects are also underway – both volunteers and donations are needed. One good source of current info is the Multidisciplinary Association for Psychedelic Studies (MAPS) – see “Organizations” at the end of the FAQ.
Some users of MDMA report an apparent decrease in resistance to disease, especially with frequent MDMA use. It is unknown how much of this may be due to the pharmacological “body load” of MDMA, to staying up all night and dancing, to increased physical contact with people with colds, to suppressed appetite and poor nutrition, etc.