MDMA Ecstasy Abuse

MDMA is usually associated with nightclubs and partying because it increases energy and makes you feel good. The drug comes with the potential for harmful effects like dehydration, heat stroke, or heart attack.

What Is MDMA?

MDMA stands for 3,4-methylenedioxy-methamphetamine. It’s a synthetic drug with psychedelic and stimulant properties.

MDMA increases blood flow and neurotransmitters so you have higher energy. You feel excited and happy when you use it, and you get physically warmer.

You may also have a distorted sense of time or your surroundings. Some physical senses may feel enhanced. For example, colors may be brighter, or textures may feel softer or more engaging.

MDMA, Ecstasy, and Molly: Drug Abuse in Clubs and the Harmful Aftereffects

Street names for MDMA include ecstasy and Molly. These names are sometimes associated with bad experiences. People take these drugs and get sick, have bad trips, and even overdose.

MDMA is falsely believed to be a safer substance, although it is the same molecule as ecstasy and Molly. People who take MDMA may believe it is not adulterated as much by drug dealers. They believe the negative effects of ecstasy and Molly are due to mixing MDMA with other dangerous drugs, like PCP, cocaine, fentanyl, or new psychoactive substances.

mdma pills

While many assume pure MDMA is safe in certain doses, this is untrue. It is possible to overdose on MDMA or ecstasy, and many people who suffer life-threatening side effects from the drug often took the “correct” amount. They had other problems associated with it that led to severe health issues.

The History of MDMA

MDMA is chemically similar to amphetamines like meth, but the drug also has hallucinogenic properties like LSD or mescaline.

The substance was originally synthesized in 1912 in Germany as an appetite suppressant, but it did not gain much popularity with that pharmaceutical use. MDMA returned to pharmaceutical use in the 1970s when researchers discovered that, in low doses, it released neurotransmitters and created an artificial sense of closeness. As a result, it was used in clinical settings for psychotherapy, especially marriage counseling.

Ecstasy abuse rose in the United States in the 1980s, becoming a popular “club drug” at dance parties. In doses larger than prescribed, ecstasy could lead to amplified energy and happiness. Those using it could dance all night until the substance wore off eight hours later.

The U.S. made ecstasy illegal in 1988, putting the drug on Schedule I after determining there was no appropriate medical use for the substance. With no pharmaceutical companies manufacturing this chemical anymore, ecstasy only comes from illicit laboratories.

Although MDMA became illegal at the federal level in 1988, nightclub aficionados continued to use it throughout the 1990s and early 2000s. The drug became almost synonymous with rave culture. MDMA is also widely abused in less public places, like college dorms or small house parties.

An Adulterated Product

Amphetamine-based drugs like MDMA are most often synthetized from benzyl methyl ketone (BMK). However, ephedrine and pseudoephedrine are also common bases.

Like crystal meth production, producing MDMA is highly toxic and dangerous due to other chemicals used in the process. Once the process is complete, the drug looks like a white or off-white crystalline powder. It may be pressed into tablets or pills, mixed into liquid, or even added to blotter paper.

Many people who abuse MDMA purchase it online, rather than through in-person drug dealers. The drug is often cut with other substances, and it’s rare to purchase pure MDMA, no matter how it is advertised.

It is almost impossible to know if this illegal substance is pure or if it contains other dangerous chemicals like pseudoephedrine, caffeine, or veterinary deworming agents. You may not even purchase MDMA at all, but instead receive something like ketamine or PCP.

Adulterated drugs or the wrong drugs can cause severe harm and lead to overdose.

That being said, even taking pure MDMA is very risky. You can overdose on pure MDMA, just like you can overdose on an adulterated product.

Many people who take ecstasy in a social setting mix it with other intoxicating substances, most often alcohol and marijuana. This compounds the risks and increases the likelihood of overdose.

What Does MDMA Do to Your Brain and Body?

The main effect of MDMA is to flood the brain with serotonin, a mood-altering neurotransmitter that is involved in pleasure, sleep regulation, and heart rate. When the brain has more serotonin, the person feels empathetic and emotionally closer to those around them.

The comedown from ecstasy abuse is notorious for its intense depression, fatigue, and physical lethargy.

doctor holding a model brain

Effects from ecstasy begin between 20 to 40 minutes after taking the drug, depending on the dose, purity, and method of consumption. Most people take MDMA orally.

There may be some nausea as the body digests the drug. About an hour to 90 minutes after taking it, you will hit peak effects, with intense psychedelic and emotional alterations.

The drug’s effects last for about eight hours. Even if you are not feeling the peak effects, you are still experiencing an impact from the drug. Side effects may feel more physical, which can be uncomfortable or dangerous.

Short-term effects associated with taking ecstasy include the following:

  • Muscle tension
  • Involuntary teeth grinding or jaw clenching
  • Nausea
  • Dehydration, especially when the drug is mixed with alcohol
  • Elevated body temperature, leading to heat exhaustion or stroke
  • Increased blood pressure, heart rate, and breathing rate
  • Feeling chills or sweating, almost like the flu
  • Blurry vision

People take MDMA for the mental effects, like feeling high, feeling connected to others, increased energy, or mild hallucinations. But the physical effects are the most dangerous part of abusing this substance. Many people have become too dehydrated, suffered from heat stroke, or had cardiovascular events after taking ecstasy. They have been hospitalized or even died due to these adverse health effects.

The Drug Abuse Warning Network (DAWN) reported in 2013 that, between 2005 and 2011, there was an increase in emergency department admissions of young people who had abused MDMA. The report noted that mental health effects could last for a week or more. Anxiety, depression, and confusion could last for days as the brain rebalanced serotonin and dopamine levels.

The DAWN report found a 128 percent increase in ER admissions among people younger than 21 years old — up to 10,176 admissions in 2011 from 4,460 in 2005. There was a greater risk for adverse effects, including heat stroke, dehydration, and heart problems, when the person combined MDMA with alcohol.

Physical Harm From MDMA: Overdosing and Mixing Substances

Harm from Molly or ecstasy increases depending on the environment in which it is abused. For example, people who take MDMA in a nightclub and then dance for hours are more likely to experience dehydration and heat stroke because they are in a hot, crowded environment and not drinking water.

The following are signs of heat stroke:

  • Elevated body temperature
  • Changed mood, mental state, or behavior
  • Hot, dry skin with no sweating or cessation of sweating
  • Nausea and vomiting
  • Rosy skin
  • Accelerated breathing
  • Rapid heart rate
  • Headaches

Heat stroke is exacerbated by dehydration. Symptoms of dehydration include the following:

  • Extreme thirst
  • Urinating less
  • Dark-colored urine
  • Fatigue
  • Dizziness
  • Confusion

Symptoms of both dehydration and heat stroke can be masked by the effects of MDMA. If you would normally feel tired, you may be artificially stimulated; if you would normally feel thirsty, the psychedelic effects may mean you do not notice; if you would normally feel uncomfortable from a fast heartbeat, you may think you are just happy. The mental effects can make the physical effects worse since you are less likely to notice the symptoms.

These effects are part of a recreational dose of the drug. While some people who frequently abuse MDMA try to make the drug safer by drinking a lot of water or staying in a cooler environment, a “normal” dose of this substance puts you at risk for harmful side effects. It is also possible to overdose on ecstasy and experience seizures or a heart attack.

Coming Down From MDMA Abuse: Long-Term Effects

A comedown is like a hangover, but rather than alcohol, it involves the mental and physical effects of a recreational drug leaving your body. Comedowns are most associated with substances like MDMA, which drastically change brain chemistry, leading to an imbalance of neurotransmitters that takes at least a day to repair.

These comedown symptoms are associated with MDMA:

  • Depression
  • Fatigue
  • Dry mouth
  • “Brain zaps,” similar to what is experienced with antidepressant or gabapentin withdrawal
  • Nightmares
  • Physical shaking and weakness
  • Appetite changes, especially eating more
  • Nausea
  • Feeling depressed or anxious for more than a day after taking MDMA

If you routinely abuse MDMA or ecstasy, you may experience serious mental harm due to chronic serotonin depletion. This can even change the receptors on neurons in your brain, so you may develop mental illnesses or make existing ones much worse.

This also increases your risk of substance abuse, both abuse of MDMA and other drugs, as you may self-medicate to regulate your brain chemistry. With help, you can stop your abuse of MDMA and achieve a state of balance.

Address MDMA or Ecstasy Addiction

Addiction treatment centers offer help with detox, including medical supervision to ease withdrawal symptoms, and rehabilitation, which involves therapists helping you understand and address your damaging behaviors. You’ll generally receive therapy in a variety of formats, including both individual and group sessions.

Treatment should be comprehensive, dealing with all aspects of life, not just the addiction. Choose a program that offers evidence-based treatment and a full continuum of care, ensuring you have the best chances of maintaining recovery.

woman in treatment


What Is MDMA? (June 2018). National Institute on Drug Abuse (NIDA).

Ecstasy. (October). Center for Substance Abuse Research (CESAR).

Ecstasy. Kelty Mental Health Resource Center, BC Children’s Hospital.

Production and Precursors. (2016). Amphetamine, Methamphetamine and MDMA — Production and Precursors (EU Drug Markets Report).

Ecstasy-Related Emergency Department Visits by Young People Increased Between 2005 and 2011; Alcohol Involvement Remains a Concern. (December 2013). Drug Abuse Warning Network (DAWN), Substance Abuse and Mental Health Services Administration (SAMHSA).

Heatstroke: Overview. (August 2017). Mayo Clinic.

Dehydration: Overview. (February 2018). Mayo Clinic.

What Are the Effects of the Drug Ecstasy? (July 2001). Scientific American.

A Comprehensive Explanation of Every Comedown Symptom. (July 2017). Vice: Drugs.

Long-Term Effects of Ecstasy: Neurotoxic? (January 2007). National Institute on Drug Abuse (NIDA).

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