MDMA (Ecstasy/Molly) Abuse


MDMA (molly, ecstasy) is a synthetic drug often taken at nightclubs, music festivals or other party-like environments to enhance mood and boost energy. Many people, especially young people, believe it to be harmless; however, it has many risks and dangers, and in some cases it may even be deadly.1,2

What Is Ecstasy?

Ecstasy is the most common street name for the drug 3,4-methylenedioxymethamphetamine (MDMA), a manmade substance that produces both stimulant and hallucinogenic effects.1 Primarily used by teens and young adults at raves, clubs, and festivals, MDMA has become increasingly popular among older adults and is sometimes used in other settings as well.2

MDMA tablets

Ecstasy is known by multiple street names, such as:1

  • Molly.
  • E.
  • X.
  • XTC.
  • Beans.

FAQs about MDMA

How is Ecstasy Used?

MDMA is most often taken as a tablet, pill or capsule, though some people may snort the powder or drink a liquid form.2

Is Molly the Same as Ecstasy?

Yes, molly and ecstasy are both MDMA. The street name “molly” supposedly indicates a pure form of MDMA that is sold in powder form, usually in capsules.2,3 However, there is no way to ensure that what is sold as molly is, in fact, pure MDMA. Many ecstasy and molly users may be unintentionally using other substances. Many samples of molly have been found to contain “bath salts” (synthetic cathinones) or other harmful drugs such as cocaine, opioids or amphetamines.1,2,4 In one study of young adult ecstasy/molly users at night clubs and festivals in New York City, 4 out of 10 users tested positive for “bath salts” and/or other novel psychoactive substances, despite reporting no lifetime use of these substances.4

Even in the case that the MDMA a user takes is pure, it is still dangerous. For example, MDMA’s health effects include significant hyperthermia (high body temperature) which can be fatal in some cases.3

Is MDMA Illegal?

Yes, ecstasy is listed as a Schedule I drug by the US Drug Enforcement Agency (DEA). This status indicates that it has a high abuse potential and no accepted medical uses. 3 Its use is not legal in the United States.2  

The Ecstasy/Molly High

MDMA acts on certain neurotransmitters in the brain, including dopamine, norepinephrine, and serotonin, to create a number of desirable short-term effects. The intoxicating effects of ecstasy may include:1,2

  • Increased energy and alertness.
  • Increased feelings of pleasure and happiness.
  • Feelings of closeness with others.
  • Increased empathy and emotional warmth.
  • Increased sexual/sensual arousal.
  • Desire for touch/hugs.
  • Altered perceptions of time.
  • Distorted senses.

How Long Is a Molly High?

Depending on how strong the dose of MDMA, the high from an ecstasy tablet begins within 30 to 45 minutes of ingestion and may last between 3 and 6 hours. It’s common for users to prolong the high by taking another dose as the effects begin to wear off. 1,2,5 With repeated doses or very high doses, the more negative side effects (below) may occur in greater number or greater intensity.6

What Are the Side Effects of Molly/Ecstasy?

Person Sweating on Ecstasy

Not all of the effects of molly/ecstasy are desirable. The feelings of pleasure and warmth may come with negative physical and psychological side effects that include:1,2,6

  • Increased heart rate.
  • High blood pressure.
  • Nausea.
  • Muscle cramps.
  • Chills and sweating.
  • Blurred vision.
  • Teeth clenching.
  • Hyperactivity.
  • Confusion.
  • Impaired decision-making and/or reckless or bizarre behaviors.
  • Agitation.
  • Anxiety.
  • Paranoia.
  • Hallucinations.
  • Depersonalization.
  • Derealization.

Some symptoms of psychological distress, such as anxiety, may begin during active intoxication may persist and worsen during and after the MDMA comedown.2

Can You Die from Ecstasy?

Many people wonder about ecstasy overdose symptoms and whether you can die from ecstasy. In reality, it’s not so much taking toxic amounts of MDMA (overdosing) that is the main worry but rather other risks that can arise even with just one dose.

Hyperthermia

One of the most serious physical health risks of MDMA use (especially in high or repeated doses) is a sharp increase in body temperature (hyperthermia), as the drug hampers the body’s ability to regulate its own temperature.1 The prolonged dancing and hot, crowded environments that are commonly associated with MDMA use can increase the risk of hyperthermia and the related harms.7

MDMA-induced hyperthermia can be deadly and may cause:1,8

Hyponatremia

MDMA users may also suffer a very serious life-threatening condition known as hyponatremia. Ecstasy can induce symptoms like dry mouth, sweating, fever, and thirst, so many people will consume a great deal of water while on the drug.9 Overconsumption of water combined with an MDMA-induced inappropriate release of a certain antidiuretic hormone can lead to hyponatremia, which may result in: 9,10

  • Nausea.
  • Vomiting.
  • Changes in mental status.
  • Brain swelling.
  • Seizures.
  • Coma.

Women may be more at risk of hyponatremia when using MDMA than men.9

Serotonin Toxicity

Another serious risk that may arise among MDMA users who also take antidepressants is a condition known as serotonin syndrome. This occurs when a quick, sharp rise in serotonin concentration happens in the central nervous system.11

Symptoms of serotonin syndrome can occur rapidly and may include:12

  • Restlessness.
  • Agitation.
  • Rapid heart high.
  • High blood pressure or rapid blood pressure changes.
  • Abnormal eye movements.
  • Loss of coordination.
  • Fever.
  • Diarrhea.
  • Nausea/vomiting.
  • Profuse sweating.
  • Changes in mental status.
  • Muscle spasms.
  • Shivering.
  • Tremors.

Without treatment, serotonin syndrome may result in death.12

Ecstasy Containing Other Drugs

MDMA may contain any number of other drugs. In some cases, a drug sold as MDMA may have no MDMA at all. Some of these other drugs may be relative harmless, such as cough suppressants, however, MDMA that isn’t pure often contains other drugs like cocaine, bath salts, PCP, opioids, or amphetamines may be lethal to unsuspecting users.13

Ecstasy Withdrawal/Comedown

Person coming down from ecstasy while laying in bed

The effects that may present themselves after an episode of ecstasy use can be severe. The term “Suicide Tuesday” is sometimes used to describe the depressed mood that many people experience after MDMA wears off.14

The MDMA comedown may bring about symptoms that include:14

  • Lethargy.
  • Fatigue.
  • Lack of appetite.
  • Lack of motivation.
  • Depression.

The negative mental health effects of MDMA may become worse over time with continued use. Repeated MDMA use can cause problems with the brain’s ability to produce serotonin, a neurotransmitter that is very important to a person’s ability to feel happy and satisfied.14,15 Not having enough serotonin can cause: 14

  • More or worse symptoms of depression.
  • Impulsive behaviors.
  • Aggression.
  • Problems with making good decisions.

Is Molly Addictive?

Whether MDMA is addictive is a question with no definitive answer. According to the National Institute on Drug Abuse, certain signs indicate MDMA’s abuse and addiction potential including the fact that animals will self-administer MDMA and that some users experience tolerance, cravings, and withdrawal symptoms like those discussed above.16

Regardless of whether MDMA is addictive or whether you meet the clinical criteria for a substance use disorder, any excessive use of a drug, including molly, that interferes with your relationships, job, or health may require treatment.

Compulsive drug use often occurs as a misguided attempt to deal with underlying issues such as a mental health disorder or untreated psychological trauma.17 At Recovery First, we don’t just address your drug use; we address the whole person with treatment that includes care for co-occurring disorders such as depression.

If you’re struggling with an inability to stop abusing molly or any other substance, we can help. We offer a variety of programs equipped to meet your needs, from inpatient rehab to outpatient programs. We’re here to talk to you 24/7, and every conversation is completely confidential. Call us at 954-526-5776 today to learn how we can help you get sober and stay that way.

References

  1. Drug Enforcement Administration. (2019). 3,4-METHYLENEDIOXYMETHAMPHETAMINE (Street Names: MDMA, Ecstasy, Molly, XTC, E, X, Beans, Adams).
  2. National Institute on Drug Abuse. (2020). MDMA (Ecstasy/Molly) DrugFacts.
  3. Drug Enforcement Administration. (2014). The Facts About MDMA.
  4. Palamar J. J. (2017). There’s something about Molly: The underresearched yet popular powder form of ecstasy in the United States. Substance abuse38(1), 15–17.
  5. National Drug Intelligence Center. (2003). MDMA (Ecstasy) Fast Facts.
  6. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  7. Liechti M. E. (2014). Effects of MDMA on body temperature in humansTemperature (Austin, Tex.)1(3), 192–200.
  8. Vanden Eede H, Montenij LJ, Touw DJ, Norris EM. Rhabdomyolysis in MDMA intoxication: a rapid and underestimated killer. (2012). “Clean” Ecstasy, a safe party drug?. J Emerg Med, 42(6), 655-658.
  9. Moritz, M. L., Kalantar-Zadeh, K., & Ayus, J. C. (2013). Ecstacy-associated hyponatremia: why are women at risk? Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association – European Renal Association28(9), 2206–2209.
  10. Matthew J. Baggott, Kathleen J. Garrison, Jeremy R. Coyle, Gantt P. Galloway, Allan J. Barnes, Marilyn A. Huestis, John E. Mendelson, “MDMA Impairs Response to Water Intake in Healthy Volunteers”, Advances in Pharmacological and Pharmaceutical Sciences, vol. 2016, Article ID 2175896, 11 pages, 2016.
  11. Dobry Y, Rice T, Sher L. (2013). Ecstasy use and serotonin syndrome: a neglected danger to adolescents and young adults prescribed selective serotonin reuptake inhibitorsInt J Adolesc Med Health, 25(3), 193-199.
  12. U.S. National Library of Medicine. (2018). Serotonin syndrome.
  13. National Institute on Drug Abuse. (n.d.). MDMA (Ecstasy or Molly).
  14. Kim, J., Fan, B., Liu, X., Kerner, N., & Wu, P. (2011). Ecstasy use and suicidal behavior among adolescents: findings from a national surveySuicide & life-threatening behavior41(4), 435–444.
  15. Dfarhud, D., Malmir, M., & Khanahmadi, M. (2014). Happiness & Health: The Biological Factors- Systematic Review ArticleIranian journal of public health43(11), 1468–1477.
  16. National Institute on Drug Abuse. (2017). Is Ecstasy Addictive?
  17. National Institute on Drug Abuse. (2020). Common Comorbidities with Substance Use Disorders Research Report, Part 1: The Connection Between Substance Use Disorders and Mental Illness.



About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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