Last Updated:October 25, 2022
- Ecstasy is a street name for the synthetic drug 3,4-methylenedioxymethamphetamine (MDMA).
- MDMA is an illicit drug that is related to stimulants and hallucinogens.
- Ecstasy pills are rarely pure MDMA, and pills without any MDMA at all are frequently sold as ecstasy.
- Common adulterants include methamphetamine and “bath salts” that are combined with MDMA in unpredictable ratios.
- Ecstasy is used for its ability to produce euphoria and enhance sensory perception.
- Unwanted side effects of ecstasy use include muscle stiffness, clenched jaw, and elevated body temperature.
- Clinical research is currently evaluating MDMA as a promising psychotherapy method for treatment-resistant PTSD and other mental health and substance use disorders.
- While MDMA itself has a low risk for dependence/addiction, illicit ecstasy pills are frequently adulterated with highly addictive methamphetamine.
Ecstasy is a popular illicit drug that is used recreationally for its ability to produce euphoria and intensely pleasurable sensory experiences. It is often referred to as a “club drug” because it is associated with dance parties and “raves.” Whether ecstasy is addictive is controversial, and the active ingredient in ecstasy (MDMA) is currently being evaluated as a promising treatment for PTSD and other mental health disorders. However, illicit use of ecstasy can be risky.
What Is Ecstasy?
Ecstasy is a commonly used street name for the synthetic drug 3,4-methylenedioxymethamphetamine (MDMA). As the chemical name suggests, MDMA is a derivative of the stimulant drug methamphetamine. MDMA is also structurally similar to the hallucinogenic drug mescaline. However, MDMA, methamphetamine, and mescaline are pharmacologically distinct, meaning that they have different methods of action and effects.
It is important to make a distinction between ecstasy and MDMA. Although they are often used interchangeably, ecstasy is rarely pure MDMA. Rather, illicit ecstasy is nearly always heavily adulterated with methamphetamine, heroin or “bath salts,” among other dangerous chemicals. It is not uncommon for ecstasy to have absolutely no MDMA in it at all.
Adulterated ecstasy has become so common that people who use it can purchase test kits that allow them to determine the chemical identity of ecstasy on-the-spot. Importantly, these kits can detect the presence of methamphetamine, bath salts, and other amphetamines that can be incredibly dangerous, even lethal, and are often powerfully addictive.
In 1985, the U.S. Drug Enforcement Administration (DEA) and Food and Drug Administration (FDA) classified MDMA/ecstasy as a Schedule I drug, meaning that the federal government does not recognize it to have a valid medical use and that it has a high potential for abuse.
However, a number of studies have been published showing that clinically-administered MDMA offers significant and meaningful relief from treatment-resistant post-traumatic stress disorder (PTSD) and in 2017 the FDA acknowledged these findings by giving MDMA “Breakthrough Therapy Designation” status. This designation removes hurdles and expedites clinical research and drug development in the case of extremely promising candidate drugs.
How is Ecstasy Used?
Traditionally, recreational ecstasy has been associated largely with “raves” or dance parties. While they are certainly common in this context, recent studies have identified other reasons for recreational ecstasy use, including coping with negative life situations, facilitating improvements in intimate relationships and increasing emotional empathy and positive social interactions.
In 2010, the federal government allowed limited clinical research on MDMA use in psychotherapy to go forward. Since then, a growing body of literature shows that MDMA use, in conjunction with psychotherapy, offers a substantial improvement over existing therapies for people who suffer from long-term treatment-resistant PTSD. A federally regulated Phase 3 clinical trial to assess the safety and efficacy of MDMA-assisted psychotherapy for PTSD is currently underway.
Augmenting psychotherapy with MDMA may be a promising new therapeutic strategy for other mental health disorders as well. Ongoing studies are evaluating MDMA as a treatment for alcohol use disorder and other substance use disorders, reducing social anxiety in autistic adults, and depressive and anxiety disorders.
Interestingly, a 2018 study found that at-risk youth who use MDMA are less likely to inject drugs intravenously (IV). The authors suggest that at-risk youth have higher rates of abuse and/or neglect that may increase future IV drug use and that MDMA may allow them to productively manage emotions and work through memories associated with childhood trauma, rather than turning to IV drugs that only temporarily cloud emotions and memories.
Dosage and Administration
Doses for recreational MDMA use are typically between 50 mg and 150 mg but may be substantially higher. Ecstasy generally comes in pill form, but can also be a powder. People who use ecstasy often use paraphernalia to enhance the sensory experience, including Vicks Vapo-Rub or other mentholated products, soft fabrics, and massage tools. In addition, lollipops, pacifiers, or chewing gum are used to mitigate grinding teeth or a clenched jaw, which is a common side effect of ecstasy.
Regular users may “stack” (take multiple doses at once) or “boost” (taking additional tablets later in a session, also known as “piggy-backing”).
Routes of administration include:
- Oral consumption (the most common route of administration)
- Insufflation (snorting)
What Does Ecstasy Look Like?
Ecstasy usually comes in pill or tablet form. Pills come in a dazzling array of vivid colors and are often stamped with appealing symbols like smiley faces, butterflies, superhero symbols, or animals. Pills come in a variety of shapes and sizes, including:
- Gummy bears
- Paw prints
- Hearts or diamonds
- Many other varieties, often reminiscent of candy pieces
Names of Ecstasy
Ecstasy has a number of common street names, including:
- E, X or XTC
- Speed for lovers
- Love drug
- Hug drug
- Scooby snacks
- Disco biscuits
- Happy pills
- Vitamin E or Vitamin X
- Malcolm X
Side Effects of MDMA and Ecstasy
It is important to differentiate between ecstasy and MDMA when discussing side effects. MDMA is a pure compound that has predictable and consistent side effects. Ecstasy is usually a combination of MDMA and one or more other drugs in varying ratios, and sometimes ecstasy has no MDMA in it at all. Therefore, the side effects of ecstasy are unpredictable and inconsistent.
Physical Side Effects of MDMA
- Increased wakefulness
- Heightened energy
- Sexual arousal
- Postponed fatigue
- Muscle tension
- Clenched jaw/grinding teeth
- Increased body temperature
- Blurred vision
Psychological Side Effects of MDMA
Many of the psychological side effects of MDMA promote feelings of empathy and connection to other people, so MDMA has been described as an “empathogen,” meaning that it promotes empathy. Other psychological side effects include:
- A sense of well-being
- Heightened sensory perception
- Increased sociability/extraversion
- A heightened sense of closeness to other people
- Increased tolerance of views and feelings of others
- Inability to focus
- Mild hallucinations
Side Effects of Ecstasy
Ecstasy use is sometimes associated with depression, fatigue, and stiffness or pain in the lower back that lasts for 1-2 days. The relative contributions of MDMA versus adulterants to these effects are unclear.
Chronic heavy use of ecstasy is associated with long-term adverse effects, including:
- Serotonin neurotoxicity: MDMA/ecstasy causes increased levels of serotonin in the brain which affects mood and mental state and, over time, damages and destroys brain cells
- Impaired decision making
- Greater impulsivity
- Liver injury
Because of the varying compositions of ecstasy, an accurate description of symptoms cannot be determined. However, because amphetamines (including methamphetamine) are the most common adulterant, amphetamine side effects are common and may include:
- Anxiety or agitation
- Bladder pain/frequent urination
- Cloudy or bloody urine
- Feeling of unreality
- Mood swings
- Rapid breathing
- Rapid heart rate
How Long Does Ecstasy Stay in Your System?
MDMA has a relatively long half-life, which is why the effects of ecstasy last for several hours. The long half-life may also help to explain why some people experience persistent side effects for a couple of days after using ecstasy. In addition, some of the metabolic byproducts of MDMA are pharmacologically active (especially the first byproduct, MDA). There are specialized drug tests that can identify metabolic byproducts of MDMA, but conventional drug tests do not look for them.
MDMA has a half-life of eight hours, meaning that it takes your body eight hours to metabolize half of the MDMA in your system, and every subsequent eight-hour window will metabolize half of the remaining MDMA. Over the course of 5 half-lives, more than 95% of the drug will be metabolized. Thus, approximately 95% of MDMA will be fully metabolized approximately 40 hours after taking it.
Is Ecstasy Addictive?
The addictive potential of MDMA is controversial, but most research indicates that MDMA/ecstasy does not meet the criteria for dependence or addiction as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Statistical Classification of Diseases (ICD-10).
Prior to 1985, when the federal government placed an emergency ban on MDMA, an estimated half a million doses were administered as an adjunct to psychotherapy in individual, couples and group therapy sessions. By most accounts, MDMA was an incredibly valuable tool that increased empathy and compassion, improved intimacy, and helped people overcome entrenched negative memories, thoughts, or perceptions. Reports of illicit use among psychotherapy patients were very uncommon, and therapists did not believe that their clients were at risk for developing MDMA dependence or addiction.
However, there are reasons to believe that regular illicit ecstasy use can cause dependence. WIth repeated ecstasy use, tolerance builds up, and ever-increasing doses are needed to achieve the desired effect. Tolerance and dependence often go hand-in-hand. In addition, it is important to remember that illicit ecstasy is very likely to have adulterants like methamphetamine, which is highly addictive. Regular illicit ecstasy use may not cause MDMA addiction, but it could certainly cause methamphetamine addiction.
Finally, chronic MDMA/ecstasy use has been linked to persistent serotonin neurotoxicity, which may indirectly potentiate addiction via dopamine-mediated activation of the “reward pathway.” Like other drugs, MDMA should not be taken without medical direction and supervision.