MDMA (3-4 methylenedioxymethamphetamine) is a synthetic, psychoactive drug with a chemical structure similar to the stimulant methamphetamine and the hallucinogen mescaline. MDMA is an illegal drug that acts as both a stimulant and psychedelic, producing an energizing effect, as well as distortions in time and perception and enhanced enjoyment from tactile experiences. It is known commonly as Ecstasy and Molly.

What is Molly short for?

3,4-methylenedioxy-methamphetamine (MDMA) is a synthetic drug that alters mood and perception. It is chemically similar to stimulants and hallucinogens. MDMA is commonly called Ecstasy or Molly. People who use MDMA typically take it as a capsule or tablet.

This illicit drug exerts its primary effects in the brain on neurons that use the chemicals serotonin, dopamine and norepinephrine to communicate with other neurons. Serotonin is most likely responsible for the feelings of empathy, elevated mood, and emotional closeness experienced with this drug. Overall, these neurotransmitter systems play an important role in regulating:

• mood
• energy/activity and the reward system
• appetite
• aggression
• sexual activity
• sleep
• sensitivity to pain
• heart rate, blood pressure.

MDMA was first synthesized by a German company in 1912, possibly to be used as an appetite suppressant. It has been available as a street drug since the 1980s, and use escalated in the 1990s among college students and young adults. Then, it was most often distributed at late-night parties called “raves”, nightclubs, and rock concerts. As the rave and club scene expanded to metropolitan and suburban areas across the country, MDMA use and distribution increased as well. MDMA is frequently used in combination with other drugs. Today, the drug is still used by a broader group of people who more commonly call it Ecstasy or Molly.

Methods of Use

MDMA is most often available in tablet or capsule form and is usually ingested orally. Ecstasy traffickers consistently use brand names and logos as marketing tools and to distinguish their product from that of competitors. The logos may be produced to coincide with holidays or special events. Among the more popular logos are butterflies, lightning bolts, and four-leaf clovers. It is also available as a powder and is sometimes snorted, taken as a liquid, and it is occasionally smoked but rarely injected.

Effects of MDMA Use

MDMA stimulates the release of the neurotransmitters such as serotonin from brain neurons, producing a high that lasts from 3 to 6 hours, but it’s length can be variably based on the user. The drug’s rewarding effects vary with the individual taking it, the dose, purity, and the environment in which it is taken.

MDMA can produce stimulant effects such as an enhanced sense of pleasure and self-confidence and increased energy. Its psychedelic effects include feelings of peacefulness, acceptance, and empathy.

MDMA Health Hazards

Users may encounter problems similar to those experienced by amphetamine and cocaine users, including addiction. Research has shown that animals will self-administer MDMA, an indicator of a drug’s abuse potential.

Damage to brain serotonin neurons can occur; serotonin is thought to play a role in regulating mood, memory, sleep, and appetite. Studies are conflicting on MDMA use and its affects on memory and cognition.

After moderate use of the drug over one week, psychological and physical effects due to withdrawal may include:

• irritability
• depression
• agression and impulsiveness
• muscle tension
• problems with sleep
• anxiety
• memory deficits
• loss of attention
• nausea and decreased appetite
• loss of interest in sex

Also, there is evidence that people who develop a rash that looks like acne after using this drug may be at risk of severe side effects, including liver damage, if they continue to use the drug. Almost 60% of people who use Ecstasy report withdrawal symptoms, including fatigue, loss of appetite, depressed feelings, and trouble concentrating.

MDMA-related fatalities at raves have been reported. The stimulant effects of the drug, which enable the user to dance for extended periods, combined with the hot, crowded conditions usually found at raves can lead to dehydration, hyperthermia (dangerous increase in body temperature), and heart or kidney failure.

Other drugs chemically similar to Ecstasy, such as MDA (methylenedioxyamphetamine, the parent drug of Ecstasy) and PMA (paramethoxyamphetamine, associated with fatalities in the U.S. and Australia) are sometimes sold as Ecstasy. These drugs can be neurotoxic or create additional health risks to the user.

Additionally, the illicit sale of Ecstasy or Molly makes it prone to being “cut” with other illicit and potentially toxic or deadly chemicals. Ecstasy or Molly may contain other substances in addition to MDMA, such as:

• ephedrine (a stimulant)
• dextromethorphan (an OTC cough suppressant that has PCP-like effects at high doses)
• ketamine (an anesthetic used mostly by veterinarians that also has PCP-like effects)
• caffeine
• bath salts
• cocaine
• methamphetamine.

While the combination of Ecstasy with one or more of these drugs may be inherently dangerous, users might also voluntarily combine them with substances such as marijuana, alcohol, or opioids, putting themselves at further physical risk.

Extent of MDMA Use

The National Institute on Drug Abuse (NIDA) regularly looks at trends of illicit drug use in the U.S. in middle and high school-aged children, teens, and adults. In the 2017 Monitoring the Future Study: Trends in Prevalence of MDMA for 8th Graders, 10th Graders, and 12th Graders, researchers found that less than 1% of 8th graders had used Ecstasy in the previous year, while 1.7% and 2.6% of 10th and 12th graders, respectively, had tried it in the last 12 months. People age 18 to 25 years appeared to be the groups with the greatest use, at 3.5%, as found in the 2017 National Survey on Drug Use and Health: Trends in Prevalence of MDMA.