3,4-Methylenedioxymethamphetamine (MDMA), commonly known as ecstasy in tablet form, Midomafetamine for medical research purposes and molly in crystal form, is an entactogen with stimulant and minor psychedelic properties. MDMA was first synthesized in 1912 by Merck chemist Anton Köllisch. It was used to enhance psychotherapy beginning in the 1970s and became popular as a street drug in the 1980s. MDMA is commonly used by attendees of dance parties, raves, and electronic dance music festivals. Tablets sold as ecstasy may be mixed with other substances such as ephedrine, amphetamine, and methamphetamine. The lethal risk from one dose of MDMA is estimated to be from 1 death in 20,000 instances to 1 death in 50,000 instances. The purported pharmacological effects that may be prosocial include altered sensations, increased energy, empathy, and pleasure. When taken by mouth, effects begin in 30 to 45 minutes and last three to six hours. Short-term adverse effects include bruxism, blurred vision, sweating, and tachycardia, and extended use can also lead to addiction, amnesia, memory disorders, paranoia, and insomnia. Deaths have been reported due to increased body temperature and dehydration. MDMA acts primarily by increasing the release of the neurotransmitters serotonin, dopamine, and norepinephrine in parts of the brain. It belongs to the substituted amphetamine classes of drugs. MDMA is structurally similar to mescaline (a psychedelic), methamphetamine (a stimulant), as well as endogenous monoamine neurotransmitters such as serotonin, norepinephrine, and dopamine. MDMA has limited approved medical uses in a small number of countries, but is illegal in most jurisdictions. MDMA-assisted psychotherapy may substantially improve PTSD symptoms, response, and remission rates compared to psychotherapy alone, but the evidence is low to very low certainty and safety data are limited, with some increased transient adverse events. In the United States, the Food and Drug Administration (FDA) has given MDMA breakthrough therapy status (though there are no current clinical indications in the US). Canada has allowed limited distribution of MDMA upon application to and approval by Health Canada. In Australia, it may be prescribed in the treatment of PTSD by specifically authorised psychiatrists.
Uses
Recreational MDMA is often considered the drug of choice within the rave culture and is also used at clubs, festivals, and house parties. In the rave environment, the sensory effects of music and lighting are often highly synergistic with the drug. The psychedelic amphetamine quality of MDMA offers multiple appealing aspects to users in the rave setting. Some users enjoy the feeling of mass communion from the inhibition-reducing effects of the drug, while others use it as party fuel because of the drug's stimulatory effects. MDMA is used less often than other stimulants, typically less than once per week. MDMA is sometimes taken in conjunction with other psychoactive drugs such as LSD, psilocybin mushrooms, 2C-B, and ketamine. The combination with LSD is called "candy-flipping". The combination with 2C-B is called "nexus flipping". For this combination, most people take the MDMA first, wait until the peak is over, and then take the 2C-B. MDMA is often co-administered with alcohol, methamphetamine, and prescription drugs such as SSRIs with which MDMA has several drug-drug interactions. Three life-threatening reports of MDMA co-administration with ritonavir have been reported; with ritonavir having severe and dangerous drug-drug interactions with a wide range of both psychoactive, anti-psychotic, and non-psychoactive drugs.
Medical
Before it was widely banned, it saw limited use in psychotherapy. In 2017 the United States Food and Drug Administration (FDA) granted breakthrough therapy designation for MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD). MDMA has limited approved medical uses in a small number of countries, but is illegal in most jurisdictions. Canada has allowed limited distribution of MDMA upon application to and approval by Health Canada. In Australia, it may be prescribed in the treatment of PTSD by specifically authorised psychiatrists. Fourteen systematic reviews of up to 353 participants suggest MDMA-assisted psychotherapy may substantially improve PTSD symptoms, response, and remission rates compared to psychotherapy alone, but the evidence is low to very low certainty and safety data are limited, with some increased transient adverse events. Some researchers have proposed that psychedelics in general may act as active "super placebos" used for therapeutic purposes.
Others Small doses of MDMA are used by some religious practitioners as an entheogen to enhance prayer or meditation. MDMA has been used as an adjunct to New Age spiritual practices.
Forms
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