MDMA

MDMA, also called ecstasy (in pill form) or molly (as a crystal), is a drug that combines stimulant effects with mild psychedelic properties and is classified as an entactogen. It was first made in 1912 by a chemist named Anton Köllisch, who worked for the company Merck. In the 1970s, therapists began using it to enhance psychotherapy sessions, and by the 1980s it had become a popular recreational street drug. People who go to dance parties, raves, and electronic music festivals often use it. Pills sold as ecstasy are sometimes cut with other drugs like ephedrine, amphetamine, or methamphetamine.

The chance of dying from a single dose of MDMA is estimated to be between 1 in 20,000 and 1 in 50,000 uses. The drug’s main effects—which can make people feel more social—include altered sensations, more energy, empathy, and pleasure. When swallowed, these effects start within 30 to 45 minutes and last three to six hours. Short-term side effects include teeth grinding, blurred vision, sweating, and a fast heart rate. Long-term use can lead to addiction, memory loss, paranoia, and insomnia. Some deaths have happened because the drug raises body temperature and causes dehydration. MDMA works mainly by making the brain release more of the neurotransmitters serotonin, dopamine, and norepinephrine. It belongs to the substituted amphetamine family and is chemically similar to mescaline (a psychedelic), methamphetamine (a stimulant), and natural brain chemicals like serotonin, norepinephrine, and dopamine.

Only a few countries allow MDMA for limited medical uses, and it is illegal in most places. Research involving 14 systematic reviews and up to 353 participants suggests that MDMA-assisted psychotherapy might significantly improve PTSD symptoms, response rates, and remission rates compared to therapy alone, but the evidence is considered low to very low certainty, and safety data are limited, with some temporary side effects. In the United States, the FDA has given MDMA breakthrough therapy status, though it is not approved for any medical use there. Canada allows limited distribution if someone applies and gets approval from Health Canada. In Australia, specially authorized psychiatrists can prescribe it for PTSD treatment.

Recreationally, MDMA is a common choice in rave culture and is also used at clubs, festivals, and house parties. The drug’s effects often blend well with the music and lighting at raves. Some users enjoy the sense of connection it creates by lowering inhibitions, while others use it for the energy boost. It is used less often than other stimulants, usually no more than once a week. People sometimes combine MDMA with other drugs like LSD (called "candy-flipping"), psilocybin mushrooms, 2C-B (called "nexus flipping"—usually taking MDMA first, then 2C-B after the peak), or ketamine. It is also taken with alcohol, methamphetamine, and prescription drugs like SSRIs, which can cause dangerous interactions. There have been three life-threatening reports of MDMA combined with ritonavir, a drug that has severe interactions with many substances.

Before it was widely banned, MDMA had limited use in psychotherapy. In 2017, the FDA granted it breakthrough therapy status for PTSD treatment. Some researchers suggest that psychedelics like MDMA might work as active "super placebos" in therapy. Small doses are also used by some religious practitioners as an entheogen to enhance prayer or meditation, and it has been used in New Age spiritual practices.

MDMA is sold in several forms. The tablet form is called ecstasy (or "E," "X," "XTC"), though these pills often contain adulterants. In the UK, the term "mandy" and in the US "molly" refer to crystalline powder thought to be pure. It is also sold as hydrochloride salt crystals or in gelcaps. Some tablets are shaped like characters from pop culture, sometimes called "fun tablets." Because of global shortages of sassafras oil—now mostly solved by newer synthesis methods—the purity of molly varies widely. Some products contain methylone, ethylone, MDPV, mephedrone, or other "bath salts" instead of or in addition to MDMA. Powdered MDMA can range from pure to crushed tablets with 30–40% purity, while tablets are often low purity due to bulking agents.