MDMA (ecstasy)

What is MDMA (ecstasy)?#

Ecstasy is the common name for the illegal synthetic drug methylenedioxymethamphetamine (MDMA). It is classed as an empathogen, which means it increases feelings of empathy and compassion towards others. It also acts as a stimulant, speeding up the central nervous system, and at high doses it can alter a person’s perception of reality, giving it hallucinogenic qualities.

MDMA is commonly used as a mood enhancer at parties and nightclubs. In high doses it can cause seizures and vomiting, and may contribute to death. Common slang terms include the “love drug”, “E”, “eckies”, “pingers” and “caps”.

MDMA is usually swallowed as a tablet but can also come as a powder or crystal. Pills come in different colours and often have pictures or logos stamped on them. Most people take pills, but some snort, smoke or inject the drug.

Because MDMA is generally made in illegal laboratories, the person taking it has no idea whether the dose will be strong or weak, or even whether it contains any MDMA at all. Pills sold as ecstasy may contain little or no MDMA. They may contain other chemicals or “fillers” (such as household products) that can have unexpected or dangerous side effects.

How MDMA works#

MDMA works by stimulating the central nervous system, which can produce a burst of energy. It can also heighten and distort the senses (sight and sound) and increase feelings of love and happiness. These effects are largely caused by an increase in brain chemicals such as serotonin and dopamine.

The effects are usually felt about 20 minutes to an hour after the drug is taken and last for around 3 to 4 hours. The comedown, as the drug leaves the body, may last one to two days or up to a week.

The effects of MDMA vary from person to person and depend on factors such as:

• how you respond to the drug (a first-time user may have different effects to someone who has used it before)
• the amount and strength of the dose
• your physical make-up and state of mind
• whether it has been mixed with other drugs

Effects on the body#

Effects can include:

• euphoria, feeling energetic, confident and affectionate
• an increased sex drive (libido) and loss of inhibitions
• accelerated heart rate, faster breathing and a rise in blood pressure
• sweating and dehydration
• nausea, loss of appetite
• jaw clenching and teeth grinding
• tingling skin, muscle aches and pains
• dilated pupils and heightened senses
• sleep problems
• changes in perception, such as auditory or visual hallucinations
• irrational or out-of-character behaviour, such as aggression, paranoia, anxiety or irritability

Drinking too much water is also a risk. Excessive thirst can lead people to drink large amounts of water, which can result in death. Drinking roughly 250 to 500 mL of water per hour is generally considered safe.

Coming down#

After the high, coming down from MDMA can be unpleasant but is rarely dangerous. Most people feel better within two to three days, though this depends on a range of factors. Symptoms may include:

• sleep problems and fatigue
• aching muscles
• anxiety and agitation
• depression
• trouble concentrating

Overdose and dangerous reactions#

If the dose is strong or MDMA is taken in large amounts, it can cause a bad reaction. Signs to watch for include:

• seizures (“fits”)
• vomiting
• a sharp rise in body temperature and blood pressure
• dizziness and confusion
• anxiety, paranoia and aggression
• muscle twitching or cramps
• heart palpitations

MDMA can lead to serious harm or death, including cardiac arrest, stroke, kidney failure, overheating (hyperthermia), dehydration and coma. It can also cause dilutional hyponatraemia, where the brain swells from drinking too much water.

In an emergency#

A quick response can save someone’s life. If you suspect an overdose or severe reaction while someone is using MDMA, dial your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) to call an ambulance immediately. Don’t delay because you think you might get into trouble — ambulance officers are not obliged to call the police.

Stay with the person until the ambulance arrives. Tell the ambulance officers as much as you can about what drugs were taken, when they were taken, and whether the person has a medical condition.

Who is at greater risk#

People with certain conditions are at greater risk of harm if they take MDMA, including epilepsy, high blood pressure, heart disease, diabetes, kidney disease, or mood or psychiatric disorders. MDMA can also be dangerous when mixed with other drugs, including alcohol, cocaine, amphetamines and ice.

Long-term effects#

Research on the long-term effects of MDMA is limited, but studies suggest that regular long-term use can cause:

• liver damage
• memory and concentration problems
• depression
• more frequent colds or flu
• risk of HIV, blood poisoning or skin abscesses if MDMA is injected using shared needles
• increased use of other drugs, such as benzodiazepines, alcohol or cannabis
• MDMA dependence and withdrawal

Some people who use MDMA find it hard to stop, which suggests it is possible to become psychologically dependent. As with many other drugs, a person can build up a tolerance, needing larger doses to achieve the same effect. This can also increase the intensity of the unpleasant side effects.

“Liquid ecstasy” is not ecstasy#

The drug known as “liquid ecstasy” is a different drug to MDMA. Liquid ecstasy is gamma-hydroxybutyrate (GHB), also known as “G”, grievous bodily harm (GBH) or fantasy. Unlike MDMA, GHB is a depressant with sedative and anaesthetic effects.

Synthetic ecstasy#

Synthetic products that claim to have similar effects to MDMA have become available. The active ingredient can include chemicals such as benzylpiperazine (BZP), mephedrone or methylenedioxypyrovalerone (MDPV), but it is difficult to know exactly what they contain. As a result, their effects can be unpredictable and more harmful than MDMA.

Treatment and the law#

Treatment options for drug use include detoxification, individual counselling and group therapy. Peer support, or talking to someone who has been in the same situation, can also be helpful. See your doctor for information and referral, or contact an alcohol and other drug service in your area.

MDMA is an illegal drug. Penalties apply under the law for anyone who drives under its influence, uses or keeps it in their possession, or supplies or sells it to another person (including without their consent, such as drink spiking).

Key points#

• MDMA is an illegal synthetic drug used as a mood enhancer at parties and nightclubs.
• In high doses it can cause seizures and vomiting and may contribute to death.
• Because it is made in illegal labs, the dose and contents are unknown and unpredictable.
• Drinking too much water while using MDMA can be dangerous.
• If you suspect an overdose, call an ambulance immediately and stay with the person.

Where to get help#