Ecstasy / MDMA
MDMA (3,4-methylenedioxymethamphetamine) is the chemical name for the active ingredient in ecstasy pills. This means ecstasy and MDMA are the same thing. MDMA is sold as pills, powders and crystals.
History and the law
MDMA was first synthesized in 1912 by Merck Pharmaceuticals. MDMA emerged as a by-product during the synthesis of another substance.
In the late 60s, MDMA was “rediscovered” by chemist Alexander Shulgin, a scientist who made several psychoactive substances in his laboratory, including MDMA, which he tested on himself and on a group of friends. He was surprised by the drug’s warm and communication-enhancing effects and he passed it on to some fellow psychotherapists. They were very excited because the MDMA caused their patients to suddenly open up, taking away their emotional inhibitions. This way, it was easier for patients to talk about difficult and traumatic experiences. The global spread of MDMA really increased in the eighties when the drug got the catchy name “Ecstasy”, which was shortened to “XTC”.
During the mid-80s, MDMA turned up in the Netherlands for the first time. Different groups of people experimented with the drug at home. The first underground house parties took place in the Netherlands in 1987. About three years later, the dance scene started to professionalize itself and MDMA became also known among the party crowd. Since then, MDMA use has increased sharply until 1998. Until 2003 the use slightly decreased and now the use of MDMA among young Dutch people is fairly stable. Still, since 2012 ecstasy seems to become more and more popular in the Netherlands and different groups of people seem to be using the drug.
Check out this short video about the history of ecstasy and MDMA, and why there’s so much confusion about what those two terms mean.
Check out ATTN‘s video on the real history of MDMA (US):
In November 1988, ecstasy was placed on Schedule I (the list of hard drugs) of the Opium Act. This happened because the government was afraid of large-scale trade and production.
Usually MDMA is swallowed in pill form. Because every tablet contains a different amount of the active ingredient, you never know how much MDMA you take in when you swallow a whole, a half or a quarter tablet.
Since 2011 the amount of MDMA in ecstasy pills in the Netherlands has increased enormously. Before 2009, a tablet contained about 80 mg of MDMA, and in 2013 about 140 mg. Pills even containing 180 mg or more are no exception. This means that it is harder for you to break or bite off the right dose. We think that first aiders at big events are increasingly busy because ecstasy tablets contain more and more MDMA. That is why it is so important to always have your pills tested!
When taking MDMA powder or “crystals”, the user licks small amounts of the substance from a wet finger. This way, the dose can slowly be increased. Another option is to put the powder in a capsule or to roll it in cigarette paper (creating a “bomb”) and then to swallow it.
Very occasionally MDMA powder is snorted and it can also be smoked, but this almost never happens. MDMA can damage your tooth enamel; if you dissolve the powder in a drink or lick it up, you increase the chance of damaging your teeth.
Rectal use or snorting
MDMA can also be used rectally (through the anus), for instance as a powder in a capsule. This way, the substance can be absorbed in the body faster so the effects come on quicker. You need a smaller dose when you use it rectally, but it is quite an uncommon way to do ecstasy.
Snorting MDMA is also possible but it is very painful. As with rectal use, the effects come on quicker and you need a smaller dose.
The dose of MDMA in ecstasy pills varies widely. Also, some tablets can contain a different (dangerous) substance like PM(M)A or mCPP. These substances are more harmful than MDMA and can cause unpleasant side effects.
A recreational dose is between 1 and 1.5 mg MDMA for each kilogram body weight per occasion (or between 0.4 and 0.7 mg MDMA for each pound body weight). This means that when you weigh 60 kg (or 130 pounds), a recreational dose would be between 60 and 90 mg MDMA for the whole evening. Does your tablet contain more than 180 mg MDMA? In that case, a half tablet (or two times a quarter tablet with at least one and a half hour in between) should be enough for the desired effect. If you take more, you will especially experience more unwanted effects like jaw tension, forgetfulness, confusion and nausea. Of course the use of MDMA is never without risks, but if you follow this advice you can limit the risks and side effects as much as possible.
Many factors have influence on the effects of MDMA, for instance your state of mind and the setting in which you use. Personal factors can play a big role because every person and every situation is different. Sometimes you will have a more positive experience than other times. This is not because of the pill, but because of you: you don’t feel the same every day.
MDMA has two effects:
- A stimulant effect
- An entactogenic effect
The stimulant effect resembles the effect of speed, only it is not as strong. You can feel awake and alert, and it may be as if you can think very fast. The entactogenic effect causes a relaxed feeling. You feel open, loving and connected to others. You feel the urge to talk and have contact with others. You have an intense experience of the music and the people around you. You are less concentrated and you can be a little forgetful. If you take a high dose or if you find it hard to let go of control, you can feel confused and anxious.
After taking MDMA, you can notice the first effects in about twenty to ninety minutes: tingling sensations though your whole body, a warm glow and euphoric feelings. The effects grow stronger, the pill (or powder) “kicks in”. Mainly this feeling lasts about five minutes. It can make you feel nauseous and maybe you even have to vomit. Your blood pressure, body temperature and hart beat rise, your appetite decreases and your muscles tighten. This can cause teeth grinding and jaw clenching. Your pupils widen, your eyes move rapidly (nystagmus) which makes your sight blurry. You have a dry mouth and it is harder to pee or you cannot pee at all. After about two hours the effects decrease and after four to six hours most people feel reasonably “sober”. Many users chose to take another dose because they want the strong rush to continue. This is not very useful; you will not have the same feeling as you had with the first dose and the physical side effects will increase, such as a dry mouth, tightened muscles and teeth grinding. These side effects often cause people to think there is (a lot of) speed in their pills, even though this is almost never the case.
Severe health incidents almost never occur, but when they do they can be fatal. Serious problems or even death are mostly caused by a combination of the pharmacological properties of the MDMA (the interaction between the substances) and the surroundings in which the drug is used (environment temperature, water intake, physical activity and other drug use, including alcohol). The risks of MDMA use are:
- Overheating (hyperthermia)
- Water intoxication (hyponatremia)
- Serotonin syndrome (serotonin poisoning)
- Higher risk of heart problems (cardiovascular disease)
- Epileptic seizure
- Acute confusional state
- Liver damage
- Psychological symptoms / hangover
MDMA disrupts your body temperature; your body gets warmer. When you use MDMA in a warm environment (in a club or in the sun during a festival) your body temperature rises even more. If you also dance for a long time without cooling down regularly, this might cause overheating. Overheating can occur with a “normal” dose of MDMA.
If your body temperature stays high, the following symptoms can appear:
- Shivering, pale appearance
- Fast heartbeat
- Reduced consciousness
- Nausea, vomiting
The situation becomes life-threatening when the body temperature rises up to 40-41 degrees Celsius. The consequences can be:
- Muscle tissue breakdown
- Blood clotting throughout the body
- Malfunctioning kidneys and liver
- Epileptic seizures
Water intoxication (hyponatremia)
MDMA can cause a dry mouth so you constantly feel thirsty. Even though drinking water does not sound very dangerous, it is not without risks; especially in combination with MDMA. If you drink too much, this can lead to water intoxication.
It is important to find a balance: try to drink enough so you don’t get dehydrated or overheated, but don’t drink too much because this can result in water intoxication.
Too much water When you drink a lot of water, the blood volume in your body increases while the concentration of salts (sodium) decreases. MDMA also causes the kidneys to excrete less water in urine, because the drug makes it hard for you to pee. Moreover, MDMA lessens your hunger and on top of this the reduced saliva production makes it difficult for you to eat. This way, you don’t obtain sodium through food. The low concentration of sodium causes water from the blood to flow into the brain cells, which makes them swell. When the brain cells swell, this is called brain oedema. Because your skull does not give, there is an increased pressure in the skull.
Symptoms of water intoxication are:
- Nausea, vomiting
And later may occur:
- Epileptic seizures
- Reduced consciousness
Make sure you drink one glass of water or soft drink per hour. This way, your body obtains enough liquids so you don’t become dehydrated. Are you still more thirsty or bothered by a dry mouth? Ice lollies are often sold at parties and festivals; these can moisturize your mouth so you don’t have to drink litres of water.
The serotonin syndrome is caused by an excessive level of serotonin in the central nervous system. Serotonin is a messenger substance (neurotransmitter) in the brain that influences emotions, sexual functioning and hunger and thirst. The serotonin system causes the loving feeling you get when you use MDMA.
Ecstasy (MDMA), amphetamine (speed) cocaine, LSD, some pharmaceuticals such as antidepressants and some natural food supplements influence the level of serotonin and they can cause serotonin syndrome. When your body uses too much serotonin, for instance because of excessive use of MDMA, this can cause a disruption of the natural level of serotonin in the long-term and potentially cause serotonin syndrome.
The impact of serotonin syndrome depends on which substances someone has used and the quantity in which they are used. The symptoms are not equally severe for everyone, but sometimes the effects can be unpredictable and even life-threatening.
What increases the risk of getting serotonin syndrome?
- When you use of large quantities of ecstasy, or combine ecstasy with amphetamine (speed), cocaine or other drugs this can increase the risk of you getting serotonin syndrome.
- Combining ecstasy with AD(H)D medication (dexamphetamine, Ritalin) or L-tryptophan can increase the chance of serotonin syndrome.
- Combining ecstasy with antidepressants, MAOIs and SSRIs increases the risk of serotonin syndrome and is perilous.
The symptoms are similar to the normal side effects of MDMA and are not necessarily serious, but when you see someone with the following complaints, you should definitely look for medical assistance:
- Unusual muscle cramps in arms or legs
- Muscle stiffness
Psychological problems and hangover (“Terrible Tuesday”)
“Terrible Tuesday” or “Suicide Tuesday” is a widely known phenomenon that can occur after the use of MDMA. When you take MDMA, your body uses serotonin, the substance that makes you feel happy and in love. During the following weeks your body needs to produce serotonin again. That is why you can feel down, depressed, sad, hypersensitive, irritable and empty. This mood dip is most often at its worst two or three days after you have used MDMA. People who use it on a Saturday may experience the strongest mood dip on Tuesday; therefore this day is called “Terrible Tuesday”.
- Brain damage
- Worsened short-term memory
- Increased risk of heart arrhythmias, heart attacks and strokes.
- Fatigue / exhaustion
- Reduced fitness
- Weight loss
- Psychological problems
- Damage to the teeth
Animal studies show that MDMA can cause damage to certain brain cells. Similar damage can be seen in the brains of heavy MDMA users. Unfortunately, it is not clear what this damage means and whether or not you can fully recover from it. It has been shown, however, that when you use two ecstasy pills every weekend for a couple of years, this will have a negative effect on your memory. It is not certain with which exact dose this is the case. Therefore, it is important to be extra careful.
We advise you not to use MDMA more often than once every six to eight weeks, and not to use more than 1 to 1.5 mg MDMA per kg body weight (or between 0.4 and 0.7 mg MDMA for each pound body weight). These quantities are based on research carried out by Unity. Do you take MDMA every weekend? Then your use is becoming dangerous. With laboratory animals, the brain damage increased as the temperature was higher. Therefore, make sure you cool down sufficiently: rest frequently, don’t wear warm clothes, drink a soda or water regularly.
Some heavy MDMA users can be left with a depression in the long-term. There is a relationship between how often and how much MDMA you use together with your sensitivity for depression, and how great the chance is that you may feel depressed after MDMA use. If you are prone to depression, don’t use too much MDMA.
Damage to the teeth
If you use MDMA often, this has consequences for your teeth. This is because people often firmly clamp their teeth together during MDMA use, grind their teeth or chew a lot of chewing gum which can cause tooth wear. MDMA also reduces saliva production. This means bacteria have more chance to multiply, causing your gums to become infected more easily. It is therefore advisable to always use sugar free gum and to take good care of your teeth in order to reduce the risks. Also make sure the MDMA does not get in contact with your teeth.
It is possible to become psychologically dependent on MDMA. Most often this dependence means that you do not enjoy going to a party any more without using MDMA or that it becomes really hard to say no to it when others are using the drug.
There is no such thing as physical dependence on MDMA. Tolerance to the effects of MDMA does occur, however. This means that your body becomes accustomed to the use of MDMA. When you use it often, the typical MDMA “love” feeling lessens, while the stimulant effect stays. If this is the case for you, you should not use MDMA for two to three months to experience the “love” feeling again.
If you’re wondering whether your MDMA use is becoming a problem, you could ask yourself the following questions:
- Is it hard to get in a good mood without using MDMA?
- Am I mentally preoccupied with the drug?
- Has the use of MDMA changed me as a person?
- Do I have to use more and more to achieve the same effect?
- Have I been using more MDMA lately? Do I take a higher dose, in more different places and on various occasions?
- Do I use more than I planned beforehand?
- Do I suffer from withdrawal symptoms when I don’t use, such as sleeping poorly, moodiness, shaking, headaches, dizziness, nausea and sweating?
- Do I sometimes use MDMA to eliminate negative effects from the last use, such as a hangover?
- Does it take me a long time to recover from using?
- Do I spend more and more money on it?
- Do I use it despite the fact that I have important things to do? Do I neglect hobbies and work?
- Does using lead to more and more problems with people around me, for instance friends and family?
- Do I use MDMA constantly, even though I know it causes damage to both my body and my social life?
The more times you answer these questions with “yes”, the more dangerous your use of MDMA has become.
Combinations with other drugs
Combining different types of drugs is extra risky and unpredictable. When you combine drugs you have a higher risk of health problems. In the following paragraphs you can read about the effects and the risks of a number of combinations that occur frequently and also a about few that are extra hazardous.
MDMA and speed or coke
This combination causes an increased pressure on heart and blood vessels and it can truly exhaust the body. The hangover is often much worse than the hangover you would have with only speed or only MDMA. Speed reduces the MDMA’s love effect. This combination increases the risk of overheating and the serotonin syndrome (see “Risks”)
MDMA and alcohol
Alcohol diminishes the effect of MDMA, so it is basically a waste of the pill. Drinking can cause you to take more MDMA to still reach the wanted effect. On top of this, the combination alcohol and MDMA can cause headaches and nausea. When you use MDMA it is harder to tell if you are getting drunk. Therefore, you may drink more than you normally would. Your hangover will be much worse.
MDMA and GHB
GHB is said to lengthen the effect of MDMA. The combination may cause you to push your boundaries even more than the separate drugs would, so take that into account. You may do things you regret afterwards.
Some people think the combination of MDMA and or amphetamine (speed) with GHB can prevent you from losing consciousness. It is true that your mind can feel clearer than when you only use GHB. But when the MDMA or amphetamine wears off, you can still pass out. There are indications that when an overdose GHB causes you to lose your consciousness, your coma might be deeper and longer if you have also used speed or MDMA. Therefore, you should never use “uppers” to prevent yourself from passing out.
MDMA en Anti-depressants
When you are depressed, it is definitely not a good idea to use MDMA. In case you use modern antidepressants, known as SSRIs, then you probably won’t feel anything from your MDMA. There is no point in using the drug. When you are on an old type of antidepressants, the so-called MAO inhibitors, it is very dangerous to use MDMA (and also speed). Your blood pressure can rise to dangerous levels and you have a higher risk of serotonin syndrome.
MDMA en anti-asthma or anti/hay fever medication
It is not a good idea to combine these substances, because this can cause your blood pressure to rise dangerously.
Different factors influence the detection time of a substance in your blood or urine. How often and how much you use, for instance, just as your personal metabolism (how fast a substance is broken down in your body, especially by the liver). Drugs are always longer traceable in urine than they are in blood. MDMA is no longer detectable in the blood or urine within two to three days.