Ecstasy / MDMA

What is ecstasy / MDMA?

MDMA (3,4-methylenedioxymethamphetamine) is the chemical name for the active ingredient in ecstasy pills. So when we are talking about XTC or ecstasy, we are talking about MDMA as well and vice versa.

MDMA is a stimulating drug with consciousness changing effects. MDMA is sold as a pill, powder and crystal.

Effects

The effect of a drug depends on the characteristics of the drug itself, but also on the set and setting of the user. Here we describe the general effects of MDMA.

MDMA has  stimulating and consciousness changing effects. The stimulant effect keeps you awake, sharp and give you the feeling you can think fast. The consciousness changing or entactogenic (get into contact with the inner you) effects could be described as a relaxing feeling. You feel open and in connection with others.

Mind you: pills or powders that are sold as MDMA can contain other drugs than MDMA. The effect will then be different.

Positive effects:

  • Euphoria
  • Compassionate
  • Entactogenic (strong feeling of connectedness with yourself and others)
  • Urge to be in contact with others, talk and intimacy
  • Energy
  • Alertness
  • More intense experience of music

Negative effects:

  • Reduced ability to concentrate
  • Forgetfulness
  • Fear, paranoia, delusions
  • Tingling
  • Reduced appetite
  • Increased blood pressure and heart rate
  • Increased body temperature
  • Difficulty peeing
  • Dry mouth
  • Dilated pupils
  • Increased muscle tension
  • Tense jaws
  • Difficulty sleeping
  • Nystagmus (very rapid eye movements)
  • Nausea, vomit
  • Sweating
  • Hallucinations

Dose and method of use

MDMA is sold as a pill, powder, crystal and capsules. Sometimes it is also available as a liquid mixture (blue 69).

Ecstasy pill

MDMA is most commonly used as a pill. Some people take a whole pill at once, others break them in halves or quarters. Because the content of a pill differs widely, you never know how much you take when you think in halves or quarters.

From 2011 onward the amount of MDMA in a pill has increased. Before 2009 a pill would contain 80 milligrams of MDMA on average. That average was already doubled in  2013 to 140 mg. High doses like 180 mg or more per pill are no exception any more. More MDMA for the same price sounds good. But with these high doses, the risks also increase. It is more difficult to dose correctly and easy to take more than you intended. Inexperienced users can get the idea that these high doses are normal. They can get into ugly situations if they think one pill is one dose. In 2020 and 2021 the testing service noticed that the amount of MDMA in a pill started to vary widely. One pill can contain 70 mg will another logo can contain 230 mg.
We suspect that the pressure on the First aid at big parties and festivals has to do with the increase in the amount of MDMA in pills. So, have your pills tested!

Also check the infographic ‘strength of ecstasy pills over the years‘ by the Drugsinfoteam.

MDMA powder

In the case of powder or crystals, users usually take small licks and build up their dose slowly. Or they put it in a capsule or roll it in a small piece of paper (bomb) to swallow it. Some users dissolve the powder in a drink. The powder can be snorted or smoked (rarely). MDMA has a negative influence on the enamel of your teeth. By putting it in a drink or by taking licks you increase the chance on damage to your teeth.

MDMA powder can differ in strenght and can be cut. So have your powders tested!

So an ecstasy pill and MDMA powder are essentially the same thing, they just look different.

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 in the Netherlands.

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.

Dose

Ecstasy pills exist in all colours and logo’s. The outside does not tell you anything about what it contains. Which substances it contains and their doses. To learn about the content you have to bring it to a drug testing service.

All drug samples that are handed in at the drug testing services nationwide are sent to the DIMS (Drugs Information Monitoring System). This gives the DIMS good view on the drug markets. In case of a dangerous situation they have the option to set up a warning campagne.
On the website of the DIMS a list with extra risky pills can be found. They are extra risky, because the use of drugs in itself caries risks as well. On this list it is mentioned what the logo is, the colour and the date when the pill was handed in.

The amount of MDMA in a pill can vary widely. Some pills contain no MDMA, while others contain three times a usual dose. And there are pills that look like regular ecstasy but contain something else, like PMMA or mCPP. These are drugs that can be more damaging to your health than MDMA or that can have nasty side effects. MDMA powder and crystals can be tested at the drug testing service. If you test pills you get the result in mg per pill. If you test a powder you get the result in percentage of the powder that is MDMA.

If you ingest it, 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. Don’t take it more often than once every 6-8 weeks. 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.

Oral dose bodyweight times 1 to 1,5 mg per event.

Duration

After 20-60 minutes you will start to feel the first effects. Tingling through your body, a warm glow and a euphoric feeling as if you are in love. The effects become stronger quickly and that feels as if you are ‘hit’ by the MDMA. That hit usually lasts for about 5 minutes. You might feel nauseous or maybe you have to vomit. After about 2 hours the effects will start to wear off. And after about 4-6 hours most people will feel fairly sober again.

Many users choose to redose to keep the buzz going. But that doesn’t always work. You won’t get the feeling back from the start of the buzz and the unwanted side effects will increase. Expect a dry mouth, forgetfulness, tense muscles and grinding of your teeth. This is often the moment when people think there is speed (amphetamine) in their pill. And people often become more introverted and have difficulty speaking.

Risks

Short-term risks

Severe health incidents rarely 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
  • Excited delerium syndrome
  • Liver damage
  • Psychological symptoms / hangover

Overheating (hyperthermia)

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.

Signs of a starting overheating:

  • Headache
  • Confusion
  • Stiff muscles
  • Dizziness

These are symptoms that are also regular side effects of MDMA itself. 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

Overheating is very dangerous and difficult to treat. Cooling down, taking rest and drinking of enough (maximum one glass per hour) water is needed to avoid becoming overheated. Sweating is another important way to cool down: by evaporating the layer of sweat on your skin, your skin cools down. But if the humidity is very high (when the drops fall from the ceiling), the sweat can evaporate much less well and therefore your body cannot cool down properly.

Water intoxication (hyponatremia)

Because overheating is one of the most serious acute risks of MDMA use, many people who use MDMA know that they should “drink plenty of water.” Some people have interpreted it to mean that you should “drink a lot of water” when taking MDMA. Unfortunately, however, there have been cases where MDMA users have died from drinking ‘too much’ water; a water poisoning.

If you drink a lot of water, this causes an increase in blood volume and a decrease in the concentration of salts (sodium) in your blood. MDMA also ensures that your kidneys excrete less water through the urine; you have difficulty or cannot urinate. Moreover, because of the MDMA you are usually not hungry and it is difficult to eat due to the reduced saliva production. This ensures that you do not ingest any salts (sodium). Due to this low concentration of sodium, water from the blood flows into the brain cells, causing them to swell. When your brain cells swell, we call it a cerebral edema. Because your skull cannot move, of course, there is increased pressure in the skull. This can lead to strokes, coma and eventually death. The most important way to avoid water intoxication is not to drink too much water.

Unitytip: don’t drink too much water when you use ecstasy and the 24 hours after you have taken it. Keep it to a maximum of 1 glass per hour.

Symptoms of water intoxication are:

  • Nausea
  • Vomiting
  • Headache
  • General unwell feeling
  • Anxiety

And later:

  • Epileptic seizures
  • Reduced consciousness
  • Coma

In 2015 we made this explainer, which tells you more about water intoxication and how to prevent it.

Serotonin syndrome

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, 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 5-HTP and L-tryptophan can increase the chance of serotonin syndrome.
  • Combining ecstasy with antidepressants, MAOIs and SSRIs increases the risk of serotonin syndrome and is dangerous.

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:

  • Fever
  • Agitation
  • Anxiety/confusion
  • Unusual muscle cramps in arms or legs
  • Muscle stiffness

Psychological problems and hangover (“Terrible Tuesday”)

After the use of MDMA you can experience a hangover. You feel tired, depressed, sad, oversensitive and empty. How bad this hangover is differs per person. But most users report at least tiredness and a bad mood in the days afterwards. It is not known what the cause of the hangover is, but a high dose, combined use of other drugs and dancing in combination with a lack of food and sleep play a big part in the hangover.

Long/term risks

  • Impaired memory
  • Increased risk of heart arrhythmias, heart attacks and strokes.
  • Fatigue / exhaustion
  • Reduced fitness
  • Weight loss
  • Mental problems
  • Damage to the teeth
  • Brain damage
  • Depression

Impaired memory

When using MDMA often your memory can be impaired. When people stop using it is possible that your memory improves somewhat. It is not clear if it fully recovers.

Mental problems

Mental problems can arise or already existing psychological complaints can worsen. For example feeling sad or anxious, not feeling well and poor concentration.

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.

Brain damage

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.

Depression

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.

Addiction

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.

Unity tips:

  • Only use drugs when you feel physically and mentally well.
  • Rest well before and after use.
  • Eat healthy before, during and after.  Especially anti-oxidants and vitamines (blue berries, raspberries, blackberries, grapes, raisins, oranges, kiwi, broccoli).
    This is perhaps the most important tip! It’s hard to eat during and after MDMA use, but try it anyway. Eating well clearly reduces the hangover! If you don’t get solid foods, think juices, breakfast drinks, smoothies.
  • You can take extra vitamins and antioxidants before and after MDMA use.
  • If you have pills, powder or crystals tested, you will know exactly what and how much is in them.
  • Do not use when you have: diabetes, weak heart, high blood pressure, pregnancy, epilepsy and mental complaints or in combination with medicines (especially not with MAO inhibitors and asthma medicines).
  • Do not use more than once every 6-8 weeks. Do not take more than 1-1.5 mg of MDMA per kg of body weight.
  • Do not drink more than 1 glass of water or soda per hour, otherwise the risk of water intoxication increases.
  • Make sure you don’t get too hot while taking MDMA: rest every now and then, don’t wear warm clothes, no headgear, and drink water or soft drinks every now and then.
  • Do not combine with alcohol and other drugs.
  • Do not participate in traffic.
  • MDMA evokes feelings of intimacy. In combination with a carefree mood, safe sex can sometimes be missed. Be prepared and have a condom with you.
  • There is no real safe use of MDMA, but the risks can be limited.

More info

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.

The law

In November 1988, ecstasy was placed on Schedule I (the list of hard drugs) of the Opium Act. This is the most strict law possible for drugs.

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.