MDMA

MDMA, also known as 3,4-methylenedioxymethamphetamine, is a synthetic drug known for its psychoactive effects.³ It was first synthesised in 1912 by the German pharmaceutical company Merck, originally to be used as a diet pill, although it was never marketed in this way.

The substance gained popularity in the 1970s when psychiatrists started using it as an aid in psychotherapy, although it was not approved by the U.S. Food and Drug Administration (FDA). The drug was classified as a Schedule I substance in the US in 1985 due to concerns about safety and potential for abuse, which put an end to its legal clinical use.⁵

MDMA primarily affects neurons in the brain that use the chemicals serotonin, dopamine, and norepinephrine to communicate with other neurons.³ These neurotransmitters are involved in mood, energy level, appetite, trust, sexual activity, emotions, and sleep. By increasing the activity of these neurotransmitters, MDMA enhances certain sensory experiences and can produce feelings of increased energy, euphoria, emotional warmth, and empathy towards others.¹

However, research indicates that MDMA can also have negative effects. Acute effects can include increased heart rate and blood pressure, which can be dangerous for people with circulatory or heart disease. Some users also experience muscle tension, nausea, blurred vision, and faintness. Following the drug’s peak effects, users may experience a “crash” characterised by feelings of fatigue, loss of appetite, and depression.⁵

Additionally, MDMA use can lead to long-term damage to parts of the brain involved in thought and memory. Studies have also found gender differences in the subjective effects of MDMA, with females tending to report more intense effects than males.²

Appearance

MDMA is most commonly found in pill or capsule form but can also be a powder or crystal. Its appearance can vary considerably: pills and capsules can come in various colours and be stamped with different logos. The powder or crystal form of MDMA is typically white or off-white.³

Tastе

 As for the taste, MDMA is often described as very bitter and unpleasant. It’s often swallowed as a pill or capsule to avoid this taste. In its powdered form, it may be taken “bombed” (wrapped in a cigarette paper) or mixed with a drink.³

Smell

The smell of MDMA is usually faint, and some people describe it as slightly sweet or chemical-like, but it’s not particularly distinctive or easily recognisable.³

The dosage of MDMA can vary widely, and the effect can depend on many factors, including the user’s weight, metabolism, tolerance, and the purity of the drug.

• Minimum dose:  amount needed to feel something, is typically around 30 mg.⁵
• A low dose of MDMA is usually considered to be 40-75 mg.
• The common dose of MDMA ranges from 75-125 mg, with most pills containing between 80-120 mg of MDMA.⁴
• A high dose would be considered 150 mg or above. Taking high doses of MDMA can increase the risk of adverse effects and overdose.

Notes on what may happen when exceeding the high dose 

Exceeding a high dose of MDMA can lead to severe and potentially fatal health effects. These include hyperthermia, dangerously elevated body temperature, heart palpitations, high blood pressure, panic attacks, loss of consciousness, and seizures. In severe cases, high doses of MDMA can result in organ failure or death.^4, 3

Users of MDMA often report feelings of intense euphoria, warmth, and heightened sensory perception. These effects are often accompanied by an increased sense of emotional openness and empathy and a decreased sense of fear and anxiety. Users may also report a feeling of increased energy or alertness.²

Risks include hyperthermia, cardiovascular problems, potential neurotoxicity, cognitive deficits, and mood disorders.

MDMA is primarily taken orally, most commonly in pill or capsule form.⁴  It can also be found as a powder or crystal which can be swallowed (“bombed”) or snorted. Less commonly, it may be injected, though this is rarer due to the associated health risks of injection drug use.³

After oral consumption, the effects of MDMA are typically felt within 30 to 60 minutes. However, this can vary based on factors such as the individual’s weight, metabolism, and food in the stomach.⁵

The effects of MDMA typically last 3 to 6 hours, depending on the dose and individual factors. Some users may take a second dose as the effects of the first begin to fade, which can prolong the duration of the effects. ³

The risks associated with MDMA use are multifaceted. Overdose can lead to severe health consequences, such as hyperthermia, cardiovascular problems, and potentially fatal organ failure.^{4 3} Other acute risks include dehydration and hyponatraemia (water intoxication). Longer-term risks can include cognitive deficits, mood disorders, and potential neurotoxicity.

As for addiction, while MDMA is not typically considered as addictive as other substances like cocaine or heroin, problematic use can develop. Dependence is characterised by continued use despite knowledge of physical or psychological harm, increased tolerance (requiring more of the drug to achieve the same effects), and experiencing withdrawal symptoms when not taking the drug. Though rarer than with other substances, there are reports of such patterns with MDMA use.⁵

In the UK, MDMA is a Class A drug under the Misuse of Drugs Act 1971, denoting it as among the most harmful substances. Penalties for possession can be up to 7 years in prison, an unlimited fine, or both. For supply and production, penalties can be up to life in prison, an unlimited fine, or both.⁶

Mixing MDMA with other substances can increase risks. For example, combining it with alcohol can exacerbate dehydration, and mixing it with other stimulants can increase the risk of cardiovascular problems. ³

1. Bedi, G., et al. (2010) ‘Effects of MDMA on sociability and neural response to social threat and social reward’, Psychopharmacology, 207(1), pp. 73-83. https://link.springer.com/article/10.1007/s00213-007-0703-5)
2. Liechti, M.E., Gamma, A. and Vollenweider, F.X. (2001) ‘Gender Differences in the Subjective Effects of MDMA’, Psychopharmacology, 154(2), pp.161-168.https://link.springer.com/article/10.1007/s002130000648)
3. Meyer, J.S. (2013) ‘3,4-methylenedioxymethamphetamine (MDMA): current perspectives’, Substance Abuse and Rehabilitation, 4, pp. 83–99.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931692/)
4. Parrott, A.C. (2007) ‘The psychotherapeutic potential of MDMA (3,4-methylenedioxymethamphetamine): an evidence-based review’, Psychopharmacology, 191(2), pp.181-193.https://link.springer.com/article/10.1007/s00213-007-0703-5)
5. Parrott, A.C. (2013) ‘Human psychobiology of MDMA or ‘Ecstasy’: an overview of 25 years of empirical research’, Human Psychopharmacology: Clinical and Experimental, 28(4), pp.289-307. https://onlinelibrary.wiley.com/doi/full/10.1002/hup.2318)
6. UK Home Office. (2021) ‘Drugs penalties’, gov. uk. https://www.gov.uk/penalties-drug-possession-dealing)