MDMA

Other names:

• Adam
• E
• Ecstasy
• Molly
• X
• XTC

Basics: 3,4-Methylenedioxymethamphetamine (MDMA) is a synthetic drug. Users typically consume MDMA orally in a pill or capsule and begin to feel its effects thirty to forty-five minutes later. The entire experience lasts about three to four hours.

MDMA interacts with neuronal connections (synapses) and causes the release of serotonin, norepinephrine, and dopamine neurotransmitters, with the largest effect being on serotonin. The transient increase in the actions of these neurotransmitters in the brain impacts arousal, attention, emotion, and memory. 

History: MDMA was first made in 1912 by the German pharmaceutical company Merck. It was used as an intermediate chemical in making a drug intended to stop blood loss. At that time, MDMA itself was not tested pharmacologically.

In 1977, the chemist and psychedelics pioneer Alexander “Sasha” Shulgin introduced the drug to Leo Zeff, a psychotherapist and also an early proponent of psychedelics in therapy. Over the next twelve years, Zeff treated more than 4,000 patients with MDMA and trained 150 therapists to use it in their work. Shulgin’s wife, Ann Shulgin, also treated many patients.

During the 1980s, MDMA became a popular recreational drug at nightclubs and raves. In 1985, the Drug Enforcement Administration placed MDMA on the list of Schedule I controlled substances, effectively stalling research into its therapeutic potential.

Potential Benefits: MDMA is known as an empathogen because while it does alter mood and has some psychedelic qualities, its effect profile differs significantly from that of the classic psychedelics. Rather than mystical-type experiences, MDMA produces a mellower experience during which people feel more empathic, more open to bonding with others, and better able to process emotional or traumatic memories.

Potential Risks and Side Effects: MDMA activates the sympathetic branch of the autonomic nervous system, causing transient increases in heart rate and blood pressure.

Therapy: In 2011, researchers published the results of the first clinical trial that showed MDMA could be used alongside therapy to treat post-traumatic stress disorder. Subsequent studies suggest it’s also effective at reducing social anxiety in autistic adults and in people with life-threatening illnesses and those living with eating disorders.

In 2021, researchers in the United States, Canada, and Israel published the results of a phase III clinical trial using MDMA-assisted therapy to treat post-traumatic stress disorder. The trial studied ninety participants and found that the treatment was safe and that, for the majority of participants who received it, MDMA relieved many, and in some cases most, of their symptoms.

Legality: In the United States, MDMA is listed in Schedule I of the Controlled Substances Act. It’s illegal to use it recreationally or in therapy outside of specially approved research settings.

Notable Studies:

• A phase II clinical trial that used culturally informed care to deliver MDMA-assisted therapy to people of color.
• Anecdotal reports that MDMA-assisted therapy can help treat substance abuse disorder.
• How MDMA’s effects on certain brain regions may help people reprocess traumatic memories.
• fMRI imaging that may help explain why patients report MDMA makes thinking and talking about negative experiences easier.