MDMA(ECSTASY)

Abuse

What is MDMA?

MDMA is an illegal drug

that acts as both a stimulant and psychedelic,

producing an energizing effect,

as well as distortions in time and

perception and enhanced enjoyment from tactile experiences.

Typically, MDMA (an acronym

for its chemical name 3,4-methylenedioxymethamphetamine) is

taken orally, usually in a tablet

or capsule, and its effects last

approximately 3 to 6 hours. The

average reported dose is one 

to two tablets, with each tablet

typically containing between 

60 and 120 milligrams of MDMA.

It is not uncommon for users to

take a second dose of the drug

as the effects of the first dose

begin to fade.

MDMA can affect the brain by

altering the activity of chemical

messengers, or neurotransmitters,

which enable nerve cells in the

brain to communicate with one

another. Research in animals has

shown that MDMA in moderate

to high doses can be toxic to

nerve cells that contain serotonin

and can cause long-lasting 

damage to them. Furthermore, 

MDMA raises body temperature.

On rare but largely unpredictable

occasions, this has 

led to severe medical

consequences, 

including death. 

Also, MDMA causes

the release of another

neurotransmitter, 

norepinephrine, which

is likely the cause of the

increase in heart rate

and blood pressure

that often accompanies

MDMA use.

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The so-called “club drug” MDMA

continues to be used by millions of

Americans across the country, despite

evidence of its potential harmful effects.

3,4-methylenedioxymethamphetamine

(MDMA, or ecstasy) has gained a

deceptive reputation as a “safe” drug

among its users. This illegal drug, which

has both stimulant and psychedelic

properties, is often taken for the feelings

of well-being, stimulation, and the 

distortions in time and sensory perceptions that it produces. MDMA first

became popular in the “rave” and 

all-night party scene, but its use has

now spread to a wide range of settings

and demographic subgroups. According

to the 2004 National Survey on Drug

Use and Health, more than 11 million 

people have tried MDMA at least once.

Myths abound about both the acute

effects and long-term consequences of

this drug, often called ecstasy or “X.”

Indeed, one reason for the rapid rise in

the drug’s popularity is that many

young people believe that MDMA is a

new safe drug. But MDMA is not new 

to the scientific community, as many

laboratories began investigating this

drug in the 1980s, and the picture

emerging from their efforts is of a drug

that is far from benign. For example,

MDMA can cause a dangerous increase

in body temperature that can lead 

to kidney failure. MDMA can also

increase heart rate, blood pressure, 

and heart wall stress. Animal studies

show that MDMA can damage specific

neurons in the brain. In humans, the

research is not conclusive at this time;

however, a number of studies show that

long-term, heavy MDMA users suffer

cognitive deficits, including problems

with memory.

NIDA-supported research is developing a clearer picture of the potential

dangers of MDMA, and this Research

Report summarizes the latest findings.

We hope that this compilation of 

scientific information will inform 

readers and help the public recognize

the risks of MDMA use.

Nora D.Volkow, M.D.

Director

National Institute on Drug Abuse

U.S. Department of Health and Human Services • National Institutes of Health

ResearchReport NATIONAL INSTITUTE ON DRUG ABUSE

SERIES
Although MDMA is known

universally among users as 

ecstasy, researchers have determined that many ecstasy tablets

contain not only MDMA but also

a number of other drugs or drug

combinations that can be harmful as well. Adulterants found in

MDMA tablets purchased on the

street include methamphetamine,

caffeine, the over-the-counter

cough suppressant dextromethorphan, the diet drug ephedrine,

and cocaine. Also, as with many

other drugs of abuse, MDMA 

is rarely used alone. It is not

uncommon for users to mix

MDMA with other substances,

such as alcohol and marijuana.

A brief history 

of MDMA

MDMA was developed 

in Germany in the 

early 1900s as a parent

compound to be used to 

synthesize other pharmaceuticals.

During the 1970s, in the United

States, some psychiatrists began

using MDMA as a psychotherapeutic tool, despite the fact that

the drug had never undergone

formal clinical trials nor received

approval from the U.S. Food and

Drug Administration (FDA) for

use in humans. In fact, it was

only in late 2000 that the FDA

approved the first small clinical

trial for MDMA that will determine if the drug can be used

safely with 2 sessions of ongoing

psychotherapy under carefully

monitored conditions to treat

post-traumatic stress disorder.

Nevertheless, the drug gained a

small following among psychiatrists in the late 1970s and early

1980s, with some even calling it

“penicillin for the soul” because

it was perceived to enhance

communication in patient 

sessions and reportedly allowed

users to achieve insights about

their problems. It was also 

during this time that MDMA first

started becoming available on

the street. In 1985, the U.S. Drug

Enforcement Administration (DEA)

banned the drug, placing it on 

its list of Schedule I drugs, corresponding to those substances

with no proven therapeutic value.

What is the 

scope of MDMA

abuse in the U.S.?

I

t is difficult to determine the

exact scope of this problem

because MDMA is often used

in combination with other 

substances, and does not appear 

in some traditional data sources,

such as treatment admission rates.

More than 11 million persons 

aged 12 or older reported using

ecstasy at least once in their 

lifetimes, according to the 2004

National Survey on Drug Use

and Health. The number of 

current (use in past month) 

users in 2004 was estimated to

be 450,000. 

The Drug Abuse Warning

Network, maintained by the

Substance Abuse and Mental

2NIDA RESEARCH REPORT SERIES

Serotonin Present in Cerebral Cortex Neurons

Long-term effects in monkeys. The left panel is brain tissue from a normal monkey. The middle

and right panels illustrate the loss of serotonin-containing nerve endings following MDMA exposure.

CONTROL 2 WEEKS AFTER ECSTASY 7 YEARS AFTER ECSTASY
Health Services Administration,

reported that mentions of MDMA

in drug abuse-related cases in

hospital emergency departments

were 2,221 for the third and

fourth quarters of 2003. The

majority of patients who came 

to emergency departments 

mentioning MDMA as a factor 

in their admissions during that

time were aged 18–20.

There is, however, some

encouraging news from NIDA’s

Monitoring the Future (MTF) 

survey, an annual survey used to

track drug abuse trends among

adolescents in middle and high

schools across the country.

Between 2001 and 2005, annual

ecstasy use decreased by 52 percent in 8th-graders, 58 percent 

in 10th-graders, and 67 percent

in 12th-graders. Rates of lifetime

MDMA use decreased significantly

from 2004 to 2005 among 12thgraders. 

In 2005, 8th-graders reported a

significant decrease in perceived

harmfulness in using MDMA

occasionally. The MTF data also

show that MDMA use extends

across many demographic subgroups. Among 12th-graders in

2005, for example, 3.9 percent of

Whites, 3.0 percent of Hispanic

students, and 1.4 percent of

African-Americans reported

using MDMA in the year prior 

to the survey.

Who is 

abusing MDMA?

MDMA first gained popularity among adolescentsand young adults in the

nightclub scene or weekendlong dance parties known as

raves. However, the profile of

the typical MDMA user has 

been changing. Community-level

data from NIDA’s Community

Epidemiology Work Group

(CEWG), continued to report 

that use of MDMA has spread

among populations outside the

nightclub scene.

Reports also indicate that use

is spreading beyond predominantly White youth to a broader

range of ethnic groups. In

Chicago, the drug continues to

be predominantly used by White

youth, but there are increasing

reports of its use by AfricanAmerican adults in their twenties

and thirties. Also, indicators in 

New York suggest that both

the distribution and use of club

drugs are becoming more common in non-White communities.

NIDA RESEARCH REPORT SERIES3

30-Day

0

2

4

6

8

10

0

2

4

6

8

10

2003 2004 2005

Annual

2003 2004 2005

8th-Graders

10th-Graders

12th-Graders

Monitoring the Future Survey*

Trends in MDMA Prevalence, 2003–2005

* These data are from the 2005 Monitoring the Future survey, funded by the National Institute 

on Drug Abuse, National Institutes of Health, DHHS, and conducted annually by the University 

of Michigan’s Institute for Social Research. “Annual” refers to use at least once during the year 

preceding an individual‘s response to the survey. “30-day” refers to use at least once during the

30 days preceding an individual‘s response to the survey.

0

20

40

60

80

100

2003 2004 2005

10th-Graders

8th-Graders

Trends in 

Perceived Harmfulness 

of MDMA Use

Perceived risk associated with MDMA use in 

selected categories.

Percentage saying

“great risk” to trying

MDMA once or twice

Percentage saying 

“great risk” to trying 

MDMA occasionally
Other NIDA research shows

that MDMA has also become a

popular drug among urban gay

males. Reports have shown that

some gay and bisexual men take

MDMA and other club drugs in

myriad venues. This is concerning

given that the use of club drugs

has been linked to high-risk sexual behaviors that may lead to

HIV or other sexually transmitted

diseases. Many gay males in big

cities report using MDMA as part

of a multiple-drug experience

that includes marijuana, cocaine,

methamphetamine, ketamine,

and other legal and illegal 

substances.

What are the

effects of MDMA?

MDMA has become a 

popular drug, in part

because of the positive

effects that a person may 

experience within an hour or 

so after taking a single dose.

Those effects include feelings of

mental stimulation, emotional

warmth, empathy toward others,

a general sense of well being,

and decreased anxiety. In 

addition, users report enhanced

sensory perception as a hallmark

of the MDMA experience.

Because of the drug’s stimulant

properties, when used in club 

or dance settings, MDMA can

also enable users to dance for

extended periods. However,

there are some users who report

undesirable effects immediately,

including anxiety, agitation, and

recklessness.

As noted, MDMA is not a

benign drug. MDMA can produce

a variety of adverse health

effects, including nausea, chills,

sweating, involuntary teeth

clenching, muscle cramping, and

blurred vision. MDMA overdose

can also occur—the symptoms

can include high blood pressure,

faintness, panic attacks, and 

in severe cases, a loss of 

consciousness and seizures.

Because of its stimulant 

properties and the environments

in which it is often taken, MDMA

is associated with vigorous physical activity for extended periods.

This can lead to one of the most

significant, although rare, acute

adverse effects—a marked rise in

body temperature (hyperthermia).

Treatment of hyperthermia

requires prompt medical attention,

as it can rapidly lead to muscle

breakdown, which can in turn

result in kidney failure. In addition, dehydration, hypertension,

and heart failure may occur in

susceptible individuals. MDMA

can also reduce the pumping

efficiency of the heart, of particular concern during periods of

increased physical activity, further

complicating these problems.

MDMA is rapidly absorbed

into the human bloodstream, but

once in the body, MDMA metabolites interfere with the body’s

ability to metabolize, or break

down, the drug. As a result,

4NIDA RESEARCH REPORT SERIES

Effects of MDMA

Reported Undesirable Effects 

(up to 1 week post-MDMA, or longer):

■ Anxiety

■ Restlessness

■ Irritability

■ Sadness

■ Impulsiveness

■ Aggression

■ Sleep disturbances

■ Lack of appetite

■ Thirst

■ Reduced interest in and 

pleasure from sex

■ Significant reductions in 

mental abilities

Potential Adverse Health Effects:

■ Nausea

■ Chills

■ Sweating

■ Involuntary jaw clenching 

and teeth grinding

■ Muscle cramping

■ Blurred vision

■ Marked rise in body 

temperature (hyperthermia)

■ Dehydration

■ High blood pressure 

■ Heart failure

■ Kidney failure

■ Arrhythmia

Symptoms of MDMA Overdose:

■ High blood pressure

■ Faintness

■ Panic attacks

■ Loss of consciousness

■ Seizures
additional doses of MDMA can

produce unexpectedly high blood

levels, which could worsen the

cardiovascular and other toxic

effects of this drug. MDMA also

interferes with the metabolism of

other drugs, including some of

the adulterants that may be

found in MDMA tablets.

In the hours after taking the

drug, MDMA produces significant

reductions in mental abilities.

These changes, particularly those

affecting memory, can last for 

up to a week, and possibly

longer in regular users. The fact

that MDMA markedly impairs

information processing emphasizes the potential dangers of

performing complex or skilled

activities, such as driving a car,

while under the influence of 

this drug.

Over the course of a week 

following moderate use of the

drug, many MDMA users report

feeling a range of emotions,

including anxiety, restlessness,

irritability, and sadness that in

some individuals can be as

severe as true clinical depression.

Similarly, elevated anxiety,

impulsiveness, and aggression, 

as well as sleep disturbances,

lack of appetite, and reduced

interest in and pleasure from sex

have been observed in regular

MDMA users. Some of these 

disturbances may not be directly

attributable to MDMA, but may

be related to some of the other

drugs often used in combination

with MDMA, such as cocaine or

marijuana, or to adulterants commonly found in MDMA tablets.

What does MDMA

do to the brain?

MDMA affects the brain

by increasing the 

activity of at least three

neurotransmitters (the chemical

messengers of brain cells): 

serotonin, dopamine, and 

norepinephrine. Like other

amphetamines, MDMA causes

these neurotransmitters to be

released from their storage 

sites in neurons, resulting in increased neurotransmitter activity.

Compared to the very potent

stimulant, methamphetamine,

MDMA causes greater serotonin

release and somewhat lesser

dopamine release. Serotonin is a

neurotransmitter that plays an

important role in the regulation

of mood, sleep, pain, appetite,

and other behaviors. The excess

release of serotonin by MDMA

likely causes the mood elevating

effects experienced by MDMA

users. However, by releasing

large amounts of serotonin,

MDMA causes the brain to

become significantly depleted of

this important neurotransmitter,

contributing to the negative

behavioral aftereffects that users

often experience for several days

after taking MDMA.

Numerous studies in animals

have demonstrated that MDMA

can damage serotonin-containing

neurons; some of these studies

have shown these effects to be

long lasting. This suggests that

such damage may occur in

humans as well; however, 

measuring serotonin damage in

humans is more difficult. Studies

have shown that some heavy

MDMA users experience longlasting confusion, depression, and

selective impairment of working

memory and attention processes.

Such memory impairments have

NIDA RESEARCH REPORT SERIES5

The Neurobiology of Ecstasy (MDMA)

MDMA alters brain chemistry by binding to serotonin transporters.
been associated with a decrease

in serotonin metabolites or other

markers of serotonin function.

Imaging studies in MDMA users

have shown changes in brain

activity in regions involved in

cognition, emotion, and motor

function. However, improved

imaging technologies and more

research are needed to confirm

these findings and to elucidate

the exact nature of the effects of

MDMA on the human brain.

It is also important to keep 

in mind that many users of 

ecstasy may unknowingly be 

taking other drugs that are sold

as ecstasy, and/or they may

intentionally use other drugs,

such as marijuana, which could

contribute to these behavioral

effects. Additionally, most studies

in people do not have behavioral

measures from before the users

began taking drugs, making it

difficult to rule out pre-existing

conditions. Factors such as 

gender, dosage, frequency and

intensity of use, age at which 

use began, the use of other

drugs, as well as genetic and

environmental factors all may

play a role in some of the cognitive deficits that result from

MDMA use and should be taken

into consideration when studying

the effects of MDMA in humans.

Given that most MDMA users

are young and in their reproductive years, it is possible that some

female users may be pregnant

when they take MDMA, either

inadvertently or intentionally

because of the misperception that

it is a safe drug. The potential

adverse effects of MDMA on the

developing fetus are of great

concern. Behavioral studies in

animals have found significant

adverse effects on tests of learning and memory from exposure

to MDMA during a developmental period equivalent to the third

trimester in humans. However,

the effects of MDMA on animals

earlier in development are

unclear; therefore, more research

is needed to determine what 

the effects of MDMA are on 

the developing human nervous

system.

Is MDMA addictive?

F

or some people, MDMA 

can be addictive. A survey

of young adult and adolescent MDMA users found that

43 percent of those who reported

ecstasy use met the accepted

diagnostic criteria for dependence, as evidenced by continued

use despite knowledge of 

physical or psychological harm,

withdrawal effects, and tolerance

(or diminished response), and 

34 percent met the criteria for

drug abuse. Almost 60 percent 

of people who use MDMA 

report withdrawal symptoms,

including fatigue, loss of

appetite, depressed feelings, 

and trouble concentrating.

MDMA affects many of the

same neurotransmitter systems 

in the brain that are targeted 

by other addictive drugs.

Experiments have shown that

animals prefer MDMA, much 

like they do cocaine, over other

pleasurable stimuli, another 

hallmark of most addictive drugs.

6NIDA RESEARCH REPORT SERIES

Life-Threatening Effects
NIDA RESEARCH REPORT SERIES7

What do we know

about preventing

MDMA abuse?

Because social context and

networks seem to be an

important component of

MDMA use, the use of peer-led

advocacy and drug prevention

programs may be a promising

approach to reduce MDMA use

among adolescents and young

adults. High schools and colleges

can serve as important venues

for delivering messages about

the effects of MDMA use.

Providing accurate scientific

information regarding the effects

of MDMA is important if we

hope to reduce the damaging

effects of this drug. Education 

is one of the most important

tools for use in preventing

MDMA abuse.

Are there effective

treatments for

MDMA abuse?

T

here are no specific treatments for MDMA abuse. 

The most effective treatments

for drug abuse and addiction 

are cognitive behavioral interventions that are designed to help

modify the patient’s thinking,

expectancies, and behaviors, 

and to increase skills in coping

with life’s stressors. Drug abuse 

recovery support groups may 

be effective in combination 

with behavioral interventions 

to support long-term, drug-free

recovery. There are currently 

no pharmacological treatments

for dependence on MDMA.

Where can I get more

scientific information

on MDMA?

T

o learn more about MDMA

and other drugs of abuse,

contact the National

Clearinghouse for Alcohol and

Drug Information (NCADI) at 

800–729–6686. Information 

specialists are available to help

you locate information and

resources.

Fact sheets, including

InfoFacts, on the health effects 

of MDMA, other drugs of abuse,

and other drug abuse topics are

available on the NIDA Web site

(www.drugabuse.gov), and can

be ordered free of charge in

English and Spanish from NCADI

at www.health.org.

NIDA Web Sites

drugabuse.gov

marijuana-info.org

steroidabuse.org

clubdrugs.org

inhalant.drugabuse.gov

hiv.drugabuse.gov

smoking.drugabuse.gov

NCADI

Web site: health.org

Phone no.: 800–729–6686

Access information 

on the Internet

• What’s new on the NIDA Web site

• Information on drugs of abuse

• Publications and communications 

(including NIDA NOTES)

• Calendar of events

• Links to NIDA organizational units

• Funding information (including program

announcements and deadlines)

• International activities

• Links to related Web sites (access to Web 

sites of many other organizations in the field)
8NIDA RESEARCH REPORT SERIES

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91:181–188 (2000).

Addiction: A chronic, relapsing disease 

characterized by compulsive drug seeking 

and use.

Adulterant: A substance, either a biologically

active material such as another drug or an 

inert material, added to a drug when it is 

formed into a tablet or capsule.

Cardiovascular system: The heart and 

blood vessels.

Dopamine: A neurotransmitter present 

in regions of the brain that regulate 

movement, emotion, motivation, and the 

feeling of pleasure.

Ecstasy: Common street name for MDMA.

Gastrointestinal system: The stomach 

and intestines.

Hyperthermia: A potentially dangerous rise 

in body temperature.

MDMA: Common chemical name for 

3,4-methylenedioxymethamphetamine.

Neurotransmitter: A chemical that acts as 

a messenger to carry signals or information 

from one nerve cell to another.

Norepinephrine: A neurotransmitter present 

in regions of the brain that affect heart rate 

and blood pressure.

Serotonin: A neurotransmitter present in 

widespread parts of the brain that is involved 

in sleep, movement, and emotions.

Tolerance: A decrease in the effect of a drug

that occurs with repeated administration.

NIH Publication Number 06-4728

Printed March 2006

Feel free to reprint this publication.

Glossary