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MDMA (3,4-methylenedioxymethamphetamine) is a synthetic, psychoactive drug 

that is chemically similar to the stimulant 

methamphetamine and the hallucinogen 

mescaline. MDMA produces feelings of 

increased energy, euphoria, emotional 

warmth, and distortions in time, perception, 

and tactile experiences.

How Is MDMA Abused?

MDMA is taken orally, usually as a capsule 

or tablet. It was initially popular among 

Caucasian adolescents and young adults 

in the nightclub scene or at weekendlong dance parties known as raves. More 

recently, the profile of the typical MDMA 

user has changed, with the drug now 

affecting a broader range of ethnic groups. 

MDMA is also popular among urban gay 

males—some report using MDMA as part 

of a multiple-drug experience that includes 

marijuana, cocaine, methamphetamine, 

ketamine, sildenafil (Viagra), and other legal 

and illegal substances.

How Does MDMA Affect 

the Brain?

MDMA exerts its primary effects in the 

brain on neurons that use the chemical (or 

neurotransmitter) serotonin to communicate 

with other neurons. The serotonin system 

plays an important role in regulating mood, 

aggression, sexual activity, sleep, and 

sensitivity to pain. MDMA binds to the 

serotonin transporter, which is responsible 

for removing serotonin from the synapse (or 

space between adjacent neurons) to terminate 

the signal between neurons; thus MDMA 

increases and prolongs the serotonin signal. 

MDMA also enters the serotonergic neurons 

via the transporter (because MDMA resembles 

serotonin in chemical structure) where it 

causes excessive release of serotonin from the 

neurons. MDMA has similar effects on another 

neurotransmitter—norepinephrine, which 

can cause increases in heart rate and blood 

pressure. MDMA also releases dopamine, but 

to a much lesser extent. 

MDMA can produce confusion, depression, 

sleep problems, drug craving, and severe 

anxiety. These problems can occur soon after 

taking the drug or, sometimes, even days 

or weeks after taking MDMA. In addition, 

chronic users of MDMA perform more poorly 

than nonusers on certain types of cognitive 

or memory tasks, although some of these 

effects may be due to the use of other drugs 

in combination with MDMA. Research in 

animals indicates that MDMA can be harmful 

to the brain—one study in nonhuman primates 

MDMA (Ecstasy)
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showed that exposure to MDMA for only 

4 days caused damage to serotonin nerve 

terminals that was still evident 6 to 7 years 

later.1 Although similar neurotoxicity has 

not been shown definitively in humans, 

the wealth of animal research indicating 

MDMA’s damaging properties strongly 

suggests that MDMA is not a safe drug for 

human consumption. 

Addictive Potential

For some people, MDMA can be addictive.2

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).3 These results are 

consistent with those from similar studies in 

other countries that suggest a high rate of 

MDMA dependence among users.4 MDMA 

abstinence-associated withdrawal symptoms 

include fatigue, loss of appetite, depressed 

feelings, and trouble concentrating.2

What Other Adverse 

Effects Does MDMA Have 

on Health?

MDMA can also be dangerous to overall 

health and, on rare occasions, lethal. 

MDMA can have many of the same physical 

effects as other stimulants, such as cocaine 

and amphetamines. These include increases 

in heart rate and blood pressure—which 

present risks of particular concern for people 

with circulatory problems or heart disease—

and other symptoms such as muscle tension, 

involuntary teeth clenching, nausea, blurred 

vision, faintness, and chills or sweating. 

In high doses, MDMA can interfere with 

the body’s ability to regulate temperature. 

On rare but unpredictable occasions, 

this can lead to a sharp increase in body 

temperature (hyperthermia), which can 

result in liver, kidney, cardiovascular system 

failure, or death. MDMA can interfere 

with its own metabolism (breakdown 

within the body); therefore, potentially 

harmful levels can be reached by 

repeated MDMA administration within 

short periods of time. Other drugs that 

are chemically similar to MDMA, such 

as MDA (methylenedioxyamphetamine, 

the parent drug of MDMA) and PMA 

(paramethoxyamphetamine, associated 

with fatalities in the United States and 

Australia),5 are sometimes sold as 

ecstasy. These drugs can be neurotoxic or 

create additional health risks to the user. 

Furthermore, ecstasy tablets may contain 

other substances, such as ephedrine (a 

stimulant); dextromethorphan (DXM, a 

cough suppressant); ketamine (an anesthetic 

used mostly by veterinarians); caffeine; 

cocaine; and methamphetamine. Although 
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the combination of MDMA with one or 

more of these drugs may be inherently 

dangerous, users who also combine 

these with additional substances such as 

marijuana and alcohol may be putting 

themselves at even higher risk for adverse 

health effects. 

What Treatment Options 

Exist?

There are no specific treatments for MDMA 

abuse and addiction. The most effective 

treatments for drug abuse and addiction 

in general are cognitive-behavioral 

interventions that are designed to help 

modify the patient’s thinking, expectancies, 

and behaviors related to their drug use 

and to increase skills in coping with life 

stressors. Drug abuse recovery support 

groups may also be effective in combination 

with behavioral interventions to support 

long-term, drug-free recovery. There are 

currently no pharmacological treatments for 

addiction to MDMA.

How Widespread Is MDMA 

Abuse?

Monitoring the Future Survey†

After sharp declines in ecstasy use since 

its peak in 2000/2001, current and pastyear use of MDMA has risen among 8th 

and 10th graders. This follows several 

years of decreases in the perceived risk and 

disapproval of using MDMA.

Use of MDMA by Students

2010 Monitoring the Future Survey

8th Grade 10th Grade 12th Grade 

Lifetime†† 3.3% 6.4% 7.3% 

Past Year 2.4% 4.7% 4.5% 

Past Month 1.1% 1.9% 1.4% 

National Survey on Drug Use and 

Health (NSDUH)†††

In 2009, an estimated 760,000 people 

(0.3 percent of the population) in the United 

States aged 12 or older used MDMA in the 

month prior to being surveyed. Lifetime use 

increased significantly among individuals 

aged 12 years or older, from 4.3 percent 

(10.2 million) in 2002 to 5.7 percent (14.2 

million) in 2009; however, past-year use 

of ecstasy decreased from 1.3 percent 

to 1.1 percent during the same period. 

Approximately 1.1 million Americans used 

ecstasy for the first time in 2009, which is a 

significant increase from the 894,000 firsttime users reported in 2008. 
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Other Information Sources

For more information on MDMA, please 

visit www.clubdrugs.org and www.

teens.drugabuse.gov. 

For street terms searchable by drug name, 

cost and quantities, drug trade, and drug 

use, visit www.whitehousedrugpolicy.

gov/streetterms/default.asp.

Data Sources

† These data are from the 2010 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National 

Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s 

Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 

1991, 8th- and 10th-graders were added to the study. The latest data are on line at www.drugabuse.gov. 

†† “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during 

the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days 

preceding an individual’s response to the survey. 

††† NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans aged 

12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of Health 

and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone from NIDA at 

877–643–2644. 

References

1 Ricaurte GA and McCann UD. Experimental studies on 3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”) and 

its potential to damage brain serotonin neurons. Neurotox Res 3(1):85–99, 2001.

2 Stone AL, Storr CL, and Anthony JC. Evidence for a hallucinogen dependence syndrome developing soon after onset 

of hallucinogen use during adolescence. Int J Methods Psychiatr Res 15:116–130, 2006.

3 Cottler LB, Womack SB, Compton WM, Ben-Abdallah A. Ecstasy abuse and dependence among adolescents and 

young adults: Applicability and reliability of DSM-IV criteria. Human Psychopharmacol 16:599–606, 2001.

4 Leung KS, Cottler LB. Ecstasy and other club drugs: A review of recent epidemiological studies. Curr Opin Psychiatry

21:234–241, 2008.

5 Kraner JC, McCoy DJ, Evans MA, Evans LE, Sweeney BJ. Fatalities caused by the MDMA-related drug 

paramethoxyamphetamine (PMA). J Anal Toxicol 25(7):645–648, 2001.