MDMA

[[File:MDMA animated.gif|thumb|165px|right|"That's the power of love!" - Huey Lewis & The News]]{{drugs}}
'''MDMA''' (3,4-methylenedioxy-''N''-methylamphetamine), commonly known as '''Ecstasy''', is a drug primarily used to help [[Caucasian|white people]] dance :D {{fact|joke}}

The result however is usually a spastic, jerking movement with eyes rolled back into the head, listening to the Phish from Vermont, whilst jaw jutting out and the urge to touch everything all the while muttering about how much you love everyone. 

MDMA is also an empathogenic [[psychedelic drug]] known to make talking to people easier, and tactile sensations more pleasant. It's generally regarded as safer than a lot of drugs; but is far from healthy for you physically. In contrast it was once used by psychotherapists for mental health and is being investigated for that purpose once more.

==History==
MDMA was first synthesized in 1912 by Merck chemist Anton Köllisch. At the time, Merck was interested in developing substances that stopped abnormal bleeding. In 1927, Max Oberlin studied the pharmacology of MDMA and observed that its effects on blood sugar and smooth muscles were similar to that of ephedrine. Researchers at Merck conducted experiments with MDMA in 1952 and 1959.<ref>Bernschneider-Reif S, Oxler F, Freudenmann RW (2006). "The origin of MDMA ('Ecstasy') – separating the facts from the myth". ''Pharmazie'' 61 (11): 966–972.</ref> In 1953 and 1954, the United States Army commissioned a study of toxicity and behavioral effects in animals of injected mescaline and several analogues, including MDMA. The [[CIA]] experimented with MDMA as an interrogation tool in [[Project MKULTRA]].<ref> Lowlinson JH, Ruiz P, Millman RB, Langrod JG. Substance Abuse: A Comprehensive Textbook. Williams & Wilkins. 1997. pp. 269–275.</ref> These originally classified investigations were declassified and published in 1973.<ref> Hardman HF, Haavik CO, Seevers MH (1973). "Relationship of the Structure of Mescaline and Seven Analogs to Toxicity and Behavior in Five Species of Laboratory Animals". ''Toxicology Applied Pharmacology'' 25 (2): 299–309.</ref>

MDMA was being used recreationally in the United States by 1970.<ref> Doblin, Rick. "A Clinical Plan for MDMA (Ecstasy) in the Treatment of Post-Traumatic Stress Disorder (PTSD): Partnering with the FDA". Multidisciplinary Association for Psychedelic Studies. Retrieved 9 December 2013.</ref> After MDMA was criminalized as a schedule 1 drug in 1985, most medical use stopped, although some therapists continued to prescribe the drug illegally. 

==Mechanisms of action==
# MDMA increases [[oxytocin]] levels, which causes the feeling of ecstasy for which the drug is named.<ref>Dumont GJ1, Sweep FC, van der Steen R, et al (2009). "Increased oxytocin concentrations and prosocial feelings in humans after ecstasy (3,4-methylenedioxymethamphetamine) administration". ''Soc. Neurosci.'' 2009;4(4):359-66.</ref>
# MDMA increases activity in the ventromedial prefrontal cortex and decreases activity in the amygdala. These may cause a decrease in stress and fear, and an improvement in emotional regulation and decrease avoidance, respectively.<ref> Gamma A, Buck A, Berthold T, et al (2000). "3,4-Methylenedioxymethamphetamine (MDMA) Modulates Cortical and Limbic Brain Activity as Measured by [H215O]-PET in Healthy Humans". ''Neuropsychopharmacology'' (2000) 23, 388–395.</ref>
# MDMA increases norepinephrine release and circulating cortisol levels, which may facilitate emotional engagement and enhance extinction of learned fear associations.<ref> Johansen PØ, Krebs TS (2009). "How could MDMA (ecstasy) help anxiety disorders? A neurobiological rationale". ''Journal of Psychopharmachology'' 23 (4): </ref> 

Typically, users begin reporting subjective effects within 30 to 60 minutes of consumption, hitting a peak at about 75 to 120 minutes which plateaus coherently for about 3.5 hours. Users note peak serotonin occurs from 2.5–3 hours after ingestion. This is followed by a comedown of a few hours.

==Apply directly to dancefloor==
[[File:Ecstasy monogram.jpg|thumb|right|Ecstasy tablets]]
===Recreational uses===
In the rave environment, the sensory effects from the music and special effects like lasers are said to be enhanced by MDMA. MDMA lowers social inhibitions and provides energy for clubbing.<ref>Reynolds, Simon (1999). ''Generation Ecstasy: Into the World of Techno and Rave Culture.'' Routledge. p. 81.</ref> MDMA can increase self-confidence, extraversion, thoughtfulness and emotional sensitivity; in addition to getting you dazed and excited.<ref> Liechti ME, Gamma A, Vollenweider FX (2001). "Gender Differences in the Subjective Effects of MDMA". Psychopharmacology 154 (2): 161–168.</ref> If you are lucky, you might get some [[hallucination]]s, but this is reportedly quite rare with pure MDMA.<ref>Shulgin AT; Nichols DE (1978). "Characterization of Three New Psychotomimetics". In Willette, Robert E.; Stillman, Richard Joseph. ''The Psychopharmacology of Hallucinogens.'' New York: Pergamon Press. pp. 74–83 </ref>

Although it is reported to make erections in men difficult, MDMA may result in an increased desire for emotionally intimate sex with whoever is available. Oxytocin is a hormone released following events such as hugging, orgasm, and childbirth, and is thought to facilitate bonding and the establishment of trust.<ref> Theodoridou A, Rowe AC, Penton-Voak IS, Rogers PJ (2009). "Oxytocin and social perception: oxytocin increases perceived facial trustworthiness and attractiveness". Horm Behav 56 (1): 128–32.</ref>

===Medical uses===
MDMA has been indicated as possibly useful in psychotherapy, facilitating self-examination with reduced fear.<ref>Greer G. and Tolbert R. (1989). "The Therapeutic Use of MDMA", pp. 21–36 in ''Ecstasy: The Clinical, Pharmacological, and Neurotoxicological Effects of the Drug MDMA,'' Peroutka, SJ (ed.) Springer</ref> No research at all was allowed in the U.S. between 1985 and 1992, when the [[FDA]] approved Dr. Charles Grob to conduct human studies.<ref>Julie Holland (2001). ''Ecstasy: The Complete Guide: A Comprehensive Look at the Risks and Benefits.'' p. 20.</ref> In the year 2000, Doctor José Carlos Bouso performed the first clinical trial of MDMA for use in treating [[PTSD|Post Traumatic Stress Disorder]] in [[Spain]], although this was stopped before the study was completed because of political pressure.<ref>Julie Holland (2001). ''Ecstasy: The Complete Guide: A Comprehensive Look at the Risks and Benefits.'' p. 391.</ref> Some scientists believe MDMA may help those with disorders often associated with a lack of feeling connected to others, such as in [[schizophrenia]], [[autism]], or antisocial personality disorder.<ref> http://psychcentral.com/news/2010/12/17/drug-%E2%80%98ecstasy%E2%80%99-may-help-individuals-with-schizophrenia-autism/21876.html</ref> MDMA is currently is Phase 3 clinical trials for the treatment of PTSD, after being granted breakthrough therapy designation by the FDA.<ref> https://maps.org/research/mdma/ptsd/phase3</ref>

==Risks==
===Real risks===
*MDMA increases body temperature and sweating. Thus there is a risk that taking MDMA will lead to {{wpl|heatstroke}}. This usually does not occur on its own, but the risk increases significantly when MDMA is combined with hot environments (as some tightly packed clubs can be), increased activity such as dancing, and increased [[alcohol]] consumption (alcohol, as a {{wpl|diuretic}}, will make you urinate more, increase dehydration, and *also* increase the risk of heatstroke). It is advised when taking MDMA you drink some water -- but not ''too'' much, as MDMA is an ''anti-diuretic'', meaning you retain water... increasing the risk of water intoxication. A sensible recommendation is to drink around 500ml per hour if active and around 250ml an hour when inactive.<ref>[https://www.vice.com/en_us/article/mb4edy/combining-mdma-molly-alcohol "This Is What Happens When You Combine Molly and Alcohol"] by Suzannah Weiss, Vice, 2018 Jul 18</ref><ref>[https://theconversation.com/how-does-mdma-kill-109506 "How does MDMA kill?"] by Nicole Lee, The Conversation, 2019 January 22</ref>  
*MDMA also can cause a potentially fatal condition known as "{{wpl|serotonin syndrome}}" when combined with certain other drugs, in particular a class of antidepressants known as {{wpl|monoamine oxidase inhibitors}}. Combining MDMA with drugs metabolized through the same liver enzyme that MDMA uses ({{wpl|CYP2D6}}) is also dangerous, as both drugs will metabolized more slowly, leading to a situation that is like taking a higher dose of both drugs. This includes {{wpl|ritonavir}}, a drug used for [[HIV/AIDS]] treatment; {{wpl|dextromethorphan}}, a drug commonly found in cough suppressant medications; and various {{wpl|opioids}} such as [[codeine]].<ref>[https://dancesafe.org/drug-information/mdma-contraindications/ "Medications and Health Conditions that Pose Considerable Risk to MDMA Users",] Dancesafe.org</ref><ref>[https://www.sciencedirect.com/science/article/pii/S0007091217350845 "Acute toxic effects of ‘Ecstasy’ (MDMA) and related compounds: overview of pathophysiology and clinical management"] by A.P. Hall and J.A. Henry, British Journal of Anaesthesia, Volume 96, Issue 6, June 2006</ref><ref>[https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)75653-1/fulltext "Fatal MDMA intoxication"] by Rafael de la Torre, Jordi Ortuno, Marta Mas, Magi Farre, and Jordi Segura, The Lancet, 1999 February 13</ref><ref>[https://www.researchgate.net/publication/23258248_The_Consequences_of_34-Methylenedioxymethamphetamine_Induced_CYP2D6_Inhibition_in_Humans "The Consequences of 3,4-Methylenedioxymethamphetamine Induced CYP2D6 Inhibition in Humans"] by Brian O'Mathuna, Amin Rostami-Hodjegan, Mari Farre, and Jiansong Yang, Journal of Clincal Psychopharmacology, 2008 November</ref>
*It can temporarily worsen pre-existing heart and blood pressure problems.
*It can cause low mood for a few days after use, which is mostly a placebo effect as a result of all the high oxytocin levels you've been feeling.
*It can be difficult to cease habitual use. Low doses are preferable, and you can usually avoid addiction as long as you limit your consumption and make sure this isn't your only source of happiness.
*Some MDMA is cut with harder drugs or poison, and a dealer won't always know what's in their product. Various raving goods stores sell testing kits. Or alternatively, you could just legalize and regulate the damn stuff.
*Surprisingly the physical withdrawal isn't the worst thing if you're smart but psychologically this stuff is a siren song. There are stories of people who turned dead inside after only 3 day binges, and still kept going. If you attempt to binge this like [[meth]] you're in for a nasty surprise.

===Myths===
[[File:Emmentaler.jpg|thumb|right|This is Emmenthal, which is lovely. It is not your brain after taking MDMA.]]
As with most popular drugs, MDMA has given rise to a plethora of myths. Just an itsy-bitsy selection of those:
*MDMA drains your spinal fluid. It really doesn't. That bad back on a terrible Tuesday morning is because you behaved like an idiot for four days.
*There is a limited supply of MDMA and it will run out (quick take some more!). 
*MDMA turns your brain into Swiss [[cheese]]. Blame [[Oprah]] and her coterie of nut-job [[woo]]-meisters for this one.

===Possible/debated risks===
Many ravers perform badly on memory and intelligence tests. Is this because of MDMA, or because of [[alcohol]] and sleep deprivation? Probably alcohol and sleep deprivation.<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3053129/ Residual Neurocognitive Features of Long-Term Ecstasy Users With Minimal Exposure to Other Drugs] by John H. Halpern et al. (2011) ''Addiction'' 106(4): 777–786. doi:10.1111/j.1360-0443.2010.03252.x.</ref><ref>[http://bjp.rcpsych.org/content/194/4/355.short Brain serotonin transporter binding in former users of MDMA ('ecstasy')] by Sudhakar Selvaraj et al. (2018) ''The British Journal of Psychiatry'' 194(4):355-359. doi:10.1192/bjp.bp.108.050344.</ref>

==Street names==
*Ecstasy
*ADAM
*Molly (US)
*Mandy (UK)
*MD (primarily UK)
*E
*X
*XTC

==See also==
*[[War on Drugs]]

==References==
{{reflist|2|90%}}

[[Category:Chemicals]]
[[Category:Drugs]]
[[Category:Alternative medicine]]

Categories: Chemicals, Drugs, Alternative medicine