Ecstasy Use and Abuse:
Prevalence, Risks, and Addiction Treatment

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What is Ecstasy?

Ecstasy is a common name for the molecule MDMA. Ecstasy or 3,4-methylenedioxymethamphetamine (MDMA) is a designer drug.  MDMA is a mind-altering synthetic drug. It is used for stimulant and hallucinogenic effects, similar to those of mescaline. Mescaline, which is obtained from the Peyote cactus, is a Schedule I controlled substance.

How Does Ecstasy Work?

Ecstasy produces stimulant and hallucinogenic effects by increasing the release of three brain chemicals: serotonin, dopamine, and noradrenaline.

Serotonin regulates your memory and perceptions while dopamine, the feel-good chemical, enhances feelings of satisfaction and pleasure. Noradrenaline stimulates the brain and causes a surge of energy. The combined effect is you experience high energy levels, increased empathy, and enhanced feelings of wellbeing.

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What Are 6 Essential Life Skills to Increase Your Chance of Success During Recovery?There are three types of MDMA products on the market:

  • Tablets that contain little or no MDMA but similar molecules such as MDA (3, 4-Methylenedioxy amphetamine) or PMA (para-methoxyamphetamine).
  • Tablets that contain high amounts of MDMA
  • Ecstasy, which is available in powder and crystalline forms. One tablet of this drug typically contains 100mg of MDMA.

MDMA products are often adulterated with other substances. These include methamphetamine, ketamine, caffeine, and ephedrine. Some products may also contain heroin, OTC cough medications, phencyclidine (PCP), and cocaine.

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Growing Use in America

Ecstasy was a popular recreational drug in the 1980s, especially in young people attending clubs, concerts, or raves. Though the U.S. government banned the drug in 1985, its use peaked in the 1980s and 1990s.

After a brief period of decline in the early 2000s, its use among youth has surged in recent years. According to the 2018 World Drug Report, there were 20.6 million users globally in 2016. During the same year, the following reported using the drug within the past year:

The number of Americans who tried the drug for the first time in the past year increased from 642,000 in 2003 to 860,000 in 2006. 3 In 2017, about 2.5 million Americans reported using the drug in the past year. Among them, 400,000 users were young people ages 18 to 25 years. 4

While there are no approved uses for MDMA, scientists are studying if it can help people with certain anxiety disorders. Ecstasy abuse can damage the heart, brain cells, and kidneys.

The United States is both a major source and destination of ecstasy shipments. While more than 80% of the drug in the country is intended for domestic use, a significant portion is smuggled to Mexico and Argentina. US authorities seized 0.9 tons of the drug in 2017, a sharp decrease from 4.7 tons in 2015. Nonetheless, a huge amount of the drug is still smuggled into the US from Canada and the Netherlands.

Molly Vs. Ecstasy: Are They The Same?

Ecstasy refers to the tablets or capsules of MDMA. Molly (slang for “molecular”), on the other hand, refers to the crystal or powder forms. It is usually available in the form of colorful tablets, while Molly may be sold as a powder or capsule.

Users believe that Molly is the purer form of the drug. However, this is not true in many cases. For example, many products marketed as Molly contain substances used in bath salts. Thus, users who believe they are using a pure drug may be taking unknown substances.

Is Molly Addictive?

Scientists do not know if Molly is addictive. What you buy as Molly may contain little to no MDMA. Besides, some products may contain other substances that may be addictive. The DEA has categorized all forms of MDMA (including Molly) as Schedule I controlled substances. Schedule I controlled substances have high abuse potential but no approved medical use.

Is Ecstasy Addictive?

Few studies have noted that the addiction potential may be lower than that of opioids, cocaine, and alcohol. Nevertheless, some users have reported withdrawal symptoms suggesting dependence. MDMA may be addictive but to a lesser extent than opioids, cocaine, and alcohol. Besides, adulterants in ecstasy may be the cause of addiction in many cases.

There is limited evidence to support that this type of drug is addictive. Few studies have noted that the abuse potential may be lower than that of opioids, cocaine, and alcohol. Nevertheless, some users have reported withdrawal symptoms suggesting dependence. The adulterants may be the cause of addiction rather than MDMA.

What Other Names Does Ecstasy Go By?

Street, slang, or code names for ecstasy include: 6

  • E
  • X
  • XTC
  • Pills
  • Rolls
  • E-tarts
  • ADAM
  • Go
  • Speed for Lovers
  • Love Drug
  • Hug Drug
  • Scooby Snacks

On the market, the drug is available under the following brand names:

  • Armanis
  • Mercedes
  • Mitsubishis
  • Ferraris
  • Volkswagons
  • Red Devils
  • Blue Nikes
  • 007s
  • Playboys
  • Yin Yangs
  • Batmans
  • Supermans
  • Rolexes
  • Pokemons
  • Red Stop Signs
  • Buddhas
  • Butterflies
  • X-Files
  • White Diamonds

How is Ecstasy Used?

Ecstasy use is an increasingly common health problem seen in young adults. Among young adults (18 to 25 years) who attended raves in New York City, 42.8% reported using the drug at least once in their lifetime.7 While the drug used to be a common staple in raves, use has now extended to college campuses, bars, and house parties.

Most users swallow tablets or capsules. Some may insert a tablet or capsule into the rectum. This is known as “plugging” or “shafting.” There have also been reports of “parachuting” the pills. Parachuting involves swallowing a piece of a napkin that is laced with the powdered drug. Occasionally, some users may snort or smoke powder. Rarely, some inject a solution of the drug.

Many users take it with alcohol and tobacco to enhance the effects. Other substances most commonly used with ecstasy include marijuana, cocaine, GHB, and ketamine.

Ecstasy Abuse Effects

Ecstasy affects the body and brain at the same time. Most often, the effects of MDMA are experienced within 45 minutes after taking a pill. The effects usually peak within the next 15 to 30 minutes. Factors such as the dose, physical health, and mental wellbeing can affect how the drug interacts with the person.

Effects on the body can include:

  • Increased heart rate
  • Rapid breathing
  • Excessive sweating
  • Nausea
  • Decreased appetite
  • Increased blood pressure
  • Dehydration
  • Teeth grinding
  • Increased energy levels

Effects on the brain can include:

  • A heightened sense of well-being
  • Increased feelings of love, peacefulness, and acceptance
  • Increased sex drive
  • Anxiety
  • Lowered inhibitions
  • Impaired judgment
  • Increased sociability, intimacy, and empathy
  • Increased alertness
  • Hallucinations
  • Loss of sleep
  • Irritability

Sometimes, anxiety may cause panic attacks and delirium. Abusing this type of drug for 2 years or more can cause many long-term effects. These could include depression and problems with memory or learning.

Talk to your doctor if you notice any of the signs of ecstasy abuse in someone you love.

Long Term Side Effects

Long-term use of ecstasy can cause severe depletion in serotonin levels several years after first use. The side effects of prolonged use can include:

  • Mental confusion
  • Aggression
  • Difficulty remembering things
  • Restlessness
  • Sleep problems
  • Irritability
  • Severe dehydration
  • Kidney damage
  • Depression
  • Severe anxiety
  • Impulsive behavior
  • High blood pressure
  • Stiff muscles
  • Fuzzy thinking
  • Liver damage

Ecstasy use during pregnancy can harm the baby. Using the drug during the first 3 months of pregnancy can cause low birth weight, learning problems, and impaired movement. The effects of drug use during the later months of pregnancy are not clear.

How Long Does The High Last?

Hallucinations usually last 3 to 5 hours after use. That said, other side effects might last several days.

How Long Does Ecstasy Stay in Your System?

The detection time for a drug depends on several factors. These include:

Dose

Generally, the greater the amount of a drug, the longer it is likely to stay in your system. For example, if you take multiple doses, the drug may be detectable for up to five days or even longer.

Half-life

The half-life of a drug is the time it takes to clear half of the drug present from your bloodstream. The half-life is about 8 hours. Generally, a drug is no longer detectable after five half-lives. This means a drug test may not show ecstasy in a blood sample 40 hours after ingestion.

Method of Drug Testing

The detection time can vary depending on the type of the sample. For example, it may be detectable in a urine sample one to three days after the last dose. However, a hair sample may contain detectable amounts of the drug for up to three months.

Urine Sample

Urine tests can give positive results one to three days after the last dose.

Blood Sample

Detectable quantities of ecstasy may be present in a blood sample one to two days after the last dose. The drug is detectable within 15 to 30 minutes after you ingest it.

Saliva Sample

A saliva sample contains detectable quantities of the drug one to two days after the last dose. Typically, it takes no longer than 15 minutes for the drug to appear in your saliva after you swallow it.

Hair Sample

Hair testing can give positive results up to three months after you take the drug.

Health Risks of Ecstasy Abuse

Overdose

Ecstasy overdose can cause death. Sadly, it is hard to pinpoint the lethal dose. However, even a small increase in the dose can cause potentially fatal effects. Death from an overdose may occur due to:

  • A rapid heartbeat that may cause a heart attack
  • Heatstroke (hyperthermia) that may cause the failure of vital organs
  • Severe dehydration
  • A sharp decrease in blood levels of sodium (hyponatremia)
  • A rapid heartbeat that may cause a heart attack
  • Heatstroke (hyperthermia) that may cause the failure of vital organs
  • Severe dehydration
  • A sharp decrease in blood levels of sodium (hyponatremia)

MDMA is used recreationally by an estimated 20 million people globally in 2021, outside of legal clinical settings. In the U.S., national surveys estimate that at least once, 7.5 percent of Americans aged 12 and over have tried Ecstasy.

MDMA is generally viewed as one of the less harmful illicit substances. However, using it outside of a clinical setting can still pose risks.

According to the Substance Abuse and Mental Health Services Administration, there were an estimated 3,211 MDMA-related emergency room visits in the United States in 2021.

Although deaths related to MDMA do occur, they are much less common than those caused by various legal and illegal drugs, including alcohol and cocaine, according to Matthew Johnson, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

It is challenging to distinguish the impact of a specific drug from others, including fatal consequences, as numerous individuals classified as ‘drug-involved’ have multiple drugs present in their system at the time of death.

Symptoms of Overdose

  • Fainting
  • Dizziness
  • Anxiety
  • High body temperature
  • Sweating
  • Chest pain
  • Breathing problems
  • Seizures
  • Muscle pain
  • Dehydration
  • Pain in the stomach
  • Problems with vision
  • High blood pressure
  • Hallucinations
  • Shaking
  • Rapid shallow breathing
  • Involuntary movement of the eye
  • Increased pupil size
  • Restlessness

Call 911 if you think an overdose has occurred.
You can also contact Poison Control at 1-800-222-1222

Overdose Treatment

There is no antidote for ecstasy overdose. Treatments are supportive and address the symptoms of overdose.  Before starting treatment, a doctor may order urine and blood tests. These tests help determine the levels of sodium and potassium, and the presence of other drugs in the body. A liver function test may also be necessary.

Treatments can include: 

Ice packs to reduce body temperature. If the person does not get better, the doctor may inject a drug known as dantrolene (Dantrium Intravenous).
Activated charcoal may help reduce drug absorption if used within one hour after ingestion.
Diazepam injection (Valium) to treat seizures.
Injection of high-concentration salt solution to restore normal salt levels in the blood.
Oxygen to maintain breathing. People who cannot breathe on their own may need to use a machine (mechanical ventilator) to continue breathing.
Some may need chest compressions to maintain blood flow.

Addiction

It is not clear if MDMA is addictive. However, some users have reported withdrawal symptoms suggesting dependence. Thus, it is likely that the drug can cause addiction in some people. Most notably, some products contain highly addictive substances, such as cocaine.

Chemical Imbalance in the Brain

Long-term use can cause unfavorable changes in brain chemistry. For example, there have been reports of low serotonin levels in chronic users. This may increase the risk of depression, anxiety, and sleep problems. Likewise, some studies suggest even a single use can cause short-term or persistent anxiety.

Does Ecstasy Help People with PTSD?

PTSD (Post-traumatic stress disorder) is a debilitating anxiety disorder. The Anxiety and Depression Association of America states that the disorder affects about 8 million Americans. PTSD can severely affect a person’s quality of life and may increase the risk of suicide.

Researchers are working to find if ecstasy can help people with PTSD and social anxiety. Most notably, it has attained a “breakthrough” therapy designation from the US Food and Drug Administration (FDA). A breakthrough drug has significant superiority over existing treatments for serious disorders (including PTSD) in early clinical studies.

In a recent study, researchers found that compared to only talk therapy, a combination of ecstasy and talk therapy improved the symptoms of PTSD. The drug is ready for entering the final trial for approval. If the final trials show positive results, the drug will likely receive an FDA approval for PTSD treatment in 2021.

How is Ecstasy Abuse and Addiction Treated?

Medications to treat ecstasy addiction are not currently available. According to the National Institute on Drug Abuse (NIDA), people with ecstasy use disorder are most likely to benefit from cognitive-behavioral therapy (CBT).
CBT is a type of talk therapy (psychotherapy). It helps a person anticipate, identify, and correct thought patterns responsible for their addictive behavior. CBT teaches the skills necessary to cope with life stressors and problematic thoughts. As a result, better control of drug use occurs.
A type of CBT known as dialectical behavioral therapy (DBT) may also help some people with substance use disorders. DBT is support-oriented talk therapy. It helps a person identify and reinforce their strengths.
Detox is usually the first step in addiction treatment. It is the process of removing the drug from the system. However, the use of medication-assisted detox for ecstasy use disorder is controversial. Stopping use causes depressive symptoms in many people. Thus, some recovery specialists may prescribe an antidepressant to relieve the symptoms.
People with severe addiction may need to stay in an inpatient rehab facility. Usually, the length of stay ranges from a month to six months. These facilities provide one-to-one CBT sessions or group therapy sessions. After completing treatment at the facility, a person may join a support group.

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