View source for MDMA

{{Short description|Psychoactive drug, often called ecstasy}}
{{Hatnote group|
{{Other uses}}
{{Distinguish|MDA (drug)|EDMA|NMDA|2,3-MDMA}}
}}
{{pp-vandalism|small=yes}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
<!-- Definition and uses -->

{{Use dmy dates|date=August 2017}}
{{Infobox drug
| Watchedfields = changed
| verifiedrevid = 632164040
| drug_name = MDMA
| INN = Midomafetamine<ref name="INN">{{cite news | title = FDA Substance Registration System | url = https://precision.fda.gov/uniisearch/srs/unii/KE1SEN21RM | access-date = 31 August 2017 | publisher = [[United States National Library of Medicine]] | archive-date = 31 August 2017 | archive-url = https://web.archive.org/web/20170831220013/https://fdasis.nlm.nih.gov/srs/unii/KE1SEN21RM | url-status = live }}</ref>
| image = MDMA.png
| image_class = skin-invert-image
| width = 250px
| alt = MDMA structure
| image2 = MDMA-enantiomers-3D-balls.png
| image_class2 = bg-transparent
| alt2 = Ball-and-stick model of MDMA molecule enantiomers
| width2 = 250px
| caption = Skeletal structures of (''R'')-MDMA (top) and (''S'')-MDMA (bottom)
| caption2 = Ball-and-stick models of (''R'')-MDMA (top) and (''S'')-MDMA (bottom)

<!-- Clinical data -->| pronounce = methylenedioxy{{shy}}methamphetamine:<br />{{IPAc-en|ˌ|m|ɛ|θ|ᵻ|l|iː|n|d|aɪ|ˈ|ɒ|k|s|i}}<br />{{IPAc-en|ˌ|m|ɛ|θ|æ|m|ˈ|f|ɛ|t|əm|iː|n}}
| pregnancy_category = 
| pregnancy_US = 
| licence_US = 
| class = [[Entactogen]]; [[Stimulant]]; [[Serotonergic psychedelic|Psychedelic]]; [[Serotonin–norepinephrine–dopamine releasing agent]]; [[Serotonin]] [[5-HT2 receptor|5-HT<sub>2</sub> receptor]] [[agonist]]
| routes_of_administration = Common: [[oral route|By mouth]]<ref name="EU2015" /><br /> Uncommon: [[Insufflation]],<ref name="EU2015" /> [[inhalation]],<ref name="EU2015" /> [[injection (medicine)|injection]],<ref name="EU2015">{{cite web | title = Methylenedioxymethamphetamine (MDMA or 'Ecstasy') | url = http://www.emcdda.europa.eu/publications/drug-profiles/mdma | website = EMCDDA | publisher = European Monitoring Centre for Drugs and Drug Addiction | access-date = 17 October 2014 | ref = EMCDDA | archive-date = 1 January 2016 | archive-url = https://web.archive.org/web/20160101211851/http://www.emcdda.europa.eu/publications/drug-profiles/mdma | url-status = live }}</ref><ref>{{cite web | title = Methylenedioxymethamphetamine (MDMA, ecstasy) | url = http://www.nhtsa.dot.gov/people/injury/research/job185drugs/methylenedioxymethamphetamine.htm | work = Drugs and Human Performance Fact Sheets. | publisher = [[National Highway Traffic Safety Administration]] | archive-url = https://web.archive.org/web/20120503102427/http://www.nhtsa.gov/people/injury/research/job185drugs/methylenedioxymethamphetamine.htm | archive-date = 3 May 2012 }}</ref> [[rectal (medicine)|rectal]]
| dependency_liability = [[Physical dependence|Physical]]: Not typical<ref name="Palmer_2012">{{cite book | vauthors = Palmer RB | title = Medical toxicology of drug abuse: synthesized chemicals and psychoactive plants | location = Hoboken, N.J. | page = 139 | date = 2012 | publisher = John Wiley & Sons | isbn = 978-0-471-72760-6 | url = https://books.google.com/books?id=OWFiVaDZnkQC&pg=PA139 | access-date = 4 September 2017 | archive-date = 13 January 2023 | archive-url = https://web.archive.org/web/20230113000533/https://books.google.com/books?id=OWFiVaDZnkQC&pg=PA139 | url-status = live }}</ref><br />[[Psychological dependence|Psychological]]: Moderate<ref>{{Cite book | vauthors = Upfal J | title = Australian Drug Guide: The Plain Language Guide to Drugs and Medicines of All Kinds | location = Melbourne | page = 319 | year = 2022 | publisher = Black Inc | isbn = 978-1-76064-319-5 | edition = 9th | quote = Habit-forming potential moderate. Ecstasy may induce psychological dependence and tolerance to its effect when used frequently. }}</ref>
| addiction_liability = Low–moderate<ref name="Malenka_2009">{{cite book | vauthors = Malenka RC, Nestler EJ, Hyman SE | veditors = Sydor A, Brown RY | chapter = Chapter 15: Reinforcement and Addictive Disorders | title = Molecular Neuropharmacology: A Foundation for Clinical Neuroscience | location = New York | page = 375 | year = 2009 | publisher = McGraw-Hill Medical | isbn = 978-0-07-148127-4 | edition = 2nd }}</ref><ref name="Betzler_2017">{{cite journal | vauthors = Betzler F, Viohl L, Romanczuk-Seiferth N | title = Decision-making in chronic ecstasy users: a systematic review | journal = The European Journal of Neuroscience | volume = 45 | issue = 1 | pages = 34–44 | date = January 2017 | pmid = 27859780 | doi = 10.1111/ejn.13480 | s2cid = 31694072 | quote = ...the addictive potential of MDMA itself is relatively small. | doi-access = free }}</ref><ref name="Substance abuse">{{cite journal | vauthors = Jerome L, Schuster S, Yazar-Klosinski BB | title = Can MDMA play a role in the treatment of substance abuse? | journal = Current Drug Abuse Reviews | volume = 6 | issue = 1 | pages = 54–62 | date = March 2013 | pmid = 23627786 | doi = 10.2174/18744737112059990005 | s2cid = 9327169 | quote = Animal and human studies demonstrate moderate abuse liability for MDMA, and this effect may be of most concern to those treating substance abuse disorders. | url = http://pdfs.semanticscholar.org/33fd/4f5decd405dee8d4f280a9158bfb16ae6e27.pdf | archive-url = https://web.archive.org/web/20200803194522/http://pdfs.semanticscholar.org/33fd/4f5decd405dee8d4f280a9158bfb16ae6e27.pdf | archive-date = 2020-08-03 }}</ref>

<!-- Legal status -->| legal_AU = {{unbulleted list
|S8 (PTSD)
|S9 (all other uses)
}}
| legal_BR = F2
| legal_BR_comment = <ref>{{Cite web | vauthors = Anvisa | title = RDC Nº 804 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial | date = 2023-07-24 | trans-title = Collegiate Board Resolution No. 804 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control | url = https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-804-de-24-de-julho-de-2023-498447451 | url-status = live | archive-url = https://web.archive.org/web/20230827163149/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-804-de-24-de-julho-de-2023-498447451 | archive-date = 2023-08-27 | access-date = 2023-08-27 | publisher = [[Diário Oficial da União]] | language = pt-BR | publication-date = 2023-07-25 }}</ref>
| legal_CA = Schedule I
| legal_DE = Anlage I
| legal_NZ = Class B
| legal_UK = Class A
| legal_US = Schedule I
| legal_UN = Psychotropic Schedule I
| legal_status = <!-- Pharmacokinetic data -->
| bioavailability = [[Oral administration|Oral]]: Unknown<ref name="Freye_2009" />
| protein_bound = Unknown<ref name="DrugBank">{{cite web | title = Midomafetamine: Uses, Interactions, Mechanism of Action | date = 31 July 2007 | website = DrugBank Online | url = https://go.drugbank.com/drugs/DB01454 | access-date = 11 December 2024 }}</ref>
| onset = [[Oral administration|Oral]]: 30–45{{nbsp}}min<ref name="Freye_2009" />
| metabolism = [[Liver]], [[Cytochrome P450 oxidase|CYP450]] extensively involved, including [[CYP2D6]]
| metabolites = [[3,4-methylenedioxyamphetamine|MDA]], [[4-Hydroxy-3-methoxymethamphetamine|HMMA]], [[4-Hydroxy-3-methoxyamphetamine|HMA]], [[3,4-Dihydroxymethamphetamine|HHMA]], [[Alpha-Methyldopamine|HHA]], [[2,4,5-Trihydroxymethamphetamine|THMA]], [[2,4,5-Trihydroxyamphetamine|THA]], [[MDP2P]], [[Methylenedioxyhydroxyamphetamine|MDOH]]<ref name="pmid22392347">{{cite journal | vauthors = Carvalho M, Carmo H, Costa VM, Capela JP, Pontes H, Remião F, Carvalho F, Bastos M | title = Toxicity of amphetamines: an update | journal = Archives of Toxicology | volume = 86 | issue = 8 | pages = 1167–1231 | date = August 2012 | pmid = 22392347 | doi = 10.1007/s00204-012-0815-5 | bibcode = 2012ArTox..86.1167C | s2cid = 2873101 }}</ref>
| elimination_half-life = {{Bulleted list | MDMA: 8.7 (range 4.6–16) hours<ref name="Straumann_2024" /><ref name="Dunlap_2018" /> | (''S'')-MDMA: 5.1 (range 3.5–7.4) hours<ref name="Straumann_2024">{{cite journal | vauthors = Straumann I, Avedisian I, Klaiber A, Varghese N, Eckert A, Rudin D, Luethi D, Liechti ME | title = Acute effects of R-MDMA, S-MDMA, and racemic MDMA in a randomized double-blind cross-over trial in healthy participants | journal = Neuropsychopharmacology | volume = 50 | issue = 2 | pages = 362–371 | date = August 2024 | pmid = 39179638 | pmc = 11631982 | doi = 10.1038/s41386-024-01972-6 | doi-access = free }}</ref> | [[(R)-MDMA|(''R'')-MDMA]]: 11 (range 5.1–24) hours<ref name="Straumann_2024" />}}
| duration_of_action = 3–6{{nbsp}}hours<ref name="Oeri_2021" /><ref name="Betzler_2017" /><ref name="Freye_2009" />
| excretion = [[Kidney]]

<!-- Identifiers -->| ATC_prefix = None
| Drugs.com = {{Drugs.com|parent|MDMA}}
| CAS_number_Ref = {{cascite|correct|TOXNET}}
| CAS_number = 42542-10-9
| CAS_supplemental = <br/>{{CAS|64057-70-1}} [[Hydrochloride|(HCl)]]
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 1556
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = KE1SEN21RM
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB01454
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 1391
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 43048
| PubChem = 1615
| IUPHAR_ligand = 4574
| KEGG = D11172
| KEGG_Ref = {{keggcite|correct|kegg}}
| PDB_ligand = B41
| synonyms = {{abbr|3,4-MDMA|3,4-Methylenedioxymethamphetamine}}; Ecstasy (E, X, XTC); Midomafetamine; Molly; Mandy;<ref name="Luciano_2014">{{cite journal | vauthors = Luciano RL, Perazella MA | title = Nephrotoxic effects of designer drugs: synthetic is not better! | journal = Nature Reviews. Nephrology | volume = 10 | issue = 6 | pages = 314–324 | date = June 2014 | pmid = 24662435 | doi = 10.1038/nrneph.2014.44 | s2cid = 9817771 | issn = 1759-5061 }}</ref><ref name="DrugFacts">{{cite web | title = DrugFacts: MDMA (Ecstasy or Molly) | url = http://www.drugabuse.gov/publications/drugfacts/mdma-ecstasy-or-molly | publisher = National Institute on Drug Abuse | access-date = 2 December 2014 | archive-url = https://web.archive.org/web/20141203115531/http://www.drugabuse.gov/publications/drugfacts/mdma-ecstasy-or-molly | archive-date = 3 December 2014 }}</ref> Pingers/Pingas<ref>{{cite web | title = Pingers, pingas, pingaz: how drug slang affects the way we use and understand drugs | date = 2020-01-08 | url = https://theconversation.com/pingers-pingas-pingaz-how-drug-slang-affects-the-way-we-use-and-understand-drugs-129452 | publisher = [[The Conversation (website)|The Conversation]] | archive-url = https://web.archive.org/web/20210115205246/https://theconversation.com/pingers-pingas-pingaz-how-drug-slang-affects-the-way-we-use-and-understand-drugs-129452 | archive-date = 2021-01-15 | url-status = live }}</ref>

<!-- Chemical data -->| IUPAC_name = (''RS'')-1-(1,3-Benzodioxol-5-yl)-''N''-methylpropan-2-amine<!--From PubChem-->
| C = 11
| H = 15
| N = 1
| O = 2
| chirality = [[Racemic mixture]]
| SMILES = CC(NC)CC1=CC=C(OCO2)C2=C1
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C11H15NO2/c1-8(12-2)5-9-3-4-10-11(6-9)14-7-13-10/h3-4,6,8,12H,5,7H2,1-2H3
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = SHXWCVYOXRDMCX-UHFFFAOYSA-N

<!-- Physical data -->| density = 1.1
| melting_point = 
| melting_notes = 
| boiling_point = 105
| boiling_notes = at 0.4{{nbsp}}mmHg (experimental)<!--Pubchem-->
}}

'''3,4-Methylenedioxymethamphetamine''' ('''MDMA'''), commonly known as '''ecstasy''' (tablet form), and '''molly''' (crystal form),<ref>{{cite journal | vauthors = Palamar JJ | title = There's something about Molly: The underresearched yet popular powder form of ecstasy in the United States | journal = Substance Abuse | volume = 38 | issue = 1 | pages = 15–17 | date = 2016-12-07 | pmid = 27925866 | pmc = 5578728 | doi = 10.1080/08897077.2016.1267070 }}</ref><ref>{{Cite web | veditors = Skaug HA | title = Hva er tryggest av molly og ecstasy? | trans-title = What is safer: molly or ecstasy? | url = https://www.ung.no/oss/rusmidler/462397.html | access-date = 2022-06-20 | publisher = Norwegian Directorate for Children, Youth and Family Affairs | website = Ung.no | language = no | publication-date = 2020-12-14 | quote = MDMA er virkestoffet i både Molly-krystaller og Ecstasy-tabletter. (MDMA is the active substance in both Molly crystals and Ecstasy tablets) | archive-date = 11 August 2022 | archive-url = https://web.archive.org/web/20220811145918/https://www.ung.no/oss/rusmidler/462397.html | url-status = live }}</ref> is an [[entactogen]] with [[stimulant]] and minor [[psychedelic drug|psychedelic]] properties.<ref name="Dunlap_2018">{{cite journal | vauthors = Dunlap LE, Andrews AM, Olson DE | title = Dark Classics in Chemical Neuroscience: 3,4-Methylenedioxymethamphetamine | journal = ACS Chemical Neuroscience | volume = 9 | issue = 10 | pages = 2408–2427 | date = October 2018 | pmid = 30001118 | pmc = 6197894 | doi = 10.1021/acschemneuro.8b00155 | url = https://shaunlacob.com/wp-content/uploads/2020/12/DC-MDMA.pdf }}</ref><ref name="Green_2003">{{cite journal | vauthors = Green AR, Mechan AO, Elliott JM, O'Shea E, Colado MI | title = The pharmacology and clinical pharmacology of 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") | journal = Pharmacological Reviews | volume = 55 | issue = 3 | pages = 463–508 | date = September 2003 | pmid = 12869661 | doi = 10.1124/pr.55.3.3 }}</ref><ref name="Meyer_2013">{{cite journal | vauthors = Meyer JS | title = 3,4-methylenedioxymethamphetamine (MDMA): current perspectives | journal = Substance Abuse and Rehabilitation | volume = 4 | pages = 83–99 | year = 2013 | pmid = 24648791 | pmc = 3931692 | doi = 10.2147/SAR.S37258 | doi-access = free }}</ref> 

<!-- Usage and history -->
MDMA was first synthesized in 1912 by [[Merck Group|Merck]] chemist [[Anton Köllisch]].<ref name="FreudenmannÖxlerBernschneider-Reif2006">{{cite journal | vauthors = Freudenmann RW, Öxler F, Bernschneider-Reif S | title = The origin of MDMA (ecstasy) revisited: the true story reconstructed from the original documents | journal = Addiction | location = Abingdon, England | volume = 101 | issue = 9 | pages = 1241–1245 | date = August 2006 | pmid = 16911722 | doi = 10.1111/j.1360-0443.2006.01511.x | url = http://www.thedea.org/docs/2006_Freudenmann_22846_1.pdf | quote = Although MDMA was, in fact, first synthesized at Merck in 1912, it was not tested pharmacologically because it was only an unimportant precursor in a new synthesis for haemostatic substances. | access-date = 23 May 2019 | archive-date = 22 September 2020 | archive-url = https://web.archive.org/web/20200922140222/http://www.thedea.org/docs/2006_Freudenmann_22846_1.pdf | url-status = live }}</ref> It was used to enhance psychotherapy beginning in the 1970s and became popular as a street drug in the 1980s.<ref name="Drugs2014">{{cite web |date=18 May 2014 |title=MDMA |url=https://www.drugs.com/illicit/mdma.html |url-status=live |archive-url=https://web.archive.org/web/20160323161153/http://www.drugs.com/illicit/mdma.html |archive-date=23 March 2016 |access-date=30 March 2016 |website=Drugs.com |publisher=Drugsite Trust |veditors=Anderson L}}</ref><ref name="NIH2016" /> MDMA is commonly associated with [[dance party|dance parties]], [[rave]]s, and [[electronic dance music]].<ref name=WHO2004>{{cite book | vauthors = ((World Health Organization)) | title = Neuroscience of Psychoactive Substance Use and Dependence | pages = 97– | year = 2004 | url = https://books.google.com/books?id=G9OhG-dZdAwC&pg=PA97 | publisher = World Health Organization | isbn = 978-92-4-156235-5 | url-status = live | archive-url = https://web.archive.org/web/20160428231233/https://books.google.com/books?id=G9OhG-dZdAwC&pg=PA97 | archive-date = 28 April 2016 }}</ref> Tablets sold as ecstasy may be [[Cutting agent|mixed]] with other substances such as [[ephedrine]], [[amphetamine]], and [[methamphetamine]].<ref name="Drugs2014" /> In 2016, about 21 million people between the ages of 15 and 64 used ecstasy (0.3% of the world population).<ref name=UN2018>{{cite book | title = World Drug Report 2018 | page = 7 | date = June 2018 | publisher = United Nations | isbn = 978-92-1-148304-8 | access-date = 14 July 2018 | url = https://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_1_EXSUM.pdf | archive-date = 27 July 2018 | archive-url = https://web.archive.org/web/20180727030037/http://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_1_EXSUM.pdf | url-status = live }}</ref> In the United States, as of 2017, about 7% of people have used MDMA at some point in their lives and 0.9% have used it in the last year.<ref>{{cite web | title = MDMA (Ecstasy/Molly) | url = https://www.drugabuse.gov/drugs-abuse/mdma-ecstasymolly | website = National Institute on Drug Abuse | access-date = 14 July 2018 | archive-date = 15 July 2018 | archive-url = https://web.archive.org/web/20180715011009/https://www.drugabuse.gov/drugs-abuse/mdma-ecstasymolly | url-status = live }}</ref> The lethal risk from one dose of MDMA is estimated to be from 1 death in 20,000 instances to 1 death in 50,000 instances.<ref name="White_2014"/>

<!-- Side effects, chemistry and mechanism -->
The purported pharmacological effects that may be [[Prosocial behavior|prosocial]] include altered sensations, increased energy, empathy, and pleasure.<ref name="Meyer_2013" /><!-- quote = desire to experience an altered state of consciousness --><ref name="Drugs2014" /><!-- Quote = producing an energizing effect, as well as distortions in time and perception and enhanced enjoyment from tactile experiences --> When taken by mouth, effects begin in 30 to 45 minutes and last three to six hours.<ref name="Freye_2009">{{cite book |title=Pharmacology and Abuse of Cocaine, Amphetamines, Ecstasy and Related Designer Drugs |vauthors=Freye E |date=28 July 2009 |publisher=Springer Netherlands |isbn=978-90-481-2448-0 |pages=151–160 |chapter=Pharmacological Effects of MDMA in Man |doi=10.1007/978-90-481-2448-0_24}}</ref><ref name="NIH2016" /> Short-term adverse effects include [[Bruxism|grinding of the teeth]], [[blurred vision]], [[sweating]], and a [[Tachycardia|rapid heartbeat]],<ref name="Drugs2014" /> and extended use can also lead to addiction, [[Amnesia|memory problems]], [[paranoia]], and [[Insomnia|difficulty sleeping]]. Deaths have been reported due to increased body temperature and dehydration. MDMA acts primarily by increasing the release of the [[neurotransmitters]] [[serotonin]], [[dopamine]], and [[norepinephrine]] in parts of the brain.<ref name="Drugs2014" /><ref name=NIH2016>{{cite web | title = DrugFacts: MDMA (Ecstasy/Molly) | date = February 2016 | url = https://www.drugabuse.gov/publications/drugfacts/mdma-ecstasymolly | website = National Institute on Drug Abuse | access-date = 30 March 2016 | url-status = live | archive-url = https://web.archive.org/web/20160323164024/https://www.drugabuse.gov/publications/drugfacts/mdma-ecstasymolly | archive-date = 23 March 2016 }}</ref> It belongs to the [[substituted amphetamine]] [[chemical classification|classes of drugs]].<ref name="EU2015" /><ref>{{cite book | vauthors = Freye E | title = Pharmacology and Abuse of Cocaine, Amphetamines, Ecstasy and Related Designer Drugs: A comprehensive review on their mode of action, treatment of abuse and intoxication | page = 147 | date = 2009 | publisher = Springer Science & Business Media | isbn = 978-90-481-2448-0 | url = https://books.google.com/books?id=OTAlolM3XlwC&pg=PA147 | language = en | access-date = 12 May 2020 | archive-date = 13 January 2023 | archive-url = https://web.archive.org/web/20230113000534/https://books.google.com/books?id=OTAlolM3XlwC&pg=PA147 | url-status = live }}</ref> MDMA is structurally similar to [[mescaline]] (a psychedelic), methamphetamine (a stimulant), as well as [[Endogeny (biology)|endogenous]] [[monoamine neurotransmitter]]s such as serotonin, norepinephrine, and dopamine.<ref>{{cite journal | vauthors = Lyles J, Cadet JL | title = Methylenedioxymethamphetamine (MDMA, Ecstasy) neurotoxicity: cellular and molecular mechanisms | journal = Brain Research. Brain Research Reviews | volume = 42 | issue = 2 | pages = 155–168 | date = May 2003 | pmid = 12738056 | doi = 10.1016/S0165-0173(03)00173-5 | s2cid = 45330713 }}</ref>

<!-- Laws and research -->
MDMA has limited approved medical uses in a small number of countries,<ref>{{cite news | vauthors = Philipps D | title = Ecstasy as a Remedy for PTSD? You Probably Have Some Questions. | date = 1 May 2018 | url = https://www.nytimes.com/2018/05/01/us/ecstasy-molly-ptsd-mdma.html | url-access = limited | archive-url = https://ghostarchive.org/archive/20220101/https://www.nytimes.com/2018/05/01/us/ecstasy-molly-ptsd-mdma.html | archive-date = 2022-01-01 | access-date = 14 July 2018 | newspaper = The New York Times | language = en }}{{cbignore}}</ref> but is illegal in most jurisdictions.<ref>{{cite book | vauthors = Patel V | title = Mental and neurological public health a global perspective | location = San Diego, CA | page = 57 | date = 2010 | url = https://books.google.com/books?id=8fihf3VWbcIC&pg=PA57 | publisher = Academic Press/Elsevier | isbn = 978-0-12-381527-9 | edition = 1st | archive-url = https://web.archive.org/web/20170910234523/https://books.google.com/books?id=8fihf3VWbcIC&pg=PA57 | archive-date = 10 September 2017 | url-status = live }}</ref> [[MDMA-assisted psychotherapy]] is a promising and generally safe treatment for [[post-traumatic stress disorder]] when administered in controlled therapeutic settings.<ref name=":1" /><ref name=":2" /> In the United States, the [[Food and Drug Administration]] (FDA) has given MDMA [[breakthrough therapy]] status (though there no current clinical indications in the US).<ref>{{cite web | vauthors = Nuwer R | title = A Psychedelic Drug Passes a Big Test for PTSD Treatment | date = 3 May 2021 | work = The New York Times | author-link = Rachel Nuwer | url = https://www.nytimes.com/2021/05/03/health/mdma-approval.html | access-date = 5 June 2021 | archive-date = 5 June 2021 | archive-url = https://web.archive.org/web/20210605190721/https://www.nytimes.com/2021/05/03/health/mdma-approval.html | url-status = live }}</ref> Canada has allowed limited distribution of MDMA upon application to and approval by [[Health Canada]].<ref>{{Cite web | title = Subsection 56(1) class exemption for practitioners, agents, pharmacists, persons in charge of a hospital, hospital employees, and licensed dealers to conduct activities with psilocybin and MDMA in relation to a special access program authorization | date = 2022-01-05 | work = Health Canada | url = https://www.canada.ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/policy-regulations/policy-documents/subsection-56-1-class-exemption-conducting-activities-psilocybin-mdma-special-access-program-authorization.html | access-date = 2022-02-20 | archive-date = 11 February 2022 | archive-url = https://web.archive.org/web/20220211203137/https://www.canada.ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/policy-regulations/policy-documents/subsection-56-1-class-exemption-conducting-activities-psilocybin-mdma-special-access-program-authorization.html | url-status = live }}</ref> In Australia, it may be prescribed in the treatment of PTSD by specifically authorised psychiatrists.<ref>{{Cite web | title = Change to classification of psilocybin and MDMA to enable prescribing by authorised psychiatrists | date = 3 February 2023 | url = https://www.tga.gov.au/news/media-releases/change-classification-psilocybin-and-mdma-enable-prescribing-authorised-psychiatrists | access-date = 4 February 2024 | archive-date = 4 February 2024 | archive-url = https://web.archive.org/web/20240204024230/https://www.tga.gov.au/news/media-releases/change-classification-psilocybin-and-mdma-enable-prescribing-authorised-psychiatrists | url-status = live }}</ref>

{{TOC limit|3}}

==Uses==
===Recreational===
MDMA is often considered the drug of choice within the [[rave]] culture and is also used at clubs, festivals, and [[house party|house parties]].<ref name="pmid22392347" /> In the rave environment, the sensory effects of music and lighting are often highly [[Synergy|synergistic]] with the drug. The psychedelic [[amphetamine]] quality of MDMA offers multiple appealing aspects to users in the rave setting. Some users enjoy the feeling of mass communion from the inhibition-reducing effects of the drug, while others use it as party fuel because of the drug's stimulatory effects.<ref>{{cite book | vauthors = Reynolds S | title = Generation Ecstasy: Into the World of Techno and Rave Culture | page = 81 | year = 1999 | publisher = Routledge | isbn = 978-0-415-92373-6 | url = https://books.google.com/books?id=tGaRJiXe74UC&q=Generation+Ecstasy+MDMA&pg=PA81 | access-date = 13 October 2020 | archive-date = 8 November 2023 | archive-url = https://web.archive.org/web/20231108064150/https://books.google.com/books?id=tGaRJiXe74UC&q=Generation+Ecstasy+MDMA&pg=PA81#v=snippet&q=Generation%20Ecstasy%20MDMA&f=false | url-status = live }}</ref> MDMA is used less often than other stimulants, typically less than once per week.<ref name="Epstein2013" />

MDMA is sometimes taken in conjunction with other psychoactive drugs such as [[LSD]],<ref name=":0">{{cite journal | vauthors = Zeifman RJ, Kettner H, Pagni BA, Mallard A, Roberts DE, Erritzoe D, Ross S, Carhart-Harris RL | title = Co-use of MDMA with psilocybin/LSD may buffer against challenging experiences and enhance positive experiences | journal = Scientific Reports | volume = 13 | issue = 1 | date = August 2023 | pmid = 37608057 | pmc = 10444769 | doi = 10.1038/s41598-023-40856-5 | article-number = 13645 | bibcode = 2023NatSR..1313645Z }}</ref> [[psilocybin mushroom]]s, [[2C-B]], and [[ketamine]]. The combination with LSD is called "candy-flipping".<ref name=":0" /> The combination with 2C-B is called "nexus flipping". For this combination, most people take the MDMA first, wait until the peak is over, and then take the 2C-B.<ref>{{Cite web | vauthors = Weiss S | title = Nexus Flipping: What Happens When You Combine MDMA and 2C-B | date = 2024-02-16 | url = https://doubleblindmag.com/nexus-flipping/ | access-date = 2024-07-10 | website = DoubleBlind Mag | language = en-US }}</ref>

MDMA is often co-administered with [[Alcohol (drug)|alcohol]], [[methamphetamine]], and prescription drugs such as [[Selective serotonin reuptake inhibitor|SSRIs]] with which MDMA has several drug-drug interactions.<ref name="Hysek_2012">{{cite journal | vauthors = Hysek CM, Simmler LD, Nicola VG, Vischer N, Donzelli M, Krähenbühl S, Grouzmann E, Huwyler J, Hoener MC, Liechti ME | veditors = Laks J | title = Duloxetine inhibits effects of MDMA ("ecstasy") in vitro and in humans in a randomized placebo-controlled laboratory study | journal = PLOS ONE | volume = 7 | issue = 5 |article-number=e36476 | date = 2012-05-04 | pmid = 22574166 | pmc = 3344887 | doi = 10.1371/journal.pone.0036476 | bibcode = 2012PLoSO...736476H | doi-access = free | quote = Fig. 7 shows the mean PD effects of MDMA plotted against simultaneous plasma concentrations at the different time points (hysteresis loops). The increases in "any drug effect" (Fig. 7a) and MAP (Fig. 7b) returned to baseline within 6 h when MDMA concentrations were still high. This clockwise hysteresis indicates that a smaller MDMA effect was seen at a given plasma concentration later in time, indicating rapid acute pharmacodynamic tolerance, which was similarly described for cocaine [33]. [...] Figure 7. Pharmacokinetic-pharmacodynamic (PK-PD) relationship. MDMA effects are plotted against simultaneous MDMA plasma concentrations (a, b). The time of sampling is noted next to each point in minutes or hours after MDMA administration. The clockwise hysteresis indicates acute tolerance to the effects of MDMA. }}</ref><ref>{{cite journal | vauthors = Yuki F, Rie I, Miki K, Mitsuhiro W, Naotaka K, Kenichiro N | title = Warning against co-administration of 3,4-methylenedioxymethamphetamine (MDMA) with methamphetamine from the perspective of pharmacokinetic and pharmacodynamic evaluations in rat brain | journal = European Journal of Pharmaceutical Sciences | volume = 49 | issue = 1 | pages = 57–64 | date = April 2013 | pmid = 23395913 | doi = 10.1016/j.ejps.2013.01.014 }}</ref><ref>{{cite journal | vauthors = Hamida SB, Tracqui A, de Vasconcelos AP, Szwarc E, Lazarus C, Kelche C, Jones BC, Cassel JC | title = Ethanol increases the distribution of MDMA to the rat brain: possible implications in the ethanol-induced potentiation of the psychostimulant effects of MDMA | journal = The International Journal of Neuropsychopharmacology | volume = 12 | issue = 6 | pages = 749–759 | date = July 2009 | pmid = 19046482 | doi = 10.1017/s1461145708009693 | s2cid = 24230367 | doi-access = free }}</ref> Three life-threatening reports of MDMA co-administration with [[ritonavir]] have been reported;<ref>{{cite journal | vauthors = Oesterheld JR, Armstrong SC, Cozza KL | title = Ecstasy: pharmacodynamic and pharmacokinetic interactions | journal = Psychosomatics | volume = 45 | issue = 1 | pages = 84–87 | date = 2004-03-01 | pmid = 14709765 | doi = 10.1176/appi.psy.45.1.84 | doi-access = free }}</ref> with ritonavir having severe and dangerous drug-drug interactions with a wide range of both psychoactive, anti-psychotic, and non-psychoactive drugs.<ref name="Carpenter_2019">{{cite journal | vauthors = Carpenter M, Berry H, Pelletier AL | title = Clinically Relevant Drug-Drug Interactions in Primary Care | journal = American Family Physician | volume = 99 | issue = 9 | pages = 558–564 | date = May 2019 | pmid = 31038898 }}</ref> <!--Users sometimes use [[menthol]]ated products while taking MDMA for its cooling sensation.{{Citation needed|date=October 2017}}-->

===Medical===
{{See also|MDMA#Research|MDMA-assisted psychotherapy}}

As of 2023, MDMA therapies have only been approved for research purposes, with no widely accepted [[medical indication]]s,<ref name="EU2015" /><ref>{{cite journal | vauthors = Sessa B, Nutt D | title = Making a medicine out of MDMA | journal = The British Journal of Psychiatry  | volume = 206 | issue = 1 | pages = 4–6 | date = January 2015 | pmid = 25561485 | doi = 10.1192/bjp.bp.114.152751 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Ebrahimian Z, Karimi Z, Khoshnoud MJ, Namavar MR, Daraei B, Haidari MR | title = Behavioral and Stereological Analysis of the Effects of Intermittent Feeding Diet on the Orally Administrated MDMA ("ecstasy") in Mice | journal = Innovations in Clinical Neuroscience | volume = 14 | issue = 1–2 | pages = 40–52 | date = 1 February 2017 | pmid = 28386520 | pmc = 5373794 | quote = MDMA is listed as a Schedule 1 drug by the United States Drug Enforcement Agency, meaning that currently there are no accepted medical uses for MDMA in the United States, there is a lack of accepted safety for use under medical supervision, and there is a high potential for abuse. }}</ref> although this varies by jurisdiction. Before it was widely banned, it saw limited use in psychotherapy.<ref name="Betzler_2017" /><ref name="EU2015" /><ref>{{cite journal | vauthors = Climko RP, Roehrich H, Sweeney DR, Al-Razi J | title = Ecstacy: a review of MDMA and MDA | journal = International Journal of Psychiatry in Medicine | volume = 16 | issue = 4 | pages = 359–372 | year = 1986 | pmid = 2881902 | doi = 10.2190/dcrp-u22m-aumd-d84h | s2cid = 31902958 }}</ref> In 2017 the [[United States Food and Drug Administration]] (FDA) granted breakthrough therapy designation for MDMA-assisted psychotherapy for [[post-traumatic stress disorder]] (PTSD).<ref>{{Cite news | vauthors = Wan W | title = Ecstasy could be 'breakthrough' therapy for soldiers, others suffering from PTSD | date = 6 August 2017 | language = en-US | newspaper = [[The Washington Post]] | url = https://www.washingtonpost.com/national/health-science/ecstasy-could-be-breakthrough-therapy-for-soldiers-others-suffering-from-ptsd/2017/08/26/009314ca-842f-11e7-b359-15a3617c767b_story.html | access-date = 3 April 2021 | archive-date = 28 August 2017 | archive-url = https://web.archive.org/web/20170828230759/https://www.washingtonpost.com/national/health-science/ecstasy-could-be-breakthrough-therapy-for-soldiers-others-suffering-from-ptsd/2017/08/26/009314ca-842f-11e7-b359-15a3617c767b_story.html | url-status = live }}</ref><ref>{{Cite web | vauthors = Kupferschmidt K | title = All clear for the decisive trial of ecstasy in PTSD patients | date = 26 August 2017 | url = https://www.science.org/content/article/all-clear-decisive-trial-ecstasy-ptsd-patients | access-date = 3 April 2021 | website = Science (magazine) | language = en | archive-date = 28 December 2021 | archive-url = https://web.archive.org/web/20211228220713/https://www.science.org/content/article/all-clear-decisive-trial-ecstasy-ptsd-patients | url-status = live }}</ref> 

Some researchers have proposed that psychedelics in general may act as [[active placebo|active]] "super [[placebo]]s" used for therapeutic purposes.<ref name="Dupuis_2022">{{cite journal | vauthors = Dupuis D, Veissière S | title = Culture, context, and ethics in the therapeutic use of hallucinogens: Psychedelics as active super-placebos? | journal = Transcultural Psychiatry | volume = 59 | issue = 5 | pages = 571–578 | date = October 2022 | pmid = 36263513 | doi = 10.1177/13634615221131465 }}</ref><ref name="van_Elk_2022">{{cite journal | vauthors = van Elk M, Yaden DB | title = Pharmacological, neural, and psychological mechanisms underlying psychedelics: A critical review | journal = Neuroscience and Biobehavioral Reviews | volume = 140 | date = September 2022 | pmid = 35878791 | doi = 10.1016/j.neubiorev.2022.104793 | article-number = 104793 | quote = In addition, the strong prior expectations that many people have about psychedelics directly contribute to the psychedelic experience and as a consequence it has been suggested that psychedelics may act as a 'super-placebo' (Hartogsohn, 2016). Specifically, strong prior expectations (e.g., that a specific intervention will likely trigger a mystical experience) will increase the likelihood of having e.g., a mystical-type experience (Maij et al., 2019), and this placebo-effect is further boosted by the psychedelic-induced suggestibility. | hdl = 1887/3515020 | hdl-access = free }}</ref>

===Others===
Small doses of MDMA are used by some religious practitioners as an [[entheogen]] to enhance prayer or meditation.<ref name="MDMA and Religion">{{cite web | vauthors = Saunders N | title = The Agony and Ecstasy of God's path | date = 29 July 1995 | url = http://csp.org/practices/entheogens/docs/saunders-ecstasy_rel.html | archive-url = https://web.archive.org/web/20130424024232/http://csp.org/practices/entheogens/docs/saunders-ecstasy_rel.html | archive-date = 24 April 2013 | work = Council on Spiritual Practices (CSP) | access-date = 11 June 2011 }}</ref> MDMA has been used as an adjunct to [[New Age]] spiritual practices.<ref name="Watson & Beck">{{cite journal | vauthors = Watson L, Beck J | title = New age seekers: MDMA use as an adjunct to spiritual pursuit | journal = Journal of Psychoactive Drugs | volume = 23 | issue = 3 | pages = 261–270 | year = 1991 | pmid = 1685513 | doi = 10.1080/02791072.1991.10471587 | url = http://research.lycaeum.org/researchpdfs/1991_watson_1.pdf | archive-url = https://web.archive.org/web/20041122213135/http://research.lycaeum.org/researchpdfs/1991_watson_1.pdf | archive-date = 22 November 2004 | access-date = 28 April 2024 | url-status = bot: unknown }}</ref>

===Forms===
[[File:1g_MDMA-HCl.jpg|thumb|1 gram of pure MDMA hydrochloride crystals]]

MDMA has become widely known as ecstasy (shortened "E", "X", or "XTC"), usually referring to its tablet form, although this term may also include the presence of possible [[adulterant]]s or diluents. The UK term "mandy" and the US term "molly" colloquially refer to MDMA in a crystalline powder form that is thought to be free of adulterants.<ref name="Luciano_2014" /><ref name="DrugFacts" /><ref name="DEA 2015 assessment" /> MDMA is also sold in the form of the hydrochloride salt, either as loose crystals or in [[Capsule (pharmacy)|gelcaps]].<ref name="Molly S05E07" /><ref name="Molly S06E05" /> MDMA tablets can sometimes be found in a shaped form that may depict characters from [[popular culture]]. These are sometimes collectively referred to as "fun tablets".<ref>{{cite web | vauthors = Kelly M | title = Man arrested for possession of ecstasy tablets shaped like Wario | date = 20 June 2019 | work = Nintendo Enthusiast | url = https://www.nintendoenthusiast.com/man-arrested-for-possession-of-ecstasy-tablets-shaped-like-wario/ | access-date = 17 June 2021 | archive-date = 24 June 2021 | archive-url = https://web.archive.org/web/20210624195901/https://www.nintendoenthusiast.com/man-arrested-for-possession-of-ecstasy-tablets-shaped-like-wario/ }}</ref><ref>{{cite web | vauthors = <!-- Not stated --> | title = Groesbeck: Students caught with deceptively shaped Ecstasy pills | date = 31 October 2019 | work = KWTX | url = https://www.kwtx.com/content/news/Students-caught-with-deceptively-shaped-Ecstasy-pills-at-local-school-564188221.html | access-date = 17 June 2021 | archive-date = 24 June 2021 | archive-url = https://web.archive.org/web/20210624195735/https://www.kwtx.com/content/news/Students-caught-with-deceptively-shaped-Ecstasy-pills-at-local-school-564188221.html | url-status = live }}</ref>

Partly due to the global supply shortage of [[sassafras oil]]—a problem largely assuaged by use of improved or alternative modern methods of synthesis—the purity of substances sold as molly have been found to vary widely. Some of these substances contain [[methylone]], [[ethylone]], [[MDPV]], [[mephedrone]], or any other of the group of compounds commonly known as [[Bath salts (drug)|bath salts]], in addition to, or in place of, MDMA.<ref name="DrugFacts" /><ref name="DEA 2015 assessment" /><ref name="Molly S05E07">{{cite AV media | title = Molly Madness | date = 13 August 2014 | medium = TV documentary | url = <!--Link for WP:V - https://www.youtube.com/watch?v=F-0Zw05A1Y0 --> | publisher = National Geographic Channel | work = [[Drugs, Inc.]] | asin = B00LIC368M }}</ref><ref name="Molly S06E05">{{cite AV media | title = Manic Molly | date = 10 December 2014 | medium = TV documentary | url = <!--Link for WP:V - https://www.youtube.com/watch?v=pd1-triBJFw --> | publisher = National Geographic Channel | work = [[Drugs, Inc.]] | asin = B00LIC368M }}</ref> Powdered MDMA ranges from pure MDMA to crushed tablets with 30–40% purity.<ref name="EU2015" /> MDMA tablets typically have low purity due to bulking agents that are added to dilute the drug and increase profits (notably lactose) and binding agents.<ref name="EU2015" /> Tablets sold as ecstasy sometimes contain [[3,4-methylenedioxyamphetamine]] (MDA), [[3,4-methylenedioxyethylamphetamine]] (MDEA), other amphetamine derivatives, caffeine, opiates, or painkillers.<ref name="Betzler_2017" /> Some tablets contain little or no MDMA.<ref name="Betzler_2017" /><ref name="EU2015" /><ref name="Toxnet MDMA after-effects">{{cite web | title = 3,4-Methylenedioxymethamphetamine | date = 28 August 2008 | url = https://www.nlm.nih.gov/toxnet/index.html | website = Hazardous Substances Data Bank | publisher = National Library of Medicine | access-date = 22 August 2014 | archive-date = 4 April 2019 | archive-url = https://web.archive.org/web/20190404201340/https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs%20hsdb%3A%40term%20%40rn%20%40rel%2042542-10-9 | url-status = live }}</ref> The proportion of seized ecstasy tablets with MDMA-like impurities has varied annually and by country.<ref name="EU2015" /> The average content of MDMA in a preparation is 70 to 120{{nbsp}}mg with the purity having increased since the 1990s.<ref name="Betzler_2017" />

MDMA is usually consumed by mouth. It is also sometimes [[Insufflation (medicine)|snorted]].<ref name="Drugs2014" />

{{Multiple image
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<!-- Image 1 -->
| image1 = Ecstasy monogram.jpg
| width1 = 434
| height1 = 424
| alt1 = Image of Ecstasy tablets
| caption1 = Ecstasy tablets which may contain MDMA

<!-- Image 2 -->
| image2 = Tan MDMA Crystals.jpg
| width2 = 4032
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| alt2 = Image of a chunk of impure MDMA
| caption2 = A salt of MDMA (typically white) with impurities, resulting in a tan discoloration

<!-- Image 3 -->
| image3 = Crushed MDMA crystals.jpg
| width3 = 4032
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| alt3 = 1 gram crushed MDMA crystals
| caption3 = Crushed MDMA (1 gram) crystals

<!-- Image 4 -->
| image4 =
| width4 = 1632
| height4 = 1224
| alt4 = Image of highly pure MDMA in capsules
| caption4 = High purity MDMA in capsules
}}

==Effects==
In general, MDMA users report feeling the onset of subjective effects within 30 to 60 minutes of oral consumption and reaching peak effect at 75 to 120 minutes, which then plateaus for about 3.5 hours.<ref name="mcn">{{cite journal | vauthors = Liechti ME, Gamma A, Vollenweider FX | title = Gender differences in the subjective effects of MDMA | journal = Psychopharmacology | volume = 154 | issue = 2 | pages = 161–168 | date = March 2001 | pmid = 11314678 | doi = 10.1007/s002130000648 | s2cid = 20251888 }}</ref> The desired short-term psychoactive effects of MDMA have been reported to include:

* [[Euphoria]] – a sense of general [[well-being]] and happiness<ref name="Meyer_2013" /><ref name="Acute amph toxicity" />
* Increased self-confidence, sociability, and perception of facilitated communication<ref name="Betzler_2017" /><ref name="Meyer_2013" /><ref name="Acute amph toxicity" />
* [[Entactogen]]ic effects—increased [[empathy]] or feelings of closeness with others<ref name="Meyer_2013" /><ref name="Acute amph toxicity" /> and oneself<ref name="Betzler_2017" />
* [[Mydriasis|Dilated pupils]]<ref name="Betzler_2017" />
* Relaxation and reduced anxiety<ref name="Betzler_2017" />
* Increased emotionality<ref name="Betzler_2017" />
* A sense of inner peace<ref name="Acute amph toxicity" />
* Mild hallucination<ref name="Acute amph toxicity" />
* Enhanced sensation, perception, or sexuality<ref name="Betzler_2017" /><ref name="Meyer_2013" /><ref name="Acute amph toxicity" />
* Altered sense of time<ref name="NIH2016" />

The experience elicited by MDMA depends on the dose, setting, and user.<ref name="Betzler_2017" /> The variability of the induced altered state is lower compared to other psychedelics. For example, MDMA used at parties is associated with high motor activity, reduced sense of identity, and poor awareness of surroundings. Use of MDMA individually or in small groups in a quiet environment and when concentrating, is associated with increased lucidity, concentration, sensitivity to aesthetic aspects of the environment, enhanced awareness of emotions, and improved capability of communication.<ref name="pmid22392347" /><ref name="Landriscina">{{cite journal | vauthors = Landriscina F | title = MDMA and the states of Consciousness | journal = Eleusis | volume = 2 | pages = 3–9 | date = 1995 }}</ref> In psychotherapeutic settings, MDMA effects have been characterized by infantile ideas, mood lability, and memories and moods connected with childhood experiences.<ref name="Landriscina" /><ref name="Baggott_2015">{{cite journal | vauthors = Baggott MJ, Kirkpatrick MG, Bedi G, de Wit H | title = Intimate insight: MDMA changes how people talk about significant others | journal = Journal of Psychopharmacology | location = Oxford, England | volume = 29 | issue = 6 | pages = 669–677 | date = June 2015 | pmid = 25922420 | pmc = 4698152 | doi = 10.1177/0269881115581962 }}</ref>

MDMA has been described as an "[[empathogen]]ic" drug because of its empathy-producing effects.<ref name="Schmid_2014">{{cite journal | vauthors = Schmid Y, Hysek CM, Simmler LD, Crockett MJ, Quednow BB, Liechti ME | title = Differential effects of MDMA and methylphenidate on social cognition | journal = Journal of Psychopharmacology | location = Oxford, England | volume = 28 | issue = 9 | pages = 847–856 | date = September 2014 | pmid = 25052243 | doi = 10.1177/0269881114542454 | s2cid = 25713943 | url = http://edoc.unibas.ch/42235/1/20160316152928_56e96dc8bdaad.pdf | access-date = 29 June 2019 | archive-date = 17 September 2020 | archive-url = https://web.archive.org/web/20200917151735/https://edoc.unibas.ch/42235/1/20160316152928_56e96dc8bdaad.pdf | url-status = live }}</ref><ref name="Wardle_2014">{{cite journal | vauthors = Wardle MC, de Wit H | title = MDMA alters emotional processing and facilitates positive social interaction | journal = Psychopharmacology | volume = 231 | issue = 21 | pages = 4219–4229 | date = October 2014 | pmid = 24728603 | pmc = 4194242 | doi = 10.1007/s00213-014-3570-x }}</ref> Results of several studies show the effects of increased empathy with others.<ref name="Schmid_2014" /> When testing MDMA for medium and high doses, it showed increased hedonic and arousal continuum.<ref name="Bravo_2001">{{cite book | vauthors = Bravo GL | veditors = Holland J | chapter = What does MDMA feel like? | title = Ecstasy: The complete guide. A comprehensive look at the risks and benefits of MDMA. | location = Rochester | date = 2001 | publisher = Park Street Press }}</ref><ref name="Metzner_2005">{{cite book | vauthors = Metzner R | veditors = Earleywine M | chapter = Psychedelic, Psychoactive, and Addictive Drugs and States of Consciousness | title = Mind-Altering Drugs: The Science of Subjective Experience | location = New York | date = 2005 | publisher = Oxford University | chapter-url = http://www.greenearthfound.org/write/psychedelic.html | access-date = 8 October 2017 | archive-date = 9 October 2017 | archive-url = https://web.archive.org/web/20171009092337/http://www.greenearthfound.org/write/psychedelic.html }}</ref> The effect of MDMA increasing sociability is consistent, while its effects on empathy have been more mixed.<ref name="KamilarBritt_2015"/>

==Side effects==
===Short-term===
Acute adverse effects are usually the result of high or multiple doses, although single dose toxicity can occur in susceptible individuals.<ref name="Meyer_2013" /> The most serious short-term physical health risks of MDMA are [[hyperthermia]] and [[dehydration]].<ref name="Acute amph toxicity" /><ref name="Keane_2014" /> Cases of life-threatening or fatal [[hyponatremia]] (excessively low sodium concentration in the blood) have developed in MDMA users attempting to prevent dehydration by [[water intoxication|consuming excessive amounts of water]] without replenishing [[electrolytes]].<ref name="Acute amph toxicity" /><ref name="Keane_2014" /><ref name="White_2014">{{cite journal | vauthors = White CM | title = How MDMA's pharmacology and pharmacokinetics drive desired effects and harms | journal = Journal of Clinical Pharmacology | volume = 54 | issue = 3 | pages = 245–252 | date = March 2014 | pmid = 24431106 | doi = 10.1002/jcph.266 | s2cid = 6223741 }}</ref>

The immediate adverse effects of MDMA use can include:

{{div col|colwidth=27em}}
* [[Bruxism]] (grinding and clenching of the teeth)<ref name="Betzler_2017" /><ref name="pmid22392347" /><ref name="Meyer_2013" />
* [[Dehydration]]<ref name="pmid22392347" /><ref name="Acute amph toxicity" /><ref name="Keane_2014" />
* [[Diarrhea]]<ref name="Acute amph toxicity" />
* [[Erectile dysfunction]]<ref name="Betzler_2017" /><ref>{{cite journal | vauthors = Spauwen LW, Niekamp AM, Hoebe CJ, Dukers-Muijrers NH | title = Drug use, sexual risk behaviour and sexually transmitted infections among swingers: a cross-sectional study in The Netherlands | journal = Sexually Transmitted Infections | volume = 91 | issue = 1 | pages = 31–36 | date = February 2015 | pmid = 25342812 | doi = 10.1136/sextrans-2014-051626 | quote = It is known that some recreational drugs (eg, MDMA or GHB) may hamper the potential to ejaculate or maintain an erection. | doi-access = free }}</ref>
* [[Hyperthermia]]<ref name="Betzler_2017" /><ref name="pmid22392347" /><ref name="Keane_2014" />
* Increased wakefulness or [[insomnia]]<ref name="Betzler_2017" /><ref name="Acute amph toxicity" />
* Increased perspiration and sweating<ref name="Acute amph toxicity" /><ref name="Keane_2014" />
* Increased [[heart rate]] and [[blood pressure]]<ref name="Betzler_2017" /><ref name="pmid22392347" /><ref name="Keane_2014" />
* Increased [[Psychomotor agitation|psychomotor]] activity<ref name="Betzler_2017" />
* Loss of [[appetite]]<ref name="Betzler_2017" /><ref name="Toxnet MDMA after-effects"/>
* Nausea and vomiting<ref name="Meyer_2013" />
* Visual and auditory hallucinations (rarely)<ref name="Betzler_2017" />
{{div col end}}

Other adverse effects that may occur or persist for up to a week following cessation of moderate MDMA use include:<ref name="Toxnet MDMA after-effects" /><ref name="Meyer_2013" />

; Physiological
{{div col|colwidth=18em}}
* Insomnia<ref name="Toxnet MDMA after-effects" />
* Loss of appetite<ref name="Toxnet MDMA after-effects" />
* Tiredness or lethargy<ref>{{Cite web | vauthors = Hahn IH | title = MDMA Toxicity: Background, Pathophysiology, Epidemiology | date = 25 March 2015 | url = http://emedicine.medscape.com/article/821572-overview#showall | website = Medscape | access-date = 14 May 2016 | archive-date = 11 May 2016 | archive-url = https://web.archive.org/web/20160511222711/http://emedicine.medscape.com/article/821572-overview#showall | url-status = live }}</ref><ref>{{Cite book | vauthors = Parrott AC | veditors = Verster J, Brady K, Galanter M, Conrod P | chapter = 13. MDMA and LSD | title = Drug Abuse and Addiction in Medical Illness: Causes, Consequences and Treatment | page = 179 | date = 2012 | chapter-url = https://books.google.com/books?id=yGeBj9U6Za8C | publisher = Springer Science & Business Media | isbn = 978-1-4614-3375-0 }}</ref>
* [[Trismus]] (lockjaw)<ref name="Meyer_2013" />
{{div col end}}
;Psychological
{{div col|colwidth=18em}}
* [[Anhedonia]]<ref name="Toxnet MDMA after-effects" />
* Anxiety or paranoia<ref name="Toxnet MDMA after-effects"/>
* Depression<ref name="Toxnet MDMA after-effects" /><ref name="Meyer_2013" />
* Impulsiveness<ref name="Toxnet MDMA after-effects" />
* Irritability<ref name="Toxnet MDMA after-effects" />
* Memory impairment<ref name="Meyer_2013" />
* Restlessness<ref name="Toxnet MDMA after-effects" />
{{div col end}}

===Long-term===
{{As of|2015}}, the long-term effects of MDMA on human brain structure and function have not been fully determined.<ref name="Abstinent MDMA fMRI review">{{cite journal | vauthors = Garg A, Kapoor S, Goel M, Chopra S, Chopra M, Kapoor A, McCann UD, Behera C | title = Functional Magnetic Resonance Imaging in Abstinent MDMA Users: A Review | journal = Current Drug Abuse Reviews | volume = 8 | issue = 1 | pages = 15–25 | date = 2015 | pmid = 25731754 | doi = 10.2174/1874473708666150303115833 }}</ref> However, there is consistent evidence of structural and functional deficits in MDMA users with high lifetime exposure.<ref name="Abstinent MDMA fMRI review" /> These structural or functional changes appear to be dose dependent and may be less prominent in MDMA users with only a moderate (typically <50 doses used and <100 tablets consumed) lifetime exposure. Nonetheless, moderate MDMA use may still be [[Neurotoxicity|neurotoxic]] and what constitutes moderate use is not clearly established.<ref name="Mueller_2016">{{cite journal | vauthors = Mueller F, Lenz C, Steiner M, Dolder PC, Walter M, Lang UE, Liechti ME, Borgwardt S | title = Neuroimaging in moderate MDMA use: A systematic review | journal = Neuroscience and Biobehavioral Reviews | volume = 62 | pages = 21–34 | date = March 2016 | pmid = 26746590 | doi = 10.1016/j.neubiorev.2015.12.010 | doi-access = free }}</ref>

Furthermore, it is not clear yet whether "typical" recreational users of MDMA (1 to 2 pills of 75 to 125{{nbsp}}mg MDMA or analogue every 1 to 4 weeks) will develop neurotoxic brain lesions.<ref>{{cite journal | vauthors = Gouzoulis-Mayfrank E, Daumann J | title = Neurotoxicity of drugs of abuse--the case of methylenedioxyamphetamines (MDMA, ecstasy), and amphetamines | journal = Dialogues in Clinical Neuroscience | volume = 11 | issue = 3 | pages = 305–317 | date = 2009 | pmid = 19877498 | pmc = 3181923 | doi = 10.31887/DCNS.2009.11.3/egmayfrank }}</ref> Long-term exposure to MDMA in humans has been shown to produce marked [[neurodegeneration]] in [[striatal]], [[hippocampal]], [[prefrontal cortex|prefrontal]], and [[occipital cortex|occipital]] serotonergic [[axon terminal]]s.<ref name="Abstinent MDMA fMRI review" /><ref name="Meth MDMA NTox">{{cite journal | vauthors = Halpin LE, Collins SA, Yamamoto BK | title = Neurotoxicity of methamphetamine and 3,4-methylenedioxymethamphetamine | journal = Life Sciences | volume = 97 | issue = 1 | pages = 37–44 | date = February 2014 | pmid = 23892199 | pmc = 3870191 | doi = 10.1016/j.lfs.2013.07.014 | quote = In contrast, MDMA produces damage to serotonergic, but not dopaminergic axon terminals in the striatum, hippocampus, and prefrontal cortex (Battaglia et al., 1987, O'Hearn et al., 1988). The damage associated with Meth and MDMA has been shown to persist for at least 2 years in rodents, non-human primates and humans (Seiden et al., 1988, Woolverton et al., 1989, McCann et al., 1998, Volkow et al., 2001a, McCann et al., 2005) }}</ref> Neurotoxic damage to serotonergic axon terminals has been shown to persist for more than two years.<ref name="Meth MDMA NTox" /> Elevations in brain temperature from MDMA use are positively correlated with MDMA-induced neurotoxicity.<ref name="pmid22392347" /><ref name="Abstinent MDMA fMRI review" /><ref name="Mueller_2016" /> However, most studies on MDMA and serotonergic neurotoxicity in humans focus more on heavy users who consume as much as seven times or more the amount that most users report taking. The evidence for the presence of serotonergic neurotoxicity in casual users who take lower doses less frequently is not conclusive.<ref>{{cite journal | vauthors = Szigeti B, Winstock AR, Erritzoe D, Maier LJ | title = Are ecstasy induced serotonergic alterations overestimated for the majority of users? | journal = Journal of Psychopharmacology | location = Oxford, England | volume = 32 | issue = 7 | pages = 741–748 | date = July 2018 | pmid = 29733742 | doi = 10.1177/0269881118767646 | s2cid = 13660975 | quote = Given the dose-response relationship between MDMA exposure and SERT reductions and the statistically non-significant SERT binding differences for users with use levels similar to the majority of real-life users, it can be speculated that SERT levels may not be significantly affected for most recreational ecstasy users. }}</ref>

However, adverse [[neuroplastic]] changes to brain [[microvasculature]] and [[white matter]] have been observed to occur in humans using low doses of MDMA.<ref name="pmid22392347" /><ref name="Abstinent MDMA fMRI review" /> Reduced [[gray matter]] density in certain brain structures has also been noted in human MDMA users.<ref name="pmid22392347" /><ref name="Abstinent MDMA fMRI review" /> Global reductions in gray matter volume, thinning of the parietal and orbitofrontal cortices, and decreased hippocampal activity have been observed in long term users.<ref name="Betzler_2017" /> The effects established so far for recreational use of ecstasy lie in the range of moderate to severe effects for [[serotonin transporter]] reduction.<ref>{{cite journal | vauthors = Roberts CA, Jones A, Montgomery C | title = Meta-analysis of molecular imaging of serotonin transporters in ecstasy/polydrug users | journal = Neuroscience and Biobehavioral Reviews | volume = 63 | pages = 158–167 | date = April 2016 | pmid = 26855234 | doi = 10.1016/j.neubiorev.2016.02.003 | doi-access = free }}</ref>

Impairments in multiple aspects of cognition, including attention, learning, memory, [[Role of serotonin in visual orientation processing#MDMA and Visual Orientation Processing|visual processing]], and sleep, have been found in regular MDMA users.<ref name="Betzler_2017" /><ref name="Meyer_2013" /><ref name=Pharm2014>{{cite journal | vauthors = Parrott AC | title = The potential dangers of using MDMA for psychotherapy | journal = Journal of Psychoactive Drugs | volume = 46 | issue = 1 | pages = 37–43 | year = 2014 | pmid = 24830184 | doi = 10.1080/02791072.2014.873690 | s2cid = 23485480 | url = https://www.researchgate.net/publication/262381558 }}</ref><ref name="Abstinent MDMA fMRI review" /> The magnitude of these impairments is correlated with lifetime MDMA usage<ref name="Meyer_2013" /><ref name="Pharm2014" /><ref name="Abstinent MDMA fMRI review" /> and are partially reversible with abstinence.<ref name="Betzler_2017" /> Several forms of memory are impaired by chronic ecstasy use;<ref name="Meyer_2013" /><ref name="Pharm2014" /> however, the effects for memory impairments in ecstasy users are generally small overall.<ref>{{cite journal | vauthors = Rogers G, Elston J, Garside R, Roome C, Taylor R, Younger P, Zawada A, Somerville M | title = The harmful health effects of recreational ecstasy: a systematic review of observational evidence | journal = Health Technology Assessment | location = Winchester, England | volume = 13 | issue = 6 | pages = iii–iv, ix–xii, 1–315 | date = January 2009 | pmid = 19195429 | doi = 10.3310/hta13050 | doi-access = free | hdl = 10871/11534 | hdl-access = free }}</ref><ref name="Meta analysis - MDMA memory impairment">{{cite journal | vauthors = Kuypers KP, Theunissen EL, van Wel JH, de Sousa Fernandes Perna EB, Linssen A, Sambeth A, Schultz BG, Ramaekers JG | title = Verbal Memory Impairment in Polydrug Ecstasy Users: A Clinical Perspective | journal = PLOS ONE | volume = 11 | issue = 2 |article-number=e0149438 | year = 2016 | pmid = 26907605 | pmc = 4764468 | doi = 10.1371/journal.pone.0149438 | bibcode = 2016PLoSO..1149438K | doi-access = free }}</ref> MDMA use is also associated with increased impulsivity and depression.<ref name="Betzler_2017" />

Serotonin depletion following MDMA use can cause depression in subsequent days. In some cases, depressive symptoms persist for longer periods.<ref name="Betzler_2017" /> Some studies indicate repeated recreational use of ecstasy is associated with depression and anxiety, even after quitting the drug.<ref>{{cite journal | vauthors = Laws KR, Kokkalis J | title = Ecstasy (MDMA) and memory function: a meta-analytic update | journal = Human Psychopharmacology | volume = 22 | issue = 6 | pages = 381–388 | date = August 2007 | pmid = 17621368 | doi = 10.1002/hup.857 | s2cid = 25353240 }}</ref> Depression is one of the main reasons for cessation of use.<ref name="Betzler_2017" />

At high doses, MDMA induces a [[neuroimmune system|neuroimmune response]] that, through several mechanisms, increases the permeability of the [[blood–brain barrier]], thereby making the brain more susceptible to environmental toxins and [[pathogen]]s.<ref name="MDMA BBB">{{cite journal | vauthors = Kousik SM, Napier TC, Carvey PM | title = The effects of psychostimulant drugs on blood brain barrier function and neuroinflammation | journal = Frontiers in Pharmacology | volume = 3 | page = 121 | year = 2012 | pmid = 22754527 | pmc = 3386512 | doi = 10.3389/fphar.2012.00121 | doi-access = free }}</ref><ref>{{cite book | vauthors = McMillan B, Starr C | title = Human biology | location = Belmont, CA | date = 2014 | publisher = Brooks/Cole Cengage Learning | isbn = 978-1-133-59916-6 | edition = 10th }}</ref>{{Page needed|date=September 2015}} In addition, MDMA has [[immunosuppressive]] effects in the [[peripheral nervous system]] and pro-inflammatory effects in the [[central nervous system]].<ref>{{cite journal | vauthors = Boyle NT, Connor TJ | title = Methylenedioxymethamphetamine ('Ecstasy')-induced immunosuppression: a cause for concern? | journal = British Journal of Pharmacology | volume = 161 | issue = 1 | pages = 17–32 | date = September 2010 | pmid = 20718737 | pmc = 2962814 | doi = 10.1111/J.1476-5381.2010.00899.X }}</ref>

MDMA may increase the risk of [[cardiac valvulopathy]] in heavy or long-term users due to activation of serotonin [[5-HT2B receptor|5-HT<sub>2B</sub> receptor]]s.<ref name="Cavero_2014">{{cite journal | vauthors = Cavero I, Guillon JM | title = Safety Pharmacology assessment of drugs with biased 5-HT(2B) receptor agonism mediating cardiac valvulopathy | journal = Journal of Pharmacological and Toxicological Methods | volume = 69 | issue = 2 | pages = 150–161 | date = 2014 | pmid = 24361689 | doi = 10.1016/j.vascn.2013.12.004 }}</ref><ref name="Padhariya_2017">{{cite journal | vauthors = Padhariya K, Bhandare R, Canney D, Velingkar V | title = Cardiovascular Concern of 5-HT2B Receptor and Recent Vistas in the Development of Its Antagonists | journal = Cardiovascular & Hematological Disorders Drug Targets | volume = 17 | issue = 2 | pages = 86–104 | date = 2017 | pmid = 28676029 | doi = 10.2174/1871529X17666170703115111 }}</ref> MDMA induces cardiac [[epigenetics|epigenetic changes]] in [[DNA methylation]], particularly hypermethylation changes.<ref>{{cite journal | vauthors = Koczor CA, Ludlow I, Hight RS, Jiao Z, Fields E, Ludaway T, Russ R, Torres RA, Lewis W | title = Ecstasy (MDMA) Alters Cardiac Gene Expression and DNA Methylation: Implications for Circadian Rhythm Dysfunction in the Heart | journal = Toxicological Sciences | volume = 148 | issue = 1 | pages = 183–191 | date = November 2015 | pmid = 26251327 | pmc = 4731408 | doi = 10.1093/toxsci/kfv170 }}</ref>

===Reinforcement disorders===
<!--Dependence-->
Approximately 60% of MDMA users experience [[drug withdrawal|withdrawal]] symptoms when they stop taking MDMA.<ref name="Toxnet MDMA after-effects"/> Some of these symptoms include fatigue, loss of appetite, depression, and trouble concentrating.<ref name="Toxnet MDMA after-effects"/> [[Drug tolerance|Tolerance]] to some of the desired<!-- (e.g., euphoria) - need ref--> and adverse<!-- (e.g., loss of appetite) - need ref--> effects of MDMA is expected to occur with consistent MDMA use.<ref name="Toxnet MDMA after-effects"/> A 2007 [[Delphi method|delphic analysis]] of a panel of experts in pharmacology, psychiatry, law, policing and others estimated MDMA to have a psychological dependence and physical dependence potential roughly three-fourths to four-fifths that of cannabis.<ref name="Nutt_2007">{{cite journal | vauthors = Nutt D, King LA, Saulsbury W, Blakemore C | title = Development of a rational scale to assess the harm of drugs of potential misuse | journal = Lancet | location = London, England | volume = 369 | issue = 9566 | pages = 1047–1053 | date = March 2007 | pmid = 17382831 | doi = 10.1016/S0140-6736(07)60464-4 | s2cid = 5903121 | author-link1 = David Nutt | author-link4 = Colin Blakemore }}<br />Lay summary: {{cite web | title = Scientists want new drug rankings | date = 23 March 2007 | website = BBC News | url = https://news.bbc.co.uk/2/hi/health/6474053.stm | access-date = 4 April 2008 | archive-date = 2 December 2007 | archive-url = https://web.archive.org/web/20071202233524/http://news.bbc.co.uk/2/hi/health/6474053.stm | url-status = live }}</ref>

<!--Addiction-->
MDMA has been shown to induce [[ΔFosB]] in the [[nucleus accumbens]].<ref name="MDMA ΔFosB">{{cite journal | vauthors = Olausson P, Jentsch JD, Tronson N, Neve RL, Nestler EJ, Taylor JR | title = DeltaFosB in the nucleus accumbens regulates food-reinforced instrumental behavior and motivation | journal = The Journal of Neuroscience | volume = 26 | issue = 36 | pages = 9196–9204 | date = September 2006 | pmid = 16957076 | pmc = 6674495 | doi = 10.1523/JNEUROSCI.1124-06.2006 }}</ref> Because MDMA releases dopamine in the [[striatum]], the mechanisms by which it induces ΔFosB in the nucleus accumbens are analogous to other dopaminergic psychostimulants.<ref name="MDMA ΔFosB" /><ref name="Robison_2011">{{cite journal | vauthors = Robison AJ, Nestler EJ | title = Transcriptional and epigenetic mechanisms of addiction | journal = Nature Reviews. Neuroscience | volume = 12 | issue = 11 | pages = 623–637 | date = October 2011 | pmid = 21989194 | pmc = 3272277 | doi = 10.1038/nrn3111 }}</ref> Therefore, chronic use of MDMA at high doses can result in [[neuroplasticity|altered brain structure]] and [[drug addiction]] that occur as a consequence of ΔFosB overexpression in the nucleus accumbens.<ref name="Robison_2011" /> MDMA is less addictive than other stimulants such as methamphetamine and cocaine.<ref>{{cite book | vauthors = Mack AH, Brady KT, Miller SI, Frances RJ | title = Clinical Textbook of Addictive Disorders | page = 169 | date = 2016-05-12 | publisher = Guilford Publications | isbn = 978-1-4625-2169-2 | url = https://books.google.com/books?id=88W_CwAAQBAJ&pg=PA171 | quote = MDMA's addictive liability appears to be lower than that of other drugs of abuse.... }}</ref><ref>{{cite journal | vauthors = Favrod-Coune T, Broers B | title = The Health Effect of Psychostimulants: A Literature Review | journal = Pharmaceuticals | location = Basel, Switzerland | volume = 3 | issue = 7 | pages = 2333–2361 | date = July 2010 | pmid = 27713356 | pmc = 4036656 | doi = 10.3390/ph3072333 | quote = It seems to present a smaller addiction potential than cocaine or methamphetamine. | doi-access = free }}</ref> Compared with amphetamine, MDMA and its metabolite MDA are less reinforcing.<ref>{{cite book | vauthors = Ries R, Miller SC, Fiellin DA | title = Principles of addiction medicine. | location = Philadelphia | page = 226 | date = 2009 | publisher = Wolters Kluwer/Lippincott Williams & Wilkins | isbn = 978-0-7817-7477-2 | edition = 4th | url = https://books.google.com/books?id=j6GGBud8DXcC&pg=PA226 | quote = MDA and MDMA are less reinforcing than amphetamine... | access-date = 11 January 2017 | archive-date = 13 January 2023 | archive-url = https://web.archive.org/web/20230113000536/https://books.google.com/books?id=j6GGBud8DXcC&pg=PA226 | url-status = live }}</ref>

<!--Diagnostic criteria-->
One study found approximately 15% of chronic MDMA users met the [[DSM-IV]] diagnostic criteria for [[substance dependence]].<ref name="Steinkellner_2011">{{cite journal | vauthors = Steinkellner T, Freissmuth M, Sitte HH, Montgomery T | title = The ugly side of amphetamines: short- and long-term toxicity of 3,4-methylenedioxymethamphetamine (MDMA, 'Ecstasy'), methamphetamine and D-amphetamine | journal = Biological Chemistry | volume = 392 | issue = 1–2 | pages = 103–115 | date = January 2011 | pmid = 21194370 | pmc = 4497800 | doi = 10.1515/BC.2011.016 | quote = ...approximately 15% of routine MDMA users recently fit the diagnostic criteria for MDMA dependence according to the Diagnostic and Statistical Manual, fourth edition/DSMIV. }}</ref> However, there is little evidence for a specific diagnosable MDMA dependence syndrome because MDMA is typically used relatively infrequently.<ref name="Epstein2013">{{cite book | veditors = McCrady BS, Epstein EE | title = Addictions: a comprehensive guidebook | location = Oxford | page = 299 | date = 2013 | publisher = Oxford University Press | isbn = 978-0-19-975366-6 | edition = Second | url = https://books.google.com/books?id=MUYfAQAAQBAJ&pg=PA299 | access-date = 11 January 2017 | archive-date = 13 January 2023 | archive-url = https://web.archive.org/web/20230113000537/https://books.google.com/books?id=MUYfAQAAQBAJ&pg=PA299 | url-status = live }}</ref>

<!--Treatment-->
There are currently no medications to treat MDMA addiction.<ref>{{cite book | vauthors = Mack AH, Brady KT, Miller SI, Frances RJ | title = Clinical Textbook of Addictive Disorders | page = 171 | date = 2016-05-12 | publisher = Guilford Publications | isbn = 978-1-4625-2169-2 | url = https://books.google.com/books?id=88W_CwAAQBAJ&q=mdma+addiction&pg=PA171 | quote = There are no known pharmacological treatments for MDMA addiction. | access-date = 13 October 2020 | archive-date = 19 January 2023 | archive-url = https://web.archive.org/web/20230119130056/https://books.google.com/books?id=88W_CwAAQBAJ&q=mdma+addiction&pg=PA171 | url-status = live }}</ref>

===During pregnancy===
MDMA is a moderately [[teratogenic drug]] (i.e., it is toxic to the fetus).<ref name="Vorhees_1997">{{cite journal | vauthors = Vorhees CV | title = Methods for detecting long-term CNS dysfunction after prenatal exposure to neurotoxins | journal = Drug and Chemical Toxicology | volume = 20 | issue = 4 | pages = 387–399 | date = November 1997 | pmid = 9433666 | doi = 10.3109/01480549709003895 }}</ref><ref name="Meamar_2010">{{cite journal | vauthors = Meamar R, Karamali F, Sadeghi HM, Etebari M, Nasr-Esfahani MH, Baharvand H | title = Toxicity of ecstasy (MDMA) towards embryonic stem cell-derived cardiac and neural cells | journal = Toxicology in Vitro  | volume = 24 | issue = 4 | pages = 1133–1138 | date = June 2010 | pmid = 20230888 | doi = 10.1016/j.tiv.2010.03.005 | bibcode = 2010ToxVi..24.1133M | quote = In summary, MDMA is a moderate teratogen that could influence cardiac and neuronal differentiation in the ESC model and these results are in concordance with previous in vivo and in vitro models. }}</ref> [[Uterus|In utero]] exposure to MDMA is associated with a [[neurotoxicity|neuro]]- and [[cardiotoxicity]]<ref name="Meamar_2010" /> and impaired motor functioning. Motor delays may be temporary during infancy or long-term. The severity of these developmental delays increases with heavier MDMA use.<ref name="Pharm2014" /><ref name=singer>{{cite journal | vauthors = Singer LT, Moore DG, Fulton S, Goodwin J, Turner JJ, Min MO, Parrott AC | title = Neurobehavioral outcomes of infants exposed to MDMA (Ecstasy) and other recreational drugs during pregnancy | journal = Neurotoxicology and Teratology | volume = 34 | issue = 3 | pages = 303–310 | year = 2012 | pmid = 22387807 | pmc = 3367027 | doi = 10.1016/j.ntt.2012.02.001 | bibcode = 2012NTxT...34..303S }}</ref> MDMA has been shown to promote the survival of fetal dopaminergic neurons in culture.<ref>{{cite journal | vauthors = Lipton JW, Tolod EG, Thompson VB, Pei L, Paumier KL, Terpstra BT, Lynch KA, Collier TJ, Sortwell CE | title = 3,4-Methylenedioxy-N-methamphetamine (ecstasy) promotes the survival of fetal dopamine neurons in culture | journal = Neuropharmacology | volume = 55 | issue = 5 | pages = 851–859 | date = October 2008 | pmid = 18655796 | pmc = 2572681 | doi = 10.1016/j.neuropharm.2008.06.062 }}</ref>

==Overdose==
MDMA overdose symptoms vary widely due to the involvement of multiple organ systems. Some of the more overt overdose symptoms are listed in the table below. The number of instances of fatal MDMA intoxication is low relative to its usage rates. In most fatalities, MDMA was not the only drug involved. Acute toxicity is mainly caused by [[serotonin syndrome]] and [[sympathomimetic]] effects.<ref name="Steinkellner_2011" /> Sympathomimetic side effects can be managed with [[carvedilol]].<ref name="Richards_2015" /><ref name="Hysek_2012b" /> MDMA's toxicity in overdose may be exacerbated by caffeine, with which it is frequently cut in order to increase volume.<ref>{{cite journal | vauthors = Vanattou-Saïfoudine N, McNamara R, Harkin A | title = Caffeine provokes adverse interactions with 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') and related psychostimulants: mechanisms and mediators | journal = British Journal of Pharmacology | volume = 167 | issue = 5 | pages = 946–959 | date = November 2012 | pmid = 22671762 | pmc = 3492978 | doi = 10.1111/j.1476-5381.2012.02065.x }}</ref> A scheme for management of acute MDMA toxicity has been published focusing on treatment of hyperthermia, hyponatraemia, serotonin syndrome, and multiple organ failure.<ref>{{cite journal | vauthors = Hall AP, Henry JA | title = Acute toxic effects of 'Ecstasy' (MDMA) and related compounds: overview of pathophysiology and clinical management | journal = British Journal of Anaesthesia | volume = 96 | issue = 6 | pages = 678–685 | date = June 2006 | pmid = 16595612 | doi = 10.1093/bja/ael078 | doi-access = free }}</ref>

{| class="wikitable unsortable" style="margin: 1em auto;"
|+ Symptoms of overdose
! scope="col" style="text-align:center"| System
! scope="col" | Minor or moderate overdose<ref name="de_la_Torre_2004" /> || Severe overdose<ref name="de_la_Torre_2004" />
|-
! scope="row"| [[Cardiovascular system|Cardiovascular]]
|
||
* [[Disseminated intravascular coagulation]]<ref name="Acute amph toxicity" />
* [[Intracranial hemorrhage]]<ref name="Acute amph toxicity" />
* Severe [[hypertension]]<ref name="Acute amph toxicity" /><ref name="Kellum_2008" /> or [[hypotension]]<ref name="Acute amph toxicity" />
* Hypotensive bleeding<ref name="Betzler_2017" />
|-
! scope="row"| [[Central nervous system|Central nervous<br />system]]
|
* [[Hyperreflexia]]<ref name="de_la_Torre_2004" />
* [[Psychomotor agitation|Agitation]]<ref name="Acute amph toxicity" /><ref name="Kellum_2008" />
* [[Mental confusion]]<ref name="Acute amph toxicity" />
* [[Paranoia]]<ref name="Acute amph toxicity" /><ref name="Kellum_2008" />
* [[Stimulant psychosis]]<ref name="Betzler_2017" /><ref name="pmid22392347" />
|
* [[Cognitive deficit|Cognitive and memory impairment]]<ref name="Acute amph toxicity" /> potentially to the point of [[retrograde amnesia|retrograde]] or [[anterograde amnesia]]<ref>{{cite journal | vauthors = Chummun H, Tilley V, Ibe J | title = 3,4-methylenedioxyamfetamine (ecstasy) use reduces cognition | journal = British Journal of Nursing | location = Mark Allen Publishing | volume = 19 | issue = 2 | pages = 94–100 | year = 2010 | pmid = 20235382 }}</ref>
* Coma<ref name="pmid22392347" /><ref name="Kellum_2008">{{cite book | vauthors = Kellum JA, Gunn SR, Singer M | title = Oxford American Handbook of Critical Care | page = 464 | date = 2008 | publisher = Oxford University Press | isbn = 978-0-19-530528-9 | oclc = 1003197730 }}</ref>
* [[Convulsion]]s<ref name="Acute amph toxicity" /><ref name="Kellum_2008" />
* [[Hallucination]]s<ref name="Acute amph toxicity" /><ref name="Kellum_2008" />
* [[Loss of consciousness]]<ref name="pmid22392347" />
* [[Serotonin syndrome]]<ref name="pmid22392347" /><ref name="Acute amph toxicity" /><ref name="White_2014" />
|-
! scope="row"|[[Musculoskeletal system|Musculoskeletal]]
|
|
* [[Hypertonia|Muscle rigidity]]<ref name="Acute amph toxicity" />
* [[Rhabdomyolysis]] (i.e., rapid muscle breakdown)<ref name="Acute amph toxicity" /><ref name="White_2014" />
|-
! scope="row"| [[Respiratory system|Respiratory]]
|
|
* [[Acute respiratory distress syndrome]]<ref name="Acute amph toxicity" />
|-
! scope="row"| [[Urogenital system|Urinary]]
|
|
* [[Acute kidney injury]]<ref name="Acute amph toxicity" /><ref>{{cite journal | vauthors = Pendergraft WF, Herlitz LC, Thornley-Brown D, Rosner M, Niles JL | title = Nephrotoxic effects of common and emerging drugs of abuse | journal = Clinical Journal of the American Society of Nephrology  | volume = 9 | issue = 11 | pages = 1996–2005 | date = November 2014 | pmid = 25035273 | pmc = 4220747 | doi = 10.2215/CJN.00360114 }}</ref>
|-
! scope="row"| Other
|
|
* [[Cerebral edema]]<ref name="pmid22392347" />
* [[Hepatitis]]<ref name="Acute amph toxicity" /><ref name="White_2014" />
* [[Hyperpyrexia]] (a life-threatening elevation of body temperature greater than or equal to {{convert|40.0|or|41.5|C|F|1}})<ref name="Acute amph toxicity" /><ref name="White_2014" />
* [[Hyponatremia]] ([[syndrome of inappropriate antidiuretic hormone]])<ref name="Acute amph toxicity">{{cite journal | vauthors = Greene SL, Kerr F, Braitberg G | title = Review article: amphetamines and related drugs of abuse | journal = Emergency Medicine Australasia | volume = 20 | issue = 5 | pages = 391–402 | date = October 2008 | pmid = 18973636 | doi = 10.1111/j.1742-6723.2008.01114.x | s2cid = 20755466 }}</ref><ref name="Keane_2014">{{cite journal | vauthors = Keane M | title = Recognising and managing acute hyponatraemia | journal = Emergency Nurse | volume = 21 | issue = 9 | pages = 32–6; quiz 37 | date = February 2014 | pmid = 24494770 | doi = 10.7748/en2014.02.21.9.32.e1128 }}</ref><ref name="White_2014" />
|}

==Interactions==
{{See also|Trip killer#Antidotes of other hallucinogens|MDMA/citalopram}}

A number of [[drug interactions]] can occur between MDMA and other drugs, including [[serotonin|serotonergic]] drugs.<ref name="Toxnet MDMA after-effects"/><ref>{{cite journal | vauthors = Silins E, Copeland J, Dillon P | title = Qualitative review of serotonin syndrome, ecstasy (MDMA) and the use of other serotonergic substances: hierarchy of risk | journal = The Australian and New Zealand Journal of Psychiatry | volume = 41 | issue = 8 | pages = 649–655 | date = August 2007 | pmid = 17620161 | doi = 10.1080/00048670701449237 | s2cid = 25832516 }}</ref> MDMA also interacts with drugs which inhibit [[CYP450]] enzymes, like [[ritonavir]] (Norvir), particularly [[CYP2D6]] inhibitors.<ref name="Toxnet MDMA after-effects"/> Life-threatening reactions and death have occurred in people who took MDMA while on ritonavir.<ref name="Papaseit_2020">{{cite journal | vauthors = Papaseit E, Pérez-Mañá C, Torrens M, Farré A, Poyatos L, Hladun O, Sanvisens A, Muga R, Farré M | title = MDMA interactions with pharmaceuticals and drugs of abuse | journal = Expert Opinion on Drug Metabolism & Toxicology | volume = 16 | issue = 5 | pages = 357–369 | date = May 2020 | pmid = 32228243 | doi = 10.1080/17425255.2020.1749262 | s2cid = 214750903 }}</ref> [[Bupropion]], a strong CYP2D6 inhibitor, has been found to increase MDMA exposure with administration of MDMA.<ref name="Fonseca_2021" /><ref name="Schmid_2015" /> Concurrent use of MDMA with certain other serotonergic drugs can result in a life-threatening condition called [[serotonin syndrome]].<ref name="Betzler_2017" /><ref name="Toxnet MDMA after-effects"/> Severe overdose resulting in death has also been reported in people who took MDMA in combination with certain [[monoamine oxidase inhibitor]]s (MAOIs),<ref name="Betzler_2017" /><ref name="Toxnet MDMA after-effects"/> such as [[phenelzine]] (Nardil), [[tranylcypromine]] (Parnate), or [[moclobemide]] (Aurorix, Manerix).<ref>{{cite journal | vauthors = Vuori E, Henry JA, Ojanperä I, Nieminen R, Savolainen T, Wahlsten P, Jäntti M | title = Death following ingestion of MDMA (ecstasy) and moclobemide | journal = Addiction | location = Abingdon, England | volume = 98 | issue = 3 | pages = 365–368 | date = March 2003 | pmid = 12603236 | doi = 10.1046/j.1360-0443.2003.00292.x }}</ref> [[Serotonin reuptake inhibitor]]s (SRIs) such as [[citalopram]] (Celexa), [[duloxetine]] (Cymbalta), [[fluoxetine]] (Prozac), and [[paroxetine]] (Paxil) have been shown to block most of the subjective effects of MDMA.<ref name="Halberstadt_2020">{{cite book | vauthors = Halberstadt AL, Nichols DE | chapter = Serotonin and serotonin receptors in hallucinogen action | title = Handbook of the Behavioral Neurobiology of Serotonin | volume = 31 | pages = 843–863 | year = 2020 | doi = 10.1016/B978-0-444-64125-0.00043-8 | series = Handbook of Behavioral Neuroscience | issn = 1569-7339 | isbn = 978-0-444-64125-0 | s2cid = 241134396 }}</ref> [[Norepinephrine reuptake inhibitor]]s (NRIs) such as [[reboxetine]] (Edronax) have been found to reduce [[emotional excitation]] and feelings of [[psychostimulant|stimulation]] with MDMA but do not appear to influence its [[entactogen]]ic or [[euphoriant|mood-elevating]] effects.<ref name="Halberstadt_2020" />

MDMA [[monoamine releasing agent|induces the release of monoamine neurotransmitter]]s and thereby acts as an indirectly acting [[sympathomimetic]] and produces a variety of [[cardiostimulant]] effects.<ref name="Fonseca_2021">{{cite journal | vauthors = Fonseca DA, Ribeiro DM, Tapadas M, Cotrim MD | title = Ecstasy (3,4-methylenedioxymethamphetamine): Cardiovascular effects and mechanisms | journal = European Journal of Pharmacology | volume = 903 | date = July 2021 | pmid = 33971177 | doi = 10.1016/j.ejphar.2021.174156 | article-number = 174156 }}</ref> It [[dose dependence|dose-dependently]] increases [[heart rate]], [[blood pressure]], and [[cardiac output]].<ref name="Fonseca_2021" /><ref name="Mendelson_2012" /> SRIs like citalopram and [[paroxetine]], as well as the [[serotonin]] [[5-HT2A receptor|5-HT<sub>2A</sub> receptor]] [[receptor antagonist|antagonist]] [[ketanserin]], have been found to partially block the increases in heart rate and blood pressure with MDMA.<ref name="Fonseca_2021" /><ref name="Liechti_2000">{{cite journal | vauthors = Liechti ME, Saur MR, Gamma A, Hell D, Vollenweider FX | title = Psychological and physiological effects of MDMA ("Ecstasy") after pretreatment with the 5-HT(2) antagonist ketanserin in healthy humans | journal = Neuropsychopharmacology  | volume = 23 | issue = 4 | pages = 396–404 | date = October 2000 | pmid = 10989266 | doi = 10.1016/S0893-133X(00)00126-3 }}</ref> It is notable in this regard that [[serotonergic psychedelic]]s such as [[psilocybin]], which act as serotonin 5-HT<sub>2A</sub> receptor agonists, likewise have sympathomimetic effects.<ref name="Wso_2023">{{cite journal | vauthors = Wsół A | title = Cardiovascular safety of psychedelic medicine: current status and future directions | journal = Pharmacological Reports | volume = 75 | issue = 6 | pages = 1362–1380 | date = December 2023 | pmid = 37874530 | pmc = 10661823 | doi = 10.1007/s43440-023-00539-4 }}</ref><ref name="Neumann_2024">{{cite journal | vauthors = Neumann J, Dhein S, Kirchhefer U, Hofmann B, Gergs U | title = Effects of hallucinogenic drugs on the human heart | journal = Frontiers in Pharmacology | volume = 15 | article-number = 1334218 | date = 2024 | pmid = 38370480 | pmc = 10869618 | doi = 10.3389/fphar.2024.1334218 | doi-access = free }}</ref><ref name="Ley_2023">{{cite journal | vauthors = Ley L, Holze F, Arikci D, Becker AM, Straumann I, Klaiber A, Coviello F, Dierbach S, Thomann J, Duthaler U, Luethi D, Varghese N, Eckert A, Liechti ME | title = Comparative acute effects of mescaline, lysergic acid diethylamide, and psilocybin in a randomized, double-blind, placebo-controlled cross-over study in healthy participants | journal = Neuropsychopharmacology | volume = 48 | issue = 11 | pages = 1659–1667 | date = October 2023 | pmid = 37231080 | pmc = 10517157 | doi = 10.1038/s41386-023-01607-2 }}</ref> The NRI [[reboxetine]] and the [[serotonin–norepinephrine reuptake inhibitor]] (SNRI) duloxetine block MDMA-induced increases in heart rate and blood pressure.<ref name="Fonseca_2021" /> Conversely, bupropion, a [[norepinephrine–dopamine reuptake inhibitor]] (NDRI) with only weak [[dopaminergic]] activity,<ref name="Hart_2024">{{cite journal | vauthors = Hart XM, Spangemacher M, Defert J, Uchida H, Gründer G | title = Update Lessons from PET Imaging Part II: A Systematic Critical Review on Therapeutic Plasma Concentrations of Antidepressants | journal = Therapeutic Drug Monitoring | volume = 46 | issue = 2 | pages = 155–169 | date = April 2024 | pmid = 38287888 | doi = 10.1097/FTD.0000000000001142 }}</ref><ref name="Eap_2021">{{cite journal | vauthors = Eap CB, Gründer G, Baumann P, Ansermot N, Conca A, Corruble E, Crettol S, Dahl ML, de Leon J, Greiner C, Howes O, Kim E, Lanzenberger R, Meyer JH, Moessner R, Mulder H, Müller DJ, Reis M, Riederer P, Ruhe HG, Spigset O, Spina E, Stegman B, Steimer W, Stingl J, Suzen S, Uchida H, Unterecker S, Vandenberghe F, Hiemke C | title = Tools for optimising pharmacotherapy in psychiatry (therapeutic drug monitoring, molecular brain imaging and pharmacogenetic tests): focus on antidepressants | journal = The World Journal of Biological Psychiatry | volume = 22 | issue = 8 | pages = 561–628 | date = October 2021 | pmid = 33977870 | doi = 10.1080/15622975.2021.1878427 | s2cid = 234472488 | url = https://serval.unil.ch/resource/serval:BIB_6FD14CC75A02.P001/REF.pdf | access-date = 10 April 2022 | archive-date = 5 May 2022 | archive-url = https://web.archive.org/web/20220505232003/https://serval.unil.ch/resource/serval:BIB_6FD14CC75A02.P001/REF.pdf | url-status = live }}</ref> reduced MDMA-induced heart rate and circulating [[norepinephrine]] increases but did not affect MDMA-induced blood pressure increases.<ref name="Fonseca_2021" /><ref name="Schmid_2015">{{cite journal | vauthors = Schmid Y, Rickli A, Schaffner A, Duthaler U, Grouzmann E, Hysek CM, Liechti ME | title = Interactions between bupropion and 3,4-methylenedioxymethamphetamine in healthy subjects | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 353 | issue = 1 | pages = 102–111 | date = April 2015 | pmid = 25655950 | doi = 10.1124/jpet.114.222356 }}</ref> On the other hand, the robust NDRI [[methylphenidate]], which has sympathomimetic effects of its own, has been found to augment the cardiovascular effects and increases in circulating norepinephrine and [[epinephrine]] levels induced by MDMA.<ref name="Fonseca_2021" /><ref name="Hysek_2014">{{cite journal | vauthors = Hysek CM, Simmler LD, Schillinger N, Meyer N, Schmid Y, Donzelli M, Grouzmann E, Liechti ME | title = Pharmacokinetic and pharmacodynamic effects of methylphenidate and MDMA administered alone or in combination | journal = The International Journal of Neuropsychopharmacology | volume = 17 | issue = 3 | pages = 371–381 | date = March 2014 | pmid = 24103254 | doi = 10.1017/S1461145713001132 | url = https://edoc.unibas.ch/35606/2/371.full.pdf }}</ref>

The [[binding selectivity|non-selective]] [[beta blocker]] [[pindolol]] blocked MDMA-induced increases in heart rate but not blood pressure.<ref name="Fonseca_2021" /><ref name="Richards_2015" /><ref name="Hysek_2010">{{cite journal | vauthors = Hysek CM, Vollenweider FX, Liechti ME | title = Effects of a beta-blocker on the cardiovascular response to MDMA (Ecstasy) | journal = Emergency Medicine Journal | volume = 27 | issue = 8 | pages = 586–589 | date = August 2010 | pmid = 20378736 | doi = 10.1136/emj.2009.079905 | url = https://www.zora.uzh.ch/id/eprint/40820/1/Hysek.pdf }}</ref> The [[α2-adrenergic receptor|α<sub>2</sub>-adrenergic receptor]] [[agonist]] [[clonidine]] did not affect the cardiovascular effects of MDMA, though it reduced blood pressure.<ref name="Fonseca_2021" /><ref name="Richards_2015" /><ref name="Hysek_2012a">{{cite journal | vauthors = Hysek CM, Brugger R, Simmler LD, Bruggisser M, Donzelli M, Grouzmann E, Hoener MC, Liechti ME | title = Effects of the α₂-adrenergic agonist clonidine on the pharmacodynamics and pharmacokinetics of 3,4-methylenedioxymethamphetamine in healthy volunteers | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 340 | issue = 2 | pages = 286–294 | date = February 2012 | pmid = 22034656 | doi = 10.1124/jpet.111.188425 }}</ref> The [[α1-adrenergic receptor|α<sub>1</sub>-adrenergic receptor]] antagonists [[doxazosin]] and [[prazosin]] blocked or reduced MDMA-induced blood pressure increases but augmented MDMA-induced heart rate and cardiac output increases.<ref name="Fonseca_2021" /><ref name="Richards_2015" /><ref name="Hysek_2013">{{cite journal | vauthors = Hysek CM, Fink AE, Simmler LD, Donzelli M, Grouzmann E, Liechti ME | title = α₁-Adrenergic receptors contribute to the acute effects of 3,4-methylenedioxymethamphetamine in humans | journal = Journal of Clinical Psychopharmacology | volume = 33 | issue = 5 | pages = 658–666 | date = October 2013 | pmid = 23857311 | doi = 10.1097/JCP.0b013e3182979d32 }}</ref><ref name="Mendelson_2012">{{cite journal | vauthors = Mendelson J, Baggott MJ, Li L, Coyle J, Galloway GP | title = Poster Session II (PII 1-111): PII-41. MDMA-Induced Increases in Blood Pressure Are Not Mediated by α-Adrenergic Mechanisms and Are Not Due To Elevated Peripheral Vascular Resistance | journal = Clinical Pharmacology & Therapeutics | volume = 91 | issue = S1 [American Society for Clinical Pharmacology and Therapeutics Abstract of papers, 2012 Annual Meeting Gaylord National Hotel and Convention Center National Harbor, Maryland March 14–17, 2012] | pages = S51–S93 (S66–S66) | date = 2012 | doi = 10.1038/clpt.2011.361 | issn = 0009-9236 | quote = MDMA increased heart rate (HR) by 25 bpm (p<.001), [cardiac output (CO)] by 1.75 L/min (p<0.01) but did not alter [stroke volume (SV)] or [systemic vascular resistance (SVR)]. Compared to MDMA alone the combination of MDMA + prazosin further increased HR by 24 bpm (p<0.001) and CO by 3.3L/min (p<0.02). MDMA increased systolic and diastolic blood pressure (SBP, DBP) by 26 mmHg (p<0.001 each); prazosin attenuated MDMA effects on DBP by 9.3 mmHg (p<001) but did not alter SBP. [...] MDMA increases HR, producing elevations in CO. The hypertensive effects of MDMA are not due to elevated peripheral vascular resistance and the blood pressure effects of MDMA are not attenuated by α-adrenergic blockade, suggesting that MDMA may produce CV effects through non-α-adrenergic mechanisms. }}</ref> The dual α<sub>1</sub>- and [[β-adrenergic receptor]] blocker [[carvedilol]] reduced MDMA-induced heart rate and blood pressure increases.<ref name="Fonseca_2021" /><ref name="Richards_2015">{{cite journal | vauthors = Richards JR, Albertson TE, Derlet RW, Lange RA, Olson KR, Horowitz BZ | title = Treatment of toxicity from amphetamines, related derivatives, and analogues: a systematic clinical review | journal = Drug and Alcohol Dependence | volume = 150 | pages = 1–13 | date = May 2015 | pmid = 25724076 | doi = 10.1016/j.drugalcdep.2015.01.040 }}</ref><ref name="Hysek_2012b">{{cite journal | vauthors = Hysek C, Schmid Y, Rickli A, Simmler LD, Donzelli M, Grouzmann E, Liechti ME | title = Carvedilol inhibits the cardiostimulant and thermogenic effects of MDMA in humans | journal = British Journal of Pharmacology | volume = 166 | issue = 8 | pages = 2277–2288 | date = August 2012 | pmid = 22404145 | pmc = 3448893 | doi = 10.1111/j.1476-5381.2012.01936.x }}</ref> In contrast to the cases of serotonergic and noradrenergic agents, the [[dopamine]] [[D2 receptor|D<sub>2</sub> receptor]] antagonist [[haloperidol]] did not affect the cardiovascular responses to MDMA.<ref name="Fonseca_2021" /><ref name="Liechti_2000a">{{cite journal | vauthors = Liechti ME, Vollenweider FX | title = Acute psychological and physiological effects of MDMA ("Ecstasy") after haloperidol pretreatment in healthy humans | journal = European Neuropsychopharmacology | volume = 10 | issue = 4 | pages = 289–295 | date = July 2000 | pmid = 10871712 | doi = 10.1016/s0924-977x(00)00086-9 }}</ref> Due to the theoretical risk of "unopposed α-stimulation" and possible consequences like [[coronary vasospasm]], it has been suggested that dual α<sub>1</sub>- and β-adrenergic receptor antagonists like carvedilol and [[labetalol]], rather than selective beta blockers, should be used in the management of stimulant-induced [[sympathomimetic]] [[toxicity]], for instance in the context of [[overdose]].<ref name="Richards_2015" /><ref name="Richards_2017">{{cite journal | vauthors = Richards JR, Hollander JE, Ramoska EA, Fareed FN, Sand IC, Izquierdo Gómez MM, Lange RA | title = β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon | journal = Journal of Cardiovascular Pharmacology and Therapeutics | volume = 22 | issue = 3 | pages = 239–249 | date = May 2017 | pmid = 28399647 | doi = 10.1177/1074248416681644 }}</ref>

==Pharmacology==
===Pharmacodynamics===
{{See also|Entactogen#Mechanism of action|Serotonin releasing agent#Effects and comparisons|Monoamine releasing agent#Mechanism of action}}

{| class="wikitable floatright" style="font-size:small;"
|+ {{Nowrap|Activities of MDMA<ref name="Dunlap_2018" />}}
|-
! [[Biological target|Target]] !! [[Affinity (pharmacology)|Affinity]] (K<sub>i</sub>, nM)
|-
| {{Abbrlink|SERT|Serotonin transporter}} || 0.73–13,300 (K<sub>i</sub>)<br />380–2,500 ({{Abbrlink|IC<sub>50</sub>|half-maximal inhibitory concentration}})<br />50–72 ({{Abbrlink|EC<sub>50</sub>|Half-maximal effective concentration}}) (rat)
|-
| {{Abbrlink|NET|Norepinephrine transporter}} || 27,000–30,500 (K<sub>i</sub>)<br />360–405 ({{Abbr|IC<sub>50</sub>|half-maximal inhibitory concentration}})<br />54–110 ({{Abbr|EC<sub>50</sub>|Half-maximal effective concentration}}) (rat)
|-
| {{Abbrlink|DAT|Dopamine transporter}} || 6,500–>10,000 (K<sub>i</sub>)<br />1,440–21,000 ({{Abbr|IC<sub>50</sub>|half-maximal inhibitory concentration}})<br />51–278 ({{Abbr|EC<sub>50</sub>|Half-maximal effective concentration}}) (rat)
|-
| [[5-HT1A receptor|5-HT<sub>1A</sub>]] || 6,300–12,200 (K<sub>i</sub>)<br />126–36,000{{nbsp}}nM ({{Abbr|EC<sub>50</sub>|Half-maximal effective concentration}})<br />21–64% ({{Abbrlink|E<sub>max</sub>|maximal efficacy}})
|-
| [[5-HT1B receptor|5-HT<sub>1B</sub>]] || >10,000 (K<sub>i</sub>)<br />513–1,700 ({{Abbr|EC<sub>50</sub>|Half-maximal effective concentration}})<br />46–91% ({{Abbr|E<sub>max</sub>|maximal efficacy}})
|-
| [[5-HT1D receptor|5-HT<sub>1D</sub>]] || >10,000 (K<sub>i</sub>)<br />51–2,630 ({{Abbr|EC<sub>50</sub>|Half-maximal effective concentration}})<br />28–51% ({{Abbr|E<sub>max</sub>|maximal efficacy}})
|-
| [[5-HT1E receptor|5-HT<sub>1E</sub>]] || >10,000
|-
| [[5-HT1F receptor|5-HT<sub>1F</sub>]] || {{Abbr|ND|No data}}
|-
| [[5-HT2A receptor|5-HT<sub>2A</sub>]] || 4,600–>10,000 (K<sub>i</sub>)<br />1,260–12,500 ({{Abbr|EC<sub>50</sub>|half-maximal effective concentration}})<br />21–77% ({{Abbr|E<sub>max</sub>|maximal efficacy}})
|-
| [[5-HT2B receptor|5-HT<sub>2B</sub>]] || 269–2,000 (K<sub>i</sub>)<br />126–>20,000 ({{Abbr|EC<sub>50</sub>|half-maximal effective concentration}})<br />32–84% ({{Abbr|E<sub>max</sub>|maximal efficacy}})
|-
| [[5-HT2C receptor|5-HT<sub>2C</sub>]] || 1,550–>13,000 (K<sub>i</sub>)<br />575–9,100 ({{Abbr|EC<sub>50</sub>|half-maximal effective concentration}})<br />44–92% ({{Abbr|E<sub>max</sub>|maximal efficacy}})
|-
| [[5-HT3 receptor|5-HT<sub>3</sub>]] || >10,000
|-
| [[5-HT4 receptor|5-HT<sub>4</sub>]] || {{Abbr|ND|No data}}
|-
| [[5-HT5A receptor|5-HT<sub>5A</sub>]] || >10,000
|-
| [[5-HT6 receptor|5-HT<sub>6</sub>]] || >10,000
|-
| [[5-HT7 receptor|5-HT<sub>7</sub>]] || >10,000
|-
| [[Alpha-1A adrenergic receptor|α<sub>1A</sub>]] || 6,900–>10,000
|-
| [[Alpha-1B adrenergic receptor|α<sub>1B</sub>]] || >10,000
|-
| [[Alpha-1D adrenergic receptor|α<sub>1D</sub>]] || {{Abbr|ND|No data}}
|-
| [[Alpha-2A adrenergic receptor|α<sub>2A</sub>]] || 2,532–15,000
|-
| [[Alpha-2B adrenergic receptor|α<sub>2B</sub>]] || 1,785
|-
| [[Alpha-2C adrenergic receptor|α<sub>2C</sub>]] || 1,123–1,346
|-
| [[Beta-1 adrenergic receptor|β<sub>1</sub>]], [[Beta-2 adrenergic receptor|β<sub>2</sub>]] || >10,000
|-
| [[D1 receptor|D<sub>1</sub>]] || >13,600
|-
| [[D2 receptor|D<sub>2</sub>]] || 25,200
|-
| [[D3 receptor|D<sub>3</sub>]] || >17,700
|-
| [[D4 receptor|D<sub>4</sub>]] || >10,000
|-
| [[D5 receptor|D<sub>5</sub>]] || >10,000
|-
| [[H1 receptor|H<sub>1</sub>]] || 2,138–>14,400
|-
| [[H2 receptor|H<sub>2</sub>]] || >10,000
|-
| [[H3 receptor|H<sub>3</sub>]], [[H4 receptor|H<sub>4</sub>]] || {{Abbr|ND|No data}}
|-
| [[Muscarinic acetylcholine M1 receptor|M<sub>1</sub>]] || >10,000
|-
| [[Muscarinic acetylcholine M2 receptor|M<sub>2</sub>]] || >10,000
|-
| [[Muscarinic acetylcholine M3 receptor|M<sub>3</sub>]] || 1,850–>10,000
|-
| [[Muscarinic acetylcholine M4 receptor|M<sub>4</sub>]] || 8,250–>10,000
|-
| [[Muscarinic acetylcholine M5 receptor|M<sub>5</sub>]] || 6,340–>10,000
|-
| [[Nicotinic acetylcholine receptor|nACh]] || >10,000
|-
| [[Trace amine-associated receptor 1|TAAR1]] || 250–370 (K<sub>i</sub>) (rat)<br />1,000–1,700 ({{Abbr|EC<sub>50</sub>|half-maximal effective concentration}}) (rat)<br />56% ({{Abbr|E<sub>max</sub>|maximal efficacy}}) (rat)<br />2,400–3,100 (K<sub>i</sub>) (mouse)<br />4,000 ({{Abbr|EC<sub>50</sub>|half-maximal effective concentration}}) (mouse)<br />71% ({{Abbr|E<sub>max</sub>|maximal efficacy}}) (mouse)<br />35,000 ({{Abbr|EC<sub>50</sub>|half-maximal effective concentration}}) (human)<br />26% ({{Abbr|E<sub>max</sub>|maximal efficacy}}) (human)
|-
| [[I1 receptor|I<sub>1</sub>]] || 220
|-
| [[Sigma-1 receptor|σ<sub>1</sub>]], [[Sigma-2 receptor|σ<sub>2</sub>]] || {{Abbr|ND|No data}}
|- class="sortbottom"
| colspan="2" style="width: 1px; background-color:var(--background-color-notice-subtle,#eaecf0); color:inherit; text-align: center;" | '''Notes:''' The smaller the value, the more avidly the drug binds to the site. Proteins are human unless otherwise specified. '''Refs:''' <ref name="PDSPKiDatabase">{{cite web | title = PDSP Database | website = UNC | url = https://pdsp.unc.edu/databases/pdsp.php?testFreeRadio=testFreeRadio&testLigand=MDMA&kiAllRadio=all&doQuery=Submit+Query | language = zu | access-date = 11 December 2024 }}</ref><ref name="BindingDB">{{cite web | vauthors = Liu T | title = BindingDB BDBM50010588 (RS)-3,4-(methylenedioxy)methamphetamine::1-(1,3-Benzodioxol-5-yl)-N-methyl-2-propanamine::1-(1,3-benzodioxol-5-yl)-N-methylpropan-2-amine::3,4-methylenedioxymethamphetamine::CHEMBL43048::DL-(3,4-Methylenedioxy)methamphetamine::MDMA::N,alpha-dimethyl-1,3-benzodioxole-5-ethanamine::N-Methyl-3,4-methylenedioxyamphetamine::US11767305, Compound MDMA | website = BindingDB | url = https://www.bindingdb.org/rwd/bind/chemsearch/marvin/MolStructure.jsp?monomerid=50010588 | access-date = 11 December 2024 }}</ref><ref name="Dunlap_2018" /><ref name="Jain_2025" /><!-- <- Not fully adapted yet, only 5-HT1A, 5-HT1B, 5-HT1D, 5-HT2A, 5-HT2B, and 5-HT2C activities --><ref name="Ray_2010">{{cite journal | vauthors = Ray TS | title = Psychedelics and the human receptorome | journal = PLOS ONE | volume = 5 | issue = 2 |article-number=e9019 | date = February 2010 | pmid = 20126400 | pmc = 2814854 | doi = 10.1371/journal.pone.0009019 | doi-access = free | bibcode = 2010PLoSO...5.9019R }}</ref><ref name="Simmler_2013" /><ref name="Simmler_2014">{{cite journal | vauthors = Simmler LD, Rickli A, Hoener MC, Liechti ME | title = Monoamine transporter and receptor interaction profiles of a new series of designer cathinones | journal = Neuropharmacology | volume = 79 | pages = 152–160 | date = April 2014 | pmid = 24275046 | doi = 10.1016/j.neuropharm.2013.11.008 }}</ref><br /><ref name="Rickli_2015">{{cite journal | vauthors = Rickli A, Kopf S, Hoener MC, Liechti ME | title = Pharmacological profile of novel psychoactive benzofurans | journal = British Journal of Pharmacology | volume = 172 | issue = 13 | pages = 3412–3425 | date = July 2015 | pmid = 25765500 | pmc = 4500375 | doi = 10.1111/bph.13128 }}</ref><ref name="Luethi_2019">{{cite journal | vauthors = Luethi D, Kolaczynska KE, Walter M, Suzuki M, Rice KC, Blough BE, Hoener MC, Baumann MH, Liechti ME | title = Metabolites of the ring-substituted stimulants MDMA, methylone and MDPV differentially affect human monoaminergic systems | journal = Journal of Psychopharmacology | location = Oxford, England | volume = 33 | issue = 7 | pages = 831–841 | date = July 2019 | pmid = 31038382 | pmc = 8269116 | doi = 10.1177/0269881119844185 }}</ref><ref name="Eshleman_2014">{{cite journal | vauthors = Eshleman AJ, Forster MJ, Wolfrum KM, Johnson RA, Janowsky A, Gatch MB | title = Behavioral and neurochemical pharmacology of six psychoactive substituted phenethylamines: mouse locomotion, rat drug discrimination and in vitro receptor and transporter binding and function | journal = Psychopharmacology | volume = 231 | issue = 5 | pages = 875–888 | date = March 2014 | pmid = 24142203 | pmc = 3945162 | doi = 10.1007/s00213-013-3303-6 | url = https://www.researchgate.net/publication/258061356 }}</ref><ref name="Gainetdinov_2018">{{cite journal | vauthors = Gainetdinov RR, Hoener MC, Berry MD | title = Trace Amines and Their Receptors | journal = Pharmacological Reviews | volume = 70 | issue = 3 | pages = 549–620 | date = July 2018 | pmid = 29941461 | doi = 10.1124/pr.117.015305 | url = https://www.researchgate.net/publication/325975689 | doi-access = free }}</ref><ref name="Simmler_2016">{{cite journal | vauthors = Simmler LD, Buchy D, Chaboz S, Hoener MC, Liechti ME | title = In Vitro Characterization of Psychoactive Substances at Rat, Mouse, and Human Trace Amine-Associated Receptor 1 | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 357 | issue = 1 | pages = 134–144 | date = April 2016 | pmid = 26791601 | doi = 10.1124/jpet.115.229765 | url = https://d1wqtxts1xzle7.cloudfront.net/74120533/eae6c6e62565b82d46b4d111bbea0f77b9c2-libre.pdf?1635931703=&response-content-disposition=inline%3B+filename%3DIn_Vitro_Characterization_of_Psychoactiv.pdf&Expires=1746838268&Signature=Sy4fJ90yUhxs68314NxYsW5PAaNrBGePRu35WRR4PIF-3YC7Z~sLdnCn5wfqqbLg9bDEGdt~oW55ugMP3D3jgA0BoRI~~GOb0NQOwrtfUEQK1PQs1uuN9qg5Y1ct8z5NsABm44RgtukkwRMdU6fO7OlfIsQ68hOiFk129Ll7UYqldxD2f1xhE2fTTfsxSpb8cMCJzHn7-ItqLdwnAUPFK7WggDIjmY1kCnaHLwIxMwdJCAq8L6DYzSTg7pZkbR8qlou~GXbTPQt~gYpyZTJp5hgW-7V6K5wLlQ7Z2xE7B0f9wEfuc1W1QNafg125Tr-vvAe4LEGKXV58bnn1bpfWKw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA | archive-url = https://web.archive.org/web/20250509235235/https://d1wqtxts1xzle7.cloudfront.net/74120533/eae6c6e62565b82d46b4d111bbea0f77b9c2-libre.pdf?1635931703=&response-content-disposition=inline%3B+filename%3DIn_Vitro_Characterization_of_Psychoactiv.pdf&Expires=1746838268&Signature=Sy4fJ90yUhxs68314NxYsW5PAaNrBGePRu35WRR4PIF-3YC7Z~sLdnCn5wfqqbLg9bDEGdt~oW55ugMP3D3jgA0BoRI~~GOb0NQOwrtfUEQK1PQs1uuN9qg5Y1ct8z5NsABm44RgtukkwRMdU6fO7OlfIsQ68hOiFk129Ll7UYqldxD2f1xhE2fTTfsxSpb8cMCJzHn7-ItqLdwnAUPFK7WggDIjmY1kCnaHLwIxMwdJCAq8L6DYzSTg7pZkbR8qlou~GXbTPQt~gYpyZTJp5hgW-7V6K5wLlQ7Z2xE7B0f9wEfuc1W1QNafg125Tr-vvAe4LEGKXV58bnn1bpfWKw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA | archive-date = 2025-05-09 }}</ref><ref name="Sotnikova_2009">{{cite journal | vauthors = Sotnikova TD, Caron MG, Gainetdinov RR | title = Trace amine-associated receptors as emerging therapeutic targets | journal = Molecular Pharmacology | volume = 76 | issue = 2 | pages = 229–235 | date = August 2009 | pmid = 19389919 | pmc = 2713119 | doi = 10.1124/mol.109.055970 }}</ref>
|}

MDMA is an [[entactogen]] or [[empathogen]], as well as a [[stimulant]], [[euphoriant]], and weak [[psychedelic drug|psychedelic]].<ref name="Dunlap_2018" /><ref name="Nichols_2022" /> It is a [[substrate (biochemistry)|substrate]] of the [[monoamine transporter]]s (MATs) and acts as a [[monoamine releasing agent]] (MRA).<ref name="Dunlap_2018" /><ref name="Docherty_2021">{{cite journal | vauthors = Docherty JR, Alsufyani HA | title = Pharmacology of Drugs Used as Stimulants | journal = Journal of Clinical Pharmacology | volume = 61 | issue = Suppl 2 | pages = S53–S69 | date = August 2021 | pmid = 34396557 | doi = 10.1002/jcph.1918 | quote = Receptor-mediated actions of amphetamine and other amphetamine derivatives [...] may involve trace amine-associated receptors (TAARs) at which amphetamine and MDMA also have significant potency.85–87 Many stimulants have potency at the rat TAAR1 in the micromolar range but tend to be about 5 to 10 times less potent at the human TAAR1, [...] Activation of the TAAR1 receptor causes inhibition of dopaminergic transmission in the mesocorticolimbic system, and TAAR1 agonists attenuated psychostimulant abuse-related behaviors.89 It is likely that TAARs contribute to the actions of specific stimulants to modulate dopaminergic, serotonergic, and glutamate signaling,90 and drugs acting on the TAAR1 may have therapeutic potential.91 In the periphery, stimulants such as MDMA and cathinone produce vasoconstriction, part of which may involve TAARs, although only relatively high concentrations produced vascular contractions resistant to a cocktail of monoamine antagonist drugs.86 | doi-access = free }}</ref><ref name="Rothman_2003">{{cite journal | vauthors = Rothman RB, Baumann MH | title = Monoamine transporters and psychostimulant drugs | journal = European Journal of Pharmacology | volume = 479 | issue = 1–3 | pages = 23–40 | date = October 2003 | pmid = 14612135 | doi = 10.1016/j.ejphar.2003.08.054 }}</ref><ref name="Rothman_2006" /> The drug is specifically a well-balanced [[serotonin–norepinephrine–dopamine releasing agent]] (SNDRA).<ref name="Dunlap_2018" /><ref name="Docherty_2021" /><ref name="Rothman_2003" /><ref name="Rothman_2006" /> To a lesser extent, MDMA also acts as a [[serotonin–norepinephrine–dopamine reuptake inhibitor]] (SNDRI).<ref name="Dunlap_2018" /><ref name="Docherty_2021" /><ref name="Rothman_2003" /> MDMA enters [[monoaminergic]] [[neuron]]s via the MATs and then, via poorly understood [[mechanism of action|mechanism]]s, reverses the direction of these transporters to produce [[efflux pump|efflux]] of the [[monoamine neurotransmitter]]s rather than the usual [[reuptake]].<ref name="Dunlap_2018" /><ref name="Sulzer_2005">{{cite journal | vauthors = Sulzer D, Sonders MS, Poulsen NW, Galli A | title = Mechanisms of neurotransmitter release by amphetamines: a review | journal = Progress in Neurobiology | volume = 75 | issue = 6 | pages = 406–433 | date = April 2005 | pmid = 15955613 | doi = 10.1016/j.pneurobio.2005.04.003 }}</ref><ref name="Reith_2020">{{cite book | vauthors = Reith ME, Gnegy ME | title = Substance Use Disorders | chapter = Molecular Mechanisms of Amphetamines | volume = 258 | pages = 265–297 | date = 2020 | pmid = 31286212 | doi = 10.1007/164_2019_251 | series = Handbook of Experimental Pharmacology | isbn = 978-3-030-33678-3 }}</ref><ref name="Vaughan_2024">{{cite book | vauthors = Vaughan RA, Henry LK, Foster JD, Brown CR | chapter = Post-translational mechanisms in psychostimulant-induced neurotransmitter efflux | title = Pharmacological Advances in Central Nervous System Stimulants | volume = 99 | pages = 1–33 | date = 2024 | pmid = 38467478 | doi = 10.1016/bs.apha.2023.10.003 | series = Advances in Pharmacology | isbn = 978-0-443-21933-7 | chapter-url = https://books.google.com/books?id=2Sr6EAAAQBAJ&pg=PA1 }}</ref> Induction of monoamine efflux by [[amphetamine-type stimulant|amphetamine]]s in general may involve [[intracellular]] [[sodium ion|Na<sup>+</sup>]] and [[calcium ion|Ca<sup>2+</sup>]] elevation and [[protein kinase C|PKC]] and [[CaMKIIα]] activation.<ref name="Sulzer_2005" /><ref name="Reith_2020" /><ref name="Vaughan_2024" /> MDMA also acts on the [[vesicular monoamine transporter 2]] (VMAT2) on [[synaptic vesicle]]s to increase the [[cytosol]]ic concentrations of the monoamine neurotransmitters available for efflux.<ref name="Dunlap_2018" /><ref name="Docherty_2021" /> By inducing release and reuptake inhibition of [[serotonin]], [[norepinephrine]], and [[dopamine]], MDMA increases levels of these neurotransmitters in the [[brain]] and [[peripheral nervous system|periphery]].<ref name="Dunlap_2018" /><ref name="Docherty_2021" />

In addition to its actions as an SNDRA, MDMA directly interacts with a number of [[monoamine receptor|monoamine]] and other [[receptor (biochemistry)|receptor]]s.<ref name="Dunlap_2018" /><ref name="PDSPKiDatabase" /><ref name="BindingDB" /><ref name="Ray_2010" /><ref name="Jain_2025">{{cite journal | vauthors = Jain MK, Gumpper RH, Slocum ST, Schmitz GP, Madsen JS, Tummino TA, Suomivuori CM, Huang XP, Shub L, DiBerto JF, Kim K, DeLeon C, Krumm BE, Fay JF, Keiser M, Hauser AS, Dror RO, Shoichet B, Gloriam DE, Nichols DE, Roth BL | title = The polypharmacology of psychedelics reveals multiple targets for potential therapeutics | journal = Neuron | date = July 2025 | volume = 113 | issue = 19 | pages = 3129–3142.e9 | pmid = 40683247 | doi = 10.1016/j.neuron.2025.06.012 | url = https://www.cell.com/cms/10.1016/j.neuron.2025.06.012/attachment/7d8365fe-51f3-4a28-bf40-9999bec837f6/mmc11.pdf }}</ref> With varying [[potency (pharmacology)|potencies]] ranging from high to low, it is a [[partial agonist]] of several of the serotonin [[5-HT1 receptor|5-HT<sub>1</sub> receptor]]s, including the serotonin [[5-HT1A receptor|5-HT<sub>1A</sub>]], [[5-HT1B receptor|5-HT<sub>1B</sub>]], and [[5-HT1D receptor|5-HT<sub>1D</sub> receptor]]s, and is a partial agonist of the serotonin [[5-HT2 receptor|5-HT<sub>2</sub> receptor]]s, including the serotonin [[5-HT2A receptor|5-HT<sub>2A</sub>]], [[5-HT2B receptor|5-HT<sub>2B</sub>]], and [[5-HT2C receptor|5-HT<sub>2C</sub> receptor]]s.<ref name="Dunlap_2018" /><ref name="Jain_2025" /><ref name="Pitts_2018" /><ref name="Setola_2003" /><ref name="Nash_1994">{{cite journal | vauthors = Nash JF, Roth BL, Brodkin JD, Nichols DE, Gudelsky GA | title = Effect of the R(-) and S(+) isomers of MDA and MDMA on phosphatidyl inositol turnover in cultured cells expressing 5-HT2A or 5-HT2C receptors | journal = Neuroscience Letters | volume = 177 | issue = 1–2 | pages = 111–115 | date = August 1994 | pmid = 7824160 | doi = 10.1016/0304-3940(94)90057-4 }}</ref><ref name="Jain_2025" /> The drug also interacts with [[alpha-2 adrenergic receptor|α<sub>2</sub>-adrenergic receptor]]s, with the [[sigma receptor|sigma]] [[sigma-1 receptor|σ<sub>1</sub>]] and [[sigma-2 receptor|σ<sub>2</sub> receptor]]s, with the [[imidazoline receptor|imidazoline]] [[I1 receptor|I<sub>1</sub> receptor]], and with other [[biological target|target]]s.<ref name="Dunlap_2018" /><ref name="PDSPKiDatabase" /><ref name="BindingDB" /><ref name="Jain_2025" /><ref name="Ray_2010" /> Along with the preceding receptor interactions, MDMA is a potent partial agonist of the rodent [[trace amine-associated receptor 1]] (TAAR1).<ref name="Gainetdinov_2018" /><ref name="Simmler_2016" /> Conversely however, due to species differences, it is far weaker in terms of potency as an agonist of the human TAAR1.<ref name="Dunlap_2018" /><ref name="Gainetdinov_2018" /><ref name="Simmler_2016" /><ref name="Lewin_2011">{{cite journal | vauthors = Lewin AH, Miller GM, Gilmour B | title = Trace amine-associated receptor 1 is a stereoselective binding site for compounds in the amphetamine class | journal = Bioorganic & Medicinal Chemistry | volume = 19 | issue = 23 | pages = 7044–7048 | date = December 2011 | pmid = 22037049 | pmc = 3236098 | doi = 10.1016/j.bmc.2011.10.007 }}</ref> The drug appears to act as a weak partial agonist of the human TAAR1 rather than as an [[intrinsic activity|efficacious]] agonist.<ref name="Gainetdinov_2018" /><ref name="Simmler_2016" /> In relation to the preceding findings, MDMA has been said to be essentially inactive as a human TAAR1 agonist.<ref name="Dunlap_2018" /> TAAR1 activation is thought to auto-inhibit and constrain the effects of amphetamines that possess TAAR1 agonism, for instance MDMA in rodents.<ref name="Docherty_2021" /><ref name="Espinoza_2014">{{cite book | vauthors = Espinoza S, Gainetdinov RR | chapter = Neuronal Functions and Emerging Pharmacology of TAAR1 | title = Taste and Smell | volume = 23 | pages = 175–194 | date = 2014 | doi = 10.1007/7355_2014_78 | series = Topics in Medicinal Chemistry | publisher = Springer International Publishing | publication-place = Cham | isbn = 978-3-319-48925-4 | quote = Interestingly, the concentrations of amphetamine found to be necessary to activate TAAR1 are in line with what was found in drug abusers [3, 51, 52]. Thus, it is likely that some of the effects produced by amphetamines could be mediated by TAAR1. Indeed, in a study in mice, MDMA effects were found to be mediated in part by TAAR1, in a sense that MDMA auto-inhibits its neurochemical and functional actions [46]. Based on this and other studies (see other section), it has been suggested that TAAR1 could play a role in reward mechanisms and that amphetamine activity on TAAR1 counteracts their known behavioral and neurochemical effects mediated via dopamine neurotransmission. }}</ref><ref name="Kuropka_2023">{{cite journal | vauthors = Kuropka P, Zawadzki M, Szpot P | title = A narrative review of the neuropharmacology of synthetic cathinones-Popular alternatives to classical drugs of abuse | journal = Human Psychopharmacology | volume = 38 | issue = 3 | article-number = e2866 | date = May 2023 | pmid = 36866677 | doi = 10.1002/hup.2866 | quote = Another feature that distinguishes [synthetic cathinones (SCs)] from amphetamines is their negligible interaction with the trace amine associated receptor 1 (TAAR1). Activation of this receptor reduces the activity of dopaminergic neurones, thereby reducing psychostimulatory effects and addictive potential (Miller, 2011; Simmler et al., 2016). Amphetamines are potent agonists of this receptor, making them likely to self‐inhibit their stimulating effects. In contrast, SCs show negligible activity towards TAAR1 (Kolaczynska et al., 2021; Rickli et al., 2015; Simmler et al., 2014, 2016). [...] It is worth noting, however, that for TAAR1 there is considerable species variability in its interaction with ligands, and it is possible that the in vitro activity of [rodent TAAR1 agonists] may not translate into activity in the human body (Simmler et al., 2016). The lack of self‐regulation by TAAR1 may partly explain the higher addictive potential of SCs compared to amphetamines (Miller, 2011; Simmler et al., 2013). }}</ref><ref name="Simmler_2013">{{cite journal | vauthors = Simmler LD, Buser TA, Donzelli M, Schramm Y, Dieu LH, Huwyler J, Chaboz S, Hoener MC, Liechti ME | title = Pharmacological characterization of designer cathinones in vitro | journal = British Journal of Pharmacology | volume = 168 | issue = 2 | pages = 458–470 | date = January 2013 | pmid = 22897747 | pmc = 3572571 | doi = 10.1111/j.1476-5381.2012.02145.x | quote = β-Keto-analogue cathinones also exhibited approximately 10-fold lower affinity for the TA1 receptor compared with their respective non-β-keto amphetamines. [...] Activation of TA1 receptors negatively modulates dopaminergic neurotransmission. Importantly, methamphetamine decreased DAT surface expression via a TA1 receptor-mediated mechanism and thereby reduced the presence of its own pharmacological target (Xie and Miller, 2009). MDMA and amphetamine have been shown to produce enhanced DA and 5-HT release and locomotor activity in TA1 receptor knockout mice compared with wild-type mice (Lindemann et al., 2008; Di Cara et al., 2011). Because methamphetamine and MDMA auto-inhibit their neurochemical and functional effects via TA1 receptors, low affinity for these receptors may result in stronger effects on monoamine systems by cathinones compared with the classic amphetamines. }}</ref><ref name="Di_Cara_2011">{{cite journal | vauthors = Di Cara B, Maggio R, Aloisi G, Rivet JM, Lundius EG, Yoshitake T, Svenningsson P, Brocco M, Gobert A, De Groote L, Cistarelli L, Veiga S, De Montrion C, Rodriguez M, Galizzi JP, Lockhart BP, Cogé F, Boutin JA, Vayer P, Verdouw PM, Groenink L, Millan MJ | title = Genetic deletion of trace amine 1 receptors reveals their role in auto-inhibiting the actions of ecstasy (MDMA) | journal = The Journal of Neuroscience | volume = 31 | issue = 47 | pages = 16928–16940 | date = November 2011 | pmid = 22114263 | pmc = 6623861 | doi = 10.1523/JNEUROSCI.2502-11.2011 }}</ref>

Elevation of serotonin, norepinephrine, and dopamine levels by MDMA is believed to mediate most of the drug's effects, including its entactogenic, stimulant, euphoriant, [[hyperthermia|hyperthermic]], and [[sympathomimetic]] effects.<ref name="Dunlap_2018" /><ref name="Docherty_2021" /><ref name="Rein_2024">{{cite journal | vauthors = Rein B, Raymond K, Boustani C, Tuy S, Zhang J, St Laurent R, Pomrenze MB, Boroon P, Heifets B, Smith M, Malenka RC | title = MDMA enhances empathy-like behaviors in mice via 5-HT release in the nucleus accumbens | journal = Science Advances | volume = 10 | issue = 17 | article-number = eadl6554 | date = April 2024 | pmid = 38657057 | pmc = 11042730 | doi = 10.1126/sciadv.adl6554 | bibcode = 2024SciA...10L6554R }}</ref><ref name="KamilarBritt_2015">{{cite journal | vauthors = Kamilar-Britt P, Bedi G | title = The prosocial effects of 3,4-methylenedioxymethamphetamine (MDMA): Controlled studies in humans and laboratory animals | journal = Neuroscience and Biobehavioral Reviews | volume = 57 | pages = 433–446 | date = October 2015 | pmid = 26408071 | pmc = 4678620 | doi = 10.1016/j.neubiorev.2015.08.016 }}</ref> The entactogenic effects of MDMA, including increased [[sociability]], [[empathy]], [[emotional intimacy|feelings of closeness]], and [[antiaggressive|reduced aggression]], are thought to be mainly due to induction of serotonin release.<ref name="KamilarBritt_2015" /><ref name="Halberstadt_2020" /><ref name="Oeri_2021">{{cite journal | vauthors = Oeri HE | title = Beyond ecstasy: Alternative entactogens to 3,4-methylenedioxymethamphetamine with potential applications in psychotherapy | journal = Journal of Psychopharmacology | location = Oxford, England | volume = 35 | issue = 5 | pages = 512–536 | date = May 2021 | pmid = 32909493 | pmc = 8155739 | doi = 10.1177/0269881120920420 }}</ref> The exact [[serotonin receptor]]s responsible for MDMA's entactogenic effects are unclear, but may include the serotonin 5-HT<sub>1A</sub> receptor,<ref name="Esaki_2023">{{cite journal | vauthors = Esaki H, Sasaki Y, Nishitani N, Kamada H, Mukai S, Ohshima Y, Nakada S, Ni X, Deyama S, Kaneda K | title = Role of 5-HT1A receptors in the basolateral amygdala on 3,4-methylenedioxymethamphetamine-induced prosocial effects in mice | journal = European Journal of Pharmacology | volume = 946 | date = May 2023 | pmid = 36907260 | doi = 10.1016/j.ejphar.2023.175653 | article-number = 175653 }}</ref> 5-HT<sub>1B</sub> receptor,<ref name="Heifets_2019">{{cite journal | vauthors = Heifets BD, Salgado JS, Taylor MD, Hoerbelt P, Cardozo Pinto DF, Steinberg EE, Walsh JJ, Sze JY, Malenka RC | title = Distinct neural mechanisms for the prosocial and rewarding properties of MDMA | journal = Science Translational Medicine | volume = 11 | issue = 522 | date = December 2019 | article-number = eaaw6435 | pmid = 31826983 | pmc = 7123941 | doi = 10.1126/scitranslmed.aaw6435 }}</ref> and 5-HT<sub>2A</sub> receptor,<ref name="Pitts_2017">{{cite journal | vauthors = Pitts EG, Minerva AR, Chandler EB, Kohn JN, Logun MT, Sulima A, Rice KC, Howell LL | title = 3,4-Methylenedioxymethamphetamine Increases Affiliative Behaviors in Squirrel Monkeys in a Serotonin 2A Receptor-Dependent Manner | journal = Neuropsychopharmacology | volume = 42 | issue = 10 | pages = 1962–1971 | date = September 2017 | pmid = 28425496 | pmc = 5561347 | doi = 10.1038/npp.2017.80 }}</ref> as well as 5-HT<sub>1A</sub> receptor-mediated [[oxytocin]] release and consequent activation of the [[oxytocin receptor]].<ref name="Dunlap_2018" /><ref name="KamilarBritt_2015" /><ref name="BlancoGandia_2015">{{cite journal | vauthors = Blanco-Gandía MC, Mateos-García A, García-Pardo MP, Montagud-Romero S, Rodríguez-Arias M, Miñarro J, Aguilar MA | title = Effect of drugs of abuse on social behaviour: a review of animal models | journal = Behavioural Pharmacology | volume = 26 | issue = 6 | pages = 541–570 | date = September 2015 | pmid = 26221831 | doi = 10.1097/FBP.0000000000000162 }}</ref><ref name="Heifets_2024">{{cite journal | vauthors = Heifets BD, Olson DE | title = Therapeutic mechanisms of psychedelics and entactogens | journal = Neuropsychopharmacology  | volume = 49 | issue = 1 | pages = 104–118 | date = January 2024 | pmid = 37488282 | pmc = 10700553 | doi = 10.1038/s41386-023-01666-5 }}</ref><ref name="Nichols_2022">{{cite journal | vauthors = Nichols DE | title = Entactogens: How the Name for a Novel Class of Psychoactive Agents Originated | journal = Frontiers in Psychiatry | volume = 13 | article-number = 863088 | date = 2022 | pmid = 35401275 | pmc = 8990025 | doi = 10.3389/fpsyt.2022.863088 | doi-access = free }}</ref> Induction of dopamine release is thought to be importantly involved in the stimulant and euphoriant effects of MDMA,<ref name="Dunlap_2018" /><ref name="Pitts_2018" /><ref name="Kaur_2023" /> while induction of norepinephrine release and serotonin 5-HT<sub>2A</sub> receptor stimulation are believed to mediate its sympathomimetic effects.<ref name="Fonseca_2021" /><ref name="Docherty_2021" /> Activation of serotonin 5-HT<sub>1B</sub> and 5-HT<sub>2A</sub> receptors is also thought to be involved in the stimulant and euphoriant effects of MDMA, while serotonin 5-HT<sub>2C</sub> receptor activation is thought to constrain these effects and limit MDMA's [[drug addiction|reinforcing potential]].<ref name="Bankson_2001">{{cite journal | vauthors = Bankson MG, Cunningham KA | title = 3,4-Methylenedioxymethamphetamine (MDMA) as a unique model of serotonin receptor function and serotonin-dopamine interactions | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 297 | issue = 3 | pages = 846–852 | date = June 2001 | pmid = 11356903 | doi = 10.1016/S0022-3565(24)29607-5 | url = https://bibliography.maps.org/resources/download/983 | archive-url = https://web.archive.org/web/20241209141749/https://bibliography.maps.org/resources/download/983 | archive-date = 9 December 2024 | url-access = subscription }}</ref><ref name="Baumann_2008">{{cite journal | vauthors = Baumann MH, Clark RD, Rothman RB | title = Locomotor stimulation produced by 3,4-methylenedioxymethamphetamine (MDMA) is correlated with dialysate levels of serotonin and dopamine in rat brain | journal = Pharmacology, Biochemistry, and Behavior | volume = 90 | issue = 2 | pages = 208–217 | date = August 2008 | pmid = 18403002 | pmc = 2491560 | doi = 10.1016/j.pbb.2008.02.018 | quote = Determining the role of specific 5-HT receptors in MDMA's effects in vivo is complicated by the presence of 14 different 5-HT receptor subtypes (Barnes and Sharp, 1999; Hoyer et al., 2002), many of which affect DA function (Alex and Pehek, 2007; Bubar and Cunningham, 2006). Nonetheless, there is general agreement that 5-HT1B, 5-HT2A and 5-HT2C receptor subtypes influence locomotor effects of MDMA. Hyperactivity produced by MDMA is mimicked by administration of the 5-HT1B agonist RU-24969 (Rempel et al., 1993), and 5-HT1B antagonists inhibit MDMA-induced ambulation (Callaway and Geyer, 1992b; Fletcher et al., 2002; McCreary et al., 1999). 5-HT2A antagonists reduce ambulation produced by MDMA (Fletcher et al., 2002; Kehne et al., 1996), whereas 5-HT2C antagonists markedly enhance it (Bankson and Cunningham, 2002; Fletcher et al., 2006). Taken together, these data reveal that 5-HT1B and 5-HT2A receptors facilitate, while 5-HT2C receptors suppress, forward locomotion evoked by MDMA administration. Importantly, the neural circuits underlying serotonergic modulation of MDMA-induced activity are largely unexplored. }}</ref><ref name="Bankson_2002">{{cite journal | vauthors = Bankson MG, Cunningham KA | title = Pharmacological studies of the acute effects of (+)-3,4-methylenedioxymethamphetamine on locomotor activity: role of 5-HT(1B/1D) and 5-HT(2) receptors | journal = Neuropsychopharmacology | volume = 26 | issue = 1 | pages = 40–52 | date = January 2002 | pmid = 11751031 | doi = 10.1016/S0893-133X(01)00345-1 }}</ref><ref name="Cole_2003">{{cite journal | vauthors = Cole JC, Sumnall HR | title = The pre-clinical behavioural pharmacology of 3,4-methylenedioxymethamphetamine (MDMA) | journal = Neuroscience and Biobehavioral Reviews | volume = 27 | issue = 3 | pages = 199–217 | date = May 2003 | pmid = 12788333 | doi = 10.1016/s0149-7634(03)00031-9 | quote = [...] 5-HT1B receptor agonists elicit locomotor hyperactivity similar to MDMA [247] and transgenic mice lacking the SERT or 5-HT1B receptor show no or reduced MDMA-induced locomotion and a behavioural pattern qualitatively reminiscent of other amphetamines [262,27]. Prior 5-HT depletion or pre-treatment of animals with SSRIs or 5-HT1B receptor antagonists block low dose MDMA hyperkinesis [42,44]. Activation of this receptor subtype may be fundamental in defining MDMAspecific locomotor activity. The 5-HT2A antagonist MDL 100,907 blocked high dose (20 mg/kg) but not low dose (3 mg/kg) MDMA-induced locomotion [157].5-HT2C receptor antagonists potentiated locomotor activation after low dose MDMA [20,115]. It has been proposed that unmasking of 5-HT1B receptor-mediated hyperactivity via 5-HT2C antagonism is only possible in the presence of the elevated DA and 5-HT concentrations seen after MDMA [19]. }}</ref><ref name="Pomrenze_2025">{{cite journal | vauthors = Pomrenze MB, Vaillancourt S, Salgado JS, Raymond KB, Llorach P, Sacai H, Rijsketic DR, Hietamies TM, Touponse GC, Cardozo Pinto DF, Rastegar Z, Casey AB, Eshel N, Malenka RC, Heifets BD | title = 5-HT2C receptors in the nucleus accumbens constrain the rewarding effects of MDMA | journal = Molecular Psychiatry | date = July 2025 | volume = 30 | issue = 11 | pages = 5405–5416 | pmid = 40707786 | doi = 10.1038/s41380-025-03128-4 | pmc = 12532699 }}</ref><ref name="Canal_2017">{{cite journal | vauthors = Canal CE, Murnane KS | title = The serotonin 5-HT2C receptor and the non-addictive nature of classic hallucinogens | journal = Journal of Psychopharmacology | location = Oxford, England | volume = 31 | issue = 1 | pages = 127–143 | date = January 2017 | pmid = 27903793 | pmc = 5445387 | doi = 10.1177/0269881116677104 }}</ref> Serotonin 5-HT<sub>2B</sub> receptor signaling appears to be required for MDMA-induced serotonin release and effects.<ref name="MartinezPrice_2002">{{cite journal | vauthors = Martinez-Price D, Krebs-Thomson K, Geyer M | title = Behavioral Psychopharmacology of MDMA and MDMA-Like Drugs: A Review of Human and Animal Studies | journal = Addiction Research & Theory | volume = 10 | issue = 1 | pages = 43–67 | date = 1 January 2002 | doi = 10.1080/16066350290001704 | publisher = Informa UK Limited | issn = 1606-6359 }}</ref><ref name="Stove_2010">{{cite journal | vauthors = Stove CP, De Letter EA, Piette MH, Lambert WE | title = Mice in ecstasy: advanced animal models in the study of MDMA | journal = Current Pharmaceutical Biotechnology | volume = 11 | issue = 5 | pages = 421–433 | date = August 2010 | pmid = 20420576 | doi = 10.2174/138920110791591508 }}</ref><ref name="Doly_2008">{{cite journal | vauthors = Doly S, Valjent E, Setola V, Callebert J, Hervé D, Launay JM, Maroteaux L | title = Serotonin 5-HT2B receptors are required for 3,4-methylenedioxymethamphetamine-induced hyperlocomotion and 5-HT release in vivo and in vitro | journal = The Journal of Neuroscience | volume = 28 | issue = 11 | pages = 2933–2940 | date = March 2008 | pmid = 18337424 | pmc = 6670669 | doi = 10.1523/JNEUROSCI.5723-07.2008 | quote = Here we show that acute pharmacological inhibition or genetic ablation of the 5-HT2B receptor in mice completely abolishes MDMA-induced hyperlocomotion and 5-HT release in nucleus accumbens and ventral tegmental area. Furthermore, the 5-HT2B receptor dependence of MDMA-stimulated release of endogenous 5-HT from superfused midbrain synaptosomes suggests that 5-HT2B receptors act, unlike any other 5-HT receptor, presynaptically to affect MDMA-stimulated 5-HT release. }}</ref><ref name="Doly_2009">{{cite journal | vauthors = Doly S, Bertran-Gonzalez J, Callebert J, Bruneau A, Banas SM, Belmer A, Boutourlinsky K, Hervé D, Launay JM, Maroteaux L | title = Role of Serotonin via 5-HT2B Receptors in the Reinforcing Effects of MDMA in Mice | journal = PLOS ONE | volume = 4 | issue = 11 |article-number=e7952 | date = 23 November 2009 | pmid = 19956756 | pmc = 2775951 | doi = 10.1371/journal.pone.0007952 | bibcode = 2009PLoSO...4.7952D | issn = 1932-6203 | doi-access = free }}</ref><ref name="Belmer_2018">{{cite journal | vauthors = Belmer A, Quentin E, Diaz SL, Guiard BP, Fernandez SP, Doly S, Banas SM, Pitychoutis PM, Moutkine I, Muzerelle A, Tchenio A, Roumier A, Mameli M, Maroteaux L | title = Positive regulation of raphe serotonin neurons by serotonin 2B receptors | journal = Neuropsychopharmacology | volume = 43 | issue = 7 | pages = 1623–1632 | date = 2018 | pmid = 29453444 | pmc = 5983540 | doi = 10.1038/s41386-018-0013-0 | issn = 0893-133X | doi-access = free }}</ref> MDMA has been associated with a unique subjective "magic" or [[euphoria]] that few or no other known entactogens are said to fully reproduce.<ref name="Baggott_2023">{{cite conference | vauthors = Baggott M | title = Beyond Ecstasy: Progress in Developing and Understanding a Novel Class of Therapeutic Medicine | location = Denver, CO | date = 23 June 2023 | conference = PS2023 [Psychedelic Science 2023, June 19–23, 2023, Denver, Colorado] | publisher = [[Multidisciplinary Association for Psychedelic Studies]] | url = https://2023.psychedelicscience.org/sessions/beyond-ecstasy-progress-in-developing-and-understanding-a-novel-class-of-therapeutic-medicine/ }}</ref><ref name="Baggott2024" /> The mechanisms underlying this property of MDMA are unknown, but it has been theorized to be due to a specific mixture and balance of pharmacological activities, including combined serotonin, norepinephrine, and dopamine release and direct serotonin receptor agonism.<ref name="Rothman_2002">{{cite journal | vauthors = Rothman RB, Baumann MH | title = Therapeutic and adverse actions of serotonin transporter substrates | journal = Pharmacology & Therapeutics | volume = 95 | issue = 1 | pages = 73–88 | date = July 2002 | pmid = 12163129 | doi = 10.1016/s0163-7258(02)00234-6 }}</ref><ref name="Baggott_2023" /><ref name="Baggott2024">{{cite web | title = Better Than Ecstasy: Progress in Developing a Novel Class of Therapeutic with Matthew Baggott, PhD. | date = 6 March 2024 | website = YouTube | url = https://www.youtube.com/watch?v=OnhJvKxwfZI&t=1048 | access-date = 20 November 2024 }}</ref><ref name="Luethi_2020">{{cite journal | vauthors = Luethi D, Liechti ME | title = Designer drugs: mechanism of action and adverse effects | journal = Archives of Toxicology | volume = 94 | issue = 4 | pages = 1085–1133 | date = April 2020 | pmid = 32249347 | pmc = 7225206 | doi = 10.1007/s00204-020-02693-7 | bibcode = 2020ArTox..94.1085L | url = https://repositorium.meduniwien.ac.at/obvumwoa/content/titleinfo/5270457/full.pdf }}</ref>

MDMA is often said to have mild or weak [[psychedelic drug|psychedelic]] effects.<ref name="Liechti_2001">{{cite journal | vauthors = Liechti ME, Vollenweider FX | title = Which neuroreceptors mediate the subjective effects of MDMA in humans? A summary of mechanistic studies | journal = Human Psychopharmacology | volume = 16 | issue = 8 | pages = 589–598 | date = December 2001 | pmid = 12404538 | doi = 10.1002/hup.348 }}</ref><ref name="Halberstadt_2020" /><ref name="Oeri_2021" /><ref name="Schenk_2018">{{cite journal | vauthors = Schenk S, Newcombe D | title = Methylenedioxymethamphetamine (MDMA) in Psychiatry: Pros, Cons, and Suggestions | journal = Journal of Clinical Psychopharmacology | volume = 38 | issue = 6 | pages = 632–638 | date = December 2018 | pmid = 30303861 | doi = 10.1097/JCP.0000000000000962 }}</ref> These effects are said to be [[dose dependence|dose-dependent]], such that greater [[hallucinogen]]ic effects are produced at higher doses.<ref name="Liechti_2001" /><ref name="Puxty_2017" /> The mild hallucinogenic effects of MDMA include [[Hallucination|perceptual changes]] like intensification of [[visual perception|visual]], [[auditory perception|auditory]], and [[tactile perception]] (e.g., brightened colors), a state of [[dissociation (psychology)|dissociation]] with feelings of [[depersonalization]] and [[derealization]] (e.g., "oceanic boundlessness"), and [[thought disorder|thinking disturbance]]s.<ref name="Liechti_2001" /><ref name="Meyer_2013a" /><ref name="Halberstadt_2020" /><ref name="Schenk_2018" /><ref name="Liechti_2000" /><ref name="Liechti_2000b">{{cite journal | vauthors = Liechti ME, Baumann C, Gamma A, Vollenweider FX | title = Acute psychological effects of 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") are attenuated by the serotonin uptake inhibitor citalopram | journal = Neuropsychopharmacology | volume = 22 | issue = 5 | pages = 513–521 | date = May 2000 | pmid = 10731626 | doi = 10.1016/S0893-133X(99)00148-7 }}</ref><ref name="Puxty_2017">{{cite journal | vauthors = Puxty DJ, Ramaekers JG, de la Torre R, Farré M, Pizarro N, Pujadas M, Kuypers KP | title = MDMA-Induced Dissociative State not Mediated by the 5-HT2A Receptor | journal = Frontiers in Pharmacology | volume = 8 | article-number = 455 | date = 2017 | pmid = 28744219 | pmc = 5504523 | doi = 10.3389/fphar.2017.00455 | doi-access = free }}</ref> Conversely, overt [[hallucination]]s do not occur, MDMA's hallucinogenic effects are described as "non-problematic" for users, and are said to be much less than those of [[3,4-methylenedioxyamphetamine]] (MDA) or especially those of fully effective [[serotonergic psychedelic]]s like [[psilocybin]].<ref name="Meyer_2013a" /><ref name="Liechti_2000" /><ref name="Oeri_2021" /> The hallucinogenic effects of MDMA have been theorized to be mediated by serotonin 5-HT<sub>2A</sub> receptor activation analogously to the case of classical psychedelics.<ref name="Liechti_2001" /><ref name="Liechti_2000" /><ref name="Puxty_2017" /><ref name="Simmler_2018" /><ref name="Meyer_2013a">{{cite journal | vauthors = Meyer JS | title = 3,4-methylenedioxymethamphetamine (MDMA): current perspectives | journal = Substance Abuse and Rehabilitation | volume = 4 | pages = 83–99 | date = 2013 | pmid = 24648791 | pmc = 3931692 | doi = 10.2147/SAR.S37258 | doi-access = free }}</ref><ref name="Straumann_2024" /> Accordingly, the serotonin 5-HT<sub>2A</sub> receptor [[antagonist]] ketanserin has been reported to reduce MDMA-induced perceptual changes in humans.<ref name="Liechti_2001" /><ref name="Halberstadt_2020" /><ref name="Liechti_2000" /><ref name="Puxty_2017" /> Conversely however, it failed to affect MDMA-induced feelings of dissociation and oceanic boundlessness.<ref name="Liechti_2001" /><ref name="Halberstadt_2020" /><ref name="Puxty_2017" /> In contrast, the serotonin reuptake inhibitor [[citalopram]], which blocks MDMA-induced serotonin release, diminished all of the psychoactive and hallucinogenic effects of MDMA.<ref name="Liechti_2001" /><ref name="Halberstadt_2020" /><ref name="Liechti_2000b" /><ref name="Liechti_2000" /> It has been noted that ''N''-[[methylation]] of psychedelic [[substituted phenethylamine|phenethylamine]]s, as in the [[chemical structure|structural]] difference between MDA and MDMA, has invariably greatly reduced or abolished their psychedelic activity.<ref name="Nichols_2018">{{cite book | vauthors = Nichols DE | title = Chemistry and Structure-Activity Relationships of Psychedelics | volume = 36 | pages = 1–43 | date = 2018 | pmid = 28401524 | doi = 10.1007/7854_2017_475 | series = Current Topics in Behavioral Neurosciences | isbn = 978-3-662-55878-2 | url = https://bitnest.netfirms.com/external/10.1007/7854_2017_475 | quote = Although the most active tryptamine hallucinogens are N,N-dialkylated, the phenethylamines generally cannot tolerate even a single N-substitution. Even small groups such as methyl or ethyl (see Table 2) abolish their hallucinogenic activity. }}</ref><ref name="Jacob_1994">{{cite book | vauthors = Jacob P, Shulgin AT | veditors = Lin GC, Glennon RA | chapter = Structure-Activity Relationships of the Classic Hallucinogens and Their Analogs | title = Hallucinogens: An Update  | volume = 146 | pages = 74–91 | date = 1994 | pmid = 8742795 | series = National Institute on Drug Abuse Research Monograph Series | publisher = National Institute on Drug Abuse | url = https://archives.nida.nih.gov/sites/default/files/monograph146.pdf | chapter-url = https://bibliography.maps.org/resources/download/11534 | archive-url = https://web.archive.org/web/20250713011914/https://bibliography.maps.org/resources/download/11534 | archive-date = 13 July 2025 | quote = [MDA] is also remarkable because the N-methyl homolog 3,4 (MDMA) has biological activity, although the nature of its action places it outside of this review. No other phenethylamine hallucinogen retains central activity on N-methylation. }}</ref> Whereas MDA and psychedelics like psilocybin induce the [[head-twitch response]] in rodents, a behavioral proxy of psychedelic effects, findings on MDMA and the head-twitch response are mixed and conflicting.<ref name="Halberstadt_2018">{{cite book | vauthors = Halberstadt AL, Geyer MA | chapter = Effect of Hallucinogens on Unconditioned Behavior | title = Behavioral Neurobiology of Psychedelic Drugs | volume = 36 | pages = 159–199 | date = 2018 | pmid = 28224459 | pmc = 5787039 | doi = 10.1007/7854_2016_466 | series = Current Topics in Behavioral Neurosciences | isbn = 978-3-662-55878-2 | quote = [MDxx] have been assessed in head twitch studies. Racemic [MDA] and S-(+)-MDA reportedly induce WDS in monkeys and rats, respectively (Schlemmer and Davis 1986; Hiramatsu et al. 1989). Although [MDMA] does not induce the HTR in mice, both of the stereoisomers of MDMA have been shown to elicit the response (Fantegrossi et al. 2004, 2005b). 5-HT depletion inhibits the response to S-(+)-MDMA but does not alter the response to R-(−)-MDMA, suggesting the isomers act through different mechanisms (Fantegrossi et al. 2005b). This suggestion is consistent with the fact that S-(+)- and R-(−)-MDMA exhibit qualitatively distinct pharmacological profiles, with the S-(+)isomer working primarily as a monoamine releaser (Johnson et al. 1986; Baumann et al. 2008; Murnane et al. 2010) and the R-(−)-enantiomer acting directly through 5-HT2A receptors (Lyon et al. 1986; Nash et al. 1994). In contrast to their effects in mice, Hiramatsu reported that S-(+)- and R-(−)-MDMA fail to produce WDS in rats (Hiramatsu et al. 1989). The discrepant findings with MDMA in mice and rats may reflect species differences in sensitivity to the HTR (see below for further discussion). }}</ref><ref name="Dunlap_2022">{{cite thesis | vauthors = Dunlap LE | title = Development of Non-Hallucinogenic Psychoplastogens | date = 2022 | publisher = University of California, Davis | url = https://escholarship.org/uc/item/5qr3w0gm | access-date = 18 November 2024 | quote = Finally, since R-MDMA is known to partially substitute for LSD in animal models we decided to test both compounds in the head twitch response assay (HTR) (FIG 3.3C).3 The HTR is a well-validated mouse model for predicting the hallucinogenic potential of test drugs. Serotonergic psychedelics will cause a rapid back and forth head movement in mice. The potency measured in the HTR assay has been shown to correlate very well with the human potencies of psychedelics.18 Neither R-MDMA or [...] produced any head twitches at all doses tested, suggesting that neither has high hallucinogenic potential. }}</ref><ref name="Halberstadt_2020" /> In addition, whereas MDA fully substitutes for psychedelics like [[LSD]] and [[DOM (drug)|DOM]] in rodent [[drug discrimination]] tests, MDMA does not do so, nor do psychedelics generally fully substitute for MDMA.<ref name="Nichols_2016">{{Cite journal | vauthors = Nichols DE | title = Psychedelics | journal = Pharmacological Reviews | volume = 68 | issue = 2 | pages = 264–355 | date = 2016 | pmid = 26841800 | pmc = 4813425 | doi = 10.1124/pr.115.011478 | language = en | issn = 0031-6997 }}</ref><ref name="Halberstadt_2020" /><ref name="Nichols_1989">{{cite journal | vauthors = Nichols DE, Oberlender R | title = Structure-activity relationships of MDMA-like substances | journal = NIDA Research Monograph | volume = 94 | pages = 1–29 | date = 1989 | pmid = 2575223 }}</ref><ref name="Nichols_1990">{{cite journal | vauthors = Nichols DE, Oberlender R | title = Structure-activity relationships of MDMA and related compounds: a new class of psychoactive drugs? | journal = Annals of the New York Academy of Sciences | volume = 600 | pages = 613–23; discussion 623–5 | date = 1990 | pmid = 1979214 | doi = 10.1007/978-1-4613-1485-1_7 }}</ref>

Long-term repeated activation of serotonin 5-HT<sub>2B</sub> receptors by MDMA is thought to result in increased risk of organ complications such as [[valvular heart disease]] (VHD) and [[primary pulmonary hypertension]] (PPH).<ref name="McIntyre_2023">{{cite journal | vauthors = McIntyre RS | title = Serotonin 5-HT2B receptor agonism and valvular heart disease: implications for the development of psilocybin and related agents | journal = Expert Opinion on Drug Safety | volume = 22 | issue = 10 | pages = 881–883 | date = 2023 | pmid = 37581427 | doi = 10.1080/14740338.2023.2248883 }}</ref><ref name="Tagen_2023">{{cite journal | vauthors = Tagen M, Mantuani D, van Heerden L, Holstein A, Klumpers LE, Knowles R | title = The risk of chronic psychedelic and MDMA microdosing for valvular heart disease | journal = Journal of Psychopharmacology | location = Oxford, England | volume = 37 | issue = 9 | pages = 876–890 | date = September 2023 | pmid = 37572027 | doi = 10.1177/02698811231190865 | url = https://unlimitedsciences.org/wp-content/uploads/2024/01/tagen-et-al-2023-the-risk-of-chronic-psychedelic-and-mdma-microdosing-for-valvular-heart-disease.pdf | quote = [...] Both [MDMA and MDA] bind to the human 5-HT2B receptor, although with a 5-fold lower Ki value for MDA compared to MDMA (Ray, 2010; Setola et al., 2003). Both compounds were agonists in an assay of PI hydrolysis, with MDA (EC50=190nM) 10-fold more potent than MDMA (EC50=2000 nM) in addition to greater intrinsic efficacy (90% vs 32%) (Setola et al., 2003). [...] A 50mg dose of MDMA resulted in a mean plasma Cmax 266nM for MDMA and 28.5nM for MDA (de la Torre et al., 2000). }}</ref><ref name="Wso_2023" /><ref name="Rothman_2009">{{cite journal | vauthors = Rothman RB, Baumann MH | title = Serotonergic drugs and valvular heart disease | journal = Expert Opinion on Drug Safety | volume = 8 | issue = 3 | pages = 317–329 | date = May 2009 | pmid = 19505264 | pmc = 2695569 | doi = 10.1517/14740330902931524 }}</ref><ref name="Rothman_2002" /><ref name="Rothman_2002a">{{cite journal | vauthors = Rothman RB, Baumann MH | title = Serotonin releasing agents. Neurochemical, therapeutic and adverse effects | journal = Pharmacology, Biochemistry, and Behavior | volume = 71 | issue = 4 | pages = 825–836 | date = April 2002 | pmid = 11888573 | doi = 10.1016/s0091-3057(01)00669-4 }}</ref> MDMA has been associated with [[serotonergic neurotoxicity]].<ref name="Costa_2022" /><ref name="Oeri_2021" /><ref name="Sprague_1998" /> This may be due to formation of toxic MDMA [[metabolite]]s and/or induction of [[serotonin–norepinephrine–dopamine releasing agent|simultaneous serotonin and dopamine release]], with consequent uptake of dopamine into serotonergic neurons and breakdown into [[reactive oxygen species|toxic species]].<ref name="Costa_2022">{{cite journal | vauthors = Costa G, Gołembiowska K | title = Neurotoxicity of MDMA: Main effects and mechanisms | journal = Experimental Neurology | volume = 347 | date = January 2022 | pmid = 34655576 | doi = 10.1016/j.expneurol.2021.113894 | article-number = 113894 | hdl = 11584/325355 | url = https://www.didyouno.fr/wp-content/uploads/2023/03/1-s2.0-S0014488621003022-main.pdf }}</ref><ref name="Oeri_2021" /><ref name="Sprague_1998">{{cite journal | vauthors = Sprague JE, Everman SL, Nichols DE | title = An integrated hypothesis for the serotonergic axonal loss induced by 3,4-methylenedioxymethamphetamine | journal = Neurotoxicology | volume = 19 | issue = 3 | pages = 427–441 | date = June 1998 | pmid = 9621349 | url = https://www.researchgate.net/publication/13663847 }}</ref> Serotonin 5-HT<sub>2</sub> receptor agonists or serotonergic psychedelics may potentiate the neurotoxicity of MDMA.<ref name="GreenMechanElliott2003">{{cite journal | vauthors = Green AR, Mechan AO, Elliott JM, O'Shea E, Colado MI | title = The pharmacology and clinical pharmacology of 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") | journal = Pharmacol Rev | volume = 55 | issue = 3 | pages = 463–508 | date = September 2003 | pmid = 12869661 | doi = 10.1124/pr.55.3.3 | url = }}</ref><ref name="GudelskyYamamotoNash1994">{{cite journal | vauthors = Gudelsky GA, Yamamoto BK, Nash JF | title = Potentiation of 3,4-methylenedioxymethamphetamine-induced dopamine release and serotonin neurotoxicity by 5-HT2 receptor agonists | journal = Eur J Pharmacol | volume = 264 | issue = 3 | pages = 325–330 | date = November 1994 | pmid = 7698172 | doi = 10.1016/0014-2999(94)90669-6 | url = }}</ref><ref name="SchmidtBlackAbbate1990">{{cite journal | vauthors = Schmidt CJ, Black CK, Abbate GM, Taylor VL | title = Methylenedioxymethamphetamine-induced hyperthermia and neurotoxicity are independently mediated by 5-HT2 receptors | journal = Brain Res | volume = 529 | issue = 1–2 | pages = 85–90 | date = October 1990 | pmid = 1980848 | doi = 10.1016/0006-8993(90)90813-q | url = }}</ref><ref name="Armstrong_2004">{{cite journal | vauthors = Armstrong BD, Paik E, Chhith S, Lelievre V, Waschek JA, Howard SG | title = Potentiation of (DL)-3,4-methylenedioxymethamphetamine (MDMA)-induced toxicity by the serotonin 2A receptior partial agonist d-lysergic acid diethylamide (LSD), and the protection of same by the serotonin 2A/2C receptor antagonist MDL 11,939 | journal = Neuroscience Research Communications | volume = 35 | issue = 2 | pages = 83–95 | date = 2004 | doi = 10.1002/nrc.20023 }}</ref>

MDMA is a [[racemic mixture]] of two [[enantiomers]], (''S'')-MDMA and [[(R)-MDMA|(''R'')-MDMA]].<ref name="Pitts_2018">{{cite journal | vauthors = Pitts EG, Curry DW, Hampshire KN, Young MB, Howell LL | title = (±)-MDMA and its enantiomers: potential therapeutic advantages of R(-)-MDMA | journal = Psychopharmacology | volume = 235 | issue = 2 | pages = 377–392 | date = February 2018 | pmid = 29248945 | doi = 10.1007/s00213-017-4812-5 }}</ref><ref name="Straumann_2024" /> (''S'')-MDMA is much more potent as an SNDRA ''[[in vitro]]'' and in producing MDMA-like subjective effects in humans than (''R'')-MDMA.<ref name="Pitts_2018" /><ref name="Rothman_2006" /><ref name="Straumann_2024" /><ref name="Anderson_1978">{{cite journal | vauthors = Anderson GM, Braun G, Braun U, Nichols DE, Shulgin AT | title = Absolute configuration and psychotomimetic activity | journal = NIDA Research Monograph | issue = 22 | pages = 8–15 | date = 1978 | pmid = 101890 | url = https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=2ab674b010611df18c029a78f6d17e52dba5f82f }}</ref> By contrast, (''R'')-MDMA acts as a lower-potency [[serotonin–norepinephrine releasing agent]] (SNRA) with weak or negligible effects on dopamine.<ref name="Pitts_2018" /><ref name="Rothman_2006" /><ref name="Acquas_2007">{{cite journal | vauthors = Acquas E, Pisanu A, Spiga S, Plumitallo A, Zernig G, Di Chiara G | title = Differential effects of intravenous R,S-(+/-)-3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) and its S(+)- and R(-)-enantiomers on dopamine transmission and extracellular signal regulated kinase phosphorylation (pERK) in the rat nucleus accumbens shell and core | journal = Journal of Neurochemistry | volume = 102 | issue = 1 | pages = 121–132 | date = July 2007 | pmid = 17564678 | doi = 10.1111/j.1471-4159.2007.04451.x }}</ref> Relatedly, (''R'')-MDMA shows weak or negligible stimulant-like and [[reward system|rewarding]] effects in animals.<ref name="Pitts_2018" /><ref name="Curry_2018">{{cite journal | vauthors = Curry DW, Young MB, Tran AN, Daoud GE, Howell LL | title = Separating the agony from ecstasy: R(-)-3,4-methylenedioxymethamphetamine has prosocial and therapeutic-like effects without signs of neurotoxicity in mice | journal = Neuropharmacology | volume = 128 | pages = 196–206 | date = January 2018 | pmid = 28993129 | pmc = 5714650 | doi = 10.1016/j.neuropharm.2017.10.003 }}</ref> Both (''S'')-MDMA and (''R'')-MDMA produce entactogen-type effects in animals and humans.<ref name="Pitts_2018" /><ref name="Straumann_2024" /> In addition, both (''S'')-MDMA and (''R'')-MDMA are weak agonists of the serotonin 5-HT<sub>2</sub> receptors.<ref name="Pitts_2018" /><ref name="Kaur_2023">{{cite journal | vauthors = Kaur H, Karabulut S, Gauld JW, Fagot SA, Holloway KN, Shaw HE, Fantegrossi WE | title = Balancing Therapeutic Efficacy and Safety of MDMA and Novel MDXX Analogues as Novel Treatments for Autism Spectrum Disorder | journal = Psychedelic Medicine | location = New Rochelle, N.Y. | volume = 1 | issue = 3 | pages = 166–185 | date = 2023 | pmid = 40046567 | pmc = 11661495 | doi = 10.1089/psymed.2023.0023 | quote = It is postulated that MDMA-induced neuronal apoptosis arises from directly stimulating the 5HT2A receptor. However, it is unclear whether MDMA binds here directly or whether one of its active metabolites (for example, MDA exhibits a 5-HT2A affinity almost 10-fold better than MDMA) is responsible.70,80,81 In addition, R-MDMA more potently activates 5-HT2A second messenger signaling, with S-MDMA having a minimal effect and racemic MDMA acting as a weak partial agonist. }}</ref><ref name="Straumann_2024" /><ref name="Setola_2003" /><ref name="Nash_1994" /> (''R'')-MDMA is more potent and efficacious as a serotonin 5-HT<sub>2A</sub> and 5-HT<sub>2B</sub> receptor agonist than (''S'')-MDMA, whereas (''S'')-MDMA is somewhat more potent as an agonist of the serotonin 5-HT<sub>2C</sub> receptor.<ref name="Pitts_2018" /><ref name="Kaur_2023" /><ref name="Straumann_2024" /> Due to it being a more potent serotonin 5-HT<sub>2A</sub> receptor agonist than (''S'')-MDMA, (''R'')-MDMA has been hypothesized to have greater psychedelic effects than (''S'')-MDMA or racemic MDMA.<ref name="Bedi_2024">{{cite journal | vauthors = Bedi G | title = Is the stereoisomer R-MDMA a safer version of MDMA? | journal = Neuropsychopharmacology | volume = 50 | issue = 2 | pages = 360–361 | date = October 2024 | pmid = 39448866 | pmc = 11631934 | doi = 10.1038/s41386-024-02009-8 | doi-access = free }}</ref><ref name="Straumann_2024" /> However, this proved not to be the case in a direct clinical comparison of (''R'')-MDMA, (''S'')-MDMA, and racemic MDMA, with equivalent hallucinogen-like effects instead found between the three interventions.<ref name="Bedi_2024" /><ref name="Straumann_2024" />

MDMA produces MDA as a minor [[active metabolite]].<ref name="de_la_Torre_2004" /> [[Cmax (pharmacology)|Peak levels]] of MDA are about 5 to 10% of those of MDMA and [[area-under-the-curve (pharmacokinetics)|total exposure]] to MDA is almost 10% of that of MDMA with [[oral administration|oral]] MDMA administration.<ref name="de_la_Torre_2004" /><ref name="Tagen_2023" /> As a result, MDA may contribute to some extent to the effects of MDMA.<ref name="de_la_Torre_2004">{{cite journal | vauthors = de la Torre R, Farré M, Roset PN, Pizarro N, Abanades S, Segura M, Segura J, Camí J | title = Human pharmacology of MDMA: pharmacokinetics, metabolism, and disposition | journal = Therapeutic Drug Monitoring | volume = 26 | issue = 2 | pages = 137–144 | date = April 2004 | pmid = 15228154 | doi = 10.1097/00007691-200404000-00009 | url = http://www.maps.org/w3pb/new/2004/2004_de_20593_2.pdf | archive-url = https://web.archive.org/web/20140305194315/http://www.maps.org/w3pb/new/2004/2004_de_20593_2.pdf | archive-date = 5 March 2014 | access-date = 25 October 2009 }}</ref><ref name="Simmler_2018" /> MDA is an entactogen, stimulant, and weak psychedelic similarly to MDMA.<ref name="Oeri_2021" /> Like MDMA, it acts as a potent and well-balanced SNDRA and as a weak serotonin 5-HT<sub>2</sub> receptor agonist.<ref name="Rothman_2006" /><ref name="Setola_2003" /><ref name="Nash_1994" /> However, MDA shows much more potent and efficacious serotonin 5-HT<sub>2A</sub>, 5-HT<sub>2B</sub>, and 5-HT<sub>2C</sub> receptor agonism than MDMA.<ref name="Kaur_2023" /><ref name="Simmler_2018">{{cite book | vauthors = Simmler LD, Liechti ME | title = New Psychoactive Substances | chapter = Pharmacology of MDMA- and Amphetamine-Like New Psychoactive Substances | volume = 252 | pages = 143–164 | date = 2018 | pmid = 29633178 | doi = 10.1007/164_2018_113 | series = Handbook of Experimental Pharmacology | isbn = 978-3-030-10560-0 | quote = MDMA is also a low-potency partial agonist of the 5-HT2A receptor. Although not frequent, mild hallucinogen-like effects of MDMA have been reported, which may be attributable to 5-HT2A agonism (Nichols 2004; Liechti et al. 2000). MDA, the active metabolite of MDMA (Hysek et al. 2011), shows a tenfold higher potency for 5-HT2A agonism than MDMA (Rickli et al. 2015c). MDA likely contributes to the mode of action of MDMA and might contribute to the mild hallucinogenic effects of MDMA. }}</ref><ref name="Nash_1994" /><ref name="Setola_2003" /> Accordingly, MDA produces greater psychedelic effects than MDMA in humans<ref name="Oeri_2021" /> and might particularly contribute to the mild psychedelic-like effects of MDMA.<ref name="Simmler_2018" /> On the other hand, MDA may also be importantly involved in [[toxicity]] of MDMA, such as [[cardiac valvulopathy]].<ref name="Luethi_2021">{{cite book | vauthors = Luethi D, Liechti ME | chapter = Drugs of Abuse Affecting 5-HT2B Receptors | title = 5-HT2B Receptors | volume = 35 | pages = 277–289 | date = 2021 | doi = 10.1007/978-3-030-55920-5_16 | series = The Receptors | publisher = Springer International Publishing | publication-place = Cham | isbn = 978-3-030-55919-9 | quote = Notably, in a study by Rickli and colleagues, MDMA did not activate the 5-HT2B receptor in the functional assay at investigated concentrations (EC50 > 20 μM); however, [MDA], the main psychoactive N-demethylated phase I metabolite of MDMA, potently activated the receptor at submicromolar concentrations [14]. This suggests that the metabolite MDA rather than MDMA itself may lead to valvulopathy and that there could be a significant metabolic contribution to MDMA-induced effects and adverse effect. }}</ref><ref name="Tagen_2023" /><ref name="Setola_2003" />

The [[duration of action]] of MDMA (3–6{{nbsp}}hours) is much shorter than its [[elimination half-life]] (8–9{{nbsp}}hours) would imply.<ref name="Mead_2020">{{cite journal | vauthors = Mead J, Parrott A | title = Mephedrone and MDMA: A comparative review | journal = Brain Research | volume = 1735 | date = May 2020 | pmid = 32087112 | doi = 10.1016/j.brainres.2020.146740 | article-number = 146740 | quote = A controlled study on eight experienced MDMA users reported that 1.5 mg/kg (comparable to what was deemed a typical dosage amount) consumed orally resulted in the subjective effects peaking within 2 h of ingestion (Harris et al., 2002). Other research indicates effects to emerge between 20 and 60 min, with them peaking between 60 and 90 min and lasting up to 5 h (Green et al., 2003). A dose of 100 mg has a half-life of 8–9h(De la Torre et al., 2004), although as mentioned above, users are unaware of the dose they ingest. }}</ref> In relation to this, MDMA's duration and the offset of its effects appear to be determined more by [[tachyphylaxis|rapid acute tolerance]] rather than by circulating drug concentrations.<ref name="Hysek_2012" /> Similar findings have been made for [[amphetamine]] and [[methamphetamine]].<ref name="Ermer_2016">{{cite journal | vauthors = Ermer JC, Pennick M, Frick G | title = Lisdexamfetamine Dimesylate: Prodrug Delivery, Amphetamine Exposure and Duration of Efficacy | journal = Clinical Drug Investigation | volume = 36 | issue = 5 | pages = 341–356 | date = May 2016 | pmid = 27021968 | pmc = 4823324 | doi = 10.1007/s40261-015-0354-y }}</ref><ref name="Cruickshank_2009">{{cite journal | vauthors = Cruickshank CC, Dyer KR | title = A review of the clinical pharmacology of methamphetamine | journal = Addiction | location = Abingdon, England | volume = 104 | issue = 7 | pages = 1085–1099 | date = July 2009 | pmid = 19426289 | doi = 10.1111/j.1360-0443.2009.02564.x | quote = Metabolism does not appear to be altered by chronic exposure, thus dose escalation appears to arise from pharmacodynamic rather than pharmacokinetic tolerance [24]. [...] The terminal plasma half-life of methamphetamine of approximately 10 hours is similar across administration routes, but with substantial inter-individual variability. Acute effects persist for up to 8 hours following a single moderate dose of 30 mg [30]. [...] peak plasma methamphetamine concentration occurs after 4 hours [35]. Nevertheless, peak cardiovascular and subjective effects occur rapidly (within 5–15 minutes). The dissociation between peak plasma concentration and clinical effects indicates acute tolerance, which may reflect rapid molecular processes such as redistribution of vesicular monoamines and internalization of monoamine receptors and transporters [6,36]. Acute subjective effects diminish over 4 hours, while cardiovascular effects tend to remain elevated. This is important, as the marked acute tachyphylaxis to subjective effects may drive repeated use within intervals of 4 hours, while cardiovascular risks may increase [11,35]. }}</ref><ref name="Abbas_2024">{{cite journal | vauthors = Abbas K, Barnhardt EW, Nash PL, Streng M, Coury DL | title = A review of amphetamine extended release once-daily options for the management of attention-deficit hyperactivity disorder | journal = Expert Review of Neurotherapeutics | volume = 24 | issue = 4 | pages = 421–432 | date = April 2024 | pmid = 38391788 | doi = 10.1080/14737175.2024.2321921 | quote = For several decades, clinical benefits of amphetamines have been limited by the pharmacologic half-life of around 4 hours. Although higher doses can produce higher maximum concentrations, they do not affect the half-life of the dose. Therefore, to achieve longer durations of effect, stimulants had to be dosed at least twice daily. Further, these immediate-release doses were found to have their greatest effect shortly after administration, with a rapid decline in effect after reaching peak blood concentrations. The clinical correlation of this was found in comparing math problems attempted and solved between a mixed amphetamine salts preparation (MAS) 10 mg once at 8 am vs 8 am followed by 12 pm [14]. The study also demonstrated the phenomenon of acute tolerance, where even if blood concentrations were maintained over the course of the day, clinical efficacy in the form of math problems attempted and solved would diminish over the course of the day. These findings eventually led to the development of a once daily preparation (MAS XR) [15], which is a composition of 50% immediate-release beads and 50% delayed release beads intended to mimic this twice-daily dosing with only a single administration. | doi-access = free }}</ref><ref name="van_Gaalen_2019">{{cite journal | vauthors = van Gaalen MM, Schlumbohm C, Folgering JH, Adhikari S, Bhattacharya C, Steinbach D, Stratford RE | title = Development of a Semimechanistic Pharmacokinetic-Pharmacodynamic Model Describing Dextroamphetamine Exposure and Striatal Dopamine Response in Rats and Nonhuman Primates following a Single Dose of Dextroamphetamine | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 369 | issue = 1 | pages = 107–120 | date = April 2019 | pmid = 30733244 | doi = 10.1124/jpet.118.254508 | doi-access = free | quote = Acute tolerance has been demonstrated for methamphetamine in rats (Segal and Kuczenski, 2006), and for D-amphetamine in rats (Lewander, 1971), [non-human primates (NHPs)] (Jedema et al., 2014) and humans (Angrist et al., 1987; Brauer et al., 1996; Dolder et al., 2017). In vivo measurement of dopamine by microdialysis was used in rats and NHPs to evaluate these time-dependent effects. In humans, various subjective measures of mood related to the drug's euphoric effects were observed to decline more rapidly than plasma concentrations following D-amphetamine oral doses ranging from 20 to 40 mg (Angrist et al., 1987; Brauer et al., 1996; Dolder et al., 2017). Whereas peak plasma concentrations and subjective effects occurred between 2 and 4 hours following administration, drug effect measures had largely returned to baseline values by 8 hours despite continued exposure to the drug (mean half-life = 8 hours following a 40 mg dose (Dolder et al., 2017)). }}</ref> One mechanism by which [[drug tolerance|tolerance]] to MDMA may occur is [[endocytosis|internalization]] of the [[serotonin transporter]] (SERT).<ref name="Bisagno_2021">{{cite book | vauthors = Bisagno V, Cadet JL | chapter = Methamphetamine and MDMA Neurotoxicity: Biochemical and Molecular Mechanisms | title = Handbook of Neurotoxicity | pages = 1–24 | date = 2021 | doi = 10.1007/978-3-030-71519-9_80-1 | publisher = Springer International Publishing | publication-place = Cham | isbn = 978-3-030-71519-9 | quote = Injections of large doses of MDMA cause massive release of 5-HT from presynaptic vesicles, followed by a rapid decrease in 5-HT and 5-hydroxyindoleacetic acid (5-HIAA) levels and decreased TPH activity (Górska et al., 2018; Lyles & Cadet, 2003). There do not appear to be losses of 5-HT uptake sites at early time points after MDMA administration (Lyles & Cadet, 2003). [...] MDMA also perturbs the function of SERT (Green et al., 2003), a marker of the integrity of serotonin neurons (Blakely et al., 1994). By virtue of its moderating synaptic 5-HT levels, SERT is crucial for the process of 5-HT neurotransmission (Green et al., 2003). MDMA downregulates SERT function without altering SERT mRNA or protein expression, and this rapid downregulation is sustained for at least 90 min and is dose-dependent (Kivell et al., 2010). }}</ref><ref name="Kivell_2010">{{cite journal | vauthors = Kivell B, Day D, Bosch P, Schenk S, Miller J | title = MDMA causes a redistribution of serotonin transporter from the cell surface to the intracellular compartment by a mechanism independent of phospho-p38-mitogen activated protein kinase activation | journal = Neuroscience | volume = 168 | issue = 1 | pages = 82–95 | date = June 2010 | pmid = 20298763 | doi = 10.1016/j.neuroscience.2010.03.018 }}</ref><ref name="Holley_2013">{{cite journal | vauthors = Holley A, Simonson B, Kivell BM | title = MDMA regulates serotonin transporter function via a Protein kinase C dependent mechanism | journal = Journal of Addiction & Prevention | volume = 1 | issue = 1 | page = 5 | date = April 2013 | issn = 2330-2178 | url = https://www.researchgate.net/publication/256328051 }}</ref><ref name="Underhill_2020">{{cite journal | vauthors = Underhill S, Amara S | title = MDMA and TAAR1-mediated RhoA Activation in Serotonin Neurons | journal = The FASEB Journal | volume = 34 | issue = S1 | page = 1 | date = 2020 | doi = 10.1096/fasebj.2020.34.s1.05856 | issn = 0892-6638 | doi-access = free }}</ref><ref name="Underhill_2022">{{cite journal | vauthors = Underhill S, Amara S | title = 3,4-methylenedioxymethamphetamine (MDMA) stimulates activation of TAAR1 and subsequent neurotransmitter transporter internalization in serotonin neurons | journal = The FASEB Journal | volume = 36 | issue = S1 | date = 2022 | article-number = fasebj.2022.36.S1.R5394 | doi = 10.1096/fasebj.2022.36.S1.R5394 | issn = 0892-6638 | doi-access = free }}</ref> Although MDMA and serotonin are not significant TAAR1 agonists in humans, TAAR1 activation by MDMA may result in SERT internalization, for instance in rodents in whom MDMA is a potent TAAR1 agonist.<ref name="Underhill_2020" /><ref name="Underhill_2022" /><ref name="Kittler_2010">{{cite journal | vauthors = Kittler K, Lau T, Schloss P | title = Antagonists and substrates differentially regulate serotonin transporter cell surface expression in serotonergic neurons | journal = European Journal of Pharmacology | volume = 629 | issue = 1–3 | pages = 63–67 | date = March 2010 | pmid = 20006597 | doi = 10.1016/j.ejphar.2009.12.010 | quote = Our results show that exposure to the SSRIs citalopram, fluoxetine, sertraline and paroxetine all induced SERT internalization, but with different efficacies. The substrates 5-HT and MDMA also induced SERT internalization, while cocaine elevated SERT cell surface expression. }}</ref><ref name="Gainetdinov_2018" /> It is thought that brain serotonin levels are depleted after MDMA administration but that levels typically return to normal within 24 to 48{{nbsp}}hours.<ref name="Betzler_2017" />

<div style="display:inline-grid; margin-right:15px;">
{| class="wikitable" style="font-size:small;"
|+ {{Nowrap|[[Monoamine releasing agent|Monoamine release]] by MDMA and related agents ({{Abbrlink|EC<sub>50</sub>|half-maximal effective concentration}}, nM)}}
|-
! Compound !! [[Serotonin releasing agent|Serotonin]] !! [[Norepinephrine releasing agent|Norepinephrine]] !! [[Dopamine releasing agent|Dopamine]]
|-
| [[Amphetamine]] || {{Abbr|ND|No data}} || {{Abbr|ND|No data}} || {{Abbr|ND|No data}}
|-
| {{nbsp}}{{nbsp}}[[Dextroamphetamine|(''S'')-Amphetamine]] (''d'') || 698–1,765 || 6.6–7.2 || 5.8–24.8
|-
| {{nbsp}}{{nbsp}}[[Levoamphetamine|(''R'')-Amphetamine]] (''l'') || {{Abbr|ND|No data}} || 9.5 || 27.7
|-
| [[Methamphetamine]] || {{Abbr|ND|No data}} || {{Abbr|ND|No data}} || {{Abbr|ND|No data}}
|-
| {{nbsp}}{{nbsp}}[[Dextromethamphetamine|(''S'')-Methamphetamine]] (''d'') || 736–1,292 || 12.3–13.8 || 8.5–24.5
|-
| {{nbsp}}{{nbsp}}[[Levomethamphetamine|(''R'')-Methamphetamine]] (''l'') || 4,640 || 28.5 || 416
|-
| [[Methylenedioxyamphetamine|MDA]] || 160 || 108 || 190
|-
| MDMA || 49.6–72 || 54.1–110 || 51.2–278
|-
| {{nbsp}}{{nbsp}}(''S'')-MDMA (''d'') || 74 || 136 || 142
|-
| {{nbsp}}{{nbsp}}[[(R)-MDMA|(''R'')-MDMA]] (''l'') || 340 || 560 || 3,700
|-
| [[Methylenedioxyethylamphetamine|MDEA]] || 47 || 2,608 || 622
|-
| [[Methylbenzodioxolylbutanamine|MBDB]] || 540 || 3,300 || >100,000
|-
| [[5,6-Methylenedioxy-2-aminoindane|MDAI]] || 114 || 117 || 1,334
|- class="sortbottom"
| colspan="4" style="width: 1px; background-color:var(--background-color-notice-subtle,#eaecf0); color:inherit; text-align: center;" | '''Notes:''' The smaller the value, the more strongly the drug releases the neurotransmitter. The [[bioassay|assay]]s were done in rat brain [[synaptosome]]s and human [[potency (pharmacology)|potencies]] may be different. See also [[Monoamine releasing agent#Activity profiles|Monoamine releasing agent § Activity profiles]] for a larger table with more compounds. '''Refs:''' <ref name="Rothman_2006">{{cite journal | vauthors = Rothman RB, Baumann MH | title = Therapeutic potential of monoamine transporter substrates | journal = Current Topics in Medicinal Chemistry | volume = 6 | issue = 17 | pages = 1845–1859 | date = 2006 | pmid = 17017961 | doi = 10.2174/156802606778249766 }}</ref><ref name="Setola_2003">{{cite journal | vauthors = Setola V, Hufeisen SJ, Grande-Allen KJ, Vesely I, Glennon RA, Blough B, Rothman RB, Roth BL | title = 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") induces fenfluramine-like proliferative actions on human cardiac valvular interstitial cells in vitro | journal = Molecular Pharmacology | volume = 63 | issue = 6 | pages = 1223–1229 | date = June 2003 | pmid = 12761331 | doi = 10.1124/mol.63.6.1223 | s2cid = 839426 }}</ref><ref name="Rothman_2001">{{cite journal | vauthors = Rothman RB, Baumann MH, Dersch CM, Romero DV, Rice KC, Carroll FI, Partilla JS | title = Amphetamine-type central nervous system stimulants release norepinephrine more potently than they release dopamine and serotonin | journal = Synapse | location = New York, N.Y. | volume = 39 | issue = 1 | pages = 32–41 | date = January 2001 | pmid = 11071707 | doi = 10.1002/1098-2396(20010101)39:1<32::AID-SYN5>3.0.CO;2-3 | s2cid = 15573624 }}</ref><ref name="Rothman_2012">{{cite journal | vauthors = Rothman RB, Partilla JS, Baumann MH, Lightfoot-Siordia C, Blough BE | title = Studies of the biogenic amine transporters. 14. Identification of low-efficacy "partial" substrates for the biogenic amine transporters | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 341 | issue = 1 | pages = 251–262 | date = April 2012 | pmid = 22271821 | pmc = 3364510 | doi = 10.1124/jpet.111.188946 }}</ref><ref name="Marusich_2016">{{cite journal | vauthors = Marusich JA, Antonazzo KR, Blough BE, Brandt SD, Kavanagh PV, Partilla JS, Baumann MH | title = The new psychoactive substances 5-(2-aminopropyl)indole (5-IT) and 6-(2-aminopropyl)indole (6-IT) interact with monoamine transporters in brain tissue | journal = Neuropharmacology | volume = 101 | pages = 68–75 | date = February 2016 | pmid = 26362361 | pmc = 4681602 | doi = 10.1016/j.neuropharm.2015.09.004 }}</ref><ref name="Nagai_2007">{{cite journal | vauthors = Nagai F, Nonaka R, Satoh Hisashi Kamimura K | title = The effects of non-medically used psychoactive drugs on monoamine neurotransmission in rat brain | journal = European Journal of Pharmacology | volume = 559 | issue = 2–3 | pages = 132–137 | date = March 2007 | pmid = 17223101 | doi = 10.1016/j.ejphar.2006.11.075 }}</ref><ref name="Halberstadt_2019">{{cite journal | vauthors = Halberstadt AL, Brandt SD, Walther D, Baumann MH | title = 2-Aminoindan and its ring-substituted derivatives interact with plasma membrane monoamine transporters and α2-adrenergic receptors | journal = Psychopharmacology | volume = 236 | issue = 3 | pages = 989–999 | date = March 2019 | pmid = 30904940 | pmc = 6848746 | doi = 10.1007/s00213-019-05207-1 }}</ref><ref name="Blough_2008">{{cite book | vauthors = Blough B | veditors = Trudell ML, Izenwasser S | chapter = Dopamine-releasing agents | title = Dopamine Transporters: Chemistry, Biology and Pharmacology | location = Hoboken [NJ] | pages = 305–320 | date = July 2008 | isbn = 978-0-470-11790-3 | oclc = 181862653 | ol = OL18589888W | publisher = Wiley | url = https://books.google.com/books?id=QCagLAAACAAJ | chapter-url = https://bitnest.netfirms.com/external/Books/Dopamine-releasing-agents_c11.pdf }}</ref><ref name="Dunlap_2018" />
|}
</div>
<div style="display:inline-grid">
{| class="wikitable" style="font-size:small;"
|+ {{Nowrap|MDMA, MDA, and enantiomers at [[serotonin]] [[5-HT2 receptor|5-HT<sub>2</sub> receptor]]s}}
|-
! rowspan="2" | [[Chemical compound|Compound]] !! colspan="2" | [[5-HT2A receptor|5-HT<sub>2A</sub>]] !! colspan="2" | [[5-HT2B receptor|5-HT<sub>2B</sub>]] !! colspan="2" | [[5-HT2C receptor|5-HT<sub>2C</sub>]]
|-
! [[Half-maximal effective concentration|EC<sub>50</sub>]] (nM) !! [[Maximal efficacy|E<sub>max</sub>]] !! [[Half-maximal effective concentration|EC<sub>50</sub>]] (nM) !! [[Maximal efficacy|E<sub>max</sub>]] !! [[Half-maximal effective concentration|EC<sub>50</sub>]] (nM) !! [[Maximal efficacy|E<sub>max</sub>]]
|-
| [[Serotonin]] || 53 || 92% || 1.0 || 100% || 22 || 91%
|-
| [[MDA (drug)|MDA]] || 1,700 || 57% || 190 || 80% || {{Abbr|ND|No data}} || {{Abbr|ND|No data}}
|-
| {{nbsp}}{{nbsp}}(''S'')-MDA (''d'') || 18,200 || 89% || 100 || 81% || 7,400 || 73%
|-
| {{nbsp}}{{nbsp}}(''R'')-MDA (''l'') || 5,600 || 95% || 150 || 76% || 7,400 || 76%
|-
| MDMA || 6,100 || 55% || 2,000–>20,000 || 32% || {{Abbr|ND|No data}} || {{Abbr|ND|No data}}
|-
| {{nbsp}}{{nbsp}}(''S'')-MDMA (''d'') || 10,300 || 9% || 6,000 || 38% || 2,600 || 53%
|-
| {{nbsp}}{{nbsp}}[[(R)-MDMA|(''R'')-MDMA]] (''l'') || 3,100 || 21% || 900 || 27% || 5,400 || 27%
|- class="sortbottom"
| colspan="7" style="width: 1px; background-color:var(--background-color-notice-subtle,#eaecf0); color:inherit; text-align: center;" | '''Notes:''' The smaller the K<sub>act</sub> or EC<sub>50</sub> value, the more strongly the compound produces the effect. '''Refs:''' <ref name="Nash_1994"/><ref name="Setola_2003" /><ref name="Kolaczynska_2022">{{cite journal | vauthors = Kolaczynska KE, Ducret P, Trachsel D, Hoener MC, Liechti ME, Luethi D | title = Pharmacological characterization of 3,4-methylenedioxyamphetamine (MDA) analogs and two amphetamine-based compounds: N,α-DEPEA and DPIA | journal = European Neuropsychopharmacology  | volume = 59 | pages = 9–22 | date = June 2022 | pmid = 35378384 | doi = 10.1016/j.euroneuro.2022.03.006 | url = https://www.researchgate.net/publication/359686098 }}</ref>
|}
</div>

===Pharmacokinetics===
====Absorption====
The MDMA [[concentration]] in the [[bloodstream]] starts to rise after about 30{{nbsp}}minutes,<ref>{{cite journal | vauthors = Mas M, Farré M, de la Torre R, Roset PN, Ortuño J, Segura J, Camí J | title = Cardiovascular and neuroendocrine effects and pharmacokinetics of 3, 4-methylenedioxymethamphetamine in humans | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 290 | issue = 1 | pages = 136–145 | date = July 1999 | pmid = 10381769 | doi = 10.1016/S0022-3565(24)34877-3 }}</ref> and reaches its maximal [[concentration]] between 1.5 and 3{{nbsp}}hours after [[oral administration]].<ref name="de_la_Torre_2000">{{cite journal | vauthors = de la Torre R, Farré M, Ortuño J, Mas M, Brenneisen R, Roset PN, Segura J, Camí J | title = Non-linear pharmacokinetics of MDMA ('ecstasy') in humans | journal = British Journal of Clinical Pharmacology | volume = 49 | issue = 2 | pages = 104–109 | date = February 2000 | pmid = 10671903 | pmc = 2014905 | doi = 10.1046/j.1365-2125.2000.00121.x }}</ref> It is then slowly [[metabolism|metabolized]] and [[excretion|excreted]], with levels of MDMA and its metabolites decreasing to half their peak concentration over the next several hours.<ref name="Farre_2000">{{cite journal | vauthors = Farré M, Roset PN, Lopez CH, Mas M, Ortuño J, Menoyo E, Pizarro N, Segura J, Cami J | title = Pharmacology of MDMA in humans | journal = Annals of the New York Academy of Sciences | volume = 914 | issue = 1 | pages = 225–237 | date = September 2000 | pmid = 11085324 | doi = 10.1111/j.1749-6632.2000.tb05199.x | bibcode = 2000NYASA.914..225D | s2cid = 29247621 | doi-access = free }}</ref> The [[duration of action]] of MDMA is about 3 to 6{{nbsp}}hours.<ref name="Oeri_2021" />

====Distribution====
The [[plasma protein binding]] of MDMA is unknown.<ref name="DrugBank" />

====Metabolism====
[[File:Main metabolic pathways of MDMA in humans.svg|class=skin-invert-image|thumb|left|300px|Main [[metabolic pathway]]s of MDMA in humans.]]

[[Metabolite]]s of MDMA that have been identified in humans include [[3,4-Methylenedioxyamphetamine|3,4-methylenedioxyamphetamine]] (MDA), [[4-hydroxy-3-methoxymethamphetamine]] (HMMA), [[4-hydroxy-3-methoxyamphetamine]]<!--File:HMA2.png--> (HMA), [[Alpha-Methyldopamine|3,4-dihydroxyamphetamine]] (DHA) (also called alpha-methyldopamine (α-Me-DA)), [[MDP2P|3,4-methylenedioxyphenylacetone]] (MDP2P), and [[Methylenedioxyhydroxyamphetamine|3,4-methylenedioxy-N-hydroxyamphetamine]] (MDOH). The contributions of these metabolites to the psychoactive and [[toxic]] effects of MDMA are an area of active research. 80% of MDMA is metabolised in the liver, and about 20% is excreted unchanged in the [[urine]].<ref name="pmid22392347" />

MDMA is known to be metabolized by two main [[metabolic pathway]]s: (1) ''O''-demethylenation followed by [[Catechol-O-methyl transferase|catechol-''O''-methyltransferase]] (COMT)-catalyzed methylation or glucuronide/sulfate conjugation; and (2) ''N''-dealkylation, deamination, and oxidation to the corresponding [[benzoic acid]] derivatives conjugated with [[glycine]].<ref name="de_la_Torre_2004" /> The metabolism may be primarily by [[cytochrome P450 oxidase|cytochrome P450]] (CYP450) [[enzyme]]s [[CYP2D6]] and [[CYP3A4]] and COMT. Complex, nonlinear [[pharmacokinetics]] arise via autoinhibition of [[CYP2D6]] and CYP2D8, resulting in [[rate equation|zeroth order kinetics]] at higher doses. It is thought that this can result in sustained and higher [[concentration]]s of MDMA if the user takes consecutive doses of the drug.<ref name="Kolbrich_2008">{{cite journal | vauthors = Kolbrich EA, Goodwin RS, Gorelick DA, Hayes RJ, Stein EA, Huestis MA | title = Plasma pharmacokinetics of 3,4-methylenedioxymethamphetamine after controlled oral administration to young adults | journal = Therapeutic Drug Monitoring | volume = 30 | issue = 3 | pages = 320–332 | date = June 2008 | pmid = 18520604 | pmc = 2663855 | doi = 10.1097/FTD.0b013e3181684fa0 }}</ref>{{primary source inline|date=October 2014}}

====Elimination====
MDMA and metabolites are primarily excreted as conjugates, such as sulfates and glucuronides.<ref name="Shima_2007">{{cite journal | vauthors = Shima N, Kamata H, Katagi M, Tsuchihashi H, Sakuma T, Nemoto N | title = Direct determination of glucuronide and sulfate of 4-hydroxy-3-methoxymethamphetamine, the main metabolite of MDMA, in human urine | journal = Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences | volume = 857 | issue = 1 | pages = 123–129 | date = September 2007 | pmid = 17643356 | doi = 10.1016/j.jchromb.2007.07.003 }}</ref> MDMA is a [[chirality (chemistry)|chiral]] compound and has been almost exclusively administered as a [[racemic|racemate]]. However, the two enantiomers have been shown to exhibit different kinetics. The disposition of MDMA may also be stereoselective, with the S-enantiomer having a shorter elimination half-life and greater excretion than the R-enantiomer. Evidence suggests<ref name="Fallon_1999">{{cite journal | vauthors = Fallon JK, Kicman AT, Henry JA, Milligan PJ, Cowan DA, Hutt AJ | title = Stereospecific analysis and enantiomeric disposition of 3, 4-methylenedioxymethamphetamine (Ecstasy) in humans | journal = Clinical Chemistry | volume = 45 | issue = 7 | pages = 1058–1069 | date = July 1999 | pmid = 10388483 | doi = 10.1093/clinchem/45.7.1058 | doi-access = free }}</ref> that the area under the [[blood plasma]] concentration versus time curve (AUC) was two to four times higher for the (''R'')-enantiomer than the (''S'')-enantiomer after a 40{{nbsp}}mg oral dose in human volunteers. Likewise, the plasma half-life of [[(R)-MDMA|(''R'')-MDMA]] was significantly longer than that of the (''S'')-enantiomer (5.8{{nbsp}}±{{nbsp}}2.2 hours vs 3.6{{nbsp}}±{{nbsp}}0.9 hours).<ref name="Toxnet MDMA after-effects"/> However, because MDMA excretion and metabolism have nonlinear kinetics,<ref name="Mueller_2008">{{cite journal | vauthors = Mueller M, Peters FT, Maurer HH, McCann UD, Ricaurte GA | title = Nonlinear pharmacokinetics of (+/-)3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") and its major metabolites in squirrel monkeys at plasma concentrations of MDMA that develop after typical psychoactive doses | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 327 | issue = 1 | pages = 38–44 | date = October 2008 | pmid = 18591215 | doi = 10.1124/jpet.108.141366 | s2cid = 38043715 }}</ref> the half-lives would be higher at more typical doses (100{{nbsp}}mg is sometimes considered a typical dose).<ref name="de_la_Torre_2000" />

==Chemistry==
{| style="float:right"
|<div class="skin-invert-image">{{Annotated image 4
| caption = MDMA is a [[racemic mixture]] and exists as two [[enantiomers]]: [[(R)-MDMA|(''R'')-MDMA]] and (''S'')-MDMA.
| header =
| header_align =
| header_background =
| alt = Racemic MDMA structure diagram
| image = (±)-MDMA-Formel Structural Formulae.svg
| align = right
| width = 200
| height = 195
| image-width = 200
| image-left = 0
| image-top = 0
| annot-font-size = 16
| icon = none
| annotations =
{{Annotation|60|70|(''R'')-MDMA}}
{{Annotation|60|175|(''S'')-MDMA}}
}}</div>
|-
|{{multiple image
| align = right
| direction = vertical
| width =

<!-- Image 1 -->
| image1 = White MDMA salt in a bag.jpg
| width1 = 200
| alt1 = A powdered salt of MDMA
| caption1 = A powdered salt of MDMA

<!-- Image 2 -->
| image2 = MDMAjakarta.jpg
| width2 = 200
| alt2 = Reactors used in synthesis
| caption2 = Reactors used to synthesize MDMA on an industrial scale in a [[clandestine chemistry|clandestine chemical factory]] in Cikande, [[Indonesia]]
}}
|}

MDMA is in the [[substituted methylenedioxyphenethylamine]] and [[substituted amphetamine]] [[chemical classification|classes of chemicals]]. As a [[free base]], MDMA is a colorless oil insoluble in water.<ref name="EU2015" /> The most common salt of MDMA is the hydrochloride salt;<ref name="EU2015" /> pure MDMA hydrochloride is water-soluble and appears as a white or off-white powder or crystal.<ref name="EU2015" />

===Synthesis===
There are numerous methods available to synthesize MDMA via different intermediates.<ref>{{cite journal | vauthors = Milhazes N, Martins P, Uriarte E, Garrido J, Calheiros R, Marques MP, Borges F | title = Electrochemical and spectroscopic characterisation of amphetamine-like drugs: application to the screening of 3,4-methylenedioxymethamphetamine (MDMA) and its synthetic precursors | journal = Analytica Chimica Acta | volume = 596 | issue = 2 | pages = 231–241 | date = July 2007 | pmid = 17631101 | doi = 10.1016/j.aca.2007.06.027 | bibcode = 2007AcAC..596..231M | hdl = 10316/45124 | hdl-access = free }}</ref><ref>{{cite journal | vauthors = Milhazes N, Cunha-Oliveira T, Martins P, Garrido J, Oliveira C, Rego AC, Borges F | title = Synthesis and cytotoxic profile of 3,4-methylenedioxymethamphetamine ("ecstasy") and its metabolites on undifferentiated PC12 cells: A putative structure-toxicity relationship | journal = Chemical Research in Toxicology | volume = 19 | issue = 10 | pages = 1294–1304 | date = October 2006 | pmid = 17040098 | doi = 10.1021/tx060123i | hdl = 10316/12872 | url = https://estudogeral.sib.uc.pt/bitstream/10316/12872/1/Synthesis%20and%20Cytotoxic%20Profile.pdf | hdl-access = free | access-date = 24 September 2019 | archive-date = 28 June 2021 | archive-url = https://web.archive.org/web/20210628070418/https://estudogeral.sib.uc.pt/bitstream/10316/12872/1/Synthesis%20and%20Cytotoxic%20Profile.pdf | url-status = live }}</ref><ref>{{cite journal | vauthors = Baxter EW, Reitz AB | title = Reductive aminations of carbonyl compounds with borohydride and borane reducing agents. | journal = Organic Reactions | location = Hoboken, New Jersey, United States | volume = 59 | page = 59 | date = April 2004 | doi = 10.1002/0471264180.or059.01 | isbn = 978-0-471-26418-7 }}</ref><ref>{{cite journal | vauthors = Gimeno P, Besacier F, Bottex M, Dujourdy L, Chaudron-Thozet H | title = A study of impurities in intermediates and 3,4-methylenedioxymethamphetamine (MDMA) samples produced via reductive amination routes | journal = Forensic Science International | volume = 155 | issue = 2–3 | pages = 141–157 | date = December 2005 | pmid = 16226151 | doi = 10.1016/j.forsciint.2004.11.013 }}</ref> The original MDMA synthesis described in Merck's patent involves brominating [[safrole]] to 1-(3,4-methylenedioxyphenyl)-2-bromopropane and then reacting this adduct with methylamine.<ref>{{cite journal | vauthors = Palhol F, Boyer S, Naulet N, Chabrillat M | title = Impurity profiling of seized MDMA tablets by capillary gas chromatography | journal = Analytical and Bioanalytical Chemistry | volume = 374 | issue = 2 | pages = 274–281 | date = September 2002 | pmid = 12324849 | doi = 10.1007/s00216-002-1477-6 | s2cid = 42666306 }}</ref><ref>{{cite journal | vauthors = Renton RJ, Cowie JS, Oon MC | title = A study of the precursors, intermediates and reaction by-products in the synthesis of 3,4-methylenedioxymethylamphetamine and its application to forensic drug analysis | journal = Forensic Science International | volume = 60 | issue = 3 | pages = 189–202 | date = August 1993 | pmid = 7901132 | doi = 10.1016/0379-0738(93)90238-6 }}</ref> Most illicit MDMA is synthesized using [[MDP2P]] (3,4-methylenedioxyphenyl-2-propanone) as a precursor. MDP2P in turn is generally synthesized from [[piperonal]], [[safrole]] or [[isosafrole]].<ref name="World Drug Report 2014">{{cite book | veditors = Mohan J | title = World Drug Report 2014 | location = Vienna, Austria | pages = 2, 3, 123–152 | date = June 2014 | publisher = [[United Nations Office on Drugs and Crime]] | isbn = 978-92-1-056752-7 | url = http://www.unodc.org/documents/wdr2014/World_Drug_Report_2014_web.pdf | access-date = 1 December 2014 | archive-date = 13 November 2014 | archive-url = https://web.archive.org/web/20141113173315/http://www.unodc.org/documents/wdr2014/World_Drug_Report_2014_web.pdf | url-status = live }}</ref> One method is to [[Isomerization|isomerize]] safrole to isosafrole in the presence of a strong base, and then oxidize [[isosafrole]] to MDP2P. Another method uses the [[Wacker process]] to oxidize safrole directly to the MDP2P intermediate with a [[palladium]] catalyst. Once the MDP2P intermediate has been prepared, a [[reductive amination]] leads to [[racemic]] MDMA (an equal parts mixture of [[(R)-MDMA|(''R'')-MDMA]] and (''S'')-MDMA).{{citation needed|date=January 2015}} Relatively small quantities of essential oil are required to make large amounts of MDMA. The essential oil of ''[[Ocotea cymbarum]]'', for example, typically contains between 80 and 94% safrole. This allows 500{{nbsp}}mL of the oil to produce between 150 and 340 grams of MDMA.<ref>{{cite journal | title = Early Warning - MDMA and MDA Producers Using Ocotea Cymbarum as a Precursor | journal = DEA Microgram Newsletter | volume = 38 | issue = 11 | page = 166 | date = 11 November 2005 | url = https://www.justice.gov/dea/pr/micrograms/2005/mg1105.pdf | archive-url = https://web.archive.org/web/20121018052300/http://www.justice.gov/dea/pr/micrograms/2005/mg1105.pdf | archive-date = 18 October 2012 | publisher = Drug Enforcement Agency, U.S. Department of Justice }}</ref>

<div class="skin-invert-image">{{multiple image
| align = left
| direction = vertical
| width =

<!-- Image 1 -->
| image1 = MDMA Synthesis 1.svg
| width1 = 600
| alt1 = Synthesis of MDMA from piperonal
| caption1 =

<!-- Image 2 -->
| image2 = MDMA Synthese 2.svg
| width2 = 400
| alt2 = Synthesis of MDMA from piperonal
| caption2 = Synthesis of MDMA from piperonal

<!-- Image 3 -->
| image3 = MDA from safrole en.png
| width3 = 400
| alt3 = Synthesis of MDMA and related analogs from safrole
| caption3 = Synthesis of MDMA and related analogs from safrole
}}</div>
{{clear left}}

===Detection in body fluids===
MDMA and MDA may be quantitated in blood, plasma or urine to monitor for use, confirm a diagnosis of poisoning or assist in the forensic investigation of a traffic or other criminal violation or a sudden death. Some drug abuse screening programs rely on hair, saliva, or sweat as specimens. Most commercial amphetamine immunoassay screening tests cross-react significantly with MDMA or its major metabolites, but chromatographic techniques can easily distinguish and separately measure each of these substances. The concentrations of MDA in the blood or urine of a person who has taken only MDMA are, in general, less than 10% those of the parent drug.<ref name="Kolbrich_2008" /><ref>{{cite journal | vauthors = Barnes AJ, De Martinis BS, Gorelick DA, Goodwin RS, Kolbrich EA, Huestis MA | title = Disposition of MDMA and metabolites in human sweat following controlled MDMA administration | journal = Clinical Chemistry | volume = 55 | issue = 3 | pages = 454–462 | date = March 2009 | pmid = 19168553 | pmc = 2669283 | doi = 10.1373/clinchem.2008.117093 }}</ref><ref>{{cite book | vauthors = Baselt RC | title = Disposition of toxic drugs and chemicals in man | location = Seal Beach, Ca. | pages = 1078–1080 | date = 2011 | publisher = Biomedical Publications | isbn = 978-0-9626523-8-7 | edition = 9th }}</ref>

{{Clear}}

==History==
===Early research and use===
{{Multiple image
| total_width = 300

| image1 = Merck MDMA Synthesis Patent.pdf
| alt1 = Merck MDMA synthesis patent
| caption1 =

| image2 = Merck patent for synthesizing methylhydrastinine from MDMA.pdf
| alt2 = Merck patent for synthesizing methylhydrastinine from MDMA
| caption2 =

| footer = German patents for MDMA synthesis and the subsequent methylhydrastinine synthesis filed by Merck on 24 December 1912 and issued in 1914
}}

MDMA was first [[chemical synthesis|synthesized]] and [[patent]]ed in 1912 by [[Merck KGaA|Merck]] chemist [[Anton Köllisch]].<ref name="Passie_2023">{{cite book | vauthors = Passie T | title = The History of MDMA | pages = 6–16, 18, 27, 29, 32, 40 | date = 29 June 2023 | doi = 10.1093/oso/9780198867364.001.0001 | publisher = Oxford University Press | isbn = 978-0-19-886736-4 | url = https://books.google.com/books?id=KSvCEAAAQBAJ&pg=PA6 }}</ref><ref name="BernschneiderReif_2006">{{cite journal | vauthors = Bernschneider-Reif S, Oxler F, Freudenmann RW | title = The origin of MDMA ("ecstasy")--separating the facts from the myth | journal = Die Pharmazie | volume = 61 | issue = 11 | pages = 966–972 | date = November 2006 | pmid = 17152992 }}</ref> At the time, Merck was interested in developing substances that stopped abnormal bleeding. Merck wanted to avoid an existing patent held by [[Bayer]] for one such compound: [[hydrastinine]]. Köllisch developed a preparation of a hydrastinine [[chemical analogue|analogue]], methylhydrastinine, at the request of fellow lab members, Walther Beckh and Otto Wolfes. MDMA (called methylsafrylamin, safrylmethylamin or N-Methyl-a-Methylhomopiperonylamin in Merck laboratory reports) was an [[reaction intermediate|intermediate compound]] in the synthesis of methylhydrastinine. Merck was not interested in MDMA itself at the time.<ref name="BernschneiderReif_2006" /> On 24 December 1912, Merck filed two patent applications that described the synthesis and some chemical properties of MDMA<ref name="Darmstadt_1914">{{cite web | vauthors = Darmstadt FE | title = German Patent 274350: Verfahren zur Darstellung von Alkyloxyaryl-, Dialkyloxyaryl- und Alkylendioxyarylaminopropanen bzw. deren am Stickstoff monoalkylierten Derivaten. | date = 16 May 1914 | url = http://v3.espacenet.com/publicationDetails/originalDocument?CC=DE&NR=274350C&FT=D | publisher = Kaiserliches Patentamt | access-date = 12 April 2009 | archive-date = 28 August 2021 | archive-url = https://web.archive.org/web/20210828153545/https://worldwide.espacenet.com/publicationDetails/originalDocument?locale=en_EP&FT=D&CC=DE&NR=274350C | url-status = live }}</ref> and its subsequent conversion to methylhydrastinine.<ref name="Darmstadt_1914a">{{cite web | vauthors = Darmstadt FE | title = German Patent 279194: Verfahren zur Darstellung von Hydrastinin Derivaten. | date = 15 October 1914 | url = http://v3.espacenet.com/publicationDetails/originalDocument?CC=DE&NR=279194C&FT=D | publisher = Kaiserliches Patentamt | access-date = 20 July 2009 | archive-date = 28 August 2021 | archive-url = https://web.archive.org/web/20210828153659/https://worldwide.espacenet.com/publicationDetails/originalDocument?locale=en_EP&FT=D&CC=DE&NR=279194C | url-status = live }}</ref> Merck records indicate its researchers returned to the compound sporadically. A 1920 Merck patent describes a chemical modification to MDMA.<ref name="Passie_2023" /><ref name="Shulgin_1990">{{cite book | vauthors = Shulgin AT | veditors = Peroutka SJ | chapter = History of MDMA | title = Ecstasy: The Clinical, Pharmacological and Neurotoxicological Effects of the Drug MDMA | volume = 9 | pages = 1–20 (2, 14) | date = 1990 | doi = 10.1007/978-1-4613-1485-1_1 | series = Topics in the Neurosciences | publisher = Springer US | publication-place = Boston, MA | isbn = 978-1-4612-8799-5 | chapter-url = http://link.springer.com/10.1007/978-1-4613-1485-1_1 | access-date = 15 May 2025 }}</ref>

MDMA's [[structural analog|analogue]] [[3,4-methylenedioxyamphetamine]] (MDA) was first synthesized in 1910 as a [[chemical derivative|derivative]] of [[adrenaline]].<ref name="Passie_2023" /> [[Gordon A. Alles]], the discoverer of the [[psychoactive drug|psychoactive]] effects of [[amphetamine]], also discovered the psychoactive effects of MDA in 1930 in a [[self-experiment]] in which he administered a high dose (126{{nbsp}}mg) to himself.<ref name="Passie_2023" /><ref name="Alles_1959a">{{cite book | vauthors = Alles GA | veditors = Abramson HA | chapter = Some Relations Between Chemical Structure and Physiological Action of Mescaline and Related Compounds / Structure and Action of Phenethylamines | title = Neuropharmacology: Transactions of the Fourth Conference, September 25, 26, and 27, 1957, Princeton, N. J. | location = New York | pages = 181–268 | date = 1959 | publisher = Josiah Macy Foundation | oclc = 9802642 | url = https://books.google.com/books?id=sDQLAQAAMAAJ&q=%22Some+relations+between+chemical+structure+and+physiological+action+of+mescaline+and+related+compounds%22 | chapter-url = https://bitnest.netfirms.com/external/Books/NeuropharmacologyTrans.4.181#page=5 | archive-url = https://web.archive.org/web/20250321230359/https://bitnest.netfirms.com/external/Books/NeuropharmacologyTrans.4.181#page=5 | archive-date = 21 March 2025 }}</ref><ref name="Alles_1959b">{{cite book | vauthors = Alles GA | chapter = Subjective Reactions to Phenethylamine Hallucinogens | title = A Pharmacologic Approach to the Study of the Mind | location = Springfield | pages = 238–250 (241–246) | date = 1959 | publisher = CC Thomas | isbn = 978-0-398-04254-7 | url = https://books.google.com/books?id=x45rAAAAMAAJ | chapter-url = https://archive.org/details/pharmacologicapp0000univ/page/238/mode/1up }}</ref> However, he did not subsequently describe these effects until 1959.<ref name="Benzenhofer_2010">{{cite journal | vauthors = Benzenhöfer U, Passie T | title = Rediscovering MDMA (ecstasy): the role of the American chemist Alexander T. Shulgin | journal = Addiction | location = Abingdon, England | volume = 105 | issue = 8 | pages = 1355–1361 | date = August 2010 | pmid = 20653618 | doi = 10.1111/j.1360-0443.2010.02948.x }}</ref><ref name="Alles_1959a" /><ref name="Alles_1959b" /> MDA was later tested as an [[appetite suppressant]] by [[Smith, Kline & French]] and for other uses by other groups in the 1950s.<ref name="Passie_2023" /> In relation to the preceding, the psychoactive effects of MDA were discovered well before those of MDMA.<ref name="Passie_2023" /><ref name="Benzenhofer_2010" />

In 1927, Max Oberlin studied the pharmacology of MDMA while searching for substances with effects similar to [[adrenaline]] or [[ephedrine]], the latter being structurally similar to MDMA. Compared to ephedrine, Oberlin observed that it had similar effects on [[vascular smooth muscle]] tissue, stronger effects at the uterus, and no "local effect at the eye". MDMA was also found to have effects on [[blood sugar]] levels comparable to high doses of ephedrine. Oberlin concluded that the effects of MDMA were not limited to the [[sympathetic nervous system]]. Research was stopped "particularly due to a strong price increase of safrylmethylamine", which was still used as an intermediate in methylhydrastinine synthesis. Albert van Schoor performed simple toxicological tests with the drug in 1952, most likely while researching new stimulants or circulatory medications. After pharmacological studies, research on MDMA was not continued. In 1959, Wolfgang Fruhstorfer synthesized MDMA for pharmacological testing while researching stimulants. It is unclear if Fruhstorfer investigated the effects of MDMA in humans.<ref name="BernschneiderReif_2006" />

Outside of Merck, other researchers began to investigate MDMA. In 1953 and 1954, the [[United States Army]] commissioned a study of [[toxicity]] and behavioral effects in animals injected with [[mescaline]] and several analogues, including MDMA. Conducted at the [[University of Michigan]] in [[Ann Arbor]], these investigations were declassified in October 1969 and published in 1973.<ref name="Hardman_1973">{{cite journal | vauthors = Hardman HF, Haavik CO, Seevers MH | title = Relationship of the structure of mescaline and seven analogs to toxicity and behavior in five species of laboratory animals | journal = Toxicology and Applied Pharmacology | volume = 25 | issue = 2 | pages = 299–309 | date = June 1973 | pmid = 4197635 | doi = 10.1016/S0041-008X(73)80016-X | bibcode = 1973ToxAP..25..299H | url = http://www.erowid.org/references/refs_view.php?A=ShowDoc1&ID=639 | hdl = 2027.42/33868 | hdl-access = free | access-date = 19 April 2009 | archive-date = 21 October 2008 | archive-url = https://web.archive.org/web/20081021151006/http://www.erowid.org/references/refs_view.php?A=ShowDoc1&ID=639 | url-status = live }}</ref><ref name="Benzenhofer_2010"/> A 1960 Polish paper by Biniecki and Krajewski describing the synthesis of MDMA as an intermediate was the first published scientific paper on the substance.<ref name="BernschneiderReif_2006" /><ref name="Benzenhofer_2010"/><ref>{{cite journal | vauthors = Biniecki S, Krajewski E | title = Production of d,1-N-methyl-beta-(3,4-methylenedioxyphenyl)-isopropylamine and d,1-N-methyl-beta-(3,4-dimthoxyphenyl)-isopropylamine. | journal = Acta Polon Pharm | volume = 17 | pages = 421–425 | date = 1960 | language = pl }}</ref>

MDA appeared as a [[recreational drug]] in the mid-1960s.<ref name="Passie_2023" /> MDMA may have been in non-medical use in the western United States in 1968.<ref name="Passie_2023" /><ref name="Siegel 1986">{{cite journal | vauthors = Siegel RK | title = MDMA. Nonmedical use and intoxication | journal = Journal of Psychoactive Drugs | volume = 18 | issue = 4 | pages = 349–354 | date = October 1986 | pmid = 2880950 | doi = 10.1080/02791072.1986.10472368 | url = http://www.maps.org/images/pdf/1986_siegel_1.pdf | access-date = 11 August 2015 | archive-date = 4 March 2016 | archive-url = https://web.archive.org/web/20160304090940/http://www.maps.org/images/pdf/1986_siegel_1.pdf | url-status = live }}</ref> An August 1970 report at a meeting of crime laboratory chemists indicates MDMA was being used recreationally in the Chicago area by 1970.<ref name="Benzenhofer_2010"/><ref>The first confirmed sample was seized and identified by Chicago Police in 1970, see {{cite journal | vauthors = Sreenivasan VR | title = Problems in Identification of Methylenedioxy and Methoxy Amphetamines | journal = Journal of Criminal Law, Criminology, and Police Science | volume = 63 | issue = 2 | pages = 304–312 | year = 1972 | doi = 10.2307/1142315 | url = http://www.erowid.org/references/refs_view.php?A=ShowDoc1&ID=1149 | jstor = 1142315 | access-date = 19 April 2009 | archive-date = 21 October 2008 | archive-url = https://web.archive.org/web/20081021200016/http://www.erowid.org/references/refs_view.php?A=ShowDoc1&ID=1149 | url-status = live | url-access = subscription }}</ref> MDMA likely emerged as a substitute for MDA,<ref name="Foderaro 1988">{{cite news | vauthors = Foderaro LW | title = Psychedelic Drug Called Ecstasy Gains Popularity in Manhattan Nightclubs | date = 11 December 1988 | url = https://www.nytimes.com/1988/12/11/nyregion/psychedelic-drug-called-ecstasy-gains-popularity-in-manhattan-nightclubs.html?pagewanted=2 | access-date = 27 August 2015 | work = The New York Times | archive-date = 17 November 2015 | archive-url = https://web.archive.org/web/20151117042408/http://www.nytimes.com/1988/12/11/nyregion/psychedelic-drug-called-ecstasy-gains-popularity-in-manhattan-nightclubs.html?pagewanted=2 | url-status = live }}</ref> a drug at the time popular among users of psychedelics<ref name="Professor X"/> which was made a [[List of Schedule I controlled substances (U.S.)|Schedule 1 controlled substance]] in the United States in 1970.<ref name="Beck 1987">{{cite web | vauthors = Beck JE | title = Drug Abuse Series: MDMA | date = April 1987 | url = https://erowid.org/chemicals/mdma/mdma_info6.shtml | website = Erowid | publisher = Drug Abuse Information and Monitoring Project | access-date = 6 August 2015 | archive-date = 4 August 2015 | archive-url = https://web.archive.org/web/20150804125927/https://www.erowid.org/chemicals/mdma/mdma_info6.shtml | url-status = live }}</ref><ref name="Pentney_2001" />

===Shulgin's research===
[[File:Shulgin sasha 2011 hanna jon.jpg|thumb|Alexander and Ann Shulgin in December 2011]]

American chemist and [[psychopharmacologist]] [[Alexander Shulgin]] reported he synthesized MDMA in 1965 while researching methylenedioxy compounds at [[Dow Chemical Company]], but did not test the psychoactivity of the compound at this time. Around 1970, Shulgin sent instructions for N-methylated MDA (MDMA) synthesis to the founder of a Los Angeles chemical company who had requested them. This individual later provided these instructions to a client in the Midwest. Shulgin may have suspected he played a role in the emergence of MDMA in Chicago.<ref name="Benzenhofer_2010"/>

Shulgin first heard of the psychoactive effects of N-methylated MDA around 1975 from a young student who reported "amphetamine-like content".<ref name="Benzenhofer_2010"/> Around 30 May 1976, Shulgin again heard about the effects of N-methylated MDA,<ref name="Benzenhofer_2010"/> this time from a graduate student in a medicinal chemistry group he advised at [[San Francisco State University]]<ref name="Professor X"/><ref>{{cite web | title = Alexander 'Sasha' Shulgin | url = http://www.shulginresearch.org/home/about/alexander-sasha-shulgin/ | publisher = [[Alexander Shulgin Research Institute]] | access-date = 8 January 2015 | archive-date = 20 December 2014 | archive-url = https://web.archive.org/web/20141220131529/http://www.shulginresearch.org/home/about/alexander-sasha-shulgin/ }}</ref> who directed him to the University of Michigan study.<ref name="PiHKAL" /> She and two close friends had consumed 100{{nbsp}}mg of MDMA and reported positive emotional experiences.<ref name="Benzenhofer_2010"/> Following the self-trials of a colleague at the [[University of San Francisco]], Shulgin synthesized MDMA and tried it himself in September and October 1976.<ref name="Benzenhofer_2010"/><ref name="Professor X"/> Shulgin first reported on MDMA in a presentation at a conference in Bethesda, Maryland in December 1976.<ref name="Benzenhofer_2010"/> In 1978, he and [[David E. Nichols]] published a report on the drug's psychoactive effect in humans.<ref name="Passie_2023" /> They described MDMA as inducing "an easily controlled altered state of consciousness with emotional and sensual overtones" comparable "to marijuana, to [[psilocybin]] devoid of the hallucinatory component, or to low levels of MDA".<ref name="isbn0-08-021938-1">{{cite book | vauthors = Shulgin AT, Nichols DE | veditors = Willette RE, Stillman RJ | chapter = Characterization of Three New Psychotomimetics | title = The Psychopharmacology of Hallucinogens | location = New York | pages = 74–83 | year = 1978 | publisher = Pergamon Press | isbn = 978-0-08-021938-7 | chapter-url = http://www.erowid.org/references/refs_view.php?A=ShowDocPartFrame&ID=961&DocPartID=832 | access-date = 4 January 2015 | archive-date = 15 May 2013 | archive-url = https://web.archive.org/web/20130515124653/http://www.erowid.org/references/refs_view.php?A=ShowDocPartFrame&ID=961&DocPartID=832 | url-status = live }}</ref>

While not finding his own experiences with MDMA particularly powerful,<ref name="PiHKAL" /><ref name="Dr. Ecstasy"/> Shulgin was impressed with the drug's disinhibiting effects and thought it could be useful in therapy.<ref name="Dr. Ecstasy"/> Believing MDMA allowed users to strip away habits and perceive the world clearly, Shulgin called the drug ''window''.<ref name="PiHKAL" /><ref name="Jennings_2004" /> Shulgin occasionally used MDMA for relaxation, referring to it as "my low-calorie martini", and gave the drug to friends, researchers, and others who he thought could benefit from it.<ref name=PiHKAL>{{cite book | vauthors = Shulgin AT, Shulgin A | chapter = Chapters 12, 22 | title = PiHKAL: A Chemical Love Story | location = Berkeley, CA | date = 1991 | author-link1 = Alexander Shulgin | author-link2 = Ann Shulgin | publisher = Transform Press | isbn = 978-0-9630096-0-9 | edition = 7th printing, 1st | title-link = PiHKAL }}</ref> One such person was [[Leo Zeff]], a psychotherapist who had been known to use psychedelic substances in his practice. When he tried the drug in 1977, Zeff was impressed with the effects of MDMA and came out of his semi-retirement to promote its use in therapy. Over the following years, Zeff traveled around the United States and occasionally to Europe, eventually training an estimated four thousand psychotherapists in the therapeutic use of MDMA.<ref name="Dr. Ecstasy">{{cite news | vauthors = Bennett D | title = Dr. Ecstasy | date = 30 January 2005 | url = https://www.nytimes.com/2005/01/30/magazine/30ECSTASY.html | work = The New York Times Magazine | access-date = 10 February 2017 | archive-date = 17 November 2011 | archive-url = https://web.archive.org/web/20111117063356/http://www.nytimes.com/2005/01/30/magazine/30ECSTASY.html | url-status = live }}</ref><ref>{{cite book | vauthors = Shulgin A | veditors = Doblin R | chapter = Tribute to Jacob | title = The Secret Chief Revealed | location = Sarasota, Fl | pages = 17–18 | date = 2004 | author1-link = Ann Shulgin | editor1-link = Rick Doblin | publisher = Multidisciplinary Association for Psychedelic Studies | isbn = 978-0-9660019-6-9 | edition = 2nd | chapter-url = http://maps.org/images/pdf/books/scr/scr.pdf | access-date = 7 January 2015 | archive-date = 16 September 2018 | archive-url = https://web.archive.org/web/20180916024833/http://www.maps.org/images/pdf/books/scr/scr.pdf }}</ref> Zeff named the drug ''Adam'', believing it put users in a state of primordial innocence.<ref name="Professor X">{{cite magazine | vauthors = Brown E | title = Professor X | date = September 2002 | magazine = Wired | url = http://archive.wired.com/wired/archive/10.09/professorx.html?pg=3&topic=&topic_set= | access-date = 4 January 2015 | archive-date = 25 June 2015 | archive-url = https://web.archive.org/web/20150625015832/http://archive.wired.com/wired/archive/10.09/professorx.html?pg=3&topic=&topic_set= | url-status = live }}</ref>

Psychotherapists who used MDMA believed the drug eliminated the typical fear response and increased communication. Sessions were usually held in the home of the patient or the therapist. The role of the therapist was minimized in favor of patient self-discovery accompanied by MDMA induced feelings of empathy. Depression, substance use disorders, relationship problems, premenstrual syndrome, and autism were among several psychiatric disorders MDMA assisted therapy was reported to treat.<ref name="Pentney_2001" /> According to psychiatrist George Greer, therapists who used MDMA in their practice were impressed by the results. Anecdotally, MDMA was said to greatly accelerate therapy.<ref name="Dr. Ecstasy"/> According to [[David Nutt]], MDMA was widely used in the western US in couples counseling, and was called ''empathy''. Only later was the term ''ecstasy'' used for it, coinciding with rising opposition to its use.<ref name="Nutt" /><ref name="pmid10450215">{{cite journal | vauthors = Milroy CM | title = Ten years of 'ecstasy' | journal = Journal of the Royal Society of Medicine | volume = 92 | issue = 2 | pages = 68–72 | date = February 1999 | pmid = 10450215 | pmc = 1297063 | doi = 10.1177/014107689909200206 }}</ref>

===Rising recreational use===
In the late 1970s and early 1980s, "Adam" spread through personal networks of psychotherapists, psychiatrists, users of psychedelics, and [[yuppies]]. Hoping MDMA could avoid criminalization like LSD and mescaline, psychotherapists and experimenters attempted to limit the spread of MDMA and information about it while conducting informal research.<ref name="Pentney_2001">{{cite journal | vauthors = Pentney AR | title = An exploration of the history and controversies surrounding MDMA and MDA | journal = Journal of Psychoactive Drugs | volume = 33 | issue = 3 | pages = 213–221 | date = 2001 | pmid = 11718314 | doi = 10.1080/02791072.2001.10400568 | s2cid = 31142434 }}</ref><ref name="Eisner" /> Early MDMA distributors were deterred from large scale operations by the threat of possible legislation.<ref name="Beck & Rosenbaum">{{cite book | vauthors = Beck J, Rosenbaum M | chapter = The Distribution of Ecstasy | title = Pursuit of Ecstasy: The MDMA Experience | location = Albany | date = 1994 | publisher = State Univ. of New York Press | isbn = 978-0-7914-1817-8 | chapter-url = https://books.google.com/books?id=SwdedK36bVMC | url-access = registration | url = https://archive.org/details/pursuitofecstasy0000beck }}</ref> Between the 1970s and the mid-1980s, this network of MDMA users consumed an estimated 500,000 doses.<ref name="Meyer_2013" /><ref name="isbn0803936788">{{cite book | vauthors = Doblin R, Rosenbaum M | veditors = Inciardi JA | chapter = Chapter 6: Why MDMA Should Not Have Been Made Illegal | title = The Drug Legalization Debate | location = London | date = 1991 | author-link1 = Rick Doblin | publisher = [[SAGE Publications]], Inc. | isbn = 978-0-8039-3678-2 | edition = 2nd | chapter-url = http://www.drugtext.org/pdf/Dance/party-drugs-clubbing/why-mdma-should-not-have-been-made-illegal.pdf | access-date = 10 August 2015 | url = https://archive.org/details/druglegalization00inci }}</ref>

A small recreational market for MDMA developed by the late 1970s,<ref name="Collin_2010">{{cite book | vauthors = Collin M, Godfrey J | chapter = The Technologies of Pleasure | title = Altered State: The Story of Ecstasy Culture and Acid House. | location = London | date = 2010 | publisher = [[Profile Books]] | isbn = 978-1-84765-641-4 | edition = Updated new | chapter-url = https://books.google.com/books?id=fc8x9qeCekQC }}</ref> consuming perhaps 10,000 doses in 1976.<ref name="Beck 1987"/> By the early 1980s MDMA was being used in Boston and New York City nightclubs such as [[Studio 54]] and [[Paradise Garage]].<ref>{{cite news | vauthors = Savlov M | title = Countdown to Ecstasy: A New Drug for a New Millennium | date = 12 June 2000 | url = http://www.weeklywire.com/ww/06-12-00/austin_music_feature.html | access-date = 6 August 2015 | work = The Austin Chronicle | publisher = Weekly Wire | archive-date = 21 January 2016 | archive-url = https://web.archive.org/web/20160121022839/http://weeklywire.com/ww/06-12-00/austin_music_feature.html }}</ref><ref>{{cite magazine | vauthors = Owen F, Gavin L | title = Molly Isn't Who You Think She Is: A Deeper Look at MDMA | date = 20 October 2013 | url = http://www.playboy.com/articles/molly-party-drug-ecstasy | access-date = 6 August 2015 | magazine = Playboy | archive-date = 27 July 2015 | archive-url = https://web.archive.org/web/20150727080003/http://www.playboy.com/articles/molly-party-drug-ecstasy }}</ref> Into the early 1980s, as the recreational market slowly expanded, production of MDMA was dominated by a small group of therapeutically minded [[Boston]] chemists. Having commenced production in 1976, this "Boston Group" did not keep up with growing demand and shortages frequently occurred.<ref name="Beck & Rosenbaum"/>

Perceiving a business opportunity, Michael Clegg, the Southwest distributor for the Boston Group, started his own "Texas Group" backed financially by Texas friends.<ref name="Beck & Rosenbaum"/><ref>{{cite book | vauthors = Sylvan R | chapter = A Brief History of the Rave Scene | title = Trance Formation: The Spiritual and Religious Dimensions of Global Rave Culture | location = New York, NY | pages = 21–22 | date = 2005 | publisher = Routledge | isbn = 978-0-415-97090-7 }}</ref> In 1981,<ref name="Beck & Rosenbaum"/> Clegg had coined "Ecstasy" as a slang term for MDMA to increase its marketability.<ref name="Jennings_2004" /><ref name=Eisner>{{cite book | vauthors = Eisner B | title = Ecstasy: The MDMA Story | location = Berkeley, CA | date = 1994 | author-link1 = Bruce Eisner | publisher = [[Ronin Publishing]] | isbn = 978-0-914171-68-3 | edition = Expanded 2nd | url = https://books.google.com/books?id=8aqUu5M6UpwC | access-date = 1 February 2016 | archive-date = 13 January 2023 | archive-url = https://web.archive.org/web/20230113000538/https://books.google.com/books?id=8aqUu5M6UpwC | url-status = live }}</ref> Starting in 1983,<ref name="Beck & Rosenbaum"/> the Texas Group mass-produced MDMA in a Texas lab<ref name="Eisner" /> or imported it from California<ref name="Jennings_2004" /> and marketed tablets using pyramid sales structures and toll-free numbers.<ref name="isbn0803936788" /> MDMA could be purchased via credit card and taxes were paid on sales.<ref name="Beck & Rosenbaum"/> Under the brand name "Sassyfras", MDMA tablets were sold in brown bottles.<ref name="Eisner" /> The Texas Group advertised "Ecstasy parties" at bars and discos, describing MDMA as a "fun drug" and "good to dance to".<ref name="Beck & Rosenbaum"/> MDMA was openly distributed in [[Austin, Texas|Austin]] and [[Dallas–Fort Worth]] area bars and nightclubs, becoming popular with yuppies, college students, and gays.<ref name="Foderaro 1988" /><ref name="Beck & Rosenbaum"/><ref name="isbn0803936788" />

Recreational use also increased after several cocaine dealers switched to distributing MDMA following experiences with the drug.<ref name="isbn0803936788" /> A California laboratory that analyzed confidentially submitted drug samples first detected MDMA in 1975. Over the following years the number of MDMA samples increased, eventually exceeding the number of MDA samples in the early 1980s.<ref>{{cite journal | vauthors = Parrott AC | title = Is ecstasy MDMA? A review of the proportion of ecstasy tablets containing MDMA, their dosage levels, and the changing perceptions of purity | journal = Psychopharmacology | volume = 173 | issue = 3–4 | pages = 234–241 | date = May 2004 | pmid = 15007594 | doi = 10.1007/s00213-003-1712-7 | s2cid = 3347303 | url = http://psy.swansea.ac.uk/staff/parrott/p-IsEcstasyMDMA-Psychopharm-2004.pdf | access-date = 7 August 2015 | archive-date = 18 September 2015 | archive-url = https://web.archive.org/web/20150918181517/http://psy.swansea.ac.uk/staff/parrott/p-IsEcstasyMDMA-Psychopharm-2004.pdf | url-status = live }}</ref><ref>{{cite journal | vauthors = Renfroe CL | title = MDMA on the street: Analysis Anonymous | journal = Journal of Psychoactive Drugs | volume = 18 | issue = 4 | pages = 363–369 | date = October 1986 | pmid = 2880953 | doi = 10.1080/02791072.1986.10472371 }}</ref> By the mid-1980s, MDMA use had spread to colleges around the United States.<ref name="Beck & Rosenbaum"/>{{rp|33}}

===Media attention and scheduling===
====United States====
[[File:Federal Register notice of planned MDMA scheduling.pdf|thumb|27 July 1984 Federal Register notice of the proposed MDMA scheduling]]

In an early media report on MDMA published in 1982, a [[Drug Enforcement Administration]] (DEA) spokesman stated the agency would ban the drug if enough evidence for abuse could be found.<ref name="Beck & Rosenbaum"/> By mid-1984, MDMA use was becoming more noticed. Bill Mandel reported on "Adam" in a 10 June [[San Francisco Chronicle]] article, but misidentified the drug as [[MMDA (drug)|methyloxymethylenedioxyamphetamine]] (MMDA). In the next month, the World Health Organization identified MDMA as the only substance out of twenty phenethylamines to be seized a significant number of times.<ref name="Eisner" />

After a year of planning and data collection, MDMA was proposed for [[Controlled Substances Act|scheduling]] by the DEA on 27 July 1984, with a request for comments and objections.<ref name="Eisner" /><ref>{{cite journal | title = Schedules of Controlled Substances Proposed Placement of 3,4-Methylenedioxymethamphetamine in Schedule I | journal = Federal Register | volume = 49 | issue = 146 |article-number=30210 | date = 27 July 1984 | url = http://maps.org/research-archive/dea-mdma/pdf/0194.PDF | access-date = 15 January 2015 | archive-date = 4 March 2016 | archive-url = https://web.archive.org/web/20160304002700/http://www.maps.org/research-archive/dea-mdma/pdf/0194.PDF | url-status = live }}</ref> The DEA was surprised when a number of psychiatrists, psychotherapists, and researchers objected to the proposed scheduling and requested a hearing.<ref name="Pentney_2001" /> In a [[Newsweek]] article published the next year, a DEA pharmacologist stated that the agency had been unaware of its use among psychiatrists.<ref>{{cite news | vauthors = Adler J, Abramson P, Katz S, Hager M | title = Getting High on 'Ecstasy' | location = Life/Style | page = 96 | date = 15 April 1985 | url = http://www.maps.org/research-archive/hmma/Newsweek4.85.pdf | access-date = 1 February 2015 | work = Newsweek Magazine | archive-date = 20 April 2016 | archive-url = https://web.archive.org/web/20160420122637/http://www.maps.org/research-archive/hmma/Newsweek4.85.pdf | url-status = live }}</ref> An initial hearing was held on 1 February 1985 at the DEA offices in Washington, D.C., with administrative law judge Francis L. Young presiding.<ref name="Eisner" /> It was decided there to hold three more hearings that year: Los Angeles on 10 June, Kansas City, Missouri on 10–11 July, and Washington, D.C., on 8–11 October.<ref name="Pentney_2001" /><ref name="Eisner" />

Sensational media attention was given to the proposed criminalization and the reaction of MDMA proponents, effectively advertising the drug.<ref name="Pentney_2001" /> In response to the proposed scheduling, the Texas Group increased production from 1985 estimates of 30,000 tablets a month to as many as 8,000 per day, potentially making two million ecstasy tablets in the months before MDMA was made illegal.<ref name=comprehensive>{{cite book | vauthors = Holland J | veditors = Holland J | chapter = The History of MDMA | title = Ecstasy: the complete guide; a comprehensive look at the risks and benefits of MDMA | location = Rochester, VT | date = 2001 | publisher = Park Street Press | isbn = 978-0-89281-857-0 }}</ref> By some estimates the Texas Group distributed 500,000 tablets per month in Dallas alone.<ref name="Jennings_2004" /> According to one participant in an [[ethnographic]] study, the Texas Group produced more MDMA in eighteen months than all other distribution networks combined across their entire histories.<ref name="Beck & Rosenbaum"/> By May 1985, MDMA use was widespread in California, Texas, southern Florida, and the northeastern United States.<ref name="Siegel 1986"/><ref name="New York Times"/> According to the DEA there was evidence of use in twenty-eight states<ref>{{cite web | title = MDMA – FDA REPORT, 1985 | date = 1985 | url = https://www.erowid.org/chemicals/mdma/mdma_law3.shtml | website = Erowid | publisher = Food and Drug Administration | access-date = 11 August 2015 | archive-date = 11 August 2015 | archive-url = https://web.archive.org/web/20150811142554/https://www.erowid.org/chemicals/mdma/mdma_law3.shtml | url-status = live }}</ref> and Canada.<ref name="Siegel 1986"/> Urged by Senator [[Lloyd Bentsen]], the DEA announced an [[Comprehensive Crime Control Act of 1984|emergency Schedule I classification]] of MDMA on 31 May 1985. The agency cited increased distribution in Texas, escalating street use, and new evidence of MDA (an analog of MDMA) neurotoxicity as reasons for the emergency measure.<ref name="New York Times">{{cite news | title = U.S. will ban 'ecstasy,' a hallucinogenic drug | date = 1 June 1985 | url = https://www.nytimes.com/1985/06/01/us/us-will-ban-ecstasy-a-hallucinogenic-drug.html | newspaper = The New York Times | access-date = 29 April 2015 | agency = The Associated Press | archive-date = 24 May 2015 | archive-url = https://web.archive.org/web/20150524161818/http://www.nytimes.com/1985/06/01/us/us-will-ban-ecstasy-a-hallucinogenic-drug.html | url-status = live }}</ref><ref>{{cite news | vauthors = Baker K | title = DEA To Ban "Ecstasy" – The Drug MDMA | date = 30 May 1985 | url = https://apnews.com/26214cd32a8b4c05e361158df14715b0 | access-date = 7 August 2015 | agency = The Associated Press | archive-date = 31 August 2018 | archive-url = https://web.archive.org/web/20180831174744/https://apnews.com/26214cd32a8b4c05e361158df14715b0 | url-status = live }}</ref><ref>{{cite news | vauthors = Corwin M | title = U.S. to Ban Use of Drug MDMA: Street Abuse Cited; Used by Psychiatrists | date = 31 May 1985 | url = https://www.latimes.com/archives/la-xpm-1985-05-31-mn-14566-story.html | access-date = 11 August 2015 | newspaper = Los Angeles Times | archive-date = 17 November 2015 | archive-url = https://web.archive.org/web/20151117032749/http://articles.latimes.com/1985-05-31/news/mn-14566_1_street-drugs | url-status = live }}</ref> The ban took effect one month later on 1 July 1985<ref name="comprehensive" /> in the midst of [[Nancy Reagan]]'s "[[Just Say No]]" campaign.<ref>{{cite news | vauthors = Weber B | title = Alexander Shulgin, Psychedelia Researcher, Dies at 88 | date = 7 June 2014 | url = https://www.nytimes.com/2014/06/08/us/alexander-shulgin-psychedelia-researcher-dies-at-88.html?_r=0 | access-date = 28 August 2015 | work = The New York Times | archive-date = 5 September 2015 | archive-url = https://web.archive.org/web/20150905200423/http://www.nytimes.com/2014/06/08/us/alexander-shulgin-psychedelia-researcher-dies-at-88.html?_r=0 | url-status = live }}</ref><ref>{{cite news | vauthors = Vastag B | title = Chemist Alexander Shulgin, popularizer of the drug Ecstasy, dies at 88 | date = 3 June 2014 | url = https://www.washingtonpost.com/national/health-science/chemist-alexander-shulgin-popularizer-of-the-drug-ecstasy-dies-at-88/2014/06/03/19fd9580-eb34-11e3-b98c-72cef4a00499_story.html | access-date = 28 August 2015 | newspaper = The Washington Post | publisher = WP Company LLC | archive-date = 5 August 2015 | archive-url = https://web.archive.org/web/20150805104454/http://www.washingtonpost.com/national/health-science/chemist-alexander-shulgin-popularizer-of-the-drug-ecstasy-dies-at-88/2014/06/03/19fd9580-eb34-11e3-b98c-72cef4a00499_story.html | url-status = live }}</ref>

As a result of several expert witnesses testifying that MDMA had an accepted medical usage, the administrative law judge presiding over the hearings recommended that MDMA be classified as a [[Controlled Substances Act#Schedule III controlled substances|Schedule III]] substance. Despite this, DEA administrator [[John C. Lawn]] overruled and classified the drug as Schedule I.<ref name="Pentney_2001" /><ref name=Harpers>{{cite news | title = Ecstasy has its pros and cons | location = Kokomo, Indiana | page = 6 | date = 23 November 1985 | newspaper = Kokomo Tribune | url = https://newspaperarchive.com/profile/Robert_Thomas/clipnumber/34618/ | agency = Harper's Bazaar | via = newspaperarchive.com | access-date = 9 September 2017 | archive-date = 28 August 2021 | archive-url = https://web.archive.org/web/20210828153542/https://newspaperarchive.com/profile/robert-thomas-512557/ | url-status = live }} {{free access}}</ref> Harvard psychiatrist [[Lester Grinspoon]] then sued the DEA, claiming that the DEA had ignored the medical uses of MDMA, and the federal court sided with Grinspoon, calling Lawn's argument "strained" and "unpersuasive", and vacated MDMA's Schedule I status.<ref>{{cite web | title = Lester Grinspoon, M.d., Petitioner, v. Drug Enforcement Administration, Respondent, 828 F.2d 881 (1st Cir. 1987) | url = https://law.justia.com/cases/federal/appellate-courts/F2/828/881/368975/ | website = Justia Law | publisher = US Court of Appeals for the First Circuit | access-date = 9 October 2021 | archive-date = 9 October 2021 | archive-url = https://web.archive.org/web/20211009212855/https://law.justia.com/cases/federal/appellate-courts/F2/828/881/368975/ | url-status = live }}</ref> Despite this, less than a month later Lawn reviewed the evidence and reclassified MDMA as Schedule I again, claiming that the expert testimony of several psychiatrists claiming over 200 cases where MDMA had been used in a therapeutic context with positive results could be dismissed because they were not published in medical journals.<ref name="Pentney_2001" /> In 2017, the FDA [[#Research|granted]] [[breakthrough therapy]] designation for its use with psychotherapy for PTSD. However, this designation has been questioned and problematized.<ref name="Halvorsen 1689–1690">{{cite journal | vauthors = Halvorsen JØ, Naudet F, Cristea IA | title = Challenges with benchmarking of MDMA-assisted psychotherapy | journal = Nature Medicine | volume = 27 | issue = 10 | pages = 1689–1690 | date = October 2021 | pmid = 34635857 | doi = 10.1038/s41591-021-01525-0 | s2cid = 238636360 | url = https://hal.archives-ouvertes.fr/hal-03414583/file/Halvorsen%20et%20al%20-%202021%20-%20Challenges%20with%20benchmarking%20of%20MDMA-assisted%20psychotherapy.pdf | access-date = 9 May 2022 | archive-date = 22 May 2022 | archive-url = https://web.archive.org/web/20220522022351/https://hal.archives-ouvertes.fr/hal-03414583/file/Halvorsen%20et%20al%20-%202021%20-%20Challenges%20with%20benchmarking%20of%20MDMA-assisted%20psychotherapy.pdf | url-status = live }}</ref>

====United Nations====
While engaged in scheduling debates in the United States, the DEA also pushed for international scheduling.<ref name="comprehensive" /> In 1985, the [[World Health Organization]]'s Expert Committee on Drug Dependence recommended that MDMA be placed in Schedule I of the 1971 United Nations [[Convention on Psychotropic Substances]]. The committee made this recommendation on the basis of the pharmacological similarity of MDMA to previously scheduled drugs, reports of illicit trafficking in Canada, drug seizures in the United States, and lack of well-defined therapeutic use. While intrigued by reports of psychotherapeutic uses for the drug, the committee viewed the studies as lacking appropriate methodological design and encouraged further research. Committee chairman [[Paul Grof]] dissented, believing international control was not warranted at the time and a recommendation should await further therapeutic data.<ref>{{cite book | title = WHO Expert Committee on Drug Dependence: Twenty-second Report. | location = Geneva | pages = 24–25 | date = 1985 | publisher = World Health Organization | url = http://whqlibdoc.who.int/trs/WHO_TRS_729.pdf | access-date = 29 August 2012 | archive-url = https://web.archive.org/web/20141019192225/http://whqlibdoc.who.int/trs/WHO_TRS_729.pdf | archive-date = 19 October 2014 }}</ref> The [[Commission on Narcotic Drugs]] added MDMA to Schedule I of the convention on 11 February 1986.<ref>{{cite web | title = Decision to place MDMA into Schedule I | date = 11 February 1986 | url = http://www.unodc.org/documents/commissions/CND/Drug_Resolutions/1980-1989/1986/CND_Decision-1986-07_S-IX.pdf | publisher = Commission on Narcotic Drugs | website = UNODC | access-date = 9 May 2015 | archive-date = 22 September 2015 | archive-url = https://web.archive.org/web/20150922000603/http://www.unodc.org/documents/commissions/CND/Drug_Resolutions/1980-1989/1986/CND_Decision-1986-07_S-IX.pdf | url-status = live }}</ref>

===Post-scheduling===
[[File:1995-04-08 Vibe Tribe 09 (10937582).jpg|thumb|A 1995 Vibe Tribe rave in [[Erskineville, New South Wales]], Australia being broken up by police. MDMA use spread globally along with rave culture.]]
[[File:Ecstasy - Is it Really the Dream Drug.ogv|thumb|A 2000 [[United States Air Force]] video dramatizing the dangers of MDMA misuse]]

The use of MDMA in Texas clubs declined rapidly after criminalization, but by 1991, the drug became popular among young middle-class whites and in nightclubs.<ref name="Beck & Rosenbaum"/> In 1985, MDMA use became associated with [[acid house]] on the Spanish island of [[Ibiza]].<ref name="Beck & Rosenbaum"/>{{rp|50}}<ref>{{cite news | vauthors = McKinley JC | title = Overdoses of 'Molly' Led to Electric Zoo Deaths | date = 12 September 2013 | url = http://artsbeat.blogs.nytimes.com/2013/09/12/overdoses-of-molly-led-to-electric-zoo-deaths/?_r=0 | access-date = 9 December 2013 | newspaper = The New York Times | archive-date = 4 December 2013 | archive-url = https://web.archive.org/web/20131204085710/http://artsbeat.blogs.nytimes.com/2013/09/12/overdoses-of-molly-led-to-electric-zoo-deaths/?_r=0 | url-status = live }}</ref> Thereafter, in the late 1980s, the drug spread alongside [[rave culture]] to the United Kingdom and then to other European and American cities.<ref name="Beck & Rosenbaum"/>{{rp|50}} Illicit MDMA use became increasingly widespread among young adults in universities and later, in high schools. Since the mid-1990s, MDMA has become the most widely used amphetamine-type drug by college students and teenagers.<ref name="Goldfrank 2011">{{cite book | vauthors = Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE | title = Goldfrank's toxicologic emergencies | location = New York | date = 2011 | publisher = McGraw-Hill Medical | isbn = 978-0-07-160593-9 | edition = 9th }}</ref>{{rp|1080}} MDMA became one of the four most widely used illicit drugs in the US, along with [[cocaine]], [[heroin]], and [[Cannabis (drug)|cannabis]].<ref name="Jennings_2004">{{cite news | vauthors = Jennings P | title = Ecstasy Rising | issue = Special edition | date = 1 April 2004 | author-link1 = Peter Jennings | work = Primetime Thursday | publisher = ABC News | url = http://www.thedocumentarygroup.com/PJP/Transcripts%20Files/Script_Ecstasy.doc | archive-url = https://web.archive.org/web/20150527163756/http://www.thedocumentarygroup.com/PJP/Transcripts%20Files/Script_Ecstasy.doc | archive-date = 27 May 2015 }}</ref> According to some estimates as of 2004, only marijuana attracts more first time users in the United States.<ref name="Jennings_2004" />

After MDMA was criminalized, most medical use stopped, although some therapists continued to prescribe the drug illegally. Later,{{when|date=January 2015}} Charles Grob initiated an ascending-dose safety study in healthy volunteers. Subsequent FDA-approved MDMA studies in humans have taken place in the United States in Detroit ([[Wayne State University]]), Chicago ([[University of Chicago]]), San Francisco (UCSF and [[California Pacific Medical Center]]), [[Baltimore]] ([[National Institute on Drug Abuse|NIDA]]–[[NIH]] Intramural Program), and [[South Carolina]]. Studies have also been conducted in Switzerland (University Hospital of Psychiatry, [[Zürich]]), the Netherlands ([[Maastricht University]]), and Spain ([[Universitat Autònoma de Barcelona]]).<ref>{{cite web | title = Bibliography of Psychedelic Research Studies. | location = Santa Cruz, CA | url = http://www.maps.org/research/ | work = Multidisciplinary Association for Psychedelic Studies (MAPS) | archive-url = https://web.archive.org/web/20131203011733/http://www.maps.org/research/ | archive-date = 3 December 2013 }}</ref>

"Molly", short for 'molecule', was recognized as a slang term for crystalline or powder MDMA in the 2000s.<ref>{{cite web | vauthors = James SD | title = What Is Molly and Why Is It Dangerous? | date = 23 February 2015 | url = https://www.nbcnews.com/health/health-news/what-molly-why-it-dangerous-n311291 | publisher = NBCNews.com | access-date = 23 February 2015 | quote = Why is it called Molly? That's short for "molecule." "You can put a ribbon and bow on it and call it a cute name like 'Molly' and people are all in," said Paul Doering, professor emeritus of pharmacology at the University of Florida. | archive-date = 24 February 2015 | archive-url = https://web.archive.org/web/20150224063219/http://www.nbcnews.com/health/health-news/what-molly-why-it-dangerous-n311291 | url-status = live }}</ref><ref>{{cite news | vauthors = Aleksander I | title = Molly: Pure, but Not So Simple | date = 21 June 2013 | url = https://www.nytimes.com/2013/06/23/fashion/molly-pure-but-not-so-simple.html | archive-url = https://ghostarchive.org/archive/20220101/https://www.nytimes.com/2013/06/23/fashion/molly-pure-but-not-so-simple.html | archive-date = 2022-01-01 | url-access = limited | access-date = 24 February 2015 | work = The New York Times }}{{cbignore}}</ref>

In 2010, the BBC reported that use of MDMA had decreased in the UK in previous years. This may be due to increased seizures during use and decreased production of the precursor chemicals used to manufacture MDMA. Unwitting substitution with other drugs, such as [[mephedrone]] and [[methamphetamine]],<ref>{{cite news | title = Mephedrone (4-Methylmethcathinone) appearing in "Ecstasy" in the Netherlands | date = 19 September 2010 | url = http://scientopia.org/blogs/drugmonkey/2010/09/19/mephedrone-4-methylmethcathinone-appearing-in-ecstasy-in-the-netherlands/ | access-date = 31 December 2012 | archive-date = 5 November 2012 | archive-url = https://web.archive.org/web/20121105125943/http://scientopia.org/blogs/drugmonkey/2010/09/19/mephedrone-4-methylmethcathinone-appearing-in-ecstasy-in-the-netherlands/ }}</ref> as well as legal alternatives to MDMA, such as [[Benzylpiperazine|BZP]], [[Methylenedioxypyrovalerone|MDPV]], and [[methylone]], are also thought to have contributed to its decrease in popularity.<ref>{{cite news | title = Why ecstasy is 'vanishing' from UK nightclubs | date = 19 January 2010 | url = https://news.bbc.co.uk/2/hi/uk_news/england/london/8468372.stm | work = BBC News | access-date = 14 February 2010 | archive-date = 7 September 2017 | archive-url = https://web.archive.org/web/20170907220833/http://news.bbc.co.uk/1/hi/england/london/8468372.stm | url-status = live }}</ref>

In 2017, it was found that some pills being sold as MDMA contained [[pentylone]], which can cause very unpleasant agitation and paranoia.<ref>{{cite journal | vauthors = Bish J | title = Watch Out for Pentylone, the Horrible New MDMA Additive | journal = Vice | date = Aug 4, 2017 | url = https://www.vice.com/en/article/watch-out-for-pentylone-the-horrible-new-mdma-additive/ | access-date = 31 May 2018 | archive-date = 1 September 2020 | archive-url = https://web.archive.org/web/20200901064627/https://www.vice.com/en_uk/article/pagjxg/watch-out-for-pentylone-the-horrible-new-mdma-additive | url-status = live }}</ref>

According to [[David Nutt]], when [[safrole]] was restricted by the United Nations in order to reduce the supply of MDMA, producers in China began using [[anethole]] instead, but this gives [[para-methoxyamphetamine]] (PMA, also known as "Dr Death"), which is much more toxic than MDMA and can cause overheating, muscle spasms, seizures, unconsciousness, and death. People wanting MDMA are sometimes sold PMA instead.<ref name="Nutt">{{cite web | title = Ecstasy on Prescription | date = 29 May 2018 | url = https://www.bbc.co.uk/programmes/w3cswgvh | work = BBC Business Daily | access-date = 10 July 2021 | archive-date = 10 July 2021 | archive-url = https://web.archive.org/web/20210710093100/https://www.bbc.co.uk/programmes/w3cswgvh | url-status = live }}</ref>

In 2025, the BBC reported on a study of 650 survivors from the [[Nova music festival massacre]]. Two-thirds were under the influence of recreational drugs (MDMA, LSD, marijuana or psilocybin) when [[Hamas]] attacked the festival on [[October 7 attacks|October 7, 2023]]. MDMA appeared to have a protective effect against later problems with sleeping and emotional distress.<ref name="Williamson_2025">{{cite web | vauthors = Williamson L | title = MDMA may have protected Nova attack survivors from trauma, study suggests | date = 2025-03-07 | url = https://www.bbc.com/news/articles/c9wpy14wyd0o | access-date = 2025-03-16 | website = BBC Home }}</ref><ref name="Burns_2025">{{cite web | vauthors = Burns B | title = MDMA and LSD may have helped October 7 survivors | date = 2025-03-08 | url = https://www.news.com.au/world/middle-east/lsd-mdma-party-drugs-may-have-helped-survivors-of-october-7-attack-study-claims/news-story/361e7726844087d6d023f010bccf1c48 | access-date = 2025-03-16 | website = news.com.au }}</ref>

==Society and culture==
{{Global estimates of illicit drug users}}

===Legal status===
MDMA is legally controlled in most of the world under the UN [[Convention on Psychotropic Substances]] and other international agreements, although exceptions exist for research and limited medical use. In general, the unlicensed use, sale or manufacture of MDMA are all criminal offences.

====Australia====
In Australia, MDMA was rescheduled on 1 July 2023 as a schedule 8 substance (available on prescription) when used in the treatment of PTSD, while remaining a schedule 9 substance (prohibited) for all other uses. For the treatment of PTSD, MDMA can only be prescribed by psychiatrists with specific training and authorisation.<ref>{{cite news | title = MDMA and psilocybin: What GPs need to know | url = https://www1.racgp.org.au/newsgp/gp-opinion/mdma-and-psilocybin-what-gps-need-to-know#:~:text=It%20means%20psilocybin%20and%20MDMA,restricts%20supply%20to%20clinical%20trials. | newspaper = Newsgp | access-date = 2023-06-13 | archive-date = 13 June 2023 | archive-url = https://web.archive.org/web/20230613073443/https://www1.racgp.org.au/newsgp/gp-opinion/mdma-and-psilocybin-what-gps-need-to-know#:~:text=It%20means%20psilocybin%20and%20MDMA,restricts%20supply%20to%20clinical%20trials. | url-status = live }}</ref>
In 1986, MDMA was declared an illegal substance because of its allegedly harmful effects and potential for misuse.<ref>{{Cite web | vauthors = Bedi G | title = Is psychiatry ready for medical MDMA? | date = 2018-03-29 | url = http://theconversation.com/is-psychiatry-ready-for-medical-mdma-94105 | access-date = 2024-04-12 | website = The Conversation | language = en-US | archive-date = 4 January 2023 | archive-url = https://web.archive.org/web/20230104131905/https://theconversation.com/is-psychiatry-ready-for-medical-mdma-94105 | url-status = live }}</ref> Any non-authorised sale, use or manufacture is strictly prohibited by law. Permits for research uses on humans must be approved by a recognized [[National Health and Medical Research Council|ethics committee]] on human research.

In [[Western Australia]] under the Misuse of Drugs Act 1981 4.0g of MDMA is the amount required determining a court of trial, 2.0g is considered a presumption with intent to sell or supply and 28.0g is considered trafficking under Australian law.<ref>{{cite web | title = Misuse of Drugs Act 1981 | date = 23 October 1981 | url = https://www.slp.wa.gov.au/legislation/statutes.nsf/main_mrtitle_4607_homepage.html | publisher = The Government of Western Australia | agency = Department of the Premier and Cabinet | access-date = 22 July 2016 | archive-date = 18 August 2016 | archive-url = https://web.archive.org/web/20160818132249/https://www.slp.wa.gov.au/legislation/statutes.nsf/main_mrtitle_4607_homepage.html | url-status = live }}</ref>

The [[Australian Capital Territory]] passed legislation to decriminalise the possession of small amounts of MDMA, which took effect in October 2023.<ref>{{cite news | title = ACT government decriminalises small amounts of illicit drugs including speed, heroin and cocaine | date = 20 October 2022 | url = https://www.abc.net.au/news/2022-10-20/act-decriminalises-small-amounts-of-illicit-drugs-heroin-cocaine/101552008 | website = ABC News | publisher = Australian Broadcasting Corporation | access-date = 2023-06-13 | archive-date = 13 June 2023 | archive-url = https://web.archive.org/web/20230613074529/https://www.abc.net.au/news/2022-10-20/act-decriminalises-small-amounts-of-illicit-drugs-heroin-cocaine/101552008 | url-status = live }}</ref><ref name="Roy 2023">{{cite web | vauthors = Roy T | title = The ACT has today decriminalised small amounts of some illicit drugs. But what does that mean? | date = 27 October 2023 | website = ABC News | url = https://www.abc.net.au/news/2023-10-28/canberra-drug-decriminalisation-laws-begin-today/103032128 | access-date = 7 June 2024 }}</ref>

====Canada====
In Canada, MDMA is listed as a [[Controlled Drugs and Substances Act#Schedule I|Schedule 1]]<ref name="CDSA Schedule I: Amphetamines">{{cite web | title = Schedule I | url = http://isomerdesign.com/Cdsa/schedule.php?schedule=1&section=18.5&structure=C | work = Controlled Drugs and Substances Act | publisher = Isomer Design | access-date = 9 December 2013 | archive-date = 10 November 2013 | archive-url = https://web.archive.org/web/20131110200556/http://isomerdesign.com/Cdsa/schedule.php?schedule=1&section=18.5&structure=C }}</ref> as it is an analogue of amphetamine.<ref name="Definitions and Interpretations">{{cite web | title = Definitions and interpretations | url = http://isomerdesign.com/Cdsa/definitions.php?structure=C | work = Controlled Drugs and Substances Act | publisher = Isomer Design | access-date = 9 December 2013 | archive-date = 10 November 2013 | archive-url = https://web.archive.org/web/20131110213450/http://isomerdesign.com/Cdsa/definitions.php?structure=C }}</ref> The [[Controlled Drugs and Substances Act]] was updated as a result of the [[Safe Streets and Communities Act]] changing amphetamines from [[Controlled Drugs and Substances Act#Schedule III|Schedule III]] to Schedule I in March 2012. In 2022, the federal government granted [[British Columbia]] a 3-year exemption, legalizing the possession of up to {{Convert|2.5|g|oz}} of MDMA in the province from February 2023 until February 2026.<ref>{{Cite web | title = Decriminalizing people who use drugs in B.C. | url = https://www2.gov.bc.ca/gov/content/overdose/decriminalization | access-date = 2023-03-08 | website = Government of BC | publisher = Government Communications and Public Engagement | archive-date = 9 March 2023 | archive-url = https://web.archive.org/web/20230309091348/https://www2.gov.bc.ca/gov/content/overdose/decriminalization | url-status = live }}</ref><ref>{{Cite news | title = B.C. recorded 211 toxic drug deaths — almost 7 a day — in January, coroner reports | date = March 7, 2023 | work = [[CBC.ca]] | url = https://www.cbc.ca/news/canada/british-columbia/bc-toxic-drugs-deaths-january-2023-1.6770643 | access-date = March 8, 2023 | archive-date = 8 March 2023 | archive-url = https://web.archive.org/web/20230308231034/https://www.cbc.ca/news/canada/british-columbia/bc-toxic-drugs-deaths-january-2023-1.6770643 | url-status = live }}</ref>

====Finland====
Scheduled in the "government decree on substances, preparations and plants considered to be narcotic drugs".<ref>{{cite web | title = Valtioneuvoston asetus huumausaineina pidettävistä aineista, valmisteista ja kasveista &#124; 543/2008 &#124; Lainsäädäntö &#124; Finlex | url = https://www.finlex.fi/fi/lainsaadanto/2008/543 }}</ref> Ecstasy is considered a very dangerous illegal drug.<ref>{{cite web | title = KKO:2005:56 &#124; 11.5.2005 &#124; Ennakkopäätökset &#124; Korkein oikeus &#124; Finlex | url = https://finlex.fi/fi/oikeuskaytanto/korkein-oikeus/ennakkopaatokset/2005/56 }}</ref>

====Netherlands====
In 2024, a Dutch state commission issued a report advocating for MDMA to be made available to patients with PTSD.<ref>{{Cite web | vauthors = Zaken MV | title = MDMA /// Beyond Ecstasy - Report - Government.nl | date = 2024-05-31 | url = https://www.government.nl/documents/reports/2024/05/31/mdma-beyond-ecstasy | access-date = 2025-04-06 | website = www.government.nl | language = en-GB }}</ref>

In June 2011, the Expert Committee on the List (Expertcommissie Lijstensystematiek Opiumwet) issued a report which discussed the evidence for harm and the legal status of MDMA, arguing in favor of maintaining it on List I.<ref name="Hennig_2014" /><ref>{{cite web | title = Rapport Drugs in Lijsten | date = 27 June 2011 | url = http://www.rijksoverheid.nl/documenten-en-publicaties/rapporten/2011/06/27/rapport-drugs-in-lijsten.html | archive-url = https://web.archive.org/web/20120306112130/http://www.rijksoverheid.nl/documenten-en-publicaties/rapporten/2011/06/27/rapport-drugs-in-lijsten.html | archive-date = 6 March 2012 | work = Rijksoverheid.nl | access-date = 29 August 2012 }}</ref><ref>{{cite web | title = Committee: the current system of the Opium Act does not have to be changed | date = 24 June 2011 | url = http://www.government.nl/documents-and-publications/press-releases/2011/06/24/committee-the-current-system-of-the-opium-act-does-not-have-to-be-changed.html | website = government.nl | access-date = 29 August 2012 | archive-date = 29 April 2012 | archive-url = https://web.archive.org/web/20120429071421/http://www.government.nl/documents-and-publications/press-releases/2011/06/24/committee-the-current-system-of-the-opium-act-does-not-have-to-be-changed.html }}</ref>

====United Kingdom====
In the United Kingdom, MDMA was made illegal in 1977 by a modification order to the existing [[Misuse of Drugs Act 1971]]. Although MDMA was not named explicitly in this legislation, the order extended the definition of Class A drugs to include various ring-substituted phenethylamines.<ref name="Drugs 2.0">{{cite book | vauthors = Power M | title = Drugs 2.0: the web revolution that's changing how the world gets high | location = London | date = 2013 | publisher = Portobello | isbn = 978-1-84627-459-6 | url = https://books.google.com/books?id=gj6zMQEACAAJ&q=Drugs+2.0 | format = epub file }}</ref><ref name="UK legality">{{cite web | title = Misuse of Drugs Act 1971 | date = 5 January 1998 | url = http://www.statutelaw.gov.uk/content.aspx?LegType=All+Primary&PageNumber=57&NavFrom=2&parentActiveTextDocId=1367412&ActiveTextDocId=1367472&filesize=411 | work = Statutelaw.gov.uk | access-date = 11 June 2011 | archive-date = 28 August 2021 | archive-url = https://web.archive.org/web/20210828153546/https://www.legislation.gov.uk/ukpga/1971/38/schedule/2/part/I/2003-04-01?timeline=true | url-status = live }}</ref> The drug is therefore illegal to sell, buy, or possess without a licence in the UK. Penalties include a maximum of seven years and/or unlimited fine for possession; life and/or unlimited fine for production or trafficking.

Some researchers such as [[David Nutt]] have criticized the scheduling of MDMA, which he determined to be a relatively harmless drug.<ref>{{Cite news | vauthors = Hope C | title = Ecstasy 'no more dangerous than horse riding' | date = 7 February 2009 | url = https://www.telegraph.co.uk/news/uknews/law-and-order/4537874/Ecstasy-no-more-dangerous-than-horse-riding.html | website = Telegraph.co.uk | access-date = 4 December 2015 | archive-date = 10 December 2015 | archive-url = https://web.archive.org/web/20151210201615/http://www.telegraph.co.uk/news/uknews/law-and-order/4537874/Ecstasy-no-more-dangerous-than-horse-riding.html | url-status = live }}</ref><ref>{{cite journal | vauthors = Nutt DJ | title = Equasy-- an overlooked addiction with implications for the current debate on drug harms | journal = Journal of Psychopharmacology | location = Oxford, England | volume = 23 | issue = 1 | pages = 3–5 | date = January 2009 | pmid = 19158127 | doi = 10.1177/0269881108099672 | s2cid = 32034780 }}</ref> An editorial he wrote in the ''[[Journal of Psychopharmacology]]'', where he compared the risk of harm for [[Horse Riding|horse riding]] (1 adverse event in 350) to that of ecstasy (1 in 10,000) resulted in his dismissal, leading to the resignation of several of his colleagues from the [[Advisory Council on the Misuse of Drugs|ACMD]].<ref name="Johnson_2009">{{cite news | vauthors = Johnson A | title = Why Professor David Nutt was shown the door | location = London | date = 2 November 2009 | url = https://www.theguardian.com/politics/2009/nov/02/drug-policy-alan-johnson-nutt | newspaper = The Guardian | access-date = 3 November 2009 | archive-date = 18 January 2014 | archive-url = https://web.archive.org/web/20140118223546/http://www.theguardian.com/politics/2009/nov/02/drug-policy-alan-johnson-nutt | url-status = live }}</ref>

====United States====
In the United States, MDMA is listed in [[Controlled Substances Act#Schedule I controlled substances|Schedule I]] of the [[Controlled Substances Act]].<ref>''Schedules of Controlled Substances; Scheduling of 3,4-Methylenedioxymethamphetamine (MDMA) Into Schedule I of the Controlled Substances Act; Remand'', 53 Fed. Reg. 5,156 (DEA 22 February 1988).</ref> In a 2011 federal court hearing, the [[American Civil Liberties Union]] successfully argued that the sentencing guideline for MDMA/ecstasy is based on outdated science, leading to excessive prison sentences.<ref>{{cite web | title = Court Rejects Harsh Federal Drug Sentencing Guideline as Scientifically Unjustified | date = 15 July 2011 | url = https://www.aclu.org/criminal-law-reform/court-rejects-harsh-federal-drug-sentencing-guideline-scientifically-unjustified | work = American Civil Liberties Union | access-date = 29 August 2012 | archive-date = 14 March 2014 | archive-url = https://web.archive.org/web/20140314210920/https://www.aclu.org/criminal-law-reform/court-rejects-harsh-federal-drug-sentencing-guideline-scientifically-unjustified | url-status = live }}</ref> Other courts have upheld the sentencing guidelines. The [[United States District Court for the Eastern District of Tennessee]] explained its ruling by noting that "an individual federal district court judge simply cannot marshal resources akin to those available to the Commission for tackling the manifold issues involved with determining a proper drug equivalency."<ref name="Hennig_2014">{{Cite journal | vauthors = Hennig AC | title = An Examination of Federal Sentencing Guidelines' Treatment of MDMA ('Ecstasy') | journal = Belmont Law Review | volume = 1 | page = 267 | year = 2014 | ssrn = 2481227 }}</ref>

===Demographics===
[[File:UNODC 2016 World Drug Report use of ecstasy in 2014 (page 1 crop).jpg|class=skin-invert-image|upright=1.5|thumb|UNODC map showing the use of ecstasy by country in 2014 for the global population aged 15–64]]

In 2014, 3.5% of 18-to-25-year-olds had used MDMA in the United States.<ref name="Betzler_2017" /> In the European Union as of 2018, 4.1% of adults (15–64 years old) have used MDMA at least once in their life, and 0.8% had used it in the last year.<ref name="European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)">{{Cite web | title = Statistical Bulletin 2018 —{{nbsp}}prevalence of drug use|url=http://www.emcdda.europa.eu/data/stats2018/gps_en|publisher=European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)|access-date=2019-02-05|archive-date=31 December 2018|archive-url=https://web.archive.org/web/20181231102708/http://www.emcdda.europa.eu/data/stats2018/gps_en|url-status=live}}</ref> Among young adults, 1.8% had used MDMA in the last year.<ref name="European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)" />

In Europe, an estimated 37% of regular club-goers aged 14 to 35 used MDMA in the past year according to the 2015 European Drug report.<ref name="Betzler_2017" /> The highest one-year prevalence of MDMA use in Germany in 2012 was 1.7% among people aged 25 to 29 compared with a population average of 0.4%.<ref name="Betzler_2017" /> Among adolescent users in the United States between 1999 and 2008, girls were more likely to use MDMA than boys.<ref>{{cite journal | vauthors = Wu P, Liu X, Pham TH, Jin J, Fan B, Jin Z | title = Ecstasy use among US adolescents from 1999 to 2008 | journal = Drug and Alcohol Dependence | volume = 112 | issue = 1–2 | pages = 33–38 | date = November 2010 | pmid = 20570447 | pmc = 2967577 | doi = 10.1016/j.drugalcdep.2010.05.006 }}</ref>

===Economics===
====Europe====
In 2008 the [[European Monitoring Centre for Drugs and Drug Addiction]] noted that although there were some reports of tablets being sold for as little as €1, most countries in Europe then reported typical retail prices in the range of €3 to €9 per tablet, typically containing 25–65{{nbsp}}mg of MDMA.<ref>{{cite book | vauthors = ((European Monitoring Centre for Drugs and Drug Addiction)) | title = Annual report: the state of the drugs problem in Europe | location = Luxembourg | page = 49 | year = 2008 | publisher = Office for Official Publications of the European Communities | isbn = 978-92-9168-324-6 | url = http://www.emcdda.europa.eu/attachements.cfm/att_64227_EN_EMCDDA_AR08_en.pdf | access-date = 1 December 2008 | archive-date = 25 April 2013 | archive-url = https://web.archive.org/web/20130425191815/http://www.emcdda.europa.eu/attachements.cfm/att_64227_EN_EMCDDA_AR08_en.pdf }}</ref> By 2014 the EMCDDA reported that the range was more usually between €5 and €10 per tablet, typically containing 57–102{{nbsp}}mg of MDMA, although MDMA in powder form was becoming more common.<ref>{{cite book | vauthors = ((European Monitoring Centre for Drugs Drug Addiction)) | chapter = Ecstasy: high purity powder available | title = European Drug Report | page = 26 | date = 2014 | doi = 10.2810/32306 | publisher = European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) | url = http://www.emcdda.europa.eu/attachements.cfm/att_228272_EN_TDAT14001ENN.pdf | isbn = 978-92-9168-694-0 | access-date = 4 June 2014 | archive-date = 7 September 2014 | archive-url = https://web.archive.org/web/20140907142119/http://www.emcdda.europa.eu/attachements.cfm/att_228272_EN_TDAT14001ENN.pdf }}</ref>

====North America====
The [[United Nations Office on Drugs and Crime]] stated in its 2014 World Drug Report that US ecstasy retail prices range from US$1 to $70 per pill, or from $15,000 to $32,000 per kilogram.<ref>{{cite web | title = Ecstasy-type substances Retail and wholesale prices* and purity levels, by drug, region and country or territory | url = http://www.unodc.org/documents/wdr2014/Statistics/Prices_ATS.xls | publisher = United Nations Office on Drugs and Crime | access-date = 2 January 2015 | archive-date = 8 December 2015 | archive-url = https://web.archive.org/web/20151208142205/http://www.unodc.org/documents/wdr2014/Statistics/Prices_ATS.xls }}</ref> A new research area named Drug Intelligence aims to automatically monitor distribution networks based on image processing and machine learning techniques, in which an Ecstasy pill picture is analyzed to detect correlations among different production batches.<ref>{{cite journal | vauthors = Camargo J, Esseiva P, González F, Wist J, Patiny L | title = Monitoring of illicit pill distribution networks using an image collection exploration framework | journal = Forensic Science International | volume = 223 | issue = 1–3 | pages = 298–305 | date = November 2012 | pmid = 23107059 | doi = 10.1016/j.forsciint.2012.10.004 | url = http://www.fsijournal.org/article/S0379-0738(12)00458-6/abstract | access-date = 9 December 2013 | archive-date = 28 August 2021 | archive-url = https://web.archive.org/web/20210828153543/http://www.allmallorcahotels.com/fsijournalorg/ | url-status = live | url-access = subscription }}</ref> These novel techniques allow police scientists to facilitate the monitoring of illicit distribution networks.

{{As of|October 2015}}, most of the MDMA in the United States is produced in British Columbia, Canada and imported by Canada-based Asian [[transnational organized crime|transnational criminal organizations]].<ref name="DEA 2015 assessment">{{cite book | chapter = MDMA (3,4-Methylenedioxymethamphetamine) | title = 2015 National Drug Threat Assessment Summary | pages = 85–88 | date = October 2015 | chapter-url = http://www.dea.gov/docs/2015%20NDTA%20Report.pdf | publisher = United States Department of Justice, Drug Enforcement Administration | access-date = 10 April 2016 | archive-date = 10 April 2016 | archive-url = https://web.archive.org/web/20160410100038/http://www.dea.gov/docs/2015%20NDTA%20Report.pdf }}</ref> The market for MDMA in the United States is relatively small compared to [[methamphetamine]], [[cocaine]], and [[heroin]].<ref name="DEA 2015 assessment" /> In the United States, about 0.9 million people used ecstasy in 2010.<ref name="Drugs2014" />

====Australia====
MDMA is particularly expensive in Australia, costing [[Australian dollar|A$]]15–A$30 per tablet. In terms of purity data for Australian MDMA, the average is around 34%, ranging from less than 1% to about 85%. The majority of tablets contain 70–85{{nbsp}}mg of MDMA. Most MDMA enters Australia from the Netherlands, the UK, Asia, and the US.<ref>{{cite web | vauthors = Dillon P | title = 10 years of ecstasy and other party drug use in Australia: What have we done and what is there left to do? | url = http://www.drugtext.org/library/articles/dillon.htm | work = Drugtext.org | archive-url = https://web.archive.org/web/20120209142314/http://www.drugtext.org/library/articles/dillon.htm | archive-date = 9 February 2012 }}</ref>

====Corporate logos on pills====
A number of ecstasy manufacturers brand their pills with a [[logo]], often that of an unrelated corporation.<ref>{{cite web | title = Erowid MDMA Vault: Images | url = https://www.erowid.org/chemicals/mdma/mdma_images.shtml | access-date = 3 March 2016 | archive-date = 6 March 2016 | archive-url = https://web.archive.org/web/20160306030258/https://www.erowid.org/chemicals/mdma/mdma_images.shtml | url-status = live }}</ref> Some pills depict logos of products or media popular with children, such as [[Shaun the Sheep]].<ref>{{cite web | vauthors = Cork T | title = Now sick dealers peddle Shaun the Sheep Ecstasy tablets | date = 31 July 2015 | url = http://www.westerndailypress.co.uk/sick-dealers-peddle-Shaun-Sheep-Ecstasy-tablets/story-27521142-detail/story.html | work = Western Daily Press | access-date = 3 March 2016 | archive-url = https://web.archive.org/web/20150812022920/http://www.westerndailypress.co.uk/sick-dealers-peddle-Shaun-Sheep-Ecstasy-tablets/story-27521142-detail/story.html | archive-date = 12 August 2015 }}</ref>

==Research==
{{See also|List of investigational hallucinogens and entactogens|List of investigational post-traumatic stress disorder drugs|Psychedelic therapy}}

MDMA-assisted psychotherapy shows promising efficacy and a generally tolerable [[Pharmacovigilance|safety profile]] for treating PTSD, with meta-analyses indicating symptom reduction, though careful dosing and controlled therapeutic settings are essential to minimize risks.<ref name=":1">{{cite journal | vauthors = Tedesco S, Gajaram G, Chida S, Ahmad A, Pentak M, Kelada M, Lewis L, Krishnan D, Tran C, Soetan OT, Mukona LT, Jolayemi A | title = The Efficacy of MDMA (3,4-Methylenedioxymethamphetamine) for Post-traumatic Stress Disorder in Humans: A Systematic Review and Meta-Analysis | journal = Cureus | volume = 13 | issue = 5 | article-number = e15070 | date = May 2021 | pmid = 34150406 | pmc = 8207489 | doi = 10.7759/cureus.15070 | doi-access = free }}</ref><ref name=":2">{{cite journal | vauthors = Smith KW, Sicignano DJ, Hernandez AV, White CM | title = MDMA-Assisted Psychotherapy for Treatment of Posttraumatic Stress Disorder: A Systematic Review With Meta-Analysis | journal = Journal of Clinical Pharmacology | volume = 62 | issue = 4 | pages = 463–471 | date = April 2022 | pmid = 34708874 | doi = 10.1002/jcph.1995 }}</ref>{{clear}}

MDMA is being investigated as a potential treatment for social impairments in [[autism]].<ref>{{cite journal | vauthors = Chaliha D, Mamo JC, Albrecht M, Lam V, Takechi R, Vaccarezza M | title = A Systematic Review of the MDMA Model to Address Social Impairment in Autism | journal = Current Neuropharmacology | volume = 19 | issue = 7 | pages = 1101–1154 | date = 2021-07-01 | pmid = 33388021 | pmc = 8686313 | doi = 10.2174/1570159X19666210101130258 }}</ref>

The [[British people|British]] [[critical psychiatrist]] [[Joanna Moncrieff]] has critiqued the use and study of MDMA and related drugs like [[psychedelic drug|psychedelic]]s for treatment of psychiatric disorders, highlighting concerns including excessive hype around these drugs, blurred lines between medical and recreational use, flawed clinical trial findings, financial conflicts of interest, strong expectancy effects and large placebo responses, short-term benefits over placebo, and their potential for adverse effects, among others.<ref name="Moncrieff2025">{{cite book | vauthors = Moncrieff J | chapter=Alternative Approaches: The Good, the Bad and the Worrying: Psychedelics for Depression | title=Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth | publisher=Flint | date=16 January 2025 | isbn=978-1-80399-680-6 | url=https://books.google.com/books?id=e0MkEQAAQBAJ | access-date=16 October 2025 | page=}}</ref>

==See also==
* ''[[I Feel Love: MDMA and the Quest for Connection in a Fractured World]]''
* [[Lykos Therapeutics]]
* [[Multidisciplinary Association for Psychedelic Studies]] (MAPS)

==References==
{{Reflist}}

==External links==
{{Sister project links|b=no|q=Drugs#MDMA|commons=Category:MDMA|wikt=MDMA|voy=no|n=MDMA|s=no|v=no|species=no|mw=no|m=no|d=Q69488}}
* [https://maps.org/mdma/ptsd/mapp2/ A Multi-Site Phase 3 Study of MDMA-Assisted Therapy for PTSD (MAPP2)]
* {{cite web | title = MDMA Facts and Statistics | date = 15 June 2020 | url = https://www.drugabuse.gov/publications/drugfacts/mdma-ecstasymolly | work = National Institute on Drug Abuse }}

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