3,4-Methylenedioxymethamphetamine

MDMA, commonly known as ecstasy or molly, is a synthetic amphetamine derivative with both stimulant and hallucinogenic properties.  As a Schedule I controlled substance in the United States, MDMA is recognized for its high potential for abuse, lack of accepted medical use, and significant safety concerns. 

It promotes the release of serotonin, dopamine, and norepinephrine in the brain, leading to euphoria, emotional warmth, and sensory distortions. 

While MDMA's acute effects include enhanced sociability and well-being, it also poses risks such as increased muscle tension, insomnia, and psychological disturbances. 

Long-term use can result in serotonin neurotoxicity, psychiatric issues, and severe physical health consequences, including liver damage and cardiovascular complications. 

Despite its lower potential for dependence compared to opioids, MDMA's serious toxicity at recreational doses warrants avoidance.

What is MDMA (3,4-Methylenedioxymethamphetamine)?  [1., 4., 7.] 

MDMA, commonly known as ecstasy or molly, is a synthetic amphetamine derivative with the chemical name 3,4-methylenedioxymethamphetamine.  

MDMA is a Schedule I controlled substance under the Controlled Substances Act in the United States, meaning it has a high potential for abuse, no currently accepted medical use, and a lack of accepted safety for use under medical supervision.  [7.] 

It acts as a stimulant and hallucinogen by promoting the release of serotonin, dopamine, and norepinephrine in the brain, producing euphoria, emotional warmth, empathy, and distortions in sensory and time perception. 

Typical recreational doses range from 50-150 mg, with effects lasting 3-6 hours.  [4., 7.] 

Effects of MDMA  [4., 7.] 

Acute Effects of MDMA

Desired acute effects of MDMA use include enhanced wakefulness, energy, endurance, sexual arousal, and sociability, along with a sense of euphoria and well-being.

Undesired acute effects may include increased muscle tension, jaw clenching, increased body temperature, headaches, nausea, blurred vision, insomnia, and fluctuating heart rate and blood pressure. 

Psychological effects include hyperactivity, anxiety, hallucinations, and occasional panic attacks or brief psychotic episodes.

Long Term Effects of MDMA

Long term effects of excessive MDMA use include:

• Serotonin Neurotoxicity: animal studies show significant damage to serotonin neurons after MDMA use. Human studies indicate reduced serotonin levels and altered brain function in long-term users, suggesting potential serotonin neurotoxicity.

• Psychiatric Issues: persistent memory impairment, decision-making difficulties, impulsivity, panic attacks, paranoia, hallucinations, and severe depression.

• Physical Problems: long-lasting issues such as tooth grinding, muscle aches, circulatory problems, and rare cases of neurological lesions like parkinsonism.

Long Term Health Consequences of MDMA Use  [4., 7.] 

MDMA use can lead to significant physical toxicity and fatality. 

Repeated or severe MDMA use can cause liver damage, potentially resulting in liver failure. 

MDMA use can also have serious cardiovascular effects.  Hypertension and tachycardia associated with MDMA use can lead to serious issues such as intracranial hemorrhages and heart failure. 

Cerebrally, hyponatremia caused by excessive water intake and sweating can lead to seizures and brain stem compression.  

Additionally, hyperpyrexia, characterized by high body temperature, can trigger severe conditions like rhabdomyolysis, renal failure, liver damage, and disseminated intravascular coagulation. 

MDMA-related fatalities arise from various causes, including cardiovascular, hepatic, cerebral, and hyperpyrexic events, as well as accidents and suicides.

While MDMA is less likely to cause dependence than opioids, its potential for serious toxicity, even at recreational doses, warrants caution.

MDMA's Impact on the Serotonergic and Dopaminergic Systems  [5., 7.]  

MDMA causes a massive release of serotonin (5-HT) from serotonergic neurons by binding to and reversing the serotonin transporter (SERT), leading to increased extracellular levels of serotonin in the brain.  [5.]

This excessive serotonin release is thought to contribute to MDMA's mood-elevating and euphoric effects.

However, this flood of serotonin also leads to depletion of serotonin stores in the neurons. Research in rodents and primates has shown that moderate to high doses of MDMA can damage serotonergic neurons, leading to reduced numbers of these neurons years after exposure.

MDMA's effects on the serotonin system are associated with negative psychological aftereffects like confusion, depression, anxiety, subclinical psychotic symptoms and memory/attention impairments in regular users. [2., 5.]   Low serotonin levels are associated with these adverse effects.  [5., 7.] 

Just as MDMA affects serotonin levels in the brain, it has also been shown to have effects on dopaminergic systems in the brain, contributing to early feelings of euphoria and neurotoxicity with chronic use.  [3., 5.] 

MDMA also promotes the release of norepinephrine.  

Lab Testing for MDMA 

Test Information, Sample Collection and Preparation

Samples can be collected from blood or urine depending on the specific requirements of the test.  No special preparation is typically required.  

Interpretation of Test Results for MDMA

The presence of MDMA in urine or blood indicates recent use of the drug MDMA.  

Testing MDMA as Part of a Drug Panel

MDMA may be tested as part of a larger drug panel, for research, clinical, or chain-of-custody purposes.  

One example of a screening panel for drugs of abuse can be found here.

Order Testing for MDMA

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