MDMA

MDMA (3,4-methylenedioxymethamphetamine), widely known as the active ingredient in ecstasy, is a central nervous stimulant drug with a chemical structure similar to that of amphetamine. It is currently being tested as a clinical aid in the treatment of post-traumatic stress syndrome (PTSD). MDMA was first synthesized in 1912, but its psychoactive effects were not recognized for several decades, and was for a time used as an aid in conversational therapy in the 1970s. After growing interest in its use as a recreational drug, it was listed as a Schedule I illicit substance by the UN in 1986.

MDMA tends to make users feel comfortable, calm, empathetic, open, and talkative. Hallucinogenic effects may also appear at higher doses. It is usually taken orally (swallowed), but can also be insufflated (sniffed) or taken rectally (plugged). When taken orally, its effects normally last for 4–5 hours, possibly with some delay if taken soon after a meal. Most users report optimal desired effects and minimal side-effects after taking between 80 and 100 mg of pure MDMA. Dosages corresponding to more than 1.5 mg per kg of body weight, as well as total dosages of more than 125 mg at a time, are not recommended. Users trying MDMA for the first time should never take more than 70 mg.

MDMA has a low potential for addiction, but can still be harmful if used too often and/or at high doses. The risk of lethal overdose is very low, but not zero. It is recommended to wait at least 3–4 weeks after each use before taking MDMA again, and to only take 1 or 2 doses each time. Users who take MDMA often are strongly recommended to take a several-month-long break from the drug at regular intervals. Many people experience a noticeable drop in mood and energy a few days after taking MDMA, especially after frequent use, high doses, and/or having overheated during the drug experience.

Please see our 10 general rules for sensible drug use. You should also be mindful of the following:

• Ensure the drug you are taking is actually MDMA. At the very least, use a rapid test kit, and ideally an analytical service like Energy Control.
  
  
• Be careful if you have a diagnosis and/or are taking medications. Check whether any of your medications interact with MDMA. Do NOT take MDMA if:
  
  
  • you are currently taking MAOI-based antidepressants, lithium, or tramadol;
    
    
  • you (or any of your close relatives) have ever experienced malignant hyperthermia or rhabdomyolysis in the past.
    
    
• Never take MDMA in combination with ayahuasca/pharmahuasca/changa, or within a few days of taking ayahauasca/pharmahuasca. Also avoid combining MDMA with any drugs in the 2C-T category.
  
  
• Avoid combining MDMA with other central nervous stimulants like cocaine or amphetamine (speed), and with large amounts of alcohol. Be careful with using MDMA if you consume large amounts of alcohol on a regular basis, as your liver's ability to break down MDMA may be reduced.
  
  
• Never dose MDMA by eye. At the very least, you should use a scale with an accuracy of 0.01 g, that is, one that can distinguish between e.g. 70 and 80 mg (0.07 and 0.08 g, respectively). Ideally, you should use a scale with an accuracy of 0.002 g or lower. If you do not have access to a scale, rather than measuring by eye, you can use volumetric dosing.
  
  
• If you are trying MDMA for the first time, take no more than 70 mg to begin with. If you have an ecstasy pill, dissolve it in water and drink only one-third to begin with. Wait until the drug has kicked in and its effects have stabilized (1–2 hours) before you consider taking more. If you still feel nothing after 2 hours, or if the drug effect feels "wrong" in any way, do NOT take more!
  
  
• Even if you have taken MDMA before, you should avoid taking any more than 1.5 mg per kg of your body weight or more than 125 mg in total. It is safest not to re-dose at all, but if you do, try to keep the total dosage below 2 mg per kg of body weight.
  
  
• If you are female, you should avoid taking a high dose of MDMA. Also, make sure to maintain your salt balance while drinking fluids, e.g. by drinking an isotonic sports drink like Powerade. Avoid all use of MDMA during or shortly after menstruation, as this can increase your risk of overdosing. If you nevertheless decide to take MDMA during or shortly after menstruation, take only half as much as you normally would, and monitor the effects before taking any more.
  
  
• Wait AT LEAST 3–4 weeks between each time you take MDMA. If you have been taking MDMA on a regular basis for some time, you should take a several month-long break from the drug altogether.
  
  
• Do not take MDMA with people you do not trust, and make sure you have someone trustworthy to talk to both during and after the experience. Be prepared that you may need to share or work through some deeply personal and potentially difficult feelings under the effects of MDMA.
  
  
• If you feel an abnormally high body temperature after taking a normal dose of MDMA, try to lower your core temperature by removing any excessive or warm clothing and/or getting some fresh air. If this does not offer any immediate relief, or if the temperature increase happened very suddenly without you having engaged in physical activity or been in a hot environment, CALL AN AMBULANCE. Also call an ambulance right away if you suspect that you or someone else has taken an overdose.
  

We employ a five-step risk scale with values ranging from "very low" to "very high" within six categories: Acute toxicity, Long-term toxicity, Dependence, Cognitive problems, Unpleasant events, and Interactions.

These values are based on qualitative reviews of available knowledge, and should only be viewed as guidelines. They are also relative, so a score of "very low risk" does not mean the substance is risk-free. The scale assumes users are normal, healthy individuals; beware that even drugs which are well-tolerated by most people may nevertheless be harmful to some users. It also assumes normal use patterns; that is, if a given drug is only harmful when used in a certain way, yet is almost never used in that way, then the drug will be considered less harmful compared to a similar drug which is commonly used in a harmful way.


ACUTE TOXICITY

⦿⦿⦾⦾⦾ (Low risk)

It is not known how much MDMA normally constitutes a lethal dose, but deaths from overdose are rare. In The Netherlands, where roughly 380,000 people are estimated to take MDMA in a given year, coronary report studies indicate that seven people in total die of MDMA every year, of which only two died of MDMA alone. However, high doses of MDMA can still be dangerous, especially for people with low body weight or a hypersensitivity to the drug. The risk is particularly high if they are in a hot environment, engaging in physical activity (e.g. dancing) that leads to high body temperature, or drinking a lot of water without any added salts/electrolytes.

There are a few cases of people dying after taking a moderate dose of MDMA. These individuals all got a sudden high fever followed by rhabdomyolysis (muscle tissue death) and organ failure. The common factor in all such cases is suspected to be a rare genetic predisposition to malignant hyperthermia, which also leads to similar complications during general anaesthesia or intense exercise. (This condition is believed to affect between one in 50,000 and one in 5,000 of patients undergoing general anaesthesia, but the genetic predisposition to it may be more widespread than that.) Such reactions require immediate medical treatment, and one should always call an ambulance if someone suddenly becomes very hot after taking MDMA.


LONG-TERM TOXICITY

⦿⦿⦾⦾⦾ (Low risk)

Recreational doses of MDMA appear to be somewhat more toxic than identical doses of amphetamine, although MDMA is probably more safe overall because it is normally not used as frequently as is typical for amphetamine. Very high doses or overdoses can, however, lead to brain damage. Antioxidant supplements may provide some protection against brain toxicity if taken a few hours before as well as during the experience. High doses of MDMA also put high strain on the liver, especially in combination with alcohol. There is a risk of heart problems when engaging in high physical activity (e.g. intense dancing) on MDMA, or if one is predisposed to heart problems in general. Some studies indicate that excessive use of MDMA over time can lead to cardiac fibrosis (thickening of the heart valves) in some people.


DEPENDENCE

⦿⦿⦾⦾⦾ (Low risk)

MDMA is not considered addictive. Users typically do not feel an urge to take the drug again right away, and the hangover effects naturally incline people to take a break from using it. Moreover, MDMA's pleasant effects decline rapidly with frequent use, while unpleasant side-effects increase. Some people may still want to repeat the drug experience more often than is advisable, e.g. because they miss the feeling of closeness to others, or because they find it hard to turn down frequent invitations to take MDMA with friends. (If more than one person in a friend group regularly takes MDMA, it may be wise to plan sessions together in such a way that tempting opportunities do not come up every weekend.)


COGNITIVE PROBLEMS

⦿⦿⦿⦾⦾ (Moderate risk)

MDMA comes with a number of cognitive hangover effects which normally set in a couple of days after use, and last for a day or two. These may include bouts of low mood, low energy, and irritability. Some also experience transient problems with short-term memory and/or long-term memory recall, like the ability to recall specific names or words. Frequent use over a long time, or occasional use of very high doses, can lead to more severe depression for a longer time after use. Hangover effects tend to be less noticeable after the first few times taking MDMA, and in general become more pronounced after each subsequent use. Hangover effects can be reduced to some extent by supplementing 5-HTP and L-tyrosine (the precursors to serotonin and dopamine, respectively) in the days after taking MDMA, but this does not reduce the need for breaks between uses. If one has taken MDMA often for a while, or if the hangover effects seem to be increasing and/or the pleasant effects seem to be decreasing, it is best to take a longer break from the drug altogether of at least a few months. This also helps reduce tolerance build-up, which can help ensure better MDMA experiences in the long run.


UNDESIRABLE EVENTS

⦿⦿⦿⦾⦾ (Moderate risk)

MDMA tends to make users very friendly and empathetic, and most people also become quite relaxed unless combining with other central nervous stimulants. The risk of users becoming violent or aggressive on the drug is thus low. MDMA can, however, make it harder for users to recognize and correctly interpret negative body language in others, which can cause them to misinterpret social situations. MDMA can also impart strong feelings of trust or love towards strangers, which can lead the user to accidentally share sensitive or highly personal details about themselves to people they would not normally trust with such information. The drug can also bring up trauma or difficult memories that need to be talked about and dealt with, which can lead to uncomfortable situations if one is with people who do not know how to handle such situations in a constructive way. MDMA also tends to reduce people's intimate boundaries, and people under the influence of the drug may consent to intimate or sexual situations that they later regret.


INTERACTIONS

⦿⦿⦿⦾⦾ (Moderate risk)

MDMA should never be combined with recreational or medical drugs that significantly inhibit the enzyme monoamine oxidase (MAO), collectively known as monoamine oxidase inhibitors (MAOI). Among recreational drugs, this mainly applies to ayahuasca and certain changa mixtures (in which the psychedelic drug DMT is combined with a MAOI) as well as any drugs in the 2C-T-series. MAOI medications include atypical antidepressants like phenelzine, moclobemide, and selegiline. Combining MDMA with a MAOI can lead to serotonin syndrome, an acute and potentially life-threatening medical emergency resulting from too much serotonin in the brain. Lithium is also believed to trigger serotonin syndrome in combination with MDMA, and there are also cases of lithium causing seizures and greatly exaggerated drug effects in combination with psychedelics.

It was previously assumed that taking MDMA while on SSRI- or SNRI-based andiepressants might also lead to serotonin syndrome, but empirical reports consistently indicate that such combinations in fact greatly reduce the subjective effects of MDMA. This does not mean that one should compensate by taking a higher dose, as this would still be harmful to the body.

MDMA should generally not be taken with other central nervous stimulants, as this combination increases the risk of overheating and brain damage. Users who nevertheless want to try should do so with caution. Combining MDMA and alcohol is also not advisable, since this puts a lot of strain on the liver, making it harder for the body to break down MDMA and thus increasing the risk of overdose. Because MDMA counteracts the effects of central nervous depressants (e.g. alcohol, benzo's), combining MDMA and depressants puts the user at risk of overdosing on the depressant without them noticing, until the MDMA wears off and the full depressant effects suddenly kick in. Users who nevertheless want to try this should therefore monitor and limit their depressant intake. MDMA should not be taken with tramadol, as this may lead to seizures.

Combining MDMA with cannabis does not appear to cause any bodily harm, but may lead to confusion and memory problems ("goldfish memory") during the drug experience, and possibly also psychosis for people who are predisposed thereto.

Combining MDMA with psychedelics or dissociatives is generally not problematic, provided one can normally handle each drug on its own. Dosages should however be reduced in these cases, since the combined effects may be synergistic and lead to a more intense experience than expected. This seems particularly to be the case with 2C-B, which can greatly increase the stimulant effects of MDMA. It is not advisable to take a psychedelic drug (with the notable exception of 2C-B) on the comedown from MDMA, as this can negatively impact the psychedelic experience.

Before taking any drug, it is important to confirm that the substance you have really is the drug you think you are taking. Professional chemical analysis is the only option that gives a more or less definitive answer, and we offer one such service in Oslo, 100% anonymously. Rapid reagent kits (test kits) are less reliable, but still very useful, and should always be used whenever a professional analysis is not possible. Test kits should be stored in a refrigerator and used within the expiration date, as expired tests can give misleading color reactions.

To test a sample of MDMA, you should always use two different reagent kits: Marquis and Mandelin.

Start with the Marquis reagent. MDMA will turn dark purple for 0.5 to 5 seconds, and then turn black. Then move on to the Mandelin reagent, which should give a similar result as Marquis, i.e. dark purple and then black.

Color reactions with drugs that mimic MDMA:

• PMMA and PMA, two of the most dangerous substances sold as MDMA, give no color reaction with the Marquis reagent. With the Mandelin reagent, they give a green color reaction which then fades into brown.
  
  
  • NOTE: always use the Mandelin reagent test kit in addition to Marquis when testing MDMA. The Mandelin reagent is the only one that can detect PMMA/PMA mixed in with real MDMA, which has been known to occur. Note however that not even the Mandelin reagent can detect all such mixtures, and the only safe way to check is to use a professional analytical service.
    
    
• Many common cathinone drugs, including MDPV, pentylone, methylone and buylone, give a yellow color reaction with the Marquis reagent.
• 2C-B gives a yellow color reaction which fades into green with the Marquis reagent, and either a faint yellow or colorless reaction with the Mandelin reagent.

DOSAGE

First-time users should start with a maximum of 70 mg. This is because some people react very strongly to a normal dose, and there is no way of knowing who might react this way ahead of time. If you start to notice positive effects without any negative reactions after one hour, you can consider taking at most another 35 mg. If, however, no effects are noticeable after 1.5 hours, do not take any more – it may be that the substance you took was not MDMA after all, but rather a different drug that takes a longer time to kick in.

Doses should never be measured out by eye. The best option is to use a digital scale with an accuracy of at least 0.01 g but ideally as low as 0.002 g. If you do not have access to a scale, it is better to dissolve a known amount of MDMA in some water, and then divide up the solution by volume using either a milliliter syringe or a measuring cup/jug/cylinder. For example, if you know that you have exactly half a gram (500 mg) of MDMA, and you want to divide it into 5 doses of 100 mg each: simply measure out exactly half a liter (500 ml) of water in a measuring jug, completely dissolve the 500 mg of MDMA into the water, and then divide the solution into 5 glasses of exactly 100 ml each. Each glass will then contain exactly 100 mg of MDMA.

Few people need more than 125 mg of MDMA to get a full effect, and higher doses than this tend to only produce stronger side-effects rather than a better experience. (There are also no documented deaths resulting from doses lower than 125 mg.) Some very big and/or heavy individuals may need up to 150–160 mg to get a full effect, but even these should start with only 70 mg when trying MDMA for the first time. People who have been taking MDMA for a while and who feel they need to take higher doses than they used to, should ideally take a several months-long break from MDMA in order to reset their tolerance as much as possible.

It is safest not to re-dose at all, but if you do, try to keep the total dosage below 2 mg per kg of body weight. For example, someone weighing 70 kg who starts off with 100 mg should avoid taking more than 35–40 mg again later that same evening.


OVERDOSE

A moderate overdose of MDMA normally results in nausea, vomiting, headache, dizziness, and profuse sweating. These symptoms normally go away after roughly half an hour.

An acute overdose can lead to severe harm or death, and requires immediate medical attention. Symptoms include fainting, intense hallucinations, cramp fits or seizures, chest pains, panic attacks, breathing difficulties, and very high body temperature.

If you suspect that anyone has overdosed on MDMA, call an ambulance immediately. Try to lower the affected person's body temperature by providing fresh air, removing potentially warm clothing, and holding a cold, damp cloth to the side of their neck.


FORM

In Norway, MDMA is most commonly sold as crystals or powder. Although frequently marketed as "pure", these forms are rarely 100% pure, since impurities often arise during production and end up in the final product. Such impurities often result in discolored crystals, ranging between brown, grey, and purple, as well as a distinctive licorice-like smell. Moreover, some dealers "cut" or dilute their product with various additives. This means that even for products sold as "pure" MDMA, it is often hard to estimate how much MDMA it actually contains, as well as what potentially harmful additives or impurities might be present, and in what quantities. However, most crystalline MDMA confiscated by norwegian police tends to be of high purity, often upwards of 90% pure MDMA hydrochloride. It is possible to clean MDMA using acetone in order to remove much of the impurities left behind from production, but this should never be attempted without a thorough understanding of the process involved.

Ecstasy pills tend to be less pure than MDMA crystals, and some confiscated pills sold as ecstasy have turned out to contain completely different substances altogether. Most pills also contain various filler or bulking compounds, making it hard to estimate the amount of MDMA in a given pill. In Europe, ecstasy pills of relatively high purity (i.e. those that only contain MDMA and no other drugs) normally contain between 80 and 150 mg per pill. However, some pills may contain as much as 300 mg; one such pill amounts to an overdose in most users, and two such pills would amount to a potentially lethal overdose in some people. For this reason, it is always safest to start with only half a pill, and then monitor your response for at least 1.5 hours before you consider taking the rest. If you still feel nothing after 1.5 hours, do not take any more.

Crystals/powder (Emma/Molly)

• Consists of MDMA in the form of a salt (hydrochloride) of varying purity
  
  
• Normally swallowed, often wrapped in paper (parachuting) or gelatine capsules
  
  
• Extremely bitter and chemical/metallic flavor
  
  
• Pure crystals are white, but impurities from the production process often results in brown, grey, or purple discoloration, and a licorice-like smell
  
  

Pills/tablets (ecstasy/knips/E)

• Each pill normally contains one average dose of MDMA, but the quantity may vary considerably
  
  
• Often contains other active ingredients (e.g. caffeine, amphetamine, ketamine, 2C-B) and fillers (starch, maltodextrine) in addition to MDMA
  
  
• Many pills contain no MDMA at all, but rather drugs with a similar effect, some of which kan be extremely dangerous (e.g. PMMA/PMA)
  
  
• Producers often emboss a logo into the pill or press them into recognizable shapes, and mix their own combination of active and inactive ingredients to distinguish their products from their competitors'. NOTE: competitors sometimes mimic each other's products, whether in order to exploit or ruin the other's reputation. This means that one easily recognizable tablet may not contain the same ingredients as another, seemingly identical one.
  
  

ROUTE OF ADMINISTRATION

Ingesting or swallowing MDMA is by far the most common way to take the drug. If it is in the form of crystals, a dose is often wrapped up in a piece of tissue or rolling paper (parachuting) or enclosed in a gelatine capsule before ingesting.

Some users prefer to take MDMA nasally (sniffing/snorting) or rectally (plugging/boofing). Both of these routes of administration give a more rapid onset and somewhat shorter duration of effects.

MECHANISM OF ACTION

MDMA is a phenethylamine, a group of chemicals which also includes mescaline, the 2C-drugs, cathinones, and amphetamine. Its mechanism of action is quite unique: it not only stimulates the brain's serotonin system in a way that causes it to release large amounts of serotonin, but also mimics serotonin itself and binds directly to serotonin receptors. MDMA also releases dopamine and noradrenaline. The mechanism as a whole is very complex, and it is still not entirely clear how the drug produces its subjective effects. Neural imaging of brains under the influence of MDMA show increased activity in the prefrontal cortex, which plays a central role in functions like self-reflection and assessment of one's own actions; and reduced activity in the amygdala, which is central to base emotions such as fear, aggression, and sexual desire.

The subjective effects of MDMA normally last for 4 to 5 hours, followed by various after-effects for another 1 to 3 hours. Effects can become noticeable after anywhere between 15 and 60 minutes after intake, but it may take up to 90 minutes to feel anything if one has recently eaten a large meal. See here for a more thorough breakdown of how MDMA works.


SUBJECTIVE EFFECTS

MDMA is known for its euphoric, empathy-promoting, and stimulant effects. Users tend to feel satisfied, wakeful, and energetic. Set and setting greatly affect the tone of the experience, and the drug will tend to feel different if taken in a calm, intimate setting with a few friends, than if taken at a crowded event with loud music and a barrage of sensory impressions. Even though MDMA is normally associated with satisfaction and bliss, it can also trigger difficult emotional experiences.

Empathy and openness MDMA tends to make users feel a sense of care and understanding towards people around them. However, users may also have a difficult time registering negative body language or facial expressions, which can lead to people around them seeming more gregarious or interested than they really are. MDMA thus tends to make people much less prone to conflict, but may at the same time cause some users to become very clingy or persistent unless told directly that their behavior makes others uncomfortable. Many users become very cuddly and feel a strong need for physical intimacy, albeit usually without any sexual interest. (However, MDMA may be sexually stimulating to some people, although it also causes sexual dysfunction and difficulty in achieving orgasm in both sexes.) New friendships are made very easily on MDMA, for better or for worse. On the one hand, this makes it possible to quickly build deep connections that end up lasting a lifetime; on the other hand, if there is no real chemistry with the other person in a sober state, then any intimacy with them on MDMA may feel awkward afterwards.

Energy and wakefulness People on MDMA tend to become very awake and alert due to its stimulant effects. Low to moderate doses can nevertheless instill a sense of calm and relaxation, and some users may even feel lightly sedated or "stoned". Higher doses, on the other hand, often lead to restlessness and a need to move around. Low to moderate doses usually come with a sense of mental clarity and sharpness, while higher doses are more confusing and disorienting. Users find they can easily socialize or party uninterrupted for several hours, and rarely feel any hunger while the drug is active. This can lead to the body using up more energy than it has readily available and instead starts burning glycogen, especially during intense dancing. This can, in turn, cause people to suddenly feel profoundly exhausted once the drug wears off – especially if they were not fully rested before taking the drug, forgot to eat something underway, or forgot to moderate their activity level during the experience (or any combination of these factors).

Euphoria and pleasure Most people feel a sense of bliss and euphoria, both physically and psychologically, on MDMA. This causes some people to feel upbeat, excited, and extroverted, whereas others might feel more reflective and introspective. Although MDMA normally comes with a sense of happiness, it can also bring about a very somber or deeply emotional atmosphere. It is not uncommon for people to want to talk about themselves and listen to others talk about themselves, or to tell people how much one cares about them and how beautiful they are, while banter and sarcasm often feel less natural.

Difficult experiences Although most people feel a reduced sense of fear and anxiety on MDMA, the opposite may be true for some individuals. It is important to keep in mind that MDMA is a powerful psychotherapeutic tool that can bring subconscious fears and concerns up to the surface. People who have a lot of trauma in their past, or who find themselves in a difficult life situation, may find that MDMA brings up memories and thoughts that they are not fully prepared to deal with. It is strongly recommended to keep this in mind when taking MDMA, and to make sure one has a trusted friend nearby to talk with if necessary, both during and after the experience.

SIDE-EFFECTS

MDMA comes with a number of side-effects that many consider unpleasant. These become more pronounced at higher doses or more frequent use. Some people seem to generally experience more side-effects than others. Women appear to be more prone to uncomfortable side-effects than men, possibly related to menstruation and hormonal swings.

Very common side-effects (regardless of dose)

• Dry mouth, leading to bad breath. Mints or lozenges may help with this.
  
  
• Higher body temperature and sweating. Not a problem when sitting still at normal room temperature, but may become problematic with high physical activity and/or high ambient temperature. Cool down by getting fresh air and avoiding too warm clothing. Eating ice cream may help.
  
  
• Urinary retention, especially in women. Normally not an issue, but can become dangerous if one drinks too much water without also taking in electrolytes (salts), thereby diluting the body's electrolytes (hypoglycaemia). Eat some salty snacks if possible, or go for an isotonic sports drink (e.g. Powerade) when thirsty.
  
  
• Faster heart rate and higher blood pressure.
  
  
• "Twitchy" eye movements (nystagmus) and unfocused eyesight. Normally not an issue, and usually passes after a short while.
  
  
• Headache when coming down, which can be quite unpleasant for some. Sugary snacks or drinks may help.
  
  
• Mild hallucinations, especially at moderate to high doses. This results from MDMA being broken down into the drug MDA (3,4-methylenedioxyamphetamine), a more hallucinogenic and harmful relative of MDMA. The amount of MDA created during metabolism can be limited by eating certain foods that inhibit the enzyme CYP3A4 (including grapefruit juice and black pepper) before taking MDMA, and by avoiding re-dosing.
  
  

Less common side-effects (more common with higher doses)

• Clenched jaw muscles and involuntary jaw movements (bruxism). This can lead to involuntarily biting one's tongue or the inside of the cheeks, resulting in painful mouth sores. Magnesium supplements can help reduce bruxism, and antibacterial mouthwash reduces the risk of infection in open sores.
  
  
• Confusion and impaired short-term memory, especially in combination with other drugs like alcohol or cannabis.
  
  
• Transient anxiety, nausea, and/or headache.
  
  
• Sudden and intense nostalgia or disappointment when the effects wear off.
  
  
• Intense and somewhat realistic hallucinations, especially at high doses. This is a result of MDMA being metabolized into its more harmful metabolite MDA. This is one reason to avoid taking too high a dose of MDMA.
  
  

Rare, abnormal side-effects (possible signs of hypersensitivity or overdose)

• Overdose symptoms include nausea, headache, anxiety, confusion, and very high body temperature. If you suspect that someone is overdosing on MDMA, call an ambulance immediately. While you wait for the ambulance, try to lower the affected person's body temperature by removing excessive clothing, providing fresh air, and by holding an ice pack or a cold, damp cloth against the jugular arteries on either sides of their throat (taking care not to put pressure on their windpipe).
  
  
• There are cases of people taking MDMA for the first time and experiencing these symptoms, despite having taken a normal dose, which suggests that some subset of the population is hypersensitive to the drug. Since it is not possible to tell ahead of time whether someone is hypersensitive, it is always recommended to start with a maximum of 60 to 70 mg when taking MDMA for the first time, and to monitor the effects for at least half an hour before taking any more.
  
  

Hangover (1 to 5 days after) It is normal to feel worn out immediately an MDMA experience, especially for those who have taken a high dose and/or danced for several hours. It is therefore recommended to get a good night's sleep once the drug effects have worn off. However, some people may still feel restless for a while after coming down and hence struggle to fall asleep, especially after re-dosing several times or combining MDMA with other stimulants. Some people combat this by taking "downers" such as benzos and/or cannabis. This is generally not necessary, as the restlessness tends to go away after an hour or two; but if you decide to try, it is recommended to take as little of the downer as possible. It is also strongly recommended to ensure at least one full day off after taking MDMA, e.g. by taking it on a friday or saturday, so as to avoid having to go back to work/school/etc. in a reduced state.

Some people experience low energy and mood for around 3 to 5 days after taking MDMA, especially after taking a high dose. If you are worried about this possibly triggering a depressive episode, make sure to take at most a few small doses, avoid combinations with alcohol or stimulants, and avoid taking MDMA too often. There is some evidence to indicate that depressive symptoms after MDMA can be reduced by taking the supplement 5-HTP for a few days after the experience (see section below). Generally healthy habits, such as getting enough sleep, eating healthy foods, and regular exercise, all contribute to a faster recovery after MDMA.

Some people develop a tolerance to MDMA after having taken it many times, at which point they find they no longer achieve the same kind of experience as before. The effects are described as more similar to amphetamine, lacking the intense feelings of love and compassion that are normally expected from MDMA. People may then try to compensate for this "loss of magic" by taking higher doses in the hope of achieving the desired effect, which leads to even higher tolerance and a higher risk of harmful side-effects – until it becomes impossible to achieve the desired effect no matter the dose. It may then take several years to reset one's tolerance to the drug. Some users report a permanent loss of the full effects of MDMA after such a tolerance buildup, even after not taking it for several years, which may indicate permanent damage to the brain's serotonin system. If you notice your MDMA experiences getting noticeably less pleasant with each use, despite taking breaks between each use, consider taking a very long break (e.g. 6–12 months) or quitting MDMA altogether.

SUPPLEMENTS

Magnesium One of the most common side-effects of MDMA is bruxism, a condition where the jaw muscles tense up and cause involuntary movements like clenching, chewing, and teeth grinding. In the worst case, this can lead to biting one's tongue or the inside of one's cheek, resulting in painful sores. Many users report that magnesium supplements help to combat bruxism, if taken beforehand or soon after the symptom arises. Any magnesium supplement appears to work, but it is recommended to choose one that contains a highly bioavailable form of the mineral, e.g. magnesium gluconate, magnesium glycinate or magnesium citrate. Chewing gum can also help by offering a more controlled outlet for the bruxism, as well as lending some protection against teeth grinding. Some users who get especially intense bruxism on MDMA choose to wear a dental guard during the experience.

Antioxidants Some research seems to indicate that strong or high-dosed antioxidants can help prevent MDMA-related neurotoxicity. Animal studies have shown that high doses of vitamin C (ascorbic acid), vitamin E (tocopherol), ALA (ɑ-lipoic acid), and ALCAR (acetyl-L-carnitine) appear to have a neuroprotective effect against high doses of MDMA. However, it is unclear whether MDMA at recreational doses is neurotoxic in humans, and results from animal studies do not always translate directly to similar results in humans. Moreover, antioxidants will not help in case of a severe overdose, and supplementing strong antioxidants on a regular basis can be harmful in itself. That said, it is probably not harmful to take an antioxidant supplement when using MDMA, if only to be on the safe side.

5-HTP/L-tryptophan Many users report that the supplement 5-HTP (which is converted to serotonin in the body) can reduce and prevent the depressive symptoms that often appear a few days after taking MDMA. If you decide to take 5-HTP, it is recommended to combine it with green tea extract, which contains high levels of ECGC (epigallocathchin gallate). This is because ECGC prevents the body from converting the extra 5-HTP into serotonin outside of the brain, so that one avoids unwanted high levels of serotonin in the rest of the blood stream. (Note, however, that this combination may cause digestion problems.) In any case, never take 5-HTP before or during MDMA, as this can increase the risk of serotonin syndrome; wait at least several hours after the effects have worn off, or even until the next day. Take as recommended by the manufacturer for up to a few days, or until the low mood goes away.

MDMA is listed as an illicit drug in Norway.* This means it is punishable by law** to use, possess, sell, manufacture, import, acquire, store, or ship MDMA without a special license for medical or scientific research purposes.

The limit for how much MDMA one can acquire or possess for personal use and still receive only a fine, as opposed to a prison sentence, is currently at 2 grams of pure MDMA or 20 pills. The equivalent limit for importing MDMA (e.g. by mail from abroad) is 1 gram or 10 pills.

* Narkotikalisten, narkotikaforskriften, legemiddelloven §22
** Legemiddelloven §31, §24; straffeloven §231

1. Schifano et al., Review of deaths related to taking ecstasy, England and Wales, 1997-2000. British Medical Journal, 2003.

2. Verschraagen et al., Post-mortem cases involving amphetamine-based drugs in the Netherlands. Comparison with driving under the influence cases. Forensic Science International, 2007.

3. Van Amsterdam et al., Fatal and non-fatal health incidents related to recreational ecstasy use. Journal of Psychopharmacology, 2020.

4. Meyer JS, 3,4-methylenedioxymethamphetamine (MDMA): current perspectives. Substance Abuse and Rehabilitation, 2013.

5. Dunlap et al., Dark Classics in Chemical Neuroscience: 3,4-Methylenedioxymethamphetamine (MDMA). ACS Chemical Neuroscience, 2018.

6. Carhart-Harris et al., The Effects of Acutely Administered 3,4-Methylenedioxymethamphetamine on Spontaneous Brain Function in Healthy Volunteers Measured with Arterial Spin Labeling and Blood Oxygen Level–Dependent Resting State Functional Connectivity. Biological Psychiatry, 2015.

7. Krebs & Johansen, How could MDMA (ecstasy) help anxiety disorders? A neurobiological rationale. Journal of Psychopharmacology, 2009.

8. Schenk & Highgate, Methylenedioxymethamphetamine (MDMA): Serotonergic and dopaminergic mechanisms related to its use and misuse. Journal of Neurochemistry, 2021.

9. Passie et al., Ecstasy (MDMA) mimics the post-orgasmic state: impairment of sexual drive and function during acute MDMA-effects may be due to increased prolactin secretion. Medical Hypotheses, 2005.

10. Vizeli & Liechti, Safety pharmacology of acute MDMA administration in healthy subjects. Journal of Psychopharmacology, 2017.

11. Papaseit et al., Key interindividual determinants in MDMA pharmacodynamics. Expert Opinion on Drug Metabolism & Toxicology, 2018.
12. Droogmans et al., Possible Association Between 3,4-Methylenedioxymethamphetamine Abuse and Valvular Heart Disease. American Journal of Cardiology, 2007.

13. Sessa et al., A Review of 3,4-methylenedioxymethamphetamine (MDMA)-Assisted Psychotherapy. Frontiers in Psychiatry, 2019.

14. Schilt et al., Cognition in Novice Ecstasy Users With Minimal Exposure to Other Drugs. JAMA, 2007.

15. Taurah et al., Depression, impulsiveness, sleep, and memory in past and present polydrug users of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy). Psychopharmacology, 2014.

16. Mithoefer et al., MDMA-assisted psychotherapy for treatment of PTSD: study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials. Psychopharmacology, 2019.

17. Ludewig et al., No lasting effects of moderate doses of MDMA (ecstasy) on memory performance and mood states in healthy humans. Biological Psychiatry, 2003.

18. Halpern et al., Residual neuropsychological effects of illicit 3,4- methylenedioxymethamphetamine (MDMA) in individuals with minimal exposure to other drugs. Drug Alcohol Dependency, 2004.

19. Mueller et al., Neuroimaging in moderate MDMA use: A systematic review. Neuroscience and Biobehavioral Reviews, 2016.

20. Green et al., Lost in translation: preclinical studies on 3,4-methylenedioxymethamphetamine provide information on mechanisms of action, but do not allow accurate prediction of adverse events in humans. British Journal of Pharmacology, 2011.

21. Biezonski & Meyer, The Nature of 3, 4-Methylenedioxymethamphetamine (MDMA)-Induced Serotonergic Dysfunction: Evidence for and Against the Neurodegeneration Hypothesis. Current Neuropharmacology, 2011.

22. Amoroso T., The spurious relationship between ecstasy use and neurocognitive deficits: A Bradford Hill review. International Journal of Drug Policy, 2019.

23. Szigeti et al., Are Ecstasy Induced Serotonergic Alterations Overestimated For The Majority Of Users? Journal of Psychopharmacology, 2018.

24. Battaglia et al., MDMA-Induced Neurotoxicity: Parameters of Degeneration and Recovery of Brain Serotonin Neurons. Pharmacology Biochemistry & Behavior, 1988.
25. Costa & Gołembiowska, Neurotoxicity of MDMA: Main effects and mechanisms. Experimental Neurology, 2022.

26. Teixeira-Gomes et al., "Ecstasy" toxicity to adolescent rats following an acute low binge dose. BMC Pharmacology and Toxicology, 2016.

27. Jones & Nock, MDMA/ecstasy use and psilocybin use are associated with lowered odds of psychological distress and suicidal thoughts in a sample of US adults. Journal of Psychopharmacology, 2022.

28. Liechti M, Effects of MDMA on body temperature in humans. Temperature, 2014.

29. Fiege et al., Induction of Malignant Hyperthermia in Susceptible Swine by 3,4-Methylenedioxymethamphetamine ("Ecstasy"). Anesthesiology, 2003.

30. Schütte et al., 3,4-Methylenedioxymethamphetamine induces a hyperthermic and hypermetabolic crisis in pigs with and without a genetic disposition for malignant hyperthermia. European Journal of Anaesthesiology, 2013.

31. Van Amsterdam et al., Hard Boiled: Alcohol Use as a Risk Factor for MDMA‑Induced Hyperthermia: a Systematic Review. Neurotoxicity Research, 2021.

32. Vercoulen & Hondebrink, Combining ecstasy and ethanol: higher risk for toxicity? A review. Critical Reviews in Toxicology, 2020.

33. Izco et al., Binge ethanol administration enhances the MDMA-induced long-term 5-HT neurotoxicity in rat brain. Psychopharmacology, 2007.

34. Hernandez-Rabaza et al., Neurotoxicity and persistent cognitive deficits induced by combined MDMA and alcohol exposure in adolescent rats. Addiction Biology, 2010.

35. MDMA & Cannabis: A Mini-Review of Cognitive, Behavioral, and Neurobiological Effects of Co-Consumption. Current Drug Abuse Reviews, 2011.

36. Dumont et al., Acute psychomotor, memory and subjective effects of MDMA and THC co-administration over time in healthy volunteers. Journal of Psychopharmacology, 2010.

37. Morley et al., Cannabinoids prevent the acute hyperthermia and partially protect against the 5-HT depleting effects of MDMA (''Ecstasy'') in rats. Neuropharmacology, 2004.

38. Górska et al., Neurochemical and Neurotoxic Effects of MDMA (Ecstasy) and Caffeine After Chronic Combined Administration in Mice. Neurotoxicity Research, 2018.

39. Camarasa et al., Association of caffeine to MDMA does not increase antinociception but potentiates adverse effects of this recreational drug. Brain Research, 2006.

40. Vanattou-Saïfoudine et al., Mechanisms mediating the ability of caffeine to influence MDMA ('Ecstasy')-induced hyperthermia in rats.British Journal of Pharmacology, 2010.

41. Papaseit et al., MDMA interactions with pharmaceuticals and drugs of abuse. Expert Opinion on Drug Metabolism & Toxicology, 2020.

42. Tancer & Johanson, The effects of fluoxetine on the subjective and physiological effects of 3,4-methylenedioxymethamphetamine (MDMA) in humans. Psychopharmacology, 2007.

43. Liechti & Vollenweider, The serotonin uptake inhibitor citalopram reduces acute cardiovascular and vegetative effects of 3,4-methylenedioxymethamphetamine ('Ecstasy') in healthy volunteers. Journal of Psychopharmacology, 2000.

44. Feduccia et al., Discontinuation of medications classified as reuptake inhibitors affects treatment response of MDMA-assisted psychotherapy. Psychopharmacology, 2021.

45. Brunt et al., Linking the pharmacological content of ecstasy tablets to the subjective experiences of drug users. Psychopharmacology, 2012.

46. Liechti & Holze, Dosing Psychedelics and MDMA. Current Topics in Behavioral Neurosciences, 2021.

47. Schmid et al., Acute subjective effects in LSD- and MDMA-assisted psychotherapy. Journal of Psychopharmacology, 2020.

48. Hysek et al., MDMA enhances emotional empathy and prosocial behavior. Social Cognitive and affective Neuroscience, 2014.

49. Kirkpatrick et al., MDMA effects consistent across laboratories. Psychopharmacology, 2014.

50. Colbert & Hughes, Evenings with Molly: Adult Couples' Use of MDMA for Relationship Enhancement. Cult Med Psychiatry, 2022.

51. Holze et al., Distinct acute effects of LSD, MDMA, and d-amphetamine in healthy subjects. Neuropsychopharmacology, 2019.

52. Bershad et al., Effects of MDMA on attention to positive social cues and pleasantness of affective touch. Neuropsychopharmacology, 2019.

53. Dolder et al., Direct comparison of the acute subjective, emotional, autonomic, and endocrine effects of MDMA, methylphenidate, and modafinil in healthy subjects. Psychopharmacology, 2018.

54. Hysek et al., Effects of methylphenidate and MDMA on appraisal of pictures of erotic stimuli and intimate relationships. European Neuropsychopharmacology, 2015.

55. Kamilar-Britt & Bedi, The Prosocial Effects of 3,4-methylenedioxymethamphetamine (MDMA): Controlled Studies in Humans and Laboratory Animals. Neuroscience & Biobehavioral Reviews, 2015.

56. Soleimani et al., Attenuation of ecstasy-induced neurotoxicity by N-acetylcysteine. Metabolic Brain Disease, 2015.

57. Shankarian et al., Ascorbic Acid Prevents 3,4- Methylenedioxymethamphetamine (MDMA)-Induced Hydroxyl Radical Formation and the Behavioral and Neurochemical Consequences of the Depletion of Brain 5-HT. Synapse, 2001.

58. Javanmard et al., The ameliorating effects of Vitamin E on hepatotoxicity of ecstasy. Journal of Research in Medical Science, 2020.

59. Barbosa et al., Pro-oxidant effects of Ecstasy and its metabolites in mouse brain synaptosomes. British Journal of Pharmacology, 2011.

60. Alves et al., Acetyl- L -carnitine provides effective in vivo neuroprotection over 3,4-methylenedioxymethamphetamine-induced mitochondrial neurotoxicity in the adolescent rat brain. Neuroscience, 2009.

61. Puerta et al., Phosphodiesterase 5 inhibitors prevent 3,4-methylenedioxy-methamphetamine-induced 5-HT deficits in the rat. Journal of Neurochemistry, 2009.

62. Puerta et al., Long-Lasting Neuroprotective Effect of Sildenafil Against 3,4- Methylenedioxymethamphetamine-induced 5-Hydroxytryptamine Deficits in the Rat Brain. Journal of Neuroscience Research, 2012.

63. Chen et al., High ambient temperature increases the toxicity and lethality of 3,4-methylenedioxymethamphetamine and methcathinone. Pharmacology Biochemistry & Behavior, 2021.

64. Baggott et al., MDMA Impairs Response to Water Intake in Healthy Volunteers. Advances in Pharmacological Sciences, 2016.

65. Tomlinson & Hoaken, Recreational Drug Use and Human Aggressive Behavior: A Comprehensive Review Since 2003. Aggression and Violent
Behavior, 2016