Ecstasy, molly, MDMA: What health practitioners need to know about this common recreational drug.
Andrew M Farrar, Isabelle H Nordstrom, Kaitlyn Shelley, Gayane Archer, Kaitlyn N Kunstman, Joseph J Palamar
Disease-a-month : DM March 1, 2025 DOI: 10.1016/j.disamonth.2024.101851 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | MDMA |
| Keywords | Designer drugs Hallucinogen Harm reduction Phenylethylamines Psychedelic Synthetic cathinones MDMA Ecstasy Substance abuse overdose Drug safety |
| Citations | 7 |
| Key findings | MDMA's acute and post-intoxication adverse effects, along with frequent adulteration of illicit supplies, complicate medical intervention, and this review provides harm reduction strategies for healthcare providers. |
Abstract
3,4-methylenedioxymethamphetamine (MDMA; commonly referred to as "ecstasy" or "molly") is a substituted amphetamine drug that is used recreationally for its acute psychoactive effects, including euphoria and increased energy, as well as prosocial effects such as increased empathy and feelings of closeness with others. Acute adverse effects can include hyperthermia, dehydration, bruxism, and diaphoresis. Post-intoxication phenomena may include insomnia, anhedonia, anxiety, depression, and memory impairment, which can persist for days following drug cessation. MDMA acts as a releasing agent for monoamine neurotransmitters, including dopamine (DA), norepinephrine (NE) and serotonin (5-HT), by interfering with vesicular storage and transporter function, thus increasing extracellular levels of DA, NE, and 5-HT. Medical intervention in response to adverse events is complicated by the fact that illicitly-acquired MDMA is frequently adulterated, contaminated, or outright replaced with other psychoactive drugs such as synthetic cathinones ("bath salts") or methamphetamine, often unknown to the person using the drug. This review provides background on the legal status of MDMA and its use patterns, including proposals for its use as an adjunct in psychotherapy. It also discusses the pharmacological properties, mental and physical health effects, and interactions of MDMA with other drugs, with special focus on harm reduction strategies. This information will help healthcare providers assess adverse health effects related to MDMA/ecstasy use in order to facilitate appropriate treatment strategies and improve patient outcomes.
Comparable studies
Other narrative reviews on MDMA, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Human Pharmacology of MDMA | 2004 | Review | |
| Human psychopharmacology of Ecstasy (MDMA): a review of 15 years of empirical research | 2001 | Review | |
| 3,4‐Methylenedioxymethamphetamine (MDMA, “Ecstasy”): pharmacology and toxicology in animals and humans | 1994 | Review | |
| (±)3,4-Methylenedioxymethamphetamine (‘Ecstasy’)-Induced Serotonin Neurotoxicity: Studies in Animals | 2000 | Review | |
| Amphetamine toxicities | 2010 | Review |
Citations in the library
Cited by 5
- Substance use predictors of arrest and self-reported criminal behavior in the United States: The role of psychedelics and rarely used drugs Journal of Psychopharmacology April 16, 2026
- Ophthalmic Effects of Recreational (“Party”) Drugs: Clinical and Translational Perspectives Journal of Clinical & Translational Ophthalmology May 12, 2026
- Exploring MDMA assisted therapy in eating disorders: mechanisms, clinical evidence, and future directions. Journal of Eating Disorders December 29, 2025
- Rare but relevant: MDMA and hyponatraemia Addiction December 8, 2025
- MDMA in Psychiatry: From PTSD to emerging indications, safety, and future directions Psychedelics October 14, 2025
Cites 66
- Differences Between the Mechanism of Action of MDMA, MBDB, and the Classic Hallucinogens. Identification of a New Therapeutic Class: Entactogens Journal of Psychoactive Drugs October 1, 1986
- Human Pharmacology of MDMA Therapeutic Drug Monitoring March 19, 2004
- MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nature Medicine October 1, 2023
- Chronic tolerance to recreational MDMA (3,4-methylenedioxymethamphetamine) or Ecstasy Journal of Psychopharmacology 2005
- Club drugs: methylenedioxymethamphetamine, flunitrazepam, ketamine hydrochloride, and gamma-hydroxybutyrate American Journal of Health-System Pharmacy June 1, 2002
and 61 more in the library