MDMA, scientifically known as 3,4-methylenedioxymethamphetamine or more commonly referred to as "ecstasy" in pill or capsule form or "molly" in crystal form, belongs to the amphetamine class of compounds. MDMA is classified as an empathogen due to its unique psychological profile that often induces empathy, euphoria, positive emotional states, and prosocial behaviour (ref). MDMA is often associated with promoting emotional openness, empathy, positive empathic attitude toward oneself, increased self-acceptance, and a greater sense of authenticity. (ref).
With MDMA, the energy that is often exerted while dancing in a recreational setting is turned inwards in the research and psychotherapeutic setting to gain personal insights, clarity and to heal difficult memories. In recent years, MDMA has gained significant attention for its potential therapeutic use in combination with psychotherapy for the treatment of post-traumatic stress disorder (PTSD) (ref).
While MDMA shows promise as a therapeutic tool, it is important to note that it is classified as a Schedule I drug in most countries, meaning it is considered to have a high potential for abuse and no recognized medical use. However, there are ongoing efforts to develop pathways that may lead to legal use of MDMA in medical settings. These efforts involve conducting rigorous research, engaging regulatory bodies, and building evidence to support its efficacy and safety.
How much should I take?
Use the following information as a guideline, not a recommendation. First, always have your drugs tested, especially MDMA. For your first dose, consider beginning with 80-100 milligrams (mg). For a first session, current research with MDMA may start with 80 mg followed by a second 40 mg dose 1.5-2.5 hours later (ref).
Its important to note that adverse medical events are more likely to occur at single doses greater than 150 mg or when taking additional doses of MDMA in the same session. Simultaneous use of MAOI's, alcohol or other drugs and stimulants increase the risk. Additionally, if you are using MDMA and drinking too much water this may lead to hyponatremia (water-toxicity) and prolonged physical activity (dancing) in a hot environment may lead to heatstroke. Hyponatremia and heatstroke is not an issue for those using MDMA for personal growth in a private setting.
How should I take it?
Orally in a capsule.
How long does it take to kick in?
30-45 minutes when swallowed.
How long does it last?
Approximately 4 hours
How does MDMA work?
MDMA interacts with and stimulates the serotonin (5-HT1 and 2A), dopamine and noradrenaline systems (ref). MDMAs pro-serotonergic effects and its unique psychological profile distinguish it from other amphetamines. MDMA results in the release of oxytocin, a hormone related to social bonding and connection (ref). Importantly, MDMA appears to reduce activity in brain regions such as the amygdala and insula implicated in fear and anxiety while increasing connectivity between the amygdala and hippocampus which may be responsible for the reprocessing of traumatic memories (ref).
MDMA also binds to adrenaline receptors resulting in a mild transient increase in heart rate and blood pressure (ref) similar to engaging in light exercise. Additionally, there are mild transient increases in body temperature of about 0.5-1 degree (ref) due to an increase in heat generation and impaired thermoregulation. For individuals dancing for hours in a hot environment with minimal water intake is a health risk. For individuals lying down in bed, in a room at 20–22 °C (68–72 °F), and having sips of water every hour is less likely to be a health risk. For others with cardiovascular co-morbidities may pose a risk for adverse medical events.
The metabolites of MDMA inhibit a key enzyme that breaks down MDMA (ref). This is important to know if you are taking a second dose of MDMA in a single session or when taking MDMA again within 7-10 day period. With less enzymatic activity, MDMA blood concentrations rise to levels that may result in greater effects and stress on the cardiovascular and thermoregulatory systems raising the toxicity profile.
The combination of MDMA and MAOIs can increase the risk of serotonin syndrome, a potentially life-threatening condition characterized by excessive serotonin activity (ref). MAOIs inhibit the enzyme responsible for breaking down serotonin, leading to elevated serotonin levels. When MDMA, a serotonin-releasing agent, is taken together with MAOIs, it can further increase serotonin levels and potentially overwhelm the body's ability to regulate serotonin activity. Serotonin syndrome presents as a collection of symptoms that may include significant agitation, confusion, rapid heart rate, high blood pressure, fever, muscle rigidity, and in severe cases, seizures.
It's important to note that not all medications that affect serotonin levels have the same interactions with MDMA. Serotonin-specific reuptake inhibitors (SSRIs), which block the reuptake of serotonin, tend to attenuate the effects of MDMA (ref, ref). This means that SSRIs may dampen the intended effects of MDMA and potentially reduce its overall efficacy.
If you are taking any medications, consult with your primary healthcare provider before considering the use of MDMA. They can assess the potential interactions, evaluate individual risk factors, and provide appropriate guidance based on your specific situation. For more information on Medications and Psychedelics click here.
- It's important to note that there is no guarantee of an ideal experience. There are a wide range of possible psychedelic experiences and so each person will have a unique experience. From experience to experience within the same journeyer, variability also exists. In general though, MDMA experiences tend to be more positive in nature.
- Just prior to the journey, journeyer’s might be feeling both excited and anxious which is all part of the experience. Journeyer’s should take solace in the preparation leading up to this point. They reflect on their intention and remind oneself to focus inwards, choose to trust, let go, be open, and say yes. Confront the light and the dark places. Meet both with trust and assertiveness.
- Onset: within the first 30-60 minutes, you may feel a warming, tingling and softening in the body. Some journeyers report a calming effect and mental clarity to start to emerge.
- Peak: Hours 2-3 often lead to a complete openness to share your thoughts and unconditional love for others without fear or reservation. A MDMA experience seems to reliably produce profound positive mood and emotional states. Journeyer’s may notice that the sense of self remains intact with MDMA. Notably, memories from the past start to emerge, both pleasant and unpleasant, which to many a journeyer's surprise, can often be seen and held in ‘stillness without fear’. Commonly, journeyer’s report being able to confront difficult memories with more ease, and importantly, see and experience them with empathy, compassion, understanding, forgiveness, and love. Some experience significant anxiety or fear when reliving these memories.
- Coming Down: With MDMA, there can be a sudden shift from intense pleasure to less pleasure. At times, this may result in some impulse to take another dose in an attempt to get back to the previous state of consciousness. Pause when this occurs and reflect on whether you really need to act on this impulse. Beyond this, you will continue to experience an increased state of joy, happiness, stillness, and mental clarity but may find an increase in sociability or desire to share aspects of your life and experience. Journeyer’s are often disinhibited and may share sensitive content they would not otherwise share in normal waking consciousness with understanding and openness. At the end of your journey, there can be the experience of a sense of peace, warmth and contentment. Others may feel emotionally flat, depressed or tired. Both states are often transient with most journeyer’s being restored within 1-2 days. Self care practices and having social support will be key here.
- Acute: clenching of the jaw (bruxism), transient anxiety, reduced decision making ability, disinhibition, and reduced movement coordination. Increase in body temperature, sweating / clamminess, increase blood pressure and heart rate (ref). Consider that these 'side-effects' may be the release of psychosomatic symptoms such as anxiety, fear, worries, etc.
- After your trip: you may experience headache, emotional sensitivity, and fatigue for 1-2 days. Some journeyer’s some mild gastro-intestinal upset and reduced appetite that lasts for 1-2 days. Because MDMA primarily acts through dopaminergic pathways, journeyer’s may feel emotionally flat for 1-2 days after.
Rare Undesirable Side-effects:
- During - Heat Stoke and Hyponatremia (ref):
When using MDMA in a recreational or party setting, people feel warm due to the impairment of thermoregulatory system in the body and from dancing, sometimes in a hot environment like a club. In some circumstances this can lead to heat stroke. Because people feel warm or might be worried about heat stoke, they will tend to drink more water than they actually require leading to a serious medical condition called hyponatremia also known as water toxicity. Drinking too much water could lead to serious medical consequences including death secondary to cerebral edema.
- If you are using MDMA in a private setting and are lying down, the risk of heat stroke is low. You may notice you feel warmer than normal and studies suggest body temperature increases by 0.5-1 degree while using MDMA - this is similar to engaging in light exercise. By drinking when you feel thirsty or having 1-2 cups of water per hour is often enough to stay adequately hydrated during the experience.
What does all this mean for me?
- Complete the medical screening to see if psychedelics are right for you. Understand some of the risks involved.
- Have your MDMA tested locally at a lab or with a home drug test kit, as this drug is historically known to contain adulterants which are cross-contaminants and or substances used to dilute or ‘cut’ a drug.
- Start with 80-100 mg in your first session to learn about the psychedelic landscape.
- Clear your schedule for the day of and 1-2-days after the journey. Do your homework, consider having a trip sitter and get them educated, prep your set, setting and intention. Grab your journal and enjoy the trip. Get ready for the integration process that follows the experience.
- If you are taking any medications to manage your mental health or have other concerns related to your health, speak to your primary healthcare provider first. Be extra cautious if you take MAOIs.