MDMA (Ecstasy)

MDMA (3,4-methylenedioxymethamphetamine) is a drug variably classified as both a stimulant and a psychedelic. MDMA is a fully synthetic substance and does not occur naturally. Pure MDMA is a crystalline, light-colored powder. However, it is most commonly used in the form of orally ingested ecstasy tablets. [1] The MDMA content in ecstasy tablets varies greatly. [1] [2] [3]

Legal status: In Finland, MDMA is classified as a narcotic. Its use, purchase, sale, and possession are prohibited. [4] [5] The Supreme Court has ruled that ecstasy is an extremely dangerous drug. [6]

How does it work?

MDMA acts on the brain by increasing the activity of the neurotransmitters serotonin and dopamine. [1] [7] The effects of MDMA begin approximately 30–60 minutes after ingestion and last around 5–6 hours depending on the dose. [1] The effects are influenced by factors such as dose size, personal metabolism, body weight, hydration, physical exertion, and cardiovascular condition. [1]

In the case of ecstasy tablets, it should be noted that the effects depend on the contents of the tablets. In addition to MDMA, tablets often contain various substances classified as psychedelics and stimulants, as well as excipients and fillers used in the pharmaceutical industry. [3] [8]

Desired effects: MDMA increases sociability, empathy, and the feeling of connection with others. It improves concentration, enhances the sense of well-being and energy. [1] MDMA sensitizes individuals to positive emotions. At the same time, negative feelings such as fear and anxiety lose significance. [9] Slight visual changes may occur, which is why MDMA is sometimes classified as a hallucinogen/psychedelic. [1]

Side effects: Common side effects of MDMA include loss of appetite, dry mouth, difficulty concentrating, jaw clenching, dizziness, restless legs, and problems with regulating body temperature. [1] [10] Muscle cramps, involuntary eye movements, and nausea are also relatively common. [1] [11] The use of ecstasy is also associated with an increased risk of anxiety and panic attacks. [1] Negative side effects are slightly more common in women than in men [10], and the likelihood increases with higher doses. [1] [10]

After the effects wear off and in the days following use, symptoms such as fatigue, low mood, appetite loss, difficulty concentrating, and/or sleep disturbances may occur. [10]

Key risks

Acute risks: Heat stroke is the most critical risk associated with the use of MDMA and ecstasy. [1] MDMA raises body temperature and blood pressure. [10] [12] Combined with physical activity, such as dancing, careless use can lead to dangerous overheating. [7]

Ecstasy has been linked to numerous sudden deaths in Europe. [1] [2] [12] The fatalities have been caused either by MDMA itself or by other substances found in ecstasy tablets. [2] [12] Among the cutting agents, the compound PMMA is considered particularly dangerous [2], and has been found in ecstasy tablets sold in Finland. [8]

Polydrug use risks: Polydrug use and tablet impurities increase the likelihood of risk. Combining MDMA or ecstasy with other stimulants (amphetamine, cocaine) or MAO inhibitors can cause a toxic state known as serotonin syndrome. Stimulants also increase the likelihood of panic attacks. [1]

Heavy use risks: The effects of long-term MDMA and ecstasy use on brain function (neurotoxicity) have been widely discussed in scientific literature. [1] [12] [13] [14] [15] MDMA is thought to lead to a decline in cognitive functions such as memory, learning, and decision-making ability, as well as to depression and impulsivity. [12] [13] The strongest evidence points to MDMA’s effects on impulsivity and risk-taking behavior. [13]

Addiction: The addiction potential of MDMA is low. [1] Mild tolerance to MDMA’s effects can develop with long-term use, requiring higher doses to achieve the desired effects. [11]

Use during pregnancy: The effects of MDMA on the fetus remain unclear. As a precaution, its use should be avoided. [1]

How can risks be reduced?

Substance use always carries risks. With illegal substances, the risks are increased due to the uncertainty of the substance’s composition. People also react very differently to the same substances and doses, which should be considered before trying or using MDMA.

There are some ways to attempt to reduce the risks associated with MDMA and ecstasy use. However, these do not eliminate the risks entirely.

The risk of overheating can be mitigated by avoiding physical exertion. If exertion occurs, the body should be cooled regularly. Adequate (but not excessive) hydration is also important. [1] [7] Individuals with cardiovascular conditions should avoid MDMA due to its stimulating effects. [10]

Taking magnesium before and during use may help with muscle cramps.
The neurotoxic effects of MDMA—harmful to the nervous system—can be avoided by using the substance as infrequently as possible.