MDMA (3,4-Methylenedioxymethamphetamine) is a synthetic drug that alters mood and perception. It is chemically similar to both stimulants and psychedelics.
MDMA was first synthesized in 1912 by the German pharmaceutical company Merck but the compound was not widely studied at that time.The substance was largely forgotten until the mid-20th century when it was rediscovered by the chemist Alexander Shulgin. In the 1970s, Shulgin introduced MDMA to a number of psychologists, who became interested in its potential therapeutic benefits. Throughout the late 1970s and early 1980s, some therapists used it as an adjunct to psychotherapy, especially in couples therapy, as they believed it helped patients open up and communicate more freely.
The recreational use of MDMA began to grow during the 1980s, particularly in the nightclub and rave scenes where it was commonly referred to as Ecstacy or Molly.. Its popularity as a party drug led to growing concern about its potential for abuse and health risks. In 1985, the Drug Enforcement Administration (DEA) in the United States classified MDMA as a Schedule I controlled substance, making it illegal to manufacture, distribute, or possess.
In the last decade, clinical trials have been conducted to investigate its efficacy in treating post-traumatic stress disorder (PTSD). MDMA is currently in the final phase of clinical trials and could be available in the near future as a prescribed treatment for PTSD when paired with psychotherapy1,2.
The effects of MDMA can include increased energy, euphoria, emotional closeness, and empathy towards others. These effects are partly due to the drug's ability to increase the release of serotonin, a neurotransmitter that plays a key role in the regulation of mood, appetite, and sleep, among other functions3.
There isn’t a single standard dosage for MDMA. However, the dosages used in recent clinical trials for the treatment of PTSD range from 80mg to 120mg with an optional 60mg booster dose1.
It's worth noting that the purity and composition of MDMA can vary widely in non medical settings, and other substances may be mixed with or substituted for MDMA, leading to unpredictable effects. This makes determining a "standard" dose particularly challenging outside of a controlled, clinical context.
MDMA increases heart rate and blood pressure. Individuals with heart conditions should exercise strong caution before taking MDMA as they are at heightened risk for cardiac arrhythmia and stroke.
Dehydration and hyperthermia (high body temperature) are risks associated with MDMA use especially in outdoor recreational settings such as festivals. Other physiological effects of MDMA include jaw clenching, lack of appetite, restless legs, nausea, hot flashes or chills, headache, sweating and muscle or joint stiffness.
Psychological side effects of MDMA may include anxiety, paranoia, confusion or impaired judgement. It can also affect perception of motion, which underscores the dangers associated with MDMA and driving.
Regular, long term use of MDMA can present additional risks such as sleep disturbances, lack of appetite, depression, concentration difficultures and impulsivity and cognitive problems.
Research related to MDMA’s addiction potential is mixed, however some people report signs of addiction and withdrawal.
It is possible that MDMA purchased on the black market can be adulterated with other drugs or compounds which could be dangerous or potentially deadly. It is always a good idea to test your MDMA with a test kit such as those sold by DanceSafe.
MDMA assisted therapy is a therapeutic approach that combines the use of MDMA with psychotherapy. The process starts with a meticulous screening phase to evaluate patient suitability, followed by preparatory therapy sessions to set expectations and build trust between the patient and therapist.
This is followed by two to three MDMA dosing sessions interspersed with additional talk therapy sessions. During the dosing sessions, MDMA is administered to enable the patient to access and discuss difficult or painful material with increased empathy and a reduction in fear. The role of the therapist during dosing sessions is primarily to support the patient during the experience1.
After the last dosing session, additional psychotherapy sessions are conducted to help the patient integrate and apply insights to their daily life and to provide ongoing monitoring of the patient ensuring safety and well-being1.
A focus of MDMA assisted therapy has been in the treatment of post traumatic stress disorder (PTSD). Lykos Therapeutics (formerly MAPS PBC) has conducted multiple clinical trials showing that MDMA assisted therapy can be useful in the treatment of PTSD2.
It is possible in the future that MDMA assisted therapy will be explored as a treatment for other mental health conditions including depression and anxiety.
SSRI medications (Prozac, Lexapro, Zoloft etc..) may blunt or block the sought after effects of MDMA1. This is likely due to the fact that both drugs target some of the same serotonin subreceptors in the brain, though in slightly different ways.
The high levels of circulating serotonin in the brain which occur as a result of combining an SSRIs with MDMA could theoretically lead to a condition called serotonin syndrome, which can be very dangerous and potentially cause a seizure or death. However, there is a lack of research data to confirm this risk, and most cases of serotonin syndrome involving MDMA occur when combining it with other drugs such as stimulants (amphetamines, cocaine) or opioids2.
United States
August 9, 2024 Update: FDA has requested an additional phase 3 clinical trial due to limitations in the existing data related to safety and effectiveness of MDMA assisted therapy1. Lykos intends to appeal the decision, however It is likely that MDMA assisted therapy won't be available for at least a few more years.
As of February 2024, Lykos Therapeutics (formerly MAPS PBC) announced that it has completed phase 3 clinical trials and a new drug application has been submitted and accepted by the FDA for MDMA assisted therapy for the treatment of PTSD2. The data still needs to be reviewed by the FDA, but it is possible that MDMA assisted therapy could be approved as a medical treatment in the United States by the end of 2024. If approved, the treatment might not be immediately available to everyone as it may take additional time to roll out the infrastructure required to accommodate this new type of treatment (therapist training, health insurance planning etc..).
Europe
As of April 2024, Lykos Therapeutics has completed European phase 2 trials for MDMA assisted therapy for the treatment of PTSD3. It will likely take a few more years before MAPS presents final data to European drug regulating agencies.
Australia
As of July 1, 2023, psychiatrists can legally prescribe MDMA assisted therapy as a medical treatment for PTSD4. However, physicians must receive special approval to prescribe these medications, which could limit their availability.
If possible, yes. One risk associated with using MDMA or any illict drug is the uncertainty about what the substance actually contains. It is not uncommon for substances sold as MDMA to contain other drugs or adulterants, some of which may be harmful or deadly.
Testing kits such as those provided by DanceSafe are available to check for the presence of MDMA and some common adulterants. These tests can potentially identify dangerous substances, however, they cannot guarantee the safety of the substance. No test can accurately determine the dosage or purity of the substance, nor can they identify every possible adulterant.
So, if you are considering using MDMA, testing it with a kit can provide some information about its content, but it does not eliminate the risks associated with its use. Regardless, testing is always a good idea.
DanceSafe provides test kits for a variety of drugs including MDMA, amphetamine, cocaine, ketamine and LSD as well as fentanyl test strips.
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