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3,4-Methylenedioxymethamphetamine (MDMA), also referred to as molly (crystal form) and ecstasy (tablet form), is an entactogen that has mild psychedelic effects and stimulant qualities.

Merck chemist Anton Köllisch created MDMA for the first time in 1912. In the 1970s, it was used to supplement psychotherapy; in the 1980s, it gained popularity as a street drug. Dance parties, raves, and electronic dance music are frequently linked to MDMA. Ephedrine, amphetamine, methamphetamine, and other drugs may be combined with ecstasy tablets.

Approximately 21 million individuals aged 15 to 64 used ecstasy in 2016 (0.3 percent of the global population). As of 2017, 0.9% of Americans had taken MDMA in the previous 12 months, and roughly 7% had used it at some point in their lives. One MDMA dose is thought to carry a deadly risk of one death out of every 20,000 to one out of every 50,000.

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Changed feelings, more energy, empathy, and enjoyment are among the alleged prosocial pharmaceutical benefits. The effects of oral medication start to take effect in 30 to 45 minutes and last for three to six hours. While prolonged use can result in addiction, memory issues, paranoia, and trouble sleeping, short-term side effects include teeth grinding, blurred vision, perspiration, and an accelerated heartbeat. Dehydration and elevated body temperature have been linked to fatalities.

In certain areas of the brain, MDMA mainly works by promoting the release of the neurotransmitters norepinephrine, dopamine, and serotonin. It is a member of the drug class known as substituted amphetamine. MDMA shares structural similarities with endogenous monoamine neurotransmitters like serotonin, norepinephrine, and dopamine, as well as the hallucinogenic mescaline and stimulant methamphetamine.

While MDMA is prohibited in most jurisdictions, it has a few approved medical uses in a select few countries. When used in regulated therapeutic environments, MDMA-assisted psychotherapy is a viable and generally safe treatment for PTSD. Although there are currently no clinical indications for MDMA in the US, the Food and Drug Administration (FDA) has designated it a breakthrough therapy. After applying to and receiving approval from Health Canada, MDMA has been permitted for limited distribution in Canada. In Australia, psychiatrists with proper authorization may prescribe it to treat PTSD.

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Uses for MDMA

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MDMA is frequently used at clubs, festivals, and home parties and is frequently regarded as the preferred drug in the rave culture. The lighting and music in a rave setting frequently have sensory effects that work in perfect harmony with the substance. In a party context, MDMA’s psychedelic amphetamine properties provide consumers with a number of alluring features. The drug’s inhibition-reducing effects give some users a sense of mass communion, while its stimulatory effects make it a party fuel for others. Compared to other stimulants, MDMA is used less frequently—usually less than once every week.

MDMA is occasionally combined with other psychoactive substances such ketamine, LSD, psilocybin mushrooms, and 2C-B. The term “candy-flipping” refers to the conjunction with LSD. “Nexus flipping” is the term used to describe the combination with 2C-B. Most individuals take the MDMA first, wait for the peak to pass, and then take the 2C-B for this combo.

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Methamphetamine, alcohol, and prescription medications like SSRIs are frequently taken with MDMA, which has a number of drug-drug interactions. Ritonavir has serious and harmful drug-drug interactions with a variety of psychoactive, anti-psychotic, and non-psychoactive medications. Three potentially fatal cases of MDMA co-administration with ritonavir have been documented.

MDMA Medical Uses
Although this differs by jurisdiction, as of 2023, MDMA therapies have only been authorized for research purposes and have no generally recognized medicinal applications. It was rarely used in psychotherapy prior to its widespread prohibition. The Food and Drug Administration (FDA) of the United States designated MDMA-assisted psychotherapy of PTSD as a breakthrough therapy in 2017.

According to some studies, psychedelics in general might serve as effective “super placebos” when taken for medical reasons.

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