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What is the Difference Between MDMA & Ecstasy?

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If you or someone you know abuses MDMA or ecstasy, you may be wondering about the differences between these two substances. For example, you might be curious about whether one is potentially safer or purer, but you may also just want to know more about each drug. Many people think MDMA and ecstasy are entirely different drugs, ecstasy being the more dangerous of the two; however, much of the MDMA sold on the streets—often “branded” as Molly—is anything but pure and could contain  just as many harmful adulterants as ecstasy.

Defining the Drugs

Different MDMA pills in color
MDMA is the acronym used to refer to the chemical, 3,4-methylenedioxy-methamphetamine, a man-made substance that is somewhat unique because it has both stimulant and hallucinogenic properties. MDMA is chemically similar to other amphetamines, but one main difference is that it contains the methylenedioxy group (-O-CH2-O-), making part of the molecule also similar in structure to the hallucinogen, mescaline. As its name implies, MDMA is a derivative of methamphetamine, also known as speed, crystal, or meth.1,2  

MDMA is the primary psychoactive substance found in ecstasy; however, some ecstasy tablets sold on the street may not actually contain any MDMA at all. Instead, they may contain compounds such as methylenedioxyethylamphetamine (MDEA), methylenedioxyamphetamine (MDA), paramethoxyamphetamine (PMA) or any number of additional substances.3

Molly is the nickname for what many people think is “pure” MDMA found on the street. This form of MDMA most commonly appears in powder or capsule form. It is a common misconception that MDMA is a safer and purer alternative to ecstasy. MDMA is a Schedule I substance, meaning that it has a high abuse potential and no accepted medical use.4 Since MDMA is illegal, it is unregulated on the street, so you can never be sure what drug you are actually taking. On the other hand, ecstasy is usually found in pill form and is generally considered to be less pure than MDMA or Molly, as people who use ecstasy often know that ecstasy is cut with other substances.2
Regardless of what dealers or friends may claim, ecstasy and MDMA are no different in the sense that they are both cut with different drugs or additives and can both have dangerous and, in some cases, deadly effects.

Why Do People Use Them?

People abuse ecstasy and MDMA to experience particular desirable effects, which include:4

  • Euphoria.
  • Feelings of closeness.
  • Increased empathy.
  • Increased sociability.
  • Reduced inhibitions.
  • Increased sexual desire/feelings.

In the past, young adults most commonly took ecstasy or MDMA in clubs or at raves or parties, but nowadays its usage has expanded to college campuses and essentially any setting where people want to experience its effects.4

While many people think taking ecstasy or MDMA is fun, abusing these drugs can actually have serious consequences on your physical and mental health.

What Are They Cut With?

Both ecstasy and MDMA are dangerous drugs that tend to be cut with other substances, such as:2,4

  • Cocaine.
  • Ketamine.
  • Methamphetamine.
  • Over-the-counter cough medicine.
  • Caffeine.
  • Synthetic cathinones, also known as bath salts.

Bath salts, or synthetic cathinones, belong to a dangerous group of substances sometimes labeled as “new psychoactive substances.” They are risky because they are unregulated and not much is known about their exact effects on the brain. Researchers do know that many common synthetic cathinones are chemically similar to drugs like MDMA, cocaine, and methamphetamine. Bath salts can produce both pleasurable and harmful effects, such as:5

  • Paranoia.
  • Hallucinations.
  • Increased feelings of friendliness.
  • Increased sex drive.
  • Panic attacks.
  • Extreme agitation and violent behavior.
  • Raised blood pressure.
  • Chest pain.
  • Increased heart rate.

In the worst case scenario, bath salts can cause death, especially when snorted or injected. People who take Molly are often unknowingly taking bath salts. One report indicated that 4 out of 10 nightclub or festival attendees tested positive for bath salts without knowing that they had taken this substance. The report also indicated that half of the tests came back positive for MDMA, and half came back positive for bath salts, with butylone and methylone being the most common “bath salt” substances found in molly/ecstasy.6 Further evidence for the impurity of supposed MDMA comes from another study, which indicated that MDMA was only present in 60% of 529 ecstasy/MDMA samples tested from 2010-2015.7

Taking a drug that is unregulated can be very hazardous because you essentially have no idea what substance you are really taking. Ecstasy can contain many different compounds that increase the risks of very serious health effects and death.7

Negative Effects on the Body & Brain

MDMA acts primarily on 3 neurotransmitter systems: dopamine, which is responsible for feelings of pleasure and reward; norepinephrine, a stress hormone that raises blood pressure and heart rate; and serotonin, which is involved in the regulation of a number of processes, including mood, appetite, and sleep. MDMA produces its effects primarily by acting as an indirect serotonergic agonist, which essentially means that it increases the amount of serotonin released into synapses.2,3

Due to this surge of serotonin, you might feel extremely hyper or alert, and you may lose your sense of time and have altered perceptions, such as sensitivity to touch. However, the serotonin surge ultimately leads to serotonin depletion in your brain, and you may then experience negative psychological effects like confusion, depression, drug cravings, and anxiety.8 Some studies have shown that ecstasy also causes a depletion of dopamine and norepinephrine, but MDMA’s consequences have largely been shown to occur due to its much greater effect on serotonin.9

concept of woman experiencing hallucination, possible long term effect of synthetic drugs
MDMA or ecstasy use can have many negative short-term effects, such as:1,8,10,11

  • Nausea.
  • Blurred vision.
  • Insomnia.
  • Increased body temperature, sweating, or chills.
  • Increased muscular tension.
  • Stiffness and pain in lower back and legs.
  • Jaw clenching and tooth grinding.
  • Heart rhythm disturbances.
  • Constant restless leg movements.
  • Agitation.
  • Delirium.
  • Brief psychotic episodes.
  • Hallucinations.
  • Depersonalization (feeling separate from your body).
  • Bizarre or reckless behavior.
  • Accidents.
  • Unintentional self-injury.

People who use MDMA or ecstasy on a long-term basis can develop dependence and addiction. Dependence develops due to repeated use after your body adapts to the presence of the drug and needs it in order to function optimally. Once physical dependence develops, you may experience withdrawal symptoms when you abruptly stop using. Addiction is a chronic brain disease in which you experience cravings and continue abusing the drug despite knowledge of the negative consequences.

Ecstasy and MDMA abuse can also have additional long-term consequences, such as:1,8,11,12

  • Brain damage.
  • Memory impairment.
  • Kidney injury or damage.
  • Hyponatremia, meaning low sodium levels in your blood.
  • Impaired decision-making abilities.
  • Greater impulsivity and lack of self-control.
  • Repeated panic attacks.
  • Recurring paranoia, hallucinations, delusions, depersonalization, or flashbacks.
  • Seizures.
  • Severe depression, which can increase the risk of suicidal thoughts and attempts.
  • Serotonin neurotoxicity.

It is theorized that there may be some neurotoxicity associated with the MDMA-mediated surge in serotonin, which ultimately results in cellular damage to the neurons that release it into the synapse (i.e., presynaptic serotonergic neurons). This neurotoxicity may underlie what ultimately amounts to a decrease in serotonin activity, which can cause numerous negative physical, cognitive, and psychiatric problems, such as loss of sexual function and higher cognitive deficits in areas of working memory, attention, and inhibition.13 Animals studies have shown that serotonin neurotoxicity can lead to neurodegeneration, hyperthermia, and death.14

Not only can MDMA and ecstasy abuse lead to negative short- and long-term consequences, it can also increase your risk of overdose, which can cause severe morbidity and even death.15

Signs & Symptoms of Overdose

If you or someone you know uses ecstasy or MDMA, it is crucial to educate yourself on the signs and symptoms of overdose so that you can seek appropriate medical attention if necessary. Overdoses are rare, but in some cases are associated with life-threatening complications. Some of the common signs of MDMA/ecstasy overdose include:3,16

  • Hyperthermia, which can lead to kidney failure and the breakdown of muscle tissue.
  • Man having panic attack from drugs

  • Irregular heart beat.
  • High blood pressure.
  • Brain hemorrhage or aneurysm.
  • Hallucinations.
  • Agitation.
  • Panic attacks.
  • Loss of consciousness.
  • Seizures.
  • Coma.

If you suspect that you or someone else is experiencing an overdose, call 911 right away. Do not leave the person alone. If they are unconscious, you’ll first want to place them on their side and ensure that the airway is clear by tilting the head back and lifting their chin.17 Remain calm and provide as much information as you can to emergency medical personnel when they arrive, including the amount of drugs taken, if known, when the drugs were taken, and any other substances ingested.

Harm Reduction Practices

Despite the risks involved with MDMA or ecstasy use, people may not always be willing to avoid using at music festivals, clubs, raves, parties, or other settings. In such cases, implementing certain harm reduction practices may help prevent or avoid serious consequences.

Pill testing has become a more common practice at music festivals because many of these festivals embrace the harm reduction stance and want festival-goers to be as informed as possible about what they are putting in their bodies. Pill testing stations allow people to receive a chemical test that reveals the purity and contents of the drug. This allows users to decide whether they want to take the substance or dispose of the drug if it’s not what they thought it was. Sometimes people might still choose to take the substance, but it’s better to be informed. One study indicated that 94% of people would be willing to use drug checking services at festivals.18

Similarly, you can purchase pill testing kits online to test your substances at home before using them. This could be a real eye-opening experience; you may quickly realize that while you thought you bought MDMA, Molly, or ecstasy, it could actually be a combination of dangerous and unpredictable drugs that could potentially result in death.

Knowing the negative consequences and dangerous health effects may not be enough to stop some people from abusing ecstasy or MDMA. Seeking professional treatment is crucial in order to address the problem before it’s too late. A comprehensive addiction treatment program is one of the most advisable ways to treat problematic drug use as it can help people cope with cravings, deal with triggers, and avoid relapse.

Sources

  1. Kalant, H. (2001). The pharmacology and toxicology of “ecstasy” (MDMA) and related drugsCMAJ: Canadian Medical Association Journal165(7), 917–928.
  2. National Institute on Drug Abuse. (2016). MDMA (Ecstasy/Molly).
  3. Australian Government Department of Health. (2004). Pharmacology of MDMA (ecstasy).
  4. Drug Enforcement Administration. (2013). 3,4-METHYLENEDIOXYMETHAMPHETAMINE (Street Names: MDMA, Ecstasy, XTC, E, X, Beans, Adams).
  5. National Institute on Drug Abuse. (2018). Synthetic Cathinones (“Bath Salts”).
  6. New York University. (2016). NYU Research: Hair Sampling Shows Unintended “Bath Salt” Use.
  7. Saleemi, S.,Pennybaker, S., Wooldridge, M. & Johnson, M. (2017). Who is ‘Molly’? MDMA adulterants by product name and the impact of harm-reduction services at raves. Journal of Psychopharmacology, 31(8), 1056-1060.
  8. Harvard University Office of Alcohol & Other Drug Services. MDMA (Molly, Ecstasy).
  9. National Institute on Drug Abuse. (2017). What are MDMA’s effects on the brain?
  10. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  11. National Institute on Drug Abuse for Teens. (2012). Meet Molly: The Truth About MDMA.
  12. Campbell, G. & Rosner. M. (2008). The Agony of Ecstasy: MDMA (3,4-Methylenedioxymethamphetamine) and the Kidney. Clinical Journal of the American Society of Nephrology, 3(6), 1852-1860.
  13. Parrott, A. (2002). Recreational Ecstasy/MDMA, the serotonin syndrome, and serotonergic neurotoxicity. Pharmacology, biochemistry and behavior, 71(4),837-44.
  14. Green, A,, Mechan, A,, Elliott, J,, O’Shea, E. & Colado, M. (2003). The Pharmacology and Clinical Pharmacology of 3,4-Methylenedioxymethamphetamine (MDMA, “Ecstasy”). Pharmacological Reviews, 55(3), 463-508.
  15. Meyer, J. (2013). 3,4-methylenedioxymethamphetamine (MDMA): current perspectives. Substance Abuse and Rehabilitation, 2013(4), 83-99.
  16. National Institute on Drug Abuse. (2017). What are the effects of MDMA?
  17. Victoria State Government. (2014). Drug overdose.
  18. Day, N., Criss, J., Griffiths, B., Gujral, S. K., John-Leader, F., Johnston, J., & Pit, S. (2018). Music festival attendees’ illicit drug use, knowledge and practices regarding drug content and purity: a cross-sectional surveyHarm Reduction Journal15, 1.

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