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MDMA Withdrawal & Detox Guide

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Symptoms, Timeline, & Effects

As a “club drug” that contains both hallucinogenic and stimulant properties, MDMA, short for 3,4-methylenedioxymethamphetamine, is commonly used for its ability to produce a pleasurable euphoria, boost energy, heighten sensory perception, as well as increase sexual desire, feelings of empathy, and closeness.1,2,3,4

First developed more than 100 years ago, MDMA was originally intended to serve as a parent compound from which to synthesize medications that control bleeding.3 Currently, the effects of MDMA use in cases of post-traumatic stress disorder (PTSD) and for cancer patients with anxiety are being researched.4 Presently, though, MDMA remains a Schedule I controlled substance, meaning that it is a drug with known abuse liability and no established medical benefit.2,3

MDMA Street Names

MDMA is better known by names including the following:4

  • Ecstasy
  • Molly
  • E
  • X
  • Hug Drug
  • XTC

MDMA is a popularly abused drug. In 2014, the National Survey on Drug Use and Health found that more than 17 million people aged 12 or older had reported using MDMA at least once in their lives.3 Teens have contributed to the prevalent rates of MDMA use in the U.S., with 4.10% of high school seniors admitting to having used the drug.2,5

Harmful Mixing

MDMA is typically taken as a capsule, pill, or tablet.1,2 Prior to being distributed, it is common for MDMA to be mixed with other harmful drugs, such as ketamine, methamphetamine, cocaine, cough medicine, or bath salts, unbeknownst to the user.1,2 In some cases, these additives can increase the risk of harmful consequences, including overdose. Additionally, it is common for people who abuse MDMA to abuse other drugs as well, such as alcohol and marijuana.4

With patterns of use that differ from many other known drugs of abuse, issues regarding MDMA addiction and MDMA dependence continue to be debated. Though its role in contributing to a classical picture of addiction may not be entirely clear, some people are certainly negatively affected by their use of the drug and have furthermore reported MDMA-related phenomena common to other addictive substances, such as experiencing a withdrawal-like crash that include symptoms such as fatigue, lack of appetite, and depression.1,2 

Though its role in contributing to a classical picture of addiction may not be entirely clear, some people are certainly negatively affected by their use of the drug.

The National Institute on Drug Abuse (NIDA) reports there is evidence to suggest the potential for MDMA addiction with 43% of users in one study showing signs of MDMA dependence.6 One well-established problem associated with MDMA abuse is the presentation of unwanted and uncomfortable withdrawal symptoms when a user abruptly quits or reduces use.2

Short-term Effects of Use

Many people abuse MDMA for the desired effects, such as euphoria, increased energy, emotional warmth, elevated empathy, and distorted time and sensory perception, but the drug also produces many unwanted, dangerous side effects.1,2,3

Some adverse short-term effects of MDMA may include:1,3,4,6

  • Anxiety.
  • Panic attacks.
  • Depersonalization (detachment from oneself).
  • Concentration difficulties.
  • Disturbed sleep.
  • Nausea.
  • Muscle cramping.
  • Clenching of the jaw or grinding teeth.
  • Blurred vision.
  • Chills or sweating.
  • Increased body temperature.
  • Sever dehydration and hyperthermia.
  • Increased heart rate and blood pressure.
  • Arrhythmias.
  • Seizures.

The effects of MDMA typically last between 3 and 6 hours, although many people will take a second dose to maintain the high.1,4

Consequences of Long-term Use

Because MDMA can promote a sense of trust or bonding with others, it could increase the likelihood of risky sexual behaviors, which, in turn, may increase the risk of contracting HIV or other sexually transmitted diseases.9 Prolonged use of MDMA may result in other adverse health outcomes, including:1,2,3,4,6  

  • MDMA addiction, resulting in an inability to control use. 

     Many people abuse MDMA for the desired effects, but the drug also produces many unwanted, dangerous side effects.

  • Decreased cognitive function, including long-term confusion and impairment of memory and attention.
  • Depression.
  • Chronic sleep disturbances.
  • Disruptions in serotonergic neural circuitry.
  • Kidney failure.
  • Heart failure.
  • Liver failure.

The longer a person abuses MDMA, the higher their risk of experiencing harmful and potentially life-threatening consequences.

Withdrawal Signs and Symptoms

MDMA abuse primarily influences brain functioning through its interactions with three neurotransmitters called:1,2,3

  • Serotonin: Helps control mood, sleep, aggression, sexual activity, aggression, and feelings of pain.
  • Dopamine: Associated with increased energy. Helps control movement, emotions, sensations like pleasure, and motivation.
  • Norepinephrine: Important for certain physiological processes such as the control of heart rate and blood pressure.

During MDMA use, activity within these neurotransmitter systems increases to abnormally high levels.1,2,3 With the release of large amounts of serotonin following the use of MDMA, the brain becomes temporarily depleted of the neurotransmitter, which could contribute to the negative after effects that some people experience following drug use.2,3 The reduction of serotonin in the brain following the surge can lead to symptoms including depression, drug craving, poor memory, and anxiety—even weeks later.2,3

Changes in functioning throughout the brain’s serotonergic and other neurotransmitter systems could help to explain the onset of a number of unwanted MDMA withdrawal symptoms. Although these detox symptoms vary from person to person, common MDMA withdrawal symptoms include 1,3,4:

  • Depression.
  • Anxiety.
  • Confusion.
  • Fatigue.
  • Loss of appetite.
  • Inattention and impaired concentration.

Detoxification Timeline

After a drug is consumed, the body works to break down the substance and eliminate it from the system in a process called detoxification (detox). The time needed to detox from MDMA depends on several factors like:3

  • Dose, purity, and potency of the drug being abused.
  • The combined effects of any additives and other adulterant drugs contained in the illicit product.
  • Whether MDMA was abused alone or with other substances, such as alcohol.
  • The amount used and frequency of use.
  • Total duration of use.
  • The presence of any significant mental or physical health issues.

The acute MDMA withdrawal syndrome may resemble the crash that occurs after a stimulant binge. The detox timeline may show great variability among different individuals, but withdrawal symptoms usually start within a day or two after last use. As with other stimulant substances, such as cocaine or amphetamine, the detox process usually ends after several days. Some withdrawal symptoms could last for 3 to 4 weeks after last use, though.

Withdrawal Effects

The effects of MDMA withdrawal, while not necessarily life-threatening or medically dangerous, can still be uncomfortable and unwanted.1 Certain withdrawal-related issues could require additional medical attention, including:1,2,3

  • Depression: The impact of depression may be mild for some, but others could experience very distressing symptoms affecting mood and overall well-being. The risk of self-harm and suicide increases with severe depression. MDMA influences the brain’s serotonin levels long after use. Regularly abusing MDMA can lead to persistent depression related to low serotonin for years into recovery. The experience of depression during withdrawal may encourage a relapse as a form of self-medication.
  • Polysubstance withdrawal: An important note to consider is that many products claiming to be MDMA are not MDMA at all or are mixed with other substances. When this occurs, withdrawal and detox may be even more unpredictable and complicated.

Detox Options

Just because MDMA withdrawal is seldom associated with overtly life-threatening effects does not mean that detox treatment is unnecessary, especially since MDMA is often abused with other substances like alcohol, LSD, and marijuana.4

Detox is only the first step towards recovery. For lasting recovery from a substance use disorder, longer-term addiction treatment will be key.

Fortunately, there are professional detox options that occur in two main settings:

  • Inpatient detox: This option involves the individual living in the detox center for the duration of detox. With 24-hour care and a safe, stable environment, the person can focus on recovering from drug abuse.
  • Outpatient detox: Outpatient detox allows the individual to attend work or school while commuting to detox treatment at a community center, doctor’s office, or substance abuse facility during the day.

With MDMA and other drugs, detox is only the first step towards recovery. For lasting recovery from a substance use disorder, longer-term addiction treatment will be key. Good detox programs will help people plan for this transition. While there are no FDA-approved medications specific for MDMA use disorder, many people have found success with behavioral therapies in their path to recovery.

Sources

  1. National Institute on Drug Abuse: DrugFacts. (2018). MDMA (Ecstasy/Molly).
  2. National Institute on Drug Abuse for Teens. (2019). MDMA (Ecstasy or Molly).
  3. National Institute on Drug Abuse. (2017). MDMA (Ecstasy) Abuse.
  4. S. Department of Justice Drug Enforcement Administration. (2017). Drugs of Abuse: A DEA Resource Guide: 2017 Edition.
  5. National Institute on Drug Abuse. (2019). Monitoring the Future Study: Trends in Prevalence of Various Drugs
  6. National Institute on Drug Abuse. (2007). The Neurobiology of Ecstasy (MDMA).
  7. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide, Third Edition.

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