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MDMA Detox Guide: Symptoms, Timeline & Effects

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people exchanging pills in clubAs a “club drug” that contains both hallucinogenic and stimulant properties, 3,4 methylenedioxymethamphetamine is commonly abused for its ability to produce euphoria, feelings of empathy and closeness, distortions in perception and time, increased energy, and strong sexual feelings while lowering inhibitions 1,2,3. The drug is better known by names like 1:

  • MDMA.
  • Ecstasy.
  • Molly.

MDMA was once a patented chemical substance, intended for use as a precursor molecule for other pharmaceutical agents. It was first synthesized more than 100 years ago 3. Currently, the effects of MDMA use in cases of post-traumatic stress disorder (PTSD) and for cancer patients with anxiety are being researched 1. To this point, though, MDMA is a recognized drug of abuse with no established medical benefit, making it an illegal Schedule I controlled substance 1.

MDMA abuse is frequent—the Drug Enforcement Administration has reported that 2.4 million people abused MDMA in 2011  2. Teens are amongst those who abuse MDMA with 4.9% of high school seniors admitting to using the drug in their lives, according to the National Institute on Drug Abuse (NIDA) 1. MDMA abuse can negatively affect a person’s physical and mental health 1,2,3.

People often abuse MDMA in combination with marijuana or alcohol.9 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.9 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. They are also more likely than non-MDMA users to have a co-occurring mental health disorder, such as bipolar disorder, depression, anxiety, and antisocial personality disorder.7

With patterns of use that differ from many other known drugs of abuse, issues regarding MDMA addiction and MDMA dependence continue to be debated 1,4. The NIDA reports that there is evidence to suggest the potential for MDMA addiction with 43% of users showing signs of MDMA dependence 4. 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 1,3,4.

 

Detoxification

doctor shaking hands with patientThe drug addiction process can begin with a single use of a drug, depending on the strength of its addictive properties. Even marijuana, a drug that is considered non-addictive by some professionals, may become habitual. Any continuous stimulation of the chemical receptors in the brain can lead to addiction. Over time, the brain becomes dependent on the stimulation, so any lapse in drug use may cause adverse reactions. Read More

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.9

Some adverse short-term effects of MDMA may include:3,9

  • Nausea.
  • Muscle cramping.
  • Clenching of the jaw or grinding teeth.
  • Blurred vision.
  • Chills or sweating.
  • Increased body temperature.
  • Dehydration.
  • Increased heart rate and blood pressure.
  • Arrhythmias.
  • Seizures.
  • Panic attacks.

The effects of MDMA typically last between 3 and 6 hours, although many people will take a second dose to maintain the high.9

Consequences of Long-term Use

Because MDMA can promote a false sense of trust or bonding feelings with others, the drug may cause the user to engage in risky sexual behaviors, thus increasing the risk of contracting HIV or other sexually transmitted diseases.9 Prolonged use of MDMA may result in other negative problems, including:3,7,9

  • MDMA addiction, resulting in an inability to control use.
  • Long-term confusion.
  • Depression.
  • Impairment of memory and attention.
  • Impairment of neuroendocrine functioning, which maintains homeostasis, controls metabolism, reproduction, drinking and eating, energy use, and blood pressure.
  • Sleep disturbances.
  • Damage to neuronal axons, white matter growth, and small blood vessels.
  • Reduction in connectivity between brain regions.
  • Kidney failure.
  • Heart failure.
  • Liver failure.

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

MDMA Withdrawal Signs and Symptoms

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

  • Serotonin: Helps control mood, sleep, and sexual arousal.
  • Dopamine: Associated with increased energy and feelings of joy.
  • Norepinephrine: Increases pulse and blood pressure.

During MDMA use, these neurotransmitters are released at high levels, which creates a shift in normal chemical balance in the brain. During MDMA use, these neurotransmitters are released at high levels, which creates a shift in normal chemical balance in the brain 4. Animal studies have demonstrated serotonergic depletion in certain regions of the brain following ecstasy use 4.

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.
  • Sleep disturbances.
  • MDMA cravings.
  • Memory problems.
  • Inattention and impaired concentration.
  • Decreased appetite.
  • Low energy/ fatigue.

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) 5,6. The time needed to detox from MDMA depends on several factors like:

  • Dose and potency of the drug being abused.
  • Additives and any adulterant drugs contained in the illicit product.
  • The amount used and frequency of use.
  • Total duration of use.
  • If MDMA was abused with other substances.
  • Mental or physical health issues.

MDMA withdrawal syndrome may resemble the crash that occurs after a stimulant binge. The detox timeline may show great variability depending on the individual, 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 5.

MDMA Withdrawal Effects

depressed woman cryingThe effects of MDMA withdrawal are not typically life-threatening or medically dangerous 5. Still, several risks exist during drug detox including 1,3,4,7:

  • 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.
  • Complicated 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. MDMA is often mixed with or substituted with substances like:
    • Caffeine.
    • Dextromethorphan.
    • Methamphetamine.
    • Ephedrine.
    • Ketamine.
    • Cocaine.

Since any MDMA use can lead to issues with dehydration and hyperthermia, relapses can be deadly. Cravings are a frequent concern during drug detox 8. The experience of depression during withdrawal may encourage a relapse as a form of self-medication. Since any MDMA use can lead to issues with dehydration and hyperthermia, relapses can be deadly 1.

MDMA Detox Options

Just because MDMA withdrawal is not overtly life-threatening does not mean that detox treatment is unnecessary, especially since MDMA is often abused with other substances like alcohol, LSD, and marijuana 2,3. Fortunately, there are professional detox options that occur in two main settings 5,6:

  • 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 maintain their typical routines 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 better, longer-lasting periods of abstinence, ongoing MDMA addiction treatment will be key 5,6. The detox treatment center will work with the individual to establish meaningful substance abuse treatment plans 5.

Sources

  1. National Institute on Drug Abuse for Teens. (2017). MDMA (Ecstasy or Molly).
  2. Drug Enforcement Administration. (2013). 3,4-Methylenedioxymethamphetamine.
  3. National Institute on Drug Abuse. (2006). MDMA (Ecstasy) Abuse.
  4. National Institute on Drug Abuse. (2007). The Neurobiology of Ecstasy (MDMA).
  5. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  6. Kalant, H. (2001). The pharmacology and toxicology of “ecstasy” (MDMA) and related drugs. CMAJ: Canadian Medical Association Journal165(7), 917–928.
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  8. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
  9. National Institute on Drug Abuse. (2016). MDMA (Ecstasy/Molly).

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