Editing MDMA (section)

==Uses==
===Recreational===
MDMA is often considered the drug of choice within the [[rave]] culture and is also used at clubs, festivals, and [[house party|house parties]].<ref name="pmid22392347" /> In the rave environment, the sensory effects of music and lighting are often highly [[Synergy|synergistic]] with the drug. The psychedelic [[amphetamine]] quality of MDMA offers multiple appealing aspects to users in the rave setting. Some users enjoy the feeling of mass communion from the inhibition-reducing effects of the drug, while others use it as party fuel because of the drug's stimulatory effects.<ref>{{cite book|vauthors=Reynolds S|title=Generation Ecstasy: Into the World of Techno and Rave Culture|year=1999|publisher=Routledge|isbn=978-0-415-92373-6|page=81|url=https://books.google.com/books?id=tGaRJiXe74UC&q=Generation+Ecstasy+MDMA&pg=PA81|access-date=13 October 2020|archive-date=8 November 2023|archive-url=https://web.archive.org/web/20231108064150/https://books.google.com/books?id=tGaRJiXe74UC&q=Generation+Ecstasy+MDMA&pg=PA81#v=snippet&q=Generation%20Ecstasy%20MDMA&f=false|url-status=live}}</ref> MDMA is used less often than other stimulants, typically less than once per week.<ref name=Epstein2013/>

MDMA is sometimes taken in conjunction with other psychoactive drugs such as [[LSD]],<ref name=":0">{{cite journal | vauthors = Zeifman RJ, Kettner H, Pagni BA, Mallard A, Roberts DE, Erritzoe D, Ross S, Carhart-Harris RL | title = Co-use of MDMA with psilocybin/LSD may buffer against challenging experiences and enhance positive experiences | journal = Scientific Reports | volume = 13 | issue = 1 | pages = 13645 | date = August 2023 | pmid = 37608057 | doi = 10.1038/s41598-023-40856-5 | pmc = 10444769 | bibcode = 2023NatSR..1313645Z }}</ref> [[psilocybin mushroom]]s, [[2C-B]], and [[ketamine]]. The combination with LSD is called "candy-flipping".<ref name=":0" /> The combination with 2C-B is called "nexus flipping". For this combination, most people take the MDMA first, wait until the peak is over, and then take the 2C-B.<ref>{{Cite web | vauthors = Weiss S |date=2024-02-16 |title=Nexus Flipping: What Happens When You Combine MDMA and 2C-B |url=https://doubleblindmag.com/nexus-flipping/ |access-date=2024-07-10 |website=DoubleBlind Mag |language=en-US}}</ref>

MDMA is often co-administered with [[Alcohol (drug)|alcohol]], [[methamphetamine]], and prescription drugs such as [[Selective serotonin reuptake inhibitor|SSRIs]] with which MDMA has several drug-drug interactions.<ref name="HysekSimmlerNicola2012">{{cite journal | vauthors = Hysek CM, Simmler LD, Nicola VG, Vischer N, Donzelli M, Krähenbühl S, Grouzmann E, Huwyler J, Hoener MC, Liechti ME | title = Duloxetine inhibits effects of MDMA ("ecstasy") in vitro and in humans in a randomized placebo-controlled laboratory study | journal = PLOS ONE | volume = 7 | issue = 5 | pages = e36476 | date = 2012-05-04 | pmid = 22574166 | doi = 10.1371/journal.pone.0036476 | pmc = 3344887 | bibcode = 2012PLoSO...736476H | veditors = Laks J | doi-access = free | quote = Fig. 7 shows the mean PD effects of MDMA plotted against simultaneous plasma concentrations at the different time points (hysteresis loops). The increases in “any drug effect" (Fig. 7a) and MAP (Fig. 7b) returned to baseline within 6 h when MDMA concentrations were still high. This clockwise hysteresis indicates that a smaller MDMA effect was seen at a given plasma concentration later in time, indicating rapid acute pharmacodynamic tolerance, which was similarly described for cocaine [33]. [...] Figure 7. Pharmacokinetic-pharmacodynamic (PK-PD) relationship. MDMA effects are plotted against simultaneous MDMA plasma concentrations (a, b). The time of sampling is noted next to each point in minutes or hours after MDMA administration. The clockwise hysteresis indicates acute tolerance to the effects of MDMA. }}</ref><ref>{{cite journal | vauthors = Yuki F, Rie I, Miki K, Mitsuhiro W, Naotaka K, Kenichiro N | title = Warning against co-administration of 3,4-methylenedioxymethamphetamine (MDMA) with methamphetamine from the perspective of pharmacokinetic and pharmacodynamic evaluations in rat brain | journal = European Journal of Pharmaceutical Sciences | volume = 49 | issue = 1 | pages = 57–64 | date = April 2013 | pmid = 23395913 | doi = 10.1016/j.ejps.2013.01.014 }}</ref><ref>{{cite journal | vauthors = Hamida SB, Tracqui A, de Vasconcelos AP, Szwarc E, Lazarus C, Kelche C, Jones BC, Cassel JC | title = Ethanol increases the distribution of MDMA to the rat brain: possible implications in the ethanol-induced potentiation of the psychostimulant effects of MDMA | journal = The International Journal of Neuropsychopharmacology | volume = 12 | issue = 6 | pages = 749–759 | date = July 2009 | pmid = 19046482 | doi = 10.1017/s1461145708009693 | s2cid = 24230367 | doi-access = free }}</ref> Three life-threatening reports of MDMA co-administration with [[ritonavir]] have been reported;<ref>{{cite journal | vauthors = Oesterheld JR, Armstrong SC, Cozza KL | title = Ecstasy: pharmacodynamic and pharmacokinetic interactions | journal = Psychosomatics | volume = 45 | issue = 1 | pages = 84–87 | date = 2004-03-01 | pmid = 14709765 | doi = 10.1176/appi.psy.45.1.84 | doi-access = free }}</ref> with ritonavir having severe and dangerous drug-drug interactions with a wide range of both psychoactive, anti-psychotic, and non-psychoactive drugs.<ref name="pmid31038898">{{cite journal | vauthors = Carpenter M, Berry H, Pelletier AL | title = Clinically Relevant Drug-Drug Interactions in Primary Care | journal = American Family Physician | volume = 99 | issue = 9 | pages = 558–564 | date = May 2019 | pmid = 31038898 | doi = }}</ref> <!--Users sometimes use [[menthol]]ated products while taking MDMA for its cooling sensation.{{Citation needed|date=October 2017}}-->

===Medical===
{{See also|MDMA#Research directions|MDMA-assisted psychotherapy}}

As of 2023, MDMA therapies have only been approved for research purposes, with no widely accepted [[medical indication]]s,<ref name=EU2015 /><ref>{{cite journal | vauthors = Sessa B, Nutt D | title = Making a medicine out of MDMA | journal = The British Journal of Psychiatry | volume = 206 | issue = 1 | pages = 4–6 | date = January 2015 | pmid = 25561485 | doi = 10.1192/bjp.bp.114.152751 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Ebrahimian Z, Karimi Z, Khoshnoud MJ, Namavar MR, Daraei B, Haidari MR | title = Behavioral and Stereological Analysis of the Effects of Intermittent Feeding Diet on the Orally Administrated MDMA ("ecstasy") in Mice | journal = Innovations in Clinical Neuroscience | volume = 14 | issue = 1–2 | pages = 40–52 | date = 1 February 2017 | pmid = 28386520 | pmc = 5373794 | quote = MDMA is listed as a Schedule 1 drug by the United States Drug Enforcement Agency, meaning that currently there are no accepted medical uses for MDMA in the United States, there is a lack of accepted safety for use under medical supervision, and there is a high potential for abuse. }}</ref> although this varies by jurisdiction. Before it was widely banned, it saw limited use in psychotherapy.<ref name=Betzler2017/><ref name=EU2015/><ref>{{cite journal | vauthors = Climko RP, Roehrich H, Sweeney DR, Al-Razi J | title = Ecstacy: a review of MDMA and MDA | journal = International Journal of Psychiatry in Medicine | volume = 16 | issue = 4 | pages = 359–72 | year = 1986 | pmid = 2881902 | doi = 10.2190/dcrp-u22m-aumd-d84h | s2cid = 31902958 }}</ref> In 2017 the [[United States Food and Drug Administration]] (FDA) granted breakthrough therapy designation for MDMA-assisted psychotherapy for [[post-traumatic stress disorder]] (PTSD),<ref>{{Cite news|vauthors=Wan W|date=6 August 2017|title=Ecstasy could be 'breakthrough' therapy for soldiers, others suffering from PTSD|language=en-US|newspaper=[[The Washington Post]]|url=https://www.washingtonpost.com/national/health-science/ecstasy-could-be-breakthrough-therapy-for-soldiers-others-suffering-from-ptsd/2017/08/26/009314ca-842f-11e7-b359-15a3617c767b_story.html|access-date=3 April 2021|archive-date=28 August 2017|archive-url=https://web.archive.org/web/20170828230759/https://www.washingtonpost.com/national/health-science/ecstasy-could-be-breakthrough-therapy-for-soldiers-others-suffering-from-ptsd/2017/08/26/009314ca-842f-11e7-b359-15a3617c767b_story.html|url-status=live}}</ref><ref>{{Cite web|vauthors=Kupferschmidt K|date=26 August 2017|title=All clear for the decisive trial of ecstasy in PTSD patients|url=https://www.science.org/content/article/all-clear-decisive-trial-ecstasy-ptsd-patients|access-date=3 April 2021|website=Science (magazine)|language=en|archive-date=28 December 2021|archive-url=https://web.archive.org/web/20211228220713/https://www.science.org/content/article/all-clear-decisive-trial-ecstasy-ptsd-patients|url-status=live}}</ref> with some preliminary evidence that MDMA may facilitate psychotherapy efficacy for PTSD.<ref name="Zarembo">{{cite news |vauthors=Zarembo A |date=15 March 2014 |title=Exploring therapeutic effects of MDMA on post-traumatic stress |work=Los Angeles Times |url=https://www.latimes.com/local/la-me-mdma-20140316-story.html |access-date=2023-04-07 |archive-date=7 April 2023 |archive-url=https://web.archive.org/web/20230407052723/https://www.latimes.com/local/la-me-mdma-20140316-story.html |url-status=live }}</ref><ref>{{Cite journal | vauthors = Singleton SP, Wang J, Mithoefer M, Hanlon CA, George MS, Mithoefer A, Mithoefer O, Coker AR, Klosinski B, Emerson AL, Doblin R |date=2023 |title=Altered brain activity and functional connectivity after MDMA-assisted therapy for post-traumatic stress disorder |journal=Frontiers in Psychiatry |volume=13 | page = 947622 |doi=10.3389/fpsyt.2022.947622 | pmid = 36713926 | pmc = 9879604 |issn=1664-0640| doi-access = free }}</ref> Pilot studies indicate that [[MDMA-assisted psychotherapy]] may be beneficial in treating [[social anxiety]] in [[Autism|autistic adults]].<ref name=":1" /><ref name=":2" /> In these pilot studies, the vast majority of participants reported increased feelings of empathy that persisted after the therapy sessions.<ref>{{Cite web |title=Psychedelic Support: First Clinical Trial: Social Anxiety in Autistic Adults Successfully Treated with MDMA Therapy – Multidisciplinary Association for Psychedelic Studies – MAPS |url=https://maps.org/news/media/psychedelic-support-first-clinical-trial-social-anxiety-in-autistic-adults-successfully-treated-with-mdma-therapy/ |access-date=2024-09-17 |website=maps.org}}</ref> Some have proposed that psychedelics in general may act as [[active placebo|active]] "super [[placebo]]s" used for therapeutic purposes.<ref name="DupuisVeissière2022">{{cite journal | vauthors = Dupuis D, Veissière S | title = Culture, context, and ethics in the therapeutic use of hallucinogens: Psychedelics as active super-placebos? | journal = Transcult Psychiatry | volume = 59 | issue = 5 | pages = 571–578 | date = October 2022 | pmid = 36263513 | doi = 10.1177/13634615221131465 | url = }}</ref><ref name="vanElkYaden2022">{{cite journal | vauthors = van Elk M, Yaden DB | title = Pharmacological, neural, and psychological mechanisms underlying psychedelics: A critical review | journal = Neurosci Biobehav Rev | volume = 140 | issue = | pages = 104793 | date = September 2022 | pmid = 35878791 | doi = 10.1016/j.neubiorev.2022.104793 | url = | quote = In addition, the strong prior expectations that many people have about psychedelics directly contribute to the psychedelic experience and as a consequence it has been suggested that psychedelics may act as a ‘super-placebo’ (Hartogsohn, 2016). Specifically, strong prior expectations (e.g., that a specific intervention will likely trigger a mystical experience) will increase the likelihood of having e.g., a mystical-type experience (Maij et al., 2019), and this placebo-effect is further boosted by the psychedelic-induced suggestibility. | hdl = 1887/3515020 | hdl-access = free }}</ref>

===Others===
Small doses of MDMA are used by some religious practitioners as an [[entheogen]] to enhance prayer or meditation.<ref name="MDMA and Religion">{{cite web | url = http://csp.org/practices/entheogens/docs/saunders-ecstasy_rel.html | vauthors = Saunders N | date = 29 July 1995 | title = The Agony and Ecstasy of God's path | archive-url = https://web.archive.org/web/20130424024232/http://csp.org/practices/entheogens/docs/saunders-ecstasy_rel.html | archive-date=24 April 2013 | work = Council on Spiritual Practices (CSP) | access-date = 11 June 2011 }}</ref> MDMA has been used as an adjunct to [[New Age]] spiritual practices.<ref name="Watson & Beck">{{cite journal |vauthors=Watson L, Beck J |year=1991 |title=New age seekers: MDMA use as an adjunct to spiritual pursuit |url=http://research.lycaeum.org/researchpdfs/1991_watson_1.pdf |journal=Journal of Psychoactive Drugs |volume=23 |issue=3 |pages=261–70 |doi=10.1080/02791072.1991.10471587 |pmid=1685513 |archive-url=https://web.archive.org/web/20041122213135/http://research.lycaeum.org/researchpdfs/1991_watson_1.pdf |archive-date=22 November 2004 |access-date=28 April 2024 |url-status=bot: unknown }}</ref>

===Forms===
[[File:1g_MDMA-HCl.jpg|thumb|1 gram of pure MDMA hydrochloride crystals]]

MDMA has become widely known as ecstasy (shortened "E", "X", or "XTC"), usually referring to its tablet form, although this term may also include the presence of possible [[adulterant]]s or diluents. The UK term "mandy" and the US term "molly" colloquially refer to MDMA in a crystalline powder form that is thought to be free of adulterants.<ref name="nature.com"/><ref name=DrugFacts/><ref name="DEA 2015 assessment" /> MDMA is also sold in the form of the hydrochloride salt, either as loose crystals or in [[Capsule (pharmacy)|gelcaps]].<ref name="Molly S05E07" /><ref name="Molly S06E05" /> MDMA tablets can sometimes be found in a shaped form that may depict characters from [[popular culture]]. These are sometimes collectively referred to as "fun tablets".<ref>{{cite web | vauthors = Kelly M | date = 20 June 2019 | work = Nintendo Enthusiast | title = Man arrested for possession of ecstasy tablets shaped like Wario | url = https://www.nintendoenthusiast.com/man-arrested-for-possession-of-ecstasy-tablets-shaped-like-wario/ | access-date = 17 June 2021 | archive-date = 24 June 2021 | archive-url = https://web.archive.org/web/20210624195901/https://www.nintendoenthusiast.com/man-arrested-for-possession-of-ecstasy-tablets-shaped-like-wario/ | url-status = dead }}</ref><ref>{{cite web | author = <!--Not stated--> | title = Groesbeck: Students caught with deceptively shaped Ecstasy pills | date = 31 October 2019 | work = KWTX | url = https://www.kwtx.com/content/news/Students-caught-with-deceptively-shaped-Ecstasy-pills-at-local-school-564188221.html | access-date = 17 June 2021 | archive-date = 24 June 2021 | archive-url = https://web.archive.org/web/20210624195735/https://www.kwtx.com/content/news/Students-caught-with-deceptively-shaped-Ecstasy-pills-at-local-school-564188221.html | url-status = live }}</ref>

Partly due to the global supply shortage of [[sassafras oil]]—a problem largely assuaged by use of improved or alternative modern methods of synthesis—the purity of substances sold as molly have been found to vary widely. Some of these substances contain [[methylone]], [[ethylone]], [[MDPV]], [[mephedrone]], or any other of the group of compounds commonly known as [[Bath salts (drug)|bath salts]], in addition to, or in place of, MDMA.<ref name=DrugFacts /><ref name="DEA 2015 assessment" /><ref name="Molly S05E07">{{cite AV media |date=13 August 2014 |title=Molly Madness |medium=TV documentary |url= <!--Link for WP:V - https://www.youtube.com/watch?v=F-0Zw05A1Y0 -->|publisher=National Geographic Channel | work = [[Drugs, Inc.]] |asin=B00LIC368M }}</ref><ref name="Molly S06E05">{{cite AV media |date=10 December 2014 |title=Manic Molly |medium=TV documentary |url= <!--Link for WP:V - https://www.youtube.com/watch?v=pd1-triBJFw -->|publisher=National Geographic Channel | work = [[Drugs, Inc.]] |asin=B00LIC368M }}</ref> Powdered MDMA ranges from pure MDMA to crushed tablets with 30–40% purity.<ref name=EU2015 /> MDMA tablets typically have low purity due to bulking agents that are added to dilute the drug and increase profits (notably lactose) and binding agents.<ref name=EU2015 /> Tablets sold as ecstasy sometimes contain [[3,4-methylenedioxyamphetamine]] (MDA), [[3,4-methylenedioxyethylamphetamine]] (MDEA), other amphetamine derivatives, caffeine, opiates, or painkillers.<ref name=Betzler2017/> Some tablets contain little or no MDMA.<ref name=Betzler2017/><ref name=EU2015 /><ref name="Toxnet MDMA after-effects">{{cite web|title=3,4-Methylenedioxymethamphetamine|url=http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@rn+@rel+42542-10-9|website=Hazardous Substances Data Bank|publisher=National Library of Medicine|access-date=22 August 2014|date=28 August 2008|archive-date=4 April 2019|archive-url=https://web.archive.org/web/20190404201340/https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs%20hsdb%3A%40term%20%40rn%20%40rel%2042542-10-9|url-status=live}}</ref> The proportion of seized ecstasy tablets with MDMA-like impurities has varied annually and by country.<ref name=EU2015 /> The average content of MDMA in a preparation is 70 to 120{{nbsp}}mg with the purity having increased since the 1990s.<ref name=Betzler2017/>

MDMA is usually consumed by mouth. It is also sometimes [[Insufflation (medicine)|snorted]].<ref name=Drugs2014/>

{{Multiple image
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<!-- Image 1 -->
| image1 = Ecstasy monogram.jpg
| width1 = 434
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| alt1 = Image of Ecstasy tablets
| caption1 = Ecstasy tablets which may contain MDMA

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| image2 = Tan MDMA Crystals.jpg
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| alt2 = Image of a chunk of impure MDMA
| caption2 = A salt of MDMA (typically white) with impurities, resulting in a tan discoloration

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| alt3 = 1 gram crushed MDMA crystals
| caption3 = Crushed MDMA (1 gram) crystals

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| alt4 = Image of highly pure MDMA in capsules
| caption4 = High purity MDMA in capsules
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