The prevalence of drug abuse in society has been on a steady rise. This is a persistent
public health issue which has been complicated further by the availability of synthetic
recreational drugs. These drugs which are often referred to as “research chemicals” or “legal
highs,” are artificial substitutes to traditional drugs of abuse. Most of these synthetic drugs
are taken for recreational purposes and they collectively fall in a class of drugs called “new
psychoactive substances” (NPS) (Baumann, 2016).
. At present, 3, 4-methylenedioxymethamphetamine (MDMA), is one of the illegal
synthetic drugs abused in the United States (U.S.). MDMA is one of the most abused drugs in
the U.S., with its users numbering to millions across the country. This drug has several
pseudo names as it is also known among its users as X, Molly, and ecstasy. At first, party
revelers were the primary users of this drug, but over time its use has spread to different
settings. The effects of consuming MDMA include stimulation, time distortion, and sensory
perceptions (Meyer, 2013).
The effects of MDMA start setting in after 45 minutes of consumption and can last for
3 hours, with their peak being between 15 and 30 minutes. Moreover, this drug causes
hangovers that last for up to two days. Typically, each tablet of ecstasy contains between 50
and 150 milligrams of MDMA, and users usually take between one and two pills with
subsequent doses aimed at boosting the dwindling effects of the drug (Abadinsky, 2018). The
users' inclination to continue with the dosage to maintain the effects of MDMA heightens the
risk of exposure to its side effects from the combined dosages (Meyer, 2013).
Most people take this drug in either its tablet or capsule form, which is sometimes
called ecstasy. However, many ecstasy tablets contain more than just MDMA but a
concoction of different drugs with varying concentrations with adverse effects on the human
body (Abadinsky, 2018). Some of the drugs contained in ecstasy include caffeine, cocaine,
phencyclidine (PCP), heroin, and anesthetic ketamine. In some cases, it may contain
extromethorphan which is an over-the-counter cough suppressant.
The crystalline form of MDMA commonly goes by the name molly among users, and
it is sold in the market either in capsule or powder forms. Similar to ecstasy, the composition
of molly is often not 100% MDMA but contains varying concentrations of other
contaminants, including stimulants such as methylone and ethylone (Passie & Benzenhöfer,
2016). The presence of varying impurities in molly exposes users to health risks from
ingesting harmful substances unknowingly.
MDMA is synthetic, and its popularity has been rising since the 1980s prompting
researchers to investigate the adverse effects associated with its continued use. These
research initiatives revealed that MDMA has the propensity of increasing blood pressure,
heart rate, and body temperature as well as causing damage to the kidneys, which in most
cases results in a fatality (Abadinsky, 2018). Also, the continued consumption of this drug
leads to memory and learning problems and an overall deficiency in the user's cognitive
At, present, there is no conclusive evidence that classifies MDMA as an addictive drug
despite the potential dangers that it exposes users to. However, MDMA has an effect on the
brain’s neurotransmitter, just like the case with other addictive drugs. When one takes
MDMA in the form of pills, the effects sets in within the first 45 minutes (Abadinsky, 2018).
Under normal circumstances, it takes approximately half an hour for its effects to peak, and it
can last up to three hours. MDMA’s adverse effects usually last for 24 hours. Recreational
consumers typically take either one to two pills, first with concentrations of MDMA ranging
between 50 and 150 milligrams (Abadinsky, 2018). To boost its effects, they take subsequent
doses when the effects decline. Most importantly, the subsequent dosage of MDMA among
users exposes them to increased risk owing to the combined dosages.
Despite the lack of evidence on MDMA being addictive, this drug has various side
effects that may be life-threatening. The symptoms related to the use of this drug include
panic attacks, hypertension, seizures, faintness, and loss of consciousness (Bora, Yılmaz &
Bora, 2016). The side effects of MDMA are associated with its stimulating properties and
conditions under which the drug is consumed. For instance, when an individual exposed to
vigorous physical activity consumes the drug, it interferes with the .ability of the human body
to regulate its temperature precipitating into hyperthermia. The onset of unchecked
hyperthermia is potentially fatal as it causes electrolyte imbalance, which is a precursor to
kidney failure. Besides, swelling of the brain, dehydration, and reduced heart pumping
efficiency are other effects of MDMA (Bora et al. 2016). Besides the adverse effects of
MDMA resulting from its use under extreme physical exertion, lack of appetite,
depersonalization, jaw clenching, nausea, sweating, headaches, illogical thoughts, and
restless legs are some of the other adverse health effects of MDMA (Abadinsky, 2018).
Despite the side effects and potential fatalities that might result from the abuse
of MDMA, research studies have pointed at some therapeutic attributes that may be derived
from this drug. For instance, the combination of this drug with psychotherapy has an
effectiveness of approximately 67% in treating patients with post-traumatic stress disorders
(Yazar-Klosinski & Mithoefer, 2017). Besides, MDMA possesses anxiolytic properties that
produce prosocial and empathetic feelings to counter anxiety problems in patients (Yazar-
Klosinski & Mithoefer, 2017). Lastly, MDMA is also appropriate for the treatment of alcohol
addiction in conjunction with apt psychotherapy regimes.
The presence of other drugs in MDMA tablets, crystals, or molecules causes some of
the disturbances experienced by the users of this drug. Additionally, research studies have
established links between continuous uses of MDMA with certain high-risk behaviors. For
instance, risky sexual behavior among the users of MDMA is much higher than the case with
individuals who abuse alcohol. According to Garin, Zurita, Velasco, Feliu, Gutierrez, Masip
& Mangues (2017), the frequent use of recreational drugs MDMA inclusive, has been shown
to interfere with desired outcomes for HIV patients. The potential adverse effects emanate
from the interaction of these drugs with the antiretrovirals prescribed for these patients (Garin
et al. 2017). According to Evers,Van Liere, Hoebe & Dukers-Muijrers (2019), MDMA is one of
the drugs involved in chemsex in the Netherlands. Additionally, there is close link in the
usage of MDMA and other drugs such as cocaine, crystal meth, and ketamine among Men
who have sex with men (MSM). According to research, almost all MSM who used MDMA
as a chemsex drug in the Netherlands, were also involved in the consumption of at least one
of the forenamed chemsex drugs (Evers, et al. 2019).
The History of MDMA
The origins of MDMA can be traced back to Germany. This drug was first developed
synthetically by a German pharmaceutical company named Merck back in 1912 and was
formerly known as Methylsafrylaminc (Abadinsky, 2018). Initially, this drug was intended
for medicinal purposes in the synthesis of bleeding control medication. This purpose
contradicts the widely held perceptions that this drug was developed to control appetite. Upon
its discovery and initial trails, MDMA was patented by Merck in 1914, who labeled it as
having potential pharmaceutical value. However, further developments of this drug would
take place decades later.
MDMA also claims some historical contribution to the Cold War as both the CIA and
the U.S. Army experimented with its use alongside other hallucinogenic drugs for suitability
in chemical warfare. These experiments took place in the 1950s under the code name MK-
Ultra and were aimed at applying MDMA as an agent for mind control (Passie &
Benzenhöfer, 2018). However, the experimental use of this drug was carried out on non-
human subjects, and the results remain relevant to this day as a basis for MDMA
Despite not having received formal approval in the U.S., this drug commanded a
substantial following in the 1970s and 1980s. It was widely believed by psychiatrists to
enhance patient communication and insights into their problems. The psychiatric use of this
drug is attributed to its wide availability in the streets. The U.S. Drug Enforcement Agency
(DEA) banned the use of MDMA in 1985 and listed it in schedule 1 of drugs. Drugs in
schedule 1 are defined as those not accepted for medicinal use and with a high propensity of
being abused (Meyer, 2013). In the U.S., the use of MDMA has close links with electronic
dance music events and the rave culture embedded in society. The venues for these events,
which are mostly clandestine, provide an apt environment for alcohol and drug abuse.
In the 1980s, raves became popular in Europe and the U.S. concurrent with the
increased street availability and use of MDMA, leading to this drug being a mainstay in these
raves. Besides, the prevalence in MDMA use during these events is associated with the
perceived spiritual aspects that revelers related to the sense of acceptance and harmony that
its intake provides (Passie & Benzenhöfer, 2016). The spread of MDMA usage became
popular in the U.S. among white professionals leading to its acquisition of the name “yuppie
drug” (Abadinsky, 2018). The usage of this drug was also initially prevalent among
individuals who were part of what was known as the New Age spiritual movement
(Abadinsky, 2018). However, with time, MDMA consumption has transcended over the
ethnic boundaries and is now commonly use among African American community and
university students in the U.S.
The manufacturing of MDMA utilizes several chemicals toxic to humans, such as
mercury, ammonium chloride, and formaldehyde. There are six necessary steps in its
manufacturing process, which start with the extraction of safrole, which is a phenylpropene
through the distillation of oil from the sassafras plant. Research evidence shows that safrole
having a carcinogenic effect on animals. The second step in the manufacture of MDMA is the
production of methylamine hydrochloride by reacting formaldehyde and ammonium chloride.
The next step involves the creation of MDP2P through the Wacker process, which is then
followed by its distillation to acquire pure MDP2P (Evans, Costrino, do Lago, Garcia, Roux
& Blanes, 2016). After the acquisition of MDP2P in its pure form, it is then reacted with
Aluminium amalgam to produce MDMA oil which then crystallizes when combined with
isopropyl alcohol and hydrochloric acid. As described above, the MDMA production process
involves the use of hazardous chemical elements and intricate procedures that may have
adverse effects on humans if not properly executed and handled. . It is therefore important for
individuals to refrain from engaging in its production.
Abadinsky, H. (2017). Drug use and abuse: A comprehensive introduction (9th Edition). San
Francisco, CA: Cengage Learning
Baumann M. H. (2016). The Changing Face of Recreational Drug Use. Cerebrum : the Dana
forum on brain science, 2016, cer-01-16.
Bernschneider-Reif, S., Öxler, F., & Freudenmann, R. W. (2006). The origin of MDMA
(‘ecstasy’)–separating the facts from the myth. Die Pharmazie-An International
Journal of Pharmaceutical Sciences, 61(11), 966-972. Retrieved from
Bora, F., Yılmaz, F., & Bora, T. (2016). Ecstasy (MDMA) and its effects on kidneys and
their treatment: a review. Iranian journal of basic medical sciences, 19(11),
Evans, E., Costrino, C., do Lago, C. L., Garcia, C. D., Roux, C., & Blanes, L. (2016).
Determination of inorganic ion profiles of illicit drugs by capillary electrophoresis.
Journal of forensic sciences, 61(6), 1610-1614.
Evers, Y. J., Van Liere, G. A., Hoebe, C. J., & Dukers-Muijrers, N. H. (2019). Chemsex
among men who have sex with men living outside major cities and associations with
sexually transmitted infections: A cross-sectional study in the Netherlands. PloS one,
Garin, N., Zurita, B., Velasco, C., Feliu, A., Gutierrez, M., Masip, M., & Mangues, M.
(2017). Prevalence and clinical impact of recreational drug consumption in people
living with HIV on treatment: a cross-sectional study. BMJ, 18;7(1) doi:
Meyer, J. S. (2013). 3, 4-methylenedioxymethamphetamine (MDMA): Current
perspectives. Substance Abuse and Rehabilitation, 4, 83–99. doi:
Passie, T., & Benzenhöfer, U. (2016). The history of MDMA as an underground drug in the
United States, 1960–1979. Journal of psychoactive drugs, 48(2), 67-75.
Passie, T., & Benzenhöfer, U. (2018). MDA, MDMA, and other “mescaline‐like" substances
in the U.S. military's search for a truth drug (1940s to 1960s). Drug Testing and
Analysis, 10(1), 72-80. doi: 10.1002/dta.2292.
Yazar-Klosinski, B. B., & Mithoefer, M. C. (2017). Potential Psychiatric Uses for MDMA.
Clinical pharmacology and therapeutics, 101(2), 194–196. doi:10.1002/cpt.565