MDMA, a.k.a. molly or ecstasy, is generally safe to ingest, but it has a unique set of risks that differ from classic psychedelics such as LSD or psilocybin mushrooms. MDMA raises core body temperature, which has a number of potential consequences. Street forms of MDMA can also be adulterated with other, more dangerous substances.
MDMA Risks
Things to Know
- MDMA is generally safe, however it is possible to overdose or suffer other negative side effects like heatstroke, and under- or overhydration
- Physical dependence is unlikely to form with MDMA
- It’s important to be conscious of water intake with MDMA, drinking not too little but especially not too much
- Some people take the supplement 5HTP to mitigate what they describe as a serotonin slump after an MDMA experience
Is MDMA Safe?
MDMA is relatively safe compared to other substances, including alcohol. In a study1 comparing MDMA’s risk level to other drugs, alcohol was the most dangerous with a rating of 72, followed by heroin at 55 and crack cocaine at 54. MDMA was rated at 9, followed by LSD at 7 and psilocybin mushrooms at 6.
The more common safety risks of MDMA include the possibility that it could be adulterated with other, more dangerous substances; contraindications with other medications or health conditions; elevated blood pressure; overexertion during the MDMA experience; drinking too much or too little water; and overheating2 . MDMA raises core body temperature, so it’s especially important to stay alert to the body’s response, particularly when taking MDMA in a hot tub, while dancing or other forms of physical activity. There’s also evidence3 that MDMA can make people more impulsive.
Because MDMA signals the release of serotonin in the brain, it can be detrimental to “roll” on MDMA too often. Doing so could lead to feelings of depression, though these feelings are often temporary. The depression is due to neural pathways adapting to the frequent influxes of serotonin from the MDMA and related dopamine release. For this reason, some people choose not to take MDMA more than once every three months, or at a minimum to wait two weeks between MDMA experiences. The “washout” period used in lab research is one to two weeks between administrations of psychedelics.
The day after ingesting MDMA, an individual might feel an afterglow. However, it’s also common to feel a little bit down, irritable, or exhausted. This can last for several days. Lastly, compared to other psychedelics, MDMA shows up in the urine for a fairly long period of time. In a 2012 study4 , researchers found that many MDMA enantiomers showed up in urine 72 hours after administration with a relatively low dose:
MDMA Frequency Modulation
The harm reduction organization DanceSafe recommends taking only one dose on any given day or weekend, avoiding overheating, physical exertion5 like exercise or prolonged dancing, and other strenuous environments. It also recommends not to mix MDMA with other stimulants like meth, or take antioxidants like Vitamins E and C.
MDMA may also6 lead to sympathomimetic toxicity, serotonin syndrome, or multi-organ failure from hyperthermia. It’s also important to drug test MDMA to ensure it’s not mixed with other toxic adulterants or to make sure that you are not ingesting a counterfeit substance.
MDMA and Hearing Loss
MDMA by itself does not contribute to hearing loss, but MDMA and loud noise may contribute to hearing loss. A 2013 study7 involving mice discovered that a moderate dose of MDMA and loud music (that exact combination) enhances noise-induced hearing loss.
Is MDMA Addictive?
While it’s unlikely for someone to form a physical dependence on MDMA8 , compulsive use is not unheard of, albeit uncommon.
MDMA and Memory Loss
Episodic memory is not affected. MDMA does not induce any distinct memory impairments in individuals—at least not after a single dose9.
MDMA Contraindications
If MDMA is mixed with SSRIs, SNRIs, or SPARIs, it’s likely the user will feel reduced effects of the MDMA10 . If MDMA is combined with Wellbutrin, it could increase the risk of seizures.
MDMA and Water Intake
It is especially important to be conscious of water intake while under the influence of MDMA. It is recommended to drink 250-500 ml of water per hour. While heatstroke11 is possible during MDMA, especially if a person is dancing or moving around a lot, overhydration can also be a risk. Hyperthermia happens because MDMA excites the dorsomedial hypothalamus, an area of the hypothalamus that’s generally responsible for temperature regulation. Adding electrolytes to water can help replenish salt when consuming fluids while under the influence of MDMA.
MDMA and 5HTP
Anecdotally, many report a serotonin slump after an experience with MDMA. In order to mitigate the effect, some people take the supplement 5HTP. It’s crucial to wait at least eight hours after a person has come down from MDMA before taking this supplement, in order to avoid potential serotonin syndrome. While the serotonin slump is widely reported, research has not found evidence to confirm it.
