MDMA, aka ecstasy, is proving itself as an effective tool in the treatment of PTSD, but how long does MDMA last? — here’s what you should know.
Overview: MDMA, also known as "Molly" or "ecstasy," is a synthetic drug that belongs to a unique group of drugs known as "entactogens" or "empathogens." While it has been categorized as a Schedule I drug by the US government, ongoing clinical trials are investigating MDMA's potential to help treat PTSD, prompting the FDA to grant MDMA-assisted psychotherapy “breakthrough therapy” status. The effects of a typical dose of MDMA last between 3-6 hours and can include feelings of empathy, emotional openness, sociability, and reduced anxiety, with some physical effects like increased energy and accelerated heart rate. Factors like dosage, method of administration, frequency of use, and physical characteristics affect how long the drug stays in the body and can be detected in blood, saliva, urine, and hair. Practicing harm reduction techniques and using MDMA in a controlled setting can reduce the likelihood of negative effects.
3,4-methylenedioxymethamphetamine (MDMA) is a synthetic drug that is colloquially referred to as "Molly" or “ecstasy.” Ecstasy generally refers to MDMA in pill or tablet form, while Molly (more common in the U.S.) is usually MDMA in crystal or powder form.
MDMA is often categorized as a psychedelic, but it actually has some important differences from classic psychedelics like LSD and psilocybin, which is the active ingredient in magic mushrooms. Rather, MDMA belongs to a unique group of drugs known as “entactogens” or “empathogens.” These terms describe drugs that can enhance emotional empathy and encourage positive social behavior. While there are some similar effects between MDMA and classic psychedelics, they are distinct in many ways.
Large-scale distribution and increasing detection by U.S. authorities in the ‘70s and ‘80s provoked the eventual banning of MDM. It was placed in Schedule I of the Controlled Substances Act in 1985, which denotes drugs with high potential for abuse and no accepted medical use.
However, ongoing clinical trials by the Multidisciplinary Association for Psychedelic Studies (MAPS) are challenging the notion that MDMA lacks medical benefits. Specifically, these trials are investigating MDMA's potential to help treat post-traumatic stress disorder (PTSD).
The results of these trials to date, which have prompted the US Food and Drug Administration (FDA) to grant MDMA-assisted psychotherapy “breakthrough therapy” status, suggest that MDMA-assisted psychotherapy could become a legal treatment option by 2024.
MDMA works by increasing the release of several neurotransmitters, including serotonin, noradrenaline, and dopamine. Neurotransmitters are chemical messengers that transmit signals between neurons in the brain and throughout the body.
Unlike other central nervous system stimulants, which primarily release dopamine and noradrenaline, MDMA triggers a massive release of serotonin. These effects on the brain are likely responsible for the unique combination of stimulant and psychedelic-like properties produced by MDMA.
MDMA's effect on serotonin release is thought to be responsible for its ability to increase feelings of empathy, emotional openness, and sociability, as well as reducing anxiety and fear. Other effects of MDMA may include:
Physical effects of MDMA may include:
The effects of a typical MDMA dose (80-150mg) last between 3-6 hours and typically begin 30-60 minutes after ingestion. The initial effects begin with a short come-up period of 15-30 minutes, followed by a peak period lasting 1.5-2.5 hours. Afterward, the effects slowly wear off during an offset period lasting around 1-1.5 hours.
Therapists typically administer a half-dose of MDMA to patients during the peak to prolong the therapeutic effects of the drug. This is a practice used in clinical trials investigating MDMA-assisted psychotherapy for PTSD, and is also common among recreational users.
Improving readability and quality: The quality of an MDMA experience is heavily influenced by several factors, including the dosage, the person's mental state, and the physical and social environment in which it is consumed. These factors collectively make up what is known as “set and setting.”
Taking MDMA in uncontrolled recreational contexts increases the likelihood of experiencing negative effects. Though practicing harm reduction techniques, such as testing substances before consumption and accurately measuring doses can greatly reduce the likelihood of experiencing harm or negative effects from MDMA use.
Notably, no serious adverse effects have been observed in the last 20 years of using MDMA in clinical contexts.
The amount of time that MDMA is present at its maximum concentration in serum (tmax) is typically observed at 2 hours after ingestion. The length of time required for the concentration of MDMA to decrease to half of its starting dose in the body (elimination half-life) is about 8–9 hours.
MDMA can be detected in blood and saliva for up to 2 days, in urine for up to 4 days, and in hair for up to 90 days. However, the detection window depends on several factors, including the route of administration, frequency of use, quantity consumed, physical characteristics, and the type of drug test used.
The detection window of MDMA depends on several factors, including the method of administration. The faster the drug enters the bloodstream, the shorter the detection window. For instance, snorting MDMA in crystal or powder form results in a shorter detection time compared to taking pressed pills or tablets orally.
One of the drawbacks of MDMA's prohibition is that the drug is often sold in highly variable dosages, often containing adulterants that can affect its presence in the body. Adulterants, such as methylone, ephedrine, methamphetamine, benzylpiperazine, and dextromethorphan, can produce their own effects and influence the length of time the drug stays in the system.
Moreover, consuming large doses or using MDMA continuously over prolonged periods can prolong the presence of the drug in the body. Medical professionals advise that moderate use, such as taking it once every few months, can mitigate its potentially toxic effects. In this case, the detection window will typically be shorter than for more regular users.
Recent studies have shown that the way MDMA is absorbed, distributed, metabolized, and excreted may not be directly linked to the amount taken. This phenomenon is known as nonlinear pharmacokinetics. Researchers have proposed several potential mechanisms to explain this nonlinearity.
When a substance is metabolized, enzymes in the body help break it down into smaller molecules that can be eliminated from the body. In the case of MDMA, when large doses are taken or when the drug is taken frequently over a short period of time, the enzymes responsible for breaking down MDMA can become saturated, meaning that they are unable to keep up with the rate of metabolism. This can lead to the drug remaining in the body for a longer period of time.
Additionally, a temporary molecule called an enzyme-substrate complex can form when MDMA binds to the enzyme responsible for its metabolism. This can cause the enzyme to undergo a temporary change in shape, which can also slow down the rate of metabolism and prolong the presence of MDMA in the body.
When MDMA is broken down in the body, it forms other chemicals called metabolites. Interestingly, the half-life (the time it takes for half of the drug to be eliminated from the body) of these metabolites is longer than that of MDMA itself. This means that even after the effects of MDMA wear off, traces of its metabolites can still be detected in the body for a longer period of time.
Metabolism can also be affected by the following factors:
It's possible for certain substances to cause a false-positive drug test result, which can be prevented by informing testing agencies of all drugs and supplements that have been taken. For example, Trazodone, an antidepressant medication, has been known to produce false positives on tests that detect MDMA in urine.
If someone receives a false positive result and is concerned or confused, they should inform the testing agency immediately. Additional confirmatory tests can be done to address any issues and ensure accurate results.
MDMA is a popular recreational drug and is commonly used at raves and electronic dance music events due to its stimulating and euphoric properties. However, after the peak of the experience, many users report a negative "comedown" that can last from 12 to 72 hours or even up to a week.
This “crash” is thought to be caused by MDMA's tendency to deplete the brain of serotonin, which plays a key role in regulating mood, appetite, and sleep. The severity of a comedown is related to the dosage taken. When higher dosages are used, more of the brain's serotonin supply is depleted, leaving less serotonin available to regulate normal brain functions.
The effects of an MDMA comedown can be quite unpleasant and may include anxiety, depression, impaired cognition, irritability, appetite suppression, insomnia, and fatigue. These symptoms can vary in severity and can significantly impact an individual's well-being and daily functioning.
The findings of a recent study suggest that MDMA can be comedown-free, particularly when used in a clinical setting. The authors of this study argue that factors relating to recreational use, such as drug impurity, alcohol consumption, excessive dancing, poor diet, overheating, dehydration, and drinking too much fluid may exacerbate the negative after effects of MDMA.
However, it is important to keep in mind that this was a small pilot study with no control group. Moreover, in MAPS trials of MDMA-assisted psychotherapy for PTSD, several effects consistent with an MDMA comedown occurred transiently in some participants in the week post-session.
Therefore, it is important to take care of one's physical and mental health when using MDMA recreationally and to be aware of the potential risks and negative consequences.
In summary, the negative after effects or comedown of MDMA can be distressing and impact an individual's well-being and daily functioning. While some new research suggests that MDMA can be comedown-free, more studies are needed to confirm these findings. Moreover, recreational use of MDMA can increase the likelihood of experiencing negative after effects, highlighting the importance of responsible use and harm reduction practices.
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