MDMA

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Summary sheet: MDMA
MDMA
MDMA.svg
Chemical Nomenclature
Common names MDMA, Molly, Mandy, Emma, MD, Ecstasy, E, X, XTC, Rolls
Substitutive name 3,4-Methylenedioxy-N-methylamphetamine
Systematic name (RS)-1-(Benzo[d][1,3]dioxol-5-yl)-N-methylpropan-2-amine
Class Membership
Psychoactive class Stimulant / Entactogen
Chemical class Amphetamine
Routes of Administration

WARNING: Always start with lower doses due to differences between individual body weight, tolerance, metabolism, and personal sensitivity. See responsible use section.



Oral
Dosage
Threshold 40 mg
Light 40 - 70 mg
Common 70 - 140 mg
Strong 140 - 180 mg
Heavy 180 mg +
Duration
Total 3 - 6 hours
Onset 30 - 45 minutes
Come up 20 - 60 minutes
Peak 1.5 - 2.5 hours
Offset 1 - 1.5 hours
After effects 12 - 48 hours









DISCLAIMER: PW's dosage information is gathered from users and resources for educational purposes only. It is not a recommendation and should be verified with other sources for accuracy.

Interactions
Alcohol
MXE
DOx
5-MeO-xxT
Cocaine
Caffeine
GHB
GBL
ΑMT
5-HTP
PCP
25x-NBOMe
2C-T-x
Serotonin releasers
MAOIs
Tramadol
DXM


3,4-Methylenedioxymethamphetamine (also known as ecstasy, E, XTC, molly, mandy, and MDMA) is an entactogen substance of the phenethylamine class. MDMA is a derivative of the amphetamine family and is considered to be the prototype member of a diverse group of substances that includes MDA, methylone, and 6-APB, all of which act by increasing levels of neurotransmitters serotonin, dopamine, and norepinephrine in the brain.

MDMA was discovered in 1912 and first saw use in underground psychotherapy circles in the 1970s.[1] In the 1980s, MDMA spread into nightlife and rave culture and was subsequently banned.[2] In 2014, MDMA was estimated to be one of the most popular recreational drugs used in the world, alongside cocaine and cannabis.[3] Researchers are investigating whether MDMA may assist in treatment-resistant posttraumatic stress disorder (PTSD), social anxiety in autistic adults,[4] and anxiety in those with life-threatening illness.[5][6][7]

Typical effects of MDMA include anxiety relief, disinhibition, enhanced empathy and sociability, relaxation, and euphoria. MDMA is classified as an entactogen due to how it facilitates feelings of closeness with oneself and others. It is commonly associated with dance parties, raves, and electronic dance music.[8] Tolerance to MDMA builds unusually quickly and many users report that it dramatically loses its effectiveness if used on a regular basis. It is commonly recommended to wait one to three months between uses to give the brain enough time to restore serotonin levels.

Acute adverse effects of MDMA are usually the result of high or multiple doses, although single dose toxicity can occur in susceptible individuals.[9] The most serious short-term physical health risks of MDMA are overheating and dehydration, which has resulted in deaths.[10] MDMA has also been shown to be neurotoxic at high doses.[11] However, it is unclear if this risk applies to typical users.[12] It is highly advised to use harm reduction practices if using this substance.

History and culture

MDMA was originally synthesized in 1912 by the Merck chemist Anton Köllisch. Köllisch was interested in developing substances that would help manage excess bleeding and was interested in the activity of MDMA, an intermediary in the production of hydrastinine, a hemostatic agent used at the time. In 1965, Alexander Shulgin synthesized MDMA while conducting experiments with methylenedioxy-substituted compounds but did not test the psychoactivity of the compound.[citation needed]

Around 1975, Shulgin heard about the effects of MDMA from a student. After hearing several more stories about the self-administration of MDMA, he decided to experiment with it. Shulgin was impressed with the effects of the substance and thought it could have therapeutic applications. Shulgin advertised the substance to therapists and psychiatrists for medical use, and it eventually became quite popular in the medical world for the treatment of various psychiatric disorders.[citation needed] During this time, the psychotherapist Dr. Leo Zeff came out of retirement and subsequently introduced the then-legal MDMA to over 4,000 patients. Then known as "Adam", from the mid-1970s to the mid-1980s there was a growth of clinicians using MDMA around California.[13]

The recreational use of MDMA became popular at around the same time, particularly in nightclubs, and eventually caught the attention of the Drug Enforcement Administration. After several hearings, a US Federal Administrative Law Judge recommended that MDMA should be made a Schedule III controlled substance so that it could be used in the medical field. Despite this, the director of the DEA overruled this and classified MDMA as a Schedule I controlled substance.[citation needed]

In the United Kingdom, the 1971 Misuse of Drugs Act, which had already been altered in 1977 to include all ring-substituted amphetamines like MDMA, was further amended in 1985 to refer specifically to Ecstasy, placing it in the Class A category.[13]

Chemistry

MDMA, or 3,4-methylenedioxy-N-methylamphetamine, is a synthetic molecule of the substituted amphetamine class. Molecules of the amphetamine class all contain a phenethylamine core comprised of a phenyl ring bound to an amino (NH2) group through an ethyl chain, with an additional methyl substitution at Rα. In addition to this, MDMA contains a methyl substitution on RN, a feature it shares with methamphetamine. Critically, the MDMA molecule also contains substitutions at R3 and R4 of the phenyl ring with oxygen groups -- these oxygen groups are incorporated into a methylenedioxy ring through a methylene bridge. MDMA shares this methylenedioxy ring with other entactogens and stimulants like MDA, MDEA and MDAI.

Pharmacology

MDMA acts primarily as a releasing agent of the three principal monoamine neurotransmitters serotonin, norepinephrine, and dopamine through its action at trace amine-associated receptor 1 (TAAR1) and vesicular monoamine transporter 2 (VMAT2).[14][15][16] MDMA is a monoamine transporter substrate (i.e. a substrate for the transporters for dopamine (DAT), norepinephrine (NET), and serotonin (SERT), enabling it to enter monoaminergic neurons via these neuronal membrane transport proteins.[15] By acting as a monoamine transporter substrate, MDMA produces competitive reuptake inhibition at the neuronal membrane transporters, competing for endogenous monoamines for reuptake.[15][17]

MDMA inhibits both vesicular monoamine transporters (VMATs), the second of which (VMAT2) is highly expressed within monoamine neurons vesicular membranes.[16] Once inside a monoamine neuron, MDMA acts as a VMAT2 inhibitor and a TAAR1 agonist.[15][18] The inhibition of VMAT2 by MDMA results in increased concentrations of the aforementioned monoamine neurotransmitters in the cytosol of the neuron.[16][19] Activation of TAAR1 by MDMA triggers protein kinase signaling events which then phosphorylates the associated monoamine transporters of the neuron.[15]

Subsequently, these phosphorylated monoamine transporters either reverse transport direction – i.e. move neurotransmitters from inside the cell to the synaptic cleft – or withdraw into the neuron, respectively producing the inflow of neurotransmitters and noncompetitive reuptake inhibition at the neuronal membrane transporters.[15] MDMA has ten times more affinity for uptake at serotonin transporters compared to dopamine and norepinephrine transporters and consequently has mainly serotonergic effects.[20]

MDMA also has weak agonist activity at postsynaptic serotonin receptors 5-HT1 and 5-HT2 receptors, and its more efficacious metabolite MDA likely augments this action.[21][22][23][24] Cortisol, prolactin, and oxytocin quantities in serum are increased by MDMA.[25]

Additionally, MDMA is a ligand at both sigma receptor subtypes, though its efficacies at these receptors and the role that they play have yet to be elucidated.[26]

Subjective effects

The effects listed below are based upon the subjective effects index and personal experiences of PsychonautWiki contributors. These effects should be taken with a grain of salt and will rarely (if ever) occur all at once, but heavier doses will increase the chances of inducing a full range of effects. Likewise, adverse effects become much more likely on higher doses and may include serious injury or death.

Physical effects
Child.svg

    • Stimulation & Sedation - MDMA is commonly regarded as being stimulating and energetic. This encourages activities such as running, climbing and dancing in a way that makes MDMA a popular choice for musical events such as festivals and raves. The distinct style of stimulation which MDMA presents can be described as forced. This means that at higher doses, it becomes difficult or impossible to keep still as jaw clenching, involuntarily body shakes and vibrations become present, resulting in an unsteadiness of the hands and a general lack of motor control. This can also paradoxically be accompanied by persistent or wave-like feelings of deep sedation and relaxation, typically at moderate to strong doses.
    • Spontaneous bodily sensations - The "body high" of MDMA can be characterized as a moderate to extreme euphoric tingling sensation that encompasses the entire body. It is capable of becoming overwhelmingly pleasurable at higher doses. This sensation maintains a consistent presence that steadily rises with the onset and hits its limit once the peak has been reached.
      • Physical euphoria - This component is reliably produced when MDMA is used responsibly (i.e. reasonable dosing and spacing between experiences) and can lead to profound feelings of social and physical disinhibition.
    • Tactile enhancement
    • Bodily control enhancement
    • Stamina enhancement
    • Bronchodilation
    • Abnormal heartbeat
    • Increased blood pressure[27][28]
    • Increased heart rate[29]
    • Temperature regulation suppression
    • Increased bodily temperature [30] - As MDMA is a serotonin releasing agent, a rise in core body temperature tends to be a significant and consistent part of the experience. Caution must be taken as too high of a dose in a dangerously hot environment can result in serotonin toxicity, which can be fatal if left untreated.
    • Muscle contractions
    • Increased perspiration[31]
    • Dehydration - Users may experience signs of dehydration such as dry mouth and sweating while dancing or in a hot environment. However, MDMA causes water retention and dilution of electrolytes. Consequently, overhydration has caused death from water intoxication[32]. It is advised that users have hydration available, drink to thirst and never over-drink.[citation needed]
    • Dry mouth
    • Difficulty urinating[citation needed] - Higher doses of MDMA result in an overall difficulty when it comes to urination. This is caused by MDMA’s promotion of the release of anti-diuretic hormone (ADH); ADH is responsible for regulating urination. This effect can be lessened by relaxing, but can also be relieved by placing a hot flannel over the genitals to encourage blood flow.[33][34]
    • Vibrating vision - At high doses, a person's eyeballs may begin to spontaneously wiggle back and forth in a rapid motion, causing the vision to become blurry and temporarily out of focus. This is a condition known as nystagmus.
    • Nausea - This effect is most commonly present during the come up phase of the experience, and at higher doses, but has been reported to occur spontaneously in those who seem to be susceptible to it.
    • Appetite suppression
    • Pain relief - This effect is generally not as powerful as it is with opioids.[35][36][37]
    • Excessive yawning
    • Pupil dilation
    • Orgasm suppression
    • Temporary erectile dysfunction
    • Teeth grinding[38] - This effect when experienced alongside the cognitive and physical euphoria can often lead to users mildly or intensely clenching their jaw muscles, sometimes even to the point where the individual’s facial expression begins to change. This is sometimes colloquially called “gurning”[39] and is typically only experienced in moderate to high dosages.
    • Seizure - This is a rare effect but is thought to be able to occur in those predisposed to them, especially when taking higher doses or redosing while in physically taxing conditions such as being dehydrated, fatigued, undernourished, or overheated.[citation needed]

Visual effects
Eye.svg

  • The visual effects of MDMA occur more selectively and less consistently than any of the traditional psychedelics. This has resulting in many people disregarding the psychedelic aspects of MDMA as a myth or rumor, despite a large body of anecdotal reports suggesting otherwise. The effects can not be guaranteed to manifest themselves, but are the most likely to occur with chemically pure MDMA at high doses, towards the end of the experience and particularly if the user has been smoking cannabis. They also seem more likely to occur if the user has prior experience with psychedelics.

    Enhancements

    MDMA presents an array of visual enhancements which are mild in comparison to traditional psychedelics, but still distinctly present. These generally include:

    Suppressions

    Distortions

    Geometry

    The visual geometry produced by MDMA can be characterized as more similar in appearance to that of psilocin than LSD. It can be comprehensively described through its variations as primarily intricate in complexity, abstract in form, organic in style, structured in organization, dimly lit in lighting, mostly monotone in colour with blues and greys, glossy in shading, sharp in edges, small in size, fast in speed, smooth in motion, equal in round and angular corners, non-immersive in-depth and consistent in intensity. At higher doses, they are significantly more likely to give rise to states of level 8A visual geometry over level 8B. Many users report that MDMA geometry presents itself with dark and menacing emotional vibes with a synthetic and nerve-racking feel to them.

    Hallucinatory states

    MDMA is capable of producing a unique range of low and high-level hallucinatory states in a fashion that is significantly less consistent and reproducible than that of most other commonly used psychedelics. These effects are far more common during either the very peak or offset of the experience and commonly include:

    • External hallucination (autonomous entities; settings, sceneries, and landscapes; perspective hallucinations and scenarios and plots) - This effect shares many similarities to those produced by deliriant substances, but does not manifest itself consistently and usually happens only at heavy, likely toxic doses. It can be comprehensively described through its variations as delirious in believability, autonomous in controllability and solid in style. They usually follow themes of memory replays and semi-realistic or expected events. For example, people could be casually holding objects or performing actions which one would expect them to be in real life before disappearing and dissolving under further inspection. Common examples of this include seeing people wearing glasses, or hats when they are not and mistaking objects for human beings or animals.
    • Internal hallucinations - The internal hallucinations which MDMA induces are only present as spontaneous breakthroughs at extremely high doses.[citation needed] This effect's variations are delirious in believability, interactive in style, new experiences in content, autonomous in controllability and solid in appearance. The most common way in which they manifest themselves is through hypnagogic scenarios which the user may experience as they are drifting off to sleep after a night of use; these can usually be described as memory replay from the previous several hours. These are brief and fleeting, but frequent and completely believable and convincing as they happen. In terms of the theme, they often are in the form of conversations with people or instead manifest as bizarre and extremely nonsensical plots.
    • Peripheral information misinterpretation[citation needed]

Cognitive effects
User.svg

  • The general head space of MDMA is described by many as one of pronounced mental stimulation, feelings of love, empathy, openness and a pronounced sense of rejuvenation and euphoria. It is capable of producing a large number of cognitive effects that are typically associated with entactogens and stimulants. The most prominent of these effects include:

Auditory effects
Volume-up.svg

    • Enhancements
    • Hallucinations
    • Distortions
    • Tinnitus - This effect is rare, but typically manifests as a muffled roaring in the ears, affected by whether the user is upright or laying down. It is most commonly reported when using in conjunction with other substances but can manifest on its own at higher doses. This may be accompanied by partial or total, yet highly temporary (on the order of a minute), hearing loss, especially when standing.

Transpersonal effects
Infinity4.svg

    • Existential self-realization - Although this effect is present, it is not quite as pronounced or as consistent when compared to hallucinogens such as mescaline, psilocybin, LSD or MXE. This component is unique to MDMA in that it almost always comes about in the form of self-affirmation and a personal appreciation for one’s self as well as others.
    • Unity and interconnectedness - Experiences of lower-level unity and interconnectedness are commonly produced by MDMA. This component most consistently manifests itself within large crowds at raves and musical events in the form of "becoming one with the crowd." Music is said to consistently intensify this effect as well.

After effects
Aftereffects (3).svg

Experience reports

Anecdotal reports which describe the effects of this compound within our experience index include:

Additional experience reports can be found here:

Forms

MDMA Pills, commonly called Ecstasy
Off-white MDMA crystals, commonly called Molly

Since the 1980s, MDMA has become widely known as "Ecstasy" (shortened to "E", "X", or "XTC"), usually referring to its street forms as illicitly pressed pills or tablets.[40] The American term "Molly" and the British equivalent term "Mandy" originally referred to crystal or powder MDMA that was purported to be of high purity and free of adulteration.[41] However, it has since evolved into a generic street term for any number of euphoric stimulants that are sold in powder or crystal form.[citation needed]

MDMA can be found in a number of forms:

  • Pills are the most common form in which MDMA is sold, and are commonly referred to as Ecstasy. They often contain other substances or adulterants that range from anything from MDA, MDEA, amphetamine, methamphetamine, caffeine, 2C-B or mCPP to synthesis by-products such as MDP2P, MDDM or 2C-H. They can also contain an array random substances such as research chemicals, prescription drugs, over-the-counter drugs, poisons or nothing at all. It is strongly recommended to take harm reduction measures such as using a reagent testing kit when ingesting unknown pills.
  • Crystals or Powder (commonly called Molly) is a white to brownish substance which can be dissolved, crushed, put into gel capsules or edible paper ("parachutes"). It can be administered orally, sublingually, buccally or via insufflation ("snorting" or "sniffing").

Research

MDMA-assisted psychotherapy for PTSD

In 2011, a pilot study on 20 patients demonstrated promising results in the treatment of post-traumatic stress disorder (PTSD). After two or three MDMA-assisted psychotherapy sessions, 83% of the patients no longer met the criteria for PTSD, compared to only 25% in the control group where MDMA was replaced with a placebo. The results sustained at two and twelve months after the treatment. The MDMA and placebo group both received non-drug psychotherapy before and after the sessions. In the study, a dose of 125mg MDMA plus a 62.5mg supplemental dose after 2 hours have been administered.[42] After completion of the study, the patients from the placebo group also received MDMA-assisted psychotherapy, and a long-term follow-up study of 19 patients published in 2013 shows that even after three years the positive results maintained.[43]

In 2017, the FDA granted MDMA a breakthrough therapy designation for PTSD, meaning if studies show promise, a review for potential medical use could occur more quickly.[44] Phase 3 clinical trials to look at effectiveness and safety expected to begin in 2018.[45]

R-MDMA

MDMA is typically produced and consumed in its racemic form (known as SR-MDMA) which consists of equal parts S-MDMA and R-MDMA. A 2017 study found that high doses of R-MDMA administered in mice increased prosocial behavior and facilitated fear-extinction learning but did not produce hyperthermia or signs of neurotoxicity. This is thought to owe itself to the lower dopamine release R-MDMA displays relative to SR-MDMA. This result suggests that R-MDMA may be a safer and more viable therapeutic than racemic MDMA.[46]

Toxicity and harm potential

Radar plot showing relative physical harm, social harm, and dependence of MDMA[47]

The short-term physical health risks of MDMA consumption include dehydration, insomnia, hyperthermia,[48][49] and hyponatremia.[50] Continuous activity without sufficient rest or rehydration may cause body temperature to rise to dangerous levels, and loss of fluid via excessive perspiration puts the body at further risk as the stimulatory and euphoric qualities of the drug may render the user oblivious to their energy expenditure for quite some time. Diuretics such as alcohol may exacerbate these risks further due to the excessive amounts of dehydration they may cause.

The exact toxic dosage is unknown, but considered to be far greater than its effective dose.[citation needed]

Neurotoxicity

The neurotoxicity of MDMA use has long been the subject of debate. Scientific study has resulted in the general agreement that, although it is physically safe to try in a responsible context, the administration of repeated or high dosages of MDMA is most certainly neurotoxic in some form.

Administration of MDMA causes subsequent down-regulation of serotonin reuptake transporters in the brain. The rate at which the brain recovers from serotonergic changes is unclear. One study demonstrated lasting serotonergic changes in some animals exposed to MDMA.[51] Other studies have suggested that the brain may recover from serotonergic damage.[52][53][54]

It is thought that MDMA's metabolites play a large role in the in the uncertain levels of neurotoxicity. For example, a metabolite of MDMA called alpha-MethylDopamine (which is known to be toxic to dopamine neurons[55][56]) was thought believed to be involved in the toxicity of MDMA to serotonin receptors. However, one study found this to not be the case as direct administration of aMD did not cause neurotoxicity.[56] Additionally, MDMA injected directly into the brain was found to not be toxic, implying a metabolite is responsible for the toxicity when MDMA is administered via insufflation or oral consumption.[56]

This study found that although aMD is involved, it is a further metabolite of aMD involving glutathione that is primarily responsible for the selective damage to 5-HT receptors triggered by MDMA/MDA.[56]This metabolite forms in higher concentrations when core temperature is elevated. It is taken up into serotonin receptors by its transporters and metabolized by MAO-B into a reactive oxygen species which can cause neurological damage.[56][57]

Cardiotoxicity

The long-term heavy use of MDMA has been shown to be cardiotoxic and may lead to valvulopathy (heart valve damage) through its actions on the 5-HT2B receptor.[58][59] In one study, 28% of long-term users (2-3 doses per week for a mean of 6 years, mean of age 24.3 years) had developed clinically evident valvular heart disease.[60]

It is strongly recommended that one use harm reduction practices when using this substance.

Dependence and abuse potential

As with other stimulants, the chronic use of MDMA can be considered moderately addictive with a high potential for abuse and is capable of causing psychological dependence among certain users. When addiction has developed, cravings and withdrawal effects may occur if one suddenly stops their usage.

Tolerance to many of the effects of MDMA develops with prolonged and repeated use. This results in users having to administer increasingly larger doses to achieve the same effects. Upon a single administration, it takes about 1 month for the tolerance to be reduced to half and 2.5 months to be back at baseline (in the absence of further consumption). MDMA presents cross-tolerance with all dopaminergic and serotonergic stimulants, meaning that after the consumption of MDMA all stimulants will have a reduced effect.

Dangerous interactions

Although many psychoactive substances are safe to use on their own, they can quickly become dangerous or even life-threatening when combined with other substances. The following lists some known dangerous combinations, but may not include all of them. A combination that appears to be safe in low doses can still increase the risk of injury or death. Independent research should always be conducted to ensure that a combination of two or more substances is safe to consume. Some interactions listed have been sourced from Tripsit.

  • 25x-NBOMe - Due to the highly unpredictable and physically straining effects of 25x-NBOMe, combinations with MDMA are strongly discouraged.
  • 5-MeO-xxT - 5-MeO tryptamines are considered to be unpredictable and should be mixed with MDMA with care.
  • Alcohol - Both MDMA and alcohol cause dehydration and bodily strain. Approach this combination with caution, moderation and sufficient hydration. More than a small amount of alcohol will dull the euphoria of MDMA.
  • Caffeine - Caffeine increases any neurotoxic effects from MDMA[citation needed] and may lead to the user becoming over-stimulated.
  • Cocaine - Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.[citation needed]
  • DOx - The combined stimulating effects of DOx and MDMA can become overbearing, particularly during the come up phase. Additionally, coming down on the MDMA while the DOx is still active can produce significant anxiety and bodily discomfort.
  • GHB/GBL - Large amounts of GHB/GBL may overwhelm the effects of MDMA on the comedown and place the user at risk of sudden loss of consciousness.
  • MXE - There have been reports of concerning serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.
  • PCP - PCP with MDMA can easily lead to hypermanic states.
  • Tramadol - Tramadol and stimulants both increase the risk of seizures and this risk is especially elevated when the two are combined.

Serotonin syndrome risk

Combinations with the following substances can lead to dangerously high serotonin levels. Serotonin syndrome requires immediate medical attention and can be fatal if left untreated.

Legal status

  • Austria: MDMA is illegal to possess, produce and sell under the SMG (Suchtmittelgesetz Österreich).[citation needed]
  • Belgium: MDMA is illegal to possess, produce and sell in Belgium.[citation needed]
  • Brazil - Possession, production and sale is illegal as it is listed on Portaria SVS/MS nº 344.[62]
  • Canada: MDMA is a Schedule I drug in Canada.[63]
  • Denmark: MDMA is illegal to possess, produce and sell in Denmark.[citation needed]
  • Egypt: MDMA is a Schedule III drug in Egypt.[citation needed]
  • Finland: MDMA is illegal to possess, produce and sell in Finland.[citation needed]
  • Germany: MDMA is an Anlage I controlled drug in Germany.[citation needed]
  • Latvia: MDMA is a Schedule I drug in Latvia.[64]
  • The Netherlands: MDMA is illegal to possess, produce and sell in the Netherlands.[citation needed]
  • New Zealand: MDMA is a Class B1 drug in New Zealand.[citation needed]
  • Norway: MDMA is illegal to possess, produce and sell in Norway.[citation needed]
  • Sweden: MDMA is illegal to possess, produce and sell in Sweden.[citation needed]
  • Switzerland: MDMA is illegal to possess, produce and sell in Switzerland.[citation needed]
  • United Kingdom: MDMA is a Class A drug in the UK.[citation needed]
  • United States: MDMA is a Schedule I drug in the US.[citation needed]

See also

External links

Community

References

  1. ↑ Ann Shulgin; Alexander Shulgin (1991). PiHKAL: A Chemical Love Story. Part I. Chapter 12. Transform Press.
  2. ↑ Pharmaceutical company unravels drug's chequered past | http://www.mdma.net/merck/history-ecstasy.html
  3. ↑ Global drug survey: 2014. | https://www.globaldrugsurvey.com/past-findings/the-global-drug-survey-2014-findings/
  4. ↑ ClinicalTrials. (n.d.). MDMA-assisted Therapy for Social Anxiety in Autistic Adults - Full Text View - ClinicalTrials.gov. Retrieved from https://www.clinicaltrials.gov/ct2/show/NCT02008396?term=mdma+social+anxiety&rank=1
  5. ↑ Multidisciplinary Association for Psychedelic Studies. (n.d.). MAPS - MDMA-Assisted Psychotherapy for Anxiety Associated with Life-Threatening Illness. Retrieved from http://www.maps.org/research/mdma/anxiety/life-threatening-illness
  6. ↑ 3,4-methylenedioxymethamphetamine (MDMA): current perspectives - Jerrold S Meyer | https://www.dovepress.com/34-methylenedioxymethamphetamine-mdma-current-perspectives-peer-reviewed-article-SAR
  7. ↑ The potential dangers of using MDMA for psychotherapy - Parrott AC | https://www.ncbi.nlm.nih.gov/pubmed/24830184
  8. ↑ World Health Organization (2004). Neuroscience of Psychoactive Substance Use and Dependence. World Health Organization. pp. 97–. ISBN 978-92-4-156235-5. Archived from the original on 28 April 2016.
  9. ↑ Meyer JS (2013). "3,4-methylenedioxymethamphetamine (MDMA): current perspectives". Subst Abuse Rehabil. 4: 83–99. doi:10.2147/SAR.S37258. PMC 3931692 Freely accessible. PMID 24648791.
  10. ↑ Greene SL, Kerr F, Braitberg G (October 2008). "Review article: amphetamines and related drugs of abuse". Emerg. Med. Australas. 20 (5): 391–402. doi:10.1111/j.1742-6723.2008.01114.x. PMID 18973636
  11. ↑ Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 15: Reinforcement and Addictive Disorders". In Sydor A, Brown RY. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. p. 375. ISBN 9780071481274.
  12. ↑ Gouzoulis-Mayfrank, E; Daumann, J (2009). "Neurotoxicity of drugs of abuse—the case of methylenedioxyamphetamines (MDMA, ecstasy), and amphetamines". Dialogues Clin Neurosci. 11 (3): 305–17. PMC 3181923 Freely accessible. PMID 19877498.
  13. ↑ 13.0 13.1 Sessa, B. (2017). The experience and the drugs. In The Psychedelic Renaissance: Reassessing the Role of Psychedelic Drugs in 21st Century Psychiatry and Society (2nd ed., p. 60). London: Muswell Hill Press.
  14. ↑ "3,4-Methylenedioxymethamphetamine". 'Hazardous Substances Data Bank. National Library of Medicine. 28 August 2008. Retrieved 22 August 2014.
  15. ↑ 15.0 15.1 15.2 15.3 15.4 15.5 Miller, G. M. (2011). The emerging role of trace amine‐associated receptor 1 in the functional regulation of monoamine transporters and dopaminergic activity. Journal of Neurochemistry, 116(2), 164-176. https://doi.10.1111/j.1471-4159.2010.07109.x
  16. ↑ 16.0 16.1 16.2 Eiden LE, Weihe E. VMAT2: a dynamic regulator of brain monoaminergic neuronal function interacting with drugs of abuse. Ann. N. Y. Acad. Sci. 1216(1)1. 86–98. January 2011. https://doi.org/10.1111/j.1749-6632.2010.05906.x
  17. ↑ Fitzgerald JL, Reid JJ. Effects of methylenedioxymethamphetamine on the release of monoamines from rat brain slices. European Journal of Pharmacology. 191(2). 217–20. 1990. https://doi.org/10.1016/0014-2999(90)94150-V}}
  18. ↑ Eiden LE, Weihe E (January 2011). "VMAT2: a dynamic regulator of brain monoaminergic neuronal function interacting with drugs of abuse". Ann. N. Y. Acad. Sci. 1216 (1): 86–98. http://doi.org/10.1111/j.1749-6632.2010.05906.x.
  19. ↑ Bogen IL, Haug KH, Myhre O, Fonnum F. Short- and long-term effects of MDMA ("ecstasy") on synaptosomal and vesicular uptake of neurotransmitters in vitro and ex vivo. Neurochemistry International. 43. 4–5. 393–400. 2003 https://doi.org/10.1016/S0197-0186(03)00027-5
  20. ↑ Nelson, Lewis S.; Lewin, Neal A.; Howland, Mary Ann; Hoffman, Robert S.; Goldfrank, Lewis R.; Flomenbaum, Neal E. (2011). Goldfrank's toxicologic emergencies (9th ed.). New York: McGraw-Hill Medical. ISBN 978-0071605939.
  21. ↑ Battaglia G, Brooks BP, Kulsakdinun C, De Souza EB. Pharmacologic profile of MDMA (3,4-methylenedioxymethamphetamine) at various brain recognition sites.European Journal of Pharmacology. 149(1–2)1. 59–63. (1988).https://doi.org/10.1016/0014-2999(88)90056-8
  22. ↑ Lyon RA, Glennon RA, Titeler M . (1986) 3,4-Methylenedioxymethamphetamine (MDMA): stereoselective interactions at brain 5-HT1 and 5-HT2 receptors. Psychopharmacology. 88(4). 525–6. https://doi.org/10.1007/BF00178519
  23. ↑ Nash JF, Roth BL, Brodkin JD, Nichols DE, Gudelsky GA. Effect of the R(-) and S(+) isomers of MDA and MDMA on phosphatidylinositol turnover in cultured cells expressing 5-HT2A or 5-HT2C receptors. Neuroscience Letters. 177(1–2). 111–5 . (1994). https//doi.org/10.1016/0304-3940(94)90057-4
  24. ↑ Setola V, Hufeisen SJ, Grande-Allen KJ, Vesely I, Glennon RA, Blough B, Rothman RB, Roth BL. 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") induces fenfluramine-like proliferative actions on human cardiac valvular interstitial cells in vitro. Molecular Pharmacology. 63(6). 1223–9 (2003). https://doi.org/10.1124/mol.63.6.1223
  25. ↑ Betzler, Felix; Viohl, Leonard; Romanczuk-Seiferth, Nina; Foxe, John (January 2017). "Decision-making in chronic ecstasy users: a systematic review." European Journal of Neuroscience. 45 (1): 34–44. https://doi:10.1111/ejn.13480...the addictive potential of MDMA itself is relatively small.
  26. ↑ Matsumoto RR. Targeting Sigma Receptors: Novel Medication Development for Drug Abuse and Addiction. Expert Rev Clin Pharmacology. 2(4), 351–8. July 2009. https://doi.org/10.1586/ecp.09.18
  27. ↑ The pharmacology and toxicology of “ecstasy” (MDMA) and related drugs | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC81503/
  28. ↑ Effects of MDMA, MDA and MDEA on blood pressure, heart rate, locomotor activity and body temperature in the rat involve a-adrenoceptors - Sotiria Bexis & James R. Docherty | http://onlinelibrary.wiley.com/doi/10.1038/sj.bjp.0706688/full
  29. ↑ The pharmacology and toxicology of “ecstasy” (MDMA) and related drugs | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC81503/
  30. ↑ Effects of MDMA on body temperature in humans - Matthias E Liechti | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/
  31. ↑ 3,4-Methylenedioxymethamphetamine (MDMA, Ecstasy) and Driving Impairment - Logan, BK & Couper, FJ | https://www.astm.org/DIGITAL_LIBRARY/JOURNALS/FORENSIC/PAGES/JFS15166J.htm
  32. ↑ Brvar M, Kozelj G, Osredkar J, Mozina M, Gricar M, Bunc M. Polydipsia as another mechanism of hyponatremia after 'ecstasy' (3,4 methyldioxymethamphetamine) ingestion. Eur J Emerg Med. 2004 Oct;11(5):302-4. | https://www.ncbi.nlm.nih.gov/pubmed/15359208
  33. ↑ Bora F, Yılmaz F, Bora T. Ecstasy (MDMA) and its effects on kidneys and their treatment: a review. Iranian Journal of Basic Medical Sciences. 2016;19(11):1151-1158. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126214/
  34. ↑ Inman, D. S., & Greene, D. (2003). ‘The agony and the ecstasy’: acute urinary retention after MDMA abuse. BJU international, 91(1), 123-123.
  35. ↑ http://www.idmu.co.uk/therapeutic-uses-of-ecstasy.htm
  36. ↑ A method of conducting therapeutic sessions with MDMA. - Greer GR, Tolbert R. | https://www.ncbi.nlm.nih.gov/pubmed/9924843
  37. ↑ http://www.maps.org/mdma-cancer/5523-a-dose-response-human-pilot-study-–-safety-and-efficacy-of-mdma-in-modification-of-physical-pain-and-psychological-distress-in-end-stage-cancer-patients
  38. ↑ Bruxism after 3,4-methylenedioxymethamphetamine (ecstasy) abuse - Bruxism and ecstasy Ricardo Jorge Dinis-Oliveira et al. | http://www.tandfonline.com/doi/abs/10.3109/15563650.2010.489903
  39. ↑ Urban Dictionary page on "gurning" http://www.urbandictionary.com/define.php?term=gurning
  40. ↑ The Pharmacology and Clinical Pharmacology of 3,4-Methylenedioxymethamphetamine (MDMA, “Ecstasy”) - A. Richard Green et al. | http://pharmrev.aspetjournals.org/content/55/3/463.short
  41. ↑ 3 cases of primary intracranial hemorrhage associated with “Molly”, a purified form of 3,4-methylenedioxymethamphetamine (MDMA) | http://www.jns-journal.com/article/S0022-510X(12)00483-2/abstract
  42. ↑ Mithoefer, Michael C., et al. “Durability of Improvement in Post-Traumatic Stress Disorder Symptoms and Absence of Harmful Effects or Drug Dependency after 3,4-Methylenedioxymethamphetamine-Assisted Psychotherapy: A Prospective Long-Term Follow-up Study.” Journal of Psychopharmacology (Oxford, England) 27.1 (2013): 28–39. https://doi.org/ 10.1177/0269881112456611
  43. ↑ Mithoefer, Michael C., et al. “Durability of Improvement in Post-Traumatic Stress Disorder Symptoms and Absence of Harmful Effects or Drug Dependency after 3,4-Methylenedioxymethamphetamine-Assisted Psychotherapy: A Prospective Long-Term Follow-up Study.” Journal of Psychopharmacology (Oxford, England) 27.1 (2013): 28–39. https://doi.org/10.1177/0269881112456611
  44. ↑ Wan, William (26 August 2017). "Ecstasy could be 'breakthrough' therapy for soldiers, others suffering from PTSD". Washington Post. Archived from the original on 29 August 2017. Retrieved 29 August 2017.
  45. ↑ Feduccia, AA; Holland, J; Mithoefer, MC (February 2018). "Progress and promise for the MDMA drug development program". Psychopharmacology. 235 (2): 561–571. doi:10.1007/s00213-017-4779-2. PMID 29152674.
  46. ↑ Curry, D. W., Young, M. B., Tran, A. N., Daoud, G. E., & Howell, L. L. (2018). Separating the agony from ecstasy: R (–)-3, 4-methylenedioxymethamphetamine has prosocial and therapeutic-like effects without signs of neurotoxicity in mice. Neuropharmacology, 128, 196-206. https://doi.org/10.1016/j.neuropharm.2017.10.003
  47. ↑ Nutt, D., King, L. A., Saulsbury, W., & Blakemore, C. (2007). Development of a Rational Scale to Assess the Harm of Drugs of Potential Misuse, 1047–1053. http://dx.doi.org/10.1016/S0140-6736(07)60464-4
  48. ↑ Nimmo, S. M., Kennedy, B. W., Tullett, W. M., Blyth, A. S., & Dougall, J. R. (1993). Drug‐induced hyperthermia. Anaesthesia, 48(10), 892-895. https://doi.org/10.1111/j.1365-2044.1993.tb07423.x
  49. ↑ Malberg, J. E., & Seiden, L. S. (1998). Small changes in ambient temperature cause large changes in 3, 4-methylenedioxymethamphetamine (MDMA)-induced serotonin neurotoxicity and core body temperature in the rat. Journal of Neuroscience, 18(13), 5086-5094. PMID: 9634574. https://www.ncbi.nlm.nih.gov/pubmed/9634574
  50. ↑ Wolff, K., Tsapakis, E. M., Winstock, A. R., Hartley, D., Holt, D., Forsling, M. L., & Aitchison, K. J. (2006). Vasopressin and oxytocin secretion in response to the consumption of ecstasy in a clubbing population. Journal of Psychopharmacology, 20(3), 400-410. https://doi.org/10.1177/0269881106061514
  51. ↑ Reorganization of ascending 5-HT axon projections in animals previously exposed to the recreational drug (+/-)3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/7643196
  52. ↑ Scheffel, U., Szabo, Z., Mathews, W. B., Finley, P. A., Dannals, R. F., Ravert, H. T., ... & Ricaurte, G. A. (1998). In vivo detection of short‐ and long‐term MDMA neurotoxicity—a positron emission tomography study in the living baboon brain. Synapse, 29(2), 183-192. https://doi.org/10.1002/(SICI)1098-2396(199806)29:2<183::AID-SYN9>3.0.CO;2-3
  53. ↑ Reneman, L., Lavalaye, J., Schmand, B., de Wolff, F. A., van den Brink, W., den Heeten, G. J., & Booij, J. (2001). Cortical serotonin transporter density and verbal memory in individuals who stopped using 3, 4-methylenedioxymethamphetamine (MDMA or ecstasy): preliminary findings. Archives of General Psychiatry, 58(10), 901-906. Chicago. https://doi.org/10.1001/archpsyc.58.10.901
  54. ↑ Selvaraj, S., Hoshi, R., Bhagwagar, Z., Murthy, N. V., Hinz, R., Cowen, P., ... & Grasby, P. (2009). Brain serotonin transporter binding in former users of MDMA (‘ecstasy’). The British Journal of Psychiatry, 194(4), 355-359. https://doi.org/10.1192/bjp.bp.108.050344
  55. ↑ Neurotoxic thioether adducts of 3,4-methylenedioxymethamphetamine identified in human urine after ecstasy ingestion (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/19349378 | http://dmd.aspetjournals.org/content/37/7/1448.full.pdf
  56. ↑ 56.0 56.1 56.2 56.3 56.4 2,5-Bis-(glutathion-S-yl)-alpha-methyldopamine, a putative metabolite of (+/-)-3,4-methylenedioxyamphetamine, decreases brain serotonin concentrations (PubMed.gov / NCBI) - Miller RT et al. | http://www.ncbi.nlm.nih.gov/pubmed/9128836
  57. ↑ Drug-induced Valvulopathy: An Update - Chandikumar S. Elangbam | http://tpx.sagepub.com/content/38/6/837.full
  58. ↑ Huang, X. P., Setola, V., Yadav, P. N., Allen, J. A., Rogan, S. C., Hanson, B. J., ... & Roth, B. L. (2009). Parallel functional activity profiling reveals valvulopathogens are potent 5-hydroxytryptamine2B receptor agonists: implications for drug safety assessment. Molecular Pharmacology, 76(4), 710-722. https://doi.org/10.1161/01.CIR.102.23.2836
  59. ↑ Drug-induced Valvulopathy: An Update - Chandikumar S. Elangbam | http://tpx.sagepub.com/content/38/6/837.full
  60. ↑ Possible association between 3,4-methylenedioxymethamphetamine abuse and valvular heart disease. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/17950805
  61. ↑ Gillman, P. K. (2005). Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity. British Journal of Anaesthesia, 95(4), 434-441. https://doi.org/10.1093/bja/aei210
  62. ↑ List of controlled substances: Portaria SVS/MS nº 344 (Portuguese) | http://portal.anvisa.gov.br/lista-de-substancias-sujeitas-a-controle-especial
  63. ↑ Canada controlled drugs and substances | http://laws-lois.justice.gc.ca/eng/acts/C-38.8/
  64. ↑ Noteikumi par Latvijā kontrolējamajām narkotiskajām vielām, psihotropajām vielām un prekursoriem (3,4-Metilēndioksifeniletānamīni) | http://likumi.lv/doc.php?id=121086


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