MDMA
Drug class | Empathogen–entactogen stimulant |
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ATC code |
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Legal status | |
Legal status |
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MDOH[13] | |
Onset of action | 30–45 minutes (by mouth)[12] |
Elimination half-life | (R)-MDMA: 5.8 ± 2.2 hours (variable)[14] (S)-MDMA: 3.6 ± 0.9 hours (variable)[14] |
Duration of action | 4–6 hours[7][12] |
Excretion | Kidney |
Identifiers | |
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JSmol) | |
Chirality | Racemic mixture |
Density | 1.1 g/cm3 |
Boiling point | 105 °C (221 °F) at 0.4 mmHg (experimental) |
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3,4-Methyl
MDMA was first synthesized in 1912 by
Short-term adverse effects include
MDMA has limited approved medical uses in a small number of countries,[31] but is illegal in most jurisdictions.[32] In the United States, the Food and Drug Administration is evaluating the drug for clinical use as of 2021[update].[33] Canada has allowed limited distribution of MDMA upon application to and approval by Health Canada.[34][35] In Australia, it may be prescribed in the treatment of PTSD by specifically authorised psychiatrists.[36]
Effects
In general, MDMA users report feeling the onset of subjective effects within 30 to 60 minutes of oral consumption and reaching peak effect at 75 to 120 minutes, which then plateaus for about 3.5 hours.[37] The desired short-term psychoactive effects of MDMA have been reported to include:
- Euphoria – a sense of general well-being and happiness[17][38]
- Increased self-confidence, sociability, and perception of facilitated communication[7][17][38]
- Dilated pupils[7]
- Relaxation and reduced anxiety[7]
- Increased emotionality[7]
- A sense of inner peace[38]
- Mild hallucination[38]
- Enhanced sensation, perception, or sexuality[7][17][38]
- Altered sense of time[22]
The experience elicited by MDMA depends on the dose, setting, and user.[7] The variability of the induced altered state is lower compared to other psychedelics. For example, MDMA used at parties is associated with high motor activity, reduced sense of identity, and poor awareness of surroundings. Use of MDMA individually or in small groups in a quiet environment and when concentrating, is associated with increased lucidity, concentration, sensitivity to aesthetic aspects of the environment, enhanced awareness of emotions, and improved capability of communication.[13][39] In psychotherapeutic settings, MDMA effects have been characterized by infantile ideas, mood lability, and memories and moods connected with childhood experiences.[39][40]
MDMA has been described as an "empathogenic" drug because of its empathy-producing effects.[41][42] Results of several studies show the effects of increased empathy with others.[41] When testing MDMA for medium and high doses, it showed increased hedonic and arousal continuum.[43][44] The effect of MDMA increasing sociability is consistent, while its effects on empathy have been more mixed.[45]
Use
Recreational
MDMA is often considered the drug of choice within the rave culture and is also used at clubs, festivals, and house parties.[13] In the rave environment, the sensory effects of music and lighting are often highly 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.[46] MDMA is used less often than other stimulants, typically less than once per week.[47]
MDMA is sometimes taken in conjunction with other psychoactive drugs such as LSD, psilocybin mushrooms, 2C-B, and ketamine. The combination with LSD is called "candy-flipping".[48] MDMA is often co-administered with alcohol, methamphetamine, and prescription drugs such as SSRIs with which MDMA has several drug-drug interactions.[49][50][51] Three life-threatening reports of MDMA co-administration with ritonavir have been reported;[52] with ritonavir having severe and dangerous drug-drug interactions with a wide range of both psychoactive, anti-psychotic, and non-psychoactive drugs.[53]
Medical
As of 2017[update], MDMA has no accepted
Other
Small doses of MDMA are used by some religious practitioners as an entheogen to enhance prayer or meditation.[62] MDMA has been used as an adjunct to New Age spiritual practices.[63]
Forms
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 adulterants 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.[2][3][64] MDMA is also sold in the form of the hydrochloride salt, either as loose crystals or in gelcaps.[65][66] MDMA tablets can sometimes be found in a shaped form that may depict characters from popular culture, likely for deceptive reasons.[clarification needed] These are sometimes collectively referred to as "fun tablets".[67][68]
Partly due to the global supply shortage of
MDMA is usually consumed by mouth. It is also sometimes snorted.[21]
Adverse effects
Short-term
Acute adverse effects are usually the result of high or multiple doses, although single dose toxicity can occur in susceptible individuals.
The immediate adverse effects of MDMA use can include:
- Bruxism (grinding and clenching of the teeth)[7][13][17]
- Dehydration[13][38][69]
- Diarrhea[38]
- Erectile dysfunction[7][71]
- Hyperthermia[7][13][69]
- Increased wakefulness or insomnia[7][38]
- Increased perspiration and sweating[38][69]
- Increased heart rate and blood pressure[7][13][69]
- Increased psychomotor activity[7]
- Loss of appetite[7][14]
- Nausea and vomiting[17]
- Visual and auditory hallucinations (rarely)[7]
Other adverse effects that may occur or persist for up to a week following cessation of moderate MDMA use include:[14][17]
- Physiological
- Psychological
Administration of MDMA to mice causes DNA damage in their brain,[74] especially when the mice are sleep deprived.[75] Even at the very low doses that are comparable to those self-administered by humans, MDMA causes oxidative stress and both single and double-strand breaks in the DNA of the hippocampus region of the mouse brain.[76]
Long-term
This section may be confusing or unclear to readers. (April 2021) |
As of 2015[update], the long-term effects of MDMA on human brain structure and function have not been fully determined.[77] However, there is consistent evidence of structural and functional deficits in MDMA users with high lifetime exposure.[77] These structural or functional changes appear to be dose dependent and may be less prominent in MDMA users with only a moderate (typically <50 doses used and <100 tablets consumed) lifetime exposure. Nonetheless, moderate MDMA use may still be neurotoxic and what constitutes moderate use is not clearly established.[78]
Furthermore, it is not clear yet whether "typical" recreational users of MDMA (1 to 2 pills of 75 to 125 mg MDMA or analogue every 1 to 4 weeks) will develop neurotoxic brain lesions.
However, adverse
Impairments in multiple aspects of cognition, including attention, learning, memory, visual processing, and sleep, have been found in regular MDMA users.[7][17][83][77] The magnitude of these impairments is correlated with lifetime MDMA usage[17][83][77] and are partially reversible with abstinence.[7] Several forms of memory are impaired by chronic ecstasy use;[17][83] however, the effects for memory impairments in ecstasy users are generally small overall.[84][85] MDMA use is also associated with increased impulsivity and depression.[7]
Serotonin depletion following MDMA use can cause depression in subsequent days. In some cases, depressive symptoms persist for longer periods.[7] Some studies indicate repeated recreational use of ecstasy is associated with depression and anxiety, even after quitting the drug.[86] Depression is one of the main reasons for cessation of use.[7]
At high doses, MDMA induces a
MDMA may increase the risk of
Reinforcement disorders
Approximately 60% of MDMA users experience withdrawal symptoms when they stop taking MDMA.[14] Some of these symptoms include fatigue, loss of appetite, depression, and trouble concentrating.[14] Tolerance to some of the desired and adverse effects of MDMA is expected to occur with consistent MDMA use.[14] A 2007 delphic analysis of a panel of experts in pharmacology, psychiatry, law, policing and others estimated MDMA to have a psychological dependence and physical dependence potential roughly three-fourths to four-fifths that of cannabis.[93]
MDMA has been shown to induce
One study found approximately 15% of chronic MDMA users met the
There are currently no medications to treat MDMA addiction.[100]
During pregnancy
MDMA is a moderately
Overdose
MDMA overdose symptoms vary widely due to the involvement of multiple organ systems. Some of the more overt overdose symptoms are listed in the table below. The number of instances of fatal MDMA intoxication is low relative to its usage rates. In most fatalities, MDMA was not the only drug involved. Acute toxicity is mainly caused by
System | Minor or moderate overdose[107] | Severe overdose[107] |
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Cardiovascular
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Central nervous system |
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Musculoskeletal
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Respiratory | ||
Urinary
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Other |
Interactions
A number of
Pharmacology
Pharmacodynamics
MDMA is a substituted amphetamine structurally, and a monoamine-releasing agent mechanistically. Like other monoamine-releasing agents, MDMA enters monoaminergic neurons through monoamine transporters. MDMA has high affinity for dopamine, norepinephrine and serotonin transporters, with some preference for the latter. The methylenedioxy- substitution provides the serotonergic activity, as most other substituted amphetamines show negligible affinity for the serotonin transporter.[citation needed]
Neurotransmitter release induced by monoamine-releasing agents differs significantly from the regular, action potential-evoked neurotransmitter release. Inside the neuron, MDMA inhibits VMAT2 and activates TAAR1. TAAR1 agonism results in the phosphorylation of monoamine transporters by PKA and PKC, which either internalizes the transporter, or reverses its flux direction.[116][117] VMAT2 inhibition prevents the packaging of the cytosolic monoamines into the synaptic vesicles, which allows them to instead be pumped out of the neuron by the phosphorylated transporters. The result is that the neuron constantly "leaks" neurotransmitters into the synapse, regardless of any signal received.[118]
MDMA has two
Pharmacokinetics
The MDMA
MDMA is known to be metabolized by two main
MDMA and metabolites are primarily excreted as conjugates, such as sulfates and glucuronides.
Chemistry
| |
MDMA is in the
Synthesis
There are numerous methods available to synthesize MDMA via different intermediates.
Detection in body fluids
MDMA and MDA may be quantitated in blood, plasma or urine to monitor for use, confirm a diagnosis of poisoning or assist in the forensic investigation of a traffic or other criminal violation or a sudden death. Some drug abuse screening programs rely on hair, saliva, or sweat as specimens. Most commercial amphetamine immunoassay screening tests cross-react significantly with MDMA or its major metabolites, but chromatographic techniques can easily distinguish and separately measure each of these substances. The concentrations of MDA in the blood or urine of a person who has taken only MDMA are, in general, less than 10% those of the parent drug.[124][136][137]
History
Early research and use
MDMA was first synthesized in 1912 by
Merck records indicate its researchers returned to the compound sporadically. A 1920 Merck patent describes a chemical modification to MDMA.
Outside of Merck, other researchers began to investigate MDMA. In 1953 and 1954, the
MDMA may have been in non-medical use in the western United States in 1968.[145] An August 1970 report at a meeting of crime laboratory chemists indicates MDMA was being used recreationally in the Chicago area by 1970.[143][146] MDMA likely emerged as a substitute for its analog methylenedioxyamphetamine (MDA),[147] a drug at the time popular among users of psychedelics[148] which was made a Schedule 1 substance in the United States in 1970.[149][150]
Shulgin's research
American chemist and
Shulgin first heard of the psychoactive effects of N-methylated MDA around 1975 from a young student who reported "amphetamine-like content".[143] Around 30 May 1976, Shulgin again heard about the effects of N-methylated MDA,[143] this time from a graduate student in a medicinal chemistry group he advised at San Francisco State University[148][151] who directed him to the University of Michigan study.[152] She and two close friends had consumed 100 mg of MDMA and reported positive emotional experiences.[143] Following the self-trials of a colleague at the University of San Francisco, Shulgin synthesized MDMA and tried it himself in September and October 1976.[143][148] Shulgin first reported on MDMA in a presentation at a conference in Bethesda, Maryland in December 1976.[143] In 1978, he and David E. Nichols published a report on the drug's psychoactive effect in humans. They described MDMA as inducing "an easily controlled altered state of consciousness with emotional and sensual overtones" comparable "to marijuana, to psilocybin devoid of the hallucinatory component, or to low levels of MDA".[153]
While not finding his own experiences with MDMA particularly powerful,[152][154] Shulgin was impressed with the drug's disinhibiting effects and thought it could be useful in therapy.[154] Believing MDMA allowed users to strip away habits and perceive the world clearly, Shulgin called the drug window.[152][155] Shulgin occasionally used MDMA for relaxation, referring to it as "my low-calorie martini", and gave the drug to friends, researchers, and others who he thought could benefit from it.[152] One such person was Leo Zeff, a psychotherapist who had been known to use psychedelic substances in his practice. When he tried the drug in 1977, Zeff was impressed with the effects of MDMA and came out of his semi-retirement to promote its use in therapy. Over the following years, Zeff traveled around the United States and occasionally to Europe, eventually training an estimated four thousand psychotherapists in the therapeutic use of MDMA.[154][156] Zeff named the drug Adam, believing it put users in a state of primordial innocence.[148]
Psychotherapists who used MDMA believed the drug eliminated the typical fear response and increased communication. Sessions were usually held in the home of the patient or the therapist. The role of the therapist was minimized in favor of patient self-discovery accompanied by MDMA induced feelings of empathy. Depression, substance use disorders, relationship problems, premenstrual syndrome, and autism were among several psychiatric disorders MDMA assisted therapy was reported to treat.[150] According to psychiatrist George Greer, therapists who used MDMA in their practice were impressed by the results. Anecdotally, MDMA was said to greatly accelerate therapy.[154] According to David Nutt, MDMA was widely used in the western US in couples counseling, and was called empathy. Only later was the term ecstasy used for it, coinciding with rising opposition to its use.[157]
Rising recreational use
In the late 1970s and early 1980s, "Adam" spread through personal networks of psychotherapists, psychiatrists, users of psychedelics, and
A small recreational market for MDMA developed by the late 1970s,[161] consuming perhaps 10,000 doses in 1976.[149] By the early 1980s MDMA was being used in Boston and New York City nightclubs such as Studio 54 and Paradise Garage.[162][163] Into the early 1980s, as the recreational market slowly expanded, production of MDMA was dominated by a small group of therapeutically minded Boston chemists. Having commenced production in 1976, this "Boston Group" did not keep up with growing demand and shortages frequently occurred.[159]
Perceiving a business opportunity, Michael Clegg, the Southwest distributor for the Boston Group, started his own "Texas Group" backed financially by Texas friends.
Recreational use also increased after several cocaine dealers switched to distributing MDMA following experiences with the drug.[160] A California laboratory that analyzed confidentially submitted drug samples first detected MDMA in 1975. Over the following years the number of MDMA samples increased, eventually exceeding the number of MDA samples in the early 1980s.[165][166] By the mid-1980s, MDMA use had spread to colleges around the United States.[159]: 33
Media attention and scheduling
United States
In an early media report on MDMA published in 1982, a Drug Enforcement Administration (DEA) spokesman stated the agency would ban the drug if enough evidence for abuse could be found.[159] By mid-1984, MDMA use was becoming more noticed. Bill Mandel reported on "Adam" in a 10 June San Francisco Chronicle article, but misidentified the drug as methyloxymethylenedioxyamphetamine (MMDA). In the next month, the World Health Organization identified MDMA as the only substance out of twenty phenethylamines to be seized a significant number of times.[158]
After a year of planning and data collection, MDMA was proposed for scheduling by the DEA on 27 July 1984 with a request for comments and objections.[158][167] The DEA was surprised when a number of psychiatrists, psychotherapists, and researchers objected to the proposed scheduling and requested a hearing.[150] In a Newsweek article published the next year, a DEA pharmacologist stated that the agency had been unaware of its use among psychiatrists.[168] An initial hearing was held on 1 February 1985 at the DEA offices in Washington, D.C., with administrative law judge Francis L. Young presiding.[158] It was decided there to hold three more hearings that year: Los Angeles on 10 June, Kansas City, Missouri on 10–11 July, and Washington, D.C., on 8–11 October.[150][158]
Sensational media attention was given to the proposed criminalization and the reaction of MDMA proponents, effectively advertising the drug.
As a result of several expert witnesses testifying that MDMA had an accepted medical usage, the administrative law judge presiding over the hearings recommended that MDMA be classified as a Schedule III substance. Despite this, DEA administrator John C. Lawn overruled and classified the drug as Schedule I.[150][176] Harvard psychiatrist Lester Grinspoon then sued the DEA, claiming that the DEA had ignored the medical uses of MDMA, and the federal court sided with Grinspoon, calling Lawn's argument "strained" and "unpersuasive", and vacated MDMA's Schedule I status.[177] Despite this, less than a month later Lawn reviewed the evidence and reclassified MDMA as Schedule I again, claiming that the expert testimony of several psychiatrists claiming over 200 cases where MDMA had been used in a therapeutic context with positive results could be dismissed because they were not published in medical journals.[150] In 2017, the FDA granted breakthrough therapy designation for its use with psychotherapy for PTSD. However, this designation has been questioned and problematized.[178]
United Nations
While engaged in scheduling debates in the United States, the DEA also pushed for international scheduling.
Post-scheduling
The use of MDMA in Texas clubs declined rapidly after criminalization, although by 1991 the drug remained popular among young middle-class whites and in nightclubs.
After MDMA was criminalized, most medical use stopped, although some therapists continued to prescribe the drug illegally. Later,[
"Molly", short for 'molecule', was recognized as a slang term for crystalline or powder MDMA in the 2000s.[184][185]
In 2010, the BBC reported that use of MDMA had decreased in the UK in previous years. This may be due to increased seizures during use and decreased production of the precursor chemicals used to manufacture MDMA. Unwitting substitution with other drugs, such as mephedrone and methamphetamine,[186] as well as legal alternatives to MDMA, such as BZP, MDPV, and methylone, are also thought to have contributed to its decrease in popularity.[187]
In 2017 it was found that some pills being sold as MDMA contained pentylone, which can cause very unpleasant agitation and paranoia.[188]
According to
Society and culture
Substance | Best estimate |
Low estimate |
High estimate |
---|---|---|---|
Amphetamine- type stimulants |
34.16 | 13.42 | 55.24 |
Cannabis | 192.15 | 165.76 | 234.06 |
Cocaine | 18.20 | 13.87 | 22.85 |
Ecstasy | 20.57 | 8.99 | 32.34 |
Opiates | 19.38 | 13.80 | 26.15 |
Opioids | 34.26 | 27.01 | 44.54 |
Legal status
MDMA is legally controlled in most of the world under the UN Convention on Psychotropic Substances and other international agreements, although exceptions exist for research and limited medical use. In general, the unlicensed use, sale or manufacture of MDMA are all criminal offences.
Australia
In Australia, MDMA was rescheduled on 1 July 2023 as a schedule 8 substance (available on prescription) when used in the treatment of PTSD, while remaining a schedule 9 substance (prohibited) for all other uses. For the treatment of PTSD, MDMA can only be prescribed by psychiatrists with specific training and authorisation.[190] In 1986, MDMA was declared an illegal substance because of its allegedly harmful effects and potential for misuse.[191] Any non-authorised sale, use or manufacture is strictly prohibited by law. Permits for research uses on humans must be approved by a recognized ethics committee on human research.
In Western Australia under the Misuse of Drugs Act 1981 4.0g of MDMA is the amount required determining a court of trial, 2.0g is considered a presumption with intent to sell or supply and 28.0g is considered trafficking under Australian law.[192]
The Australian Capital Territory has passed legislation to decriminalise the possession of small amounts of MDMA, due to take effect in October 2023.[193]
United Kingdom
In the United Kingdom, MDMA was made illegal in 1977 by a modification order to the existing Misuse of Drugs Act 1971. Although MDMA was not named explicitly in this legislation, the order extended the definition of Class A drugs to include various ring-substituted phenethylamines.[194][195] The drug is therefore illegal to sell, buy, or possess without a licence in the UK. Penalties include a maximum of seven years and/or unlimited fine for possession; life and/or unlimited fine for production or trafficking.
Some researchers such as
United States
In the United States, MDMA is listed in Schedule I of the Controlled Substances Act.[199] In a 2011 federal court hearing, the American Civil Liberties Union successfully argued that the sentencing guideline for MDMA/ecstasy is based on outdated science, leading to excessive prison sentences.[200] Other courts have upheld the sentencing guidelines. The United States District Court for the Eastern District of Tennessee explained its ruling by noting that "an individual federal district court judge simply cannot marshal resources akin to those available to the Commission for tackling the manifold issues involved with determining a proper drug equivalency."[201]
Netherlands
In the Netherlands, the Expert Committee on the List (Expertcommissie Lijstensystematiek Opiumwet) issued a report in June 2011 which discussed the evidence for harm and the legal status of MDMA, arguing in favor of maintaining it on List I.[201][202][203]
Canada
In Canada, MDMA is listed as a Schedule 1[204] as it is an analogue of amphetamine.[205] The Controlled Drugs and Substances Act was updated as a result of the Safe Streets and Communities Act changing amphetamines from Schedule III to Schedule I in March 2012. In 2022 the federal government granted British Columbia a 3-year exemption, legalizing the possession of up to 2.5 grams (0.088 oz) of MDMA in the province from February 2023 until February 2026.[206][207]
Demographics
In 2014, 3.5% of 18 to 25 year-olds had used MDMA in the United States.[7] In the European Union as of 2018, 4.1% of adults (15–64 years old) have used MDMA at least once in their life, and 0.8% had used it in the last year.[208] Among young adults, 1.8% had used MDMA in the last year.[208]
In Europe, an estimated 37% of regular club-goers aged 14 to 35 used MDMA in the past year according to the 2015 European Drug report.[7] The highest one-year prevalence of MDMA use in Germany in 2012 was 1.7% among people aged 25 to 29 compared with a population average of 0.4%.[7] Among adolescent users in the United States between 1999 and 2008, girls were more likely to use MDMA than boys.[209]
Economics
Europe
In 2008 the European Monitoring Centre for Drugs and Drug Addiction noted that although there were some reports of tablets being sold for as little as €1, most countries in Europe then reported typical retail prices in the range of €3 to €9 per tablet, typically containing 25–65 mg of MDMA.[210] By 2014 the EMCDDA reported that the range was more usually between €5 and €10 per tablet, typically containing 57–102 mg of MDMA, although MDMA in powder form was becoming more common.[211]
North America
The United Nations Office on Drugs and Crime stated in its 2014 World Drug Report that US ecstasy retail prices range from US$1 to $70 per pill, or from $15,000 to $32,000 per kilogram.[212] A new research area named Drug Intelligence aims to automatically monitor distribution networks based on image processing and machine learning techniques, in which an Ecstasy pill picture is analyzed to detect correlations among different production batches.[213] These novel techniques allow police scientists to facilitate the monitoring of illicit distribution networks.
As of October 2015[update], most of the MDMA in the United States is produced in British Columbia, Canada and imported by Canada-based Asian transnational criminal organizations.[64] The market for MDMA in the United States is relatively small compared to methamphetamine, cocaine, and heroin.[64] In the United States, about 0.9 million people used ecstasy in 2010.[21]
Australia
MDMA is particularly expensive in Australia, costing A$15–A$30 per tablet. In terms of purity data for Australian MDMA, the average is around 34%, ranging from less than 1% to about 85%. The majority of tablets contain 70–85 mg of MDMA. Most MDMA enters Australia from the Netherlands, the UK, Asia, and the US.[214]
Corporate logos on pills
A number of ecstasy manufacturers brand their pills with a logo, often being the
Research
In 2017, doctors in the UK began the first clinical study of MDMA in
The potential for MDMA to be used as a rapid-acting antidepressant has been studied in clinical trials, but as of 2017 the evidence on efficacy and safety were insufficient to reach a conclusion.
MDMA in combination with psychotherapy has been studied as a treatment for post-traumatic stress disorder, and four clinical trials provide moderate evidence in support of this treatment.[219] However, the lack of appropriate blinding of participants likely leads to overestimation of treatments effects due to high levels of response expectancy.[220][221] In addition, there are no trials comparing MDMA-assisted psychotherapy for PTSD with existent evidence-based psychological treatments for PTSD, which seems to attain similar or better treatment effects compared with that achieved by MDMA-assisted psychotherapy.[178]
In 2018 researchers identified MDMA as a psychoplastogen which refers to a compound capable of promoting neuroplasticity and received the “breakthrough therapy” designation by the Food and Drug Administration for treating PTSD.[222]
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External links
- "MDMA Facts and Statistics". National Institute on Drug Abuse. 15 June 2020.
- "Methylenedioxymethamphetamine (MDMA or 'Ecstasy') drug profile". European Monitoring Centre for Drugs and Drug Addiction.
- "MDMA-Assisted Psychotherapy". Multidisciplinary Association for Psychedelic Studies.