Prevention Chemsex: Sexualised Substance Use MDMA (Ecstasy)

MDMA (Ecstasy)

AKA: Mandy, Molly, E, ecstasy, pills.

MDMA is a derivative of amphetamine. It used to be better known as ecstasy, E or pills, and was more commonly found in tablet form.

As with all powdered drugs, MDMA is often cut with other substances.

How it’s used

MDMA tends to come as slightly off-white (yellow or brown) crystals, which can be crushed into a powder.

The powder can be snorted, wrapped in tissue and swallowed (bombed) or dabbed on the gums. If it’s a tablet, it’s likely to be swallowed.

Highs and lows of MDMA


About half an hour after taking MDMA – or longer, depending on how much has been eaten – the user will start to ‘come up’. It’s now that their brain releases its ‘feel good’ chemicals dopamine and serotonin.

For up to four hours they might be buzzing with energy and feeling less uptight.

They may feel high and ‘loved up’. Sounds and lights can be enhanced, which is another reason for MDMA’s popularity with clubbers.


Jaw clenching, teeth grinding and sweating while high on MDMA are also common.

MDMA can sometimes cause anxiety or panic attacks, and leave people feeling disorientated or confused.

The drug can push up body temperature to what could be life-threatening levels, which is made worse by hot clubs and dancing. 

MDMA-related deaths are often due to heatstroke, heart failure or drinking too little or too much water.

Once the brain’s ‘feel good’ chemicals have been used up they take a few days to be replaced – so there’s little point taking more MDMA. Any extra buzz that might be achieved will come from whatever the drug’s been cut with, and it’s often cut with things like speed, aspirin, caffeine or ketamine.

Sex on MDMA

MDMA can make people horny, with an increased sense of touch. But it can also make it difficult to get a hard-on or to cum. As the drug lowers inhibitions it can make some people more likely to risk getting or passing on HIV.

MDMA is often taken with Viagra. This combination is used to get around the problem of getting and keeping a hard-on, however, this can be dangerous and lead to an erection that will not subside for more than four hours. If this happens, users need to seek urgent medical help.

A long-term relationship?

Tolerance to MDMA can build up quickly, with more needed to get the same high.

Although MDMA has not been shown to be highly addictive, some people come to rely on the drug and can’t imagine clubbing without it. Some research suggests that prolonged MDMA use can cause long term memory loss, depression, anxiety, and cognitive problems.

MDMA with other drugs


Alcohol can deaden the effects of MDMA while MDMA masks the effects of the booze, making it difficult for someone to tell how drunk they are.

Both dehydrate the body, put strain on the liver and kidneys, and raise body temperature. MDMA-related deaths often involve booze.

HIV drugs

Some of these – especially protease inhibitors such as ritonavir – could increase levels of MDMA to life-threatening levels in the body as they prevent it from being broken down in the liver. The advice is for users to check with their HIV doctor before getting high.


Taking MDMA when on a course of some antidepressants can be fatal, as it increases the risk of ‘serotonin syndrome’. This is a dangerous reaction with symptoms of agitation, sleeplessness, sweating, faster heartbeat and muscle spasms.

If this happens, the user needs to seek urgent medical help.

The advice is that if a user is on antidepressants they should get medical advice before taking MDMA. An older type of antidepressants called monoamine oxidase inhibitors (MAOIs) mix particularly badly with MDMA.

Cocaine, speed, mephedrone, crystal meth

These stimulant drugs taken with MDMA can put the heart under a dangerous level of stress, leading to a risk of heart attack.

Viagra-type drugs

As well as possible extra stress on the heart, there have been a few reports of this combination possibly leading to erections that won’t go down for over four hours. If medical help isn’t found quickly, this can cause lasting damage to the users cock.

Useful information to know and share

Users can avoid overheating and dehydration by drinking a pint of water for every hour that they’re dancing, and by taking breaks. But drinking too much water can be dangerous, so try not to exceed that amount. Drinks that contain minerals are also recommended.

If they’re hyperactive or dancing, take regular breaks to bring their body temperature down.

MDMA should be avoided by people with a history of mental illness or depression as it can trigger depression or make it worse if you have it already.

As MDMA pushes up blood pressure and heart rate, it should be avoided if you’ve got any of the following:

  • high blood pressure
  • heart, liver, or kidney problems
  • the eye condition glaucoma
  • a history of stroke.

Next module: Ketamine

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