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MDMA (3,4-methylenedioxy-N-methylamphetamine) is an empathogenic drug of the phenethylamine and amphetamine classes of drugs. MDMA has become widely known as "ecstasy" (shortened to "E", "X", or "XTC"), usually referring to its street form, although this term may also include the presence of possible adulterants. The UK term "Mandy" and the US term "Molly" colloquially refer to MDMA that is relatively free of adulterants. Although recently, "Molly" is no longer essentially MDMA, but potentially a host of other related serotonergetic compounds, such as Methylone and Butylone.. [3] [4] MDMA can induce euphoria, a sense of intimacy with others, diminished anxiety, and mild psychedelia. Many studies, particularly in the fields of psychology and cognitive therapy, have suggested MDMA has therapeutic benefits and facilitates therapy sessions in certain individuals, a practice for which it had been formally used in the past. Clinical trials are now testing the therapeutic potential of MDMA for post-traumatic stress disorder, anxiety associated with terminal cancer[5][6] and addiction.[7] MDMA is criminalized in most countries. Some limited exceptions exist for scientific and medical research. For 2008, the UN estimated between 10 and 25 million people globally used MDMA at least once in the past year. This was broadly similar to the number of cocaine, amphetamine, and opioid users, but far fewer than the global number of cannabis users.[8] It is taken in a variety of contexts far removed from its roots in psychotherapeutic settings, and is commonly associated with dance parties (or "raves") and electronic dance music.[9] Regulatory authorities in several locations around the world have approved scientific studies administering MDMA to humans to examine its therapeutic potential and its effects.[10] Medical use See also: Effects of MDMA on the human body MDMA has been indicated as possibly useful in psychotherapy, facilitating self-examination with reduced fear.[11][12][13] Indeed, some therapists, including Leo Zeff, Claudio Naranjo, George Greer, Joseph Downing, and Philip Wolfson, used MDMA in their practices until it was made illegal. George Greer synthesized MDMA in the lab of Alexander Shulgin and administered it to about 80 of his clients over the course of the remaining years preceding MDMA's Schedule I placement in 1985. In a published summary of the effects,[14] the authors reported patients felt improved in various mild psychiatric disorders and experienced other personal benefits, especially improved intimate communication with their significant others. In a subsequent publication on the treatment method, the authors reported one patient with severe pain from terminal cancer experienced lasting pain relief and improved quality of life.[15] In the United States, no research on MDMA was allowed at all, from 1985 until 1992, when the FDA approved Dr. Charles Grob to conduct human studies.[16] In the year 2000, Doctor Jose Carlos Bouso performed the first clinical trial of MDMA for use in treating Post Traumatic Stress Disorder.[17] Since 2009, two randomized, controlled trials of MDMA-assisted psychotherapy for post-traumatic stress disorder were published. Although small, these trials are consistent with earlier results. The patients treated with two or three sessions of MDMA-psychotherapy showed greater improvement than the ones treated by placebopsychotherapy[18] or placebo-inactive dose of MDMA.[19] This improvement was generally maintained on a follow-up several years later.[20] Recreational use Tablets containing MDMA Small doses of MDMA are used as an entheogen to enhance prayer or meditation by some religious practitioners.[21] MDMA is often considered the drug of choice within the rave culture and is also used at clubs, festivals and house parties. In the rave environment, the sensorial effects from the music and setup such as lasers are often highly synergistic with the drug. The psychedelic amphetamine quality of MDMA lends it to variable reasons as to why it appeals to users in the "rave" setting. Some users enjoy the feeling of mass communion from the inhibition-depressing effects of the drug, while others use it as party fuel because of the drug's stimulatory effects.[22] MDMA is occasionally known for being taken in conjunction with psychedelic drugs, such as LSD or psilocybin mushrooms, or even common drugs such as cannabis. As this practice has become more prevalent, most of the more common combinations have been given nicknames, such as “candy flipping” for MDMA combined with LSD, “hippy flipping” for MDMA with psilocybin mushrooms, or “kitty flipping” for MDMA with ketamine.[23] The term “flipping” may come from the subjective effects of using MDMA with a psychedelic in which the user may shift rapidly between a more lucid state and a more psychedelic state several times during the course of their experiences. Many users use mentholated products while taking MDMA for its cooling sensation while experiencing the drug’s effects. Examples include menthol cigarettes, Vicks VapoRub, NyQuil,[24] and lozenges. Subjective effects The primary effects attributable to MDMA consumption are predictable and fairly consistent among users. In general, users begin reporting subjective effects within 30 to 60 minutes of consumption, hitting a peak at about 75 to 120 minutes, reaching a plateau that lasts about 3.5 hours.[25] This is followed by a comedown of a few hours. After the drug has run its course, many users report feeling fatigue. The following subjective effects of MDMA were statistically significant in a placebo-controlled trial, using Altered States of Consciousness rating scale: derealization, depersonalization, altered perception of space and time, positive basic mood, mania-like experience, anxious derealization, thought disorder, fears of loss of thought or body control, visual hallucinations or pseudohallucinations, synesthesia, changed meaning of percepts, facilitated recollection or imagination. On an Adjective Mood rating scale, the following measurements were significantly increased: self- confidence, heightened mood, apprehension-anxiety, thoughtfulness-contemplativeness, extroversion, dazed state, sensitivity, and emotional excitation.[25] After-effects Effects reported by some users once the acute effects of MDMA have worn off include: Psychological o Anxiety and paranoia o Depression[31][32][33][34] o Irritability[32] o Fatigue[33][34] o Impaired attention, focus, and concentration, as well as drive and motivation (due to depleted serotonin levels)[31] o Residual feelings of empathy, emotional sensitivity, and a sense of closeness to others (afterglow) Physiological o Dizziness, lightheadedness, or vertigo[34] o Loss of appetite[31] o Gastrointestinal disturbances, such as diarrhea or constipation o Insomnia[31] o Aches and pains, usually from excessive physical activity (e.g., dancing)[31][33] o Exhaustion[32][34] o Jaw soreness, from bruxism[34][35][36] A slang term given to the depressive period following MDMA consumption is Tuesday Blues (or "Suicide Tuesday"), referring to the low mood that can be experienced by midweek from depleted serotonin levels following MDMA use on the previous Friday or Saturday when raves or dance concerts were frequently scheduled. Some users reported consuming 5-HTP, L-tryptophan and vitamins the day after use can reduce the depressive effect by replenishing serotonin levels (magnesium supplements are also used prior to or during use, in an attempt to prevent jaw/muscle clenching).[37] Purity and dosage of "ecstasy" MDMA powder Another concern associated with MDMA use is toxicity from chemicals other than MDMA in ecstasy tablets. Due to its near-universal illegality, the purity of a substance sold as ecstasy is unknown to the typical user. The MDMA content of tablets varies widely between regions and different brands of pills and fluctuates somewhat each year. Pills may contain other active substances meant to stimulate in a way similar to MDMA, such as amphetamine, mephedrone, methamphetamine, ephedrine, caffeine, all of which may be comparatively cheap to produce and can help to boost overall profits. In some cases, tablets sold as ecstasy do not even contain any MDMA. Pills may include a variety of non-psychoactive substances as well, such as paracetamol, ibuprofen, talcum powder, etc.[88] A number of deaths have been attributed to para-methoxyamphetamine (PMA), a hallucinogenic amphetamine, being sold as ecstasy.[89][90] PMA is unique in its ability to quickly elevate body temperature and heart rate at relatively low doses, especially in comparison to MDMA. Hence, users believing they are consuming two 120-mg pills of MDMA could actually be consuming a dose of PMA that is potentially lethal, depending on the purity of the pill. Not only does PMA cause the release of serotonin, but it also acts as a monoamine oxidase inhibitor. When combined with an MDMA or an MDMA-like substance, serotonin syndrome can result.[91] Combining MAO inhibitors with certain legal prescription and over-the-counter medications can also lead to (potentially fatal) serotonin syndrome. History -MDMA was first synthesized in 1912 by Merck chemist Anton Köllisch. -In the early 1980s clubbers started using MDMA in Ibiza’s discos