In the text below, I present a general overview of the findings from recent my recent survey-based research on the long-term effects of MDMA. The full paper associated with this research can be found here, and goes into a lot more detail and discussion about the findings. Both the paper linked here, and the text below, have not yet undergone ‘peer review’, in which other researchers critique and check the work. As with any research, even that which has been peer reviewed, my findings and interpretations of them are not the final say on the topic.

Do you have an interest in participating in similar research regarding MDMA or other drugs? If yes, you can provide a contact address here and I will inform you when we conduct further research that you express an interest in!

Background

MDMA (‘ecstasy’) is among the most commonly used recreational drugs. The short-term effects of MDMA are well-known: intense feelings of euphoria, heightened sociability and openness, a rush of energy, and often a heightened appreciation of the senses. Negative short-term effects, such as anxiety/paranoia, dehydration, and teeth-grinding are also known to occur, though less reliably than the more typical euphoric effects.

Relatively less is known about the long-term impact of MDMA. In an analysis of a host of different drugs by David Nutt and colleagues (2010), ecstasy was ranked among the least harmful drugs under consideration, both in terms of harm to users and society. Users also rate the drug as having few negative effects, and possible benefits (Morgan et al., 2013). However, other researchers highlight the potential neurotoxic effects of MDMA, and the possibility that use - and particularly heavy use - might result in long-term mood and concentration problems (Parrott, 2013).

Discussion of possible long-term risks is often framed in a classic ‘short-term vs. long-term tradeoff’ perspective: long-term risks are uncertain, difficult to pick up on, and won’t happen immediately. Short-term benefits (the euphoric effects of the drug) are near-immediate and undeniable. MDMA users are essentially seen as making a risky cost-benefit miscalculation.

Although it is important to acknowledge the risks associated with MDMA use, I believe there is space for considerably more nuance in understanding the long-term effects of MDMA. Most notably, considerations of the long-term effects of MDMA have focused heavily on the possible negative effects (the development of mental illness and cognitive deficits), with much less attention given to possible positive effects. Perceived benefits of MDMA may be more than just a short-term high, with some users having profound and even ‘peak’ experiences, entering into areas of consciousness they had not previously accessed, or learning important things about themselves and their place in the world. Such experiences may have a lasting impact, beyond short-term drug effects.

New research

I investigated user perceptions of the long-term effects of MDMA with a questionnaire that enabled users to endorse or disagree with a large range of both positive and negative long-term effects of MDMA. Over 1000 people expressed interest in the questionnaire, resulting in about 900 valid responses from users. As you can see from the map below, the majority of respondents were from the USA and the Netherlands, followed by Canada and the UK.

The possible effects were based on previous MDMA research, long-term effects of other psychoactive drugs, extrapolations from short-term effects of MDMA, and anecdotal reports, totaling 13 positive and 13 negative effects (and space where respondents could put their own effect).

Users were asked to consider long-term effects they attributed to taking MDMA, and to ignore short-term effects or those they experienced when recovering from use (i.e., during a comedown) when answering the long-term effects questions. Effects were phrased as personal statements, for which the user could indicate whether or not it was true for them, for example:

Positive effect:

“Because of using ecstasy/MDMA, I find I am better able to see the world as a positive and welcoming place”

Negative effect:

“Because of using ecstasy/MDMA, I find I am more inclined to see the world as a negative and unfriendly place”

For each statement, they were asked to select any number from 0-100, to indicate how much that statement could apply to them (0 = ‘not at all true for me’, 100 = ‘completely true for me’).

Findings

Perceived long-term effects

An overview of user responses for a range of long-term effects can be seen in the graph below. Note that these findings are currently being prepared for publication and have not yet been subjected to peer review (where other experts evaluate the research design and conclusions). Before going straight to the graph, it is worth understanding exactly what it represents. It is tricky to represent all 800-900 responses to 26 different questions in a way that is interpretable. I have reduced the several hundred responses to each question to 50 dots for each question, which are allocated according to a proportional representation voting scheme. You can think of these dots as representing how 50 members of a parliament would place their votes if they had to represent all of the respondents. The more dots you see in each section (0-10, 11-20, 21-30 … 91-100), the more the respondents were endorsing those numbers. Pale blue/full blue dots represent responses to the negative version of a long-term effect, and yellow/orange dots represent responses to the positive version of a long-term effect.

For most of the negative items, the 50 votes (blue dots) are almost all cast at very low levels of endorsement: the bulk of respondents answered between 0-10 on a 100 point scale when indicating how much they had experienced these negative effects. In contrast, for the positive long-term effects, responses are much more varied, with votes (yellow/orange dots) being allocated over a greater range of responses, but always receiving more overall endorsement than the respective negative effect. Now that you know how the graph works, take a moment to look over the different effects and responses for yourself.

Many participants ranked experiences on MDMA as being among the most positive experiences they’ve ever had, providing them with great memories they enjoy looking back on. Respondents also endorsed a range of other effects that go beyond just experiencing a high and having a good time while on the drug - for example, feeling that MDMA had increased their aesthetic sensibilities, improved their friendships, and helped them see their lives or the world in a different and more positive way. The positive effect receiving the least endorsement was the idea that using MDMA had helped reduce use of other problematic drugs. This makes sense, as MDMA is often taken in an environment in which other drugs are easily available.

Overall, negative effects received far less endorsement than positive effects. However, two effects stand out as receiving relatively more agreement than the others: long-term effects on concentration, and more negative feelings about life and the future. While still only experienced by a minority of respondents, a subset of people clearly felt that MDMA might have negatively impacted them in these domains. This is in line with some of the negative long-term effects highlighted by previous research.

Relationships among motives, short-term effects, comedown/afterglow effects, and long-term effects

Beyond looking at overall impressions of MDMA’s impact, we were able to explore a range of associations among variables that may highlight promising areas for further investigation. A visual display of these relationships can be found in the full text paper. People who said they used MDMA to fit in with other people or to cope with problems were statistically more likely to report having had negative long-term effects of MDMA use, and for the fitting in motivation, lower endorsement of several positive effects. These associations are consistent with research in other drugs, in which motivation to use drugs either due to peer influence or to escape/cope with problems is often considered problematic. This may also highlight that while therapeutic use of MDMA is seen as a means of dealing with problems, it is unlikely that simply taking MDMA will produce benefits when the user’s motivation is just to get rid of negative feelings. Whereas in therapy MDMA is used as a tool to delve into one’s problems, the coping motivation was framed more like a form of escapism or avoidance, which is typically counterproductive in the long-term. It is therefore of further note that taking MDMA to gain insight into oneself was the strongest positive correlate of beneficial long-term effects.

Acute and subacute effects of MDMA were also associated with long-term effects in sensible directions: generally negative effects – feeling anxious, having unpleasant physiological experiences, or a comedown – were positively associated with multiple negative long-term effects, and associated with lower endorsement of several positive long-term effects. In contrast, feeling euphoric, having heightened aesthetic experiences, connecting with people, and having an afterglow experience were associated with higher endorsement of all positive long-term effects except reduced use of other drugs.

Hence, the picture painted of the effects of MDMA use is by no means completely positive. Some people may also be more likely to experience negative effects than others. So, even though on average people are quite unlikely to report experiencing such negative effects, certain types of user may be more at risk.

Conclusions and caveats

One thing to keep in mind is that the survey responses are not a ‘population’ sample or ‘representative’ sample of all MDMA users. It is possible that we had access to a subset of MDMA users who have had different experiences with MDMA than some other types of user. For example, a sizable proportion of the respondents were reached by outlets that typically have a positive overall view of drug use and particularly such drugs as MDMA. They may have been hesitant to cast MDMA in a negative light.

It should also be stressed that we really are investigating user perceptions of the long-term effects of their MDMA use. We cannot know whether people have mis-attributed changes they’ve experienced over time or for reasons other than taking MDMA, to having taken MDMA.

Despite these limitations, the findings contribute to our understanding of MDMA use and its possible effects. Knowing about perceived positive effects of MDMA is important even if you have a very negative view of MDMA use and believe people shouldn’t take it: understanding what people believe they are getting from taking it is essential when communicating with users.

Given the range of positive effects that respondents endorsed, I believe the results highlight how a lot of the discussion around drug use is framed too simplistically. Users presumably don’t only take drugs to get a short-term high and discount the long-term negative effects. For many users, their experiences with MDMA are sometimes perceived as having a profound long-term impact. If backed up by more research, knowledge of such effects might update our understanding of the relative costs and benefits of MDMA use, with implications for drug policy.

The findings I present here are only a small step in understanding the possible impact of MDMA. The full data set is available so that other researchers can explore trends in the data and gain inspiration for studies that might help understand causal mechanisms behind the observed effects (link). The data set contains information on a number of other informative variables, such as the frequency of MDMA and other drug use, combined use of MDMA with other drugs, motivations for taking MDMA, and short-term effects of use. I would reiterate again that the findings presented above have not yet undergone peer review and may be subject to change, although I am confident in the findings as presented.

I would also like to thank several people involved in the project. This study evolved out of a teaching assignment at the University of Amsterdam, and several students helped with getting the survey together and providing translations of survey questions, as well as reaching out to people to fill in the questionnaire: Anouk Fieten, Vivianna Wuestman (both of whom also helped clean and organise the final data set), Bryan Opdam, Emanuella Schuuring, and Tola Agbaje.

I would also like to express my sincere thanks to all the people who completed the survey. I was genuinely amazed by the number of people who completed the questionnaire, as we only offered a monetary prize draw as compensation and had no budget to promote the work. Nevertheless, over 1000 people took part and several sent me very kind personal messages about the project. I really am grateful for your effort if you took part!

References

Morgan, C. J., Noronha, L. A., Muetzelfeldt, M., Feilding, A., & Curran, H. V. (2013). Harms and benefits associated with psychoactive drugs: findings of an international survey of active drug users. Journal of Psychopharmacology, 27(6), 497-506.

Nutt, D. J., King, L. A., & Phillips, L. D. (2010). Drug harms in the UK: a multicriteria decision analysis. The Lancet, 376(9752), 1558-1565.

Parrott, A. C. (2013). Human psychobiology of MDMA or ‘Ecstasy’: an overview of 25 years of empirical research. Human Psychopharmacology: Clinical and Experimental, 28(4), 289-307.