Contributed by StartYourRecovery.org
Reviewed by Kim Dennis, MD, CEDS
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StartYourRecovery.org (SYR) provides helpful information for people who are dealing with substance use issues — and their family members, friends, and co-workers, too.  SYR knows that there is no one-size-fits-all solution to the challenges faced by those who misuse alcohol, prescription or illegal drugs, or other substances, and they aim to break through the clutter to help people at any stage of recovery.

MDMA — nicknamed ecstasy or molly — has a reputation of being relatively safe and even therapeutic.1,2,3 But the truth is that this illicit “party drug” can be dangerous.4

If you or a loved one is experiencing an eating disorder and using MDMA, know that help is available, and treatment works.

What is MDMA?

MDMA, which is short for 3,4-methylenedioxy-methamphetamine, has stimulant and hallucinogenic effects that can start within 30 minutes and last up to six hours.5,6,7 Known as a “party” or “club” drug, MDMA can make people feel alert, energetic, happy, and close with others. It can also distort senses, suppress appetite, and cause the body to dangerously overheat.5,8

Taking ecstasy or molly frequently, in high doses, or with alcohol or other drugs can cause serious physical and mental health problems and lead to a substance use disorder.8,9 And ecstasy or molly products rarely contain pure MDMA alone. If they are laced with fentanyl or other opioids, these drugs can be deadly. If you take SSRIs, a class of commonly prescribed antidepressants, using MDMA can cause serotonin syndrome, which is a medical emergency.10

Link Between Eating Disorders and MDMA

Both eating disorders and opioid use disorder can be serious and even lethal.11,12,13,14 Substance misuse may lead to an eating disorder, and an eating disorder may lead to substance misuse. People who try risky weight-loss practices may be at greater risk of misusing ecstasy and other substances.

Eating and substance use disorders share some common risk factors, such as:12,18,19,20

  • Anxiety.
  • Depression.
  • Family history of these or other mental illnesses.
  • Impulsivity.
  • Low self-esteem or a susceptibility to social pressures.
  • Trauma and adverse life experiences.

Researchers are studying whether MDMA, combined with clinical supervision and behavioral therapy, can help treat eating disorders.21 However, MDMA has not at this time been approved as a treatment for eating disorders. Studies in human subjects are limited. If you are considering taking MDMA and you have an eating disorder, it is important to seek advice from a trained clinician who can ensure you are fully aware of potential risks.

Can You Overdose on MDMA?

Use of crystal MDMA or other forms of pure MDMA rarely leads to fatal overdoses.22 But the illicit form of the drug is not always “pure”: MDMA products are often unknowingly laced with other substances, including fentanyl, which carries a high risk of overdose death.22,23

Those who use MDMA should carry fentanyl test strips, to test for the presence of this harmful opioid in their MDMA, and naloxone, to reverse an opioid overdose. Naloxone, known by brand names like Narcan and RiVive, is an over-the-counter medicine that can stop an opioid overdose and save a life.

If you suspect someone is experiencing an opioid overdose:

  • Call 911.
  • Administer naloxone if available.
  • Keep the person awake and lying on their side until first responders arrive.

Find Treatment and Start Your Recovery

Recovery from eating disorders and/or substance use disorders is a personal journey, and there’s no single solution that works for everyone.24 

Start by finding a trained health care professional to assess your physical and mental health needs. They then can work with you to create a recovery plan.15 Locate treatment and support near you for eating disorders and substance misuse. 

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Sources

[1] Multidisciplinary Association for Psychedelic Studies. (2022, March 9). MDMA-assisted therapy for eating disorders (MED1). MAPS. Available at: https://maps.org/mdma/eating-disorders/

[2] Mitchell, J. M., Bogenschutz, M., Lilienstein, A., et. al. (2021, May 10). MDMA-Assisted therapy for severe PTSD: A randomized, double-blind, placebo-controlled phase 3 study. Nature News. https://www.nature.com/articles/s41591-021-01336-3

[3] Latimer, D., Stocker, M. D., Sayers, K., Green, J., Kaye, A. M., Abd-Elsayed, A., Cornett, E. M., Kaye, A. D., Varrassi, G., Viswanath, O., & Urits, I. (2021). MDMA to Treat PTSD in Adults. Psychopharmacology bulletin, 51(3), 125–149. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374929/

[4] Baker, J. H., Mitchell, K. S., Neale, M. C., & Kendler, K. S. (2010). Eating disorder symptomatology and substance use disorders: prevalence and shared risk in a population based twin sample. The International journal of eating disorders, 43(7), 648–658. https://doi.org/10.1002/eat.20856

[5] NIDA. (2020, June 15). MDMA (Ecstasy/Molly) DrugFacts. National Institute on Drug Abuse. Available at: https://nida.nih.gov/publications/drugfacts/mdma-ecstasymolly

[6] Department of Justice/Drug Enforcement Administration. (2020, April). Drug fact sheet: Ectasty/MDMA. https://www.dea.gov/sites/default/files/2020-06/Ecstasy-MDMA-2020_0.pdf

[7] Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine 6th Edition. Wolters Kluwer.

[8] NIDA. (2021, April 13). What are the effects of MDMA?. National Institute on Drug Abuse. Available at: https://nida.nih.gov/publications/research-reports/mdma-ecstasy-abuse/what-are-effects-mdma

[9] Parrott A. C. (2013). Human psychobiology of MDMA or ‘Ecstasy’: an overview of 25 years of empirical research. Human psychopharmacology, 28(4), 289–307. https://doi.org/10.1002/hup.2318

[10] Makunts, T., Jerome, L., Abagyan, R., & de Boer, A. (2022). Reported Cases of Serotonin Syndrome in MDMA Users in FAERS Database. Frontiers in psychiatry, 12, 824288. https://doi.org/10.3389/fpsyt.2021.824288

[11] American Psychiatric Association. (2023). What are eating disorders? Available at: https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders

[12] Eskander, N., Chakrapani, S., & Ghani, M. R. (2020). The Risk of Substance Use Among Adolescents and Adults With Eating Disorders. Cureus, 12(9), e10309. https://doi.org/10.7759/cureus.10309

[13] Substance Abuse and Mental Health Services Administration. (2023). Mental health and substance use disorders. SAMHSA. Available at: https://www.samhsa.gov/find-help/disorders

[14] Mellentin, A. I., Mejldal, A., Guala, M. M., Støving, R. K., Eriksen, L. S., Stenager, E., & Skøt, L. (2022). The Impact of Alcohol and Other Substance Use Disorders on Mortality in Patients With Eating Disorders: A Nationwide Register-Based Retrospective Cohort Study. The American journal of psychiatry, 179(1), 46–57. https://doi.org/10.1176/appi.ajp.2021.21030274

[15] Substance Abuse and Mental Health Services Administration. (2011). Clients With Substance Use and Eating Disorders. SAMHSA Advisory, (10) 1. Available at: https://store.samhsa.gov/sites/default/files/d7/priv/sma10-4617.pdf

[16] Bruening, A. B., Perez, M., & Ohrt, T. K. (2018). Exploring weight control as motivation for illicit stimulant use. Eating behaviors, 30, 72–75. https://doi.org/10.1016/j.eatbeh.2018.06.002

[17] De Berardis, D., Matarazzo, I., Orsolini, L., Valchera, A., Tomasetti, C., Montemitro, C., Mazza, M.,Fornaro, M., Carano, A., Perna, G., Vellante, F., Rovere, R., Martinotti, G., Trotta, S., & di Giannantonio, M. (2019). The Problem of Eating Disorders and Comorbid Psychostimulants Abuse: A Mini Review. Neuropsychiatry. 9(3). 749-751. https://www.jneuropsychiatry.org/peer-review/the-problem-of-eating-disorders-and-comorbid-psychostimulants-abuse-a-mini-review.pdf

[18] National Center on Addiction and Substance Abuse at Columbia University. (2003). Food for thought: Substance abuse and eating disorders. Commonwealth Fund & National Institute on Drug Abuse. Available at: https://www.ojp.gov/ncjrs/virtual-library/abstracts/food-thought-substance-abuse-and-eating-disorders

[19] Ressler, A. (2008). Insatiable Hungers: Eating Disorders and Substance Abuse. Social Work Today, (8) 4, 30. Available at: https://www.socialworktoday.com/archive/070708p30.shtml

[20] Munn-Chernoff, M. A., Grant, J. D., Agrawal, A., Sartor, C. E., Werner, K. B., Bucholz, K. K., Madden, P. A., Heath, A. C., & Duncan, A. E. (2015). Genetic overlap between alcohol use disorder and bulimic behaviors in European American and African American women. Drug and alcohol dependence, 153, 335–340. https://doi.org/10.1016/j.drugalcdep.2015.05.043

[21] Brewerton, T. D., Wang, J. B., Lafrance, A., Pamplin, C., Mithoefer, M., Yazar-Klosinki, B., Emerson, A., & Doblin, R. (2022). MDMA-assisted therapy significantly reduces eating disorder symptoms in a randomized placebo-controlled trial of adults with severe PTSD. Journal of psychiatric research, 149, 128–135. https://doi.org/10.1016/j.jpsychires.2022.03.008

[22] Papaseit, E., Pérez-Mañá, C., Torrens, M., Farré, A., Poyatos, L., Hladun, O., Sanvisens, A., Muga, R., & Farré, M. (2020). MDMA interactions with pharmaceuticals and drugs of abuse. Expert opinion on drug metabolism & toxicology, 16(5), 357–369. https://doi.org/10.1080/17425255.2020.1749262

[23] Drug Policy Alliance . (2015). Facts about MDMA. DrugPolicy.org. https://drugpolicy.org/wp-content/uploads/2023/05/2023.04.05_MDMA_factsheet.pdf

[24] Bahji, A., Mazhar, M. N., Hudson, C. C., Nadkarni, P., MacNeil, B. A., & Hawken, E. (2019). Prevalence of substance use disorder comorbidity among individuals with eating disorders: A systematic review and meta-analysis. Psychiatry research, 273, 58–66. https://doi.org/10.1016/j.psychres.2019.01.007