MDMA (3,4-Methylenedioxymethamphetamine) continues to be one of the most prevalent club drugs worldwide. Recent statistics indicate that MDMA use has increased among young adults, with approximately 2.6% of adults aged 18-25 reporting use in the past year1. Let us examine the basics of drug testing for MDMA use, including requirements, windows of detection, cutoff levels and interpretation of results.
What Is MDMA?
MDMA is a synthetic compound that acts as both a stimulant and mild psychedelic, producing unique effects that have earned it the classification of an “empathogen” or “entactogen.”
It is currently classified as a Schedule I controlled substance in the United States, indicating high abuse potential with no accepted medical use. Although, recent FDA clinical trials have shown promising results for MDMA-assisted therapy in treating PTSD2.
In its pure form, MDMA exists as a crystalline powder. It is most commonly sold as pressed 100 mg tablets known as “ecstasy” or in powder form called “molly.” Tablets are sometime sold in 50 mg and 150 mg varieties as well.
Street samples often contain adulterants like ephedrine and caffeine, among others, in order to add bulk and/or to mimic the MDMA effects.
MDMA is also used as a main ingredient in the new drug cocktail known as “Pink Cocaine” or “Tusi”.
The most common route of administration for MDMA is oral ingestion of tablets. Tablets can also be crushed and either snorted, smoked or injected.
MDMA’s Effect On The Body
MDMA primarily affects three neurotransmitter systems in the brain:
1. Serotonin: Causes massive release and prevents reuptake
2. Dopamine: Increases release and blocks reuptake
3. Norepinephrine: Stimulates release and prevents reuptake
These mechanisms produce onset of effects within 30-45 minutes after administration, peaking at around 90 minutes and last between 4-6 hours.
Users commonly experience the following immediate effects: intense feelings of well-being, increased empathy and sociability, enhanced sensory perception, elevated energy levels, increased heart rate and blood pressure, hyperthermia, bruxism (jaw clenching) and pupil dilation.
Heat exhaustion, heat stroke, dehydration and electrolyte imbalance can also occur due to increased body temperature and activity levels.
As the effects of MDMA begin to wear off, users often experience a comedown which is characterized by depression, anxiety, irritability, aggression, impulsiveness, loss of appetite, insomnia, fatigue, memory problems, attention deficit, loss of interest in sex. This large swing in mood is dramatic and can cause users to take more of the drug in order to keep the high going, putting the user at risk for an overdose. This also puts users at an increased risk for suicidal ideations.
When Is Drug Testing For MDMA Use Required?
Workplace requirements are the most likely reason for MDMA drug testing. It may be tested for during pre-employment screening, random testing, post-accident testing and reasonable suspicion testing.
The Department of Transportation (DOT) drug testing program, which covers safety-sensitive employees in transportation industries, mandates testing for five specific drug categories which include: marijuana metabolites, cocaine metabolites, amphetamines (includes methamphetamine and MDMA), opioids (includes codeine, morphine, heroin, hydrocodone, hydromorphone, oxycodone, and oxymorphone) and phencyclidine (PCP). DOT tests for MDMA use since it falls under the amphetamine category. MDMA is also required for most non-DOT drug tests as well.
Other situations that may drug testing for MDMA use are law enforcement investigations, probation/parole monitoring, substance abuse treatment programs and child custody cases.
What Specimens Are Used for MDMA Drug Testing?
MDMA can be detected in various biological specimens. The type of specimen chosen depends on testing factors like purpose, desired detection window, and method availability.
Urine is the most commonly used specimen for MDMA drug testing. Blood, hair and oral fluid (saliva) can also be tested, although they are rarely used.
What Are The Test Cutoff Levels for MDMA?
The initial cutoff level for MDMA for DOT employees is 500 ng/mL3. If the sample contains drug levels that exceed the initial cutoff, the sample will be retested using a lower cutoff level to confirm the positive result. The cutoff used for confirmatory testing is 250 ng/mL.
Cutoffs for non-DOT employees typically mirror these same levels.
How Long Is MDMA Detectable?
MDMA is metabolized primarily by demethylation to form the active metabolite, MDA. Generally, MDMA or MDA is detectable in urine for 1 to 2 days after last use4. Detection times will depend on several factors like body mass index (BMI), metabolism, organ health, hydration status, age, gender, drug potency and frequency of use.
Who Are The Main Users of MDMA?
MDMA first gained popularity in the 1980s among adolescents and young adults in the nightclub scene, as well as dance parties known as raves. However, beginning in 1999, data began to show use starting to spread outside the nightclub scene. Data also shows that sexual orientation influences MDMA usage rates. Gay and bisexual men and women are more likely than their heterosexual counterparts to have used MDMA within the last 30 days and to report harm associated with its use5.
Conclusion
MDMA is a widely used drug, especially with the young population and rave party crowds. Although users often have pleasant sensory experiences, potentially fatal negative symptoms can also occur. If you or someone you know suffers from MDMA addiction, reach out for help from a qualified medical professional as soon as possible.
References
1.Molly Addiction: Symptoms, Effects, Treatment and Consideration . (2024, September 20). Retrieved from The Grove Estate: https://grovetreatment.com/addiction/molly-addiction/
2.Mitchell, J. B. (2021, May 10). MDMA-assisted therapy for severe PTSD: a randomized, double blind, placebo-controlled phase 3 study. Retrieved from Nature Medicine: https://www.nature.com/articles/s41591-021-01336-3
3.DOT Rule 49 CFR Part 40 Section 40.85. (2023, June 6). Retrieved from U.S. Department of Transportation: https://www.transportation.gov/odapc/part40/40-85
4.Medical Review Officer Guidance Manual . (2024, Feb 1). Retrieved from Substance Abuse & Mental Health Services Administration: https://www.samhsa.gov/sites/default/files/mro-guidance-manual-2024.pdf
5.MDMA (Ecstasy) Abuse . (2017, Sep). Retrieved from National Institute of Health: https://nida.nih.gov/sites/default/files/1763-mdma-ecstasy-abuse.pdf
