The long-term health impacts of MDMA are still under investigation, but several studies have found that substances like MDMA have far lower potential to cause harm than legal drugs like alcohol.1

Some researchers suggest that slight brain changes may result from heavy use, such as impacts on memory,2 but the evidence is far from conclusive.3 In fact, MDMA use alone does not appear to cause cognitive differences between people who use it and those who do not.4 Evidence also shows that “[a]dverse effects decrease with… abstinence” (that is, the impacts start reversing themselves once you stop taking the drug).5

The main challenge of determining long-term health effects of MDMA is that people who use it often take other drugs as well, making specific impacts very hard to isolate.6

  1. David J Nutt, Leslie A King, and Lawrence D Phillips, "Drug Harms in the Uk: A Multicriteria Decision Analysis," The Lancet 376, no. 9752 (2010); David Nutt et al., "Development of a rational scale to assess the harm of drugs of potential misuse," The Lancet 369, no. 9566 (2007); van Amsterdam et al., "European rating of drug harms; Lachenmeier and Rehm, "Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach."
  2. See e.g., D. Wagner et al., "A prospective study of learning, memory, and executive function in new MDMA users," Addiction 108, no. 1 (2013): 136-45; T. Schilt et al., "Cognition in novice ecstasy users with minimal exposure to other drugs: A prospective cohort study," Archives of General Psychiatry 64, no. 6 (2007): 728-36.
  3. S. de Sola et al., "Auditory event-related potentials (P3) and cognitive performance in recreational ecstasy polydrug users: evidence from a 12-month longitudinal study," Psychopharmacology (Berl) 200, no. 3 (2008): 425-37; R. Doblin et al., "A reconsideration and response to Parrott AC (2013) "Human psychobiology of MDMA or 'Ecstasy': an overview of 25 years of empirical research"," Hum Psychopharmacol 29, no. 2 (2014). Charles S Grob, "Deconstructing ecstasy: the politics of MDMA research," Addiction Research & Theory 8, no. 6 (2000): 549-88; A. R. Green et al., "Lost in translation: preclinical studies on 3,4-methylenedioxymethamphetamine provide information on mechanisms of action, but do not allow accurate prediction of adverse events in humans," Br J Pharmacol 166, no. 5 (2012).
  4. John H. Halpern et al., "Residual neurocognitive features of long-term ecstasy users with minimal exposure to other drugs," Addiction 106, no. 4 (2011): 777-86. See also, J. H. Halpern et al., "Residual neuropsychological effects of illicit 3,4-methylenedioxymethamphetamine (MDMA) in individuals with minimal exposure to other drugs," Drug Alcohol Depend 75, no. 2 (2004): 135-47. G. Jager et al., "Incidental use of ecstasy: no evidence for harmful effects on cognitive brain function in a prospective fMRI study," Psychopharmacology (Berl) 193, no. 3 (2007): 403-14.
  5. J. E. Fisk et al., "Modelling the adverse effects associated with ecstasy use," Addiction 106, no. 4 (2011): 798-85.
  6. J. E. Fisk et al., "Temporal and visual source memory deficits among ecstasy/polydrug users," Hum Psychopharmacol 29, no. 2 (2014): 172-82; T. J. Watkins et al., "Human ecstasy (MDMA) polydrug users have altered brain activation during semantic processing," Psychopharmacology (Berl) 227, no. 1 (2013): 41-54.