This week’s briefing highlights emerging trends, recent findings and key developments related to MDMA use and public health implications across the US.

3,4-Methylenedioxymethamphetamine (MDMA), commonly known as Ecstasy or Molly, remains a significant topic in public health, substance use surveillance and policy discussions. While often associated with nightlife and music festival settings, MDMA use extends beyond these environments and continues to evolve alongside changing drug markets.

Recent concerns include the increasing presence of counterfeit products sold as MDMA, the co-use of other substances and the growing risk of adulterants such as fentanyl appearing in the illicit drug supply. At the same time, ongoing research examining MDMA-assisted therapy for mental health conditions has contributed to increased public attention and discussion. 

As always, we welcome your input.

Nationally, 16,335 nonfatal EMS encounters involving suspected nonfatal overdoses with indication of MDMA use were recorded from January 1, 2023 to June 30, 2026. Of these 2,705 occurred in Western states, 2,557 in Midwestern states, 8,955 in Southern states, and 2,118 in Northeastern states. Top counties per region with highest encounter rate per 10,000 population and ≥ 10 encounters are presented below.
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Why are we reporting on this? MDMA continues to generate substantial discussion across online drug communities, with recent discussions highlighting significant public health concerns regarding frequent high-dose consumption, and polydrug combinations. Reddit discussants frequently detail extreme usage patterns, methods to prolong or potentiate sexual and entactogenic effects, and challenges associated with severe comedowns or adulterated supplies. Commenters frequently discuss MDMA in sexual and relationship contexts, focusing on how its unique prosocial effects, such as heightened empathy, forced emotional bonding, and lowered inhibitions, complicate interpersonal dynamics and sexual consent. Multiple discussions highlight ethical concerns regarding whether drug-induced trust and affection can obscure sober boundaries, leading individuals to engage in sexual activity they would not have otherwise chosen.

What is MDMA? MDMA (3,4-methylenedioxymethamphetamine) is an empathogenic and entactogenic stimulant that primarily stimulates the release of serotonin, dopamine, and norepinephrine in the central nervous system. It is commonly consumed in crystalline, powder, or pressed pill forms in social, recreational, or private settings.

Previous NDEWS Web Monitoring Reports:
September 5, 2025 

Public Health Impacts: Reddit discussants report severe adverse effects linked to frequent use and high-dose consumption, including pronounced cognitive impairment, memory loss, emotional dysregulation, and persistent depressive states during comedowns. Multiple discussants detail acute physiological distress such as severe muscle tremors, rapid temperature fluctuations, cardiovascular strain, and prolonged difficulty urinating or ejaculating. Additional public health concerns include risks associated with potential fentanyl contamination in powder substances, neurotoxicity from high-frequency dosing schedules, and situations where individuals engage in non-consensual or compromised sexual encounters while under the influence.

How is it Being Discussed? Reddit discussants frequently evaluate the pharmacological properties of MDMA, noting its balanced release of serotonin and dopamine compared to other stimulants like methamphetamine or mephedrone. A recurring topic involves frequency of use and tolerance, with commenters asking about appropriate spacing between MDMA experiences and describing concerns about repeated consumption. Some discussions focus on individuals reporting difficulty stopping frequent MDMA use, while others describe efforts to understand recovery, after-effects, and long-term impacts on cognition, mood, and emotional functioning. Substantial discussion centers on polydrug practices, including combining MDMA with LSD, 2C-B, amphetamines, or erectile dysfunction medications to extend sessions or alter the nature of the experience. Community members regularly share strategies regarding administration methods, such as oral ingestion, snorting, or rectal administration (boofing), while debating the relative purity and safety of raw crystals versus pressed Ecstasy pills. There is also widespread dialogue surrounding tools such as reagent testing kits, dosage management, and the psychological impact of using MDMA during major life stressors or social events.

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A recently published study in Rand Health Quarterly by Priest et al. presented new data and analysis with survey results on the use of 11 psychedelic substances and detailed information about the prevalence of microdosing for psilocybin, LSD, and MDMA. Key findings from the study included that approximately 10 million US adults microdosed psilocybin, MDMA, or LSD in the past year and that psilocybin, MDMA, Amanita muscaria mushrooms, ketamine, and LSD were the top five psychedelic substances used by US adults. The authors mentioned that further research into amounts consumed in full doses and microdoses of these substances can aid in generating estimates for the total amount of these substances that are consumed nationwide. 

Read the full study here.

A recently published study in the American Journal of Preventative Medicine by Yang et al. reports findings from a nationally representative survey that examines lifetime and current microdosing; frequency of microdosing; and reasons for microdosing cannabis, psilocybin, LSD, and MDMA among US adults. The results from the 1,523 web-based surveys indicated that cannabis was the most commonly microdosed substance, followed by psilocybin, LSD, and MDMA. The authors noted that despite cannabis, psilocybin, LSD, and MDMA remaining illegal at the federal level, a considerable number of US adults reported having microdosed these substances in their lifetime. 

Read the full study here.

A recently published case report in the Journal of Forensic Sciences by Byrska et al. analyzed 150 Ecstasy tablets seized in Poland between 2020 and 2021, shaped as “Stormtrooper” heads, to identify their chemical composition.  The analysis detected MDMA, 3,4-methylenedioxyamphetamine (MDA), and for the first time in Polish seizures, a novel phenylethylamine derivative—3,4-methylenedioxy-N,N-dimethylamphetamine (MDDM). MDDM has limited pharmacological data and reportedly mild psychoactive effects. Its presence is likely linked to impurities or by-products formed during illicit MDMA synthesis. The findings underscore public health concerns about the unpredictable composition of street drugs, highlighting the need for ongoing forensic monitoring and greater awareness of evolving synthetic drug markets.

Read the full case report here.

The recently published European Drug Report 2026 by the European Union Drugs Agency included reports that MDMA (ecstasy) remains the second most commonly used illicit stimulant in Europe after cocaine. The report suggests that annual consumption is relatively stable overall, although signals from wastewater monitoring suggest MDMA consumption may be declining.

Read the full report here.
Read about the methods and references here.

As gabapentin prescribing has doubled over the past decade, its nonmedical use has risen in parallel, primarily in people with opioid use disorder. Yet the assumptions driving both clinical practice and scheduling policy have largely outpaced the evidence. This webinar presents data from multiple studies spanning national surveillance surveys, Medicaid claims, urine drug testing data, and clinical interviews that together reframe the gabapentin problem and moves us forward toward understanding the role of gabapentin as friend or foe in the ongoing opioid crisis.

📅 Date: Thursday, July 30, 2026

🕑 Time: 1:00 pm - 2:00 pm ET

📍 Location: Virtual via Zoom

Register here.

Are you committed to advancing the science of substance use and public health? The University of Florida’s NIDA-funded T32 Training Program offers predoctoral and postdoctoral scholars an exceptional opportunity to launch impactful research careers focused on NDEWS!

What We Offer:
- Interdisciplinary training at the intersection of addiction science, epidemiology, and surveillance
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- Hands-on research with landmark and important NIH-funded projects and access to rich data
- Career development support, including grant writing, publishing, and professional networking
- A collaborative, inclusive research community committed to reducing the burden of substance use

Eligibility:
- US citizens or permanent residents
- Interested in a PhD in Epidemiology, or early-stage postdoctoral fellows
- Demonstrated interest in substance use, addiction, or public health research

Location: Gainesville, Florida — a dynamic hub for scientific innovation with high quality of life and low cost of living.

The NDEWS Weekly Briefing curates emerging data and findings from across the Early Warning Network, which includes three core components: our Scientific Advisory Group (SAG), comprised of national experts and federal partners; our Sentinel Site Directors (SSDs), who lead local surveillance in key geographic regions; and our Community-Based Health Experts, who provide on-the-ground insights from populations most impacted by drug trends. Together, these contributors generate timely, multidisciplinary and impactful information, ranging from peer-reviewed research findings to local surveillance data. These contributions inform public health and research communities.

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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:

     • NDEWS Hotspot Alerts using substance-related EMS data
     • NDEWS Rapid Street Reporting (RSR) survey data reports
     • NDEWS Web Monitoring Team Reddit Alerts
     • NDEWS Sentinel Site Reports
     • Previous issues of the NDEWS Weekly Briefings

The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), NYU Langone Health (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.