User perceptions of long-term costs and benefits of MDMA use: findings from a large online sample

Previous research has focused on risks associated with non-clinical MDMA use, contrasting short-sighted hedonistic motivations with negative long-term consequences. User perceptions may be more nuanced, incorporating numerous underexplored positive long-term effects. We aimed to: (1) Assess MDMA user perceptions regarding both positive and negative long-term effects, and (2) Generate a large, open dataset with correlates to explore for future research. 886 non-clinical MDMA users completed an online, opt-in survey, with self-reported measures of acute, subacute, and long-term effects, motivations, use context, and polydrug use. User perceptions of MDMA’s long-term effects were far more positive than negative. Respondents endorsed long-term increases in aesthetic appreciation, deeper social connections, and positive changes in life perspectives, among other positive outcomes. A minority of users reported negative effects (e.g. on concentration/memory and mood), which remain important. Long-term effects showed several correlations with acute effects and motivations, with use due to peer influence being repeatedly linked to lower positive and higher negative long-term effects. MDMA users report getting much more than a momentary high from taking the drug. A nuanced appreciation of user perceptions can inform drug safety communication, and advance our understanding of drug effects by highlighting targets for further investigation.