Mixing Cocaine & MDMA (Ecstasy)

Polydrug use—the practice of using different drugs concurrently—has many dangers.

This article will discuss the effects and risks of mixing cocaine and ecstasy, as well as options for addiction treatment for a stimulant use disorder.

What is Cocaine?

Cocaine is a very powerful central nervous system stimulant drug that is sometimes used as local anesthesia. Cocaine is commonly sold on the black market in a fine, white powder and is used by snorting it, rubbing it on the gums, or by dissolving it in liquid and injecting it intravenously.¹

The crystal form of cocaine—known as crack—is smoked for an intense but short-lived high.¹

Cocaine is classified as a Schedule II substance by the DEA, indicating that it has a high potential for misuse.²

What is MDMA?

3,4-methylenedioxy-methamphetamine (MDMA), better known by street names such as ecstasy and Molly, has both stimulant and hallucinogenic properties.¹

While originally synthesized as a pharmaceutical drug, the United States Drug Enforcement Administration (DEA) classifies ecstasy as a Schedule I controlled substance, indicating that it has no currently accepted medical uses and a high potential for misuse.^2,3

MDMA is a powder or liquid that is usually snorted or swallowed (often as a capsule or tablet).³

Effects of Mixing Cocaine and MDMA

MDMA is sometimes combined with cocaine, the mixture of which has been referred to as “cloud mind” or “bumping up.”⁴ Mixing MDMA and cocaine can introduce significant health risks to the user. Some of the more significant concerns associated with combining molly and cocaine are outlined below.

• Hyperthermia. Taking both of these drugs together may increase the risk of overdose. One of the biggest risks of MDMA use is increased body temperature which may lead to hyperthermia.⁵ Cocaine overdose may also result in a higher body temperature, so combining them may compound this risk.⁶ Hyperthermia may lead to very serious issues, such as muscle fiber breakdown (rhabdomyolysis) and associated kidney injury/failure, as well as significant electrolyte disturbances and subsequent brain swelling.⁵
• Stroke. Both cocaine and MDMA may increase stroke risk. Taking these drugs concurrently may increase this risk. Should such a cerebrovascular event occur, users may abruptly experience neurological symptoms and may lose consciousness. ^4,7,8
• Cardiac changes. Both MDMA and cocaine may produce tachycardia or increased heart rate.⁷ A racing heartbeat may be accompanied by symptoms such as chest pain, shortness of breath, and, in rarer cases, may be associated with cardiac arrest.⁹ Both MDMA and cocaine users may also experience arrhythmias (changes to the normal heart rhythm).^10,11
• Increased anxiety and paranoia. Both cocaine and MDMA may result in an onset of anxiety and/or paranoia.^11,12 Taking both drugs together may result in worsened mental health symptoms like these.
• Significantly impaired judgment: The use of either drug can lead to issues with judgment, and combining the drugs may significantly impair a person’s ability to make good decisions.^13,14 This can lead to an increased potential to engage in risky behaviors that can result in accidents and other serious consequences.¹⁵
• Severe crashes. Both cocaine and MDMA elicit similar crash or comedown symptoms. Users may experience symptoms such as depressed mood, anxiety, and sleep changes. In some cases, the user may experience suicidal thoughts.¹⁶ Such unpleasant developments can lead to drug-seeking behaviors and other attempts to resolve the “crash” that are inherently dangerous.

Long-Term Effects of Mixing Molly & Cocaine

Chronic mixing of ecstasy and cocaine may also result in some significant issues. Some of the long-term consequences of chronically combining cocaine with MDMA include:

• Increased dopaminergic response. Animal studies show that taking cocaine + MDMA may increase the dopaminergic response to both drugs, producing a synergistic effect and leading to a greater feeling of reward from both substances.⁴ This may result in increased drug liking and promote compulsive use.
• Cognitive and psychiatric issues: According to the National Institute on Drug Abuse, regularly combining MDMA with substances like cocaine may result in difficulties with concentration, depression, impulsivity, and impaired cognitive function.⁵
• Liver dysfunction/disease: Both MDMA and cocaine may result in liver injury. MDMA-related liver injury may be related to issues such as increased body temperature or the harmful effects of adulterant substances in tablets sold as MDMA.¹⁷ Cocaine-related liver toxicity may result from the effects of a toxic metabolite of cocaine, by hyperthermia, acute hepatocellular necrosis, or in association with ischemic changes resulting in organ injury.¹⁸
• Barotrauma injuries. Barotrauma refers to injuries resulting from pressure changes that result in the compression or expansion of gas in certain parts of the body.¹⁹ Snorting drugs can produce these pressure changes and result in conditions like pneumothorax, a condition in which air accumulates in the space around the lungs resulting in partial or complete lung collapse.²⁰ Snorting just one drug can increase your risk of experiencing a barotrauma-related injury, and snorting multiple drugs may compound this risk.
• DNA damage. Studies on mice indicated that both cocaine and MDMA may cause DNA damage in blood cells and that both drugs are potent genotoxins.²¹
• Social issues: Individuals who consistently engage in polysubstance use may suffer in their personal relationships, jobs, and other areas of their lives. They may eventually develop a substance use disorder, characterized by an inability to stop using substances despite all of the negative consequences.²²
• Increased risks for other harmful effects: Individuals who combine central nervous system stimulants (or even just use one central nervous system stimulant) often resort to using a central nervous system depressant, such as alcohol or benzos, to ease the adverse effects of the stimulants or to help with the comedown.^12,23 Adding more substances to the mix adds to the risks and the long list of possible side effects.

 People that engage in chronic substance misuse put themselves at a high risk of developing an addiction. Drug addiction—or substance use disorder (SUD)—is the compulsive use of substances despite serious harm caused by this behavior.²⁴

Treatment for Polysubstance Addiction

Treatment for cocaine and MDMA use may have several components:

• Detox: While cocaine and MDMA don’t often have many dangerous physical withdrawal symptoms, the psychological symptoms that come with withdrawal may be disconcerting enough that a medical detox is warranted.  Withdrawal management services may provide supportive care for patients in withdrawal and may give medications to manage certain symptoms.
• Behavioral treatments: The major component of the recovery program includes behavioral interventions that often consist of cognitive-behavioral therapy, family therapy, case management services, skills-building, drug education classes, vocational rehabilitation
• Supplemental and alternative treatments (e.g., yoga, music therapy, etc.)
• Aftercare. This may range from an extended stay in a sober-living facility to simply joining a 12-step peer-support program.

Sunrise House Treatment Center can help you or your loved one recover from addiction. Call to start addiction treatment today. Our admissions navigators can answer questions about our levels of addiction treatment, using insurance to pay for addiction treatment, and other ways to pay for rehab. 

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