Cocaine and MDMA: What to Expect

Mixing cocaine and ecstasy

MDMA, better known by street names such as ecstasy and Molly, has both stimulant and hallucinogenic properties.1 While MDMA was originally synthesized by German chemists as part of their pharmaceutical development efforts, it later became a drug of abuse.2 The United States Drug Enforcement Administration (DEA) classifies it as a Schedule I controlled substance, indicating that it has no currently accepted medical uses and a high potential for abuse.3

Cocaine is a very powerful central nervous system stimulant drug. It is classified as a Schedule II substance by the DEA, indicating that it also has a high potential for abuse.4

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.”5 Mixing MDMA and cocaine can introduce significant health risks to the user. Some of the more significant concerns associated with combining these powerful substances 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.6 Cocaine overdose may also result in a higher body temperature, so combining them may compound this risk.7Hyperthermia 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.6
  • 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. 5,8,9
  • Cardiac changes. Both MDMA and cocaine may produce tachycardia, or increased heart rate.8 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.10 Both MDMA and cocaine users may also experience arrhythmias, or changes to the normal heart rhythm.11,12
  • Increased anxiety and paranoia. Both cocaine and MDMA may result in an onset of anxiety and/or paranoia.12,13 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.14,15 This can lead to an increased potential to engage in risky behaviors that can result in accidents and other serious consequences.16
  • 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.17 Such unpleasant developments can lead to drug-seeking behaviors and other attempts to resolve the “crash” that are inherently dangerous.

More chronic, combined use of these drugs 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.5 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.6
  • 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 substance in tablets sold as MDMA.18 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.19
  • 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.20 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.21 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.22
  • Social issues: Individuals who consistently engage in polysubstance abuse 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.23
  • 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.13,24Adding more substances to the mix adds to the risks and to the long list of possible side effects.

Treatment for Polysubstance Abuse

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Treatment for cocaine and MDMA abuse 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 supervised 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 could consist of some or all of the following:
  • Complementary and alternative treatments (e.g., yoga, music therapy, etc.)


  1. National Institute on Drug Abuse. (n.d.). MDMA (Ecstasy/Molly).
  2. com. (n.d.). MDMA.
  3. United States Drug Enforcement Administration. (n.d.). Drug Scheduling.
  4. S. Food & Drug Administration. (2018). CFR – Code of Federal Regulations Title 21.
  5. Mohamed, Wael & ben hamida, Sami & Cassel, Jean-Christophe & Vasconcelos, Anne & Jones, Byron. (2011). MDMA: Interactions with other psychoactive drugs. Pharmacology, biochemistry, and behavior. 99. 759-74.
  6. National Institute on Drug Abuse. (2018). MDMA (Ecstasy) Abuse.
  7. University of Arizona. (n.d.). Cocaine Overdose.
  8. Egred M, Davis GK. (2005). Cocaine and the heart. Postgraduate Medical Journal, 81, 568-571.
  9. Liesbeth Reneman, Jan B. A. Habraken, Charles B. L. Majoie, Jan Booij and Gerard J. den Heeten. (2000). MDMA (“Ecstasy”) and Its Association with Cerebrovascular Accidents: Preliminary Findings. American Journal of Neuroradiology, 21 6), 1001-1007.
  10. American Heart Association. (2016). Tachycardia: Fast Heart Rate.
  11. Hoffman R. S. (2010). Treatment of patients with cocaine-induced arrhythmias: bringing the bench to the bedsideBritish journal of clinical pharmacology69(5), 448–457.
  12. Johns Hopkins All Children’s Hospital. (n.d.). MDMA (Ecstasy).
  13. National Institute on Drug Abuse. (2018). Cocaine.
  14. Morton W. A. (1999). Cocaine and Psychiatric SymptomsPrimary care companion to the Journal of clinical psychiatry1(4), 109–113.
  15. Bosker, W. M., Kuypers, K. P., Conen, S., Kauert, G. F., Toennes, S. W., Skopp, G., & Ramaekers, J. G. (2012). MDMA (ecstasy) effects on actual driving performance before and after sleep deprivation, as function of dose and concentration in blood and oral fluidPsychopharmacology222(3), 367–376.
  16. P. Hall, J. A. Henry. (2006). Acute toxic effects of ‘Ecstasy’ (MDMA) and related compounds: overview of pathophysiology and clinical managementBJA: British Journal of Anaesthesia, 96(6), 678–685.
  17. Penn State Hershey Milton S. Hershey Medical Center. (2019). Cocaine withdrawal.
  18. Arain, A., & Robaeys, G. (2014). Eligibility of persons who inject drugs for treatment of hepatitis C virus infection.World journal of gastroenterology20(36), 12722–12733.
  19. National Institutes of Health. (n.d.). Cocaine.
  20. Bove, Alfred A., MD, PhD. (2017). Barotrauma. Merck Manual, Consumer Version.
  21. S. National Library of Medicine. (n.d.). Primary spontaneous pneumothorax.
  22. Alvarenga TA, et al. (2010). Single exposure to cocaine or ecstasy induces DNA damage in brain and other organs of mice. Addict Biol, 15(1), 96-9.
  23. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  24. Drug Enforcement Administration. (2013). Benzodiazepines.
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