Quick Answer: No, taking ecstasy (MDMA or “molly”) while on Suboxone (buprenorphine/naloxone) is not safe. MDMA can cause overheating, dangerous heart and sodium changes, and serotonin syndrome, and pills sold as “molly” are often contaminated with other drugs, including fentanyl. It can also trigger cravings and relapse. If you’ve already taken both, don’t stop your Suboxone, and talk to your prescriber as soon as you can.
Medical emergency: Call 911 if someone who has taken MDMA has a very high body temperature, seizure, severe confusion, chest pain, trouble breathing, or can’t be woken.
Suboxone (buprenorphine/naloxone) is a prescription medication used to treat opioid use disorder. It reduces cravings and withdrawal and lowers the risk of relapse and overdose. Because it’s now more widely available, more people are taking it for longer periods, and many wonder how it fits with other drugs.
If you’re on Suboxone, you probably know opioids are off-limits. It’s natural to wonder whether a non-opioid like ecstasy is a different story. But mixing Suboxone with MDMA carries real risks, from the drug’s own dangers to contaminated supply to a higher chance of relapse. This article explains why, and what to do if you’ve already used.
What is Suboxone and How Does it Work?
Suboxone is a brand-name prescription medication used to treat opioid dependence and addiction. It comes in the form of a sublingual film that dissolves under the tongue and contains two drugs: buprenorphine and naloxone.[1]
Buprenorphine is a partial opioid agonist meaning it binds to opioid receptors and activates them, but to a lesser degree than full opioid agonists do. By binding to and activating opioid receptors, buprenorphine can relieve symptoms of opioid withdrawal.
Naloxone, on the other hand, is an opioid antagonist that is added to Suboxone to deter possible buprenorphine abuse. Naloxone doesn’t do anything unless you inject buprenorphine or take another opioid. When you try to get high by taking an opioid or try injecting your Suboxone, naloxone will prevent you from getting high and may cause withdrawal symptoms.
Suboxone can be used during detox to ease withdrawal, and it is also widely used as a longer-term maintenance treatment to reduce cravings and lower the risk of relapse and overdose. Many people stay on buprenorphine for months or years. Combined with behavioral therapy, counseling, and peer support, it can significantly improve treatment outcomes.
What is Ecstasy (MDMA)?
Ecstasy, also known as MDMA or molly is a synthetic drug composed of 3,4-methylenedioxy-methamphetamine. This substance alters mood and perception. It has both stimulant and hallucinogenic properties, often producing side effects such as increased energy, pleasure, emotional warmth, and a distorted sense of time.[2]
Ecstasy is popular in nightclubs and rave scenes, but it can be used recreationally for a number of purposes. People usually take it as a capsule, but some swallow it in liquid form or snort MDMA powder. Ecstasy is often used in combination with other drugs such as marijuana, alcohol, cocaine, or psilocybin mushrooms.
Ecstasy works by increasing the activity of three neurotransmitters in the brain:
- Dopamine – a chemical that produces energy and acts as a reward system to reinforce certain behaviors.
- Norepinephrine – a stress hormone that increases heart rate and blood pressure.
- Serotonin – a hormone that affects mood, appetite, sleep, and sexual arousal. People who use MDMA often experience emotional closeness and empathy toward others, and this is thought to be caused by excess serotonin.
Other side effects of MDMA may include:
- Muscle cramping
- Teeth clenching
- Blurred vision
- Chills
- Sweating
- Impulsivity
- Irritability
- Anxiety
- Sleep problems
Risks of Taking Ecstasy While on Suboxone
Ecstasy is a mood-and-mind-altering substance, and if you are prescribed Suboxone, it is because you are struggling with addiction and trying to get sober. As a result, it isn’t a good idea to take ecstasy or any other illicit drug while you are on Suboxone.
Possible interactions and risks include:
| Risk | What can happen | Why |
|---|---|---|
| MDMA’s own dangers | Overheating (hyperthermia), dehydration, dangerously low sodium, irregular heartbeat, seizures | These risks exist whether or not you take Suboxone, and they can be fatal |
| Serotonin syndrome | Agitation, confusion, fast heartbeat, high blood pressure, tremor, muscle rigidity, fever, seizures | MDMA releases large amounts of serotonin, and buprenorphine’s label warns about combining it with serotonin-boosting drugs. The risk is considered low, but it is a medical emergency when it happens |
| Contaminated “molly” | Unexpected exposure to fentanyl, methamphetamine, synthetic cathinones, or sedatives | Illicit pills and powders often contain other drugs, and you can’t tell by looking |
| Relapse risk | Cravings, lowered inhibitions, and a return to opioid use | Using any mood-altering drug can weaken recovery routines and trigger cravings |
| Pressure to stop or skip Suboxone | Withdrawal or overdose risk if you stop your medication to use | Stopping buprenorphine suddenly can cause withdrawal and lowers protection against overdose |
Don’t assume Suboxone makes ecstasy safer, or that it blocks it. There’s no reliable evidence that buprenorphine reduces MDMA’s risks, and trying to “get through” a weaker effect by taking more can be dangerous.
If you are considering taking ecstasy while on Suboxone, you should consult with your prescribing physician or an addiction specialist. He or she can help you work through your cravings, adjust your dose of Suboxone, if needed, and modify your treatment plan to better promote sobriety.
Warning Signs: When to Call 911
| Possible serotonin syndrome | Possible MDMA overheating or low sodium |
|---|---|
| Agitation or restlessness | Very high body temperature or feeling extremely hot |
| Confusion | Severe headache |
| Racing heart and high blood pressure | Nausea, vomiting, and confusion |
| Dilated pupils | Seizures |
| Muscle twitching, stiffness, or tremor | Collapse or fainting |
| Heavy sweating, diarrhea | Dark urine or little urination |
| Fever | Swelling or bloating, especially with a lot of water intake |
Call 911 right away if you notice any of these signs, and don’t wait for them to pass. Tell responders everything that was taken, including your Suboxone.
The Hidden Risk: What’s Really in “Molly”
Pills and powders sold as ecstasy or molly often contain other substances, including fentanyl, methamphetamine, synthetic cathinones (“bath salts”), or sedatives. You can’t see, smell, or taste the difference. For someone on Suboxone, this matters in two ways. First, contamination makes any use unpredictable. Second, Suboxone doesn’t make a fentanyl exposure safe, so overdose is still possible. If someone is unresponsive or breathing very slowly, call 911 and give naloxone (Narcan) if you have it. Naloxone is safe to try and is available over the counter at many pharmacies. Fentanyl test strips can detect some contamination but are not foolproof.
If You’ve Already Taken Ecstasy While on Suboxone
- Watch for the emergency signs above and call 911 if any appear.
- Don’t take extra Suboxone or other drugs to “balance” the effects.
- Don’t stop your Suboxone to avoid a conflict. Keep taking it as prescribed unless a clinician tells you otherwise.
- Stay with someone you trust, and don’t use alone.
- Tell your prescriber. A single slip doesn’t erase your progress, and honest information lets them help you adjust your plan. Policies vary by clinic, but most providers would rather know than not.
- Plan for cravings and triggers. A slip is often a signal that your recovery plan needs more support.
If you feel hopeless or are having thoughts of suicide, call or text 988. For free, confidential treatment referrals, call the SAMHSA National Helpline at 1-800-662-4357 (24/7).
Find Help Today
If you’re on Suboxone and using other drugs, or you’re worried about a loved one, support is available without judgment. Your treatment plan can be adjusted, and extra support can help you stay on track.
At Moving Mountains Recovery in Randolph, NJ, we provide Partial Care (PHP), Intensive Outpatient (IOP), and Outpatient (OP) care, plus dual-diagnosis treatment for co-occurring mental health conditions, and we help clients access detox placement when needed. We also support people using medication-assisted treatment as part of their recovery. Learn more about opiate addiction treatment and polydrug abuse treatment. Call (973) 453-0317 or verify your insurance.
Frequently Asked Questions About Ecstasy and Suboxone
Can you take ecstasy (MDMA) while on Suboxone?
No, it isn’t considered safe. MDMA can cause overheating, dangerously low sodium, heart rhythm problems, and serotonin syndrome, and street “molly” is often contaminated with other drugs like fentanyl. Using it can also trigger cravings and relapse. If you’re thinking about it, talk to your prescriber first.
Is it dangerous to mix molly and buprenorphine?
Yes, it can be. MDMA is risky on its own, and combining it with buprenorphine adds uncertainty, including a possible serotonin syndrome risk and exposure to contaminants in street drugs. There’s no reliable evidence that buprenorphine makes MDMA safer, so assume the full risks of MDMA still apply.
Can mixing Suboxone and ecstasy cause serotonin syndrome?
It’s possible. MDMA releases large amounts of serotonin, and buprenorphine’s label warns about serotonin syndrome when combined with serotonergic drugs. The risk is considered low but real. Signs include agitation, confusion, fast heartbeat, tremor, muscle stiffness, sweating, and fever. It’s a medical emergency, so call 911.
Does Suboxone block the effects of ecstasy?
There’s no reliable evidence that it does. Suboxone acts on opioid receptors, while MDMA mainly affects serotonin, dopamine, and norepinephrine. Don’t assume the effects will be weaker, and never take more to compensate. Higher doses and unknown pill contents raise the risk of overheating, seizures, and overdose.
Can fake molly contain fentanyl if I’m on Suboxone?
Yes. Illicit pills and powders sold as molly often contain other substances, including fentanyl, methamphetamine, or synthetic cathinones, and you can’t tell by sight or taste. Suboxone doesn’t make fentanyl exposure safe. Keep naloxone (Narcan) on hand, never use alone, and call 911 for any overdose signs.
What should I do if I took ecstasy while on Suboxone?
Watch for emergency signs such as high body temperature, confusion, seizures, chest pain, or trouble breathing, and call 911 if they appear. Don’t take extra Suboxone or other drugs, and don’t stop your medication. Stay with someone you trust, and tell your prescriber as soon as you can.
Will I get kicked out of treatment if I use ecstasy on Suboxone?
Policies vary by clinic, but a slip doesn’t automatically end treatment, and most providers prefer honesty so they can adjust your plan. Hiding use can make it harder to get the right support. Ask your prescriber how your program handles relapses and what extra help is available.
Where can I get help if I’m on Suboxone and using other drugs?
Talk to your prescriber first, or call the SAMHSA National Helpline at 1-800-662-4357 for free, confidential referrals. Moving Mountains Recovery offers Partial Care, Intensive Outpatient, and Outpatient programs in New Jersey, plus dual-diagnosis care. Call (973) 453-0317. If you’re in crisis, call or text 988.
References:
- U.S. Food and Drug Administration (FDA): Suboxone Highlights of Prescribing Information, Retrieved June 2023 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022410s000lbl.pdf
- National Institute on Drug Abuse (NIDA): MDMA (Ecstasy/Molly) DrugFacts, Retrieved June 2023 from https://nida.nih.gov/publications/drugfacts/mdma-ecstasymolly
- National Library of Medicine: Serotonin Syndrome, Retrieved June 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832/
