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Bars of MDMA Ecstasy Pills were first made in 1912. It was used to improve psychotherapy beginning in the 1970s and became popular as a street drug in the 1980s. MDMA is commonly associated with dance parties, raves, and electronic dance music. It is often sold mixed with other substances such as ephedrine, amphetamine, and methamphetamine. In 2016, about 21 million people between the ages of 15 and 64 used ecstasy (0.3% of the world population). This was broadly similar to the percentage of people who use cocaine or amphetamines but fewer than for cannabis or opioids. In the United States, as of 2017, about 7% of people have used MDMA at some point in their life, and 0.9% have used it in the last year.

Ecstasy developed a reputation for being cut with a lot of harsher and more addictive chemicals, so when Molly came on the scene later, the powder was allegedly purer than the pill. Molly is ingested orally, like ecstasy, but rather than binding it into a pressed pill. Molly is put into a gel capsule. Since the pill form of MDMA requires fillers to bind the main ingredient, the implication of powdered Molly is that the drug has not been cut or changed in any way. However, this is rarely the case; a report published in the Wall Street Journal in 2013 found that only 13 percent of drugs suspected to be Molly by law enforcement officials were actually MDMA.