You might imagine psilocybin mushrooms (aka magic mushrooms) and LSD as being very similar since they both have a reputation for producing mind-bending psychedelic experiences. But these two drugs have key differences that impact both the people who use them and the researchers who study them.

The same is true for many other drugs that tend to be used under similar circumstances, including MDMA (molly) and cocaine. People tend to use both drugs in party situations. But like mushrooms and LSD, molly and coke have some major differences.

Here’s a closer look at how molly and coke differ when it comes to their effects, risks, and comedown experiences.

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Cocaine and MDMA are both considered stimulants, so they tend to cause similar feelings of energy, euphoria, and alertness (hence their popularity as party drugs).

Both cocaine and MDMA can also cause:

Despite their similar effects, these drugs work differently in the brain, creating two very distinct experiences:

  • MDMA: In addition to being a stimulant, molly is also an entactogen. Entactogens are drugs that can produce feelings of empathy, connectedness, and love. As a result, MDMA tends to be associated with increased emotionality and sexual behavior. Some people also report feeling a slowed or changed awareness of time.
  • Cocaine. Compared to MDMA, cocaine tends to produce more feelings of confidence and self-assurance. People also tend to describe the effects of cocaine as feeling more intense and short-lived than those of MDMA.

Keep in mind that “set and setting” — your mindset and surroundings when using a drug — can have a big influence on your experience with various substances.

If you’re under a lot of stress or feeling pressure from others, you might have a more anxious, frightening, or generally negative experience. Same goes for someone consuming drugs in a disorienting, heavily stimulating, or unfamiliar location.

Just about every drug includes an acute withdrawal period, often called a “comedown,” and cocaine and MDMA are no exception. Both impact the levels of various neurotransmitters — namely serotonin, dopamine, and norepinephrine — in your brain.

But cocaine tends to have a bigger impact on dopamine, while MDMA has a stronger effect on serotonin. This difference provides some clues about the comedown associated with each.

Cocaine works by blocking the reuptake of dopamine, aka the “feel good” neurotransmitter that helps you feel pleasure, among other things.

Cells in your brain produce dopamine and deposit it into the spaces between neurons, called synaptic clefts. Dopamine needs to be in this cleft in order to do its work in the brain — and produce many of the effects associated with cocaine.

Usually, cells around the cleft will take up some of the dopamine, diminishing its effects. Cocaine blocks this process from happening, leaving more dopamine in the cleft.

A similar example can be seen in selective serotonin reuptake inhibitors (SSRIs), a common type of antidepressant. SSRIs keep more serotonin, a neurotransmitter linked to feelings of relaxation and happiness, available in the synaptic cleft where it can exert its effects.

MDMA alsoworks as a serotonin reuptake inhibitor, but with a key difference. SSRIs create a controlled effect by selectively blocking the reuptake of serotonin (hence the name).

MDMA, on the other hand, casts a wide net, blocking this reuptake extensively. That’s why molly can quickly produce feelings of happiness and love, while SSRIs produce more gentle feelings of contentment, with a slower and more controlled onset.

As the drugs wear off, all that excess serotonin and dopamine gets reabsorbed or broken down. It can take a day or two for your brain to rebuild its usual neurotransmitter levels, during which many people report feeling “low” or noticing flu-like symptoms.

Due to their effects on different neurotransmitters, cocaine and MDMA can produce slightly different comedown experiences.

Coming down from MDMA tends to involve:

  • feelings of depression
  • fatigue
  • irritability

Coming down from cocaine can involve:

  • malaise
  • body aches
  • sensitivity to light and sound.

As your brain rebuilds its stock of depleted neurotransmitters, you’ll gradually start to feel better.

Cocaine and MDMA are fairly popular drugs, but that doesn’t mean they don’t carry risks.


As stimulants, both cocaine and MDMA turn the dial up on your body’s metabolism. Your heart rate, blood temperature, body temperature, and breathing are all speed up.

These effects aren’t always inherently dangerous, but they can make some people more likely to experience a seizure, especially if they’ve previously experienced one.

In addition, cocaine impacts the neurotransmitters GABA and glutamate, which can lead to too much glutamate and not enough GABA. This imbalance can increase your risk of having a seizure.

Cardiac issues

Cocaine can contribute to a range of heart problems. It not only impacts your heart’s internal rhythm that keeps it beating, but also tightens the small blood vessels that feed the muscle. If the blood vessels tighten enough to stop the flow of blood, it can cause a heart attack. This risk is greater if you have a history of heart disease or another underlying heart condition.

A note about cocaine and alcohol

Speaking of cocaine’s effects on the heart, it’s best to avoid adding alcohol into the mix. When you consume coke and alcohol together, your liver breaks them down and forms cocaethylene, a substance that seems to have an even greater effect than coke alone on the health of the heart.

In addition, alcohol can blunt the effects of cocaine, leading you to consume more cocaine in order to feel the desired effects. The more cocaine you consume, the higher your risk of negative effects, including a more severe comedown.

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Serotonin syndrome

Because of its effect on serotonin levels, MDMA may cause something called serotonin syndrome — a condition that results from too much serotonin in the body — when mixed with other substances that increase serotonin.

Serotonin syndrome symptoms include:

  • high body temperature
  • disorientation
  • seizure
  • tremors
  • diarrhea
  • sweating

Molly-related serotonin syndrome typically involves antidepressants, including SSRIs, SNRIs, MAOIs, and tricyclic antidepressants.

Taking any of the following with MDMA could theoretically also lead to serotonin syndrome:

  • certain herbs, including St. John’s wort and ginseng
  • triptans, a type of migraine medication
  • over-the-counter medications containing dextromethorphan

While serotonin syndrome isn’t common, it can be life threatening in some cases. So, it’s best to call 911 right away if you notice someone experiencing these symptoms.

Substance use disorders

It’s unclear whether molly use alone can contribute to substance use disorder. But some older research suggests that a small number of people who use molly become concerned about their use and seek treatment.

Cocaine, on the other hand, is thought to carry a higher risk of substance use disorder partly due to its effects on dopamine pathways in the brain.

Learn more about the link between dopamine and substance use disorders.


Aside from the risks posed inherently by coke and molly, it’s important to remember that drugs obtained illegally are often contaminated with unexpected ingredients.

For example, levamisole — a veterinary deworming medication — is often found in cocaine. It can cause your bone marrow to stop making white blood cells called granulocytes, leaving you vulnerable to infections. It might also be behind some of coke’s less desirable effects, like bloating.

Fentanyl and other synthetic drugs are also increasingly showing up in non-opioid drugs, including coke and molly. Even a small amount of fentanyl contamination can greatly increase your risk of experiencing a potentially fatal overdose.

Potential signs of an overdose include:

  • limp body
  • slow or interrupted breathing
  • blue lips or fingernails
  • being unresponsive, even when you rub your knuckles on their sternum

If someone is showing these symptoms, call 911 or your local emergency number right away.

If you plan on using molly or coke, there are a few steps you can take to reduce the risk of overdose:

  • Test your drugs. You can get free and reduced-cost fentanyl test strips from NextDistro or your local syringe service program.
  • Carry naloxone. Naloxone is a medication that can reverse an opioid overdose. You can order it by mail and learn how to use it from NextDistro. Make sure you and those you’re with know when and how to use it.
  • Don’t use alone. Always make sure there’s someone nearby who can step in if things take a turn. You can also use the overdose prevention hotline Never Use Alone, which will stay on the line with you and send help if you become unresponsive.

Cocaine and molly are both stimulants, but they work differently in the brain. This can create two very distinct experiences, but both have the potential to cause serious health issues.

If you’re planning on using either one, remember that community is safety. Make sure everyone around knows how to recognize an overdose and what to do in response.

If you’re concerned about your drug use, there’s help available. If you feel comfortable, you can bring it up to a healthcare professional. Keep in mind that patient confidentiality laws will prevent them from reporting this information to law enforcement.

You can also reach out to one of the following free and confidential resources:

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Claire Zagorski earned a bachelor’s degree at the University of Texas at Austin and a master’s degree at the University of North Texas Health Science Center. She has practiced clinically as a paramedic in multiple treatment settings, including as a member of the Austin Harm Reduction Coalition. She founded Longhorn Stop the Bleed and is committed to supporting healthcare professionals who seek to integrate harm reduction principles in their practice.