Country-by-country guide to MDMA legality: Australia's prescribing program, decriminalization in Portugal and the Czech Republic, and the US executive order.
Nowhere, recreationally. MDMA is a controlled substance in virtually every country. The only place where MDMA-assisted therapy is legal is Australia, and even there it is restricted to specifically authorised psychiatrists treating PTSD. A small number of countries have decriminalized personal possession, meaning reduced penalties rather than legal access to the drug or to therapy.
| Country | Status | Details |
|---|---|---|
| Australia | Legal (therapy) | Since July 1, 2023, authorised psychiatrists can prescribe MDMA for PTSD under the TGA Authorised Prescriber scheme. Available in 6 of 8 states/territories. ~87 patients treated by September 2025. Government funding began in 2025–26. Supplied by Optimi Health. |
| Portugal | Decriminalized | Since 2001, personal possession of all drugs — including MDMA — is an administrative offense, not criminal. Referred to a dissuasion commission rather than courts. Production, trafficking, and sale remain criminal. No therapeutic access. |
| Czech Republic | Decriminalized | Possession of small quantities of MDMA (typically <4 tablets / <2 g) is a misdemeanor, not a criminal offense. Sale, production, and larger quantities are criminal. No therapeutic program. |
| Canada | Compassionate use | MDMA is Schedule I (CDSA). Health Canada’s Special Access Program (SAP) allows case-by-case requests for patients with serious conditions when conventional treatments have failed. 41 MDMA requests were approved in February 2024, but approvals have declined sharply since. Procurement of pharmaceutical-grade MDMA remains difficult. |
| Israel | Compassionate use | Israel approved a compassionate use program for MDMA in 2019, allowing approximately 50 individuals with PTSD to receive MDMA-assisted therapy outside of clinical trials. MDMA remains a controlled substance; the program is limited and not open enrollment. |
| United States | Schedule I | MDMA is federally Schedule I with no approved therapeutic use. The FDA rejected Lykos’ NDA in August 2024. The April 2026 executive order accelerates regulatory review but does not change MDMA's legal status. Access: clinical trials and FDA Expanded Access only. |
| United Kingdom | Class A | MDMA is Class A under the Misuse of Drugs Act 1971 — the highest restriction category. No therapeutic access pathway exists outside of licensed research. Penalties for possession are up to 7 years; for supply, up to life. |
| Netherlands | Prohibited | Despite liberal policies on psilocybin truffles, MDMA sale, possession, and use are prohibited. The Netherlands is a major producer of illicit MDMA but does not permit legal therapeutic or recreational use. |
| Germany | Anlage I (BtMG) | MDMA is classified under Anlage I of the Narcotics Act (Betäubungsmittelgesetz), equivalent to Schedule I. No therapeutic access outside of research. The MIND Foundation conducts MDMA research in Berlin. |
| Switzerland | Compassionate use | MDMA is a controlled substance, but the Federal Office of Public Health can grant exceptional permissions for compassionate use. Several Swiss psychiatrists have used MDMA and LSD in therapeutic settings under these exemptions. Not a general access pathway. |
| Mexico | Partial decrim | Mexico decriminalized personal possession of small amounts of various drugs in 2009 (MDMA threshold: 40 mg, roughly one dose). Amounts over the threshold remain criminal. No MDMA therapy programs exist. |
| Japan | Prohibited | MDMA is strictly prohibited under the Narcotics and Psychotropics Control Act. Harsh penalties for possession (up to 7 years) and supply (up to life). No research or therapeutic exemptions. |
On July 1, 2023, Australia became the first — and still the only — country where MDMA can be legally prescribed for PTSD. The Therapeutic Goods Administration (TGA) rescheduled MDMA from Schedule 9 (Prohibited) to Schedule 8 (Controlled Drug) specifically for use by psychiatrists approved as Authorised Prescribers.
How it works: a psychiatrist must apply to the TGA and receive approval from a human research ethics committee. Once authorised, they can prescribe MDMA capsules — currently supplied by Optimi Health — for PTSD under a structured treatment protocol of up to three dosing sessions with psychotherapy.
By September 2025, 35 Authorised Prescriber applications had been approved (18 for MDMA, 17 for psilocybin), and approximately 87 patients had been treated with MDMA-assisted therapy with no serious adverse events recorded. The program has expanded to six of Australia’s eight states and territories, including regional areas. The Australian government has begun funding treatment where eligible, with enhanced supports funded over four years from 2025–26.
Limitations: this pathway is available only to Australian residents, only for PTSD, and only through approved psychiatrists. It is not available to international medical tourists. Treatment costs are significant, though government subsidies are beginning to reduce the barrier.
On April 18, 2026, President Trump signed the executive order Accelerating Medical Treatments for Serious Mental Illness, the most significant US federal action on psychedelics since the Controlled Substances Act of 1970. The order does not legalize MDMA or change its Schedule I status, but it establishes four mechanisms to accelerate the regulatory pipeline (full breakdown in our dedicated Trump psychedelics executive order explainer):
The executive order improves the future outlook for MDMA but does not help today. MDMA currently lacks Breakthrough Therapy designation (required for the priority voucher) and needs a new Phase 3 trial before any NDA resubmission. Realistically, even under the accelerated framework:
The Right to Try pathway is the most immediately relevant provision for MDMA, as it could allow certain patients to access MDMA before full approval — but this pathway is still being established and details have not been finalized.
The legal access routes as of May 2026 are limited:
Underground MDMA therapy exists in many countries but carries legal risk, no quality assurance, and no medical oversight. The main MDMA guide covers the clinical evidence, safety profile, and what the FDA rejection means in more detail.
Australia is the only country where MDMA can be legally prescribed. Since July 1, 2023, specifically authorised psychiatrists can prescribe MDMA for PTSD under the Therapeutic Goods Administration's Authorised Prescriber scheme. As of late 2025, approximately 87 patients had been treated with MDMA-assisted therapy across six of Australia's eight states and territories, with no serious adverse events recorded. No other country has approved MDMA for therapeutic use.
Portugal decriminalized personal possession of all drugs in 2001 — MDMA included — treating it as a health matter rather than a criminal offense. The Czech Republic treats possession of small quantities of MDMA (typically under 4 tablets) as a misdemeanor, not a criminal offense. Neither country has legalized MDMA or approved it for therapy; decriminalization means reduced penalties for personal possession, not legal access to treatment.
No. MDMA is Schedule I under the Controlled Substances Act. No US state has legalized or decriminalized MDMA. On April 18, 2026, President Trump signed an executive order directing the FDA and DEA to fast-track psychedelic reviews and allocating $50 million for state research programs. The order does not change MDMA's Schedule I status but creates a pathway for faster future review if a new Phase 3 trial succeeds.
Canada allows access to MDMA through the Special Access Program (SAP), where a licensed practitioner can request MDMA for a patient with a serious or life-threatening condition when conventional treatments have failed. However, SAP approvals for psychedelic-assisted therapy have declined sharply since 2024, and procuring pharmaceutical-grade MDMA remains difficult. MDMA is Schedule I in Canada — the SAP is a narrow compassionate use exception, not general legalization.
No. Despite the Netherlands' comparatively liberal drug policies (psilocybin truffles are legal, for example), MDMA sale, possession, and use are prohibited under Dutch law. The Netherlands is a major producer of illicit MDMA but does not permit legal therapeutic or recreational use.
On April 18, 2026, President Trump signed 'Accelerating Medical Treatments for Serious Mental Illness,' which: (1) directs the FDA to issue National Priority Vouchers to psychedelic drugs with Breakthrough Therapy designation, cutting review timelines from 6–12 months to 1–2 months; (2) requires the FDA and DEA to create a Right to Try pathway for investigational psychedelics including MDMA; (3) allocates $50 million through ARPA-H to match state research investments; and (4) directs the Attorney General to initiate rescheduling reviews upon successful Phase 3 completion. The order does not reschedule MDMA or make it legal — it accelerates the regulatory pipeline.
Yes. 'Molly' is a street name for MDMA (3,4-methylenedioxymethamphetamine). MDMA is a Schedule I controlled substance under the federal Controlled Substances Act, meaning it has no currently accepted medical use and carries federal felony penalties for possession or distribution. This applies regardless of the form — pills, capsules, or powder.
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