Ecstasy Heath and Safety
If you choose to use, use as safely as possible
What is Ecstasy?
Ecstasy (also known as E, X) is the common name for a chemical compound called Methylene-dioxy-methamphetamine, or MDMA for short. In its pure form, it is a while crystalline powder. It is usually seen in capsule form on in pressed pills of various sizes, shapes and colours. Pressed pills are usually stamped with a logo, such as a dove or a crown. The average cost ranges from $10-$30 a dose. Currently MDMA is on a the US list of Schedule I controlled substances and it illegal to manufacture, possess or distribute. Virtually all Ecstasy sold around the world today is manufactured in illicit laboratories.
A Brief History
MDMA was patented in 1913 by the German pharmaceutical company Merck, although it was never marketed. In the 1970s MDMA made its first real appearance when psychologists began using it with their patients as a therapeutic aid. By the mid 1980s hundreds of therapists across the country were legally using MSMA in group therapy sessions, couples counseling, and individual patient sessions.
Around the time the US Drug Enforcement Agency took notice of MDMA, as it began to be used “recreationally” by people outside of traditional therapeutic settings. A three-year court battle ensued between the DEA, who wanted to ban MDMA outright, and a coalition of therapists, who fought to keep it accessible to trained psychologists. In 1985 the DEA won, and MDMA was listed as a schedule I controlled substance. The recreational use of MDMA increased dramatically in the late 1980s, especially among young people involved in the newly emerging rave/dance club culture. Today it is estimated that about a million doses of Ecstasy are consumed each week in the US. (In the first six months of 1999, customs seized 950, 000 doses of Ecstasy coming across the border, which they estimate to be perhaps 5% of the total. This means approximately 80 million doses of Ecstasy are imported into the United States each year.)
Ecstasy stimulates the release of neurotransmitters in the brain called serotonin, which has been associated with the regulation of mood. Sine prescription antidepressant drugs like Prozac and Zoloft work by increasing the availability of serotonin in the brain. They are called Selective Serotonin Reuptake Inhibitors, or SSRIs. The effects of MDMA result primarily from a massive release of serotonin. This temporarily increases the amount of available serotonin in the brain to a degree much greater than that produced by SSRIs.
Some images of serotonin brain cells and the synapse
When you take Ecstasy, the vesicles inside the axons of your serotonin brain cells release massive amounts of serotonin into the space between your brain cells (the synapse). Here the serotonin binds to receptors on the dendrites of other, nearby brain cells, which is the primary cause of Ecstasy’s subjective effects. For a complete explanation of Ecstasy’s pharmacological effect on the brain, which is explains the above drawing and many others in full detail, visit www.harmreduction.org.
- Before you take Ecstasy, your brain has a full amount of serotonin.
- Immediately after you take Ecstasy, your serotonin levels are depleted.
- Over the next few days, your brain starts to replenish its depleted serotonin.
- Within a week your serotonin levels are almost back to normal.
- Somewhere between one and two weeks you should be fully recovered.
In releasing serotonin, Ecstasy also depletes serotonin, and it takes a while for your brain to replenish its stores. During this time you may experience “post-e” depression. Frequent Ecstasy use will increase your chances of experiencing depression related to depleted serotonin levels.
One of the main psychological effects of MDMA is empathogenesis. MDMA belongs to a class of drugs (all serotonin releasing agents) known as empathogenesis. Empathogenesis is defined as a feeling of emotional closeness to others and to one-self, coupled with a lifting of personal communication barriers. People on MDMA report an increased ability to understand and empathize with others. This effect is what made MDMA so popular with psychologists as therapy aid.
Entactogenesis, another effect, is characterized by a generalized feeling that all is right and good with the world. People on MDMA often report feeling “at peace” and describe and generalized “happy” or “lucid” feeling. Most people use MSMA primarily for this effect at parties or raves, and especially when dancing, to brighten their mood and have a good time.
Important Heath and Safety Concerns
(medications that react dangerously with Ecstasy)
- Monoamine Oxidase Inhibitors (MAOIs): MDMA is very dangerous to take if you are also taking an MAOI. An MAOI is a type of prescription antidepressant. You would probably know if you were on one because your doctor most likely would have warned you about a number of other drugs and foods that are dangerous to take while taking an MAOI. If you are unsure whether a drug you are taking is an MAOI, find out before you take Ecstasy. If you are taking an MAOI, you should quit for at least two weeks before you take Ecstasy.
MAOIs like Nardil, Pamate and Marplan should not be confused with selective SSRIs like Prozac and Zoloft. Ecstasy is not known to react dangerously with SSRIs. However, Ecstasy use will likely interfere with the effectiveness of SSRI medications. People who take SSRIs for depression may therefore experience a relapse of symptoms if they use Ecstasy.
- Drugs that interfere with MDMA metabolism: Ritonivar is a protease inhibitor used in the treatment of HIV. It inhibits the function of a liver enzyme, CYP2D6 (pronounced “sip-two-see-six”), that is needed to metabolize or break down MDMA. This means that someone who takes MDMA while on Ritonivar could end up having dangerous levels of MDMA in their bloodstream. At least one person has from this combination.
Other drugs which inhibit CYP2D6 function and in high enough doses could theoretically also lead to dangerously high levels of MDMA in the bloodstream include codeine, and opiate pain-killer, and Dextromethorphan, or DXM, a common ingredient in cough syrup.
Note: Pharmaceutical companies are not required to list MDMA , or any illegal drugs for that matter, on the contraindications lists. If you are taking a newly-released or relatively unknown medication, even your doctor may not know if it is contraindicated with an illegal drug. You may need to research this yourself.
Preexisting Health Conditions
MDMA produces a significant increase in heart-rate and blood pressure. A recent study at the University of California San Francisco, where MDMA was administered to human subjects in a clinical setting, has shown that the MSMA-induced increase in heart-rate is even greater than that of amphetamines. This means that people with heart conditions may be more vulnerable to heart attacks or other heart complications if they take MDMA.
Like many drugs, MDMA stresses the liver. There have been a few cases of MDMA-induced liver damage, although they appear to be idiosyncratic (inherent to an individual’s genetic condition). If you have hepatitis or any other known liver dysfunction, you may be particularly vulnerable to such damage.
There has been at least one known instance of an individual dying after taking a single tablet of Ecstasy without being on any contraindicated medications, nor dehydrating or overheating from physical exertion. An autopsy of this individual showed an abnormally high level of MDMA in his bloodstream, indicating that he may have had a peculiar liver dysfunction making him incapable of metabolizing MDMA. Such a preexisting condition seems to be extraordinarily rare.
Nevertheless, if you have never taken Ecstasy before, and you have already decided you are going to, you may wish to consider undergoing a routine liver analysis beforehand. Incidentally, someone with such a condition would also be vulnerable to a number of other prescription and over-the-counter drugs which are metabolized by the CYP2D6 enzyme.
People with psychiatric disorders of any kind should be particularly careful before taking Ecstasy or any other strong, psychoactive drug. MDMA has been known to cause anxiety in some people, and on rarer occasions seizures or panic attacks. Those people who suffer from seizures, excessive anxiety or recurring panic attacks may be particularly sensitive to MDMA. Regular MDMA use has also been known to cause temporary yet prolonged periods of depression in some people (due mainly to serotonin depletion). If you already suffer from depression, MDMA use may exacerbate your symptoms.
Taking Too Much
What does it mean to “overdose” on Ecstasy?
Most people think of “overdosing” as a life-threatening event. However, it is highly unlikely that you will die from an overdose of Ecstasy. While larger doses of Ecstasy may increase the risk of dehydration, overheating, and serotonin syndrome, most Ecstasy-related deaths have been a result of contraindicated medications, preexisting health conditions, adulterated pills and behaviors such as overexertion and not drinking enough water. In most of the cases where someone has died after taking Ecstasy, they had not taken an abnormally high dose. Accidentally taking too much Ecstasy is therefore not the greatest danger facing Ecstasy users. Nevertheless, taking too much either all at once of during the same evening does carry health risks. Increases your chances of experiencing post-E depression, as well as building up a tolerance. Some researchers also correlate overdoses with the potential for neurotoxic damage.
How Much is Too Much?
A standard dose of MDMA is between 80 and 150 milligrams, depending on one’s body weight. However, you can never really know how many milligrams of MDMA are in a black market Ecstasy tablet. Laboratory testing projects around the world have found that while some pills do contain MDMA within the standard dose range, most pills contain much less. Be aware also that most dealers do not know the number of milligrams of MDMA in the pills they are selling, even if they think they do.
3 Ways to Avoid taking too much E
- Be cautious with new pills. If you are taking a new brand of pill for the first time, start with half a pill and wait an hour to see how strong it is before you take more. You may be used to taking two or more pills at once, but this new brand could be two or three times stronger than the ones you have been taking.
- Avoid the temptation to take more when you come down. Ecstasy is not like other drugs where you can simply take more when the effects start to wear off. While you may regain some of the MDMA effect, you will usually just bring on overdoes symptoms.
- Wait a while between uses. The longer you wait between uses the less tolerance you will build up and the less you will be tempted to take higher doses the next time in order to achieve the same effect. Taking higher doses each time to achieve the same effect eventually stops working.
Dehydration and Overheating
MDMA dehydrates the body. It also inhibits your body’s thermoregulatory ability, meaning its ability to maintain a normal temperature. Therefore, if you are in a hot environment, and particularly if you are physically exerting yourself, your body temperature may become dangerously high. This increases your risk of dying from overheating and/or serotonin syndrome. Although Ecstasy-related deaths are rare, most of them have resulted from a combination of overheating and dehydration and could have been prevented with proper caution.
The greatest danger facing Ecstasy users is “serotonin syndrome” which is the name given to a set of life-threatening symptoms that can arise in people who are taking drugs that affect the serotonin system. When an Ecstasy user experiences these symptoms and is taken to the hospital, medical staff may refer to it as an “Ecstasy overdose”. However, this is not quite accurate. Serotonin syndrome can occur in people who have taken normal or even low doses of MDMA, and depends more on factors such as physical exertion, dehydration, temperature and contraindicated medications, rather than the amount of MDMA consumed. It is possible, of course, to take a lethally high dose of MDMA. What amount would be lethal by itself? This is hard to say. In laboratory monkeys, the dose level at which one-half the animals died was 22mg per kilogram of body weight. No human has been known to take such a high dose of MDMA.
Five Tips to Avoid Dehydration/Overheati
- Drink water. It is very important to stay hydrated while on The number of Ecstasy-related deaths world-wide has been estimated at around 100, which is very small compared to most other recreational drugs, including and especially nicotine and alcohol.. Most people get thirsty, but even if you don’t, you should drink enough water.
- Don’t drink too much water. A few people have died on E from drinking too much water, perhaps because they thought water would make them come down. Unfortunately, water does not counteract the subjective effects of MDMA. Water only counters dehydration. One pint per house is plenty.
- Take breaks for dancing. It is easy to dance for long periods of time while on E. Even if you have lots of energy and are feeling great, you should take breaks regularly, sit down and relax a while.
- Stay cool and avoid very hot environments. Indoor clubs packed full of people can often get very hot. If you are feeling uncomfortably hot, go outside and get some fresh air. Be careful of hot summer days as well. If you plan to do E outdoors, make sure there is some shaded areas where you are going. Also, stay out of hot tubs while you are on E.
- Avoid mixing alcohol with E. Alcohol dehydrates your body as well, adding to the risk. It also lessons your ability to detect the warning signals your body may be giving you.
Is Serotonin Syndrome Different from over-heating?
Yes and no. Thermo-deregulation is one of the effects of MDMA-induced serotonin release. Serotonin syndrome and overheating on MDMA are therefore inter-related, resulting from a combination of pharmacology, environment and behavior.
Symptoms of serotonin syndrome include high body temperature, muscle spasms, cramping, faintness, and feelings of panic. If you being to feel any of these symptoms sit down, relax, take a few deep breaths and drink some water or juice. In the unlikely event that someone becomes unconscious or starts having seizures, get them to a hospital immediately.
Note: The number of Ecstasy-related deaths world-wide has been estimated at around 100, which is very small compared to most other recreational drugs, including and especially nicotine and alcohol.
Promoters and Club Owners: Adopt policies that put safety first!
- Avoid venues that do not have running water or cool spaces to chill out.
- Provide free bottled water to your patrons (add a dollar to the cover charge if necessary rather than selling bottled water inside)
- If there’s no outdoor patio, use hand stamps so patrons can leave the club for fresh air and still get back inside without having to pay again.
- Provide health and safety information at your events. Find out if there’s groups in your local area who do harm reduction work.
- In general, take a harm reduction approach. Remember, people are going to use drugs at your events, regardless of how much you discourage it. Encourage police and city officials to cooperate with harm reduction strategies as well.
Ecstasy releases serotonin that is stored in your brain. This is the primary cause of its emphatic effects and the reason so many people enjoy using it. At the same time, MDMA also depletes serotonin. This is because when serotonin is released, it gets broken down or metabolized away. Your brain is therefore left with less serotonin than it had before, and it takes a good bit of time for it to replenish its supply. Animal studies suggest that under normal circumstances it takes somewhere between one and two weeks for your serotonin levels to return to normal, although this depends on many factors such as diet, frequency of use, dose level, other drugs used, etc. During this time you may experience symptoms of depression related to lower serotonin levels, especially if you use MDMA frequently. Many regular, weekend Ecstasy users report experiencing such “post-E depression.”
There is also some evidence suggesting that post-E depression may be related not only to short-term serotonin depletion, but also to “serotonin receptor downgrading” in the brain. While not permanent, this may cause longer, more prolonged periods of depression, which are sometimes reported by frequent Ecstasy users. It has also been suggested that post-E depression may be related to neurotoxic damage. See the section on neurotoxicity for more information.
Four Ways to Lessen Ecstasy-Related Depression
- Moderation. There are biochemical reasons why frequent MDMA use increases the likelihood of experiencing post-E depression. Using less frequently can help prevent it.
- Eat well. Your body produces serotonin by combining together various amino acids found in proteins. Maintaining a well balanced diet that includes enough complete proteins and the proper vitamins and minerals will help you stay healthy and rebound more easily from serotonin depletion.
- Sleep. Many of your brain’s restorative processes take pace while you sleep. Not getting enough sleep may significantly lengthen the time it takes for your brain to replenish its serotonin.
- Use lower doses and avoid “booster” doses, or taking more when you come down. Remember, when you come down from MDMA you have already depleted much of your serotonin. Depleting it even more will likely lengthen the time it takes for it to be replenished.
Note: Following the above tips in no way guarantees protection from Ecstasy-related depression. MDMA is a powerful serotonin-depleting drug, and repeated use will always carry this health risk.
Why do some people never get post-E depression?
Everyone’s brain is unique, and people’s serotonin systems are all different. It seems that some people are simply more sensitive to MDMA than others.
Should I seek medical treatment if I get post-E depression?
It is always a good idea to see a psychiatrist if you are experiencing an abnormally prolonged period of depression, regardless of its cause. There are very successful treatments for depression.
Can I take 5-HTP to avoid Ecstasy-Related Depression?
Many Ecstasy users claim that the amino-acid supplement, 5-Hydroxy-Tryptophan (5-htp), help lessen post-E depression. 5-htp is the direct pre-curser to serotonin in your body. Your body produces it on its own in the process of creating serotonin. It is not a drug, but an amino-acid and is currently sold in most health food stores as an herbal supplement (extracted from Griffonia seeds). Clinical studies of 5-htp have demonstrated that it does, indeed, relieve symptoms of serotonin-related depression in many people. It does this by increasing the amount of 5-htp in the brain, thus making it easier for the brain to make serotonin. All this indicated that the supplementing with 5-htp may lesson post-E depression by helping your body restore its serotonin levels more quickly.
Caution: 5-htp supplementation may make you feel normal again more quickly after taking Ecstasy, and this may tempt you to take Ecstasy again sooner than you would have otherwise. The beneficial effects of 5-htp (restoring serotonin) could then be off-set because you are depleting your serotonin more frequently. 5-htp, therefore, is not a substitute for moderation. If you find yourself taking 5-htp in order to enjoy Ecstasy more often than you would otherwise, consider slowing down. Remember the more frequently you use Ecstasy, the greater your chances of experiencing post-E depression.
One more thing: 5-htp works by helping your brain restore itself to a normal state. It is not a drug and does not simply “mask” or cover-up the after-effects of Ecstasy use. Taking other drugs (like downers or speed) in order to mask the symptoms of post-E depression, or the negative effects of the comedown experience, can easily lead to unwanted patterns of regular drug use as well as physical dependency on these other drugs.
Avoiding Fake and Adulterated Pills
Recently organizations in Europe, England and the United States have been analyzing pills sold as Ecstasy and have found them to contain many substances besides MDMA. Some pills are complete fakes, containing aspirin and other inactive substances. A few have contained potentially dangerous substances like Atropine and dog working medication, although these are extremely rare. Most of the “fake” Ecstasy pills, however, contain other active drugs. The most common are MDA, MDEA, Ketamine, amphetamine, Methamphetamine, caffeine and ephedrine. Many pills, as well, are combinations of these drugs, and most users have no idea what they are actually taking. Each of these drugs has different effects on the user, both psychologically and pharmacologically.
MDA and MDE are analogues to MDMA. They are also “empathogens”, which release serotonin. MDA, however, lasts about twice as long as MDMA and is slightly psychedelic. MD is shorter in duration and usually produces an extremely “stoned” feeling, which is partially responsible for the false rumors that MDMA is cut with heroin. Ketamine is a dissociative anesthetic similar to nitrous oxide, and can produce a very stoned, “dreamy” state.
Asking the Right Questions
Determining what is in a particular pill before it is consumed can be difficult. The easiest and best method is to purchase from someone you know and trust, and as other who have taken pills of the same description what it made them feel like. Good questions to ask include: How long did it last? Was it speedy? Does it cause hallucinations? By comparing the answers to what you know about carious drugs, you can get a better idea of what’s in a particular pill.
Ecstasy Testing Kits
Another way to determine what substance is in a pill is to use an Ecstasy testing kit. These kits utilize a chemical called “Marquis reagent,” which changes colour in the presence of drugs with amphetamine-like molecular structures. Putting a single drop of reagent onto a tiny scraping of the Ecstasy pill and watching the colour change can help you avoid some fake pills as well as identify the pills that contain speed. For more information on these kits and where to get one visit www.harmreduction.net.
Laboratory Pill Analysis Project
The website mentioned above (www.harmreduction.net) also posts laboratory test results of current Ecstasy tablets, listing the actual ingredients along with a photograph of each pill. You can also send in one of your pills to this program, anonymously, and have it tested. The results will be posted to the website. This is the only way to know for sure what’s in a particular pill. (Incidentally, the laboratory that performs the tests has a DEA license and is legally allowed to receive and analyze anonymously-sent controlled substances. The program is totally above ground and legal.)
WOW! Too bad this doesn’t exist anymore!
Very often a particular brand of Ecstasy will get a good reputation and then “copy-cats” or “look-a-likes” will appear on the market which resemble the good pill but contain a different drug or drug combination. It is therefore a good idea to inspect each pill carefully, in the light, noticing the exact size, shape and colour. This will help you determine the authenticity of future pills. Some regular users even keep a written log of pills they have taken with a detailed description of the pill and its effects. When inspecting a pill it is also a good idea, if you can get a hold of a set of calipers, to measure its height and width, for it is very difficult for copy-cat manufacturers to match the exact size of a known brand. Also, talk to other users about their experiences with various brands of Ecstasy. Everyone is in the same boat when it comes to avoiding fake and potentially dangerous pills, and most users are more than willing to help each other out.
What we Know so Far
There is solid experimental evidence that MDMA, administered in large or repeated doses, causes the partial degeneration of serotonin nerve receptors in laboratory animals. Studies have shown that some if these receptors grow back over time, some grow back differently and other never grow back.
What does this mean for human users? Scientists do not know whether MDMA affects humans in the same way as laboratory animals, or if it does, what amount or frequency of use would be necessary to produce a neurotoxic effect. So far there have been so studies on human MDMA users that have revealed any negative psychological or behavioral irregularities. Nevertheless, some caution may be prudent. In light of these animal studies, the notion of some kind of neurotoxic effect in humans, especially with larger or more frequent doses, cannot be rules out entirely.
Can Prozac Prevent the Damage?
If you are especially concerned about MDMA’s neurotoxicity, recent studies have shown that the administration of fluoxetine (Prozac) within six hours of MDMA completely prevents MDMA’s neurotoxic effect in laboratory animals. While this doesn’t mean Prozac is guaranteed to protect humans in the same way, scientific research suggests that users who take a single Prozac when they start coming down from Ecstasy may be preventing damage to their serotonin neurons.
Disclaimer: Nothing you do can make using Ecstasy completely safe. All drug use has inherent risks and dangers. The suggestions in the pamphlet can only help you reduce some of the associated risks.
Other Things to Consider
Safe Sex and MDMA
While on MDMA it may become easier to have unsafe sex. If you think you might have sex while on MDMA, you and your partner may want to lay out safer sex supplies beforehand in a place you’ll be sure to see them, and agree that you’ll use them if the occasion arises.
Does MDMA drain your spinal fluid?
No. This is an urban legend apparently started because some clinical studies are done by giving subjects MDMA, then withdrawing some of their spinal fluid for analysis using a spinal tap. It is MDMA research, not MDMA that may drain your spinal fluid.
Does MDMA cause Parkinson’s disease?
No. MDMA does not cause Parkinson’s disease. This rumor apparently got started because of confusion between MDMA and MPTP. MPTP is a contaminant that can result from the incorrect manufacture of a synthetic opiate, and has caused tragic neural damage to unfortunate recipients of the contaminated black market batch. MPTP bears no chemical relation to MDMA, and has not been associated with MDMA manufacture.
Finding truthful information about Ecstasy and other recreational drugs in order to make informed choices about your own health and safety can be difficult. The following websites are good places to start researching on your own: