Safer Using – MDMA

About MDMA

MDMA or 3,4-methylenedioxy-N-methylamphetamine is a stimulant drug known for its ability to produce intense feelings of euphoria and empathy.¹ It is structurally related to amphetamines, but it produces very different effects including anxiety reduction and pro-social effects.² MDMA is commonly called “ecstasy”, “molly”, “E”, “M” and the experience is often called “rolling”.¹

MDMA was first synthesised by Merck in 1912 but it was rediscovered in the mid-1970s when Alexander Shulgin and David Nichols first reported its unique psychoactive effects in humans.² MDMA became a popular party drug in the 1980s and was banned in the US in 1985.² As of 1 July 2023, psychiatrists can legally prescribe MDMA for the treatment of post-traumatic stress disorder in Australia.³ This is following research by MAPS demonstrating that MDMA has a significantly positive effect for people with PTSD in combination with psychotherapy.² This may be due to its ability to increase feelings of compassion, make unpleasant memories less disturbing and enhance communication and introspection.² MDMA is also undergoing research for the treatment of anxiety and eating disorders.⁴

MDMA is commonly sold illegally as crystals or powder in a gelatine capsule (commonly called “caps”) or as a pressed pill.¹^,5 This makes it easy for dealers to adulterate or for dealers to sell entirely different drugs as “ecstasy”.¹^,5 It is also more difficult for users to accurately gauge the dose when MDMA is in a pressed pill. Hence, it is especially important to test MDMA before taking it either by using reagent test kits at home (e.g., https://dancesafe.org/product/mdma-testing-kit/) or by taking it to a drug checking site (e.g., https://www.cahma.org.au/services/cantest/).

MDMA Effects

The effects of MDMA can vary from person to person, but the commonly reported effects include:¹^,5

Elevated mood, euphoria.
Increased energy (stimulation).
Decreased fear and anxiety.
Feelings of comfort and closeness to others.
Feelings of love and empathy.
Increased awareness of senses.
Profound and spiritual experiences.
Decreased pain.
Decreased appetite.
Visual distortions.
Involuntary eye jiggling (nystagmus).
Increased heart rate and blood pressure.
Restlessness, nervousness.
Decreased ability to regulate body temperature (often resulting in increased body temperature).
Mood swings.
Compulsion to take more when coming down.
Jaw clenching, chewing and teeth grinding.
Muscle tension.
Insomnia.
Erectile dysfunction and difficulty reaching orgasm.
Memory problems.
Nausea and vomiting.
Headaches and dizziness.
Pupil dilation.

The effects of MDMA can last between 3 and 6 hours in total, with a come up typically lasting 30-60 minutes.² People often report an unpleasurable comedown as the effects of MDMA wear off.¹ This can include feelings of sadness, a sense of loss and an urge to repeat the experience.¹ It is common to feel extremely drained the day after taking MDMA and people can feel slightly depressed, typically beginning on the second day following MDMA.¹ This can last for up to 5 days afterwards (or weeks depending on the dosage and the frequency of use).¹

It is important to be mindful of body temperature, hydration, and electrolytes while on MDMA.¹ Since MDMA suppresses your appetite, eating before the experience can help to supply electrolytes and micronutrients. Staying hydrated throughout the experience is important but be careful not to drink too much water.¹^,⁵

While many of the effects of MDMA are considered very positive and pleasurable, the openness, confidence, and pro-social effects experienced on MDMA can lead to unintended consequences. For example, people can experience unintended emotional bonding and a tendency to say things you might feel uncomfortable about later.¹

Taking MDMA alongside SSRIs (e.g., escitalopram and fluoxetine) appears to block most of the effects of MDMA.¹^,⁶

MDMA Dosing

It is always recommended to start at a low dose and wait before redosing recreational drugs (start low and go slow). Remember that redosing will have more potent effects than the first dose which is known as a stacking effect.

The common dosages for MDMA are as follows:⁷

LOW DOSE – 40-75 mg

COMMON DOSE – 75-125 mg

STRONG DOSE – 125-175 mg

HEAVY, POSSIBLE OVERDOSE – 175+ mg

MDMA can increase heart rate and blood pressure, which increases with dose.¹ Hence, there are serious risks associated with taking MDMA if you have certain health conditions such as heart, liver or kidney issues, high blood pressure, and a history of stroke or heart attack.¹ Additionally, the other unpleasant effects of MDMA appear to increase with dose (especially doses higher than 175 mg), such as teeth grinding, increased body temperature, vibrating vision (nystagmus) and memory problems.⁵

MDMA Overdose, Serotonin Syndrome and Neurotoxicity

Some of the complications associated with MDMA overdose include:^1,5^,⁸

Abnormal heart rate and rhythm.
Hyperthermia.
Seizures.
Muscle breakdown.
Serotonin syndrome.

MDMA may also increase the risk of overhydration leading to water poisoning.^1,5 This is because it can cause excessive thirst and difficulty urinating leading to electrolyte imbalances.⁵

MDMA causes an increase in the concentration of multiple neurotransmitters in the brain, such as serotonin, norepinephrine and dopamine, but many of its subjective effects are caused by the release of massive amounts of serotonin.^2,⁹ Serotonin syndrome is a potentially life-threatening condition resulting from too much serotonin in the brain, which can be triggered by high doses of MDMA.¹⁰ Taking MDMA alongside other drugs that increase serotonin greatly increases the risk of serotonin syndrome.¹⁰ This includes monoamine oxidase inhibitors (a type of antidepressant), tramadol, dextromethorphan (DXM) and possibly some supplements (e.g., 5-HTP).¹⁰^,¹¹

The symptoms of serotonin syndrome include:¹⁰

Agitation.
Overactive reflexes.
Dangerously high body temperature.

Tremor.
Rhythmic muscle contractions (clonus).
Sweating.

The neurotoxicity of MDMA is heavily debated.⁶ Very high doses of MDMA have been shown to damage serotonin neurons in monkeys, but the same has not been clearly observed in humans.⁶ Scientists have observed a reduction in serotonin transporters in the brains of people who have recently used MDMA lasting at least several weeks, possibly indicating damage to serotonin neurons.⁶^,¹² A reduction in serotonin transmission in the brain may explain the depressed mood people experience following MDMA use.⁶ The effect is likely not permanent as serotonin transporters appeared normal in people who hadn’t used MDMA for at least 20 weeks.⁶^,¹²

A major risk factor for neurotoxicity is overheating, so avoiding hot environments and avoiding mixing MDMA with other stimulants may lower the risk of neurotoxicity.^1,⁶ The possibility of neurotoxicity also appears to increase with dose and the frequency of use.^1,⁶ So, it is important to space out MDMA use, ideally avoiding using MDMA more than once every few months.^1,⁶