Like with any popular recreational drug, there's no reason MDMA should be killing people.
Nearly every death comes from improper dosing, a bad environment, bad combinations, or other
factors.
Once you're just looking at MDMA's safety, it's not a very concerning substance.
Because of prohibition and a lack of education, however, it's pretty easy for people to make
mistakes.
So in this video I want to run through a few key safety tips that'll prevent toxicity and
death in most cases.
And throughout the video, please keep this general principle in mind.
If you take a common dose sitting around someone's house in a temperate environment, there's
almost no chance of harm.
Therefore, when toxicity is seen, MDMA itself isn't really to blame.
Before we can even talk about safe usage, you need to have MDMA.
This is a prohibited market, so tons of people are using ecstasy or Molly, but they're not
taking MDMA.
Instead, they're often being exposed to substituted cathinones or other stimulants.
Those may work on the same neurotransmitters, but they have different safety and effect
profiles.
You might not die because of accidentally taking a random cathinone, but it's still
a lot riskier than knowing what you're using.
Even worse, there are some drugs occasionally sold as MDMA that can easily be lethal, like
PMA and PMMA.
Just a couple doses could kill you and even at sub-lethal doses, neither substance is
pleasant.
So please, if you're trying to use MDMA, use a reagent test kit.
If you can afford MDMA, there's no reason not to also have reagent liquids on hand.
You can easily order them from companies like DanceSafe and Reagent Tests UK.
All you have to do is apply a drop of a testing liquid to your drug sample and observe the
color change.
You'll either add the liquid directly to a powder or crystal sample, or you'll scrape
off some powder from a tablet.
The most common test for MDMA is the Marquis reagent.
In this case you'll usually see a flash of purple that quickly become black.
If that's what you get, there's a fairly good chance you have MDMA.
There are other drugs, like MDA and 6-APB, that could give a similar result.
And although this is rare, a positive test could mask the presence of another non-MDMA
drug.
But, overall, this is a fairly good way to make your usage safer.
If you want to be even safer, there are other options.
The best is to send a sample to EcstasyData, Energy Control, or another drug checking organization.
Doing so typically costs money and it'll take some time to receive the results.
But when you get those results, they'll be drastically more reliable than a reagent test.
These services use an advanced analytical technique called GC-MS.
Unlike with reagent liquids, GC-MS can tell you the chemical components of a sample.
Depending on your location, you may also have access to another spectroscopy tool.
Organizations like The Loop, which functions in the UK, bring analytical tools to events
in order to test drug samples.
So if you're attending an event where those tools are available, I recommend utilizing
them.
And for everyone else, reagents are basically the way to go.
Once you're pretty confident you have MDMA, using the right dose is vital.
There's no reason for almost anyone to take more than 200 mg over the course of a night.
That includes your initial dose and redoses.
If you're using more, you're probably using too much.
Unfortunately, there are some drug using cultures in certain locations that think 2, 3, or 400
mg is a reasonable dose.
This is absolutely false.
You don't need nearly that much to receive MDMA's pleasurable effects and using that
amount raises the chance of harm and the chance of a harsher comedown.
Tablets somewhat complicate this issue, because there's no good way to know how much they
contain.
While they've historically had 75 to 150 mg, they'll sometimes contain 200 and even 300
mg.
High-dose tablets have become a bigger issue in recent years.
Because you're not going to know your dose when taking these products, you need to treat
your tablet as though it may be particularly strong.
As such, start your evening with half and, based on how you feel, decide if you want
the other half 90 to 120 minutes later.
Even though this is sometimes going to result in someone underdosing, it's much better than
overdosing.
And it's definitely better than taking multiple tablets like a lot of people do.
Remember, if you have a high-dose tablet, using just 2 or 3 could expose you to 300
to 500 mg of MDMA or more.
That's when serious health risks become a greater concern and you're also not going
to feel as good when the drug wears off.
You're better off using powder or crystals since you can weigh those with a milligram
scale.
With a scale like the GeminiPro-20, you'll want to weigh out a dose based on a simple
equation.
Take your weight in kilograms and add 50 milligrams.
If you weigh 70 kilograms, your dose will be 120 milligrams.
The safest way to take MDMA is to only take that single dose.
But I get that a lot of people insist on redosing since it can potentially extend the duration.
If you are absolutely insistent on redosing, take half your initial dose around 2 hours
later.
One of the main acute concerns with MDMA is hyperthermia.
Even if you're just sitting around doing very little, your body temperature can increase,
but your heath isn't at-risk.
Whereas if you take a large dose, are dancing for hours, and you're in a really hot environment,
you could surpass 102 or 104 degrees Fahrenheit, or 40 degrees Celsius.
This is why I strongly believe it's not a great idea to use the drug in a hot environment,
like at many clubs or outdoor festivals.
Using MDMA in the middle of the summer in Las Vegas is a pretty good way to exacerbate
whatever harm potential there is.
Yet I understand it's not reasonable to expect people to avoid those settings.
If you're going to use in a less-than-ideal environment, it's good to take breaks.
Just stepping away from the crowd and relaxing for 10 minutes every hour or so can be somewhat
protective.
And above all else, you should definitely stick to a common dose in these situations.
It's also good to make sure you're drinking enough, though this comes with a caveat.
The next acute harm to watch out for is hyponatremia.
Hyponatermia involves a significant dilution of your blood's sodium level.
This happens for a few reasons.
One, people drink a ton of water thinking it'll reduce hyperthermia or otherwise make
MDMA safer.
This is a really bad idea.
Second, the drug's inherent endocrine effects, specifically on the hormone Vasopressin, can
raise the chance of hyponatremia.
And third, people are drinking a lot of water in the absence of sodium intake.
Hyponatremia can present with symptoms like headache, nausea, muscle cramps, and mental
status changes.
If you push it too far, you could encounter cerebral edema, seizures, and brain herniation.
In other words, it's really something you want to avoid.
Sodium dilution can occur even with a typical dose and a fair bit of water, but it usually
won't be dangerous unless you're excessively drinking water.
Therefore, stick to a max of 500 mL per hour of activity.
Even better than using a hypotonic fluid, like water, is using isotonic fluids, like
sports drinks.
These contain some sodium and alternatively, you can take a sodium supplement alongside
regular water, aiming for 200 to 300 mg per 500 mL.
It's worth noting females may be at a greater risk for hormonal reasons, making these tips
even more important.
MDMA reliably increases your heart rate and blood pressure, but like with the temperature
increases, it's not a big deal if you're using it safely.
Once you add intense physical exertion, other stimulants, or high doses to the mix, that's
when cardiovascualr concerns appear.
Because of its stimulant properties, it does raise the risk of myocardial infarction, stroke,
and other issues.
You can nearly eliminate your risk by taking a common dose, avoiding other stimulants,
and not being active for too long.
And of course, if you have a preexisting cardiovascular issue, avoid MDMA.
People often combine other drugs with MDMA.
Sometimes that's fine, but other times it's pretty risky.
There are some combinations that should simply be avoided, including MAOIs, 5-HTP, tramadol,
and other stimulants, including caffeine.
That list isn't exhaustive, but it covers some of the main combinations you should stay
away from.
Those combinations can raise the risk of acute harm and in some cases also raise the risk
of neuronal dysfunction or neurotoxicity, which I'll talk more about soon.
SSRIs are often said to be a bad combination, but this isn't really the case.
They actually function in a way that can pharmacologically oppose MDMA's activity, so they don't exacerbate
each other's harms.
But because they can block MDMA's activity, it's also pretty pointless to combine them.
All in all, if you pay attention to these areas, it's highly unlikely MDMA will be physically
dangerous.
There are just a couple other points I want to touch on before ending the video, those
are frequency of use and neurotoxicity.
Both receive a lot of attention and in the case of neurotoxicity, it's one of the most
popular topics in the media and scientific literature.
By far, the most people frequency recommendation is to wait 3 months between uses.
This is even referred to as the "3-month rule," so you'd almost think there's some science
behind it.
Sadly, there isn't.
Waiting 3 months is as arbitrary as most other frequency recommendations.
To be honest, there's no frequency that's been proven safe in the long-term, so anything
I say is basically a best guess.
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If you're taking MDMA in an ideal way (low dose, good environment) I don't see a reason
why 1 month is especially concerning.
This is based on some anecdotal reports and on MAPS's protocol.
MAPS is studying MDMA in a formal, scientific way to see if it's a good treatment for PTSD
and other conditions.
Their approved protocol involves administering the drug a few times with only 3 to 5 weeks
between sessions.
Of course, that's with a common dose of pure MDMA and it's in a very relaxed setting.
But it demonstrates the core point that the safety of the drug itself is quite different
from the safety of how some people choose to use it.
If you're deciding to use it in a riskier way, perhaps 2 to 3 months makes sense.
It's not based on any real science, but I think the principle of "less is better and
even less is even better" does apply.
The whole point of waiting an extended period between uses is to recover your preexisting
serotonin levels and to avoid an increased risk of neuronal dysfunction.
It doesn't take months for your serotonin to return and we have little reason to think
you're at a higher risk of dysfunction after you've been sober for a month.
So I can't identify a good reason to say 3-months is drastically better than 1-month if you're
using it in a relatively safe way.
This leads directly to the issue of neurotoxicity .
You should watch my neurotoxicity video and read the TDC page since those will go into
far more detail.
Briefly, it appears MDMA does have the potential to cause neuronal dysfunction or toxicity.
This is more likely if you use too often, at high doses, or in really bad environments.
This kind of dysfunction may present with lasting declines in serotonin, cognitive impairment,
and mood disruption.
At the most extreme end, it could hypothetically damage serotonergic neurons for months or
years.
Evidence that reasonable use in humans leads to functional problems is lacking, but the
drug definitely isn't 100% safe.
Exactly how the toxicity or dysfunction occurs isn't clear.
A key part seems to be oxidative stress arising from certain metabolites, including N-methyl-alphamethyldopmaine
and alpha-methyldopamine.
The N-acetylcysteine and glutathione conjugates of those chemicals have neurotoxic or neurotoxic-like
potential.
Raising the ambient temperature can exacerbate the damage, while lowering the temperature
seems to be protective.
This could mean your environment's temperature and your temperature can partly determine
how safe MDMA is.
Hyperthermia might be an issue due to it increasing harm from oxidative stress.
Other potential routes of toxicity include dopamine uptake into serotonergic axon terminals,
tyrosine uptake into terminals, and cellular energy disruption.
Dopamine has long been blamed because its metabolism can also increase oxidative stress.
But it's not entirely clear how big a role dopamine plays.
Regardless of the mechanism, the fact that MDMA could cause lasting disruptions in neuronal
activity is important.
Some people have speculated the most common outcome of this is the phenomenon of "losing
the magic."
This is when someone takes MDMA, often at high doses or too frequently, and eventually
loses much of the drug's activity.
Even more concerning are the potential cognitive and mood outcomes.
They haven't been sufficiently demonstrated in the scientific literature, but that doesn't
mean their impossible.
Because of this issue, using common doses relatively infrequently is quite important.
You might be able to further reduce your risk by adminstering certain substances alongside
MDMA.
Based on animal studies, those protective substances include Alpha-lipoic acid, ALCAR,
Vitamin C, Vitamin E, N-acetylcysteine, sildenafil, cannabinoids, memantine, MK-801, and ginger.
I think if you're interested in some combination of those, it's fair to take Vitamin C, alpha-lipoic
acid, and n-acetylcysteine.
It's not even guaranteed that you need to take substances to avoid harm, but if you
have the money to spend, it's not a bad idea.
There are two other factors that also seem to modulate MDMA's toxic potential.
One in exercise, which seems to be protective.
In general, I'm inclined to believe having good sleep habits, a good diet, and an overall
healthy body will reduce your chance of harm.
And the second is stress.
Chronic stress can be associated with higher glucocorticoid levels and that appears to
make MDMA more dangerous in rats.
In the rat study, the implicated hormone was corticosterone.
For us, this would be cortisol.
The study demonstrated you could raise corticosterone levels by exposing rats to stressful situations.
This would then raise MDMA's harm potential.
Further, when the researchers block glucocorticoid synthesis with a drug called metyrapone (me-teer-a-pon),
stressful situations no longer raised the risk.
This suggests higher stress hormone levels directly mediate an increase in toxicity or
neuronal dysfunction.
There are already countless reasons to lower your stress levels, but this may be another.
If you want to learn more about MDMA and MDMA toxicity, check out my videos on the topic
and the relevant TDC pages.
All of those will be linked in the description.
And if you have any questions, feel free to post them in the comments or to contact me
at seth@thedrugclassroom.com
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