How to Take MDMA

Overview: MDMA, also known as “Ecstasy” or “Molly,” is a synthetic drug belonging to the phenethylamine class, with both stimulant and psychedelic effects, and has been a popular recreational drug since the 1980s. Recently, MDMA-assisted psychotherapy has demonstrated clinical efficacy for post-traumatic stress disorder. MDMA can be ingested in various forms, including crystals, powder, or pills, which can be either snorted or swallowed. MDMA poses several potential dangers and practicing harm reduction when using MDMA is crucial in ensuring a positive and safe experience. By implementing simple harm reduction measures and being mindful of one's environment and dose, users can mitigate potential negative health effects and maximize the benefits of using this powerful drug.

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Understanding MDMA: Effects, Risks, and Harm Reduction

MDMA, also known as “Ecstasy” or “Molly,” was initially synthesized by Dr. Anton Köllisch at Merck for hemostatic purposes, despite false claims suggesting that Merck intended to market it as an appetite suppressant.

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MDMA has been a popular recreational drug since the 1980s. Recently, MDMA-assisted psychotherapy has demonstrated clinical efficacy for post-traumatic stress disorder (PTSD). As a result, this treatment looks set to be approved for the treatment of PTSD by 2024.

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As a member of the phenethylamine class, MDMA has both stimulant and psychedelic-like effects and belongs to a unique subclass of drugs known as “empathogens” or “entactogens” that are known for promoting empathy and feelings of emotional connectedness. MDMA can also produce strong euphoria, energy boosts, a deep sense of love and warmth, and enhanced intimacy and openness with friends and loved ones thus fostering deeper connections. 

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That said, practicing harm reduction when using MDMA is crucial in ensuring a positive and safe experience. By implementing simple harm reduction measures, users can mitigate potential negative health effects and maximize the benefits of using this powerful drug.

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This involves taking necessary precautions to maintain a stable body temperature, staying hydrated, monitoring the dose, and avoiding dangerous combinations with other substances.

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Engaging in harm reduction practices also helps users make informed decisions about their drug use and reduces the risk of harm to both the individual and those around them. By prioritizing safety, individuals can have a fulfilling and enjoyable experience while minimizing the risk of harm.

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How to Take MDMA

MDMA can be ingested in various forms, including crystals, powder, or pills. The powder form of MDMA is merely crushed MDMA crystals, both of which can be either snorted or swallowed. 

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While the exact nature of an individual's experience with MDMA cannot be predicted with certainty, taking steps to create a positive environment can greatly reduce the likelihood of negative experiences. For instance, being in a good mood and a safe, comfortable setting can go a long way toward ensuring a positive and fulfilling experience.

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The crucial role of “set and setting” in shaping an individual's experience is widely recognized, but the dose of the substance is also a crucial factor that is often overlooked. During clinical trials, participants are typically given a dose of 80-150mg of MDMA, followed by a supplemental dose 90-150 minutes later.

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The onset of the effects of MDMA typically begins between 30-60 minutes after consumption. This is followed by a period of 15-30 minutes during which the effects intensify and reach their peak, which can last between 90-150 minutes.

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Importantly, it is not recommended to re-dose if no effects are felt after consuming MDMA, as tolerance levels vary, and there is a possibility of having consumed a different or potentially dangerous substance.

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Risks Associated with MDMA Use

When it comes to recreational drugs, MDMA is considered to be relatively safe. While the drug itself does not typically cause any serious or life-threatening health risks, there are some potential dangers associated with its use that can be prevented through responsible harm reduction practices.

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One of the main risks associated with MDMA is its interference with the body's ability to regulate temperature, which, in combination with prolonged physical exertion and exposure to warm, crowded environments, can lead to overheating (hyperthermia). To reduce the risk of overheating, it is recommended that users take regular breaks from physical activity and ensure they stay adequately hydrated.

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However, it is important to be mindful of not overhydrating, as MDMA can cause water retention and increase the risk of low blood sodium levels (hyponatremia). To avoid this, users should carefully monitor their water intake. 

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Contraindicated Medications and Medical Conditions 

It is strongly recommended not to mix MDMA with any other illicit drugs, as interactions can be unpredictable and potentially hazardous, especially with other unregulated substances. Mixing MDMA with other drugs can lead to unexpected or dangerous effects, as has been observed in some MDMA-related deaths.

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Additionally, drinking alcohol while taking MDMA can result in dehydration and decrease its positively-experienced subjective effects, as MDMA is a stimulant and alcohol is a depressant. It is also important to note that consuming alcohol or other drugs before taking MDMA can impair judgment and increase the risk of overdose.

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MDMA is primarily serotonergic, but it also affects the levels of the neurotransmitters dopamine and norepinephrine (noradrenaline). Therefore, it is advisable to avoid using MDMA if you are taking medication that also interacts with these neurotransmitters, such as selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), or monoamine oxidase inhibitors (MAOIs), which are commonly used for treating depression.

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It is also important to be mindful of other forms of medication or herbal supplements, such as 5-HTP, which could affect serotonin levels. 

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Furthermore, excess levels of norepinephrine cause heart rate and blood pressure to increase, and the release of serotonin causes a constriction of the blood vessels (vasoconstriction). This can pose a serious risk for those with heart or blood pressure problems in particular. 

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The effects of MDMA on blood pressure and heart rate are dose-dependent, so it is important to be mindful of correct dosing to ensure safety. Physical exertion during an MDMA experience can also increase heart rate, so users must be mindful of their activity level.

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Ensuring Safe Consumption of MDMA: Factors to Consider

There are several confounding factors that can contribute to MDMA-related adverse events, including individual sensitivity, pre-existing health conditions, environment and setting, polydrug use, lack of harm reduction practices, and purity and dosage.

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It is important to note that consuming illegal substances, including MDMA, is always associated with risks due to the lack of regulation. This means that the purity and content of the drug can vary greatly, and pills or powders sold as MDMA may contain other dangerous compounds, such as paramethoxyamphetamine (PMA), which can be life-threatening at high doses.

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When considering taking MDMA, safety is a primary concern and can be ensured by properly identifying the substance and accurately determining the dosage.

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Before consuming any form of MDMA, including pills, powder, or crystals, it is recommended to test the substance, for example using a reagent test. These are legal chemicals that offer a simple, color-based way of identifying drugs.

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By dropping a few drops of the reagent chemical onto a small sample of MDMA and comparing the color change to a reference chart, one can determine whether the substance is in fact MDMA. This is a potentially life-saving harm reduction practice.

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Dosage is another crucial factor in ensuring the safe consumption of MDMA. As the substance is active at a milligram level, even small variations in dosage can result in significant differences in subjective effects and safety.

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When consuming powder or crystals, it is essential to measure the dosage using a milligram scale. With pills, the dosage can be more difficult to determine, as there is often no standardization in the amount of MDMA contained within each pill. To minimize the risk, it is recommended to start with a small amount, such as a quarter to a half of a pill, after verifying its contents with a reagent test.

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It is also important to note that taking a higher dosage does not necessarily result in a more positive experience, but may instead increase the risk of negative effects such as overheating, overstimulation, and other unpleasant physical effects.

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MDMA: A Powerful Tool, but Mindful Use is Key

MDMA is commonly used recreationally for its euphoric, prosocial, and energetic effects. It is reported that users feel heightened emotions of love and connectedness, as well as increased confidence and sociability.

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However, it is crucial to practice harm reduction and be mindful of the potential health risks associated with its use, including the risk of overheating and overhydration, as well as potential adverse cardiac effects. Users should be informed about these risks and be educated about the actionable steps they can take to minimize harm and maximize benefit.

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While MDMA has the potential to serve as both a powerful therapeutic aid and a recreational substance, it is important to exercise caution and employ harm reduction practices in its use to minimize potential risks and negative consequences.