Why Microdosing MDMA May Not Be Your Best Bet

Overview: MDMA, also known as “ecstasy” or “Molly,” is a popular recreational drug with stimulant and psychedelic-like effects. While it has been recognized for its prosocial and euphoric effects, its use for microdosing purposes is questionable due to safety concerns. Unlike classic psychedelics, MDMA's pharmacological properties, including its impact on serotonin levels and potential neurotoxic effects, raise significant health concerns. Research on microdosing MDMA is limited, with studies suggesting that low doses may not offer significant benefits. Therefore, it is widely advised against microdosing MDMA due to potential health risks, including serotonin depletion, cardiac complications, and tolerance development. For those still considering experimentation, prioritizing safety measures such as testing samples for purity and starting with low doses is strongly recommended.

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Introduction to MDMA

MDMA, also known as “ecstasy” or “Molly,” is a popular recreational drug with stimulant and psychedelic-like effects. Ecstasy typically refers to MDMA in pill form, while the term Molly often refers to MDMA in crystal/powder form, although they may be used interchangeably. Belonging to a class of drugs known as entactogens, MDMA is recognized for its prosocial and euphoric effects, making it a sought-after substance in recreational settings.

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MDMA was initially synthesized in 1912 by Merck chemist Anton Köllisch. Aside from some animal tests conducted in the 1920s and 1950s, MDMA remained largely overlooked for many years, with human studies not commencing until the 1970s.

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MDMA made its initial appearance as a recreational drug during the 1960s and 1970s before gaining attention within a network of underground therapists. Re-synthesized by Dr. Alexander “Sasha” Shulgin in the mid-70s, MDMA found its way to psychologist Leo Zeff in 1977. Deeply impressed by its therapeutic effects, Zeff delayed retirement to share his insights about MDMA's potential among fellow therapists.

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MDMA was catapulted into therapeutic circles by Zeff's advocacy, as he recognized its profound benefits in psychotherapy. Initially used in couples therapy for its ability to foster openness and connection, MDMA soon garnered increasing attention beyond the therapy room.

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As its popularity grew, MDMA transitioned from underground therapy to mainstream culture, eventually earning the nickname “ecstasy” as its use in nightclubs, festivals, and raves continued to grow. Despite legal challenges and its eventual classification as a Schedule I Controlled Substance in 1985, MDMA remained prevalent in recreational settings, particularly within rave scenes during the 1990s and 2000s.

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However, amidst legal restrictions, a dedicated group of advocates continued to speak out passionately about MDMA's therapeutic potential. Their passion fueled decades-long efforts to conduct clinical trials and explore MDMA’s potential in addressing various mental health challenges.

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In recent years, it has become clear that these efforts were justified, with MDMA-assisted therapy now proving to be an effective treatment for post-traumatic stress disorder (PTSD). 

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Therapeutic Use of MDMA for PTSD

The Multidisciplinary Association for Psychedelic Studies (MAPS) was established in 1986 by Rick Doblin, Ph.D., a leading advocate for clinical MDMA research. Through years of dedicated effort, MDMA's therapeutic potential has gained increasing recognition.

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Early clinical studies demonstrated MDMA's promising effects in alleviating PTSD symptoms, prompting the US Food and Drug Administration (FDA) to designate MDMA as a “breakthrough therapy” for PTSD treatment in 2017. Subsequent larger clinical trials have confirmed these findings, showing significant symptom reduction following MDMA-assisted therapy and good patient tolerability.

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This progress suggests that MDMA may soon become available as a prescription medicine in the US, UK, and other countries. Australia took a step in this direction by rescheduling MDMA and psilocybin in July 2023, acknowledging their potential in treating PTSD and treatment-resistant depression (TRD). Authorized psychiatrists can now prescribe MDMA for PTSD and psilocybin for TRD.

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MAPS has developed a protocol for MDMA-assisted therapy and has submitted a new drug application for MDMA-assisted Therapy for PTSD. This application represents an important milestone in the regulatory process, indicating MAPS’ efforts to seek approval for MDMA's therapeutic use.

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Key elements of MDMA-assisted therapy include thorough clinical screening to ensure patient suitability, multiple preparatory therapy sessions, the presence of two qualified therapists during MDMA sessions, a controlled and comfortable therapeutic setting for MDMA sessions, and follow-up integration therapy sessions.

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Microdosing: What is it? 

Microdosing involves the use of psychedelic drugs, typically LSD or psilocybin mushrooms, at doses below the threshold of perceptual effects. Unlike traditional psychedelic experiences aimed at inducing a full-blown trip, microdosing aims for subtle enhancements in mood, focus, and creativity.

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A typical microdose is about one-tenth of the amount used for a full psychedelic trip. Unlike occasional small doses taken sporadically, microdosing involves the repeated use of small doses on a fixed schedule. For example, mycologist Paul Stamets and psychologist James Fadiman have each developed microdosing protocols that prescribe specific dosing regimens to achieve desired outcomes. 

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Though microdosing psychedelics is deemed safe, caution is still warranted. If microdosing LSD, for example, it's crucial to ensure the purity of the substance. Similarly, accurate identification of psilocybin mushrooms is crucial when foraging mushrooms from natural environments. To help promote the safe identification of magic mushrooms, check out this field guide. 

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Precise dosing is another factor that deserves due research and caution, as slight variations in dosage can lead to unexpected effects, particularly with potent psychedelics like LSD. Some individuals have reported unintended full psychedelic experiences when aiming for subtle mood or performance enhancements. Therefore, careful attention to sourcing, testing, and dosing is essential to minimize risks when microdosing.

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While formal research on microdosing is still in its early stages, anecdotal reports and user surveys suggest promising outcomes. However, some of the perceived benefits of microdosing may be attributed to the placebo effect. This effect occurs when an individual experiences benefits solely due to their belief that microdosing will work, even if the treatment itself has no therapeutic effect. 

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While many claim to derive meaningful benefits from microdosing LSD and psilocybin, very few scientists or psychonauts endorse microdosing MDMA for the reasons discussed below. 

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Microdosing MDMA: Unpacking the Risks 

For those who may have experienced profound feelings of love and connection with MDMA, the idea of microdosing it to enhance mood and relationships, for example, may seem appealing. However, the pharmacological effects of MDMA — how it behaves in the brain — raise concerns about its safety for microdosing.

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Unlike LSD and psilocybin, which primarily bind to serotonin receptors in the brain, MDMA acts primarily as a serotonin releaser and reuptake inhibitor. This means that it increases serotonin levels by preventing its reabsorption into nerve cells (neurons). Additionally, MDMA increases the levels of the neurotransmitter norepinephrine and, to a lesser extent, dopamine — check out the science of MDMA for a more in-depth description of MDMA’s effects on the brain. 

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The use of MDMA is associated with a depletion of serotonin in the days following use, often accompanied by emotional lows and fatigue known as the “MDMA comedown.” Depleting serotonin reserves over consecutive days can be hazardous, potentially causing long-term harm to serotonin neurons in the brain. This “neurotoxicity,” as it is termed, may negatively affect sleep, mood, and one’s ability to deal with stress. 

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While the brain can synthesize serotonin, prolonged depletion from frequent MDMA use is strongly discouraged. Moreover, although moderate MDMA use is considered physically safe, it does have significant effects on heart rate and blood pressure during use, and chronic long-term use has been linked to serious cardiac complications. In contrast, classic psychedelics like psilocybin and LSD have better safety profiles in this regard. 

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Furthermore, repeated long-term use of MDMA can result in the development of tolerance, diminishing the euphoric and other positive effects commonly associated with its use. This phenomenon, often referred to as “losing the magic,” can lead to a decrease in the intensity of the experiences or, in some cases, render them barely noticeable.

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Due to these factors, it is strongly recommended that users limit their MDMA use to no more than once every 2-3 months. Using MDMA more frequently than this is generally considered excessive and could increase the likelihood of adverse effects on both physical and mental health.

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Research on Low-Dose MDMA

Research on microdosing MDMA is lacking. One dose-response study examined the effects of different MDMA doses, including a low dose of 30 milligrams (mg). 30 mg of MDMA showed no noticeable benefits in this study, while another study examining the effects of 40 mg doses yielded similar results.

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Additionally, the participants who received these lower doses were more likely to report increased fatigue and headache than those who received higher doses. Although 30 mg and 40 mg are approximately half of a typical full dose, and so cannot be considered microdoses, the findings suggest that microdosing MDMA, or at least consuming low doses of MDMA, may not confer benefits.

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It's important to note that the experiences of PTSD patients in these studies may not fully translate to generally healthy individuals considering microdosing MDMA for other purposes. However, the results align with the prevailing notion that the most beneficial effects of MDMA are typically experienced at higher doses, while doses that are too low can lead to discomfort and anxiety.

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Also, MDMA’s effectiveness in PTSD treatment has been observed only in clinical research settings involving carefully controlled and expertly supervised sessions spaced several weeks apart. Given the absence of research on the risks and benefits of microdosing MDMA, further investigation is necessary to determine its safety and potential applications.

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In light of the significant physical impact and health risks associated with frequent MDMA use, it is widely acknowledged that microdosing MDMA is not advisable. While this practice has shown promise with certain classic psychedelics, the safety profile of MDMA suggests it is ill-suited for microdosing purposes, and the consensus leans heavily against it.

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Safety Considerations for Microdosing MDMA

For individuals considering experimenting with MDMA microdosing despite the potential health risks involved, it's important to prioritize safety measures.

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Firstly, the sample should be tested for the presence of MDMA and adulterants, as many “ecstasy” pills do not contain MDMA at all and could potentially contain harmful substances. Reagent testing kits are readily available and can help detect both MDMA and adulterants. Alternatively, where feasible, getting the sample analyzed in a lab, for example through the international drug testing service Energy Control, provides a more accurate analysis of what a sample contains.

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If one decides to proceed with microdosing MDMA, it's advisable to begin with a low dose ranging from about 3 to 5 milligrams. Gradually increasing the dosage by a milligram at a time until faint physical effects are noticed is recommended. Once these effects are observed, dropping back by a milligram or two can help identify the optimal dosage for desired effects while minimizing potential risks.

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Similar to microdosing psychedelics, resetting tolerance would be necessary with MDMA. However, due to the limited practice and lack of established protocols for MDMA microdosing, the specifics regarding tolerance reset remain uncertain.

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Microdosing MDMA: Key Takeaways

In conclusion, while MDMA has gained popularity as both a recreational and therapeutic drug, its suitability for microdosing purposes is questionable. The unique pharmacological properties of MDMA, including its impact on serotonin levels and potential neurotoxic effects, raise concerns about its safety for microdosing.

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Unlike classic psychedelics such as LSD and psilocybin, which have better-established safety profiles, MDMA use carries risks of serotonin depletion, cardiac complications, and tolerance development, leading to diminished effects over time. Research on the safety and efficacy of microdosing MDMA is limited, and current evidence suggests that low doses may produce unpleasant effects.

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Therefore, it is widely advised against microdosing MDMA due to the potential health risks involved. For those still considering experimentation despite these risks, it is crucial to prioritize safety measures such as testing samples for purity, starting with low doses, and exercising caution due to the lack of established protocols for MDMA microdosing.