10 Things To Know About MDMA: A specialist's guide

Dr. Adam Winstock, the Consultant Psychiatrist & Addiction Medicine Specialist behind the 2014 Global Drug Survey, has penned an essential ‘10 Things To Know About MDMA’ guide, which like the Survey itself sets out to separate fact from fiction and provide users with essential harm reduction advice.

Running until December 20, the Global Drug Survey is for the first time this year including Ireland in its brief, with Hot Press the official partners.

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MDMA, Molly and ecstasy – if you are lucky they are all the same thing – ideally at a dose of about 80mg/pill or dab. Sadly, and sometimes tragically, that is not always the case. So here are few things that might help keep you informed and safe. We’ll update them on the back of the results of this year's Global Drug Survey that has big section on safer ecstasy use. So after you’ve read this, if it was at all interesting or useful, do me a favour: grab a coffee and join over 60,000 other people by going to [link]www.globaldrugsurvey.com/GDS2014[/link] to help inform change by taking part in the world’s biggest drug survey ever.

1) What’s with MDMA powder; any different or better than pills?

MDMA crystal or powder (just crushed crystals) is another preparation of the drug but the most common form of ‘ecstasy’ that people report taking, according to last year’s Global Drug Survey. In our view, it’s a bit of rebranding and remarketing. Most users consider it to be a more premium product, particularly a few years back when poor quality pills were being sold in abundance. But while people think powder equals better purity and quality, it’s really no better or worse. The powder is no guarantee that what you are getting is MDMA alone or something else altogether. But the consumer is king and most people prefer powder. They think it’s better and it is easier to dose.

If used sensibly it could reduce the risk of taking much – or exposing yourself to a big dose of something really nasty like PMA (Para Methoxy Amphetamine) or PMMA (Para Methoxy Meth Amphetamine). But in exactly the same way you don’t know what you’re getting with a pill by the logo or color, powders are the same. Of particular worry is that good quality MDMA crystal can look exactly like good quality methamphetamine –that would end up being a very different sort of night and day and night…

2) So is the ‘ecstasy’ that is about now better? If so why?

If by better you mean more likely to contain MDMA, then yes (though there is significant intra-country variation).

It really does seem to be the case that good quality MDMA is available in abundance across much of the world. Well, at least until the biggest MDMA lab in the world was shut down last month in the Netherlands. More people are saying that pills are getting better. Pill seizures/amnesty bin sample analysis in the UK and Europe are showing most pills contain MDMA, sometime in a very high dose. And pill prices seem to be edging up in many countries.

One of the most plausible explanations for the return to good quality MDMA is the adoption of new synthetic pathways using less tightly regulated precursors. Precursors are the chemical ingredients you need to make MDMA and the way governments internationally try and reduce the production of ecstasy is to make these chemical ingredients really hard to access.

3) So who has got the cheapest MDMA in the world?

According to last year’s Global Drug Survey, the mean price per pill across the world was about $14/pill and $55/gram. The cheapest pills were found in Canada at a mean price of $8.50/pill and the most expensive in Australia with a mean pill price of $22/pill. It did not seem to matter what you paid however – in every country MDMA was voted the best value for money drug, while cocaine was voted the worst (a mean value rating of 2.5 /10 compared to 7.3/10 for MDMA). We look forward to seeing which country has got the best value drugs this year.

4) People seem to be dying a lot more often from MDMA in 2013 and there are rumours of contaminated pills being to blame. Is it true?

The number of MDMA-related deaths that occur each year is not an absolute figure like the number of games the New York Yankees won last season. It depends on what you call an MDMA-related death. Is a death where someone dies in a road vehicle accident a drug-related death if they have MDMA in their system (even though they may have taken it three days ago)?

Does there have to be a particularly high level of MDMA in someone’s system before you say that MDMA is to blame if someone who dies at a club also has an underlying heart condition?

How about if MDMA is one of four different drugs they find? I am not being difficult. it’s just that it is not straightforward.

All that said, there is no doubt that in the UK and the USA there have been way more ‘media headlines’ about death and contaminated pills than in the last few years. Recent data released in the UK showed that deaths related to PMA increased from a single fatality in 2011 to 23 deaths in 2013.

I am really not yet convinced by this figure nor how they came to this conclusion.

One possible explanation for more regular appearance of PMA in toxicology reports is the adoption of new synthetic pathways using less tightly regulated precursors. It also might be that it is the mix of PMA which comes on very slowly (and might lead to inadvertent over-dosing) and MDMA together is the most dangerous combination. Combining two serotonin releasing drugs is risky. It also might be that people are not that used to taking really high doses of MDMA – though as we said earlier dose is not major player in MDMA-related deaths.

Deciding what someone died from is really hard. It’s not just the drug that causes death but what people are doing, what else they have taken and whether or not there are any underlying medical conditions particularly those of the heart or liver.

5) What do people die of when they say someone died from pill/MDMA?

Death from ecstasy is unbelievable rare and there are many activities, including horse riding, which are much more dangerous. Although statements like that can cost you your job as a Government advisor in some countries – see example of Professor David Nutt in the UK! Every death of a young person is tragic – when it is due to the consumption of a drug that they thought would be source of fun that just compounds it. People don’t intentionally do something they think is dangerous.

Most people die either as a result of severe idiopathic (unknown and unpredictable) reactions to MDMA which are not usually dose related or due to a combination of severe overheating and dehydration leading to multi-organ failure. Abnormal heart rhythms leading to heart attacks, liver failure and strokes also feature, as do cases of serotoninergic syndrome (very high body temperatures, muscle rigidity and extreme agitation or coma). There's also the exceedingly rare but media-loved water intoxication (actually it’s called SIADH and it's due to the excess secretion of a hormone called Anti Diuretic Hormone, so you don’t pee out excess water you take on board).

6) If contaminated pills are about would it be useful to test my pills or powder?

First things first. Even if you know what’s in your pill you can’t guarantee yourself a good or fun time (but would it help? – yes). Remember, when someone dies at a club, the likelihood is that loads of other people took the same pill and got home safely that night. But it’s not easy to know what is in your pill. If you had a mobile GC-MS or HPLC machine (your own personal scientist in a white coat) which could give you the precise composition then that information could be useful. If you found you had a pill with 140mg of MDMA in it you might think, 'hm… best take half.'

If it has 100mg of PMA you would be smart in thinking, 'this is going to be trashed and I am telling everyone I know not to take them.' The home pill test kits you can get offer some limited conformation that your pill or powder might contain MDMA but unless you have full complement (usually four different chemical reagents) you won’t spot really nasty stuff like PMA.

Remember none of these kits tell you the dose or purity – and size does matter when it comes to the dose of drugs. Big doses of MDMA (>150-200mg) can make you feel very, very unwell and can be potentially quite dangerous. So don’t put your foot down until you know what you are driving! Driving when you can’t see what is round the corner is asking for trouble.

7) OK death is very rare, dodgy pills are also probably very rare, but it would be nice how to minimise the risk of it. Any tips?

Yes – and that advice comes from those who die as well as the living. Based on last year’s Global Drug Survey, 0.35% of almost 6000 users of MDMA sought emergency medical treatment as result of taking – at least what they thought was – MDMA. That’s about 1 in 300. Most of those who turned up had taken doses in excess of 250mg (about three normal dose pills) over the course of a drug-using session longer than 12 hours. They had also drank lots of alcohol and had used other stimulant drugs. So based on common sense and bit of science, here are our Top 5 Tips to keep your safe on the dance floor:

• STAY COOL AND STAY HYDRATED:MDMA affects your body’s ability to regulate its temperature, as well as causing you to urinate and sweat more, causing dehydration. Given that most potentially avoidable deaths involve dehydration and overheating common sense says stay cool – take a break from dancing if you feel too hot, are sweating loads, and feel faint. Step outside, sit down, drink non-alcoholic fluids and settle for a while.
• TEST YOUR DRUGS: “If you’re going to be a guinea pig, be a clever one.” Unless you're a chemist with a mass spectrometer you'll never know exactly what you're about to take so by starting with a small test dose you can reduce the risk of being exposed to something nasty as well as get a feel for what’s in your pill.

If your pills are contaminated with something toxic, the less you take, the less harm you are likely to do. So take a half (or a quarter) first, wait for an hour and only take more if there are no ill effects and you feel like you would expect to, when you would expect to. If you are in a group who have all scored your drugs from the same place maybe one of you should test drive for the group and the others can keep an eye on you. Oh yes and that’s reminds me don’t be on your own! And don’t score off random strangers.
• DON’T MIX WITH MEDICATION: Always avoid taking ecstasy with medication that affects the heart and liver (most drugs are metabolised by the liver including antibiotics). Taking them together increases the risk of sudden heart problems and liver failure. If you’re on anti-depressants, don’t take ecstasy at the same time. Not only can the combination be risky by causing dangerous levels of serotonin in the body, but ecstasy can make the antidepressant less effective and lower your mood further. And don’t mix with other drugs or lots of alcohol.
Banging pills every weekend will eventually take a physical and mental toll. No one is invincible. Getting moody, feeling down, worrying, poor sleep are all warning signs. Have a week (or 2 of 3 or 4) off once in a while, maybe go to the cinema, go out for food, play Scrabble (it’s got ‘Es' in it!), whatever,. Just give your brain and body time reboot, repair and restore.
IF YOU FEEL SICK FIND HELP: Big clubs and events should have trained friendly staff who will know how to help if you feel ill. It might be embarrassing, but if you’re not feeling right, let a friend know and get yourself checked out. If there is something seriously wrong, the earlier you seek treatment, the more likely you will be OK.

8)OK so that’s safer use – how about how to get the most enjoyment from MDMA?

That’s easy – don’t use too much, don’t use too often. Don’t mix with alcohol (which brings you down), drinks lots of non-alcoholic fluids if you are being super active, avoid other stimulant drugs especially cocaine and methamphetamine. Also, make sure you are with good friends in a place you like can feel safe with good music.

9) How do I minimise my comedown?

That feeling a day or two after taking MDMA of being tired, a little moody, fragile, snappy, and not being able focus is due to depletion of serotonin and other neurotransmitters that have squeezed out, leaving your brain a little low on happy ‘monoamine’ chemical reserves.

MDMA also irreversibly the enzyme that turns tryptophan (an amino acid) into serotonin – that delays recovery as well. Depending on your baseline and how much you have stressed the system it can take anywhere from 1-5 days to feel back to normal. Eating and sleeping well before and after using MDMA can help. Foods rich in the amino acid precursors tryptophan, tyrosine and phenylalanine (e.g turkey, almonds, bananas, kiwi fruit, honey, marmite) can make an awesome recovery smoothie.

As a general rule, comedowns tend to be longer lasting and more severe in those with underlying depression, so if you are depressed, especially if you are on medication, best avoid MDMA (the combination can also occasionally lead to unpleasant interactions and the MDMA tends to work against the antidepressant). The bigger the dose, the longer your session, the worse your comedown. This will be compounded by using lots of alcohol and other stimulant drugs at the same time. Leaving at least 2-4 weeks between sessions gives your brain time to recover as well.

10) What else should I do?

Take the survey and help us get better information to you next year!

It’s safer than taking drugs, kids….


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