- 07 Aug 19
Dr. Adam Winstock, the Consultant Psychiatrist & Addiction Medicine specialist behind the Global Drug Survey, has some essential harm reduction advice for users
Death from ecstasy is unbelievably 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 the 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).
QUESTION: 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, "Hmmm... 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.
OK death is very rare, dodgy pills are also probably very rare, but it would be nice how to minimise the risk of it. Here are our top tips to keep your safer on the dancefloor:
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.
PRAGMATIC HEDONISM: 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.
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.