MDMA Harm Reduction

3,4-methylenedioxymethamphetamine (MDMA) combined with dancing, a hot crowded environment and not drinking enough or to much water, can become a deadly mix, sometimes resulting in heatstroke. A small dose of MDMA can raise body temperature one degree or more and inhibits the body’s thermoregulation, increasing the probability of heatstroke. The risk of heat strokes can be reduced with the implementation of basic harm reduction measures like drinking water and keeping your body cool. Rarely, Ecstasy users drink too much water and die from hyponatremia. This is more common in women and the risk can be reduced by substituting water with electrolytes like Gatorade.

Black-market MDMA possesses a higher risk profile than pure MDMA. The risks associated with the consumption of MDMA increase if you take it in an unsafe physical or psychological setting, have insufficient knowledge about MDMA, have inadequate access to basic harm reduction measures, or have ingested a more dangerous substance that is sold as MDMA. MDMA is an illegal and dangerous drug. It has been associated with serotonin syndrome, which can lead to death. It is also closely associated with free radical damage to brain cells, which may cause long-term brain damage.

MDMA stimulates the release and inhibits the reuptake of serotonin (5-HT) and other neurotransmitters such as dopamine. ¹⁷ Serotonin syndrome often develops when hyperthermia (elevated body temperature), mental confusion, and hyperkinesia (increase in muscular activity) are predominate. Rest in a cooler environment generally helps with these problems, although they can develop into emergencies and occasionally prove fatal. This acute serotonergic overactivity is worsened by high body temperatures, overcrowding, and use of other stimulants. The on-drug experience is generally followed by negative moods.¹⁶Single doses of MDMA can cause serotonergic nerve damage, with repeated doses causing extensive loss of distal axon terminals. MDMA users often show reduced cerebrospinal 5-HIAA (colorless body fluid found in the brain and spinal cord), reduced density of 5-HT transporters, memory problems, altered appetite, higher cognitive deficits, various psychiatric disorders, and a reduction of sexual interest. Issues may remain long after drug comedown and are consistent with serotonergic axonal loss in higher brain regions.¹⁵

Neurotoxicity alters the normal activity of the nervous system causing damage to nervous tissue. This can damage or kill neurons. Neurotoxicity such as from the production of free radicals can result from many items in your daily life and also from illicit substances. Symptoms may appear immediately or be delayed and can include side effects such as limb weakness or numbness, loss of memory, vision, intellect levels, delusions, obsessive behaviors, headache, behavioral problems and sexual dysfunction. Individuals with certain disorders may be especially susceptible to neurotoxins.²¹

The most common emergency associated with MDMA is heatstroke, but overdosing is still a risk especially when mixing or taking unknown substances.

Some of the signs include

• Weakness
• Seizures
• Loss of consciousness
• Diarrhea
• Palpitations

What should I do

• Seek medical help immediately, do not try to self-treat!
• If you are in a hot, crowded environment and the person is still conscious, move them to somewhere cooler and calm while you find help.