MDMA Harm Reduction

What happens on MDMA?

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What could go wrong?


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.

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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.

What drugs are sold as MDMA?


MDMA is in one of the most contaminated drug markets. The purity of MDMA varies and there are several common imitators. Black-market drugs are commonly cut with any number of substances or are an entirely different substance than what is labeled. This is what makes MDMA extremely dangerous.

The List of possible impurities include but are not limited to aspirin, caffeine, methamphetamine, psychoactive substances designed to mimic the effects of MDMA like MDA (methylene-dioxyamphetamine a.k.a. “sass”), “bath salts” (a general term for synthetic cathinones), stimulants like amphetamine cocaine, methamphetamine; more rarely anesthetics such as ketamine (“Special K”) or dextromethorphan (DXM – an ingredient found in over-the-counter cough medicines).18

What other side effects could happen?


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

Do I need to know more?



Free radicals are atoms with unpaired electrons. These molecules are highly reactive with other cellular structures. Free radicals are the outcome of natural processes, including the metabolic process and immune system responses. Free radical-generating substances can be found in unhealthy food, drugs, polluted air, and contaminated water. Free radicals cause damage to parts of cells such as DNA, proteins, and membranes through the process of stealing electrons during oxidation also known as “oxidative damage.” When free radicals oxidize components of the cell, those parts lose their ability to function normally, and the buildup of such damage may cause the cell to die.

Antioxidants are compounds that either reduce the formation of free radicals or react to neutralize them. Antioxidants often work by donating an electron to the free radical before it can oxidize other cells. Once the electrons of the free radical are paired, the free radical is stabilized and becomes non-toxic. 19 Treatment aimed at increasing the availability of antioxidants in cells may be useful in preventing or slowing the course of neurological damage.

What about my brain?


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

What are some street names for MDMA?


Ecstasy, Drop, Double Drop, Thizzing, Flip, Flipping, Roll, Rolling, Cuddle Puddle, E-Puddle, E-tard, Raver, Raving, X, E, XTC, Beans, Candy, Dancing Shoes, Disco, Biscuits, Doves, E-bomb, Happy Pill, Hug Drug, Love Drug, Malcolm, Malcolm X, Molly, Scooby Snacks, Smartees, Sweets, Skittles, Thizz, Vitamin E, Vitamin X, Vowels, Happy pill20

Is my friend overdosing?


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.

Do you have any tips?



  • Most MDMA medical emergencies are often due to hyperthermia (heat stroke)
  • The more MDMA that you take, the higher your body temperature will be


  • Helps prevent hypernatremia by balancing osmolality of your blood
  • Don’t exceed 500ml/hr,  over-hydration can be deadly, especially for women


  • You have a heart condition, are prone to seizures, have had meningitis, or have a predisposition to heat sensitivity
  • You are taking MAOIs (last two weeks), SSRIs, SNRIs, TCAs, Parnate, Marphan, DXM, Opiates or Ritonivar. This list is not complete and MDMA may interfere with other drugs.


  • Reducing the risk of neurotoxicity and free radical damage
The more MDMA you take, the higher the risk profile


  • Utilize antioxidants & electrolytes
  • Test your substance!
    • Most “MDMA” sold on the street is mixed with other drugs and can dramatically increase your risks
    • Never purchase MDMA/Ecstasy inside a venue or from unknown sources