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darkeyes said:
With all the deaths,or near deaths caused by Ecstacy, why does this person want to take it???????
If one is in treatment and on prescription meds for an existing problem, taking "unprescribed" (street drugs) will only contribute to the existing problem(s), it's counter productive
So often people mess with their meds, and mix them with other "stuff" which docs didn't prescribe, and then are surprised when things backfire, and blame the physicians and/or pharmaceutical companies. I just don't get it.
I can't stress enough, and I'm sure almost everyone knows this stuff and mixing unprescribed meds is so very dangerous. There is so much more a higher risk of something going wrong, than when a person is taking prescribed meds.
Try to encourage you friend not to take the risk.
I hope all works well.
Take care,
DE

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Hi everyone

I run a drug harm reduction group down here, we have set up at the local raves and such and given out info /taken care of people who get too high and such.

I am not condoning ecstacy or the use of it. However, it is important to note that less people die of ecstacy usage than die from reactions to things like aspirin and other over the counters. Most people do not die from ecstacy use, they die from either dehydration or heat stroke if they do not cool down and drink enough water every so often.

I'd like to provide some unbiased info from www.erowid.org on ecstacy that may help your friend make an unbiased descision.

DESCRIPTION
MDMA, or 'ecstasy' is a 'psychedelic amphetamine' that has gained popularity over the past 20 years because of its ability to produce strong feelings of comfort, empathy, and connection to others. It most frequently comes in tablet form, although it is occasionally sold in capsules or as powder. It is most frequently used orally and rarely snorted. MDMA use is closely tied to the underground rave (and dance club) scene throughout the world, but has also been widely used by therapists as an adjunct to psychotherapy.

MDMA IMAGES
Because MDMA is so popular and because it goes well with dance parties, the demand for it usually exceeds supply--especially at any given location on any given night. This creates an opening for unscrupulous individuals to sell virtually anything as 'ecstasy'. While 'ecstasy' is the popular name for MDMA, the functional definition of ecstasy is any pill represented as MDMA on the street. Ecstasy pills are notoriously unreliable in content, more so than most other street drugs, and commonly contain either caffeine, ephedrine, amphetamines, MDA, MDE, DXM, or--in rare cases--DOB, and don't necessarily contain MDMA or any psychoactive. This problem has led to the development of simple MDMA testing kits that may help give the user a general sense of the content of a pill.
[ Main MDMA Vault ]

Dose
A standard oral dose of MDMA is between 80 - 150 mg. Most good quality pills contain somewhere in this range, generally 80-120 mg. A large percentage of users find that, unlike with many other psychoactives such as LSD or mushrooms, there is a 'sweet spot' in MDMA dosage. Once this spot is found, higher dosages are not particularly desirable as they don't increase the sought after effects or duration.

Price
The price of MDMA varies wildly depending on where it's purchased and in what quantity. A single tablet bought at a rave can cost as much as $50 though more commonly $10-$25. Purchased in higher quantities MDMA generally sells for $100-$250 per gram (about $10-25 per dose), with wholesale prices as low as $50 per gram.

Law
MDMA is illegal in the United States (Schedule I) and in most other countries. It is also listed as Schedule I in the International Convention on Psychotropic Substances, an international drug control treaty.

Chemistry
3,4-methylenedioxy-N-methamphetamine (MDMA) is a synthetic chemical that can be derived from an essential oil of the sassafras tree.

History
MDMA was first synthesized in the 1890s and later patented by Merck pharmaceuticals on December 24, 1912, but it wasn't until the mid 1970s that articles related to its psychoactivity began showing up in scholarly journals. In the late '70s and early '80s MDMA was used as a psychotherapeutic tool and also started to become available on the street. Its growing popularity led to it being made illegal in the United States in 1985 and its popularity has continued to increase since then.

Slang
The Substance : MDMA, ecstasy, X, XTC, E, M, adam, bean, roll,
The Experience : X-ing, rolling, tripping, wigging

EFFECTS

Onset
Depending on how much and how recently one has eaten, MDMA generally takes 30-60 minutes (although sometimes as long as 2 hours) to take effect. Unlike with many other psychoactives, the onset of MDMA is very quick. Often at the point one realizes that perhaps they are starting to notice effects, they are already 'launching' quickly towards the peak. This quick and extremely sharp 'launch' can be unnerving, feeling a bit like it's too quick and hard to know when it's going to end, but the feeling generally only lasts a few minutes until the full effects are reached.

Duration
The primary effects of MDMA last approximately 3-4 hours when taken orally. For many people there is an additional period of time (2-6 hrs) where it is difficult to go to sleep and there is definitely a noticeable difference from everyday reality, but which is not strong enough to be considered 'tripping'. Many people also experience a noticeable shift in mood for several days after use; for some this is a period of depression while others experience lifted mood.

The Experience
When the full effects of MDMA manifest, barring an uncommon negative reaction, users are likely to find that suddenly everything is right with the world. The primary effects sought by those using MDMA recreationally are the emotional openness, euphoria, stimulation, reduction of critical and cynical thoughts, and decrease of inhibitions that can accompany its use. MDMA is used by some individuals in a therapeutic setting to attempt to work through difficult interpersonal issues. Although MDMA can cause nystagmus (eye wiggles), most individuals experience few prominent open or closed eye visuals. A small percentage of users report significant visual distortions.

The Crash
Some users of MDMA experience a dramatic worsening of mood as the peak effects wear off, often called the "crash". This is often the result of coming down from a wonderful experience, not wanting the feelings to go away, and being sad, scared, or annoyed afterwards. Crashes do not happen after every experience and some users never experience them. One of the primary problems associated with crashing is that some users find themselves redosing in order to stave it off.

Hangover and the Week After
Many users report feeling extremely drained the day after MDMA use. This 'day after' effect means for many MDMA users that they need to plan 2 days for the experience: one for the peak experience and one recovery day, with very little planned. Many users also experience some level of post-MDMA depression, often starting on the second day after the experience and lasting for up to 5 days. A small percentage of users report depressive symptoms for weeks afterwards. Alternately, some users report feeling better than normal for a week or so after taking MDMA. The negative after-effects of taking MDMA appear to be worse with higher frequencies of use, higher dosages, and perhaps total lifetime usage.

PROBLEMS
One of the primary problems with MDMA is the low quality of street ecstasy. Street ecstasy, especially pressed pills, is often mixed with a wide variety of adulterants that can cause a variety of negative side effects both unpleasant and dangerous. MDMA is a known neurotoxin, but how damaging it is to use is very controversial and quite complex.

Negative effects can include overheating, nausea, vomiting, jaw-clenching, eye-twitching, and dizziness, as well as depression and fatigue in following days. After frequent or heavy use, some users report bouts of dizziness or vertigo which gradually subside after cessation of use. There have been problems with MDMA users experiencing dehydration, hyperthermia, hyponatremia, exhaustion, blackouts, and a few cases of death generally while using MDMA at clubs or raves. MDMA users would be wise to drink water and take occasional breaks.

Another possible difficult situation arising from MDMA use is the release of emotions which one may be unprepared to deal with. This could include confronting past episode of abuse, re-experiencing painful memories, encountering emotional crises, or unearthing previously unrecognized feelings either alone or while in conversation with friends and loved ones. In these situations, therapists suggest one should try to remain calm and avoid fighting the feelings. Find a supportive friend and a safe, comfortable space to sit while working through the feelings. If at all possible, try to find support among friends as emergency rooms are poorly equipped to handle emotional crises.

Addiction Potential
MDMA has the potential to be psychologically addicting. Individuals who use it regularly may find they have an increased desire to continue using it. There is a short period of tolerance after MDMA use. Using MDMA two days in a row is likely to lead to a greatly diminished experience the second day, though spaced 7 or more days apart, this effect is lessened. Some users report noticing reduced effects for up to 2 or 3 weeks after initial use.

"Loss of Magic"
Many users report that their enjoyment of MDMA seems to decrease as total lifetime usage increases. Some users report that E 'loses its magic' with as few as 10 experiences, while others have reported hundreds of uses before the empathic qualities fades or disappears.

Increased Negative Effects
Most users stop taking E because of either an increased awareness or an actual increase in negative side effects during use, a reduced quality of the high, and increases in the post-MDMA depression and day after hangover.

Increasing Dosage
Most users report that when using more than once a month, or merely over increased total lifetime use, they need to increase the dosage in order to get positive effects with MDMA. Increased dosage is associated with increased side effects, hangover, and week-after depression.

Neurotoxicity
There is an ongoing debate about the possible neurotoxicity of MDMA. Most experts now agree that MDMA is neurotoxic, but there is little agreement on what the consequences of this toxicity are. Alcohol is also a neurotoxin, for instance, as are many other medications. There is some evidence of changes to the brain in those who use MDMA heavily and/or frequently and a few studies have shown reductions in memory & increases in depression and anxiety, but these studies have not been completely verified and debate continues. This is a very complicated issue.

Contraindications
# Do not take MDMA if you are currently taking an MAOI. MAOIs are most commonly found in the prescription anti-depressants Nardil (phenelzine), Parnate (tranylcypromine), Marplan (isocarboxazid), Eldepryl (l-deprenyl), and Aurorex or Manerix (moclobemide). Ayahuasca also contains MAOIs (harmine and harmaline). MDMA and MAOIs are a potentially dangerous combination. Check with your doctor if you are not sure whether your prescription medication is an MAOI.

# Avoid taking MDMA if you are currently using the protease inhibitor Ritonavir. This may be a life-threatening combination.

# Individuals with a history of heart ailments, high blood pressure, aneurysm or stroke, glaucoma, hepatic (liver) or renal (kidney) disorders, or hypoglycemia may be at higher risk.

# Avoid strong stimulants in combination with MDMA.

# Avoid high doses and frequent use. Recent studies suggest that the heavier and more frequent the use, the more concerning the long term after-effects may be.

# A small percentage (1-10% depending on race & family history) are "slow metabolizers", who have low levels of a liver enzyme (P450 2D6) which metabolizes many drugs, including MDMA (as well as Prozac, DXM, and many other pharmaceuticals). These people may be more sensitive to MDMA, might require lower doses, and should be cautious.


People frequently ask whether taking anti-depressants can affect their MDMA experience in any way. The simple answer is that SSRIs (Prozac, Paxil, & Zoloft among others) may reduce the effects of MDMA. Other types of antidepressants include MAOIs, which could cause dangerous or even fatal reactions if taken with MDMA or other strong stimulants. Bupropion (Wellbutrin) alters MDMA's effects but does not appear to weaken the effects, however, the safety of this combination is not well documented. Tricyclic antidepressants, which may cause a change and increase in effects, are also not well documented.

Please also see:

* Interactions between Hallucinogens and Antidepressants
* Letter to the Editor of the NEJM about MDMA & SSRI's by Earth & Fire Erowid

Reduction of Effects

SSRIs tend to cause reduced physiological and mental effects when taken before MDMA. A study for which there was a poster at the College on Problems of Drug Dependence in June of 2002, administered 20mg Paroxetine (Paxil, a common dosage) orally to subjects for 3 days before administering MDMA. Subjects had reduced experiential and physiological responses to the MDMA. See http://www.erowid.org/references/refs_view.php?ID=1388.

An important study by Liechti et al., concerning the effects of SSRI pretreatment on subjective MDMA effects in humans, administered Citalopram (an SSRI) at 40mg by IV and found that the Citalopram reduced physiological and emotional responses:

"The main result of this study is that the psychoactive effects of 1.5 mg/kg MDMA were substantially attenuated by pretreatment with the SSRI citalopram (40 mg iv). Citalopram inhibited most of the psychological effects of MDMA. MDMA-induced increases in positive mood, derealization and depersonalization phenomena, thought disorder, and the loss of thought and body control were all attenuated by citalopram pretreatment. MDMA-evoked intensification of sensory perception, changes in the meaning of percepts, and subjectively facilitated imagination were also inhibited by citalopram as compared to MDMA alone. Citalopram alone also lowered scores on some scales compared to placebo. Most of these changes, however, were clearly due to side effects of citalopram such as fatigue, headache, and nausea, which influenced the mood rating. MDMA also produced marked increases in emotional excitability and sensitivity that, however, were not reduced by citalopram."
See http://www.erowid.org/references/refs_view.php?ID=392.

"We investigated the effect of citalopram pretreatment (40 mg i.v.) on vegetative and cardiovascular effects of MDMA (1.5 mg/kg p.o.) in a double-blind placebo-controlled study in 16 healthy volunteers. MDMA moderately increased blood pressure and heart rate, slightly elevated body temperature and produced a broad range of acute and shortterm side-effects. Citalopram reduced all these MDMA-induced physiological changes except for body temperature."
See http://www.erowid.org/references/refs_view.php?ID=1073.

A further relevant study, from the Spanish group studying MDMA In humans, is:

Segura M, Farré M, Pichini S, Peiró AM, Roset PN, Ramírez A, Ortuño J, Pacifici R, Zuccaro P, Segura J, de la Torre R (2004) Contribution of CYP2D6 to 3,4-methylenedioxymethamphetamine (MDMA) disposition in humans: use of paroxetine as a metabolic inhibitor probe. Clin Pharmacokin (in press).

As of Feb 2005 this study is still in press, but in a different paper Farre et al. state that the study shows that "...a reduced cardiovascular activity and euphoria induced by MDMA were measured in the combination treatment (paroxetine and MDMA)."

Finally, chronic use of SSRIs, as is done in the treatment of depression, seems to reduce the effects of MDMA. That is, a higher dose of MDMA is required to achieve the entactogenic effect.

Nerve Cell Damage Protection?

Some people take SSRIs (selective serotonin reuptake inhibitors) several hours after taking MDMA in an attempt to reduce or block suspected neurotoxicity (brain cell damage). See MDMA (Ecstasy) Neurotoxicity, by Baggott and Mendelson.
http://www.erowid.org/chemicals/mdma/mdma.shtml



http://www.thegooddrugsguide.com/ecstasy/faq.htm
The UK figures suggest seven ecstasy-related deaths per million users. This compares to 625 alcohol-related deaths per million drinkers. In fact, more people in the UK die from choking on peanuts than from taking ecstasy.


Finally, please pass Erowid on to your friend. Ask her to read the info, maybe some of the experiences, and be careful. She may want to start with a smaller dose than normal to see how she feels.

Ultimately though If we choose to tell people to just not do it, most will end up doing it anyways. I prefer to give info and allow people the free will to make their own informed descision. Please note, I fully understand that there are dangers to doing ecstacy and my posting this is in no way meant to suggest a lighthearted approach to it.