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About MDMA Ecstasy
Dosing:
Usual doses of MDMA range from around 80 to 160 milligrams (orally), though monks have used lower doses (40-60 mg) to assist meditation, and therapists have sometimes taken similarly low doses to become more in tune with clients. A benchmark standard dose is often considered to be 2 mg of MDMA per kilogram of body weight (though response to the drug is not strictly proportional to body weight). When MDMA is taken by mouth, the effects manifest about 30-45 minutes later; snorting, smoking or injecting produces much quicker onset. The primary effects usually reach a plateau at T+1:00 (one hour after taking the dose) to T+1:30, stay there for some two hours, then start tapering gradually. The primary effects are pretty much over by T+4:00 to T+6:00. Secondary effects (afterglow) may be felt for days, and tertiary psychological effects (e.g. improved outlook) may last indefinitely.
Supplemental dosing: If you have taken an ordinary dose of MDMA (say 2 mg/kg), you like where you are at about T+1:30 (you will have reached plateau by then), and would like to prolong your stay there, take a supplement equal to about 1/3 to 1/2 the initial dose. Taking much more than this is likely to induce or increase unwanted side effects without providing additional benefit in return.
Contraindications and overdose information:
MDMA causes an increase in blood pressure and pulse rate, modest in most people, similar to moderate exercise. Because of this, and because a few people may have a more pronounced cardiac response to MDMA, people with a history of high blood pressure, heart trouble, or stroke are advised not to use MDMA, or at the very least are advised to start with a much lower than average dose. The same warning applies to people who are hypersensitive to drugs. Liver or kidney problems may also contraindicate MDMA use. It is, of course, desirable to hear from your physician that you're in good overall health before ingesting any powerful substance.
Deaths have been reported of some MDMA users who were also taking Monoamine Oxidase Inhibitors (MAOIs are often prescribed as antidepressants). MDMA is *not* recommended to anyone taking any MAOI. Ask your doctor or pharmacist if you're unsure whether a drug you are taking is an MAOI. Also be aware that some antidepressants (e.g. Prozac and Zoloft) may inhibit some of the effects of MDMA.
MDMA is thought by many to be a fairly safe drug, as long as you keep track of what your body is telling you (see Section III below for more discussion of safety). The euphoria that it induces can make it easy to ignore bodily distress signals, so be watchful for things like dehydration (drink lots of water or fruit juices!), muscle cramping, dizziness, exhaustion or overexertion. Several reports from England tell of dosed ravers dancing themselves into severe dehydration and heat exhaustion that required hospitalization and in a few cases resulted in death. An MDMA overdose is characterized by high pulse or blood pressure, faintness, muscle cramping, or panic attacks. If you experience any of these symptoms, sit down, rest, and drink some fruit juice, water, or a gatorade-type sports drink. In the unlikely event someone has a more severe reaction, e.g. loss of consciousness or seizures, get medical help as soon as possible.
Effects:
The physical effects of usual doses of MDMA are subtle and variable: some users report dryness of mouth, jaw clenching, teeth grinding, nystagmus (eye wiggles), sweating, or nausea. Others report feelings of profound physical relaxation. At higher doses (overdoses), the physical effects of MDMA resemble those of amphetamines: fast or pounding heartbeat, sweating, dizziness, restlessness, etc.
The psychological effects are a bit more difficult to describe, since they are many and of widely varying effects. The major ones are:
Entactogenesis ("touching within") This is a generalized feeling that all is right and good with the world. People on MDMA often describe feeling "at peace" or experiencing a generalized "happy" feeling. Also, common everyday things may seem to be abnormally beautiful or interesting. Alexander Shulgin reported that mountains that he had observed many times before appeared to be so beautiful that he could barely stand looking at them.
Empathogenesis:
Empathogenesis is a feeling of emotional closeness to others (and to one's self) coupled with a breakdown of personal communication barriers. People on MDMA report feeling much more at ease talking to others and that any hangups that one may have with regard to "opening up" to others may be reduced or even eliminated. This effect is partially responsible for MDMA's being known as a "hug drug" - the increased emotional closeness makes personal contact quite rewarding.
Many people use MDMA primarily for this effect, reporting that it makes potentially awkward or uncomfortable social situations (singles bars, dance clubs, etc.) much more easily dealt with. "[Conversation] just flows like water" said one person. "It seems like you know exactly what to say and when to say it. It's like a filter between what you want to express and what comes out of your mouth that you didn't even know existed is stripped away." This same person also reported that they used to use alcohol for many of these same reasons, but found MDMA to be more effective.
An enhancement of the senses:
MDMA can significantly enhance (sometimes distort) the senses - touch, proprioception, vision, taste, smell. MDMAers can sometimes be seen running their hands over differently textured objects repeatedly, tasting and smelling various foods/drinks. This effect also contributes to the "hug drug" effect because of the novel feeling of running one's hands over skin and having one's skin rubbed by someone else's hands.
Before it was made illegal, MDMA was gaining a reputation among the psychiatric community as a valuable therapeutic tool. People under its influence often report seeing their lives in a whole new light. "I was completely blown away the first time I did X" said the same person quoted above. "I saw some of my problems that I didn't even know I had! All of a sudden, It seemed like the source, nature and sometimes even the solution of all my personal difficulties were completely obvious." Surfacing of repressed memories has also been reported.
Despite the legal risks surrounding Schedule I drugs, some therapists are still using MDMA in their practices. For a report on the subjective experiences and psychological/behavioral sequelae of 20 psychiatrists who took MDMA, see "Phenomenology and Sequelae of 3,4 Methylenedioxy-methamphetamine Use" (Liester, Grob, Bravo, and Walsh) in J. Nervous and Mental Disease, Vol 180, No. 6, June 1992, Serial No. 1315. Most people find the MDMA state so valuable by itself that it's not clear there's much to be gained from combining MDMA with most other substances MDMA is used by different people for different things. Because the drug has such a wide range of effects, it can add to almost any activity. Here are some of the more common activities than people take MDMA and engage in.
Raves:
Raves (dance events featuring "house" music) are common settings for taking MDMA. The atmosphere of a Rave is designed to be conducive to enjoying the MDMA experience, in the company of other people who may also be taking MDMA, or who can be as friendly and open without chemical assistance. MDMA's enhancement of proprioception (deep body sense) makes movement notably pleasant, so Ravers on MDMA often dance for long periods of time (remember to drink water frequently!). The feeling of unity and shared ecstatic joy at a successful Rave can be overwhelmingly wonderful. Some ravers regard this as spiritual or religious practice. For more info on raves, subscribe to the newsgroup alt.rave or obtain the alt.rave FAQ from hyperreal.com.
Self-psychotherapy:
Since MDMA can catalyze a broad range of psychotherapeutic effects (surfacing of repressed memories, dealing with emotional issues, etc.), MDMAers sometimes will trip by themselves or with a trusted guide, and spend the experience thinking about their lives. It has been said that "one hit of X [MDMA] is worth 3 months of conventional psychotherapy". Whether that is an exaggeration or not, MDMA has been praised by many psychotherapists as a notably effective means of dealing with personal issues. People who have had an MDMA experience of this kind often will want to talk to some people they are close to in order to discuss what MDMA has made them more aware of.
A substitute for speed:
MDMA is also sometimes used for some of the same things that amphetamines are used for, typically activities that require concentration, motivation, creativity, or energy. Doing homework, studying, writing, playing video games, and dieting are some of the many activities that MDMA may facilitate.
The sensorium:
The sensory enhancement of MDMA can make sensual activities unusually enjoyable. Touching can become such an intensely pleasurable sensation that close personal contact (sexual or otherwise) can be quite fun, especially when coupled with MDMA's empathogenic effects. Hugging someone and running your hands over them are such a common thing to see people on MDMA doing that it is known to some as the 'Hug Drug'. Eating, drinking, smelling flowers and even the sensations of waste elimination can become special experiences on MDMA.
Behavioral Safety Concerns:
A primary psychological effect of MDMA is to make the user feel "safe", at peace with the world, pleasantly reconciled to things as they are, and things however they will be. However as noted as a worse case scenario, High does of MDMA can remarkably diminish one's ability to make sound judgments during the session. Examples: It becomes easy to want to prolong the MDMA state by taking more and more of the drug (or of other drugs), beyond what you would judge wise or worthwhile when not under its influence. It becomes easier to have unsafe sex. You may "forget," judge that the risk of infection is very small, or feel that infection wouldn't be such a terrible thing after all. If you think you might have sex while on MDMA, it may help you and your partner to stay safe if you lay out safer sex supplies before dosing in a place you'll be sure to see them later, and agree beforehand that you'll use them if the occasion arises. Another danger stems from MDMA's lessening of the awareness of pain (whether through chemical analgesia, or through psychological analgesia). Combined with the extra energy the drug gives, it becomes easy to sustain bruises, blisters, or other bodily damage from extensive dancing, hiking, climbing, etc., without noticing it until after the damage is done. Under MDMA, it may seem "right" to make immediate changes in relationships (increasing or decreasing commitment) of all kinds. The fresh points of view appreciated during an MDMA session are one of the drug's most prized benefits, but it is probably unwise to actually make lasting relationship changes until you have a chance to see how you feel about them after the drug and its afterglow wear off.
However ones judgment is not always impaired in this manner with low or milled "normal" doses of MDMA.
Neurotoxicity?
One claimed effect of MDMA use is lowered brain serotonin levels. One study (Peroutka) found no evidence for this, but at least two others (Ricaurte) have found significantly reduced serotonin metabolite levels, the more recent study showing a 30% average difference between the control group of non-MDMA users and the experimental group consisting of people who had used MDMA about 75 times each, on average. (Note though, that some of these studies used psychiatric patients or "polydrug abusers" - not representative user samples.)
What does this mean for users? Anecdotal evidence from years of legal and illegal use suggests that this is not of much concern for most people. Some folks, however, report periods of depression after using MDMA, on rare occasion severe depression. Considering that a primary action of many antidepressant drugs (MAOIs, SSRIs) is to increase brain serotonin levels, a connection between MDMA use and subsequent depression is not unbelievable. Psychological factors - sadness at returning to an ordinary state of consciousness after ecstasy - may also account for feeling down for a while. In any event, most users report the opposite: feelings of well-being or gentle euphoria in the days following an MDMA session. To get a better understanding of why the serotonin system may be critical to normalcy for some individuals and less so for others, see Listening to Prozac by Peter D. Kramer (Viking 1993). The entire book is worthwhile, but note pages 134-136 especially.
There is solid experimental evidence that MDMA, administered in large doses and/or repeatedly, causes partial loss of serotonergic neurons in laboratory animals. Uncertain is whether this loss is permanent, reversible, or important. One study found in the rat nearly 100% recovery within a year. In another study (Ricaurte), non-human primates were dosed with MDMA and their brains were examined for morphological changes. Ricaurte found that there was no effect after 2.5 mg/kg oral doses given every two weeks, for a total of eight doses. But after a single oral dose of 5 mg/kg, he observed a 20% reduction in serotonin and its metabolite 5-HIAA, only in the thalamus & hypothalamus. There appeared to be some regrowth over time, not necessarily complete, and also some "collateral sprouting" - growth of other types of neurons in the reduced serotonin areas. Note that in all of the animal studies, even when there are quite large serotonin system reductions (up to 90% in high MDMA dose rat studies), no behavioral deficits are observed.
It is also uncertain how these studies would extrapolate to humans - the human brain may well be more or less sensitive, or sensitive in different areas, compared with other animals. In any case, what is known is that there are no reported cases that link behavior changes in humans with MDMA-induced serotonin system changes or neuronal loss. And, the long-term human behavior changes that are noted (in studies and from anecdotal case reports) are generally regarded as positive - lowered impulsiveness and hostility, improved social/interpersonal functioning, changes in religious/spiritual orientation or practice, etc.
One of the reasons so little is known about the lasting effects of MDMA on the human brain is that no subjects (to date) have recorded their drug use history, then volunteered their brains for post-mortem study. If you would like to consider doing this, you can get donor information at 1-800-UM-BRAIN. Studies with live human subjects are also underway - both volunteers and donations are needed. One good source of current info is the Multidisciplinary Association for Psychedelic Studies (MAPS) - see "Organizations" at the end of the FAQ. Immune System. Some users of MDMA report an apparent decrease in resistance to disease, especially with frequent MDMA use. It is unknown how much of this may be due to the pharmacological "body load" of MDMA, to staying up all night and dancing, to increased physical contact with people with colds, to suppressed appetite and poor nutrition, etc.
Preventive Measures:
A fundamental precaution is to stay well hydrated. Drink water frequently during the MDMA session, and moreso if you're physically active. Under the influence, time can pass surprisingly quickly. It is useful if trip guides or trip buddies remind each other to drink water often.
For those who are concerned about the possibility of serotonin level or serotonin system changes in humans with therapeutic doses of MDMA, some researchers reckon changes can be lessened or prevented by taking antioxidants. In an article titled "Phenethylamines, Free Radicals, and Antioxidants" (MAPS Newsletter, Volume IV Number 1), author Brian Leibovitz suggests in Table 1 taking as a preventive measure the following: 5 mg B-Carotene; 2 grams Bioflavonoids; 100 mg Coenzyme Q10; 2-4 grams L-Ascorbic acid; 1 gram L-Carnitine; 2 grams N-Acetylcysteine (NAC); 250 ug Selenium, and 1,000 IU Vitamin E. "There is nothing magic about the doses listed; it is my best estimate based on present knowledge in nutrition." If you don't feel like buying out the local vitamin store, taking a subset of these (even just the ascorbic acid - vitamin C) could well be helpful. And, if you're really concerned, recent non-human animal research suggests that most or all of the serotonin system reduction may be prevented by taking Prozac (fluoxetine) 0-6 hours after taking the MDMA (see McCann and Ricuarte in J. Clinical Psychopharmacology, 13 (3):pp. 214-217, 1993). One might speculate that other SSRI drugs (Zoloft, Paxil) may work too. Note, however, that some people report that Prozac taken before or in the early part of an MDMA session lessens some of the desirable effects of the MDMA.
**Props to Visions Of Grandeur for informative post**