160 lines
8.8 KiB
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160 lines
8.8 KiB
Plaintext
Newsgroups: alt.psychactives,alt.drugs
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Here is some material that was recently submitted for inclusion in a future
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revision of the MDMA FAQ - I thought it may be of interest to some people
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sooner rather than later. If you have any corrections or constructive
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comments, you could send them to me <rnj%lila@us.oracle.com> and to Jon Taylor,
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the author and maintainer of the MDMA FAQ <jmt0165@u.cc.utah.edu>. Thanks.
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ps: note that these sections of text are not intended to stand alone. the FAQ
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contains important information - dosing, contraindications, etc. - that is not
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replicated here.
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Neurotoxicity and Safety Discussion
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===================================
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Neurotoxicity?
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One claimed effect of MDMA use is lowered brain serotonin levels. One
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study (Peroutka) found no evidence for this, but at least two others (Ricaurte)
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have found significantly reduced serotonin metabolite levels, the most recent
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study showing a 30% average difference between the control group of non-MDMA
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users and the experimental group consisting of people who had used MDMA about
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75 times each, on average.
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What does this mean for users? Anecdotal evidence from years of legal and
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illegal use suggests that this is not of much concern for most people. Some
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folks, however, report periods of depression after using MDMA, on rare occasion
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severe depression. Considering that a primary action of many antidepressant
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drugs (MAOIs, SSRIs) is to increase brain serotonin levels, a connection
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between MDMA use and subsequent depression is not unbelievable. Psychological
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factors - sadness at returning to an ordinary state of consciousness after
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ecstasy - may also account for feeling down for a while. In any event, most
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users report the opposite: feelings of well-being or gentle euphoria in the
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days following an MDMA session. To get a better understanding of why the
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serotonin system may be critical to normalcy for some individuals and less so
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for others, see Listening to Prozac by Peter D. Kramer (Viking 1993). The
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entire book is worthwhile, but note pages 134-136 especially.
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There is solid experimental evidence that MDMA, administered in large
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doses and/or repeatedly, causes partial loss of serotonergic neurons in
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laboratory animals. Uncertain is whether this loss is permanent, reversible,
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or important. One study found in the rat nearly 100% recovery within a year.
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In another study (Ricaurte), non-human primates were dosed with MDMA and their
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brains were examined for morphological changes. Ricaurte found that there was
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no effect after 2.5 mg/kg oral doses given every two weeks, for a total of
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eight doses. But after a single oral dose of 5 mg/kg, he observed a 20%
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reduction in serotonergic neurons, only in the thalamus & hypothalamus. There
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appeared to be some regrowth over time, not necessarily complete, and also some
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"collateral sprouting" - growth of other types of neurons in the reduced
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serotonin areas.
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Note that in all of the animal studies, even when there are quite large
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serotonin system reductions (up to 90% in high MDMA dose rat studies), no
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behavioral deficits are observed.
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It is also uncertain how these studies would extrapolate to humans - the human
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brain may well be more or less sensitive, or sensitive in different areas,
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compared with other animals. In any case, what is known is that there are no
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reported cases that link behavior changes in humans with MDMA-induced serotonin
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system changes or neuronal loss. And, the long-term human behavior changes
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that are noted (in studies and from anecdotal case reports) are generally
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regarded as positive - lowered impulsiveness and hostility, improved
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social/interpersonal functioning, changes in religious/spiritual orientation or
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practice, etc.
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One of the reasons so little is known about the lasting effects of MDMA on the
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human brain is that no subjects (to date) have recorded their drug use history,
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then volunteered their brains for post-mortem study. If you would like to
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consider doing this, you can get donor information at 1-800-UM-BRAIN.
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Studies with live human subjects are also underway - both volunteers and
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donations are needed. One good source of current info is the Multidisciplinary
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Association for Psychedelic Studies (MAPS) - see "Organizations" at the end of
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the FAQ.
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Immune System
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Some users of MDMA report an apparent decrease in resistance to disease,
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especially with frequent MDMA use. It is unknown how much of this may be due
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to the pharmacological "body load" of MDMA, to staying up all night and
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dancing, to increased physical contact with people with colds, to suppressed
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appetite and poor nutrition, etc.
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Preventive Measures
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-------------------
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A fundamental precaution is to stay well hydrated. Drink water frequently
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during the MDMA session, and moreso if you're physically active. Under the
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influence, time can pass surprisingly quickly. It is useful if trip guides or
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trip buddies remind each other to drink water often.
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For those who are concerned about the possibility of serotonin level or
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serotonin system changes in humans with therapeutic doses of MDMA, some
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researchers reckon changes can be lessened or prevented by taking antioxidants. In an article titled "Phenethylamines, Free Radicals, and Antioxidants" (MAPS
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Newsletter, Volume IV Number 1), author Brian Leibovitz suggests in Table 1
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taking as a preventive measure the following: 5 mg B-Carotene; 2 grams
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Bioflavonoids; 100 mg Coenzyme Q10; 2-4 grams L-Ascorbic acid; 1 gram
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L-Carnitine; 2 grams N-Acetylcysteine (NAC); 250 ug Selenium, and 1,000 IU
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Vitamin E. "There is nothing magic about the doses listed; it is my best
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estimate based on present knowledge in nutrition." If you don't feel like
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buying out the local vitamin store, taking a subset of these (even just the
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ascorbic acid - vitamin C) could well be helpful.
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And, if you're really concerned, recent non-human animal research suggests
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that most or all of the serotonin system reduction may be prevented by taking
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Prozac (fluoxetine) 0-6 hours after taking the MDMA (see McCann and Ricuarte in
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J. Clinical Psychopharmacology, 13 (3):pp. 214-217, 1993). One might speculate
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that other SSRI drugs (Zoloft, Paxil) may work too. Note, however, that some
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people report that Prozac taken before or in the early part of an MDMA session
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lessens some of the desirable effects of the MDMA.
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Behavioral Safety Concerns
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--------------------------
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As noted, a primary psychological effect of MDMA is to make the user feel
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"safe", at peace with the world, pleasantly reconciled to things as they are,
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and things however they will be. This can remarkably diminish one's ability to
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make "sound" judgements during the session. Examples:
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- It becomes easy to want to prolong the MDMA state by taking more and more of
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the drug, beyond what you would judge wise or worthwhile when not under its
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influence.
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- It becomes easier to have unsafe sex. You may "forget", judge that the risk
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of infection is very small, or feel that infection wouldn't be such a terrible
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thing after all. If you think you might have sex while on MDMA, it may help
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you and your partner to stay safe if you lay out safer sex supplies before
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dosing in a place you'll be sure to see them later, and agree beforehand that
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you'll use them if the occasion arises.
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Another danger stems from MDMA's lessening of the awareness of pain
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(whether through chemical analgesia, or through psychological analgesia).
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Combined with the extra energy the drug gives, it becomes easy to sustain
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bruises, blisters, or other tissue damage from extensive dancing, hiking,
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climbing, etc., without noticing it until after the damage is done.
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Under MDMA, it may seem "right" to make immediate changes in relationships
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(increasing or decreasing commitment) of all kinds. The new points of view
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appreciated during an MDMA session are one of the drug's most prized benefits,
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but it is probably unwise to actually make lasting relationship changes until
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you have a chance to see how you would feel about them after the drug and its
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afterglow wear off.
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Conclusion?
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-----------
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One take on all this information is that there are a great many questions
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unanswered by research as yet. Thus a conservative, prudent assumption is that
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the risk of some kind of subtle neurological "damage" in humans from MDMA use
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is not zero. Yet there is no empirical evidence of neurological harm in humans
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(and there is considerable evidence of psychological benefits) - this in many
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years of legal use (before 1986 in the US), and quite widespread illegal use
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since then.
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Given any non-zero risk, it makes sense to examine the benefit side of the
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equation, and take the drug only when you expect to get some tangible positive
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outcome from it that you feel makes taking the risk worthwhile.
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