MDMA | MD | Pills | Mandy

Pills are the most common form in which MDMA is sold and are commonly referred to as Ecstasy. They often contain other substances or adulterants that range from anything from MDA, MDEA, amphetamine, methamphetamine, caffeine, 2C-B or mCPP to synthesis by-products such as MDP2P, MDDM or 2C-H. They can also contain an array of random substances such as research chemicals, prescription drugs, over-the-counter drugs, poisons or nothing at all. It is strongly recommended to take harm reduction measures such as using a reagent testing kit when ingesting unknown pills.
The average concentration of MDMA in ecstasy pills, tested in a drug-checking program in Zurich, doubled between 2010 and 2018. The percentage of pills containing more than 120 mg MDMA rose from 4% to 73%. In the same period, the rate of pills containing other psychoactive compounds dropped from 53% to 7%.

Toxicity and Potential Harm

Short-term physical health risks associated with MDMA use include dehydration, teeth grinding (bruxism), sleep disturbances (insomnia), elevated body temperature (hyperthermia), and low sodium levels (hyponatremia). Typically, MDMA alone does not pose life-threatening effects unless compounded by additional factors such as prolonged exposure to high ambient temperatures and humidity, strenuous physical activity, inadequate fluid intake, or lack of acclimatization.

Engaging in continuous activity without adequate rest or hydration can lead to dangerously elevated body temperatures, while excessive sweating exacerbates the risk due to MDMA's stimulating and euphoric effects, which may cause users to disregard their physical condition. Diuretics like alcohol can further heighten these risks by promoting dehydration. Users are advised to monitor their water intake carefully, avoiding both excessive and insufficient consumption, and to avoid overexertion to prevent heatstroke, which can be fatal.

Toxic Dose

The precise toxic dosage of MDMA remains uncertain but is believed to be substantially higher than its effective dose.

Water Intoxication and Electrolyte Imbalance

Symptoms of water intoxication typically manifest when an individual consumes over 3-4 liters of water within an hour. Hyponatremia, characterized by low blood sodium levels due to excessive water intake, is a significant cause of death following MDMA use.

MDMA users commonly experience dry mouth (xerostomia), leading to increased fluid consumption, which may be exacerbated by hyperthermia and the emphasis on harm reduction messages advocating hydration. Higher MDMA doses can hinder urination, primarily by promoting the release of anti-diuretic hormone (ADH), responsible for regulating urination. While relaxation techniques or applying a warm cloth to the genitals can alleviate urinary retention, MDMA also induces water retention and electrolyte dilution, potentially leading to overhydration and fatal water intoxication.

Signs of dehydration such as dry mouth and sweating may occur while dancing or in hot environments. It is advisable to avoid consuming more than 3 liters of water within a few hours and to prevent hyponatremia by consuming fluids containing sodium, such as sports drinks.

Retracted Article on Dopaminergic Neurotoxicity of MDMA

The article "Severe Dopaminergic Neurotoxicity in Primates After a Common Recreational Dose Regimen of MDMA" by George A. Ricaurte, published in the peer-reviewed journal Science in September 2002, was later retracted. It was found that methamphetamine, not MDMA, was used in the study.