MDMA (3,4-Methyl​enedioxy​methamphetamine)

MDMA promotes the release of dopamine, norepinephrine, and serotonin neurotransmitter in the central nervous system (CNS) which causes the user to experience feelings of pleasure.

MDMA tends to come as slightly off-white (yellow or brown) crystals, which can be crushed into a powder and put into capsules or pressed into tablet form. When in capsule or tablet form, MDMA is commonly mixed with other substances which are unknown to the user (CAMH, 2010b).

MDMA is often referred to as an ‘empathogen’ because users are likely to experience feelings of increased empathy and sociability (Bedi et al., 2010). MDMA also causes the senses to heighten, making most sensations feel pleasurable (NIDA, 2020). Other effects of MDMA may include:

•       Feeling energized.
•       Increased confidence.
•       Increased sexual arousal.
•       Suppression of appetite.
•       No urge to sleep.
•       Teeth grinding and jaw pain.
•       Increased blood pressure, heart rate, and body temperature.
•       Pupil dilation.

When using MDMA, adverse effects are likely to occur when using large amounts, if the batch is strong, or if other substances are mixed into the batch (CAMH, 2010b). Adverse effects may include:

•       Anxiety and/or panic attacks.
•       Blurred vision.
•       Nausea and vomiting.
•       Seizures.
•       Stroke.
•       Kidney and/or heart failure.

MDMA can cause death that is usually related to extreme dehydration. Since MDMA increases heart rate and blood pressure, combined with increased physical activity (e.g. dancing), body temperature begins to rise leading to heart failure or stroke (CAMH, 2010b). 

Service Provider Tip: Remind guys to stay hydrated while they are using MDMA. Drinking 8oz of water per hour will help prevent serious health complications related to dehydration.

When the effects of MDMA begin to wear off, the user may experience feelings of anxiety, irritability, and depression. These ‘after’ effects may last for several days after use. Other ‘after’ effects may include:

•       Difficulty concentrating.
•       Restlessness and/or exhaustion.
•       Paranoia.

Depending on how MDMA is administered, the effects may vary in terms of intensity and duration. Additionally, MDMA capsules or tablets likely contain other substances that are unknown to the user, which may alter the intended effects. 

Ingestion

MDMA is ingested when in capsule or tablet form. Sometimes MDMA will be sold as a powder which can be put into capsules or mixed into a drink and consumed. The onset of MDMA effects usually begin around 1 hour after ingestion and last for 3-4 hours (CAMH, 2010b).

Injection (Intravenous)

When MDMA is in liquid form, the substance can be injected. Similar to stimulant drugs like crystal methamphetamine and cocaine, injecting MDMA will cause an intense ‘rush’. Injecting increase the bioavailability of MDMA in the body, increasing risk of adverse effects related to stress placed on the cardiovascular system (Australian Government Department of Health, 2004). 

Service Provider Tip: Remind guys that sharing needles can increase transmission risk of infectious diseases. To encourage safer use, sharing needles should be avoided. Guys should only use a needle once as the needle can become blunt, reusing the same needle can damage veins and increase risk of infection.

Snorting

When MDMA is in powder form, it can be inhaled into the nose. Tools including a rolled piece of paper such as a bill, business card, paper straw or other materials may be used to facilitate inhalation. 

Service Provider Tip: Remind guys that sharing tools when snorting MDMA can increase transmission risk of infectious diseases. To encourage safer use, tool sharing should be avoided, or tools should be cleaned/disinfected between users.

Booty Bumped (Anal Insertion)

MDMA may also be booty bumped by dissolving MDMA in water or alcohol and using a needless syringe to insert the substance into the rectum.

Service Provider Tip: Booty bumping causes damage to the rectum. Encourage guys to alternate between different administration techniques to give the rectum a chance to heal. Remind guys to avoid sharing syringes or to ensure any materials used for booty bumping have been cleaned/disinfected between users to reduce harms.

Prescribed Substances

MDMA can cause serious and life-threatening adverse effects when used with certain HIV medications, antidepressants, and Viagra-Type drugs.

HIV Medications

• Ritonavir and Cobicistat are used to boost the availability of other substances (primarily other HIV medications) in the body by decreasing the breakdown of these substances (Lindsey et al., 2012).
• Ritonavir and Cobicistat interact with MDMA by increasing the availability of MDMA in the body, leading to adverse effects (Lee et al., 2021).
• Interactions with MDMA have been observed with the Cobicistat-Boosted Elvitegravir regimen (Lee et al., 2021).

• There is weak potential for the Atazanavir HIV medication to interact with MDMA (Lee et al., 2021).

Antidepressants

• Monoamine Oxidase Inhibitors (MAOIs) and Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat depression by blocking the reuptake of the serotonin neurotransmitter in the body (Bracchi et al., 2015; CAMH, 2010b; Lindsey et al., 2012).
• MDMA metabolism has been blocked by SSRIs including fluoxetine and paroxetine (Bracchi et al., 2015).
• Use of MDMA with MAOIs may cause dangerously high blood pressure, increased body temperature, and serotonin syndrome/toxicity (CAMH, 2010b).

Erectile Dysfunction Agents (Sildenafil, Tadalafil and Vardenafil)

• Since MDMA increases feelings of empathy and sociability, combining MDMA with erectile dysfunction agents can increase sexual behaviours. MDMA also lowers inhibitions, increasing risk of engaging in unsafe sexual practices (NIDA, 2020).

Recreational Substances

When MDMA is used with other recreational substances, this is known as polysubstance use and can lead to serious or life-threatening-threatening adverse effects.

Alcohol

• Alcohol can dull the effects of MDMA and decrease inhibitions, increasing risk of using more MDMA and leading to adverse effects (Hernández-López et al., 2002).
• MDMA can mask the effects of alcohol, leading to over consumption of alcohol and increasing risk of alcohol poisoning.
• Over using both MDMA and alcohol can strain the liver and kidneys, dehydrate the body and increase body temperature, increasing risk of death related to dehydration and heatstroke (Hernández-López et al., 2002).

Stimulants

• Using MDMA with other stimulants like crystal methamphetamine can increase risk of heart attack and stroke (Vera et al., 2020). The user may also experience increased anxiety, leading to psychosis.

Recently, Canada passed the “Good Samaritan Drug Overdose Act.” This means that if police attend a 911 call for an overdose and there are drugs present, anyone in attendance is protected against simple drug possession charges, even if they’re on probation or parole. See this helpful info by the Canadian HIV/AIDS Legal Network. You can download a PDF of it [here].