A “Safe” Party Drug? The Effects of Ecstasy Drug Interactions
Twenty percent of high school seniors attend raves, 7.7% on a monthly basis, and over 35% of those attendees have admitted to using drugs besides marijuana. Among rave drugs, MDMA (ecstasy) is the number one drug of choice. MDMA is a psychostimulant that causes feelings of euphoria, well-being, and empathy. Despite its reputation as a generally “safe” drug, acute MDMA toxicity can occur in the presence of certain risk factors. Some symptoms include nausea, tremor, muscle rigidity, and palpitations, which can be dangerous or even deadly. Even so, death and morbidity rates associated with MDMA use are low; the greater part of the risks of MDMA is usage in combination with other drugs to enhance pleasurable effects, protect against toxicity, or ease “coming down.” This combination of MDMA and other drugs results in MDMA drug interactions (MDMA-DIs). Because of MDMA’s widespread recreational use, as well as its emerging potential as a therapeutic drug for psychotherapy and post-traumatic stress disorder (PTSD), examining the possible dangers of MDMA-DIs is extremely important.
MDMA can commonly interact with pharmaceuticals or other recreational drugs in the body. Studies examined the interactions between MDMA and medicines. For example, certain antidepressants like paroxetine and bupropion reduce the breakdown rate of MDMA. As a result, when these antidepressants are taken before MDMA, it increases the amount of MDMA remaining in the body by up to 30% more than normal. MDMA thus stays in the body for a longer amount of time, increasing the risk of toxicity and acute effects.
The converse can also be true. When dextromethorphan (DEX), a compound commonly found in cough medicines, is taken after MDMA, the rate of breakdown of DEX is slowed. On the other hand, using methylphenidate, a drug used to treat attention deficit hyperactivity disorder (ADHD), before MDMA does not change the metabolism of MDMA. Instead, this combination causes a greater increase in heart rate than either drug alone. No significant effects of MDMA interaction with heart medicines, mainly antihypertensives, have yet been discovered.
MDMA can commonly interact with pharmaceuticals or other recreational drugs in the body. Studies examined the interactions between MDMA and medicines. For example, certain antidepressants like paroxetine and bupropion reduce the breakdown rate of MDMA. As a result, when these antidepressants are taken before MDMA, it increases the amount of MDMA remaining in the body by up to 30% more than normal. MDMA thus stays in the body for a longer amount of time, increasing the risk of toxicity and acute effects.
The converse can also be true. When dextromethorphan (DEX), a compound commonly found in cough medicines, is taken after MDMA, the rate of breakdown of DEX is slowed. On the other hand, using methylphenidate, a drug used to treat attention deficit hyperactivity disorder (ADHD), before MDMA does not change the metabolism of MDMA. Instead, this combination causes a greater increase in heart rate than either drug alone. No significant effects of MDMA interaction with heart medicines, mainly antihypertensives, have yet been discovered.
Risk factors of ecstasy toxicity include high room temperature, vigorous activity, lack of water, MDMA purity, contamination and concentration, and binge use—many of which are present at raves or clubs.
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Studies have also investigated MDMA-DIs with drugs of abuse or social drugs. MDMA interactions with itself (MDMA-MDMAIs), which occur when users dose repeatedly at once, result in up to 29% increased accumulation of the drug in the body after the second dose. Alcohol, another substance commonly used with MDMA, has been shown to extend the duration of MDMA’s subjective effects. Alcohol also affects blood pressure and heart rate, in addition to increasing MDMA content by 7–13% in the body. The cardiovascular effects are not only greater in intensity but also last for longer durations. Meanwhile, the effects of cannabis on MDMA are different from that of alcohol. A study showed a decrease in heart rate but no effect on MDMA breakdown when MDMA was taken with marijuana. Lastly, when considering caffeine--another common chemical stimulant--MDMA usage increases the rate of breakdown of caffeine.
Overall, MDMA-DIs can have a variety of effects on heart rate and metabolism, but interactions that can lead to acute toxicity include MDMA interactions with itself, some antidepressants, and alcohol. Out of these interactions, MDMA-MDMAIs are the most potentially dangerous. Research is still severely lacking in this field, and so far, studies only mimic ideal lab conditions. As a result, care must be taken when extending conclusions to the real world, where people may vary in their experiences of the drug. In the future, researchers should expand on the risks of using MDMA for treatment on patients who may be taking other medications. Media portrayals should also make efforts to advise young party-lovers of the potential dangers of MDMA drug interactions.
Overall, MDMA-DIs can have a variety of effects on heart rate and metabolism, but interactions that can lead to acute toxicity include MDMA interactions with itself, some antidepressants, and alcohol. Out of these interactions, MDMA-MDMAIs are the most potentially dangerous. Research is still severely lacking in this field, and so far, studies only mimic ideal lab conditions. As a result, care must be taken when extending conclusions to the real world, where people may vary in their experiences of the drug. In the future, researchers should expand on the risks of using MDMA for treatment on patients who may be taking other medications. Media portrayals should also make efforts to advise young party-lovers of the potential dangers of MDMA drug interactions.
Featured Image Source: Piqsels
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