(This article was last updated on the 23rd of March, 2018.)
This article on the effects of ecstasy is based on research from the Dutch Trimbos Institute. Examples in the article refer to incidents that happened in the Netherlands.
Women are more sensitive towards the effects of ecstasy than men when they take the same amount of product. Why this is the case is not yet clear. Clinical studies have shown that the female body responds differently to MDMA than the male body. The female body needs more time to remove all the MDMA from the body. The maximum concentration of MDMA in the blood, when the same amount of MDMA per kg of bodyweight is given, is higher among women than men. The female body is made up out of relatively more fat than the male body leading them to have a lower volume of fluid in the body. Because MDMA can only spread over a lower volume of fluid the concentration increases more rapidly for women than for men.
Most serious ecstasy related health disturbances and fatalities are cases that also involve alcohol. A big part of those fatalities are due to overheating after excessive dancing in a hot and crowded establishment where people start to sweat a lot. Fluids are lost due to the excessive perspiration and are not replenished. One the of possible effects ecstasy is overheating and dehydration, alcohol also dehydrates the body. Combining both products thus increases the chance of dehydration and with that overheating.
Ecstasy still has an effect on the body even though the subjective (desired) effects have worn off. Depending on the taken amount of MDMA the effects of ecstasy can last for many hours, even a day.
Some people believe that you can only die from polluted ecstasy pills. Yes, ecstasy pills that contain PMA or PMMA instead of MDMA pose a greater health risk but people have also died from “pure” MDMA. Autopsy reports in the Netherlands show that many people have died from taking just one or multiple “pure” ecstasy pills or MDMA powder.
Taking half a pill first is in general less bad than swallowing an entire pill entirely. For most users the total amount of substance taken is the most important factor, not spreading it out in smaller doses. It should be noted that back in 2015 three young women in the Netherlands died because of ecstasy use even though they first took one half of an ecstasy pill and two hours later the other half. In all three cases victims got ill immediately after taking the second half of the pill.
Water Intoxication due to ecstasy use is a rare occurrence. Due to media attention (in the Netherlands) a lot of people believe it’s the most dangerous side effect of ecstasy use. The number of people who arrive at the intensive care due to overheating or heart problems is far greater. Prevent water intoxication by drinking a maximum of 1 glass of liquid per hour.
The current medical literature shows that people who are on medication have a heightened risk of side effects. People who already have high blood pressure or hart problems should avoid MDMA. Same goes for people with liver or kidney problems. Multiple fatalities have been recorded where people were also on anti depressants. Some anti depressants (Prozac, Zoloft) can suppress some effects of MDMA, which can lead to people taking more ecstasy. The biggest threat, according to the literature, is HIV inhibitors. Using ecstasy in combination with other types of medication can also lead to dangerous side effects.
Many sites on the internet give information about the composition of ecstasy pills. Pills with the same appearance (logo, diameter, thickness and color) can have totally different contents. It is best to test each pill individually.
Some users present ecstasy as a harmless drug. Indeed, ecstasy addiction almost never happens, but taking ecstasy is definitely not risk free. A few people die every year in the Netherlands due to the effects of ecstasy. Long and intensive use possibly leads to brain damage and damages the liver and kidneys. Safe ecstasy use is therefor impossible, even when ecstasy pills are tested!
This is a persevering misconception. Ecstasy on the Dutch market is generally quite pure. Back in the 90’s large batches of ecstasy sometimes contained amphetamine instead of MDMA. In 2008/2009 the Dutch market was also quite ‘polluted’. Since 2009 there are more pills with high MDMA dosing, this adds risk.
This is incorrect! The literature shows that there are multiple fatal cases of people who had used ecstasy before. It is possible that a different set of circumstances had a big effect on the outcomes in those cases. MDMA disrupts multiple regulatory mechanisms in the body. The body might not have needed to ‘intervene’ the first time because internal or external conditions didn’t demand it. The next time, when it was necessary, it didn’t happen because the regulatory mechanisms were disrupted by MDMA.