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It’s the advent of ecstasy.

MDMA is a rave-drug turned wonder-therapy. It has the potential to help people with PTSDalleviate social anxiety, and save struggling relationships – and as most users will tell you, it makes you pretty good at dancing.

Having been recently approved for phase III clinical trials in the US, it looks like MDMA will soon be entering mainstream society as a legitimate therapeutic tool.

While this is a fantastic piece of news for PTSD sufferers and proponents of drug-policy reform, it might not make much difference to the average person. The MDMA-assisted psychotherapy being trialed by the Multidisciplinary Association for Psychedelic Studies would only become available to a select few – most likely those who could afford the treatment, or had serious medical reasons for needing it.

Unsurprisingly, the public will still want to get its share of the life-enhancing benefits being touted by researchers and therapists.

As the trend of microdosing illustrates, if people want to reap the benefits of a substance, they’ll find the most effective way to do it. Everyone from entrepreneurs to artists are microdosing psychedelics like LSD, psilocybin, and mescaline for spiritual, creative, and productive enhancement.

So could MDMA fall in among the usual microdosing suspects?

HAVE PEOPLE TRIED MICRODOSING WITH MDMA?

It’s certainly not become as popular as microdosing LSD or shrooms, but there is a growing number of people who are giving it a go.

Reports from Reddit users are mixed:

“I microdose very successfully on MDMA. I do it about once a week, sometimes a bit more, every four to five days. I take very, very tiny eyeballed doses, maybe milligrams, if I were to guess. It’s extraordinary; I’ve been doing it for years.”

“I tried microdosing with MDMA twice a week at 25mg for two-and-a-half weeks, wouldn’t recommend it at all. Even with vitamin supplements you will struggle to feel “normal,” sleep gets disrupted, mood disorders can be badly affected.”

One British student attempted to microdose MDMA for a week during her exams. The benefits were interesting… but weren’t worth the intense hangover she experienced for weeks after.

“I was more active, running around doing what I needed to do […] I was more social, I buzzed and felt I was glowing at pre-drinks, my high flowed into the night […] I got a first in that essay, though.

“I wouldn’t recommend it to anyone. The come down left me in my bed for weeks. I refused to see people, shut my phone off, and genuinely hid from the outside world.”

(The Tab)

It’s not just the extended hangover that should give you second thoughts about taking MDMA in a regular microdosing regimen…

MICRODOSING WITH MDMA COULD BE DEADLY

There is a lot of evidence to suggest that frequent MDMA use can be very bad for you. MDMA is not like classic psychedelics; it’s an amphetamine, a stimulant, and will be doing very different things to your body than a tab of LSD.

One well-known study looked at 29 recreational users of ecstasy, who typically took high doses more than twice a week.[1] The study found that 28% of these people were suffering from defects in their heart valves, which could lead to serious heart problems. None of the control subjects had any similar defects.

It’s thought that the reason MDMA is so toxic at frequent high doses is because of its effects on a specific receptor in the heart. High concentrations of the 5HT2B receptor are found on the heart – and when these are activated by MDMA, it sets in motion a signaling pathway that can cause defects in the heart valves if kept active for too long.[2]

WHAT’S THE TAKE-HOME MESSAGE?

Although studies of MDMA’s toxicity have been looking at very frequent, very high-dose use of the drug, and we don’t know how microdoses would compare, we still can’t be sure if microdosing will be safe. Even for normal doses of MDMA (100mg or higher), it’s recommended to avoid taking it more than once every few months.

It’s best to assume that any chronic, long-term activation of the 5HT2B receptors on the heart could have health risks. MDMA is one of the strongest activators of the 5HT2B receptor, so it could still be having a significant effect at low doses.

Despite the reports of beneficial effects from microdosing MDMA, we don’t recommend trying it. Perhaps a therapeutic dose, in a comfortable surrounding and with appropriate support, is still the safest and most effective way of benefitting from ecstasy.

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  1. Microdosing stimulants can make you over sensitive to it. To the point where eating your dinner normally at night even gives you a rush. Another main issue is if you microdose mdma for a while then take a normal dose, might you overdose?

  2. I find it odd that this person experienced any negative comedown from taking pure MDMA. In my experience that only occurs when it is adulterated, probably with speed. As for it being bad for the heart, I have taken it many times and several doctors have told me I have the healthiest heart they have ever seen for someone like me, who was born with congenital heart disease.

    • Haha

      You are prety misinformed about the purity vs comedown.

      and DUDE! You have a cogenital heart disease! Do *NOT* Use any stimulant you dumb f**k!

      You CAN and WILL die if you keep taking stuff like speed or MDMA or basically anything that messes with your pulse/heart.

      ” I have the healthiest heart they have ever seen for someone like me, who was born with congenital heart disease.”

      The.. healthiest… heart they have ever seen, for a PERSON WHO WAS BORN WITH A CONGENITAL HEART DISEASE <- that doest NOT mean "You have a birth defect on your heart so you can do mdma as much as you want"

      What it means is: You are born with a disease that can kill you in an instant if your heart gets stressed and there is nothing you can do about it, but during the circumstances it looks fine but dont do too uch coffee sudden excercise and especially not pulsemodulating drugs, but we are both adults to i dont actually need to *Say* that, rite?"

    • Omg yes, I was born with nitro valve prolapse and after 4 hard years of taking 400 mg in a 5 day period of time, my heart is in excellent health.

  3. Extremely thin argumentation in this post. The anecdotes of users are questionably and some (like the girl taking 25mg per day) are clearly not to be considered “microdosing” (considering a recommended ‘recreational dose’ of not more than 80mg for a female).

    And it is quite dubious to claim that microdosing “could be deadly” if all you can show is that HIGH doses of MDMA can have potential lethal effects on the heart. Ohhh those deadly 5HT receptors on the heart “activated by MDMA”. No , they are activated by Serotonin. Heard of that? The stuff already present in your blood? It should be obvious that a only small increase of Serotonin as caused by microdosing does not have the same effect on the heart and probably none at all. Otherwise merely having a good day with lots of fun which comes with a similar increase of Serotonin would be deadly as well.

    You just claim that daily use of MDMA is risky. And this is true – if you take “recreational” doses daily. But this is to circumstances like serotonin depletion. Again it should be obvious that serotonine depletion does not happen with microdosing. Otherwise the “microdose” would be the normal “recreational” dose. Really, how can you totally ignore the correlation between dosing and serotonine release and treat it like every dose does the same?

    Now, I have no opinion really about MDMA microdosing yet. And I certainly don’t know if it is free of risk. But your article really does not help at all and feels little more than just fearmongering with thin and borderline invalid arguments.

    • Firstly, frequent high doses don’t have ‘potentially’ lethal effects on the heart. They have *proven* significantly damaging effects on the heart that lead to heart disease and probably an early death.

      You’re right that the main effects of MDMA are through MDMA’s amplification of serotonin signaling, rather than MDMA’s direct agonism of the 5-HT receptors (although MDMA *does* act as an agonist on the 5-HT receptors so does directly contribute to 5-HT2BR activation as well). However, MDMA *acutely* increases serotonin signaling in a manner that is unique, even among other serotonergic substances. Therefore even small doses of MDMA are probably affecting serotonin signaling in a manner that is incomparable to other boosts of serotonin, such as lifestyle factors that affect serotonin levels. Even microdoses, that don’t boost serotonin signaling enough to have a noticeable psychological effect, could potentially be altering serotonin signaling enough to activate the 5-HT2BR pathway that leads to valvular strand formation – especially if this is a chronic activation like you would see in microdosing.

      You mention serotonin depletion – but that’s not the issue here. We are drawing people’s attention to the *known* serious risk of developing heart problems with MDMA, and that it is a justified concern that chronic microdosing of MDMA would also increase the risk of heart problems. It is also not possible to rule out the fact that serotonin depletion could be a factor in chronic microdosing. We simply don’t know how frequent microdoses of MDMA would affect the serotonergic system in the long run, and it is very possible that the body would not be able to keep up with the requirements of constantly producing higher-than-normal levels of monoamines.

      I take a firm stance on this. Our article is not fearmongering. We have looked at the evidence, and there is a clear *potential* physiological risk with MDMA microdosing. It would be deeply wrong for us to not report on this.

      • @Haya
        Your response is what should have been included in the “article” (the scare quotes in this case refer to the fact that this is really just a fluff piece/blog post in its current form). Sarah’s points are valid, and should have been discussed in the article. What was published lacks any meaningful data, and uses a scant set of anecdotes and allusion to research surrounding frequent high-dose MDMA use rather than actually discuss *potential* concerns that should be taken seriously when considering exploration of a relatively untested MDMA usage scenario.

        The lack of data in and of itself is not surprising, since there likely isn’t any clinical research into micro-dosing of MDMA, but without discussing what science there is surrounding the action MDMA takes on the brain, there is little use to this piece other than to spread fear and misinformation.

        The responsible thing to do is admit what is known and what isn’t known before providing your speculation about why it COULD be a bad idea—which you can then back up with existing data on health risks associated with MDMA, as long as you qualify the data very clearly as not pertaining to low-dosage use. Then you can give anecdotes that MIGHT back up your speculation, but it would be better to also identify the obvious variation in the anecdotes, and the pitfalls when considering anecdotal reporting (dose/substance variation, background/health of people providing the anecdote, duration of self administration, etc., etc.).

        25mg is not what I would consider a micro-dose, and was even studied in the Phase II clyinical trials of the MAPS MDMA studies for treatment of PTSD as the lowest dose administered in the double blind because it does have noticeably psychoactivity/physical effects. Rule of thumb on micro-dosing is more typically thought of as 10% or less of a “dose” (which is a total shot from the hip, since there is little to no research on the matter, everyone is effected differently, there is no consensus on what a “micro-dose” really is, and there is so much variation in strength/purity of most black market substances. If I were trying to micro dose on MDMA, I would probably start with 5mg of 84% MDMA (highest chemical purity—hard if not impossible for most people to acquire in the first place, but the only MDMA I would consider ingesting), and then work my way up to 8-10mg. If I started to feel any discernible effects, I would back it down from wherever that was.

        The reason I bring up dosages, as with most drugs, outcomes are very dose-specific. Adderall (levoamphetamine-dextroamphetamine), when used in high doses, can have the same effects you describe for “heavy” MDMA usage and others you didn’t mention—cardiogenic shock, cerebral hemorrhaging, circulatory collapse, serotonin syndrome, acute amphetamine psychosis, sympathomimetic toxidrome (which can lead to a heart-attack, among other life threatening things), rhabdomyolysis, dangerously high blood pressure, hyperpyrexia (dangerously high body temperature) and other deadly effects. It is also not recommended that people with heart conditions take Adderall, as with any amphetamines. Yet the medical community has deemed this drug “safe” for medically administered treatment on a grand scale. The administration of amphetamines is DOSE SPECIFIC for good reason. Whether or not it is a good idea that we give kids amphetamines so they can pay attention to lectures for 8 hours a day is a whole other can of worms, but it is clear that most people can live relatively healthy lives while taking daily doses of amphetamines, if done in proper dosage ranges. Since your article fails to make any compelling argument about why MICRO doses of MDMA are PROVEN to be dangerous, your title alone is fear mongering.

        My speculative “feeling” about frequent MDMA usage in sub-psychoactive doses, is that it would likely be no more of a threat than taking Adderall in low doses (which would obviously be different in terms of milligrams, since they have different potency and slightly different neuroactivity pathways). Would there be any potential benefits? That would be an even further speculation that I’m not willing to make.

        You should be ashamed of the click-bate misinformation you’re spreading, since you evidently know more than you shared in the article (as evidence by your reply to Sarah). The last paragraph in your reply to Sarah is wrong. You may have looked at evidence, however you fail to clearly demonstrate that the research you looked at is relevant to your claim—thus you are not entitled to claim with any certainty that micro-dosing MDMA is dangerous for the reasons you provide. I personally don’t believe it is, but this speculation would not entitle me to make a claim that it IS safe.

        It is fear mongering (or willful ignorance) to make the assertions you do without discussing the inherent flaws of self-reported anecdote, the dose-quantity mismatch between the study/studies you mention (which you don’t cite—another failure in your writing) and what would more likely be a sensible micro-dose quantity range. This kind of rumor pedaling is what lead a generation of people to believe that acid flashbacks were a thing, crack is 100x more dangerous than cocaine (and that both are physiologically addictive), prescribed opioids are safe and non-addictive but heroin is death, etc. I can remember people swearing that once you’ve taken acid, cracking your back could “release LSD crystals into your brain” and other B.S. like that. Know that without editing this article significantly, you are contributing to the misinformation echo-chamber that prevents people from objectively considering the potential benefits of all drugs while considering the downsides in a measured and educated fashion.

        • Hi Sid. Thanks for your concern on this topic. We appreciate people guarding against scaremongering and keeping the psychedelic community aware of the dangers of false information.
          However, we won’t be changing anything in this article until new scientific information is available.
          We make it clear that the studies performed on MDMA are on high doses. We make it clear that there is no solid evidence that microdosing MDMA would be toxic. But we highlight the need for caution and the fact that the science points towards MDMA being a potentially harmful substance.
          I do not believe this is fearmongering. I don’t think it’s comparable to the LSD myths that were perpetuated in the 60s and 70s. Our stance here is based on solid research and caution, rather than irrational fear and prejudice.
          Our mission at The Third Wave is to educate people, and this article educates people about what is known about MDMA and its *potential* risks. I believe we have not misrepresented any of the research, or misled anyone.
          This is a harm-reduction article designed to protect people from undertaking a potentially risky activity. If people read the article and decide the evidence isn’t strong enough to suggest a risk, then they can go ahead and microdose. I believe this article presents the evidence in a way that lets people make up their own mind based on the incomplete knowledge that we possess.
          We do not once claim “with certainty” that microdosing MDMA is harmful. We are providing solid evidence that MDMA can be toxic, and it would be reasonable to avoid microdosing until more is known. I stand by the way this article is presented and the reasoning within it.
          Please do keep interacting with us. This kind of discussion is crucial to make sure the community is going in the right direction.
          -Patrick

  4. Even after being given tips on how to edit this article to make it clear that it is accurate information & not just fear mongering (like citing/linking sources/studies. CLEARLY identifying that microdosing hasn’t been proven to be DEFINITIVELY hazardous YET. Using anecdotes that state potentially recreational doses as “micro-dosing” i.e 25mg being WAY too high of a dose for micro-dosing…I know people who get sufficiently high off of 25mg. Especially small girls, 25mg for a friend of mine weighing under 100lbs is her ideal dose when product is very high purity)…Even after all of these tips to make the article more credible, educational & accurate the author (authors?) refuse to change it in any way. Therefore stating potentially false information and presenting it as fact (as far as the reader knows) as a way to stop people from doing something they have no proof is harmful, as opposed to presenting their theory as just that, a theory, based on a very educated guess mind you, and then advising people to not micro-dose MDMA until further studies+proven information that is is/is not harmful becomes available.
    In my mind, and I’m sure many others as well, this is basically TEXT BOOK FEAR MONGERING and I’d advise anyone who reads it to take it as such until the author starts using more professional practices of harm reduction and relaying accurate information.

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