CAN YOU KEEP YOURSELF SAFE?

CAN YOU KEEP YOURSELF SAFE?

Advocates and critics disagree about whether people can protect them­selves from MDMA-induced toxicities by taking measures to keep their body temperature down and keep hydrated. Savvy ravers have adopted several practices designed to try to protect themselves from MDMA's dangers. They drink extra water, try to keep their body temperature down by using "mist rooms" in which people spray each other with water, keep the room temperature low, and sometimes even take SSRIs like fluoxetine (Prozac) in an attempt to protect against neurotoxicity and the amino acid tryptophan when they are coming down to help restore serotonin levels. Do these practices work? Certainly, the organ damage caused by high body temperature can be avoided if you stay in a cold enough envi­ronment. Protecting yourself against neurotoxicity is more controversial. There is animal literature showing that changes in serotonin neurons don't happen if animals are kept cold. However, we don't know yet if these findings extend to people. The same story is true of taking SSRIs like Prozac. This approach has worked in studies on animals but is untested in people. If you take SSRIs before taking MDMA, these drugs keep MDMA from getting into the terminal. This prevents the damage completely but also prevents MDMA's effects. So users take it when they are coming down. Could this be dangerous? Theoretically, if you take an SSRI too early, while lots of serotonin is still floating around, you could trigger the "serotonin syndrome." SSRIs keep the serotonin from being recaptured by the nerve terminal, just like MDMA does. In combination, you can get a dangerous elevation of serotonin that leads to the effects of an MDMA overdose. A mild case could cause nausea, diarrhea, increased muscle tone, and increased blood pressure; a severe case could cause greatly ele­vated body temperature and death. Cases of serotonin syndrome have been reported after MDMA alone, and theoretically the combination could increase the risk.

MDMA raises some challenging ethical questions. Should this drug be used clinically? This question is debated actively by some scientists, and there are credible arguments on both sides of the issue. In favor of its use, MDMA does not cause dangerous effects at doses that would likely be used clinically. Certainly, there are many clinically approved drugs like morphine and amphetamine that are equally dangerous at high doses, so the dangerous side effects are hardly unique. Furthermore, certain cir­cumstances exist, like compassionate use at the end of life, when the potential long-term effects are not an issue. Offsetting these "positives" are many open questions: Are there long-term consequences to low-level use that could be dangerous? Can scientists advocating clinical use show convincingly that MDMA offers unique advantages that outweigh the advantages of other medications? What are the benefit and harm caused by a drug that can apparently treat "personality" rather than disease? Would a completely safe entactogen be a valid clinical drug or a "tonic" for treating the ills of normal life? Can insights and positive feelings aroused during a drug-induced state carry over into normal life? (The same issue has arisen with the incredible popularity of Prozac, as addressed in the book Listening to Proztic by Peter D. Kramer.) We can't answer these questions here, but we will raise a cautionary note. Some­times there is a good reason for bad feelings: they are caused by bad expe­riences, and they often motivate personal change for the better.