8 ms·

The fact that one of the doctors in the article compares the dangers to opioids is misleading or misguided. MDMA has an exceptionally small potential for long t

by CoryG89 10y ago

The fact that one of the doctors in the article compares the dangers to opioids is misleading or misguided. MDMA has an exceptionally small potential for long term abuse when compared to most other drugs. Despite having studied brain damage in chronic users (not very many of these), I doubt the doctor has ever personally done opiates and MDMA. Anyone who has had any significant experience with both would laugh at the comparison when it comes to potential for abuse.

DINKDINK 10y ago
Source?
- CoryG89 10y ago
  I feel that the first chart/plot on this wiki gives a pretty good estimate on the relative potentials for abuse of various drugs. Note the relative positions of Ecstasy, Cannabis, and Heroin: https://en.wikipedia.org/wiki/Substance_abuse https://en.wikipedia.org/wiki/Substance_abuse PDF for the actual paper containing the chart: https://www.thevespiary.org/rhodium/Rhodium/Vespiary/talk/files/6416-615_Pharmacology_Therapeutics_NUTT_Rational_Scale_Harm_Drugs_Misuse07ea.pdf https://www.thevespiary.org/rhodium/Rhodium/Vespiary/talk/fi...
  - r_smart 10y ago
    Spoiler for anyone that doesn't want to click through to the first link: MDMA is apparently roughly the same in physical harm as marijuana, but rates lower on the dependence scale. I did not expect that, but then, I've never done MDMA.
    - rudolf0 10y ago
      That seems highly misleading. I think MDMA is far more physically dangerous than cannabis. Many people have directly died from irresponsible use of MDMA, but no one has (directly) died from any use of cannabis. MDMA can certainly be safe and beneficial if taken responsibility, but: - Doses should generally be spaced at least 2 (many recommend 3) months apart. - The minimum effective dose should be taken. Even a light overdose can create an uncomfortable, traumatizing, or even physically dangerous situation. - Hydration and access to cool environments is important. Overhydration can also be a risk, so it's good to have access to electrolyte-laden drinks (Gatorade etc.). Overhydration, dehydration, and brain overheating are the leading causes of MDMA-related death. - Supplements should be taken to reduce the inherent neurotoxicity even if you do all of the above things right. Some good examples on http://www.rollsafe.org http://www.rollsafe.org. It's true that dependence-wise, cannabis is probably worse, though. It's pretty hard to build a dependence on MDMA, as you'll likely only feel the uncomfortable stimulant effects (and other negative symptoms; this can lead to long-term or permanent neuroreceptor damage and dysfunction) if you take it on a weekly or daily basis.
      - CoryG89 10y ago
        No one has ever died directly from an MDMA overdose (as far as I know). Yes there have been indirect deaths usually from over-hydration (which causes the brain to swell, with or without MDMA), which usually happens in a rave/dance setting. I'm sure there have been many indirect deaths from cannabis as well. Lung cancer, car crashes, falling down an elevator shaft, etc. This is going to be true of any sufficiently powerful psychoactive substance.
        rudolf0 10y ago
        If you completely ignore deaths for a moment, many report severe negative symptoms, lasting weeks or more, resulting from dehydration or overheating from MDMA. Overheating is also speculated by many researchers to be responsible for some of MDMA's neurodegenerative and neurotoxic effects. You probably won't die due to MDMA, but if you're not careful you can certainly cause brain issues. And that makes it more physically dangerous than cannabis.
        CoryG89 10y ago
        Perhaps. Personally if I drew the graph, I would put MDMA and cannabis closer together in terms of physical harm. I think they are dangerous in different ways and it's difficult to say which is more dangerous in absolute terms. Like you say, if you are careful and informed, you can avoid lots of the dangers of MDMA with responsible use. It's difficult to smoke pot and not do some damage to your lungs, no matter how careful you are. Vaporizers not withstanding, but vaping was probably not considered in the graph.
      - GordonS 10y ago
        I think one of the biggest problems with MDMA is that what you are getting is not always MDMA[1] Better access to drug testing for consumers could help here. [1] https://www.ecstasydata.org https://www.ecstasydata.org
        CoryG89 10y ago
        I agree, but this isn't a problem with MDMA, but with illicit drugs in general. When you buy cannabis, LSD, cocaine, or anything else on the street, you have no way of knowing what's in it for sure unless you have a way to test it. This is one of the big arguments for legalization / decriminalization. It won't be an issue with the MDMA these trial patients are receiving for example.
    - metaphorm 10y ago
      that's not a very accurate way of phrasing it. in some scales it's considered similar in abuse potential but that is extremely different than physical harm. both are considered medium for abuse potential. cannabis is so non-toxic it doesn't even chart for physical harm. mdma is medium toxic, especially with sustained use.
      - deleted 10y ago
        [deleted]
      - CoryG89 10y ago
        Not according to the graph or the study. Source? Toxicity is not the only measure for physical harm.
  - deleted 10y ago
    [deleted]
  - TTPrograms 10y ago
    And even heroin as a drug causes less physical harm in principle than stated - proper administration primarily results in constipation and very rarely organ damage. The primary danger come from improper intravenous drug use along with variable concentrations of drug due to buying from a black market, resulting in accidental overdose. Khat is a funny one - didn't we already go through the racial disparities in prosecuting "crack" and "cocaine" differently? It's too bad the African Khat-using community didn't muster as much political muscle as the kratom community is.
- jjawssd 10y ago
  Primary. Can confirm. Not even in the same ballpark. If you've ever been in love and been with with that person and it feels like a moment could stretch on to eternity and everything is perfect... thats what opiates feel like. With MDMA everything seems unique, there is a pronounced clarity of mind including insight, and vision. Tactile senses are heightened - it is a full, wholistic high. Perspective often shifts from minutae to space/time. Heightened senses (tactility) and feelings of empathy, understanding, oneness are universal. You may want to dance, sit down, look at the carpet, hug a friend. The difference may seem subtle to a drug-naïve individual but they are two totally different head spaces
  - Cyph0n 10y ago
    I want to try a light psychedelic but not sure where to start. Never taken any sort of drugs before, including alcohol. Any suggestions? Edited
    - jjawssd 10y ago
      Completely unrelated. Not comparable. I suggest you visit http://bluelight.org/ http://bluelight.org/ to learn more, including a lot about safety.
      - Cyph0n 10y ago
        Thanks, I'll start there.
      - loeg 10y ago
        I'd also recommend https://www.erowid.org/ https://www.erowid.org/ .
        alexpatin 10y ago
        I second erowid. Fantastic resource.
    - colechristensen 10y ago
pc86 10y ago
> I doubt the doctor has ever personally done opiates and MDMA Well it's a good thing that's not a prerequisite to getting someone's opinion. I'm all for sensible drug policy, and you may be right that MDMA and opioids are completely different classifications of substances, but the fact that the doctor hasn't personally done both is no reason to dismiss his statements out of hand.
- CoryG89 10y ago
  You're right. Although I am much more likely to trust someone who has had significant experience with both (especially if they have also managed to become a doctor or something similar). I don't have much information, but based on the article, I believe this doctor is biased by the fact that he has focused only on the very rare cases of individuals which develop an obsession with the drug and continue to use it even after it's primarily sought-after effects have stopped working. If you use MDMA every day for a prolonged time, then you are definitely going to get brain damage. The reason this generally isn't a problem with MDMA is that, long before this happens, you will use up all your serotonin (temporary) and the drug essentially stops working, even with increased dosage. This usually means that people stop taking it before any major damage is done. Contrast this with opiates, where you can keep upping the dose and keep the high going indefinitely over a prolong time (until you overdose). I dismiss the doctors statements not just because he hasn't done these drugs himself, all I need to do is look at the number of heroin addicts in rehab vs the number of chronic MDMA users.
  - nv-vn 10y ago
    Is there any proof that serotonin issues are temporary with MDMA? I've heard of people having severe long-term consequences after frequent (> once a week) use for as little as 3 months. Also, I disagree about the potential for abuse. I've heard of many people abusing MDMA, with daily use for long periods of time (all of which have reported memory issues and other permanent problems).
    - CoryG89 10y ago
      There aren't many good studies in the US precisely because of it's scheduling under the DEA. But serotonin levels are definitely restored. Most estimates range anywhere from a few days to six weeks before serotonin levels are fully restored. Not that permanent damage is impossible with frequent or high enough doses. More than once a week is definitely too much. More than once every month is probably still too much if you want to be safe. Most recommend 2-3 months for maximum safety. I don't believe there are 'many' people who take MDMA daily for long periods of time, unless they only want negative side effects. They definitely aren't getting the same experience after the third day, regardless of how much they take. You only have so much serotonin. Perhaps these people are not actually taking what they think they are? Here is an article about a decent study from the UK: http://newatlas.com/study-effects-ecstasy/10995/ http://newatlas.com/study-effects-ecstasy/10995/
paulcole 10y ago
> MDMA has an exceptionally small potential for long term abuse when compared to most other drugs. (Citation Needed)
- CoryG89 10y ago
  See my additional reply to DINKDINK's comment, further below for source/citation.
duaneb 10y ago
While I tend to agree with you, I think the opiate epidemic is salient as an illustration of unintended consequences. Do I think this will lead to addicts? No. Do I think people will get hurt? Most likely; it's not exactly a brisk cup tea in terms of physiological AND psychological effects. Will it get abused? Of course. People abuse sugar. My point being, there's a line between caution and fear mongering. I think you COULD interpret this as being cautious rather than illustrating an irrational fear.
- CoryG89 10y ago
  I agree, I don't think the doctor is intentionally fear-mongering. I think this doctor is probably just biased from his own second hand experience with a very, very small and unrepresentative portion of MDMA users. Misguided. My issue with the doctor's statements is concerning only the potential for abuse/addiction (which is not even worth talking about when compared to opioids). The potential for harm is definitely worth being cautious over.
newtohn 10y ago
The comparison with opioids is erroneous because prescribed opiates are given to a patient to take home, allowing abuse and diversion. MDMA use will take place at a medical practice. No abuse or diversion will take place (barring theft).

by CoryG89 10y ago

DINKDINK 10y ago

Source?

CoryG89 10y ago
I feel that the first chart/plot on this wiki gives a pretty good estimate on the relative potentials for abuse of various drugs. Note the relative positions of Ecstasy, Cannabis, and Heroin: https://en.wikipedia.org/wiki/Substance_abuse https://en.wikipedia.org/wiki/Substance_abuse PDF for the actual paper containing the chart: https://www.thevespiary.org/rhodium/Rhodium/Vespiary/talk/files/6416-615_Pharmacology_Therapeutics_NUTT_Rational_Scale_Harm_Drugs_Misuse07ea.pdf https://www.thevespiary.org/rhodium/Rhodium/Vespiary/talk/fi...
- r_smart 10y ago
  Spoiler for anyone that doesn't want to click through to the first link: MDMA is apparently roughly the same in physical harm as marijuana, but rates lower on the dependence scale. I did not expect that, but then, I've never done MDMA.
  - rudolf0 10y ago
    That seems highly misleading. I think MDMA is far more physically dangerous than cannabis. Many people have directly died from irresponsible use of MDMA, but no one has (directly) died from any use of cannabis. MDMA can certainly be safe and beneficial if taken responsibility, but: - Doses should generally be spaced at least 2 (many recommend 3) months apart. - The minimum effective dose should be taken. Even a light overdose can create an uncomfortable, traumatizing, or even physically dangerous situation. - Hydration and access to cool environments is important. Overhydration can also be a risk, so it's good to have access to electrolyte-laden drinks (Gatorade etc.). Overhydration, dehydration, and brain overheating are the leading causes of MDMA-related death. - Supplements should be taken to reduce the inherent neurotoxicity even if you do all of the above things right. Some good examples on http://www.rollsafe.org http://www.rollsafe.org. It's true that dependence-wise, cannabis is probably worse, though. It's pretty hard to build a dependence on MDMA, as you'll likely only feel the uncomfortable stimulant effects (and other negative symptoms; this can lead to long-term or permanent neuroreceptor damage and dysfunction) if you take it on a weekly or daily basis.
    - CoryG89 10y ago
      No one has ever died directly from an MDMA overdose (as far as I know). Yes there have been indirect deaths usually from over-hydration (which causes the brain to swell, with or without MDMA), which usually happens in a rave/dance setting. I'm sure there have been many indirect deaths from cannabis as well. Lung cancer, car crashes, falling down an elevator shaft, etc. This is going to be true of any sufficiently powerful psychoactive substance.
      - rudolf0 10y ago
        If you completely ignore deaths for a moment, many report severe negative symptoms, lasting weeks or more, resulting from dehydration or overheating from MDMA. Overheating is also speculated by many researchers to be responsible for some of MDMA's neurodegenerative and neurotoxic effects. You probably won't die due to MDMA, but if you're not careful you can certainly cause brain issues. And that makes it more physically dangerous than cannabis.
        CoryG89 10y ago
        Perhaps. Personally if I drew the graph, I would put MDMA and cannabis closer together in terms of physical harm. I think they are dangerous in different ways and it's difficult to say which is more dangerous in absolute terms. Like you say, if you are careful and informed, you can avoid lots of the dangers of MDMA with responsible use. It's difficult to smoke pot and not do some damage to your lungs, no matter how careful you are. Vaporizers not withstanding, but vaping was probably not considered in the graph.
    - GordonS 10y ago
      I think one of the biggest problems with MDMA is that what you are getting is not always MDMA[1] Better access to drug testing for consumers could help here. [1] https://www.ecstasydata.org https://www.ecstasydata.org
      - CoryG89 10y ago
        I agree, but this isn't a problem with MDMA, but with illicit drugs in general. When you buy cannabis, LSD, cocaine, or anything else on the street, you have no way of knowing what's in it for sure unless you have a way to test it. This is one of the big arguments for legalization / decriminalization. It won't be an issue with the MDMA these trial patients are receiving for example.
  - metaphorm 10y ago
    that's not a very accurate way of phrasing it. in some scales it's considered similar in abuse potential but that is extremely different than physical harm. both are considered medium for abuse potential. cannabis is so non-toxic it doesn't even chart for physical harm. mdma is medium toxic, especially with sustained use.
    - deleted 10y ago
      [deleted]
    - CoryG89 10y ago
      Not according to the graph or the study. Source? Toxicity is not the only measure for physical harm.
- deleted 10y ago
  [deleted]
- TTPrograms 10y ago
  And even heroin as a drug causes less physical harm in principle than stated - proper administration primarily results in constipation and very rarely organ damage. The primary danger come from improper intravenous drug use along with variable concentrations of drug due to buying from a black market, resulting in accidental overdose. Khat is a funny one - didn't we already go through the racial disparities in prosecuting "crack" and "cocaine" differently? It's too bad the African Khat-using community didn't muster as much political muscle as the kratom community is.
jjawssd 10y ago
Primary. Can confirm. Not even in the same ballpark. If you've ever been in love and been with with that person and it feels like a moment could stretch on to eternity and everything is perfect... thats what opiates feel like. With MDMA everything seems unique, there is a pronounced clarity of mind including insight, and vision. Tactile senses are heightened - it is a full, wholistic high. Perspective often shifts from minutae to space/time. Heightened senses (tactility) and feelings of empathy, understanding, oneness are universal. You may want to dance, sit down, look at the carpet, hug a friend. The difference may seem subtle to a drug-naïve individual but they are two totally different head spaces
- Cyph0n 10y ago
  I want to try a light psychedelic but not sure where to start. Never taken any sort of drugs before, including alcohol. Any suggestions? Edited
  - jjawssd 10y ago
    Completely unrelated. Not comparable. I suggest you visit http://bluelight.org/ http://bluelight.org/ to learn more, including a lot about safety.
    - Cyph0n 10y ago
      Thanks, I'll start there.
    - loeg 10y ago
      I'd also recommend https://www.erowid.org/ https://www.erowid.org/ .
      - alexpatin 10y ago
        I second erowid. Fantastic resource.
  - colechristensen 10y ago

pc86 10y ago

> I doubt the doctor has ever personally done opiates and MDMA Well it's a good thing that's not a prerequisite to getting someone's opinion. I'm all for sensible drug policy, and you may be right that MDMA and opioids are completely different classifications of substances, but the fact that the doctor hasn't personally done both is no reason to dismiss his statements out of hand.

CoryG89 10y ago
You're right. Although I am much more likely to trust someone who has had significant experience with both (especially if they have also managed to become a doctor or something similar). I don't have much information, but based on the article, I believe this doctor is biased by the fact that he has focused only on the very rare cases of individuals which develop an obsession with the drug and continue to use it even after it's primarily sought-after effects have stopped working. If you use MDMA every day for a prolonged time, then you are definitely going to get brain damage. The reason this generally isn't a problem with MDMA is that, long before this happens, you will use up all your serotonin (temporary) and the drug essentially stops working, even with increased dosage. This usually means that people stop taking it before any major damage is done. Contrast this with opiates, where you can keep upping the dose and keep the high going indefinitely over a prolong time (until you overdose). I dismiss the doctors statements not just because he hasn't done these drugs himself, all I need to do is look at the number of heroin addicts in rehab vs the number of chronic MDMA users.
- nv-vn 10y ago
  Is there any proof that serotonin issues are temporary with MDMA? I've heard of people having severe long-term consequences after frequent (> once a week) use for as little as 3 months. Also, I disagree about the potential for abuse. I've heard of many people abusing MDMA, with daily use for long periods of time (all of which have reported memory issues and other permanent problems).
  - CoryG89 10y ago
    There aren't many good studies in the US precisely because of it's scheduling under the DEA. But serotonin levels are definitely restored. Most estimates range anywhere from a few days to six weeks before serotonin levels are fully restored. Not that permanent damage is impossible with frequent or high enough doses. More than once a week is definitely too much. More than once every month is probably still too much if you want to be safe. Most recommend 2-3 months for maximum safety. I don't believe there are 'many' people who take MDMA daily for long periods of time, unless they only want negative side effects. They definitely aren't getting the same experience after the third day, regardless of how much they take. You only have so much serotonin. Perhaps these people are not actually taking what they think they are? Here is an article about a decent study from the UK: http://newatlas.com/study-effects-ecstasy/10995/ http://newatlas.com/study-effects-ecstasy/10995/

paulcole 10y ago

> MDMA has an exceptionally small potential for long term abuse when compared to most other drugs. (Citation Needed)

CoryG89 10y ago
See my additional reply to DINKDINK's comment, further below for source/citation.

duaneb 10y ago

While I tend to agree with you, I think the opiate epidemic is salient as an illustration of unintended consequences. Do I think this will lead to addicts? No. Do I think people will get hurt? Most likely; it's not exactly a brisk cup tea in terms of physiological AND psychological effects. Will it get abused? Of course. People abuse sugar. My point being, there's a line between caution and fear mongering. I think you COULD interpret this as being cautious rather than illustrating an irrational fear.

CoryG89 10y ago
I agree, I don't think the doctor is intentionally fear-mongering. I think this doctor is probably just biased from his own second hand experience with a very, very small and unrepresentative portion of MDMA users. Misguided. My issue with the doctor's statements is concerning only the potential for abuse/addiction (which is not even worth talking about when compared to opioids). The potential for harm is definitely worth being cautious over.

newtohn 10y ago

The comparison with opioids is erroneous because prescribed opiates are given to a patient to take home, allowing abuse and diversion. MDMA use will take place at a medical practice. No abuse or diversion will take place (barring theft).