MDMA safety: Practical medical tips for ravers who choose to use ecstasy

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In writing the second part of this article about “Ecstasy Safety”, I found almost as many urban myths surrounding the medical aspects of Ecstasy as there are surrounding the legal aspects of the drug.

That’s why I’m super fortunate to be able to collaborate with Stefanie Jones and Missi Wooldridge from DanceSafe.

DanceSafe is a grassroots organization that promotes health, education and safety within the rave and festival community. DanceSafe is also one of the leading groups promoting “harm reduction” policies in the rave and festival community.

“Harm Reduction” is a public health philosophy that encourages policy choices at raves and fests that reduce the risks associated with the use of MDMA.

Think of this article as a form of ”Personal Harm Reduction”. What specific, practical medical tips should ravers who choose to use Ecstasy know?

RAVER MEDICAL TIP #1
The Number One Risk in using MDMA isn’t actually using MDMA.

Woah. This first tip reads a bit like a Zen Koan. Allow me to explain what I mean.

People make irrational and illogical decisions when it comes to weighing perceived risks all the time.

I mean, we have a 5 second rule for foods because, “Oh God! I couldn’t possibly touch a Fig Newton off that disgusting floor.” And we put dainty paper rings down on our toilet seats to avoid the rampaging public health threat of TSTBDs (Toilet Seat Transmitted Butt Diseases).

But pass around an unknown powder which may or may not contain any active ingredient other than rat poison? All of a sudden it’s, “Let me hit that shit!…Is there enough for me?”

In preparing this article I had a chance to speak to Dr. Julie Holland, who ”wrote the book” on Molly in her book, Ecstasy: the Complete Guide: A Comprehensive Look at the Risks and Benefits of MDMA.

Turns out Dr. Holland puts “ingesting unknown substances into your body” into the “risk” rather than “benefit” category of Ecstasy usage:

What’s happening these days, though, is you have no idea what you’re taking. Maybe it’s MDMA, but it could also be any other number of drugs, research chemicals, or prescription drugs. When someone buys “Ecstasy” or “Molly” maybe it’s MDMA, but it’s very possible it could be anything else you can think of. A bag of white powder is inherently very dangerous since you have no idea what’s in it.

Missi Wooldridge at DanceSafe makes the same point. Unless you have a testing kit, you literally have NO idea what you are putting in your body

What is sold as Molly is often a mystery powder and may not contain MDMA at all. Most frequently, it contains a new psychoactive substance such as those from the family of Cathinones (i.e., Mephedrone, Methylone, Butylone or MDPV). Other common adulterants include 2C(x); PMA/PMMA, mCPP, and other Piperzines; and Methamphetamine. NEVER obtain drugs from a stranger!

In his recent article for Forbes Magazine, Jacob Sollum put it this way…. “Molly these days is the shit… but not in a good way”.

(PS – Here is a bonus Zen Koan tip. That tree falling in the forest without anyone there? It definitely makes a sound. Leave your iPhone in the forest and hit that red “record” button if you don’t believe me…Boom. Done. I just totally saved you a trip to a Zen monastery.)

RAVER MEDICAL TIP #2
Unless you happen to be crazy, test your Stuff.

Okay, so Ecstasy/Molly may contain things you had no idea you were putting in your body. Like what? Well, for example, there are synthetic Cathinones, a common ingredient in those “bath salts” that supposedly turn people into flesh-eating zombies. (FYI, Stefanie Jones says that of all the pills tested by DanceSafe, less than half contain actual MDMA.)

Given that, Tip 2 should be pretty obvious — You have to be crazy to use an unknown powder without having it tested.

I asked Missi why she advocates so strongly for testing kits to be available for use at raves and festivals:

I advocate for testing kits because NOT providing them is morally and medically negligent. The other side of this is how highly adulterated substances are now. Until we screen/test people’s substances, we aren’t doing anything at all to reduce the risk of people taking adulterated substances at these big events where we are seeing tragedies.

Another huge reason for testing your stuff is the danger of unintentionally mixing substances. Experts usually have some idea what one drug may do to you. But when you combine it with another drug, you are basically a “drug guinea pig”. That’s because it’s so difficult to predict how two drugs will react together in an individual.

This issue of these so called “drug cocktails” came up in the Electric Zoo deaths as well. Toxicology tests showed that the young woman (Olivia Rotondo) died from acute intoxication after taking pure MDMA. However, the young man (Jeffrey Russ) had actually taken a fatal mixture of MDMA and Methylone.

Missi uses the term “morally and medically negligent” to describe the decision not to test an unknown substance. I would describe the decision to not to test as falling into the “Don’t you know I’m loco? Insane in the membrane. Insane in the brain!” level of crazy decision-making.

DanceSafe provides adulterant screening on site at events when they are allowed to do so. But if you are going to “roll responsibly”, you need to buy and use your own test kits.

RAVER MEDICAL TIP #3
Take steps to properly hydrate and chill out.

Every music audience seems to have it’s own mood altering substance of choice. When I saw Snoop Dogg at Coachella, he came out with a gigantic blunt and encouraged the audience to “light up”. This might have been the most unneeded direction given by a performer to an audience ever. I don’t think there was anyone there who was NOT smoking weed.

On the other hand, if you go to a “rave”, chances are high some folks will be using Ecstasy. But the combo of high-energy dance music and “rolling” can be dangerous without taking precautions.

That’s because MDMA (and Methylone, which is one of the most common things in Molly), and Methamphetamine all work in part by increasing your heart rate and blood pressure and body temperature. Dancing for hours uninterrupted by breaks, especially in hot temperatures and with other people packed together does the same thing. It’s this combo of raving and rolling that can potentially be lethal.

I asked Dr. Holland what she would tell a raver taking MDMA to do to increase their safety:

To increase safety, there needs to be chill out rooms, free water readily available, and a lot of outreach and education. People need to be instructed to take breaks, drink water or electrolyte solutions, not alcohol or energy drinks, and also not too much water, which can be dangerous. Try to only replace fluids lost by sweating.

As Jules Winnfield would tell you, “we all have to be like Little Fonzies…and what’s Fonzie like? …Cool.”

So everyone just needs to be cool and everything is fine, right? Well not really. That’s because you can’t just hydrate and chill out and solve the danger. The problem is that MDMA causes fluid retention, especially in women, and hyponatremia (overhydration) can also be lethal.

For a while, people in the community were treating water like a “toxic drug flush”. The myth has been floating around (ha! see what I did there?) that if you just drank enough water that it would flush out the bad stuff in your body. But that’s not true. Water is an antidote to dehydration, not to the effects of Ecstasy or other drugs. You have to be careful hydrating too.

RAVER MEDICAL TIP #4
Make sure your Festival buddies are okay.

As I mentioned in a previous article, making a commitment to be responsible for your friend’s safety at an event is the “Golden Rule” of being a good Festival Buddy.

I asked Missi Wooldridge what a Festival Buddy should know to be able to take care of their buddy who takes Molly:

This may be stating the obvious, but LOOK OUT FOR YOUR FRIENDS and never let someone wander alone. Drink water and replenish electrolytes. Take breaks and cool down. Communicate with someone around you if you start to feel overwhelmed or are having a difficult experience. If someone around you seems fatigued, confused, or is having a difficult time breathing and/or standing on their own two feet, get them somewhere safe to sit and cool down. Seek onsite medical personnel.

I started to dedicate a portion of this article to talk about what symptoms or signs people should be looking for when it comes to determining if their fest buddy is overdosing or having a bad reaction. But I realized it would be safer and smarter to direct you to two resources that answer these questions in more detail.

First of all, I encourage you to look at the DanceSafe advice page talking about how to avoid dehydration, heat exhaustion, and heat stroke.

It’s also a good idea to download the DanceSafe app. (it’s just Android App right now but IOS shortly). The emergency response sections of the app talks a great deal about what to do if you feel your friend is overdosing or having a “bad trip”.

Boom Festival, one of the largest Psytrance Festivals on the planet,
is a great example of how drug checking has been integrated into an event.

In 2002, Senator Joe Biden attempted to pass a bill called the RAVE act in Congress. When opposition to the bill started to organize, they changed the name to the Illicit Drug Anti-Proliferation Act of 2003, attached it to the popular Amber Alert legislation and quietly snuck it into law.

The bill basically makes it illegal for for anyone to “knowingly” put on an event that has the purpose of “using, distributing or manufacturing any controlled substance.”

This is why promoters and festival organizers are in such a tough spot. They know that if they allow test kits and other “harm reduction” activities they are potentially exposing themselves to civil and criminal liability.

Why? Well, because someone after the fact may say, “see they KNEW there were going to be people using Ecstasy at this event. They even had test kits to help them use it!”

On the other hand, if they don’t take basic “harm reduction” steps (chill out rooms, medics on hand, plenty of water available) they get accused of not taking care of their audience and could potentially end up with people getting hurt or killed.

Missi Wooldridge thinks the key is for promoters and raves and fests to integrate “harm reduction” services while at the same time adopting a “zero tolerance” drug policy:

There is a thin line, but the line is walkable. If you familiarize yourself with the NEWIP and TEDI project, these are great examples of how government, public health officials, and the nightlife industry can come together to improve the quality of life for this community. Boom Festival in Portugal is a great example of how drug checking has been integrated into the event.

Remember a few articles back when I wrote about needing to bring back the second “R” in PLUR? The one promoting “Responsibility”? To me the “Second R” means encouraging promoters and club/venue owners to adopt and promote harm reduction practices and policies. It also means not supporting or attending events that don’t follow these practices.

I’m trying, Ringo. I’m trying real hard with this article to be the shepherd. But honestly, people in the dance community themselves are the only ones who can fix this problem. They can do that by demanding safe events. And if they don’t see harm reduction policies in place, they can force change by not going to that event again.

RESOURCES
Join and promote organizations like Dance Safe that promote harm reduction

As you can tell, I am a big fan of DanceSafe. I have all their albums.

DanceSafe provides on site harm reduction services, both stationary and mobile to events. Typically, they will set up a table and provide patrons with condoms, water, ear plugs, sunscreen, unbiased drug information, and adulterant screening (upon approval). They also provide a safe space for people to cool down and have healthy conversations about the drug use and their health.

Go like them on Facebook or follow them on Twitter @dancesafe.

Once again, huge thanks to Missi Wooldridge and Stefanie Jones for all their time and attention to this article. This is collaboration in the best sense of the word.