Ecstasy: Reactions with other drugs or substances

Last modified: Sunday, 31. May 2009 - 2:06 pm

Ecstasy is most often taken in combination with other drugs, intentionally or unintentionally. A person taking ecstasy might also drink alcohol; smoke marijuana; or take cocaine, methamphetamine, PCP, ketamine or additional “club drugs,” among others. In different regions of the country, users have nicknames for particular drug combinations with ecstasy. For example, “candy-flipping” is a name for mixing LSD with ecstasy.
The Substance Abuse and Mental Health Administration sponsors a system called the Drug Abuse Warning Network (DAWN), which tracks drug-related visits to emergency rooms in the United States. The number of ecstasy-related emergency room visits reported to this network jumped from 250 in 1994 to nearly 3,000 visits in 1999. Almost 80% of these episodes involve the use of another drug in addition to ecstasy, and for nearly half of these, the other drug was alcohol. About one quarter of ecstasy-related emergency room visits also show marijuana use; nearly 20% show cocaine use; and close to 40% involve combinations with ketamine.
The ways in which these drugs react with ecstasy is still unclear, partly due to a phenomenon called synergy. Synergy refers to a reaction that magnifies the effects of drugs when they are combined. The effect of one dose of drug plus another dose of drug might add up to two, or because of synergy this combination of one plus one might add up to three or four or ten. Although alcohol is a depressant and ecstasy has stimulant properties, they both dehydrate the user, possibly in a synergistic fashion. Many of the other drugs taken at the same time as ecstasy produce similar physical reactions, such as modifications in heart rate, blood pressure, and body temperature. Therefore the health effects described in the previous section could be magnified many times over, explaining why most emergency room visits involve multiple drugs.
At times, the use of other drugs in addition to ecstasy might be part of the social scene in which ecstasy is taken, especially as particular drugs are combined or taken with ecstasy to achieve a specific effect. However, sometimes the drug combinations are unknown because they are part of the tablet or substance being sold as ecstasy. Many of the reported ecstasy overdose reactions have been attributed to substances other than MDMA, including PMA, which are much more toxic than MDMA. There is also evidence that some of these substances can have a harmful reaction with certain antidepressants or other prescription medication. Besides taking the drug to a laboratory for analysis, there is no way for the user to know what combinations of drugs are contained in the substance assumed to be ecstasy. Ecstasy testing kits provide a false sense of security because although they might identify the presence of an ecstasy-like substance, the kit doesn’t differentiate between MDMA-like substances, tell how much of it is actual MDMA, or reveal what other potentially harmful substances are combined with it. An ecstasy-like substance could be any number of compounds, either more or less harmful than MDMA, including dextromethorphan (DXM), which is the active ingredient in cough medicine.
It is difficult to identify specific reactions ecstasy has with other drugs because most of the time it is unknown what drugs are being combined with each other. Some harmful effects might be due to synergy; others could be related to metabolism. Metabolism is the process that breaks down substances that are taken into the body and eliminates them. Some drugs, both legal and illegal, modify how the body would normally metabolize ecstasy, which could lead to a toxic buildup of very high concentrations of the drug in the system. However, because of the uncertainty of drug combinations and reactions with ecstasy, it is difficult to predict when a harmful reaction could occur.

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