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Dose, strength and purity

As there is no quality control, ecstasy is notorious for containing a vast array of drugs and fillers including methamphetamine, ketamine, MDA, PMA, MDEA, caffeine and paracetamol to name a few.  Some ecstasy tablets have been found to contain no stimulants at all.

Pill testing kits and pill branding can give an indication but cannot prove that a pill will be safe to take.

Successful pill brands are often copied on pills but have a different chemical makeup, so even if you think you've taken it before it may actually be a completely different and have completely different effects.

A pill testing kit may indictate that there is MDMA present in your pill but it does not mean that there are no other harmful drugs or fillers in it. 

If you are going to use, only take a half or a quarter and wait to see how the drug reacts with your body.

Using ecstasy with other drugs 

Avoid using ecstasy with medication, alcohol and other drugs - it puts a lot of extra strain on the body and can lead to overdose.

• Prescription medication - Mixing ecstasy with prescription medication can have serious effects. If ecstasy is mixed with some anxiety and ADHD medication and some antidepressants such as SSRIs (selective-serotonin reuptake inhibitors), St John's Wort, or MAOIs (monoamine oxidase inhibitors), the effects can be especially serious such as dangerously high blood pressure, seratonin toxicity, heart attack, stroke, kidney failure, overheating and fits.  If used with medications for psychotic disorders such as schizophrenia and HIV, medications can stop working.
• Other stimulants: Ecstasy is classed as a stimulant if it is used with other stimulants such as coke or ice as the risk of overdose is greatly increased because of the extra strain on the heart.
• Depressants: If ecstasy is used with a depressant such as alcohol, benzos or cannabis the effects of the stimulant drug (ecstasy) will usually mask the effects of the depressant drug. This means that the effects of the depressant drug may not be felt. Using alcohol with ecstasy can be especially risky as both drugs raise body temperature and blood pressure.Overheating is one of the most common forms of overdose among ecstasy users.

If you are planning to take any illicit substance or alcohol while you are going to be on medication that is about to be prescribed to you, talk with your doctor. Unless they have immediate concerns for your safety it will remain confidential. Each drug is different and interactions can be unpredictable and very dangerous. This is especially so if you’re on any highly specialised drugs (e.g. for heart problems, neurological – brain and nerves – problems, blood thinning medications or drugs for cancer).

Overdose - what it looks like and what to do

The term overdose refers to the use of a drug or a mixture of drugs in a way which results in harmful or undesired physical and/or mental side effects.  These side effects can be short or long-term. Ecstasy overdose like all stimulant overdoses should be taken very seriously as it can lead to heart attack and stroke.

Overheating and dehydration are the most common forms of overdose among ecstasy users.  The risk of overdosing in these ways can be greatly reduced by taking regular sips of water (around 500 ml if dancing and 250 ml per hour if inactive) and even taking regular breaks from dancing.

Signs of stimulant overdose include:

• Loss of consciousness or coma
• Faster breathing
• Seizures or uncontrollable twitching
• Overheating
• Racing or irregular heart beat
• Chest pain

What to do if someone feels tense and anxious

• Calm the person down and reassure them that everything is alright.
• Talk quietly and explain that the feelings will pass.
• Keep them away from loud noises and bright lights. 
• Encourage them to breathe slowly and deeply to prevent hyperventilation

What to do if someone is overheating

• Move person to a cool area - either outside or a chill out zone 
• Remove excess clothing
• Encourage them to sip non-alcoholic fluids such as soft drinks.
• Pat the back of the neck and wrists with a cold wet towel
• Do not leave the person alone as overheating can cause the person to lose consciousness.

What to do if someone loses consciousness

• Call an ambulance on 000 - police do not routinely attend overdoses.
• Do not leave the person alone.
• Put the person in the recovery position (i.e. On their side making sure their airways are clear so that  they cannot choke).
• Loosen any tight clothing that might restrict their breathing.
• Keep them warm – unless the fainting is due to overheating.
• If they stop breathing, perform CPR until the ambulance arrives.

What to do I do if someone has a fit

• Call an ambulance on 000 - again, as police do not routinely attend overdoses
• Do not restrict the person in any way
• Remove any objects from around the person that could cause injury
• Do not leave the person alone until the ambulance arrives

Driving after using ecstasy

Driving or operating machinery under the influence of ecstasy is illegal.  This is because even at low doses ecstasy can effect concentration and coordination.  Like other stimulants ecstasy increases confidence and lowers inhibitions which can lead to dangerous driving.  As ecstasy also has hallucinogenic effects it may cause you to see or hear things that are not real which could lead to an accident on the road. 

Don't drive at all. Have a designated driver or keep money separately for a taxi. If the police suspect you of driving under the influence of drugs, they can have your blood or urine tested at a hospital.  The penalties for driving under the influence of drugs include fines, loss of driving licence or even a prison sentence.

Mood, environment and personal factors

Mood

How you are feeling when you use ecstasy can influence how the drug will affect you.  If you are feeling anxious or paranoid the drug may only enhance these feelings. Ecstasy works by releasing feel-good chemicals such as serotonin in the brain to create euphoric effects for users.  This can lead to depression for days afterwards because the brains stock of feel-good chemicals has been depleted. 

Acknowledgement: Bluebelly

Environment

The setting in which you choose to use ecstasy can also influence the effect it will have on you. 

If you use ecstasy, it's best to use it in a place where you feel safe and relaxed. This may reduce the chance of an anxiety attack or paranoia and as with all drugs, have a close friend nearby in case anything goes wrong.

Personal Factors

Like alcohol, personal factors such as weight, height, sex and general health all influence the way in which a drug will affect you. 

Make sure you eat and sleep well if you are planning on taking drugs as this will better equip your body to deal with the substance.  This is especially relevant in the case of ecstasy as ecstasy reduces appetite and ability to sleep. 

Tolerance

Tolerance refers to how people build up a resistance to a drug after prolonged use.  This means that the person will gradually have to use more and more of the drug to achieve the same effects.

If you are using ecstasy again after taking a break, keep in mind that your tolerance for the drug may have gone down so you may not need the same dose as previously to get the same effects. 

Method

• Swallowing:  Swallowing is the least harmful way to take ecstasy.
• Snorting:  If you take ecstasy this way do not share straws or paper as this can pass on all types of germs including hepatitis C.
• Injecting: This is the most dangerous way to take any drug.  Using this method any contaminants in the ecstasy will go straight into the blood stream as injecting bypasses all of the bodies natural defences.  It also increases risk of blood-borne viruses (such as HIV and AIDS) and infections from using dirty equipment.

Pregnancy

Little is known about the effects of ecstasy on the foetus. As the contents of ecstasy varies so widely,  it can often contain toxic chemicals that should not be taken by pregnant women.

This fact sheet was prepared with assistance from the Australian Drug Foundation.