MDMA: harm minimisation strategies

General safety tips

Understand your substance

• Know the effects and risks: because MDMA increases serotonin levels in the brain, it can give you feelings of joy and a sense of love and understanding towards others. However, it can also cause negative effects like dehydration, hyperthermia, and serotonin syndrome. Serotonin syndrome is a dangerous drug reaction and can cause death.
• Unregulated supply: non-prescribed drug supply is currently illegal in Australia and unregulated. You can't be certain what you're taking or how strong it is.
• Use a reagent test kit to check the purity of the MDMA, and the presence of other substances. Start with a small dose to measure the potency. Information about a standard dose of MDMA can be found here, but remember, the potency of MDMA can vary greatly between batches, especially in pill form (so it could be stronger than you expect and effects can vary). The impacts can also vary depending on your body weight.

Measure your doses accurately

• Avoid taking more than 150 milligrams in one go.
• You could also follow a guideline for measurement that is based on bodyweight. This MDMA measurement information can be found here. 
• Wait at least two hours before re-dosing.

Look after your body

• Drink enough water to stay hydrated (but not too much). The amount to aim for will depends on whether you’re taking a break and resting, or being active. Consume one glass (250 ml) per hour when inactive or two glasses (500 ml) per hour when active. Drink plenty of water 24 hours before you use.

Set and setting

Your mindset (set) and environment (setting) can strongly influence how MDMA affects you - and whether the experience feels enjoyable or overwhelming. Being aware of these factors can help reduce unwanted effects.

Set: think about how you’re feeling before you use MDMA. If you’re anxious, stressed, depressed or in a negative mood, MDMA could make those feelings even worse. Setting: use in a familiar safe place, and ideally with friends you trust. Try to avoid hot and crowded places, to reduce the chance of getting too hot. This can make your experience more enjoyable and safer.

Mixing and masking

Knowing what happens when you mix certain substances is important, to help minimise potential harm when you’re using MDMA.

Mixing MDMA with other substances can mask the effects of each, which can be very risky.

• Mixing: avoid mixing with other drugs, especially alcohol, caffeine, other stimulants, and substances that affect serotonin levels (e.g., antidepressants, DMT, methamphetamine). These combinations can increase the risk of negative effects and serotonin syndrome.
• Masking: mixing a depressant and a stimulant can ‘mask’ effects of each drug and make your body feel like it’s not under much strain. Different drugs can also wear off faster than others, so if this happens you might overamp or overdose.

Risky mixes with MDMA

• MDMA and alcohol: increases your risk of dehydration and overheating.
• MDMA and stimulants (cocaine, methamphetamine): can lead to serious cardiovascular stress and serotonin syndrome. Serotonin syndrome happens when the chemical serotonin builds up too much in your body. Too much serotonin can cause serious effects, and can lead to death if it’s not treated. Be on the lookout for warning signs: things like rapid breathing, a fever, muscle twitching, seizure, and/or a high pulse rate. If you see any of these signs in you or in someone you’re with, get medical attention immediately.
• MDMA and antidepressants (SSRIs, MAOIs): increases the risk of serotonin syndrome.

Ways to use MDMA: understanding the different risks

Oral (swallowing)

• Pills: start with a small dose (e.g., a quarter of a pill) and wait at least 2 hours before thinking of having more. This helps you understand the strength and avoid overuse.
• Parachuting: for powder, wrap it in a small amount of paper and swallow with water. This helps you control the dose.

Snorting:

1. 1. Choose a clean surface.
2. 2. Finely grind the MDMA.
3. 3. Use your own clean straw or spoon for snorting (try not to use money).

Shelving (inserting into your bottom):

• Apply lubrication to avoid tearing, and use a condom or latex glove to prevent scratches.
• Wash your hands before and after use.

Injecting

• Use sterile syringes and equipment.
• Wash your hands thoroughly.
• Dispose of syringes responsibly.
• Our Safer Injecting article has some more information about this method.

Re-dosing

• Allow at least two hours before re-dosing to reduce the risk of negative effects from using too much.

MDMA overdose

Signs of an MDMA overdose:

• hyperthermia (overheating)
• confusion or disorientation
• severe agitation or paranoia
• seizures
• irregular heartbeat.

What to do if you’re with someone who has overdosed

• Call emergency services (000) immediately: tell them clearly what substance was taken, and what symptoms are showing. Calling 000 can save a life, but there may be risks depending on your situation. You don't have to share more than what is needed for help. Remember that medical and emergency services are there to help you.
• Stay with the person: keep them calm and monitor their condition.
• Cool down: move to a cooler environment, use cold water to cool down, and stay hydrated.

MDMA withdrawal

MDMA withdrawal can be challenging and can affect you both physically and emotionally.

Managing withdrawal safely

• Medical supervision: talk to a healthcare provider if you're feeling strong withdrawal symptoms.
• Supportive care: stay hydrated and choose healthier foods to help your body recover.
• Rest: good quality sleep and rest is important for recovery.
• Counselling and support: reach out to support groups or try counselling to manage the emotional side of withdrawal. Seeking support from friends and family can also help.