Harm Reduction: MDMA pleasure and Harm Reduction (2)

This is a continuation of Harm_Reduction: MDMA_pleasure_and_Harm_Reduction_(1) so I suggest reading that :))

Medical aspects

As with any other drug, MDMA is contraindicated in people suffering from certain diseases, as the risk of serious adverse reactions, toxicity or death is much higher than in healthy people.

As a general rule, people suffering from:
• Hypertension • Heart or liver diseases • Hyperthyroidism • Epilepsy • Glaucoma • Diabetes • Immunosuppression

Should refrain from using MDMA. However, a specialist in the subject could assess the risks of a particular patient in certain circumstances. Its use should also be avoided in people with psychological or psychiatric disorders.

It is not clear whether MDMA can affect the fetus or to what extent it eliminates through breast milk, but common sense indicates that pregnant or breastfeeding women should only use those drugs that are strictly essential, and this does not include any illegal drug.

Interactions between different drugs and MDMA are also significant. Many possible interactions exist, but only a few are of practical relevance.

The most serious of these is that between MDMA and protease inhibitors (PIs). PIs (ritonavir, saquinavir, nelfinavir, amprenavir, lopinavir...) are a family of drugs commonly used to treat HIV-AIDS infection. Several cases of fatal intoxication have been reported in people treated with ritonavir (Norvir®) after having used MDMA. Although these persons had consumed regular amounts, extraordinarily high concentrations of MDMA were detected in their blood, since ritonavir does not allow the enzymes responsible for degrading MDMA to work. Thus, people with HIV infection or AIDS being treated with PIs (especially Norvir® and Kaletra® (lopinavir/ritonavir) should avoid the use of MDMA .

Another potentially lethal interaction is that between MDMA and monoamine oxidase inhibitor drugs (MAOIs). MAOIs are a type of antidepressant not widely used at present (only moclobemide (Manerix®) and tranylcypromine (Parnate®) are currently marketed in Europe. MAOIs can also be found in some herbal products (Hypericum, St. John's Wort) and some ayahuasca preparations. Several cases of deaths from the simultaneous ingestion of moclobemide and MDMA have been reported. Another MAOI not marketed in Europe, phenelzine (Nardil ®), can cause very serious intoxications in combination with MDMA.

Other pharmacological interactions are known through theoretical models or anecdotal cases. The simultaneous use of MDMA and β-adrenergic inhalers (drugs used in the treatment of asthma and other respiratory diseases such as salbutamol or terbutaline), stimulants such as methylphenidate are not recommended, although the practical importance of these interactions is much less than those previously described.

There are no known interactions with the contraceptive pill or the most commonly used antibiotics. However, the consequences of MDMA on the immune system could reactivate an infection.