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Comment by pc86 | Hacker News Reader

> I doubt the doctor has ever personally done opiates and MDMA

Well it's a good thing that's not a prerequisite to getting someone's opinion.

I'm all for sensible drug policy, and you may be right that MDMA and opioids are completely different classifications of substances, but the fact that the doctor hasn't personally done both is no reason to dismiss his statements out of hand.

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You're right. Although I am much more likely to trust someone who has had significant experience with both (especially if they have also managed to become a doctor or something similar).

I don't have much information, but based on the article, I believe this doctor is biased by the fact that he has focused only on the very rare cases of individuals which develop an obsession with the drug and continue to use it even after it's primarily sought-after effects have stopped working. If you use MDMA every day for a prolonged time, then you are definitely going to get brain damage.

The reason this generally isn't a problem with MDMA is that, long before this happens, you will use up all your serotonin (temporary) and the drug essentially stops working, even with increased dosage. This usually means that people stop taking it before any major damage is done. Contrast this with opiates, where you can keep upping the dose and keep the high going indefinitely over a prolong time (until you overdose).

I dismiss the doctors statements not just because he hasn't done these drugs himself, all I need to do is look at the number of heroin addicts in rehab vs the number of chronic MDMA users.

Is there any proof that serotonin issues are temporary with MDMA? I've heard of people having severe long-term consequences after frequent (> once a week) use for as little as 3 months. Also, I disagree about the potential for abuse. I've heard of many people abusing MDMA, with daily use for long periods of time (all of which have reported memory issues and other permanent problems).

There aren't many good studies in the US precisely because of it's scheduling under the DEA. But serotonin levels are definitely restored. Most estimates range anywhere from a few days to six weeks before serotonin levels are fully restored. Not that permanent damage is impossible with frequent or high enough doses. More than once a week is definitely too much. More than once every month is probably still too much if you want to be safe. Most recommend 2-3 months for maximum safety.

I don't believe there are 'many' people who take MDMA daily for long periods of time, unless they only want negative side effects. They definitely aren't getting the same experience after the third day, regardless of how much they take. You only have so much serotonin. Perhaps these people are not actually taking what they think they are?

Here is an article about a decent study from the UK:

http://newatlas.com/study-effects-ecstasy/10995/

Obviously it's the minority (<1%) of users who are abusing the drug at anywhere near that level. I'm sure that the positive effects are long gone by that point, but I think people who abuse to that extent have become dependent on MDMA in order to feel normal (or have convinced themselves that this is the case). While I'm sure most of these people aren't consuming pure MDMA, there's likely some cases where it is still what's really being used.

Anyways, I've seen many people claiming to have done this (or having friends who have done this) on Reddit:

https://www.reddit.com/r/Drugs/comments/45sgbe/daily_mdma_us... https://www.reddit.com/r/Drugs/comments/1ldmka/so_really_how... https://www.reddit.com/r/MDMA/comments/2765jb/i_used_100mg_o... https://www.reddit.com/r/MDMA/comments/211jkj/ive_been_rolli...

Lots of these cases may be false, but there still seems to be at least a few real cases of this. Of course, that's no reason to make the substance illegal (and especially not a reason to stop studies attempting to use it). Better regulation as a controlled substance is probably the best solution (i.e. enforcing the 2-3 month rule by only allowing MDMA to be purchased at those intervals).

I wouldn't put too much stock in these Reddit testimonials. I agree, there are definitely cases where individuals have used MDMA chronically, but I believe the percentage is much, much less than 1% of users.

There are also cases of individuals who believe they need to eat glass on a daily basis.

Anyone can convince themselves of anything if they want to believe it badly enough. I would be willing to bet that most of these chronic users would not exist in the first place had they sufficient knowledge about the drug.

> I've heard of many people abusing MDMA, with daily use for long periods of time (all of which have reported memory issues and other permanent problems)

I've heard of many people abusing alcohol, with daily use for long periods of time (all of which have reported memory issues and other permanent problems).

Still legal though.

1. You are correct about the potential for long term damage. However the evidence I have seem indicates the permanent damage is due to neurotoxicity while the serotonin is depleted, while the serotonin depletion itself is temporary. Contrary to other posts here, the serotonin depletion can last in the order of 2 years, however, although this is usually in extreme cases.

2. When speaking about potential for abuse, it's worth making a distinction between drugs which cause dependency and/or chemical craving, and drugs that don't. You can develop habits without dependence or craving, but that can apply to almost anything, and is much less of an indicator that the thing is harmful. MDMA certainly had Prentiss for habitual use, usually as part of a multiple-drug-abuse condition, but in and of itself does not have dependence or craving properties.

Fortunately, both of your arguments make clear the need for more research, and thankfully it's finally happening.

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