While MDMA has an excellent safety record (far better than that of alcohol or cigarettes), there are some medical conditions that might make you a poor candidate for use.

 

Physical Health Concerns

      The primary concern is cardiovascular health. MDMA produces a moderate increase in blood pressure and pulse, and, because of its stimulant qualities, encourages physical activity (dancing, walking, etc.) While these effects are no danger to a reasonably healthy person, not everybody fits into that category.

     A good general question might be "do I have any medical condition that would make going for a long brisk walk likely to harm me?" Specific conditions to be aware of:

Heart Disease: There have been several deaths from people who had serious preexisting heart disease (coronary artery blockage) and took MDMA.

Severe Asthma/lung disease: One death has been reported in an asthmatic who was using MDMA. It's not clear what affect the victim's drug use played. Again, if you aren't sure if you can survive a few hours of mild to moderate exercise (such as walking, biking), don't use. (Several asthmatics report that MDMA actually helps their asthma, which isn't entirely unreasonable since, like epinephrine 'rescue' inhalers, MDMA causes vasoconstriction.)

Suppressed Immune System: MDMA, like many drugs, places a strain on your body, including the immune system. For healthy people, about all that means is a slightly increased risk of catching a cold or such the day of/after use. For people who's immune systems are not normal (due to AIDs, anti-rejection drugs used for organ transplant patients, etc.) the additional strain on the immune system could be dangerous. No deaths or serious illnesses have been reported that I know of, but such cases could easily be overlooked by doctors (since infections in immunocompromised patients are expected and might not be traced to drug use.)

Diabetes: On the one hand, insulin-dependant (Type 1) diabetics have reported successful and uneventful use of MDMA. On the other hand, there have been several reported cases of serious ketoacidosis in young Type 1 diabetics that had spent hours dancing and had not taken any insulin for 12-24 hours.[1] If you are insulin-dependant and plan to use MDMA, do so at home (or in an otherwise controlled environment) and keep an eye on blood sugar levels.

Pregnancy: The effects of MDMA on a developing fetus are not well known, although there is some evidence that it could increase the risk of birth defects (as does alcohol and amphetamines.) Using MDMA while pregnant may increase the risk of harm to the fetus and lower birth weight. MDMA is also excreted in breast milk; women who are nursing should avoid drug use.

Allergies: There has been a rumor that having an allergy to penicillin (or related antibiotics) means you could have an allergic reaction to MDMA. This concern is baseless; the two drugs are far too different for an allergy to one to translate into an allergy to the other. There are also no known cases of anybody ever having had an allergic reaction to MDMA.  (It's probably too small of a molecule for the immune system to react to and cause an allergy.)

 

Mental Health Concerns

Depression: While a depressed person is unlikely to be at any greater medical risk than a non-depressed person, they are almost certainly at higher risk of becoming compulsive in their use (since MDMA is a powerful antidepressant, providing temporary relief from their symptoms.) Unfortunately, the temporary impairment of the serotonin system following MDMA use can make depression worse, causing a destructive cycle of taking MDMA to feel better and ending up feeling even worse when the high fades.

     On the other hand, MDMA has also been known to snap people out of depressed states and allow resolution of emotional problems. If you are depressed and want to try MDMA, beware of the temptation of frequent use. If you start having serious drug cravings, talk to a doctor about how you feel. Antidepressants (like Prozac, Paxil, and even 5-HTP) can provide some of the emotional relief of MDMA with far less side effects and disruption of your life. MDMA is a wonderful place to visit, but you're in for trouble if you try to live there. Common antidepressants such as Paxil, Zoloft, and Wellbutrin interfere with how MDMA works, reducing it's potency.

Psychotics: If hearing voices in your head telling you that aliens are plotting against you is a normal occurrence for you, I don't recommend any sort of stimulant drug. I'm aware of a single case of a person with no known previous history of mental illness becoming temporarily psychotic within 12-24 hours of using MDMA (he believed he was part of an elaborate role-playing game that required him to smash people's car stereos.) The patient had also been drinking heavily. The doctors who treated this patient suggested that the reduction in serotonin levels following MDMA use caused a reduced inhibition of the dopamine system, with the MDMA-elevated levels of dopamine activity triggering an underlying vulnerability to psychosis.[2] A strange and unclear case, although the theory offered seems reasonable.

Schizophrenia: Schizophrenics probably should not take MDMA. I'm not aware of MDMA use being associated with the development of schizophrenia in people with a family history of schizophrenia. That doesn't mean it can't happen...just that I've never heard of it. (Question asked on Dancesafe.)

Epilepsy: There have been sporadic reports of seizures associated with MDMA use; epileptics are almost certainly at greater risk.

 

General Health

 

     MDMA should be avoided if you are tired or otherwise not feeling well, not out of medical concern but simply because you might not enjoy the experience. MDMA is not amphetamine–it does a poor job of waking you up. If you are very tired and take MDMA, you'll probably be very tired and on-edge when the drug kicks in. It's not much fun; better to wait until you feel up to a big night. Likewise, if you take MDMA while sick (colds, etc.) the additional strain may make the illness worse or prolong recovery.

 

On to The Drugs (Pill testing and drug interactions.)

 

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[1] Seymour HR, Gilman D, Quin JD "Severe Ketoacidosis Complicated by 'Ecstasy' Ingestion and Prolonged Exercise" Diabet Med, 1996; 13(10):908-9. Abstract.

[2] Vaiva G, Boss V, Bailly D, Thomas P, Lestavel P, Goudemand M "An 'Accidental' Acute Psychosis with Ecstasy Use" Journal of Psychoactive Drugs, 2001; 33(1):95-8. Abstract.