Psychedelics: Know the risk of women with MDMA – 27/08/2023 – Virada Psychedelica

The risk of hyperthermia (overheating) with MDMA in the club is well known. Fewer people will have heard of hyponatremia, dangerously low levels of sodium in the body that seem to affect young women more and can be made worse by drinking water to combat overheating.

The alert appears in the review article “Women and MDMA: Particularities of Gender and Sex”, published on the 23rd in English in the journal International Review of Psychiatry. The authors are Brazilian: Fabio Carezzato, Ilana Falcão de Arruda, Caio Petrus Monteiro Figueiredo and João Mauricio Castaldelli-Maia.

The group of medical researchers works in the area of ​​psychiatry at the Faculty of Medicine of USP. Psychiatrist Carezzato has been working with problematic drug use by women for a decade and coordinates an outpatient clinic that cares for them at FMUSP’s Instituto Perdizes, on Rua Cotoxó.

He says he decided to carry out a broad review of the subject after being approached by journalists, at two carnivals in a row, to talk about the effect on women of MDMA (the base of ecstasy, also known as candy). In these interviews, the focus was already on hyponatremia.

Cases of low sodium levels after consuming MDMA are rare, but it is not ruled out that the symptoms lead to serious conditions. Nausea, vomiting, headache, confusion, lethargy, and seizures may progress to encephalopathy, cerebral edema, and, exceptionally, death.

In order not to cause panic among young people who use MDMA with some frequency, it should be noted that in the United Kingdom, where more than 750,000 people use the drug every weekend, complications after consuming ecstasy cause less than four deaths per year. A small risk, comparable to dying from being struck by lightning (two occurrences per year).

The number of MDMA deaths varies from 1 to 17 per year in other countries, but there is no data for Brazil. A survey in California indicated that, from 2000 to 2005, only 73 cases of documented hyponatremia could be related to MDMA use, of which 55 occurred in women.

“I believe that it would be very important to evaluate a larger number of women, due to their susceptibility both to the therapeutic and side effects of MDMA. Most of the studied population is made up of reserve military men”, says Carezzato, referring to clinical tests with the substance in psychotherapy for post-traumatic stress disorder (PTSD).

MDMA is the psychedelic in the most advanced stage of studies for therapeutic use. The US drug agency FDA is expected to receive final data from phase 3 clinical trials later this year, and its authorization to support psychotherapeutic treatments for PTSD is expected by 2024.

Many researchers prefer to call MDMA an empathogen, or entactogen, due to its ability to induce closeness with other people and with oneself (trauma included). The drug acts not only on the serotonin circuit, like the classic psychedelics DMT (ayahuasca), LSD, mescaline (peyote) and psilocybin (mushrooms), but also on oxytocin, a hormone involved in the formation of social and loving bonds.

In the article, the literature reviewed indicates that girls seek drugs such as MDMA to deal with negative emotions. Boys, on the other hand, usually start with peer pressure or attraction to strong sensations.

On the other hand, they have more adverse effects, such as anxiety. They are also more likely to contract sexually transmitted diseases when giving up condoms in an altered state of consciousness.

Physiologically, they seem less likely to develop hyperthermia and more vulnerable to hyponatremia. This difference between the sexes appears to be mediated by hormones such as estrogen.

Ilana Falcão de Arruda, a third-year student in the psychiatry residency, tells that one of the most important internships for her took place in the Program for Chemically Dependent Women (Promud) at the Institute of Psychiatry at FMUSP, when she was able to see up close particularities of substance use in women , both from a biological and psychosocial point of view.

“As a woman, the broader issue of the lack of scientific investigation into differences between sexes and between genders in responses to substances, whether abused or drugs, has always caught my attention and concerned me”, says the co-author of the article. She cites a 2019 Lancet review, according to which 8 out of 10 drugs withdrawn from circulation between 1997 and 2001 were more harmful to women than to men.

Psychiatrist Carezzato points out that cases of hyponatremia only started to appear in the history of recreational use of MDMA, and suddenly, after harm reduction actions were implemented by encouraging water intake to avoid hyperthermia. Dancing and sweating a lot, the levels of sodium in the organism were continuously lowering.

It is the classic unintended effect of a positive measure: hydration counteracts overheating and, at the same time, increases the risk of hyponatremia. Once configured, this can be treated with an intravenous injection of 100 ml of 3% sodium.

As for its concomitant prevention with that of hyperthermia, a recommendation would be to consume isotonic liquids instead of water. Ilana Arruda considers, however, that commercial drinks of this type tend to have a lot of sugar, which can contribute to dehydration.

She points out that there are simpler and more guaranteed measures: not drinking more than a liter of water per hour, not combining it with alcohol and making salty snacks. And, if possible, take breaks and leave the dance floor from time to time.

As for the eventual licensing of MDMA for post-traumatic stress, the doctor says that it is possible that there is a difference in the effectiveness or safety of the treatment for men and women, so that the choice of dose, for example, may be influenced by factors related to the biological sex. “It would undoubtedly be important for the FDA to require evidence of safety in both sexes independently.”

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NOTICE TO NAVIGATORS – Psychedelics are still experimental therapies and certainly do not constitute a panacea for all psychic disorders, nor should they be the object of self-medication. Speak with your therapist or doctor before venturing into the area.

On the tendency to legalize the therapeutic and adult use of psychedelics in the US, see the article “Cogumelos Livres” in the December 2022 issue of Piauí magazine.

To learn more about the history and new developments of science in this area, including in Brazil, look for my book “Psiconautas – Viagens com a Ciência Psychedelica Brasileira”.