Tolerance to ecstasy

While tolerance to ecstasy is uncommon, it can occur in regular or high doses users. More on the phenomenon of tolerance here, with a section for your questions at the end.

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As with any psychoactive drug, a user can build up a tolerance to ecstasy. But how and why does tolerance occur and how is tolerance different than physical dependence on ecstasy? More here, with a section for your questions or comments about tolerance as a sign of addiction to ecstasy at the end.

Developing tolerance to ecstasy

The phenomenon of tolerance occurs when you take a drug regularly and need larger and larger doses to achieve the same initial effect. While tolerance to ecstasy is fairly uncommon, lab studies on animals have shown that regular or long term use of ecstasy can develop tolerance to MDMA (the main psychoactive ingredient in ecstsay) and its reinforcing effects. Additionally, chronic tolerance and bingeing are statistically linked to higher rates of drug-related psychobiological problems. Why does tolerance to ecstasy happen?

The underlying mechanisms of how and why users develop tolerance to ecstasy are currently unclear. Several traditional processes are probably involved, but one of the possible causes is a novel mechanism largely unique to amphetamine derivatives called “serotonergic neurotoxicity”. In this condition, deficits in a wide range of bio-behavioral functions with a serotonergic component occur and can affect memory and cognitive skills.

Ecstasy tolerance: How long?

How long does it take to build a tolerance to ecstasy? At the moment, researchers are still learning about the timeline of MDMA use and how long it takes to build tolerance. But they think it’s related to dosing, especially stacking or boosting several doses one on top of another. While regular users typically take 2-3 tablets during an ecstasy session, the most experienced users may take 10-25 tablets in a single session. And after a period of repeated bingeing (a series of 4 days per month or more), researchers estimate that tolerance effects can begin.

Ecstasy tolerance symptoms

What are the main symptoms of ecstasy tolerance? Prolonged cognitive and behavioral effects can occur when you build up tolerance to ecstasy. In fact, specific symptoms may occur if you become tolerant to MDMA and can include poor memory recall, flashbacks, panic attacks, psychosis, and depersonalization due to serotonergic neuron damage and decreased serotonin production as a result of long-term use.  Additionally, there is extensive evidence for chronic pharmacodynamic tolerance to recreational MDMA. However, when considering use of ecstasy in general, two areas of toxicity are of concern: these are acute systemic toxicity and neurotoxicity of MDMA.

1. Acute systemic toxicity refers to the acute severe reactions that occur occasionally, and that may lead to hospitalization or even can be fatal. It is now well recognized that a greatly increased body temperature plays a pivotal role. Control of body temperature is therefore the most important means in preventing the severe reactions to MDMA. Recently, concerns have also been raised about a possible idiosyncratic liver toxicity.  Because MDMA affects major organs of the body, it is not only important to watch dosage, it is equally important to withdraw from ecstasy safely and under medical supervision.

2. Neurotoxicity of MDMA occurs when long term effects of MDMA take place on the serotonergic system. High doses or repeated administration of MDMA cause serotonin nerve terminal degeneration and serotonin axonal degeneration in animals. Lower doses result in changes, usually decreases, of serotonin neuronal markers, amongst which reduced serotonin brain tissue levels, reduced density of the serotonin reuptake transporter protein, and reduced activity of tryptophan hydroxylase. It is unclear if the changes that are observed after administration of low doses of MDMA are of a neuromodulatory nature, or if these are a reflection of neurodegenerative processes, or if it is a combination of these two possibilities.

Questions about ecstasy tolerance

Do you still have questions about developing tolerance to ecstasy? Please leave your questions in the comment section below. We’ll do our best to respond to you promptly.

Reference Sources: NHTSA: Ecstasy
NCBI: Chronic tolerance to recreational MDMA (3,4-methylenedioxymethamphetamine) or Ecstasy
NCBI: Tolerance to 3,4-Methylenedioxymethamphetamine (MDMA) in Rats Exposed to Single High-Dose Binges
NIDA: MDMA/Ecstasy Research: Advances, Challenges, Future Directions A Scientific Conference
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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