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E for Ecstasy
by Nicholas Saunders

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Chapter 11: Suggestions for first time users This chapter is not an encouragement to take Ecstasy. It is an illegal drug and in some situations can be dangerous. These suggestions are included for the benefit of those who have already decided to take Ecstasy, so that they may get the best out of it and reduce the dangers to a minimum.

Health First check on your physical condition. MDMA puts extra strain on the body, so you should be healthy and rested. In particular, your heart, liver and kidneys all have to work harder. If you have ever suffered from jaundice(106), you may have a weak liver. If you have doubts about your body's ability to deal with the extra strain, then have a check up. Avoid taking MDMA if you are on antidepressants of the MAOI type(107, 127) (The SSRI type are OK but you may feel no effect.(142)) You may want to follow the more thorough screening code used in therapy by Dr. Greer.(99) If you are especially sensitive to other drugs (such as Contac, sold for colds), then you may also overreact to MDMA and you should first see the effect of a very small dose.(141, 178)

Your mental health is equally important, and rather more difficult to assess. If you are unsure of this, or have doubts about being stripped bare of your image, then you should avoid taking psychoactive drugs.

It's probably wise to stay off MDMA if you are pregnant(58), although trials show that it does not harm the offspring of rats.(108)

Situation Find a situation where you feel good. If you enjoy large parties and clubs, a rave could be ideal especially if you are with friends. Taking Ecstasy with a lover can be wonderful, but avoid being with people you are not sure of, especially someone you are emotionally attached to but have doubts about unless you are prepared to use situation explore your relationship. The ideal home setting for taking Ecstasy is a spacious room where you feel secure and can let yourself go without arousing the neighbours.

Alternatively it can be nice to take E outdoors in warm weather and pleasant familiar surroundings. It's important to feel free to express yourself without inhibition or interruption, so choose a place where you will not be seen or overheard.

Looking after yourself If you have any doubts at all, take a very small dose and wait an hour (the time it takes to come on) before deciding whether to take more. Half a dose is quite enough for many first time users, especially women and small people. Drink plenty of water or fruit juice (except black currant(141)) but avoid alcohol and other drugs, and if you are dancing, realise that you may be dangerously overheated even without feeling uncomfortable. Look after friends and get them to look after you. The ultimate precaution would be to use a forehead thermometer, a plastic strip that changes colour with temperature, sometimes available free from Boots to promote their own-brand medicines.

Taking vitamin C and E may help to reduce exhaustion.(36) Get good sleep afterwards.

Folklore has it that calcium and magnesium help prevent jaw clench (and even toxicity). This was suggested in 1984 and has been repeated in popular writings on Ecstasy(7), but is not supported by medical evidence.

Guide If you decide to take Ecstasy at home, choose a guide who is thoroughly familiar with its effects, and who you can trust completely, to look after you. Although a lover may seem the obvious choice, taking E with someone you are intimate with carries risk that you may 'see through' your relationship or reveal hurtful things to each other. The ideal choice is someone who you know well and have no conflicts with; someone you feel you do not have to impress, and to whom you are happy to reveal your needs and failings.

Preparations Ensure that you will not be disturbed by visitors or by the telephone. Make sure there are comfortable places to sit or lie down. Have plenty of fruit juice and plain water on hand to drink and some chewing gum to chew in case of jaw clenching. Wear loose, light clothing but have extra clothes and a downy or blanket to hand in case you need to warm up. Line up some of your favourite music, both for dancing and as a pleasant background. Bring some personal objects that you are fond of - things to handle and look at, or perhaps some photographs of people you are fond of. A mirror could be useful for looking at yourself. A tape recorder and camera or video camera can be fun and help to you relive the experience later, but, if you don't have access to these, have a pen and paper ready in case you have the urge to make notes. Earplugs and a blind like the ones used by people who want to sleep on planes can be useful, too. Finally, make the space attractive: have nice things to look at, smell and touch - such as flowers, essential oils and silk.

You really don't have to plan anything for the trip itself; just let it happen and 'go with the flow'. But a guide can help you sample a range of pleasant experiences that you would otherwise miss, as there is a tendency to get absorbed in one aspect of the drug's effect and to be reluctant to switch to something else.

Timing The full effect of the drug only lasts for three or four hours, but you should allow a minimum of eight hours and it is best to reserve a whole weekend free of committments.(43) This allows you time after the trip to go over your experiences with your guide. This is usually really enjoyable and can be particularly valuable if anything came up during the trip which needs resolving.

If you can't take more than one day off, start reasonably early in the morning so that you will have plenty of time with your guide after the trip before going home to get a full night's sleep. If you can't allow yourself a whole day, then start early one evening and make time to discuss the experience the next day.

Rules Establish with your guide a clear set of rules for the trip. You may like to keep the rules used in therapy(28), or you may like more relaxed rules such as confidentiality, no sex and no activity that could be destructive or draw attention from neighbours. It's a good idea to write down the rules so as to be quite clear.

Notes for guides To be a guide is usually a delightful experience, but it is a responsibility that must be taken seriously. Take time beforehand to find out the aims and expectations of the person you are to guide. You should not only ask them whether they are sufficiently fit and free from emotional problems to take Ecstasy, but also judge for yourself. It's not a good idea to play the guide to someone who is looking for something to 'cure' them unless your are an experienced therapist. But however well you vet people, difficulties can still arise and you must be prepared to deal with them. People used to taking E at raves may react differently when they take it with only their guide for company.(32)

Obviously it is important to make the venue pleasant and free from interruptions, but it is also important to show that you put care into the preparations. As one person remarked, "When I arrived and saw how much care and attention had gone into preparing for my trip I immediately relaxed as I knew I was going to be well looked after". Present yourself as a servant and as a committed supporter.

It is also important that you give the expectation of a wonderful time. If you show signs of worrying, this may make your friend look for something to go wrong with the trip; if you are enthusiastic and expect your friend to have a wonderful experience, you will help to bring this about.(109) Discuss beforehand what the purpose of the session is. If it is just for fun and to experience the effects of the drug, you can offer to give a 'guided tour' of the effects from looking inside to dancing and perhaps a walk outdoors. But maybe the person wants to explore something about themselves, in which case the guide's job is to simply 'be there': to provide security by giving reassurance when appropriate and to be available to talk to, typically as the effects wear off. Side effects very often manifest as a result of emotional problems, and it may be helpful to suggest looking at the underlying cause. People who become 'stuck' can be supported in what they are feeling, and if it is uncomfortable, reminded that they will become unstuck as the drug wears off.