Is plugging ecstasy a safer alternative?

Dear Unplugged in NY, 

It may be time to plug up some of the misconceptions around plugging ecstasy. Ecstasy (E), or N-methyl-3,4-methylenedioxyamphetamine (MDMA), is a synthetic drug that’s commonly used at parties and raves because of its pleasurable and arousing effects (there’s a reason it’s called the “hug drug”!). In fact, ecstasy was commonly used by therapists and marriage counselors in the 1950s as a way for patients to increase their ability to get in touch with their emotions. There are many types of ecstasy, although people who use ecstasy typically take it orally through pills or powder. There are risks associated with taking ecstasy regardless of method of insertion, such as nausea, increased body temperature and blood pressure, muscle tension, and dehydration. It’s possible that these side effects are exacerbated if ecstasy is inserted anally through plugging, and plugging may also increase the risk of overdosing. It's difficult to say which method is "safer" because there is little scientific research on the topic. For more information on the biological mechanisms of plugging ecstasy, read on! 

Plugging, or inserting drugs such as ecstasy into the anus, can give the same sensations as taking the drug orally (through the mouth). Effects may be experienced more quickly when substances are inserted anally because the walls of the colon allow the substance to be absorbed more quickly into the bloodstream than the walls of the stomach. The effects of ecstasy usually hit their peak around 90 minutes after being taken and wear off around three to four hours later — this timeline may be sped up when plugging. While the effects of ecstasy may be experienced more quickly, they also wear off more quickly than if taken orally. There could be a greater risk of overdose when inserting anally because more drug is taken to perpetuate the effects, despite the fact that your body is still processing the previous dose. There’s some evidence to suggest the effects will be stronger because bypassing the stomach avoids the body's customary initial digestive process. Taking E orally sometimes causes nausea. For those with a sensitive stomach, taking drugs anally may result in fewer stomach problems.  

The method of ingestion won’t make a difference in damage to the liver. The liver's job is to filter toxins (such as ecstasy) out of the blood. Drugs end up in the bloodstream whether they enter from the mouth or the anus, so there’s no way to "bypass" the liver or digestive tract. In fact, the more concentrated doses that the liver receives from ecstasy inserted anally may be more intense and cause more damage to the liver. The increased potency is what may contribute to the more intense high experienced more quickly for people who plug versus swallow ecstasy. People with hepatitis or other liver ailments may be especially vulnerable to liver damage from using E.  

Potential dangers from plugging include damage to anal and rectal tissues, which are more delicate than the stomach. If the rectal tissues are irritated, it may increase the risk of sexually transmitted infections during anal sex. Plugging is discouraged for people who experience constipation, diarrhea, any ano-rectal disease, thrombocytopenia (low blood platelet count), or poor circulation. In addition to these risks associated with anal insertion, ecstasy in general has undesirable side effects, such as muscle tenseness, increased heart rate and blood pressure, psychological effects such as confusion or paranoia, and occasionally visual impairment such as blurred vision. Many people who take E experience a period of low activity when coming down from their ecstasy high, which may encourage additional substance intake to avoid the crash. Long-term effects include internal organ damage, mood disorders, and memory problems. 

No matter through which end the drugs enter, it’s helpful to remember the following: substances sold "underground" can contain many additives and impurities, increasing the risk of adverse effects. Mixing E with other drugs on top of that, such as alcohol, increases those effects further. Most deaths associated with the use of ecstasy have been the result of heat stroke due to fluid loss from dancing in hot clubs without drinking enough water. Ironically, ecstasy can also lead users to drink too much water, causing hyponatremia, also known as water toxicity. E inhibits the body's ability to urinate, which can lead to edema or swelling of the brain. Slowly drinking two to four cups of water an hour and eating something salty can help keep the body's fluids and electrolytes balanced, whether you’re plugging or taking E orally. If taken before going to a party with a lot of dancing or activity, it may also be helpful to take breaks often to help lower your heart rate and cool your body down. 

There are risks associated with E no matter how you take it, so it would be inaccurate to call either plugging or swallowing "safer." Each person's body responds differently to substances. One route or the other may be more comfortable, or produce a better sensation, or induce a different side effect, depending on your body.