Information Sheet from INPUD –
The International Network of People who Use Drugs
Issue 1, October 2013
WARNING! PMA Contaminated Ecstasy and MDMA Alert
for MDMA and Ecstasy Users
Deaths caused by ecstasy contaminated with the drug para-Methoxyamphetamine (PMA) have increased substantially over the last two years. The Office for National Statistics records no PMA deaths in 2008, 2009, and 2010 in England and Wales, up to a recorded one death in 2011 to around twenty deaths in 2012. This trend has continued into 2013. There have been media and police reports that in recent months, a man has died in Manchester, with several people additionally requiring hospitalisation, and there were more reported deaths in Manchester towards the beginning of the year; in addition, at least two people have died this year in Cheshire, further people have died in the North of England, in Oxford, and in Hampshire, and we aware of numerous people who have mistakenly taken PMA in London. Deaths have been recorded in England and Wales, Northern Ireland, Scotland, the USA (several states), Canada, Denmark, Norway, and Australia.
If you use ecstasy and/or MDMA, you cannot afford to think of this as one of those things that happens to other people. There is lots of misinformation going around, and people using uppers, ecstasy, and MDMA need some straightforward facts.
What is PMA?
PMA is a dangerous compound. Using it has substantial negatives, not the least of which are high morbidity and high mortality, and there is little by way of psychoactive positives to justify these downsides. This is different from uncontaminated MDMA, which is substantially safer to the individual using the drug than many other psychoactive substances, including alcohol and tobacco (its Class A status is nonsensical as an indicator of harm).
Most people are not deliberately buying and taking PMA in greater numbers; instead the ecstasy they are using, the active ingredient of which is ideally MDMA, has been contaminated. The reasons for this contamination are unclear, but it is possible that a precursor to the synthesis of PMA is easier to acquire than a precursor to MDMA.
Regardless of the reason, the fact is that people are dying due to taking a drug they did not intend to take.
Is PMA ‘stronger’ than MDMA?
No. The UK’s government-run ‘Talk to Frank’ website, as well as other websites andnewspapers including the BBC’s Newsbeat website and the Daily Mail’s website, irresponsibly and erroneously note that PMA is much “stronger” than MDMA. This suggests that psychoactive effects are greater, more potent, and/or more enjoyable that MDMA. This is dangerous misinformation, and could lead to people deliberately seeking out this enormously dangerous substance.
PMA is not ‘stronger’, but it is more toxic and dangerous than MDMA. Though it causes the release of serotonin (like MDMA), it actually releases less serotonin into the body than MDMA, meaning there are less euphoric and energetic effects.
Instead, PMA works by preventing your body’s reabsorbing serotonin. This can lead to dramatically increased body temperature, heart rate, and toxicity. This is especially true if you are taking anti-depressant or anti-anxiety1 medication (such as SSRIs and MAOIs), which already affect your serotonin system.
Is it worth the risk of taking PMA?
Almost certainly not. The psychoactive effects of PMA at small doses are variable. It can feel similar to a small amount of MDMA (a little bit of euphoria, love, chattiness, enthusiasm); however, there are reports of it actually feeling like the opposite of euphoria – foreboding and general unpleasantness. We have heard reports of confusion, grogginess, feelings akin to drunkenness or having taken a small amount of ketamine, feeling unusually hot, or feeling nothing at all. A room full of people who have taken it can have variable experiences, and toxic doses are low (there are reports of as little as 50-60mg being toxic).
If I take more, will it improve my experience?
Taking (even a bit) more PMA does not increase the positives; it does considerably increase the risk of you dying. There is a knife-edge difference between feeling slight psychoactive effects (or no effects) and overdosing (possibly as little as 10mg). Bluntly, it is not a forgiving or rewarding drug.
From the initial psychoactive impacts (which range from slight and banal, to uncomfortable and disturbing), the switch to potentially fatal serotonin syndrome can be rapid upon even slightly increasing your dose.
Symptoms of PMA overdose include hyperthermia (overheating), high blood pressure, a fast heart rate, and seizures/convulsions. Other complications can include bleeds in your brain, muscle breakdown, and (resultant) kidney failure.
In short, people are becoming far too hot, are collapsing, and are dying, and this is all happening pretty quickly on fairly low doses (taking as little as 1.5 or two pills of contaminated ecstasy, for example, though there are reports of as little as half a pill being toxic). If you suspect symptoms of overdose you should get to hospital fast.
1 Though some anti-depression/anxiety medication (such as SSRIs and MAOIs) can exacerbate the dangers of PMA, benzodiazepines like diazepam (valium), which can also be used to treat anxiety, are sometimes prescribed in a monitored environment to those experiencing adverse effects of PMA. However, it is dangerous to give these in a non-medical context due to the likelihood of becoming sedated and unresponsive.
Why are people taking such a dangerous drug?
Few people take PMA intentionally. Instead, they believe they are buying and using uncontaminated ecstasy or MDMA (with the former ideally containing predominantly the latter). However, due to prohibition these drugs are produced in a black market context where there are no mechanisms to monitor and control the safety of their production and content. Thus, substances purporting to be these drugs (like PMA) can be produced and sold instead. This is what is resulting in harm in this context.
These people have not died because of the harms of MDMA; it is prohibition that has resulted in these unnecessary deaths.
What can I do to avoid the harms of PMA?
If you want to be entirely sure that you do not mistakenly take PMA you need to stop taking MDMA and ecstasy. Taking drugs that have been produced in an illegal context, it is practically impossible to guarantee the purity of drugs without fairly involved testing equipment. The only way to guarantee that you don’t mistakenly consume PMA is to avoid illicitly produced drugs altogether.
This is unhelpful advice (though it is regularly given out), however, the fact of the matter is that people will of course carry on using ecstasy, MDMA, and other illicit drugs.
So how can they do so more safely? Avoid contaminated pills?
Unfortunately, people who use and sell drugs alike, by and large, have little to no idea what they are taking and/or selling, and it is a sad irony that it is prohibition itself that causes and exacerbates so many of the harms surrounding drug use. Not only has prohibition resulted in people mistakenly taking toxic drugs, but the British Government has failed to roll out pill testing and drug purity/content testing facilities, as are available in The Netherlands. An attempt in recent weeks in Manchester at pill testing of confiscated drugs accompanied by an announcement of pills to avoid is simply not enough: this only highlights some pills to avoid, not what the content is of the pills you are intending to take. Though the Government’s ambition is to abolish drug use, this is irrelevant to the fact that people are currently using drugs and people are avoidably dying from contaminated drugs.
“High quality, accessible drug content testing
could have cheaply prevented these deaths
from PMA overdose.”
You can buy testing kits yourself, but these can be unreliable and inaccurate, and may not identify PMA; they may also identify MDMA presence in a pill that also contains PMA without necessarily indicating the presence of the latter. We are aware of plenty of cases where testing kits did not do what they claimed to.
A cursory survey of online forums, newspaper reporting, and contacts of the authors reveals the following pills to be problematic: pills with a Rolex logo; Mitsubishi logo; Chanel (in print, or variations, such as Chanl). This is by no means a definitive list, and the variability and mutability of the culprit pills tells us that no pills should be considered safe, irrespective of who you buy them from. There are reports of people buying pills from contacts of many years that have contained PMA.
2: Switch the uppers you use?
In the context of PMA contamination, some MDMA and ecstasy users are now taking other uppers. Some people may not mind a switch to mephedrone or methylone, for example (unlike PMA, methylone is similar in feeling to MDMA, and is far safer than PMA). Please bear in mind that these drugs have their own risks, and are argued by some to be more detrimental than uncontaminated MDMA; they are certainly, however, less dangerous than PMA, and we are not aware of them being contaminated with PMA similarly to ecstasy.
3: When taking MDMA or ecstasy…
If you are going to take ecstasy or MD that you are unfamiliar with, avoid taking a whole pill, and absolutely do not double drop.
Start with a half, or even a quarter of a pill (this sounds tame and dull, and of course you want a lovely come-up, but even small amounts of PMA can be dangerous).
Wait for a while to feel any effects – PMA can take longer to have an effect, so don’t be tricked into upping your dose. Wait for an hour; if nothing has happened, wait for two hours.
The same applies if you are bombing MDMA – halve your usual dose (a 16th of a gram instead of an 8th for a first bomb).
If you are snorting MD, have a far smaller line and wait for a while to see what it does.
If it feels different from what you are expecting, or if you feel nothing after a long wait (which you should not from a decent MDMA pill), do not take any more in the hope that increasing the dose will increase the positive psychoactive effects. Do not take any more MDMA-related products either: far from improving your experience, MDMA can add to the negatives and dangers of PMA, and increase the chances of overdose, serotonin syndrome, and death.
To reiterate, if you think you, or anyone that you know, may have taken PMA, or if you/they start feeling hot (and don’t quickly cool down), confused, or sick, get yourself/them to the hospital immediately.
Symptoms and serotonin syndrome may escalate rapidly and you can quickly become incapacitated, and the earlier treatment is started for overdose the better the outcomes; the best idea would be to call an ambulance immediately and let someone trusted (and preferably nearby) know that you may be having difficulty.
The faster you get help, the better your chances.
Dr Jay Levy, Dana Smith, Dr Celia St. John-Green