Here are some brief summaries of research articles from all over the world confirming understanding on preventing MDMA-induced long term damage. They are organized into the following categories:

• Antioxidants & Supplements for Prevention
• Environmental Factors - Temperature, Set and Setting
• Stress Levels and Physical Exercise
• Current guidelines - Dosing, Amounts, How often....
• MDMA-induced Damage and Risks
• Harm Reduction Strategies
• Capitalizing on the Benefits of MDMA

Antioxidants and Supplements for Prevention

Multiple Studies on rodents from around the world confirm that taking antioxidants 30 minutes before and 5 hours afterwords prevents MDMA-induced damage

• Alpha Lipoic Acid
  • Research from the University of Navarra in Pamplona, Spain highlights the neuroprotective effects of Alpha-Lipoic Acid (ALA) in preventing serotonin depletion and glial activation from MDMA exposure.
• Acetyl-L Carnitine 
  • Research from Portugal highlights the neuroprotective effects of Acetyl-L-Carnitine (ALC) in preventing mitochondrial toxicity from MDMA.
• Coenzyme Q10
  • A 2005 study from the University of Cincinnati suggests that niacin and coenzyme Q10 may help counteract MDMA-induced damage
• Pycogenol (French Maritime Pine Bark Extract) - Aescin (Horse Chestnut) - Centella asiatica (Gotu Kola)
  • Published in 2019, authors from University of Lodz, Poland review potentials of pycnogenol, Gotu Kola and other flavonoids to prevent inflammation and chronic venous insufficiency.
  • Published in 1998 from the University of California - here is a review on pycnogenol and its influence on nitric oxide regulation
• Fructose & N-acetyl-L-cysteine
  • A study conducted by researchers at the University of Tokyo in Japan investigates how fructose and N-acetyl-L-cysteine (NAC) can protect against the hepatotoxic effects of two psychoactive compounds, 5-MAPB and MDMA, in rat liver cells.
• Grape Seed Extract
  
  • A 2019 study from Poland University of Lodz published in Nutrients investigated the potential anticoagulant and antiplatelet properties of grape seed extract (GSE).
• Magnesium
  • A comprehensive examination from University of Adelaide in Australia delves into the multifaceted role of magnesium in mitigating addiction
• Stevia
  • Researchers from Egypt and Saudi Arabia published this study in the African Journal of Traditional, Complementary and Alternative Medicines, exploring stevia extract’s antibacterial and antioxidant effects.
• Vitamin B3 (niacinamide)
  • Researchers from the University of Cincinnati (2005) found that niacin and coenzyme Q10 may help counteract MDMA-induced damage
• Vitamin B12
  • A 2018 study from Iran investigated the potential neuroprotective effects of vitamin B₁₂ against methamphetamine (METH)-induced brain damage in mice.
• Vitamin C
  • Research from Sichuan University China (2006) highlights how antioxidants may counteract MDMA's neurotoxic effects.
• Vitamin D3
  • A 2018 study from Budapest, Hungary investigated the impact of MDMA (3,4-methylenedioxymethamphetamine) on gene expression in the hippocampus, focusing on the vitamin D receptor (VDR)-regulated gene set.
• Vitamin E
  • A 2001 study from the University of Cincinnati found that combining Vitamin E with MDMA helps reduce liver cell damage.
  • Researchers from Urmia University of Medical Sciences and Urmia University, Iran, published this study in the International Journal of High Risk Behaviors and Addiction, investigating Vitamin E's protective effects against MDMA-induced reproductive toxicity in male mice.

MDMA-induced Damage and Risks

Several systems have shown to be at risk to MDMA-induced damage

• Nitrous Oxide Signaling
  • A review of "the biology of Nitric Oxide signaling and MDMA" From the "Handbook of Substance Misuse and Addictions" whose authors are from Spain.
• Hyperthermia (Overheating) - Hyponatremia (low sodium/electrolytes) - Hypertension (High Blood Pressure) - Kidneys
  • From the "Iranian Journal of Basic Medical Sciences", 2016 - A brief look at how MDMA (Ecstasy) can cause acute kidney injury (AKI) through dehydration, hyperthermia, and muscle breakdown.
• Free Radical Damage - Liver - Heart - Brain - Mitochondria

  • A review of the MDMA-induced damage from "Current Pharmaceutical Biotechnology" 2010, written by a Maryland collaboration 

• Cardiovascular System
  • A 2022 case series from St Thomas' Hospital, London, UK published in Research and Practice in Thrombosis and Haemostasis reported five instances of coagulopathy following the use of MDMA (3,4-methylenedioxymethamphetamine), commonly known as ecstasy.
• Serotonin Syndrome and Serotonergic Injury
  • Sydney, Australia; 2007—Researchers from the University of New South Wales conducted a qualitative review to assess the risk of serotonin syndrome associated with the concomitant use of ecstasy (MDMA) and other serotonergic substances, establishing a hierarchy of risk for clinicians.
  • Boca Raton, Florida; 2017—Researchers from Florida Atlantic University and Ross University School of Veterinary Medicine examined how non-drug environmental factors, such as ambient temperature and physical activity, influence the severity of serotonin syndrome induced by MDMA (Ecstasy) use.
  • Melbourne, Australia; May 22, 2024—Researchers from Monash University have published a comprehensive review detailing critical information pharmacists need to know regarding 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy, especially following its approval for treating post-traumatic stress disorder (PTSD) in Australia.
  • A German and USA collaboration published in Behavioural Brain Research, 2013 - A systematic review of animal models of serotonin syndrome

 

Capitalizing on the Benefits of MDMA

• Social Emotional Benefits
• Reorganizing Traumatic Memory and Pathways
• Reopen the Critical Learning Period

Harm Reduction Strategies

• A Scoping Review 2024 from Australia on People Who Use MDMA and Their Harm Reduction Practices

• Boca Raton, Florida; 2019—A study conducted by researchers from Florida Atlantic University and Ross University School of Veterinary Medicine investigated how varying doses of MDMA (Ecstasy) and environmental conditions influence the onset and severity of serotonin syndrome and subsequent serotonergic injury in rats.