<?xml version="1.0" encoding="utf-8"?>
<feed xmlns="http://www.w3.org/2005/Atom"><title>illegitimate musings</title><link href="/" rel="alternate"/><link href="/feeds/all.atom.xml" rel="self"/><id>/</id><updated>2025-08-02T16:29:00-07:00</updated><entry><title>The Return</title><link href="/The-Return.html" rel="alternate"/><published>2025-08-02T16:29:00-07:00</published><updated>2025-08-02T16:29:00-07:00</updated><author><name>al_eberia</name></author><id>tag:None,2025-08-02:/The-Return.html</id><summary type="html">&lt;p&gt;I find it pretty funny to see that the last post is announcing a hopeful return, now over two years old. Once again the occasion is the demise of the previous server, requiring me to move everything over to a new VM. I'm still not entirely sure what happened to …&lt;/p&gt;</summary><content type="html">&lt;p&gt;I find it pretty funny to see that the last post is announcing a hopeful return, now over two years old. Once again the occasion is the demise of the previous server, requiring me to move everything over to a new VM. I'm still not entirely sure what happened to the old VM, dkpg hooks started giving errors during updated and a cursory attempt to repair it (assisted by Claude and Gemini) made things worse, leaving me to export everything I could remember off the VM before nuking it and reinstalling Ubuntu server. Shoutout to Digital Ocean's rescue ISO and &lt;a href="github.com/magic-wormhole/magic-wormhole"&gt;Magic Wormhole&lt;/a&gt; for saving me from having to regenerate my wireguard keys and rebuild my nginx confs.&lt;/p&gt;
&lt;p&gt;My documentation for the VM was pretty scattered, so I need to rediscover the &lt;a href="https://www.tangramvision.com/blog/what-they-dont-tell-you-about-setting-up-a-wireguard-vpn"&gt;wireguard tutorial&lt;/a&gt; I had originally used to find the iptables rules need to to make it correctly route traffic for my internal Pleroma VM. The lounge IRC client is still putting up a fight despite copying over the folder passed to the docker instance, but I'm pretty certain I can get it fixed. This does make me want to go through all of my self hosted infrastructure to confirm that the backups are working correctly and it's all documented. When I do so I plan on making another blog post about it. Hopefully sooner than two years from now.&lt;/p&gt;</content><category term="Blog"/><category term="Blog"/><category term="Meta"/><category term="Personal"/><category term="Pleroma"/></entry><entry><title>Not Dead Yet</title><link href="/Alive.html" rel="alternate"/><published>2023-02-11T17:00:00-08:00</published><updated>2023-02-11T17:00:00-08:00</updated><author><name>al_eberia</name></author><id>tag:None,2023-02-11:/Alive.html</id><summary type="html">&lt;blockquote&gt;
&lt;p&gt;I didn't want to add to the massive statistic of blogs with one or two cheerful posts that have languished untouched for years since&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Well, that didn't go quite as planned. I can now see why so many dead blogs litter the web, with a bight start and then quickly …&lt;/p&gt;</summary><content type="html">&lt;blockquote&gt;
&lt;p&gt;I didn't want to add to the massive statistic of blogs with one or two cheerful posts that have languished untouched for years since&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Well, that didn't go quite as planned. I can now see why so many dead blogs litter the web, with a bight start and then quickly dropping off. The blog followed a similar pattern as many other plans and hobbies I have attempted, starting off with a burst of interest and then fading away. Still, as the VPS it lives on is reaching it's end (I'm locked out of changing the expiring credit card info on it due to lost 2FA), I figured I would move it over to some existing infrastructure I have and give it a reboot.&lt;/p&gt;</content><category term="Blog"/><category term="Blog"/><category term="Meta"/><category term="Personal"/></entry><entry><title>What is the MDMA "three month rule"?</title><link href="/Three-Month-Rule-MDMA.html" rel="alternate"/><published>2020-10-19T17:28:00-07:00</published><updated>2020-10-19T17:28:00-07:00</updated><author><name>al_eberia</name></author><id>tag:None,2020-10-19:/Three-Month-Rule-MDMA.html</id><summary type="html">&lt;p&gt;What is the three month rule? Anywhere the use of MDMA is discussed on the internet&lt;/p&gt;
&lt;p&gt;The direct origin of the rule seems to be Ann Shulgin, the wife of Alexander (Sasha) Shulgin who rediscovered and spread word of MDMA to a number of therapists.&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;The only thing that has …&lt;/p&gt;&lt;/blockquote&gt;</summary><content type="html">&lt;p&gt;What is the three month rule? Anywhere the use of MDMA is discussed on the internet&lt;/p&gt;
&lt;p&gt;The direct origin of the rule seems to be Ann Shulgin, the wife of Alexander (Sasha) Shulgin who rediscovered and spread word of MDMA to a number of therapists.&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;The only thing that has happened with everyone I know who has used MDMA a great deal is that if they used it more than 4 times a year, they developed a tolerance, and after a few years, it begins to not work for them. They want to get back the magic of the first experience, and that is a mistake, because - as Sasha likes to say -- "You never step into the same river water twice. " I found out, for myself, that using MDMA more often than four times a year was not wise. I used MDMA as a writing drug for about a year. Once a week, I would do a great deal of writing using MDMA; it was a wonderful experience for me to use it that way, but I discovered after that kind of use that I had to go up in dosage to get an effect, and the effect became less and less the magical insight; it was more and more the stimulant effects, and for many years now, I have been totally unable to use it. Not only because now it is illegal, but because I used it once a week, and that was too often. Nobody knew that, then, but now I would advise anyone who wants to use MDMA not to take it more than 4 times a year if you want to continue to get the best effects from it, otherwise you risk losing its effects entirely and permanently.&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;-Ann Shulgin&lt;/p&gt;</content><category term="Writing"/><category term="Advice"/><category term="Drugs"/><category term="MDMA"/></entry><entry><title>What are the risks in ordering drugs from a Darknet Market? A FAQ</title><link href="/Darknet-Market-Risks.html" rel="alternate"/><published>2020-10-19T16:28:00-07:00</published><updated>2020-10-19T16:28:00-07:00</updated><author><name>al_eberia</name></author><id>tag:None,2020-10-19:/Darknet-Market-Risks.html</id><summary type="html">&lt;p&gt;Another post &lt;a href="https://www.reddit.com/r/al_eberia/comments/aenp6t/dnm_risks/"&gt;originally written on Reddit&lt;/a&gt;, to answer a few of the endless questions posed by worried individuals (to the extent that they can be answered).&lt;/p&gt;
&lt;h2&gt;What are the chances that I will get caught?&lt;/h2&gt;
&lt;h2&gt;&lt;strong&gt;We Don't Know&lt;/strong&gt;&lt;/h2&gt;
&lt;p&gt;The authorities are being uncooperative by not releasing the exact numbers of …&lt;/p&gt;</summary><content type="html">&lt;p&gt;Another post &lt;a href="https://www.reddit.com/r/al_eberia/comments/aenp6t/dnm_risks/"&gt;originally written on Reddit&lt;/a&gt;, to answer a few of the endless questions posed by worried individuals (to the extent that they can be answered).&lt;/p&gt;
&lt;h2&gt;What are the chances that I will get caught?&lt;/h2&gt;
&lt;h2&gt;&lt;strong&gt;We Don't Know&lt;/strong&gt;&lt;/h2&gt;
&lt;p&gt;The authorities are being uncooperative by not releasing the exact numbers of people they have prosecuted for purchasing from DNMs. Nobody can tell you that only 0.56% of buyers ever run into a legal issue. What we do know is that the vast majority of buyers never have any sort of issue with law enforcement. Is there a risk? Absolutely. Even with the best planning and choices bad luck can interfere. Your package might be the one that is torn open by a sorting machine, or the vendor you are ordering from might be being watched by police as they drop off a package with your name on it. If you demand a 0% risk, stick to the liquor store.&lt;/p&gt;
&lt;h2&gt;What are the chances that an order from [place] to [place] will be intercepted?&lt;/h2&gt;
&lt;h2&gt;&lt;strong&gt;We Don't Know&lt;/strong&gt;&lt;/h2&gt;
&lt;p&gt;Unfortunately, customs and vendors have not collaborated to figure out the exact percentage of packages that get captured coming in from each country. The risks will also vary depending on where you are living and what is going on at the time. Is your president ranting about murderous drugs arriving from a certain country? You might expect there to be more focus on mail coming from that country. &lt;/p&gt;
&lt;p&gt;We do know a few things. Generally mail within a country has a very low risk of interception. There is very little attention paid to it and it is almost never seriously inspected. Crossing borders brings mail into contact with customs, who are focused on trying to detect things. For the lowest risk stick to domestic mail. For international mail, do some research to see what the hot countries are for your location. There are some universal risky countries (looking at you NL), but the rest will vary from location to location.&lt;/p&gt;
&lt;h2&gt;If [amount] of [drug] is discovered will I get in trouble/will there be a controlled delivery?&lt;/h2&gt;
&lt;h2&gt;&lt;strong&gt;We Don't Know&lt;/strong&gt;&lt;/h2&gt;
&lt;p&gt;The answer to this depends entirely on your location. Unless you post your zipcode nobody can help you with it. Is your local police department overstretched or bored and looking for action? Have some drugs been effectively (or legally) decriminalized or are they considered considered a menace to be stamped out? Check your local news. Has [drug] been showing up at local high schools and is the police chief denouncing it at press conferences? Even a tiny amount might trigger a strong response if the authorities want to demonstrate that they are taking action. Know your environment and you will be able to understand the risks.&lt;/p&gt;
&lt;hr&gt;
&lt;p&gt;As a addendum up to these questions, if you are currently buying drugs in person you are already taking risks. It's not like buying from a local dealer is risk free. If you are buying small personal quantities I would go out on a limb and say that buying locally is the higher risk. Making a bust for a mailed order is an order of magnitude more work (dealing with the postal inspectors, getting a warrant to search the package, scheduling the controlled delivery, getting the anticipatory search warrant, getting a full search team together) than just pulling someone over after they meet with a suspected dealer and running a drug dog around the car. Unless you live in a suburban police state I think only one of these is likely to happen for a gram or two.&lt;/p&gt;
&lt;p&gt;Some qualifications: this is only in regard to serious consequences such as being arrested or directly charged. You might get a seizure letter if you are attempting to import internationally, and there have been limited reports of law enforcement coming around for "talks" to scare buyers into admitting something incriminating. Obviously &lt;a href="https://www.youtube.com/watch?v=d-7o9xYp7eE"&gt;never fucking talk to the police&lt;/a&gt;. End the conversation and shut the door. If they persist talk to a lawyer.&lt;/p&gt;
&lt;p&gt;Also Germany is a authoritarian police state and they &lt;a href="https://www.reddit.com/r/SilkRoad/comments/4l7m4t/sr1_seller_natural_weed_arrested_german_buyer/"&gt;can fuck you based on your name showing up in a database&lt;/a&gt;. Luckily most of the rest of the world has saner laws.&lt;/p&gt;</content><category term="Writing"/><category term="Advice"/><category term="Drugs"/><category term="DNM"/></entry><entry><title>MDMA purity and the 84% myth</title><link href="/MDMA-84-Percent-Purity.html" rel="alternate"/><published>2020-08-10T11:30:00-07:00</published><updated>2020-08-10T11:30:00-07:00</updated><author><name>al_eberia</name></author><id>tag:None,2020-08-10:/MDMA-84-Percent-Purity.html</id><summary type="html">&lt;p&gt;One of the most enduring myths about MDMA is the idea that the maximum possible purity for it tops out at 84%. Why 84%? Because in MDMA.HCl, only 84.1% of the content by mass is the freebase MDMA molecule, and the rest is the HCl salt. On the …&lt;/p&gt;</summary><content type="html">&lt;p&gt;One of the most enduring myths about MDMA is the idea that the maximum possible purity for it tops out at 84%. Why 84%? Because in MDMA.HCl, only 84.1% of the content by mass is the freebase MDMA molecule, and the rest is the HCl salt. On the face of it, this doesn't make much sense. Generally when people talk about purity, they mean the absence of undesirable impurities or added cuts. A counterion isn't an impurity, and I suspect most people would prefer getting MDMA.HCl crystal or powder to having to handle oily freebase MDMA.&lt;/p&gt;
&lt;p&gt;Indeed, this preference shows in the market. Freebase MDMA is almost never seen, and all MDMA available to consumers is MDMA.HCl. Experience reports, dosage recommendations and even scientific papers are all based on MDMA.HCl. Even harm reduction labs (with the &lt;a href="https://www.erowid.org/columns/crew/2017/01/oddity-testing-service-defines-pure-mdma-as-84-pure/"&gt;strange exception of the Dutch&lt;/a&gt;) use MDMA.HCl as their reference standard, leading to many reports of MDMA with a purity above the famous 84% limit. &lt;/p&gt;
&lt;p&gt;This myth needs to die. All it does is give advantage to dealers of low quality MDMA, who can try to claim that MDMA with purities in the low 80% range is actually of the highest quality. It can also confuse some users, who think they may need to increase their dosages to account for the "missing" 16%, not realizing all dosing recommendations already take this into account. When it comes down to it, the 84% myth is like if you are handed a glass of Coke at a party, and ask if it is just Coke to get the reply "no you don't have pure Coca Cola, you have 10% Coca Cola syrup and the rest is water". It's unhelpful and confusing when what you really want to know is if anyone has put rum in your Coke yet.&lt;/p&gt;</content><category term="Writing"/><category term="Drugs"/><category term="MDMA"/><category term="Myths"/></entry><entry><title>Saved Links</title><link href="/Link-Collection.html" rel="alternate"/><published>2020-06-18T19:00:00-07:00</published><updated>2020-06-18T19:00:00-07:00</updated><author><name>al_eberia</name></author><id>tag:None,2020-06-18:/Link-Collection.html</id><summary type="html">&lt;p&gt;This is a collection of some of the posts I have saved to my Reddit account over the course of years of reading. As always with Reddit often the discussion in the comments is as valuable as the initial post.&lt;/p&gt;
&lt;h1&gt;General&lt;/h1&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/2asny1/what_are_some_classic_posts_about_drugs_which/"&gt;What are some classic posts about drugs which everyone …&lt;/a&gt;&lt;/p&gt;</summary><content type="html">&lt;p&gt;This is a collection of some of the posts I have saved to my Reddit account over the course of years of reading. As always with Reddit often the discussion in the comments is as valuable as the initial post.&lt;/p&gt;
&lt;h1&gt;General&lt;/h1&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/2asny1/what_are_some_classic_posts_about_drugs_which/"&gt;What are some classic posts about drugs which everyone should know about?&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;What better way to start off a collection than with another collection? Most of the links in this are to outside Reddit. I mainly use it to get the link to &lt;a href="http://www.bluelight.org/vb/threads/461215-Amphetamine-The-Drug-You-Learn-to-Hate"&gt;Amphetamine: The Drug You Learn To Hate&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/95cnfx/boyfriend_keeps_showing_up_high/"&gt;boyfriend keeps showing up high?&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;The other side of every post talking about taking Adderall to be smoother on dates.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/bqm1oz/i_fell_into_my_moms_honesty_trap/"&gt;I fell into my mom's honesty trap&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;"You can tell me anything, I just want you to be safe"&lt;/p&gt;
&lt;h1&gt;Trainwrecks&lt;/h1&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/2uf81y/drunk_classmate_stole_my_acid_during_a_house/"&gt;Drunk classmate stole my acid during a house party, and ate 500ug as his first time.&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;Classic clusterfuck.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/248exx/might_get_expelled_for_lsd/"&gt;Might get expelled for lsd.&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;This is a fun one as the Reddit account is still active, so you can see how everything turned out.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/LSD/comments/5q8l2e/babysat_my_friend_while_he_did_lsd_he_basically/"&gt;Babysat my friend while he did lsd, he basically tried to rape me, then blamed me&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;Clear content warning on this one from the title.&lt;/p&gt;
&lt;h1&gt;Dealer Perspectives&lt;/h1&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/4apvcz/as_told_by_a_drug_dealer/"&gt;As told by a drug dealer..&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;Why you probably don't want to be a drug dealer.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/4xfffu/ill_never_be_one_of_those_shitty_dealers/"&gt;"I'll never be one of those shitty dealers"&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;There's a long discussion in the comments on this one about if LSD should ever be sold for a profit.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/5ewxyr/experimented_with_being_a_club_dealer_over_the/"&gt;Experimented with being a "club" dealer over the summer and thought I would share my experience.&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;Fairly detailed&lt;/p&gt;
&lt;h1&gt;MDMA Usage&lt;/h1&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/MDMA/comments/5a9a1x/my_friends_experience_on_microdosing_mdma/"&gt;My friends' experience on microdosing MDMA&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;People keep asking about it, so it's handy to have an instant rebutal.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/4jyzph/ive_been_taking_mdma_every_weekend_for_about_3/"&gt;I've been taking MDMA every weekend for about 3 years now and I've recently started to notice some unpleasant symptoms&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;A good thread about how the effects of MDMA abuse can creep up on you.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/44sbu7/some_people_here_in_the_uk_doing_absolutely/"&gt;Some people here in the UK doing absolutely ridiculously farcical doses of MDMA and other stimulants EVERY WEEKEND.&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;A discussion about UK drug culture.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://www.reddit.com/r/Drugs/comments/8eg2fz/the_effects_of_taking_mdma_three_days/"&gt;The effects of taking MDMA three days consecutively&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;A handy link to give to those planning for multi-day festivals.&lt;/p&gt;</content><category term="Other"/><category term="Reddit"/><category term="Drugs"/></entry><entry><title>First time MDMA experiences</title><link href="/First-Time-MDMA.html" rel="alternate"/><published>2020-06-18T16:28:00-07:00</published><updated>2020-06-18T16:28:00-07:00</updated><author><name>al_eberia</name></author><id>tag:None,2020-06-18:/First-Time-MDMA.html</id><summary type="html">&lt;p&gt;MDMA is a drug that will always hold a special place in my heart. I've spent years discussing it and giving advice regarding it, mainly on various drugs related subreddits. I even moderate a subreddit discussing it's therapeutic use. All of this stems from my very first encounter with MDMA …&lt;/p&gt;</summary><content type="html">&lt;p&gt;MDMA is a drug that will always hold a special place in my heart. I've spent years discussing it and giving advice regarding it, mainly on various drugs related subreddits. I even moderate a subreddit discussing it's therapeutic use. All of this stems from my very first encounter with MDMA. I've included a trip report of that experience below:&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;I took MDMA for the first time at a small house party. It was intended to be a larger party but not many people showed up (holding it during exams was probably the issue). I didn't intend to take MDMA and didn't know much about it, but when I arrived at the house my friend who was living their explained that his roommate was selling some. He recommended I try it so I paid $20 for two points (100mg each) and took them wrapped up in a single ply of toilet paper 10 minutes apart.&lt;/p&gt;
&lt;p&gt;The comeup was fantastic, one moment I thought I might be feeling something and the next I was feeling the best I had ever felt in my life. The baseline anxiety of my life vaporized and I realized how much of a weight it was on me. I was able to be completely open about some of my insecurities with people I didn't know very well or know at all. Backing up the lack of anxiety was what felt like maximum happiness, as if this was the extreme limit of the emotion only reached when every drop of serotonin in my brain was unleashed and directed to the task. I had taken mushrooms and LSD before but the uniqueness of this experience, the complete erasure of anxiety, fear and depression made this seem even more transformative than tripping had been. &lt;/p&gt;
&lt;p&gt;After talking with everyone for a bit I moved off with my friend and we started talking one on one, moving into some deeper discussions. I realized how much the death of a parent while I was a child had impacted the rest of my life. I was able to easily bring it up and talk through it, to a degree that I never had been able to even with my remaining parent and sibling. It easily ranks as on of the most emotionally soothing and meaningful experiences of my life and it took place sitting in a walk in closet with my friend just talking for two hours while ignoring the rest of the party going on outside.&lt;/p&gt;
&lt;p&gt;I walked back home at the end of the night and enjoyed an afterglow that lasted for at least 2 days.&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;I often feel that my intial experience has given me a different view of MDMA than people who might have had a more straighforwardly recreational time. I strongly suspect that the set and setting of the initial MDMA encounter can color how the drug is later viewed and experienced. &lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;“I believe that with whom you do MDMA for the first time might even be more important than with whom you have sex for the first time,”&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;- &lt;a href="https://www.newyorker.com/culture/persons-of-interest/how-ayelet-waldman-found-a-calmer-life-on-tiny-doses-of-lsd"&gt;Ayelet Waldman&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;Based on my first MDMA experience, I created a short bit of advice that I could give to individuals who posted asking for advice regarding their first times taking MDMA, or to individuals who were planning on introducing friends to the drug. I would normally start by asking what the set and setting would be, and respond with this if they mentioned a festival, nightclub or large music event.&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;Will you be with any close friends? And does the event have a quiet place you can be in if you need to talk? One thing is that MDMA can bring up things in your life that you really don't think about or have suppressed and make you realized how much of an impact they have had on you. When this happens it can be incredibly helpful to talk over those feelings with someone you trust, even better if they are also on MDMA. Rick Doblin, the guy spearheading the campaign to get MDMA recognized as a treatment for PTSD &lt;a href="https://youtu.be/MEk_4wwvSLE?t=2150"&gt;explains it on a podcast here&lt;/a&gt; (Youtube link, I highly recommend listening to it). &lt;/p&gt;
&lt;p&gt;It doesn't have to be something like sexual assault, the first time I took MDMA I realized how much the death of a parent while I was a child had impacted the rest of my life. it easily ranks as on of the most emotionally soothing and meaningful experiences of my life and it took place sitting in a walk in closet with my friend at a party just talking for two hours while ignoring everything else. So make sure that there is someone you would feel comfortable opening up to around (comfortable while sober, on MDMA you are comfortable opening up to everyone which can be awkward later) and somewhere quiet you can go to talk.&lt;/p&gt;
&lt;/blockquote&gt;</content><category term="Writing"/><category term="Advice"/><category term="Drugs"/><category term="MDMA"/><category term="Personal"/><category term="Therapy"/></entry><entry><title>Combining MDMA with SSRIs - Are there possible dangers? A review of recent literature</title><link href="/MDMA-SSRIs.html" rel="alternate"/><published>2020-06-18T15:18:00-07:00</published><updated>2020-06-18T15:18:00-07:00</updated><author><name>al_eberia</name></author><id>tag:None,2020-06-18:/MDMA-SSRIs.html</id><summary type="html">&lt;p&gt;Note: &lt;a href="https://www.reddit.com/r/DrugNerds/comments/ceyc9z/combining_mdma_with_ssris_are_there_possible/"&gt;This was originally published as a post on the /r/DrugNerds subreddit, and garnered a number of interesting comments there&lt;/a&gt;. &lt;/p&gt;
&lt;p&gt;Does combining MDMA and Selective serotonin reuptake inhibitors (SSRIs) put you at a fatal risk of serotonin syndrome? This seems to be common knowledge in many parts of the …&lt;/p&gt;</summary><content type="html">&lt;p&gt;Note: &lt;a href="https://www.reddit.com/r/DrugNerds/comments/ceyc9z/combining_mdma_with_ssris_are_there_possible/"&gt;This was originally published as a post on the /r/DrugNerds subreddit, and garnered a number of interesting comments there&lt;/a&gt;. &lt;/p&gt;
&lt;p&gt;Does combining MDMA and Selective serotonin reuptake inhibitors (SSRIs) put you at a fatal risk of serotonin syndrome? This seems to be common knowledge in many parts of the internet, but where is the evidence? I had seen a number of papers to the contrary, which indicated that SSRIs would be neuroprotective against the harms of MDMA. However the "common knowledge" must have come from somewhere. Was I just missing some vital information? Luckily a quick google search brought up a relatively recent (2013) paper that seems to be trying to summarize the research about the interaction of MDMA and SSRIs, with a view of warning the world.&lt;/p&gt;
&lt;p&gt;Dobry, Y., Rice, T., &amp;amp; Sher, L. (2013). Ecstasy use and serotonin syndrome: a neglected danger to adolescents and young adults prescribed selective serotonin reuptake inhibitors. International Journal of Adolescent Medicine and Health, 25(3). doi:10.1515/ijamh-2013-0052&lt;/p&gt;
&lt;p&gt;&lt;a href="https://sci-hub.tw/10.1515/ijamh-2013-0052"&gt;Sci-Hub link for paper&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;Well the title certainly indicates that the authors think there is a risk. Lets give this a read. From the abstract:&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;MDMA, in combination with the widely prescribed SSRI  antidepressant  class,  can  lead to rapid, synergistic rise of  serotonin (5-HT) concentration in the central nervous system,  leading to the  acute  medical emergency known as serotonin syndrome. &lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Well that seems pretty definitive. Lets see how they came to that conclusion.&lt;/p&gt;
&lt;p&gt;The paper starts by giving an overview of how SSRIs and MDMA work, and the mechanisms of serotonin syndrome. Lets skip that and get into the meat of it though.&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;&lt;strong&gt;Ecstasy in combination with SSRI increases the risk of serotonin syndrome&lt;/strong&gt;&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Now that's the title we've been looking for. Surely all the facts are in here.&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;Despite a clear need, basic and clinical science has done little to investigate a physiological interaction between SSRIs and MDMA This omission disregards the powerful potential of both drugs  to tremendously raise synaptic cleft serotonin. Microdyalisis and measured lab data has shown that SSRIs are capable of very rapid, and large increases of serotonin (5-HT) concentration in animal brains (60–62), and that MDMA administration releases serotonin at various brain sites at a rate possibly above that produced by the SSRIs (63, 64).&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;That's in isolation though, what about when they are combined?&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;The combined pharmacokinetic drug-drug interaction additionally ensues when SSRIs that are also potent CYP450 2D6 inhibitors reduce MDMA metabolism (53, 65). MDMA can conversely exert metabolic effects upon SSRI metabolism. Paroxetine and fluoxetine administration, for example, has been shown to increase MDMA levels by as much as 30% (66)&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Well, the amount of MDMA in the blood being elevated to that degree does sound alarming, especially if it's releasing all that serotonin. Lets look at the cited paper.&lt;/p&gt;
&lt;p&gt;(66) Farre M, Abanades S, Roset PN, Peiró AM, Torrens M, et al. Pharmacological interaction between 3,4-methylenedioxy-methamphetamine (ecstasy) and paroxetine: pharmacological effects and pharmacokinetics. J Pharmacol Exp Ther 2007&lt;/p&gt;
&lt;p&gt;&lt;a href="http://public-files.prbb.org/publicacions/b52755a0-7bd7-012a-a768-000c293b26d5.pdf"&gt;PDF link for paper&lt;/a&gt;&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;Even though plasma concentrations of MDMA were increased, a boost in pharmacological and subjective effects was not observed. On the contrary, a clear decrease was observed, which indicates a pharmacodynamic interaction.&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Hmm, it seems like this is more complicated than just blood levels.&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;In vitro studies have shown that fluoxetine inhibits MDMA-induced release of serotonin into the synaptic space (Gudelsky and Nash, 1996), and there is some evidence that pre-treatment with SSRIs reduces some MDMA-related effects (Liechti et al., 2000; Liechti and Vollenweider, 2000b; Tancer and Johanson, 2007). SSRIs, such as paroxetine, antagonize MDMA activity either by preventing its interaction with the 5-HT uptake site or alternatively by blocking the efflux of 5-HT through the carrier.&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Oh. So even with more MDMA in the blood, less serotonin is being released. I'm not seeing where serotonin syndrome would come from. Maybe there are other sources? Lets get back to the main paper.&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;Moreover, increased body heat from muscle use during prolonged dancing and cooling dysregulation brought about by dehydration can significantly increase body temperature, leading to an excessive increase in the serotonin release rate through the amplified thermodynamic processes (70, 71).&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Well I can't find fault with thermodynamics. This seems unrelated to SSRIs though, getting too hot is classic MDMA. What happens with SSRIs in the mix? Lets get back to citation 66.&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;During the paroxetine condition, the increase in temperature shown during the administration of MDMA alone decreased by approximately 50%.&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;So adding SSRIs to the MDMA would reduce the amount of serotonin released via thermodynamics, not increase it. Another dead end. I'm beginning to wonder how deeply the authors read the papers they cited.&lt;/p&gt;
&lt;p&gt;Well the pharmacological dynamics seem to be a bust for causing serotonin syndrome, but those were all measured in sterile laboratories. The real world can be messier and throws in curveballs. Do they have any data about it happening in the real world?&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;A survey of 216 young adults from Sydney, Australia who had used Ecstasy at least once in the previous 6 months reported 19 cases of purposeful concomitant use of antidepressant medication with MDMA. A considerable number of these subjects took the SSRI either to enhance their Ecstasy high or to prevent neurotoxic effects. This sample was analyzed for neuropsychiatric symptoms and a large proportion has been shown to display symptoms consistent with serotonin syndrome of various severity (75)&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;This seems to show exactly what I was talking about, lets see the facts on the ground. The paper cited:&lt;/p&gt;
&lt;p&gt;(75) Copland J, Dillon P, Gascoigne M. Ecstasy and the concomitant use of pharmaceuticals. Addict Behav 2005;31:367–70&lt;/p&gt;
&lt;p&gt;&lt;a href="https://sci-hub.se/10.1016/j.addbeh.2005.05.025"&gt;Sci-Hub link for paper&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;Only four pages, extremely brief&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;SSRI and MAOI antidepressants were reported 19 times&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;The paper grouped SSRIs and MAOIs in a single category when reporting symptoms resulting from MDMA combined with antidepressants - Cited only as SSRIs. That's no good. We know that MAOIs can cause serotonin syndrome when combined with MDMA (and lots of other drugs). That's going to really skew the results.&lt;/p&gt;
&lt;p&gt;However that paper was also concerned about this risks of MDMA and anti-depressants.&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;This is of concern, as some of these ecstasy-pharmaceutical combinations can have potentially serious health consequences (Singh &amp;amp; Catalan, 2000; Sternbach, 1991)&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Lets keep going down the chain and read the papers they used to come to this conclusion.&lt;/p&gt;
&lt;p&gt;Singh, A. N., &amp;amp; Catalan, J. (2000). Rave drug (ecstasy) and selective serotonin reuptake inhibitor anti-depressants. Indian Journal of Psychiatry,42(2), 195–197.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957712/pdf/IJPsy-42-195.pdf"&gt;PDF link for paper&lt;/a&gt;&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;We report two cases of misuse of selective serotonin re-uptake inhibitors (SSRIs) antidepressants in combination with Ecstasy and their beneficial subjective effects experienced by misusers. We hypothesis the probable underlying pharmacological reasons and recommend its use in the treatment of neurotoxic effects of MDMA&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Where is the harm? Not in this paper. They actually come to the opposite conclusion.&lt;/p&gt;
&lt;p&gt;Sternbach, H. (1991). The serotonin syndrome [comment].American Journal of Psychiatry,148(6), 705–713.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://sci-hub.se/10.1176/ajp.148.6.705"&gt;Sci-Hub link for paper&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;A paper about the dangers of serotonin syndrome – Focused on MAOIs (don’t combine them with your lithium).
Zero mention of MDMA, and only really mentions SSRIs in terms of them being combined with MAOIs (don't).&lt;/p&gt;
&lt;p&gt;It seems like when you dig into the citations of harm there is almost zero evidence of the claims they are supposed to support. To really demonstrate that, lets finish up back at Dobry &lt;em&gt;et al&lt;/em&gt;&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;One of the case reports even describes death from the combination of fluoxetine and &lt;strong&gt;MDMA&lt;/strong&gt; (84)&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Bold is mine.&lt;/p&gt;
&lt;p&gt;Have we finally found the harm? A full case report showing the fatal combination of SSRIs and MDMA?&lt;/p&gt;
&lt;p&gt;(84) Byard RW, Gilbert J, James R, Lokan RJ. Amphetamine derivative fatalities in South Australia-is “Ecstasy” the culprit? Am J Forensic Pathol 1998;19:261–5.&lt;/p&gt;
&lt;p&gt;&lt;a href="http://www.maps.org/images/pdf/1998_byard_1.pdf"&gt;PDF link for paper (thanks MAPS)&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;A collection of six case reports of deaths related to "ecstasy", including a single case where fluoxetine was present.&lt;/p&gt;
&lt;blockquote&gt;
&lt;p&gt;Toxicologic analysis of blood revealed elevated, but apparently not lethal, levels of &lt;strong&gt;PMA&lt;/strong&gt;, with therapeutic levels of fiuoxetine (Prozac). &lt;strong&gt;Ecstasy not detected&lt;/strong&gt;.&lt;/p&gt;
&lt;/blockquote&gt;
&lt;p&gt;Bolds are mine.&lt;/p&gt;
&lt;p&gt;PMA and  a SSRI, not MDMA and a SSRI. PMA can be fatal if a user mistakes it for MDMA, but if a scientific author makes the same mistake it can really fill in the gaps in their evidence. &lt;/p&gt;
&lt;p&gt;Overall my confidence in peer-review has really taken a hit after going through this. Now I'm wonder how many other papers I've taken on faith can also be taken to pieces by actually checking the citations. I've actually been convinced that SSRIs can really help with protecting from some of the damage MDMA might cause, and I'm planning on popping some paroxetine on the comedown of my next roll.&lt;/p&gt;</content><category term="Writing"/><category term="Drugs"/><category term="MDMA"/><category term="SSRIs"/><category term="Peer Review"/><category term="Reddit"/></entry><entry><title>Starting the Blog</title><link href="/Start.html" rel="alternate"/><published>2020-06-18T15:00:00-07:00</published><updated>2020-06-18T15:00:00-07:00</updated><author><name>al_eberia</name></author><id>tag:None,2020-06-18:/Start.html</id><summary type="html">&lt;p&gt;Like many people, starting a simple blog has long been a goal of mine, though one often shoved into the apsirational category due to my unwillingness to put in the work. I had made it to the point of exploring the various options (different static site generators, hosting possibilities) a …&lt;/p&gt;</summary><content type="html">&lt;p&gt;Like many people, starting a simple blog has long been a goal of mine, though one often shoved into the apsirational category due to my unwillingness to put in the work. I had made it to the point of exploring the various options (different static site generators, hosting possibilities) a number of times but had bounced off the task for a number of reasons. One of these was the degree of content required. I didn't want to add to the massive statistic of blogs with one or two cheerful posts that have languished untouched for years since. My personal need to have a solid slug of content already written and ready to go was a major blocker. During my most recent review of the matter, I realized that I already had more than enough content pre-written (and even in markdown). I have been an active Reddit user for years at this point, and have amassed a number of decent posts that I feel could translate well over to a blog. With that obstacle out of the way, real progress could be made.&lt;/p&gt;
&lt;p&gt;The other major blocker for me had been the task of actually building the site. This had confounded me a number of times in the past, as the array of options and installation difficulties for the different static site generators I had attempted in the past had given me just enough friction to grind to a halt. This time I discovered that the advent of the Windows Subsystem for Linux (WSL) and the integration of Visual Studio Code with it had solved many of the difficulties of the past. I won't go step by step through the process I followed, but will instead link to the guides I followed.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://matthewkapfhammer.github.io/githubpages-pelican-in-wsl.html"&gt;Using GitHub Pages and Pelican in Ubuntu on Windows&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;This guide by Matthew Kapfhammer covered all of the basics of instaling Pelican, setting up WSL and intializing the site.&lt;/p&gt;
&lt;p&gt;&lt;a href="https://jackdewinter.github.io/2019/08/18/static-websites-choosing-a-static-web-site-generator/"&gt;Static Site Generators&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;This excellent guide by Jack De Winter went much more in-depth into the details of Pelican, including updating the defaults and choosing a theme. &lt;a href="https://jackdewinter.github.io/categories#integrating-technology-ref"&gt;The author has another series of posts covering RSS and plugins for Pelican&lt;/a&gt;. I'm still working my way though these posts and will likely be using them to upgrade the blog for a while to come.&lt;/p&gt;</content><category term="Blog"/><category term="Blog"/><category term="Meta"/><category term="WSL"/><category term="Pelican"/><category term="Personal"/></entry></feed>