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Polydrug use involves the concurrent ingestion of more than one intoxicating substance. There are several reasons this may occur: to increase the high of one or more drugs, to reduce unwanted side effects, to relieve withdrawal symptoms, or in an attempt to self-manage certain health issues such as chronic pain, sleep problems, or mental health issues.1 Combining drugs can be very dangerous, however, and it can increase the risk of overdose, toxicity, and addiction.
Marijuana is one of the most widely abused drugs in the US, especially now that recreational use of the drug is legal in several states and the District of Columbia.Many people across the country feel that marijuana is not dangerous or addictive. Such perceptions mean that, like alcohol and tobacco, marijuana may be more likely to be abused in combination with other substances, including prescription medications and other recreational drugs.
One drug often mixed with marijuana is ecstasy. This drug is famous for being used at parties, raves, or nightclubs as a primary drug of abuse. People who abuse ecstasy are more likely to engage in polydrug use, including marijuana.
Marijuana is derived from the leaves, stems, seeds, and flowers of the Cannabis sativa plant. There are two active chemicals in marijuana – delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD)—that people seek out when they ingest the drug.2 Many consider CBD to be a potentially therapeutic chemical, as it may be associated with relaxation, pain reduction, and better appetite. Those who use marijuana for recreational reasons prefer high-THC pot for its mind-altering effects.
When a person is high on marijuana, they may experience:2
Side effects associated with chronic cannabis use, whether smoked or eaten, include:3
The concentration of THC in recreational marijuana has been increasing through plant cultivation for several years. Various strains can have very different, very intense effects.
There were a reported 19.8 million people in the US in 2013 who use marijuana, according to the Centers for Disease Control and Prevention (CDC).4 This makes marijuana one of the most widely abused drugs in the country despite the associated dangers.
Ecstasy is one name for a drug containing 3,4-methylenedioxymethamphetamine, or MDMA.5This substituted amphetamine was once used in small doses in therapeutic settings in the 1970s, but the substance grew in popularity as a drug of abuse in social or nightclub settings in the 1980s. Ecstasy, usually taken in pill or tablet form, reached peak popularity in the 1990s.5 Although it is still around today, other “branded” versions of MDMA, like Molly, are more commonly circulated because they are mistakenly believed to be purer and therefore safer.
People use ecstasy for its somewhat unique milieu of psychoactive effects—including mild hallucinations and other changes in sensory perception, as well as its impact on mood. The drug affects serotonin neurotransmission, which may underlie an elevation in mood and changes in how the brain experiences sensory input.5
Some of the associated effects of ecstasy include:5
Several potential negative side effects may occur, both during and after taking ecstasy. On average, the drug may begin to affect the user roughly 20-40 minutes after it is taken. Desired effects may peak around 60 – 90 minutes after consumption, which may begive way to more subjectively negative effects and adverse physiological changes.5
Negative side effects may include:5
The comedown from ecstasy can be uncomfortable as the brain slowly recovers from the high spike in serotonin levels, only to have a sudden decrease in serotonin as the drug wears off. Depression is one of the most common comedown effects. Users may feel drained for up to two days afterwards due to the strain that the drug causes on the body.5
Other after-effects include:6
The comedown effects often lead people to use other drugs to moderate these effects, either in combination with ecstasy or during the withdrawal period. One of the most common drugs used with ecstasy, as a way to moderate the strong effects of the drug, is marijuana.
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A review published in 2007 in the Journal of Neural Transmission found that more than 90 percent of those who use MDMA, Molly, and ecstasy recreationally also use marijuana.7
Common reasons people ingest marijuana and ecstasy in combination include:7
Some reports suggest that the first two reasons—easing comedown effects and the availability of both in social situations—are the most common reasons people combine ecstasy and weed. The aforementioned review article from the Journal of Neural Transmission suggested that combining ecstasy and marijuana led to somewhat opposing effects on physical arousal, body temperature, and oxidative stress—the latter a result of a disturbed balance in the production of free radicals and protective antioxidants.7
The review mentions one survey of more than 1,000 club-going participants in which 82% reported that cannabis was used to ease depression and anhedonia when coming down from ecstasy use.7 Another cited survey, involving 364 young adults who were polydrug users, found that 52 percent used marijuana to ease ecstasy’s negative comedown effects.7
The journal article also cited a study that found that 36 percent of people who used cannabis reported taking it with MDMA to enhance the stimulant’s psychedelic and euphoric effects or to have a more mellow high while taking ecstasy.7
Researchers suggested that marijuana may offer some anti-inflammatory and antioxidative effects, which can modulate the oxidative stress and cell damage caused by MDMA. Marijuana may also reduce body temperature, reducing the risk of hyperthermia in people taking ecstasy. Some studies also suggest that using marijuana with ecstasy reduces neurotoxicity compared to taking the amphetamine alone or in combination with any other drug. However, there is little evidence that this works as the evidence cited was anecdotal only.7
The consequences of combining these drugs are potentially serious. For example, both drugs can impair memory. Ecstasy disrupts long-term memory formation while marijuana reduces the ability to form short-term memories and also harms motivation and cognition. People who ingest both drugs may be more at risk of significant problems with memory.7
Other cognitive deficits associated with both drugs may also worsen with greater consumption. Though a period of abstinence might allow for some resolution of these issues, people who consistently abuse multiple drugs may require a relatively longer period of abstinence for full restoration of cognitive functioning.7
Taking marijuana and ecstasy, either alone or in combination, could also increase the risk of certain mood disorders. Marijuana may cause anxiety while the comedown from ecstasy can induce depression. If a person takes one drug and experiences the symptoms of a mood disorder, they may begin taking other drugs to alleviate these issues. Using drugs to moderate the symptoms of other drugs can lead to an accumulation of mental and physical health issues and could increase the risk of polysubstance overdose.1