A recent TikTok from the University of Bristol’s student TV station has sparked conversation for giving students advice on how to take MDMA.
The UBTV video, overlaid with text reading ‘how often should I take breaks from MDMA’, was presented by a spokesperson from The Drop, part of Bristol Drugs Project, which offers information and support for people using drugs recreationally.
So far, it’s racked up more than 35,000 views, but comments aren’t all positive, with the top liked reply simply saying ‘or don’t do it’.
But given that one in three UK adults admit to using drugs at some point in their lives — and 8.8% have done so in the last 12 months — judgement-free information like this is vital from the perspective of harm reduction.
Instead of abstinence, the harm reduction approach to drugs accepts that people will take them, regardless of any ban or warning put in place.
It therefore focuses on practical strategies to minimise negative impacts, from overdose prevention to signposting to addiction support services, with the ultimate goal being to prevent drug-related deaths (now at the highest numbers since records began in England in Wales).
Encouraging safer use is a key cornerstone of this approach, and leaving gaps between ‘sessions’ can go a long way in keeping drug users safe.
Recreational vs dependent
Organisations like The Drop acknowledge that many people won’t stop using drugs, and won’t get addicted.
The harm reduction approach offers advice for people that occasionally use drugs recreationally, for pleasure and enjoyment.
Addiction however, is a chronic condition, defined by the NHS as ‘not having control over doing, taking or using something to the point where it could be harmful to you’.
A person who is dependent or addicted to drugs has a compulsion to use, despite the negative impact the habit may be having on their life.
Dr Rayyan Zafar, neuropsychopharmacologist at Drug Science, tells Metro: ‘A break [between drug taking] isn’t just letting the drug leave the system, it’s about giving the brain and body the time to reverse potential neuro-adaptations that happen in response to the drug.’
These include changes to your tolerance level, a temporary decrease of different chemicals or hormones, and overstimulation of parts of the brain required for you to function at your best.
‘On top of that is the restoration of sleep and appetite, and the reduction of harm to organs,’ he adds.
According to Dr Zafar, ‘it’s a frequency in the dose that drives the harm, not single one-off exposures per se,’ which is why breaks are so important. The risks also multiply if you combine different substances.
The fact is, there are no ‘safe use guarantees’ when it comes to either dose or time limit, and beyond the potential health dangers, getting caught in possession of illegal drugs can also carry a penalty of up to seven years in prison.
However, if you are going to take them, these science-backed guidelines may help lessen the long-term impact.
GHB, heroin, methamphetamine and crack cocaine
Although all drugs can be harmful, GHB, heroin, methamphetamine and crack cocaine have been omitted from this piece, as Dr Zafar says they have no safe limits between use — and because they’re so extremely dangerous, should be avoided altogether.
MDMA: 3 months
Although Dr Zafar says six to eight weeks is the minimum amount of time you should leave between MDMA doses, he recommends a ‘more conservative’ break of three months (as advised in the UBTV TikTok).
There’s no evidence to suggest recreational MDMA use causes any long-term damage to the adult brain, but because it stimulates the production ofserotonin — a hormone related to stress, sleep and temperature — Dr Zafar says it’s possible that, over time, the changes to your brain’s serotonin system may affect how you feel and think.
Recent studies suggest the brain doesn’t fully-form until age 32, so extra caution is also advised for younger people.
Despite this though, Dr Zafar adds that MDMA is ‘by and large, in the way that people use it, a very safe drug.’
MDMA-related fatalities are typically the result of inadequate temperature regulation, taking it alongside other drugs, and high-potency pills, with the risks increasing for first-time users and women (because of how it interacts with the oestrogen and vasopressin in their bodies).
Need support?
If you’re concerned about your own or a loved one’s drug use, the NHS recommends speaking to your GP or visiting the Frank website to find specific support services near you.
If you’re having trouble finding the right sort of help, call the Frank drugs helpline on 0300 123 6600 and they can talk you through your options.
Cocaine: At least a month
Cocaine may be one of the most popular recreational drugs in the UK, but according to Dr Zafar, there’s ‘no evidence-based safe gap’ between sessions.
At the very least, he recommends avoiding consecutive days, as there’s a ’24-fold heart attack increase in the hour after using cocaine’ which decreases over time, but a break of a month or more is preferred.
‘Even weekly use of cocaine can lead to something called dopamine sensitisation,’ Dr Zafar continues. ‘So weekend binge culture can actually make your brain become more dependent on it, and cause sleep loss, anxiety, dependence, risk and cardiotoxicity (heart damage) when combined with alcohol.’
Cannabis: 1 month
‘Tolerance to cannabis is linked to the CB1 receptor,’ explains Dr Zafar. That’s the part of the brain that helps regulate things like appetite, pain, memory and mood. ‘There’s evidence that its density normalises four weeks after abstinence in daily users,’ says Dr Zafar.
After two weeks without a joint, your tolerance is reduced, but a month’s break is better for a ‘complete reset’ of the CB1 receptor, where you can ‘noticeably’ feel a difference.
In terms of regular users, he says dependency often develops as people try to avoid the withdrawal that comes with CB1 receptor downregulation.
‘Basically, the cannabis will dampen it down, which is a response to kind of having loads of like THC in the system,’ he adds. ‘It tries to reduce the number of receptors to reduce the effects… But then, when you stop using the drug, you have the withdrawal like effect, and then they’ll grow back up.’
Amphetamines: 1 month
If you’ve taken amphetamines such as speed, you need to wait a month before doing so again, both to combat the effects of sleep deprivation and overheating, and to avoid falling into chronic use, which ‘is linked to neurochemical and neuroanatomical changes.’
Dr Zafar explains: ‘There are brain changes and also psychiatric risk, with reviews of alterations to the dopamine systems in the brains of people who regularly use amphetamines.’
You may have heard that one of these drugs, mephedrone – also known as M-CAT or meow meow – is being trialled as a psychiatric drug, and has been advocated as a reduced-harm alternative to cocaine by Drug Science founder, Professor David Nutt, a former UK government drug advisor, because it’s less neurotoxic and causes fewer deaths.
‘But the issue with M-CAT is people generally tend to stay up for days on it, where it’s harder to stay up to days on cocaine because of the pharmacokinetic profile,’ adds Dr Zafar. ‘So we can’t take away from the harms entirely.’
Hallucinogens: 3 to 7 days
‘Psychedelics like LSD and psilocybin (magic mushrooms) tolerance builds up really fast, but it also drops really fast, so you probably need around three to seven days to clear acute tolerance,’ says Dr Zafar.
Essentially, if you take hallucinogens more than once or twice within a week, you’ll feel less each time — which is why in clinical psychedelic therapy programs researchers schedule breaks of two to four-weeks between doses.
On retreats, however, people are often given two or three doses over the course of as many days, and when it comes to ‘meaning making’, ‘the longer the breaks are, the more insight.’
Keep in mind too, that while there’s limited evidence of neurotoxicity with these drugs, in some cases they can precipitate psychosis, and it’s important to take them in a comfortable and supportive environment because they’re ‘quite powerful’.
Ketamine: Minimum 2 weeks
Alongside avoiding frequent use, Dr Zafar says you should ‘think weeks between sessions – at minimum two weeks – and stop immediately if you get urinary symptoms’.
He continues: ‘There is a cumulative bladder and urinary tract toxicity that occurs, which is a standout harm for ketamine, and the risk rises significantly with regular patterns… For example, using ketamine at least three times a week over a period of two years has been shown to result in alterations in bladder function.’
This level of use applies to a ‘small and increasing number of people’, but even though it’s not likely to have bladder issues with infrequent recreational comsumption, you should still be careful and seek medical advice if you do experience any worrying symptoms.
After all, it’s better to be safe than sorry.
Alcohol: 2 weeks
You may not consider alcohol as a ‘drug’, but despite the fact it’s readily available and widely used, Professor David Nutt, considers it one of the most harmful.
And although the NHS guideline is no more than 14 units a week, Dr Zafar says ‘no amount of alcohol is safe for the body’ due to how it ‘affects every organ in the body destructively.’
The impact also worsens following ‘cumulative exposure’, with studies showing that three days of drinking in a row causes your liver to start producing ‘alcohol-related fatty deposits’, which can then lead to cirrhosis.
To mitigate this somewhat, Dr Zafar recommends spreading your drinking you out as much possible, from taking specific days off booze each week to practicing Dry January and Sober October for a bigger reset.
He says most people begin to feel more energetic, less irritable and have better sleep better after two weeks abstinence.
‘If you go and have a binge again, then you then got to wait another two weeks to get back to the point that you’ve just earned,’ Dr Zafar concludes.
Tips for harm reduction
Whatever the substance, Dr Zafar recommends these tips to limit its negative impact on your health:
- Don’t mix drugs.
- Avoid binges.
- Watch out for warning signs, from psychological symptoms like anxiety and low mood to physical ones like chest pains, breathlessness and headaches; ‘that’s your body’s way of basically saying you need to be in recovery.’
- Check the drug’s potency. Legally-available testing kits can give you an example of what’s inside a drug, as well as the potential potency of the drug, helping you make an informed decision on how much you should take.
- Seek support as soon as you feel use is becoming problematic, for example if ‘you’re beginning to feel like when you’re off the drug, you’re not feeling great’ — ‘that might be the start of a bigger problem.’
Do you have a story to share?
Get in touch by emailing MetroLifestyleTeam@Metro.co.uk.
