Home Colunas Portas da Percepção MDMA e Redução de Danos

MDMA e Redução de Danos

por Fernando Beserra

mdmaO 3,4-metilenodioximetanfetamina (MDMA) é uma substância proscrita no Brasil e deveria ser a substância presente nas balas (ecstasy) e MDs. Diante do cenário de não regulamentação deste importante psicodélico e empatógeno, há um grande número de adulteração nestas substâncias. Sabe-se que pode ocorrer a presença de anfetamina, cafeina, MDA, PMA, PMMA, metilona, dentre outras substâncias, inclusive com a ausência completa de MDMA. Grupos de redutores de danos têm testado estas substâncias e identificado quais substâncias estão realmente presentes nas balas e MDs. Além disso, favorecem os usuários para que lidem com experiências psicodélicas difíceis. Aqui no Brasil também há grupos de redutores de danos como o Coletivo Balance e o Respire.

 

Para aplicarmos ações de redução de danos e promoção de saúde orientadas por evidências científicas no caso do consumo de MDMA não é nada fácil. Para começar, o pesquisador Jon C. Cole no artigo “MDMA and the ecstasy paradigm”, publicado no Journal of Psychoactive Drug em 2014 nos indica a problemática da pesquisa com MDMA. Esta substância já é estudada a pelo menos 3 décadas e não faltam artigos científicos e pesquisas sobre ela, no entanto, grande parte destes estudos é composto por um amontoado de viéses proibicionistas e alarmistas, resultando em grande acriticidade que Cole chama do “paradigma do ecstasy”. O paradigma do ecstasy tem distorcido os resultados e avaliações dos pesquisadores de seus efeitos de curto e longo prazo, criando uma imagem do MDMA como se ele fosse bem mais danoso a saúde do que de fato é.

Um dos riscos no consumo abusivo de MDMA está relacionado a hipertermia, isto é, ao aumento da temperatura corporal acima de 38ºC. Este quadro afeta, em estudos clínicos, cerca de 4% dos usuários. Em contextos laboratoriais ou clínicos o aumento da temperatura corporal após o consumo de MDMA costuma aumentar entre 0.2 à 0.8ºC e não resulta em um quadro conhecido como hiperpirexia, no qual ocorre a temperatura ultrapassa os 40ºC, muitas vezes cursando com a presença de delírios. No entanto, o uso lúdico de MDMA em conjunto com danças prolongadas com sol escaldante pode resultar, mesmo que raramente, na hiperpirexia. Este quadro é considerado um dos mais graves que podem ocorrer a usuários de MDMA (LIECHTI, 2014), isso é, no caso do usuário estar usando, de fato, MDMA. Desarte sua rara ocorrência, o quadro pode ser grave e a hiperprexia pode levar a coagulação intravascular, rabdomiólise e insuficiência renal ou falência de outros órgãos (LIECHTI, 2014).

Importante ressaltar que as evidências apontam no aumento da temperatura corporal, resultante apenas do MDMA, é dose-dependente e ocorre apenas em doses médias ou altas. Em estudos clínicos com doses de 75mg não houve aumento de temperatura significativo. Já com 125mg de MDMA tipicamente houve aumento da temperatura corporal. O modo mais exato de pensar a dose-dependência do MDMA e o aumento da temperatura, no entanto, é pensando a quantidade de MDMA utilizada por kg do usuário. O aumento máximo de temperatura ocorre entre 2 e 2,5 horas após o uso da substância e foram observadas entre 90min e 4 horas após o uso do MDMA (LIECHTI, 2014). Embora já conhecido, há estudos apontando que a temperatura corporal aumenta mais em ambientes quentes e reduz em ambientes frios, logo, a importância de ambientes frescos, com música baixa e suporte emocional em locais nos quais ocorre uso de MDMA não deveria ser desconsiderada, pelo contrário, é uma importante ação de redução de riscos e danos.

Vários fatores podem ser importantes para a alteração da temperatura corporal inclusive: doses repetidas, doses muito altas, atividade física, alta temperatura no ambiente e espaços muito lotados, além da própria interação social. Mais um que deve ser tomado como central é a ausência de líquidos. Isto é: o usuário de MDMA deve se hidratar. Cuidado deve ser tomado também para que a hidratação seja continua em doses moderadas e não um excesso de hidratação de uma única vez, na medida em que a hiperhidratação pode gerar desregulação corporal pela perda de eletrólitos.

Retornando ao aumento de temperatura, sabe-se que os efeitos do MDMA estão ligados a sua ação sobre os neurotransmissores serotonina e norepinefrina, além da dopamina em menor escala. Possivelmente o aumento da disponibilidade biológica destes neurotransmissores está relacionada ao aumento de temperatura após o uso do empatógeno. O cenário de adulteração aumenta os riscos, inclusive quanto a hipertermia. A parametoxianfetamina (PMA) e a parametoximetanfetamina (PMMA), possíveis adulterantes das balas e MD´s, aumentam mais do que o MDMA a temperatura corporal. O consumo em conjunto com outras substâncias que aumentam a temperatura corporal, como anfetamina e cocaina, pode piorar a situação.

Em alguns casos, além disso, pode ocorrer a chamada síndrome serotoninérgica (SS), na qual a hipertermia é apenas um dos sintomas. Desta forma, sempre é importante saber o que se usa, pois o MDMA é uma substância que provoca aumento liberação da 5-hidroxitriptamina (5HT), isto é, do neurotransmissor conhecido como serotonina. Caso o usuário esteja usando um antidepressivo inibidor seletivo de recaptação de serotonina (ISRS) isso aumenta grandemente a chance de síndrome serotoninérgica. Há alguns sites e pessoas que recomendam ao usuário de MDMA uma dieta rica em alimentos com l-triptofano, no entanto, o que pode ser correto no pós-uso, no entanto, não o é ao longo do uso em caso de ocorrência de SS poderia agravar a situação, pois o l-triptofano é um precursor do 5HT.

Sobre a SS em outro post aprofundamos!

Referências:

COLE, MDMA and the ecstasy paradigm In: Journal of Psychoactive Drug. 2014.

LIECHTI, Matthias E. Effects of MDMA on body temperature in humans 2014.

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