Plugging ecstasy?

Dear Alice,

On "big nights out" (about once a month) friends of mine "plug" ecstasy tablets — by which I mean they each stick one up their butt instead of swallowing.

They claim that is a "safer" way to ingest E because it bypasses the liver and goes right into the bloodstream. They also claim the effects are heightened.

I have been tempted to try this method as they swear by it, but thought I'd get your opinion first — are there any potential side effects to plugging? Is it really a "safer" way to use E?

— Unplugged in NY

Dear Unplugged in NY,

Plugging, or inserting drugs like Ecstasy (E) into the butt, can give the same sensations as taking the drug orally (through the mouth). It's difficult to say which method is "safer" because there is little scientific research on the topic. Effects may be experienced more quickly when substances are inserted anally, because the walls of the colon allow the substance to be absorbed more quickly into the bloodstream than the walls of the stomach. There is some evidence to suggest the effects will be stronger because bypassing the stomach avoids the body's customary initial digestive process. Taking E orally sometimes causes nausea. For those with a sensitive stomach, taking drugs anally may result in fewer stomach problems.

The method of ingestion will not make a difference in damage to the liver. The liver's job is to filter toxins (like Ecstasy) out of the blood. Drugs end up in the bloodstream whether they enter from the mouth or the anus, so there is no way to "bypass" the liver. People with hepatitis or other liver ailments may be especially vulnerable to liver damage from using E. Potential dangers from plugging include damage to anal and rectal tissues, which are more delicate than the stomach. If the rectal tissues are irritated, it may increase the risk of sexually transmitted infections during anal sex. Plugging is discouraged for people who suffer from constipation, diarrhea, any ano-rectal disease, thrombocytopenia (low blood platelet count), or poor circulation.

No matter through which end the drugs enter, it is important to remember the following: substances sold "underground" can contain many additives and impurities, increasing their danger. Mixing E with other drugs like alcohol increases the risk of adverse effects. Most deaths associated with the use of Ecstasy have been the result of heat stroke due to fluid loss from dancing in hot clubs without drinking enough water. Ironically, Ecstasy can also lead users to drink too much water, causing hyponaetremia, also known as water toxicity. E inhibits the body's ability to urinate, which can lead to edema or swelling of the brain. Slowly drinking 2-4 cups of water an hour and eating something salty will help keep the body's fluids and electrolytes balanced, whether you are plugging or taking E orally.

E is a mood elevator, meaning it produces a relaxed, euphoric state. It acts as a short-term antidepressant. Some people may unconsciously use it to self-medicate for depression. If this is the case, a doctor may be able to prescribe more effective treatments. Frequent use of E is likely to reduce its euphoric impact no matter how it is ingested. Scientists are unsure of long term effects, but ongoing use of E has been associated with brain damage affecting memory, mood, sleep, sex, and appetite.

There are serious risks associated with E no matter how you take it, so it would be inaccurate to call either plugging or swallowing "safer." Each person's body responds differently to substances. One route or the other may be more comfortable, or produce a better sensation, or induce a different side effect, depending on your body.

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