harm reduction · not medical advice
molly
a letter · revised 2026

hi, i'm

molly .

You probably know me by a few names — mandy, E, MDMA, or just that pill a friend handed you at a party.

I have been studied more than you might think. I can be gentle, and I can be genuinely harmful — and almost always the difference comes down to how well you know me before we meet.

So let's sit down. I want to tell you about myself.

five short chapters below
♥
with love
04

chapter 04

who i get along with.

and who I really don’t

Who I get along with (and who I really don't)
some substances and i make decent company. others, we really shouldn't be in the same room.

psychedelics & cannabis

Cannabis (THC/CBD)Hippy Flip (informal)

Often used during comedown or throughout

lower risk

combined effects

  • ♥Can intensify MDMA effects and visuals
  • ♥May help with comedown anxiety and sleep
  • ♥CBD may provide neuroprotective benefits
  • ♥Can increase heart rate when combined

risks

  • ·May increase anxiety or paranoia in some users
  • ·Can cause confusion or disorientation at high doses
  • ·Impairs short-term memory more than either alone
  • ·May mask warning signs of overheating

how to be careful

  • Start with low cannabis doses if combining
  • Wait until after MDMA peak to use cannabis
  • Avoid high-THC strains if prone to anxiety
  • CBD-dominant products are generally safer
  • Stay hydrated and monitor body temperature

source: TripSit, PsychonautWiki, anecdotal reports

LSD (Acid)Candy Flip

LSD typically taken 3-4 hours before MDMA

tread carefully

combined effects

  • ♥Intense synergistic psychedelic experience
  • ♥Strong euphoria and emotional openness
  • ♥Enhanced visuals and sensory perception
  • ♥Can feel deeply meaningful and therapeutic

risks

  • ·Very long duration (12+ hours total)
  • ·Increased risk of overwhelming experience
  • ·Higher cardiovascular strain
  • ·More demanding on serotonin system
  • ·Difficult to dose appropriately first time

how to be careful

  • Be experienced with both substances separately first
  • Use lower doses of each (50-75% of normal)
  • Take LSD first, MDMA 3-4 hours later
  • Have a trip sitter present
  • Ensure safe, comfortable environment
  • Allow extra recovery time afterward

source: Erowid, PsychonautWiki, harm reduction communities

Psilocybin (Mushrooms)Hippy Flip

Mushrooms typically taken 1-2 hours before MDMA

tread carefully

combined effects

  • ♥Warm, empathogenic psychedelic experience
  • ♥Enhanced emotional depth and introspection
  • ♥More body-focused than candy flip
  • ♥Shorter duration than LSD combination

risks

  • ·Nausea may be intensified
  • ·Can be emotionally overwhelming
  • ·Unpredictable intensity
  • ·Increased body load and temperature

how to be careful

  • Be experienced with both substances separately
  • Use lower doses of each (50-75% of normal)
  • Take mushrooms first, MDMA 1-2 hours later
  • Have ginger tea ready for nausea
  • Comfortable setting is essential
  • Have a sober trip sitter

source: Erowid, PsychonautWiki, clinical observations

DMT

DMT typically smoked during MDMA peak

tread carefully

combined effects

  • ♥Brief but extremely intense psychedelic experience
  • ♥MDMA can provide emotional grounding for DMT
  • ♥Potentially less anxiety entering DMT space
  • ♥Enhanced sense of meaning and connection

risks

  • ·Overwhelming sensory overload possible
  • ·Rapid heart rate increase
  • ·Disorientation and confusion
  • ·Short duration but high intensity
  • ·Risk of injury if standing during DMT

how to be careful

  • Be very experienced with both substances
  • Use low-moderate DMT doses
  • Be seated or lying down before smoking DMT
  • Have a sitter to hold the pipe/device
  • Wait until fully returned before moving
  • Ensure proper set and setting

source: Erowid, DMT Nexus, harm reduction communities

2C-BNexus Flip

2C-B typically taken during MDMA comedown or 2-3 hours after MDMA

tread carefully

combined effects

  • ♥Extends and transforms the MDMA experience
  • ♥Adds psychedelic visuals to the empathogenic state
  • ♥Can feel very euphoric and sensual
  • ♥Smoother transition than other psychedelics

risks

  • ·Increased body load and nausea
  • ·Can intensify anxiety if not prepared
  • ·Longer total experience duration
  • ·May be overwhelming for inexperienced users

how to be careful

  • Use lower doses of 2C-B (10-15mg) when combining
  • Wait 2-3 hours after MDMA peak before taking 2C-B
  • Have experience with both substances separately
  • Comfortable setting is essential
  • Stay hydrated and maintain electrolytes

source: PsychonautWiki, Erowid, harm reduction communities

25x-NBOMe compounds

N/A - dangerous combination

please don’t

combined effects

  • ♥Intense and unpredictable psychedelic experience
  • ♥Strong stimulation

risks

  • ·Severe cardiovascular strain
  • ·Seizure risk
  • ·Hyperthermia
  • ·Vasoconstriction
  • ·Psychotic episodes
  • ·NBOMes have caused multiple deaths even alone

how to be careful

  • Avoid this combination entirely
  • NBOMes are dangerous on their own
  • Combined with MDMA, physical risks multiply
  • Test your substances - NBOMes are sometimes sold as LSD

source: PsychonautWiki, case reports, harm reduction warnings

everything else

KetamineKitty Flip

Ketamine typically used during MDMA comedown

tread carefully

combined effects

  • ♥Dissociative and psychedelic combination
  • ♥Can extend and transform the experience
  • ♥May ease comedown discomfort
  • ♥Dreamy, floaty headspace

risks

  • ·Bladder damage risk with regular ketamine use
  • ·Disorientation and impaired coordination
  • ·Difficulty communicating or asking for help
  • ·Nausea risk, especially with movement
  • ·Memory impairment

how to be careful

  • Use low ketamine doses when combining
  • Stay seated or lying down
  • Avoid frequent ketamine use (bladder health)
  • Wait until MDMA peak has passed
  • Have a sober sitter present
  • Stay hydrated but don't over-drink

source: TripSit, harm reduction organizations

Alcohol

Often consumed before or during MDMA

risky

combined effects

  • ♥May reduce anxiety before MDMA onset
  • ♥Can dull the MDMA experience
  • ♥Disinhibition effects compound

risks

  • ·Severe dehydration risk
  • ·Masks MDMA warning signs
  • ·Increased neurotoxicity potential
  • ·Much worse hangovers
  • ·Impaired thermoregulation
  • ·Higher risk of dangerous behavior
  • ·Memory blackouts more likely

how to be careful

  • Avoid alcohol with MDMA if possible
  • If drinking, limit to 1-2 drinks maximum
  • Never drink heavily before or during MDMA
  • Prioritize water and electrolytes
  • Alcohol does NOT help with comedown

source: Clinical literature, harm reduction consensus

Cocaine

Sometimes used during MDMA experience

please don’t

combined effects

  • ♥Increased stimulation and energy
  • ♥May prolong alertness

risks

  • ·Severe cardiovascular strain
  • ·High risk of heart attack or stroke
  • ·Dangerous hyperthermia risk
  • ·Cocaine blocks MDMA's positive effects
  • ·Much worse comedown
  • ·Compulsive redosing behavior

how to be careful

  • Strongly avoid this combination
  • If used: monitor heart rate closely
  • Never use with pre-existing heart conditions
  • Seek medical help if chest pain occurs

source: Clinical case reports, cardiology literature

Amphetamines (Adderall, Speed)

N/A - not recommended

please don’t

combined effects

  • ♥Increased stimulation
  • ♥Extended duration of effects

risks

  • ·Severe cardiovascular strain
  • ·Dangerous hyperthermia
  • ·Increased neurotoxicity
  • ·Serotonin syndrome risk
  • ·Compulsive behavior
  • ·Severe comedown/crash

how to be careful

  • Avoid this combination entirely
  • MDMA is already an amphetamine derivative
  • Combined stimulant load is dangerous
  • If on prescription amphetamines, consult harm reduction resources

source: Pharmacology research, harm reduction literature

GHB / GBL

Sometimes used during MDMA comedown

risky

combined effects

  • ♥May ease the MDMA comedown
  • ♥Increased euphoria and disinhibition
  • ♥Enhanced music appreciation

risks

  • ·Unpredictable dosing - narrow margin between recreational and dangerous dose
  • ·Risk of sudden unconsciousness
  • ·Respiratory depression when combined
  • ·Memory blackouts
  • ·Dangerous if combined with alcohol
  • ·Vomiting while unconscious risk

how to be careful

  • Avoid this combination if possible
  • Never combine GHB/GBL with alcohol
  • Use much lower GHB doses than usual
  • Have a sober sitter who knows signs of overdose
  • Never redose GHB - wait at least 2 hours
  • Recovery position if someone becomes unconscious

source: PsychonautWiki, TripSit, clinical reports

MXE (Methoxetamine)

MXE should only be taken after MDMA effects subside

risky

combined effects

  • ♥Dissociative and entactogenic combination
  • ♥Can produce unique psychedelic states
  • ♥May help with comedown discomfort

risks

  • ·Serotonergic interactions reported when taken simultaneously
  • ·Unpredictable effects
  • ·Increased confusion and disorientation
  • ·Cardiovascular strain
  • ·Mania or psychosis risk

how to be careful

  • Never take MXE during MDMA peak
  • Wait until MDMA effects have mostly subsided
  • Use low doses of MXE
  • Have a sober sitter present
  • Avoid if you have history of psychosis

source: PsychonautWiki, harm reduction reports

Nitrous Oxide

Typically used during MDMA peak for brief intensification

lower risk

combined effects

  • ♥Brief but intense euphoric peak
  • ♥Temporary intensification of MDMA effects
  • ♥Dissociative enhancement
  • ♥Enhanced music and sensory experience

risks

  • ·Brief disorientation - fall risk
  • ·Oxygen deprivation if used excessively
  • ·B12 depletion with heavy/regular use
  • ·Fainting risk - never use while standing

how to be careful

  • Always sit or lie down before use
  • Never use with a bag over head - use balloons
  • Limit number of uses per session
  • Breathe normal air between uses
  • Supplement B12 if using regularly

source: PsychonautWiki, TripSit, harm reduction consensus

Opioids (Heroin, Oxycodone, etc.)

Sometimes used to ease comedown - not recommended

risky

combined effects

  • ♥May reduce comedown discomfort
  • ♥Sedation and pain relief
  • ♥Euphoria from both substances

risks

  • ·Respiratory depression
  • ·Masks signs of MDMA overheating
  • ·Increased nausea and vomiting risk
  • ·Higher overdose risk - unpredictable interaction
  • ·Severe dehydration
  • ·Compulsive redosing of opioids

how to be careful

  • Avoid this combination
  • If using: never use alone, have naloxone available
  • Use much lower opioid doses than normal
  • Never combine with alcohol or benzodiazepines
  • Monitor breathing and temperature

source: Clinical literature, harm reduction organizations

Benzodiazepines (Xanax, Valium, etc.)

Sometimes used to ease comedown or help sleep

tread carefully

combined effects

  • ♥Can reduce MDMA-induced anxiety
  • ♥Helps with sleep after MDMA
  • ♥Muscle relaxation
  • ♥Reduces stimulation somewhat

risks

  • ·May dull positive MDMA effects if taken too early
  • ·Memory blackouts
  • ·Disinhibition leading to risky behavior
  • ·Next-day grogginess
  • ·Dependence potential with regular use

how to be careful

  • Reserve for comedown/sleep only if truly needed
  • Use lowest effective dose
  • Do not combine with alcohol or other depressants
  • Avoid using benzos regularly - high addiction potential
  • Short-acting benzos (like triazolam) preferred for sleep

source: Clinical practice, harm reduction consensus

Caffeine

Often consumed before or during MDMA use

lower risk

combined effects

  • ♥Increased stimulation and alertness
  • ♥May extend wakefulness
  • ♥Enhanced energy for dancing

risks

  • ·Increased heart rate and blood pressure
  • ·May increase anxiety
  • ·Additional dehydration
  • ·Can make comedown worse
  • ·Increased jaw clenching

how to be careful

  • Limit caffeine intake - avoid high doses
  • Stay extra hydrated
  • Avoid energy drinks with high caffeine content
  • Monitor heart rate if combining
  • Stop caffeine early enough to eventually sleep

source: General pharmacology, harm reduction consensus

MAOIs (Ayahuasca, Syrian Rue, etc.)

N/A - extremely dangerous combination

please don’t

combined effects

  • ♥Dramatically increased MDMA effects
  • ♥Extended duration

risks

  • ·Life-threatening serotonin syndrome
  • ·Hypertensive crisis
  • ·Hyperthermia
  • ·Seizures
  • ·Death

how to be careful

  • NEVER combine MDMA with MAOIs
  • This includes ayahuasca, Syrian rue, and MAOI medications
  • Wait at least 2 weeks after stopping MAOIs before using MDMA
  • This is one of the most dangerous drug combinations

source: PsychonautWiki, clinical literature, multiple fatality reports

SSRIs / SNRIs (Antidepressants)

Chronic medication use

tread carefully

combined effects

  • ♥SSRIs typically block or greatly diminish MDMA effects
  • ♥The experience may feel "flat" or barely noticeable
  • ♥Some residual stimulation may occur

risks

  • ·Temptation to take higher MDMA doses (dangerous)
  • ·Unpredictable interactions
  • ·Some serotonergic risk remains
  • ·Stopping SSRIs abruptly is dangerous

how to be careful

  • MDMA will likely not work well on SSRIs
  • Do NOT stop SSRIs abruptly to take MDMA
  • Do NOT take more MDMA to try to overcome the block
  • If you must use MDMA on SSRIs, keep doses normal
  • Consult harm reduction resources for your specific medication

source: PsychonautWiki, clinical research, harm reduction literature

Never, under any circumstance
these have killed people. no exaggeration.

MAOIs

Including ayahuasca, Syrian rue, and MAOI medications. Life-threatening serotonin syndrome and hypertensive crisis. Wait 2+ weeks after stopping MAOIs.

Tramadol

High risk of seizures and serotonin syndrome. This combination has caused fatalities. Never combine these substances.

DXM (cough medicine)

Serotonin syndrome risk. DXM is found in many OTC cough medicines — check ingredients before taking any cold medication.

Lithium

Can dramatically increase effects and cause seizures. Extremely unpredictable and dangerous combination.

25x-NBOMe

Dangerous alone, deadly with me. Severe cardiovascular strain, seizures, hyperthermia. Often mis-sold as LSD — always test your substances.

5-HTP (same day)

Never take 5-HTP before or during. Wait until the day after. Taken too close together, it can cause serotonin syndrome.