Is XTC more harmful than alcohol?

Pillen en alcohol

The popular party drug XTC is being used more and more each year. The Trimbos Insitute wrote that in 2018, 2.8% of the population had used XTC at some point. In 2019, this rose to 3.4%. In 2020, the percentage slightly decreased (to 3.1%) because hardly any festivals took place. But the expectation is that in 2021 and 2022, XTC use will rise again once the party scene comes back in full swing.

We often hear discussions about whether taking an XTC pill might actually be less harmful than a night of heavy drinking. That’s why I dug into some interesting facts and stats about both substances and laid them out for you below. I do want to mention: this blog is not here to encourage you to use either one based on which is “less harmful.” It’s just here to give you the knowledge to be well-prepared in any conversation about XTC and alcohol.

The harm of XTC and alcohol

Let’s first go over the risks of both substances. There’s still a lot of ongoing research about the long-term negative effects of XTC. Alcohol is a different story, as it’s been consumed for centuries and is, of course, legal.

After using XTC, short-term risks can include dehydration, overheating, damage to your liver, kidneys, and other organs, heart problems, depressive symptoms, water intoxication, physical overload, and the infamous Tuesday Dip. Long-term risks may include brain damage, memory issues, concentration problems, and even depression. Of course, these are potential risks. Generally, the lower the dose and frequency, the lower the chance of these effects.

Alcohol brings risks on the short-term like alcohol poisoning, blackouts, passing out, coma, reduced inhibitions, slower reaction time, lower testosterone levels, bad sleep, and the all-too-familiar hangover. But the long-term risks of alcohol are far worse. It can damage your liver, stomach lining, and brain. It also increases the risk of mouth, throat, larynx, and esophagus cancer. Other risks include reduced fertility, psychosis, weight loss, weight gain, and social problems. What’s scary is that these risks can already kick in with just a couple of glasses per week, even if that sounds harmless.

Drug ranking

What really caught my interest was a report by the RIVM (Netherlands Institute for Public Health and the Environment) published in 2009 called Ranking of Drugs. This report ranked 19 types of soft and hard drugs based on short- and long-term toxicity, addictive potential, and social harm. Strikingly, alcohol ended up in 3rd place, while XTC (MDMA) ranked 13th. Based on that report alone, you could conclude that alcohol is more harmful than XTC.

That said, the report is from 2009, so it’s outdated. Today, XTC pills are a lot stronger, according to Van der Gouwe from the Trimbos Institute. That means the average MDMA dose per person has gone up, which could change the level of toxicity.

Addiction potential

The Ranking van Drugs report also considered how addictive each substance is—worth diving into a bit more. XTC is addictive. Many people want to relive that euphoric feeling, but for most, quitting isn’t very difficult. You can’t take XTC every day because it depletes your serotonin. You have to wait several days for your serotonin levels to recover before you can feel the effects again. That makes physical addiction to XTC less likely.

Alcohol is a different story. Sadly, there aren’t any recent stats on alcohol addiction in the Netherlands, but the most recent data from 2007–2009 shows alcohol dependency occurred in about 0.7% of adults. Still, many people who’ve tried XTC want to use it again, simply because the effects are way more intense than just a few glasses of wine. If this happens multiple times in a short period (like within two months), it can be damaging to your brain, and the typical XTC “love” feeling starts to fade. Overall, alcohol is more addictive—but that doesn’t mean frequent XTC use is risk-free.

Incidents

You often hear people say that one bad XTC pill can kill you, and that’s why alcohol is the “safer” option. There’s a grain of truth in that, but it’s important to have the right info to truly compare the two.

In the article Recreational ecstasy use in the Netherlands (2020), researchers analyzed various global studies to draw conclusions about XTC safety. The Netherlands doesn’t officially register fatal XTC incidents, but data from England and Wales suggests that if we extrapolate their stats, there are likely up to 37 MDMA-related deaths per year in the Netherlands. The report clearly states that XTC is not a safe drug and carries serious health risks. However, if you look at risk per user or per pill, the fatality rate of XTC is relatively low—and comparable to alcohol.

I should add: these comparisons are tricky. The cause of death is often not just a “bad pill,” but can involve mixing with other drugs or taking too much. The same goes for excessive alcohol use. Also, XTC is currently an illegal substance. If it were legalized, a maximum strength per pill could be regulated. In arguments for legalization, some even suggest government production of XTC pills. That way, we’d have fewer “bad” pills on the market and clear ingredient lists—possibly leading to fewer health incidents. But again, that’s all speculative. To stay safe, always test your pill before you take it.

Dosing

When you take the recommended amount of XTC, you’ll feel the effects for a few hours—effects that can really transport you to another world. After that, it’s recommended to wait at least two months before using again.

Alcohol, on the other hand, is easier to dose. You can have 1–2 glasses a day without major short-term effects. The Dutch Nutrition Center recommends drinking no more than one glass per day. And with a maximum of 0,5 blood alcohol level (about 2 drinks), experienced drivers are still legally allowed on the road. With XTC, no dose is ever considered safe behind the wheel. That’s not just because it’s illegal, but also because even a low dose of XTC can have way more intense effects than alcohol.

Final thoughts

So, is XTC more harmful than alcohol? It's hard to answer that directly because we're talking about two totally different substances. But when someone throws that question at you, you’ll now be fully equipped with the facts and insights to handle the conversation like a pro. If you stick to the recommended amounts, it’s totally possible to enjoy a pill now and then and sip a nice drink here and there—without ruining your health.

Curious about tips to beat your XTC comedown or dreaded Tuesday Dip? Then check this page!

Drop your thoughts in the comments: Is XTC more harmful than alcohol?


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