Buprenorphine, alcohol and black-outs

What is the relation between buprenorphine, alcohol and black-outs?

Regarding buprenorphine and alcohol being co-administered. Last week I drank 2-3 alcoholic beverages too quickly. Also, I am taking 4MG of buprenorphine daily. So, is it blacking out for an extended period of time?

Originally posted in SR 2.0 15/10/2013. Reviewed 20/2/22

Buprenorphine is a medication that is primarily used to treat opioid addiction.  Blackouts or amnesic episodes are not typical side effects. In fact, this possibility is not even mentioned as a rare side effect in the technical sheet of the product.

However, the consumption of alcohol can lead to blackouts or amnesic episodes, even without any other factors present. Drinking alcohol too quickly, especially high concentration beverages, can increase the likelihood of experiencing a blackout. During a blackout, a person may engage in activities as talking, walking… but they have no recollection of these events the next day.

This occurs because alcohol interferes with the formation of new memories in the hippocampus. The hippocampus is a part of the brain that is responsible for forming and storing memories. 

To prevent blackouts, it is recommended to drink alcohol in moderation, avoid binge drinking, and stay hydrated by drinking water between alcoholic beverages. It is important to pace yourself when drinking and to be aware of the concentration of the beverages you consume. 

In conclusion, while blackouts are not a known adverse effect of buprenorphine, consuming alcohol too quickly or in high concentrations can lead to blackouts or amnesic episodes. 


Ketamine or methoxetamine

Hi DoctorX!
Great thread!!! I wish every doctor was like you…
I am thinking about trying dissociatives…what should be the safest option…PCP, ketamine or methoxetamine?

Originally posted in SR 2.0 20/10/2013. Reviewed 20/2/22


Ketamine is a well known drug, widely used in therapy during 50 years. Recreative use of ketamine has, more or less, 15-20 years. In the last 5 years there have been a lot of scientific reports talking about bladder and urinary problems in ketamine users.So, this was an unknown problem until 2005 (more or less), and has been detected after 15-20 years of recreative, intranasal use. In general, it only affects to intensive users. Ketamine dependence is another problem with this drug.


PCP was used in medicine from 1920 to 1950 and it was finished then because of its adverse side effects, such as hallucinations, mania, delirium, and disorientation. In fact ketamine has its substitute, because it has less adverse effects. PCP has been linked to neurotoxicity in animals, but it is not probably extrapolable to humans.

Additionally, PCP can be lethal in overdose, this event is much less likely with ketamine.Methoxetamine is a very new substance. We don´t know anything about its pharmacological properties and toxicity in humans, although there are reports of problems linked to its use:





Considering overall risks and benefits, probably ketamine is the safest, most pleasurable and less risky of all dissociatives, although it has it own problems associated indeed.


Cannabis and tachycardia

Is there a cause-effect relation between cannabis and tachycardia?

Marijuana is sort of famous for increasing heart rate. Some websites talk about it effecting an increase of 40 bpm, while others mention an increase of 50% over resting heart rate.

Personally, my heart rate goes from a resting rate of 70 bpm, to about 120 bpm (as if I’m jogging). But I have measured it to go as fast as 156 bpm, which is about 80% the maximum heart rate for my age group. This >120 bpm heart rate can persist for an hour, sometimes two.

Of course, if I were running a marathon, this would be considered normal. But all of this is when I am at rest and not exerting myself at all. Is such an elevated heart rate for such a long time dangerous to the body? Would this become risky as I age and the heart and blood vessels deteriorate, and maximum heart rate lowers to 130? 

Originally posted in SR 2.0 16/10/2013. Reviewed 20/2/22

Cannabis increases heart rate by a different mechanism than stimulants. The main effect is relaxation of veins and arteries. This effect lowers blood pressure. To compensate this and mantaining blood flow heart beats more quickly. Im general, cardiovascular toxicity related with cannabinoids is limited, compared to stimulants.

There are some cases reports of cardiovascular damage induced by cannabis, but are anecdotal and uncommon. But the main risk is fainting using cannabis too strong or too quickly. So if you feel dizzy, lie down to avoid hurting if you fall as a result of loss of consciousness.

The increase in frecuency you report is important and long-lasting. Possibly it does not mean a health problem.Or maybe you are particularly sensible to that effect. It is possible that it is just related to cannabis potency (you should try another variety or use less quantity).

But, also, it is theoretically possible that cannabis use could trigger an asymptomatic arrhythmia or pathological tachycardia.So, it should be interesting to have an electrocardiography test to rule out this possibility. 


Sex on MDMA

What is sex on MDMA like?

I plan on using MDMA to engage in a sexual encounter with a very close friend. We’ll be using it together.Is sex on MDMA a good idea? What dangers should i look out for? what can I do to limit risks, or make the experience the best it can be??

Originally posted in SR 2.0 16/4/14. Reviewed 9/2/23

Opinions about sex on MDMA vary widely. It is often a matter of personal preference. But, certainly, is one of the «classical» combination for sex and drugs.  Generally, people tend to prefer engaging in sexual activity 3-4 hours after taking MDMA. At this point, the intense mental effects are beginning to subside, but the sensations of enhanced tactile stimulation and general well-being persist.

A Rollercoaster Ride for men

One potential issue for men is that MDMA can make it more difficult to achieve and maintain an erection. However, this effect diminishes after three to four hours for most people. Some people counteract this effect using anti-impotence drugs. This is an option in healthy persons and using reasonable dosages.

Another common experience for men using MDMA during sex is retarded ejaculation. This can be either an advantage or disadvantage depending on the person and the situation. Although many individuals prefer engaging in sexual activity after taking MDMA, some prefer it during the peak experience.

Is not just a question of erection, on MDMA you can explore thousands ways of creative and enhanced sexuality

MDMA: Sex enhancer or love potion?

Disinhibition can have positive aspects (especially if people know each other beforehand and are familiar with the experience). It may be easier to explore fantasies or propose activities that we repress in the usual state of consciousness.
If we are talking about sex with strangers, or people who have not previously experimented with MDMA, things may be different. It is important to maintain the measures to protect one’s own health  (contraceptives, PREP, condoms…). And be aware about self’s modified state of consciousness and impact on decisions.

Add a bit of paraphernalia to sex

To optimize the experience, it is best to look for an intimate space free of distractions and to adopt a good set and setting. Showers, bubble bath, massage, porn, erotic talk, fantasies, black light and UV paint, glow sticks, candy….Possibilities are unlimited.

This can involve being free of worries and leaving room for improvisation Moderate dosages (no higher than 100-120 mg) are recommended. Engaging in sexual activity is no more risky than dancing at a rave (from a cardiovascular point of view), so adding MDMA does not introduce significant differences. As always, general rules of risk reduction for MDMA apply.

LSD, MDMA and infliximab interactions

Hello I was wondering if you knew anything about tnf-alpha remicade(infliximab). I like to know if it is there are LSD, MDMA and infliximab interactions, dangerous for a person using this drug for IBD.

Originally posted in SR 2.0 . Reviewed 20/2/22

Infliximab is one of the most recent treatments available in inflamatory bowel disease (IBD, inflammatory bowel disease: Crohn’s Disease /Ulcerative Colitis). 

Infliximab is sometimes used intravenously in severe disease flares. In these circumstances the use of recreational drugs or psychedelics is contraindicated. The patient is usually hospitalized and in poor general condition. So he will not probably find psychedelics enjoyable. 

But, on other occasions it is used periodically subcutaneously. If the patient’s general condition (both physical and psychological) is acceptable, there are no data to assume that MDMA or LSD increase the risk significantly. An increase in adverse, toxic or toxic effects is not to be expected.