Why You Gurn When You Take MDMA

Gurning is an inescapable part of taking MDMA or ecstasy, whether you've been double-dropping since The Hacienda or you took your first Mitzi last weekend. Of course, some gurn worse than others, and a cursory nose around YouTube will reveal reams of videos of people afflicted with more extravagant facial contortions than you've probably ever seen in the flesh. Still: it affects all those who dabble.

But what causes it?

"Gurning is likely predominately a result of bruxism, which is prolonged jaw clenching," says Harry Sumnall, Professor in Substance Use at the Centre for Public Health. "And also trismus, which describes reduced mouth opening. This can lead to chewing motions and lateral movements of the teeth."

Bruxism is a problem that generally affects people when they're sleeping, and according to the NHS it can be attributed to increased stress or anxiety in 70 percent of cases. The most common symptom is the grinding of teeth, and in the worst cases can lead to premature tooth loss, or—in the the case of your very intense friend Eccie Ian—a face that looks like it's being suspended from a crane by the lower jaw.

"Orofacial effects are probably a result of a release of serotonin, and to a lesser extent dopamine and noradrenalin. Studies in rats have shown that the release of serotonin after MDMA inhibits protective jaw opening reflexes, which usually serve to prevent clenching and teeth grinding. When rats are administered multiple doses of MDMA, different neurotransmitter systems come into play and there is the further inhibitory effect of noradrenaline," says Sumnall.

Tangible evidence for this in relation to humans is scarce, and he says: "It's always difficult to extrapolate directly from rodent studies to human use of MDMA, but these studies are plausible and in keeping with what we know about bruxism in general."

So should we be wary of the negative effects of gurning/bruxism, beyond the possibility that a picture of our masticating face will end up on social media and be turned into a wildly circulated meme that will prevent us from ever gaining meaningful employment again?

"Although ecstasy gurning is not inherently harmful, dentists have expressed concern because people often report prolonged dry mouth due to reduced saliva secretion after taking it," says Sumnall, adding that this can last up to 48 hours. "Combine this with bruxism, which is reported by many users for up to 24 hours after taking the drug; dehydration from prolonged dancing; and the possible consumption of acidic fizzy drinks, and there is the potential for dental damage."

As well as the harm to your teeth, another common complaint following a night on the beans is jaw soreness. This will be tenderness in the temporomandibular joint (TMJ), the "hinge" that connects the jaw to the temporal bones of the skull, in front of each ear, and where any bruxism-related clenching will be focused.

When it comes to traditional pre-emptive treatments, there's little that would appeal to the average pill-taker, with the Bruxism Association recommending splints or mandibular advancement devices, AKA gum shields. Sadly, unless you're super into looking like you just wandered off a rugby pitch on a night out, neither of these are really an option.

Instead, it's the old trick that'll work the best: sugar-free chewing gum. Harry also says that "dentists have recommended the use of fluoride mouthwash to alleviate dry mouth rather than fizzy drinks," though whether anyone is going to bother smuggling a bottle of Colgate into a club with them is doubtful.

A trawl through the depths of Reddit will find many posters bestowing the virtues of magnesium pills. A lack of magnesium is often cited as a trigger for bruxism, and most bodies naturally lack it anyway, so the thinking goes that if you keep it in surplus it might stop you gurning. That said, there's little data out there to prove it.

I'm interested in the connection between drug strength and the severity of one's gurn. The UK is currently in the midst of an epidemic of industrial strength MDMA and ecstasy. Data from 2014 suggested the average pill had 108mg of MDMA, compared to the 80mg average of the early 90s. Fiona Measham from drugs harm reduction company The Loop tells me there's even "been pills up to 330mg," which, frankly, sound absolutely terrifying.

Unexpectedly, the answer turns out to be yes. Probably. "Effects are likely dose-related," says Sumnall. "So higher dose tablets might be more likely to lead to these [gurning symptoms], but so too would repeated dosing of lower strength tablets."

And what effect does your age have on your susceptibility to an intense gurn? Will a relatively experienced drug user in their late twenties have to pack double the amount of Airwaves compared to a kid that's still in the florid embrace of a pill honeymoon?

"You might see a difference between a 21-year-old and a 50-year-old, but probably not between someone who's 21 and 35. However, younger users will tend to have more frequent patterns of use, so there might be greater likelihood of tolerance to some of the effects, whereas older people's use will tend to be sporadic and infrequent, so they may be more likely to experience these effects. Saying that, younger people will be more likely to use higher doses anyway, so it might counteract that."

Whatever your age: if you want to keep your gurn at bay, don't go to the party without your gum.

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