The illegal drug 3,4-methylenedioxymethamphetamine (MDMA) is commonly referred to as ecstasy or molly. While many people think ecstasy is a safe drug, the illegal stimulant has a number of toxic and potentially life-threatening side effects.
Among the most common causes of MDMA-related deaths is heatstroke. People using molly have also died from brain swelling, acute liver failure, strokes, sudden heart failure, abnormal bleeding and seizures.
If you believe someone has overdosed on MDMA, call 911 immediately. After calling 911, try to cool the person down until help arrives.
Lethal overdoses of MDMA are rare, but the drug has unique physiological effects that can trigger dangerous elevations in body temperature.
The hot and crowded clubs and dance venues where people frequently use molly, along with all-night dancing, can worsen this problem. Some people’s body temperatures have reached as high as 110 degrees while using ecstasy.
Signs and symptoms of an MDMA overdose include:
Fatal overdoses can occur within two to 60 hours of consuming the drug, according to a 2003 review of ecstasy intoxication and treatment by researchers at the Federal University of Health Sciences of Porto Alegre in Brazil.
There are several ways MDMA can lead to death. Common causes of MDMA-related fatalities are heatstroke, serotonin toxicity and water intoxication, according to a 2006 medical report in the British Journal of Anaesthesia.
MDMA causes elevated levels of several chemicals in the body, including serotonin, norepinephrine and dopamine.
These chemicals contribute to the euphoric high, increased energy and sociability, and other effects of molly.
But too much serotonin can trigger a condition known as serotonin syndrome. Serotonin syndrome is an extremely dangerous condition that causes sweating, confusion, shivering, rigid muscles and high body temperature (hyperthermia).
Up to 15 percent of people who develop this condition die. People taking certain types of antidepressants, including MAOI inhibitors and serotonin reuptake inhibitors, have a higher risk of developing serotonin syndrome when using ecstasy.
People consuming ecstasy often dance for extended periods of time at warm and crowded venues, which can raise body temperature even more and set off a cascade of internal damage.
Under such conditions, a person using MDMA may rapidly deteriorate. As their body temperature soars, their blood pressure and heart rate spike. They may sweat excessively and develop muscle spasms. Their skin may appear pale or blue-gray, and they may lose consciousness.
At that point, most individuals suffering from an MDMA overdose will have developed rhabdomyolysis, which occurs when muscle tissue breaks down and protein floods the bloodstream causing severe kidney damage or kidney failure.
A complication called disseminated intravascular coagulation, or DIC, typically follows. DIC causes small blood clots and bleeding from multiple sites in the body. In medical circles, DIC is often referred to as “death is coming,” because it signals a poor prognosis. Multiple organ failure usually follows.
Sadly, people have also died after using MDMA because they drank a lot of water or carbonated beverages to avoid overheating.
While many clubs and festivals have areas with free water available, there is such a thing as too much water. When a person consumes excessive amounts of water, it can dilute the levels of sodium in their blood. This can lead to swelling of the brain, which can lead to coma and death.
Symptoms of water intoxication include confusion, seizures and delirium.
MDMA-related deaths have also been attributed to liver failure and strokes.
Symptoms of liver failure include abdominal pain and yellowing of the skin, or jaundice. Some patients may exhibit changes in thinking, mood or personality.
Common symptoms of a stroke include:
Unlike many drugs that cause an overdose only when taken in high doses, ecstasy can cause deadly reactions at any dose.
While many people experience toxicity after taking large doses of the drug, people have overdosed after consuming just one pill.
Anyone experiencing the symptoms of an MDMA overdose needs prompt medical treatment.
Unlike a heroin or opioid overdose, which can be reversed with the drug naloxone, there is no antidote for an MDMA overdose.
Treatment typically involves rapid cooling of a person’s body and treating organ failure and other complications as they arise. In severe cases, a person may require advanced life support.
If a person is treated for an overdose within an hour of swallowing ecstasy, they may be given activated charcoal to absorb the drug so less enters the bloodstream.
A muscle relaxant called dantrolene has shown promise in reducing life-threatening elevations in body temperature and muscle rigidity in patients experiencing a life-threatening MDMA overdose.
A 2010 case report published in the Canadian Journal of Emergency Medicine noted that a 31-year-old man suffering from overdose symptoms after taking three ecstasy tablets recovered rapidly after being administered dantrolene.
In the case of water intoxication, fluid restriction will often correct the problem.
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