MDMA Overdose

The illegal club drug MDMA, also called molly or ecstasy, can cause severe overheating and death. A fatal overdose can occur even with just one dose. A person experiencing overdose symptoms needs prompt medical attention.
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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.

MDMA Overdose Signs and Symptoms

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:
  • Abnormal heart rhythms
  • High blood pressure or low blood pressure
  • Fainting
  • Elevated body temperature (greater than 104 F)
  • Jaw clenching or lockjaw
  • Rigid muscles
  • Pale skin
  • Dry mouth
  • Agitation and panic attacks
  • Hallucinations
  • Fast breathing or difficulty breathing
  • Nausea and vomiting
  • Delirium
  • Coma
  • Seizures
  • Sudden death
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.

How Does Ecstasy Kill You?

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.

Serotonin Toxicity

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.

Exertional Heat Exhaustion

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.

Water Intoxication

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:
  • Trouble speaking
  • Sudden weakness or numbness in one’s face, arm or leg
  • Blurred vision
  • Headache
  • Trouble walking

How Much Molly Is Too Much?

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. Mixing molly and alcohol can increase the risk of heatstroke and serious organ damage. Chronic use of ecstasy may also lead to an MDMA addiction.

Treating MDMA Overdoses

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. Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.
Amy Keller, RN, BSN
Content Writer,
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.

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