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How does someone die from taking ecstasy?

“When someone dies after taking ecstasy, what causes the death? My friends who take the drug say that if it is MDMA then it is safe. Is that true?”

Ecstasy deaths are rare but they do happen. In Australia and the UK, the number of ecstasy-related deaths has increased in recent years. The reason why an ecstasy-related death occurs is not always easy to explain, particularly when the person who died took exactly the same pill or capsule as everyone else around them and they experienced no problems at all.

Ecstasy or MDMA (Methylenedioxymethamphetamine) is an illegal drug and is sold as a tablet, capsule, powder and in crystal form. The strength of MDMA can vary enormously, as does the content of tablets, capsules, powders and crystals sold as ecstasy. As a result, one of the major causes of ecstasy-related deaths is the presence of ‘adulterants’.

Drugs sold as ecstasy may contain little or no MDMA. Tablets and powders may contain a range of substances, some of which may be more likely to cause harm than MDMA. For example, PMA is notable for its high toxicity resulting in a relatively small amount potentially causing significant harm, including death. PMA also takes longer to take effect, resulting in some users taking more, believing that the drug they took was not working. There have been a number of PMA-related deaths in Australia, where people took what they believed to be ecstasy and died due to the presence of the far more dangerous substance.

It is important to acknowledge, however, that MDMA itself has been the cause of a number of deaths over the years. These tend to fall into the following categories:

  • Heatstroke: Using ecstasy in a hot environment such as a club, combined with dancing can cause body temperature to rise over the danger limit of 40°C. This can lead to very serious medical problems including convulsions, very low blood pressure and accelerated heart rate. Death is caused by respiratory collapse as MDMA reacts with the chemicals that control blood clotting meaning that blood coagulates where it shouldn’t, such as in the lungs; air cannot get through and the person dies.
  • Water intoxication: There been a number of deaths caused by excess water intake – this is known as dilutional hyponatremia. MDMA affects the kidneys by producing an anti-diuretic hormone that prevents the body from getting rid of fluids. Water is retained in the body, especially in the highly water-absorbent brain cells. Eventually the pressure shuts down breathing and heartbeat and leads to coma and death. Early warning signs include dizziness and disorientation.
  • Heart failure: MDMA causes significant rises in blood pressure and heart rate, which a fit young person can normally sustain. A small number of young people, however, have succumbed to these stimulant effects, sometimes as a result of an undiagnosed heart condition.
  • MDMA toxicity or overdose: A cause of the rise in ecstasy-related deaths is likely to be MDMA poisoning or overdose i.e. taking too much or taking a ‘dose’ that is ‘over’ the safe amount. Research suggests that the acute lethal dose of MDMA is two grams (2000 mg), while the active dose of MDMA is considered to be about 80–100 mg. Theoretically, this means that there is a relatively large difference between the lethal and active dose. However, more susceptible individuals, including women, those of lower weight, and those with less efficient livers can and have died from using much lower doses of the drug

While the increase in strength of MDMA may have contributed to some deaths, many questions remain unanswered. It is unclear as to why one person may die after taking an ecstasy pill or capsule while many others who took exactly the same drug had no adverse effects at all. It would appear therefore that some people may be predisposed to ecstasy-related harm. Ecstasy/MDMA-related deaths are not the norm but MDMA is not a ‘safe’ drug – things can and do go wrong.

First published: March 2019

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