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Why would the same MDMA pill or cap kill one person and have no effect on another?

“Why would someone die after taking an MDMA pill or cap and others with them who took exactly the same thing not even get sick? If there’s something poisonous in a batch, why wouldn’t everyone get sick? Could it be that there was something wrong with the person who died in the first place?”

Ecstasy (or MDMA) deaths are unusual but they do happen and when they do they attract a great deal of media attention. Stories are splashed over the front pages of newspapers and there’s always a great deal of speculation about what could have caused the death. Often authorities talk about a ‘bad batch’, i.e., that the drug could have contained some particularly dangerous substance, but this is not always based on any real evidence. Unfortunately, it can take a very long time to work out what caused the death and by the time the actual cause has been confirmed, the media has moved onto another story and the public never finds out what really happened.

There have been many high-profile cases where someone has died after taking a pill or capsule that appeared, on the face of it, to be exactly the same as the one their friends took, i.e., it was bought at the same time, from the same dealer, apparently coming from the same ‘batch’, and nothing happened to them. In many cases, their friends didn’t even get sick. So why would different people have such different effects after taking what seems to be the same drug?

The most important thing to remember for anyone considering using any drug (legal, illegal or pharmaceutical), is that different drugs affect different people in different ways. More importantly, each time a person uses any substance, they are likely to get a different effect. This effect depends on so many things, e.g., where they take the drug, what they’ve eaten and even their mood or the time of the day it was taken! It must also be remembered that MDMA is not a safe drug – things can and do go wrong when people take it. Even if the user takes a pill or capsule that contains MDMA, this doesn’t mean that it’s safe – people have died from MDMA poisoning or overdose.

If we look at the research we have on MDMA-related deaths, apart from those caused by poisoning, they are usually caused by overheating (usually resulting in respiratory collapse), ‘water intoxication’ (water is retained, flooding to the brain) or heart failure. Why this happens to some and not others isn’t always clear. We’re able to identify what caused the person to die (e.g., overheating) but not be able to establish why it happened to them and not others they were with. As you suggest, there are cases where this could have been caused by an undiagnosed medical condition or individual difference, i.e., they had some unique reaction to as substance contained in what they took. Sadly, however, sometimes there’s no simple explanation and the death can only be attributed to a tragic set of circumstances and ‘bad luck’.

Although MDMA-related deaths are rare they do happen. It’s important to remember that if you choose to use any illicit drug, you never really know what you’re taking and what effect you’re going to get.

First published: May 2015
Reviewed and updated: October 2023

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