With the increasing use of ecstasy (MDMA) as a recreational drug, overdosing is fairly common. Ecstasy is an illicit drug, often used in combination with other drugs, which greatly increases the risk of toxicity. There is no such thing as a safe dose of the drug and even a minimum amount can produce toxicity and death. It is not just about individual sensitivity and dose, but also the substances added to bulk up the drug (“cut” it) that may contribute to this toxicity. There is no antidote for ecstasy poisoning.
The Drug Ecstasy
Ecstasy or 3, 4-methylenedioxymethamphetamine (MDMA) is a semi-synthetic psychoactive drug which possesses both hallucinogenic and stimulant properties. Ecstasy is a “designer” amphetamine and contains chemical variations of the stimulant amphetamine or methamphetamine, as well as a hallucinogen such as mescaline. This causes feelings of euphoria, emotional intimacy, increased sensuality, and loss of inhibition, as well as distorted sensory perceptions.
Although often used in combination with other drugs, it is usually not taken with alcohol since alcohol is believed to reduce its effects. Ecstasy is widely used in the mistaken belief that it is a harmless drug with minimum chance of toxicity. Although it may not be addictive to all users, serious physical complications are possible, even leading to death.
History and Use
Illicit use of ecstasy became popular since the late 1980s and early 1990s. It has become fashionable among young people for recreational use and is commonly distributed and consumed at “raves”, rock concerts, and nightclubs. It may be used on its own or as part of a polydrug experience with other drugs such as marijuana, cocaine, sildenafil (Viagra), ketamine, methamphetamine, and other substances.
Ecstasy is also known as E, X, XTC, Adam, Stacy, white dove, white burger, clarity, red and black, beans, lover’s speed, hug, and love drug. It is taken orally, usually in tablet or capsule form. The multicolored, attractive tablets, some with cartoon-like images on them, are sometimes the cause of ecstasy poisoning in young children who may inadvertently ingest the tablets as candy. Read more about the forms and use in the article about ecstasy.
Effects of Ecstasy on the Human Body
The main effect of ecstasy is on the neurons in the brain that use the neurotransmitter serotonin for transmitting information to other neurons. The serotonin pathway is important for mood regulation, aggression, sexual activity, sensitivity to pain, and sleep. MDMA can cause massive release of serotonin (5-hydroxytryptamine or 5-HT) as well as inhibit its uptake.
Dosage and Duration
Ecstasy has stimulant as well as hallucinogenic properties. It causes feelings of well-being, lack of aggression, disinhibition, and increased sensuality. Effects are usually felt within 1 hour of ingestion and may last from 4 to 6 hours with doses of 75 to 150 mg. With higher doses, such as 100 to 300 mg, effects may last up to 48 hours. Tolerance develops easily and higher doses may be needed by regular users so as to get the desired effect.
Toxicity and Poisoning
Ecstasy toxicity may occur due to other cheaper substances being mixed with the drug, such as amphetamine, methamphetamine, caffeine, or ephedrine. Also, drugs sold as ecstasy may not contain any MDMA at all but may instead contain a combination of other unspecified drugs or substances which can produce toxic reactions.
Drug interactions between MDMA and other drugs may be the cause of toxicity and death in some individuals. The drugs that may interact with MDMA are ritonavir (used in treatment of HIV infection) and certain monoamine oxidase inhibitors (MAOIs) such as phenelzine, tranylcypromine, or moclobemide.
Symptoms of Ecstasy Overdose
The effects of overdose may include :
- Muscle pain.
- Trismus or locked jaw (jaw clenching).
- Dilated pupils.
- Blurred vision.
- Dry mouth.
- Memory loss or amnesia.
- Visual hallucinations.
- Paranoid psychosis.
- Loss of consciousness.
- High or low blood pressure.
- Rapid heartbeat.
- Muscle incoordination and unsteadiness.
- Dehydration is common.
Some people suffer from water intoxication due to drinking excessive water which leads to hyponatremia (decreased salt in the body fluids outside the cells).
Death may occur due to :
- Cardiac arrhythmias, such as supraventricular and ventricular arrhythmias, which may lead to cardiac failure.
- Disseminated intravascular coagulation (DIC).
- Hyperthermia (increased body temperature) and its various complications.
- Rhabdomyolysis or breakdown of muscle fibers. This causes release of myoglobin into the bloodstream which may cause kidney damage.
- Acute renal failure.
- Hepatocellular necrosis and liver failure.
- Cerebral hemorrhage.
- Water intoxication causing severe hyponatremia, may lead to seizures, coma, and death.
- Acute respiratory distress syndrome (ARDS).
Diagnosis of Ecstasy Toxicity
A clear history of ecstasy ingestion may be obtained from the patient. Teens especially need to be convinced that accurate information is essential for rapid medical intervention as they may attempt to mislead the doctor. Tests may be required in case of moderate to severe toxicity or if the history is not forthcoming.
- Complete blood count (CBC).
- Blood glucose.
- Electrolyte levels, sodium in particular.
- Liver function tests.
- ECG, cardiac monitoring, and cardiac enzymes in patients complaining of chest pain.
- Creatinine kinase to rule out rhabdomyolysis.
- Dipstick urinalysis for myoglobinuria.
- Pregnancy tests in female patients.
- Urine toxicology is nonspecific.
- Gas chromatography or mass spectrometry may be done for a confirmed diagnosis.
Treatment of Ecstasy Poisoning
There is no specific antidote for ecstasy poisoning. Treatment is supportive and symptomatic, and may include :
- Airway, breathing, and circulation (ABC).
- Oxygen administration.
- Obtaining IV access.
- Monitoring the blood glucose level.
- Monitoring the vital signs such as temperature, blood pressure, and respiration.
- Assessing consciousness of the patient.
- Short-acting benzodiazepines such as lorazepam may be given IV or IM in severely agitated patients.
- Administration of activated charcoal.
- Benzodiazepines for seizures.
- Severe hyperthermia may be treated with rapid cooling measures such as cooling fans, applying ice packs, or ice-bath immersion and adequate fluids. Dantrolene IV may be used.
- Hyponatremia may be treated with administration of hypertonic saline and fluid restriction.
- Treatment of hypertension with nifedipine or sodium nitroprusside.
- If cardiac monitoring and ECG suggest cardiac dysrhythmias then medication, cardioversion, or defibrillation may be necessary.