MDMA TOXICITY

MDMA TOXICITY

MDMA can be unpleasant and even dangerous when used in high doses (two to four times greater than a usual single dose of 80 to 120 milli­grams). The bad effects are typical of an overdose of serotonin-releasing drugs. People report jitteriness and teeth clenching as the dose moves up, as well as all the classic signs of overstimulation of the sympathetic ner­vous system. Hunger is suppressed, and people typically experience dry mouth, muscle cramping, and sometimes nausea. At higher doses, MDMA can cause a large increase in body temperature--one reason for its toxicity: the high temperature may be responsible for the muscle breakdown and kidney failure that have been seen in lethal cases reported from raves. When people dance for long periods of time in close quarters, the physical activity and tendency for dehydration can synergize in an especially dan­gerous way with the effects of the drug. MDMA has also caused lethal car­diovascular effects in people with underlying heart disease. It has caused heart attacks and strokes in a few people. Unfortunately, it is hard to know what dose is actually toxic based on these reports. People have usually taken Ecstasy at a party, often with other drugs, and later had little recol­lection of how much drug they took. Like most amphetamine-like drugs, MDIVIA can cause seizures at extremely high doses. PMA is more toxic at recreational doses, and people taking this drug inadvertently are more likely to experience a dangerous elevation of body temperature and car­diovascular function. However, the common myth that MDMA itself is not toxic is wrong. It is possible to take a lethal dose of NIDMA in a typi­cal recreational setting, though overall, the number of deaths caused by recreational MDMA use is small. In 2013, a number of deaths across the country at dance parties have been attributed to MDMA or methylone in Molly. In at least a few cases, no other drugs that could have contributed to death were present. It has become popular to ingest M DMA/Molly as a powder, and case reports of deaths indicate that blood levels of those who die are greater than those that occur after a normal recreational dose, suggesting that inexperienced users are colliding with a dosage form in which it is difficult to control how much you take. The Drug Abuse Warn­ing Network (DAWN) reported 22,298 emergency room visits due to MDMA in 2011 (compared to 505,224 for cocaine).

Some deaths attributed to MDMA actually have resulted from attempts to prevent MDMA toxicities. Many people try to protect against MDMA-induced dehydration and hyperthermia (high body temperature) by drinking lots of water. Some people ingest so much water in a short time, however, that they dilute the concentration of sodium in their blood. This condition, called hyponatremia, can lead to headache, nausea, vom­iting, seizures, and, in extreme cases, brain swelling and death. MDMA or hyperthermia-induced changes in the level of antidiuretic hormone can contribute to the situation by concentrating the urine and leaving water in the circulation. However, the biggest reason is simple: people drink much more water than needed to replace lost fluid. This happens to marathon runners, too. In the 2002 Boston Marathon, a study showed that 22 percent of the women runners were hyponatreinic by the end of the race. This gender balance is relevant to MDMA because recent research shows that women are also more sensitive to the hyponatremia that MDMA causes. How much is too much? It depends on how much you sweat, and there are no experiments with MDMA users. For mara­thon runners, slow runners who drank about a liter an hour (thirty-six ounces, or one quart) tended to get in trouble. Fortunately, people can usually recover from hyponatremia if they receive medical care.

MDMA use has been responsible for a number of psychiatric/psycho­logical problems. The most common consequence is the "down" that hap­pens a few days after MDIVIA use. This is almost always temporary, but the mood changes can be severe enough to measure in the range of mild clini­cal depression. Some people also feel more irritable or aggressive. This

effect can persist in heavy users and may be more severe in women than in

men. Some patients have complained of panic attacks after repeated use of

MDMA. These usually resolve eventually but have continued for months

in a few people. Similarly, hallucinations and amphetamine-like paranoid psychotic symptoms have occurred in chronic, high-dose users. Again, these symptoms waned when drug use stopped.

Are there long-term effects of MDMA use? Understanding the long‑

term psychological effects of 1VIDMA is difficult because most heavy

MDMA users also use other drugs, including marijuana, alcohol, stimu‑

lants, and narcotics that influence their health and brain function. Some studies report that heavy use of MDMA (several hundred times) has been associated with reports of persistent anxiety, involvement in risky behav­iors, and other psychological problems, but further research is needed to tease out what role MDMA has in these effects. A number of research reports show that heavy use of MDMA can be associated with impaired memory that is due specifically to the MDMA—not to the use of other drugs. We don't know yet if these changes are reversible: the scientific lit­erature is still a little mixed on this topic, although in at least some stud­ies, ex-Ecstasy users perform better than current users. Furthermore, we also don't know if some of the reported changes (like increases in impul‑

sivity) are simply characteristics that the users had before they ever start­ing using MDMA.