Ecstasy, Molly MDMA Can Be Fatal in Warm Environments

By far the most common cause of MDMA-related medical emergencies and death is heatstroke, where MDMA was only one of a number of factors involved. A normal dose of MDMA raises body temperature about one degree and also inhibits the body’s natural thermoregulation. This increases the risk of heatstroke, especially when other factors are involved, like aerobic dancing in a hot environment and not drinking enough water. This underscores the importance of establishing safe settings protocols for EDM events. Reducing ambient temperatures, offering chill rooms, and providing free and easily-accessible water and electrolytes are all actions that can reduce the risk of heatstroke emergencies, regardless of whether or not people are using drugs.

Hyperthermia is the technical term for a loss of internal control over body temperature that can produce severe or even fatal changes in organ health. For a long time, doctors and researchers have known that use of large doses of the “club drug” MDMA (more commonly known as Ecstasy or Molly) is linked to increased chances of experiencing this dangerous temperature dysregulation. One study concluded that even a fairly moderate dose of the drug can trigger lethal spikes in brain temperature when consumed in warm or hot environments (1).

1  Eugene A. Kiyatkin, Albert H. Kim  et al, Critical Role of Peripheral Vasoconstriction in Fatal Brain Hyperthermia Induced by MDMA (Ecstasy) under Conditions That Mimic Human Drug Use, Journal of Neuroscience 4 June 2014, 34 (23) 7754-7762; DOI:

Low blood salt levels (hyponatremia)

One of the most serious medical complications associated with ecstasy use is hyponatremic encephalopathy [1]. There are over 25 reports of ecstasy-associated hyponatremic encephalopathy in the literature, and over half of them are fatalities. Almost all cases are reported in young females between the ages of 15 and 30 with a serum sodium of ≤130 following the ingestion of just one dose of ecstasy [2]. Symptoms typically develop within 2–12 h of ecstasy ingestion. Presenting symptoms are headache, nausea and vomiting followed by altered mental status, coma, seizure, cardio respiratory arrest, brainstem herniation and death [2]

1 Kalantar-Zadeh K,  Nguyen MK,  Chang R, et al. Fatal hyponatremia in a young woman after ecstasy ingestion, Nat Clin Pract Nephrol , 2006, vol. 2 (pg. 283-288)

2  Campbell GA,  Rosner MH. The agony of ecstasy: MDMA (3,4-methylenedioxymethamphetamine) and the kidney, Clin J Am Soc Nephrol , 2008, vol. 3 (pg. 1852-1860)

3  Nephrology Dialysis Transplantation, Volume 28, Issue 9, 1 September 2013, Pages 2206–2209, https://doi.org/10.1093/ndt/gft192

Too much water can kill.

Athletes drinking too much during exercise can cause over-hydration known as exercise-associated hyponatremia. It occurs when athletes drink even when they are not thirsty and the sodium content of blood is diluted to abnormally low levels. Drinking too much water when profusely sweating over a prolonged exercise period also can overwhelm the kidney's compensation mechanism and reduce the body's ability to remove water. Taking MDMA and some other drugs and dancing in hot weather and drinking lots of water increases the risk of low sodium and this can be dangerous. (Loyola University Health System. "Drinking too much water can be fatal to athletes."ScienceDaily, 2 September 2014).

 

Female endurance athletes reportedly have the highest risk for the development of

hyponatremia. As many as 45% of female race finishers in the New Zealand Ironman triathlon

developed hyponatremia compared to 14% of male race finishers (Speedy, D. B., Noakes, T. D., & Schneider, C. (2001). Exercise-associated hyponatremia: A review. Emergency Medicine, 13, 17-2)..

 

There are many good sports electrolyte replacement drinks available always carry and use these and have them readily available stay out of the sun and take time out to cool down have some instant ice packs with you as well

Heat Injury/ exhaustion

Heat exhaustion is a serious condition that can develop into heat stroke and needs to be treated seriously and quickly. If you start to suffer the symptoms of heat injury it is important to slow and cool down, you can’t run or exercise through heat injury and progression can result in heat stroke which is a serious medical emergency.

 

Warning signs may include:                              

●Pale and sweating

●Rapid heart rate

●Muscle cramps, weakness

●Dizziness, headache

●Nausea, vomiting

●Fainting

 

Heat Stroke

Heat stroke is a life-threatening emergency. It occurs when the body is unable to prevent the temperature rising rapidly.

The symptoms may the same as for heat exhaustion, but the skin may be dry with no sweating, and the person’s mental condition worsens. They may stagger, appear confused, have a seizure, appear to have a stroke or collapse and become unconscious.

Heat stroke exists when the core body temperature exceeds 40–41ºC. It usually results from a prolonged exposure to extreme heat or physical activity during extreme heat.

Heat injury and heat stroke treatment

Mortality (death) increases significantly when cooling is delayed. The combination of atomised tepid water from a spray bottle and standing fans cools at a comparable rate to ice bath immersion and is much more amenable.

 

Heat Stroke is a medical emergency and the casualty MUST be cooled quickly and send for help call OOO

●Loosen or remove clothing get them out of the sun or off a hot road and wet skin and hair with water and fan.

●Send for expert help (000) call the for Medics/first aid at the event.

●Only give sips of cool water even better electrolyte such as hydrolyte as large quantities can cause vomiting and stomach cramps

●Continue cooling with water (sprayed is best) and fanning until medical help arrives.

●Put cold packs under arms, on sides of neck, in groin

●Stop actively cooling person when T below  39°C

●If unconscious place on side and keep airway clear.

●Do CPR if not breathing properly and unresponsive 

 

Prevention is best;

●Acclimatise

●Keep well hydrated

●Wear a ventilated hat or cap

●Wear clothes that allow sweat to evaporate and cool the body

●If you start to feel the symptoms STOP and cool down. You can’t run through heat injury or heat stroke.

How to work out when it is too hot to continue exercising

have a water spray bottle and instant ice packs with you at all hot weather and high energy events.

Most sports groups the Defence Force and many others now use a WBGT (Wet Bulb Globe Temperature)

This WBGT device is a measurement tool that uses ambient temperature, relative humidity, wind, and solar radiation from the sun to get a measure that can be used to monitor environmental conditions during exercise.

The Australian Bureau of Meteorology has developed a graph (see below) that can be used to give an approximation of the WBGT measurement for those who don’t have a WBGT available.

About the approximation to the WBGT used by the Bureau of Meteorology

The following approximation is used by the Bureau of Meteorology and does not take into account variations in the intensity of solar radiation or of windspeed, and assumes a moderately high radiation level in light wind conditions.

Use of this approximation may lead to incorrect estimates of thermal stress, particularly in cloudy and windy conditions. Under these conditions the approximation is likely to lead to an overestimate of the stress. The approximation will also overestimate night-time and early morning conditions when the sun is low or below the horizon.

Prevention is best don't take illegal drugs and don't mix alcohol and drugs or take combinations of drugs.

If you suffer any illness or side effect of any medication or drug inform and talk to your healthcare professional. Also, patients and health care professionals should report negative side effects from any drug use to FDA’s MedWatch Adverse Event Reporting Program. and to the TGA in Australia

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