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MDMA (Methylenedioxymethamphetamine), commonly referred to as ‘Ecstasy’, was manufactured as a potential pharmaceutical early last century. It had some limited use in the 1970s as a therapeutic aid in trauma treatment and in relationship counselling, and more recent studies using MDMA for trauma have shown some promise.

Most problems with recreational MDMA are acute. That means they occur during or shortly after intoxication; dependence and other long-term problems are quite rare. Most fatalities from taking MDMA are a result of a combination of factors, not just the drug itself. Pharmaceutical grade MDMA has relatively low toxicity when it is taken in therapeutic doses.

The majority of potentially fatal conditions don’t result in death if they are attended to early, but because of the stigma associated with using illicit drugs, sometimes people don’t seek help quickly enough.

Contaminants and polydrug use

Because drugs are illegal, they are manufactured by backyard chemists in clandestine laboratories, which makes them much more dangerous. Unlike alcohol, which is a highly regulated drug, there’s no way to tell how potent illicit drugs are or what’s in them, unless you test them.

In Australia, what is sold as ecstasy may contain a lot of MDMA or very little. Pills can contain other more dangerous drugs that mimic the effects of MDMA, and benign substances, such as lactose, as filler agents. Reports from drug checking trials show that about half the pills tested were of low purity. Some 84% of people who had their pills tested thought they had bought MDMA but only 51% actually contained any MDMA.

Although it’s possible to take too much MDMA and experience severe toxic effects, as with other illicit drugs, most ecstasy-related deaths involve multiple drugs.

Some of the more dangerous contaminants found in pills include PMA (paramethoxyamphetamine), which is more toxic at lower doses than ecstasy; N-Ethylpentylone, a cathinone which is a lot more potent than MDMA making it easier to take too much; and NBOMes (N-methoxybenzyl), which is more toxic at lower doses than other hallucinogenic drugs and can cause heart attack, renal failure, and stroke. Pills have also been detected in UK and NZ with up to three ‘doses’ of MDMA in a single pill.


Heatstroke or hyperthermia (dangerously high body temperature) is one of the most common issues among people taking MDMA. MDMA increases body temperature and sweating, and using it is often accompanied by physical activity (such as dancing) in a hot environment (such as a crowded venue or in the summer heat), exacerbating fluid loss. If you don’t have enough fluids your body can’t cool itself properly. These effect of ecstasy can be exacerbated by consuming alcohol. Alcohol is a diuretic, so it makes you urinate more and increases dehydration. Dehydration increases risk of heatstroke.

Water intoxication

People using MDMA can get really thirsty. Some is probably the direct effect of MDMA, some because they’re hot, and some from dehydration. But if you have too much water the ratio of salts and water in the body becomes unbalanced – basically the level of salt in your body gets too low and your cells start swelling with water. The technical name is hyponatraemia. MDMA is an anti-diuretic, so it makes you retain water, which can increase risk of water intoxication.

Serotonin syndrome

The main action of MDMA in the brain is an increase in serotonin, which among other things is responsible for regulating pro-social behaviour, empathy and optimism. This is why people who have taken MDMA feel connection with, and positivity towards, others. But too much serotonin can result in “serotonin syndrome”. It usually occurs when other drugs that also raise serotonin levels (other stimulants, antidepressants) are taken together with MDMA.Signs include high body temperature, agitation, confusion, problems controlling muscles, headache and the shakes. People might also experience seizures or loss of consciousness.

Other causes

More rarely, fatalities have been reported as a result of other health complications after taking ecstasy, especially if the person has pre-existing risk factors, such as high blood pressure or a heart condition. Complications related to heart failure, liver failure and brain haemorrhage are rare but have been reported in people already at high risk of these problems.

The number of people who die from party drugs is relatively small compared to other drugs such as heroin, alcohol, and pharmaceuticals. But the media tend to report a higher proportion of these deaths compared to other drugs, increasing the perception of harm. Most of the deaths are not directly from the drug itself but other complications or contaminants.

If you are worried about someone you know who is taking MDMA, don’t panic. Chances are they will have few if any negative effects. But make sure they know what to do to be safer if they choose to try it.

(Article summarised from