Toxic effects of Ecstasy
“Ecstasy” (3,4-methylenedioxymethamphetamine, MDMA) has become established as a popular recreational drug worldwide now. Ecstasy, sometimes called a “party drug” or a “rave drug” is a stimulant related to amphetamine, sometimes taken during all-night dances or weekend parties. Users say it increases their energy, improves their mood, and keeps them awake. The drug is also known as MDMA, Adam, Eve, among a frequently-changing list of other street names.
Clinically important toxic effects including fatalities have been reported with the use of Ecstasy. Though the impact depends on the dosage frequency of use, the phenomenon of hyperpyrexia and multi-organ failure is a common scenario, some other serious effects have become apparent more recently. Patients with acute MDMA toxicity often present themselves to doctors working in departments of Anaesthesia, Intensive Care and Emergency Medicine.
Toxic effects of Ecstasy
There will be an acute increase in the intra-synaptic concentration of these transmitters like serotonin (5-hydroxytryptamine; 5-HT), dopamine and norepinephrine in the central nervous system on consumption of MDMA, followed by a period of depletion. Usage of Ecstasy induces toxicity in the blood of the users. Toxicity in blood levels in asymptomatic users and those with serious side-effects are often observed to be similar, suggesting that adverse reactions are likely to relate to the circumstances in which the drug is taken. It is also suspected that slow metabolizers are at a higher risk of acute Ecstasy related toxicity. This toxicity is also related to genetic variations.
Acute toxic effects
- Sudden death
- Exertional hyperpyrexia leading to rhabdomyolysis and multi-organ failure
- Serotonin syndrome
- Hyponatremia and cerebral oedema
- Isolated acute liver failure
- Cerebrovascular accidents
- Acute anxiety and panic disorder
- Pharmacology and pharmacokinetics
Immediate effects
The immediate effects of Ecstasy range from universal minor conditions to those that are rare to potentially life-threatening effects that could result in fatalities.
Common side effects
Common side-effects include trismus, tachycardia and bruxism.
Long term effects
Long term effects include midweek ‘lows’ and a prolonged ‘hangover’ that may last up to 5 days.
Effects related to trauma
Ecstasy has been reported as a major associated factor in fatalities on road. An increased risk of trauma, particularly from road traffic accidents, is self-evident. Additional association of ecstasy in morbidity and mortality related to trauma is in the process of getting quantified. Studies have reported an association between Ecstasy use and cerebral haemorrhage, cerebral venous sinus thrombosis, and aplastic anaemia.
Ecstasy and sudden death
Because Ecstasy is a stimulant, an ecstasy overdose can cause high blood pressure, a rapid heart rate, and seizures in users. Taking ecstasy during rapid activities, for example, dancing for a long time in a hot room can cause dehydration and dangerously high body temperatures, and eventually death.
Extensive studies are now focusing on the aetiology of sudden death in ecstasy users. A dysrhythmic catastrophe could be caused in an otherwise healthy individual. However, undiagnosed cardiomyopathy, hypertension or viral myocarditis may be involved in sudden death of ecstasy abusers. A number of other individuals with congenital cardiac conduction abnormalities are evidently at risk of sudden death from excessive sympathetic stimulation.
Summary
It is clear that Ecstasy is consumed on a large-scale during parties and events. It is also clear that many different neuroendocrine systems can be affected with the use of Ecstasy and that the variety of side-effects may depend upon a multitude of other factors including environmental and pharmacogenetic. In fact, the possibility of permanent damage to serotonergic neurological pathways in users of ecstasy in long term is immense and irreversible. The major challenge here being addiction, do you really have to suffer? Fortunately, no.
