From one rave “Twelve patients with 3,4-methylenedioxymethamphetamine (MDMA) toxicity from a single rave event presented to multiple San Francisco Bay area hospitals with various life-threatening complications including seizures and hyperthermia. Eight required emergent endotracheal intubation and six had hypotension. Hyperkalemia, acute kidney injury, and rhabdomyolysis were present in most of the patients. In all, 2 patients died, 4 survived with permanent neurologic, musculoskeletal, and/or renal sequelae, and 6 survived without any apparent lasting deficits. Hyperthermia was present in 10 patients and was severe (40.9-43° C) in 7. Using multiple cooling methods, the average time to achieve cooling was 2.7 hours. Serum drug analysis was performed on 3 patients, demonstrating toxic MDMA concentrations without the presence of other xenobiotics. Two capsules confiscated by police at the event contained 82% and 98% MDMA, respectively, without other pharmacologically active compounds. Capsule #2 contained 270 mg MDMA, which is more than twice the amount of MDMA usually contained in 1 dose. The MDMA-induced hyperthermia significantly contributed to the morbidity and mortality in this case series. Factors contributing to the severity of the hyperthermia include ingestion of large doses of MDMA, a warm ambient environment, and physical exertion.”
To be clear drug testing would have discovered fentanyl or other common drugs in their bloodstream, so it’s not just based on the pills recovered. Granted legalization would likely result in more consistent doses which would help, but the drug itself would still be risky if people just kept consuming more.
Equvalent to saying Alcohol is toxic amongst a sample of people that died due to drunk driving.
It appears thar heat stroke caused the problems not "toxic MDMA concentrations". The LD50 of MDMA is estimated to be 180mg/kg - Were those ravers taking tens of capsules? I presume there are toxicology reports from the deaths that estimated the dosages. But alcohol is poisonous if you have too much - we don't usually call it "toxic".
Weirdly they mention "a warm ambient environment" but what were the humidity levels? I presume there is good information on the underlying causes of death elsewhere? That summary is terribly uninformative.
Disclaimer: personally I'm not a MDMA user. I'm a concerned citizen that thinks raves are generally healthier than bars. "sensible" MDMA usage anecdotally within those events seems safe to me (sample of thousands of people, zero deaths). Number of people I know dead from MDMA: zero. Number of people I personally know dead from alcohol: many (I am a middle aged guy so some were long term effects, one was in a house fire).
MDMA is one of many drugs that interferes with temperature regulation. It’s a direct contributing factor and they wouldn’t have had severe medical issues without taking it.
Drunk driving is a more indirect risk, but I am also including that as one of the risks of Alcohol consumption elsewhere in the thread. If you’re objecting to the name fine, but the risk still exists as MDMA consumption regularly kills people due to this and other risks.
PS: Water toxicity is a similar situation. It’s not just the amount of water alone that’s a problem instead the amount they’ve been sweating is often a contributing factor. Oddly, they also mention MDMA as a risk: https://en.wikipedia.org/wiki/Water_intoxication
"Large dose" doesn't mean the same thing as "overdose". For context, the LD50 for MDMA is 160 mg/kg for rats.
MDMA screws up the body's ability to regulate temperature. But without the warm environment and physical activity leading to hyperthermia, I can't imagine any of those people would have even needed medical attention.
That said, personally I would never call MDMA "the poster child for safe illegal drugs". Just because it won't kill you, doesn't mean it is safe or risk-free.
If you’re suffering significant medical issues from taking excessive amounts of a drug, that’s called an overdose.
More broadly, I’m including traffic fatalities as a risk from alcohol and falls under LSD, so having deadly issues regulating body temperature definitely qualifies in an apples to apples comparison here.
> If you’re suffering significant medical issues from taking excessive amounts of a drug, that’s called an overdose.
Again, no, that San Francisco situation is strictly not describing an overdose. From the comfort of your living room, you can consume a massively higher amount of MDMA than what was described in that paper, and won't suffer significant medical issues.
> I’m including traffic fatalities as a risk from alcohol
OK, but that doesn't mean a drunk-driving fatality is an overdose on alcohol.
What defines an overdose is the impact it has on your body not the specific quantity consumed. Thus you can OD on insulin even if the amount is needed at other times.
If they had taken that much at home it may not have resulted in an overdose, but in this situation it did.
Well, by that logic, if someone has a panic attack from consuming cannabis, you'd view them as "overdosing" on weed.
I suppose you're free to say that, and everyone else is free to ignore this as ridiculous nonsense which is completely out-of-step with the widely-used definition of "overdose".
You're completely ignoring the context of the event. Have you ever been to a rave? Some promoters are good and understand the importance of providing free/inexpensive water, proper ventilation, and security who are able to spot attendees requiring medical intervention. Other promoters are shady AF and do none of those things. In the latter case, if someone consumes MDMA and also dances for hours without hydration and the venue is way too hot / oversold, yes that person is at risk of hyperthermia.
That can also happen even to sober people, I've literally seen it.
Try asking your GP about what it an insulin OD entails and they will refer to the results not the specific dose. Though obviously there’s a dose large enough it’s never appropriate.
