Recreational Ecstasy User Dies, Responses Typical: How about publicizing the tox screens?

Jan 12 2009 Published by under Drug Fatality, MDMA

In a post on the death of Heath Ledger a year ago I talked about the frustration of not being able to review the toxicity panels from his body tissues after the autopsy. In the end, the medical examiner report just said something along the lines of "in my professional opinion it was the combination of drugs which did him in". Which one might interpret as meaning the tox panels did not identify an apparently lethal level of any one particular drug (or its metabolites). But as an interested party, I would like to see the numbers. Because in my view they would reinforce the message. Whether it be a drug interaction or a loss of tolerance (or for that matter a tolerance issue) that is associated with a highly public drug toxicity case, it is an opportunity to help people to understand basic pharmacological concepts as they apply to recreational drug use. Another sad case is in the news this month and once again, the data would be exceptionally helpful.
An Australian woman died after allegedly taking two ecstasy tablets.

Neville and Gerry Bebendorf, both high school teachers, are left to mourn their eldest daughter, whom Mrs Bebendorf described as "a beautiful, fragile person who touched many hearts".
"Rosie was cruelly treated by unscrupulous people who took advantage of her vulnerability and generosity," she said.
"If any good is to come of this, it may serve as a warning to young people never to start taking drugs."


To get the attitude out of the way---is the mom kidding us? A 28 year old woman taking a couple of Ecstasy tablets voluntarily is being "cruelly treated" and "taken advantage of"? Whatevs....
This is a tragedy and by no means the first. Additional coverage of this story notes:

Tony Wood, whose 15-year-old daughter Anna died after taking ecstasy for the first time in Sydney 13 years ago, said not enough was being done to address Australia's "enormous" drug problem.
...
He said he was regularly contacted about deaths linked to ecstasy but few were ever made public.
"A year after Anna's death, friends of ours lost their son. He had half a tablet at 4pm then the other half at 9pm. He was dead by 11pm. Police couldn't believe such a big, strapping young man could be knocked down by a little pill."


ecstasypills.jpgThese reports keep trickling along, for those who are paying attention. It is absolutely not in question that people do die after consuming tablets that they and their friends/associates apparently thought were "Ecstasy". One presumes in most cases that the individual thought "Ecstasy" was MDMA and MDMA alone. As in this little set of news reports, it is interesting that it is frequently emphasized that the individual in question took Ecstasy (or cocaine, see Len Bias) for the first time, although I suspect the validity of such claims is poor. Parents are usually clueless and teen associates sure aren't going to be motivated to 'fess up to having rolled with the decedent a dozen times in the past. It is also quite fascinating that the individuals are represented as having consumed a fairly low number of tablets. In this case two, meaning by most prior published reports somewhere between 100 to 300 mg of MDMA, assuming that was the content. Depending on content and how large the woman was probably 1.3 to 2 mg/kg at the low end and up to 6 mg/kg. This latter depends on about the high water mark for MDMA tablet content (150 mg) and a 50 kg (110 lb) woman.
Let us start with the reader comments on the courier mail piece. You will find the usual protestations about Alcohol and Aspirin or whathaveyou causing more deaths. And about how generally Evil are Alcohol and Tobacco and how great and Awesomest is Ecstasy.
e.g.:


Oh and FYI in recent studies ecstasy is actually ranked to be causing less harm then other legal drugs such as alcohol and tabacco.
At events I have been to everyone who has consumed ecstasy is in a pleasent state and enjoying themselves. Generally all of the trouble causers have been drinking alcohol and not taking drugs.

or:

Have you thought that some people decide on mdma because they feel it is actually safer then drinking. 1 - you have control of yourself. Your not vomiting. Your not killing you liver. Your not falling over. Your not getting in random fights. Your not making irrational choices. Your not getting fat with all the carbs. I could go on.... Many educated people take MDMA.... Not random e pills on the street but MDMA - do the research.

More interesting to me, and relevant to the leadoff about tox reports are the following:

I find it disturbing that the media makes it out that Ecstasy is the cause of the death... I gurantee you 100% that this so called estasy did not contain MDMA, which is what E is meant to have in it. In holland there is no death because you can test it.

and:

All of you that are saying E is just MDMA and nothing else - and that makes it safe. You are all WRONG! E is always cut with something just like speed. There could be ANYTHING in your pill.

there are more in a similar vein, but head on over to bluelight for additional comment such as:

Quote:
Originally Posted by FlowMotion View Post
Do they have any ideas what was in the pills? My guess is PMA.
I agree. No way can they od on two pure as can be MDMA pills unless they didn't drink a drip of water a couple hours before popping and the whole experience.

or

It's annoying how the media insinuate that the person has died from standard ecstasy without including the fact that it most likely wasn't MDMA. If someone passes someone a piece of metal in the shape of a pill, says it's ecstasy, and the person dies... will the media report it as an ecstasy overdose? YES! Argh! So angry!</small

and

I love how the media covers these stories. It's always the same biased bullshit. All the coverage about this incident should read something like 'woman trying to purchase MDMA is sold fake drugs and dies from REAL FUCKING REASON HERE. But of course that's not going to happen. We need to blow blue moon stories like this out of proportion so specific drugs can continue being illegal.

Hopefully you get the flavor. They have a point. Street ecstasy tablets are notoriously variable in psychoactive drug content. Structurally related compounds such as MDA, MDE and good ol' Methamphetamine are commonly detected. Behaviorally related but structurally unrelated caffeine is also observed, as are a host of what might be "filler" compounds such as tylenol. Paramethoxyamphetamine (PMA) is a decent suspect as it does seem to exhibit a fairly steep dose-response function. Another way to look at this is a narrow recreational-index, i.e. the difference between the dose which produces the desired recreational effect and adverse consequences in a substantial fraction of the population is small.
Nevertheless, it is also the case that MDMA itself is capable of producing the types of lethal and near-lethal effects that are reported in Case Reports and the popular media. There are the occasional reports in which no other suspect drugs are reported. Moreover, resort to the animal research literature shows that under certain conditions, MDMA and MDMA alone is capable of causing death in mice, rats, dogs and nonhuman primates. The best reference is Hardman et al. 1973 because this is an LD50 study. If you keep close track of the literature (where endpoints other than death were the experimental goal) you will see the occasional (near) lethal condition or unusual outcome reported in studies but you may have to read the Methods carefully.
This latter type of evidence gives us to suggest that lethal consequences are dose related. Duh. However some of the human case reports include blood levels of MDMA that are pretty consistent with only one or two tablets consumed. Much like the assertions in the newscoverage linked above.
The thing is, we don't really know. Did the case reported in the popular media take lots and lots of MDMA, more than was reported? Did s/he obtain "ecstasy" tablets that were actually PMA, Meth or some combination with MDMA? All of this is knowable and likely will eventually be known by the Medical Examiner (or whatever the Aussie version of that job is). Question is, will it be published? Will we get all the details?
We should. It is imperative that if this woman has died from MDMA and MDMA alone that the yammering commenters who just know that it "must have" been PMA are informed. Similarly, if it was PMA or METH or some combination or whateverelse that is not MDMA, we need to chalk that up on the board too.

51 responses so far

  • JLK says:

    DM, I'm curious to find out what you know about the alleged long-term effects of MDMA use. I know I had read in magazine and news articles 8-9 years ago that there was something about serotonin depletion in the brain or something like that.
    Ecstasy is a drug that I find incredibly fascinating. I've taken it twice in my life (my first year of college was when doing X was all the rage) and wasn't particularly impressed, but I've known several people who absolutely loved it back then.
    I agree that it's incredibly important that we get all the facts behind these news stories. I'd be shocked to learn that these people got their hands on enough "pure" MDMA to cause an overdose. Every case of death I've known about having to do with ecstasy use was caused by two sides of the same problem - extreme dehydration or (I don't know what the scientific term is) drinking so MUCH water that they basically drowned themselves internally. (I'll try to find that particular news story, because I didn't think it was actually possible)

  • iwood says:

    Does popular media ever report on the potential therapeutic use of MDMA, as suggested by recent promising research into its anti-anxiety effects? It could realistically be used as an adjunct to psychotherapy to encourage openness in afflicted patients.
    No, instead it prefers to zero in on death-by-ecstasy type rare incidents because they're far more sensationalistic and affirming of the current scare-mongering rhetoric about the drug's inherent evilness.
    It's starting to wear thin.

  • DrugMonkey says:

    Are you trolling me, JLK ? 🙂
    briefly (considering the real answer) and long (for a comment).
    first, let me quote my disclaimer which many of you no doubt ignore. It is important mostly in case any of my MDMA denialist friends stop by and this gets involved. I want casual readers to labor under no delusions if this discussion gets extensive.
    The author DrugMonkey is funded by the NIH and many of the topics under discussion are those for which DrugMonkey may have previously held, currently holds or is actively seeking to hold NIH funding to investigate. The reader is encouraged to read DrugMonkey postings with this in mind.
    Second, I'm not going to do a formal review, i.e. with cites. There are endless numbers of reviews a simple PubMed away and as I note repeatedly, the MAPS database (see sidebar) has most of the relevant articles (review and primary) freely available. There is little reason for me to do that work for you.
    I know I had read in magazine and news articles 8-9 years ago that there was something about serotonin depletion in the brain or something like that.
    Yes. There is now a very lengthy literature on so-called serotonin neurotoxicity associated with MDMA in a variety of animal models. Mice are a little weird because being a liver wrapped in fur the doses get high to the point of perhaps being something different in nature-they get a dopamine hit. Otherwise, from multiple rat strains to swine to guinea pig to three different nonhuman primate species the effects are consistent. Lasting decrement in markers for serotonin terminal integrity. This includes tissue levels of serotonin, it's major metabolite and an important synthetic enzyme as well as the serotonin transporter. (I will note that there is a debate as to whether the axon terminals themselves are still there without expression or with internalization of some markers- I find this a boring semantic distinction myself although it does have some implications, I recognize). Lasting meaning up to 7 years in the squirrel monkey, the longest duration study of which I am aware.
    The effects are very well replicated.
    The area of controversy (to put it mildly) is whether it happens in human users, a question which is unbelievably complicated given that most Ecstasy users are very promiscuous poly-drug users, sometimes unintentionally (see the post), on top of all the usual problems with human subjects' research. Add in the fact that MDMA is not usually lethal and in young populations so we don't have a lot of posthumous tissue to go by. There is a report or two (S. Kish is an author to search out) that is consistent but very unsatisfying.
    From a behavioral perspective, heavy ecstasy users are found to have affective problems (anxieties and depressions) that are not inconsistent with lasting decrement in serotonin function. Not conclusive but supporting the hypothesis.
    This leaves PET studies where results are contentious-again remember that users are hardly ever a pure MDMA-exposed population so getting perfect controls is nearly impossible. There is a study from the Netherlands that was designed as a prospective investigation, but the initial reports are from very light users.
    This brings me back to dose. In animal models the usual experimental regimen to produce the effect breaks down to 10-20 mg/kg of MDMA twice per day for four days in rats. Change to 5-10 mg/kg per dose in nonhuman primates. I've posted before on species-scaling issues (higher dose in a smaller mammal for comparable effect, this is Pharm101 not just MDMA), which are real and important but hard to grapple with because they are ultimately only estimates. Ricaurte argues that 5 mg/kg in a squirrel monkey is equivalent to 1.7 mg/kg in a human. Others...disagree.
    Studies which focus on the threshold are hard to come by for various reasons. One early study found that 2.5 mg/kg twice a day for four days didn't do the job in monkey (I think it was rhesus and from the Slikker group). Ricaurte (a major figure) had one paper showing detectable effects after a single oral 5 mg/kg does in squirrel monkey. These tend to be the usual threshold touchpoints but it is a very thin lit when it comes to this.
    soooo..........
    Do humans ever do that? Repeated high doses on sequential days? Hell yes. How often? Hard to estimate. There is also a bit of lit on models of MDMA boosting (taking another tablet sever hours after the first) which I'm ignoring here for simplicity but that may be a more-frequent human phenomenon. In either case, whopping use frequently occurs after a long prior history so then we bring up tolerance issues which have not been well explored in animal models.

  • DrugMonkey says:

    Does popular media ever report on the potential therapeutic use of MDMA, as suggested by recent promising research into its anti-anxiety effects?
    Please go to the archive and click on MDMA. Read my posts including the links back to the old site on WordPress.
    The popular media has been reporting on very little else other than the supposedly "promising research" on MDMA as an adjunct for PTSD psychotherapy. This has been a major sea change, true, but it is pronounced in the past 2-3 years.
    Your complaint is sadly out of date.

  • DrugMonkey says:

    Every case of death I've known about having to do with ecstasy use was caused by two sides of the same problem - extreme dehydration or (I don't know what the scientific term is) drinking so MUCH water that they basically drowned themselves internally.
    Incomplete. Hyponatremia (excessive water to salts, particularly sodium, ratios) is a common player in deaths. MDMA has been reported to increase antidiuretic hormone / arginine vasopressin secretion so it is not just excessive water consumption. This seems to be more likely in women but the numbers are too small for good conclusions.
    Second category are cardiac arrhythmia related.
    Third I would categorize as the unknown in a sense but ultimately hyperthermia driven. Individuals commonly appear at emergency medical services after exhibiting seizure-type symptoms or being "found unresponse" the type of thing that freaks the friends out enough to call 911. There is frequently a (very) high body temperature observed. Sometimes the Emergency Room cools them down and they survive and sometimes they die. disseminated intravascular coagulation and kidney failure causes are common and probably related to the high temperature. This gets slightly involved since there is a muscular condition/genotype which makes people sensitive to a Malignant Hyperthermia syndrome under gas anesthesia- there is evidence a similar mechanism may be at play although unknown if the genotypic sensitivity is a factor. look for MDMA and rhabdomyolysis. It may also be the case that seizure comes first and starts the individual down the hyperthermia path.
    I'd hate to generalize further, see Schifano 2004 for an overview and toehold on additional lit.

  • Martijn says:

    The few xtc related deaths that occurred here in the Netherlands in the nineties were always reported being due to hyperthermia.

  • Dr. Feelgood says:

    Yeah I am an agreement here with DM. As an MDMA researcher I get these types of questions all the time. (I got a fabulous email from a kid high on MDMA, its a hoot..I will forward to DM perhaps for posting)...When it comes to toxicity issues my guess its most of the bad rxns are associated with adulteration with PMA (wish we had the tox screens...). As it relates to hyperthermia, MDMA produces temperature dysregulation, not hyperthermia. So colder environments reduce body temp, hotter ones increase temp. Therefore, the drug doesnt bake you alive, it depends on what you are doing. Hanging with friends and listening to music you probably wont fry.
    My personal view from the literature (and from personal experience in my illustrious past) is that acute toxicity is an extremely rare occurrence when actual MDMA is ingested within its effective range. The demonizing of the drug really started with Ricaurte (yes hes the shmuck who got it to Schedule I) in the 80s. His work is often notoriously poorly constructed, assumes some whacky interspecies scaling, and much like the public, he seems to have a problem distinguishing MDMA from other amphetamines, particularly in his own laboratory's vials (sorry for the run-on).
    The reason that MDMA gets such a bad rap in the press is that it sells newspapers, and gets people to click-thru to a story. If the same story said woman dies from methamphetamine....yawn. Everyone knows thats bad for you so who cares? It also is not currently in trials like MDMA for its therapeutic potential. Most of this is a result of a combination of government bias (DEA) against all drugs that are "fun" and uneducated press that want a titillating story.
    Dr F.

  • Add in the fact that MDMA is not usually lethal and in young populations so we don't have a lot of posthumous tissue to go by.

    HAHAHAHAHAHAHAHAHAH! Dude, you are fucking hilarious. "Not usually lethal"!
    When you leave for work every day, do you tell your kids, "Don't worry kids. Driving to work is not usually lethal."? When you go for a walk to the store, do you tell your wife, "Don't worry, pedestrians don't usually get killed."?
    If you're all about the SKIENZE, then how about forgoing the inflammatory linguistic histrionics?

  • Brian says:

    If you're all about the SKIENZE, then how about forgoing the inflammatory linguistic histrionics?

    Wait, what?

  • Beaker says:

    methamphetamine....yawn. Everyone knows thats bad for you so who cares? It also is not currently in trials like MDMA for its therapeutic potential.
    Meth is a medically approved pharm (Desoxyn) for the treatment of ADHD, albeit not as smokeable therapy...
    I don't see how anybody could disagree with DM's original point, which was "more data good." The info in the medical examiner's report would be useful to researchers, clincians, users, and illicit manufacturers alike. The wide dissemination of the tox report would lead to fewer deaths. It's a win-win--both for interested parties and for those interested in partying.

  • Julie Stahlhut says:

    Seriously, buying drugs illegally is a crapshoot -- what's to stop the seller from either lying about the merchandise or not asking his own supplier what's in it? And people partying with pills often mix them with alcohol and yet more pills.
    How detailed are toxicology reports? No matter how one feels about recreational drug use, it would be good to know exactly what is going on when people die or become seriously ill this way.

  • daedalus2u says:

    I disagree with Dr Feelgood (and perhaps with the conventional wisdom) that the only danger of hyperpyrexia is due to getting too hot. That heat is generated by mitochondrial uncoupling which causes ATP depletion. If ATP gets depleted too much you are dead no matter what your temperature is.
    My hypothesis is that the stimulants of abuse have the final common pathway of ATP depletion, and this induces the euphoria of the near death metabolic state, the state that physiology induces when you are running from a bear. Physiology induces a euphoric state so that you can continue to run no matter the state of your muscles (which may be necrosing from ATP depletion), your bones (which may be broken), or other injuries. My hypothesis is that this is the euphoria of the runner’s high, autoerotic asphyxiation, solvent huffing, drowning and other near death metabolic states. That euphoric state will let you run yourself to death. Being able to run yourself to death is a very powerful survival factor when being chased by a predator where to be caught is certain death. From an evolutionary standpoint death by exhaustion and death by being caught are “the same”, an evolutionary fail.
    There are mechanisms to neurogenically trigger the euphoric near death state. There have to be so they can be triggered when a bear starts chasing you. I presume that stimulant drugs of abuse lower the threshold for triggering that state. Enough of the drug lowers the threshold to zero and induces the state.
    The "problem" is that the euphoric near death state is not an "abnormal" state per se, it is a "normal" state that physiology induces under extreme life-threatening stress. Your body can induce that state in a heart beat if it needs to. If that state is invoked and can't be de-invoked, then you will die.
    What I would like to see is a respiration profile on mitochondria from someone who has died of hyperpyrexia or MDMA. There is a similar state observed in pigs called slaughter stress that results from similar effects.

  • Lorax says:

    It is imperative that if this woman has died from MDMA and MDMA alone that the yammering commenters who just know that it "must have" been PMA are informed. Similarly, if it was PMA or METH or some combination or whateverelse that is not MDMA, we need to chalk that up on the board too.
    Right, because once the yammerers have the facts they'll suddenly get it. I mean these folks aren't simply making weak justifications to continue doing an activity they will keep doing anyway. (It reminds me of the vaccine=autism contingent.) Since the conclusion is already known the facts must be wrong.

  • DrugMonkey says:

    Actually, Lorax, when it comes to the rather confirmed MDMA users they are quite sensitive to the available science. In comparison with users of other drugs and in a certain way of looking at it, despite their overwhelming motivation to continue using.
    Chill out rooms and recommendations to drink water were the initial responses to a recognition of problematic use. (Now there is a recognition that water consumption should be just right, not too much, not too little.) So called harm reduction websites abound and are littered with suggestions to limit use, space out dosing, avoid tablets containing non-MDMA psychoactives, take tryptophan, and a bunch of other stuff. Much of this comes from the ongoing science (including case reports) through the eighties and nineties, not just user-lore.
    There is another goal here which is the relatively naive user who may be deciding to take Ecstasy for the first time or three. Suppose they go on the web, what do you think they are going to conclude? If they are reflexively suspicious of "official" websites like NIDA and ONDCP (and they are) they will trust the advocates who go on and on and on (and on) about how MDMA itself cannot possibly be a problem. I happen to think it can be, all by itself and in less than overwhelmingly high doses. This is the audience I mostly hope to reach either directly or by proxy*.
    __
    * I am often startled by the lack of awareness of the MDMA science in undergrad and even graduate students who are in neuroscience and psych disciplines. Given that many of them and their buddies are taking Ecstasy.

  • nm says:

    Great post DM. Cheers.

  • Lorax says:

    Thanks for the response, I consider myself more educated on the subject. (Although Im still skeptical that if clear and obvious data demonstrated clear risks with Ecstasy use, the pro-Ecstasy website would reflect this and Ecstasy users would actually change their behavior.)

  • Anonymous says:

    OK, so I'll bite on the requisite stupid question for this post: Why aren't tox screens generally reported? Is this a privacy issue? I could see where having this kind of detailed information in conjunction with a full name and age reported in the paper could be in violation of patient confidentiality (which still applies even after a patient has died, right?). A clinician using this data for a study would be obligated to protect a subject's identity, why would a coroner's office be exempt?

  • A superb post.
    Street drugs are surprisingly analogous to herbal medicines: often multicomponent mixtures of unknown individual percentages. Add to that the shortcuts made with home syntheses and you've got a whole bunch of byproducts with potential neurotoxic effects (MPTP was the big one when I was growing up).
    Not to jest about this serious issue but The Scientist had an article I blogged on at the old place in late 2005 about an Austrian chemist (Rainer Schmid) who would run MDMA samples at Vienna raves - his reasoning was that if kids were taking it, at least they should be taking something pure and of known dosage. In the US, he'd be in Gitmo probably.

  • fnu says:

    (Although Im still skeptical that if clear and obvious data demonstrated clear risks with Ecstasy use, the pro-Ecstasy website would reflect this and Ecstasy users would actually change their behavior.)

    Those are some odd prejudices you have. Ever actually looked at a pro-e website?
    http://www.erowid.org/chemicals/mdma/mdma_neurotoxicity1.shtml
    http://www.erowid.org/general/survey/survey_ecstasy_article1.shtml

  • Dallas says:

    While researching the literature on a toxic polyurethane I've been studying, methylenedianiline, sometimes abbreviated as MDA, I came across a medical case where some kids decided to make there own ecstasy and used the wrong MDA (methylenedianiline instead of methylenedioxyamphetamine). A few died, a few others just had horrible liver diseases, which I'm assuming probably shortened their life spans considerably.
    It's a tragic case, but such a silly mistake. If only they would have read the chemical name rather then trusting the abbreviation they could have potentially lived long lives.

  • Dallas says:

    How dare I comment about people making silly mistakes... I used "there" instead of "their". I hate that.

  • Turkeyphant says:

    99% of media reports attributing death to "ecstasy" did not involve MDMA as the lethal substance.
    MDMA is not a dangerous substance. Unless you're incredibly stupid or incredibly unlucky, it's pretty much impossible to kill yourself with it.

  • DrugMonkey says:

    Turkeypants this is AWESOMES!!! Just what I've been looking for. Please share the source of your comprehensive data on this assertion.

  • Dave says:

    Re CPP in #8: "When you leave for work every day, do you tell your kids, "Don't worry kids. Driving to work is not usually lethal."? When you go for a walk to the store, do you tell your wife, "Don't worry, pedestrians don't usually get killed."?
    If you're all about the SKIENZE, then how about forgoing the inflammatory linguistic histrionics?

    Jeezus, CPP. It is not unusual for you to be obnoxious, but you are usually not so incredibly illogically insultingly stupid.
    It must be horrible to live in your bizaarro paranoid world where even the tiniest threat of danger leads to paralysis. Perhaps you need to consider the possibility that there is a 0.001% chance some obsessive reader here will be offended by your insults, track you down, and beat the shit out of your pathetic flabby ass. In which case maybe you better stop posting. Forever.

  • daedalus2u says:

    A problem with the site linked to, and I think a problem in general is that any adverse changes are characterized as "damage", or are only due to "toxicity", where we know this is simply not the case.
    It is well known that adverse neurological changes can occur in the absence of "damage" and/or in the absence of "toxicity". PTSD happens with no "damage" and with no "toxicity".
    If we use exposure to a war zone as analogous to exposure to MDMA, some times being in a war zone kills you, but if you are in a war zone long enough your chances of getting PTSD only increase. I suspect that no measure of PTSD is sensitive enough to measure any changes that occur on any given day, but with enough exposure your chances of getting it approach 100%.
    Why does PTSD happen? I suspect it is an adaptive response to living in a war zone. If you are in a war zone, being hypervigilant is a good thing. Not sleeping is a good thing. Being paranoid might save your life if/when there are people trying to kill you on a daily basis. Tuning your reflexes to respond violently might save your life too.

  • DuWayne says:

    Lorax -
    Like fnu said, look at some pro-E sites. The MAPS folks that DM links in his side bar are quite definitely pro-MDMA and they are very much concerned about providing the best possible information, even when that information delineates the associated risks of MDMA use. This is true of every single pro-MDMA site I have come across.
    Erowid (linked by fnu) is not only a great site for a clear picture of MDMA, both pro and con, it is also a great site for such information about a wide range of enthogens.
    The thing to keep in mind about pro-MDMA folks, is that they really see MDMA as far more than a recreational drug and want to do everything they can to legitimize it. While many of them feel that we should move forward on legal use and/or it's use as a medicinal therapy, they are generally very keen on making sure that people who use it, do so with eyes wide open.

  • DrugMonkey says:

    Of course I disagree with DuWayne....mostly in the shading. I view even the more science heavy advocacy sites as taking an unjustifiably denialist cant on the lit.

  • DuWayne says:

    I don't disagree with you DM, I just wasn't clear about the implied bias of such sites. At the same time, MAPS and Lycaeum, both pro MDMA sites provided me with the information that led me not to try MDMA. This is no small feat, as I had tried virtually every drug I came across, until about eight years ago, when I quit using any sort of hallucinogen.

  • Dr. Feelgood says:

    OMG, this keyboard feels soooo good. I love all of you!
    Dr F

  • DrugMonkey says:

    Gotta watch those accidental needlesticks in the lab, DocF.

  • Turkeyphant says:

    Of course a statistical claim is facetious but for every media report backed up by toxilogical data blaming solely MDMA, I can show you at least 99 where other substances were to blame.

  • DrugMonkey says:

    Nice goal post move with the "solely" there.
    I doubt your hyperbole on the numbers, but let's take the general issue.
    What you no doubt mean is that when someone dies with MDMA in their system there are always a host of other potential factors involved. Factors including possible things that cause fatality by themselves, things that may interact with MDMA to cause fatality, and physiological mechanisms of death that may or may not be uniquely associated with MDMA itself.
    It is emphatically the case that human fatalites are complicated. What is absolutely disingenuous is to brush off the cases where MDMA was the most obvious source of fatality, the science that suggests no consistent, predictable causal role of other suspected factors (like alcohol, dancing, high ambient temp environment, approximately equal doses of meth or MDA, etc) and to insist that every possible ambiguous case is evidence for MDMA being perfectly safe.
    Just by way of one example, the modes of death for alcohol and MDMA are very different. One is a sedative and respiratory suppression effect, the other I've detailed above. So when someone comes in positive for EtOH and MDMA but was reported to have seizure like symptoms, goes into hyperthermia, rhabdomyolysis, kidney failure in the Emergency room, well, it's kinda stupid to say "the alcohol dun it!".
    Do you actually read the Case Reports? I'm right there with you that the press gives us too little information. did you read my post? but the failures of journalism say nothing about objective reality vis a vis the safety or lack thereof of MDMA.

  • JLK says:

    I've been out of the blogosphere for a couple of days, so I'm trying to get caught up here.
    First @ DM - I don't know what you mean by "trolling" so you'll have to clarify. I thought trolling meant harassing and being an asshole on other people's blogs. I hope that's not what you mean!
    2nd @ DM - I asked my questions as a layperson out of pure curiosity. I am interested in what YOU have to say, because you're the expert. I have no intention of reading a shitload of journal articles on a substance I don't use just for the sake of doing it. I posed similar questions to SciCurious about cocaine - something I would NEVER use. My area of psychology has absolutely nothing to do with drugs of any kind - not even antidepressants. So I don't study up on that stuff because it's irrelevant to me. But if someone posts about something that I find interesting, I will ask questions, even if it blatantly reveals my utter lack of knowledge about the subject.
    Mostly I find it interesting because my husband used to be one of those "MDMA never killed anyone, it's awesome" kinda people. He was also a chemistry major, go figure. Lol.
    So if I can go back to my curious layperson standpoint....
    When I was in college the first time, ecstasy was a "raver" and "club" drug. So you had all these moron college kids taking X, going out to a club, drinking alcohol all night and getting overheated from dancing. People I knew said that they would "forget" to drink water while on MDMA and not be aware of their rising body temperatures. All I ever did the two times I tried it was sit around my apartment, have long, involved conversations and chew incessantly on straws so that I wouldn't grind my teeth.
    One thing I did learn at the time - M&Ms taste really weird when you're on ecstasy. 😉

  • JLK says:

    Oh, and having been a nontrad undergrad for the past two years and overhearing some stupid ass 18-19yr old conversations - no one is really using ecstasy recreationally anymore (at least not in New England).
    Instead, they've turned to mom and dad's medicine cabinet for Vicodin, Valium, and Oxycontin.

  • DrugMonkey says:

    I thought trolling meant harassing and being an asshole on other people's blogs. I hope that's not what you mean!
    I use it in a manner analogous to the fishing variety. Throwing bait out there to see what fish will bite. (I would NEVER do this myself, of course....)
    I asked my questions as a layperson out of pure curiosity. I am interested in what YOU have to say, because you're the expert. I have no intention of reading a shitload of journal articles on a substance I don't use just for the sake of doing it.
    aaaaaggghhhh! NO, BAD JLK! BAD! Do not take the opinion of some random 'ssklown on the intertoobz for the truth. My role is to lead you to water in hopes that you will drink from the PubMed lake...
    When I was in college the first time, ecstasy was a "raver" and "club" drug. ... All I ever did the two times I tried it was sit around my apartment, have long, involved conversations and chew incessantly on straws
    Full circle my friend. I'm old enough that the MDMA fans during my formative years were the sitting around the dormroom going "whoa dude" types. Then came the raves. Are we back to the dorm rooms now? (I joke, there have always been the latter type of user. In fact you will see them turn up, you guessed it, in the Case Reports).

  • I'm old enough that the MDMA fans during my formative years were the sitting around the dormroom going "whoa dude" types.

    More like: "Whoah! I've never felt this close to someone in my entire life! What's your name?"

  • JLK says:

    Ah, but DM - I didn't say I would take your word as truth! I said I was interested in your opinion on the topic, because while I am just "JLK" you are "DRUG"monkey.
    And quite honestly, just because it's published science doesn't make it truth either! The truth may be what we are all pursuing, but that doesn't mean it's what we found!

  • DuWayne says:

    JLK -
    While it's true that using prescription drugs is becoming all the rage, as it were, ecstasy is far from out of the mainstream. I think that what you're seeing is more the effect of it no longer being quite what it was in the late nineties. Most drugs go through cycles of popularity, often strongly dependent on geography.
    CPP -
    More like: "Whoah! I've never felt this close to someone in my entire life! What's your name?"
    No, more like, *"Whoah! I've never felt this close to someone in my entire life! Do you mind if I touch your hair? How about your face? Would it be ok if my b-friend touched you too? You feel really nice...."
    *Actually happened to me. They didn't ask my name. They got a little more personal than most people would have been comfortable with. I wasn't on MDMA (never have been), I just happened to meet their friend in a coffee shop, while trying to find a subtle place to smoke some of my really good weed. I'm thankfully not uncomfortable with people touching me in impertinent places, especially when they really don't intend anything untoward by it. Not that it really bothers me if they do mean something untoward by it - least ways it didn't used to bother.

  • leigh says:

    anecdotal comment:
    my students anonymously self-reported a hallucinogen use rate of about 17%. (i lumped mdma in with the hallucinogens in my data reporting, we can debate that another time along with the complications of self-reporting.)
    but really, mdma wasn't very prevalent in their lists. mostly i saw soma and shrooms listed for hallucinogens.
    that was a very interesting exercise for me.

  • Turkeyphant says:

    I guess the point is that, taken responsibly, MDMA is at least as safe as (probably many times safer than) other drugs such as alcohol or many medicines. There is no credible evidence to suggest that 150 mg of MDMA in a controlled setting is remotely life threatening. If someone kills themselves by abusing legal substances we say that they are stupid. It is misleading to say that MDMA is a dangerous substance when anything can be dangerous when used irresponsibly.
    Furthermore, the central issue is that when people die from taking PMA-pills or forgetting to drink in a overcrowded warehouse while on 750mg MDA p.o., the reports typically blame "ecstasy". Given most people use this as a synonym for MDMA, the result is that MDMA all too often takes the blame when, were we talking about a legal substance, things would be viewed very differently.
    I'm in no way an apologist for recreational MDMA use. In fact, I think that people should be made more aware of the dangers (not least the way it turns you into a moron for 4-6 hours). However, to suggest that you're playing Russian roulette by bombing an eighth of a gram is simply false.

  • DrugMonkey says:

    However, to suggest that you're playing Russian roulette by bombing an eighth of a gram is simply false.
    I am by no means suggesting your odds of dying on MDMA are 1/6. Not even close.
    There is no credible evidence to suggest that 150 mg of MDMA in a controlled setting is remotely life threatening.
    Well, at least we are making some progress from your initial position at #22. And do keep in mind that my continual point is that we do not know enough about thresholds for adverse outcomes, nor do we know enough about the contributing factors which may contribute to MDMA related fatality.
    Really, take the trouble to read Schifano, 2004 and Patel et al, 2004 (unfortunately this latter is not in the MAPS collection).
    You will see what I mean about some cases reported with very low blood levels of MDMA (hint, look at the SD not just the mean!). Also some stats and/or cites on the percentage of cases in which no other psychoactives were reported. Although this is all I need for my essential point (that MDMA is capable of killing people all by itself) see a prior comment for why the presence of other drugs doesn't necessarily exonerate MDMA as a causal agent.
    In addition to the review, you might want to also peruse the individual case reports for those ones where, again, the blood levels were consistent with a 1-2 tablet dose.
    the central issue is that when people die from taking PMA-pills or forgetting to drink in a overcrowded warehouse while on 750mg MDA p.o., the reports typically blame "ecstasy". Given most people use this as a synonym for MDMA, the result is that MDMA all too often takes the blame
    If you reread the OP you will see that I'm in favor of journalists reporting tox information accurately. This is a secondary issue to whether or not MDMA itself is capable of killing people, which you are (inaccurately) disputing.
    It is misleading to say that MDMA is a dangerous substance when anything can be dangerous when used irresponsibly.
    Completely and utterly false and illogical. Being a pedestrian in a busy urban environment and driving an automobile or motorcycle just about anywhere involve nonzero risk. The risks go up when "used irresponsibly". Does this mean we tell people that if they drive the speed limit they are risk free? Do we use the evidence that people routinely and daily exceed the freeway speed limit without any adverse consequences to argue against speed limits? no. we do not. (and before you start in with red herrings about risk to others, just think about seatbelt laws and motorcycle helmet laws for a second. )

  • Turkeyphant says:

    If you reread the OP you will see that I'm in favor of journalists reporting tox information accurately.
    Firstly, in my mind, this issue is far more vital than recreational drug proselytizers underemphasising the negative aspects of MDMA use.
    Completely and utterly false and illogical. Being a pedestrian in a busy urban environment and driving an automobile or motorcycle just about anywhere involve nonzero risk. The risks go up when "used irresponsibly". Does this mean we tell people that if they drive the speed limit they are risk free? Do we use the evidence that people routinely and daily exceed the freeway speed limit without any adverse consequences to argue against speed limits? no. we do not.
    Aspirin has a non-zero risk. So does water. But physicians do not go to the trouble to go on and on about these risks as they are trivial minimised to point of negligibility. Likewise, MDMA has a non-zeo risk but, used responsibly, it's so small to not be worth mentioning other than to recognise that it exists.

  • daedalus2u says:

    If you look at the Patel et al 2004 paper in PubMed, and click on "related articles", the next one is this:
    http://www.ncbi.nlm.nih.gov/pubmed/15963623
    Indicating an association of cardiac hypertrophy with MDMA related deaths, which is similar to the side effects of abuse of other stimulants.
    This is exactly consistent with the idea that stimulants of abuse trigger the normal fight or flight stress pathways mediated through low NO, and the euphoria of stimulant abuse is the euphoria of the near death metabolic state. If this is correct, then a single use may well cause irreversible damage. Damage that may not be apparent in young and otherwise healthy individuals because they have a lot of redundancy, and can tolerate a lot of irreversible damage before it impacts them enough to notice.
    If this is the case, the "damage" is not due to toxicity or dose, it is due to the triggering of normal physiological pathways. If those pathways are triggered enough to cause euphoria, then there will be damage.

  • DuWayne says:

    daedalus2u -
    That is why I ultimately chose to quit using hallucinogens. Not because all of them caused that triggering, but because some of them had (Especially the mayapple root) and I found it possible to trigger a similar response when I was merely on acid or even mushrooms. Neither of them would by themselves trigger that response, but while on them, I found it pretty easy-peasy to turn around and fuck with breathing patterns and my heart rate, in a way that I knew had to be unhealthy.
    I know that I did a fair amount of permanent damage and realized that I was pushing things to the point where the damage was going to become noticeable. It was rather a close thing, because there was a part of me that just didn't fucking care. I like how making a stiff batch of mushroom tea makes me feel. I love how consuming large doses of acid makes me feel. But I don't like the picture of living like a few people I know are going to live for the rest of their lives.
    But I bloody damned well plan on eventually leaving life with a bang.

  • Andrew says:

    Mayapple root? Good lord, I'm not surprised you felt like you experienced a "near death metabolic state".
    It took me a long time to feel comfortable eating mayapple fruits; they're delicious, but don't eat the seeds and make sure they're fully ripe, and even then I'm kind of paranoid about eating more than a couple. Mayapple is pretty damn toxic.
    I wouldn't take anything purported to be psychoactive unless there are MULTIPLE references to it being used as a psychoactive. There's a lot of very sketchy information in the ethnobotanical literature about something that may have been used as a psychoactive by some group of people. This info gets picked up by the psychonaut community and doesn't get vetted any further. Some of these psychoactives might be better described as "ordeal poisons", where any psychoactive effects are precisely due to it coming damn close to killing you (assuming it doesn't actually kill you). Misidentifications in the literature are also a problem.
    In the case of mayapple (Podophyllum), it's also known as mandrake. Apparently reports of psychoactivity are due to confusion with mandrake (Mandragora). I'd consider taking Mandragora to be a pretty bad idea, but not as bad as Podophyllum.
    Based on the reference I've got at hand, (Ratsch, Encyclopedia of Psychoactive Plants), it sounds like Emboden is the source for Podophyllum's purported psychoactivity. Emboden pushes some pretty marginal stuff; I'm very skeptical about water lilies. For that matter, the Ratsch book lists a lot of plants with very sketchy info about psychoactivity (e.g., the bananas and the whole peel thing), but at least some of them are debunked, and the sketchy stuff is in it's own section, "Reputed Psychoactive Plants". Don't bother trying any of the reputed plants; if you really insist, at least find out whether they'll kill you before ingesting them.

  • DuWayne says:

    Andrew -
    Trust me, podophyllum will make you trip. And I went into it knowing that it could be potentially fatal. I was as careful as possible to avoid that happening, but made an error in dosage that did nearly kill me. I handled and cut up the raw roots with bare hands, getting my hands pretty well covered in the juices. I had no idea that it would absorb through my skin.
    The experience was very intense to say the least. It was an intense euphoric, accompanied by auditory and for a little while, discernible visual hallucinations (there were "tracers" and patterns for much longer).
    Mandragora was actually a very interesting experience, closer in effect to that of atropa belledonna. It definitely provided for a more overt "high" than belledonna, but the hallucinatory effects were very similar. With belledonna there is virtually no physical high, while there are intensely vivid auditory and visual hallucinations that don't seem like hallucinations. I.e. I would suddenly be having a conversation with someone that was just suddenly there and just as suddenly they wouldn't be there. With mandrake, this lasted for a few days, with belledonna, this would last for a couple of months.
    The worst of all worlds of course, was datura stramonium. I definitely appreciate having had the experience, but have done everything possible to discourage anyone else from using it. The line between an effective dose and a fatal dose is just way too fine (it is for belledonna too) for reason.
    The thing that should be understood about psychoactive plants, is that there isn't a single one that is actually psychoactive, that isn't also fairly toxic. Neurotoxicity is what makes most hallucinogens hallucinogens. It should also be understood that one doesn't reasonably take very many of them for recreational purposes. For good or bad, when I was taking them, it was a part of my spiritual journey - one that has ironically led me to reject revealed religion altogether.
    And in all honesty, one of the things that has kept me hanging onto the notion of physical/spiritual duality, is the fact that I am still alive, after the experiences I've had with the substances we are talking about. Not only alive, but not too much worse for the wear. And really, pretty much as sane as I was before I used them.
    Not that this should ever be taken as encouragement for anyone to try any of these substances. Most of them are extremely toxic. And even if they don't kill you, they can seriously fuck up your head (see my last comment on this thread). I know people who will never be whole again, who did far less than I did. From people who are mildly retarded, to people who may never see the outside of an institution again. Just not worth the fucking risks involved.

  • daedalus2u says:

    DuWayne, what you relate is very interesting. I do think the final common pathway of essentially all agents that induce euphoria is a near death experience, specifically an ATP depletion. Many of the agents do so via oxidative stress, they generate superoxide via activation of MAO or P450 enzymes and that superoxide pulls down the NO level which lowers the ATP level via their common action on sGC.
    Euphoria is a complex state which can be triggered by normal physiology (i.e. the near death state as caused by asphyxiation). Complex states are complex. The complexity comes from normal physiology and can have a simple trigger. Complex physiological responses don’t require complex triggers. Anaphylaxis is very complex but can be triggered quite simply.
    Very simple things can trigger euphoria, simple asphyxiation can, huffing solvents can. Presumably those same things trigger the final common pathway too. It is not at all clear to me that it is even possible to invoke the euphoric state without causing damage. In bipolar disorder the euphoria of the manic or hypomanic state is accompanied by reductions in gray matter, the loss of brain cells. I suspect that any activation of the pathways that induce euphoria will be accompanied by damage. Probably some acute damage and likely some compensatory pruning later to reduce the metabolic load in the brain volumes affected to increase the threshold for metabolic stress the next time. Pruning brain cells to make the neural network more reliable in the short term at the expense of future functionality is a good evolutionary trade-off except when people trigger those emergency pathways unnecessarily.
    That "pruning" is via excitotoxicity, which causes cell death due to ATP depletion. The most metabolically stressed cells are the ones that get pruned. Once they are pruned, they never come back.
    I speculate that you are somewhat on the autism spectrum, perhaps with a degree of Asperger’s. The characteristic neuroanatomy of people with Asperger’s, autism and also of many scientists is to have more numerous minicolumns comprised of smaller but more numerous neurons. My speculation is that this finer-grained neuronal structure is part of what facilitates some of the improved sensory abilities of ASDs, and is responsible for some of the savant abilities and the improved ability to think about minutia. (to really compound my speculation) That may relate to a characteristic difference in the brain when driven to near failure, ASDs experience a “melt-down”, while NTs experience psychosis. That may be why your experience was different from that of your aquaintences.

  • DuWayne says:

    daedalus2u -
    I keep meaning to ask, are you a Stargate geek or a mythology geek? Or like me, are you both?
    I am not going to state categorically that I'm not ASD, but I sincerely doubt it. I have been diagnosed with severe ADHD and have been diagnosed bipolar as well. And I have been an insomniac since birth. But I wouldn't dispute your hypothesis, which would apply just as well to me if I'm not ASD. At the least, I am certainly not NT.

  • daedalus2u says:

    Neither.
    I am an inventor, and really liked the Daedalus column that was in Nature some years ago. That is my kind of inventing, on the edge and beyond.
    I think you are close enough. I think the fine-grained structure and other neuroanatomy of ASDs does facilitate a more robust "theory of reality" but at the expense of ability to communicate. That "theory of reality" is built from the bottom up, rather than from the top down (as NTs build their theory of reality via communication).
    A bottom up structure is more stable and when it gets fractured it can be rebuilt. A top down structure can't be. I think your acknowledgement that what you were doing could have been fatal while you were doing it is quite different than the denial that most NT drug users exhibit. I think that denialism is quite characteristically an NT trait. Being able to be deceptive is so important to NTs, that many deceive themselves without appreciating it.

  • drghughes says:

    While you won't get a full tox report, if you do a search for "coroner" plus the person's name, you may get some information that will indicate what the actual levels were.
    As an example, I Googled "coroner mdma site:.au" and got this report [PDF] amongst others.
    The report into the case you discussed here won't be available for a while, but if you've got some other names you might be able to find out what happened.
    Presumably similar reports are available in other countries.

  • Klem says:

    One news story says, "Police believe the pills that apparently killed Ms Bebendorf were among a bad batch of drugs circulating in southeast Queensland that left three others in hospital." This then links to a news story that these three people had taken GHB.
    This sort of dangerous confusion about drug contents is what the US Pure Food and Drug Act of 1906 was designed to prevent.
    Very sad story. I wonder how long people around her waited before calling an ambulance. Delay caused by fear of the police is perhaps the main cause of death from drug overdose.
    Len Bias, young football player who died from cocaine in 1986, mentioned often by DM, apparently was allergic to cocaine and went into shock three times before friends called an ambulance, several hours after the medical emergency started.
    I just read this about Len Bias in an interesting book: Why Our Drug Laws Have Failed and What We Can Do About It: A Judicial Indictment of the War on Drugs (2001) Temple University Press, written by James Gray, a California Superior Court justice.

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