Another festival, more medical emergencies, another MDMA-associated death

Jul 01 2010 Published by under Drug Fatality, MDMA

From the LA Times we learn that the Los Angeles edition of the Electric Daisy Carnival held this past weekend resulted in about 120 emergency room visits. An estimated 185,000 persons attended the event.
As one might predict, at least one person died from taking Ecstasy. LA Times:

At 15, Sasha Rodriguez did not meet the minimum age requirement of 16 to enter the event without a legal guardian. Family and friends said that she attended the party with a 16-year-old friend and that doctors told them she had the hallucinogenic drug Ecstasy in her system when she was taken by ambulance to the emergency room.
Rodriguez ... died at California Hospital Medical Center downtown before 5:30 p.m. Tuesday after her family decided to remove the comatose teen from life support.

Yes it is the MDMA.
Are teenage girls at particular risk? I don't know the answer to this.


There is a little tickling of evidence that perhaps women or girls are more sensitive to hyponatremia. This is a fairly common finding in MDMA-associated medical emergency and death. MDMA releases arginine vasopressin, aka antidiuretic hormone, thus causing the body to retain water. What I need to follow up on a bit is whether there is any indication that MDMA-induced hyponatremia may be more severe or have more severe consequences (i.e., it may be an indirect effect) in women.
Ms. Rodriguez may have suffered from hyponatremia.

[Sasha Rodriguez] was one of two rave attendees who were in critical condition at California Hospital Medical Center after the 14th annual Electric Daisy Carnival.
...
"She came in as an emergency patient from the rave. She was in respiratory arrest when she got here, and she never recovered," said Salgado, who said Sasha was in a coma and experienced multiple organ failure.
...
Doctors told Sasha's family that she had the drug ecstasy in her system when the ambulance got her to the emergency room.
...
A 16-year old friend who was with Sasha at the rave said Sasha was dancing, got hot and began quickly drinking cold water.
Doctors said "her sodium, electrolytes were so low that when she started replacing them so quickly [with cold water], ecstasy messes up your body's ability to process that, so it threw her body out of whack," said Keith.

I'm struck by this tragedy, of course. As you know, I'm a parent and I can think of nearly nothing so horrifying as to get a call telling me one of my children has died.
What I find sort of interesting as a scientist, however, is that these tragedies are met with calls for banning raves. This is similar to the hoopla in the earlier part of this year when the United Kingdom got concerned about some deaths associated with mephedrone / 4-methylmethcathinone and subsequently put this previously legal substance under legal control. These actions are certainly understandable...and they appear politically dramatic.
Still, why aren't these events followed by calls to learn more about the mechanisms by which these individuals have died? Why is there not a tremendous amount of political gasbaggery being blown at scientific understanding? Wouldn't that be a more productive response* in the long term?
__
*What can I say? I believe in the hammer of science and knowledge..guess what kind of nails I construe in the world about me?

13 responses so far

  • Dirk Hanson says:

    You don't have to represent the hammer of science (but feel free to do so, you're certainly qualified) to make a suggestion of such common sense. One of these days a law enforcement official or a politician is gonna make a call for more research when this kind of thing happens, rather than looking for someone to arrest or something to shut down.

  • inverse_agonist says:

    There aren't calls to learn more because the point of publicizing these things is that Drugs Are Bad and maybe your local police department could use some more SWAT gear.
    Our culture has a huge vindictive streak about drug users, so nobody cares about the nuts and bolts of how a Bad Person killed themselves doing something Bad.
    We don't have a collective freakout every time an NSAID causes a cardiovascular or liver problem. People can and do die of those things, too, but we don't wring our hands about whether we should ban Advil and maybe close down all the drug stores.
    Have people died from taking ecstasy? Yes. Is the risk of death high on the list of considerations when deciding to take ecstasy? No. It's undeniable that taking a lot of ecstasy all the time isn't a good idea, but the LA Times doesn't spend a lot of time worrying about how we hand driver's licenses to 16 year old boys. In fact, it has a whole section dedicated to how awesome it is to drive fast, expensive cars.

  • we have better information on any type of situation how are you.

  • Jamie says:

    "We don't have a collective freakout every time an NSAID causes a cardiovascular or liver problem."
    Yup. forsyth et al, 2001. over one decade the ratio of ecstasy deaths to ecstasy newspaper reports was essentially 1:1; basically, every ecstasy death was reported upon. it took 265 deaths from paracetamol for a single one to be reported. the statistics for blog posts are unknown

  • Synchronium says:

    RE: Mephedrone in the UK. The two most famous deaths weren't actually related to mephedrone. Of course, the post mortem came after the ban which was rushed through parliament.
    If you want any more info on the situation in the UK, get in touch. Plenty of scandal, intrigue and general political bullshit to be scoffed at.

  • DrugMonkey says:

    Nice try Synchronium. Just because there are false alarms does not mean that there are no genuine deaths. There are several, including the index case* of the Swedish woman, in which 4MMC is confirmed.
    The approach of the recreational advocates has been to bleat the fact that two recent UK cases were negative for 4MMC all over the place. Doing so without acknowledging the confirmed death cases. This just as BS as any similar shading on the part of anti-recreational use advocates.
    This is very early days indeed, compared to the recreational use of MDMA. We know very little so far. But the idea that this mephedrone / 4-MMC compound is going to fail to produce medical emergencies and death is nonsense. (I, of course, will be interested in questions of why, who and under what circumstances)
    *so to speak.

  • DrugMonkey says:

    oh and Synchronium, while you are here..
    http://www.ixion.demon.co.uk/mmcat.htm
    What's all this heart rate and peripheral circulation complication stuff? I'm seeing this sort of comment over at Bluelight too.
    This is sounding very non-MDMA-like to me. Not exactly amphetamine(s)-like either and yet the early lit on cathinone and methcathinone has it basically as a weak stimulant, i.e., dopamine transporter inhibitor.
    User reports are not the best source for making pharmacological inferences but this sure is sounding like a unique set of negative outcomes to me so far.

  • Synchronium says:

    I'm not saying it shouldn't have been banned because of those deaths, but those deaths were the ones that the media kept on writing about.
    Here's some interesting articles on the situation:
    http://www.guardian.co.uk/society/2010/jun/06/louis-wainwright-nicholas-smith-mephedrone-nrg1
    http://www.guardian.co.uk/commentisfree/2010/may/28/mephedrone-ban-drug-classification
    My problem with the banning of it was partly for the reasons I wrote about here ( http://www.synchronium.net/2010/01/06/should-mephedrone-be-legal/ & http://www.synchronium.net/2009/12/31/top-10-reasons-why-legal-highs-should-stay-legal/), but also for reasons that apply to all drugs, for example, the fact that drugs are a legal issue, not a health issue; the fact that alcohol costs our health service about £3bn a year and hospitalises about 1200 people per day; if our government really cared about the people and were trying to help, regulation would be better for everyone; banning stuff puts money into the hands of criminals (not a bad thing because they deal the illegal substances, but those already breaking the law would have less of a problem breaking more laws (guns, violence) than a legitimate business).
    The other problem with how the UK went about it was the lack of any real evidence. Key sections in the ACMD's report ( http://www.synchronium.net/2010/04/04/acmd-mephedrone-report-1/ ) showing this lack of evidence are 3.17, 3.19, 4.12, 4.7 & 5.1. Several members quit this advisory council because of this, following even more resignations a few months ago as a result of political interference: http://www.synchronium.net/2009/11/02/nutt-sacked/
    Re: side effect profile - obviously, you get the same stuff as other powerful stimulants (tachycardia, vasoconstriction --> high BP, sweating, dry mouth), but there are some unique ones, mainly people have started turning blue.
    If this were just vasoconstriction it would surely start at the extremities, turning your finger tips, etc blue first, but people are going blue in the knees, elbows, hands, feet - basically around the joints. I've not looked into it any further for quite a while now, so no idea if new evidence has arisen since, but it looks suspiciously like autoimmune vasculitis rather than simple vasoconstriction.
    All in all, it's not the safest drug - it's worse than cannabis, LSD and MDMA for example - but it's not that bad either. It was EVERYWHERE in the UK. Everyone was at it all the time, even the non-druggy people who thought it was fine because it was legal. A lot of people were taking more than a gram a day for months at a time and I've even seen a few reports of people IVing 1g in a single shot. Obviously that kind of usage is ridiculous and side effects got worse with larger doses, but it can't be *that* dangerous if only a handful of people died from it.
    Re: effects & comparisons - this is copied from http://www.synchronium.net/2009/12/03/mephedrone-the-facts/

    Effects include an initial euphoria, which tapers off to a milder stimulation. Mephedrone does seem to oil social situations rather well and get everyone talking, laughing and having a good time, especially during the initial euphoria. Several users have compared it to cocaine, but some how less jittery and “arrogant”, while others will compare it to a more rushy ecstasy (which has to be a good thing, given the current state of the MDMA market). Actually, the effects seem to depend very much on dose and your chosen route of administration.

    Up the nose = faster onset, higher peak = more of a rush
    Oral ingestion = slower onset, longer duration = more of an ecstasy-like euphoria
    Sorry for all the links - feel free to delete as appropriate.
    Cheers.

  • DrugMonkey says:

    the fact that drugs are a legal issue, not a health issue;
    first you say that, then you write:

    obviously, you get the same stuff as other powerful stimulants (tachycardia, vasoconstriction --> high BP, sweating, dry mouth), but there are some unique ones, mainly people have started turning blue.
    If this were just vasoconstriction it would surely start at the extremities, turning your finger tips, etc blue first, but people are going blue in the knees, elbows, hands, feet - basically around the joints.

    c'mon now. these are legal symptoms? really?
    it looks suspiciously like autoimmune vasculitis
    It is interesting to me how frequently the pro-drug crown likes to resort to "allergic reaction" when they really have no idea that the immune system is involved. It is probably more accurate to suggest individual differences in response to the pharmacology of the drug. I think people resort to this notion of an allergic reaction because it allows a sort of mental shift by which the compound itself is further exonerated.

  • JohnV says:

    Last weekend when I had 300 beers and passed out it was just an allergic reaction to the alcohol, right?

  • Synchronium says:

    c'mon now. these are legal symptoms? really?

    I woke up this morning with some terrific legal side effects. Dry mouth, headache, slight delerium, felt sick and had dodgy vision all thanks to too much wine.
    Thankfully, that was it for me, but other common side effects include vomiting, violence, other dangerous lowering of inhibitions, liver failure, etc.
    My view is ALL drugs should be banned (which, as we know does nothing to stop people taking them and leads to more harm, eg, alcohol prohibition over there) or none of them should (ideally, but never going to happen) or at least a great deal of them should be legalised - at least all of the ones less harmful that alcohol.
    If we can choose legally to put ourselves though that, why shouldn't we be able to legally put ourselves through some other set of different, but equally dangerous side effects (which would be much more predictable and less severe with pure, regulated drugs)?
    David Nutt's paper from last year (I think) compared the dangers of ecstasy with the dangers of horse riding - both of them are responsible for a handful of deaths in the UK each year. Other harmful recreational activities include skateboarding, rock climbing, swimming, etc. Banning those would be ridiculous.
    I'm not resorting to "allergic reaction" here. At least, not intentionally! From what I've read, I thought it was more of an immunomodulatory thing than an accute allergic reaction. A lot of users started out not seeing this bluing round the joints originally, which then manifested several "sessions" later. It can also last for quite a while in the heavier users. It eventually happens to the majority of long term users, so it is something the drug is responsible for, rather than hundreds of thousands of individual allergic reactions.
    JohnV: I'm not really sure what point you're trying to make.

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