MDMA (ecstasy) intoxication
- Robert J Hoffman, MD
Robert J Hoffman, MD
- Division of Emergency Medicine
- Sidra Medical and Research Center
MDMA (3,4-methylenedioxymethamphetamine, also commonly called “Molly” or “ecstasy”) is a synthetic compound with structural and pharmacologic similarities to both amphetamines and mescaline. First developed in 1914 as an appetite suppressant, MDMA found use as a psychotherapeutic agent during the 1970s [1,2]. However, its potential for abuse was quickly recognized, leading government agencies to place tight restrictions on its use [3,4].
MDMA is a commonly abused drug, particularly among young party-goers at electronic dance music venues, including dance clubs and large music festivals. Typical effects include feelings of euphoria, wakefulness, intimacy, sexual arousal, and disinhibition .
The clinical features and management of acute MDMA intoxication will be reviewed here. A summary table to facilitate emergency management is provided (table 1). Detailed discussions of related issues, such as serotonin syndrome, severe hyperthermia, and a general discussion of the poisoned patient are found separately. (See "Serotonin syndrome (serotonin toxicity)" and "Severe nonexertional hyperthermia (classic heat stroke) in adults" and "General approach to drug poisoning in adults" and "Approach to the child with occult toxic exposure".)
Abuse of MDMA fluctuates [6,7]. Use among adults may be decreasing overall, but this may not be true of adolescents. In 1996, 5.7 percent of United States 12th grade students reported using MDMA, but in 2013 4.4 percent of 12th grade students did so. The number of younger users may be due in part to the erroneous belief that MDMA provides a “safe” high. In fact, MDMA shares toxicities with amphetamine, in addition to unique adverse effects, and adverse events including deaths associated with its use have increased since 2013. A number of electronic dance music festivals in the United States have experienced partygoer deaths from MDMA use [8,9]. As experimental use of MDMA to treat a number of psychiatric disorders (eg, posttraumatic stress) increases, more persons may become exposed to MDMA .
PHARMACOLOGY AND CELLULAR TOXICOLOGY
MDMA (3,4-methylenedioxymethamphetamine) is a sympathomimetic amphetamine that causes release of endogenous catecholamines (particularly norepinephrine and dopamine) and blocks their reuptake into presynaptic vesicles.
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- PHARMACOLOGY AND CELLULAR TOXICOLOGY
- CLINICAL FEATURES
- Vital signs
- Cardiovascular stimulation
- Hyperthermia and related effects
- Manifestations of hyponatremia
- Serotonin syndrome findings
- DIFFERENTIAL DIAGNOSIS
- LABORATORY EVALUATION
- Initial resuscitation
- - Airway
- - Breathing
- - Circulation
- Gastrointestinal decontamination
- Cardiac effects
- Psychomotor agitation
- Serotonin syndrome
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS
- Pharmacology and presentation