Ecstasy (MDMA) goes by various street names, including Molly and XTC. The drug produces stimulant effects similar to the effects produced by amphetamines as well as hallucinogenic effects similar to those produced by mescaline.

MDMA was originally used in the treatment of certain types of psychiatric conditions and continues to be researched regarding its utility for the treatment of psychological disorders, such as trauma- and stressor-related disorders. The drug became a popular drug of abuse in the late 1990s and early 2000s as a “rave drug” that was often used by younger individuals at clubs or parties.

Its major psychoactive effects are related to the stimulant properties that produce euphoria, heightened levels of energy, feelings of wellbeing, and sociability. The use of MDMA is also associated with numerous negative effects, including both short-term and long-term issues. The negative effects of MDMA use discussed here are all related to its stimulant properties that result in the development of hyperthermia.

Hyperthermia

The stimulant properties of ecstasy lead to its tendency to increase an individual’s body temperature when the drug is used; an increase in body temperature is referred to as hyperthermia. This effect is dose-dependent, such that individuals who use more of the drug will likely become overheated more rapidly. The hyperthermia associated with MDMA use results from the drug activating the neurons in the central nervous system (the brain and spinal cord) and the nerves in the sympathetic nervous system, which is a division of the peripheral nervous system (the nerves outside the central nervous system) that typically results in speeding up various bodily processes. The sympathetic nervous system is part of the autonomic nervous system that is involved in functions that are not under direct voluntary control, such as body temperature, heart rate, digestion, etc.

MDMA use leads to over-excitation of the central nervous system and an increase in neuronal firing, particularly neurons that release the neurotransmitters serotonin, dopamine, and norepinephrine in conjunction with the sympathetic nervous system activation. This leads to vasoconstriction, which can lead to increased heat production and difficulty with heat dissipation in the body. The increase in body temperature can be particularly problematic when individuals are in an environment where there is little ventilation, such as a party or club. When the drug is used in these tight surroundings, individuals can become overheated rapidly.

Hyperthermia can be fatal as a result of brain damage associated with overheating. Ecstasy use also increases the potential for neurotoxic effects as a result of the neurons in the brain rapidly firing and becoming damaged.

Treatment for hyperthermia typically involves the use of benzodiazepines or muscle relaxants, changing the individual’s environment to cool them off and to provide less stimulation, and using ice packs or administering IV fluids in some cases. Hyperthermia leads to other side effects, including dehydration and increased perspiration.

Dehydration and Increased Perspiration

When an individual uses MDMA and experiences hyperthermia, this can be associated with increased perspiration and even dehydration. Dehydration can occur because the drug results in the individual’s system working in “overdrive,” and fluids become rapidly depleted. Hyperthermia also increases perspiration, and this can lead to dehydration as fluids are not replaced. In addition, as stated above, the environment can also exacerbate issues with hyperthermia, perspiration, and dehydration.

The Effects of Drugs

Because MDMA is often used at parties or clubs where alcohol is served, individuals often use MDMA in conjunction with alcohol. This practice is a sort of doubling down on the potential to become dehydrated, as alcohol is a diuretic and drinking increasing amounts of alcohol leads to individuals losing fluids. Ecstasy may also result in the individual’s hypothalamus releasing an anti-diuretic hormone that stops the kidneys from producing urine and makes it difficult for individuals to urinate. As individuals become overheated, perspire, and become dehydrated, they may consume more alcohol, which can lead to further dehydration.

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If the individual begins drinking large quantities of water, some of the effects of dehydration may be countered, but drinking too much water can result in a condition known as hyponatremia where essential minerals and salts are diluted in the blood. This can also lead to medical complications. In addition, using alcohol and ecstasy together places significant strain on the cardiovascular system and can increase the potential for stroke or heart attack, particularly when individuals become overheated.

Signs associated with hyperthermia, dehydration, and excessive perspiration as a result of MDMA use can include:

  • Feeling very hot and nauseous
  • Confusion, slurred speech, or jumbled speech
  • Headache
  • Elevated heart rate even when resting
  • Lack of sweating despite physical activity (a sign of dehydration)
  • Fainting spells
  • Seizures

Individuals who faint as a result of overheating or display seizure-¬like activity need immediate medical attention.