Overheating and water balance
MDMA, amphetamines, meth, cocaine and mephedrone each push body temperature up and make it harder for the body to shed heat. A hot, crowded room and hours of dancing push the same way, and cocaine in particular blunts the feeling of being too hot, so you cannot wait until you feel it. Overheating is one of the main ways MDMA seriously harms people. MDMA has a second, opposite danger: it makes the body hold on to water, so drinking a lot to be safe can dilute the salt in your blood until the brain swells. The fix for one makes the other worse, which is why the amounts matter.
- Faint, dizzy, cramping, pale and clammy, or throwing upHeat exhaustion: the stage before heat stroke, while cooling still works fast.
- Hot to the touch, with confusion, a throbbing headache, or agitationHeat stroke. Hot, dry skin that has stopped sweating is a late sign, so do not wait for it.
- Headache, nausea, confusion or drowsiness in someone who has been drinking a lot of waterToo much water, not too little. Rarer than overheating, and it happens to women more often.
- A seizure, or someone who cannot be woken
- 01Hot and confused: cool them and call 911.Somewhere cool, layers off, cold water on the skin and a fan, cold packs under the armpits and on the neck. Cooling is the treatment, so do it while you wait.
- 02Confused, drowsy or having a seizure: nothing more to drink.If it is too much water, more water makes it worse. A drink is only for someone awake enough to hold the cup.
- 03Tell paramedics what was taken and how much water went in.Overheating and water intoxication are treated differently.
If you are going to combine anyway
- Sip, don't gulp: about a pint (500 ml) an hour if you are dancing, half that if you are not.A sports drink or salty snacks alongside the water replace what sweat takes out.
- Take breaks from dancing before you feel you need them.Shade or a cool room, and loose clothes. The drug hides how hot you are.
- Do not redose.
- Skip the alcohol.It takes more fluid out than it puts in, and it is not a way to cool down.
How it happens
The body gets rid of heat by sweating and by sending blood to the skin. Stimulants work against both: they make the body produce more heat, narrow the blood vessels near the skin, and in the case of cocaine blunt sweating and the feeling of being hot. In a hot room with people dancing, heat builds faster than it can leave.
MDMA also changes how the body handles water, so the kidneys hold on to it instead of passing it. Drink a lot on top of that and the salt in the blood gets diluted. That is hyponatraemia: brain cells take on water and swell, which is what causes the headache, confusion and seizures. In one study, over a third of volunteers given MDMA with no limit on drinking developed it. None did when drinking was limited.
Alcohol is the most common thing taken with MDMA. It adds fluid loss on top, and more ecstasy deaths on the England and Wales record involved alcohol than ecstasy alone.
Substances that carry this risk
MixSafe raises a whole-mix warning when two or more of these are in the same mix, or when MDMA is mixed with alcohol. The list is kept narrow on purpose, so it is not every drug that can contribute. Each pair still has its own rating.