MDMA and other stimulants in hot environments

Nine people recently became unwell after using MDMA at a music event. Some were also exposed to PMMA, synthetic cathinones and/or methamphetamine

MDMA (‘ecstasy’) is an empathogen/entactogen stimulant with effects including euphoria and increased sociability, but also increased body temperature, heart rate and blood pressure. Seven people who became unwell had specialised blood tests, all of which showed MDMA. Six had very high concentrations of MDMA.

PMMA and synthetic cathinones are stimulant drugs. They have some similar effects to MDMA but appear to have a higher risk of producing unpredictable effects. They are most likely to be sold as, or mixed into, MDMA. One person had PMMA and three people had cathinones (methylone, pentylone, dipentylone) in blood results.

Methamphetamine is a stimulant with effects including euphoria, alertness and sociability, but also increased body temperature, heart rate and blood pressure. Three people had methamphetamine in blood results but do not appear to have consumed it intentionally.

Consuming these substances at a hot, humid music event will increase the risk of life-threatening hyperthermia

All patients in this cluster experienced life-threatening hyperthermia (high body temperature). Consuming MDMA causes your core body temperature to increase. It does this by turning up the body’s ‘thermostat’, releasing hormones that produce more body heat, and reducing the body’s ability to shed heat.

A larger dose of MDMA on its own can be enough to cause hyperthermia. Additional factors will make the body even hotter. The more of these factors are present, the greater the risk:

• Hot, crowded environments: This includes hot weather, environments with hot air, tightly packed crowds, poor ventilation and airflow, and structures where heat cannot dissipate vertically.
• Humid environments: The body cools itself by sweating and allowing the sweat to evaporate off the skin. Humidity (high levels of water vapour in the air) slows evaporation and reduces the body’s ability to cool itself.
• Physical exertion: Vigorous physical activities like dancing or exercise will further increase body temperature.
• Other substances: Consuming alcohol or other drugs – especially other stimulants like cocaine, amphetamines or cathinones, which further elevate body temperature – will increase the chance of unpredictable and toxic effects.

Know the signs – and don’t wait to get help

Signs of drug-related hyperthermia include feeling uncomfortably hot, nausea and vomiting, excessive thirst, confusion, agitation, muscle spasms, seizures or losing consciousness. Experiencing even one of these signs is reason to get help.

If you experience any unusual or unexpected effects, or notice someone appearing confused or unwell, seek urgent medical attention. Don’t delay seeking help. If you’re at a festival, seek out the First Aid Service – these services often provide a very high level of emergency care. Their assistance can be the difference between life and death.

Reduce the risk of harm

All alcohol and other drug use comes with serious risks, so:

• Start low and go slow with dosing. The amount of MDMA in pills and capsules varies significantly and can reach up to 250mg or more – so start with a low dose. Even if you’ve used MDMA before, hot and humid conditions can make your ‘normal’ dose hazardous. Go slow if consuming any other substance or redosing – wait until peak effects have passed. You shouldn't need to take as much when redosing to maintain the same effect. Delayed or different effects could be a sign of unexpected ingredients like PMMA or cathinones.
• Stay hydrated by sipping water slowly, but don’t drink too much.
• Find a cool spot to take breaks from dancing.
• Make sure you’re in a safe environment with people you trust.
• Remember, even ‘pure’ drugs can produce serious side effects and death. Get the facts at Alcohol and Drugs Foundation. Some common mental health medications – such as SSRIs, SNRIs and TCAs – may increase the risk of toxicity from stimulants. Always seek information about your medications before mixing with other substances.
• Be aware that other false or contaminated drug products may circulate in Victoria, even if no specific warning has been issued about them.

Contact Harm Reduction Victoria’s DanceWize team for anonymous support and education from peers. Talk to DanceWize volunteers by email at info@dancewize.org.au.

If you or someone you know needs help with alcohol or drug use, call DirectLine on 1800 888 236 or visit directline.org.au for information and support to access treatment.

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