Multiple MDMA (Ecstasy) Overdoses at a Rave Event

Twelve people who took MDMA at a single rave were hospitalized in the San Francisco Bay area with life-threatening complications including seizures and hyperthermia. Eight needed emergency breathing tubes, and six had dangerously low blood pressure. Most had high potassium levels, acute kidney injury, and muscle breakdown. Two died, four survived with permanent neurological, muscle, or kidney damage, and six recovered without lasting harm. Ten had hyperthermia, with seven reaching extreme temperatures between 40.9°C and 43°C. Cooling took an average of 2.7 hours. Drug analysis of two confiscated capsules showed they contained 82% and 98% pure MDMA, with one capsule holding 270 mg—more than twice a typical dose. The MDMA-induced hyperthermia, worsened by large doses, a warm environment, and physical exertion, was a major cause of death and injury.

Study at a glance

Abstract

Twelve patients with 3,4-methylenedioxymethamphetamine (MDMA) toxicity from a single rave event presented to multiple San Francisco Bay area hospitals with various life-threatening complications including seizures and hyperthermia. Eight required emergent endotracheal intubation and six had hypotension. Hyperkalemia, acute kidney injury, and rhabdomyolysis were present in most of the patients. In all, 2 patients died, 4 survived with permanent neurologic, musculoskeletal, and/or renal sequelae, and 6 survived without any apparent lasting deficits. Hyperthermia was present in 10 patients and was severe (40.9-43° C) in 7. Using multiple cooling methods, the average time to achieve cooling was 2.7 hours. Serum drug analysis was performed on 3 patients, demonstrating toxic MDMA concentrations without the presence of other xenobiotics. Two capsules confiscated by police at the event contained 82% and 98% MDMA, respectively, without other pharmacologically active compounds. Capsule #2 contained 270 mg MDMA, which is more than twice the amount of MDMA usually contained in 1 dose. The MDMA-induced hyperthermia significantly contributed to the morbidity and mortality in this case series. Factors contributing to the severity of the hyperthermia include ingestion of large doses of MDMA, a warm ambient environment, and physical exertion.