Hard Boiled: Alcohol Use as a Risk Factor for MDMA-Induced Hyperthermia: a Systematic Review

Abstract

Although MDMA (ecstasy) is a relatively safe recreational drug and is currently considered for therapeutic use for the treatment of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), recreational MDMA use occasionally elicits hyperthermia and hyponatremia, sometimes with a fatal outcome. Specific risk factors for both adverse effects are profuse sweating while vigorously dancing under unfavorable conditions such as high ambient temperatures and insufficient fluid suppletion which result in dehydration. Concomitant use of MDMA and alcohol is highly prevalent, but adds to the existing risk, because alcohol facilitates the emergence of MDMA-induced adverse events, like hyperthermia, dehydration, and hyponatremia. Because of potential health-related consequences of concomitant use of MDMA and alcohol, it is important to identify the mechanisms of the interactions between alcohol and MDMA. This review summarizes the main drivers of MDMA-induced hyperthermia, dehydration, and hyponatremia and the role of concomitant alcohol use. It is shown that alcohol use has a profound negative impact by its interaction with most of these drivers, including poikilothermia, exposure to high ambient temperatures, heavy exercise (vigorous dancing), vasoconstriction, dehydration, and delayed initiation of sweating and diuresis. It is concluded that recreational and clinical MDMA-users should refrain from concomitant drinking of alcoholic beverages to reduce the risk for adverse health incidents when using MDMA.

Trends in Mortality From Novel Psychoactive Substances as “Legal Highs”: Gender Differences in Manner of Death and Implications for Risk Differences for Women

“…Clearly, polydrug use features in all these cases as such cases (with methadone and benzodiazepines) were selected for analysis, however the amount of drugs found implicated or at post mortem indicates, at best, recklessness among chronic drug users and naivety among those that could be described as “recreational” users. While there is a difference between implicated drugs (those causative of death) and those found at post mortem, the presence of multiple interactive and cumulative substances is commonly reported in polydrug deaths ( 17 , 18 ). There are also no implied differences between these female deaths and male NPS-related deaths.…”

Identifying Risk Factors for Hospitalization with Behavioral Health Disorders and Concurrent Temperature-Related Illness in New York State

“…Alcohol and drugs are known to impair mental state [ 35 ], behavioral responses, and can increase the risk of cold exposure [ 35 ]. Several substances, including alcohol, cocaine, and other stimulants have been found to affect thermoregulation [ 38 , 39 ].…”

A rapid scoping review of self-initiated harm reduction strategies for ecstasy (MDMA) users in recreational settings

“…Ecstasy is often taken in settings such as night clubs and raves where an individual may engage in prolonged and vigorous dancing, often coupled with high temperatures, while drinking very little water (ACMD, 2008). As a consequence, hyperpyrexia (hyperthermia; heatstroke) are frequently reported adverse drug reactions (ADRs) (MAPS, 2021;van Amsterdam et al, 2021). Another ADR that is frequently reported is water intoxication with secondary low sodium levels, referred to as hyponatremia (MAPS, 2021;van Amsterdam et al, 2021).…”

“…As a consequence, hyperpyrexia (hyperthermia; heatstroke) are frequently reported adverse drug reactions (ADRs) (MAPS, 2021;van Amsterdam et al, 2021). Another ADR that is frequently reported is water intoxication with secondary low sodium levels, referred to as hyponatremia (MAPS, 2021;van Amsterdam et al, 2021). The concurrent use of MDMA and alcohol may increase the risk of hyperthermia and hyponatremia (van Amsterdam et al, 2021).…”

“…Another ADR that is frequently reported is water intoxication with secondary low sodium levels, referred to as hyponatremia (MAPS, 2021;van Amsterdam et al, 2021). The concurrent use of MDMA and alcohol may increase the risk of hyperthermia and hyponatremia (van Amsterdam et al, 2021). Other ADRs as described in published case reports range from milder problems, such as restlessness, insomnia, bruxism/muscular clenching, nausea and dry mouth, to serious health issues including psychiatric problems, hepatotoxicity secondary to hyperthermia, cardiac and/or respiratory disorders, acute renal failure, aplastic anaemia, allergic reactions and anaphylaxis, eye and skin conditions (MAPS, 2021).…”