Media Coverage of "Ecstasy Overdoses" is Dishonest and Dangerous
The week following New Year's Eve has been sadly, but predictably filled with reports of drug-related hospitalizations and deaths. Much of the coverage of these incidents has been full of inaccuracies and misinformation - and dishonest or inaccurate reporting on this topic perpetuates misconceptions that can have deadly consequences.
It's important to start this discussion with some definitions. According to the US National Institute of Health's website MedlinePlus: "An overdose is when you take more than the normal or recommended amount of something, usually a drug. An overdose may result in serious, harmful symptoms or death."
"Ecstasy" is the most widely used street name for MDMA. MDMA is the abbreviation of 3,4-methylenedioxy-methamphetamine. Being a slang term for an illegal drug, there is no official medical definition for "ecstasy," and there are plenty of cases of substances other than MDMA being sold as "ecstasy." However, given the prevalent understanding that "ecstasy" refers to MDMA, it's appropriate to define it as such.
So an "ecstasy overdose" death would be a death that resulted directly from the consumption of an excessive quantity of MDMA, regardless of other factors. A brief survey of the medical literature on the matter indicates that these sorts of deaths are incredibly rare - despite what frequent media headlines might suggest.
The common use of "overdose" to describe drug-related deaths comes from the history of deaths resulting from actual overdoses of heroin and other opiate drugs. A majority of heroin-related deaths are true overdoses - an excessive quantity of the drug is introduced into the users body and directly causes fatal suppression of the respiratory system, severe drop in blood pressure leading to cardiac arrest, or other physiological conditions resulting in death.
By contrast, the vast majority of MDMA-related deaths are the result of heatstroke, which under normal circumstances is not an effect of even large doses of MDMA. Taking MDMA does cause a slight increase in body temperature, and a reduction in the body's normal ability to regulate temperature. When combined with long periods of intense physical activity (like dancing) in a very hot environment (like a 100°F+ dance floor at a music festival) and dehydration, these factors can become deadly.
It's crucial to note that normal recreational doses of MDMA will cause this danger under these conditions. When media outlets describe deaths involving heatstroke and MDMA as "ecstasy overdoses," they are creating the false sense that users who take normal doses are not in danger. When users see headlines about "overdose" deaths, they may assume that as long as they don't take too much, they are avoiding these risks - which is absolutely not true.
The primary dangers associated with MDMA use at concerts or festivals - excessive heat and insufficient water - are easily avoided if users are educated, and event organizers implement simple harm-reduction measures like abundant free water and cooler temperatures in dance spaces. It's also important to realize that heatstroke commonly causes harm among attendees at music events who haven't taken any drugs, or who've only consumed alcohol. So these measures would protect every attendee, regardless of drug use.
[A reader brought it to our attention that we should note excessive consumption of water can also be a problem for those on MDMA. Consuming too much water, in conjunction with the water-retention that MDMA causes can lead to hyponatremia, a potentially dangerous sodium deficiency in the bloodstream. Drinking a moderate amount of water every hour should ensure hydration, without risking hyponatremia. Electrolyte-rich sports drinks like Gatorade can be a better option, because they provide ample hydration while also providing enough sodium to maintain safe levels.]
Calling MDMA-related deaths "overdoses" also distracts from some of the other risk factors that come with normal (or even small) doses of MDMA for certain people - specifically for people who have preexisting heart problems, and those who are taking certain prescription medications which have dangerous interactions with MDMA.
The slight increase in blood pressure and heart rate that MDMA causes are typically not dangerous for healthy people, but in individuals with high blood-pressure, enlarged hearts, arrhythmia, or a number of other heart conditions, these normal side effects can be very dangerous. MDMA affects the body's regulation of the neurotransmitter serotonin in such a way that is not typically dangerous for most people. However, for individuals that are on prescription MAOI (Monoamine Oxidase Inhibiting) drugs, the interaction of the MDMA and the MAOI can cause a dangerous, potentially deadly excessive buildup of serotonin in the body, referred to as serotonin syndrome. In both of these cases, a normal dose of MDMA that would pose little danger to most people, could be fatal.
Of course there is another factor that contributes to "ecstasy" deaths - the myriad other drugs that are sold as "ecstasy," many of which are much more dangerous than MDMA. When media outlets report deaths and injuries resulting from drugs other than MDMA, and refer to them as "ecstasy overdoses," they are parroting the dangerous lies of manufacturers and dealers, and perpetuating more dangerous misinformation. Because again, users hear the term "overdose" and assume that as long as they take a reasonable amount, they are avoiding danger. But many of the other drugs sold as "ecstasy" can be deadly at doses that MDMA would be relatively harmless at.
The proliferation of these dangerous compounds is the direct result of prohibition, as production is pushed into unregulated black markets, and drug manufacturers constantly invent new compounds to circumvent laws prohibiting known drugs such as MDMA. The simplest solution to this danger would be to encourage users to test their drugs before ingesting, to ensure they are not taking something far more dangerous than they expected. But sadly, disastrous legislation such as The RAVE Act has instead made drug testing less accessible by threatening event organizers with harsh penalties for any harm reduction measures that could be construed as encouraging or facilitating use.
While there are countless social, political, and economic factors needed to end the incredible harm caused by the War on Drugs, the media plays an essential role. Taking a drug like MDMA can never be totally safe, but accurate knowledge of the real dangers, and of measures to minimize these dangers, can prevent a huge percentage of tragic outcomes. It is long past time media outlets take greater responsibility for reporting accurately and honestly on drug related harm - instead of exploiting tragedies for the sake of sensational headlines.
If you want to help fight to make life saving education and harm reduction more accessible at music events, sign the petition to amend The RAVE ACT: