Other Medical Issues...
Liver Damage (Hepatoxicity):
the most common (although still rare) lasting serious injury associated
with 'ecstasy' use
is liver damage. Some patients spontaneously recover, but in severe
cases transplants are needed if the patient is to be saved. Even
aggressive medical care, not all victims survive. As usual, where
the story gets interesting is not simply that some people suffer
damage, but how that damage can occur.
liver cells to MDMA, even at levels that would represent a fatal overdose
in humans, do not show significant toxicity. However,
suspecting that temperature might be a major factor, scientists decided
to try to simulate heatstroke by heating the liver cells. The liver
cells that were heated began to suffer damage even without MDMA; the
liver cells that were both heated and exposed to high concentrations
of MDMA suffered even greater damage.  In the
words of the researchers, "By itself, hyperthermia was an important
cause of cell toxicity. MDMA [had] a negligible effect on lipid peroxidation
and cell viability at [37C]."
Going beyond cell cultures,
Carvalho et al later performed MDMA liver toxicity experiments on
rats, which confirmed that overheating was a critical factor in liver
Sometimes the same
bad penny keeps popping up. Severe overheating is key to most MDMA
related deaths. It's key to neurotoxicity. And it's even the key
to liver damage. (Mixing large amounts of alcohol with MDMA will
also increase the strain on the liver, perhaps dangerously so.) It's
note that at the extreme high end of hyperthermia even small differences
can have a large impact on injury and death.
In many cases of MDMA-related
liver damage, the principle cause of liver injury appears to be due
to the liver being overloaded with waste products from muscles that
are breaking down (rhabdomyolysis) due to severe heatstroke.
syndrome is a grouping of physical and neurological symptoms associated
with overactivation of serotonin receptors. Symptoms include confusion,
altered blood pressure/muscle tone, and hyperthermia. It's usually
the result of combinations of serotonergic drugs (such as mixing MAOIs
and SSRIs) but can also be produced by overdoses of single serotonergic
drugs. Severe cases of serotonin syndrome can be fatal. To some extent,
the MDMA high represents a form of serotonin syndrome. (Current
on serotonin syndrome.)
Kidney (renal) failure:
Kidney failure is seen
with some frequency in MDMA-related heatstroke victims. Assuming the
victim lives, full spontaneous recovery is the usual outcome, although
in at least one case long-term dialysis was required.
MDMA does not show significant toxicity to renal tissue.
Damage appears to be linked to strain placed on the kidneys from rhabdomyolysis
(muscle breakdown) during heatstroke.
Cardiotoxicity (heart damage):
Part of the possibility
that MDMA heart damage could occur is based on mouse research which
of MDMA while exposed to loud noise had more structurally abnormal
mitochondria after the treatment than mice who were not.  Cardiac
tissue damage itself (myocytolysis) was not seen at any dose, even
in the mice who received 120 mg/kg MDMA. It seems a
bit of a stretch to interpret this research as a sign of significant
danger to humans. In broad terms, muscle breakdown (including the
occur under severe heatstroke conditions, making heart failure a
possible aspect of multiple organ failure heatstroke cases.
Other researchers have
found evidence of damage to rat's hearts from repeated
'binges' of MDMA (up to 9 mg/kg injected daily for four days strait.) As
a rule, prolonged exposure to powerful stimulants is harmful to the
cardiovascular system and should be avoided.
More recently, MDMA has been
found to activate 5-HT2b (serotonin) receptors in heart tissue; a
phenomenon associated with abnormal growth/development of heart valve
in users of drugs like fenfluramine. Fenfluramine
has an even greater affinity for these receptors than MDMA, yet problems
prescription fenfluramine users have been rare (in spite of daily
use for prolonged periods.) Given this, the risk of developing similar
heart valve problems seems low for 'ecstasy' users, but may pose
a legitimate concern for quite heavy users.
Mitral Valve Prolapse:
MVP is a usually minor and
very common abnormality in a heart valve. By some accounts, as many
as 15% of young women have it. There are no known deaths from people
with MVP using MDMA, but such deaths could be overlooked. Doctors
actually often tell people with MVP to get exercise as part of their
treatment (and don't even advise against competitive sports like basketball/football
for mild cases) which, coupled with the rarity of 'unexplained' MDMA-related
deaths, makes me believe the risk is low. (Question asked on Dancesafe.)
Strange Things I Have Heard:
Priapism (a painful
erection lasting for hours, even days) was reported in a single man
who had used 'ecstasy' a month before. A very unlikely connection.
One group of authors have
suggested that the use of MDMA could cause a sort of rash/pimples.
They base their theory on two cases, one of which showed signs of
liver damage. The authors suggest that the peculiar facial rash may
have been a side-effect of impaired liver function caused by MDMA
hepatoxicity. The connection is speculative but not unreasonable.
However, due to how common various rashes/acne is (especially in people
engaging in high levels of activity/sweating), it seems alarmist to
suggest that the symptom has a significant diagnostic value. (So if
you get a rash, that's not really a reason to panic.)
Speculation into the unknown:
It has been suggested
that, as a relatively new drug, there may be some horrible long-term
problem caused by it that we just haven't found yet. I believe this
is unlikely. Although the general public has become most aware of
'ecstasy' in the past few years, this drug has been in somewhat widespread
use for several decades. If tens of thousands of users for 15-20 years
isn't a large enough population to have found problems from, nothing
Although MDMA feels relatively
unique, its actual metabolism and effects on the brain/body are unremarkable.
The cardiovascular response, stress reaction, metabolic pathways,
etc. are well studied and have shown no surprises. The methoxyphenethylamine
group of drugs has been around for a long time, with some examples
such as mescaline having seen widespread use for literally thousands
of years with no detectable negative impact. Likewise, amphetamine
type drugs have been in extremely widespread use and abuse for much
of this century; Germany and Japan virtually drowned themselves under
amphetamine and methamphetamine during and after WW2. I simply can
see no novel pharmacology or mechanism that might yield a nasty surprise
down the road. Of course, I may be horribly wrong and we're all going
to grow extra arms out of our assholes in a few more years...but I
doubt it. I remain entirely comfortable with the idea of using this
drug myself, recognizing that the risks are real but small, fairly
well known and avoidable.
 Beitia G, Cobreros
A, Sainz L, Cenarruzabeitia E "MDMA (ecstasy)-induced hepatoxicity;
effect on cytosolic calcium signals in isolated hepatocytes",
Liver 1999; 19(3):234-41. Abstract.
 Carvalho M, Carvalho
F, and Bastos ML "Is hyperthermia the triggering factor for the
hepatoxicity induced by 3,4-methylenedioxymethamphetamine (ecstasy)?
An in vitro study using freshly isolated mouse hepatocytes",
Arch Toxicol 2001; 74:789-93. Abstract.
 Carvalho M, Carvalho
F, Remiao F, de Lourdes Pereira M, Pires-Das-Neves R, de Lourdes Bastos
M "Effect of 3,4-methylenedioxymethamphetamine ('ecstasy') on
body temperature and liver antioxidant status in mice: influence of
ambient temperature", Arch Toxicol 2002; 76(3):166-172.
 Woodrow G, Harnden
P, Turney JH "Acute renal failure due to accelerated hypertension
following ingestion of 3,4-methylenedioxymethamphetamine ('ecstasy')",
Nephrol Dial Transplant 1995; 10(3):399-400. Abstract.
 Carvalho M, Hawksworth
G, Milhazes N, Borges F, Monks TJ, Fernandes E, Carvalho F, Bastos
ML "Role of metabolites in MDMA (ecstasy)-induced nephrotoxicity:
an in vitro study using rat and human renal proximal tubular cells",
Arch Toxicology 2002; 76(10):581-8. Abstract.
 Cunningham M. "Ecstasy-induced
rhabdomyolysis and its role in the development of acute renal failure",
Intensive Crit Care Nursing 1997; 13(4):216-23. Abstract.
 Gesi M, Lenzi P,
Soldani P, Ferrucci M, Giusiani A, Fornai F, Paparelli A "Morphological
effects in the mouse myocardium after methylenedioxymethamphetamine
administration combined with loud noise exposure" Anat Rec
2002; 267(1):37-46. Abstract.
 Dublin NN, Razack
AH "Priapism: Ecstacy Related?", Urology 2000;
 Wollina U, Kammler
HJ, Hesselbarth N, Mock B, Bosseckert H "Ecstasy pimples - a
new facial dermatosis" Dermatology, 1998; 197(2):171-3.
 Badon LA, Hicks
A, Lord K, Ogden BA, Meleg-Smith S, Varner KJ "Changes in Cardiovascular
Responsiveness and Cardiotoxicity Elicited during Binge Administration
of Ecstasy" J Pharmacol Exp Ther, 2002; 302(3):898-907.
 Setola V, Hufeisen
SJ, Grande-Allen KJ, Vesely I, Glennon RA, Blough B, Rothman RB,
Roth BL (2003) 3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy")
Induces Fenfluramine-Like Proliferative Actions on Human Cardiac
Valvular Interstitial Cells in Vitro" Mol Pharmacol. 2003;63,