MDMA Dosage Guide

## Recognizing an MDMA Emergency MDMA overdose is a medical emergency that kills through hyperthermia, hyponatremia, serotonin syndrome, or cardiovascular collapse -- sometimes in combination. Recognizing the signs early and acting immediately can be the difference between life and death. **Warning signs that demand immediate action:** - **Extreme body temperature** -- skin that is burning hot to touch, or paradoxically, the person has stopped sweating despite being overheated (this is a critical danger sign indicating thermoregulatory failure) - **Confusion or delirium** beyond what is expected from MDMA -- the person seems disconnected from reality, cannot respond to simple questions - **Seizures** -- any seizure activity requires emergency medical care - **Rapid or irregular heartbeat** -- pounding, racing, or visibly irregular pulse - **Severe muscle rigidity or spasms** -- body becoming stiff, especially combined with high temperature - **Loss of consciousness** -- person cannot be roused - **Dark-colored urine** -- indicates rhabdomyolysis (muscle breakdown), a sign of severe overheating - **Serotonin syndrome signs**: agitation, muscle twitching (myoclonus), hyperreflexia, diarrhea, high fever, dilated pupils ## What to Do -- Step by Step **1. Call emergency services immediately.** Do not wait to see if the person improves. Call 911 (US), 999 (UK), 112 (EU), or your local emergency number. Most jurisdictions have Good Samaritan laws that protect callers from drug-related prosecution -- someone's life is more important than legal anxiety. **2. Cool the person down.** Move them to the coolest available environment. Remove excess clothing. Apply cool (not ice-cold) water to the skin, especially the neck, armpits, and groin where major blood vessels run close to the surface. Fan them if possible. Emergency departments use ice water immersion for severe cases, aiming to reduce core temperature to 101F/38.3C within 30-45 minutes. **3. Manage hydration carefully.** If the person is conscious, alert, and not seizing, offer *small* sips of an electrolyte drink. Do not force fluids. If there is any suspicion of hyponatremia (excessive water intake, confusion, seizures), do NOT give more water -- this will make it worse. **4. Recovery position.** If the person is unconscious but breathing, place them in the recovery position (on their side) to prevent aspiration if they vomit. **5. Stay with them.** Do not leave someone in medical distress alone. Monitor their breathing and consciousness until help arrives. ## What NOT to Do - Do not put them in an ice bath without medical supervision -- rapid cooling can cause cardiac arrhythmia - Do not give them more drugs to "counteract" the MDMA - Do not assume they will "sleep it off" -- MDMA complications escalate rapidly - Do not let fear of legal consequences prevent you from calling for help ## Medical Treatment There is no specific antidote for MDMA. Hospital treatment is supportive: aggressive cooling for hyperthermia, benzodiazepines for agitation and seizures, IV fluid management (with extreme caution if hyponatremia is suspected), cyproheptadine for serotonin syndrome, and monitoring for cardiac, hepatic, and renal complications. Rhabdomyolysis is treated with aggressive IV hydration and urine alkalinization.