You may have heard of deaths involving MDMA as ‘overdoses’, however, overdoses are actually very rare and most MDMA-related deaths are not usually the outcome of taking too much but simply from having consumed MDMA itself.

The drug use experience and potential negative effects can be caused by a number of factors including:

• the strength (purity) of the MDMA taken; and/or
• other unknown substances used to make the drug; and/or
• the environment the drug is taken in; and/or
• individual factors relating to the person using the drug.  

MDMA can contribute to causing dangerously high body temperatures (heat stroke/hyperthermia), brain swelling (from water intoxication and low salt levels [hyponatremia]), and seizures (from serotonin toxicity). These conditions can cause death unless recognised and treated early.

The potential of harm occurring after using MDMA is increased at music events, festivals and nightclubs because of the high temperatures, dancing for long periods of time (physical activity), close crowds and difficulty accessing water.

What else is in mixed in with MDMA? And what tests can I use?

Though most pills, powders, and crystal sold as MDMA do contain MDMA, not everything sold as MDMA does. Many forms of available testing can’t tell you how much MDMA is in your pills and cannot always detect the presence of other drugs. Re-agent tests are limited, although they can tell you if your drug simply does not contain MDMA. Also, be aware that people respond to drugs differently, so just because a friend was alright on a particular drug it is no guarantee that you will be.

Adulterants and contaminants have been reported in all forms of MDMA (pills, powder and crystal); no form can be guaranteed as ‘pure’. Also remember, purer MDMA does not mean safer MDMA.

Choosing not to use drugs is always the safest option, but if you and/or your friends do choose to use MDMA, you should educate yourself about the risks; great work by starting with this page. Here are some other things you should know:

1. Know about the drug you are planning on taking. Do some research, talk to friends who have used MDMA, find out the basics like how it might make you feel, dose, how long it takes for the effect to start, how long before it peaks and how long it will be before you feel back to normal.
2. Hydrate safely – stick to 500ml (one small bottle or two cups) of water each hour.³ MDMA can cause your body to retain water, causing salt imbalances which leads to harmful effects such as your cells swelling and seizures (hyponatremia).¹
3. Chill out and take a break, especially if you’re feeling hot,⁵ it will help to cool you down. MDMA alters your bodies ability to regulate its temperature, increasing your risk of serious heat stroke (hyperthermia), especially in hot environments and when you have been dancing.⁶
4. Try a small amount and wait to feel the effects. Everyone should take a test-dose. Purer MDMA does not mean safer MDMA; it’s the MDMA in MDMA that increases the risk of harm. Some forms of MDMA have been reported to contain three times the amount of what is considered a single dose.^7-9 The time it takes to feel the effects can vary due to a number of factors including how hard pressed your pill is or how full you stomach is. The notable effects of MDMA can last for 4-6 hours so re-dosing too early or taking too much can lead to negative effects or harm rather than increased pleasurable effects. If you don’t get any feeling, don’t take more, the drug you’ve taken probably isn’t MDMA.
5. Have salty snacks or sports drinks.^1,2
6. Know the signs that you need help (see below).³
7. Remember the medics will help you, not call the police*. Even if you don’t think it’s serious, the most important thing is that you get help ASAP.
8. Stick with your mates and make emergency plans;download the festival map, have a meeting point, make sure mobiles are charged, stick together and know where on-site support services are.
9. Do not mix different kinds of drugs, including alcohol.¹⁰ This increases the chance of something going wrong and the effects are unpredictable. Most people who end up seeking emergency medical treatment after taking MDMA have used other drugs including alcohol. 
10. Avoid alcohol. Alcohol will dehydrate you and increase your risk of heat stroke.¹¹ Also don’t drink caffeine, including energy drinks.¹¹
11. Don’t double drop. Besides the fact that you don’t know that there isn’t something else in your drug that isn’t MDMA, or that it even contains MDMA, it’s important to realise that the amount (dose) of MDMA varies even in pills from the same batch and caps could contain even higher doses. High dose MDMA puts you at increased risk of harm and even overdose.⁸ The relationship between MDMA dose and blood concentration is not linear, and small increases in dose may produce larger increases in effect, possibly contributing to toxicity.^3,6

Screenshot this and send it to your friends.

If you feel unwell, tell someone and seek help as soon as possible.

There are many early warning signs. You don’t have to have all of these signs, only a few could still mean you need to get help ASAP even if you think it’s normal. It’s important to get help early - visit the first aid tent or call 000 -  the best outcome is that there is nothing wrong. Remember the medics are there to help and not call the police* and you won’t be kicked out. Getting checked out by first aiders or emergency medical services if in doubt is the safest thing to do. The following are signs and symptoms of hyponatremia, hyperthermia, or serotonin toxicity – all of which can be caused by MDMA use.

Do you have any of the following signs? ^{2, 3, 12-14}

• Feeling too hot
• Problems controlling the shakes, aches or cramps
• Unusual amount of sweating
• Rapid breathing
• Nausea or vomiting
• Diarrhoea
• Headache
• Confusion or agitation 
• Delirium - confused thinking and reduced awareness
• Hallucinations
• Psychosis
• Seizures
• Reduced or loss of consciousness

Watch out for your mates – they might not know what the dangers are.

 Screenshot this and send to your friends or keep it saved on your phone to check later! 

If you’re at a festival or event: go to the nearest First Aid tent.

If you aren’t at a venue with a First Aid tent: call an ambulance on triple zero 000 or go to the nearest Emergency Department.

What you can do - DRSABCD:

Perform DRSABCD only if the person has collapsed or is unresponsive.

Danger: Check for danger to self and others.

Response: Check to see if they respond to touch or sound.

Send: Send for help. Call an ambulance on 000.

Airway: Clear and open the airway.

Breathing: Check for breathing.

• If breathing normally put in the recovery position (on their side)
• Normal breathing is 2-3 breaths per 10 seconds

CPR: If not breathing normally commence CPR and continue until help arrives

• 30 chest compressions to every 2 breaths

Defibrillator: Use defibrillator if available, turn on and follow the prompts.

If the person responds, monitor them and wait with them until medical help arrives.

Get the facts: find out more about MDMA

Learn about the illicit drug harm minimisation campaign, Party Smarter.

*Police will only attend if there has been a death or the medics feel threatened.

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8. Grigg J, Barratt MJ, Lenton S. Double dropping down under: Correlates of simultaneous consumption of two ecstasy pills in a sample of Australian outdoor music festival attendees. Drug and alcohol review. 2018;37(7):851-5.
9. Kalant H. The pharmacology and toxicology of “ecstasy”(MDMA) and related drugs. Cmaj. 2001;165(7):917-28.
10. Fernández-Calderón F, Díaz-Batanero C, Barratt MJ, Palamar JJ. Harm reduction strategies related to dosing and their relation to harms among festival attendees who use multiple drugs. Drug Alcohol Rev. 2019;38(1):57-67.
11. McNamara R, Maginn M, Harkin A. Caffeine induces a profound and persistent tachycardia in response to MDMA (“Ecstasy”) administration. European journal of pharmacology. 2007;555(2):194-8.
12. Li W, Gunja N. Illicit drug overdose: Prevalence and acute management. Australian family physician. 2013;42(7):481.
13. Moritz ML, Kalantar-Zadeh K, Ayus JC. Ecstacy-associated hyponatremia: why are women at risk? Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2013;28(9):2206-9.
14. Silins E, Copeland J, Dillon P. Qualitative Review of Serotonin Syndrome, Ecstasy (MDMA) and the use of Other Serotonergic Substances: Hierarchy of Risk. The Australian and New Zealand journal of psychiatry. 2007;41:649-55.

MDMA | The Facts