Posted: 22 May 2017

MDMA and the emergency room – what GDS2017 can tell you about how to avoid it!

Some drug related harm is predictable – and following some simple rules can make a huge amount of difference to that risk. 


Dr Adam R Winstock

Founder and Managing Director Global Drug Survey

Consultant Psychiatrist and Addiction Medicine Specialist


Of the roughly 25,000 MDMA users from around the world who took part in GDS2017, 1.2% sought emergency medical treatment (EMT) in the previous 12 months. Now you could argue that out of 25,000 people who use on averaged 9 times in the last year that is not a huge figure, working out at 1 episode of emergency treatment seeking for every 1000 episodes of use. And I do agree that for most people on most occasions, MDMA is not a hugely risky drug accepting of course that over 50 people per year have died from MDMA in the UK for last 3 years).  While the determinants of MDMA risk are many it pretty much come down to the interaction between the person, the amount and types of drugs they take and what they do when they use.  Among the most important things are dose, overheating and under and over watering.


The finding from GDS2017 highlight that risks vary widely across cultures, reflected by the marked variation of in the rates of MDMA users in our study seeking EMT in the last year. The highest rates were seen in Denmark (2.5%) and lowest rates in Italy (0.3%). Of interest was the relatively high rate in The Netherlands (1.7%) and the falling rate in the UK (0.8% down from 1.2% last year).  The downward trend in the UK is good news and though it might reflect changes in sampling or how people decide if they need to seek EMT, I like to think it might be down to people in the UK starting to use more safely and sensibly. For the last 2 years GDS, Mixmag, The Loop and lots of other groups have been pushing safer use of MDMA with a focus on how to manage higher dose pills and high purity MDMA. While lots of the advice is old school common sense, people sometimes doubt is validity. Some of the findings from GDS2017 give support to some of these key messages and that what you do or don’t do on the night makes a difference.


This year 60% of MDMA users in our study from around the world reported taking a test dose from new batches of pills or powders in line with our campaign ‘don’t be daft start with a half’.  Lots of others stayed well hydrated and avoided too much booze. The time between first and second doses was on average 75 minutes – not long enough for most people to peak and avoid peak level problems. GDS suggest you wait 2-3 hours to avoid getting too intoxicated, especially after your first dose. But overall, most people, most of the time seem to have had a good time without major issues. But not everyone.


So who were the 1.2% who ended up seeking EMT and what had they done that day? Over half had used pills (55%), 30% had used powder and 15% both. Women tended to seek treatment 2-3 times more frequently than men.  Only one in 5 took a test dose that day, over half were already drunk before they took their first dose of MDMA, 40% took more than usual and over 40% reported feeling unwell either physically or psychological unwell before they started using that night.  Only 7% reported not using any other drug or alcohol.


All of this gives really gives support to 3 main things that we can make a real difference – these things are free, easy and entirely under your control.

  • Test dose from new batch (start of using a small amount of a new powder or a ¼ or a half of new pill) and wait at least 2 hours before redosing – 3 is even better.
  • Don’t get drunk before you start dosing (or afterward for that matter)
  • If you don’t feel well – don’t take anything, save it for another day