Drinking too much water after taking ecstasy can be lethal, a study has confirmed.
The researchers have identified the substance that they believe can lead to deadly "water intoxication" in people who have taken the drug.
Ecstasy-related deaths are rare, but in a few highly publicized cases, clubbers have died after taking small doses of the drug. Heatstroke has been blamed for most of these deaths. But in other cases, doctors suspect a rather different cause of death.
One such case is that of Leah Betts, the British teenager who fell into a coma and died after taking one ecstasy tablet in 1995. Her brain had swelled with water, diluting the salt vital for nerve and brain cell function.
After people have taken ecstasy, their blood contains unusually high concentrations of vasopressin. As levels of this hormone increase, the body retains more water.
The researchers exposed lab cultures of rat neurons from the hypothalamus to ecstasy and a breakdown product called 4-hydroxy-3-methoxymethamphetamine (HMMA).
When people take ecstasy their bodies break down the drug into HMMA. The release of vasopressin that follows boosts water retention and so dilutes the sodium and other salts in the blood. This can damage brain and nerve tissue, which is especially sensitive to abnormal levels of sodium in cells.
"It's basically water intoxication," says Mary Forsling of the Center for Neuroscience at King's College, who presented the results this week at the Society for Endocrinology's annual meeting in London.
Forsling believes the risk of this happening probably depends on the speed at which individuals break down ecstasy's principal ingredient, called MDMA (3,4-methylenedioxymethamphetamine), into HMMA. "It's good to be a poor metabolizer," Forsling says, but only 10 per cent of the population are protected in this way.
The conclusion unmasks another risk factor for ecstasy users, says Forsling. Women of reproductive age are already known to be most at risk of salt starvation. High levels of estrogen midway between periods are thought to make the nervous system particularly vulnerable to damage from salt starvation. So far, however, this is not reflected in the numbers of water intoxication cases, which show a roughly even split between men and women. The team notes, too, that only one or two of the dozen or so ecstasy-related deaths that occur in Britain each year are put down to "water intoxication."
"My advice is not to take ecstasy," says Forsling. "But if people do, they should rehydrate themselves, but be sensible in the amount they drink," she says. Another possibility is to top up sodium levels by adding salt to bottled water.
Drug abuse expert John Henry, one of Forsling's co-researchers at St Mary's Hospital, London, says that the findings show that the dangers posed by ecstasy can vary, depending on people's genetic makeup. "It means that some people metabolize more of the drug, so the risk varies between individuals," he says.
This article is excerpted from New Scientist, a weekly science and technology magazine based in London. Visit http://www.newscientist.com
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