A study published this week in the British Medical Journal found that 81 people died from using MDMA (ecstasy) in Britain between 1997 and 2000. But nearly two-thirds (62%) of those deaths also involved other drugs, usually opiates, and only 7% were attributed to ecstasy poisoning (overdose) alone. A little less than one-third (31%) of the deaths were attributed to "other causes," such as heat stroke or heart attack.
The research, conducted by Dr. Fabrizio Schifano and colleagues at St. George's Hospital Medical School in London reviewed national records on substance abuse deaths. Many of those who died ecstasy-related deaths were "known to health services as drug addicts, and died at home," the researchers noted.
According to the British drug policy research group Drugscope (http://www.drugscope.org.uk), half a million people take ecstasy every weekend in Britain. Extrapolating from those figures, Brits gobbled down approximately 100 million ecstasy tablets during the period examined by Schifano and his colleagues. With only 31 deaths attributable to ecstasy overdose, high body temperature, water intoxication, or heart attack, it appears that the odds of dying after ingesting ecstasy alone were a little less than one in three million.
Published responses to the report suggested a significant role for opiates and possibly alcohol in many deaths included in Schifano's data. Neil Hunt, lecturer in Addictive Behavior at the University of Kent, wrote: "From the data presented, it is hard to see how the detection of ecstasy in many opiate-associated deaths enables the conclusion that ecstasy had 'at least a facilitating role in causing death,' when opiates themselves could provide a sufficient explanation for the 59% of the sample who had used them. Is there unpublished data on the mechanism by which ecstasy operated as a potentiator of other drugs in these cases? This may be an unwarranted leap from association to causation. In fact, we cannot rule out the possibility that the use of a stimulant may even confer some protective effect for some people who have overdosed on depressants. This seems unlikely to me, but interactions within combinations of street drugs remain poorly understood. It is also regrettable that data on alcohol consumption was either unavailable or omitted. It seems highly unlikely that none of the 81 cases had consumed alcohol."
A second respondent, Alexander RW Forrest, Professor of Forensic Toxicology, at the University of Sheffield, had some information on that score. He reported that of 45 ecstasy-related deaths he investigated during the same time period, 60% had "significant concentrations of ethanol in either their blood or their urine" and 36% had opiates in their systems.
Visit http://www.bmj.com/cgi/content/full/326/7380/80 to read the report and responses in the British Medical Journal.