Can This Drug Prevent Ecstasy-Related Medical Emergencies at Festivals?
Publisher's note: This article originally appeared under the headline "Can This Drug Cure MDMA Overdoses?" but was corrected by the editorial team at Everfest. We recognized the regrettable mistake and apologize for perpetuating dangerous and misleading sensationalizing. For more, our friends at Dancesafe.org and THUMP have written about why this is a problem in the media.
Last winter, a small flurry of stories made the rounds across several electronic dance music websites heralding a drug called Dantrolene as the new saving grace of drug-related emergency response. According to Dance Music NW , the drug was found to be useful in possible life threatening MDMA (aka Ecstasy or Molly) related overheating, and is set to be made available at huge mainstay events such as Electric Daisy Carnival (EDC) in Las Vegas next month.
When it comes to updates around safety and security, fans and medical teams alike want to be assured that everyone’s well-being is top among newly announced initiatives around drug use. We’ve come a long way from Electric Zoo’s 2014 mandatory anti-drug PSA that reinforced counterproductive and harmful stereotypes, but when news is reported that appears too good to be true – as may be the case around a so-called MDMA overdose cure – it’s important to be aware of the facts and realistic possibilities in the face of all the hype.
Dantrolene is a drug that’s been used since the early 1990s to treat people for a very specific genetic disorder that sometimes arises as a side effect from procedures involving anesthesia. Insomniac, the company behind EDC and other massive festivals around the country, reportedly conducted an “observational trial” of eight people they treated with the drug at last year’s event, proclaiming incredibly positive results. Pete Carlo, an emergency room assistant who works on the medical team at festivals in California, New York, and Nevada, claims extensive experience working with the drug and wanted to set the record straight when he spoke to Everfest. “It’s not the cure for this, it’s treating a certain condition of hyperthermia, that’s all it’s treating.”
Carlo explained how in his experience treating people suffering from extreme overheating, referred to medically as hyperthermia, traditionally the most effective methods of cooling people down, like seating them in a shaded area or immersing them in an ice bath, is more complicated when the patient has taken drugs that affect the body’s ability to regulate its temperature.
“Our first patient we treated with Dantrolene had a core body temperature well over 100 degrees,” said Carlo. “We put him in the ice bath for fifteen minutes and his core body temperature had dropped eight degrees.” Carlo admitted that the patient was also being treated with other medicines that could lower body temperature, and was sent directly to the hospital from the festival’s medical tent, but he and his colleagues were optimistic about what they saw.
Pumping the Brakes
Some of the initial stories made corrections explaining the difference between an approved observational trial and the less scientific approach taken in treating patients with whatever the medical experts think might work in the moment. Although no controlled clinical trials have been conducted on the use of Dantrolene for treating MDMA related hyperthermia, there are at least two dozen cases that, while potentially biased for only reporting positive outcomes, suggest its usefulness in very extreme cases.
But Lewis Nelson, a medical toxicologist and emergency medicine physician, has a much more cautioned tone about the promise of Dantrolene as a hyperthermia cure. “If you have MDMA related hyperthermia, the easiest way to treat that person is to turn off the brain since that’s what’s causing the body to overheat, by forcing the muscles to become rigid. When you turn off the brain, with say a benzodiazepine such as Valium, it’s going to take an hour or two for a patient to cool down completely, so things like ice baths are going to help, but ultimately the difference is in what’s causing the hyperthermia in these kinds of situations, which Dantrolene doesn’t counteract.”
Recognizing the complicated differences between what measures are appropriate in a hospital, Nelson is receptive to more research, but for now he’s unconvinced. “Technically, if I give anyone Dantrolene, it will loosen them up and relax them, but that doesn’t make it the right medicine to use,” says Nelson, then adding, “It’s very expensive, and using it can be complicated to administer. It’s not necessarily going to be harmful, but there are more effective treatments that have much more evidence in the research literature.”
Festival emergency response is highly unpredictable, especially in an environment where a lot of drugs of questionable purity are being taken by inexperienced people. To add insult to injury, strict anti-drug laws dictate what type of services can be offered. For example, drug checking kits, which detect whether a batch of molly has a cocktail of more dangerous drugs than MDMA added to it, cannot be used by official festival organizers since the events are legally declared to adopt strict zero-tolerance policies around illegal drug use.
But Stefanie Jones at the Drug Policy Alliance – whose efforts to reform problematic drug laws in order to improve harm reduction at festival and nightlife events – in the meantime has created a safer partying checklist. These include clueing in a sober (or moderating) friend about any drugs being taken, keeping a lookout for anyone needing help, and being mindful of purity issues by testing small amounts.
“People should be aware that there are currently some very high-dose pills on the market,” said Jones. “This makes the basic harm reduction advice of ‘start low, go slow’ even more crucial – reagent drug checking will not tell you whether or not you have a high-dose pill. Taking a smaller-than-usual amount and waiting to see its effects is an important way to reduce risk for people who choose to use MDMA.”
Jones agreed that while the science may not directly speak to Dantrolene’s use treating drug-induced hyperthermia, if an organization like Insomniac can afford to equip their staff with multiple options for treating patients, “I’m all for it,” Jones proclaimed emphatically. She continued, “I’m a big fan of trying whatever you can try. If you have someone on the edge of dying and they’re treated with something that doesn’t cause harm, and gives better results than expected, from a harm reduction perspective it’s important to let people know about this.”