Emergency

Overdose signs

• Overheating / very high body temperature — heavy sweating, then hot dry skin (the leading cause of MDMA deaths, worse when dancing in hot venues)
• Muscle rigidity, jaw clenching, tremor, or twitching (possible serotonin syndrome)
• Fast, pounding heartbeat; chest pain
• Agitation, confusion; seizures
• Hyponatremia (water intoxication) — headache, confusion, drowsiness, vomiting, and seizures from drinking too much water
• Nausea/vomiting; collapse or unconsciousness

First response

• Move them somewhere cool and help them cool down — overheating is the main danger
• Sip water to stay hydrated but DO NOT overdrink — roughly a cup (250 ml) per hour if active; too much water can be deadly (hyponatremia)
• Get them to rest and stop dancing
• For overheating, seizures, chest pain, muscle rigidity/tremor, confusion, or unresponsiveness, call emergency services
• Recovery position if drowsy or vomiting; stay with them
• Be ready to give rescue breaths / CPR

For the medical team

Tell the dispatcher: MDMA / entactogen suspected, what was taken, how much, when, and key signs (body temperature, seizures, how much water they've drunk). Two specific dangers beyond a normal stimulant: overheating / serotonin syndrome (far worse if mixed with antidepressants, MAOIs, or other stimulants) and hyponatremia from drinking too much water. PMA/PMMA are especially dangerous — slow onset tempts re-dosing, then causes severe hyperthermia.

Resolution

Most resolve with cooling, rest, sensible hydration, and time. The life-threatening dangers are hyperthermia, serotonin syndrome, and hyponatremia (too much water) — each a medical emergency, not something to wait out.

Every recorded risk