DROWNING IN ECSTASY

Dance drug can lead to a fatal build-up of water in the brain

DRINKING too much water after taking ecstasy really 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 publicised 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). "We found that HMMA is at least
twice as potent at getting the hypothalamic cell to release vasopressin,"
she says.

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
Centre 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
metaboliser," Forsling says, but only 10 per cent of the population are
protected in this way.

The finding 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 oestrogen 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 are split roughly 50:50 between men and women.
The team notes, too, that only one or two of the dozen or so ecstasyrelated
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 make-up. "It means that
some people metabolise more of the drug, so the risk varies between
individuals," he says.