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Doctor and epidemiologist Esther Croes, project leader of Monitor Drug Incidents, reflects on the medical consequences of ecstasy use in several blogs this summer. Part 1. Death, horrible and unpredictable. Despite the rain this summer, the festival season is in full swing. Thousands of people attend festivals to enjoy music and performances, dance and relax with friends. This is regularly combined with drug use, ecstasy being the favorite. Experience the music more intensely, the idea of deeper friendships, better conversations and deserved relaxation in this demanding world. But the downside of drug use is always looming. First aiders at festivals and emergency departments in hospitals are working overtime because of the raw edges of substance use. Emotional impact. A death from ecstasy has a major emotional impact. To the family, friends, those left behind. To the healthcare providers, police and other professionals involved. Four stories in a nutshell:. It deepened our relationship, we thought. And now I am a widower with a two-year-old son without a mother. The group of friends was not crazy, and thought nothing would happen to them. They prepared, slept in, tested pills, no alcohol or other substances, drank enough water and one person would not use drugs to keep an eye on everyone. They were devastated when one of them died. I can name dozens of examples of people who have died in the Netherlands in recent years due to the use of ecstasy. They were looking for a nice evening, and it ended in death. Young people, often in their teens and twenties. Sometimes after three ecstasy pills, and sometimes after only half. Sometimes mixed with other substances, and sometimes with nothing at all. Sometimes after many hours of dancing, loud music, warmth, and sometimes at the beginning of the party. Sometimes at a busy festival, and sometimes at a house party. Rarely someone with an underlying disease. Rarely overdosed on purpose. Rarely an explanation why this particular person died. In almost all cases just sheer bad luck. An unpredictable, raw effect of ecstasy. Yes, I knew. The paramedics, the emergency department, the doctors at the intensive care, the first aiders at festivals, the prevention officers of addiction care institutions knew it. The police, like no other. And the professionals who are always right, but also always a little late: the toxicologists and pathologists of the Netherlands Forensic Institute. Ecstasy is an unpredictable drug. Its use is never safe. And it will not be if the drug is produced legally. Not even as a medicine. There is always a risk of dying after using ecstasy. A common cause of death from ecstasy use is overheating. Ecstasy disrupts the temperature regulation center in the brain and sets that thermostat too high. The body actively warms up because it thinks it has to. We pull out all the stops to cool the patient. All to buy time when the ecstasy wears off and the thermostat goes back down on its own. The core temperature of the body can rise to 43 degrees Celsius due to the effect of ecstasy. Anyone who has ever boiled an egg knows that it is irreversible. Organs fail one after the other. The patient dies. Sometimes within a day, sometimes after a few days. Almost inescapable. They know each other from back in the day. No student is concerned about the risks of ecstasy use. Those are incorrect. Ecstasy is unprecedentedly pure in the Netherlands. Nevertheless, formerly very healthy young people die, who have adhered to all tips to reduce the risks of use. But what about alcohol mortality? A lot more people die from alcohol, I hear you think. That is true. At the same time, there are also many more users of alcohol. And they also drink alcohol much more often than the average ecstasy user takes an ecstasy pill, over so many more years. Apples with pears, or better: comparing watermelons with blueberries. This kind of beauty contest even seems to lower the threshold for using ecstasy, without increasing the risk perception of alcohol. Dying from alcohol is also reasonably explicable: a deadly traffic accident, for example, while drunk. Or drowning from an alcohol coma. After years of high alcohol consumption, they die from the consequences of a destroyed liver, acute pancreatitis, cancer or a stroke. Clear stories. Death from too much alcohol, too much in one day or too much in life. All fairly predictable. But mortality from ecstasy is unpredictable. Why does one die after half a pill and another notices little after three of those pills? The year-old man who had already taken ecstasy forty times and did nothing else on the 41st time, but died. The ten friends, about the same age, the same health, the same height, the same hydration, ate about the same, and all one pill from the same sachet. One dead, why? Opium law list 1. You could almost forget, but it already is in the Netherlands, and has been for a very long time. It is on list 1 of the Opium Act. The list includes substances with an unacceptable risk to health. That is seriously different from list 2 substances, with cannabis as the best-known example. Not safe substances either, of course: you can become addicted to them and that can turn your whole life upside down loss of relationships, work, financial problems , make you anxious, make you hallucinate, but you will not suddenly die unexpectedly. That unique raw edge of ecstasy makes it an Opium Act List 1 substance. Plea for a rational choice. Am I arguing against ecstasy? I am concerned. Worried about the collective forgetfulness about why this is an Opium Act List 1 drug. Concerned about the fact that some take for granted that a fun party calls for ecstasy. Concerned to hear that a national political party advocates legalization to reduce crime. But the health risks are not much smaller. And the number of users is expected to increase. Concerned when I hear a scientist on YouTube claim that alcohol is really harmful and that ecstasy falls short of that. Concerned that these kinds of signals get in the way of a rational, well-informed decision about whether or not to take ecstasy. Know the facts. Know that anyone who uses ecstasy can die from it. Safe use does not exist. Be aware of the uniquely raw edge of ecstasy. What did you think of this blog? Get in contact with doctor and epidemiologist Esther Croes. This article was originally published in Dutch. You can read the original version here. Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. The raw edges of ecstasy by Kate Sep 27, News 0 comments Doctor and epidemiologist Esther Croes, project leader of Monitor Drug Incidents, reflects on the medical consequences of ecstasy use in several blogs this summer. Death, horrible and unpredictable Despite the rain this summer, the festival season is in full swing. Emotional impact A death from ecstasy has a major emotional impact. Unpredictable I can name dozens of examples of people who have died in the Netherlands in recent years due to the use of ecstasy. Overheating A common cause of death from ecstasy use is overheating. Plea for a rational choice Am I arguing against ecstasy? Submit a Comment Cancel reply Your email address will not be published. Sign up for the ESI newsletter. First name. Last name.