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"Saturday night fever": ecstasy related problems in a London accident and emergency department
H Williams1, L Dratcu, R Taylor
1UMDS, St Thomas' Hospital, London.
Objectives:
To report on the extent and nature of acute MDMA (ecstasy) related problems presenting to a large London hospital's accident and emergency (A&E) department.
Method:
The computerised attendance records for all patients attending the A&E department over a 15 month period were retrospectively screened. Potential cases thus identified had their case notes systematically reviewed to confirm the history of MDMA use and to extract other relevant data.
Results:
Forty eight consecutive MDMA related cases were identified. All were in the 15-30 year age group with the majority presenting in the early hours at weekends and having consumed the drug at a night club. The mean number of tablets consumed was two and almost 40% had taken MDMA before. Polydrug use was common with half of the sample having concurrently taken another illicit substance--most commonly other stimulants (amphetamines and cocaine). A wide range of adverse clinical features was found. The most common symptoms were vague and non-specific such as feeling strange or unwell, however many patients had collapsed or lost consciousness. The most common signs elicited were related to sympathetic overactivity, agitation/disturbed behaviour, and increased temperature. The more serious complications of delirium, seizures, and profound unconsciousness (coma) were commoner when MDMA was used in combination with other substances.
Conclusions:
For young adults presenting late at night at weekends and exhibiting symptoms of sympathetic overactivity, disturbed behaviour, and increased temperature ("Saturday night fever") the use of stimulant dance drugs especially MDMA should be suspected. As MDMA use does not appear to occur in isolation, the clinical picture is likely to be complicated by multiple rather than single drug ingestion. This poses increased diagnostic and management challenges for A&E staff who typically represent the front line response to dance drug related problems.
Insights
Acute problems related to 3,4-methylenedioxymethamphetamine (MDMA) or ecstasy are common in young adults presenting to emergency departments, often involving polydrug use and complex symptoms. Emergency staff should suspect MDMA use in patients with "Saturday night fever" symptoms.
Area of Science:
- Emergency Medicine
- Toxicology
- Public Health
Background:
- 3,4-methylenedioxymethamphetamine (MDMA), commonly known as ecstasy, is a widely used recreational drug.
- Adverse events associated with MDMA use necessitate emergency medical attention.
Purpose of the Study:
- To investigate the characteristics and frequency of acute MDMA-related emergencies presenting to an urban accident and emergency (A&E) department.
- To understand the clinical features and contributing factors of these presentations.
Main Methods:
- Retrospective screening of A&E attendance records over a 15-month period.
- Systematic review of case notes for confirmed MDMA-related incidents.
- Data extraction on patient demographics, drug use patterns, and clinical presentation.
Main Results:
- Forty-eight MDMA-related cases were identified, predominantly young adults (15-30 years) presenting during weekend nights.
- Polydrug use was frequent, with half the sample using other illicit substances, notably stimulants like amphetamines and cocaine.
- Common symptoms included feeling unwell, collapse, and loss of consciousness, with signs of sympathetic overactivity, agitation, and hyperthermia. Serious complications like delirium and seizures were more frequent with polydrug use.
Conclusions:
- Suspect MDMA use in young adults presenting with symptoms of sympathetic overactivity, agitation, and hyperthermia, particularly during weekend nights.
- MDMA is often used in conjunction with other substances, complicating diagnosis and management in emergency settings.
- A&E departments face significant challenges in managing these complex dance drug-related presentations.