Water, Hyponatremia, MDMA & Heat Stroke: How Not to Die

 

By Terry Gotham

Now that the summer festival season is in full swing and we’ve all been dripping with sweat once at least once, it’s time to have a little chat. If you’re one of the people who hasn’t pissed clear at a festival since Dubya was president, this is 100% for you. If you’re the person in your circle that hounds everyone else to stay hydrated and eat salty snacks Wednesday morning on playa, this is also 100% for you. For this edition of Do No Harm, I spoke to Dr. Daniel E. Rusyniak, Professor of Emergency Medicine & Adjunct Professor of Pharmacology/Toxicology and Neurology at the IU School of Medicine. He dropped a pile of knowledge, so I’m going to be able to walk you through what happens to your body when you roll your face off. Down to the hormonal level, putting yourself at risk for heatstroke & hyponatremia. And of course, also illustrate how to NOT do that.

In your body, there’s this antidiuretic hormone called Vasopressin, also known as ADH. ADH’s job is to ensure your body retains water (hence it being known as an antidiuretic), and to constrict blood vessels. By increasing the water pemeability of the kidneys, it plays a key role in keeping your fool ass hydrated. When it’s heavily secreted, your kidneys get the signal to fast track water reabsorption & pissing yellow. This happens in a few complicated ways you can read about here. Guess what MDMA happens to affect?MDMA, along with many of the novel psychoactive substances taken at festivals, regional burns, and EDM shows can be grouped in the term “amphetamines and stimulants.” Which have the much desired effect of decreasing fatigue, especially fatigue you generate from exertion. You know, that thing you’re actively taking drugs to ignore?  Kind of like missing red flags on date 3 & 4, ignoring warning signs from your cardiovascular systems can have disastrous effects on your health.

Fatigue is crucial in preventing heat stroke. The reason this signal is being sent, is to keep your temperature from spiking too high. The thing that everyone forgets about amphetamine use is that it doesn’t actually give you super powers. The fact that you’re getting tired more quickly in hot environments is a warning/break point signal to your body/mind that you’re being fatigued.  When sober, mammals reach a point of exertional fatigue and maximum temperature, at which point you begin to tap out.  Guess what amphetamines & stimulants do?

By allowing you to push past your operational limits, stimulants turn you from a person who will collapse before overheating into a person with a non-trivial risk of doing the exact opposite of that. The perfect storm Dr. Rusyniak described could be used for most, if not all of the MDMA death at festivals in recent years, especially the ones at New York City’s Electric Zoo.

The summer outdoor dance party is therefore the perfect condition for exertional heat stroke to occur. Warm environment (decreasing heat dissipation), increased exertion (dancing), use of drugs that blunt normal protective responses to exertional heat stroke.
~Daniel E. Rusyniak, MD (Medical Director of the Indiana Poison Center)

The problem is exacerbated by the fact that most usual methods for rapidly cooling MDMA users may not be applicable. That person sweating their face off/rolling so hard you can see them chewing the inside of their mouth off from 15 feet away, is probably not giving up his spot in the crowd to get water. Even if he did, especially on day 2 or 3 of the festival, hyponatremia becomes a real risk. Exertion when you’ve not had zero calories, zero sleep and a cocktail of uppers and downers amplifies this risk . This is the reason why smart festivals hand out Gatorade & salty snacks after day 1. This stuff isn’t rocket science, but it does need to be planned ahead and there are plenty of ways to mess it up if you’re not careful.

There are two other wildcards to the MDMA experience. At higher doses (you know who you are), MDMA has been seen to cause cutaneous vasoconstriction. This vasoconstriction increases your blood pressure and can hamper heat release at the same time it raises your temperature. You’ll feel exceptionally hot, and then drink a ton of water, amplifying your risk for hyponatremia. It’s very hard to troubleshoot what’s going on in your cardiovascular system when you’re running a 101 degree temperature in the middle of the dance floor during a Steve Aoki set.

The idea that you can actually overheat is real, verified science, and we need to stop pretending is a myth. It can happen and when you go hard, it’s much more likely. Take breaks, don’t party in direct sunlight for 15 hours a day (you know who you are), and try to be as consistent as you can with water. On playa, Piss Clear is well known, but I think Piss Clear Regularly, should become as important. Drink water consistently, starting early in the day, before you start feeling faint. This way, you’re not fucked up thinking you have to drink a gallon of water when your anxiety spikes and you start telling your friends you feel like you’re dying.

It’s important to build good habits that don’t involve your limits, because when you’re on stimulants of whatever that shady dealer is peddling as the purest molly this week, you might just forget they exist. Additionally, you’re not a varsity or high performance athlete. While it’s been shown that marathon runners and athletes can be cooled from temperatures exceeding 107 degrees, let’s not pretend that any festival will ever have the capacity for you to consider that a way to justify being irresponsible. If you’re LeBron, you can expect a cold water bath and sodium testing on game day; you better expect an hour wait for water and impure drugs. If you’re not LeBron, please follow these simple tips:

  • If a festival or party allows Camelbaks, BPA-free reusable water bottles or any form of BYOW, take advantage of it.
  • Know where the free water stations are at any festival. If you’re at a festival or party that doesn’t have free water, berate them on social media until they have them. Don’t pay for parties that don’t have readily accessible water.
  • If you’re one of those people who use repetitive motions when rolling to de-stress, attempt to build a habit of reaching for your Camelbak nib and taking water as one. That’s way less damaging than finding people to date or smoking cigarettes in response to the jagged energy.
  • Salty snacks and food with savory tastes are your friend, especially after day 1 of events.
  • Alcohol + MDMA = Dehydration Bonanza. Pick one. Seriously, that’s the express train to FailVille, population you.
  • If you feel like a sweaty mess, believe yourself and go get some water. If you don’t feel like a sweaty mess and you’ve been on the dance floor for an hour in direct sunlight, GO GET SOME WATER.
  • If you’re drinking, try to have at least 8-12oz serving of water for every 2-3 drinks. If you’re drinking and dancing, make that ratio as close to 1:1 as you’re able to.
  • Don’t be embarrassed if you need to slow down, take breaks, ask for help or flag down emergency services. That’s what the staff & EMTs are there for. If you try to shrug off serious symptoms of heat stroke, you’ll still need to see EMTs…you’ll be out of commission for much much longer.
  • Taking breaks earlier on are much more rejuvenating. Giving yourself breaks every couple of hours at a multi-day event can make day 2 & 3 a lot easier than forced crashing for 4hrs because you can’t handle it anymore.

Don’t try to be a super hero y’all. The summer is long, and Dr. Rusyniak & I want to make sure every single one of you see Fall 2017 as well as your favorite DJs over the summer.

War on Drugs Leads to Wholesale Rainforest Destruction

Photograph by Luke Duggleby www.lukeduggleby.com

Photograph by Luke Duggleby http://www.lukeduggleby.com

By Terry Gotham

I usually talk about how to reduce the damage drugs can do to people, but today I want to switch it up a little bit. I’m going to tell you about the Mreah Prew Phnom trees of Asia, the Sassafras trees of America, and how our voracious appetite for drugs is hurting them. This isn’t a story about water usage or gang violence, but of appetites. The explosion in popularity of MDMA has ensured one of the trees that produce a precursor substance, safrole oil, is now critically endangered. It’s estimated (not verified) that more than 5 million trees have been destroyed over the last 10 years.

Photograph by Luke Duggleby www.lukeduggleby.com

Photograph by Luke Duggleby http://www.lukeduggleby.com

 

 

Formally named Cinnamomum parathenoxylon, the tree grew in Bhutan, India, Indonesia, Laos, Malaysia, Myanmar, Nepal, Pakistan & Vietnam, but is currently most often found in Cambodia. The remaining population is clustered in the Phnom Samkos Wildlife Sanctuary, as cultivation of the tree is increasingly restricted. When the roots are chopped up and processed, safrole, an essential oil is produced. This stuff has been an herbal remedy, a critical part of perfumes, soaps & can be used to make MDMA.

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Ten Questions With Terry Gotham: Brad Burge – MAPS

(Interviewing the Multidisciplinary Association for Psychedelic Studies has been a dream of mine for years. I’m honored to present this conversation with their Director of Communications & Marketing Brad Burge. Not only does he give us an update on the SIX (6!) Phase II clinical trials of MDMA for PTSD, but he also shares totally new developments & tips on how to talk about this stuff for people who don’t quite dig yet. And a couple of his favorite tunes to boot!)
~Interview By Terry Gotham

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brad_burge1. How was 2015 for MAPS? Any good news from the front to share?
Just a little.

I can say without hesitation that 2015 was our busiest, most exciting year yet. This year (2016) we celebrate MAPS’ 30th anniversary, and all that we’ve accomplished in those three decades. Our Phase 2 clinical trials of MDMA-assisted psychotherapy for the treatment of posttraumatic stress disorder (PTSD) are now nearly complete, and this year we’ll be meeting with the U.S. Food and Drug Administration (FDA) to plan the much larger Phase 3 trials needed to make MDMA a legal prescription medicine, approved for use in conjunction with psychotherapy to treat PTSD. We are on track for FDA approval as soon as 2021.

As one of the first steps to getting this first approval, in February 2015, we announced the formation of the MAPS Public Benefit Corporation (MPBC), a new wholly owned subsidiary of MAPS which will serve as a vehicle for conducting MAPS’ research, and for balancing social benefits with income from the legal prescription sale of MDMA, other psychedelics, and marijuana. We also initiated the purchase of one kilogram of pharmaceutical grade MDMA manufactured under current Good Manufacturing Practices (GMP) to be used in our Phase 3 trials. This batch of MDMA will cost us approximately $400,000, which we are seeking to raise this year through the Global Psychedelic Dinners and 30th Anniversary Banquet in Oakland, Calif.

Another major 2015 success is our Canadian Phase 2 study of MDMA-assisted psychotherapy for PTSD, which finally started after eight years of effort. This study has already completed treatments as of early 2016, and has been the first clinical psychedelic therapy trial in Canada in over 40 years. In 2015, we also completed and fully funded our two largest Phase 2 clinical trials, one in South Carolina primarily in U.S. military veterans, and one in Colorado primarily in female survivors of sexual assault and abuse.

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Serotonin Syndrome: A Quick & Dirty Primer

serotonin syndromeBy Terry Gotham

As opposed to continuing to rattle off drugs that most of our readers may have never heard of with few having ever taken, I thought it would be a good idea to shift to discussion to more general harms. Don’t worry, we’ll still be going over other wacky controlled substances in the future, but today I wanted to focus on serotonin syndrome. This thing is a somewhat amorphous phenomenon that occurs when humans have too much serotonin in their CNS or peripheral nervous system.
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Methylone: Proof The Market Decides, Not The Legality

c/o New York DanceSafe

c/o New York DanceSafe

by Terry Gotham

Continuing the series on “things your dealer cuts your drugs with,” this week I’m talking about Methylone. We’re a couple of years out from peak Methylone (circa 2012), but it’s still popping up in MDMA & Molly across the US, the UK & Australia/NZ. We live in the digital age now, so instead of people being busted for selling it in the club, we’ve got dealers getting pinched for buying it online. Including one who was indicted for murder because a kid died after taking it.

I wanted to use it as a quick case study on how little recreational drug users care about scheduling & legality. There are enough years of data on Methylone vs. MDMA to get a sense of the last couple of years & Stay Safe Seattle has done some anecdotal research which provides a neat explanation of what’s been going on. For more formal information on Methylone, check out this doc by the UNODC (United Nations Office On Drugs & Crime).

Graph c/o Stay Safe Seattle.

Graph c/o Stay Safe Seattle.

The ravers, burners or club kids who have consistently rolled since the economic crash of 2008, you may remember the MDMA shortages that plagued the first term of Obama’s presidency. Because of the lack of viable sources for many people, dealers began cutting their MDMA with Methylone & other legal highs.

Cutting pressed pills or baggies of “Molly” isn’t anything new. But instead of cutting them with Stacker 2, Dexetrim, pseudoephedrine & other grey market stimulants, dealers began adding “legal highs” to the stuff to ensure people still had an oxytocin-filled good time.

c/o New York DanceSafe

c/o New York DanceSafe (Yes, this was a legit info sheet)

This stuff was legal for years, but it definitely isn’t harmless. It’s been implicated in the deaths of a number of people, notably three young people in Florida back in 2012. Remember those two kids who died at Electric Zoo in 2013? One of them had taken Methylone instead of MDMA. Granted, the dehydration/heatstroke was the exacerbating factor in their deaths, but let’s be real about the fact that they probably didn’t know what they were getting.

Of course, there are a subset of recreational drug users who enjoy Methylone & would prefer to take it, even if they had access to MDMA. Unlike other legal highs, Methylone has developed a following across the Western world. The shorter duration, the lack of cardiovascular stimulation, reported empathogenic effects and dose control are preferred to the dice some roll when it come to pills (That pun was awful). Though, when purity of MDMA tablets rose & it was more easily found in a lot of areas, rates of Methylone consumption plummeted, as the graph above illustrates.

At the end of the day, I want to emphasize (like I always do), that the problem is that people don’t have access to the drug that provide the experiences they want to have. When they can’t get what they want, they’ll start looking for a proxy substance that can provide a similar, if not exact array of symptoms.  Of course, there are plenty of people who took the drug, found out they liked it, and were able to correctly disentangle the MDMA experience from the Methylone experience. But that takes time, effort, access to vaguely pure substances and honest dealers. If you’re showing up at a party and you’ve never taken either of these before, you won’t be able to tell the difference, as you have no point of reference.

The drug war forces people to make these choices, simply because they can’t get what they want. Instead of requiring humans to play street chemist & behaviorist, let people do what they want. Legalize, regulate, require branding to disclose ingredients & allow users to discuss effects with their doctor. As opposed to Lupo their street pharmacist telling them how dope the new Molly is & how it’ll have them hugging their friends and grinding their teeth by the time that new Axwell & Ingrosso track hits the deck.

I’ll leave you with this quote from a Playboy in 2013 that documented just how bad it had gotten in Miami:

“According to the Miami Police Department, methylone and mephedrone, along with another synthetic cathinone called 4-MEC, account for the vast bulk of the molly seized by narcotics cops in the area. A DEA spokesperson told me that in the first six months of 2013, the DEA’s Miami field office seized 106 consignments of molly, which contained 43 different substances, 19 of them so obscure even government chemists couldn’t identify them. So much for purity.”

Test your shit folks. Know your source, know your set/setting & do your research before setting off on a new adventure. Tally ho into the wilderness, but we want y’all to come back safe & sound with stars in your eyes. To talk more about this, join me, Ravelrie, NY DanceSafe & Stay Safe Seattle on Twitter at 1:30p PST using the hashtag #M1FF on Friday, Sept. 18th.