by Crystal Phend

Overdoses of the “club drug” ecstasy at all-night rave dance parties may be a rising but under-reported public health problem, the CDC said.

What may be the first public health investigation into the epidemiology of ecstasy overdose revealed that 18 patients landed in hospital emergency departments for illness related to the hallucinogenic stimulant within 12 hours after a Los Angeles New Year’s Eve rave.

This cluster of events was accompanied by the death of a previously healthy 24-year-old man at home the day after the rave, according to the Los Angeles Department of Public Health investigation reported in the June 11 issue of Morbidity and Mortality Weekly Report.

A note from MMWR editors accompanying the report called overdose with ecstasy (3,4-methylenedioxymethamphetamine, MDMA) an increasing public health concern.

The editors pointed to a second cluster of events in the San Francisco Bay Area in which two young people died from ecstasy overdose and eight others were hospitalized after a May 29 rave, less than six months after the L.A. cases.

Tainted ecstasy was initially suspected by police there. But contamination has subsequently been ruled out, a Daly City police spokesperson told MedPage Today.

Ecstasy overdose itself rather than contamination also appeared to account for the L.A. cases, the MMRW editors noted.

“This conclusion is supported, in part, by the lack of a common description of the ecstasy tablets ingested by patients and the finding of MDMA, but no known toxic contaminants, in the ecstasy tablet from one of the patients,” they wrote.

Raves emerged as underground parties in the 1980s but have become high-priced organized commercial events.

Because of the frequent use of ecstasy at raves, 14 ambulances and roving emergency medical technicians accompanied police and undercover narcotics officers who mingled with the roughly 45,000 people attending the annual Los Angeles New Year’s rave.

A cluster of apparent overdoses reported by a physician at a nearby hospital triggered the investigation, Laurene Mascola, MD, MPH, chief of the L.A. County Department of Public Health Acute Communicable Diseases Control Unit, and colleagues wrote in the MMWR.

Among the 30 patients who had attended the rave and ended up in emergency departments, one was a trauma case; the rest were drug or alcohol intoxication — 16 with self-reported ecstasy use (12 toxicologically confirmed) and two with ecstasy use found on toxicology testing alone.

All arrived within two hours of the end of the rave except one case in which a patient had taken additional ecstasy at home after the event.

The age of these patients ranged from 16 to 34 with a mean of 21.3.

Ecstasy symptoms noted in the emergency department included agitation, hypertension, mydriasis, and tachycardia. One of the three patients admitted, though, had a seizure, rhabdomyolysis, renal failure requiring hemodialysis, and hepatic failure.

The consequences of overdose for this severely-affected man were long term — he was discharged to home outpatient hemodialysis after a 28-day hospital stay.

The one death was determined by the coroner to have been caused by multiple drug intoxication (friends reported he took ecstasy and cocaine at the rave and injected heroin at home afterward). It didn’t meet the case definition because it was medically unattended and more than 12 hours after the rave.

These cases occurred in the context of an apparent rise in ecstasy use in the community overall, Mascola’s group and the MMRW editors agreed.

L.A. County laboratories have seen an increase in the number of specimens that contain ecstasy from 5.2 per 100,000 county residents per year in 2005 to 13.4 per 100,000 in 2009.

Ecstasy as the primary drug of choice rose 6.5-fold over the same period among L.A. County residents entering drug treatment programs, Mascola’s group wrote.

The editorial note cited a 74.8% increase in ecstasy-related emergency department visits from 2004 to 2008.

The editors recommended collaboration among public health, emergency medical services, law enforcement, and substance-abuse treatment services providers in developing overdose prevention plans for raves and other mass gatherings.

Crystal Phend is a MedPage Today Senior Staff Writer.

Originally published in MedPage Today. Visit MedPageToday.com for more public health news.