Does an "ecstasy" overdose raise your body temperature to 108 degrees?
Dear Straight Dope:
In the past week or so, I have seen several news reports (local papers, MSNBC.com, etc.) about an additive in some "ecstasy" tablets (PMA, I believe) that raises body temperatures to 108 degrees F (42.2 C) and has killed six people in the Orlando area. Alarm bells rang as I noticed no names or dates mentioned, as well of the abundance of the phrase "according to drug agents." Even more suspicious, one victim's temperature was reported to remain at 106 degrees F (41.1 C) even four hours after death! I only have a bachelor's degree in biology, but somehow I don't think this is possible. Cecil, is this another scare tactic from our drug czars, or is there some truth to this story?
Drug enforcers may use scare tactics, but this isn't one of them. Those news reports contain more fact than fiction, and the facts are pretty frightening. Curiously, however, the roots of this story lie not in biology, but in the law.
Writing an enforceable drug law is no simple task. If the law is written too broadly, it will inadvertently criminalize all sorts of harmless and even beneficial substances. In outlawing marijuana, for example, legislators couldn't simply ban the marijuana plant, commonly known as hemp, because it's also used to make rope, birdseed, and other useful products. Instead the law had to be narrowly written to criminalize only the bad stuff, as legislators saw it. This can get pretty involved. In my home state of Louisiana, the law describes marijuana as "all parts of plants of the genus Cannabis [except] the mature stalks of such plant, fiber produced from such stalks, oil or cake made from the seeds of such plant, any other compound, manufacture, salt, [etc.,] (except the resin extracted therefrom), fiber, oil, or cake, or the sterilized seed of such plant," blah blah blah.
When it comes to manufactured drugs, things get a little easier. You simply state that it is illegal to possess any substance with a given chemical structure (or any compound that contains said substance). This description can get down to the level of a molecular formula. An example of this is cocaine. Legislators couldn't just outlaw "cocaine-like compounds," because then we'd have to arrest dentists and physicians for possession of analogues such as novocaine, benzocaine, and lidocaine. Instead they banned cocaine hydrochloride, the technical name for the white powder people snort with those little spoons. Then somebody came up with the off-white, rock-like substance known as crack. Crack is cocaine, period (the hydrochloride group has been removed). Since crack is not chemically identical to cocaine, for a time in some jurisdictions it was legal.
You see the problem. In order to make drugs laws workable, lawmakers make the language highly specific. Maybe too specific. Enter designer drugs. These drugs mimic the "desirable" effects of a recreational drug but are sufficiently different chemically as not to be illegal.
From a drug lord's perspective designer drugs have another advantage--they make it harder to detect the clandestine labs where many illegal drugs are manufactured. These labs, which are really not much more than kitchens, use readily available chemicals known as "precursors." One way for the authorities to monitor illegal drug making is to monitor sales of the precursors. After all, who the heck needs a thousand packages of nasal decongestant? But drug makers are on to the fact that government watchdogs are on to them. Designer drugs help them avoid detection by using substances that aren't monitored. It's akin to having a recipe for spaghetti but buying ketchup instead of tomato sauce: you get something that looks close, but in reality isn't. Maybe catastrophically so.
That brings us to MDMA and PMA. "Ecstasy" is the street name of methylenedioxymethamphetamine, or MDMA. As its name implies, it's a variant of amphetamine, but technically it's not a designer drug. First synthesized early in the last century, MDMA was patented by Merck in 1914, long before the club and rave scene. Common street names include "e," "XTC," "Adam," "STP," "X," "clarity," and "lover's speed."
Paramethoxymethamphetamine (PMA) is a designer-drug variant of MDMA--or at least an attempt at it. First synthesized in the 70's, it never became popular as a recreational drug for two reasons: low amusement value and high toxicity.
MDMA's documented effects include feelings of intimacy, a state of relaxation and euphoria, and rushes of exhilaration, as well as enhanced physical sensation. PMA produces somewhat similar effects at low doses--an increase in energy, minor visual hallucinations, and a mild euphoric state. At slightly higher doses, however, PMA suddenly increases the heart rate, blood pressure, and (aha!) body temperature. In one documented case, an individual had a recorded body temperature of 115 degrees F (46.1 C).
After death, a human body cools at the rate of roughly one-and-a-half degrees F per hour (<1 degree C), a process known as algor mortis. (Factors like ambient temperature, clothing, etc., affect the cooling rate.) After four hours, a body at 115 degrees F/46.1 C could have cooled down to 109 F/42.8 C. That's close enough to the temperature reported in news accounts to make it unlikely somebody just made this up.
A notable difference between MDMA and PMA is that PMA takes about an hour to have a noticeable effect while MDMA takes about fifteen minutes. It's believed that people overdose on PMA because they think it's MDMA. After fifteen minutes with no results they take another "hit," thinking the first one was no good. After another fifteen minutes passes and still nothing, they pop yet another and before you know it, the morgue has another resident.
The six deaths in the Orlando area really happened but the death toll doesn't start or stop there. According to the Drug Enforcement Agency, PMA-related deaths in the U.S. go back as far as 1973. That same year nine people died in Canada from PMA ingestion. The next known deaths occurred over twenty years later, when PMA claimed ten more lives. Just recently, three more people died in the Chicago area. There are easier ways to raise your body temperature. Haven't these guys ever heard of a Jacuzzi?
The author, Arthur Young (Hawk), graduated with a B.S. in pre-medical sciences in 1991, after which he went to work for the Acadiana Criminalistics Laboratory as a forensic biology specialist. He would like to extend his appreciation to Ms. Laurette Rapp and Mr. Kevin Ardoin, both of the chemistry section, for their assistance in writing this article.
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