This means that if they take a normal dose, they can overdose. In Europe, there have been dozens of deaths related to this problem. No one knows why the death toll isn't even greater given the high incidence of the defect, but this is not unusual with drug metabolism questions. To prevent overheating, it's important for people to stay in cool places, not overdo dancing and drink plenty of water. This has long been the advice given to club-goers in the U.K. Unfortunately, in some cases, the advice itself has been deadly.
Users can also die from drinking too much water and causing a fatal electrolyte imbalance.
Leah Betts, a 15-year old girl whose death caused an uproar in the British press over Ecstasy, died this way. Another problem is neurotoxicity or brain damage. No one knows yet what the long term effects are of killing of the ends of serotonin neurons - but since low serotonin is linked with suicide and depression and since some heavy MDMA users report depression, chances are, it's not a good thing. However, MDMA itself was found in most of the bodies of those whose deaths were investigated in Europe. And this can exacerbate the Catch-22 which seems inherent in the relationship between neurotoxicity and liver problems.