Since the 1980s, methylenedioxymethamphetamine (MDMA) has been a popular recreational drug, used particularly among those who attend raves and nightclubs. Over the past 3 years, the popularity of this drug has once again increased and there has been an associated rise in deaths. The pathophysiology of MDMA toxicity is complex and much remains to be understood. This article aims to increase readers' knowledge of patient presentations, the pathophysiology behind life-threatening toxicity, current treatments and the use of extracorporeal membrane oxygenation as a potential future treatment.

Nicola Davies - Senior Sister, Emergency Department, Royal London Hospital

William English - NIHR Academic Clinical Fellow in General Surgery, Royal London Hospital

Johann Grundlingh - Emergency Medicine and Intensive Care Consultant, Royal London Hospital