‘I felt like my life force leaving, I felt my body stop’
Sophie Horne was convinced she was going to die - and as she felt her "life force leaving" - she thought of her mother.
Aged 19, Sophie collapsed shortly after leaving the Hardcore Til I Die music festival where she popped three pills of what she believed to be the party drug MDMA.
But they turned out to be something far more sinister.
Ms Horne assumed the pills she had bought from her ex-boyfriend were duds until she suddenly felt like she had "forgotten how to breathe".
"I remember panicking and being like, I had to actually consciously tell myself breathe in and breathe out because I thought if I didn't do that I would stop breathing and I would die," she said of that life-changing day in 2010.
"I couldn't really walk, I just kind of dropped to the ground and I could feel that my heart was just that (thumping)."
Her friends, worried about getting in trouble with police, ignored her desperate pleas to "call a f***ing ambulance" and insisted she was "fine".
"I was lying on the concrete and thinking, alright this is it, I can't really battle this out anymore and so I closed my eyes and so I just gave in," Ms Horne said.
"I remember just going into blackness and I felt like my life force was leaving, I actually felt my body stop."
"I thought at that point how much life I still wanted to live and I thought of my Mum and I was actually saying I'm sorry to her because I literally thought I was about to die.
"And then for some miraculous reason I think my heart started beating again or something and I was back."
During that time, her friends did not call an ambulance. It wasn't until she went home and visited the doctor that she was told just how lucky she was. The pills she had taken were PMA, which has similar psychedelic effects to MDMA but far more toxic at lower doses.
MDMA has been linked to the deaths of six young people at Australian music festivals. Their body temperatures soared to lethal levels, with some above 41C.
Experts say this overheating is caused by a combination of factors including hot weather, hours of non-stop dancing and MDMA "interfering" with the body's natural thermostat.
NSW Ambulance critical care emergency doctor Sarah Coombes said one of the main MDMA-related problems revellers are treated for is significant hyperthermia, where their temperature goes through the roof.
She said people with a high temperature can often become agitated, driving it up even higher where "effectively they start to cook all their internal organs".
"Their brain cooks and their kidney cooks and their muscles cook," Dr Coombes said.
"The muscles are a problem because when they start to break down they release chunks of protein into the blood that clog up the kidney and can cause kidney failure."
"If they've got a high temperature they're agitated, you need to get aggressive control of them … most of the time that will be with chemical sedation - physical holding down will only make the situation worse."
Guy Jones, a senior chemist for UK drug checking organisation The Loop, described an MDMA overdose as a "horribly traumatic experience".
"You have a stimulant that's keeping you awake through this process but your body is totally overheating so it's a pretty miserable experience," he said.
University of Sydney clinical professor professor Andrew Dawson said the major issue with MDMA was the dose.
"A single tablet can potentially kill - while that's technically true it's highly unlikely," he said.
"The risk is greatest when high doses are taken, typically with multiple tablets."
"People, if they're going to take multiple tablets should be waiting at least an hour between tablets to work out what effects they've got."
Another complication - but less common - is when people drink too much water, diluting their blood and causing sodium levels to drop, which may lead to seizures, coma and, ultimately, death.
While drug users are encouraged to drink water, they can develop "hyponatremia" or water intoxication after taking MDMA because it disrupts the body's thirst response.
"The problem is when they develop hyperthermia … that drives thirst response in body and they over drink, drink five-litres plus and then that dilutes their blood so it's the sodium levels in the blood that drop," Dr Coombes said.
"You may drink two or three-litres (over 10-12 hours) … but if you're still drinking over five-litres that's not so sensible."
Revellers can also keep an eye on the colour of their pee if they are worried about overhydrating.
"If it's looking like a dark yellow you haven't drunk enough and if it's looking like it's not coloured at all or is a really pale yellow you can stop drinking," Dr Coombes said.
A coronial inquest into the deaths of the six festival-goers heard each died from lethal quantities of MDMA after taking between one and nine tablets.
Experts say there are a number of warning signs people can look out for if they suspect a friend or fellow reveller could be experiencing an MDMA overdose.
A person may start sweating excessively, have difficulty breathing and experience mild to severe chest pain. They could appear confused, struggle to recognise their friends or surroundings, and become anxious or paranoid. People who ingest MDMA may also clench their jaw, experience uncontrolled body movements, such as muscle spasms and vomiting.
If any of these symptoms appear, revellers are told to ask a friend for help, find a support person for advice or go straight to a medical tent to see a professional.
Dr Coombes stressed all treatment is "completely confidential" and that paramedics have no obligation to tell authorities about drug use.
If you need help? Please call Lifeline Australia 13 11 14 - 24 hours a day, 365 days a year or in the event of a medical emergency, call Triple-0 immediately.