This case report describes injuries after a traffic accident involving a 29-year old man (the driver) and a 26-year old man (a passenger) who had both taken ecstasy (and possibly methamphetamine). The driver suddenly steered his vehicle off the road and hit an electric pole. He suffered head and chest injuries, and was comatose on arrival. The passenger suffered a lower-limb crush injury and mild skin lacerations on his skull, and was lethargic on arrival. The passenger denied any previous alcohol or drug use. However, samples of blood and urine taken before each patient entered the operating room detected MDMA, MDA, and methamphetamine in both patients. Blood MDMA was 1.15 mg/L in patient 1 and 0.9 mg/L in patient 2, and blood methamphetamine was greater than 250 ng/mL in both patients. Urinary MDMA was 60 mg/L in Patient 1 and 55 mg/L in Patient 2. The driver showed signs of hepatic insufficiency and rhabdomyolysis, and was re-admitted to the intensive care unit, with symptoms resolving within 5 days. The second patient showed mildly increase in liver enzymes, but levels returned to normal within a few days without any intervention. Both patients had elevated body temperatures (37.6-37.9 deg. C in Patient 1 and up to 38 deg. C in Patient 2) without seizures or signs of infection. Three days after admission, the passenger stated that he and the driver had taken 2 ecstasy tablets on the evening before the accident. After treating these patients, the author proposes that MDMA should be among the compounds routinely tested in bodily fluids of people entering the emergency room. Along with other cases (for example Crifasi and Long 1996; Bost 1988, also see Logan 2001 for a review and original data), this case report provides evidence for impaired driving after ecstasy use. Human laboratory studies of the effects of MDMA, alone or when combined with ethanol, have also found impaired performance on skills that might play a role in driving ability (Cami et al. 2000; Hernandez-Lopez et al. 2002).