Demographics of Ecstasy-related fatalities in England and Wales were collected over a 4-year period (July 1, 1997-June 30, 2000) using the National Programme on Substance Abuse Deaths. Fatalities were considered Ecstasy-related if a coroner's report contained the text "Ecstasy," "XTC," "MDMA" or "MDA" (the last is sometimes sold as Ecstasy). 81 cases were reported in this time period, and results of toxicological examination were available in 75 of 81 cases. MDMA was detected in 68 of 75 cases (91%), MDA in 7 of 75 cases (9%), and opiates or opioids were also detected in 44 of 75 cases (59%). Hypnotics or sedatives had also been prescribed to the deceased in 26 cases (38%). Most fatalities were male (66 men versus 15 women) and in their mid-20s (average age 27.2, range = 16-50). Fatalities were more likely to be White (71 versus 3 Black, 7 Other) and to die at home (40 at home versus 25 in hospital and 2 at a pub or club). Only 6 out of 81 (7%) died after taking Ecstasy only. Paralleling Ecstasy use patterns in general, more deaths were liable to occur during weekends than weekdays (45 on Saturday and Sunday versus 36 on all other days) and during vacation periods (10 deaths in July, 8 in August, and 10 in January and 53 in all other months). The number of cases of opiate or opioid coadministration was high; this somewhat unexpected finding is also reported in a case series of Ecstasy fatalities in New York City (Gill et al. 2002). Higher numbers of opiate users in Ecstasy fatalities may arise for one or more reasons, though all remain untested at present, and include drug interactions and differences health prior to death. The age of the deceased is also somewhat higher than would be expected given that young adults and adolescents most frequently use Ecstasy. No information is provided on amount of Ecstasy taken in these cases, or in the estimated numbers of people using Ecstasy in England and Wales during this time period. A tentative calculation can be made if it is assumed that between 300,000 and 500,000 people use Ecstasy every year, and assuming approximately equal distribution of deaths across years, it would appear that fatalities after Ecstasy use is well below 1%.