Fatalities caused by the MDMA-related drug paramethoxyamphetamine (PMA)

Area of Science:

• Forensic Toxicology
• Pharmacology
• Public Health

Background:

• Recreational use of 3,4-methylenedioxymethamphetamine (MDMA), or Ecstasy, has increased, particularly at rave events.
• Paramethoxyamphetamine (PMA) shares structural and pharmacological similarities with MDMA but may be a more potent stimulant.
• Fatalities attributed to PMA have been reported, necessitating further investigation into its toxicity and prevalence.

Observation:

• Three recent fatalities in the midwestern United States involved individuals who believed they were ingesting MDMA.
• Autopsies revealed severe hyperthermia, convulsions, and hemorrhage as symptoms.
• Postmortem blood analysis confirmed the presence of PMA at concentrations ranging from 0.60 to 1.90 mg/L, with no detectable MDMA.

Findings:

• Gas chromatography-mass spectrometry confirmed PMA as the sole amphetamine detected in the deceased.
• PMA is not a contaminant of MDMA; these cases involved pure PMA ingestion.
• The metabolism of PMA involves cytochrome P450 2D6, an enzyme known for genetic polymorphism, potentially affecting individual susceptibility.

Implications:

• This study underscores the critical danger of misidentifying PMA as MDMA due to potentially fatal outcomes.
• Onsite pill screening tests, like the Marquis Test, can help differentiate PMA from MDMA.
• Awareness of PMA's distinct pill appearance (e.g., white with a Mitsubishi symbol) is crucial for harm reduction efforts.