Methylenedioxymethamphetamine-related deaths in Taiwan: 2001-2008

Methylenedioxymethamphetamine (MDMA) has been one of most popular drugs in the "club" scene in Taiwan. This epidemic was studied through the examination of toxicological data obtained from the 59 fatalities tested positive for MDMA during the period of January 2001 to December 2008. Ketamine was found in 28 of these cases, signifying the popularity of this drug in Taiwan. The annual number of deaths in each of the 8 years in this period was 4, 7, 9, 14, 8, 9, 2, and 6, respectively. Among these 59 deaths, 39 (66.1%) were men, and the mean, median, and range of ages were 24.6, 23, and 14-46, respectively. Causes of death ruled by the attending pathologists and the distributions for these fatalities were acute intoxication, 40 and mechanical injury, 19, including 3 hanging and 2 drowning. The manners of death were ruled as accidental, 44; homicidal, 6; suicidal, 7; and undetermined, 2. In this study, postmortem whole blood was analyzed by gas chromatography-mass spectrometry with a limit of quantitation at 0.05 microg/mL for both MDMA and MDA. The mean, median, and range of MDMA concentrations in the cases, where MDMA acute intoxication was ruled as the cause of death, were 4.75, 2.60, and 0.12-40.41 microg/mL. MDA was found in 30 of these 40 cases with the following mean, median, and range data: 0.19, 0.13, and 0.05-1.81 microg/mL. The corresponding data of MDMA and MDA in the remaining 19 MDMA-related deaths were significantly lower: 1.25, 0.97, 0.08-3.05 and 0.11, 0.09, 0.06-0.24 microg/mL, respectively.