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Published on: April 23, 2019
"Ecstasy" associated deaths: what is a fatal concentration ? Analysis of a case series
1Eastern Ontario Forensic Pathology, Unit of the Ontario Forensic Pathology Service, Division of Anatomical Pathology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K2A 2L4, Canada. cmilroy@toh.on.ca
Abstract:
Amphetamine derivative drugs, particularly 3,4-methylenedioxymethamphetamine (MDMA), commonly known as ecstasy, are popular recreational drugs. MDMA is associated with causing death by a number of mechanisms, including hyperpyrexia, cardiac arrhythmia water intoxication and liver failure. Seventy-seven deaths where MDMA was detected in body fluids/organs were reviewed. Of these cases 59 deaths had MDMA present in blood. In 13 cases death was attributable to the toxic effects of MDMA alone with a range of 0.478-53.9 mg/l, mean 8.43 mg/l, median 3.49 mg/l. In 22 cases death was due to polydrug use, with an MDMA range of 0.04-41.5 mg/l, mean 2.90 mg/l, median 0.76 mg/l. In 24 cases death was due to trauma with an MDMA range of 0.035-4.81 mg/l, mean 0.862 mg/l, median 0. 483 mg/l. There is considerable overlap between the concentration of MDMA seen in deaths from direct MDMA toxicity and deaths associated with trauma. These findings show, that like other stimulant drugs, no specific concentration can be used to determine death without consideration of the history and full autopsy findings.
Insights
3,4-methylenedioxymethamphetamine (MDMA), or ecstasy, is linked to various fatal mechanisms. Blood MDMA concentrations in fatal cases overlap significantly, meaning no single level determines death. Autopsy findings and case history are crucial for accurate assessment.
Area of Science:
- Forensic Toxicology
- Pharmacology
- Clinical Toxicology
Background:
- 3,4-methylenedioxymethamphetamine (MDMA), a popular recreational amphetamine derivative, is associated with multiple causes of death.
- These mechanisms include hyperpyrexia, cardiac arrhythmias, water intoxication, and liver failure.
Purpose of the Study:
- To review fatal cases involving MDMA detection.
- To analyze blood MDMA concentrations in relation to cause of death (MDMA toxicity, polydrug use, trauma).
Main Methods:
- Retrospective review of 77 deaths where MDMA was detected in body fluids or organs.
- Analysis of blood MDMA concentrations in cases of direct toxicity, polydrug use, and trauma.
Main Results:
- MDMA was present in blood in 59 of the 77 reviewed deaths.
- In 13 cases, death was attributed to MDMA toxicity alone (blood range: 0.478-53.9 mg/L).
- In 22 cases of polydrug use, MDMA blood levels ranged from 0.04-41.5 mg/L.
- In 24 trauma-related deaths, MDMA blood levels ranged from 0.035-4.81 mg/L.
- Significant overlap in MDMA concentrations was observed between direct toxicity and trauma-associated deaths.
Conclusions:
- No specific blood MDMA concentration can definitively determine death.
- Accurate determination of cause of death requires consideration of autopsy findings and clinical history.
- MDMA's role in fatalities, especially those involving trauma, necessitates comprehensive toxicological and forensic evaluation.
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