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Severe paramethoxymethamphetamine (PMMA) and paramethoxyamphetamine (PMA) outbreak in Israel
Yael Lurie1, Asher Gopher, Ophir Lavon
1Rambam Health Care Campus, Israel Poison Information Center, Haifa, Israel.
Context:
Paramethoxymethamphetamine (PMMA) is a hallucinogenic synthetic substituted amphetamine that was not included in the Israeli Controlled Substance Act (CSA).
Objective:
To report a severe PMMA and paramethoxyamphetamine (PMA) outbreak.
Patients And Methods:
The Israeli national forensic toxicology laboratory analyzes the body fluids of unnatural deaths by means of screening immunoassays and chromatographic confirmation and quantification. Samples are referred to this laboratory by the Israeli Forensic Medicine Institute and by hospitals following consultation with the Israel Poison Information Center. The forensic toxicology laboratory began determining PMMA and PMA in February 2007. In all fatal cases with a positive immunoassay screen for amphetamines, a chromatographic analysis of PMA and PMMA was performed. The laboratory and demographic data of consecutive patients in whom PMMA or PMA were detected, were collected during 1 year and subjected to descriptive analysis.
Results:
Of 108 fatal cases with a positive screen for amphetamines, 32 were confirmed. Twenty-four of the 32 cases tested positive for PMMA and PMA--age 27 ± 5 years, 79.2% males, post mortem whole blood PMMA and PMA concentrations 0.35 ± 0.24 and 2.72 ± 1.67 mcg/mL, respectively. Co-exposures were detected in 17 (70.8%) fatalities; including methylenedioxymethamphetamine, methylenedioxyamphetamine, cocaine, cannabinoids, cathinone derivatives, ephedrine/pseudoephedrine, opiates, and ethanol. In addition, five non-fatal male cases were identified; age 32 ± 5 years, four had co-exposures to cocaine, cathinone derivatives, and cannabinoids. These findings led to the inclusion of PMMA in the CSA in July 2007, resulting in only three more fatalities in the following year.
Discussion:
We report an outbreak of PMMA and PMA poisoning resulting in 24 fatalities, and the post mortem whole blood and urine concentrations of these two compounds. PMA was probably the result of PMMA metabolism. Stimulant co-exposures may have contributed to the severity of the poisoning.
Conclusion:
Forensic laboratory and poison center co-operation is important in identifying a new drug of abuse.
Insights
A severe outbreak of paramethoxymethamphetamine (PMMA) and paramethoxyamphetamine (PMA) caused 24 fatalities. Forensic analysis identified PMMA and PMA in fatal cases, leading to PMMA
Area of Science:
- Forensic Toxicology
- Clinical Toxicology
- Drug Abuse Research
Background:
- Paramethoxymethamphetamine (PMMA) is a synthetic amphetamine with hallucinogenic properties.
- PMMA was not initially regulated under the Israeli Controlled Substance Act (CSA).
- This study addresses a significant public health issue involving PMMA and PMA.
Purpose of the Study:
- To document and analyze a severe outbreak of paramethoxymethamphetamine (PMMA) and paramethoxyamphetamine (PMA) poisoning.
- To determine the toxicological and demographic profiles of affected individuals.
- To inform regulatory action regarding novel psychoactive substances.
Main Methods:
- Utilized screening immunoassays and chromatographic confirmation for detecting PMMA and PMA in biological samples.
- Analyzed data from unnatural deaths referred by the Israeli Forensic Medicine Institute and Poison Information Center.
- Conducted a 1-year descriptive analysis of laboratory and demographic data for confirmed PMMA/PMA cases.
Main Results:
- Confirmed 32 cases of amphetamine-related fatalities, with 24 testing positive for PMMA and PMA.
- Identified high post-mortem blood concentrations of PMMA (0.35 ± 0.24 mcg/mL) and PMA (2.72 ± 1.67 mcg/mL).
- Observed frequent co-exposures to other substances, including MDMA, cocaine, and cannabinoids, in fatal and non-fatal cases.
Conclusions:
- The study highlights a significant outbreak of PMMA and PMA poisoning with substantial fatalities.
- Paramethoxyamphetamine (PMA) is likely a metabolite of PMMA.
- Co-ingestion of stimulants may exacerbate the toxicity of PMMA and PMA, underscoring the need for robust forensic and poison control collaboration.
- The findings led to PMMA's inclusion in the CSA, reducing subsequent fatalities.
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