The PMMA epidemic in Norway: Comparison of fatal and non-fatal intoxications

Abstract

During a 6 month period (July 2010-January 2011) we observed 12 fatal intoxications and 22 non-fatal cases related to the drug paramethoxymethamphetamine (PMMA) in Norway (4.8 mill inhabitants). This toxic designer drug, also known as "Death", is occasionally found in street drugs offered as "ecstasy" or "amphetamine". The present study aimed to evaluate the cause of death, and to compare the PMMA blood concentrations in fatal and non-fatal cases. Methods for identification and quantification of PMMA are presented. The median age of fatalities was 30 years (range 15-50) with 67% males; in non-fatal cases 27 years (20-47) with 86% males. In the 12 fatalities, the median PMMA blood concentration was 1.92 mg/L (range 0.17-3.30), which is in the reported lethal range of 0.6-3.1 mg/L in peripheral blood and 1.2-15.8 mg/L in heart blood. In the 22 non-fatal cases, the median PMMA concentration was 0.07 mg/L (range 0.01-0.65). Poly-drug use was frequent both in fatal and non-fatal cases. The PMA concentrations ranging from 0.00 to 0.26 mg/L in both groups likely represented a PMMA metabolite. Three fatalities were attributed to PMMA only, six to PMMA and other psychostimulant drugs, and three to PMMA and CNS depressant drugs, with median PMMA concentrations of 3.05 mg/L (range 1.58-3.30), 2.56 (1.52-3.23) and 0.52 mg/L (0.17-1.24), respectively. Eight victims were found dead, while death was witnessed in four cases, with symptoms of acute respiratory distress, hyperthermia, cardiac arrest, convulsions, sudden collapse and/or multiple organ failure. In summary, all fatalities attributed to PMMA had high PMMA blood concentrations compared to non-fatal cases. Our sample size was too small to evaluate a possible impact of poly-drug use. A public warning is warranted against use and overdose with illegal "ecstasy" or "speed" drugs.

“Spice,” “Kryptonite,” “Black Mamba”: An Overview of Brand Names and Marketing Strategies of Novel Psychoactive Substances on the Web

“…These pills mainly contain the empathogenic substance MDMA (3,4-methylenedioxy-N-methylamphetamine; 'Ecstasy') or PMA (para-methoxy-amphetamine); PMA is a serotonergic substance of the amphetamine class, with psychedelic and antidepressant properties; it first came into circulation in the early 1970s, when it was used as an alternative to LSD for its hallucinogenic effects. Since the 70s it caused more than 90 deaths in Canada, USA, Australia and Europe (Vevelstad et al 2012), mostly related to the consequences of acute temperature elevation (hypertemia) leading to multi-organ failure occurring at dosages only slightly above the usual recreational range.…”

Sewage‐based epidemiology in monitoring the use of new psychoactive substances: Validation and application of an analytical method using LC‐MS/MS

“…The main families monitored by EU Early Warning System (EWS) since 2005 include synthetic cannabinoids, phenethylamines, other substances (derivatives, medicinal products, intermediates and precursors), arylalkylamines, cathinones, opioids, benzodiazepines, tryptamines, aminoindanes, arylcyclohexylamines, piperazines, piperidines, pyrrolidines, and plants and extracts . Often, NPS are easily acquired legally through the Internet and smart shops where they are sold under various product labels with misleading information about their effects and safety . They are considered a growing problem in many communities and are responsible for numerous fatal intoxications …”

Trends of novel psychoactive substances (NPSs) and their fatal cases

“…Vevelstad et al [30] reported 12 fatal intoxications related to PMMA in Norway during a 6-month period (July 2010-January 2011). PMMA is the 4-methoxy analogue of methamphetamine, and PMA (paramethoxyamphetamine), its toxic metabolite, is the 4-methoxy analogue of amphetamine.…”