PATHOLOGY OF DEATHS ASSOCIATED WITH ECSTASY AND EVE MISUSE

Aims-To study the postmortem pathology associated with ring substitute d amphetamine (amphetamine derivatives) misuse. Methods-The postmortem findings in deaths associated with the ring substituted amphetamines 3,4-methylenedioxymethylamphetamine (MDEA, ecstasy) and 3,4-methylened ioxyethylamphetamine (MDEA, eve) were studied in seven young white men aged between 20 and 25 years. Results-Striking changes were identifie d in the liver, which varied from foci of individual cell necrosis to centrilobular necrosis. In one case there was massive hepatic necrosis . Changes consistent with catecholamine induced myocardial damage were seen in five cases. In the brain perivascular haemorrhagic and hypoxi c changes were identified in four cases. Overall, the changes in four cases were the same as those reported in heat stroke, although only tw o cases had a documented history of hyperthermia. Of these four cases, all had changes in their Liver, three had changes in their brains, an d three in their heart. Of the other three cases, one man died of fulm inant liver failure, one of water intoxication and one probably from a cardiac arrhythmia associated with myocardial fibrosis. Conclusions-T hese data suggest that there is more than one mechanism of damage in r ing substituted amphetamine misuse, injury being caused by hyperthermi a in some cases, but with ring substituted amphetamines also possibly having a toxic effect on the liver and other organs in the absence of hyperthermia.