AMPHETAMINE DERIVATIVE FATALITIES IN SOUTH AUSTRALIA - IS ECSTASY THECULPRIT

Objective: To analyze features of a series of fatalities caused by amp hetamine-derivative designer drugs marketed as ''Ecstasy'' in South Au stralia, and to identify reasons for the recent marked increase in num ber of these deaths. Materials and Methods: Following the death of a 2 6-year-old woman after alleged ingestion of Ecstasy tablets, a retrosp ective search of files at State Forensic Science, Adelaide and the Sou th Australian State Coroner's Department was undertaken from February 1992 to January 1997 to identify similar cases. Results: Six fatalitie s were found, all of which have occurred since September 1995 (M:F rat io, 1:1; age range, 22 to 36 years; average age, 27.7 years). All indi viduals had histories of recent ingestion of illegal drugs thought to be Ecstasy (methylenedioxymethamphetamine, MDMA) at the time of purcha se. Delay occurred in seeking medical attention, despite severe sympto ms. Causes of death involved documented hyperthermia in 3 cases (tempe ratures of 41.5-46.1 degrees C), with features of hyperthermia in one other case, and intracranial hemorrhage in another. Drugs in toxic/let hal amounts identified at postmortem included paramethoxyamphetamine ( PMA) in all cases, amphetamine/methamphetamine in 4 cases, and methyle nedioxymethamphetamine (MDMA or Ecstasy) in only 2 cases. Interaction with a prescription medication (fluoxetine) may have occurred in 1 cas e. Conclusions: The number of deaths due to amphetamine derivatives ap parently due to substitution of PMA for MDMA (Ecstasy) have recently i ncreased markedly in Adelaide. Potential users should be warned that P MA has been associated with a much higher rate of lethal complications than other designer drugs, and that no guarantee can be made that tab lets sold as Ecstasy are not PMA.