A 29-year-old man died from aortic dissection and cardiac tamponade after taking ecstasy (MDMA) at a rave. He had no history of hypertension or other known risk factors for aortic dissection, though a minor degree of cystic medial necrosis was found in the aorta. Autopsy toxicology showed low residual MDMA levels in the blood about 48 hours after ingestion. The report suggests a probable link between MDMA use and aortic dissection in a previously healthy young adult, discusses possible mechanisms, and notes challenges in diagnosing this complication.
From 2000 to 2023 in Australia, 43 deaths involving LSD (33 cases) or psilocybin (10 cases) were identified. Most deaths were from traumatic accidents (36.4% for LSD, 40.0% for psilocybin) or self-harm by physical means (12 cases, all involving LSD). Multiple drug toxicity accounted for about a fifth of deaths. Only one death was attributed solely to LSD toxicity, and two followed a cardiovascular event after LSD use. In four psilocybin cases the cause was undetermined. Severe agitation was the most common clinical presentation. Median blood concentrations were 0.8 μg/l for LSD and 20 μg/l for psilocin. Pre-existing organ pathology was uncommon.
From 2000 to 2025, 70 fatal poisonings involving new psychoactive stimulants and hallucinogens (NPSH) were identified in Australia, the first occurring in 2007. In nearly a quarter of cases, the person appeared unaware they were consuming an NPSH, and about a third involved injection. Common signs of acute poisoning included intense agitation, sudden collapse, and hyperthermia. Cathinones were the most frequently detected NPSH, followed by phenethylamines and tryptamines. Over a quarter of cases had multiple NPSH in the blood. In the 2020s, tryptamines became more common while phenethylamines became less common, and a wider range of NPSH were detected. Psychoactive drugs besides NPSH were present in most cases, especially psychostimulants and hypnosedatives.
The term 'synthetic cannabis' is a misnomer for a group of drugs that should instead be called synthetic cannabinoid receptor agonists (SCRAs). These substances differ substantially from delta-9-tetrahydrocannabinol (THC) in pharmacodynamics, mechanisms of action, and physiological effects, exhibiting greater potency and efficacy along with psychostimulant-like properties. The authors argue that the misnomer has negative clinical and public health implications, and that adopting the term SCRAs could reduce confusion and harms. The constant evolution of this drug class requires distinct policy responses regarding terminology, harm reduction, epidemiology, treatment, and legal status.