Trends in MDMA‐related mortality across four countries
Amanda Roxburgh, Bülent Şam, Pirkko Kriikku, Jane Mounteney, Antonio Castañera Ajenjo, Mário Dias, Isabelle Giraudon
Addiction March 19, 2021 DOI: 10.1111/add.15493 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective analysis of national forensic databases Peer reviewed |
|---|---|
| Sample size | 2,052 |
| Population | Deaths in which MDMA was considered contributory by forensic pathologists in Australia, Finland, Portugal, and Turkey |
| Topics | MDMA |
| Keywords | Forensic toxicology Demography Cause of death Poison control Demographics Mortality rate Environmental health |
| Citations | 27 |
| Key points | MDMA-related death rates increased in all four countries from 2011 to 2017, with MDMA toxicity alone causing a minority of deaths (13–25%) and multiple drug toxicity being more common. |
Abstract
Abstract Aims To determine trends in 3,4 methylenedioxymethamphetamine (MDMA)‐related death rates across Australia, Finland, Portugal and Turkey and to analyse the toxicology and causes of death across countries.
Design: Analysis of MDMA‐related deaths extracted from a national coronial database in Australia (2001–19) and national forensic toxicology databases in Finland (2001–17), Portugal (2008–19) and Turkey (2007–17). Presentation of MDMA use and seizure data (market indicators).
Setting: Australia, Finland, Portugal and Turkey. Cases All deaths in which MDMA was considered by the forensic pathologist to be contributory to death.
Measurements: Information collected on cause and circumstances of death, demographics and toxicology.
Findings: A total of 1400 MDMA‐related deaths were identified in Turkey, 507 in Australia, 100 in Finland and 45 in Portugal. The median age ranged from 24 to 27.5 years, and males represented between 81 and 94% of the deaths across countries. Standardized mortality rates significantly increased across all four countries from 2011 to 2017 during a period of increased purity and availability of MDMA. The underlying cause of death was predominantly due to drug toxicity in Australia ( n = 309, 61%), Finland ( n = 70, 70%) and Turkey ( n = 840, 60%) and other causes in Portugal ( n = 25, 56%). Minorities of all deaths across the countries were due to MDMA toxicity alone (13–25%). These deaths had a significantly higher blood MDMA concentration than multiple drug toxicity deaths in Australia, Finland and Turkey. Drugs other than MDMA commonly detected were stimulants (including cocaine, amphetamine and methamphetamine) (Australia 52% and Finland 61%) and alcohol (Australia 46% and Portugal 49%). In addition to MDMA toxicity, benzodiazepines (81%) and opioids (64%) were commonly identified in these deaths in Finland. In comparison, synthetic cannabinoids (15%) and cannabis (33%) were present in a minority of deaths in Turkey.
Conclusions: Deaths related to 3,4 methylenedioxymethamphetamine (MDMA) increased in Australia, Finland, Portugal and Turkey between 2011 and 2017. Findings show MDMA toxicity alone can be fatal, but multiple drug toxicity remains more prevalent.