PMID- 11599617
OWN - NLM
STAT- MEDLINE
DCOM- 20020228
LR  - 20190513
IS  - 0146-4760 (Print)
IS  - 0146-4760 (Linking)
VI  - 25
IP  - 7
DP  - 2001 Oct
TI  - Fatalities caused by the MDMA-related drug paramethoxyamphetamine (PMA).
PG  - 645-8
AB  - The past several years have seen a marked increase in the recreational use of 
      3,4-methylenedioxymethamphetamine (MDMA) or "Ecstasy". MDMA use is especially 
      common among young people participating in dance parties called "raves". 
      Paramethoxyamphetamine (PMA) exhibits both structural and pharmacological 
      similarity to MDMA. It may, however, be a more potent central stimulant, 
      particularly in its effects on serotonergic transmission. Several fatalities from 
      PMA have been reported in Australia, and here we report three recent fatalities 
      that occurred in the midwestern United States in which each of the decedents 
      believed that they were ingesting MDMA. Symptoms observed included agitation and 
      bruxism, progressing to severe hyperthermia, convulsions, and hemorrhage. Blood 
      was screened for drugs of abuse by enzyme immunoassay with the presence of 
      amphetamines indicated in each case. Confirmation and quantitation for 
      amphetamines was performed by gas chromatography-mass spectrometry. The deceased, 
      two males ages 19 and 24 and a female age 18, had postmortem blood PMA 
      concentrations of 1.07, 0.60, and 1.90 mg/L, respectively. PMA is not a 
      contaminant of MDMA, and no MDMA was found in any of these cases. The primary 
      metabolite of PMA is produced by O-demethylation to 4-hydroxyamphetamine, a 
      reaction catalyzed by cytochrome P450 2D6. This enzyme is noted to be genetically 
      polymorphic. Those with the "slow metabolizer" phenotype may be likely to have 
      higher peak blood concentrations of PMA. Whether any of the decedents described 
      herein were of the slow metabolizer phenotype is not known. Several groups have 
      advocated the onsite use of the Marquis Test for the purpose of pill screening in 
      efforts to distinguish PMA from MDMA. A dark purple is consistent with MDMA, 
      whereas PMA imparts no color change in this test. PMA is often in the form of a 
      white pill with a Mitsubishi symbol on one side. This design has been identified 
      in at least one of these fatalities.
FAU - Kraner, J C
AU  - Kraner JC
AD  - AIT Laboratories, Indianapolis, Indiana 46241, USA.
FAU - McCoy, D J
AU  - McCoy DJ
FAU - Evans, M A
AU  - Evans MA
FAU - Evans, L E
AU  - Evans LE
FAU - Sweeney, B J
AU  - Sweeney BJ
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - J Anal Toxicol
JT  - Journal of analytical toxicology
JID - 7705085
RN  - 0 (Amphetamines)
RN  - 0 (Central Nervous System Stimulants)
RN  - 44RAL3456C (Methamphetamine)
RN  - CK833KGX7E (Amphetamine)
RN  - EC 1.14.14.1 (Cytochrome P-450 CYP2D6)
RN  - OVB8F8P39Q (4-methoxyamphetamine)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Amphetamine/*adverse effects/blood/metabolism
MH  - Amphetamines
MH  - Autopsy
MH  - Central Nervous System Stimulants/*adverse effects/blood/metabolism
MH  - Cytochrome P-450 CYP2D6/genetics/metabolism
MH  - Drug Overdose
MH  - Female
MH  - Gas Chromatography-Mass Spectrometry
MH  - Humans
MH  - Male
MH  - Methamphetamine
MH  - Phenotype
EDAT- 2001/10/16 10:00
MHDA- 2002/03/01 10:01
CRDT- 2001/10/16 10:00
PHST- 2001/10/16 10:00 [pubmed]
PHST- 2002/03/01 10:01 [medline]
PHST- 2001/10/16 10:00 [entrez]
AID - 10.1093/jat/25.7.645 [doi]
PST - ppublish
SO  - J Anal Toxicol. 2001 Oct;25(7):645-8. doi: 10.1093/jat/25.7.645.