PMID- 33739562
OWN - NLM
STAT- MEDLINE
DCOM- 20211008
LR  - 20211008
IS  - 1360-0443 (Electronic)
IS  - 0965-2140 (Linking)
VI  - 116
IP  - 11
DP  - 2021 Nov
TI  - Trends in MDMA-related mortality across four countries.
PG  - 3094-3103
LID - 10.1111/add.15493 [doi]
AB  - 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.
CI  - (c) 2021 Society for the Study of Addiction.
FAU - Roxburgh, Amanda
AU  - Roxburgh A
AUID- ORCID: 0000-0001-8609-0075
AD  - Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia.
AD  - Discipline of Addiction Medicine, the Central Clinical School, Sydney Medical 
      School, the Faculty of Medicine and Health, University of Sydney, Sydney, 
      Australia.
AD  - National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
FAU - Sam, Bulent
AU  - Sam B
AD  - Member of the Council of Mortality Related Cases, the Council of Forensic 
      Medicine of Ministry of Justice, Turkey.
FAU - Kriikku, Pirkko
AU  - Kriikku P
AD  - Forensic Toxicology Unit, Finnish Institute for Health and Welfare, Helsinki, 
      Finland.
AD  - Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
FAU - Mounteney, Jane
AU  - Mounteney J
AUID- ORCID: 0000-0002-9612-5179
AD  - European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, 
      Portugal.
FAU - Castanera, Antonio
AU  - Castanera A
AD  - Servico de Quimica e Toxicologia Forenses do Instituto Nacional de Medicina Legal 
      e Ciencias Forenses, Lisboa, Portugal.
FAU - Dias, Mario
AU  - Dias M
AD  - Servico de Quimica e Toxicologia Forenses do Instituto Nacional de Medicina Legal 
      e Ciencias Forenses, Lisboa, Portugal.
AD  - Laboratorio de Ciencias Forenses e Psicologicas Egas Moniz, Almada, Portugal.
FAU - Giraudon, Isabelle
AU  - Giraudon I
AD  - European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, 
      Portugal.
AD  - University NOVA and National School of Public Health, Lisbon, Portugal.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210415
PL  - England
TA  - Addiction
JT  - Addiction (Abingdon, England)
JID - 9304118
RN  - KE1SEN21RM (N-Methyl-3,4-methylenedioxyamphetamine)
SB  - IM
MH  - Adult
MH  - Australia/epidemiology
MH  - Finland/epidemiology
MH  - Humans
MH  - Minority Groups
MH  - *N-Methyl-3,4-methylenedioxyamphetamine
MH  - Portugal
MH  - Young Adult
OTO - NOTNLM
OT  - Drug-related deaths
OT  - MDMA
OT  - ecstasy
OT  - mortality
OT  - toxicity
OT  - toxicology
EDAT- 2021/03/20 06:00
MHDA- 2021/10/09 06:00
CRDT- 2021/03/19 12:31
PHST- 2021/01/11 00:00 [revised]
PHST- 2020/09/24 00:00 [received]
PHST- 2021/03/10 00:00 [accepted]
PHST- 2021/03/20 06:00 [pubmed]
PHST- 2021/10/09 06:00 [medline]
PHST- 2021/03/19 12:31 [entrez]
AID - 10.1111/add.15493 [doi]
PST - ppublish
SO  - Addiction. 2021 Nov;116(11):3094-3103. doi: 10.1111/add.15493. Epub 2021 Apr 15.