Combining MDMA (ecstasy) with moclobemide, a reversible MAO-A inhibitor, can cause fatal serotonin toxicity. Four deaths in Australia are reported where this drug interaction led to symptoms including hyperthermia, hyperkalemia, profuse sweating, twitching, and shaking. Two cases had moclobemide concentrations consistent with prescribed doses, while two had higher, toxic levels. Three of the four individuals had some form of heart disease. Despite known risks, few fatalities from this combination have been documented.
From 2010 to 2019 in Victoria, Australia, methylamphetamine (MA) was the most prevalent drug among fatally and injured drivers, detected in 12.3% of fatalities and 9.1% of injured drivers, with an increasing trend. Overall, 16.8% of car drivers and motorcyclists tested positive for one or more drugs, and 14% of crashes involved a blood alcohol concentration of 0.05% or higher. Among motorcyclist fatalities between 2015 and 2019, MA was detected in 27.9%, followed by THC (18.3%) and alcohol at 0.05% or higher (14.2%). Alcohol detections in fatalities declined but increased among injured motorcyclists and car drivers until 2017. THC detections rose among injured drivers until 2018. MDMA-positive driving decreased among injured drivers and remained stable at about 1% of fatalities. Drug-driving persists despite enhanced road safety measures.