Over nine months, six deaths involved the combination of two new psychoactive substances: 4-fluoroamphetamine (4FA) and 25C-NBOMe. Four deaths were directly caused by the drugs' adverse effects, one resulted from a fall while intoxicated, and one occurred during restraint. In the four direct drug-caused fatalities, postmortem blood concentrations ranged from 330 to 682 ng/L for 4FA and 1.4 to 12 ng/mL for 25C-NBOMe. None of the cases showed concentrations suggesting high recreational doses. Other drugs were present in most cases, but the two substances together were considered the primary triggers. Agitation or aggression preceded collapse in two cases, and seizures possibly occurred in three.
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.