Forensic Science International
May 20, 2011
Jennifer L. Pilgrim, Dimitri Gerostamoulos, Noel Woodford et al.
44 citations
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.
Journal of Analytical Toxicology
May 1, 2011
Jennifer L. Pilgrim, Dimitri Gerostamoulos, Olaf H. Drummer
36 citations
MDMA (ecstasy) is increasingly used and often combined with pharmaceutical drugs, especially serotonergic medications, raising concerns about toxicity and dangerous interactions. A review of all closed coronial cases in Victoria, Australia, from 2002 to 2008 identified 106 fatalities where MDMA was detected. Of these, 43 cases (41%) involved the concurrent use of MDMA with other drugs, including pharmaceuticals that could cause adverse reactions. Four cases were high-risk, involving the combination of MDMA and moclobemide, with additional moderate- and minor-risk cases. These findings underscore the need to recognize and publicize potentially lethal drug interactions, particularly serotonin toxicity.
Journal of analytical toxicology
March 21, 2023
Dimitri Gerostamoulos, Linda Glowacki, Maria Pricone et al.
9 citations
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.
Drug and alcohol review
November 1, 2024
Rebekka Syrjanen, Martin Dutch, Shaun L. Greene et al.
3 citations
At three Australian music festivals in 2022/2023, blood samples from 24 critically ill patrons revealed that unreported illicit drugs or new psychoactive substances were detected in 18 patients. Among these, methylamphetamine was found in 10 patients, cathinones in 7, and benzodiazepine-type new psychoactive substances in 6. The most frequently reported and detected drugs were MDMA, ketamine, and cocaine. The toxicosurveillance network provides additional intelligence for harm reduction, aiming to identify high-risk drug use patterns and inform evidence-based messaging.
Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention
January 21, 2025
Jennifer Schumann, Matthew Di Rago, Noel Woodford et al.
1 citation
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.