Four deaths occurred after people took moclobemide and MDMA ('ecstasy') together. The likely cause of death in each case was serotonin syndrome, a dangerous condition caused by the interaction between the two drugs. None of the victims had a prescription for moclobemide; each apparently took it to boost the effects of MDMA, leading to fatal outcomes. The authors call for warnings against uninformed efforts to enhance the effects of illicit drugs.
Amphetamine, methamphetamine, and MDMA have a similar capacity to cause death when fatal toxicity is expressed as deaths per million doses. In Finland, poisoning deaths from these stimulants correlated significantly with drug consumption measured by wastewater-based epidemiology across the years 2012, 2014, 2016, 2018, and 2020. Methamphetamine showed the highest fatal toxicity (at an estimated 50 mg dose), followed by MDMA (100 mg dose) and amphetamine (50 mg dose). The fatal toxicity of these stimulants was close to that previously reported for many prescription opioids and tricyclic antidepressants. This is the first study to quantitatively compare fatal toxicity of amphetamine-type stimulants by linking deaths with consumption estimates from wastewater.