Trends in MDMA‐related mortality across four countries

Between 2011 and 2017, MDMA-related death rates increased in Australia, Finland, Portugal, and Turkey, coinciding with higher MDMA purity and availability. Across 1,400 deaths in Turkey, 507 in Australia, 100 in Finland, and 45 in Portugal, most decedents were young males (81–94% male; median age 24–27.5 years). Drug toxicity was the primary cause in Australia (61%), Finland (70%), and Turkey (60%), while other causes dominated in Portugal (56%). Only 13–25% of deaths were due to MDMA alone; these had significantly higher blood MDMA concentrations than multiple-drug toxicity deaths. Other drugs commonly detected included stimulants and alcohol in Australia and Finland, benzodiazepines and opioids in Finland, and synthetic cannabinoids and cannabis in Turkey.

Study at a glance

Abstract

Abstract 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.