Differences in the clinical presentation of acute 3,4-methylenedioxymetamfetamine intoxication by co-intoxication and patient sex to European emergency departments.
Joep J. J. Ouwerkerk, David M. Wood, Alison M. Dines, Christopher Yates, Florian Eyer, Fridtjof Heyerdahl, Isabelle Giraudon, Knut Erik Hovda, Matthias E. Liechti, Òscar Miró, Odd Martin Vallersnes, Paul I. Dargan, F. M. J. Gresnigt, Monia Aloise, Jacek Sein Anand, Kurt Anseeuw, Erato Antoniou, Robertas Badaras, George Bailey, Marcin Bitel, Jeffrey Bonnici, Miran Brvar, Blazena Caganova, Feriyde Calýskan, Alessandro Ceschi, David Curtelin, Laurence Daveloose, Miguel Galicia, Birgit Gartner, Ketevan Gorozia, Damjan Grenc, Laura Hondebrink, Gesche Jürgens, Jutta Konstari, Soso Kutubidze, Gabija Laubner, Evangelia Liakoni, Viesturs Liguts, Cathelijne Lyphout, Roy McKenna, Bruno Mégarbane, Adrian Moughty, Gabriela Viorela Nitescu, Roberta Noseda, Niall O’Connor, Raido Paasma, Juan Ortega Perez, Marius Perminas, Per Sverre Persett, Kristiina Põld, Erik Puchon, Jordi Puiguriguer, Julia Radenkova-Saeva, Jan Rulisek, Perla Sader, Caroline Samer, Yasmin Schmid, Irene Scholz, Roberts Stašinskis, Jonas Surkus, Irma Van den Hengel-Koot, Federico Vigorita, Severin Vogt, William Stephen Waring, Ioanna Yiasemi, Sergej Zacharov, Tobias Zellner
Clinical toxicology (Philadelphia, Pa.) March 1, 2025 DOI: 10.1080/15563650.2025.2453052 via PubMed
Summary
AI-generated from the abstractWhen 3,4-methylenedioxymetamfetamine (MDMA) is taken with alcohol, emergency department visits show higher odds of agitation, drowsiness, and vomiting compared to MDMA alone. Co-intoxication with other substances increases odds of bradycardia, psychosis, and coma. Mortality rates remain low across all groups. Female patients report less chest pain but more vomiting, headache, and hypotension than males. These variations suggest that physicians should consider both the type of co-intoxication and patient sex to optimize treatment.
Study at a glance
| Characteristics | Retrospective analysis Peer reviewed |
|---|---|
| Sample size | 4,102 |
| Population | Emergency department presentations with acute drug intoxication from 28 sentinel centres in 18 European countries |
| Topics | MDMA |
| Keywords | Drug toxicology Substance abuse MDMA Effects Emergency medicine 3,4-methylenedioxymet-amfetamine |
| Citations | 1 |
| Key finding | Co-intoxication with ethanol or other substances and patient sex are associated with distinct clinical features in acute MDMA intoxication, though mortality risk remains low. |
Abstract
This study hypothesized that 3,4-methylenedioxymetamfetamine intoxication presents with distinct clinical features and outcomes when combined with other substances of misuse, compared to mono-3,4-methylenedioxymetamfetamine intoxication. This study investigated the clinical presentation of acute mono-3,4-methylenedioxymetamfetamine intoxication, 3,4-methylenedioxymetamfetamine intoxication with exclusive co-usage of ethanol, and 3,4-methylenedioxymetamfetamine-co-intoxication with co-usage of other substances with or without ethanol, with a focus on patient sex differences. A retrospective analysis was conducted using the Euro-DEN Plus database (2013-2022), which collects data on emergency department presentations with acute drug intoxication from 28 sentinel centres in 18 European countries. Odds ratios for clinical features were calculated for the three study groups with mono-3,4-methylenedioxymetamfetamine intoxication as the reference group. A sub-analysis explored patient sex differences in clinical features. Among 4,102 presentations, 3,4-methylenedioxymetamfetamine-ethanol intoxication (n = 1,376) was associated with increased odds of agitation (OR: 1.34), drowsiness (OR: 2.30), and vomiting (OR: 1.85) compared to mono-3,4-methylenedioxymetamfetamine intoxication (n = 359). 3,4-Methylenedioxymetamfetamine-co-intoxication (n = 2,367) was associated with higher odds of bradycardia (OR: 3.14), psychosis (OR: 1.91), and coma (OR: 1.72). Mortality rates did not significantly differ across groups. Females reported a lower incidence of chest pain (OR 0.78) while reporting higher rates of vomiting (OR: 1.64), headache (OR: 1.61), and hypotension (OR: 1.89) compared to males. The variation in clinical manifestation of acute 3,4-methylenedioxymetamfetamine intoxication is associated with co-intoxication and patient sex. Co-intoxication with ethanol or other substances was associated with an increased incidence of more severe symptoms, such as agitation and psychosis, necessitating tailored management. These variations suggest the need for physicians to consider the type of co-intoxication and patient sex to optimize treatment strategies. Although co-intoxication affected the clinical trajectory, the mortality risk remains low. Ethanol co-intoxication, co-intoxication with other substances of misuse, and patient sex were associated with varying clinical presentations in the emergency department, necessitating tailored treatment approaches.