Rambam Health Care Campus, Israel Poison Information Center, Haifa, Israel.
Clin Toxicol (Phila). 2012 Jan;50(1):39-43. doi: 10.3109/15563650.2011.635148. Epub 2011 Dec 13.
Paramethoxymethamphetamine (PMMA) is a hallucinogenic synthetic substituted amphetamine that was not included in the Israeli Controlled Substance Act (CSA).
To report a severe PMMA and paramethoxyamphetamine (PMA) outbreak.
The Israeli national forensic toxicology laboratory analyzes the body fluids of unnatural deaths by means of screening immunoassays and chromatographic confirmation and quantification. Samples are referred to this laboratory by the Israeli Forensic Medicine Institute and by hospitals following consultation with the Israel Poison Information Center. The forensic toxicology laboratory began determining PMMA and PMA in February 2007. In all fatal cases with a positive immunoassay screen for amphetamines, a chromatographic analysis of PMA and PMMA was performed. The laboratory and demographic data of consecutive patients in whom PMMA or PMA were detected, were collected during 1 year and subjected to descriptive analysis.
Of 108 fatal cases with a positive screen for amphetamines, 32 were confirmed. Twenty-four of the 32 cases tested positive for PMMA and PMA--age 27 ± 5 years, 79.2% males, post mortem whole blood PMMA and PMA concentrations 0.35 ± 0.24 and 2.72 ± 1.67 mcg/mL, respectively. Co-exposures were detected in 17 (70.8%) fatalities; including methylenedioxymethamphetamine, methylenedioxyamphetamine, cocaine, cannabinoids, cathinone derivatives, ephedrine/pseudoephedrine, opiates, and ethanol. In addition, five non-fatal male cases were identified; age 32 ± 5 years, four had co-exposures to cocaine, cathinone derivatives, and cannabinoids. These findings led to the inclusion of PMMA in the CSA in July 2007, resulting in only three more fatalities in the following year.
We report an outbreak of PMMA and PMA poisoning resulting in 24 fatalities, and the post mortem whole blood and urine concentrations of these two compounds. PMA was probably the result of PMMA metabolism. Stimulant co-exposures may have contributed to the severity of the poisoning.
Forensic laboratory and poison center co-operation is important in identifying a new drug of abuse.
甲氧基苯丙胺（PMMA）是一种致幻性合成苯丙胺类兴奋剂，未被列入以色列《管制物质法》。
报告 PMMA 和对甲氧基苯丙胺（PMA）的严重爆发事件。
以色列国家法医毒理学实验室通过筛选免疫分析和色谱确证和定量分析来分析非自然死亡的体液。以色列法医研究所和在与以色列中毒信息中心协商后，将样本转交给该实验室。法医毒理学实验室于 2007 年 2 月开始测定 PMMA 和 PMA。在所有阿片剂免疫分析呈阳性的致命病例中，均进行了 PMA 和 PMMA 的色谱分析。在一年内收集了连续检测到 PMMA 或 PMA 的患者的实验室和人口统计学数据，并进行了描述性分析。
在 108 例阿片剂免疫分析呈阳性的致命病例中，有 32 例得到证实。在 32 例病例中，有 24 例对 PMMA 和 PMA 呈阳性，年龄 27 ± 5 岁，79.2%为男性，死后全血 PMMA 和 PMA 浓度分别为 0.35 ± 0.24 和 2.72 ± 1.67 mcg/mL。在 17 例（70.8%）致命病例中检测到共同暴露，包括亚甲二氧基甲基苯丙胺、亚甲二氧基苯丙胺、可卡因、大麻素、卡西酮衍生物、麻黄碱/伪麻黄碱、阿片类药物和乙醇。此外，还发现了 5 例非致命男性病例，年龄 32 ± 5 岁，其中 4 例共同暴露于可卡因、卡西酮衍生物和大麻素。这些发现导致 PMMA 于 2007 年 7 月被列入《管制物质法》，随后的一年中仅发生了另外 3 例死亡。
我们报告了一起 PMMA 和 PMA 中毒暴发事件，导致 24 人死亡，并报告了这两种化合物的死后全血和尿液浓度。PMA 可能是 PMMA 代谢的结果。兴奋剂的共同暴露可能导致了中毒的严重性。
法医实验室和中毒中心的合作对于识别新的滥用药物非常重要。
