Division of Forensic Medicine and Drug Abuse Research (DFMDA), Norwegian Institute of Public Health (NIPH), Oslo, Norway.
Forensic Sci Int. 2012 Jun 10;219(1-3):151-7. doi: 10.1016/j.forsciint.2011.12.014. Epub 2012 Jan 17.
During a 6 month period (July 2010-January 2011) we observed 12 fatal intoxications and 22 non-fatal cases related to the drug paramethoxymethamphetamine (PMMA) in Norway (4.8 mill inhabitants). This toxic designer drug, also known as "Death", is occasionally found in street drugs offered as "ecstasy" or "amphetamine". The present study aimed to evaluate the cause of death, and to compare the PMMA blood concentrations in fatal and non-fatal cases. Methods for identification and quantification of PMMA are presented. The median age of fatalities was 30 years (range 15-50) with 67% males; in non-fatal cases 27 years (20-47) with 86% males. In the 12 fatalities, the median PMMA blood concentration was 1.92 mg/L (range 0.17-3.30), which is in the reported lethal range of 0.6-3.1 mg/L in peripheral blood and 1.2-15.8 mg/L in heart blood. In the 22 non-fatal cases, the median PMMA concentration was 0.07 mg/L (range 0.01-0.65). Poly-drug use was frequent both in fatal and non-fatal cases. The PMA concentrations ranging from 0.00 to 0.26 mg/L in both groups likely represented a PMMA metabolite. Three fatalities were attributed to PMMA only, six to PMMA and other psychostimulant drugs, and three to PMMA and CNS depressant drugs, with median PMMA concentrations of 3.05 mg/L (range 1.58-3.30), 2.56 (1.52-3.23) and 0.52 mg/L (0.17-1.24), respectively. Eight victims were found dead, while death was witnessed in four cases, with symptoms of acute respiratory distress, hyperthermia, cardiac arrest, convulsions, sudden collapse and/or multiple organ failure. In summary, all fatalities attributed to PMMA had high PMMA blood concentrations compared to non-fatal cases. Our sample size was too small to evaluate a possible impact of poly-drug use. A public warning is warranted against use and overdose with illegal "ecstasy" or "speed" drugs.
在 2010 年 7 月至 2011 年 1 月的 6 个月期间，我们在挪威（拥有 480 万居民）观察到了 12 例与药物甲氧基苯丙胺（PMMA）有关的致命中毒和 22 例非致命中毒事件。这种有毒的设计药物，也被称为“死亡”，偶尔会在作为“摇头丸”或“安非他命”提供的街头毒品中被发现。本研究旨在评估死因，并比较致命和非致命病例中的 PMMA 血液浓度。本文介绍了 PMMA 的鉴定和定量方法。致命病例的中位年龄为 30 岁（范围 15-50 岁），男性占 67%；非致命病例的中位年龄为 27 岁（范围 20-47 岁），男性占 86%。在 12 例死亡病例中，PMMA 血液浓度中位数为 1.92 毫克/升（范围 0.17-3.30），处于外周血中 0.6-3.1 毫克/升和心脏血中 1.2-15.8 毫克/升的报告致死范围之内。在 22 例非致命病例中，PMMA 浓度中位数为 0.07 毫克/升（范围 0.01-0.65）。在致命和非致命病例中，多药滥用都很常见。两组中浓度范围在 0.00 至 0.26 毫克/升的 PMA 浓度可能代表 PMMA 代谢物。有 3 例死亡归因于 PMMA 单独，6 例归因于 PMMA 和其他苯丙胺类兴奋剂，3 例归因于 PMMA 和中枢神经系统抑制剂，PMMA 浓度中位数分别为 3.05 毫克/升（范围 1.58-3.30）、2.56 毫克/升（范围 1.52-3.23）和 0.52 毫克/升（范围 0.17-1.24）。8 名受害者被发现死亡，而 4 名受害者死亡时出现了急性呼吸窘迫、体温过高、心脏骤停、抽搐、突然衰竭和/或多器官衰竭等症状。总之，与非致命病例相比，所有归因于 PMMA 的死亡病例都具有较高的 PMMA 血液浓度。我们的样本量太小，无法评估多药使用的可能影响。需要对非法“摇头丸”或“速度”药物的使用和过量使用发出公共警告。
