The PMMA epidemic in Norway: comparison of fatal and non-fatal intoxications

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.

The concentrations, appearance and taste of nine sedating drugs dissolved in four different beverages

Sedating drugs are reported to be used in cases where people have been drugged unwittingly. In the present experiments we studied whether nine sedating medicinal drugs would dissolve in four different beverages to reach concentrations which could possibly cause impairment and whether the drugs altered the appearance and taste of the beverages. Nine sedating medicinal drugs were added separately to water, beer, Coca-Cola and ethanol. Drug concentrations were measured 5, 10, 20 and 40 min after spiking. The amount of drug in one swallow (50 mL) was calculated. Appearance and taste were recorded after 10 min. Flunipam, Sobril, Valium and Xanor dissolved faster than Rohypnol, Imovane, Somadril, Rivotril and Dolcontin. Ten minutes after adding Flunipam, Sobril, Imovane (in beer and Coca-Cola), Valium and Xanor, the concentrations had reached more than 50% of maximum theoretical concentration. Most of the drugs caused sediment, pieces and/or turbidity in one or more of the beverages. Some of the solutions were dyed from added Rohypnol (turquoise or green), Dolcontin (red) and Valium (yellow). Flunipam and Valium caused extensive frothing in beer. The tastes of Imovane and Somadril were distinct in all the beverages, while the taste of other drug solutions was less distinct. The ingestion of all solutions could probably have caused impairment. All the nine drugs were, however, apparent to the consumer from the altered appearance and/or taste of the beverages.

Determination of amphetamine and methamphetamine in blood by derivatization with perfluorooctanoyl chloride and gas chromatography/mass spectrometry

A relatively simple method for quantitation of amphetamine and methamphetamine in blood was developed. Blood samples were extracted with cyclohexane, and the extracts were derivatized with perfluorooctanoyl chloride prior to gas chromatography/mass spectrometry. Selected ions were monitored at m/z 118 and 440 for amphetamine, m/z 118 and 454 for methamphetamine, and m/z 121 and 443 for the internal standard amphetamine-d3. The imprecision was less than 5% for amphetamine and less than 9% for methamphetamine. Limits of detection were 11 micrograms/L for amphetamine and 13 micrograms/L for methamphetamine, while limits of quantitation were 22 and 34 micrograms/L, respectively. Calibration curves were linear in the ranges 14-2700 micrograms/L and 15-3000 micrograms/L, respectively. Some drugs that were known or suspected to interfere with immunological or chromatographic methods for amphetamine and methamphetamine were tested for interference. None of the drugs tested interfered, except for a substance in putrefied blood samples, which was found to interfere with one ion (m/z 118) for amphetamine but not with the second ion.