MDMA-related deaths: About 3 cases

MDMA is currently regaining popularity, especially in festive context. In this context, MDMA is usually consumed [1] with other psychostimulants, including cocaine, to increase level of vigilance, and/or [2] with cannabis and alcohol, in order to prolong the feeling of well-being, and/or with sedatives [3], especially benzodiazepines, in order to manage side effect [1]. Currently, the degree of purity together with the MDMA content of Ectasy resold on the clandestine market increases [2]. Although fatalities stills considered rare [1], the authors report three cases of death related to massive MDMA uptake in the south of France during the summer of 2018. Case 1: 29-year-old man found dead in his swimming pool after a party; the initial diagnosis was drowning. Cases 2 and 3: a 17-year-old man (case 2) and his girlfriend (case 3), aged 18, are found dead in their studio by the young man's parents, last contact dated from the night before. Autopsies, performed the day after the discovery in all three cases, showed only diffuse polyvisceral congestion, and no sign of drowning in case 1. For cases 1 and 2, usual toxicological samples, including fluorinated peripheral blood were send to the laboratory (for case 1, a pool water sample was taken). In case 3, analyzes were performed in urine and lung exsudate as no blood sample was available. Screenings (including NPS) were performed using LC-HRMS. Alcohols were analyzed by HS-GC-FID, illicit drugs by GC-MS and LC-MS/MS. For the case 1, strontium was measured in blood and pool water sample using ICP-MS. Analyzes show the following results (Table 1). In all three cases, death was attributed to MDMA (the drowning diagnosis was ruled out in case 1). The blood levels found in MDMA users after usual single oral dose (125 mg) are generally between 20 and 250 μg/L. Concentrations in MDMA-related deaths range from 478 to 53,900 μg/L for MDMA alone and from 40 to 41,000 μg/L in cases of polydrug use [3]. In the context of a recent upsurge in MDMA consumption, three cases confirm that health monitoring stills necessary to promote information, prevention, risk reduction and learning of the effects management for potential users and health professionals.