27 fatalities from laboratory-confirmed exposure to PMMA (“Dr. Death”)

April 18, 2015, 2:22 pm

★★★★☆

Deaths from exposure to paramethoxymethamphetamine in Alberta and British Columbia, Canada: a case series. Nicol JJE et al. CMAJ Open. 2015 Jan 13;3(1):E83-9

Full Text

From June 2011 through April 2012, 27 deaths in the Canadian provinces of Albert and British Columbia were attributed to the hallucinogenic stimulant para-methoxy-N-methylamphetamine (PMMA) as the primary toxic agent based postmortem examination and toxicology results. PMMA is so dangerous that it is known on the street as “Death” and “Dr. Death.” This paper constitutes a retrospective review of those cases based on records from the Chief Medical Examiner and Coroners Service of those respective provinces.

in all cases laboratory results confirmed exposure to PMMA. In cases where details were known, all decedents believed they were consuming MDMA (ecstasy). All subjects tested positive for multiple other stimulants, including PMA, MDA, amphetamine, and cocaine.

Since the information about these cases came from the coroner and medical examiner — not from medical records — there is limited clinical information available about these victims, 17 of whom died in hospital. However, some of the details presented here are fascinating:

  • The median initial temperature recorded at hospital was 39.4oC (102.9oF) [highest initial temperature, 43.8oC (110.8oF)]
  • Sixteen of the seventeen patients who survived to arrival at hospital had findings consistent with serotonin syndrome, according to the Hunter criteria. (For more on the Hunter Criteria for the diagnosis of serotonin syndrome, click here.)
  • End-organ dysfunction seen in the patients who survived to hospital included renal failure, rhabdomyolysis, hepatic injury, coagulopathy, cardiac ischemia, and dysrhythmias.

The authors point out that PMMA is similar in structure to MDMA (ecstasy), and that its major pharmacological mechanism is enhancing serotonin release. Given that, the Hunter Criteria for serotonin syndrome includes some specific neuromuscular findings, and I have doubts if much reliable information to this point would be available in records from the coroner or medical examiner.

The online version of this article has links to the alerts issued for health care professionals at the time of these deaths, as well as well as the FAQ information sheet issued by local poison centers to educate the public and the media.

All in all, a very well done article, made much more valuable by the laboratory confirmation of PMMA exposure in all cases. And thanks to the authors for including TPR in their list of references.
Related posts:

Hallucinogenic stimulant PMMA found in “Superman” pills that killed 4 in Britain

Epidemic of PMMA-associated deaths in Norway

Meet “Dr. Death”: PMMA and PMA

Potent stimulant PMMA associated with ecstasy deaths

 

 

 

 

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