Now this is how you report fatality involving MDMA

Feb 17 2010 Published by under Drug Fatality, MDMA

My readers are no doubt becoming a little bored with this but I assure you I do not bother to blog every one that pops up. Yes, another tragedy. A life cut short at 19 years of age because of the recreational drug MDMA, aka Ecstasy.

Friend Darren Anscombe said: 'Me and him took some.
'We were having a laugh at that time. I went into the kitchen and heard Danny's girlfriend scream.
'I went into the front room and he was lying on the floor, lifeless.'
Mr Anscombe dialled 999 and under instruction from the operator, carried out chest compressions until paramedics arrived.
Mr Anscombe said Daryl had been 'happy' that night but starting 'acting strangely'.

Here is what I like about the reporting on this. They head off much speculation this way:

Dr Barbara Borek, forensic pathologist, said: 'Toxicological analysis has detected the presence of a potentially fatal concentration of MDMA, commonly known as ecstasy.'
Tests showed there was 4,491mg of the drug per litre in his blood.


4,491 mg/L. of MDMA. Useful to know. It helps us continue with our efforts to understand more about lethal thresholds for this frequently used compound. Of course, this is the inquest reporting, not the initial splash but still. There was followup. Good.
Especially given the Facebook tribute page. "died in is (sic) sleep"? not one mention of the drug OD on the Wall? Obit says "passed away suddenly"?
but WOW! I look at that MDMA level and I wonder if perhaps that should be a decimal instead of a comma or if the units have been screwed up. My read of the Case Report literature is that something two orders of magnitude lower would be the range. For example, one that I blogged here reported 1.5 mg/L in a fatality. If you look at the pharmacokinetic data in human experiments a 1.6 mg/kg oral dose of MDMA results in a peak plasma concentration of 255 ng/ml. Another paper reviewed existing lit and reported about 500 ng/ml as the high end in human laboratory studies. Doing the unit conversion shuffle this would be 0.255-0.500 mg/L. Conversely, the 1.5 mg/L in the above mentioned fatal case would be about 1500 ng/ml.
So I'm thinking that perhaps the pathologist reported the blood levels as 4,491 ng/ml and somehow this was translated to the more-typical for human case reports mg/L without the unit conversion.

10 responses so far

  • JohnV says:

    It is a story from Europe so presumably the comma is taking the place of a decimal in our American system.

  • DrugMonkey says:

    You know JohnV I was sort of aware of that so I tried some Googling on the decimal marker. Seemed as though perhaps the official UK standard is to use decimal but then comma demarcation is still fairly common? Could be someone writing the article who is from another country I suppose....

  • JohnV says:

    I know, I thought about the obviousness of my comment right after I hit post :p Units being off as you suggested is just as likely (would still be a big dose but not uh 4.5g/L)
    Anyhow, we went through this on Orac's blog a day or two ago when some Morgellon's crank from Europe had a number in his comment and several people responded acting like seeing a number written in the form of "100.000,00" was the numerical equivalent of seeing an alligator riding a unicorn to the grocery store.

  • Chrisj says:

    I think you'll find it's a unit/order of magnitude error by the reporter. Most of non-English-native-speaking Europe uses commas as a decimal separator, but the UK doesn't, either officially or in common usage. (Most people in the UK are probably unaware that non-English-native-speakers use a comma instead of a point there.)
    (Possibly worth adding that I say this as a UK-native who's aware of the difference in usage primarily because it's an occasional issue in scientific journals.)

  • Lou says:

    As a UK resident I can vouch for this.
    A comma is not used as a decimal separator in the UK.
    And I'm sure that even in The Portsmouth News (or whatever the local paper is called), there are editing standards.

  • Pascale says:

    Regardless of the drug units or decimal points, this guy took a shit-load of MDMA and died.
    I wonder if he saw that alligator riding a unicorn to the grocery store right before he collapsed?

  • DrugMonkey says:

    Pascale, it is, as always, unclear that he took "a shit-load" if by this you mean wildly, outrageously more than either he had before or other people take and do not die. The case reports have deaths from anywhere from ~1 mg/L up to 9 mg/L although I will not claim to have an exhaustive list. (Some at lower amounts but there are questions of timeline from ingestion to the blood collection that suggest one may be looking at something very far from peak drug levels.)
    after this it gets pretty murky because you have to pour through supposed consumption amount in the cases, likely pill content, reported practices from user populations etc. My read is that if mortality was a simply relationship between dose consumed, therefore plasma levels we'd be seeing "a shit load" more deaths. So to shrug off a reported death as "well of course you die if you take that much" does not exactly satisfy. IMO, anyway.

  • Adi says:

    As far as I was aware, MDMA pills (when they actually contain MDMA) can have between 1-20 mg of the stuff in a 200-400 mg pill. Still, a search on ecstasydata.org shows pills with as much as 105mg?! Outside the U.S. of course.
    I guess I'd have to say that in my experience, people take multiple pills sometimes, and an excessively strong one could push them over the edge, depending on metabolic restriction I guess... These cases are relatively rare though.

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