A fatal paramethoxymethamphetamine intoxication
Introduction
The ring-methoxylated phenethylamine derivatives paramethoxyamphetamine (PMA) and paramethoxymethamphetamine (PMMA) are structurally related to mescaline and to the compounds of the so-called ecstasy group including 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA) and 3,4-methylenedioxyethylamphetamine (MDEA). PMA and PMMA, two powerful stimulants, are cheaper and easier to manufacture than ecstasy and far more dangerous. These drugs all exhibit hallucinogenic properties. During the last years in Germany a marked increase in the use of amphetamines such as ecstasy has been observed. The use of these recreational drugs is especially common among young people participating in rave parties. Occasionally PMA and PMMA occur among pills being sold as ecstasy. Many of these pills are stamped with a three-diamond Mitsubishi logo.
Section snippets
Case history
A 22-year-old man died after the ingestion of ecstasy pills containing PMMA and PMA. The young man was witnessed to be hallucinating at a party. Later, he started to convulse and developed respiratory distress. An ambulance was called but an attempted resuscitation failed. Police inquiry revealed that the deceased had a past history of occasional use of cannabis. At autopsy no evidence of any disease that might have caused death was found. A typical mark of venipuncture was seen on the left
Experimental
Screening of urine was performed using fluorescence polarization immunoassay (FPIA) on the Abbott ADx analyzer (amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, opiates, tricyclics), the automated drug-profiling system REMEDi (Bio-Rad Laboratories) and gas chromatography–mass spectrometry (GC/MS). Ethanol was quantified by means of standard GC (head space) and enzymatic (ADH) methods. Quantification was done with a routinely used analytical method for the
Results and discussion
Routine screening of urine by immunoassay techniques revealed the presence of a high level of amphetamines and trace amounts of cocaine metabolites. HPLC screening of urine with REMEDi identified parahydroxymethamphetamine. It is used in Germany for the treatment of hypotension and available without prescription (Pholedrin). The second larger peak could not be identified by the REMEDi library. The following GC/MS screening of urine then identified high amounts of PMA and PMMA as well as
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