Recent Paramethoxymethamphetamine (PMMA) Deaths in Taiwan

Abstract

Paramethoxyamphetamine (PMA) and paramethoxymethamphetamine (PMMA) are methoxylated phenylethylamine derivatives that have been banned in Taiwan since December 2005. The case history and pathological and toxicological findings of eight recent PMMA fatalities were investigated. All specimens from these cases were initially identified by an AxSYM fluorescence polarization immunoassay screening test for amphetamines with a 300 ng/mL cutoff. Specimens screened positive were confirmed and quantitated by gas chromatography-mass spectrometry. The mean age of these PMMA-related fatalities was 18.9 +/- 4.4 years in the range of 14-25. Seven (87.5%) of these eight cases were men. The mean, standard deviation, and range of PMA found in the heart blood collected from these 8 cases were 0.213, 0.144, and 0.079-0.489 microg/mL, respectively. The corresponding data for PMMA were 4.312, 4.806, and 1.208-15.824 microg/mL, respectively. Other drugs, such as MDA, MDMA, ketamine, norketamine, hydroxymidazolam, methamphetamine, and pentobarbital, were also found in these cases.

Linking the pharmacological content of ecstasy tablets to the subjective experiences of drug users

“…However, most studies on subjective effects of BZP were done in healthy, drug-naive volunteers and doses were not determined in the present study, important factors which might contribute to the differences in effects found and make comparisons difficult. The adverse subjective effects reported in this study after ingestion of tablets containing MDMA with PMMA largely support the existing toxicological findings by others of casualties and fatalities after consumption of PMMA or its metabolite PMA (Caldicott et al 2003;Johansen et al 2003;Becker et al 2003;Lin et al 2007). Extreme hyperthermia was described as one of the symptoms of PMMA intoxication, especially in crowded environments (Rohanova and Balikova 2009;Páleníček et al 2011).…”

Enantiomeric profiling of chiral drug biomarkers in wastewater with the usage of chiral liquid chromatography coupled with tandem mass spectrometry

“…Even though PMA is a minor metabolite of PMMA, as reported by Lin et al2007, most PMMA is excreted unchanged in the urine. So, PMA could be a suitable biomarker only for PMA intake [24].…”

Surveillance of emerging drugs of abuse in Hong Kong: validation of an analytical tools

“…Nevertheless, PMMA is a highly toxic methamphetamine derivative that has been sold on the drug market as MDMA (3,4-methylenedioxymethamphetamine) substitute. 8 The drug has been reported to have caused up to 90 fatalities worldwide over the years, including eight fatalities in Taiwan. 8,17 In particular, PMMA-associated fatalities have also been reported recently in Hong Kong.…”

“…8 The drug has been reported to have caused up to 90 fatalities worldwide over the years, including eight fatalities in Taiwan. 8,17 In particular, PMMA-associated fatalities have also been reported recently in Hong Kong. 6 On the other hand, TFMPP is a piperazine derivative with mild hallucinogenic effects and, when taken with another piperazine derivative benzylpiperazine (BZP), causes ecstasy-like effects.…”

“…7 Some of these novel drugs pose a significant health threat and numerous fatalities have been reported worldwide. [8][9][10] In particular, PMMA and the NBOMe drugs have been associated with severe clinical toxicity and fatalities in Hong Kong. 6,7 Effective diagnosis and treatment of emerging DOA intoxication rely on the timely and accurate detection of these substances.…”