‘ADAM’ or ‘EVE’? — a toxicological conundrum

doi:10.1016/0379-0738(95)01846-8

Forensic Science International

Volume 77, Issues 1–2, 12 January 1996, Pages 101-108

https://doi.org/10.1016/0379-0738(95)01846-8 Get rights and content

Abstract

The 3,4-methylenedioxy ring-substituted amphetamines, including ‘ADAM’ and ‘EVE’, are currently popular drugs of abuse. Adverse reactions are reported in the clinical literature but few fatal cases are documented and little toxicological data is available to guide those determining the cause or manner of death in such cases. We report two deaths presenting in a similar manner and with similar clinical features. Various body fluid samples were analysed for amphetamines by gas chromatography/mass spectrometry. In one case, amphetamine alone was detected at levels of 1.54 mg/l and 1.47 mg/l in postmortem blood and admission serum, respectively. The other involved several 3,4-methylenedioxy ring-substituted amphetamines, namely MDA, MDMA and MDEA, at levels of 0.25 mg/l, 0.43 mg/l and 0.3 mg/l, respectively in postmortem femoral blood and 0.24 mg/l, 0.55 mg/l and 0.49 mg/l in admission blood. The interpretation of these toxicological results and some novel legal issues are discussed.

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Citation Excerpt :
Deaths are related to cardiovascular, cerebrovascular and hyperthermic effects. Pre-existing pathological conditions, such as cardiomyopathy, coronary disease, functional arrythmia and asthma can be aggravated by AMPs due to an arrhythmogenic cardiotoxic effect [10–12]. Considering the death conditions in case 1, the autopsy findings, and the results of the toxicological analysis, the cause of death was certified as toxic effects of MDMA and MDEA.
Until 1997, only one amphetamine related derivatives (AMPs) fatality had been reported in Greece. Since then, amphetamine (AMP) or AMPs have been found in seven out of 1500 post-mortem toxicological cases. The cause and manner of death of these seven cases were: 3,4-methylenedioxy-N-methamphetamine (MDMA) and 3,4-methylenedioxy-N-ethylamphetamine (MDEA) poisoning (n=1), drowning in water (n=4), cranial injuries caused by a traffic accident (n=1) and heart failure (n=1).
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Three fatal cases of MDMA/MDEA misuse have been examined. These referred to white males between 19 and 20 years of age, in which post-mortem toxicology showed the presence of MDMA (in one case), MDEA (in one case) and both (in one case). The clinical data were analysed and the histopathological findings were studied following immunohistochemical investigations. A complete immunohistochemical study has made it possible to demonstrate rhabdomyolysis and myoglobinuria with alterations of the organs typical of a DIC. Clinical, histopathological and toxicological data suggest that severe or fatal complications following ecstasy ingestion could be related to idiosyncratic response.

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‘ADAM’ or ‘EVE’? — a toxicological conundrum

Abstract

Lancet

Lancet

Forensic Sci. Int.

Analytical Procedures for Therapeutic Drug Monitoring and Emergency Toxicology