MDMA Toxicity Differential Diagnoses

Updated: May 30, 2020
  • Author: In-Hei Hahn, MD, FACEP, FACMT; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Diagnostic Considerations

The United Nations Office on Drugs and Crime reports that there are three main types of products sold as MDMA: "ecstasy” tablets that contain little or no MDMA, “ecstasy” tablets with an extremely high content of high-purity MDMA, and “ecstasy” sold in powder/crystal form,under a variety of street names. The tablets with little or no MDMA may contain adulterants or substiutes One such substitute is para-methoxymethamphetamine(PMMA), which has a slower onset of action than MDMA and does not producet he same euphoric/empathogenic effects; this may lead unsuspecting users to assume that the dose is too low and take more, which may lead to potentially fatal intoxication. [22]

In the United States, adulteration of MDMA tablets decreased markedly from 2009 to 2016, with MDMA being the only psychoactive component in almost half of “ecstasy” tablets tested in 2016, versus only 8.7% in 2009). In particular, many fewer tablets are adulterated with stimulants. [22]

Mephedrone (4-methylmethcathinone) is a novel psychoactive substance that produces effects similar to those of MDMA (3,4-methylenedioxymethamphetamine, ecstasy). Use of mephedrone has been associated with adverse effects and fatal intoxications. A study in 12 male volunteers found that mephedrone produced a significant increase in systolic and diastolic blood pressure, heart rate, and pupillary diameter, along with stimulant-like effects, euphoria, and well-being similar the effects of MDMA. However, the effects of mephedrone peaked earlier and were shorter in duration. [26]

Differential Diagnoses