In the period 2000–2019, MDMA was detected in 142/34,639 (0.4 %) of fatalities and 2,377/101,896 (2.3 %) of arrested drug drivers. In ten cases, the national ID number was incorrect or missing and could not be linked. A total of 132 cases had a known cause of death. Figure 1 shows that the percentage of detected cases with MDMA findings in fatalities fell from 2000–2004 to 2010–2014, and rose in the period 2015–2019. There was a similar trend for arrested drug drivers.
The median age of fatalities increased from 26 years (IQR 20 to 31) in 2000–2004 to 32 years (25 to 37) in 2015–2019. There was a smaller change among arrested drug drivers in the same periods, from 24 years (21 to 29) to 27 years (23 to 35). Men made up the majority in both groups throughout the study period (fatalities: 101/132 (76 %); arrested drug drivers: 2,103/2,377 (89 %)).
From 2010 to 2019, the number of seizures increased from 79 to 1,134 and the quantity from 4,400 tablets to 260,700 (22). According to Kripos, the strength of seized powder and crystalline material varied but was often high (average of 84 % in 2019) (22). In the 2000s, the usual content of the tablets was considerably lower (approx. 100 mg/tablet) than in 2019 (177 mg/tablet) (22).
Figure 2 shows the distribution of MDMA concentrations (median and interquartile range) over 5-year periods among fatalities in the study period. The median concentration among fatalities increased from 1.9 µmol/L in 2000–2004 to 3.8 µmol/L in 2015–2019. Similarly, Figure 3 shows the distribution of MDMA concentrations among arrested drug drivers. These were relatively stable over the 20-year period.
The percentage of fatalities with MDMA concentrations higher than 5 µmol/L in the period 2000–2004 was 11/46 (24 %). This increased significantly to 31/68 (46 %) in 2015–2019. There was no significant difference among arrested drug drivers in the two periods (2000–2004: 15/701 (2.1 %); 2014–2019: 19/1,096 (1.7 %)).
Among the fatalities, MDMA was always detected with polydrug use, most often amphetamine and/or methamphetamine. The percentage of post-mortems in which four or more additional substances were detected has increased from the first five-year period (2000–2004: 11/46 (24 %)) to the last five-year period (2015–2019: 32/68 (47 %)). Among arrested drug drivers, there was also an increase in the percentage of cases where four or more additional substances were detected (from 228/488 (32 %) in 2000–2004 to 486/629 (44 %) in 2015–2019).
Among the fatalities with known cause of death, 94/132 (71 %) were categorised as overdoses. T43.6 was stated as the primary diagnosis in 33/94 cases (35 %), and the code F15 was stated in 2/94 cases (2 %) – so 35/94 (37 %) of the overdoses were caused by ingestion of MDMA and/or other CNS stimulants. A total of 20/33 cases (61 %) where T43.6 was stated as the primary intoxicant occurred during the last five years of the study period.
MDMA was detected without other amphetamines in 14/35 (40 %) of the fatalities with T43.6 or F15 as the cause of death code. Among these, the median MDMA concentration was 13.0 µmol/L (IQR 5.5 to 25.5). In the remaining 21/35 (60 %) of fatalities, the median MDMA concentration was 5.3 µmol/L (3.3 to 13.0). The median amphetamine concentration (total of amphetamine and methamphetamine) was 16.0 µmol/L (6.1 to 32.8).
Among the causes of death where overdose was not the primary cause, 38/132 (29 %) were transport and drowning accidents, suicide and intentional self-harm (not caused by overdose), murder and diseases of the circulatory system, but recreational drug use was considered to be contributory to the death in 12 of these. There were consequently a total of 106 deaths related to recreational drugs: 94 overdoses and 12 cases where recreational drug use was an indirect contributory factor to the death. MDMA and/or other CNS stimulants were associated with the death in 35 and 12 cases respectively.