From the UK: Hospitalisations and deaths associated with Ecstasy-like tablets

From the UK: Hospitalisations and deaths associated with Ecstasy-like tablets

Below is an information note from the Chief Medical Officer in the UK.

There have been recent reports across regions in the UK of cases of hospitalisations, and sudden deaths, linked to the use of ecstasy-like pills.

It has been reported that pills taken by those affected have contained, either alone or in combination, para-methoxyamphetamine (PMA), MDMA (the usual active ingredient expected in ‘ecstasy’ pills), or other ecstasy-like stimulants.

Individuals who consume ecstasy-like tablets will not normally know whether their pills really do contain MDMA, PMA or some other ecstasy-like drug(s). The pills reported in the recent cases have been described with a variety of colours and with a variety of different logos stamped on them.

PMA has similar effects to MDMA. Both can make users feel alert, alive and full of energy, and can create feelings of closeness to others. Both can increase body temperature and cause dehydration. However, PMA is stronger than MDMA and it poses an additional risk because its effects can take longer to be felt. Because of this delay, some users who believe they are taking MDMA, may overdose by prematurely taking additional PMA pills to compensate for an apparent lack of effect. Like MDMA, PMA can cause a fatal rise in body temperature; and, as with MDMA, users should always be careful to regulate their level of physical activity and their fluid intake. PMA and MDMA are Class A drugs under the Misuse of Drugs Act.

The following presentations represent the instances when people are most likely to benefit from clinical attention:

• Acute toxic effects should be managed symptomatically and may need urgent referral to A&E.
• Less severe or less acute physical or psychological problems should be assessed and managed symptomatically as for any other users of psychoactive drugs.
  • Some may attend after recent use with a temporary 'comedown' with low mood, requiring appropriate reassurance, support and monitoring
  • Those who have started to show signs of dependence from more regular use may need referral for assessment at specialist substance misuse services.
  • Others may present with physical or psychological symptoms that they believe might be linked to their drug use, in which case, appropriate diagnostic assessments are needed as per normal clinical practice.

To report any new similar cases, or to report any potentially useful additional intelligence concerning drug use or clinical risks in affected cases, or to report any confirmed chemicals found on testing in affected cases, please contact Dr Mark Prunty or Stewart Killala at the Department of Health’s Drugs Policy team, so that suitable information can be shared with relevant agencies, and to help in assessment of the need for any further action.

Q1. What is PMA?
PMA is similar to MDMA (the active ingredient in ecstasy). It can make users feel alert, alive and full of energy. Its similarity means that PMA is actually sometimes sold as ecstasy.

Q2.What are the effects of PMA?
PMA has similar, but stronger effects, to MDMA, although they do take longer to develop:

• An energy buzz that can make users feel alert and alive.
• Feeling in tune with surroundings.
• Sounds and colours are more intense.
• Feelings of great love for friends and strangers

The effects of PMA can a take a while to kick-in so there’s a risk of the user double-dosing to compensate,
risking a fatal overdose. Other risks include:

• Increase in blood pressure and pulse rates.
• Feelings of paranoia and depression.
• Muscle spasms and users have reported feeling very sick after taking it
• Overheating and dehydration, so users should take regular breaks to cool down and should keep hydrated.

Q3. What are the street names for PMA?
Because of its similarity to MDMA, the active ingredient in ecstasy, PMA is often sold as ecstasy pills rather than sold by its own name. So the majority of street names associated with PMA are actually street names
for ecstasy pills. These include Red Mitsubishi, Pink McDonalds, Pink Ecstasy, Mitsubishi turbo, Killer, Dr Death, double stacked, Chicken Yellow, Chicken Fever.

Q4. Is PMA legal?
PMA is a Class A drug which means possession can result in up to seven years in prison and/or an unlimited fine. While supplying someone else, even friends, can result in a life sentence and/or an unlimited fine. (This is UK-related information).

Q5. How should symptoms of the use of PMA be treated?
Those with acute toxic effects should be managed symptomatically and may need urgent referral to A&E. Less acute physical or psychological problems should be assessed and managed as for any other users of
psychoactive drugs.

Some patients may present early with a temporary 'comedown' and low mood from recent drug use, and may just need reassurance, support and monitoring. Others may have started to show signs of dependence and
need specialist assessment. Others may present with physical or psychological symptoms that they believe may be linked to their drug use, in which cases, appropriate diagnostic assessments are needed, as per normal clinical practice.

Source: Department of Health, United Kingdom

Click here for further information on PMA