Methylenedioxymethamphetamine (MDMA)‐related fatal poisoning in Australia, 2016 to 2025: Trends, characteristics and toxicology

Abstract Aims To determine: (1) Population rates of fatal methylenedioxymethamphetamine (MDMA)‐related poisoning over the period 2016–2023, years with high closure rates in the National Coronial Information System (NDIS); (2) the case characteristics of known cases of fatal MDMA‐related poisoning, 2016–2025; and (3) whether there have been changes in case characteristics of known fatal cases in the period pre‐COVID (2016–2019), COVID (2020–2022) and post‐COVID (2023–2025). Design Retrospective study of fatal MDMA‐related poisonings in Australia retrieved from the NDIS, 2016–2025. Setting Australia‐wide. Cases 217 cases of fatal MDMA‐related poisoning. Measurements Population rates, case characteristics, circumstances of death, toxicology, major autopsy findings. Results There was a statistically significant increasing trend in the population rate over 2016–2019 [annual percentage change (APC) = 61.52], and a statistically significant decreasing trend over 2019–2023 (APC = −26.72). The mean age was 33.5 years, and males comprised 170 cases (78.3%). In 179 cases (82.5%) the cause of death was attributed to multiple drug toxicity. The fatal incident occurred in a private setting in 171 cases (78.8%), with 16 (7.4%) occurring at a music festival. The median MDMA blood concentration was 0.41 mg/l (range 0.00–25.0 mg/l). Cases in which death was attributed solely to MDMA toxicity had a higher median MDMA concentration than multiple drug toxicity deaths (1.7 vs. 0.30 mg/l). Psychoactive drugs other than MDMA were detected in 199 cases (91.7%), most commonly other psychostimulants (147, 67.7%) and opioids (98, 45.2%). Cardiomegaly was diagnosed in 33 cases (16.6%) in which the heart was examined, and severe coronary artery disease in 27 (13.6%). There were no statistically significant differences across time periods in age, sex, substance use issues, injecting drug use, intentionality, MDMA concentrations or diagnoses of cardiomegaly. Summary While death rates in Australia from methylenedioxymethamphetamine‐related poisoning have declined from 2019, case characteristics have remained relatively stable.