Roxburgh, AmandaSam, BulentKriikku, PirkkoMounteney, JaneCastañera, AntonioDias, MárioGiraudon, Isabelle2023-03-062023-03-062021Roxburgh, A., Sam, B., Kriikku, P., Mounteney, J., Castanera, A., Dias, M., & Giraudon, I. (2021). Trends in MDMA-related mortality across four countries. Addiction (Abingdon, England), 116(11), 3094–3103.http://hdl.handle.net/10400.26/44025Findings: A total of 1400 MDMA-related deaths were identified in Turkey, 507 in Australia, 100 in Finland and 45 in Portugal. The median age ranged from 24 to 27.5 years, and males represented between 81 and 94% of the deaths across countries. Standardized mortality rates significantly increased across all four countries from 2011 to 2017 during a period of increased purity and availability of MDMA. The underlying cause of death was predominantly due to drug toxicity in Australia (n = 309, 61%), Finland (n = 70, 70%) and Turkey (n = 840, 60%) and other causes in Portugal (n = 25, 56%). Minorities of all deaths across the countries were due to MDMA toxicity alone (13-25%). These deaths had a significantly higher blood MDMA concentration than multiple drug toxicity deaths in Australia, Finland and Turkey. Drugs other than MDMA commonly detected were stimulants (including cocaine, amphetamine and methamphetamine) (Australia 52% and Finland 61%) and alcohol (Australia 46% and Portugal 49%). In addition to MDMA toxicity, benzodiazepines (81%) and opioids (64%) were commonly identified in these deaths in Finland. In comparison, synthetic cannabinoids (15%) and cannabis (33%) were present in a minority of deaths in Turkey.engDrug-related deathsMDMAEcstasyMortalityToxicityToxicologyjournal article10.1111/add.15493