Two Decades of Ecstasy: Shifting Demographic Trends in Decedents Using MDMA

Abstract

Abstract Deaths associated with the party drug, 3,4-methylenedioxymethamphetamine (MDMA), over the 20-year period from 2000 to 2019 in San Francisco are presented to identify shifting demographic trends. Of the 148 cases, 129 (87.2%) were male with mean and median ages of 30 and 28 years, respectively. The most common manner of death (MOD) in males was homicide (65 of 129) and accident (49 of 129). The most common MOD in females was accident (15 of 19). Regarding racial demographics, Black homicide deaths accounted for 59 of 67 (88.1%) total homicides. The most prevalent cause of death for homicides was gunshot wounds (63 of 67, 94.0%). Homicide prevalence was high in the first decade of the study (53 of 88, 60.2%), sharply dropping off after 2011. White accidental deaths made up most of the accidental deaths (45 of 64, 70.3%). Since 2015, accidental deaths with MDMA began to rise (40 of 60, 66.7%)—most with other coingestants. Similar MDMA concentrations (median, mean ± SD) were observed between homicide (290, 450 ± 490 ng/mL) and accidental (250, 680 ± 1,120 ng/mL) deaths. MDMA concentrations were elevated in central blood compared to peripheral blood from unmatched cases. MDMA was detected in a variety of decedents during the two decades within 2000-2019, with primarily young Black male gunshot wound homicide victims in the first decade and primarily young White male accidental polydrug victims in the second decade. This study demonstrates that MDMA is no longer confined to a party setting, but can also be found in different socioeconomic strata, including its association with violent homicidal deaths.