Comparison of poisoning deaths with wastewater-based consumption estimates and assessment of fatal toxicity for amphetamine-type stimulant drugs.

Amphetamine, methamphetamine, and MDMA have a similar capacity to cause death when fatal toxicity is expressed as deaths per million doses. In Finland, poisoning deaths from these stimulants correlated significantly with drug consumption measured by wastewater-based epidemiology across the years 2012, 2014, 2016, 2018, and 2020. Methamphetamine showed the highest fatal toxicity (at an estimated 50 mg dose), followed by MDMA (100 mg dose) and amphetamine (50 mg dose). The fatal toxicity of these stimulants was close to that previously reported for many prescription opioids and tricyclic antidepressants. This is the first study to quantitatively compare fatal toxicity of amphetamine-type stimulants by linking deaths with consumption estimates from wastewater.

Study at a glance

Abstract

Among several established indicators that are used to monitor the illicit drug scene, drug-related deaths and wastewater-based epidemiology (WBE) stand out for population-level coverage. In this study, we aimed to compare temporal trends with respect to amphetamine, methamphetamine and methylenedioxymethamphetamine (MDMA) revealed by these indicators and explore the differences in fatal toxicity between the stimulants. All deaths in which poisoning caused by amphetamine, methamphetamine or MDMA was either the underlying or contributing cause of death in Finland in 2012, 2014, 2016, 2018 and 2020 were included in the study. Consumption of the studied drugs was measured by WBE in the same years. There was a significant correlation between poisoning and drug consumption for all three stimulants, and for amphetamine and MDMA, these figures increased over the study period. The highest fatal toxicity, as expressed by the number of deaths per million doses, was obtained for methamphetamine at an estimated dose of 50 mg, followed by MDMA (100 mg dose) and with amphetamine (50 mg dose). The fatal toxicity found here for the stimulants was close to that previously reported for many prescription opioids and tricyclic antidepressants. Our study is the first to quantitatively investigate the fatal toxicity of amphetamine-type stimulants by comparing deaths with consumption estimates derived from WBE. It shows that amphetamine, methamphetamine and MDMA possess a quite similar capacity to cause death. This new approach adds to the earlier methods of estimating drug-related harm.