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Presentation of MDMA use and seizure data (market indicators).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Australia, Finland, Portugal and Turkey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Cases<\/jats:title>\n                    <jats:p>All deaths in which MDMA was considered by the forensic pathologist to be contributory to death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Information collected on cause and circumstances of death, demographics and toxicology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      A total of 1400 MDMA\u2010related deaths were identified in Turkey, 507 in Australia, 100 in Finland and 45 in Portugal. The median age ranged from 24 to 27.5\u00a0years, 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                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0309, 61%), Finland (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a070, 70%) and Turkey (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0840, 60%) and other causes in Portugal (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a025, 56%). Minorities of all deaths across the countries were due to MDMA toxicity alone (13\u201325%). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Deaths related to 3,4 methylenedioxymethamphetamine (MDMA) increased in Australia, Finland, Portugal and Turkey between 2011 and 2017. Findings show MDMA toxicity alone can be fatal, but multiple drug toxicity remains more prevalent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.15493","type":"journal-article","created":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T07:30:55Z","timestamp":1616139055000},"page":"3094-3103","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Trends in MDMA\u2010related mortality across four countries"],"prefix":"10.1111","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8609-0075","authenticated-orcid":false,"given":"Amanda","family":"Roxburgh","sequence":"first","affiliation":[{"name":"Behaviours and Health Risks Program Burnet Institute  Melbourne Australia"},{"name":"Discipline of Addiction Medicine, the Central Clinical School, Sydney Medical School, the Faculty of Medicine and Health University of Sydney  Sydney Australia"},{"name":"National Drug and Alcohol Research Centre UNSW  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bulent","family":"Sam","sequence":"additional","affiliation":[{"name":"Member of the Council of Mortality Related Cases, the Council of Forensic Medicine of Ministry of Justice  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pirkko","family":"Kriikku","sequence":"additional","affiliation":[{"name":"Forensic Toxicology Unit Finnish Institute for Health and Welfare  Helsinki Finland"},{"name":"Department of Forensic Medicine University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9612-5179","authenticated-orcid":false,"given":"Jane","family":"Mounteney","sequence":"additional","affiliation":[{"name":"European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)  Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Castanera","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Quimica e Toxicologia Forenses do Instituto Nacional de Medicina Legal e Ci\u00eancias Forenses  Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Dias","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Quimica e Toxicologia Forenses do Instituto Nacional de Medicina Legal e Ci\u00eancias Forenses  Lisboa Portugal"},{"name":"Laborat\u00f3rio de Ci\u00eancias Forenses e Psicol\u00f3gicas Egas Moniz  Almada Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Giraudon","sequence":"additional","affiliation":[{"name":"European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)  Lisbon Portugal"},{"name":"University NOVA and National School of Public Health  Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,15]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"United Nations Office on Drugs and Crime (UNODC).World Drug Report 2020. 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