Interpretation of a 3,4-methylenedioxymethamphetamine (MDMA) blood level: discussion by means of a distribution study in two fatalities

The amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy" is a currently used or abused designer drug and fatalities are frequently encountered in forensic practice. However, the question remains open whether an MDMA blood level can be toxic or even potentially lethal. In order to provide insight in the interpretation of a detected MDMA concentration, the distribution of MDMA and its metabolite 3,4-methylenedioxyamphetamine (MDA) in various body fluids and tissues was studied and discussed in two different fatalities. Apart from peripheral blood samples (such as femoral and subclavian blood), various blood samples obtained centrally in the human body and several body fluids (such as vitreous humour) were examined. In addition, various tissues such as cardiac muscle, lungs, liver, kidneys, and brain lobes were analysed. In contrast to the peripheral blood levels, high MDMA and MDA levels were found in cardiac blood and the majority of the organs, except for the abdominal adipose tissue. The high concentrations observed in all lung lobes, the liver and stomach contents indicate that post-mortem redistribution of MDMA and MDA into cardiac blood can occur and, as a result, blood sampled centrally in the body should be avoided. Therefore, our data confirm that peripheral blood sampling remains "the golden standard". In addition, a distinct difference in peripheral blood MDMA concentrations in our two overdose cases was established (namely 0.271 and 13.508 microg/ml, respectively). Furthermore, our results suggest that, if a peripheral blood sample is not available and when putrefaction is not too pronounced, vitreous humour and iliopsoas muscle can be valuable specimens for toxicological analysis. Finally, referring to the various mechanisms of death following amphetamine intake, which can result in different survival times (e.g. cardiopulmonary complications versus hyperthermia), the anatomo-pathological findings and the toxicological results should be considered as a whole in arriving at a conclusion.     

What Ministers Do

Having been a minister in three different departments for a period of over nine years (1999–2008), during the Blair and, briefly, the Brown governments, I thought it might be useful to reflect on what ministers actually do, their functions and how they spend their days. In thinking about what I did as a minister, I have avoided going back to some of the classic constitutional texts on what ministers supposedly do, how they are accountable and such like. I am sure there is good literature on this from political scientists and constitutionalists, but I have avoided influencing my own views and approach by consulting these texts.     

Austerity's Wasted Years

Austerity has become the norm of economic management in the EU, Britain and the USA. In each it is offered as the answer to different problems but everywhere the result is cuts in public spending, higher unemployment and low growth, none of which helps recovery from recession. Labour's response should not be to endorse or continue austerity but to initiate a Keynesian expansionary stimulus based on borrowing and spending on a huge programme of building public housing for rent. This should be accompanied by a competitive exchange rate, an industrial policy to boost the manufacturing sector and a National Investment Bank, the aim being to expand the production base so that it can pay the nation's way in the World and support the structure and the improvements Labour needs. This makes the choice at the next election the issue of what kind of Britain the electorate wants to see: a low wage, mean economy or a determined attempt to rebuild a stronger nation with a more powerful economy.