Sydney Morning Herald
by Nick O'Malley
Sept 30, 2004
A hallucinogen sold in pill form and mistakenly taken by party-goers as ecstasy has caused a series of collapses and one near-fatality in inner Sydney, causing alarm at St Vincent's Hospital's emergency department. "It's a toxic, nasty drug," said Gordian Fulde, director of emergency medicine, describing para-methoxyamphetamine, or PMA.
Last Friday night, a man whose temperature had soared into the 40s - 41 degrees is considered serious hyperthermia - almost died as doctors fought to resuscitate him in the hospital's intensive care ward. "We got him around but it was touch-and-go there for at least 24 hours," Professor Fulde said.
As with a handful of other overdose victims treated over the past two weeks, he believes the man had taken the hallucinogenic stimulant, which increases blood pressure, temperature and pulse rates.
"When it goes bad it acts very differently on the patient than any of the other [recreational] drugs. None of the other ones melt you down like that," Professor Fulde said. "Basically what happens is you just cook from inside. The actual machinery inside each cell just melts down and bursts and that is the end of it."
The victims told doctors they had taken red ecstasy-type pills, stamped with the three-triangled Mitsubishi symbol. Websites around the world carry warnings stretching as far back as 2001 of red Mitsubishi pills causing PMA overdoses and in some cases death. The AIDS Council of NSW yesterday issued a warning about the drug, fearing people attending this weekend's Sleaze Ball, and its associated recovery parties, may be at risk.
"ACON's harm minimisation messages in the lead-up to this weekend's Sleaze 2004 have focussed on crystal meth and GHB, but the appearance of this relatively new drug is of major concern. We would urge everyone to be extremely cautious," said the council's chief executive, Stevie Clayton. Because the onset of the psychoactive affect of PMA is slow compared with MDMA, or ecstasy, some users are taking second and third doses before their first even hits them.
Compounding the problem for emergency teams, one of most common drugs used in the resuscitation and intubation of overdose victims reacts with PMA, amplifying its effects. Professor Fulde believes other victims with milder reactions may have passed through the St Vincent's emergency department. He has briefed staff on how to detect and treat overdose patients, but formal protocols have yet to be drawn up. "St Vincent's now knows PMA," he said yesterday.
Professor Fulde was first alerted to the drug's presence in Australia by David Caldicott, an emergency research fellow at Royal Adelaide Hospital, who warned of a recent police seizure. Dr Caldicott co-wrote a research paper on PMA after its use in Adelaide in 2000 left one young man dead. He says the Sydney experience should sound warning bells in emergency departments Australia-wide.
"It is not only alarming for the person who has overdosed, it is also alarming for the medical professional as well. "You do not expect these kids to die, and they will, and there is nothing scarier than watching people's lives slip between your hands, it is absolutely traumatic for the medical people involved," he said. "If [Sydney doctors] have a PMA problem on their hands, they have a big problem on their hands."
IN A SPIN
The effects of Red Mitsubishi
Last Friday night, a man whose temperature had soared into the 40s - 41 degrees is considered serious hyperthermia - almost died as doctors fought to resuscitate him in the hospital's intensive care ward. "We got him around but it was touch-and-go there for at least 24 hours," Professor Fulde said.
As with a handful of other overdose victims treated over the past two weeks, he believes the man had taken the hallucinogenic stimulant, which increases blood pressure, temperature and pulse rates.
"When it goes bad it acts very differently on the patient than any of the other [recreational] drugs. None of the other ones melt you down like that," Professor Fulde said. "Basically what happens is you just cook from inside. The actual machinery inside each cell just melts down and bursts and that is the end of it."
The victims told doctors they had taken red ecstasy-type pills, stamped with the three-triangled Mitsubishi symbol. Websites around the world carry warnings stretching as far back as 2001 of red Mitsubishi pills causing PMA overdoses and in some cases death. The AIDS Council of NSW yesterday issued a warning about the drug, fearing people attending this weekend's Sleaze Ball, and its associated recovery parties, may be at risk.
"ACON's harm minimisation messages in the lead-up to this weekend's Sleaze 2004 have focussed on crystal meth and GHB, but the appearance of this relatively new drug is of major concern. We would urge everyone to be extremely cautious," said the council's chief executive, Stevie Clayton. Because the onset of the psychoactive affect of PMA is slow compared with MDMA, or ecstasy, some users are taking second and third doses before their first even hits them.
Compounding the problem for emergency teams, one of most common drugs used in the resuscitation and intubation of overdose victims reacts with PMA, amplifying its effects. Professor Fulde believes other victims with milder reactions may have passed through the St Vincent's emergency department. He has briefed staff on how to detect and treat overdose patients, but formal protocols have yet to be drawn up. "St Vincent's now knows PMA," he said yesterday.
Professor Fulde was first alerted to the drug's presence in Australia by David Caldicott, an emergency research fellow at Royal Adelaide Hospital, who warned of a recent police seizure. Dr Caldicott co-wrote a research paper on PMA after its use in Adelaide in 2000 left one young man dead. He says the Sydney experience should sound warning bells in emergency departments Australia-wide.
"It is not only alarming for the person who has overdosed, it is also alarming for the medical professional as well. "You do not expect these kids to die, and they will, and there is nothing scarier than watching people's lives slip between your hands, it is absolutely traumatic for the medical people involved," he said. "If [Sydney doctors] have a PMA problem on their hands, they have a big problem on their hands."
IN A SPIN
The effects of Red Mitsubishi
- Increase in energy (stimulation)
- Minor visual hallucinations
- General change in consciousness (as with most psychoactives)
- Pupil dilation
- Erratic eye movements
- Muscle spasms
- Increased blood temperature
- Increased blood pressure
- Increased body temperature (fever)
- Increased pulse rate
- Laboured breathing
- Nausea and vomiting
- Convulsions, coma and death