Now this is how you report fatality involving MDMA

My readers are no doubt becoming a little bored with this but I assure you I do not bother to blog every one that pops up. Yes, another tragedy. A life cut short at 19 years of age because of the recreational drug MDMA, aka Ecstasy.

Friend Darren Anscombe said: ‘Me and him took some.
‘We were having a laugh at that time. I went into the kitchen and heard Danny’s girlfriend scream.
‘I went into the front room and he was lying on the floor, lifeless.’
Mr Anscombe dialled 999 and under instruction from the operator, carried out chest compressions until paramedics arrived.
Mr Anscombe said Daryl had been ‘happy’ that night but starting ‘acting strangely’.

Here is what I like about the reporting on this. They head off much speculation this way:

Dr Barbara Borek, forensic pathologist, said: ‘Toxicological analysis has detected the presence of a potentially fatal concentration of MDMA, commonly known as ecstasy.’
Tests showed there was 4,491mg of the drug per litre in his blood.

4,491 mg/L. of MDMA. Useful to know. It helps us continue with our efforts to understand more about lethal thresholds for this frequently used compound. Of course, this is the inquest reporting, not the initial splash but still. There was followup. Good.
Especially given the Facebook tribute page. “died in is (sic) sleep”? not one mention of the drug OD on the Wall? Obit says “passed away suddenly“?
but WOW! I look at that MDMA level and I wonder if perhaps that should be a decimal instead of a comma or if the units have been screwed up. My read of the Case Report literature is that something two orders of magnitude lower would be the range. For example, one that I blogged here reported 1.5 mg/L in a fatality. If you look at the pharmacokinetic data in human experiments a 1.6 mg/kg oral dose of MDMA results in a peak plasma concentration of 255 ng/ml. Another paper reviewed existing lit and reported about 500 ng/ml as the high end in human laboratory studies. Doing the unit conversion shuffle this would be 0.255-0.500 mg/L. Conversely, the 1.5 mg/L in the above mentioned fatal case would be about 1500 ng/ml.
So I’m thinking that perhaps the pathologist reported the blood levels as 4,491 ng/ml and somehow this was translated to the more-typical for human case reports mg/L without the unit conversion.