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NEWS : 30.11.09 - Ecstasy death shows failings (NZ)

kingpin007

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Ecstasy death shows failings

By GILES BROWN - The Press

Last updated 05:00 30/11/2009

A coroner has called for stricter health and safety rules for nightclubs after the death of a young man who collapsed at a popular Christchurch music venue after taking ecstasy.

Timothy Raymond Mertin Crozier, 23, died early on December 17, 2006 outside The Ministry nightclub on Lichfield Street. An autopsy found he had 2.8 milligrams of MDMA (ecstasy) per litre of blood in his system.

In his findings, released on Saturday, regional coroner Richard McElrea agreed with a Department of Labour investigation which concluded the level of first aid given to Crozier was "minimal" and "at worst falling below the duty of care that could reasonably be expected".

Club manager Bruce Williamson rejected the "biased" findings of the coroner, but said the club had changed some of its procedures after the death.

Crozier, a fitter and welder from the Arnold Valley on the West Coast, collapsed on the dance floor of The Ministry and was taken to the pavement outside by staff. Passers-by and other customers tried to resuscitate him and an ambulance arrived about 4.40am. The ambulance crew stopped trying to resuscitate Crozier at 4.53am.

The coroner said Crozier died of an "adverse physiological response" to taking ecstasy.

Ambulance staff said when they arrived it had been difficult to identify club staff and there had been no "handover" information.

The fact Crozier was taken to the pavement outside the club meant a crowd gathered, some of whom were angry at the "apparent indifference" of staff, the coroner said.

The inquest heard that Williamson and another staff member decided it would be unsafe to intervene due to the "antagonism".

If Crozier had been dealt with inside the club and given emergency aid by staff this problem would not have occurred, the coroner said.

"This case highlights the need for the proper training and accreditation of persons undertaking management and security work in a nightclub or similar environment."

Staff should be clearly identifiable, there should be a safe place in a club where first aid could be carried out and an effective management plan to deal with emergencies, he said.

Williamson said the club now provided a first aid room. People who fell ill were no longer taken onto the pavement to avoid "interference" from the public.

"In hindsight, we agree fully that a loss of control occurred due to that interference, and this will not be able to occur in the future," he said. But he attacked the coroner for having a "clear agenda" to criticise the club during the inquest. There had been two staff members working that night who were "fully trained and certified in advanced first aid".

Williamson said Crozier had taken a large amount of ecstasy and "only one person put those pills in the deceased's mouth, and that was himself".

The coroner said he would refer his findings to Justice Minister Simon Power.

http://www.stuff.co.nz/national/health/3107740/Ecstasy-death-shows-failings
 
I have seen security staff at sydney venues grab the person and drag them outside then try and stand them up and slapping them in the face and peeling their eyes open ... rough handling is common.

security kick the shit out of people so why would they be gentle with you when you have overdosed.

Nightclubs , security , bar staff all should be made to do courses on first aid and how to properly handle people who drop on the dance floor.

The Venues where people die are usually put out of business and or close down because of bad publicity when something like this happens and why they try and get you outside away from their business and then your on your own but things are now not as bad as they used to be.
 
I have seen security staff at sydney venues grab the person and drag them outside then try and stand them up and slapping them in the face and peeling their eyes open ... rough handling is common.

security kick the shit out of people so why would they be gentle with you when you have overdosed.

Nightclubs , security , bar staff all should be made to do courses on first aid and how to properly handle people who drop on the dance floor.

The Venues where people die are usually put out of business and or close down because of bad publicity when something like this happens and why they try and get you outside away from their business and then your on your own but things are now not as bad as they used to be.
One of my friends who's a security guard told me it's a compulsory part of all security courses in Australia
 
it is also compulsary in VIC. 2.8mg of mdma per litre whats that calculated to roughly how many mg's of mdma he might of took yo?
 
There's about 5 1/2 litres of blood in the average human body so it equates to about 15.4mg which doesn't sound quite right. :\

I'm sure PD will be able to give an overview of MDMA in blood v metabolised material.
 
I'm sure PD will be able to give an overview of MDMA in blood v metabolised material.


In keeping things simple, this has to do with distribution and permeability which in turn is affected by many things such as blood flow, protein binding and tissue binding, pH, etc.

So the blood Concentration Maximum (Cmax) reflects both dosage and pharmacokinetics. A drug like MDMA is widely distributed, permeating interstitial and intracellular tissue, and becomes concentrated in organs such as the liver and brain, so blood concentration by itself is not a direct measure of dosage.

From The pharmacology and toxicology of "ecstasy" (MDMA) and related drugs

...the usual "recreational" dose of MDMA or MDEA produces blood levels in the range of 100–250 ng/mL, or 100–250 µg (0.1–0.25 mg) per litre. Most of the cases of serious toxicity or fatality have involved blood levels ranging from 0.5 mg/L to 10 mg/L, that is, up to 40 times higher than the usual recreational range. However, some have had levels as low as 0.11–0.55 mg/L, that is, overlapping the "normal" range and a little above it. This is an important point, because it demonstrates the degree to which the seriousness of the effects can be dependent on environmental factors other than the drug concentration.
 
I wonder if the tests they did would show up any other substances that might be in the system or if they had to specifically look for them.

For example, lets say the guy had used moclobemide either by prescription from his doctor or as a silly method to try and get higher...............would that have shown up in the results?
 
For example, lets say the guy had used moclobemide either by prescription from his doctor or as a silly method to try and get higher...............would that have shown up in the results?

Normally the presence of other drugs will be indicated.
 
So it appears the concentration was actually quite high. Is there any way of knowing what kind of dosage would lead to such a high result?
 
Yes, the concentration would have been high.

The problem with estimating dosage is that blood concentration / dosage is not linear. This has to do with many factors, including, but not limited to things like elimination rates, enzyme saturation etc. as well as environmental influences.

From the above linked paper

Doses of 50 mg, 75 mg and 125 mg to healthy human volunteers produced peak blood concentrations of 106 ng/mL, 131 ng/mL and 236 ng/mL respectively.

Converting to blood concentration/ Litres of blood, the above Cmax values are in micrograms i.e. 106ug/L, etc.

This guy had 2.8mg/L (28000ug/L), so that would imply quite a bit was consumed. However, actual dosage, as said is not calculable by averaging the above figures and working backwards i.e. ((50/106) + (75/131) + (125/236))/3 = .5246, so x = .5246 x 28000 = ~14.7g or [edit] graphing of the three above, establishing slope ( y = 65x + 27.66) and working out x for the y value of 28000 (which gives 13.986g)

In all likelihood, for the reasons mentioned, the dosage was probably quite a bit lower. From the Bluelight FAQ on MDMA the LD50 for MDMA in humans is stated to be around the 80mg/kg, equating to 5600mg (5.6g) or around 50-60 good pills for a 70kg person. Note; as mentioned there are additional variables that could easily influence an unfavorable outcome from a far lesser amount.

Incidentally, most if not all MDMA is a mixture of the two enantiomers. Each of these has vastly different metabolism 1/2 lives and elimination rates, meaning that if additional dosages are administered, plasma (blood) levels of the R enantiomer rise against levels of the S enantiomer which is regarded as the more potent of the two. As this is the effect users are after, you can begin to see how toxic levels of the R enantiomer could be reached with repeated dosing.
 
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Most venues care infinitely more about their image than the health of their patrons.

Sad, but true.

Fortunately I have never had the displeasure of working for such a place.
 
Great posts p_d, very informative. The quote from that paper adds some perspective to the 2.8mg/L blood concentration.

The fact Crozier was taken to the pavement outside the club meant a crowd gathered, some of whom were angry at the "apparent indifference" of staff, the coroner said.

The inquest heard that Williamson and another staff member decided it would be unsafe to intervene due to the "antagonism".

If Crozier had been dealt with inside the club and given emergency aid by staff this problem would not have occurred, the coroner said.

Very sad state of affairs :(
 
14.7g or [edit] graphing of the three above, establishing slope ( y = 65x + 27.66) and working out x for the y value of 28000 (which gives 13.986g)

In all likelihood, for the reasons mentioned, the dosage was probably quite a bit lower. From the Bluelight FAQ on MDMA the LD50 for MDMA in humans is stated to be around the 80mg/kg, equating to 5600mg (5.6g) or around 50-60 good pills for a 70kg person. Note; as mentioned there are additional variables that could easily influence an unfavorable outcome from a far lesser amount.

Firstly awesome information phase_dancer, this death actually happened in my home town.

Even being extremely conservative with his calculated oral concentrations, of maybe only 1-2grams of MDMA, is still a hugely ridiculous amount. From what I hear from a friend who was at that same gig that night said there were some strong pills going around. But even so, pills in nz in that time still were unlikely to be much over 120mg per pill. Considering our HIGH local prices, I very much doubt anyone would take for argument sake 10-15pills in one sitting (1-1.5grams of mdma), especially if one was enough for most.

Is it a more likely explanation that he was one of these rare cases of having unusually low levels of the enzymes that breakdown MDMA in his liver, so the result of taking a couple of strong pills combined with the intense heat of this nightclubs dancefloor could of resulted in overheating. This leads me to another question, what is the most common mechanism of death with a MDMA overdose?

edit: PS - Maybe the lab results were botched, due to the inexperience of measuring MDMA plasma concentrations in NewZealand.
 
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