BANGOR, Maine — The state’s first confirmed bath salts overdose death involved a man who took so much of the synthetic street drug that he was delusional and attempted to beat himself up just minutes before he had three heart attacks, his autopsy report states.

Ralph E. Willis, 32, of Bangor consumed a toxic level of methylenedioxypyrovalerone, or MDPV, a key ingredient of bath salts, in July and died accidentally from “complications of MDPV toxicity,” the report says.

The Bangor Daily News requested a copy of Willis’ autopsy report, which was completed recently after months of delay caused by pending toxicology test results. The report revealed that he was a danger to himself and others on the day he died.

“This is a very complicated case with at least two episodes of physical subdual (restraint) and multiple injuries,” Dr. Margaret Greenwald, the state’s chief medical examiner, said in the autopsy report.

Her report also states that Willis had sought help for his drug addiction.

“Mr. Willis had a prior history of using bath salts for which he was hospitalized at Acadia [Hospital] twice in the weeks prior to his death,” the report says.

Bath salts emerged on the streets of Bangor in February 2011 and by July had grown into a regional problem that has spread throughout the state.

Bangor police Sgt. Paul Edwards said Tuesday that officers had heard horror stories from out-of-state law enforcement agencies about bizarre and violent behavior caused by bath salts use, but for the most part Bangor’s users — until last summer — had been mostly calm.

That all changed when Bangor police ran into a delusional and confrontational Willis on the evening of July 22, 2011, the sergeant said. Willis was running around and yelling at people on Center Street near Brookings-Smith Funeral Home around 6:45 p.m. when Officer Brian Smith arrived, Edwards said.

“He was volatile from the second Officer Smith came to the scene,” the sergeant said. “We had never seen anything like that. This guy was instantly angry. It was a very dangerous situation.”

Willis charged at Smith, and that led to a brief physical altercation on the trunk of Smith’s police cruiser and a smashed back window, Edwards said. Backup was called.

“It required multiple officers to arrest him,” Willis’ autopsy report states. “Physical force was used including strikes and baton.”

Smith arrested and charged Willis with disorderly conduct, criminal mischief and refusing to submit to arrest.

“In the case of Mr. Willis, we learned that people using so-called bath salts can be very unpredictable, and sometimes violent,” Bangor Police Chief Ron Gastia said Tuesday in an email statement. “In a situation, this one or any other, in which officers are confronted with a violent individual who poses a threat to the safety of the officer or others, I expect officers to respond appropriately to insure the safety of all concerned, as was done in this case.”

Gastia added: “In this case, the responding officer acted appropriately in handling Mr. Willis.”

About 7 p.m. July 22, police Officer Chad Foley took Willis to the Penobscot County Jail, where Willis “continued to be agitated and uncooperative … yelling and fighting with deputies,” the autopsy report states. “It eventually required multiple deputies to restrain him in order to place him in a suicide smock and get him into a holding cell.”

Willis seemed to calm down and the restraints were removed at 7:11 p.m., the medical examiner’s report states, but by 7:45 p.m. deputies became concerned because “he appeared unresponsive” and didn’t answer questions.

“They opened the door and he immediately began to yell, grab onto his testicles and bang his head and extremities on the wall,” the autopsy report states.

A decision was made to take him to Eastern Maine Medical Center, but before rescue personnel could arrive, Willis rolled onto his stomach, flailed his arms and legs and stopped breathing, the report says.

“He was resuscitated and transported to [the] EMMC emergency room, where he was pronounced dead after [being] aggressively resuscitated and three cardiac arrests,” the autopsy report says.

The time of death was 9:39 p.m., Greenwald said in her report.

Willis had 150 nanograms per milliliter of MDPV in his bloodstream, a body temperature of 103 degrees and an erratic heartbeat when he got to the emergency room — all side effects of the hallucinogenic stimulant — the report states.

“There are so many factors that go into [a bath salts] death that have nothing to do with the level” of drugs ingested, Karen Simone, a toxicologist and director of the Northern New England Poison Control Center in Portland, said Tuesday. “Maybe it killed him, and maybe it didn’t.”

Physically restraining bath salts users who are severely agitated and in a state of excited delirium can be harmful and even life-threatening because they usually have increased heart rates and high blood pressure, Simone and Dr. Jonnathan Busko, an emergency room doctor at Eastern Maine Medical Center in Bangor, have said.

“What we have learned over a period of time, both from experience and from discussions with medical personnel, [is] a person in a state of excited delirium is a medical emergency,” Gastia said Tuesday. “At that time, we did not know, nor did the medical professionals, how to tell the level of immediacy that is involved in such cases. We did not specifically learn this from the case of Mr. Willis, but over a period of time. Control needs to occur first, and then immediate medical intervention is necessary.”

The experience of treating people who are overdosing on bath salts, including Willis, has helped educate police, ambulance attendants and hospital staff about the most effective treatments, Simone confirmed.

“It’s obvious now what to do,” she said, noting that chemical restraint — using chemicals to counteract the ones ingested — would be used on a person exhibiting the same out-of-control symptoms today.

While it is sad that Willis died from complications of MDPV poisoning, “it’s good that it led to some changes,” Simone said.

Because of what happened in July with Willis, the Penobscot County Jail no longer accepts inmates who are under the influence of bath salts. In addition, the Bangor Police Department, Penobscot County Sheriff’s Office and other law enforcement agencies now dispatch officers in pairs, whenever possible, when confronted with a person on bath salts.