“Tampering to Death”: A Fatal Codeine Intoxication Due to a Homemade Purification of a Medical Formulation

Fais, Paolo; Pigaiani, Nicola; Cecchetto, Giovanni; Montisci, Massimo; Gottardo, Rossella; Viel, Guido; Pascali, Jennifer P.; Tagliaro, Franco

doi:10.1111/1556-4029.13492

Cited by 13 publications

(8 citation statements)

References 11 publications

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“…The death scene investigation immediately suggested to examine ethyl chloride's role in causing the death, confirming the importance of a correct and comprehensive crime scene investigation (Fais et al 2017). Considering the analysis of the crime scene, death seemed to occur accidentally and related to recreational abuse instead of a voluntary suicide or a homicide.…”

Section: Discussionmentioning

confidence: 92%

Is old stuff back? A fatal case of ethyl chloride sniffing

Pascali

Fais

Viel

et al. 2019

Egypt J Forensic Sci

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Background: Ethyl chloride (EC) or chloroethane is a colourless halogenated hydrocarbon gas regularly employed as a topical anaesthetic spray for pain-related injuries and muscle spasm in athletes. However, EC became also popular as a street drug in the 1980s. Brief inhalations of EC vapour can result in dizziness, euphoria, confusion, incoordination, hallucinosis, impairment of short-term memory and narcosis. Inhalation of higher doses, usually employed to "get high", may be related to severe depression of the central nervous system. Indeed, toxicity and deaths have been reported so far.Case presentation: A 40-year-old man was found unresponsive after EC inhalation. EC determination was performed by dynamic headspace gas chromatography coupled to mass spectrometry. EC was detected in the peripheral blood (0.156 g/L), central blood concentration (0.203 g/L) and the lung and brain (19 and 25 mg/kg). EC in the vitreous humour showed a sensitively lower respect to blood (0.018 vs 0.203 g/L). Conclusions: Considering the results of toxicological analyses of investigations on the death scene besides the absence of any signs of trauma, death was attributed to inhalation of ethyl chloride.

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Section: Discussionmentioning

confidence: 92%

Is old stuff back? A fatal case of ethyl chloride sniffing

Pascali

Fais

Viel

et al. 2019

Egypt J Forensic Sci

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“…These data are difficult to estimate for humans particularly due to differences in tolerance. However, lethal doses for morphine and codeine in humans can be inferred from overdose case reports where these drugs are implicated .…”

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confidence: 99%

Quantification of Morphine, Codeine, and Thebaine in Home‐Brewed Poppy Seed Tea by LC‐MS/MS

Powers

Erickson²,

Swortwood

2017

Journal of Forensic Sciences

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Recently, medical examiners reported two cases of a 21-year-old male and 24-year-old male with high amounts of morphine in their blood at autopsy. It was suspected that the decedents ingested lethal amounts of morphine from home-brewed poppy seed tea. No studies to date have investigated opium alkaloid content extracted from poppy seeds by home-brewing methods. Various poppy seed products were purchased from online sources and extracted with four home-brewing methods representative of recipes found on drug user forums. Morphine, codeine, and thebaine were quantified in the tea extracts by liquid chromatography-tandem mass spectrometry using a validated analytical method. Morphine, codeine, and thebaine concentrations from seeds were <1-2788 mg/kg, <1-247.6 mg/kg, and <1-124 mg/kg, respectively. Alkaloid yield varied between extractions, but regardless of extraction conditions, lethal amounts of morphine can be rinsed from poppy seed coats by home-brewing methods.

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“…For all participants, failed attempts at CWE if the techniques are not used correctly means that high amounts of paracetamol in the extracted solutions could remain. Likewise, variation in employing the CWE procedures, for example by switching between different brands of coffee filters for each attempt at extraction or cooling the solutions to different temperatures each time, will likely yield varying results over consecutive attempts and lead to inconsistencies between the amounts of codeine and paracetamol (or ibuprofen) left in the extracted solutions [14,21,24]. This represents a risk of harm from paracetamol overdose such as hepatoxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Reports of harms associated with CWE have been published elsewhere [22,23], including reports of one fatality in which a pot and coffee filters were found near the fatality (toxicological analyses of blood and urine confirmed the presence of opioids) [24]. A case series of presentations at two London hospitals compiled data from six patients with self-reported ingestion of codeine or dihydrocodeine treated with CWE [13].…”

Section: Introductionmentioning

confidence: 99%

Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

Kimergård¹,

Parkin²,

Jennings³

et al. 2020

Harm Reduct J

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Background Tampering of psychoactive medicines presents challenges to regulation and public health. However, little is currently known about what influences the decisions to treat codeine-containing medicines (CCM) with cold water extraction (CWE) from the perspective of individuals employing these techniques. The article identifies factors influencing utilisation of CWE to separate codeine from compounded analgesics, such as paracetamol and ibuprofen, found in CCM. Methods Purposive sampling of 27 participants residing in England who took part in a qualitative interview. Of these, 14 individuals (11 males and 3 females) reported tampering of psychoactive medicines, and the relevant transcripts were included in the analyses for the study. Participants were recruited from one addiction treatment service and from an online survey. The mean age of the participants was 31.5 years (range = 18–42 years). Qualitative data analysis followed the processes of iterative categorization (IC). The codes ‘harm reduction’, ‘information sources’ and ‘changes on the drug markets’ were grouped and summarised. The coding of the data was done in a Microsoft® Word document. Results Two groups of participants were identified in the data analysis: (i) individuals who used CCM (n = 5), and (ii) individuals who used CCM and heroin (n = 9). Participants in both groups used CWE due to concerns of paracetamol overdose from the use of excessive dosages of CCM. For both of them, information obtained from the internet encouraged the use of CWE. Participants using CCM described how the many steps involved in conducting CWE, including sourcing codeine boxes from pharmacies (over the counter), presented a barrier against using CWE. Participants using CCM and heroin explained how reduced availability in the local heroin supply influenced utilisation of CWE techniques to maintain their use of opioids and avoid withdrawal. Withdrawal symptoms and cravings outweighed the concerns about the quality of the extracted codeine mixtures in this participant group, especially the ability of CWE to remove paracetamol and tablet fillers. Conclusions Utilisation of CWE of codeine was influenced by several factors including drug market supply, the availability of detailed information on the internet about CWE and restrictions on codeine sourcing in pharmacies. Risks identified with CWE include consumption of unknown doses of paracetamol if the CWE techniques are not used correctly. Attempts at extracting codeine from CCM should be considered in risk assessments of opioid medicines.

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“Tampering to Death”: A Fatal Codeine Intoxication Due to a Homemade Purification of a Medical Formulation

Cited by 13 publications

References 11 publications

Is old stuff back? A fatal case of ethyl chloride sniffing

Is old stuff back? A fatal case of ethyl chloride sniffing

Quantification of Morphine, Codeine, and Thebaine in Home‐Brewed Poppy Seed Tea by LC‐MS/MS

Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

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