Fatal poisoning with intravenously injected methadone and no fresh injection marks found

Drugs addicts are commonly brought to casualty wards where they often pose a diagnostic problem. They are typically brought in unconscious with no signs of disease or trauma. The suspicion of poisoning arises by the finding of fresh injection marks. This paper describes a case in which a young male drug addict was dead on arrival in hospital without recognizable recent injection marks but with some old wounds or necroses in both groins. The autopsy and toxicological analyses revealed that death was caused by an overdose of methadone and that the necroses in the groins were fistulas facilitating administration of the drugs directly into larger veins.