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Identification at autopsy of pulverized pills in lungs of a first-time methadone user
Henry J Carson1, Bradley L Feickert
1Linn County Medical Examiner's Office, Cedar Rapids, IA, USA. hjcmd@earthlink.net
Abstract:
We recently encountered a 25-year-old white man who died of substance abuse including methadone. The route of administration of the drug(s) appears to have been insufflation. He was found dead at home. There were bottles of prescribed medications and an empty bottle of non-prescribed methadone. There was a grinding device nearby. At autopsy, no needle tracts were identified. Microscopically, the bronchi had desquamated ciliated respiratory epithelium admixed with red-brown pigment, which was found under plane-polarized light to be comprised of birefringent finely-granular material consistent with pulverized pills. Blood toxicology was positive for tetrahydrocannabinol, sertraline, nicotine, and methadone. The cause of death was ruled drug interactions with cerebral and pulmonary edema, the manner of death accidental. The decedent fit a profile of a victim of prescription drug abuse, for whom the mode of administration of drugs may be altered from intended use in as many as 80% of cases.
Insights
A young man died from accidental drug interactions after crushing and inhaling prescribed and non-prescribed medications, highlighting risks of altered drug administration routes in substance abuse cases.
Area of Science:
- Forensic Toxicology
- Pulmonology
- Pharmacology
Background:
- Prescription drug abuse is a significant public health concern.
- Altered routes of drug administration are common in individuals with substance use disorders.
Observation:
- A 25-year-old male was found deceased at home with evidence of substance abuse.
- Autopsy revealed no needle tracks, but microscopic examination showed pulverized pills in the bronchi.
- Toxicology confirmed the presence of multiple substances including methadone.
Findings:
- The cause of death was attributed to drug interactions leading to cerebral and pulmonary edema.
- Evidence suggested insufflation (insufflation) of crushed pills as the route of administration.
- The decedent's drug use profile indicated potential alteration from prescribed use.
Implications:
- This case underscores the critical need to identify and address non-intended drug administration methods in prescription drug abuse.
- Forensic analysis of pulmonary tissue can reveal evidence of crushed medication inhalation.
- Accidental deaths from drug interactions can occur through altered administration routes.
