An accidental fatal intoxication with methoxetamine

Area of Science:

• Forensic Toxicology
• Pharmacology
• Clinical Chemistry

Background:

• Methoxetamine (MXE) is a novel psychoactive substance, structurally related to ketamine, increasingly used recreationally.
• The emergence of new synthetic drugs necessitates toxicological analysis for accurate cause-of-death determination.
• Understanding the toxicological profile of MXE is crucial for forensic investigations.

Observation:

• An autopsy case revealed a 26-year-old male with a history of drug abuse, deceased in his apartment with packaging labeled 'methoxetamine' and 'Haze'.
• Toxicological analysis of the deceased's femoral blood showed a high concentration of methoxetamine (8.6 µg/g).
• The deceased's blood also contained tetrahydrocannabinol and three synthetic cannabinoids (AM-694, AM-2201, JWH-018).

Findings:

• Reference methoxetamine concentrations in four living drug abusers ranged from 0.13 to 0.49 µg/g.
• The femoral blood methoxetamine concentration in the deceased was significantly higher than in living subjects.
• Co-occurrence of methoxetamine with multiple synthetic cannabinoids was observed in both the deceased and some living subjects.

Implications:

• The high methoxetamine blood concentration strongly suggests acute fatal intoxication.
• The presence of synthetic cannabinoids may have contributed to the fatality, highlighting the complex interactions of polydrug use.
• This case underscores the importance of comprehensive toxicological screening for novel psychoactive substances in post-mortem investigations.