Fatal intoxication due to transrectal methamphetamine overdose: A case report

Area of Science:

• Forensic Toxicology
• Clinical Toxicology
• Pharmacology

Background:

• Methamphetamine (MA) abuse is prevalent in Asian countries, with common administration routes including injection, absorption, and ingestion.
• While survival after transrectal MA administration has been documented, fatalities are unreported.
• This case represents the first reported death due to intentional transrectal MA overdose.

Observation:

• A 42-year-old male with a history of MA use was found deceased.
• Autopsy revealed a plastic container with MA in the rectum.
• MA was detected in blood at lethal concentrations.

Findings:

• The cause of death was determined to be transrectal MA overdose.
• Rectal absorption bypassed the liver's first-pass metabolism.
• Unmetabolized MA reached systemic circulation, causing rapid and severe intoxication.

Implications:

• This case highlights a novel and potentially lethal route of MA administration.
• Understanding alternative MA absorption pathways is crucial for forensic investigations.
• The absence of hepatic first-pass metabolism significantly increases the risk of acute toxicity.