Gabapentinoid-associated fatalities in forensic practice: An autopsy-based retrospective study

Area of Science:

• Forensic Toxicology
• Medicolegal Death Investigation
• Pharmacology

Background:

• Gabapentinoids are frequently found in medicolegal death investigations.
• Interpreting their role in fatal outcomes is challenging due to complexity and polydrug use.

Purpose of the Study:

• To examine deaths attributed to pregabalin and/or gabapentin intoxication.
• To analyze cases within the context of non-medical use and polydrug involvement.

Main Methods:

• Retrospective autopsy-based study of cases from a national forensic board.
• Systematic review of expert opinion files, evaluating demographics, clinical history, circumstances, toxicology, and cause of death.
• Thematic classification of deaths based on substance involvement patterns.

Main Results:

• Sixty-eight cases were analyzed, predominantly involving young to middle-aged males with substance use disorder.
• Combined substance exposure (illicit drugs, alcohol, other medications) was the dominant pattern; isolated gabapentinoid toxicity was rare.
• Fatalities often occurred in private residences, indicating concealed polydrug use.

Conclusions:

• Gabapentinoid-related deaths are seldom caused by isolated toxicity.
• Accurate determination requires integrated forensic evaluation within the context of non-medical use and polydrug exposure.
• Autopsy findings combined with toxicological and contextual data are essential for defensible cause-of-death rulings.