First Occurrence of Fatal Intoxication Involving Methiodone (IC-26) in Finland; a Medicolegal Autopsy Case Report

Methiodone (IC-26) is a non-fentanyl novel synthetic opioid which has recently been detected in drug seizures in Europe. There is still limited data about the drug in published toxicological case work, both in non-fatal and fatal cases. We present a medicolegal autopsy case report on a fatal intoxication in an individual undergoing opioid agonist treatment. A methiodone concentration of 1.5 mg/L was detected in the femoral vein blood and was considered the primary intoxicant causing death. This is the first published occurrence of fatal intoxication involving methiodone in Finland and emphasizes the need for constant monitoring of substance abuse during substitution therapy, including the potential use of novel synthetic opioids.