Methylone intoxication in a strangulation death: Suicide, homicide or overdose?

Abstract

Aim

Methylone (MDMC, BK-MDMA) is a synthetic cathinone with entactogenic and euphoric properties which, according to the literature and the DRAMES survey in France, is rarely found in toxic deaths today. We present here a case of potentially lethal intoxication, with measurement of blood, urine, tissues and hair methylone concentrations. A 45-year-old woman who had been missing for 5 days after a swinger's party and a violent argument with her partner was found dead in a semi-seated position, hanging by the handle of her backpack from the branch of a tree. According to the investigation, alcohol and MDMA were consumed during the evening. The Prosecutor's Office request an autopsy and toxicological analyses as part of the investigation into the cause of death.

Method

Analyses are carried out using the laboratory's usual techniques (GC/FID, GC-MS, LC-MS/MS), including the detection and determination of blood alcohol, narcotics, drugs including psychotropic drugs and synthetic products. A specific LC-MS/MS method was used to perform determination for methylone with methylone-D3 as internal standard, on all available specimen.

Results

Macroscopic autopsy data favoured violent death following strangulation by cervical hanging, with a possible toxic contribution, and did not rule out the intervention of a third party. Toxicological analyses identified ethanol (2.2 g/L), THC (0.5 μg/L) and THC COOH (1 μg/L), benzoylecgonine (27 μg/L), and amphetamine in blood. Methylone was identified in all samples at the following concentrations: 1450 μg/L (heart blood), 1341 μg/L (peripheral blood), 7494 μg/L (urine), 4937 μg/L (bile), 2.4 mg/Kg (brain), 2.5 mg/Kg (lung), 1.5 mg/Kg (kidney), 3.5 mg/Kg (liver) and 1.3 mg/Kg (heart). To check whether the subject was a chronic consumer, a hair analysis was also carried out. 3 segments of 4 cm were taken. Methylone was quantified at concentrations of 10,000; 3,350 and 2,360 pg/mg respectively. THC, CBD, amphetamine, MDMA, cocaine and metabolites were also identified in the 3 segments.

Cathinones can be sold instead of MDMA, because they have similar properties, are euphoric and increase sociability. Only a few data are published in the literature on methylone. Concentrations of 60 to 3300 μg/L (mean: 835 μg/L) in heart blood, 500 to 3300 μg/L (mean: 1174 μg/L) in peripheral blood, 420 to 1800 μg/L in bile, 0.16 to 2.3 mg/Kg in kidney and 0.14 to 1.8 mg/Kg in liver, are described in several fatality cases in 2012 (Pearson, J Anal Toxicol, 2012, 36, 444–451; Cawrse, J Anal Toxicol, 2012, 36, 434–439) and from 6 to 98 pg/mg in hair tested positive (Salomone, J Anal Toxicol, 2017, 41, 376–381). The concentrations measured in our case are in favour of very recent consumption, potentially lethal and compatible with an overdose without it being possible to establish the contribution of intoxication to death. Hair analysis provides information on the subject's drug use profile over several months and supports significant methylone use in the period preceding death.

Conclusion

This case illustrates the still existing use of methylone which was rather “fashionable” ten years ago among synthetic cathinones. It underlines the importance of including these molecules in the reference toxicological expertise in accordance with the recently published SFTA recommendations for the investigation of NPS (https://www.sfta.org/articles/view/recommandations-de-la-sfta-pour-la-realisation-des-analyses-toxicologiques-impliquant-des-nps-version-2024) as part of the search for causes of death. Quantification in various biological specimen enrich existing data, and capillary analysis can highlight regular consumption of this cathinone.