Death by intoxication involving various new psychoactive substances including bromazolam

Aim

Benzodiazepines are frequently involved in deaths with toxicological components. In recent years, synthetic designer benzodiazepines (DBZD) have emerged, leading to new consumption patterns. Identifying these poorly documented molecules is essential in toxicologically induced death cases. We report here the case of a Caucasian 42-year-old woman who died in a context of NPS poly-consumption. Ten packets labeled as Research Chemicals were found near the body. Three packets, identified as containing Bromazolam and 2-MMC, were empty. Seven others, labeled as containing 4F-MPH, 4-FMA, 2-MMC, and O-DSMT, held tablets of various shapes and colors. A forensic body examination was conducted in order to collect blood sample. We performed a blood sample collection from the right subclavian artery. The tablets and post-mortem blood samples were collected and analyzed. The aim of the study is to report concentration levels in a fatality involving various new psychoactive substances (NPS), including Bromazolam and 2-MMC.

Method

Blood sample (200 μL) was extracted with 300 μL of zinc sulfate solution at 0.1 M and additional 500 μL of methanol containing the internal standards were supplemented. Supernatants were evaporated and residues were dissolved in 200 μL of mobile phase. NPS identification in blood and tablets were performed using a qualitative liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) (Xevo TQ-XS, Waters).

Quantification was conducted on blood sample using a full scan analysis by liquid chromatography-high-resolution mass spectrometry (LC-HRMS) (Q-Exactive®, Thermo Scientific) with standard solution of 2-MMC, bromazolam, 4-FMA, O-desmethyltramadol and quality controls.

Results

The post-mortem peripheral blood analysis revealed the following concentrations: bromazolam 308 ng/mL, 2-MMC 12616 ng/mL, O-desmethyltramadol 1410 ng/mL, and 4-FMA 3176 ng/mL. The identification of the tablets was consistent with the packaging label.

Conclusion

The death resulted from intoxication involving multiple NPS: 2-MMC, 4-FMA, O-desmethyltramadol, and bromazolam, with the latter being reported for the first time in France. The concentrations were higher than “lethal” concentrations reported in the scientific literature.

The accessibility of NPS leads to high-risk poly-consumption. Combining multiple substances from different chemical families, such as DBZD, is relatively common in the literature and can result in toxicological fatalities.