Forensic pathological study of methadone-related deaths in the Genoa (Italy) district: A six-year study

A case of complex asphyxia sheds light on problems in the classification of asphyxias

Death from positional asphyxia is often an accidental event occurring when the victim's body assumes a position which can compromise an effective respiration. Its diagnosis is usually not simple, because it needs to know the exact circumstance in which the body was found and the original positioning of all the body segments. In this case, a 41-year-old man with a history of opioid drugs abuse was found dead in a knee-chest position; the head was down on the floor with the face resting on a plastic bag. Pictures of the scene of death was taken while the body was still in its original position. At first, the main suspicion was that of a fatal overdose. Following the autopsy examination, completed by histological and toxicological examinations, the cause of death was determined as postural asphyxia secondary to intoxication by methadone, in the presence of ischemic heart disease. Some features, moreover, were typical of the death in head down position, and the prolonged knee-chest position was also associated with the obstruction of mouth and nose by the plastic bag, which may have contributed to the asphyxiation. These cases of "combined" asphyxia represent a challenge for the current classifications of asphyxia, which are very variable and not standardized, as we observe from a brief review of the literature. The elaboration of new systems of classification for asphyxias, which must be clear, simple and shareable, is necessary to avoid confusion in categorizing cases that present overlapping between several types of asphyxiation modalities.

Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System

INTRODUCTION

Deliberate self-poisoning (DSP) using drugs is the preferred method of suicide at a global level. Its investigation is hampered by limited sample sizes and data reliability. We investigate the role of the US FDA Adverse Event Reporting System (FAERS), a consolidated pharmacovigilance database, in outlining DSP habits and toxidromes.

METHODS

We retrieved cases of 'intentional overdose' and 'poisoning deliberate' from the FAERS (January 2004-December 2021). Using descriptive and disproportionality analyses, we estimated temporal trends, potential risk factors, toxidromes, case-fatality rates and lethal doses (LDs) for the most frequently reported drugs.

RESULTS

We retrieved 42,103 DSP cases (17% fatal). Most cases were submitted in winter. Reports of DSP involved younger people, psychiatric conditions, and alcohol use, compared with non-DSP, and fatality was higher in men and older patients. Suspected drugs were mainly antidepressants, analgesics, and antipsychotics. Multiple drug intake was recorded in more than 50% of the reports, especially analgesics, psychotropics, and cardiovascular agents. The most frequently reported drugs were paracetamol, promethazine, amlodipine, quetiapine, and metformin. We estimated LD25 for paracetamol (150 g).

CONCLUSION

Worldwide coverage of the FAERS complements existing knowledge about DSP and may drive tailored prevention measures to timely address the DSP phenomenon and prevent intentional suicides.