Identification at autopsy of pulverized pills in lungs of a first-time methadone user.
We recently encountered a 25-year-old white man who died of substance abuse including methadone. The route of administration of the drug(s) appears to have been insufflation. He was found dead at home. There were bottles of prescribed medications and an empty bottle of non-prescribed methadone. There was a grinding device nearby. At autopsy, no needle tracts were identified. Microscopically, the bronchi had desquamated ciliated respiratory epithelium admixed with red-brown pigment, which was found under plane-polarized light to be comprised of birefringent finely-granular material consistent with pulverized pills. Blood toxicology was positive for tetrahydrocannabinol, sertraline, nicotine, and methadone. The cause of death was ruled drug interactions with cerebral and pulmonary edema, the manner of death accidental. The decedent fit a profile of a victim of prescription drug abuse, for whom the mode of administration of drugs may be altered from intended use in as many as 80% of cases.
Carson
Henry J
HJ
Linn County Medical Examiner's Office, Cedar Rapids, IA, USA. hjcmd@earthlink.net
Feickert
Bradley L
BL
D000280:Administration, Inhalation; D000328:Adult; D001929:Brain Edema / Q000139:chemically induced / Q000473:pathology; D013759:Dronabinol / Q000097:blood; D004347:Drug Interactions; D055030:Drug Users; D017809:Fatal Outcome; D053593:Forensic Toxicology; D006801:Humans; D008168:Lung / Q000473:pathology*; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D009294:Narcotics / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D009538:Nicotine / Q000009:adverse effects / Q000097:blood; D018722:Nicotinic Agonists / Q000009:adverse effects / Q000097:blood; D011654:Pulmonary Edema / Q000139:chemically induced / Q000473:pathology; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000097:blood; D020280:Sertraline / Q000009:adverse effects / Q000097:blood; D015813:Substance Abuse Detection; D013607:Tablets
D013759:Dronabinol; D008691:Methadone; D009294:Narcotics; D009538:Nicotine; D018722:Nicotinic Agonists; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline; D013607:Tablets