title: Use of hair testing to determine methadone exposure in pediatric deaths.
abstract: A case of death attributed to methadone acute poisoning in an infant aged 11 months is reported. A sudden infant death syndrome (SIDS) was suspected, whereas a traumatic cause of death was excluded regarding autopsy findings. Specimens were submitted to a large toxicological analysis, which included ethanol measurement by HS-GC-FID, a targeted screening for drugs of abuse and various prescription drug classes followed by quantification using UPLC-MS/MS methods. Methadone and its metabolite (EDDP) were detected in all the tested fluids, as well as in hair, with a blood concentration of methadone considered as lethal for children (73 ng/mL). The cause of death was determined to be acute "methadone poisoning", and the manner of death was "accidental". A discussion of the case circumstances, the difficulties with the interpretation of toxicological findings in children (blood concentration and hair testing), and the origin of exposure are discussed.
authors.affiliation: Forensic Institute, School of Medicine, CHRU of Lille, rue André Verhaeghe, 59037, Lille, France; Laboratory of Forensic Toxicology, Center of Biology and Pathology, CHRU of Lille, 59037, Lille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Tournel
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Pollard
authors.forename: Luc
authors.initials: L
authors.lastname: Humbert
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Wiart
authors.forename: Valéry
authors.initials: V
authors.lastname: Hédouin
authors.forename: Delphine
authors.initials: D
authors.lastname: Allorge
mesh_terms: D001942:Breast Feeding / Q000009:adverse effects; D016241:Child of Impaired Parents; D005260:Female; D053593:Forensic Toxicology; D006197:Hair / Q000737:chemistry*; D006801:Humans; D007223:Infant; D008297:Male; D008431:Maternal-Fetal Exchange; D008691:Methadone / Q000032:analysis* / Q000506:poisoning*; D009294:Narcotics / Q000032:analysis* / Q000506:poisoning*; D058850:Opiate Substitution Treatment; D011247:Pregnancy
chemical_list: D009294:Narcotics; D008691:Methadone
keywords: 2-ethylidine-1; 3-diphenylpyrrolidine (EDDP); 5dimethyl-3; acute methadone toxicity; forensic science; hair testing; pediatric