title: "Tampering to Death": A Fatal Codeine Intoxication Due to a Homemade Purification of a Medical Formulation.
abstract: Many homemade tamper processes of medical codeine formulations are available on selected "forums" on the Internet, where recreational codeine users claim to be able to purify codeine by removing additives, such as acetaminophen, to avoid or limit adverse effects. In this work, it is reported and discussed a fatal case of codeine intoxication. The findings of objects such as jars, filters, and tablets, and amounts of unknown liquid material at the death scene investigation suggested a fatal codeine intoxication after the tampering procedure called "cold water extraction." Toxicological results obtained from the analysis of both the nonbiological material and the body fluids of the decedent integrated with the information collected at the death scene investigation confirmed the above-mentioned hypothesis. This report underlines the importance of a tight interconnection between criminalistics and legal medicine to strengthen the identification of the cause of death and the reconstruction of the event.
authors.affiliation: Department of Medical and Surgical Sciences - Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fais
authors.affiliation: Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Pigaiani
authors.affiliation: Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio 50, 35121, Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cecchetto
authors.affiliation: Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio 50, 35121, Padova, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Montisci
authors.affiliation: Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Gottardo
authors.affiliation: Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio 50, 35121, Padova, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Viel
authors.affiliation: Forensic Toxicology Division, Department of Health Science, University of Florence, Italy.
authors.forename: Jennifer Paola
authors.initials: JP
authors.lastname: Pascali
authors.affiliation: Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Tagliaro
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000138:chemical synthesis / Q000506:poisoning*; D002626:Chemistry, Pharmaceutical; D003061:Codeine / Q000138:chemical synthesis / Q000506:poisoning*; D004339:Drug Compounding; D062787:Drug Overdose; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders; D013607:Tablets / Q000138:chemical synthesis*
chemical_list: D000701:Analgesics, Opioid; D013607:Tablets; D003061:Codeine
keywords: codeine-related death; death scene investigation; drug abuse; drug tampering; forensic pathology; forensic science; opiate abuse; toxicology