Fatal intoxication due to transrectal methamphetamine overdose: A case report

Methamphetamine (MA) abuse is common in Asian countries. The major ways of abuse include intravenous injection, absorption, and ingestion. Although two cases of survival after transrectal MA administration have been reported in the clinical field, to the best of our knowledge, there is no report of death due to intentional transrectal MA overdose. This is the first report of such a death. A single, 42-year-old male with a history of habitual MA use was found dead at his home. The police found numerous unused injectors in his closet. A rapid test of his urine was positive for MA. The cause of death was unclear, so a medicolegal autopsy was performed. Results: Autopsy findings revealed a tubular plastic container without a lid in the rectum at the time of excision, with a small, open plastic bag inside. MA was detected in both the plastic container and the plastic bag. The MA concentration in the femoral vein blood was enough to cause death, and the cause of death was considered transrectal MA overdose. MA was absorbed through the lower part of the rectum, so the absorbed MA bypassed the liver and was transported directly to the systemic circulation. Since MA is largely metabolized in the liver, the absorbed MA was unaffected by the hepatic first-pass effect and may have caused more rapid and serious intoxication.