Fatal methamphetamine poisoning by body stuffing

BackgroundMethamphetamine (MA) represents the most commonly used stimulant drug of amphetamine type stimulants (ATS) worldwide. An increased consumption of MA can also be observed in Europe. In 2014 the number of seizures of crystalline MA (crystal) in Germany reached a climax with 3905 cases and atotal quantity of 74kg. Since then, there has been aslight decrease in seizures of amounts of crystal nationwide (2015: 66.9kg, 2016: 62.2kg). In Saxony alone, atotal of 14.3kg of crystal was confiscated in 2016 (23% of the total amount). The geographical location of Saxony at the German-Czech Republic border facilitates the illegal importation of crystal to Saxony.MethodsAll autopsy cases at the Institute of Forensic Medicine in Dresden from 2009-2017 (until 30 April 2017) were retrospectively analyzed regarding fatal MA poisoning as well as body packing and body stuffing.ResultIn 15 out of 3178 autopsy cases between January 2009 and April 2017 poisoning by MA was the cause of death (13adults, 2neonates). Of the deceased adults 9 were men and 4 were women with an average age of 29years (+/- 5.89 years). Packaged MA in the intestinal tract was found in 3 of these cases. The deceased had lethal concentrations of MA in blood between 6 and 12.48 mu g/ml. An additional influence of THC was verified in one case (1.5ng/ml).DiscussionBody packing and body pushing describe the intentional swallowing or hiding of carefully packaged illegal drugs for transportation in the gastrointestinal tract, vagina or rectum. In contrast body stuffers swallow illegal drugs suddenly and spontaneously, e.g. to prevent detection of drugs in astop and search by the police. Due to usually inadequate packaging, the risk of poisoning by body stuffing is much higher than by body packing. Aspecial form, also known as parachuting, represents the ingestion of packaged drugs (e.g. MA) in which the wrapping is deliberately damaged and rolled-up to attain aslow and continuous drug release into the gastrointestinal tract with a sustained drug effect. In 3 out of the 15cases with fatal MA poisoning, packaged MA was found in the digestive tract. Physicians as well as police officers should be aware of the risk of poisoning after astop and search or acustody takeover. The occurrence of unspecific indicative signs of aMA poisoning needs further medical clarification.