LAUSR

Toxicologists are often confronted with the abuse of multiple drugs and are obliged to decide which compound may have been the cause of death. We report on a 21-year-old man (182 cm, 84 kg), who was found unconscious in his bed. Beside him the police found several controlled substances, among them dried opium poppy pods containing thebaine, codeine and morphine, a clear liquid with the designer benzodiazepines flualprazolam and clonazolam, and a white powder with the imprint SGT 25, instead of SGT-78 (CUMYL-4CN-BINACA). These compounds were also found in the urine sample following a non-targeted GC-MS and a targeted LC-MS-MS screening approach. Subsequently, these compounds were quantified in whole femoral blood and scalp hair. Based on the concentrations measured in femoral blood in particular, we assume that the deceased had taken a lethal dose of the designer benzodiazepines flualprazolam (0.74 mg/L) and clonazolam (2.08 mg/L), an extremely high dose of the opiates thebaine (0.81 mg/L), codeine (0.23 µg/mL) and morphine (0.13 µg/mL) and a high dose of the synthetic cannabinoid CUMYL-4CN-BINACA (0.01 mg/L). Besides postmortem concentrations, we also present electron impact (EI) and electrospray ionization (ESI) mass spectra of compounds found in the vicinity of the decedent, namely the tryptamines 4-HO-MIPT, 4-HO-MET and 4-ACO-DET, the amphetamines 3-FEA and 2-FMA, and the arylcyclohexylamines O-PCE, 3-MeO-PCP and 3-MeO-PCE.