Thanatogenesis and forensic assessment of severe acute methadone poisoning

BACKGROUND: Modern scientific data show that only 1.1% die from methadone poisoning in medical institutions. Currently available forensic medical data about this nosology were produced from samples obtained from corpses of individuals who has not undergone any previous therapeutic and diagnostic procedure. The dynamics and role of metabolic disorders in the thanatogenesis of acute methadone poisoning and the forensic assessment of such cases have not been widely studied in forensic medicine. AIM: To perform a forensic medical assessment of fatal cases of acute methadone poisoning in patients admitted to a multidisciplinary hospital and establish the role of metabolic disorders in the occurrence of death. MATERIALS AND METHODS: A single-center, retrospective, sample, cohort study was conducted. Medical records and data from forensic medical reports were examined. All included observations with a positive determination of methadone were confirmed in the framework of lifetime chemical and toxicological studies and during postmortem forensic chemical studies of the biological environment of corpses. For the final interpretation of the results and evaluation of their statistical significance, the Pearson’s Chi-square (χ2) criterion was used. RESULTS: A comparative analysis of clinical and forensic data from most cases revealed consistent causes of death established in vivo and posthumously. Moreover, the leading pathological process that led to death was a combination of pulmonary and cerebral edema. The variability in the causes of death in some cases was due to the background pathology determined by thanatogenesis. The life expectancy of patients was determined by the effectiveness of intensive therapy (ventilator, infusion therapy, vasopressor, inotropic support, correction of metabolic disorders) and characterized by background pathologies and duration of hospital stay. CONCLUSION: A number of main and related conclusions of practical forensic and clinical interest were drawn from obtained data. Notably, in all cases, the fatal outcome of methadone poisoning was associated with metabolic disorders and severe hypoxia. Moreover, the use of antidote therapy with naloxone and wait-and-see techniques without respiratory support in the treatment of such patients is unreasonable.