Unusual Case of Fatal Virtual Chemsex Session Involving 3-Chloromethcathinone (3-CMC)

TL;DR

A man died after a chemsex session involving 3-CMC, highlighting the need for proper blood storage and testing to detect unstable synthetic drugs.

Contribution

The case emphasizes the importance of freezing blood samples and testing for metabolites to detect synthetic cathinones in postmortem investigations.

Findings

3-CMC and its metabolites were detected in frozen blood but not in samples stored at +4 °C.

Toxic levels of GHB were found in peripheral blood.

Only metabolites of 3-CMC were detected in urine.

Abstract

Synthetic cathinones, frequently used in chemsex, are difficult to identify in postmortem blood due to their short half-life and in vitro degradation. This unusual case of chemsex involving 3-CMC highlights the importance of freezing a blood aliquot and testing for metabolites. A 62-year-old man was found dead with chemsex paraphernalia beside him. Peripheral blood with sodium fluoride (PB), cardiac blood (CB) and urine were collected at autopsy. A PB sample was frozen at −20 °C for cathinone testing. In PB at +4 °C, alcohols were measured by HS-GC/FID, drugs and narcotics by LC-HRMS, GHB by GC-MS and cannabinoids by LC-MS/MS. Analysis of PB at +4 °C revealed a toxic concentration of GHB (330 µg/mL). Determination of cathinones in frozen PB revealed the presence of 3-CMC (17 ng/mL), dihydro-3-CMC and N-desmethyldihydro-3-CMC, while no cathinones or metabolites were identified in samples stored at +4 °C. Only metabolites were detected in urine. This case confirms the need to systematically screen for cathinones in suspected chemsex cases and, due to their instability, to screen for different metabolites and to freeze a blood sample after autopsy.

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