4-methylethcathinone (4-MEC) is a designer cathinone classified as an illegal narcotic since July 2012 in France. This report presents the first fatality related to consumption of 4-MEC in France.

A 36 year-old man, in psychotherapy for drug addiction and suicide attempts, was found dead in his apartment. Three empty syringes were found near the corpse. His boyfriend told the police that the deceased was an intravenous user of drugs purchased on the Internet. No obvious cause of death was identified at autopsy. Several marks from needle and a rectal foreign body were observed. Blood, urine, vitreous humor, bile, gastric contents and hair samples were collected.

Immunological screening for amphetamine, methamphetamine, opiates, cannabinoids, cocaine, buprenorphine and MDMA was performed on urine. Identification and quantification of major amphetamine derivatives (amphetamine, methamphetamine, MDMA, MDA, MDEA and MBDB) was performed on urine and blood, following the SFTA GC-MS consensus protocol. General unknown screening (GUS) was performed on peripheral blood and gastric contents by GC-MS (spectral libraries: Nist11, Pfleger2011, Wiley, SWDrug) and on central blood by LC/DAD after liquid-liquid extraction. 4-MEC was quantified in blood by GC-MS/MS, using mephedrone-d3 as internal standard. The assay was validated for linearity, selectivity, limits of detection, precision and accuracy at 3 concentration levels. Analysis of ethanol and other volatile compounds was performed using headspace gas chromatography coupled to flame ionization detector.

Immunological screening was positive for amphetamine, methamphetamine and MDMA. Confirmation analysis for major amphetamine derivatives was negative. Hydroxyzine was quantified at therapeutic concentration (160ng/ml) in blood. 4-MEC was detected on GUS by GC-MS using the SWDrug mass spectra library. The concentration of 4-MEC was 14,600ng/mL in peripheral blood. Quantification in other matrices is ongoing. No other drugs/toxins were found, and screening for ethanol was negative. Analysis of syringes, performed in a different laboratory, detected 4-MEC.

Reports of use of 4-MEC have mainly described nonfatal intoxications, with blood concentrations about 100-fold lower than in the present case; only one fatal case has been reported in the literature (Rojek S., Meeting of IAFT, Japan, 2012), in which 4-MEC blood concentration was 1,267ng/ml. In the present case, the circumstances of death, autopsy findings and toxicology results, with a 4-MEC concentration of 14,600ng/ml, were consistent with 4-MEC overdose as cause of death.