Fatal comedown after taking 3-methylmethcathinone (3-MMC): A case report

The use of cathinones is a recent phenomenon linked to the emergence of new psychoactive substances. Certain population groups, such as men who have sex with other men (MSM) while under the influence of stimulants, known as "chemsex", may be more exposed. The authors report an original finding that seems indirectly linked to the death of a user. At 10.30 a.m., an argument broke out between a homosexual couple. One may have been a narcotics user and had taken cathinones several times in two days. To prevent an unpleasant comedown, he wanted to take some more drugs but his companion was opposed to it. At 8.35 p.m., the individual was found hanged at his workplace. The autopsy findings were consistent with hanging. A standard toxicological expertise was ordered that revealed the presence of 3-methylmethcathinone (3-MMC) at the following concentrations: femoral blood (49 ng/mL), cardiac blood (53 ng/mL), urine (310 ng/mL), stomach contents (74 ng/mL), and bile (205 ng/mL). GC/MS was essential to differentiate 3-MMC from 4-MMC (mephedrone). The pubic hair analyses revealed the following: 12 pg/mg of MDMA, 4 pg/mg of 3-MMC, and 28 pg/mg of buphedrone. The analysis of a vial found at the victim's home revealed the presence of buphedrone. Finally, 3-MMC and traces of MDMA, MDA, and buphedrone were found on the victim's clothes (T-shirt, underwear). All the 3-MMC concentrations were most probably underestimated owing to the renowned chemical instability of this molecule. The suicide appears to be related to the comedown described after taking stimulants. The circumstances seem similar to the rare cases described in the literature with a high prevalence of hanging. (C) 2020 Societe Francaise de Toxicologie Analytique. Published by Elsevier Masson SAS. All rights reserved.