FATALITY DUE TO GAMMA-HYDROXYBUTYRIC ACID (GHB) AND HEROIN INTOXICATION

The first case of fatal intoxication due to ingestion of gamma-hydroxybutyric acid (GHB) and intravenous use of heroin is reported. A 42-year-old man, known to have been a heroin addict and to have taken other psychoactive substances, who had been in treatment with GHB for several months, was found dead. Anatomo-histopathologic examination showed generalized visceral congestion, edema and pulmonary anthracosis, chronic bronchitis and chronic active hepatitis. Toxicological findings included fluid and tissue distributions of GHB, morphine and 6-monoacetylmorphine. GHB and morphine concentrations were respectively 11.5 and 0.77 mu g/mL (blood), 84.3 and 0.3 mu g/mL (vitreous humor), 258.3 and 1.35 mu g/mL (urine), 57.0 and 14.3 mu g/mL (bile), 40.0 and 0.43 mu g/g (brain), 43.0 and 0.60 mu g/g (liver), 47.0 and 0.68 mu g/g (kidney). Blood and urine levels of 6-monoacetylmorphine were 28.5 and 12.1 ng/mL respectively. The presumed mechanism of action and pharmacokinetics of GHB are briefly reviewed, with reference to its therapeutic use and to reports of non-fatal GHB intoxication.