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Leg Med (Tokyo). 2018 Jan;30:5-9. doi: 10.1016/j.legalmed.2017.10.010. Epub 2017 Nov 2.

Death by self-mutilation after oral cannabis consumption.

Author information

1
Aix Marseille Univ, APHM, CNRS, EFS, ADES, France; APHM, CHU Timone, Service de Médecine Légale, Marseille, France. Electronic address: clemence.delteil@ap-hm.com.
2
APHM, CHU Timone, Service de Médecine Légale, Marseille, France.
3
Aix Marseille Univ, APHM, CNRS, EFS, ADES, France; APHM, CHU Timone, Service de Médecine Légale, Marseille, France.
4
APHM, SPMC, Pôle Universitaire de Psychiatrie, Hôpital de la Conception, Marseille, France.
5
Laboratoire Toxlab, Paris, France.
6
X-Pertise Consulting, 84 route de Saverne, F-67205 Oberhausbergen, France; Institut de Médecine légale, 11 rue Humann, F-67000 Strasbourg, France.
7
Aix Marseille Univ, APHM, CNRS, EFS, ADES, France.
8
Aix Marseille Univ, APHM, INSERM, INMED, CHU Timone, Service de Médecine Légale, Marseille, France.

Abstract

Major self-mutilation (amputation, castration, self-inflicted eye injuries) is frequently associated with psychiatric disorders and/or substance abuse. A 35-year-old man presented with behavioral disturbances of sudden onset after oral cannabis consumption and major self-mutilation (attempted amputation of the right arm, self-enucleation of both eyes and impalement) which resulted in death. During the enquiry, four fragments of a substance resembling cannabis resin were seized at the victim's home. Autopsy confirmed that death was related to hemorrhage following the mutilations. Toxicological findings showed cannabinoids in femoral blood (tetrahydrocannabinol (THC) 13.5 ng/mL, 11-hydroxy-tetrahydrocannabinol (11-OH-THC) 4.1 ng/mL, 11-nor-9-carboxy-THC (THC-COOH) 14.7 ng/mL, cannabidiol (CBD) 1.3 ng/mL, cannabinol (CBN) 0.7 ng/mL). Cannabinoid concentrations in hair (1.5 cm brown hair strand/1 segment) were consistent with concentrations measured in chronic users (THC 137 pg/mg, 11-OH-THC 1 pg/mg, CBD 9 pg/mg, CBN 94 pg/mg). Analysis of the fragments seized confirmed that this was cannabis resin with high levels of THC (31-35%). We discuss the implications of oral consumption of cannabis with a very high THC content.

KEYWORDS:

Autopsy; Oral cannabis consumption; Self-mutilation; THC/CBD ratio; Toxicology

PMID:
29125965
DOI:
10.1016/j.legalmed.2017.10.010
[Indexed for MEDLINE]

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