Forensic-psychiatric relationships in the context of forensic medical examination of new psychoactive substance-related deaths

Introduction
The aim of this study was to find causal relationships between the use of new psychoactive substances (NPS), the so-called “legal highs”, and the cause of death, taking into account information indicating the victim’s mental disorders before death.

Material and methods
The research material includes the results of toxicological analyses of blood samples collected during autopsies of 40 deceased persons whose cause of death was associated with the ingestion of new psychoactive substances (NPS). The blood samples were subjected to solid phase extraction (SPE), and then analyzed by liquid chromatography coupled with electrospray ionization tandem mass spectrometry (LC–ESI-MS-MS) for quantification. Information on individual cases was taken from case files provided by the prosecutor’s office for research purposes.

Results
As a result of the analyses, 24 types of NPS were detected, comprising synthetic cathinones – 15 cases, synthetic cannabinoids – 10 cases, synthetic opioids – 13 cases, other – 2 cases. In the study group there were 5 women (12.5%) and 35 men (87.5%). Suicide was demonstrated in 10 cases (25%), while the remaining 30 cases (75%) were accidental deaths, including those in which the actual motivation of drug use could not be determined. Drugs used to treat mental disorders were detected in 6 cases, while analgesics were demonstrated in 5 cases.

Conclusions
In the majority of cases, including suicides and accidental deaths where the manner of death was unknown, NPS use and consequent death from various causes are associated with psychiatric disorders.