Fatal defenestration and lethal heroin concentration: Suicide versus hidden homicide?

The authors present here the case of a 23-year-old man found dead after suicidal defenestration in a context of heroin use. This case highlights the parent compounds and metabolites concentrations interpretation problems in heroin, and the difficulty of formally implicating opioid use as the cause of death, due to the tolerance induced by these products. Police investigations and forensic findings were consistent with a suicidal act, leading to fatal polytrauma. However, toxicological analysis revealed a potentially lethal level of free morphine in blood (2168 ng/mL) in the context of chronic heroin abuse (morphine and 6 -MAM concentrations ranging from 3,827 to 4,984 pg/mg and 283 to 414 pg/mg, respectively, in the different hair segments), raising the question of the man's degree of consciousness when he fell. When high doses of toxic substances are found in traumatic suicide cases, the forensic pathologist must systematically discuss and reject the theory of a hidden homicide. (c) 2023 Societe Francaise de Toxicologie Analytique. Published by Elsevier Masson SAS. All rights reserved.