A fatal motor vehicle collision involving multiple novel psychoactive substances

Novel psychoactive substances comprise a number of chemically diverse substances that have emerged in the illicit market over the past decade and continue to be readily available. These compounds have been considered “legal alternatives” for typical drugs of abuse and often share similar pharmacological profiles. Presented herein is a case from the United States of a 29-year-old male with no known past medical history that was suspected of impaired driving while traveling at a high rate of speed. The vehicle stopped when the decedent lost control and collided with a guardrail. The decedent was ejected and found lying near the guardrail with extensive blunt force trauma and was pronounced deceased at the scene. Initial screening of the decedent’s cardiac blood revealed 3-methoxy-PCP, butylone, delorazepam, and N-ethylpentylone. Further testing provided by an outside reference laboratory additionally confirmed 3-fluorophenmetrazine, diclazepam, etizolam, and fluoroamphetamine. Testing of scene evidence revealed the presence of 2-fluoro-deschloroketamine, butylone, diclazepam, etizolam, and N-ethylpentylone. The cause of death was attributed to an internal hemorrhage due to a laceration of the aortic root with multiple skeletal fractures resulting from blunt force trauma. The manner of death was accidental. The compounds detected in this case may have played a significant role in facilitating this fatal crash. This report documents a unique instance of poly-NPS use, and a discussion on the analytical and interpretive considerations commonly encountered when analyzing NPS is also presented.