Forensic Science International 231 (2013) e1e3

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Forensic Science International

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Case report

Acute methylone intoxication in an accidental drowning A case

report
Iain M. McIntyre *, Catherine E. Hamm, Lenore Aldridge, Craig L. Nelson
County of San Diego Medical Examiners Ofce, 5570 Overland Avenue, Suite 101, San Diego, CA 92123, USA

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 10 April 2013
Received in revised form 31 May 2013
Accepted 9 June 2013
Available online 2 July 2013

A 19-year-old woman who was known to use illicit drugs (ecstasy and marijuana) was found oating in
the ocean 100 yards from the beach. When last seen the previous evening, she had said to a friend that
she was going to get in the water. Reports to police indicated that she may have been on ecstasy.
There were no notes of a suicidal nature, illicit drugs, drug paraphernalia, tobacco cigarettes, or alcoholic
beverages at the scene. Autopsy ndings were consistent with drowning. Postmortem blood initially
screened positive for methamphetamine and cannabinoids by ELISA and was subsequently conrmed for
methylone by a specic GCMS SIM analysis following solid-phase extraction. Concentrations found in
the peripheral blood, central blood, vitreous, liver and gastric contents were measured at 3.4 mg/L
3.4 mg/L, 4.3 mg/L, 11 mg/kg, and 1.7 mg, respectively. No other amphetamine-like compound
(including ecstasy) was detected. These results are discussed in relation to previous cases of toxicity,
and the lack of potential for substantial methylone postmortem redistribution.
Published by Elsevier Ireland Ltd.

Keywords:
Methylone
Fatality
Postmortem concentrations
Postmortem distribution
Redistribution

1. Introduction
Methylone
[2-methylamino-1-(3,4-methylenedioxyphenyl)
propan-1-one] is a derivative of methylenedioxymethamphetamine [MDMAecstasy]. Originally synthesized as a potential
antidepressant and antiparkinsonian drug [1], it inhibits the
reuptake of norepinephrine, dopamine, and serotonin [24]. This is
not surprising given that bupropion (Wellbutrin1) [()-2-(tertbutylamino)-1-(3-chlorophenyl) propan-1-one], also a substituted
cathinone and substituted amphetamine structurally similar to
methylone, has been used successfully as an antidepressant and
adjunct to antidepressant treatment for a number of years [5].
Methylone, however, already demonstrated to have a high abuse
potential [6], is a drug of the class previously marketed as legal
alternatives to methamphetamine and MDMA and sold as bath
salts, plant food, or hookah pipe cleaner. When used/abused as a
stimulant, it is commonly found in combination with other drugs
such as mephedrone and methylenedioxypyrovalerone (MDPV)
(which have similar clinical effects such as euphoria, alertness, and
empathogenic effects). To date, there have been relatively few reports
of methylone in the absence of other signicant sympathomimetic
drugs particularly in postmortem cases.
The toxicity of methylone is not fully understood, but there are
reports discussing acute toxicity at the molecular level [6,7].

* Corresponding author. Tel.: +1 858 694 2907; fax: +1 858 495 5383.
E-mail address: Iain.McIntyre@sdcounty.ca.gov (I.M. McIntyre).
0379-0738/$ see front matter . Published by Elsevier Ireland Ltd.
http://dx.doi.org/10.1016/j.forsciint.2013.06.005

Additionally, it has been reported to exhibit adverse effects

including tachycardia, agitation, hallucinations, and hypertension
[8]. In the limited reported postmortem cases, methylone has been
directly associated with six fatalities [6,911]. Other cases where
the drug has been detected, but not directly found as an
independent cause of death, have included a gunshot suicide, an
accidental drowning, a homicide [6], and a motor vehicle (at fault)
accident [12]. Postmortem blood concentrations in these reports
have ranged from 0.06 to 3.3 mg/L [6,912].
The metabolism of methylone occurs through N-demethylation
to form methylenedioxycathinone (MDC), and demethylation and
O-methylation
forming
4-hydroxy-3-methoxymethcatinone
(HMMC) and 3-hydroxy-4-methoxymethcathinone (3-OH-4MeO-MC). The HMMC metabolite is the most prevalent, although
all compounds have been detected in urine following dosing with
methylone [13,14].
2. Methods
2.1. Case report
The decedent was a healthy 19-year-old woman with a history of recreational
drug use including marijuana and ecstasy. She was found in the morning oating
face down approximately 100 yards from the shore of a popular beach. Lifeguards
retrieved her body and conrmed death without medical intervention based on the
presence of rigor mortis.
Little was known about her antemortem events, but an acquaintance reported
speaking with her the night before, and said that she was going to get in the water.
It was also noted that she may have been on ecstasy, although no clarifying details
were given. The water temperature on the night of her death was 55 degrees
Fahrenheit/12.8 8C and wave conditions were 23 feet. Her clothes were found

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I.M. McIntyre et al. / Forensic Science International 231 (2013) e1e3

neatly folded on the beach the next day. No suicide note was reported from any of
her belongings and she had no known history of suicidal ideations or attempts.
The autopsy, performed within 24 h after the time that she was found,
documented multiple ndings consistent with drowning, including frothy uid in
her airway, pulmonary congestion/edema and pleural effusions, watery uid in her
sphenoid sinus, watery gastric contents, and maceration of her palms and soles.
Additionally, she had numerous external abrasions and contusions consistent with
her body being tossed in the surf and striking rocks and marine growth. However,
she had no trauma causative or contributory to her death. Natural disease identied
at autopsy was limited to an atrophic left kidney with renal pelvic and ureteral
dilatation. The right kidney was unremarkable.
2.2. Postmortem specimen collection
All specimens analyzed were collected at autopsy at the San Diego County
Medical Examiners Ofce. Peripheral blood was drawn from the left common iliac
vein (blood returning from the leg and visually identied in the pelvis at autopsy)
and stored in standard glass tubes containing sodium uoride (100 mg) and
potassium oxalate (20 mg). Central blood was collected from the intrapericardial
inferior vena cava and placed in identical tubes. Vitreous humor samples were
withdrawn from the eye with a syringe and stored in a glass tube without
preservative. A section of the right lobe of liver was collected and stored in a sterile
four ounce container without preservative. The gastric contents were collected and
stored in a new four ounce container without preservative. All samples were stored
at 4 8C until analyzed.
2.3. Toxicology
A complete toxicological screening regimen was requested and performed.
Postmortem blood was screened for alcohol and volatile compounds (GC-FID
headspace), drugs of abuse by ELISA (cocaine metabolite, opiates, methamphetamine, benzodiazepines, cannabinoids, fentanyl, synthetic cannabinoids, oxycodone, methadone, zolpidem, carisoprodol, and buprenorphine) (Immunalysis Inc.,
CA), an alkaline drug screen by GCMS following solid phase extraction, and an
acid/neutral drug screen with HPLC-photodiode array detection following
specimen precipitation with acetonitrile. Positive results were conrmed and
quantied by subsequent and specic techniques.
2.4. Alkaline drug screen (GCMS)
The drug screening procedure, although previously unpublished, has been
utilized by this laboratory for over ve years. It consists of a routine solid phase
extraction technique. Briey, 2.0 mL of calibrators, controls and casework were
extracted with cyclizine (1.0 mg: internal standard), ascorbic acid (200 mL, 2%
solution), zinc sulfate (5 mL, 5% methanolic solution) and sodium acetate buffer
(4 mL, pH 6.0). After elution from the solid phase columns (using 2 mL
dichloromethane/isopropanol/ammonium hydroxide solution: 78/20/2) and evaporation (low heat <30 8C, under a stream of nitrogen), reconstitution was achieved
with 100 mL of ethyl acetate. One mL (splitless) of each extract was then injected on
to the GC-MS system to attain separation and identication of alkaline drugs. A
15 m, 0.25 mm diameter, 0.25 mm lm thickness analytical column was used with
helium as the carrier gas. The inlet temperature of the gas chromatograph (Agilent
Technologies, 7890A) was 250 8C, and oven temperature was initially 85 8C, ramped
40 8C up to 170 8C (held 4 min), then 40 8C190 8C (held 5 min), and nally 10 8C up
to 300 8C (held 7.3 min). The MS Aux was 280 8C. The mass selective detector
(Agilent Technologies, 5975C), was set in scan mode with a solvent delay of
2.64 min. Peak identication was determined by relative retention time (relative to
the internal standard), and then mass spectral matching from a commercial MS
library (at least 70% match). Several commonly detected compounds with
established four point calibration curves (0.10 mg/L1.0 mg/L) were extracted
with each analytical run. Other compounds were extracted using a single point
calibrator to provide concentration estimates for casework. In casework,
concentrations of several compounds when detected at therapeutic concentrations
are routinely reported directly from this procedure if the identication criteria are
met, the respective positive control concentrations are within 20% of the
established mean, and the calibration curves meet acceptable criteria (r2  0.98).
Otherwise, compounds are subsequently conrmed and quantitated by an
appropriately validated second and different technique.
2.5. Methylone conrmation and quantitation analysis (GCMS SIM)
2.5.1. Materials
Solvents (dichloromethane, methanol, ethyl acetate, isopropanol and acetone)
were EMD Chemicals OmniSolv1 grade, purchase through VWR International
(Radnor, PA). Pentauoropropionic Anhydride (PFPA) was obtained from Sigma
Aldrich (St. Louis, MO). Ammonium hydroxide (ACS) and glacial acetic acid (ACS)
were obtained from VWR International. Zinc sulfate heptahydrate (Certied ACS)
was obtained from Fisher Scientic (Pittsburg, PA), and anhydrous sodium acetate
(GR ACS Mallinckrodt) was obtained from VWR Inc. Methylone and methylone-D3
were obtained from Cerilliant (Austin, TX). Solid phase extraction (SPE) columns

were Trace-B1 from SPEWare Corp. (Baldwin Park, CA). GC column Zebron-1MS
was purchased from Phenomenex1 (Torrance, CA).
Aqueous working standard containing 1.0 mg/L of methylone and internal
standard containing 1.0 mg/L of methylone-D3 were prepared. A linear calibration
curve from 0.02 mg/L to 1.0 mg/L produced using ve calibrators (0.02, 0.05, 0.25,
0.5 and 1.0 mg/L) were made by diluting the working standard. Linearity was
achieved by applying a linear least squares calibration curve (r2  0.99). All
calibrators were prepared in deionized water. Whole-blood (and liver) controls
containing 0.10 mg/L and 0.40 mg/L of methylone were prepared in house from a
second source of drug stock using porcine blood (or liver) as a matrix, and was run
with the calibrators and case specimens. Additionally, both blank (extract
containing no additives) and negative control (extract containing only internal
standard) specimens were extracted to conrm the lack of interference and/or
contamination.
2.5.2. Extraction
Methylone was extracted using a solid phase extraction procedure. A 2.0 mL
sample was extracted for all calibrators, controls and casework (blood, vitreous,
liver and gastric). Working internal standard (0.30 mL) was added to all tubes. 5 mL
5% zinc sulfate/methanol solution (50/50) was added to each tube, which were
vortexed and centrifuged at 2400  g for 10 min. The supernatant was buffered
with 4 mL 0.1 M sodium acetate buffer pH 6.0. The SPE columns were conditioned
by adding sequentially 2 mL each ethyl acetate, methanol, and acetate buffer (pH
6.0). The buffered supernatant was added to the SPE columns and allowed to ow
through at 25 mL/min. Columns were then washed by adding sequentially 2 mL
deionized water and 1 mL each 0.1 M acetic acid, methanol, and ethyl acetate.
Columns were dried at maximum pressure (40 psi nitrogen) for 6090 s.
Compounds were eluted with 2 mL elution solvent (dichloromethane/isopropanol/ammonium hydroxide 78/20/2), and allowed to drip through. The extracts were
evaporated at room temperature under a stream of nitrogen until just dry.
Derivatization was accomplished by adding 50 mL PFPA, capping tightly, vortexing,
and allowing to stand at room temperature for 20 min. The derivatives following
evaporation of PFPA were reconstituted with 200 mL ethyl acetate, mixed by
vortexing, and then transferred to autosampler vials.
2.5.3. Instrumentation
One mL splitless injections were made onto an Agilent Technologies 6890 gas
chromatograph. The analytical column was a Zebron ZB-1MS (15 m, 0.25 mm
diameter, 0.25 mm lm thickness) with helium as the carrier gas. The oven was
programmed to an initial temperature of 50 8C for 1 min, ramped 15 8C/min to
250 8C, and held for 3 min. An Agilent Technologies 5973 MSD was used for the
selective ion monitoring (SIM). The GCMS was controlled by Chemstation
software. The total chromatography time per injection was 17 min.
The following ions were monitored for quantitation: m/z 353 for methylone and
m/z 356 for methylone-D3. The ions monitored as qualiers: m/z 204, 160 for
methylone and m/z 207 for methylone-D3.
2.5.4. Validation
The limit of detection (LOD) was 0.01 mg/L, and limit of quantitation (LOQ),
determined from the lowest calibration concentration, was 0.02 mg/L. The 0.10 mg/
L and 0.40 mg/L blood controls measured 0.095  0.004 mg/L, (mean  standard
deviation), and 0.388  0.004 mg/L (mean  standard deviation) over six determinations, respectively. Similarly, the 0.10 mg/kg and 0.40 mg/kg liver controls measured
0.094  0.001 mg/kg, (mean  standard deviation), and 0.376  0.003 mg/kg (mean
 standard deviation) over four determinations, respectively. Any potentially
signicant matrix extraction effects were negated by the use of deuterated
(methylone-D3) internal standard.

3. Results and discussion

Although the initial methamphetamine ELISA screen was
positive, none of the routine compounds examined by subsequent
GCMS amphetamine conrmation were detected. The compounds usually detected and quantied with the conrmation
method include methamphetamine, amphetamine, methylenedioxymethamphetamine (MDMA), methylenedioxyamphetamine
(MDA), ephedrine, pseudoephedrine, phentermine, and phenylephrine. This method, previously described [15], has limits of
detection and quantitation of 0.01 mg/L and 0.02 mg/L, respectively for all compounds.
The ELISA screen, established with 50 ng/mL of methamphetamine as a reference, provides a positive result with about 28%
binding compared to a negative sample (100% binding). In this
case, the blood demonstrated 22% binding a clearly positive
nding. Subsequent evaluation of blood samples purposely spiked
with increasing concentrations of methylone revealed 70%, 48%,

I.M. McIntyre et al. / Forensic Science International 231 (2013) e1e3

38% and 35% binding for concentrations of 0.5 mg/L, 1.0 mg/L,
2.0 mg/L and 4.0 mg/L methylone, respectively, on the methamphetamine ELISA test. Although not achieving sufcient binding to
be considered as a positive nding, a clear trend with increasing
methylone concentration was observed. The apparent conclusion
is that a methylone metabolite (or metabolites) was present in
adequate concentration to produce enough additional binding so
as to generate a positive ELISA result in this case.
Methylone was also detected and conrmed, by full mass
spectral scan, on the GCMS alkaline drug screen following the
extraction of peripheral blood. It was detected at a retention time
of 4.5 min (internal standard cyclizine at 8.6 min) with ions of 58,
149, 121, 91 and 42. No methylone metabolites (or unknown
peaks) were observed. Subsequent specic GCMS SIM quantitation (method described above) conrmed concentrations in
peripheral blood of 3.4 mg/L, central blood 3.4 mg/L, vitreous
4.3 mg/L, liver 11 mg/kg and gastric contents 1.7 mg. While the
peripheral blood concentration showed a comparable level to the
highest previously reported [9], the liver concentration was
substantially elevated (six times greater) when compared to other
cases previous liver concentrations ranging from 0.14 mg/kg to
1.8 mg/kg [6,9,10].
After a full toxicology screening, the only other compounds
detected were delta-9 tetrahydrocannabinol (THC) and its carboxy
metabolite (THC-COOH) at concentrations of 3.2 ng/mL and
110 ng/mL, respectively, in peripheral blood. Based on the autopsy
and toxicology results, the cause of death was certied as
drowning due to acute methylone intoxication. The manner of
death was certied as accident.
Previous fatalities due directly to methylone toxicity have been
reported with postmortem blood concentrations ranging from
0.27 mg/L to 3.3 mg/L [6,911]. Although some deaths were
associated with elevated core body temperature and seizure
activity [9], this has not been recorded in all fatalities [10,11].
Different mechanisms of toxicity have been suggested as a possible
explanation high doses of methylone resulting in acute rapid
death (presumably cardiotoxicity), whereas lower doses may
cause a subacute toxic manifestation that includes extremely
elevated body temperatures followed by multiple organ failure [9].
Similar incidences of hyperthermia, as a consequence of serotonin
syndrome, have been documented for other central nervous
system stimulants such as methamphetamine and MDMA [16]. In
the case presented, the cause of death was drowning due to acute
methylone intoxication. No elevated temperature was reported or
known but, in this unwitnessed incident, cannot be excluded and
may have served as a reason for the decedents swim. Considering
that these are the highest methylone concentrations reported to
date, elevated core temperature is at least possible, as is
cardiotoxicity. In either case, incapacitation led to drowning.
In the case reported herein, the central blood to peripheral
blood (C/P) ratio was 1.00, the liver to peripheral blood (L/P) ratio
3.23, and the vitreous to peripheral blood ratio 1.26. Data from
previous reports are scant but comparable. Pearson et al. [9]
found an average C/P ratio of 1.11 in two cases, a L/P ratio of 1.57
in one case and a vitreous to peripheral blood ratio of 1.62 in a
single case. Similarly, Cawrse et al. [6] reported a C/P ratio of 1.10
in a single case and a L/P ratio of 2.69 in one case; although they
also found central blood to liver ratio averaging 2.74 in four cases
(peripheral blood concentrations were not reported). Kovacs
et al. [10] reported a L/P ratio of 1.42 in a single case report. Given
recent information documenting the L/P ratio as a marker for
postmortem redistribution (PMR), these data suggest minimal, if
any, PMR potential for methylone: based on criteria of ratios
exceeding 2030 indicative of a propensity for signicant PMR,
and ratios less than 5 indicating little to no propensity toward
PMR [1720]. This proposition is further substantiated by a case

e3

report comparing antemortem to postmortem peripheral blood

methylone concentrations in the same individual [9]. Pearson
et al. reported a methylone antemortem concentration of
0.70 mg/L compared to the postmortem blood level of
0.84 mg/L an increase of only 20%.
In conclusion, the present case revealed the highest blood and
liver methylone concentrations reported to date and, for the rst
time, positive reactivity on an ELISA drug screen for methamphetamine. First detected by ELISA, then conrmed by a routine
alkaline GCMS screen, concentrations were quantied by a
specic GCMS SIM analysis. Despite previous reports of fatal
toxicity to methylone at lower concentrations, death in the present
case was a result of incapacitation leading to drowning. Methylone
is not expected to be prone to substantial postmortem redistribution.
Acknowledgements
The authors would like to thank the San Diego County Chief
Medical Examiner, Dr. Glenn Wagner, for making available case
details described in this report.
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