Fatal \u03b1-PVP and amphetamine poisoning during a sauna and autoerotic practices

Philippe Lunetta,Pirkko Kriikku,Julius Tikka,Ilkka Ojanperä

doi:10.1007/s12024-020-00236-1

Abstract

We describe the sudden death of a middle-aged man while having a sauna under the influence of α-pyrrolidinovalerophenone (α-PVP) (PM blood concentration: 0.8 mg/L), amphetamine (0.34 mg/L), and other drugs (buprenorphine, benzodiazepines), and engaging in solitary sexual activities. The drugs’ effects on the cardio-circulatory system and on body thermoregulation combined with the high temperatures are likely to have been central mechanisms leading to death. The high levels of adrenaline triggered by sexual arousal and the respiratory depression caused by buprenorphine, in association with benzodiazepines, may have also contributed to his death. This previously unreported type of accidental autoerotic death illustrates the risk of using amphetamine-like sympathomimetic drugs (e.g. cathinone derivates) in hot environments such as a sauna, and during sexual activities therein.

Highlights

Deaths associated with autoerotic activities have been described in the medical literature for over a century [1]
Byard and Bramwell [2] have recommended that the use of this term is restricted to accidental deaths that occur “during individual, usually solitary, sexual activity in which a device, apparatus, or prop that was employed to enhance the sexual stimulation of the deceased in some way caused unintended death”
We describe an atypical accidental death (AAD) of a middle-aged man during a sauna while under the influence of αpyrrolidinovalerophenone (α-PVP), amphetamine, and other drugs

Summary

Introduction

Deaths associated with autoerotic activities have been described in the medical literature for over a century [1]. The man had a history of multidrug abuse and was participating in a buprenorphine replacement therapy program (Suboxone®). The victim was found dead on the second highest bench of the sauna, in a supine position partially on his right side. He was unclothed except for a woman’s bra, which was placed around his hips. The victim’s body showed mild to moderate burn-like lesions caused by exposure to heat in the sauna. Traces of naloxone were detectable in PM blood, which is in accordance with the victim having been in buprenorphine replacement therapy. “Effect of high temperature (hot air, sauna)” was deemed a contributing cause of death

Discussion

Key points