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A Drug Toxicity Death Involving Propylhexedrine and Mitragynine

A Drug Toxicity Death Involving Propylhexedrine and Mitragynine

  1. Basoodler
    A Drug Toxicity Death Involving
    Propylhexedrine and Mitragynine*

    Justin M. Holler, Shawn P. Vorce, Pamela C. McDonough-Bender, Joseph Magluilo, Jr.,
    Carol J. Solomon, and Barry Levine†
    Division of Forensic Toxicology, Armed Forces Medical Examiner System, Armed Forces Institute of Pathology,1413 Research Blvd., Bldg. 102, Rockville, Maryland

    A death involving abuse of propylhexedrine and mitragynine is
    reported. Propylhexedrine is a potent αα-adrenergic
    sympathomimetic amine found in nasal decongestant inhalers.
    The decedent was found dead in his living quarters with no signs of
    physical trauma. Analysis of his computer showed information on
    kratom, a plant that contains mitragynine, which produces opiumlike
    effects at high doses and stimulant effects at low doses, and a
    procedure to concentrate propylhexedrine from over-the-counter
    inhalers. Toxicology results revealed the presence of 1.7 mg/L
    propylhexedrine and 0.39 mg/L mitragynine in his blood. Both
    drugs, as well as acetaminophen, morphine, and promethazine,
    were detected in the urine. Quantitative results were achieved by
    gas chromatography–mass spectrometry monitoring selected ions
    for the propylhexedrine heptafluorobutyryl derivative. Liquid
    chromatography–tandem mass spectrometry in multiple reactions
    monitoring mode was used to obtain quantitative results for
    mitragynine. The cause of death was ruled propylhexedrine
    toxicity, and the manner of death was ruled accidental.
    Mitragynine may have contributed as well, but as there are no
    published data for drug concentrations, the medical examiner did
    not include mitragynine toxicity in the cause of death. This is the
    first known publication of a case report involving propylhexedrine
    and mitragynine.