Scopolamine fatal outcome in an inmate after buscopan® smoking

Scopolamine is an alkaloid which acts as competitive antagonists to acetylcholine at central and peripheral muscarinic\r\nreceptors. We report the case of a 41-year-old male convict with a 27-year history of cannabis abuse who suddenly died\r\nin the bed of his cell after having smoked buscopan® tablets. Since both abuse of substances and recent physical assaults\r\nhad been reported, we opted for a comprehensive approach (post-mortem computed tomography CT (PMCT), full forensic\r\nautopsy, and toxicology testing) to determine which was the cause of the death. Virtopsy found significant cerebral edema\r\nand lungs edema that were confirmed at the autopsy and at the histopathological examination. Scopolamine was detected in\r\nperipheral blood at the toxic concentration of 14 ng/mL in blood and at 263 ng/mL in urine, and scopolamine butyl bromide\r\nat 17 ng/mL in blood and 90 ng/mL in urine. Quetiapine, mirtazapine, lorazepam, diazepam, and metabolites and valproate\r\nwere also detected (at therapeutic concentrations). Inmates, especially when they have a history of drug abuse, are at risk to\r\nuse any substance they can find for recreational purposes. In prisons, active surveillance on the management and assumption\r\nof prescribed drugs could avoid fatal acute intoxication.