Unusual Case of Fatal Virtual Chemsex Session Involving 3-Chloromethcathinone (3-CMC)

Synthetic cathinones, frequently used in chemsex, are difficult to identify in postmortem blood due to their short half-life and in vitro degradation. This unusual case of chemsex involving 3-CMC highlights the importance of freezing a blood aliquot and testing for metabolites. A 62-year-old man was found dead with chemsex paraphernalia beside him. Peripheral blood with sodium fluoride (PB), cardiac blood (CB) and urine were collected at autopsy. A PB sample was frozen at -20 °C for cathinone testing. In PB at +4 °C, alcohols were measured by HS-GC/FID, drugs and narcotics by LC-HRMS, GHB by GC-MS and cannabinoids by LC-MS/MS. Analysis of PB at +4 °C revealed a toxic concentration of GHB (330 µg/mL). Determination of cathinones in frozen PB revealed the presence of 3-CMC (17 ng/mL), dihydro-3-CMC and N-desmethyldihydro-3-CMC, while no cathinones or metabolites were identified in samples stored at +4 °C. Only metabolites were detected in urine. This case confirms the need to systematically screen for cathinones in suspected chemsex cases and, due to their instability, to screen for different metabolites and to freeze a blood sample after autopsy.