Death by self-mutilation after oral cannabis consumption.
Major self-mutilation (amputation, castration, self-inflicted eye injuries) is frequently associated with psychiatric disorders andor substance abuse. A 35-year-old man presented with behavioral disturbances of sudden onset after oral cannabis consumption and major self-mutilation (attempted amputation of the right arm, self-enucleation of both eyes and impalement) which resulted in death. During the enquiry, four fragments of a substance resembling cannabis resin were seized at the victims home. Autopsy confirmed that death was related to hemorrhage following the mutilations. Toxicological findings showed cannabinoids in femoral blood (tetrahydrocannabinol (THC) 13.5 ngmL, 11-hydroxy-tetrahydrocannabinol (11-OH-THC) 4.1 ngmL, 11-nor-9-carboxy-THC (THC-COOH) 14.7 ngmL, cannabidiol (CBD) 1.3 ngmL, cannabinol (CBN) 0.7 ngmL). Cannabinoid concentrations in hair (1.5 cm brown hair strand1 segment) were consistent with concentrations measured in chronic users (THC 137 pgmg, 11-OH-THC 1 pgmg, CBD 9 pgmg, CBN 94 pgmg). Analysis of the fragments seized confirmed that this was cannabis resin with high levels of THC (31-35%). We discuss the implications of oral consumption of cannabis with a very high THC content.