A fatal chemsex case involving γ-butyrolactone and 4-methylethcathinone

The intentional consumption of certain psychoactive and nonpsychoactive substances in the context of sex parties and sexual intercourse with the intention of facilitating and/or enhancing the sexual encounter mostly among men who have sex with other men (MSM) has been indicated as “chemsex.” Whereas in the 1990s, the most commonly abused drugs in the “party and sex” contest were alcohol, cocaine, and methamphetamines, more recently chemsex has been associated also with the use of sex enhancers such as erectile dysfunction agents; γ‐hydroxybutyric acid (GHB), also used as a depressant rape drug; and new psychoactive substances (NPS), such as cathinones or ketamine. When a death is suspected to have taken place in the context of chemsex, special attention should be paid to the toxicological analysis of the most appropriate biological matrices to disclose the eventual presence of psychoactive and pharmacologically active substances that may also have played a role in the death. We present here a fatal chemsex case with suspicion of substances consumption, which was confirmed by toxicological analysis of decedent biological fluids and exhibits at the crime scene.