Suicides In Physicians: Two Cases Of Poisoning Involving Fentanyl And Phenobarbital

Two cases of poisoning involving two physicians (an anesthesiologist and a cardiologist) are herein presented. In both cases, autopsy and toxicological analyses were requested for forensic purposes. A systematic toxicological analysis by gas chromatography-mass spectrometry or liquid chromatography with tandem mass spectrometry was applied to biological specimens collected at autopsy and on paraphernalia (vials, residues within bottles, used syringes, and needles) seized at the scene of death. Each positive result obtained by systematic toxicological analysis was confirmed by a specific quantitative gas chromatography - mass spectrometry analysis. In the first case, fentanyl was revealed in the bottles and in all biological specimens in concentrations above the pharmacological levels. In the second case, biological samples were positive for phenobarbital, morphine, and codeine, but only phenobarbital was present at lethal concentrations. Morphine, codeine, papaverine, noscapine, and phenobarbital were identified on the syringe. The toxicological results in the present cases were compared with data reported in other cases of suicides involving fentanyl and phenobarbital. Risk factors linked to suicide in physicians and the general population were also discussed.