Toxicologic Laboratory Findings in Cases Reported with Hanging Death: a Two-Year Retrospective Study in Northeast Iran

Background: Suicide is one of the leading factors of death worldwide. Hanging is one of the most common methods of suicide. This study was designed to evaluate post mortem toxicology laboratory findings of subjects with hanging death in northeast Iran.  Methods: This study was carried out on reported cases with hanging death to Razavi Khorasan Province-General Office of Iranian Legal Medicine Organization during 2009 to 2011. In this study, toxicologic investigations were performed on urine samples using thin layer chromatography and gas chromatography mass spectrometry techniques. For cases which required confirmation, another sample was also obtained from blood or the vitreous. Autopsy and scene investigation findings were also studied and entered into a predesigned checklist. Results: In total, 94 men (90.4%) and 10 women (9.6%) were studied. Suicide was proven in one hundred and one (97%) corpses and according to primary scene investigations and autopsy findings three (3%) cases were highly suspicious of non-suicidal events which eventually were clarified with the help of toxicology tests. No drug metabolites, substance or ethanol were noticed in 68 (65%) cases. Among 36 cases with discovered substances, morphine was the most common substance which was found in 27 (75%) cases. Ethanol and codeine came next and were reported in 9 (25%) and 8 (22%) cases, respectively. After plotting discovered substances against age groups, it was found that the presence of ethanol was significantly higher in younger individuals (P = 0.04). Conclusion: Although the nature of hanging death can be clarified by scene investigations, performing postmortem toxicology tests are also crucial to specify suicidal, homicidal or accidental background. In this study morphine was the main substance found in suicidal hanging cases. Hence, the abuse of opioids can be considered as one of the major risk factors of committing suicidal hanging in Iran.