Citation

Dinis-Oliveira RJ, Durão C. Forensic Sci. Res. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Informa - Taylor and Francis Group)

DOI

10.1093/fsr/owad015

PMID

unavailable

Abstract

It was in 1936 that Lancet [1] first published three cases of intoxication by nitrites. The authors mentioned that poisoning by sodium nitrite was rare, and they were not able to trace any other record of fatal poisoning in the UK. Then, in 1939, three fatal cases due to sodium nitrite poisonings were reported in Journal of the American Medical Association (JAMA) [2]. That reality was maintained rare and virtually unheard of until very recently [3, 4]. Indeed, as forensic experts, we are very alarmed at how easily is being adver- tised and purchased this suicide means in different countries that ended in several series of fatal events [5-7]. In other words, more fatal cases of intoxication by sodium nitrite were published in the last 2 years than before. The toxi- covigilance data justify urgent and restrictive regulations for the use of sodium nitrite, but perhaps the market around this substance restraints further measures to be undertaken. Indeed, since sodium nitrite has several industrial applications, accidental exposure to contaminated water and food but espe- cially intentional ingestion has been associated with severe toxicity and deaths. Moreover, since routine tests for this substance are rarely available in different clinical and forensic settings, several other cases are certainly being missed. The tip of the iceberg as we unfortunately anticipated is becoming reality [7].

However, how people were aware of this possible means of suicide? Who is advertising? What kind of websites and services are helping the "exit"? We tried to obtain some answers, which were compiled here to alert clinical and foren- sic practitioners and toxicologists to this new trend of poison- ing: (i) the networks supporting euthanasia provide receipts, step-by-step instructions, and recommendations on how to use exit suicide kits containing sodium nitrite. Some websites demonstrate a high number of views. For instance, the Sanc- tioned Suicide website drew over 10 million page views in September 2022 and as of March 2023, the forum has over 30 000 members; (ii) sodium nitrite also gained attractiveness through online pro-suicide forums probably due to efficacy and easy access; (iii) sodium nitrite is advertised as a peaceful suicide means due to its mechanism of toxicity; and (iv) this food additive for meat curing can be easily purchased with a high level of purity (98%-99%) via different online vendors and consumer marketplaces. For instance, Amazon, already in 2022 and 2023, has been accused in multiple...

Language: en