{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:27:30Z","timestamp":1753892850497,"version":"3.41.2"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Prison riots, though often sensationalized in the media, have profound consequences, with a significant death toll. Prison populations, historically plagued by psychiatric disorders, witness high rates of suicide, particularly linked to turbulent events like riots. This study examines three drug overdose deaths resulting from a prison riot during the initial wave of the SARS-CoV-2 pandemic in Italy. To ascertain the nature of these deaths, a comprehensive toxicological analysis was conducted. Immunochemical screening and gas chromatography-mass spectrometry were employed to detect a spectrum of drugs, including MDMA, methadone, morphine, cannabis derivatives, benzodiazepines, and others. The toxicological findings revealed high concentrations of various substances in the biological fluids of the deceased inmates. Tramadol and mirtazapine were implicated in one case, while methadone was a common factor in the deaths of two inmates, one of whom also ingested diazepam. The synergistic effects of substances were explored, with methadone identified as a leading cause of death in two cases. Prison riots exacerbate drug abuse issues within prisons, leading to mass intoxication and overdose, as witnessed in historic incidents globally. The study underscores the challenges in determining whether such deaths are accidental, intentional (suicidal), or a consequence of uncontrollable drug consumption during a riot. The prison environment also amplifies pre-existing psychiatric disorders, and incidents like riots can trigger a cascade of uncontrollable psychological reactions. The three potential scenarios are drug dependence, accidental overdose in recreational drug use, and suicide attempts through substance ingestion.<\/jats:p>","DOI":"10.3389\/fpsyt.2024.1377995","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T04:45:25Z","timestamp":1726202725000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Drug overdose deaths during prison riots and mental states of prisoners: a case study"],"prefix":"10.3389","volume":"15","author":[{"given":"Luca","family":"Tomassini","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianni","family":"Giuli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo","family":"Bottoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Chiara","family":"David","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Scendoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","DOI":"10.2466\/pr0.100.2.407-419","article-title":"Prison rioters: exploring infraction characteristics, risk factors, social correlates, and criminal careers","volume":"100","author":"Graeve","year":"2007","journal-title":"Psychol Rep"},{"key":"B2","first-page":"49","article-title":"Deaths from acute drug reactions in Galician (Spain) Prisons (2001\u20132010)","volume":"19","author":"Miguel-Arias","year":"2017","journal-title":"Rev Espanola Sanid Penit"},{"key":"B3","doi-asserted-by":"crossref","DOI":"10.1111\/j.1556-4029.2011.01858.x","article-title":"Suicide behind bars: trends, inconsistencies, and practical implications","volume":"56","author":"Felthous","year":"2011","journal-title":"J Forensic Sci"},{"key":"B4","doi-asserted-by":"crossref","DOI":"10.1111\/1556-4029.13671","article-title":"Suicide by medication overdose in prison: A study of three cases","volume":"63","author":"Bartoli","year":"2018","journal-title":"J Forensic Sci"},{"key":"B5","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2016.03.009","article-title":"Risk factors for unnatural death: Fatal accidental intoxication, undetermined intent and suicide: Register follow-up in a criminal justice population with substance use problems","volume":"162","author":"Olsson","year":"2016","journal-title":"Drug Alcohol Depend"},{"key":"B6","doi-asserted-by":"crossref","DOI":"10.1177\/0025817220923693","article-title":"Covid-19 emergency in prison: Current management and forensic perspectives","volume":"88","author":"Caputo","year":"2020","journal-title":"Med Leg J"},{"key":"B7","unstructured":"COSA INSEGNA LA RIVOLTA IN CARCERE2021"},{"key":"B8","unstructured":"Coronavirus, carceri, ancora proteste. Tre detenuti morti a Rieti, le vittime salgono a dodici - la Repubblica2021"},{"year":"","key":"B9","article-title":"Prison and drugs in Europe: current and future challenges"},{"key":"B10","first-page":"17","article-title":"The global epidemiology of drug use in prison","volume-title":"Drug use in prisoners: epidemiology, implications, and policy responses","author":"Carpentier","year":"2018"},{"key":"B11","article-title":"Substance misuse among prisoners in England and Wales","volume":"15","author":"Singleton","year":"2003","journal-title":"Int Rev Psychiatry Abingdon Engl"},{"key":"B12","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1186\/s12888-023-05195-9","article-title":"Prescription drugs with potential for misuse in Irish prisons: analysis of national prison prescribing trends, by gender and history of opioid use disorder, 2012 to 2020","volume":"23","author":"Durand","year":"2023","journal-title":"BMC Psychiatry"},{"key":"B13","doi-asserted-by":"crossref","DOI":"10.1111\/bcp.14397","article-title":"Nonmedical use of benzodiazepines and Z-drugs in the UK","volume":"87","author":"Hockenhull","year":"2021","journal-title":"Br J Clin Pharmacol"},{"key":"B14","doi-asserted-by":"crossref","DOI":"10.1111\/bcp.14797","article-title":"Nonmedical use of prescription drugs","volume":"87","author":"Cremers","year":"2021","journal-title":"Br J Clin Pharmacol"},{"key":"B15","doi-asserted-by":"crossref","DOI":"10.1111\/add.13877","article-title":"Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women","volume":"112","author":"Fazel","year":"2017","journal-title":"Addiction"},{"key":"B16","article-title":"[Prison riots in U.S.A. 1951\u20131971]","volume":"15","author":"Kabealo","year":"1973","journal-title":"Quad Criminol Clin"},{"key":"B17","doi-asserted-by":"crossref","DOI":"10.1093\/oxfordjournals.aje.a113740","article-title":"Risk factors for victimization during the 1980 riot at the Penitentiary of New Mexico","volume":"119","author":"Lapham","year":"1984","journal-title":"Am J Epidemiol"},{"volume-title":"Report of the Attorney General on the February 2 and 3, 1980 Riot at the Penitentiary of New Mexico","year":"","key":"B18"},{"key":"B19","unstructured":"Venezuelan prisoners die of drug overdose following riots | Euronews"},{"key":"B20","unstructured":"Venezuela jail drug overdose kills 35 inmates in Uribana - BBC News"},{"key":"B21","unstructured":"Droghe e dipendenze [Internet]. XV rapporto sulle condizioni di detenzione2019"},{"key":"B22","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4321\/S1575-06202019000100005","article-title":"The discourses of risk of drug users in prison","volume":"21","author":"Clua-Garc\u00eda","year":"2019","journal-title":"Rev Esp Sanid Penit"},{"key":"B23","article-title":"Predictors of drug use in prison among women convicted of violent crimes","volume":"24","author":"Baltieri","year":"2014","journal-title":"Crim Behav Ment Health CBMH"},{"key":"B24","article-title":"Patterns of drug use and HIV-related risk behaviors among incarcerated people in a prison in Iran","volume":"87","author":"Zamani","year":"2010","journal-title":"J Urban Health Bull N Y Acad Med"},{"key":"B25","doi-asserted-by":"crossref","DOI":"10.1016\/S0196-0644(83)80466-1","article-title":"Medical consequences of the New Mexico State Penitentiary riot","volume":"12","author":"Price","year":"1983","journal-title":"Ann Emerg Med"},{"first-page":"947","volume-title":"Diagnostic and statistical manual of mental disorders: DSM-5","year":"2013","key":"B26"},{"key":"B27","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.forsciint.2007.07.010","article-title":"Fatal intoxication due to tramadol alone: case report and review of the literature","volume":"175","author":"De Decker","year":"2008","journal-title":"Forensic Sci Int"},{"volume-title":"New psychoactive substances in prison: results from an EMCDDA trendspotter study","year":"2018","key":"B28"},{"key":"B29","unstructured":"EMCDDA home page"},{"key":"B30","doi-asserted-by":"crossref","DOI":"10.1002\/dta.3263","article-title":"NPS detection in prison: A systematic literature review of use, drug form, and analytical approaches","volume":"14","author":"Vaccaro","year":"2022","journal-title":"Drug Test Anal"},{"key":"B31","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.drugpo.2016.10.003","article-title":"Adding Spice to the Porridge1: The development of a synthetic cannabinoid market in an English prison","volume":"40","author":"Ralphs","year":"2017","journal-title":"Int J Drug Policy"},{"key":"B32","unstructured":"Synthetic cannabinoids: What are they? What are their effects? | HSB | NCEH2022"},{"key":"B33","doi-asserted-by":"crossref","DOI":"10.1002\/dta.3002","article-title":"A transnational perspective on the evolution of the synthetic cannabinoid receptor agonists market: Comparing prison and general populations","volume":"13","author":"Norman","year":"2021","journal-title":"Drug Test Anal"},{"key":"B34","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0068944","article-title":"Psychosocial characteristics and social networks of suicidal prisoners: towards a model of suicidal behaviour in detention","volume":"8","author":"Rivlin","year":"2013","journal-title":"PloS One"},{"key":"B35","doi-asserted-by":"crossref","DOI":"10.1007\/s13181-014-0456-6","article-title":"Symptomatic exposures among california inmates 2011\u20132013","volume":"11","author":"Butterfield","year":"2015","journal-title":"J Med Toxicol"},{"key":"B36","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/j.1521-0391.2009.00005.x","article-title":"Drug Interactions of Clinical Importance among the Opioids, Methadone and Buprenorphine, and other Frequently Prescribed Medications: A Review","volume":"19","author":"McCance-Katz","year":"2010","journal-title":"Am J Addict"},{"key":"B37","article-title":"Mirtazapine overdose is unlikely to cause major toxicity","volume":"52","author":"Berling","year":"2014","journal-title":"Clin Toxicol Phila Pa"},{"key":"B38","article-title":"Methadone blockade of cardiac inward rectifier K+ Current augments membrane instability and amplifies U waves on surface ECGs: A translational study","volume":"11","author":"Klein","year":"2022","journal-title":"J Am Heart Assoc Cardiovasc Cerebrovasc Dis"},{"key":"B39","article-title":"Efficacy and safety profile of combination of tramadol-diclofenac versus tramadol-paracetamol in patients with acute musculoskeletal conditions, postoperative pain, and acute flare of osteoarthritis and rheumatoid arthritis: a Phase III, 5-day open-label study","volume":"7","author":"Chandanwale","year":"2014","journal-title":"J Pain Res"},{"key":"B40","first-page":"1964","article-title":"Tramadol for acute pain: a review of the evidence","volume":"72","author":"Sonis","year":"2005","journal-title":"Am Fam Physician"},{"key":"B41","doi-asserted-by":"crossref","DOI":"10.1016\/j.jad.2019.01.002","article-title":"Relative toxicity of analgesics commonly used for intentional self-poisoning: A study of case fatality based on fatal and non-fatal overdoses","volume":"246","author":"Hawton","year":"2019","journal-title":"J Affect Disord"},{"key":"B42","article-title":"Tramadol overdose causes seizures and respiratory depression but serotonin toxicity appears unlikely","volume":"53","author":"Ryan","year":"2015","journal-title":"Clin Toxicol Phila Pa"},{"key":"B43","doi-asserted-by":"crossref","DOI":"10.3109\/15563659709043367","article-title":"Prospective multicenter evaluation of tramadol exposure","volume":"35","author":"Spiller","year":"1997","journal-title":"J Toxicol Clin Toxicol"},{"key":"B44","doi-asserted-by":"crossref","DOI":"10.1016\/S0376-8716(99)00070-8","article-title":"Methadone, methadone treatment and non-fatal overdose","volume":"58","author":"Neale","year":"2000","journal-title":"Drug Alcohol Depend"},{"key":"B45","doi-asserted-by":"crossref","DOI":"10.1126\/science.2902689","article-title":"In vivo administration of anti-CD3 prevents Malignant progressor tumor growth","volume":"242","author":"Ellenhorn","year":"1988","journal-title":"Science"},{"key":"B46","first-page":"577","article-title":"A systematic review of the cardiotoxicity of methadone","volume":"14","author":"Alinejad","year":"2015","journal-title":"EXCLI J"},{"key":"B47","doi-asserted-by":"crossref","DOI":"10.1016\/j.jpainsymman.2007.11.003","article-title":"Methadone: to ECG or not to ECG \u2026 That is still the question","volume":"36","author":"Cruciani","year":"2008","journal-title":"J Pain Symptom Manage"},{"key":"B48","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.amjmed.2007.10.009","article-title":"A community-based evaluation of sudden death associated with therapeutic levels of methadone","volume":"121","author":"Chugh","year":"2008","journal-title":"Am J Med"},{"key":"B49","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/00000433-200209000-00021","article-title":"A review of methadone deaths in Jefferson County, Alabama","volume":"23","author":"Mikolaenko","year":"2002","journal-title":"Am J Forensic Med Pathol"},{"key":"B50","doi-asserted-by":"crossref","DOI":"10.1136\/ewjm.172.1.11","article-title":"Toxicology and pathology of deaths related to methadone: retrospective review","volume":"172","author":"Karch","year":"2000","journal-title":"West J Med"},{"key":"B51","doi-asserted-by":"crossref","DOI":"10.1520\/JFS13932J","article-title":"An investigation of medical examiner cases in which methadone was detected, Harris County, Texas, 1987\u20131992","volume":"41","author":"Barrett","year":"1996","journal-title":"J Forensic Sci"},{"key":"B52","doi-asserted-by":"crossref","DOI":"10.1111\/j.1467-842X.2002.tb00185.x","article-title":"Fatal methadone toxicity: signs and circumstances, and the role of benzodiazepines","volume":"26","author":"Caplehorn","year":"2002","journal-title":"Aust N Z J Public Health"},{"key":"B53","article-title":"Post mortem redistribution of drugs: current state of knowledge","volume":"23","author":"Sastre","year":"2017","journal-title":"Curr Pharm Des"},{"key":"B54","doi-asserted-by":"crossref","DOI":"10.1016\/j.forsciint.2004.12.008","article-title":"Comparison of ethanol concentrations in right cardiac blood, left cardiac blood and peripheral blood in a series of 30 cases","volume":"156","author":"Pelissier-Alicot","year":"2006","journal-title":"Forensic Sci Int"},{"key":"B55","doi-asserted-by":"crossref","DOI":"10.1007\/s00414-012-0736-0","article-title":"Can subclavian blood be equated with a peripheral blood sample? A series of 50 cases","volume":"127","author":"Sastre","year":"2013","journal-title":"Int J Legal Med"},{"key":"B56","doi-asserted-by":"crossref","DOI":"10.1002\/gps.715","article-title":"Older criminals: a descriptive study of psychiatrically examined offenders in Sweden","volume":"17","author":"Fazel","year":"2002","journal-title":"Int J Geriatr Psychiatry"},{"key":"B57","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(22)00093-7","article-title":"The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis","volume":"7","author":"Baranyi","year":"2022","journal-title":"Lancet Public Health"},{"key":"B58","first-page":"1092","volume-title":"DSM-5. Manuale diagnostico e statistico dei disturbi mentali","author":"Biondi","year":"2014"},{"key":"B59","first-page":"300","volume-title":"Crowds, psychology, and politics, 1871\u20131899","author":"van Ginneken","year":"1992"},{"volume-title":"A history of social psychology: From the eighteenth-century Enlightenment to the Second World War","year":"2007","author":"Jahoda","key":"B60"},{"key":"B61","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0220267","article-title":"Depressive symptoms and its associated factors among prisoners in Debre Berhan prison, Ethiopia","volume":"15","author":"Reta","year":"2020","journal-title":"PloS One"},{"key":"B62","doi-asserted-by":"crossref","first-page":"9984","DOI":"10.3390\/ijerph19169984","article-title":"Protection of prisoners with mental health disorders in Italy: lights and shadows after the abolition of judicial psychiatric hospitals","volume":"19","author":"Di Mizio","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1002\/dta.3541","article-title":"Hair analysis: Assessment of homemade hair treatment effects on drug concentrations in the keratin matrix","author":"Mestria","year":"2023","journal-title":"Drug Test Anal"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2024.1377995\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T04:46:02Z","timestamp":1726202762000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2024.1377995\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,13]]},"references-count":63,"alternative-id":["10.3389\/fpsyt.2024.1377995"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2024.1377995","relation":{},"ISSN":["1664-0640"],"issn-type":[{"type":"electronic","value":"1664-0640"}],"subject":[],"published":{"date-parts":[[2024,9,13]]},"article-number":"1377995"}}