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Succinylcholine: Is It the Perfect Murder Weapon? Not Exactly.

11 Jan

Succinylcholine, SUX for short, is a neuromuscular paralytic drug. This means that it works at the junction of the nerves and muscles and causes muscular paralysis. It paralyzes all the muscles of the body, including those used for breathing. Without ventilatory support anyone who receives this drug will die from asphyxia. The bad news is that they will be wide awake while this occurs because SUX causes muscular paralysis but has no sedative effects.

In medicine, it is used as part of anesthesia. Since it causes complete muscular relaxation it makes passing the endotracheal (ET) tube much easier. This ET tube is passed through the nose or the mouth and into the trachea where a balloon is inflated to keep it in position. The tube has been used to ventilate the patient throughout the surgery.

Succinylcholine, or some similar paralytic agent, is part of the three drug cocktail used in lethal injection executions. The first is a sedative to put the person to sleep, the second is the paralytic drug that paralyzes all muscles, and the final is potassium chloride which immediately stops the heart.

Succinylcholine must be injected and it works very quickly—within seconds to a minute. It is very short acting because enzymes in the body begin to break down the drug almost immediately. This makes it tough for the crime lab. There is no Succinylcholine left to test and so testing for it will prove negative. However testing for the breakdown products, also called metabolites, of the drug has proved successful in many cases.

The ability to test for these breakdown products stemmed from the case of Carl Coppolino, one of F. Lee Bailey’s most famous cases. This case is a milestone in Forensic Toxicology.

The Carl Coppolino Case

Carl Coppolino and his wife Carmela were both physicians, who moved from New Jersey to Longboat Key, Florida. On the night of August 28, 1965, Carl called his friend Dr. Juliette Karow and told her he had found his wife dead of an apparent heart attack. Dr. Karow came to the Coppolino home, agreed with Carl’s assessment, and ultimately signed Carmela’s death certificate, stating that her death was due to a coronary thrombosis. The Sarasota County Medical Examiner also agreed so no autopsy was performed.

Slightly more than a month later, Carl married wealthy socialite Mary Gibson, which angered his neighbor Marjorie Farber. It seems that Marjorie and her husband knew the Coppolinos in New Jersey. In fact, Marjorie and Carl had been having an affair. After the death of Marjorie’s husband William and Carl’s move to Florida, she followed the Coppolinos to Florida so she could continue her relationship with Carl.

Marjorie visited her friend Dr. Karow and told her that Marjorie’s husband’s death back in New Jersey had not been the natural event everyone thought. She said that Carl, who was an anesthesiologist, had given her a syringe filled with a liquid and instructed her how to inject her husband with it. Her attempt was only partially successful and she managed to inject only a small amount of the drug into her husband. She panicked and called Carl who came over and finished off William by strangling him. Carl returned home and then Marjorie called the Coppolino’s home, saying that her husband had died of an apparent heart attack. Ironically, Carmela had gone to Marjorie’s home and as a physician had pronounced William Farber dead and signed his death certificate, stating that his death was due to coronary thrombosis.

After Marjorie’s revelations, an investigation into both deaths followed with New York Chief Medical Examiner Dr. Milton Helpern performing an autopsy on each of the victims. Attorney F. Lee Bailey managed to gain an acquittal for Carl on the death of William Farber, but the interesting case was that of Carl’s wife, Carmella. Halpern was well aware that Carl was an anesthesiologist and guessed that he might have access to many anesthetic drugs, including the muscle paralytic drug succinylcholine, which at that time was essentially impossible to find in a corpse. Dr. Halpern brought toxicologist Dr. Charles Umberger into the case. After months of research, Umberger finally managed to isolate some of the metabolites of succinylcholine, one of which was succinic acid. He then found large quantities of this acid in the brain tissues of Carmela Coppolino. Carl was convicted of second-degree murder.

There have been many other famous cases in which Succinylcholine was employed or at least suspected to have been used. Here are a couple of interesting ones:

Genene Jones

Kathy Augustine/Chaz Higgs

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45 Comments

Posted by on January 11, 2010 in Interesting Cases, Poisons & Drugs

 

45 responses to “Succinylcholine: Is It the Perfect Murder Weapon? Not Exactly.

  1. Bob Doerr

    January 11, 2010 at 1:31 pm

    Excellent info. I was aware that this (or a similar) drug was used in the three part cocktail used in executions here in Texas. Just like guns and sharp knives, another thing I have to remember to keep away from my wife.

     
  2. Toxdoc

    March 18, 2010 at 6:40 am

    Er, several years ago the FBI lab reported that Unger’s test for succinylcholine is completely invalid. This resulted in the reversal of several convictions that depended upon it. BTW, the invalidity of the test was well-known for years to pretty much anyone who really looked at it. In fact, I testified on it in one case, alas to no avail.

     
    • D.P. Lyle, MD

      March 18, 2010 at 7:46 am

      The testing is difficult and must follow very strict protocols but opinions differ as to its accuracy. In the famous Las Vegas case of the alleged murder of Kathy Augustine the drug was found in her urine and proved to be important evidence in the case. DPL

       
  3. Toxdoc

    April 12, 2010 at 5:44 pm

    The National medical services SC test was completely invalid. As used in various murder cases, all it measured was background noise. In fact, the amount “found” in (e.g.) the Genenine Jones case was less than that shown in the tissue blank in the original animal studies. The FBI lab came to the same realization . Total fraud or complete incompetence.

    Stated simply, if you do proper tissue blanks (which everyone does in toxicology except NMS), ya find the same amount of “succinyl choline” in the tissues of everyone. If ya turn the gain up enough, you can find whatever the DA requires.

     
    • Toxdoc

      April 12, 2010 at 5:56 pm

      Addendum: I’m a ABT and ABMT-certified MD toxicologist who was originally a PhD toxicologist with a lot of experience in analytical toxicology. Which is how I know ya gotta do blanks– at lower concentrations, the analytical techniques get down to the level of “noise”. You cannot call background a “positive”.

      In fact, for this reason these days the standard practice it tox labs is not to report a positive toxicology finding except for values above a certain cut-off. NMS practice with their succinylcholine test was to report everything as a “positive”. Resulted in a lot of false convictions before the FBI blew the whistle.

       
      • Justin

        September 13, 2010 at 8:08 am

        hello i am doing a paper on succinylcholine and i am wondering if it this will show up on a tox screen?

         
      • D.P. Lyle, MD

        September 13, 2010 at 8:17 am

        No. And testing for it is difficult and controversial.

         
    • D.P. Lyle, MD

      April 12, 2010 at 7:05 pm

      Thanks for your input. That’s the thing with science–it isn’t static. It marches forward and what we believed one day is no longer true tomorrow. We once thought the world was flat, that diseases came from bad humors, and treated syphilis with arsenic. That was then, this is now. And the point you make is not an isolated one. In the OJ Simpson trial the defense made a big deal out finding EDTA in OJ’s blood sample and said that was proof the blood was planted. Of course we all have EDTA in our blood but that little fact was lost in the smoke and mirrors. And so it goes.

       
      • toxdoc

        August 6, 2010 at 8:19 am

        It really isn’t “succinylcholine”, “edta” or whatever. What is present is something that looks like these substances if you turn the gain on your detector up high enough. Either that, or just “noise”, like the static on your TV. Such false positives are why these days tox screens report anything below a certain threshold level as “negative”.

         
  4. melissayuaninnes

    July 14, 2010 at 3:19 am

    Dr. Lyle, thank you and Toxdoc for this fascinating article and discussion. Does this mean that, in 2010, the metabolites of succinylcholine really aren’t detectable?

    Looking at this article, http://drugsafetysite.com/succinylcholine/, I gather that if the murder victim had atypical cholinesterase (homozygous), he couldn’t break down the succinylcholine and then I assume you might be able to detect succ hours later. Does that sound accurate? If so, would blood or urine or both be positive?

    Many thanks,
    Melissa, writer & M.D., but certainly not a toxicologist

     
    • D.P. Lyle, MD

      July 14, 2010 at 12:16 pm

      Yes and no. What it means is that the testing might or might not be accurate enough for court cases. But whether this evidence is admitted is completely up to the judge on a case by case basis under the Frye and Daubert rules. This is one of the many areas that the forensic world and the courts must look at to standardize what is and isn’t allowed in courtrooms—and not leave it up the trial judge.

       
    • toxdoc

      August 6, 2010 at 8:24 am

      The “metabolites” of succylcholine are succinic acid and choline. Both of these are natural body consitituents. So finding them in specimens means absolutely nothing.

       
      • D.P. Lyle, MD

        August 6, 2010 at 8:34 am

        Depends on the level. Naturally the levels are very low. If a higher level is found it might mean something. Or not.

         
  5. Lee

    November 19, 2010 at 6:22 pm

    I am the former ex-girlfriend of Chaz Higgs.
    We lived together for 2 years .I know he did not do this .He was charming,nice,caring,
    romantic,funny,supportive,He encouraged me to further my college education,He went to work every day, He paid all my bills.He had an excellent bed side manner ,and would wait on me hand and foot ,if I were sick.
    He diffently is not a sociopath.We shared many emotional moments together.He under went testing through the court,that further proves he is not a sociopath.There is no motive in this case or evidence to prove he is guilty.He has had several Exs in the past in every situation he walked away with nothing and gave his exs everything.He was not greedy and did not care about money.He also has experience with jealous,controlling women.I recall ex-wife
    # 2 after we broke up.She came to my work on there wedding night and made some pretty mean coments to me ,(I guess she wanted to throw this in my face ?)She was escorted out.Through out the next year She constantly called me,harassed me,came to my work I told her I was going to get a restraining order if she did not stop.She was out of control.My point is he did not kill her,He simply walked away and divorced her.I could see how Kathy’s friends and family were quick to judge him because he was different and did not fit into their social circle.He was not conservative,nor stuffy,He had more of a South Beach ,Miami style,He liked italian loafers, r&b music,jeans and a tight shirt to show off his amazing physique.Her Friends/associated/family probably found him stuffy because he had no real interest in politics.however he was present to show support for his wife.It seems as everyone was quick to judge him and point the finger at him.I know everone thinks he showed no emotion ???? Well behind the scene,he knew family and friend of Kathy were pointing the finger at him.His wife just died ,He has no support on their end .He was even told to leave his own residence ,so that kathys brother and mother could stay there,and they did not want to be around him????? I believe all the stess of her death and her family led to his suicide attempts.He has always had alot of support and encouragement from his friends and family.
    Also I have met his family and spent time with them,they are all super people.I do know his Dad could be hard on Chaz and would never support him now ,unless he knew for sure he was innocent.
    It seems strage that Kathy had received death threats 1 and 2 wekks before her death.This was not investigated???????? Just before Kathys death she had discoved some very curropt events ,fraud,bad,bad things going on with some high ranking officials,she was going to expose this.She shared all info with Chaz .I have current communication with him now while he is in prison.He has names and details.Maybe this is why he did not get a fair trial???? nobody wants to expose this scandal because maybe they too,will end up dead?He is INNOCENT…… and would never kill anyone.

     
    • D.P. Lyle, MD

      November 20, 2010 at 9:25 am

      Yes, this is a very muddy and confusing case. Thank you for sharing your thoughts with my readers. If Chaz is indeed innocent I hope his appeals work out.

       
  6. Lee

    December 9, 2010 at 6:53 pm

    I have a questions in regards to the testing of succinylcholine .specifically pertaining to the Chaz Higgs case .The urine sample obtained From Kathy Augustine was taken postmorteum, but she had technically died .then paramedics revived her and she remained in a comatose state.Urine specimen was frozen and fe-exed to FBI they received it in a unfrozen state,it was then refrozen. What is the validity of this test ? Are there any new or updated testing proceedures or regulations for succinylcholine
    pertaining to testing or samples ?

     
    • D.P. Lyle, MD

      December 10, 2010 at 4:50 pm

      The accuracy of this testing under any circumstances is controversial but if removed at autopsy and properly stored the sample should be OK—it’s the testing itself that might be problematic.

       
  7. Tonya Pinkins

    December 30, 2011 at 11:04 pm

    I’ve read that 10cc’s is a lethal dose and that it would take 3 minutes to administer this amount. My husband works in forensic labs and has said he would kill me this way. I think he would get the most fun out of being acquitted for the murder. Is there really no way to test for this substance in tissues after death?

     
    • D.P. Lyle, MD

      December 30, 2011 at 11:07 pm

      Actually 10 CCs can be given in about 2-3 seconds. Just push the plunger. Testing for SUX and its breakdown products is difficult and controversial so it might or might not be detected in a given case.

       
  8. journeyofjordannaeast

    January 24, 2012 at 5:38 pm

    Glad I came across this post! SUX is the murder weapon of choice for the main character in my novel. I did quite a bit of research on it before beginning my writing, but coming across your info was a nice little refresher course!

     
  9. GlendaJones

    May 20, 2012 at 4:56 pm

    Just watched a BIO story of the drug SUX. We don’t have it here in Australia but have other drugs we use of course. Most of the BIO shows I watch always come up with the same drug. Is it so easy to get in America. We have strong regulatory compliance strategies here in OZ, but it seems so easy in America. It was the Chaz Higgs and Kathy Augeatine trial. How can people be indicted for murder based on the evidence given in these murder trials. D. P Lyle constantly says it cannot be found in the body, but is able to be detected in body fluids stored for longer periods of time. Why does this drug not disappear whilst being stored, and then found if fluids tested for same at a later time. is this just a ruse for people who are not liked by the community to be found guilty of the crime using this drug. It appears that this drug is very easy to obtain in the States, and therefore, there should be more research into finding a vaccine for this drug, change the legislation with regards to the availability of this drug, or perhaps look at removing this drug from the market completely. If there is no drug, then there would be more people still alive.
    I have been a Registered Nurse here in Australia for 43 years, so I do know about drugs, the legislation and how drugs are stored, we have to double sign for any drugs above an S4. And if this is the case in the States, then not only the person on trial is guilty but also the person who co-signed the drug out with the accused.
    Maybe there needs to be a big clean up of the way drugs are dispensed in America.
    It is so hard to believe these stories could be true based on how difficult it is to obtain these types of drugs here in Australia.
    Glenda.J.J
    Reg. nurse.
    QLD.
    Australia.

     
    • D.P. Lyle, MD

      May 21, 2012 at 7:51 am

      We have the same safe guards here in the US but anything can be stolen, particularly if it’s an inside job. Not to mention black market purchases. SUX is not easily obtained but it can be pilfered by medical personal who use it everyday. Those that work in Ors, ERs, pharmacies, supply houses, etc. have access and can walk away with small amounts.

       
  10. Meghal Naik

    June 11, 2012 at 3:29 am

    my novel also uses succinylcholine as murder weapon. and i guess the drug can be risked as a murder weapon cz of the negligble chances of detection.
    bt i want to knw somethng abt the availability of this drug…. could u plz hlp…?

     
    • D.P. Lyle, MD

      June 11, 2012 at 8:15 am

      SUX is used in hospitals and is available from pharmaceutical supply houses. So it can be purchased or stolen.

       
  11. Carol

    June 12, 2012 at 2:13 pm

    Is there a test to find this drug in postmortum tissue stored at the ME office for 3 years? Can it be found in a hair sample of the deceased? Any info on where to look for it? This victim was 30 and the spouce worked in the ER with access to everything and we know something was not right. They are walking free and we need some advice. Thanks

     
    • D.P. Lyle, MD

      June 12, 2012 at 3:18 pm

      Carol–This sounds as if you are asking about a current, real case and for medico-legal reasons I never comment on those.

       
      • Carol

        June 13, 2012 at 8:40 am

        Dr.Lyle, I just need an answer as to where it can be found and for how long. I can not find the info anywhere on my own. I am not involved in any case medical or legal. You happen to be the only one who talks about sux and that is why I asked. All of the other questions were of a similar nature to mine and were answered. I know it is difficult to find. I was just asking for your opinion…not putting you under oath. Any info you can relay would be appreciated. Thanks!

         
      • D.P. Lyle, MD

        June 13, 2012 at 9:18 am

        It is used in hospitals and supplied by pharmaceutical suppliers so could be stolen from either of these locations. Or maybe bought through a supply house of on the black market. Testing for it is difficult, fraught with problems, and very controversial as to accuracy.

         
  12. Grace

    August 28, 2012 at 12:11 pm

    Is it easy to get this succinylcholine?

     
    • D.P. Lyle, MD

      August 28, 2012 at 3:57 pm

      No but it can be had. Stolen from a hospital or ordered from a pharmaceutical supplier.

       
      • Meghal Naik

        September 16, 2012 at 1:09 am

        can a person with pharmacy degree order for sux even if he/she is not employed by a hospital??

         
      • D.P. Lyle, MD

        September 16, 2012 at 12:16 pm

        It depends but if they were employed at a pharmacy, then likely yes.

         
  13. Grace

    August 28, 2012 at 12:13 pm

    Is it easy to get?

     
  14. Grace

    August 28, 2012 at 12:13 pm

    Tnx

     
  15. George

    September 11, 2012 at 11:26 am

    I was reading a novel by Tom Clancy “The Teeth of the Tiger” and it mentioned succinylcholine, and since I just had an andoscopy and a colonoscopy done a month ago, I thought the drug sounded familiar. Could this have been used to put me out during the procedure ? If so what is the safe dosage ? Thanks.

     
    • D.P. Lyle, MD

      September 11, 2012 at 11:33 am

      SUX very easily could have been used but not as a sedative–to knock someone out—but rather as a paralytic drug to relax the muscles and allow for easier intubation and respiratory control by the anesthesiologist.

       
  16. Edward Harrison

    December 12, 2012 at 12:36 pm

    I believe this is how my sister and her son killed my brother for insurance money.They did it fast. He has been dead for two years.We are going to have his body exhumed and examined.

     
  17. KR

    January 28, 2013 at 6:18 pm

    Dear Doctor,

    Another question from someone writing a fictional story: I would like my book to be as highly medically literate, in the event a potential reader is a medical professional ( and scrutinized ) like those who watch HOUSE :) My book is a who done it, VS death by natural cause.

    My character is a 39 year old female found dead in the passenger seat of a vehicle in a parking lot. She lived out of her truck, was a former NURSE who had a history of narcotic use and heavy alcohol, however no drugs found on toxicology, and only small amount of alcohol in stomach content, none in blood.

    ( other details excluded ) except I will ADD my characters ex-husband (who had recently divorced her ) was a respiratory therapist ( they have access to SUX and similar acting agents right?

    My character also had 2 pin prick abrasions on the anterior aspect pf the right forearm ( my character is right handed ) injections of any kind by my character would reasonably be into the left anterior aspect of forearm, if right handed. My characters autopsy also revealed numerous different type scratches and abrasions on the wrists, and forearms, a long with as described ” the to pin point abrasions on anterior aspect of right forearm ”

    The autopsy performed found moderate amount of fat on the subepicardial region and minor RIGHT sided ( coronary small vessel disease ) the heart was slightly enlarged @ 330 grams and the face had a very congested appearance, in addition, so too the lungs had a very DIFFUSE CONGESTED appearance and a small amount of mild edema fluid excuded from cut surface.

    My character was either killed by her ex-husband or died as a result of an arrhythmia ( and there is no way to prove one died from an arrhythmia ) In addition, there is no way to prove the respiratory tech injected SUX, HOWEVER :::::::::::::::::::

    When someone suffocates, the autopsy findings will reveal diffuse lung congestion, to include a congested appearance in the face.

    Given, there was no obvious suffocation like strangulation, SUX would cause both suffocation ( the victim can’t breath after being injected with SUX, and the diffuse lung congestion and the face appearing congested as well, not to mention, SUX can also cause an arrhythmia.

    Autopsy findings of suffocation victims, lacking obvious signs of strangulation, having these markers ( diffuse lung congestion, congested appearing face ) could be potential things to llok for in suspected SUX victims, do you agree, especially if foul play is suspected.

     
  18. George Hook

    February 23, 2013 at 2:46 pm

    In Tom Clancy’s latest book, Threat Vector, John Clark determines that he will be unable to inject SUX into Target Two. So he opts for injecting it into the veal that his Target will be eating. Is this a viable method for fatal delivery?

     
    • D.P. Lyle, MD

      February 23, 2013 at 7:58 pm

      No, it would be destroyed by the stomach acids and digestive enzymes.

       
  19. Elizabeth Earles

    July 27, 2013 at 3:44 pm

    Could a death from SUX look like drowning if a body was dumped in and found in water and had been there for a few weeks

     
    • D.P. Lyle, MD

      July 28, 2013 at 1:50 pm

      SUre. Unless they looked for the SUX–which they might or might not find even if they do.

       
  20. Ben

    October 26, 2013 at 10:50 am

    I work in an operating room and use this drug almost everyday. It can be quite easy to obtain for most anyone who has access to the OR (surgeons, anesthesia, nurses, scrub techs, OR techs). In my hospital our drug carts that contain this drug are left unlocked all day so anyone could snatch a vial.
    Ben, Anesthetist

     
  21. Fabiani

    January 28, 2014 at 3:51 pm

    The elephant in the room is the fact that each and any drug made available to the medical profession is manifactured in great quantity without much in terms of control measures. In this case anyone with a basic license to purchase research chemicals is able to order SUX literally by the ounce through Sigma, Fisher and other lifescience suppliers.

     

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