Case Report

By Dr. Zija Ismaili , Dr. Bledar Xhemali , Dr. Linda Matua , Dr. Gentian Vyshka , Dr. Fatos Zace
Corresponding Author Dr. Zija Ismaili
Institute of Forensic Medicine, Tirana , - Albania
Submitting Author Dr. Gentian Vyshka
Other Authors Dr. Bledar Xhemali
Institute of Forensic Medicine, Tirana, - Albania

Dr. Linda Matua
Institute of Forensic Medicine, Tirana, - Albania

Dr. Gentian Vyshka
Biomedical and Experimental Department, Faculty of Medicine, University of Medicine in Tirana, Rr Dibres 371 - Albania

Dr. Fatos Zace
Institute of Forensic Medicine, Tirana, - Albania


Drug addiction, suicide in custody room, withdrawal syndrome, illicit substances

Ismaili Z, Xhemali B, Matua L, Vyshka G, Zace F. Risk of suicide in custody for drug addicted detainees: an emerging phenomenon. WebmedCentral FORENSIC MEDICINE 2014;5(1):WMC004522
doi: 10.9754/journal.wmc.2014.004522

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 22 Jan 2014 07:08:07 PM GMT
Published on: 23 Jan 2014 10:07:01 AM GMT


This paper analyzes the emerging phenomenon of suicides in the custody room of drug addicted subjects in Albania. A case report of a drug addicted subject that has committed suicide in custody room is presented, together with data regarding the six years trend of suicides in custody room. One of the causes of the phenomenon is the isolation of drug addicted subjects. From forensic point of view, drug addicted subjects are intoxicated and are in need of specialized medical help. The clinical symptoms of withdrawal are different, but the most principal one are anxiety and depression. The question is that should these persons be detained in the custody rooms or should they be put in special institutions, in order to be helped and detoxified. In Albania this phenomenon of drug addicted is increasing. According to the Albanian Law (article 283), the possession of illicit substances from subjects will be followed from isolation in custody room in police department by the time they get arrested; with foreseen sentences up to 5 – 15 years of imprisonment.


The aim of this paper is to sensitize the Albanian legislative power to make changes in the law for illicit drugs (Article 283) for narcotic substances. Detainees are arrested and held in jail or custody rooms instead of detoxification centres, where this type of fatalities might be avoided. We will discuss and evaluate the suicides of drug addicted subjects in detention rooms during the period 2007-2012, and we are presenting a classical case of hanging in custody room of a heroine abuser.

Case Report(s)

K. B., a 27 years old male was found dead in the custody room in the department of Police. Apparently the young man committed suicide by hanging himself. The subject was known to the law enforcement officers as a drug addict and he also was sentenced earlier for burglary. His wife pretended that he was injured by the policemen and as result of that he died. The policemen that hold him under custody in the department pretended that the victim was still alive when arrived in the hospital from the custody room. A total autopsy was performed in the morgue. Apparently there were no signs of head bones deterioration. Above the hyoid bone a bruises scarf in the neck region was seen with the strangulation furrow, which had an irregular shape but otherwise continuous. Medico-legal diagnosis was that of a mechanical asphyxia from the neck pressure with loop.

Pathological findings: A total autopsy was performed in the forensic facility. Apparently there are no signs of head bones deterioration; the face is lightly bruised and turgid. The neck has cylindrical shape; it was symmetrical and with a normal length, confronted with the body length. Above the hyoid bone there is a bruises scarf in the neck region, the strangulation drill, which has an irregular shape, continuous from the front side of the neck, the lateral side and interrupted in the back side of the neck, where the interruption length was 7 cm (Figure 1). The drill had inclination from down – up and from frontward to backward with a width of 2.5 cm and a collateral width 1.2 cm. The strangulation drill was brown –reddish in colour, hard at touch (Meksi S, Çipi B). In the left inguinal region was present a cicatrix measuring 0.8 cm (Figure 2).

The subcutaneous tissues of the neck and in the muscles below the region where the strangulation furrow is projected were dissected. A hematoma in deep red color was found. The hyoid bone was bilaterally broken. The tissue around the break was covered with blood (Di Maio 2002). The upper respiratory airways were free, with their internal involucres shiny and light pink coloured. The lungs presented bigger volumes, in the visceral pleura were found dark reddish hemorrhagic spots (Tardieu`s spots). The lungs were ventilated and with blue – reddish colour. During dissection, the lung`s surface was brown coloured, and when squeezed it came out a dark coloured liquid with a little air bubbles.

Histological – pathological findings: neck tissues from the strangulation furrow and the muscles beneath it were taken, also samples of brain, heart, lungs, kidneys etc) were taken for histological examination (Philips. D.P). The samples of the neck tissue and muscles beneath it revealed haemorrhagic infiltration between the muscular cells, oedema, erythrocytes extravasation and around the blood vessel the presence of necrotic cells, as well as blood vessel with injured walls.  

Anatomic – pathological diagnosis: mechanical asphyxia due to pressure of the neck with a loop, wide furrow of one-fold strangulation, whose inclination was from downwards to upwards, interrupted from behind; haematoma of the subcutaneous tissues where the strangulation furrow was projected, fracture of the hyoid bone in 1/3 of its length and from both sides, acute lung emphysema, haemorrhagic dots in the lung and heart viscera (Tardieu`s spots) (Guarner J. Hanzlich R.)

Toxicological findings: stomach with its content was taken from the corpse, also blood and urine samples. The toxicological analysis revealed no presence of poisons (organophosphates, phostoxin or organic chlorinated substances) as well as no presence of ethylic alcohol. In urine samples opiate metabolites were detected, and benzodiazepines as well (Clarks’ 2000)


We have reviewed retrospectively all cases of suicides during 2007 – 2012. Attempts to suicides are not presented here (G. Perret J. Forensic Sciences 2006) (See Illustration 4)

The suicides and attempted suicides in custody room of police departments is an emerging phenomenon in Albania. One of the causes of the phenomenon is the isolation of drug addicted subjects. In Albania this phenomenon of drug addicted is increasing. According to the Albanian law these subjects must be isolated in custody room in police departments by the time they get arrested. The case presented here was of a classic suicide.

The reviewed data during 2007 – 2012 in Albania present an increasing trend (Figure 3). Suicides in custody room are usually performed by hanging (A. R. Felthaus 2011).   

The autopsy revealed: strangulation furrow with inclination from frontward to backward, from downwards to upwards, wide, one folded and interrupted in the back of the head, subcutaneous haematoma of the neck tissues where the strangulation furrow was seen, broken hyoid bone in both sides, haemorrhagic spots in the visceral pleura of lungs and in the heart tissues, cicatrix (of injection) in the left thigh, presence of opiate metabolites and benzodiazepines in urine samples. The injuries were caused from the total body strangulation (Di Maio, Forensic Pathology). The cause of death was the mechanical asphyxia.


The serious problem of suicides in custody room has been long scrutinized in the whole world, but for Albania is a new phenomenon, especially if we are talking about drug addicted subjects. 

The main question is if a drug addicted should be isolated in custody room or should he/she be treated in special institutions, in order to avoid these fatalities?

Until the 90`s the drug addiction did not existed in Albania but this phenomenon appeared in the period after 1990 and so. Inasmuch this phenomenon did not existed, so there were no legal dispositions in Albanian laws to prevent or condemn this attitude. The after 90`s governments took experience from foreign laws and the adapted them for the Albanian constitution (Article 283). One of these bills is the law dealing with the narcotic and psychotropic substances, substances that are forbidden to be used, cultivated or traded; this is because the narcotic phenomenon is increasing in our country. Actually, in Albania there is only a detoxification centre for drug dependent subjects, but the drug addicted number is quite higher than the capacity of this single centre. Subjects dependent from drugs tend to commit penal offenses like burglary, mug, drug dealing etc. From forensic point of view, drug addicted subjects are intoxicated and are in need of specialized medical help (Meksi S. Çipi B). The clinical symptoms during the withdrawal syndrome are different, but the most frequent are the anxiety and the depression. In these conditions, these subjects when isolated have a high risk of attempts and committing suicide; this is the reason that isolation can bring to fatal episodes. Ideally this subjects shouldn`t be isolated but they should be treated in detoxification centres. In our case report the isolated subject committed suicide using as a hanging tool his joggers, because in deep depression during this custody-forced withdrawal syndrome, he was not offered specialized medical and psychological support.


1. J. Urban Health. The epidemiology of firearm suicide in the United States 2002 Mar. 79(1): 38-48.
2. Lee C. J, Collins KA. Suicide under the age of eighteen, retrospective study of ten years. (J. of F. Medicine) 1999, 23-30.
3. Philips. D. P. Suicide and Life (Threatening Behavior) 1993, 24 (4), 307-309.
4. Guarner J. Hanzlich R. Suicide by hanging a reviewing of 56 cases (Am. J. Forensic Med. Path.) 1987, 8 (1) 23-26.
5. Art. 283; Albanian Law for Illicit substances.
6. Di Maio, Forensic Pathology, second edition 2002.
7. Çuberi B. Demtimet me arme zjarri (Gun-related injuries; in Albanian).
8. Meksi S, Çipi B. Legal Medicine, 2003.
9. Myftari. E Dallimi I vrasjeve nga vetëvrasjet. Kqyrja e vendit të ngjarjes, Tiranë, 1996 (Distinction of homicides from suicides and crime scene investigation; in Albanian).
10. Knight B. Simpson’s Forensic Medicine, E. Arnolds. London 199
11. Zeneli Xh. Tanatologjia Ligjore, Tiranë 2006 (Legal Thanatology; in Albanian).
12. Clarks’, Isolation of drugs 2000.

Source(s) of Funding

No funding received.

Competing Interests

No competing interests to disclose.

3 reviews posted so far

Suicidal Tendencies Among Addicted Prison Inmates
Posted by Ms. Eligible Hon. Dr. Jaimie E Dimitrius on 07 Jun 2014 02:54:16 PM GMT Reviewed by WMC Editors

Custody deaths
Posted by Dr. Raghavendra B YP on 06 Feb 2014 04:05:50 AM GMT Reviewed by WMC Editors

The Risk of Suicide in Custody for drug addicted detainees
Posted by Dr. William J Maloney on 29 Jan 2014 06:52:59 PM GMT Reviewed by Interested Peers

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)