Medication Tampering

"Well, botulinum is injectable, and our current timeline puts the killer at Sam's office on the night of his death. But maybe, with insulin as the method of delivery, all he or she would need to do is inject the toxin into a single insulin vial and wait for Sam to use it, like a ticking... bomb."

— Liv Baker, Resident Alien, "Sexy Beast"

Killing someone by tampering with their medication. At its simplest, this can involve just substituting their medication for something fatal, or somehow putting something fatal IN the medicine. However, the more subtle version involves swapping the medication for something that has no medicinal value. Even if it’s not actively harmful, the victim will not be getting the benefit of their medication, and when they die, it will look like natural causes.

One more complex way to do this is to invoke a Dangerous Phlebotinum Interaction by dosing the target with another substance that reacts badly with the medicine they're already on.

See also Tampering with Food and Drink.

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Examples:

Anime & Manga

• In JoJo's Bizarre Adventure: Phantom Blood, Dio Brando elects to take his adoptive father's medicine up to him since the servant is old and prefers not to use the stairs. Dio uses this opportunity to switch out George Joestar's medicine for a similar-looking and hard-to-detect poison he purchased from a Chinese merchant. It fails when Jonathan Joestar realizes that Dio's father died with the same symptoms, implying Dio had used the same trick on his own father, although he ends up killing him in another fashion anyway.

Comic Books

• Blacksad: In "A Silent Hell" Sebastian's heroin dealer is being paid by a man dressed as this world's version of the Grim Reaper to give Sebastian his own heroin. The dealer confesses to Blacksad that Sebastian is likely not gonna survive, likening the dope to rat poison. Weekly finds Sebastian's trail but Blacksad arrives too late to stop him from injecting himself.

Films — Live-Action

• In Attack of the 50 Foot Woman, Harry tries to kill Nancy with a morphine overdose. He's stopped when the nurse turns on the light, which also reveals Nancy's growth.
• One of the Devil's random acts of petty evil in Bedazzled (2000) is to exchange all of the medicines that are being readied to hand out to patients in a hospital with candies. One of the changes that are explicitly mentioned is that of someone's anti-psychotics being replaced with Tic-Tacs.
• In Blackenstein, Dr. Stein's assistant, the lovesick Malcolm, switches Eddie's DNA injections, causing him to transform into a gigantic killer.
• In A Blueprint for Murder, Lynne tampers with Polly's calcium pills to ensure that she receives a second fatal dose of strychnine while she is in the hospital.
• In Crooked House, Aristide Leonides is murdered when the killer switches his insulin for toxic eye drops.
• In Deadly Advice, Jodie empties out her sister's heart medication capsules and refills them with flour.
• Dumb and Dumber does this accidentally. Joe joins up with Harry and Lloyd with the intention of killing them with poison pills. After they stop at a diner, they trick him into eating spicy food and irritate his ulcer. He asks them to give him the stomach medication he's carrying to fix the problem. After they give him the pills, he sees they gave him the poison by mistake and dies.
• In 'Green for Danger, the murderer paints a green cylinder of carbon dioxide to disguise it as a black-and-white cylinder of oxygen, so that when the anaesthetist Dr. Barnes administers oxygen to bring the patient round, he is actually giving them pure carbon dioxide, causing them to asphyxiate.
• The other part of Pengkor's plan in Gundala. After he sends people to poison the national rice supply with a serum that apparently will make pregnant ladies give birth to children incapable of differentiating between good and evil, he also controls the medical company that creates the supposed anti-serum. The anti-serum will actually give the unborn children physical birth defects in addition to a lack of morals.
• In Heist (2015), Dante dies after the vet student injects him with what is supposed to pain medication. Vaughn strongly implies that Dirty Cop Marconi substituted it for something lethal.
• In Knives Out, Harlan discusses with Marta what an effective means of murdering someone switching their medications would be. This happens after Marta has seemingly just injected him with a lethal dose of morphine after picking up the wrong vial. Later it is revealed that Ransom had earlier deliberately switched the labels on the vials of morphine and ketorolac so Marta would inject a fatal overdose. However, Marta instinctively picked up the correct vial without looking at the labels so no switch ever actually occurred.
• The Net: Dr. Alan (Dennis Miller) is killed by the movie villains via hacking and changing both his pharmacy and medical computer records giving him lethal doses of medications.
• Nightbreed: Dr. Decker replaces Aaron Boone's medication with hallucinogenic drugs to make him think that he was responsible for several murders that Decker himself committed.
• Downplayed in Police Academy 4. While Lt. Harris is taking a shower, someone (later implied to be Zed) replaces his underarm deodorant with mace. He doesn't die, but he does irritate his armpits.
• Played for Drama and Inverted in Repo! The Genetic Opera. Ill child Shilo is kept homebound due to a rare blood condition, which she takes daily medication for. In the finale, it is revealed that Shilo's father has been poisoning her with the "medicine," which causes her to exhibit the symptoms of her vague illness; she is completely healthy when not taking it.
• In Shock, Dr. Cross administers insulin shock therapy to Janet and intends to use the last dose as a cover to murder her by insulin overdose.
• In Trash Fire, Violet sabotages Owen's epilepsy medication, eventually causing him to collapse.
• In The Young Poisoner's Handbook, Graham spikes his stepmother's stomach medication: first with antimony and later with thallium.

Literature

Authors

• Used multiple times in the works of Agatha Christie:
  • In The Mysterious Affair at Styles, The victim's medication, which contained strychnine, is tampered with using a chemical that precipitates the strychnine to the bottom, ensuring the victim ingests all the strychnine from the bottle in one go when she takes the last dose.
  • In Dumb Witness, the victim’s liver pills are doctored with phosphorus. The hint is given by the ‘aura’ seen around the woman: the phosphorescence of her breath.
  • In Miss Marple novel The Mirror Crack'd from Side to Side, someone who uses some medication in an inhaler makes the mistake of trying to blackmail the murderer. The next time she uses her inhaler, she gets a lungful of Bitter Almonds.
  • In Crooked House, the eye drop solution the victim used for his glaucoma is put in a bottle labeled as insulin for treating his diabetes. The eye medicine proves to be quite deadly when taken via intramuscular injection.
  • In Murder is Easy, one of the supposedly accidental deaths was of Amy Gibbs, who confused her cough medication with hat paint.
  • In A Murder Is Announced, a character takes "aspirin" from Miss Blacklock's bottle. Turns out it was poison.

Individual works

• In Black Orchids, Bess Huddleston is killed by a bottle of silver argyrol containing tetanus germs swapped for a bottle of iodine.
• Played straight in Edenborn when Penny swaps one of Hessa's medications as a prank, resulting in Hessa's death from Black Ep.
• The Footprints on the Ceiling: Madame Rappourt routinely took "trance capsules" containing morphine and scopolamine before conducting a seance. When another character in the novel thinks she's developing mediumistic abilities and begs Rappourt to let her try the capsules, Rappourt empties out a couple and fills them with sugar instead. Then before she can hand over the altered capsules, the murderer spikes them with cyanide.
• The Hunt for Red October: This occurred in the backstory of Captain Marko Ramius of the Soviet submarine Red October. His wife died after a simple operation (an appendectomy) when she developed a post-op infection and the "antibiotics" she was given were actually just distilled water. The guilty parties were all politically connected, so they couldn't be punished. Ramius' rage and grief drove him to strike back at the entire Soviet system by defecting to the West and bringing Red October with him.
• In Murder, My Dear, a young woman who is taking care of a wealthy old woman who was bedridden finds out that somebody has been tampering with the woman's medication in the hopes that she would die. Originally it was thought to be one of her relatives, hoping to get at her inheritance, but as it turns out, it was her old friend, an author of murder books, who sought revenge against her for taking the only man she loved out of her life and caused him to die of leukemia.
• Murder Without Icing: The second murder of the novel is performed by substituting cyanide tablets for the victim's cold medicine.
• The Narrows: The solution for the death of Posthumous Character Terry McCaleb. It turns out that McCaleb, a heart transplant recipient, found out that his body was rejecting the donor heart. A second heart transplant would bankrupt his family. So Terry tampered with his own medication so that he would die and his death would look like natural causes.
• In The Queen's Thief book King of Attolia, Eugenides' medicine is spiked with a dangerous hallucinogen that is used to induce oracular visions and can lead to death if misused—as well as screaming nightmares. He put it there himself and didn't take it because he gets screaming nightmares anyway, and he needed to "expose" his chief attendant as a traitor without compromising his ability to secretly gather evidence for the way the attendant actually tried to murder him.
• In the Quiller novel The Striker Portfolio, West German fighter planes are crashing at a suspicious rate. When Quiller finds the saboteur, he turns out to be the psychiatrist who's been giving the pilots sedatives to cope with stress. One of the pills in each tube is an increased dosage that knocks out the pilot so they crash. Quiller is incredulous that it's something so simple.
• In Shadow of Doubt someone spikes Alinadar's medication with cleaning solvent. It causes massive damage to her vein and starts to reach her heart before the paramedics manage to stop it. Even then she needs cellular rejuvenation therapy to survive.

Live-Action TV

• Agatha Raisin: The Victim of the Week in "Agatha and the Wizard of Evesham" is murdered by the killer injecting ricin into his vitamin tablets.
• In Better Call Saul we find out how Tio Salamanca wound up in that wheelchair; his abused henchman Ignacio switched out his heart medication with regular, unhelpful ibuprofen.
• Buffy the Vampire Slayer: A variant: a de-powered Buffy manages to kill a powerful but ill vampire by replacing the water that he uses to wash down his medication with holy water.
• Burn Notice: In "Bad Breaks", Michael poisons a bank robber (while posing as a doctor after they wound a hostage) by putting stolen anxiety and allergy meds into his energy drink. The meds by themselves are "a scary combination", and that's before you account for the high dose of caffeine.
• Columbo, episode "The Most Dangerous Match": Dudek having survived his fall from the stairs, Clayton finishes him off by tampering with the medications Dudek needs for his diabetes and heart disease.
• The Coroner: In "That's the Way to Do It," the unpopular mayor of Lighthaven has her scone spiked with shellfish (to which she is allergic) and her epi-pen and inhaler removed from her handbag. The would-be murderer knows that the allergy won't actually kick in until the mayor engages in vigorous exercise and knows that she will be meeting up with her lover for an illicit sex session. The killer hopes the murder will be written off as exercise-induced anaphylaxis.
• CSI: In "Primum Non Nocere," the team doctor for an ice hockey team murders the Victim of the Week by swapping his painkiller tablet for a quinine tablet that he knows will interact fatally with the player's heart condition.
• CSI: Cyber: In "Click Your Poison", the team goes after a pharmacy website that sells fake prescription medication for heart disease, at a low price, to those who either can’t get it from their doctors or whose insurance doesn’t cover that type of medication. The downside to these cheap pills is that they don’t do what they’re supposed to do: make the patient better.
• CSI: Miami: "Paint it Black" features an artist who pays an accomplice to replace the contents of his protege's anti-psychotic medication with sugar, believing that it is her mental condition that makes her brilliant. However, the medication causes her to suffer a psychotic break and murder her roommate.
• CSI: NY:
  • In "Blood Actually," the killer swaps a diabetic victim's insulin for sugar syrup so that when he goes to inject himself with insulin, he is in fact shooting up more sugar.
  • In "Time's Up," a college student has her asthma inhaler switched for a drug that enhances sexual arousal, causing her to suffer a fatal asthma attack while orgasming in a cafe.
• Death in Paradise:
  • In "Death in the Clinic," the killer swaps the Victim of the Week's pain medication with a dose of botox strong enough to paralyze her lungs and cause her to suffocate.
  • In "Hidden Secrets", a doctor diagnoses his friend as suffering from an incurable degenerative nerve disease, as part of a plot to drive him to suicide. The drugs he supplies him to 'treat' the condition are actually antipsychotics that will simulate the symptoms of degenerative nerve damage.
  • In "Wish You Weren't Here", the murderer kills his second victim by surreptitiously dumping a large amount of heart medication the victim was already taking in his drink. Combined with his regular daily dose this was enough to trigger an overdose.
• In Desperate Housewives, pharmacist George Williams, who lusts after Bree van de Kamp, replaces her husband Rex's medications with potassium pills, and Rex suffers a fatal heart attack as a result.
• The Doctor Blake Mysteries: In "King of the Lake," the murderer substitutes the Victim of the Week's heart medication for similar-looking slimming pills; knowing that when he is thrown into the lake as happens at the end of every rowing race, the sudden immersion in cold water will trigger a fatal heart attack.
• Forensic Files: Yazeed Essa from "The Car Accident" killed his wife by slipping cyanide into her calcium supplements.
• Gotham: The father of Oswald Cobblepot explains to him that he has a heart condition, a hole in his heart that does not seem to resolve itself despite the medication he takes. His wife brings him the medication as he is explaining that, and after leaving the room takes the exact same white "pill" from a mints box and eats it.
• In Guardian: The Lonely and Great God, evil eunuch Park Joong-heon poisoned drugs to slowly kill the kings and Make It Look Like an Accident.
• Haven: In "Ain't No Sunshine", Rand and Wilson were withholding chemotherapy medication and selling it to other clinics, which led to the rapid death of Thornton's wife. This starts his Trouble, which kills them, although he does not appear to be aware that his shadow is actually killing people.
• An episode of Homicide Hunter found that a man had injected insecticide into his hospitalized wife's IV (she was being treated for blood clots in her leg). However, he was thwarted when the IV system's alarm went off and shut down the pump upon detecting that a foreign substance had been introduced into the solution. Particularly stupid, given the man was a doctor himself and should have known that that would happen.
• In a variation, one episode of Law & Order was centered around a man who was selling a fake flu vaccine that was actually just a placebo. In this case, it wasn't specifically to harm anyone but rather an attempt to take advantage of the shortage for financial gain. He still ends up being convicted of 16 counts of manslaughter for patients who died because they weren't immunized (and, contributing to the Moment of Awesome, McCoy convinces the judge to give him consecutive sentences for each count).
• Law & Order: Criminal Intent: In "In Treatment", a psychiatrist gives one of his patients an antidepressant that he knows is contraindicated with the antidepressant he is currently taking. The combination causes a variety of side effects, including delirium, which causes the patient to commit suicide.
  • In another episode, a pharmacist is found to have been watering down medications to save on costs. This caused the death of several patients.
• In an episode of Law & Order: SVU, the team discovers that a doctor intentionally faked a teenager's schizophrenia diagnosis, including using medication to induce symptoms, because she was having an illicit sexual relationship with him.
  • In an earlier episode, a corrupt group home had cut a schizophrenic man off his medications because he witnessed the death of another resident and they wanted to make sure that no one would take him seriously if he tried to report it. Once the case is uncovered, the detectives inform the group home that they're not only on the hook for that death but also for a murder the schizophrenic man had committed because he wasn't medicated.
• Leverage:
  • In "The Miracle Job," the crew induces a panic attack in the mark by replacing his anti-anxiety medication with pills that are a mix of caffeine and dexamphetamine.
  • In "The Second David Job," the crew cause a museum director to think he has contracted an infection from a mummy by swapping his allergy medication for a mixture of ragweed pollen and dexamphetamine.
• Midsomer Murders: The second Victim of the Week in "Death in Disguise" is killed when the murderer deliberately withholds their heart medication as they suffer a heart attack.
• Miss Fisher's Murder Mysteries: In "Death by Miss Adventure", one victim's medication is found to be spiked with bleach. It only partially works, leaving the victim weakened but not dead; the actual death comes elsewhere.
• One episode of Monk features a pharmacist who had murdered his partner years earlier and buried him on church grounds. When he learns the church is going to expand and dig up his partner, he concocts an elaborate hoax to convince the church that their fountain's waters are divine and heal people. He manages this by switching out the prescriptions he's supposed to be filling with sugar pills so that the patients' conditions worsen. He then anonymously directs them to drink from the fountain's waters. Once he learns that they've taken the bait, he begins providing them with proper medication again. As far as they know, they've been getting the medicine the entire time, so they believe the fountain is responsible.
• Murder, She Wrote: In "Angel of Death," a playwright has his sedatives swapped for powerful anti-depressives as part of a Gaslighting scheme.
• My Life Is Murder: In "Mirror Mirror", the murderer laces the lidocaine cream being used on the Victim of the Week's chest for a minor cosmetic procedure with barbiturates. This knocks the victim out several hours later and the killer force-feeds her more barbiturates and then injects her with a fatal dose of botulinum toxin to make it look like a case of self-medication gone wrong.
• A victim-of-the-week on NCIS runs afoul of this. His wife replaces his contact lens solution with a drug that reacts with his anti-depression meds, making him suicidal. But when that isn't quite enough (because Gibbs shows up to talk him down and nearly succeeds), she simply shoots him.
• One Life to Live. Determined to keep her mentally ill sister from revealing family secrets, Dorian Lord replaces her antipsychotics with sugar pills, prompting the woman to go off the deep end after years of stability.
• Perception (2012): The Villain of the Week in the first season finale kills her husband by replacing his blood thinner medication with sugar pills, which caused him to suffer a fatal stroke.
• Psych: In "Shawn, Interrupted", Bernie actually seems to be getting better, right up until someone starts tampering with his medication and he suffers a relapse.
• Stargate SG-1: The recurring character Martin Lloyd had his medicine tampered with to suppress his memory from before coming to earth, by his former crew-mates, which had the end result of making him seem like a Conspiracy Theorist. They did this because he wanted to continue their original mission of finding allies to reclaim their home world instead of making a new life on earth like the rest.
• The Tales from the Crypt episode "Undertaking Palor" has four teenage boys stumbling across a murder plot between the town's mortician and pharmacist with this as the crux of it. Specifically, the pharmacist poisons the medication of the locals, the mortician arranges the funerals, and the two split the take.
• Tales of the Unexpected: In "Force of Evil", the doctor attempts to kill the psychopath who is stalking his family by poisoning the stalker's insulin.
• A non-fatal version in Ugly Betty: Wilhelmina has Marc swap her sister's anti-psychotic meds with useless ones so she'll become mentally unstable and Wilhelmina can have her committed to an asylum.
• Ultraseven X: Peginera, from episode 4 ""DIAMOND "S"", splits its own cells into countless parasites and takes over the entire staff of Nano Cybertech, tainting their most popular product with its cells to infect thousands more, even children.
• Witse:
  • The killer of the episode "Natuurlijke selectie" killed his unborn son by prescribing the mother a substance that induces labour (ensuring pre-mature birth) instead of a medicine to counter her pregnancy poisoning.
  • The killer of "Sister morfine" bypassed the victim's automatic morphine pump by draining it with a syringe and subsequently injecting a month's dose of morphine into the victim.
• The Wire mixing poison into heroin is used twice. First, when Avon Barksdale needs to get rid of a troublesome guard at the prison, so he has the package he is smuggling into the prison poisoned leading to a rash of deaths overnight. Later, Bubbles tries to use potassium cyanide to get rid of an aggressive junkie that robs him daily, but unfortunately his young protege Sherrod snorts the vial when Bubbles is sleeping and dies.

Theater

• In keeping with the source material, Hook poisons Pan's medicine in the Play Within a Play in Peter Pan Goes Wrong. However, unlike the original, this goes on to have near-fatal effects on the actress playing Tink.
• The Solve-It Squad Returns!: Few doctors would be okay with using the term "medication", but Scrags replacing Esther's drug stash with placebos is a positively-intentioned version of this trope, essentially forcing Esther to go cold turkey without realizing it.

Video Games

• CSI: In "Extinguished", the stepson replaced the victim's cancer medicine with sugar, which obviously did nothing at all to treat the disease.
• In an early-game Dishonored side mission, the player can agree to work for Granny Rags, poisoning an elixir still used by Slackjaw's Bottle Street Gang with rat viscera.
• In The Elder Scrolls IV: Oblivion, one of the Dark Brotherhood quests requires you to assassinate a sickly bandit leader by replacing the medicine in his cupboard with an identical bottle of poison.
• Hitman 2: In "The Finish Line", 47 can poison Robert Knox's eye drops so that if he uses them, he'll poison himself in his bathroom.
• In Phoenix Wright: Ace Attorney - Trials and Tribulations, Dahlia Hawthorne poisons Phoenix's cold medicine so that she can retrieve a necklace she used for a past poisoning. However, she abandons that plan after deciding that another man needed to be killed off more than Phoenix, and the poisoned cold medicine ends up being the decisive evidence that proves her guilt.
• Star Wars: The Old Republic: An Imperial sidequest on Taris involves tampering with kolto tanks in a ruined hospital near the Republic base to contaminate the kolto with the rakghoul virus, in hopes that the Republic will salvage the stuff and infect their own troops.

Web Original

• Nightmare Time: In the episode "Honey Queen," Sam uses his status as a police officer in order to gain access into Mima Chambers' hospital room, where he alters her chart in order to change the dosages of all her medications. This ends up killing her.

Western Animation

• In King of the Hill, Bobby tries to get even with Luanne when her then-boyfriend throws a party at Boomhauer's house where he was house-sitting. He sets up pranks against Luanne and she retaliates back. Finally, he goes far enough to change Luanne's birth control pills with candy. Hank and Peggy decide to make Bobby "marry" Luanne to teach him a lesson.

Real Life

• Sadly Truth in Television, where certain pain and anxiety medications that also get abused recreationally have become such high value that some dealers use pill presses to make bootleg pills, sometimes using Fentanyl, a strong synthetic opioid. Such bootleg pills have led to the deaths of both Prince and Mac Miller.

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