“It Smells Like Almonds…”

A brief history of the 1982 Chicago Tylenol Murders

Abstract

The evolution of pharmaceutical safety can be traced back to several significant events in history. Whether it be the illegal experimentation of people without their knowledge, or the secret tampering of products (just to name a few), the process of protecting human rights and safety is an ongoing battle.

One of the events leading to an evolution in safety was the 1982 Chicago Tylenol Murders. These tragic homicides prompted pharmaceutical giant Johnson & Johnson to rethink how consumers could be protected against malicious intent, and introduced a concept we now know very well; tamper-evident packaging. At the time of the Murders, pill bottles were easily accessible to manipulation throughout the manufacturing process. A fact an unknown individual took advantage of when they chose Tylenol to randomly spike with potassium cyanide.

This post, along with the media clip included at the very bottom, is intended to give a general overview of the few facts that are known about these poisonings, as well as the series of events leading to the discovery and evidence of potassium cyanide toxicity.

Searchable keywords: Johnson & Johnson, Chicago Tylenol Murders, Tylenol, Potassium Cyanide, Almonds, RetroReport

Introduction

The fall of 1982 forever changed the pharmaceutical industry when seven people in the greater Chicago area fell victim to lethal cyanide poisonings. Each of these individuals had ingested what seemed to be standard over-the-counter Extra Strength Tylenol, manufactured by Johnson & Johnson and purchased at local drug stores. Unbeknownst to all, an unidentified individual had laced these bottles, and potentially many more, with fatal concentrations of potassium cyanide. While the perpetrator for these random acts of homicide has yet to be identified, security measures resulting from his/her actions are still in place today. These include additional quality checks of products prior to distribution, increased security within manufacturing, and – perhaps the most beneficial – the presence of tamper-evident seals placed across the openings of pill bottles immediately after they are filled during manufacturing. Additionally, warning labels are featured on every product instructing the user to discard the bottle should that seal appear damaged in any way¹.

Potassium cyanide appears as a white granular or crystal solid, and in the case of the Chicago Tylenol Murders, camouflaged perfectly with the consistency of the tablets. Exposure can be rapidly fatal even with minimal concentrations and has systemic consequences. The hydrogen cyanide gas released by potassium cyanide acts as a toxic asphyxiant, limiting the use of oxygen within the body. Thus, organs that are highly oxygen dependent such as the brain, heart, and lungs, are most detrimentally affected². Symptoms reported by each victim able to communicate before passing included dizziness, confusion, shortness of breath, and headache. However, the cause of death attributed via autopsy was suffocation- despite blood oxygen levels being above normal. It was only after extensive interviews and post-mortem toxicology reports identifying the presence of potassium cyanide that health and police officials were able to establish a commonality¹.

 

Claim (Research Question)

How was cyanide poisoning identified as the cause of death during the Chicago Tylenol Murders of 1982?

Why this topic? (Reason)

I am unashamedly a ‘true-crime junkie’; I was listening to an Apple Podcast and happened to come across “Poisoned Pill – The Chicago Tylenol Murders” on “Unsolved Murders; True Crime Stories”³. As I was listening, I kept wondering “How did they know it was cyanide? How did they figure out it was the Tylenol? How was someone able to poison the pill, weren’t there tamper-evident seals? Could something like this happen again?” This assignment gave me an opportunity to answer those questions.

 

 

 

Poisoned Pill; The Chicago Tylenol Murders

 

 

Evidence

Mary Kellerman – Female, age 12 died Sept. 30, 1982
Adam Janus – Male, age 27 died Sept. 30, 1982
Stanley Janus – Male, age 25 died Sept. 30, 1982
Mary Reiner  – Female, age 27 died Sept. 30, 1982
Mary McFarland –  Female, age 35 died Sept. 30, 1982
Paula Prince – Female, age 35 died Oct. 1, 1982
Theresa Janus – Female, age 19 died Oct. 1, 1982

Series of events:

Firefighter Inspector Richard Keyworth noted Tylenol listed as medications for the first 4 victims. However, this fact is quickly dismissed as “everyone in the world took Tylenol. That didn’t seem out of order” – Keyworth⁶

 

 

 

 

Public Health Nurse Helen Jensen is first to identify a connection between the Janus Family deaths and Tylenol; “I found a bottle of Tylenol and there were six capsules missing – and three people dead. In my mind, it had to be something to do with the Tylenol.” – Jensen⁶

 

Potassium cyanide has an odor similar to that of raw almonds. However, that odor is often undetected and is not a sufficient warning. At best, only 60% of the population might be able to smell cyanide, yet of that 60% a large fraction may suffer olfactory fatigue, making immediate identification even less likely⁵. Fortunately, Cook County Medical Examiner’s Office Investigator Nick Pishos is one of the rare few able to detect the scent of almonds extruded by potassium cyanide. After recovering the bottles of Tylenol from several of the victims’ homes, Dr. Pishos noted a peculiar similarity; all the remaining pills smelled like almonds. He is credited for the second connection and first significant association between Tylenol and all the known poisoning victims.

 

Dr. Thomas Kim, Medical Director of Northwest Community Hospital’s ICU, also deduced cyanide poisoning was the most likely cause of death, however far-fetched the idea seemed. He sent blood for toxicology testing – an act that was thus far uncommon. The reports came back showing 100-1,000 times the minimum lethal dose of potassium cyanide (250mg⁸)

Discussion

Within 24 hours of the first reported deaths, officials identified tampered Tylenol bottles with control number MC2880 to be the source of cyanide exposure. Johnson & Johnson immediately recalled all containers from that lot and all Tylenol products nationwide within days. The mass recall was estimated at 31 million bottles valued at more than $100 million⁶.

 

 

This mass recall was the first of its kind. Many predicted it would permanently mar the company, however the act contributed to a very positive public response. In the months that followed, Johnson & Johnson was reported as a transparent company who “placed consumers first” and showed dedication to product safety by reissuing Tylenol with triple-ply tamper-proof packaging (three times the FDA minimum) and new safer tablet forms. Replacement products were also offered free of charge. Despite these new measures costing the company millions, revenue and market sharing quickly recovered to the standings observed prior to fall of 1982^7,9.

 

The Chicago Tylenol Murders of 1982 remain unsolved. However, one suspect was closely followed after Johnson & Johnson received a letter demanding ransom for the cessation of poisonings. James Lewis was adamantly questioned and requitted of his theoretical connection to the murders. However, as Mr. Lewis did in fact send this letter – and an additional one to the White House, along with several other crimes – he was charged with fraud and extortion and sentenced to 20 years in jail⁴.

 

 

Although undoubtedly tragic, the Tylenol Murders have been able to contribute several advances in the safety of pharmaceuticals, as well as motivation for toxicologists to better understand the effects of potassium cyanide. These understandings have led to many documents identifying potential routes of exposure, methods of action, and available antidotes². Also as a direct result, the U.S. Congress passed The Federal Anti-Tampering Act (aka the “Tylenol Bill”) in 1983, making tampering with packaged consumer products a federal offence. Potassium Cyanide continues to be studied, with specific emphasis on antidotes and sensory identification (I.E. – identification by means other than lab tests, colorimetric  analysis,  and gas chromatography–mass spectrometry  (GC-MS)). However, further research is needed to truly combat this poison.

Unfortunately, no new information on these homicides is available as the case was reopened in 2009. The Tylenol Murders are now considered under open investigation and media coverage is limited¹¹.

 

 

As to the “million-dollar question”; could this happen again? The short answer is ‘maybe’ – there are people all over the world who have demonstrated random destructive and malicious intent. However, thanks to the federal regulations surrounding all aspects of pharmaceuticals and known toxic substances, the odds of copy-cat performances are substantially minimized.

References:

1. The Associated Press. Chronology of Events in Tylenol Poisonings with AM-Tylenol. The Associated Press 1986 February 13, 1986.

 

2. National Institute for Occupational Safety and Health (NIOSH). Potassium Cyanide. 2011;UN 1680 (Guide 157).

 

3. Roy C, Mackenzie W. “Poisoned Pill” – The Chicago Tylenol Murders. 2017. Retrieved from https://podcasts.apple.com/au/podcast/e130-poisoned-pill-the-chicago-tylenol-murders/id1122804248?i=1000428209591 April 15, 2021

 

4. Criminal Minds F. The Tylenol Killer. 2021; Available at: https://criminalminds.fandom.com/wiki/The_Tylenol_Killer#Known_Victims. Accessed March/14, 2021.

 

5. Department of Health, New York State. The Facts About Cyanide. 2004; Available at: https://www.health.ny.gov/environmental/emergency/chemical_terrorism/cyanide_tech.htm#:~:text=Between%2020%20and%2040%20percent,detect%20the%20odor%20of%20cyanide. Accessed March/14, 2021.

 

6. Revisiting Chicago’s Tylenol Murders. Chicago Magazine 2012:March/14, 2021.

 

7. Rehak J. Tylenol Made a Hero of Johnson & Johnson : The Recall that Started them All. International Herald Tribune, The New York Times 2002:March/14, 2021.

 

8. Jethava D, Gupta P, Kothari S, Rijhwani P, Kumar A. Acute Cyanide Intoxication: A Rare Case of Survival. Indian Journal of Anesthesia 2014;58(3):312-314.

 

9. Funding Universe. Johnson & Johnson History. 2001; Available at: http://www.fundinguniverse.com/company-histories/johnson-johnson-history/. Accessed March/14, 2021.

 

10. Johnson & Johnson, Our Story. 2018; Available at: https://ourstory.jnj.com/timeline. Accessed March/14, 2021.

 

11. Coen J, Marx G, Ahmed A, Bzdak Z, Janega J, Lighty T, et al. FBI Reopens Tylenol Tampering Case. Chicago Tribune 2009:March/14, 2021.

 

12. Markel H. How the Tylenol Murders of 1982 Changed the Way We Consume Medication. 2014; Available at: https://www.pbs.org/newshour/health/tylenol-murders-1982. Accessed March/14, 2021.

 

13. Mystery of Seven Deaths. 2021. Available at: https://prezi.com/kvab9j9hjaxj/mystery-of-seven-deaths/?frame=2f255d34b1eae9853a20ff090a897983d5334d1d. Accessed March/14, 2021

 

14. Coen J, Marx G. FBI Reopens Tylenol Tampering Case. Chicago Tribune 2009:March/14, 2021.

 

15. Digital Staff M. How an Unsolved Murder Mystery Changed our Pill Bottles. 2018; Available at: https://www.wsmv.com/news/us_world_news/how-an-unsolved-murder-mystery-changed-our-pill-bottles/article_4b1e4b4f-2f24-5947-85d2-14f0b2f19ba9.html. Accessed March/14, 2021.

Additional Media Coverage via #RetroReport

Reference for above video:

A Trusted Pill Turned Deadly. How Tylenol Made a Comeback | Retro Report Sept. 16, 2019. Available at https://www.youtube.com/watch?v=l1R0EnzGB3I&t=26s. Accessed April 17, 2021.