What is a drug death?

1. What is a drug death? Dr Marjorie Black Forensic Medicine and Science University of Glasgow

2. Drug Related Deaths, 1985 - 1999

3. Drug Related Death - Definition • Where there is … evidence of a fatal overdose of controlled drugs…..recent drug misuse e.g. controlled drugs and/or a syringe found in close proximity to the body &/or the person is known to the police as a drug misuser…. • 1994 Scottish Office ‘Ministerial Drugs Task Force Report’

4. Excludes • Deaths from infection resulting directly from injecting drug use • Deaths from chronic disease which is a result of drug abuse e.g. Hep C • Deaths from a pathology caused by illicit drug use • Suicides

5. Forensic Medicine and Science • Responsible to the Crown Office for the provision of pathology and toxicology services in the West of Scotland. • Responsible for the toxicological analyses of all sudden and unexpected deaths in Strathclyde, whether or not these are initially thought to be drug-related.

6. Drug Related Death - Definition • A sudden or unexpected death where drugs of abuse were implicated as a cause of death either through toxicology or circumstance. • Death as a result of long term drug abuse. • Death of a known drug abuser as a result of an overdose of non illicit drugs.

7. Police Sudden Death Report • Scene Observations • Drug paraphernalia • Terminal Events • Drug misuse witnessed • Recent Prison Release • Medical History • Known drug user • Prescribed medication • Drug rehabilitation programmes

8. Pathology Examination • Needle marks/sinuses • recent and healing • Signs of infection • Injuries • Any pathology or disease process • Congestion & oedema of lungs

9. Cause of Death • A full post mortem examination is essential to identify accurately whether the death is a result of drugs to • exclude natural disease/pathology • exclude infection/trauma • The pathologist must carefully consider the toxicological results in conjunction with the individual circumstances

10. Drugs Detected, 1995 - 1998

11. Toxicology, 1995 - 1998

12. Blood Alcohol Concentrations

13. Blood Concentrations - Benzodiazepiness

14. Blood Concentrations - Opiates

15. Interpretation of PM drug levels • Very rapid death • Period of unconsciousness before death • Redistribution of the drug in the body after death • Site of blood sampling

16. Interpretation of PM Drug Levels • There is no “absolute” toxic level for the interpretation of drug levels • Drug Interactions (e.g. morphine + benzodiazepines) • Drugs with different modes of action

17. Amphetamines & Cocaine • Different mechanisms of death • Not necessarily dose related • Can cause brain haemorrhage or cardiac arrest • Can cause chronic problems

18. Factors Affecting Interpretation • General Health • Tolerance • Periods of Abstinence • Invaluable information • Medical history • Drug history • Recent circumstances • Immediate circumstances of the death

19. Conclusions • Recent use of illicit drugs does not mean that they died of a drugs overdose • The finding of a drug in the blood does not mean that it caused (or even contributed) to death • A toxicology report does not give the cause of death

20. Conclusions • An accurate cause of death can only be determined by an experienced pathologist after review of the post mortem findings including toxicology and taking into consideration the medical/drug history and the circumstances of the death

21. Conclusions • The drug(s) considered to have caused the death should be identified in the death certificate • Accurate information on the drugs implicated in death is essential to target intervention and reduce deaths

22. Conclusions • If death has been caused by a pathology e.g.cardiac disease or infection which has resulted from illicit drug use the drug use should be identified on the death certificate • These deaths are also directly attributable to drug misuse • Information should be available to target risk groups