TY - JOUR
T1 - Cocaine in sudden and unexpected death: a review of 49 post-mortem cases
AU - Pilgrim, Jennifer Lucinda
AU - Woodford, Noel
AU - Drummer, Olaf Heino
PY - 2013
Y1 - 2013
N2 - Cocaine is a potent sympathomimetic drug that is associated with cardiotoxicity, including ventricular
arrhythmia, systemic hypertension, acute myocardial infarction and left ventricular hypertrophy. The
use of cocaine in Australia has risen steadily since the late 1990s. What remains unclear in the literature
is whether cocaine-associated death can occur in the absence of other contributing factors, such as
concomitant drug use or natural disease. A search was conducted on the National Coroners Information
System database, to identify all deaths occurring in Victoria, Australia, between January 2000 and
December 2011, where cocaine or its metabolites were detected by post-mortem toxicological analysis.
All cases were closed by the Coroner. These cases were examined with regards to case circumstances,
pathology and toxicology results, and coronial findings, to determine the prevalence of cardiotoxicity
and the involvement of cocaine in the deaths compared with other contributing factors. There were 49
cases where cocaine, benzoylecgonine, ecgonine methyl ester, methylecgonine or cocaethylene, were
detected in the 11-year period. The individuals ranged in age from 16 to 70 years (median 30). There
were 36 males. In 22 cases the cause of death was determined to be drug toxicity, 22 were external injury
and 5 were attributed to natural disease. The concentration of cocaine in the cases was relatively low
(range 0.01?3 mg/L, median 0.1 mg/L). Cocaine metabolites were detected frequently in blood and urine:
benzoylecgonine (46 cases); ecgonine methyl ester (12 cases); cocaethylene (8 cases); and
methylecgonine (9 cases). Opioids were commonly detected (23 cases), in addition to amphetamines
(15 cases), ethanol (17 cases) and benzodiazepines (12 cases). Of the 43 cases receiving a full autopsy,
there were 14 cases involving significant heart disease. This included coronary artery disease (11 cases),
an enlarged heart (5 cases), myocarditis and contraction band necrosis. Cocaine is detected relatively
infrequently in Victorian coronial cases. However it appears to be associated with a significant degree of
cardiotoxicity, particularly coronary artery disease and ventricular hypertrophy, independent of cocaine
concentration.
AB - Cocaine is a potent sympathomimetic drug that is associated with cardiotoxicity, including ventricular
arrhythmia, systemic hypertension, acute myocardial infarction and left ventricular hypertrophy. The
use of cocaine in Australia has risen steadily since the late 1990s. What remains unclear in the literature
is whether cocaine-associated death can occur in the absence of other contributing factors, such as
concomitant drug use or natural disease. A search was conducted on the National Coroners Information
System database, to identify all deaths occurring in Victoria, Australia, between January 2000 and
December 2011, where cocaine or its metabolites were detected by post-mortem toxicological analysis.
All cases were closed by the Coroner. These cases were examined with regards to case circumstances,
pathology and toxicology results, and coronial findings, to determine the prevalence of cardiotoxicity
and the involvement of cocaine in the deaths compared with other contributing factors. There were 49
cases where cocaine, benzoylecgonine, ecgonine methyl ester, methylecgonine or cocaethylene, were
detected in the 11-year period. The individuals ranged in age from 16 to 70 years (median 30). There
were 36 males. In 22 cases the cause of death was determined to be drug toxicity, 22 were external injury
and 5 were attributed to natural disease. The concentration of cocaine in the cases was relatively low
(range 0.01?3 mg/L, median 0.1 mg/L). Cocaine metabolites were detected frequently in blood and urine:
benzoylecgonine (46 cases); ecgonine methyl ester (12 cases); cocaethylene (8 cases); and
methylecgonine (9 cases). Opioids were commonly detected (23 cases), in addition to amphetamines
(15 cases), ethanol (17 cases) and benzodiazepines (12 cases). Of the 43 cases receiving a full autopsy,
there were 14 cases involving significant heart disease. This included coronary artery disease (11 cases),
an enlarged heart (5 cases), myocarditis and contraction band necrosis. Cocaine is detected relatively
infrequently in Victorian coronial cases. However it appears to be associated with a significant degree of
cardiotoxicity, particularly coronary artery disease and ventricular hypertrophy, independent of cocaine
concentration.
UR - http://www.sciencedirect.com/science/article/pii/S0379073812004008
U2 - 10.1016/j.forsciint.2012.08.037
DO - 10.1016/j.forsciint.2012.08.037
M3 - Article
SN - 0379-0738
VL - 227
SP - 52
EP - 59
JO - Forensic Science International
JF - Forensic Science International
IS - 1-3
ER -