Transcript Drug Related Death - Scottish Drugs Forum

What is a drug death?
Dr Marjorie Black
Forensic Medicine and Science
University of Glasgow
Drug Related Deaths, 1985 1999
200
180
Number of Cases
160
140
120
All DRDs
DoA Overdose
100
80
60
40
20
0
1985
1987
1989
1991
Year
1993
1995
1997
1999
Drug Related Death - Definition
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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’
Excludes
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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
Forensic Medicine and
Science
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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 drugrelated.
Drug Related Death Definition
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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.
Police Sudden Death Report
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Scene Observations
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Terminal Events
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Drug paraphernalia
Drug misuse witnessed
Recent Prison Release
Medical History
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Known drug user
Prescribed medication
Drug rehabilitation programmes
Pathology Examination
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Needle marks/sinuses
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recent and healing
Signs of infection
Injuries
Any pathology or disease process
Congestion & oedema of lungs
Cause of Death
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A full post mortem examination is
essential to identify accurately whether
the death is a result of drugs to
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exclude natural disease/pathology
exclude infection/trauma
The pathologist must carefully consider
the toxicological results in conjunction
with the individual circumstances
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Number of Positive Cases
Drugs Detected, 1995 - 1998
300
250
200
150
100
50
0
Toxicology, 1995 - 1998
5 Drugs
2%
6/7 Drugs
1%
1 Drug
27%
4 Drugs
10%
2 Drugs
37%
3 Drugs
23%
Blood Alcohol Concentrations
1995
Average
(mg/100ml)
92
Range
(mg/100ml)
5 - 256
1996
91
5 - 371
1997
110
12 - 348
1998
151
9 - 462
Blood Concentrations Benzodiazepiness
1995
1996
1997
1998
Temazepam
Range (mg/litre)
2.1
(0.05 – 29.9)
0.92
(0.02 – 4.23)
0.85
(0.05 – 6.85)
0.92
(0.03 – 2.24)
Diazepam
Range (mg/litre)
0.37
(0.04 – 2.64)
0.37
(0.031 – 1.6)
0.45
(0.03 – 1.6)
0.41
(0.06 – 1.76)
Blood Concentrations - Opiates
1995
1996
1997
1998
Morphine
Range (mg/litre)
0.45
(0.002 – 3.1)
0.36
(0.015 – 1.16)
0.25
(0.014 – 0.67)
0.34
(0.025 – 1.26)
Methadone
Range (mg/litre)
0.6
(0.004 – 5.6)
0.8
(0.013 – 4.59)
0.55
(0.003 – 2.11)
0.26
(0.05 – 0.85)
Interpretation of PM drug levels
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Very rapid death
Period of unconsciousness before death
Redistribution of the drug in the body
after death
Site of blood sampling
Interpretation of PM Drug Levels
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There is no “absolute” toxic level for the
interpretation of drug levels
Drug Interactions (e.g. morphine +
benzodiazepines)
Drugs with different modes of action
Amphetamines & Cocaine
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Different mechanisms of death
Not necessarily dose related
Can cause brain haemorrhage or cardiac
arrest
Can cause chronic problems
Factors Affecting Interpretation
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General Health
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Tolerance
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Periods of Abstinence
Invaluable information
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Medical history
Drug history
Recent circumstances
Immediate circumstances of the death
Conclusions
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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
Conclusions
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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
Conclusions
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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
Conclusions
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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