Sudden Death In Cocaine Abusers

January 14, 2010




Dr JoaquÃƒ­n Lucena, MD PhD, Head of the Forensic Pathology Service at the Institute of Legal Medicine (Seville, Spain) who led the study, said: “Our findings show that cocaine use causes adverse changes to the heart and arteries that then lead to sudden death.”

Dr Lucena and his colleagues found that median levels of cocaine in blood or urine were 0.1 and 1.15 mg/L respectively, with a range that varied widely but which depended on a number of factors related to the drug itself (how it was taken, how people’s bodies processed it and what other substances were taken at the same time), and to the people themselves (body mass index, acute or chronic use of the drug, other underlying health issues, age and sex). They wrote: “Any amount of the drug can be considered to have the potential for toxicity due to the fact that some patients have poor outcomes with relatively low blood concentrations, whereas others tolerate large quantities without consequences.”

The researchers also found that 81% of the men who died after cocaine use also smoked, and 76% had drunk alcohol. Ethanol, the intoxicating ingredient in alcoholic drinks, enhances the “high” obtained from cocaine while minimising the subsequent “low”. However, both smoking and alcohol are associated with heart disease and Dr Lucena said: “The combination of cocaine with either or both of these habits can be considered as a lethal cocktail that promotes the development of premature heart disease.”


“For the correct diagnosis of the sudden death, especially in young adults, it is important to use a uniform autopsy protocol, including a toxicology investigation of the blood and urine for illicit drugs,” said Dr Lucena. “Cocaine abuse is a growing public health issue in Europe and we can only monitor its prevalence by performing these detailed autopsies whenever someone dies suddenly.”



To put the rates of sudden deaths in context, he added: “According to our experience in the Forensic Pathology Service at the Institute of Legal Medicine, the rate of cocaine-related deaths per year in Seville, is roughly half the number of people who die suddenly from haemorrhagic stroke.” [3]


They agreed that uniform protocols were required for post-mortems on victims of sudden death, including toxicological examination of the blood and urine for illicit drugs. “Until these are accomplished, the prevalence of cocaine and other illicit drug use will be underestimated, and cocaine-related complications will not be recognized,” they wrote. “Physicians should consider the possibility of cocaine abuse in a young individual with cardiovascular disease or sudden death, especially in those without traditional risk factors for atherosclerosis. Finally, the notion that recreational cocaine use is ‘safe’ should be dispelled, since even small amounts may have catastrophic consequences, including sudden death.”

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