Skip to main content
SpringerLink
Log in

Deaths Due to Drug and Alcohol Misuse

  • Chapter
Essentials of Autopsy Practice

  • 400 Accesses

Abstract

While drugs have been used by mankind since prehistoric times [1] there has been an apparent large increase in the misuse of drugs in the United Kingdom (UK) and elsewhere in the last three decades. There is great variation in the pattern of drug misuse over time and between regions, which reflects on the number of drug- related deaths. There are multiple factors which influence the pattern of drug misuse including availability, cost, fashion, social context and underlying mental illness. While, at least in the UK, drug misuse is common in all social classes, deaths are over represented in poorer socio-economic groups (author’s unpublished observations). Many young people experiment with drugs, but relatively few go on to become problematic long-term users. Children of drug using parents may accidentally ingest oral drugs such as methadone [2] and without a high index of suspicion such cases will be missed by the pathologist.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Rudgley R. The archaic use of hallucinogens in Europe: an archaeology of altered states. Addiction 1995;90:163–4.

    Article  PubMed  CAS  Google Scholar 

  2. Binchey JM, Molyneux EM, Manning J. Accidental ingestion of methadone by children in Merseyside. BMJ 1994;308:1335–6.

    Google Scholar 

  3. Strang J, Darke S, Hall W, Farrell M, Ali R. Heroin overdose: the case for take-home naloxone. BMJ 1996;312:1435–6.

    PubMed  CAS  Google Scholar 

  4. Darke S, Zador D. Fatal heroin ‘overdose’: a review. Addiction 1996;91(12):1765–72.

    Article  PubMed  CAS  Google Scholar 

  5. General Medical Council. Serious communicable diseases. 1997.

    Google Scholar 

  6. Hirsch CS. Dermatopathology of narcotic addiction. Human Pathology 1972;3:37–53.

    Article  PubMed  CAS  Google Scholar 

  7. Forrest ARW. Obtaining samples at post mortem examination for toxicological and biochemical analysis. J Clin Pathol 1993;46:292–6.

    Article  PubMed  CAS  Google Scholar 

  8. Pounder DJ, Fuke C, Cox DE, Smith D, Kuroda N. Postmortem diffusion of drugs from gastric residue — an experimental study. Am J Forensic Med Pathol 1996;17:1–7.

    Article  PubMed  CAS  Google Scholar 

  9. Rollins DE, Wilkins DG, Gygi SP, Slawson MH, Nagggasawa PR. Testing for drugs of abuse in hair experimental observations and indications for future research. Forensic Sci Rev 1997;9:24–37.

    Google Scholar 

  10. Wetli CV. Fatal cocaine intoxication — a review. Am J Forensic Med Pathol 1987;8:1–2.

    Article  PubMed  CAS  Google Scholar 

  11. Sims DN, Lokan RJ, James RA, Felgate PD, Felgate HE, Gardiner J, Vozzo DC. Putrefactive pleural effusions as an alternative sample for drug quantification. Am J Forensic Med Pathol 1999;20:323–46.

    Article  Google Scholar 

  12. MacSween NM, Anthony PP, Scheuer PJ, Burt AD, Portmann BC, The pathology of the liver (3rd ed.), London: Churchill Livingstone, 1994,259-61.

    Google Scholar 

  13. Vella EJ, Edwards CW. Death from pulmonary microemboiism after intravenous injection of temazepam. BMJ 1993;307:26.

    Article  PubMed  CAS  Google Scholar 

  14. Scott RN, Going J, Woodburn KR, Gilmour DG, Reid DB, Leiberman DP, et al. Intra-arterial temazepam. BMJ 1992;304:1630.

    Article  PubMed  CAS  Google Scholar 

  15. Peturssson H. The benzodiazepine withdrawal syndrome Addiction 1994;89:1455–9.

    Google Scholar 

  16. Strang J, Griffiths P, Glossop M. Heroin smoking by ‘chasing the dragon’: origins and history. Addiction 1997;92:673–83.

    Article  PubMed  CAS  Google Scholar 

  17. Norvick D, Ochshorn M, Ghali V, et al. Natural killer cell activity and lymphocyte subsets in parenteral heroin abusers and long term methadone maintenance patients. J Pharm and Exp Ther 1989;250:606–10.

    Google Scholar 

  18. Karch SB Pathology of drug abuse: myocardial alterations in drug abusers. In: Karch SB (ed.) Drug abuse handbook. Boca Raton: CRC Press, 1998,101–9.

    Google Scholar 

  19. King J, Richards M, Tress B. Cerebral arteritis associated with heroin abuse Med J Aust 1978;2:444–5.

    CAS  Google Scholar 

  20. Rabl W, Markwalder C. Fatal posture-and heroin-related intestinal infarction and leg muscle necrosis after snorting heroin. Am J Forensic Med Pathol 1996;17:163–6.

    Article  PubMed  CAS  Google Scholar 

  21. Schwartzfarb L, Sing G, Marcus D. Heroin-associated rhabdomyositis with cardiac involvement. Arch Intern Med 1977;137:1255–7.

    Article  PubMed  CAS  Google Scholar 

  22. Wolters E, Wijigaarden G, Stam F, et al. Leucoencephalopathy after inhaling “heroin” pyrolypsate. Lancet 1982;1233-7.

    Google Scholar 

  23. Stachura I. Renal lesions in drug addicts. Pathology Annual 20: New York: Appleton-Century-Crofts, 1985,83–99.

    Google Scholar 

  24. Levine B, Green D, Smialek JE. The role of ethanol in heroin deaths. J Forensic Sci 1995;40:808–10.

    PubMed  CAS  Google Scholar 

  25. Lipski J, Stimmel B, Donoso E. The effect of heroin and multiple drug abuse on the electrocardiogram. Am Heart J 1973;86:663–8.

    Article  PubMed  CAS  Google Scholar 

  26. Preston A. The methadone briefing. London, Institute for the Study of Drug Dependency, 1996.

    Google Scholar 

  27. Olsen GD, Wilson JE, Robertson GE. Respiratory and ventilatory effects of methadone on healthy women. Clin Pharmacol Ther 1981;29:373–80.

    Article  PubMed  CAS  Google Scholar 

  28. Wu C, Henry JA. Deaths of heroin addicts starting on methadone maintenance Lancet 1990;335:424.

    CAS  Google Scholar 

  29. Isenschmid DS, Levine YH, Caplan A. A comprehensive study of the stability of cocaine and its metabolites. J Anal Toxicol 1989;13:250–6.

    PubMed  CAS  Google Scholar 

  30. Simpson RW, Edwards WD. Pathogenesis of cocaine-induced ischaemic heart disease. Arch Pathol Lab Med 1986;110:479–84.

    PubMed  CAS  Google Scholar 

  31. Minor RL, Scott BD, Brown DD, Winniford MD. Cocaine-induced myocardial infarction in patients with normal coronary arteries. Ann Intern Med 1991;115:797–806.

    PubMed  Google Scholar 

  32. Brickner ME, Willard JE, Eichorn EJ, Black J, Grayburns PA. Left ventricular hypertrophy associated with chronic cocaine use. Circulation 1991;84:1130–5.

    PubMed  CAS  Google Scholar 

  33. Inser J, Chokshi S. Cardiovascular complications of cocaine. Curr Prob Cardiol 1991;I6:89–123.

    Google Scholar 

  34. Zhang L, Xiao Y, He J. Cocaine and apoptosis in myocardial ceils Anat. Rec. 1999;257:208–16.

    CAS  Google Scholar 

  35. Silva MO, Roth D, Reddy R, Frenandez JA, Albores-Saavendra J, Schiif ER. Hepatic dysfunction accompanying acute cocaine intoxication. J Hepatol 1991;12:312–5.

    Article  PubMed  CAS  Google Scholar 

  36. Holzman C, Paneth N. Maternal cocaine use during pregnancy and perinatal outcomes. Epidemiol Rev 1994;16:315–34.

    PubMed  CAS  Google Scholar 

  37. Karch SB. Drug abuse and trauma. In: Mason JK, Purdue BN (eds) The pathology of trauma,3rd edn. London: Arnold, 2000,422–40.

    Google Scholar 

  38. Ruttenber AJ, Lawler-Heavner J, Yin M, Wetli CV, Hearn WL, Mash DC. Fatal excited delirium following cocaine use: epidemiologic findings provide new evidence for mechanisms of cocaine toxicity. J Forensic Sci 1997;42:25–31.

    PubMed  CAS  Google Scholar 

  39. Karch SB, Stephens BG. Drug abusers who die during arrest or in custody. J Roy Soc Med 1999;92:110–3.

    PubMed  CAS  Google Scholar 

  40. Robson P (1999) Forbidden drugs, 2nd ed., Oxford: Oxford University Press, 1999.

    Google Scholar 

  41. Hong R, Matsuyama E, Nuir K. Cardiomyopathy associated with the smoking of crystal metham- phetamine. JAMA 1991;265:1152–4.

    Article  PubMed  CAS  Google Scholar 

  42. Karch SB. Pathology of drug abuse 2nd ed., Boca Raton, CRC Press, 1996.

    Google Scholar 

  43. He SY, Matoba R, Fujitani N, Sodesaki K, Onnishi S. Cardiac muscle lesions associated with chronic administration of methamphetamine in rats. Am J Forens Med Pathol 1996;17:155–62.

    Article  CAS  Google Scholar 

  44. Karch SB, Stephens BG, Ho C-H. Methamphetamine related deaths in San Francisco: demographic, pathologic, and toxicological profiles. J Forensic Sci 1999;44:359–68.

    PubMed  CAS  Google Scholar 

  45. Henry JA. Effect of MDMA on water homeostasis (abstract). London: The Royal College of Pathologists, 1998.

    Google Scholar 

  46. Henry JA. Ecstasy and the dance of death. BMJ 1992;305:5–6.

    Article  PubMed  CAS  Google Scholar 

  47. Henry JA, Jeffreys KJ, Dawling S. Toxicity and deaths from 3,4-methylenedioxymethamphetamine (“ecstasy”). Lancet 1992;304:384–7.

    Article  Google Scholar 

  48. Maxwell DL, Polkey MI, Henry JA. Hyponatraemia and catatonic stupour after taking “eastasy”. BMJ 1993;307:1399.

    Article  PubMed  CAS  Google Scholar 

  49. Harris DP, De Silva R. “Ecstasy” and intracerebral haemorrhage. Scot Med J 1992;37:150–2.

    Google Scholar 

  50. Ellis AJ, Wendon JA, Portman B, Williams R. Acute liver damage and ecstasy ingestion. Gut 1996;38:454–8.

    Article  PubMed  CAS  Google Scholar 

  51. Milroy CM, Clarke JC, Forrest ARW. Pathology of deaths associated with “ecstasy” and “eve” misuse. J Clin Pathol 1996;49:149–53.

    Article  PubMed  CAS  Google Scholar 

  52. Redfearn PJ, Agrawal N, Mair LH. An association between regular use of 3,4 methylenedioxy methamphetamine (Ecstasy) and excessive wear of teeth. Addiction 1998;93:745–8.

    Article  PubMed  CAS  Google Scholar 

  53. Steele TD, McCann UD, Ricautre GA. 3,4-Methylenedioxymethamphetamine (MDMA,“Ecstasy”): pharmacology and toxicity in animals and humans. Addiction 1994;89:539–51.

    Article  PubMed  CAS  Google Scholar 

  54. McCann UD, Ridenour A, Shaham Y, Ricaurte GA. Seronergic neurotoxicity after (±)3,4-methylene- dioxymethamphetamine (MDMA; “Ecstasy”): a controlled study in humans. Neuropsychopharmacology 1994;10:129–38.

    PubMed  CAS  Google Scholar 

  55. Thomas G, Bonner S, Gascoign A. Coma induced by abuse of g-hydroxybutyrate (GBH or liquid ecstasy): a case report. BMJ 1997;314:35–6.

    PubMed  CAS  Google Scholar 

  56. Anderson HR, Macnair RS, Ramsey JD. Deaths from volatile substance abuse: a national epidemiological study. BMJ 1985;209:304–7.

    Article  Google Scholar 

  57. Shepherd RT. Mechanisms of death associated with volatile substance abuse. Human Toxicol 1989;8:287–92.

    Article  CAS  Google Scholar 

  58. Cunningham SR, Dalzell GWN, McGirr PPP, Khan MM. Myocardial and primary ventricular fibrillation after glue sniffing. BMJ 1987;294:739–40.

    Article  PubMed  CAS  Google Scholar 

  59. Sarvesvaran ER, Fysh R, Bowen DAL. Amyl nitrite related deaths Med Sci Law 1992;32:267–9.

    CAS  Google Scholar 

  60. Lolin Y. Chronic neurological toxicity associated with exposure to volatile substances. Human Toxicol 1989;8:293–300.

    Article  CAS  Google Scholar 

  61. Krornfield M, Moser AB, Moser HW, Kleinschmidt-DeMasters B, Nolte K, Phelps A. Solvent vapour abuse leukoencephalopathy. Comparison to adrenoleukodystrophy. J Neuropathol Exp Neurol 1994;53:389–98.

    Google Scholar 

  62. Fortenberry JD. Gasoline sniffing. Am J Med 1985;79:740–4.

    Article  PubMed  CAS  Google Scholar 

  63. Ennngstrand DA, England DM, Huntington RW. Pathology of paint sniffers’ lung Am J Forensic Med Pathol 1986;7:232–6.

    Article  Google Scholar 

  64. Corrigan B. Anabolic steroids and the mind. Med J Aust 1996; 165:222–5.

    PubMed  CAS  Google Scholar 

  65. Behrendt H, Boffin H. Myocardial cell lesions caused by an anabolic hormone. Cell Tissue Res 1977;181:423–6.

    Article  PubMed  CAS  Google Scholar 

  66. Luke JL, Farb A, Virmani R, Sample RHB. Sudden cardiac death during exercise in a weight-lifter using anabolic androgenic steroids: pathological and toxicological findings. J Forensic Sci 1990;35:1441–7.

    PubMed  CAS  Google Scholar 

  67. Ferrara PC, Putnam DL, Verdile VP. Anabolic steroids and the possible precipitant of dilated cardiomyopathy. Cardiology 1997;88:218–20.

    Article  Google Scholar 

  68. Johnson HRH. At what blood levels does alcohol kill? Med Sci Law 1985;25:127–30.

    PubMed  CAS  Google Scholar 

  69. Preedy VR, Richardson PJ. Ethanol induced cardiovascular disease. Brit Med Bull 1994;50:152–63.

    PubMed  CAS  Google Scholar 

  70. Tegragaki M, Takeuchi K, Takeda T. Clinical and histological features of alcohol drinkers with congestive cardiac failure. Am Heart J 1993;125:808–17.

    Article  Google Scholar 

  71. Clark JC. Sudden death in the chronic alcoholic. Forensic Sci Int 1988;36:105–11.

    Article  PubMed  CAS  Google Scholar 

  72. Day CP, James OFW, Butler TJ, Campbell RWF. QT prolongation and sudden cardiac death in patients with alcoholic liver disease. Lancet 1993;341:1423–8.

    Article  PubMed  CAS  Google Scholar 

  73. Hendrickse MT, Triger DR. Peripheral and cardiovascular autonomic impairment in chronic liver disease: prevalence and relation to hepatic function. J Hepatol 1992;16:177–83.

    Article  PubMed  CAS  Google Scholar 

  74. Harper C. The neuropathology of alcohol-specific brain damage, or does alcohol damage the brain? J Neuropath Exp Neurol 1998;57:101–10.

    Article  PubMed  CAS  Google Scholar 

  75. Adams RA, Victor MM, Mancall EL. Central pontine myelinolysis Arch Neurol Psychiat 1959;81:154–72.

    CAS  Google Scholar 

  76. Pounder DJ, Jones AW. Measuring alcohol postmortem. In: Karch SB (ed.) Drug abuse handbook. Boca Raton: CRC Press, 1998,356–74.

    Google Scholar 

  77. Pounder DJ. The nightmare of postmortem drug changes. In: Wecht CH (ed.) Legal Medicine. New Hampshire: Butterworth Legal Publishers, 1993,163–90.

    Google Scholar 

Download references

Authors
  1. P. Fineron
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Forensic Pathology, Medico-Legal Centre, Watery Street, Sheffield, UK

    Guy N. Rutty MBBS,MRCPath,DipRCPath (Forensic)

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer-Verlag London Limited

About this chapter

Cite this chapter

Fineron, P. (2001). Deaths Due to Drug and Alcohol Misuse. In: Rutty, G.N. (eds) Essentials of Autopsy Practice. Springer, London. https://doi.org/10.1007/978-1-4471-0699-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-0699-9_10

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-1181-8

  • Online ISBN: 978-1-4471-0699-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation