Page 122 - CFDI Guide

are narcotics, depressants, stimulants and hallucinogens. Prescription drugs are common drugs of

abuse and overdoses and in doing so are considered illicitly used. Fatality is by respiratory depression,
fatal arrythmia, and anaphylactic reaction.

II. How Drugs Cause Deaths / Overdoses

Drug related and caused deaths are not toxicology only – other factors are considered. These are body
size, gender, any food in the stomach, combinations of drugs – including alcohol, how often and how

much taken, any tolerance or perceived tolerance, and altitude or elevation.

Depressants include alcohol, marijuana, pain killers (prescription and OTC - Nyquil, Dramamine, and
Tylenol), and barbiturates or sedatives. Indicators of depressant overdoses include respiratory

depression, other interactions, causing seizures, and vomiting.

Stimulants include amphetamines, cocaine, caffeine, strychnine, etc. – prescription and OTC, and illicit
drugs and abuse. Indications of stimulant overdoses include mania and aggression, high fever,

convulsions, and loss of consciousness.

Cocaine heart is found from cocaine use, as well as methamphetamine, ecstasy, and other narcotics.
Use causes dead heart tissue and become fatal. At autopsy there is often an absence of coronary

artery disease.

Excited Delirium is seen in cocaine and methamphetamine use. This is erratic behavior and
hyperthermia – undressing is often seen, with psychosis. Cardiac arrest may occur in stressful and

resistant events – such as police restraint.

Date Rape Drugs are GHB (gamma hydroxy butyrate) and Rohibnol (these are used by bodybuilders).

They are designed to cause unconsciousness and amnesia. Testing is difficult due to the metabolism by
the body and elapsed time to reporting the circumstances with loss of memory and details.

Toxicology should be routine in all autopsies – whether limited or full by external and internal

examinations. The determination of Manner of Death is based on the circumstances – if a drug causes
or contributes to an otherwise natural manner of death, it is Accident. Scene investigation in drug

deaths, as well as medical and social history, are important.

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