Approach to toxicological deaths

Drug intoxication deaths are encountered with increasing frequency in medicolegal death investigations. An examination of the scene may yield critical information that suggests a drug intoxication. The autopsy examination is a critical part in the investigation of a potential death due to a drug intoxication. At autopsy, blood (cardiac and femoral), vitreous humor, and urine are standard toxicology specimens. Blood should be collected in a sodium fluoride (Na–F)-containing tube to prevent the in vitro enzymatic breakdown of cocaine and the production of ethanol. Cocaine, opioids (fentanyl, heroin), and stimulants (cocaine) are further discussed, as are issues encountered in toxicologic suicides. Postmortem changes can result in the alteration of various drugs and their concentrations from what was present at the time of death. In order to certify a death as due to a drug intoxication, there are three considerations: (1) the history and scene are consistent with a drug intoxication death, (2) the autopsy fails to disclose a more compelling disease or physical injury with a severity that is inconsistent with continued life, and (3) the toxicological concentrations are in the range typically encountered in such deaths.