SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

P28
DRUG RELATED DEATHS IN THE CITY AND COUNTY SAN FRANCISCO
NP Lemos*, PhD, SB Karch, MD, E Lin, MS, G Nazareno, MD, V Azar, MD, A Hart, MD and BG
Stephens, MD
Aims: The timely detection of drug-related health problems and emerging drug trends depend, at least in
part, on information provided by coroners and medical examiners. To assist in this process we reviewed all
drug-related deaths occurring in our jurisdiction during 2002.
Design: Retrospective analysis of all death investigations carried out by the San Francisco Office of the
Chief Medical Examiner (SFOCME), from January 1, 2002 until December 31, 2002, where postmortem
toxicology revealed the presence of psychoactive or abused drugs, and complete autopsy performed.
Methods: If available, urine is first screened with EMIT testing and results confirmed by GCIMS or
LCIMS. In the absence of urine, GCIMS is used to screen blood, liver, CSF or other biological specimens
directly.
Findings: The SFOCME serves a population of approximately 750,000, and this number has been stable for
several decades. In 2002, 1463 cases came under the jurisdiction of our office, and drugs were detected in
257 of these cases. Cocaine or benzoylecgonine was found in the blood and/or urine of 153 (59%) cases.
Morphine and/or codeine were detected in the blood or urine of 119 (46%), and methamphetamine was
present in 19% (48/257). Poly-drug abuse was common among the cases which came under our
jurisdiction. Morphine was present in nearly a third (72/257, 28%), of the cocaine users. The occurrence
rate for other drugs was much lower; methadone was present in 33 cases, oxycodone in 23, fentanyl in 7,
hydrocodone in 6, MDMA in 5, and PCP in 2 cases.
Conclusions: The number of methamphetamine-related deaths continues to be remarkably stable within our
jurisdiction and is, in fact, lower than in 1994, when 52 deaths were recorded (J Forensic Sci. 1999 Mar;
44(2):359-68). The rate for methadone related deaths also appears to be stable, while the number of
oxycodone-related deaths appears to be increasing, suggesting that allocating additional resources to treat
methadone diversion may be unnecessary in our jurisdiction. On the other hand, the increasing number in
fentanyl-related deaths suggests that diversion of Duragesic® patches in our jurisdiction is an increasing
problem worthy of further investigation.
Keywords: Drug, Epidemiology, San Francisco
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