SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

P33
POSTMORTEM CASES RELATED TO COCAINE IN THE NETHERLANDS
Ll. Bosman*, M. Verschraagen, KJ. Lusthof
Netherlands Forensic Institute
Cocaine is a popular drug and is often encountered in postmortem toxicology cases. In this study, we
present cocaine-'related deaths in the Netherlands from October 2002 to October 2003. In this period, the
presence of cocaine, benzoylecgonine and methylecgonine was demonstrated in 45 cases in which cocaine· .
concentrations were 0.02 mg/I or higher. Of these 45 cases, 34 were male. The 45 deaths were divided into
the following categories:
I. anatomical cause of death; cocaine present with or without ethanol and other drugs (ACD, n=17)
2. toxicological cause of death, cocaine as most likely cause (TCD, n=12)
3. toxicological cause of death, cocaine and other drugs present, other drug(s) as most likely cause or
combination (TCD+, n=6)
4. no clear cause of death, cocaine present with or without ethanol and other drugs (NCD, n=8)
In 12 ofthese 45 cases, cocaine-overdose (TCD) was the most probable cause of death. In these 12 cases,
mean concentrations (± standard deviation) of cocaine, benzoylecgonine and methylecgonine in femoral
blood were 8.0 (±4.9) mg/I, 9.4 (±4.0) mg/I and 7.0 (±3.9) mg/I, respectively. In eleven of these cases,
packages were found in the stomach. The other case was most probably a fatal case of cocaine delirium
with a cocaine concentration in femoral blood of 0.23 mg/I, a benzoyJecgonine concentration of 7.0 mg/!
and a methylecgonine concentration of 1.64 mg/1.
The mean concentrations of cocaine and metabolites in femoral blood in the TCD+ category were much
lower compared to the TCDcategory: the concentrations of cocaine, benzoylecgonine and methylecgonine
. in these cases were 0.54 mg/I, 1.99 mg/l and 1.21 mg/I, respectively. In these cases of TCD+, combinations
with ethanol, amphetamines, benzodiazepines, methadone, morphine and GHB were found.
Compared to the TCD and TCD+ category, the mean concentrations of cocaine and metabolites in femoral
blood in the categories ACD and NCD were much lower: the mean concentrations were 0.10 mg/I and 0.18
mg/I for cocaine, 1.11 mg/I and 1.91 mg/I for benzoylecgonine and 0.25mg/l and 0.45 mg/I for
methylecgonine , respectively. In the cases of anatomical cause of death (A CD), there were two cases in
which cocaine was the only drug present. In the other 15 cases of ACD, combinations of cocaine with
ethanol and other drugs (amphetamines, benzodiazepines, methadone and morphine) were found. Out of 8
cases where no clear cause of death (NCD) was found, 7 cases had combinations of cocaine and ethanol or
other drugs (benzodiazepines, methadone and morphine). There were no striking differences between the·
categories TCD+; ACD and NCD in combinations of drugs found together with cocaine.
In two of the total 45 cases, the cause of death could be anatomical as well as toxicological. One of these
cases was a woman with packages in the stomach and one package in the trachea (mechanical obstruction):
the concentrations of cocaine, benzoylecgonine and methylecgonine in femoral blood were 3 mg/I, 4.3 mg/I
and4.7 mg/I respectively. The other case was a shooting; a cocaine concentration in femoral blood of 1.9
mg/I was found.
Keywords: postmortem blood concentrations, cause of death, cocaine
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