Toxicology Testing in Death, Part II

As I started my last post: Drugs cause or contribute to a huge number of deaths.

Let’s look at some toxicology testing results from an individual who died a drug-related death. If you are a number-o-phobe look away now. Although there is no arithmetic involved, there are some funky numbers and potentially intimidating units of measure, which you can ignore for the most part in this discussion.

What do his results tell us?

Blood: Ethanol: 0.261%; Cocaine: 0.043 mg/L; Cocaethylene: 0.092 mg/L; Benzoylecgonine: 2.42 mg/L; Acetaminophen: 43.38mg/L

Urine: Ethanol: 0.241%; Cocaine: 7.549 mg/L; Cocaethylene: 7.749 mg/L; Benzoylecgonine: 66.5 mg/L; Acteaminophen 20.3 mg/L; Oxycodone: 7.22 mg/L

First a bit of translation is in order. Ethanol is the kind of alcohol that you drink in beer, wine, etc. Acetaminophen is the stuff in Tylenol brand and is included in several combination prescription pain meds. Oxycodone, as you might guess, is branded OxyContin, among other names. The other fancy words in the results are cocaine and its metabolites, the stuff our body breaks cocaine down into as we process it out of our body. Worth a mention, cocaethylene is a metabolite that only occurs in our bodies as we try to clear both alcohol and cocaine together.

These results tell us that this gentleman died from a poly-substance ingestion, presuming that the rest of the death investigation showed no other contributing factors to his death, like a bullet hole. (I’d mention here that the word “ingestion” used in this way is not restricted only to substances taking by mouth.) He obviously drank a lot of alcohol, giving him a blood level 3 times the “legal limit” for intoxication/impairment. It is also apparent from these numbers that he used cocaine within a few of hours of his death, contributing to his death. There is no safe level, or amount of use, for cocaine. In addition, he took or was taking a oxycodone-acetaminophen combination medication (like Percocet) in a fairly hefty amount.

To seal his death the cocaine starved this man’s heart and brain of nutrients by slowing/stopping their delivery while at the same time increasing the need/demand for those nutrients in those critical organs. In conjunction with that, the combined heart and breathing depressant effects of a large amount of alcohol mixed with oxycondone (and an acetaminophen kicker) brought this individual to his death.

“Drugs, they can make you high and they can make you die”.

Comments

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  • The question I have is not how toxicology establishes the cause(s) of death, but why the news reports always say that "the cause of death awaits toxicology reports, which will take approx. a month?"

    In a case such as Michael Jackson's, it shouldn't take too long to figure out what kind of anesthetic was in his system.

  • In reply to jack:

    The reason is that there are only a handful of labs in the country that will do post-mortem testing. A few ME or Coroner offices have their own labs, but that is rare. Hospitals will not do the testing and the usual labs that hospitals send their specimens to also will not do post-mortem testing.

    Built into the time is considering and interpreting the results in the context of the overall death investigation as well. A death ruling is not based on the numbers alone.

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    Dick Keller

    I am a trained medicolegal death investigator with over 6 years experience working in the field as a coroner. That experience is bolstered by my years as a medical practitioner and medical educator. I want to demystify death and forensics, and maybe impact preventable deaths along the way.

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