Thursday, January 14, 2010

Cocaine Sudden Death

We have known that cocaine is sometimes associated with sudden cardiac death and occasionally hear about someone in the news who has died that way. We haven't known particulars though such as prevalence, doses of cocaine used, age ranges and other concomitant drug or alcohol use. A recent study from Spain published in the European Heart Journal has provided us with some of this information.

The study from the Institute of Legal Medicine in Seville, Spain is the first study to look at cocaine-related deaths in a systematic way with autopsies and toxicology screens in a series of 600 consecutive sudden death victims. The study showed that 3% of these sudden deaths were cocaine-related with the majority due to cardiac causes.

All the cocaine deaths were males. Myocardial infarction (heart attack) was the most common cause of death although there were strokes as well. Interestingly the serum cocaine concentrations varied widely so any amount of cocaine can be deadly. The demographic findings were that most of the victims were working and died at home on the weekends suggesting that they were "recreational " users rather than chronic cocaine addicts. 81% smoked and 76% had used alcohol along with the cocaine both which decrease coronary arterial blood flow. The most important take home message from this study is that no amount of cocaine is "safe".

In the United States there are approximately 500,000 emergency room visits per year for cocaine related events. We have no idea of the figures of sudden death because we have no way at present of reporting cocaine related sudden death and also because autopsies with toxicology screens are not usually performed but left to the discretion of the pathologist. It would be a good idea for us to develop some standard reporting procedures.

Thought for the day

No amount of cocaine use is safe.

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