New Study: Cocaine Abuse And Sudden Death

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Sudden deaths, which are often seen as an in-custody police problem, in reality occur with significant frequency from “natural causes” in the general population and are related to cocaine abuse in at least 3 out of every 100 cases, according to a new study.

Researchers analyzed 668 sudden deaths across 32 months, and in none did they report police tactics or equipment causing the fatalities.

“The media and family survivors often connect sudden deaths with police actions, such as Tasering,” observes Dr. Bill Lewinski, executive director of the Force Science Institute. “But this study indicates that people die suddenly more often than is generally realized—and totally independent of police involvement. They’re predisposed to die by their physical condition which is aggravated, in some cases, by their personal decision to use dangerous illegal drugs.”

Even occasional “recreational” users of cocaine in small amounts, said by street lore to be largely “safe” from harmful side effects, increase their risk of sudden death, according to the researchers.


The study, conducted at the Institute of Legal Medicine in Seville, Spain, surveyed forensic autopsies of 1,114 natural deaths. Roughly 60% (668) met the criteria for being sudden and unanticipated.

Of these, cocaine was found in blood and/or urine of 21 (3.1%), all males with an average age of 35. (Men are 7 times more likely to experience sudden death than women, says the study director, Dr. Joaquin Lucena, and more likely to abuse cocaine. Overall, nearly 4% of the European population between 15 and 64 years old is thought to consume cocaine, the most commonly used illicit drug besides marijuana. In the US, an estimated 2,000,000 people currently use it. Here a lifetime prevalence of at least recreational cocaine use is estimated at about 15% of the population.)

The cocaine users among the sudden deaths were the focus of the researchers’ attention. The causes of their abrupt demises were found to be cardiovascular (related to the heart and circulatory system) in 62%, cerebrovascular (involving the brain and blood vessels that feed it) in 14%, “excited delirium” in 14%, and “respiratory and metabolic” in 5% each.


Their cardiovascular problems detected on autopsy included heart enlargement, heart tissue damage from an inadequate blood supply, a narrowing of blood vessels due to plaque buildup, and clotting of congested blood—all of which were significantly more pronounced among the coke users than the researchers found among “control” cases involving males of similar age who had died suddenly in traffic accidents or suicides but who had no history or evidence of cocaine use.

The vast majority of the cocaine users also smoked cigarettes and/or drank alcohol along with their coke abuse. This tends to substantially increase the negative impact of cocaine on the body, the researchers say.

“Any amount of [cocaine] can be considered to have the potential for toxicity due to the fact that some [subjects] have poor outcomes with relatively low blood concentrations,” the researchers report. There is no such thing as “safe” recreational use of small amounts of the drug, Lucena says. “Pharmacologically, it’s more dangerous than heroin and other opiates.”


According to Dr. Lewinski, who was not involved in this research, the study has implications for law enforcement beyond documenting that sudden deaths occur in profusion quite apart from any police involvement:

  1. “Line officers should recognize that anyone who abuses cocaine, including occasional, casual users, is a potential candidate for sudden, unexpected death. When you know or suspect such involvement, consider engaging medical personnel as a possibility.” The same risk, he says, is likely to pertain where methamphetamine use is involved.
  2. “Coroners and medical examiners need to be encouraged to perform thorough forensic autopsies in cases of sudden death. This should include screening blood and urine for evidence of cocaine and other illicit drugs. At present, we do not have good data on sudden death in this country, gathered from a uniform, mandatory autopsy protocol, and this information is necessary for us to fully understand the factors involved in this phenomenon.”
  3. “It is important to note that among the causes of death listed by the investigators in this study is excited delirium. They do not elaborate on this, other than to describe it as ‘a syndrome characterized by psychosis or delirium accompanied by agitation and hyperthermia.’ But they do tacitly acknowledge that it does exist as an identifiable condition, capable of resulting in death, the same as heart, brain, respiratory, and metabolic disorders.”

The full report of the Seville study, “Cocaine-related Sudden Death,” appears in the European Heart Journal. Click here to read it.

[Our thanks to Wayne Schmidt, executive director of American for Effective Law Enforcement, and Michael Brave, president of Liability Assessment & Awareness International, Inc., for alerting Force Science News to this study.]

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