title: National Association of Medical Examiners position paper on the certification of cocaine-related deaths.
abstract: The National Association of Medical Examiners Committee on Cocaine-related Deaths recommends that the following guidelines be applied in the process of documenting, interpreting, and certifying potential cocaine-related fatalities. The committee cautions that the investigation of any drug-related death requires a complete investigation of the circumstances of death, the death scene, and past medical history. It is also necessary to have the results of the forensic toxicological analysis and those of a complete forensic autopsy examination prior to formulating an opinion as to the cause and manner of death. Cocaine should be considered the underlying cause of the death when 1 or more of the following is true: (1). the circumstances surrounding the death can be associated with an acute cocaine exposure and there are no supervening causes of death; (2). the immediate cause of death is directly due to a readily identifiable mechanism or disease such as a gunshot wound or a stroke, yet the acute use of cocaine was the direct underlying cause of the trauma or the disease process; and (3). chronic cocaine use leads to a disease that results in an ultimately fatal pathologic process leading to organ injury and death. The committee further cautions that reported drug levels may not directly relate to the toxic or lethal effects of the drug upon the patient. These guidelines are intended for use by practicing medical examiners and physicians who certify drug deaths, as well as providing education tools for students.
authors.affiliation: Office of the Chief Medical Examiner, City and County of San Francisco, San Francisco, California 94103-4603, USA. boyd.stephens@sfov.gov
authors.forename: Boyd G
authors.initials: BG
authors.lastname: Stephens
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Jentzen
authors.forename: Steven
authors.initials: S
authors.lastname: Karch
authors.forename: Charles V
authors.initials: CV
authors.lastname: Wetli
authors.forename: Deborah C
authors.initials: DC
authors.lastname: Mash
mesh_terms: D001344:Autopsy / Q000592:standards; D019411:Clinical Laboratory Techniques / Q000592:standards; D003042:Cocaine / Q000506:poisoning*; D003334:Coroners and Medical Examiners / Q000592:standards*; D018765:Dopamine Uptake Inhibitors / Q000506:poisoning*; D005554:Forensic Medicine / Q000592:standards*; D006801:Humans; D011041:Poisoning / Q000175:diagnosis; D012955:Societies, Medical; D014116:Toxicology / Q000592:standards*; D014481:United States
chemical_list: D018765:Dopamine Uptake Inhibitors; D003042:Cocaine