Alcohol and cocaine use prior to suspected suicide: Insights from toxicology

Abstract

Introduction. This study investigates whether there is a relationship between alcohol and cocaine use in deaths where suicide by self-injury is the suspected cause of death. Methods. Adults referred by coroners to the Imperial College London Toxicology Unit for toxicological analysis between 2012 and 2016 were reviewed for inclusion criteria. Those who died by self-injury reasoned to be deliberate were included in the analysis. Femoral blood alcohol concentration (BAC) and presence of cocaine or benzoylecognine (a metabolite of cocaine) in blood and/or urine were tabulated and odds ratios calculated. Results. A total of 1722 decedents met inclusion criteria. BAC was ≥50 mg/dL in 29% of decedents. Cocaine was detected in 8.4% of cases. The likelihood of testing positive for cocaine increased with BAC and was most frequent between 100 and 199 mg/dL, consistent with moderate to severe intoxication (odds ratio 5.88, 95% confidence interval 3.80, 9.09; P ≤ 0.001) compared to those with BAC <10 mg/dL. Discussion and Conclusions. This study demonstrates a correlation between increasing BAC and likelihood of cocaine use prior to suspected suicide, up to a level consistent with severe intoxication. Cocaine use was found in a high proportion of cases relative to the general population reporting regular use. This pattern of drug and alcohol use has previously been given little attention in suicide prevention strategies and clinical prioritisation.

Prevalência de suicídio em usuários de Cocaína

“…O uso de cocaína foi encontrado em alta proporção de casos em relação à população geral que relatou uso regular. Esse padrão de uso de drogas e álcool recebeu pouca atenção anteriormente nas estratégias de prevenção do suicídio e na priorização clínica [19].…”

Prevalence of suicide in cocaine users accessing health services: a systematic review and meta-analysis

“… 78 In a sample from England and Wales, cocaine use was also associated with 8.4% of deaths by self-injury. 79 About 20% of the drug overdose deaths in the United States involve cocaine use. 80 Suicidality and substance use increases the burden on mental health services, and have relevant social and economic consequences.…”

Beyond self‐reports: Ways to obtain more comprehensive insights into substance use events

“…Third, sensor and registry data can generate entirely new insights and evidence when obtaining self‐reports is very difficult or even impossible. Examples include death registries to examine the co‐occurrence of alcohol and cocaine in suicide decedents [17] or continuous transdermal alcohol monitoring during a multiday music festival [11].…”

“…Three studies included in the Special Section demonstrate the usefulness of analysing death registry data [17,19,20] to provide insights into substance use or related outcomes as an alternative to self‐report or in circumstances where self‐report is not possible. Bailey et al .…”

“…Bailey et al . [17] analysed 1722 decedents in England who died by deliberate self‐injury and found a higher likelihood of cocaine use prior to suspected suicide with increasing levels of BAC. These results emphasise the need to include substance use and co‐use in suicide prevention approaches, which is often not done today [17].…”