Cause and Manner of Death in Fatalities Involving Methamphetamine

Abstract

We reviewed a series of deaths in which methamphetamine was detected in the decedent's blood. Analysis of postmortem whole blood was performed by gas chromatography/mass spectrometry with a limit of quantitation of 0.05 mg/L. Methamphetamine was detected in 146 cases; 52 were drug caused, i.e., a death in which the direct toxic effects of the drug caused or contributed to the death, 92 were classified as drug related, i.e., a death in which the drug was demonstrated in the blood, but did not directly cause death. A large proportion of the deaths resulted from homicidal (27%) or suicidal (15%) violence. An examination of methamphetamine concentrations in drug related deaths (n = 92), suggests that the range of concentrations in the recreational abusing population is substantial (0.05–9.30 mg/L) but with a median concentration of 0.42 mg/L, and with 90% of that population having concentrations less than 2.20 mg/L. There was substantial overlap in methamphetamine concentration between drug related deaths and drug caused deaths, although the highest concentrations were seen in the unintentional (accidental or undetermined) drug caused deaths. Methamphetamine related traffic deaths (n = 17) showed patterns of driving behavior consistent with reports elsewhere, and showed blood methamphetamine concentrations ranging from 0.05–2.60 mg/L (median 0.35 mg/L). The data show that most methamphetamine deaths occur with blood concentrations greater than 0.5 mg/L, but can occur with levels as low as 0.05 mg/L, though usually in conjunction with other drugs or significant natural disease. Neither apparently toxic nor therapeutic concentrations should be used in isolation to establish conclusively whether a death was caused by methamphetamine; proper classification of deaths involving methamphetamine requires complete death investigation, including investigation of the scene and circumstances of death, and a complete autopsy.

Long-Term Methamphetamine Administration in the Vervet Monkey Models Aspects of a Human Exposure: Brain Neurotoxicity and Behavioral Profiles

“…Although the METH doses we modeled were less than the daily 0.5-1 g quantities self-reported in the human study by Simon et al, those amounts may represent overestimates since they were not independently verified for either METH quantity or drug purity. Nonetheless, the estimated peak plasma METH concentrations of 1-3 mM during the past 2 months of this experimental exposure did correspond to plasma METH concentrations measured in several studies of human abusers (Miyazaki, 1986;Logan et al, 1998;Melega et al, 2007).…”

A review of the clinical pharmacology of methamphetamine

“…Other fatalities have arisen from septic injection or asphyxia by aspiration of vomitus [57]. A number of studies suggest that a significant and possibly greater proportion of methamphetamine-related fatalities arise from accidents, suicide and homicides, suggesting severe psychological and behavioural disturbances at toxic doses [58][59][60]. [30][31][32]39,152,154] Arousal is facilitated by a1-and b-adrenoceptor stimulation in the medial basal forebrain [18].…”

“…Methamphetamine-induced mind-racing was correlated with activation in the anterior cingulated cortex and ventral striatum [157] Euphoria: high, elation, good drug effect, intoxication Inoue and colleagues proposed toxic plasma methamphetamine ranges of 200-5000 mg/l and fatal levels at >10 000 mg/l [56]. These figures should be considered as guides only, as fatalities have been reported at plasma concentrations as low as 90 mg/l [58], whereas survival has been reported at 9460 mg/l [37]. In terms of dose, fatal methamphetamine overdose has been reported following an intravenous dose of 20 mg [29] and elsewhere an experimental subject was observed to survive an intravenous dose of 640 mg methamphetamine, albeit with transient psychosis [40].…”

Modeling Human Methamphetamine Exposure in Nonhuman Primates: Chronic Dosing in the Rhesus Macaque Leads to Behavioral and Physiological Abnormalities

“…Studies suggest that the doses of METH used by humans recreationally or in medical studies range from 5 to 1000 mg over a 24 h period (Mitler et al, 1993;Simon et al, 2002). Post-mortem drug testing in a forensic study revealed a large range in the blood METH concentration among decedents (Logan et al, 1998). In this study low post-mortem METH concentrations were frequently observed, with the highest concentrations occurring in only a small subset of the decedents where METH was determined to be the direct cause of death, suggesting that lower doses are commonly used.…”