Cocaine Detection in Postmortem Samples Following Therapeutic Administration

Abstract

Cocaine is one of the most widely abused drugs and one that is frequently encountered in forensic toxicology laboratories. Most often, the detection of cocaine would lead toxicologists and forensic pathologists to believe that the drug was used illicitly; however, cocaine is an effective local anesthetic and vasoconstrictor and is used clinically in surgeries of the eye, ear, nose, and throat. Therefore, it is important to note that the presence of cocaine and its metabolites in forensic samples cannot always be attributed to abuse and that a thorough investigation and review of medical records is warranted before an informed conclusion can be made. In this case report, a 54-year-old male died three days after an altercation in which he suffered multiple injuries. In addition to natural disease and injuries documented at autopsy, cocaine and its metabolites were detected in the decedent's urine, and a review of surgical records showed that earlier on the day of death, he was administered cocaine clinically during a procedure to repair nasal bone fractures. If not for this comprehensive investigation and review of surgical records, the assumption of cocaine abuse might have otherwise been made and the cause and manner of death incorrectly established.

Drugs of Abuse Testing

“…It was later revealed that cocaine was used during his nasal surgery as a local anesthetic, which explained the presence of both cocaine and its metabolite (benzoylecgonine) in his urine specimen: it was from medical use of cocaine [12]. Three days later a surgical procedure was performed to repair his nose and he was released from the hospital later that day with a prescription of Percocet (oxycodone, 5 mg; and acetaminophen, 325 mg) for pain relief.…”

True‐Positive Drugs of Abuse Test Results Due to Use of Prescriptions and Nonprescription Drugs

“…In addition, family members may suffer from undue anguish if their loved one was falsely identifi ed as an illicit drug abuser (45) . Therefore, it is very important that not only medical review offi cers but also laboratory professionals including toxicologists and pathologists be aware of all sources of alternative explanations for positive GC/MS confi rmation of an abused drug in urine in a subject undergoing workplace drug testing.…”