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Fatal Cocaine Interactions: A Review of Cocaine-Related Deaths in Bexar County, Texas

Molina, D. Kimberley MD; Hargrove, Veronica M. MS

The American Journal of Forensic Medicine and Pathology: March 2011 - Volume 32 - Issue 1 - p 71-77
doi: 10.1097/PAF.0b013e3181ed79fe
Original Articles

Although cocaine is a widely abused illicit substance that is known to cause death, deaths due to its use appear to occur in a minority of those who use it. This report was designed to review drug-related deaths due to cocaine, and the concomitant use of other drugs/ medications. A retrospective review of drug deaths at the Bexar County Medical Examiner's Office in San Antonio, Texas, was undertaken for cases where cocaine was one of the drugs implicated in causing death. Analysis was performed comparing the concentrations of cocaine and benzoylecgonine present and the absence or presence of other drugs. The data obtained showed that cocaine was toxic over a large range with deaths occurring at concentrations ranging from 0.01 to 78 mg/L. Analyses also indicated an increased lethality when cocaine is used in combination with ethanol, heroin, opiates, and antidepressant/antipsychotic medications, which is consistent with previous reports and research. Antihistamine data showed that there may be relationship between increased toxicity and coingestion, although more research is necessary.

From the Bexar County Medical Examiner's Office, San Antonio, TX.

Manuscript received July 21, 2009; accepted July 28, 2009.

Reprints: D. Kimberley Molina, MD, Bexar County Medical Examiner's Office, 7337 Louis Pasteur, San Antonio, TX 78229. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.