NDARC Technical Report No. 171 (2003)
EXECUTIVE SUMMARY
The coronial records of all cocaine-related deaths that occurred in New South Wales between 1 January 1993 and 31 December 2002 were reviewed. The study examined trends in the number of such deaths, demographic characteristics, circumstances of death, toxicological findings, and major autopsy findings.
Number of cocaine-related fatalities, 1993-2002
A total of 146 cases were identified. Cocaine was a direct cause of death in 86% of cases, an antecedent cause in 8% and a significant contributing condition in a further 7%. The number of cocaine-related fatalities increased substantially over the 1998-2001 period, peaking in 1998 and 2001.
Geographic distribution
All but three fatalities occurred within the Sydney metropolitan area. Sixty percent of fatalities occurred in the City/Eastern Suburbs region of Sydney. The most frequent suburbs in which cocaine-related deaths occurred were Kings Cross (26 cases), Darlinghurst (14 cases), Surry Hills (5 cases) and Redfern (5 cases). Overall, 37% of cases occurred within the 2010/2011 postcode region centred on Kings Cross.
Demographics
The mean age of decedents was 34.1yrs, and 84% were male. Half of the sample was employed, with 26% being employed professionals at the time of death. Three quarters of decedents were married or in defacto relationships, and three quarters were Australian born. Eighty nine percent of decedents were not enrolled in drug treatment at the time of death.
Circumstances of death
The predominant form of cocaine administration was injection (86%). Non-parenteral routes were employed in 16% of cases. Nasal (8%), oral (3%), smoking (1%) and anal administration (1%) were all recorded. A disproportionate number of deaths occurred on weekends (57%).
The most common location for death in all metropolitan regions was a private home (53%). A significantly greater proportion of deaths occurred in hotels in the City/Eastern Sydney region than in other regions (25% v 3%). No intervention occurred prior to death in the 82% of cases. An ambulance was called prior to death in 15% of cases, and 10% of cases were hospitalised.
Toxicology
Blood cocaine was detected in 64% of cases, with a median blood cocaine concentration of 0.10mg/L (range 0.01->8.00mg/L). Benzoylecgonine was detected in all but one case, with a median blood benzoylecgonine concentration of 0.40mg/L (range 0.00->20.00mg/L).
Decedents had a mean of 3.5 (range 1-7) drugs present at time of death, and in only 4% of cases was cocaine the only drug detected. The most common co-occurring drug was morphine (79% of cases). Alcohol was detected in 36% of cases, with a median blood alcohol concentration of 0.07g/100ml (range 0.01-0.30g/100ml). Cannabis was detected in 32% of cases, but blood THC in only 6 cases.
Major autopsy findings
Cardiac pathology was noted in 57% of cases. The most common pathology was coronary artery atherosclerosis (39% of cases), which was much more common among males (45% v 9%). In 15% of cases, all of which were male, moderate or severe arterial occlusion due to atheroma was noted. Cardiac hypertrophy was noted in 14% of cases, all of whom were male. Cerebrovascular pathology was noted in 22% of cases. The most commonly reported pathology was cerebrovascular atherosclerosis (10%), most commonly of the basal vessels of the brain (6%).
Citation: Darke, S., Kaye, S. and Duflou, J. (2003) Cocaine-related fatalities in New South Wales, Australia, 1992-2002, Sydney: National Drug and Alcohol Research Centre.