The National Association of Medical Examiners Committee on
Cocaine-related Deaths recommends that the following guidelines be applied in the process of documenting, interpreting, and certifying potential
cocaine-related fatalities. The committee cautions that the investigation of any
drug-related death requires a complete investigation of the circumstances of death, the death scene, and past medical history. It is also necessary to have the results of the forensic toxicological analysis and those of a complete forensic autopsy examination prior to formulating an opinion as to the cause and manner of death.
Cocaine should be considered the underlying cause of the death when 1 or more of the following is true: (1). the circumstances surrounding the death can be associated with an acute
cocaine exposure and there are no supervening causes of death; (2). the immediate cause of death is directly due to a readily identifiable mechanism or disease such as a
gunshot wound or a
stroke, yet the acute use of
cocaine was the direct underlying cause of the
trauma or the disease process; and (3). chronic
cocaine use leads to a disease that results in an ultimately fatal pathologic process leading to organ injury and death. The committee further cautions that reported
drug levels may not directly relate to the toxic or lethal effects of the
drug upon the patient. These guidelines are intended for use by practicing medical examiners and physicians who certify
drug deaths, as well as providing education tools for students.