Classes of drugs and their prevalence in multiple drug intoxication in suicides and accidents

In autopsy cases of multiple drug intoxication (MDI), the drugs identified may seem inadequate to cause death, especially when no drug is present in a concentration that is considered lethal. We sought to describe the combinations of drugs in MDI and to discern trends that could aid in the investigation of these deaths. Medical examiner autopsy cases were surveyed. MDI was established by postmortem blood screening. Of 24 cases, 13 were determined to be suicides, 9 were accidents, and 2 were indeterminate. The mean age was 37 years. Men were more likely to die from MDI by accident while women were more likely to die from suicide. The mean number of drugs found in suicides was 4, compared to 2 in accidents (p = 0.0274). Opiates, antidepressants, benzodiazepines, ethanol, and cocaine were equally likely to be present in either group. Other legal drugs were more likely to be found in the suicides (p = 0.0115). Ethanol was considerably less common in fatal MDI than controlled prescription drugs such as opiates and benzodiazepines, and also less common than other prescription drugs. These data suggest profiles that may help elucidate manner of death in indeterminate cases of death from MDI.