[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Forensic medicine](https://durgical.com/en/forensic-medicine/) › [Toxicology, evidence and identification](https://durgical.com/en/forensic-medicine/areas/evidence/) › Deaths from illicit drugs # Deaths from illicit drugs - Topic In drug deaths, the scene and toxicology usually weigh more than the body's findings, and several substances are often involved. Updated Nov 13, 2026 ## Key points - Scene: syringes, spoons, paper wraps, pipes, powder, witnesses, a history of use or of recent release from prison or treatment. - External exam: recent and old injection marks, froth at the mouth and nose, nasal lesions with snorted use. - Autopsy: pulmonary oedema and congestion, non-specific; its value is to rule out other causes. - Tolerance is lost after abstinence: the risk of overdose rises on relapse. - Certificate: "acute intoxication by the combined effects of…" naming each substance. ## What it is Deaths related to illicit drugs (opioids, cocaine, amphetamines and others) are mostly accidental and often involve several substances at once, including alcohol. The autopsy usually shows non-specific findings: pulmonary oedema, congestion, froth in the airway. Its role is to rule out other causes (injuries, natural disease, assault), document signs of use and guide sampling. Forensic pathologists' recommendations for opioid deaths stress a full investigation of the scene, autopsy and toxicology, and a certificate that names every substance involved. ## Key facts - Opioids: respiratory depression; froth and pulmonary oedema are common but not exclusive. - Cocaine and stimulants: death from arrhythmia, infarction, cerebral haemorrhage or hyperthermia; heart disease may coexist. - Skin from an injection site is kept for histology: it tells a recent puncture from chronic use. - A death during a chase or physical restraint is not attributed to the drug alone: it is investigated as a death in custody. - Peripheral blood taken early is the reference sample; hair shows chronic use. ## Next step: what to do and document - If a patient dies from a suspected overdose, keep the admission samples, the clothing and the items they carried, and notify the authorities. - Record whether an opioid antagonist was given and the response: the expert needs this. - Describe injection marks, injuries and signs of physical restraint with photographs and measurements. - Notify Sivigila: poisonings by psychoactive substances are group 8 of INS event 365. - Do not write "natural death" or "cardiorespiratory arrest": it is a violent death under investigation and goes to a medico-legal autopsy. ## Legal framework in Colombia - The INS protocol (event 365, 2024) includes poisonings by psychoactive substances in acute poisoning surveillance. - Packets, substances and items found with the body are evidence and are handed over with chain of custody. ## Test yourself Think of the answer, then tap the question to see it. ## Why does an apparently obvious overdose still need an autopsy? Because overdose findings are non-specific and the autopsy must rule out injuries, assault or natural disease before attributing death to the drug. ## Why does the risk of overdose rise after a period of abstinence, such as release from prison? Because tolerance is lost; an amount that used to be tolerated can cause fatal respiratory depression. ## How is the cause of death written when several drugs are involved? As acute intoxication by the combined effects of the substances, naming each one, as forensic pathologists recommend. ## Why keep the skin of an injection site? For histology: it helps tell a recent puncture from the changes of chronic use. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/forensic-medicine/deaths-from-illicit-drugs/) ## Connections ## Related 6 - [Body packers and drug concealment](https://durgical.com/en/forensic-medicine/body-packers-and-drug-concealment/) - [The autopsy in a suspected poisoning](https://durgical.com/en/forensic-medicine/the-autopsy-in-a-suspected-poisoning/) - [Interpreting postmortem drug levels](https://durgical.com/en/forensic-medicine/interpreting-postmortem-drug-levels/) - [Forensic toxicology: which samples and how](https://durgical.com/en/forensic-medicine/forensic-toxicology-which-samples-and-how/) - [Drug-facilitated sexual assault and robbery](https://durgical.com/en/forensic-medicine/drug-facilitated-sexual-assault-and-robbery/) - [The death scene: inspección técnica a cadáver (levantamiento)](https://durgical.com/en/forensic-medicine/the-death-scene-inspeccion-tecnica-a-cadaver/) ## Related conditions 2 - [Opioid overdose](https://durgical.com/en/conditions/opioid-overdose/) - [Cocaine and sympathomimetic toxicity](https://durgical.com/en/conditions/cocaine-and-sympathomimetic-toxicity/) [← All of forensic medicine](https://durgical.com/en/forensic-medicine/) Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority. Sources: [Recommendations for the investigation, diagnosis, and certification of deaths related to opioid drugs (NAME and ACMT position paper)](https://pmc.ncbi.nlm.nih.gov/articles/PMC3951636/) (Journal of Medical Toxicology, 2014); [A Forensic Diagnostic Algorithm for Drug-Related Deaths: A Case Series](https://pmc.ncbi.nlm.nih.gov/articles/PMC9024928/) (Toxics, 2022); [Postmortem redistribution of drugs: a literature review](https://pmc.ncbi.nlm.nih.gov/articles/PMC11790690/) (Forensic Science, Medicine and Pathology, 2024); [Protocolo de vigilancia en salud pública: intoxicaciones agudas por sustancias químicas (código 365, versión 07)](https://www.ins.gov.co/buscador-eventos/Lineamientos/Pro_Intoxicaciones%20agudas%20por%20sustancias%20qu%C3%ADmicas%202024.pdf) (Instituto Nacional de Salud, 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/forensic-medicine/deaths-from-illicit-drugs/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/deaths-from-illicit-drugs/