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Characteristics and circumstances of death related to the self‐administration of ketamine
Author(s) -
Darke Shane,
Duflou Johan,
Farrell Michael,
Peacock Amy,
Lappin Julia
Publication year - 2021
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.15154
Subject(s) - ketamine , medicine , cause of death , sedation , forensic toxicology , anesthesia , accidental , demographics , chemistry , physics , demography , disease , chromatography , sociology , acoustics
Background and aims Ketamine is used for anaesthesia, sedation and the treatment of mood disorders, but is also widely used for non‐medical purposes. This study aimed to: (1) determine the characteristics and circumstances of all recorded cases of self‐administered ketamine‐related death in Australia, 2000–19 and (2) determine the toxicology and major organ pathology of cases. Design Retrospective study of all Australian cases in which self‐administered ketamine was a mechanism contributory to death, retrieved from the National Coronial Information System. Setting Australia‐wide. Cases Sixty‐eight cases, with a mean age of 35.2 years (standard deviation = 11.5, range = 16–63), 76.5% male. Measurements Information was collected on cause of death, demographics, circumstances of death, toxicology and major organ pathology. Findings Death was attributed to toxicity in 82.3% of cases (accidental, 58.8%; deliberate, 23.5%), suicide by violent means (8.8%) and traumatic accident (8.8%). In six cases the decedent had been prescribed ketamine. In 32.4% the final route of ketamine administration was by injection. The fatal incident predominantly occurred in a private environment (72.1%). Ketamine was present in the blood of 90.1% and other biomarkers in the remainder. The median blood ketamine concentration was 0.2 mg/l (0.02–6.9 mg/l). Other drugs were detected in 95.5% of cases: opioids (59.1%), hypnosedatives (57.6%), psychostimulants (50.0%), alcohol (27.3%), Δ‐9‐tetrahydrocannabinol (18.2%), antidepressants (28.8%) and antipsychotics (9.1%). Pulmonary oedema was present in 82.2% of cases that underwent autopsy and pneumonia in 26.7%. Conclusions The typical case of self‐administered ketamine‐related death in Australia, 2000–19, was a male in his mid‐30s who had used multiple drugs, with the fatal incident most commonly occurring in a private setting. Death due to accidental drug toxicity was the most common manner of death, but suicide was highly prevalent.