ALCOHOL-USE IN COMBINATION WITH COCAINE, HEROIN AND METHADONE BY MEDICAL EXAMINER CASES

Objective: The purpose of this review of all appropriate, available me dical examiner (ME) studies is to provide information on cases with po sitive toxicologies for cocaine, morphine (the heroin metabolite) and methadone that have positive blood or brain alcohol concentrations (BA Cs). Method: Criteria for inclusion of U.S. ME studies in this review are (1) at least 20 cases with a positive toxicology for cocaine, morp hine or methadone and (2) BAC test findings according to specific drug positivity. Only 19 studies conducted from 1969 to 1992 met these cri teria; most studies reviewed were not included primarily because of th eir failure to present or link available BAC test findings with positi ve toxicologies for these other drugs. Results: The BAG-positive range s were similar for cocaine and heroin. In reports on both heroin and m ethadone or on all three drugs, heroin-positive cases had the highest proportions and methadone-positive cases had the lowest proportions wi th positive BACs. Conclusion: Published data confirm the substantial p resence of alcohol in combination with cocaine, heroin and methadone a mong ME cases. Future ME studies should endeavor to link BAC and toxic ology findings for other drugs according to drug-induced or drug-relat ed manner of death. These data would advance our knowledge about the r ole of alcohol in drug deaths and provide additional information on su bstance abuse trends.