Drug deaths all over the the world

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Anonymous has left a new comment on your post "Another drug-related death":

Dear Dr Keller
On 22/10/2005 my brother was found unconsience in his room. He was hospitilized 14:00 and was pronounced dead 17:15. The Post mortem was found to be PULMONARY EMBOLISM FOLLOWING OVERDOSE OF MORPHINE AND COCAINE. A toxic was done and the following was found - Amitriptylline - 0.08micorgram per ml of blood, Caffiene in the blood, Cocaine, Codeine, Morphine, Bensylecgonine and paracetamol in the urine. No external injuries was found on his body. He also had a Secondary haemorrage in the midbrain. Pleura dn lungs - both lungs congested with saddle thrombus in the pulmonary artery. Mediastinum and oesaphagus, trachea and bronchi, intestines and mesentry, pancreas, Liver, Galbladder and biliary passages, spleen, Kidneys was all congested. Would this all be from one substance he took or several, could it have been suicide? What does congested mean? I would realy appreciate your opinion.
Regards from South Africa

My reply

The congestion referred to is vascular congestion likely related to decreased cardiac output (heart pumping action) and/or increased venous stasis (with dilated blood vessels) due to the cardiovascular effects of the drugs. The cocaine directly can cause a midbrain bleed.

That vascular congestion also contributes to the formation of clots (thrombi) that can travel to the lugs resulting in death.

The 2 primary substances in this intoxication are cocaine (its metabolite benzylecgonine) and “morphine”. The source of the “morphine” might be heroin or any number of opiates that metabolize to morphine in the body (with codeine as a co-metabolite, co-ingestion, or as the source of the morphine).

Suicides using illicit drugs is fairly rare, most of these deaths are “accidents” related to drug use and abuse.