The conclusion of the study was that:
“Decedents with a history of chronic drug abuse appear to be at an increased risk of dying by their chronic drug abuse, even in the absence of any anatomical or toxicological finding at autopsy…” [Arch Pathol Lab Med, vol 132, Dec 2008, 1903-1906]
This really is contrary to what has been commonly thought; that drugs really only kill when they are at elevated levels in the body and sober deaths are not really related to the drugs.
Their original hypothesis was that “drug abuse induces some change that persists after the drug is no longer detectable in the body…presumably at the molecular level…increase(s) the likelihood of sudden death”. (This molecular level of effect brings to mind William Burroughs’ saying in “Junkie” that the junk gets into your cells with use, causing addiction, and has an effect basically forever.)
The study did find this effect in a broad range of drugs of abuse, some that you would suspect, but also others that might seem a bit of a surprise. The drugs included cocaine, amphetamines, opiates, other pain meds, benzodiazepines, and barbiturates.
The authors relate this increased risk of sudden death with chronic drug abuse to the already recognized similar occurrence with chronic alcohol abuse.
So, yet another reason to not abuse drugs: an increased risk of suddenly dying, even if not acutely intoxicated at the time of death. That should give folks pause and new meaning to a phrase I have used a time or two: “Drugs, they can make you high, they can make you die”.