Post-mortem investigations of fatal cases of narcotic addiction

Organic lesions induced by narcotics are caused by the mode of application as well as directly or indirectly by the toxic effect of the substances.The cause of death is very often oedema of the lungs and brain, toxic circulatory failure or failure of certain vital organs, due to cellular degeneration.Narcotics abusers show mainly liver damage. Cell degeneration and infiltration of round cells have to be interpreted as drug hepatopathy and usually not as viral hepatitis.Histochemical tests show reduced enzyme levels in the impaired liver tissue. Toxic degeneration and inflammatory reactions are seen in the kidneys. Brain lesions are confined to cellular damage without necrotic degeneration of larger areas. Sporadically there are perivascular haemorrhages.The heart and the vascular system show mainly inflammatory reactions due to the application of the drug and rarely capillary embolism subsequent to the injection of dissolved tablets. Centrally stimulating substances cause hypertrophy of the tunica media in the pulmonary vessels combined with pulmonary hypertension.With progressive social collapse the drug addict suffers from dental caries, profound inflammatory periodontopathy as well as from fractures and fissures as a result of gnashing the teeth (bruxism).